Korean J Dermatol.  2025 May;63(3):67-73.

Autoimmune and Autoallergic Traits and Their Association with Treatment Response in Chronic Idiopathic Urticaria

• Kang Y
• Kang H
• Kim JE

Abstract

Background
Chronic idiopathic urticaria (CIU) is commonly associated with autoimmune and autoallergic traits that may influence treatment responses and guide therapeutic choices.
Objective
This study evaluated the baseline characteristics of patients with CIU, focusing on autoimmune and autoallergic traits, and identified correlations between these traits, disease severity, and optimal treatment strategies.
Methods
A retrospective chart review was conducted to collect data on demographics, disease duration, disease severity, laboratory findings, and treatment history. Autoimmune traits were defined as positive results for autologous serum skin test, anti-thyroid peroxidase, or anti-nuclear antibody; autoallergic traits were characterized by high total immunoglobulin E (IgE) (＞100 IU/mL) but low or absent specific IgE. The three treatment approaches were (1) antihistamines alone, (2) cyclosporine or omalizumab, and (3) a combination of cyclosporine and omalizumab, with the treatment intensity increasing across categories.
Results
A total of 25 patients were enrolled between May 20, 2020, and May 28, 2021. Autoimmune and autoallergic traits were not directly correlated with disease severity. However, higher urticarial activity scores were significantly associated with the need for more intensive treatment (correlation coefficient=0.464, p=0.005). Patients with autoimmune traits received cyclosporine more frequently. In contrast, those with auto-allergic traits were more effectively treated with omalizumab. Patients exhibiting both traits required combination therapy with cyclosporine and omalizumab (p=0.031).
Conclusion
Treatment strategies for CIU should be guided by the urticarial activity and the presence of autoimmune or autoallergic traits. Further studies with expanded datasets are necessary to confirm these findings and refine the treatment algorithms.

Keyword

Chronic urticaria; Cyclosporine; Omalizumab