Progress and Challenges in the Understanding of Chronic Urticaria 英文参考文献.docVIP

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Progress and Challenges in the Understanding of Chronic Urticaria 英文参考文献.doc

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Progress and Challenges in the Understanding of Chronic Urticaria 英文参考文献

ORIGINAL ARTICLE ProgressandChallengesintheUnderstandingofChronic Urticaria MartaFerrer,MD,PhDandAllenP.Kaplan,MD Chronicurticariaisaskindisordercharacterizedbytransientpruriticwealsthatrecurfromdaytodayfor6weeksormore.Ithasa great impact on patients’ quality of life. In spite of this prevalence and morbidity, we are only beginning to understand its physiopathology and we do not have a curative treatment. Moreover, a patient with chronic urticaria may undergo extensive laboratoryevaluationsseekingacauseonlytobefrustratedwhennoneisfound.Inrecentyearstherehavebeensignificantadvances inourunderstandingofsomeofthemolecularmechanismsresponsibleforhiveformation.ThepresenceandprobableroleofIgG autoantibodiesdirectedagainstepitopesexpressedonthealpha-chainoftheIgEreceptorandtolesserextent,toIgEinasubsetof patientsisgenerallyacknowledged.TheseautoantibodiesactivatecomplementtoreleaseC5a,whichaugmentshistaminerelease, andIL4andleukotrieneC4arereleasedaswell.AperivascularcellularinfiltrateresultswithoutpredominanceofeitherTh1orTh2 lymphocyte subpopulations. Basophils of all chronic urticaria patients (autoimmune or idiopathic) are hyperresponsive to serum, regardlessofsource,butpoorlyresponsivetoantiIgE.Inthisreviewwewillsummarizetherecentcontributionstothisfieldandtry toprovideinsightstopossiblefuturedirectionsforresearchonthisdisease. Keywords: autoimmunity,basophils,chronicurticaria,cotinine,IgEreceptor,mastcells C hronic urticaria is a skin disorder characterized by transientpruriticwealsthatrecurfromdaytodayfor anti–immunoglobulinautoimmunity might ha(Ig)Eve a rantibodiesole.4,5 Hidesuggestedet al corrothatbo- 6 weeks or more. We recently calculated a 0.6% (95% confidence interval 0.4–0.8) prevalence in a population study.1 Ithas agreat impact onpatients’ quality oflife,2,3 to a degree equal to that experienced by sufferers from triple-vessel coronary artery disease. rated the occasional presence of IgG anti-IgE and demonstrated the presence of functional autoantibod