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Eosinophils in chronic urticaria Supporting or leading Actors.doc

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Eosinophils in chronic urticaria Supporting or leading Actors

REVIEWS EosinophilsinChronicUrticaria:Supportingor LeadingActors? RiccardoAsero,MD,1 MassimoCugno,MD,2 andAlbertoTedeschi,MD3 autoantibodies and in vivo autoreactivity can also be Abstract:Althoughtheirnumbermaybeincreasedinskinlesions, detected inotherconditions andinhealthy subjects. 7–10 All eosinophilshavebeenratherneglectedaspossibleparticipantstothe pathogenesisofchronicurticariabecauseoftheabsenceofperiph- eraleosinophiliainpatientswiththisdisease.However,recentdata suggest a potentially relevant role played by activated eosinophils bothintriggeringthetissuefactorpathwayofcoagulationcascade and as a source of vascular endothelial growth factor. Such phe- nomenaseemmorepronouncedinpatientsshowingamoresevere disease. The present study will rediscuss the potential role of this celllineinchronicurticariainthelightoftheserecentobservations. this means that the factors triggering histamine release in chronic urticaria remain a mystery in many cases. The reported ef?cacy ofomalizumab inpatients withrefractory CU either with or without detectable autoantibodies 11–15 and the observed, although not totally speci?c, inhibitory effect of heparin on autoantibody-triggered histamine re- lease from basophils in vitro, 16,17 suggest a common ?nal pathway in histamine release, irrespective of the hista- mine-releasing factor involved. KeyWords:chronicurticaria,mastcells,eosinophils,VEGF, tissuefactor HISTOLOGYOFCU (WAOJournal2009;2:213–217) It is generally accepted that the histologic picture is moreorlessthesameinallpatientswithCUirrespectiveof the presence or absence of autoantibodies. A perivascular in?ltrate of CD4? lymphocytes is always present. cells have the characteristics of both T 1 and T 2 cells; increasednumbersofintradermalCD3,CD4,CD8-positiveT In?ltrating 18 INTRODUCTION hronicurticaria(CU),de?nedastheoccurrenceofspon- taneous wheals, with or without angioedema, for more H H C cells have been detected with a T 0 cytokine pro?le. Neu- H trophils and a vari