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Mechanisms

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Mechanisms of urticaria

  • mechanisms of urticaria can be either:
    • immune-mediated - IgE located on the mast cells an basophils cross-links with the allergen and activates the cells e.g.- urticaria induced by medication (penicillin), foods
    • complement-mediated - mast cells are activated directly by compliments ( mainly by C3a, C4a, and C5a) e.g.- serum sickness and transfusion reactions which cause the activation complement cascade leading to urticaria
    • non-immune mediated - mast cells are activated by non IgE mechanisms e.g.- physical stimuli, alcohol, radiocontrast dye, and medications (opiates, vancomycin, aspirin)
    • autoimmune-mediated - circulating auto-antibodies activates the mast cells (1)
  • all of the above mentioned mechanisms lead to dermal mast cells degranulation in response to a variety of stimuli releasing mediators which produce vasodilatation, dermal oedema, and a perivascular infiltrate of lymphocytes and eosinophils (1). When deep dermis / subcutaneous tissues involved = angioedema
  • vasoactive mediators commonly released during urticaria include:
    • histamine
    • prostaglandin D 2
    • leukotrienes C 4 and D 4
    • platelet activating factor
    • cytokines (1)

Reference:

1. Zuberbier T, Abdul Latiff AH, Abuzakouk M, et al. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy. 2022 Mar;77(3):734-66.

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