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Chronic Urticaria — SCE Dermatology MCQ

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HardInflammatory DermatosesChronic UrticariaSCE Dermatology

A 49-year-old woman presents with recurrent crops of intensely pruritic wheals lasting 4-6 hours each, occurring daily for 8 months. She has no angioedema, urticaria vasculitis is excluded on biopsy, and thyroid function is normal. Anti-IgE receptor antibodies are positive. This type of chronic urticaria is classified as what?

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Correct answer: C — Chronic spontaneous urticaria — autoimmune type I (autoallergy)

The 2022 EAACI/GA²LEN classification divides chronic spontaneous urticaria (CSU) into autoimmune subtypes. Type IIb autoimmune CSU involves IgG autoantibodies against FcεRI (high-affinity IgE receptor) or IgE itself, causing mast cell activation. Anti-IgE receptor antibodies (detected by basophil activation test or autologous serum skin test) indicate this autoimmune mechanism. This distinction has therapeutic implications — patients with type IIb autoimmune CSU may respond differently to Omalizumab compared to type I (IgE-mediated autoallergic) CSU, where IgE antibodies are directed against autoantigens.

Reference: EAACI/GA²LEN 2022 Urticaria Guideline; BAD