Persistent bacterial infections and serum activity in chronic urticaria - role of molecular mimicry?

Annoying symptoms of chronic urticaria, which are often lasting daily for y ears or decades, are suggested to be mediated by mast cell and basophil med iator release. However, the exact pathomechanisms of effector cell activati on are far from being clear. For the patients, failure to identify a trigge r is often the most troubling aspect or the disease. Immunologic mechanisms , i.e. a specific IgE response can not be identified in nearly all of the c ases. Therefore, besides pseudoallergic mechanisms persistent bacterial inf ections (e.g. with streptococci, Helicobacter pylori) and an autoimmune ser um activity with production of autoantibodies against IgE and the high affi nity IgE receptor Fc epsilon RI alpha as well as against thyroid are discus sed to be of pathogenic relevance. On the one side, this review Summarizes the current knowledge of the pathogenic role of infections (particularly wi th Helicobacter pylori) in chronic urticaria and their potential associatio n to autoimmune mechanisms. On the other side based on our experience of se veral years in the care of about 600 patients, a reliable diagnostic proced ure for patients with chronic urticaria is presented.