Serological evidence that activation of ubiquitous human herpesvirus-6 (HHV-6) plays a role in chronic idiopathic/spontaneous urticaria (CIU)

Clin Exp Immunol. 2016 Feb;183(2):230-8. doi: 10.1111/cei.12704. Epub 2015 Nov 24.

Abstract

Acute infection with viral pathogens in the herpesviridae family can trigger acute urticaria, and reactivation of herpesviridae is associated with cutaneous urticarial-like syndromes such as drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DRESS). Reactivation of latent herpesviridae has not been studied systematically in chronic idiopathic/spontaneous urticaria (CIU). This review proposes that CIU is an inflammatory disorder with autoimmune features (termed 'CVU' for chronic viral urticaria), based on serology consistent with the hypothesis that reactivation of a latent herpesvirus or -viruses may play a role in CIU. Serology obtained from a cohort of omalizumab (Xolair)-dependent patients with severe CIU was consistent with previous HHV-6 infection, persistent viral gene expression and replication. CIU patients also exhibited serological evidence of increased immune response to HHV-4 (Epstein-Barr virus, or EBV) but not all CIU patients were infected with EBV. These observations, combined with case reports of CIU response to anti-viral therapy, suggest that HHV-6, possibly interacting with HHV-4 in cutaneous tissues, is a candidate for further prospective study as a co-factor in CIU.

Keywords: DRESS; Th2 cytokine; chronic urticaria; herpesviridae; omalizumab; virokine; virome.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adult
  • Antibodies, Viral / blood
  • Autoimmune Diseases / immunology
  • Autoimmune Diseases / virology
  • Drug Hypersensitivity Syndrome / immunology
  • Drug Hypersensitivity Syndrome / virology
  • Female
  • Herpesviridae Infections / immunology*
  • Herpesviridae Infections / virology*
  • Herpesvirus 4, Human / genetics
  • Herpesvirus 4, Human / immunology
  • Herpesvirus 6, Human / genetics
  • Herpesvirus 6, Human / immunology*
  • Herpesvirus 6, Human / physiology*
  • Humans
  • Male
  • Middle Aged
  • Omalizumab / therapeutic use
  • Urticaria / drug therapy
  • Urticaria / immunology*
  • Urticaria / physiopathology
  • Urticaria / virology*
  • Virus Activation*
  • Virus Latency

Substances

  • Antibodies, Viral
  • Omalizumab