What is the role of immune hypersensitivity in the pathophysiology of acute urticaria (hives)?

Updated: Mar 21, 2018
  • Author: Henry K Wong, MD, PhD; Chief Editor: Michael A Kaliner, MD  more...
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Histamine is the ligand for 2 membrane-bound receptors, the H1 and H2 receptors, which are present on many cell types. The activation of the H1 histamine receptors on endothelial and smooth muscle cells leads to increased capillary permeability. The activation of the H2 histamine receptors leads to arteriolar and venule vasodilation. [3, 4, 5] This process is caused by several types of immune hypersensitivity mechanisms as follows:

  • The type I allergic immunoglobulin (Ig) E response is initiated by antigen-mediated IgE immune complexes that bind and cross-link Fc receptors on the surface of mast cells and basophils, thus causing degranulation with histamine release.

  • The type II immune response is mediated by antibodies bound to cell surface, causing complement-mediated or antibody-dependent cell cytotoxicity.

  • The type III immune-complex disease is associated with systemic lupus erythematosus and other autoimmune diseases that cause urticaria. [4]

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