Immune stimulus exposure as a trigger for the development of chronic pruritus and circulating blood type 2 inflammation

Jaya Manjunath BS , Viviane Liao BS , Anusha Kambala BS , Aaron Bao BA , Alexander L. Kollhoff MD , Emily Z. Ma BS , Brenda Umenita Imo MS , Hannah Cornman BS , Sriya V. Reddy BS , Kevin K. Lee BS , Weiying Lu BS , Selina M. Yossef BA , Madan M. Kwatra PhD , Shawn G. Kwatra MD
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Abstract

Background

Chronic pruritus (CP) is a poorly characterized condition associated with intense pruritus without a primary skin eruption. This condition tends to emerge more commonly in older adults, and there is limited research on triggering factors.

Objective

To explore the clinical characteristics and pathophysiology of CP following exposure to an immune stimulus.

Methods

Clinical characteristics and plasma samples were collected from 15 patients who developed CP following an immune stimulus such as checkpoint inhibitors or vaccination. A multiplex panel was used to analyze plasma cytokine concentrations within these patients.

Results

Most immunotherapy-treated patients experienced CP during treatment or after 21 to 60 days of receiving treatment, while vaccine-stimulated patients developed pruritus within a week of vaccination. Plasma cytokine analysis revealed elevated levels of 12 cytokines in patients with immune-stimulated CP compared to healthy controls. Notably, T helper 2 (Th2) related cytokines interleukin (IL)-5 (fold change 2.65; q < 0.25) and thymic stromal lymphopoietin (fold change 1.61 q < 0.25) were upregulated.

Limitations

Limitations of this study include limited sample size, particularly in the plasma cytokine assay.

Conclusions and Relevance

This study reveals triggers of CP development and describes alterations in blood Th2 markers in patients with CP, including IgE, increased blood eosinophils, and cytokines IL-5 and thymic stromal lymphopoietin.

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免疫刺激暴露是慢性瘙痒症和循环血液 2 型炎症发展的诱因。
背景慢性瘙痒症(CP)是一种特征不明显的疾病,与剧烈瘙痒而无原发性皮肤糜烂有关。方法 收集了15名在接受检查点抑制剂或疫苗接种等免疫刺激后出现慢性瘙痒的患者的临床特征和血浆样本。结果大多数接受免疫治疗的患者在治疗期间或接受治疗 21 至 60 天后出现了 CP,而接受疫苗刺激的患者在接种疫苗一周内出现了瘙痒。血浆细胞因子分析显示,与健康对照组相比,免疫刺激型 CP 患者的 12 种细胞因子水平升高。值得注意的是,与 T 辅助细胞因子 2(Th2)相关的细胞因子白细胞介素(IL)-5(折叠变化 2.65;q <;0.25)和胸腺基质淋巴细胞生成素(折叠变化 1.61 q <;0.25)被上调。本研究揭示了CP发病的诱因,并描述了CP患者血液中Th2标记物的变化,包括IgE、血液中嗜酸性粒细胞增加、细胞因子IL-5和胸腺基质淋巴细胞生成素。
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来源期刊
JAAD International
JAAD International Medicine-Dermatology
CiteScore
3.60
自引率
0.00%
发文量
169
审稿时长
45 days
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