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<p>Chronic spontaneous urticaria (CSU) is a heterogeneous disease with incompletely defined immunological endotypes. <i>Staphylococcus aureus</i> enterotoxins have been implicated in disease pathogenesis, but their clinical relevance remains unclear. In this prospective study, we evaluated IgE sensitization to staphylococcal enterotoxins (SEA, SEB) in 91 CSU patients and 29 healthy controls, and investigated its association with clinical and immunological features. Enterotoxin-specific IgE sensitization was detected in 24.2% of CSU patients and in none of the controls. Sensitized patients exhibited significantly higher total IgE levels, eosinophil and basophil counts, consistent with a type-2 inflammatory profile. Sensitization was predominantly observed in the allergic phenotype and was least frequent in the autoimmune phenotype. Total IgE demonstrated acceptable discriminatory performance for predicting sensitization (AUC = 0.833), with an optimal cutoff of 134.5 IU/mL. In multivariable analysis, log-transformed total IgE independently predicted sensitization. These findings suggest that enterotoxin-specific IgE may serve as a marker of a microbial-associated type-2 inflammatory endotype in CSU. Importantly, total IgE may serve as a simple and clinically accessible surrogate biomarker to support biomarker-based patient stratification, although prospective validation in independent cohorts is warranted.</p>

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Staphylococcal enterotoxin-specific IgE Identifies a type-2 inflammatory endotype in chronic spontaneous urticaria

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月7日

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  • Kasım Okan,
  • Ragıp Fatih Kural,
  • Ceyda Tunakan Dalgıç,
  • Elif Azarsız,
  • Asuman Çamyar,
  • Yeliz Kaşko Arıcı,
  • Aytül Zerrin Sin

摘要

Chronic spontaneous urticaria (CSU) is a heterogeneous disease with incompletely defined immunological endotypes. Staphylococcus aureus enterotoxins have been implicated in disease pathogenesis, but their clinical relevance remains unclear. In this prospective study, we evaluated IgE sensitization to staphylococcal enterotoxins (SEA, SEB) in 91 CSU patients and 29 healthy controls, and investigated its association with clinical and immunological features. Enterotoxin-specific IgE sensitization was detected in 24.2% of CSU patients and in none of the controls. Sensitized patients exhibited significantly higher total IgE levels, eosinophil and basophil counts, consistent with a type-2 inflammatory profile. Sensitization was predominantly observed in the allergic phenotype and was least frequent in the autoimmune phenotype. Total IgE demonstrated acceptable discriminatory performance for predicting sensitization (AUC = 0.833), with an optimal cutoff of 134.5 IU/mL. In multivariable analysis, log-transformed total IgE independently predicted sensitization. These findings suggest that enterotoxin-specific IgE may serve as a marker of a microbial-associated type-2 inflammatory endotype in CSU. Importantly, total IgE may serve as a simple and clinically accessible surrogate biomarker to support biomarker-based patient stratification, although prospective validation in independent cohorts is warranted.