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Increased filaggrin expression was found to be correlated with severity scores in chronic spontaneous urticaria (CSU); however, the role of filaggrin breakdown products (FBPs) in CSU has not been studied. We collected stratum corneum (SC) specimens from the volar forearms of 10 CSU patients, 10 AD patients, and 10 healthy normal controls (NCs) and measured contents of FBPs (pyrrolidone carboxylic acid [PCA] and urocanic acid [UCA]) using UPLC-MS/MS, transepidermal water loss (TEWL) and epidermal pH. Compared to NCs,  cis -UCA level was increased in CSU lesions ( P  < 0.05) and decreased in AD lesions ( P  < 0.01). The  cis- to- trans- UCA ratio in SC specimens from CSU patients was significantly greater than those from AD and NC subjects. AD lesions had lower FBP and PCA contents compared to NC skin (both  P  < 0.001), and higher TEWL and pH compared to CSU lesions. Moreover,  cis -UCA, but not  trans -UCA, enhan c ed the IgE-mediated basophil activation, as well as IgE- and calcium-mediated degranulation of LAD-2 cells, in a dose-dependent manner. These findings suggest that increased  cis -to- trans  UCA ratio in the epidermis is a distinct feature of CSU, which could enhance mast cell degranulation. Modulation of  cis -UCA may be a potential target for skin diseases associated with IgE-mediated mast cell degranulation.

Increased cis-to-trans urocanic acid ratio in the skin of chronic spontaneous urticaria patients