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We thank Dr Grattan1 for commenting on our recent article2 and for proposing that the subtype of chronic spontaneous urticaria (CSU) we call type II autoimmune CSU might better be called type IIb or type V autoimmune CSU. Type IIb and type V are not part of the original classification by Gell and Coombs,3 which we used to distinguish the 2 types of autoimmunity currently thought to be involved in the pathogenesis of CSU (ie, type I and type II). Modifications of this original classification, such as the introduction of type IIb and type V, reflect the fact that not all type II reactions (ie, reactions caused by autoantibodies that bind to a target cell antigen or one that has become closely associated with it) are cytotoxic.

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