Autologous Serum Skin Test as a Diagnostic Aid in Chronic Idiopathic Urticaria

Chronic spontaneous urticaria (CSU) in children is mostly spontaneous in onset (57%). Treatment comprises long-term antihistaminic therapy without need for elaborate investigations. A subset of such patients don't respond to conventional treatment and novel therapies to help reduce pill burden is the need of the hour. To determine the efficacy and safety of autologous serum therapy (AST) in pediatric patients with chronic spontaneous urticaria. All pediatric patients, aged between 6-16 years, attended to our OPD from March 2019 to March 2020 were recruited. Clinico-demographic data and baseline investigations of all patients were performed. Two-weekly AST therapy was given for 8 visits with levocetrizine tablet 5mg on an on-demand basis. Urticaria activity score (UAS) sheet was provided to record and return every 2 weeks. Statistical analysis was done using the IBM SPSS 26 software package. Autologous serum skin test (ASST) was positive in 63% patients. Both the ASST positive and ASST negative group showed significant reduction in UAS7 score at week 14 compared to baseline. The reduction in mean UAS7 score was associated with a decreased pill burden and positive response in the patient and physician global assessment scale. No statistically significant difference between the two groups in terms of mean UAS7 reduction was found. This study has explored the efficacy and safety of autologous serum therapy in the pediatric CSU patients. Both ASST positive and ASST negative group respond to AST therapy.

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Objective To investigate the relationship between HLA-DRB1 alleles and chronic urticaria with positive autologous serum skin test (ASST) in Guangxi Zhuang Autonomous Region.Methods ASST was conducted in 144 patients with chronic urticaria,who were subsequently divided into two groups according to the test result:positive group (n =62) and negative group (n =82).PCR amplification with sequence-specific primers was used to determine the genotypes of HLA-DRB1 alleles in the patients and 199 normal human controls.Chi-square test was performed to analyse the difference in the frequency of HLA-DRB1 alleles between the 3 groups by using the SPSS 13.0 statistical software package.Results There were significant differences in the frequency of HLA-DRB1*01,*1401 and *16 alleles among the patients with positive and negative ASST and the controls (x2 =10.92,Pc =0.032;x2 =35.34,Pc ＜ 0.01 ;x2 =12.69,Pc =0.032).Paired comparison revealed significant differences in the frequency of HLA-DRB1*1401 allele between the patients with positive ASST and controls (RR =17.09,Pc ＜ 0.01 ) as well as between the patients with positive and negative ASST (RR =7.20,Pc ＜ 0.01).Conclusion HLA-DRB1*1401 allele may be,or be linked to,the predisposing gene of chronic urticaria with positive ASST in Guangxi Zhuang Autonomous Region. Key words: Urticaria; Alleles; Genes, MHC class Ⅱ; Skin tests

Background Chronic Spontaneous Urticaria is considered to be an autoimmune phenomenon in half of the total cases. Autologous serum skin test is a simple screening test for the presence of auto-antibodies in chronic urticaria. Significant impairment in quality of life have been observed in autologous serum skin test positive cases. There are limited literatures on chronic spontaneous urticaria, autologous serum skin test and associated Dermatology Life Quality Index in Nepal till date.
 Objective To find the proportion of autologous serum skin test positive cases in chronic urticaria and impairment in quality of life in such patients.
 Method This was a retrospective review of outpatient records of patients diagnosed with chronic spontaneous urticaria, from January 2018 to December 2019, from a tertiary care hospital in Kathmandu, Nepal. Details of the patients, autologous serum skin test and dermatology life quality index scores were analyzed and presented.
 Result Among the total 114 cases positive autologous serum skin test was seen in 48.2% of cases. The mean total Dermatology Life Quality Index score was 8.06±6.64. A significantly higher quality of life impairment was observed in in patients with positive autologous serum skin test as compared to the negative ones. The odds of finding a positive autologous serum skin test in patients with angioedema was 2.1, however the difference was not statistically significant.
 Conclusion Chronic spontaneous urticaria was more common in females as compared to males. A positive autologous serum skin test was present in half of the patients which was in turn associated with a greater impairment of quality of life.

Background:About 25–45% of patients of chronic urticaria (CU) have been stated to have histamine releasing autoantibodies in their blood. The term autoimmune urticaria is increasingly being accepted for this subgroup of patients. Review of the literature suggests high autologous serum skin test (ASST) positivity and presence of antithyroid microsomal antibodies in patients with autoimmune urticaria.Aims:To study prevalence of ASST positivity and antithyroid microsomal antibodies in chronic “idiopathic” urticaria and to study the correlation between the two parameters.Methods:All patients of chronic idiopathic urticaria satisfying inclusion/exclusion criteria were enrolled in the study after written informed consent. Patients of CU secondary to infections and infestations, physical urticaria including dermatographism, mastocytosis, urticarial vasculitis and those on treatment with immunosuppressive drugs for urticaria were excluded from the study. In all of these patients, complete blood count; ASST, serum T3/T4/thyroid stimulating hormone levels, antithyroid microsomal antibody (AMA) levels were done. Statistical analysis was done by Chi-square test, Fisher exact test and Kappa statistics.Results:Study included 24 males and 26 females with mean age of 39.54 years. Majority of patients belonged to 20–40 years of age. Females showed more ASST positivity. A total of 12 out of 50 (24%) patients showed positive ASST. A total of four out of 12 (33.33%) had positive ASST and raised AMA levels.Conclusion:Only 25% of patients of chronic idiopathic urticaria had positive ASST. ASST and AMA levels were positively correlated in our study. Further studies are required to authenticate this association.

A positive autologous serum skin test (ASST) is considered to reflect the presence of anti-FceRI and/or anti-IgE autoantibodies that are capable of activating mast and basophil cell degranulation. The ASST is regarded as a reliable in vivo test in chronic idiopathic urticaria (CIU) patients, with diagnostic, therapeutic and prognostic implications. However, positive ASST results have also occasionally been demonstrated in patients with other diseases and in healthy subjects. To evaluate the specificity and sensitivity of the ASST in a cohort of CIU patients compared to a cohort of respiratory-allergic patients and a group of normal individuals. ASST was performed in a cohort of 116 subjects, 47 subjects with seasonal allergic rhinitis, 32 respiratory-symptom-free CIU patients, and 37 healthy individuals. The results were compared statistically to those of the CIU patients. The intradermal injection of autologous serum induced a weal and flare reaction in 17/32 (53.1%) CIU patients; 14/47 (29.8%) patients with seasonal allergic rhinitis (P=0.06) and in 15/37 (40.5%) of the healthy controls (P=0.34). The sensitivity and specificity of the ASST in the CIU patients and the seasonal allergic rhinitis patients was 53 and 28%, respectively. When comparing the CIU patients with the healthy controls the sensitivity and specificity was 55 and 31%, respectively. The positive and negative predictive values of the ASST when comparing CIU patients with healthy controls were 53 and 59.5%, respectively. The positive and negative predictive values of the ASST in the CIU patients compared to seasonal allergic rhinitis patients were 53 and 70%, respectively. The relatively low sensitivity and specificity of the ASST in the CIU patients compared to the seasonal allergic rhinitis patients and healthy controls warrants a more critical interpretation of the ASST in chronic idiopathic urticaria.

IntroductionThe basophil activation test showing CD63 up regulation could be a specific and sensitive in vitro complementary text to the in vivo autologous serum skin test for the activity assessment of the patients suffering autoimmune chronic spontaneous urticaria. The aim of this study is to define the basophil activation test as a useful tool in clinical practice in order to identify those patients with more active disease.MethodsWe screened 139 patients (96 women) diagnosed of chronic spontaneous urticaria using simultaneously autologous serum skin test and basophil activation test and their relationship with disease activity.ResultsPositive autologous serum skin test was found in 56.8%; from them, 31.6% were basophil activation test positive. Negative autologous serum skin test result was found in the 43.2% of the sample that showed negative CD63 expression results in all cases, except one. Patients with positive autologous serum skin test and positive CD63 by basophil activation test showed significant higher Urticaria Activity Score of 7 days (P = 0.004) and of 3 weeks (P = 0.001) than patients with positive autologous serum skin test and negative CD63 (mean ± standard deviation [SD] 26.57 ± 10.56 versus 18.40 ± 12.05 for the Urticaria Activity Score of 7 days and 56.47 ± 23.78 versus 39.88 ± 25.44 for the Urticaria Activity Score of 3 weeks).ConclusionsThe CD63 expression on basophils appears as a reliable in vitro marker, useful in clinical practice in combination with autologous serum skin test to define chronic spontaneous urticaria patients with the highest urticaria activity that impairs a normal life.

Chronic urticaria sera increase basophil CD203c expression

The addition of zafirlukast to cetirizine improves the treatment of chronic urticaria in patients with positive autologous serum skin test results

Previous studies on the correlation between positive autologous serum skin test (ASST) responses and the clinical features of patients with chronic spontaneous urticaria (CSU) have provided conflicting results. To evaluate the significance of ASST responses in CSU, a variety of databases were searched from inception to March 2018 to identify relevant studies on CSU. Data were analyzed with use of the Cochrane Collaboration's Review Manager 5.2. Multiple relevant factors of CSU were evaluated by calculating the weighted mean difference, odds ratio and 95% confidence interval. The results indicated that CSU cases with positive ASST responses had higher urticaria activity scores and higher levels of total serum immunoglobulin E than CSU cases with negative responses in the ASST. In addition, a positive ASST response was more likely to be accompanied with the presence of thyroid autoantibodies and angioedema. An increased prevalence of CSU was identified in females, who were more likely to have a positive response in the ASST. It was also indicated that a greater incidence of positive ASST responses was present in CSU patients as compared with that in healthy controls. No statistically significant differences were obtained between positive and negative ASST responses with regard to age and duration of disease. Based on these results, it was concluded that the ASST provides an effective means of predicting urticaria activity and recurrence in CSU patients.

BackgroundChronic spontaneous urticaria (CSU) is a common skin disorder with etiology that is not well understood.MethodsIn this study, we evaluated the prevalence of autologous serum skin test (ASST) and skin prick testing (SPT) to house dust mite (HDM) in 862 CSU cases in China. Clinical features, courses and treatment responses were also recorded.ResultsThe prevalence of positive ASST was 46.3%, and patients aged 30–39 years had the highest positive rate (52.1%). Positive SPT to HDM was seen in 153 patients (17.7%) with the highest positive rate (34.2%) in patients aged 20 or less. Patients with positive ASST had higher urticaria activity scores (UAS) (4.18±0.65 vs. 3.67±0.53) but lower positive rates of HDM (24.6% vs. 37.6%), as compared with those with negative ASST (odds ratio (OR) 1.84, 95% CI 1.38–2.47). Patients could be categorized into four groups based on the results of ASST and SPT to HDM and patients with positive ASST and positive SPT to HDM had the highest disease activity scores, experienced higher frequencies of angioedema, diseases duration, and required higher dosage of loratadine every month, compared with other subgroups (P<0.0001).ConclusionsPatients with CSU showed varied responses of positive ASST and varied sensitivity to HDM, Patients with positive ASST and/or positive SPT had more disease activity compared with patients with negative ASST and/or negative SPT. Further classification can be made based on the result of SPT and ASST.

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Urticaria affects up to 20% of the population during their life time. Urticaria occurring on almost all days for more than 6 weeks is classified as chronic urticaria. Chronic urticaria is one of the most vexing management problems the dermatologists face. Chronic urticaria cases in which no etiology can be found are labelled chronic idiopathic urticarial (CIU). In most cases of idiopathic urticaria, autoimmunity may be the initiating factor- chronic autoimmune urticaria. Autologous serum skin test (ASST) is a simple and reliable method to detect autoimmune urticaria.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Among patients with chronic idiopathic urticaria, ASST is done to detect ASST positivity and thereby chronic autoimmune urticaria. Patient’s serum is separated and 0.05 ml injected intradermally on left forearm. Normal saline is injected intradermally at least 5 cm away as control. Wheal and flare at serum site which is 1.5 mm more than that of control is taken as positive. Results were analyzed using Microsoft excel and Epi info7&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;49 patients were studied and 34 (69.4%) showed ASST positivity, which is an indicator of autoimmune urticaria. Moreover, it was seen that ASST positive patients had more episodes of urticaria per week, compared to ASST negative patients. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; ASST is a simple and reliable method to detect chronic autoimmune urticaria. &lt;span lang="EN-IN"&gt;ASST positive patients have more episodes of urticaria compared to ASST negative patients.&lt;/span&gt;&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: Chronic urticaria, with or without angioedema, has been defined as daily or almost daily symptoms and signs recurring for more than six weeks. Chronic urticaria has an idiopathic etiology in majority. This is called as chronic idiopathic urticaria (CIU) or chronic spontaneous urticaria (CSU). Aim and objectives were to compare the clinical features in CIU patients with a positive autologous serum skin test (ASST) and negative ASST.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: Fifty clinically diagnosed patients of CIU attending the department of DVL OPD at tertiary care teaching hospital, were enrolled based on the inclusion and exclusion criteria.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; ASST was positive in 48% (24/50) of patients with CSU. In study of 50 patients, 66% were females and 34% were males. The mean age of patients was 36.8 years. The disease's median duration was 10 months and 11 months in ASST positive and ASST negative groups respectively. Of the 50 patients, 20 patients showed a positive response to the test for simple dermographism, of which 13 were ASST positive. Of the 50 patients, 8 patients gave a history of atopy, of which 5 were in the ASST positive group, 3 were in ASST negative group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions&lt;/strong&gt;: In the present study ASST was positive in 48% of patients with CIU. Majority of ASST positive patients had almost daily attacks. ASST positive patients had a longer duration of persistence of wheals. ASST is a fairly good indicator of autoimmune etiology for chronic urticaria.&lt;/p&gt;

Chronic spontaneous urticaria (CSU) is a multifactorial, mast cell driven disorder characterized by wheals, angioedema, or both, lasting for more than six weeks. Autoimmunity, particularly Type IIb autoimmunity, involving IgG autoantibodies directed against either IgE or its high affinity receptor (FcεRI) on mast cells and basophils, plays a significant role in CSU pathogenesis. The Autologous Serum Skin Test (ASST) is a practical tool for detecting IgG autoantibodies and may be associated with the disease severity and the presences of autoimmune antibodies. Nonetheless, previous studies on ASST responses and the clinical features of patients with CSU have conflicting results. This study aimed to establish the relationship between ASST positivity and disease activity, assessed by the Urticaria Activity Score 7 (UAS7) and to determine the associations with autoimmune antibodies including anti-thyroid peroxidase (anti-TPO), antithyroglobulin antibodies, and antinuclear antibodies (ANA). This cross- sectional study was conducted over a five months period, from January to May 2024, at the Department of Dermatology, in the tertiary hospital located in the capital city of Malaysia. Participants underwent ASST, laboratory evaluation for autoimmune antibodies, and assessment of disease activity using UAS7. In this study, 24 of the 59 patients were ASST positive, resulting in a prevalence rate of 41%. ASST positive patients demonstrated significantly higher disease activity, with a mean UAS7 score of 23.96 ± 10.55, compared to 13.51 ± 10.88 in ASST negative individuals (p = 0.001). A significant association was also found between ASST positivity and higher UAS7 severity categories (p = 0.011). Furthermore, a significant gender difference was observed with females more likely to exhibit ASST positivity (p = 0.016). Nevertheless, no significant associations were found between ASST results and presence of angioedema (p =1.0), atopy (p = 0.968), or autoimmune antibodies including ANA, anti-TPO, and anti-thyroglobulin antibodies (p > 0.05) CONCLUSION: The significant association between ASST positivity and increased UAS7 scores heightened interplay between autoimmunity, disease severity, and clinical characteristics in CSU, particularly Type IIb autoimmunity subtype. Hence, ASST is a practical clinical tool for identifying autoimmune profile in CSU patients, and aids dermatologist in prognosis assessment and treatment strategies.

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic urticaria (CU) is defined as urticaria persisting daily as or almost daily for more than 6 weeks and affecting 0.1% of the population. In chronic autoimmune urticaria, immunoglobulin G (lgG) auto antibodies react to the alpha subunit of the high-affinity lgE receptor (FceR1) on dermal mast cells and basophils, leading to chronic stimulation of these cells. This results in the release of histamine and other inflammatory mediators which cause urticaria and angioedema. More than half of the patients have autoimmune urticaria. ASST is the only in vivo test to detect autoimmune urticaria. The aim was to study the frequency of ASST positivity among patients with chronic spontaneous urticaria and to identify the clinical and laboratory parameters associated with positive ASST.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The present study is prospective observational study of chronic spontaneous urticaria. ASST was performed in 250 patients fulfilling exclusion and inclusion criteria. Baseline investigations (CBC, ESR, urine, stool, RBS and CRP) were done for all the patients whereas specific investigations (ANA, Thyroid Profile, IgE, Anti H.Pylori IgG and skin biopsy) were done in selected cases.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 250 patients examined, 60% had positive autologous serum skin test suggestive of autoimmune urticaria. H. pylori antibodies were significantly higher (29%) in ASST positive patients. While antinuclear antibody (ANA) was positive in 4% and thyroid antibodies were present in 7% of patients with positive ASST. Serum IgE was elevated in 32% ASST positive patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; ASST is an easy, simple and cost effective screening test for chronic autoimmune urticaria.&lt;/p&gt;