Efficacy and Safety of Autologous Serum Therapy in Chronic Spontaneous Urticaria in the Pediatric Population: A Prospective Pilot Study.

Background. Chronic urticaria is defined as urticaria persisting daily for more than six weeks. A significant number of patients had autoimmune basis where autologous serum skin test is widely used for detection of chronic autoimmune urticaria. Objectives. To estimate the frequency of autoimmune urticarial in Iraqi patients utilizing the autologous serum skin test and to evaluate its results with the variable clinical features of chronic idiopathic urticaria. Methods. In this prospective study, 54 patients with chronic idiopathic urticaria were investigated with autologous serum skin test where its results were examined with the different clinical parameters of chronic autoimmune urticaria. Results. Twenty two patients (40.7%) out of 54 patients with chronic idiopathic urticarial had positive autologous serum skin test. Statistical analysis of the clinical variables did not show a significant difference between patients with positive and negative autologous serum skin test except for the distribution of wheals on the face and extremities which was significantly associated with positive autologous serum skin test results (P value 0.004). Conclusion. Autologous serum skin test is a simple, office-based test for detecting chronic autoimmune urticaria patients who have no distinctive clinical features differentiating them from chronic idiopathic urticaria patients.

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.

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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

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.

Chronic spontaneous urticaria (CSU) is an autoimmune disease characterised by urtica lesions and/or angioedema accompanying an itching sensation, recurring for at least six weeks without any specific trigger. Autologous serum therapy (AST) is an adjuvant therapy for CSU that is resistant to H1 antihistamines. This therapy is an economical option in developing countries. There were a few studies discussing the role of AST in CSU. This systematic review and meta-analysis were conducted to evaluate the efficacy of AST based on urticaria activity scores (UAS or UAS7) and urticaria total severity scores (TSS) so that clinicians can consider them. Data were searched systematically in Cochrane, PubMed, Google Scholar, Willey, and EMBASE from 2000 to March 2023. Data analysis using Excel 2010 (Microsoft Corp) and MedCalc version 20.218. There were 14 studies: 4 randomised controlled trials (RCT), 9 prospective, and 1 cross-sectional. The average improvement in UAS and TSS scores at the end of therapy was 42.24% and 41.24%. Results of subgroup analysis of AST administration in the group autologous serum skin test (ASST) positive and ASST negative based on the end of therapy UAS score (p=0.18). Results of subgroup analysis of AST administration in the positive ASST and negative ASST groups based on the TSS score at the end of therapy (p=<0.001). Results of subgroup analysis of AST administration versus placebo based on TSS score (p=0.861). Based on subgroup analysis, autologous serum therapy improves TSS scores in CSU patients (ASST positive). However, AST is not significantly different from placebo.

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">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.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">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</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">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. </span></p><p class="abstract"><strong>Conclusions:</strong> ASST is a simple and reliable method to detect chronic autoimmune urticaria. <span lang="EN-IN">ASST positive patients have more episodes of urticaria compared to ASST negative patients.</span></p>

Introduction: Chronic urticaria (CU) is as a distressing condition that may present with short-lived itchy weal, angioedema, or both. Autologous serum skin test (ASST) is a simple in vivo clinical test for the detection of basophil histamine-releasing activity. ASST is a very simple, quick test which consists of intradermal injection of patient's own serum into the volar aspect of forearm. A significant association between increased total IgE and CU severity was found. The present study was done to find out the clinical profiles of CU in MGM Medical College and LSK Hospital. ASST was done, and serum IgE level in patients with chronic spontaneous urticaria estimated and to give an insight on degree of serum IgE level with ASST positivity.Materials and Methods: This was a cross-sectional study where a total of 100 patients were enrolled. Detailed history, physical examination, and routine investigations were recorded for all patients. ASST and serum IgE were done in all patients.Results: Of total of 100 patients enrolled in the study, ASST positive group consists of 29 patients and ASST negative group consists of 71 patients. A total of 46 patients got raised IgE, and the rest 54 had normal IgE level; out of IgE positive, 34 patients were ASST negative, and rest 12 patients were ASST positive. Majority of ASST positive patients had normal serum IgE level (n = 17). Nine and three patient's IgE level were in the range of 200–300 and 300–400 IU/ml, respectively.Conclusion: The ASST is a simple, practicable in vivo intradermal test for the detection of autoimmune urticaria. There was significant association seen with the duration of disease and ASST positivity. The present study did not show any association between increased serum IgE and ASST positivity.

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.

Autologous serum therapy (AST) is considered a potentially curative therapeutic option in the treatment of chronic urticaria, especially in the autoreactive type. To determine the ratio of patients with a positive autologous serum skin test (ASST) in chronic urticaria and the efficacy of AST. A total of 77 (29 male and 48 female) patients with chronic urticaria were enrolled in the study. The autologous serum skin test (ASST) was performed for all patients and the patients were classified into two groups: ASST positive and ASST negative. Intramuscular injection of AST was administered and the total severity score (TSS) of the urticaria was calculated weekly for ten weeks. The TSS was calculated for another ten weeks without AST. There were 34 patients (11 men and 23 women) in the positive group and 43 (18 men and 25 women) in the negative group. Reduction of symptoms of urticaria begins in the fourth week of the study in both groups. At week 20, 21 (61.7%) patients of the ASST (+) group and 12 (27.2%) patients of the ASST (-) group showed complete clearance. The use of antihistamines decreased from 100% at baseline in both groups to 8.82% and 25.58% in the ASST (+) and ASST (-) groups, respectively, at the end of the study. AST is a low-cost, cost-effective and potentially curative treatment with no adverse effects in these patients. It can reduce the burden of antihistamines.

<p><strong>Background</strong>: 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.</p><p><strong>Methods</strong>: 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.</p><p><strong>Results:</strong> 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.</p><p><strong>Conclusions</strong>: 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.</p>

This small study evaluates the effectiveness and safety of cyclosporine (CsA) in the treatment of patients with chronic idiopathic urticaria with a positive autologous serum skin test (ASST), who fail to respond to conventional therapy, and requiring long-term oral steroid treatment. This small study evaluates the effectiveness and safety of cyclosporine (CsA) in the treatment of patients with chronic idiopathic urticaria with a positive autologous serum skin test (ASST), who fail to respond to conventional therapy, and requiring long-term oral steroid treatment. Small open-label trials suggest that cyclosporine (CsA), used at a range of different daily dosages (<5 mg/kg) and duration, could be of therapeutic value in patients with chronic idiopathic urticaria (CIU) that is unresponsive to conventional therapy.1–4 Five adult patients (4 females and 1 male) in the age group of 20-50 years with mean age of 37.8 years with severe disease ranging from 6 weeks to 5 years (Table 1), unresponsive to antihistamines and showing a positive ASST, were advised to take 3 mg/kg per day of CsA for 12 weeks after taking consent for treatment, along with cetirizine (10 mg). Exclusion criteria included other concomitant forms of urticaria, any contraindications to cetirizine and CsA, and relevant systemic disorders. The clinical efficacy was measured with an activity score of wheal numbers and itch (Urticaria Activity Score, UAS). All patients were followed up to assess response to treatment. Table 1 Distribution of patients by sex and disease duration All patients were reviewed at 0,2,4,8 and 12 weeks with urticaria activity score. The UAS consists of the sum of the wheal number score and the itch severity score.5 The wheal numbers are graded from 0 to 3 as follows: 0 - less than 10 small wheals (diameter, 3 cm); 2 - greater than 50 small wheals or 10 to 50 large wheals; and 3 - almost the whole body is covered. The severity of itching is graded from 0 to 3 (0, none; 1, mild; 2, moderate; and 3, severe). Baseline investigations included urine examination, complete blood count, blood sugar, urea, creatinine and serum electrolytes. Repeat tests were done at 2, 4, 8 and 12 weeks. Blood pressure was monitored every two weeks. Average urticaria activity score was 5.4. Within two weeks of starting cyclosporine, the score came down to 1.6. The male patient discontinued cyclosporine due to high cost of therapy. Score came down to less than one in all four female patients who continued treatment. Side effects were few. In one patient, blood pressure went up 120/90 mm of Hg requiring amlodipine (2.5 mg) therapy. By the end of treatment, 3/4 (75%) patients were in full remission (score 0) and the remainder scored 1. This uncontrolled study has shown that low-dose CsA is effective in treating CIU patients, and can be given safely for 3 months. One study showed that prolonged treatment with CsA is beneficial for maintaining remission in severe cases of CU. It spares the need for corticosteroids and is accompanied with mild side effects.6 We could not perform ASST after stopping treatment, but one study from Italy has shown that ASST becomes negative in majority of patients with remission of symptoms.7 Methotrexate can be used in patients who cannot afford cyclosporine as reported by us.8

The epidemiologic profiles of chronic urticaria (CU) vary considerably among regions, and few such data are available from China. We performed a multicenter open questionnaire investigation about the clinical and laboratory features of CU, defined as recurrent wheals with/without angioedema lasting for ≥6 weeks, among 3027 patients. Female preponderance was observed (female/male ratio, 1.46 : 1). The mean age at diagnosis was 34.7 ± 13.8 years, and the mean disease duration was 18.5 ± 46.1 months (range, 1.5-127 months). Patients were classified as having chronic spontaneous urticaria (CSU, 61.0% of patients), physical urticaria (PU, 26.2%), or other urticaria types (OU, 2.3%). Nocturnal attacks were reported by 60% of cases. The Urticaria Activity Score (UAS) in patients with CSU was 3.8 ± 1.4. The mean Dermatology Life Quality Index was 7.3 ± 3.4 (range 0-30). Induction or exacerbation of wheals with alcohol drinking was reported by 55.7% of patients. Chronic hepatitis B was less prevalent in our CU patients compared with the general Chinese population (2.7% vs 7%). Positive autologous serum skin tests (ASSTs) were observed in 66.9% of patients. Patients with positive ASST had higher UAS, greater angioedema frequencies, longer disease durations, and poorer QoL compared with patients with negative ASST (P < 0.05). In this Chinese population, CU usually affected youth, and CSU was the most common subtype. Autoreactivity and alcohol consumption were the top two triggers for CU, whereas latent infectious and chronic inflammatory diseases were not as common as in previous reports.

[Objective] To evaluate the efficacy of autologous whole blood injections in patients with chronic spontaneous urticaria and positive autologous serum skin test (ASST).[[Methods]] After assessment of clinical history,patients with chronic spontaneous urticaria underwent skin prick test (SPT) and ASST.Then,100 patients with positive ASST but negative SPT for common allergens were randomly classified into treatment group (n =60) and control group (n =40).Oral loratadine was given to all the patients with a gradual tapering to the least maintenance dose.Patients in the treatment group were also injected with autologous whole blood once a week for 12 times.Patients were evaluated by urticaria activity score (UAS) and dermatology life quality index (DLQI) at the baseline,the end of the 3rd and 6th month after the initial treatment.The total amount of antihistamines required for the control of urticaria every month was calculated.The UAS,DLQI,accumulative amount of administrated antihistamines,and the diameter of wheal/flush induced by autologous serum were compared by t test before and after the treatment,and the efficacy was compared by rank sum test between the two groups.[Results] No significant difference was observed between the control and treatment group in UAS at the baseline (5.73 ± 0.51 vs.5.32 ± 0.79,P＞ 0.05).The UAS reached 1.57 ± 1.42 and 0.69± 0.92 with a decrease rate of 69％ and 81％ in the treatment group,and 3.65 ± 1.53 and 2.65 ± 1.61 with a decrease rate of 35％ and 53％ in the control group,respectively at the end of the 3rd and 6th month,and statistical difference was observed for the decrease in both groups at the two time points (all P ＜ 0.05).The total amount of antihistamines required for the control of urticaria per month averaged 8.63 pills and 3.83 pills respectively in the treatment group after 3 and 6 months of treatment,significantly less than that in the control group (16.85 and 15.27 pills,respectively).[Conclusion]s The combination of oral antihistamine and autologous whole blood injections can not only reduce disease activity and improve patients' quality of life,but also decrease the total amount of antihistamines required for the control of urticaria. Key words: Urticaria; Skin tests; Autologous serum; Autologous whole blood injection

Sex differences in the pathogenesis of chronic urticaria