Autologous Serum Skin Test Positive Patients Research Articles

A Comparative Study of Autologous Serum Therapy and Histaglobulin in Chronic Urticaria: Underutilized Modalities Revisited!

ABSTRACT Aim and Objective: To assess and compare effectiveness of autologous serum therapy and histaglobulin in the treatment of chronic urticaria. Materials and Methods: All chronic urticaria patients attending skin Out Patient Department were recruited in the study after informed consent and consideration of the inclusion and exclusion criteria. Urticaria Activity Score (UAS) was assessed after which Autologous Serum Skin Test (ASST) was done. ASST positive patients were divided into two groups, Group A and B and were given autologous serum therapy (AST) and histaglobulin, respectively, whereas ASST negative patients were divided into Group C and Group D and were given AST and histaglobulin, respectively, once a week for 8 consecutive weeks. Levocetrizine 5 mg was administered throughout the study period on an on-demand basis. Urticaria activity score (UAS) was assessed every week. Results: AST and histaglobulin showed considerable improvement in UAS irrespective of the ASST status. In addition, patients showed a marked reduction in the daily intake of antihistamines by the end of the study. Conclusion: Immunotherapies such as autologous serum therapy and histaglobulin are extremely feasible with minimal to no side effects. Our study highlights the effectiveness of both AST and histaglobulin irrespective of ASST status, and their role in improving the quality of life by reducing the intake of daily antihistamines. Thus, in spite of being underutilized, autologous serum therapy and histaglobulin should be considered as better alternatives among the armamentarium of treatment options already available for chronic urticaria.

Autologous Whole Blood Therapy in Chronic Spontaneous Urticaria: A Comparative Study Between Autologous Serum Skin Test Positive and Negative Patients

Introduction: Chronic Spontaneous Urticaria (CSU) is frequently encountered in our day to day practice. Patients are often reluctant to take medicines for prolonged durations and seek interventions for rapid and prolonged remission. Autologous Whole Blood Therapy (AWBT) has been used with varied results in CSU and Autologous Serum Skin Test (ASST) reactivity has shown to influence the therapeutic response in some studies. Aim: To compare the efficacy of AWBT in ASST positive versus negative CSU. Materials and Methods: The present prospective, interventional, parallel group study was conducted in the Department of Dermatology, Command Hospital Air Force (tertiary care centre), Bangalore, India, from January 2014 to December 2015. Eight weekly injections of AWB (5 mL) were administered to 30 ASST positive and 30 age and sex matched ASST negative patients of CSU and followed-up for four weeks. Modified Urticaria Severity Score (MUSS) was recorded at baseline, 4th, 8th and 12th weeks to assess objective response to AWBT. Subjective response was documented as poor, satisfactory, good and excellent based on patient’s feedback at the end of 12 weeks. Independent two-sample t-test, Chi-square (χ2 ) test and cross tabulations were used to analyse the data through Statistical Package for the Social Sciences (SPSS) software version 21.0. A p-value of <0.05 was considered statistically significant. Results: A total of 102 consenting patients were subjected to ASST, out of which 38 patients were ASST positive. After excluding those who were lost to follow-up, data from 30 ASST positive patients and corresponding age and sex matched ASST negative controls were analysed. Baseline MUSS of ASST positive group was significantly higher, indicating more severe nature of CSU. With AWBT, improvement in MUSS of ASST positive group (68.49±10.32%) was significantly higher than the ASST negative group (p-value <0.001) and ASST positive group required significantly lesser doses of rescue antihistamines (p-value <0.001) at the end of 12 weeks. Subjective response to AWBT was either good or excellent in both groups. Conclusion: Although AWBT resulted in significant reduction of MUSS in ASST positive patients, it benefited patients in both groups irrespective of their ASST reactivity status. AWBT can be used as an effective adjuvant in the treatment of CSU.

Autologous serum skin test in chronic spontaneous urticaria and its correlation with biochemical markers- A descriptive study from a tertiary hospital of North India

Autoimmune urticaria (AIU) is an important subset of chronic spontaneous urticaria (CSU) and can be relatively difficult to manage. Autologous serum skin test (ASST) has served as a useful bedside test to detect AIU and its comparison with various blood biomarkers may unlock avenues in diagnosing autoimmune urticaria. Aim of our study was to assess role of ASST in CSU and its correlation with relevant biomarkers. It was a hospital-based study in which 58 patients were enrolled. ASST was done in all with routine investigations including Absolute Eosinophil Count (AEC), Thyroid stimulating hormone (TSH) and Immunoglobulin E(IgE). ASST was positive in 44.8% out of 58 patients. ASST positive patients showed longer disease duration, higher severity and more generalised disease than the negative group. AEC was relatively lower, although statistically insignificant in ASST positive patients (284.21±57.43 cells/ul) as compared to AEC in ASST negative patients (310.64±71.05 cells/ul) (p=0.131). TSH on the other hand showed comparable values in both the groups (p=0.744). Mean serum IgE showed statistically significant difference between those who were ASST positive (297.96 ±42.34 IU/ml) vs ASST negative. (323.57 ±44.16 IU/ml) (p=0.029*). ASST can serve as a useful test to diagnose patients with autoimmune urticaria which can often be more severe and prolonged as well as being refractory to conventional treatment. Lower values of AEC and IgE in ASST positive patients may complement the diagnosis of autoimmune urticaria.

Comparison of chronic idiopathic urticaria patients with positive and negative autologous serum skin test

<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>

Low frequency of CD4+CD25highFOXP3+ T regulatory cells in Egyptian patients with chronic spontaneous urticaria

Chronic urticaria is a prevalent disabling dermatological disease. About 90%, are considered idiopathic and referred to as chronic spontaneous urticaria (CSU), and nearly half of them are likely to have autoimmune mechanisms. Regulatory T cells play a substantial role to prevent autoimmune diseases. Subsets of Tregs expressing the CD4+CD25high and forkhead-box-P3 (FOXP3) transcription factor, crucial for their development and function, are best characterized in maintenance of self-tolerance. The objective of this study was the analysis of peripheral CD4+CD25highFOXP3+(T regs) frequency in chronic spontaneous urticaria; and its possible association with autologous serum skin test (ASST). Fifty chronic spontaneous urticaria patients (25 with positive ASST and 25 with negative ASST) and 20 healthy controls were enrolled in this study. The frequency of CD4+CD25highFOXP3+ (T regs) was analyzed by flow cytometry. A Significant decrease in peripheral blood CD4+CD25highFOXP3+ T regs% was detected in CSU patients in comparison to healthy individuals (median [IQR], 1.47% [0.71-3.12] vs 1.79% [1.15-4.00]; P = 0.05). When ASST positive patients were compared with ASST negative patients, no significant difference was found in percentage of T regs, (P=0.112). In conclusion our data provided further insights into CSU pathogenesis. Reduced frequency of CD4+CD25highFOXP3+(Tregs) in patients with urticaria, support the notion that CSU is an immune mediated disease and may help researchers to develop a novel immunotherapy strategy.

Association between Clinico-epidemiological Features in Chronic Urticaria with Autologous Serum Skin Test: A Cross-sectional Observational Study

Introduction: Urticaria is a frequent and heterogeneous skin disease characterised by the development of wheals (hives), angioedema, or both. Chronic urticaria is characterised by the occurrence of wheals lasting less than 24 hours, with or without angioedema occurring daily or almost daily lasting more than six weeks. The two subtypes of chronic urticaria are Chronic Spontaneous Urticaria (CSU) and Chronic Inducible Urticaria (CIU). Autologous Serum Skin Test (ASST) is the simplest and the best in-vivo clinical test for the detection of basophil histamine- releasing activity. ASST has a sensitivity of approximately 70% and a specificity of 80%. Aim: To study the association between clinico-epidemiological features of CSU with positive and negative ASST. Materials and Methods: The cross-sectional study was conducted on 80 clinically diagnosed cases of CSU attending the Department of Dermatology Venereology Leprology Outpatient Department at Mahatma Gandhi Memorial Hospital (Kakatiya Medical College), Warangal, Telangana, India; during the period of January 2016 to September 2017. The detailed history was taken; complete physical and cutaneous examination and laboratory investigations like Complete Blood Picture (CBP), Absolute Eosinophil Count (AEC), Erythrocytic Sedimentation Rate (ESR), Thyroid Function Test (TFT) were carried out. ASST was done and read after 30 minutes. Chi- square test was applied and the results analysed using Statistical Package for the Social Sciences (SPSS) version 10.0. Results: Out of total 80 patients included in the study, ASST was positive in 36 (45%) and negative in 44 (55%). ASST positive patients showed longer duration of the disease with increased frequency of attacks and longer duration of wheals. However, both ASST positive and negative groups did not show statistically significant difference in the age of occurrence, gender, angioedema, dermographism. Conclusion: Autoimmune urticaria has no distinctive clinical features. ASST positive, autoimmune urticaria patients have more severe disease with greater impact on quality of life. Thus, they may need more aggressive treatment.

A Hospital Based Study of Association of Chronic Spontaneous Urticaria with Autologous Serum Skin Test

Introduction: Chronic Spontaneous Urticaria (CSU), is spontaneous occurrence of wheals for more than 6 weeks. CSU patients with autoreactivity as indicated by positive Autologous serum skin test (ASST) have severe disease requiring higher doses of antihistamines and even immunomodulatory agents.
 Objective: The objective of this study was to observe the association between CSU and ASST.
 Materials and Methods: Over a period of one year, 104 CSU patients were enrolled in the study. Autologous serum skin test was done using 0.05 ml of patient’s serum, with 0.05 ml of histamine as positive control and normal saline as negative control. Prevalence of positive ASST in CSU patients was determined. Clinical and demographic characteristics were compared in both ASST positive and negative patients.
 Results: The ASST was positive in 68 patients (65.4%). Mean age (SD) of the patients in ASST positive group was 33.78 (14.38) versus 35.64 (14.47) in ASST negative group (p=0.533). Male:Female ratio in ASST group was 1:2.7 versus 1:1.1 in ASST negative group (p=0.033). Patients with positive ASST had significantly longer duration of wheals (p=0.002), generalized distribution (p=0.020) and high rmean urticaria activity score, 4.66 versus 3.28 in ASST negative patients, p<0.001. Angioedema was more common in ASST positive patients (p < 0.001).
 Conclusion: ASST was significantly positive in CSU patients and more common in females. ASST positive patients had more severe clinical manifestations and it can be a simple test to detect severe form of CSU.

Autologous serum skin test as an indicator of chronic urticaria in comparison with serum IgE level at a tertiary care center in North-Eastern India

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.

Autologous serum therapy in chronic urticaria

Autologous serum therapy in chronic urticaria - IJCED- Print ISSN No: - 2581-4710 Online ISSN No:- 2581-4729 Article DOI No:- 10.18231/j.ijced.2019.059, IP Indian Journal of Clinical and Experimental Dermatology-IP Indian J Clin Exp Dermatol

Diagnostic value of autologous serum skin test in chronic auto immune urticaria

<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>

Azathioprine in autologous serum skin test positive chronic urticaria: A case-control study in a tertiary care hospital of eastern India.

Context:Urticaria, also referred to as hives or wheals is a common and distinctive reaction pattern characterized by spontaneous eruption of wheals. About 30–50% of patients categorized as idiopathic urticaria have autoimmune urticaria, needing immunosuppressive agents. Immunosuppressive agents are either too costly or have serious side effects. Azathioprine seems to address both these issues, being less costly.Aims:The aim was to evaluate the role of azathioprine in autologous serum skin test (ASST) positive chronic urticaria (CU).Settings and Design:A single-blind randomized control trial of ASST positive patients of CU.Materials and Methods:Patients with positive ASST were allotted into two treatment groups, named group A and group B. Patients in group A were administered azathioprine (50 mg/day) for a period of 8 weeks and followed up till 36 weeks, while patients in group B were given placebo pills. All patients were directed to take levocetirizine (5 mg) on as and when basis, in addition. Urticaria was assessed by total severity score.Statistical Analysis Used:MedCalc statistical software (v 12.5 for Windows) to calculate P values in independent samples by t-test, Mann–Whitney test, Friedmann test, and ANOVA.Results:Administration of azathioprine in group A resulted in a significant diminution of the intensity of the disease as well as in the requirement of rescue antihistamine (positive primary and secondary outcome).Conclusion:Azathioprine not only had immunomodulatory properties during the treatment period, but also had lasting therapeutic effect as well. There were some gastrointestinal side effects in the initial stages but no incidence of hematological or biochemical disturbances.

Serum concentration of IL‐17, IL‐23 and TNF‐α among patients with chronic spontaneous urticaria: association with disease activity and autologous serum skin test

Chronic spontaneous urticaria (CSU) is a common skin disorder, which is considered in a subset of patients to be an autoimmune disorder. T helper 17 (Th17) cells are crucially involved in the pathogenesis of some autoimmune diseases. Our aim was to test the association of Th17 with CSU. We examined interleukin (IL)-17, IL-23 and tumor necrosis factor-alpha (TNF-α) serum levels in CSU patients and studied their association with urticaria activity and autologous serum skin test (ASST). Serum concentration of IL-17, IL-23 and TNF-α were measured in 75 patients with CSU and 30 healthy control subjects. Disease activity was assessed by using urticaria activity score (UAS) as recommended by EAACI/GA(2)LEN/EDF/WAO Guidelines. Serum concentration of IL-17, IL-23 and TNF-α were significantly higher in CSU patients as compared with the healthy control subjects (mean: 35.51 ± 31.14 vs. 4.60 ± 1.38 pg/mL; P < 0.001, 38.95 ± 27.82 vs. 9.87 ± 4.62 pg/mL; P > 0.001 and 17.93 ± 6.05 vs. 6.87 ± 3.73 pg/mL; P = 0.004, respectively). There were significant positive correlation between serum IL-17, IL-23, TNF-α and disease activity assessed by cumulative UAS for 7 days before blood sampling. The Serum concentration of IL-17, IL-23 and TNF-α were also significantly higher in ASST positive patients than in ASST negative patients. Our results showed high serum levels of IL-17, IL-23 and TNF-α among CSU patients which may highlight a functional role of these cytokines in the pathogenesis of this important and common skin disease. It also may provide the rationale for new treatment strategies in chronic urticaria.

Allergic diseases of the skin and drug allergies – 2024. Autoserum therapy in autologous serum skin test positive patients of chronic spontaneous urticaria

Background Chronic spontaneous urticaria (CSU) patients demonstrate functional autoantibodies against high affinity receptors of IgE (FcerI). Autologous serum skin test(ASST)is mostly used in chronic spontaneous urticaria to show its autoreactivity. ASST positive patients represent a severe group which can be benefited from autoserum therapy (AST). So, aim of our study is to evaluate the efficacy of autoserum therapy in ASST positive patients.

Prolactin and Dehydroepiandrosterone Sulfate: Are They Related to the Severity of Chronic Urticaria?

Elevated prolactin and reduced dehydroepiandrosterone sulfate (DHEA-S) levels are associated with autoimmune diseases. A limited number of studies have investigated these hormones in chronic urticaria (CU). The autologous serum skin test (ASST) reaction has also been linked to autoimmune diseases, and a positive reaction is usually associated with a more severe disease. We aimed to compare serum prolactin and DHEA-S levels between female CU patients with positive and negative ASST reactions and healthy controls. The study included 30 female CU patients with a positive ASST reaction, 30 female CU patients with a negative ASST reaction, and 30 healthy female controls. All identifiable causes of urticaria were excluded. Serum prolactin and DHEA-S levels were measured in all subjects. Prolactin was significantly higher among ASST positive patients than among ASST negative patients and controls but did not differ between ASST negative patients or controls. Higher prolactin levels were associated with increasing disease severity among ASST positive patients. DHEA-S levels did not differ between ASST positive or negative patients but were significantly lower among both patient subgroups than controls. DHEA-S levels did not differ according to the severity of disease among either of the patient subgroups. DHEA-S levels did not correlate with prolactin among any group. We demonstrate for the first time a possible role for prolactin in ASST-positive CU patients and its association with disease severity. We recommend larger prospective studies to assess changes in prolactin and DHEA-S levels after complete disease remission.

Prevalence and relevance of skin autoreactivity in chronic urticaria

Autoreactive urticaria, a subgroup of chronic spontaneous urticaria, is caused by circulating mast cell-activating serum factors. Skin autoreactivity can be identified by a wheal-and-flare reaction following the injection of autologous serum into the skin. This autologous serum skin test also functions as a screening tool for functional mast cell-activating autoantibodies against IgE or its high affinity receptor FceRI consistent with autoimmune urticaria. To confirm the presence and relevance of these autoantibodies in autologous serum skin test-positive patients, western blot/ELISA and cell activation assays are required. This review focuses on the prevalence and relevance of skin autoreactivity in chronic spontaneous urticaria. It describes diagnostic procedures and treatment options and gives an outlook on how to improve the management of autoreactive urticaria.