Positive Autologous Serum Skin Test Research Articles

EAACI taskforce position paper: evidence for autoimmune urticaria and proposal for defining diagnostic criteria

An autoimmune subset of chronic spontaneous urticaria is increasingly being recognized internationally, based on laboratory and clinical evidence that has accrued over the last 20years. This evidence has been reviewed by a taskforce of the Dermatology section of the European Academy of Allergy and Clinical Immunology. Functional autoantibodies in chronic urticaria (CU) patient sera have been demonstrated against IgE and FcεRIα by basophil and mast cell histamine release assays and by basophil activation assays. Antibody specificity has been confirmed by immunoassay, but there is a poor correlation between functionality and immunoreactivity. Approximately 25% of CU patients have a positive basophil histamine release assay and show autoreactivity (a positive autologous serum skin test), whereas 50% are negative regarding both. Functionality of CU sera appears to be complement dependent on mast cells but not exclusively on basophils. Basophil activation by CU sera is predominantly restricted to IgG1 and IgG3 subclasses. Circumstantial evidence for CU being an autoimmune disease comes from an observed association with other autoimmune diseases, a strong association between serum functionality and HLA-DR4 haplotype and the good response of CU patients to immunotherapies. It was proposed that a study should be undertaken to prospectively validate potentially relevant clinical criteria (from the history, examination and routinely available clinical investigations) against a new 'gold standard' for the diagnosis of ACU (positive autoreactivity, functional bioassay and immunoassay) to define preliminary criteria sets for the diagnosis of ACU based on clinical and laboratory features with highest individual sensitivity and specificity.

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.

Efficacy of atorvastatin and antihistamines in comparison with antihistamines plus placebo in the treatment of chronic idiopathic urticaria: a controlled clinical trial.

Chronic idiopathic urticaria is defined as recurrent hives occurring for at least 6 weeks. In the majority of cases, there is no identifiable underlying etiology despite extensive evaluation. A subset of these patients is classified as having autoimmune urticaria defined by the presence of a functional IgG antibody to the α subunit of the high-affinity IgE receptor (FceRIa) or to IgE. The aim of this study was to evaluate the effects of the drug atorvastatin in patients with chronic urticaria compared to the placebo.In this single-blind study, 50 patients suffering from chronic urticaria (15-45 years old) were selected and divided into two groups by simple randomization method. The first group was treated with atorvastatin and antihistamines and the second group (control group) was treated with placebo and antihistamines for 3 months. Urticaria severity was measured by score index, before and after the treatment course: ASST (autologous serum skin test) was performed for all patients and sera were collected to measure cytokines. In cases, IL-5 decreased and IL-10 increased after treatment compared to the time point before treatment (p<0.05). All patients with severe utricaria according our scoring, had positive ASST.The patients with severe urticaria identified by urticaria score and ASST positivity had chronic idiopathic urticaria. By prescribing the atorvastatin plus antihistamines in severe and resistant forms of urticaria, the use of more toxic medications like cytotoxic drugs may be avoided.

HLA among Brazilian patients with spontaneous chronic urticaria and positive autologous serum skin test

An association between class I and II alleles of the major histocompatibility complex and idiopathic chronic urticaria has previously been observed in different populations, but there are still no studies on Brazilian populations in this regard. The involvement of the major histocompatibility complex classes I and II (loci A, B and DR) in Brazilian patients with idiopathic chronic urticaria and a positive autologous serum skin test was investigated and compared with a healthy population group. DNA was extracted from the blood of 42 patients with idiopathic chronic urticaria and major histocompatibility complex classes I and II alleles were determined using the polymerase chain reaction and a laboratory test for oligonucleotide hybridization using a single-filament probe. The frequencies of these alleles in patients with chronic urticaria were compared with the frequencies in 1000 genetically unrelated voluntary blood donors from the same region of Brazil. The diagnosis of idiopathic chronic urticaria was based on the patients' clinical history and routine laboratory tests. Only the patients with positive autologous serum skin test were selected. The allele distribution resulted from the patient and control groups were analyzed using odds ratios and 95% confidence intervals. No statistically significant differences were found between the positive autologous serum skin test patients with chronic urticaria and the control group. We found that in this population group, there was no specific association between the HLA alleles studied and chronic urticaria. We believe that further population studies are needed in order to investigate the possible existence of this association.

Autologous whole blood injections to patients with chronic spontaneous urticaria and positive autologous serum skin test: an efficacy evaluation

[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

Skin autoreactivity in Hashimoto's thyroiditis patients without urticaria: Autologous serum skin test positivity correlation with thyroid antibodies, sonographical volume and grading

Recent studies have shown an association between anti-thyroid antibodies and autologous serum skin test (ASST) positive urticaria patients. However, a connection between thyroid and this reliable skin test for mast cell autoreactivity, ASST, has not been reported yet. We investigated ASST in patients with Hashimoto's thyroiditis (HT) without urticaria and compared the results with laboratory and sonographical findings of HT. 154 HT patients, 100 healthy volunteers without HT as a first control group and 46 patients with multinodular goitre but without autoimmune thyroid disease as a second control group underwent testing with ASST. ASST was applied to these groups according to two criteria, first as ASST(new): autologous serum red wheal response 1.5mm bigger than negative control; second as ASST(old): serum red wheal response 5mm bigger than negative control accepted as positive. Free triiodothyronine (fT3), free thyroxine (fT4), thyroid-stimulating hormone (TSH), thyroid peroxidase antibody (anti-TPO) and thyroglobulin antibody (anti-Tg) levels were measured. ASST(old), ASST(new) scored positive in 51.3-60.4% of HT patients, with statistically significant differences. Thyroid volume grades were inversely proportional with ASST(old) and (new) positivity. Moderate (+) titers of anti-Tg in ASST(old) and (new) (+) cases were significantly higher than the same titers of anti-Tg in ASST(old) and (new) (-) cases. The prevalence of ASST positivity in HT patients was not affected by the following factors: gender, age at screening, laboratory measurements of thyroid function tests, anti-TPO antibodies and thyroid ultrasound (US) echogenicity. Positivity of ASST in HT has shown that there is a skin mast cell autoreactivity in HT patients independent of autoreactive chronic urticaria (ACU).

Elevated serum B-cell activating factor in patients with chronic urticaria

The B and T cells abnormalities that have been described among CU patients, lend support to its regard as an autoimmune disease. In this study we compared serum B-cell activation factor (BAFF) levels in 46 CU patients to 24 healthy controls and evaluated a possible association between elevated serum BAFF in CU patients and the presence of autologous serum skin test, anti-thyroid antibodies, antinuclear antibodies, high total IGE levels, and urticaria disease severity. We found that serum BAFF levels is elevated statistically significant in CU patients compared to healthy control (1228±342 pg/ml vs. 758±313 pg/ml, P<0.0001). CU patients with severe disease activity had significantly higher serum BAFF levels compared to patients with mild CU (1394.6±299.6 vs. 1097.6±221.3, P=0.0008). No association was found between the presence of positive autologous serum skin test, anti-thyroid antibodies or antinuclear antibodies or high levels of total IgE and serum BAFF levels in CU Patients. We conclude that CU patients have higher levels of serum BAFF which associate with disease severity.

Relationship between HLA-DRB1 alleles and chronic urticaria with positive autologous serum skin test

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

576 Hla and Chronic Urticaria with Positive Autologous Serum Skin Test among Brazilians

BackgroundMany autoimmune diseases are associated with certain alleles of the human leukocyte antigen (HLA) system, and recent studies have shown that, in many cases, chronic urticaria has autoimmune etiology. An association between class I and II alleles of the major histocompatibility complex (MHC) and idiopathic chronic urticaria (ICU) has previously been observed in different populations, but there are still no studies on Brazilian populations in this respect. The involvement of MHC classes I and II (loci A, B and DR) in Brazilian patients with ICU and a positive autologous serum skin test (ASST) was investigated and compared with a healthy population group.MethodsDNA was extracted from the blood of 42 patients with ICU (28 women; mean age ± SD: 44 ± 12 years; range: 19 to 88 years) and MHC classes I and II alleles were determined using the polymerase chain reaction (PCR) and a laboratory test for oligonucleotide hybridization using a single-filament probe. The frequencies of these alleles in patients with chronic urticaria were compared with the frequencies in 1000 genetically unrelated voluntary blood donors from the same region of Brazil. The diagnosis of idiopathic chronic urticaria was based on the patients’ clinical histories and routine laboratory tests. Only the patients with positive ASSTs were selected. The allele distribution results from the patient and control groups were analyzed using odds ratios and 95% confidence intervals.ResultsNo statistically significant differences were found between the ASST-positive patients with chronic urticaria and the control group, in relation to the MHC classes I and II alleles studied.ConclusionsWe found that in this population group, there was no specific association between the HLA alleles studied (HLA-A, HLA-B and DRB1) and ASST-positive chronic urticaria. We believe that further population studies are needed in order to investigate the possible existence of this association.

CD63 e CD123 expressão, autoanticorpos IgG e acurácia do teste do soro autólogo em pacientes com urticária crônica

INTRODUÇÃO: Na urticária crônica (UC), o teste cutâneo do soro autólogo (TCSA) pode sugerir a etiologia autoimune. Recentemente, uma nova técnica laboratorial denominada teste de ativação de basófilos (TAB) vem sendo utilizada para esse diagnóstico. OBJETIVOS: Analisar o TCSA em relação ao TAB, assim como avaliar os receptores da interleucina 3 (IL3) (CD123) e a presença de autoanticorpos da classe de imunoglobulina G (IgG) inespecíficos ligados aos basófilos de pacientes com UC. MÉTODOS: Estudamos 33 adultos com UC espontânea com idade média de 42,5 + 14 anos. Por meio da citometria de fluxo foi feita a análise da expressão das moléculas CD63 em basófilos de um doador atópico após o estímulo pelo soro dos pacientes com UC. Também realizamos a pesquisa da expressão da molécula CD123 e de autoanticorpos IgG inespecíficos. RESULTADOS: O odds ratio (OR) entre o TCSA e o TAB foi de 1 (intervalo de confiança [IC] 95%: 0,22-4,5). O TCSA para o diagnóstico da UC autoimune mostrou acurácia de 54,5%, sensibilidade de 66%, especificidade de 33%, valor preditivo positivo de 63% e valor preditivo negativo de 36%. Não houve diferença estatística entre os grupos estudados quanto à média de expressão dos anticorpos IgG inespecíficos e das moléculas CD123 (para um p < 0,05). DISCUSSÃO: Este estudo demonstrou baixa precisão do TCSA no diagnóstico da UC autoimune; o grupo de pacientes com TCSA positivo não mostrou diferença estatística em relação ao grupo com TCSA negativo nos demais aspectos analisados. CONCLUSÃO: Pelos poucos estudos existentes e pela relevância do assunto, acreditamos na necessidade de mais estudos abordando esses aspectos.

Aeroallergen Prick Skin Test and Autologous Serum Skin Test Results in Patients with Chronic Urticaria and Their Comparison

Dear Editor: The etiology of chronic urticaria (CU) cannot be identified in more than 75% of patients, even after an exhaustive search. The autologous serum skin test (ASST) based on the intradermal injection of autologous serum is a simple screening diagnostic procedure used in CU. Studies have shown that ASST is positive in almost half of patients with CIU1. Aeroallergen prick skin test (ASPT) can provide useful confirmatory evidence for immediate type I hypersensitivity2. The purpose of our study was to assess the prevalence of positivity of ASST and ASPT, and their relevance in patients with CU. Fifty CU patients (female/male: 35/15, mean age: 33.32±9.42 years) and 50 controls (female/male: 20/30, mean age: 36.84±13.13 years), who were classified according to age and gender, were included in the study. In all of the patients, physical urticaria, food and drug allergies, as well as urticarial vasculitis, were ruled out after taking a detailed history and performing relevant laboratory investigations. Clinical and laboratory details of all of the patients were recorded, using a standard format. The ASST and the ASPT were performed intradermally. The aeroallergen, used for ASPT, were Dermatophagoides farinae, D. pteronyssinus, betulecea (alder, birch, hazel, hornbeam), salicacea (poplar, willow), mixture of 4 cereals (barley, maize, oat, wheat), mixture of 5 grasses (cocksfoot, rye-grass timothy meadow grass, sweet vernal-grass), mixture of 12 grasses (cocksfoot, rye-grass timothy meadow grass, sweet vernal grass, oat grass, wild oat, meadow fescue, bent grass, yorkshire fog bermuda grass, bromus), compositae (golden rod, dandelion, cocklebur, ox-eye daisy), feathers mixture (duck, goose, hen), and cat. Data were analyzed by using SPSS 11.5 software (SPSS Inc., Chicago, IL, USA). Ki kare test was used for the statistical analytical approach, and t test was used for other variables. There was a significant difference between patients (27 patients, range: 34%) and controls (5 controls, range: 10%), according to ASST positivity (p 0.5). The most prevalent aeroallergens in the patients were D. farinae (16% of patients). Sixteen percent of the patients reacted to a mixture of 4 cereals, 12% reacted to a mixture of 5 grasses and 12% reacted to a mixture of 12 grasses. The difference, according to the controls, was not meaningful (p>0.05). ASST has been suggested as a screening test for CIU. In our study, based on the disease duration, there was no significant difference between the ASST positive and negative groups, similarly, the studies of Kultanan et al.2 and Nettis et al.3 Grattan et al.4 reported a 35% positive ASST result in patients with CU. Coban et al.5 found a positive ASST in 25 of 40 patients (62.5%) with CC. Our findings are similar to those reported in those studies. CIU can be provoked by a number of known and unknown factors and allergens. Some of these allergens can be identified by prick tests. In our study, the most positive reactions were seen with house dust mites. Caliskaner et al.6 prick tested 259 patients with CU with common aeroallergens. Seventy-one of the patients had positive reactions to one or more allergens. The most common allergens were house dust mites, followed by pollens, cockroaches and moulds. Tezcan et al.7 prick tested 5,055 patients, 556 of whom had CU. According to this study, 42% of patients reacted to house dust mites, 54% reacted to grass pollen and 45% reacted to cereal pollen. In our study, ASPT positivity was not high because the living area is not mouldy. In addition, both the number and species of plants and pollens are scarce. In our setting, ASST is the only available test for the diagnosis of autoimmune urticaria. It is a simple and inexpensive, semi-invasive and easy-to-perform test, which can be undertaken by a dermatologist to determine whether the patient's CIU is autoimmune in origin. As conventional approaches to management may be unsuccessful, ASST is especially important from the therapeutic point of view, as it can help the dermatologist to determine whether to initiate immunosuppressive therapy in CIU patients. When investigating the etiology of patients with CIU, the ASPT should be made with anamnesis.

Individual IL-3 priming is crucial for consistent in vitro activation of donor basophils in patients with chronic urticaria

The invivo autologous serum skin test (ASST) is the diagnostic gold standard to detect autoantibodies against FcεRI or IgE itself, as well as other autoreactive serum components, in patients with chronic spontaneous urticaria (CU). Coincubation of patient sera with donor basophils and measuring their degranulation invitro could be a safe alternative but has shown inconsistent results. Optimization of the basophil activation test to detect autoreactive serum components in patients with CU. The ability of patient sera to induce CD63 and CD203c in donor basophils (n= 15) was measured by means of flow cytometry. Sera of 20 patients with CU (10 with positive ASST results), 15 patients with cold urticaria, and 27 healthy control subjects were included to optimize test conditions with donor basophils and a basophil cell line (RBL703/21) followed by testing of 110 consecutive patients from clinical routine. We demonstrate that individual IL-3 priming normalized the initially inconsistent basophil reactivity and led to reproducible and comparable test results irrespective of the basophil donors used. CD203c as an activation marker and the use of a basophil cell line were less suitable for this purpose. The basophil activation test with individualized IL-3 priming for each basophil donor is a reproducible and reliable alternative to the ASST. There are several advantages over the ASST: no risk of accidental infection, no influence of antihistamines on the test result, quantifiable results, and a potential in providing treatment monitoring. The exact nature of the degranulating factor or factors in patient sera remains an open question.

Chronic Urticaria: Etiology and Natural Course in Children

Background: Chronic spontaneous urticaria (CSU) in childhood is infrequent, and information about the disease in children is limited. We attempted to investigate its etiologic factors, natural course, and predictors of prognosis. Methods: All children aged ≤18 years followed for CSU during an 8-year period were analyzed retrospectively, and the final outcomes were queried via a telephone interview. Results: One hundred patients (male/female ratio 1.27) with a median age of 9.2 years (range 0.7–17.2) at symptoms onset were evaluated. The median follow-up was 2.5 years (range 0.2–18.1). An autologous serum skin test was positive in 46.7% of the subjects (n = 45), with a female predominance (71.4%) (p = 0.023). In 13.8% of the children, ANA titers were over 1/100. Food allergy (n = 1), thyroid autoantibodies (n = 3), possible collagen disease (n = 1), and drug usage (deferoxamine) (n = 1) were found to be associated factors. Infections could not be confirmed as the cause of CSU. Recovery was seen in 16.5, 38.8, and 50.0% of the children after 12, 36, and 60 months, respectively. Though in multivariate analysis none of the factors, including age, gender, autologous serum skin test positivity, the presence of angioedema, or other allergic diseases, appeared to predict the prognosis, in univariate analysis being female and being older than 10 years of age predicted an unfavorable prognosis. Conclusion: The etiology of CSU in children is mainly related to an autoreactive background, as in adults. CSU has a favorable prognosis, and resolution is seen in half of the children within 5 years. Girls older than 10 years may have an unfavorable prognosis.

Autologous serum skin test response in chronic spontaneous urticaria and respiratory diseases and its relationship with serum interleukin-18 level

Autologous serum skin test (ASST) is mostly used in chronic spontaneous urticaria (CSU) to show autoreactivity. Interleukin-18 (IL-18) has also been shown to be involved in autoimmune conditions. To investigate the role of autoreactivity assessed by ASST in CSU and respiratory diseases and to investigate whether this autoreactive state is related to IL-18 level or other clinical covariates. Fifty-five patients with CSU (mean age: 40.3±12.3years), 70 patients with persistent asthma (mean age: 43.7±9.6years), 21 patients with seasonal allergic rhinitis (SAR) (mean age: 35.5±11.8years) and 20 normal controls (mean age: 37.7±9.8) were included. All subjects underwent a laboratory examination and skin prick test. ASST was performed and serum IL-18 levels were measured in all subjects. Positive response to ASST and serum IL-18 levels were higher in CSU patients than those with respiratory diseases (asthma and SAR) (P=0.034 and 0.002, respectively) and normal controls (P=0.004 and 0.031, respectively). Considering all patients, IL-18 levels were higher in patients with positive ASST (301.8±194.4 vs. 241.8±206.3pg/ml, P=0.036) than ASST negative patients. ASST response was associated with disease severity in CSU (P=0.037) and asthma patients (P=0.001). Multivariate analysis showed that positive response to ASST was significantly associated with diagnosis of CSU (OR: 3.13, 95% CI: 1.25-7.87) and female gender (OR: 3.98, 95% CI: 1.19-13.38). ASST response could be related with activity of the disease. A positive ASST response found in respiratory diseases patients suggests that it may occur as a result of some inflammatory events during the diseases' process.

Chronic Idiopathic Urticaria in Taiwan: A Clinical Study of Demographics, Aggravating Factors, Laboratory Findings, Serum Autoreactivity and Treatment Response

Chronic idiopathic urticaria (CIU) is not uncommon, yet there is little information about the clinical features of CIU patients in Taiwan. The purpose of this study was to investigate the clinical features of CIU in Taiwan. Patients with CIU were collected consecutively from the Urticaria Special Clinic in a medical center in northern Taiwan from December 2005 to May 2006. Clinical features and laboratory findings were studied. We also evaluated the therapeutic response of CIU patients with second-generation H1 receptor antagonist monotherapy for 6 weeks. A total of 62 CIU patients were investigated. The female to male ratio was 2.1:1 with a mean age of 31.8 years. The mean duration of the disease was 25.7 months (1.5-180 months). The most common aggravating factor was weather (79.7%), especially hot weather (50.8%). Fifty percent of the patients had atopy, and 37.3% of patients had positive autologous serum skin test. Besides, 61.3% of patients had at least one serum specific IgE antibody to the 18 common allergens examined. Finally, 60.7% of patients responded well to second-generation H1 receptor antagonist. Non-responders tended to have atopy (p = 0.0471), especially allergic rhinitis (p = 0.0107). This study provided an overview of CIU patients in a medical center in northern Taiwan. We found that atopy did not influence the severity or durtation of CIU. Nevertheless, atopy was associated with a poor therapeutic response of second-generation antihistamine. A survey of personal atopy history, especially allergic rhinitis, is important for management of CIU patients in Taiwan.

Correlation Between Clinical Findings and Results of Autologous Serum Skin Test in Patients with Chronic Idiopathic Urticaria

To investigate the correlation between the clinical characteristics of chronic idiopathic urticaria (CIU) and the results of autologous serum skin test (ASST). This prospective observational study was performed in the Motahari Allergy Clinic and included 69 patients referred to the clinic with a diagnosis of CIU. ASSTs were performed on all patients. We compared the disease characteristics, including duration severity, number of urticaria, and size of urticaria between those with positive and negative results of ASST. Of 69 patients with CIU, 39 (56.5%) were female and 30 (43.5%) were male with a mean age of 32.5±12.3 (range 6-62) years. Patients with a positive ASST had a significantly higher number of wheals (P=0.043) with larger sizes (P=0.031). They also had higher frequencies of wheals (63.8% vs. 46.4% daily; P=0.039) and higher disease activity scores (1.57±0.9 vs. 2.01±1.6; P=0.044). The disease activity score was positively correlated with the size of the wheals, duration of the wheals, duration of the disease, and total number of wheals. Patients with positive ASST results had significantly higher frequencies of arthritis (P=0.027). Positive ASST results are associated with more severe disease determined by the larger wheals' size, longer duration of the disease, and higher frequencies of the disease. As ASST reveals the autoimmune basis of the CIU, it can be concluded that CIU patients with autoimmune basis will suffer from more severe disease.

Treatment of Autoimmune Urticaria with Low-dose Cyclosporin A: A One-year Follow-up

Patients with autoimmune urticaria (AIU) and positive autologous serum skin test (ASST) represent a more serious type of chronic urticaria that does not respond to treatment with antihistamines, but responds completely to systemic corticosteroids. Because of the chronic course of the disease, there is a risk of side-effects. Cyclosporin A (CsA) is an alternative treatment for patients with AIU. In order to determine the efficacy of CsA at the lowest possible dose in patients with chronic idiopathic urticaria and positive ASST, 30 patients were included in a 5-month study with a follow-up one year after the end of treatment. All patients had positive ASST before treatment and autoantibodies were present in 73%. Twenty- three patients completed the study and responded to low-dose CsA treatment. Three patients did not respond to a dose of 2.5 mg/kg CsA, and 4 patients dropped-out due to side-effects. After the first month of treatment, an improvement of 31% was noted, reaching 88% after the fifth month of treatment. The mean dose of CsA was 2.16 mg/kg for the first month and 0.55 mg/kg for the fifth month. Three to 6 months after the end of the study, the ASST was repeated and was negative in 78.3% of patients. At the one-year follow-up, 20 patients were symptom-free (87%) and 3 had relapsed (13%). CsA, even in low-doses, can be an effective and short-term treat- ment with minimum side-effects in patients with AIU.

Unmet clinical needs in chronic spontaneous urticaria. A GA2LEN task force report1

Chronic spontaneous urticaria, formerly also known as chronic idiopathic urticaria and chronic urticaria (CU), is more common than previously thought. At any time, 0.5-1% of the population suffers from the disease (point prevalence). Although all age groups can be affected, the peak incidence is seen between 20 and 40 years of age. The duration of the disease is generally 1-5 years but is likely to be longer in more severe cases, cases with concurrent angioedema, in combination with physical urticaria or with a positive autologous serum skin test (autoreactivity). Chronic spontaneous urticaria has major detrimental effects on quality of life, with sleep deprivation and psychiatric comorbidity being frequent. It also has a large impact on society in terms of direct and indirect health care costs as well as reduced performance at work and in private life. In the majority of patients, an underlying cause cannot be identified making a causal and/or curative treatment difficult. Nonsedating H₁-antihistamines are the mainstay of symptomatic therapy, but treatment with licensed doses relieves symptoms effectively in < 50% of patients. Although guideline-recommended updosing up to fourfold increases symptom control in many patients, a substantial number of patients have only little benefit from H₁ -antihistamines. Consequently, there is a great need for new therapeutic strategies.

Urticaire et auto-immunité

An autoimmune aetiology of chronic urticaria has been suggested by the presence of auto-antibodies to Fc epsilon RI or to IgE itself capable of activating mast and basophil cell degranulation and/or positive autologous serum skin test in 30–60 % of patients. There are still several unsolved problems relating to the role of such antibodies in the disease. Moreover, chronic urticaria is associated with autoimmune conditions, especially thyroid autoimmunity. The prevalence of anti-thyroid antibodies has been estimated as 12 to 30 %. However, most studies have suggested that these autoantibodies are not a direct causative agent in chronic urticaria.

Increased Mean Platelet Volume and C-Reactive Protein Levels in Patients With Chronic Urticaria With a Positive Autologous Serum Skin Test

IntroductionActivation of the coagulation cascade resulting in thrombin production is a prominent feature of exacerbations in chronic spontaneous urticaria (CU). Autologous serum skin test (ASST) causes wheal-and-flare reactions in 30% to 50% of CU cases. ObjectiveThe aim of this study was to evaluate the clinical and laboratory data in patients with CU with positive and negative ASST. To understand the role of platelets in CU, we investigated the relation between CU clinical severity, platelet count and their mean platelet volume (MPV). MethodsClinical and laboratory data were prospectively collected from 373 patients with CU who attended our Allergy and Clinical immunology Clinic during the period 2003 to 2007. The laboratory data were compared with 46 healthy subjects. ResultsThere were no significant differences in platelet counts between the groups, nevertheless the platelets in ASST-positive CU patients were characterized by a higher MPV (9.12 ± 1.25 fl), than that in ASST-negative patients (7.95 ± 1.08 fl; P=0.039) and control group (7.72 ± 1.04 fl; P=0.007). There was a significant positive correlation between CU severity score and MPV in ASST-positive patients (r=0.44; P < 0.001) but not in ASST-negative patients. Higher levels of C-reactive protein (5.31 ± 2.74mg/L) were measured in the ASST-positive CU group compared with the ASST-negative CU group (2.53 ± 1.27; P=0.029) and the control group (2.34 ± 1.38; P=0.003). ConclusionCU with positive ASST is characterized with higher clinical severity, increased MPV and C-reactive protein.