Autologous Serum Test Research Articles

Comparison of the Efficacy and Safety of Bilastine 20mg versus Fexofenadine 180mg for Treatment of Perennial Allergic Rhinitis: Randomized Controlled Study.

Antihistamines has always remained the mainstay drug treatment for Allergic Rhinitis (AR). Bilastine is a novel, non-sedative antihistamine with a super-selective H1 receptor antagonist property. Both bilastine and fexofenadine are second generation antihistamine drugs commonly used to manage AR and Chronic Urticaria (CU). Autologous Skin Serum Test (ASST) is a practical test for histamine release in CU. These tests have been studied in AR patients with limited data studies. 114 patients diagnosed with perennial AR were recruited and divided into two groups of 57 each. One group was started Bilastine 20mg once a day and other group, fexofenadine 180mg once a day. Total Nasal Symptom Score (TNSS) was calculated at presentation and two weeks of antihistamine therapy. ASST was hypothesized to be the test for AR and performed at the time of presentation and at two weeks follow-up. Intergroup and Intragroup assessment of TNSS, ASST and its variables were done using unpaired and paired t test respectively. Patients showed reduction in symptoms of AR with both antihistamines. A significant improvement of sneezing and rhinorrhoea was seen in Fexofenadine group as compared to Bilastine group. TNSS showed statistically significant improvement in both the groups. ASST had statistically significant reduction in both the groups. Both Bilastine and fexofenadine were found to be effective in reduction of symptoms of allergic rhinitis. Bilastine was found to be more effective in overall as well as sneezing and rhinorrhoea noted two weeks after therapy. The online version contains supplementary material available at 10.1007/s12070-024-04770-0.

Precision Dermatology: A Review of Molecular Biomarkers and Personalized Therapies.

The evolution of personalized medicine in dermatology signifies a transformative shift towards individualized treatments, driven by the integration of biomarkers. These molecular indicators serve beyond diagnostics, offering insights into disease staging, prognosis, and therapeutic monitoring. Specific criteria guide biomarker selection, ensuring attributes like specificity, sensitivity, cost feasibility, stability, rapid detection, and reproducibility. This literature review, based on data from PubMed, SCOPUS, and Web of Science, explores biomarkers in Hidradenitis Suppurativa (HS), Psoriasis, Atopic Dermatitis (AD), Alopecia Areata (AA), Vitiligo, and Chronic Spontaneous Urticaria (CSU). In HS, TNF-α, IL-1β, and MMPs serve as biomarkers, influencing targeted therapies like adalimumab and anakinra. Psoriasis involves biomarkers such as TNF-α, IL-23, and HLA genes, shaping treatments like IL23 and IL17 inhibitors. AD biomarkers include ECP, IL-4, IL-13, guiding therapies like dupilumab and tralokinumab. For AA, lipocalin-2, cytokines, and genetic polymorphisms inform JAK inhibitors' use. Vitiligo biomarkers range from cytokines to genetic markers like TYR, TYRP1, guiding treatments like JAK inhibitors. CSU biomarkers encompass IgE, cytokines, and autologous serum tests, influencing therapies like omalizumab and cyclosporine. Comparing conditions, common proinflammatory markers reveal limited specificity. While some biomarkers aid diagnosis and standard treatments, others hold more scientific than clinical value. Precision medicine, driven by biomarkers, has shown success in skin malignancies. Future directions involve AI-powered algorithms, nanotechnology, and multi-omics integration for personalized dermatological care.

The results of a survey of Russian doctors in order to identify the compliance of the management of children with chronic urticaria with clinical recommendations

Introduction. Primary observation of children with (CU) in Russia is performed by pediatricians, dermatologists, and algologists. It is unclear how clinical guidelines are used in a heterogeneous group of specialists.Materials and methods. Online survey of pediatricians, allergists, and dermatologists (n = 304) in the Russian Federation using a questionnaire, from 5 blocks of questions related to etiology, diagnosis, and therapy. 316 physicians with a median experience of 10 [5; 20] years were included in the questionnaire.Results. 83.3 % of respondents observed no more than 2 children with CU per month. Self-education to expand knowledge (video lectures, special literature) was indicated by 72.6 % of participants. The clinical guidelines used by physicians were documents of pediatric and allergy associations of Russia (77.3 and 55.9 %, respectively), international guides were used by 27 % of respondents.The most frequent deviations from the recommended algorithm were the prescription of biochemical blood tests (64.9 %), ultrasound examination of organs (56.9 %), consultations of specialists without indications: gastroenterologist (48.2 %), infectious disease specialist (31.8 %), rheumatologist (27.1 %). The autologous serum test in children is not used by 87.2 % of physicians for various reasons.During allergy testing, respondents recommend: the concentration of total IgE in serum (63.9 %), the number of eosinophils in the blood (61.2 %). The importance of determining specific IgE was indicated by no more than one third of the respondents. Skin tests during remission period were supported by 59.1 % of all physicians, who considered allergologic examination to be necessary. Diet: 18.6 % of respondents do not recommend a special diet for children; 27.7 % exclude from the diet foods to which sensitization is detected, the rest recommend an nonspecific elimination diet.Antihistamines of 2nd generation (AG II) are the most used in clinical practice (86.5 %). Physicians named cetirizine (25.7 %) and levocetirizine (19.7 %) as the drugs of choice up to 12 years of age. The need to double the dose of AG II in the absence of response to the standard dose was supported by 59.5 % of physicians. The other physicians preferred a change of AG II molecule in the standard dose. Experience with the use of omalizumab was reported by 20 % of specialists, with 76.3 % understanding the significance and willingness to use biologic therapy. If omalizumab is ineffective, 44.1 % of physicians consider glucocorticosteroids to be the drug of choice; 38.8 % — cyclosporine A. About one third of physicians use alternative therapies not considered in the clinical guidelines.Conclusion. A significant number of physicians do not use recommendations based on evidence-based studies in real practice. AG II are the basis of CU therapy in children in all age groups.

Omalizumab in Chronic Spontaneous Urticaria (CSU): Real-Life Experience in Dose/Interval Adjustments and Treatment Discontinuation.

Data on real-life experience with omalizumab dose/interval adjustments are still limited, as well as on omalizumab discontinuation. To evaluate efficacy and safety of omalizumab dose/interval adjustment in a Portuguese cohort of patients with chronic spontaneous urticaria (CSU) and to characterize those who discontinued omalizumab. A retrospective study of patients who started omalizumab for CSU at a Portuguese Urticaria Center of Reference and Excellence (UCARE) was conducted between 2009 and 2021. Response criteria were based on a weekly Urticaria Activity Score (UAS7) <7 points (partial: UAS7 7-15 points; nonresponders: UAS7 >15 points) and minimal important difference >10 points. A total of 138 patients were enrolled in the study; 83% of them were women, and the median age was 49 years (interquartile range: 40-58 years). On 300 mg q4 weeks, 96 (70%) patients were responders, 29 (21%) partial responders, and 13 (9%) nonresponders. After dose/interval adjustments (up to 600 mg q2 weeks), 108 (78%) were responders, 27 (20%) partial responders, and 3 (2%) nonresponders. No adverse events were reported. Updosing was more frequent in patients with angioedema, body mass index >30 kg/m2, positive basophil activation test, and autologous serum test. A total of 71 (51%) patients lengthened interval, presenting higher median pre-omalizumab D-dimer (0.2 vs 0 mcg/mL, P= .038) and C-reactive protein (0.3 vs 0.1 mg/dL, P= .030) values than those with a standard dose. In total, 37 patients (27%) stopped omalizumab, but 14 (38%) of them needed retreatment on average 11 months after discontinuation. Patients with angioedema and a longer omalizumab duration had higher chance of relapse. Omalizumab dose and/or interval adjustment is effective and safe and should be implemented in partial/nonresponders for response improvement and in responders for further discontinuation. A protocol for regimen adjustments is proposed.

ASSOCIATION OF AUTOIMMUNE STATUS WITH ASST, AUTOIMMUNE AND ATOPIC DISEASES IN CSU PATIENTS

Chronic spontaneous urticaria (CSU) is a mast cell-driven skin disease characterized by the recurrence of transient wheals, angioedema, or both for more than 6 weeks. Autoimmunity is thought to be one of the most frequent causes of CSU.CSU represents an important burden that compromises patient’s quality of life, interferes with routine daily activities. Aim of the study: The aim of this study is to make an association of autologous skin serum test (ASST), autoimmune diseases and atopic diseases with the autoimmune status in patients with HSU. Materials and methods: This study assessed 230 patients with CSU. The study is prospective, proceeding at the Department of Dermatology at City General Hospital “8mi Septemvri”, Skopje, in the period from January - November 2021. The study and the data collection were conducted with the approval of the institutional and ethical committee. Inform consent was obtained from all patients. Patients were divided in two groups according to their autoimmune status: patients with positive and patients with negative autoimmune status. Autoimmunity was defined in the case of a personal history of autoimmune disease or in the presence of at least one type of autoimmune antibodies (AAbs) (included anti- TPO, anti-nuclear antibodies (ANA) and rheumatoid factor (RF)).ASST was performed on untreated patients by the intradermal injection of 50 μL of the patient’s own serum into the volar part of the forearm. Anamnestic data on the course of the disease, accompanying autoimmune diseases and allergic diseases were taken. Results: Positive autoimmune status was confirmed in 40.28% of patients with HSU. Patients with a positive autoimmune status significantly more often than patients without an autoimmune status had a certain autoimmune disease (75.17% vs 10.59%):Hashimoto Tireoiditis39.31% vs10.59 %,Vitiligo13.79% ,Arthritis Rheumatica9.66 %,Morbus Crohn 5.52%, Hashimoto Tireoiditis + Vitiligo6.9% . Patients had a personal history of atopy (67.59% vs 55.29%), asthma (61.38% vs 44.71%), personal history for allergic rhinitis (57.24% vs 49.41%), positive ASST (86.9% vs 16.47%). To conclude, in this study, we obtained a high incidence of association of ASST, autoimmune diseases and atopic diseases with positive autoimmune status in CSU patients, thus providing additional evidence in the association of HSU with autoimmunity.

Comparison of indicators of autologous serum obtained by different methods and used for the treatment of macular hole

BACKGROUND: In recent years, autologous serum has been increasingly used in the treatment of macular hole. The study carried out a biological analysis of autologous serum obtained by various methods.&#x0D; AIM: The aim of the investigation is to compare the cellular and biochemical composition of autologous serum obtained using different methods for use in the macular hole treatment.&#x0D; MATERIALS AND METHODS: The study of the number of platelets, leukocytes and fibrinogen level in the blood serum of 24 patients obtained by centrifugation in original systems for harvesting autologous serum and laboratory test tubes was performed.&#x0D; RESULTS: The indices of P-PRP obtained in the Arthrex ACP system and in a laboratory test tube do not statistically differ in quantitative indices of fibrinogen and platelets (p 0.05), and differ in the content of leukocytes (p 0.05) in the direction of increasing the number of leukocytes in the substrate obtained in a laboratory test tube. The indicators of L-PRP obtained in the Ycellbio-Kit system and in a laboratory test tube do not statistically differ in the amount of fibrinogen (p 0.05) and differ in the content of platelets and leukocytes (p 0.05) in the direction of decreasing the concentration of leukocytes and platelets in the autologous serum obtained in a laboratory test tube.&#x0D; CONCLUSIONS: Currently, autologous serum obtained in the Arthrex ACP system is of great interest for macular hole surgery due to the minimal content of leukocytes, the closed character of the system, and the best coagulation properties of the substrate obtained. Laboratory test tubes may be considered a more affordable alternative for the production of autologous serum (P-PRP) for the treatment of macular hole. The autologous serum (L-PRP) obtained in the Ycellbio-Kit system and in a laboratory test tube is less suitable for macular hole surgery according to its composition.

Evaluation of serum levels of C-reactive protein, D-Dimer and Autologous Serum Skin Test in patients with Chronic Spontaneous Urticaria in a Brazilian tertiary center : a cross-sectional study

BackgroundThe pathophysiology of urticaria is still poorly understood. Recent studies demonstrate that the activation of coagulation is correlated with the clinical activity of Chronic Spontaneous Urticaria. Coagulation and inflammation are strongly linked. ObjectivesTo correlate the severity and activity of Chronic Spontaneous Urticaria with the levels of D-dimer, C-reactive protein, and autologous serum test in patients with Chronic Spontaneous Urticaria. MethodsThe study included 55 patients diagnosed with chronic spontaneous urticaria. D-dimer levels were measured using enzyme-linked fluorescent assay and C-reactive protein levels were measured using the nephelometric method; autologous serum testing was performed on patients who discontinued antihistamine therapy. The severity of the disease was assessed using the urticaria activity score. Resultspatients with severe, spontaneous, and difficult-to-control chronic urticaria had elevated serum levels of D-dimer, as well as a positive autologous serum test. Little correlation was demonstrated between the severity of chronic spontaneous urticaria and the levels of C-reactive protein. ConclusionThe authors concluded that patients with severe Chronic Spontaneous Urticaria showed signs of activated fibrinolysis. Most patients with high clinical scores had high D-dimer values. Patients with positive results for the autologous serum test also had more severe Chronic Spontaneous Urticaria and needed more drugs to control the disease. Finally, little correlation was found between C-reactive protein levels and disease severity. Study limitationsThe main limitation was the small sample of patients. In the present patients, it was demonstrated that serum D-dimer levels and the autologous serum test can act as predictive markers of severity and activity of Chronic Spontaneous Urticaria.

Comparative analysis of clinical and laboratory parameters of autoimmune and idiopathic chronic urticaria patients

Background: According to the cause, chronic urticaria is most frequently divided into autoimmune and idiopathic urticaria. Aim of the paper was to determine the frequency of autoimmune urticaria using autologous serum skin testing and a comparative analysis of chronic idiopathic and chronic autoimmune urticaria by disease course, severity and most common comorbidities. Methods: Analysis covered 64 adult patients of both sexes with chronic urticaria, divided into two groups according to their positivity in autologous serum skin testing (group I with positive test and group II with negative test). General haematological and biochemical parameters, antithyroid antibodies, hepatitis serum markers, Helicobacter pylori and Borrelia burgdorferi antibodies were performed for patients in both groups. First group patients were treated by autologous blood therapy (autohaemotherapy). The analytical statistical tool SPSS (Statistical Product and Service Solutions) version 20 for descriptive statistics and statistical methods was used. The significance level used was p = 0.05. Results: The frequency of positive autologous serum test in total population of patients with chronic urticaria was 43.8 %. The average duration of urticaria was 20 months in both groups. Statistically significant difference was found in weekly scores between the studied groups (p = 0.032) in favour of chronic autoimmune urticaria with a positive autologous serum test. Subjects with chronic autoimmune urticaria had a significantly higher association with autoimmune thyroid diseases. Conclusions: Direct relation was established between the use of autologous blood therapy in patients with autoimmune chronic urticaria and improvement of the clinical picture.

Refractory chronic urticaria in adults: clinical characterization and predictors of severity

BackgroundChronic urticaria (CU) is defined as recurrent urticaria lasting for more than 6 weeks.ObjectivesWe aimed to characterize the phenotypes of patients with CU refractory to standard dose anti-H1 antihistamine treatment and search for clinical predictors of poor disease control.MethodsRetrospective collection of data regarding clinical characteristics, comorbidities, treatment, and disease control of all adult refractory CU patients presenting to the Allergy and Immunology Department during 1 year.ResultsSixty-one adult patients were included, 74% females, average age 44.5 years (18 to 84 years old). Most patients (78.7%) had initiated CU less than 1 year before enrolment. Chronic spontaneous urticaria (CSU) accounted for 55.7% of the patients, CSU associated with chronic inducible urticaria (CIndU) as a comorbidity for 44.3%, and angioedema was present in 55.7%. Medically-confirmed psychiatric disorders were present in 78.7%. Complementary diagnostic tests were performed in cases with more severe presentation (UAS7 ≥ 28 and/or UCT < 12) or with longer evolution (> 1 year), corresponding to 42 tested patient. Evidence for autoimmunity (positive anti-thyroid peroxidase antibodies, anti-nuclear antibodies or autologous serum test) was found in 45.2% (n = 19/42), and high C-reactive protein was present in 14.3% (n = 6/42), half of these also had positive antinuclear antibodies. Forty-six patients (75.4%) had at least one significant exacerbation, requiring medical appointment, emergency room, hospitalization or job absenteeism. The number of exacerbations correlated with the presence of angioedema (p = 0.022), with a recent diagnosis (< 1 year), and with higher UAS7 severity (p = 0.006). Although ClndU was associated with poor symptom control (p = 0.022), it was also associated with less exacerbations requiring medical observation or hospitalization (p = 0.015). All patients were using antihistamines and 21.3% (n = 13) of them were also under treatment with omalizumab, ciclosporine or montelukast for disease control.ConclusionsAutoimmunity can affect about half of the patients with severe or long-term CU. UAS7 and angioedema are associated with disease exacerbations. UAS7 and UCT presented unequal accuracy, with UAS7 better associating with the occurrence of exacerbations and treatment doses. Patients with refractory CU frequently present psychiatric disorders. Accurate diagnostic tests, namely autoimmune parameters and inflammatory markers, should be recommended in some individual cases.

Kronik ürtiker’li çocuklarda serum otolog deri testi: hastalığın ağırlığı ile ilişkisi var mı?

INTRODUCTION: We aimed to contribute to the limited number of studies that investigated the association between autologous serum test positivity and the severity of childhood chronic spontaneous urticaria. MATERIALS and METHODS: Eighty-seven pediatric patients who underwent autologous serum test for chronic spontaneous urticaria were retrospectively investigated. Urticaria severity was assessed according to urticaria activity score. RESULTS: In 19 of our patients (21.83%), the autologous serum test was positive. When clinical and laboratory parameters of patients with positive and negative autologous serum test are evaluated; age, sex, onset of symptoms, total IgE and eosinophil (%) were not statistically significant. Patients with positive autologous serum test had significantly higher urticaria activity scores (p 0.001). CONCLUSIONS: In our study, urticaria activity score was found higher in patients with autologous serum test positive. The choice of treatment for patients with a positive autologous serum test will ensure that symptoms and the quality of life of the patients will be improved faster if they are taken into consideration that the disease may be more severe.

Omalizumab usage in chronic urticaria and atopic dermatitis: data from South-East province of Turkey.

IntroductionOmalizumab is a current treatment option for IgE-associated dermatoses, such as urticaria and atopic dermatitis.AimTo evaluate the clinical and laboratory findings of patients with chronic urticaria and atopic dermatitis who received omalizumab.Material and methodsThis study was planned as a cross-sectional and retrospective one. One hundred forty-six cases were included in the study. Omalizumab at a dose of 300 mg for patients with chronic urticaria and 600 mg for patients with atopic dermatitis, was given every 4 weeks. The response to the given treatment and remission status of patients were investigated.ResultsOf 146 patients included in the study, 70.5% (n = 103) were female and their mean age was 42.3 ±13.8 (min.–max.: 14–85). Of the patients, 136 had chronic urticaria and 10 had atopic dermatitis. 29.9% (n = 26) of patients with chronic urticaria had a complete response to omalizumab treatment, whereas 40% (n = 4) of patients with atopic dermatitis had remission.ConclusionsThe decline of complaints with different treatment schemes in different patients suggests that treatment should be designed individually and that personal biomarkers playing a role in the effectiveness of the drug are important. Patients with the high IgE and eosinophil percentages and positive autologous serum test had a better treatment response to omalizumab treatment. Meanwhile, remission was found to be more frequent in atopic dermatitis patients with omalizumab treatment compared to the patients with urticaria. It may be more appropriate to choose patients based on certain criteria to ensure cost-effectiveness in omalizumab treatment.

Advances in Chronic Urticaria

In recent years, there have been important advances in our knowledge and management of chronic urticaria, a frequently debilitating disease. This review will be an update on the significant progress made in diagnostic and therapeutic procedures, as well as the classification, pathophysiology and assessment tools available for urticaria. Some of the latest advances will be detailed, including new findings that shed light on the mechanism of chronic urticaria. Updated information on optimal management of chronic urticaria will be discussed, including evidence on newer therapy, primarily the humanized monoclonal anti-IgE antibody, omalizumab. This is now considered to be third-line therapy after licensed doses of antihistamines and unlicensed updosing of antihistamines fourfold. Further understanding of the pathogenesis of chronic urticaria may help explain the mechanisms involved in the action of treatments. This would then aid the clinician with the appropriate diagnostic tests and therapeutic options. Extensive research on the administration of omalizumab has determined optimal dosage, the interval and duration of treatment. Recent studies have significantly advanced the treatment of chronic urticaria refractory to antihistamines, and the stepwise treatment algorithm has been updated in accordance with new evidence. Biomarkers, such as the basophil histamine release assay and autologous skin serum test, have been useful to identify chronic autoimmune urticaria, a subset of chronic urticaria, and may aid selection of third-line therapy, as well as predict speed of response and prognosis.

Urticaria. Angioedema

ConceptUrticaria is a skin disease, acute or chronic, with hives that last less than 24hours and usually accompanied by angioedema. PathophysiologyHistamine, released by mast cells and basophils, is the main mediator involved in its pathophysiology. ClassificationIt is divided into subgroups according to its etiology, being the cholinergic urticaria the most frequent one. EtiopathogenesisIt has been related to food pseudoallergens, infections (Helicobacter pylori, hepatitis B and C, dental infections), parasites, Anisakis simplex and autoimmunity alterations. DiagnosisDiagnosis is clinical and occasionally a biopsy is required for the differential diagnosis, autologous serum test helps determine autoreactivity. TreatmentInitial treatment are non-sedating antihistamines, other second-line drugs such as cyclosporin and omalizumab have proven their efficacy.

Involvement of new oxidative stress markers in chronic spontaneous urticaria.

IntroductionOxidative stress is a result of an imbalance between endogenous production of free reactive oxygen species and reduced effectiveness of antioxidant defence mechanisms. Advanced glycation end products (AGEs) and advanced oxidation protein products (AOPPs) are compounds formed by transformation of macromolecules, including proteins which can serve as markers of oxidative stress and inflammation in several diseases.AimTo investigate the role of AGEs and AOPPs as new markers of oxidative stress and inflammation in patients with chronic spontaneous urticaria (CSU).Material and methodsAdvanced glycation end products and AOPP levels were determined in the sera of 85 patients with CSU and 64 healthy controls, using spectrofluorimetry and spectrophotometry, respectively.ResultsAdvanced oxidation protein products levels in patients were statistically higher than those in controls. These levels were not affected by the presence of positive autologous serum test results or autologous plasma test results. No statistically significant differences were found between AGE levels in patients and controls.ConclusionsFormation of AGEs and AOPPs may be accelerated in immunological and allergic disorders. Depending on the sites evaluated, the presence or absence of oxidative stress in chronic urticaria is controversial. To our knowledge, this is the first study showing the possible involvement of AOPPs in CSU. The different behaviour observed for these two biomarkers is very likely due to the activation of specific related biochemical pathways associated with the condition under study.

Co-Occurrence of Chronic Spontaneous Urticaria with Immunoglobulin A Deficiency and Autoimmune Diseases

Background: Immunoglobulin (Ig) A deficiency is a primary immunodeficiency in which autoimmunity is frequently observed. Thirty to fifty percent of patients with spontaneous chronic urticaria have autoantibodies that are able to cross-link FcεRI on mast cells and basophils. Methods: We investigated whether spontaneous chronic urticaria in patients with IgA deficiency meets the criteria for autoimmunity. Four patients were screened for positivity to a skin prick test and an autologous serum skin test and for the presence of other autoimmune diseases. Patient sera were tested for the ability to activate basophils and mast cells in vitro by measuring surface CD63 expression and β-hexosaminidase release, respectively. Results: The autologous serum test was positive in all patients, and patient sera were found to induce CD63 upregulation on basophils and degranulation of an LAD2 mast cell line. Moreover, all patients were affected by other autoimmune disorders. Conclusion: For the first time, these data point out chronic autoimmune urticaria in subjects with an IgA deficiency and confirm that different autoimmune disorders are common among patients with an IgA deficiency. Patients with chronic autoimmune spontaneous urticaria should be screened for IgA deficiency, especially if they are affected by other autoimmune disorders. Thus, spontaneous urticaria could mirror more complex systemic diseases, such as immune deficiency.

Urticaires inductibles et urticaires chroniques spontanées

In the recently published 2013 revision of the guidelines of urticaria, chronic urticaria (CU) gathers chronic spontaneous urticaria (CSU) and inducible urticaria (IU), and excludes pseudourticarial rashes with more than 24h-lasting rash or more than 72h-lasting angiœdema. Activity and psychosocial impact of the disease must be measured with validated scores such as Urticaria and Angioedema Activity Scores, Urticaria Control Test, CU-Q2OL, AE-QOL. Although an allergic cause is generaly absent in CU, pathomecanisms remain elusive even since the well-known role of mast cell degranulation and the presence of autoantibodies anti-FcRεI or anti-IgE. Coagulation pathways may be involved, at least as an amplifying phenomenon. Mean duration of CU is 1 to 4 years, but many patients still have symptoms after 10 years, some predictive factors being known as severity, angioedema, a positive autologous serum test, inducible urticaria. Recommended routine diagnosic tests are validated provocation tests for IU (and cryoproteins for cold urticaria), blood cell count and CRP for CSU, since a thorough history and a normal detailed physical examination should avoid unnecessary tests. Management of CU has been improved by the off-label use of increased dosages of second generation anti- H1 antihistamines, but a subsequent therapeutic intensification may be necessary in some cases. Educational program may prevent this intensification. Independent studies evaluating available molecules are needed, along with more fundamental research studies.

Usefulness of the autologous serum test for the diagnosis of chronic idiopathic urticaria.

BackgroundThe majority of chronic urticaria cases are chronic idiopathic urticaria (CIU) with no specific identifiable etiology. The role of autoantibodies in such cases remains controversial.ObjectiveThis study determined the positivity rate of autologous serum tests in CIU patients.MethodsThis study was performed on 30 patients with CIU and 30 individuals without any systemic or dermatologic disease. After the volar parts of right and left forearms were cleansed, 0.05 ml serum physiologic and 0.05 ml autologous serum were injected intradermally on the right forearm 5 cm apart from each other, resulting in the formation of small papules; meanwhile, 0.05 ml histamine alone was injected to the left forearm. The test results were evaluated after 30 minutes as positive in positive cases.ResultsThe autologous serum test produced significant and non-significant results in patients with CIU and controls, respectively. The positivity rates of the autologous serum test in the CIU and control groups were 53.3% and 26.6%, respectively. There was no relationship between autologous serum test positivity and sex in either group. In male patients with CIU, positive results ranged widely with age, while in female patients, positive results were mainly observed at younger ages with a narrow age range.ConclusionThe autologous serum test is a useful test in the diagnosis and treatment of CIU as well as the selection of immunotherapy, especially in patients refractory to classic therapy.

Urtikaria

There are specific diagnostic recommendations for approaching chronic spontaneous urticaria, physical urticaria and special forms of urticaria. They include the detection of subclinical viral and bacterial infections, particularly with Helicobacter pylori. Frequently an autoimmune urticaria is diagnosed by using the autologous serum test. Less specific findings, such as leukocytosis and elevated CRP can sometimes be helpful in suggesting subclinical infections as the cause of acute urticaria; usually no further procedures are recommended. However, in cases with a long history of intermittent attacks, particularly with severe and generalized symptoms, it is recommended to look for IgE-mediated reactions (e.g. alpha-Gal, Omega-5-Gliadin). In our hands at the Department of Dermatology and Allergy at the Hannover Medical School a standardized set of diagnostic procedures was successfully established, and is now individually completed with selected single allergens and allergen components.

Different Frequencies of Tc17/Tc1 and Th17/Th1 Cells in Chronic Spontaneous Urticaria

Background: Chronic urticaria is associated with an immune dysregulation usually mediated by T lymphocytes. Recently, Th17 and Tc17 have been implicated in autoimmune diseases; however, their role in urticaria is not clear yet. Methods: For the study we recruited 20 patients [10 of them had autoreactive chronic spontaneous urticaria (positive autologous intradermal serum test response, ASST+), and the other 10 were nonautoreactive chronic spontaneous urticaria patients (ASST–)] and 17 healthy age- and gender-matched controls (HG). The frequency and functional activity of Th17/Tc17 and Th1/Tc1 cells were evaluated by flow cytometry and type 2 cytokine mRNA by real-time PCR. Results: Our results demonstrated a significant decrease in Th17 frequency in both chronic urticaria groups compared to HG; regarding the amount of IL-17, at the single cell level, it was reduced in ASST– compared to HG. Concerning the Th1 and Th17 cells producing IFN-γ, IL-2, and TNF-α, a lower frequency was noted in chronic urticaria patients compared to HG. In contrast, a significantly increased frequency of Tc1 cells producing these cytokines was noted in ASST+ compared to HG and ASST–. Also, the frequency of Tc17 cells producing TNF-α was increased in ASST+ compared to HG; however, with respect to the amount of TNF-α, at the single cell level, we found a decrease in ASST+ compared to HG. Regarding type 2 cytokine mRNA, a higher expression was verified in ASST+ compared to HG. Conclusion: Our data suggest a probable involvement of cytotoxic T cells, mainly the Tc1 and Tc17 subsets, in chronic urticaria, particularly in the ASST+ group.

Autologous intradermal skin tests in women with Hashimoto’s thyroiditis

IntroductionIn a large proportion of patients with chronic urticaria, a coexisting autoimmune type of Hashimoto's thyroiditis is being diagnosed. An intradermal test with autologous serum has been generally considered as a screening procedure indicating the presence of triggering autoimmune inflammatory factors in the sera of patients with urticaria. These factors could be possibly involved in the pathogenesis of the disease. Now, it seems that in order to complete the screening diagnostic procedures of autoimmune component in patients with spontaneous chronic urticaria, intradermal tests with autologous plasma could be also useful.AimTo assess skin reactivity in patients suffering from the autoimmune type of Hashimoto's thyroiditis with serum and plasma intradermal tests.Material and methodsThirty-five female patients with Hashimoto's thyroiditis aged 23-78 years were recruited for our study. The control group consisted of 20 healthy volunteers with a negative history and no signs or symptoms of any thyroid as well as autoimmune diseases. Intradermal tests with autologous plasma, serum and with 0.9% NaCl (negative control) were performed.ResultsFive patients with the autoimmune type of Hashimoto's thyroiditis presented positive results of the autologous serum test (14.2%) while positive results of the autologous plasma test were obtained in 2 cases (5.7%). It seems to be important that subjects with positive results of intradermal tests have not been treated with L-thyroxine. In the case of healthy volunteers results of our diagnostic procedures were negative.ConclusionsThis study suggests that thyroid suppression by L-thyroxine can result in clinical remission of urticaria symptoms.