Chronic Idiopathic Urticaria Group Research Articles

Autologous Whole Blood Injection for the Treatment of Antihistamine-Resistant Chronic Spontaneous Urticaria.

Dear Editor: Recently, the term chronic spontaneous urticaria (CSU) is used to indicate spontaneous and persistent wheals, independent of external physical stimuli1. CSU is classified into two groups according to the presence of autoantibodies: chronic autoimmune urticaria (CAU) and chronic idiopathic urticaria (CIU)2. Several treatment methods are available for patients with CSU. However, CSU can be resistant to conventional treatment, including high-dose antihistamines (up to 4-fold dose of H1 antihistamines). Autologous whole blood (AWB) injection, a prevalent method to treat allergic rhinitis, atopic dermatitis, and viral disease, is scientifically unproven3,4. Few reports have documented the clinical improvement of CSU after injection of AWB5,6. Although its mechanism of action remains widely unknown, we believe that AWB injection may desensitize the patient against triggering factors including autoanti-bodies. The aim of this study was to evaluate the efficacy of AWB injection in treating CSU, and to compare its efficacy on CAU and CIU. The study was approved by the hospital ethics committee (E-2013096), and all patients gave their informed consent. We treated 22 patients with CSU, who had uncontrolled urticaria most days of the week despite antihistamine therapy for >6 weeks, by administering AWB injections for 8 consecutive weeks. Patients who had developed urticarial due to foods, drugs, or physical and environmental factors, female patients who were pregnant or lactating, patients with any severe systemic disease, and patients who had taken any immunosuppressive agent within 4 weeks of entry were excluded from the study. The patients were classified into two groups after autologous serum skin test (ASST): positive (CAU) and negative (CIU). After the cessation of antihistaminic treatment for at least 3 days, ASST was performed. A wheal with a diameter at least 1.5 mm greater than that of a saline-induced wheal at 30 min was considered positive. We took venous blood samples and immediately administered a gluteal intramuscular AWB injection. The volume of injection was 2.5 ml at week 0, and 5 ml/week for the subsequent injections. All patients underwent laboratory examinations before treatment, including complete blood count, liver and renal function tests, urinalysis, and D-dimer analyses. Only antihistamines were allowed during the AWB injection phase for worsening pruritus or wheals. The outcome measures were pruritus intensity; wheal number, size, and duration; and sleep and daily activity interference by using score values from 0 to 3. The sum of all six severity parameters were calculated to obtain the urticaria activity score (UAS)7 every week, and the UAS at week 0 and week 8 was compared between responders and non-responders. The consumption of antihistamines was calculated at the endpoint. A was defined as a patient with >30% improvement of UAS after repeated AWB injections5. In total, 8 of 22 patients (36.4%) with CSU were responders to AWB injection; 2 of 7 (28.6%) CAU and 6 of 15 (40.0%) CIU patients were considered responders (Table 1). There was no significant difference in responder ratios between the CAU and CIU groups. The antihistamine consumption at week 8 did not show any significant differences compared with baseline (data not shown). Between responders and non-responders, we found that CSU patients with a high baseline UAS improved markedly after repeated AWB injections (p=0.019); however, there was no difference with respect to disease duration, sex, age, ASST result, D-dimer, and C-reactive protein level (Table 2). No patients experienced serious adverse events; however, minor adverse events such as bruising and injection pain were noted. Table 1 Efficacy of AWB injection after 8 week of treatment Table 2 Comparison between responders and non-responders to autologous whole blood injection among 22 CSU patients Although desensitization with repeated AWB injections theoretically provided better efficacy in patients with CAU than in those with CIU, our results showed that there were no significant differences between groups at the endpoint. Mori and Hashimoto8 reported that an ASST-positive patient was completely cured after AWB injections; however, the patient remained ASST positive. These findings suggest that the underlying mechanism of AWB injections is attributed to other pathogenetic factors. Unlike in previous reports5,8, AWB injection did not cause a dramatic response in patients with antihistamine-resistant CSU regardless of the skin test results to autologous serum. Nevertheless, the most important finding of this study is that AWB injection might be more efficient in treating patients with CSU who had high disease activity at baseline. Therefore, AWB injections may be an option in treating patients with antihistamine-resistant CSU who have high disease activity. Further studies are required to reinforce the current results concerning AWB injection in patients with CSU, and evaluate its efficacy, duration, treatment interval, and dose.

Temperament and character profiles of patients with chronic idiopathic urticaria.

IntroductionPsychosocial factors have been implicated as being important in the onset and/or exacerbation of urticaria.AimTo examine both personality factors of patients with chronic idiopathic urticaria (CIU) and the correlations between illness duration, severity of itching, urticaria activity score (UAS) and temperament-character dimensions.Material and methodsA total number of 70 CIU patients and 60 healthy individuals were included in the study. The Temperament and Character Inventory (TCI) was administered individually. The relationship between UAS, illness duration and severity of pruritus and TCI subscales were evaluated.ResultsThe CIU group had significantly higher scores of novelty seeking and lower scores of cooperativeness, reward dependence and self-directedness than the control group.ConclusionsThe current study shows that CIU patients have distinctive temperament and character dimensions when compared with the control group. We suggest that evaluation and treatment of CIU should also include psychosomatic approaches in clinical practice.

Ürtikerli Hastalarda Tiroid Otoimmunitesinin Araştırılması

Objective: An autoimmune etiology has been suggested in up to one-third of cases of chronic idiopathic urticaria (CIU). It is known that thyroid autoimmunity may be associated with urticaria. The objective of our present study was to verify the prevalence of thyroid antibodies in the patients with urticaria. Material and Methods: Seventy nine patients aged 14–70 years, who met criteria for urticaria, and 40 agedmatched healthy controls (10 males and 30 females) were participated in this study. Serum thyroid-stimulating hormone (TSH), free T3, free T4, anti-peroxidase (TPO), and anti-thyroglobulin (anti-Tg) antibody levels were measured. Results: The total ATA positive rate was 26.7% in the CIU group. The prevalence of anti-TG, and anti-TPO were 10.7 %, 17.9 % respectively. The prevalance of anti TPO was significantly higher in patients with CIU than controls (p=0,023). The total ATA positive rate was %10 in the acute urticaria. Conclusion: We determined that the prevalance of thyroid antibodies was significantly higher in our CIU patients. It is important to evaluate the relationship between thyroid auto-immunity and thyroid function in CIU patients. Understanding this relationship will be potentially useful in evaluating the treatment benefits of either thyroidhormones or anti-thyroid drugs in resistant cases of CIU

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.

Association of genome DNA methylation with pathogenesis of chronic urticaria

Objective To explore the association of genome methylation with the pathogenesis of chronic urticaria by detecting genome methylation level of chronic idiopathic urticaria and autoimmune urticaria. Methods 45 patients with chronic urticaria were divided into chronic idiopathic urticaria group and autoimmune urticaria group using ASST method. Serum TgAb, TPOAb, ANA, SAM, and SAH were detected. Results The positive rate of ASST was 46.7% in patients with chronic urticaria, as compared with 0% in control group. There was a statistical significance between the two groups. The positive rates of TgAb, TPOAb, and ANA were 23.80%, 14.29%, and 14.29% in autoimmune urticaria group, 4.16%, 4.16%, and 0 in chronic idiopathic urticaria group, and 5%, 0%, and 0% in the control group. TgAb differed significantly between autoimmune urticaria group and the other two groups, but not between chronic idiopathic urticaria group and the control group. TPOAb and ANA did not differ statistically between the two groups. SAM, SAH, and SAM/SAH did not differ significantly. Conclusions Autoimmune urticaria accounts for 46.7% in patients with chronic urticaria. TGAb is significantly higher in autoimmune urticaria patients than in those with chronic idiopathic urticaria. Further research should be done to confirm whether TGAb can be a kind of valuable clinical detection index of autoimmune urticaria. There is no statistical significance in SAM, SAH, and SAM/SAH between the two groups, which is likely to suggest that methylation is not involved in the pathogenesis of autoimmune urticaria. But this conclusion needs to be confirmed by bigger samples. Key words: Urticaria; DNA methylation; S-adenosylmethionine; S-adenosylhomosysteine

Clinical and laboratory features of chronic idiopathic urticaria in the elderly

There are few data regarding epidemiology and clinical features of urticarial diseases in the elderly population. The aim of the study was to determine the clinical and laboratory characteristics of chronic idiopathic urticaria (CIU) in the geriatric population. Electronic medical records of outpatient allergy consultations due to a diagnosis of CIU were retrospectively reviewed to collect demographic data, urticaria activity score, results of autologous serum skin test (ASST), and laboratory workup. From 1598 patients with chronic urticaria, there were 1319 (82.5%) adult (adult CIU group) and 124 (9.4%) elderly subjects (elderly CIU group). The elderly CIU group was characterized by lower prevalence (46.7%) of women compared to the adult CIU group (69.2%; P = 0.022); fewer wheals (1.4 ± 0.5) vs. (2.3 ± 0.7; P < 0.001); lower rates of concomitant symptomatic dermographism 2 (2.2%) vs. 121 (12.6%; P = 0.003); and lower rates of angioedema, 3 (14.1%) vs. 362 (37.8%; P < 0.001). Fewer elderly patients with CIU (18.1%) than adult patients with CIU (44.7%; P = 0.019) demonstrated a positive ASST. There were no differences in laboratory data between the study groups. CIU in the elderly population is nearly equally distributed in both sexes and is characterized by fewer wheals, lower rates of concomitant symptomatic dermographism, lower rates of angioedema, and lower ASST positivity.

Effects of the polysaccharide nucleic acid fraction of bacillus Calmette-Guérin on the production of interleukin-2 and interleukin-10 in the peripheral blood lymphocytes of patients with chronic idiopathic urticaria

Urticaria is one of the most frequent dermatoses and its prevalence in the general population is estimated to be ~20%, whereas a substantial percentage of the cases may be classified as chronic idiopathic urticaria (CIU). The inflammatory response presenting with spontaneous wheals exhibits pro-inflammatory characteristics, involving a prominent role for lymphocytes with a mixed Th1/Th2 response in which interleukin (IL)-2 and IL-10 are prominently secreted by Th1 and Th2 cells, respectively. In CIU patients, it was demonstrated that IL-10 production was elevated and IL-2 reduced compared to controls. Therefore, inhibition of IL-10 and promotion of IL-2 production by the lymphocytes, indicating Th2 inhibition and Th1 promotion, may facilitate the treatment of CIU. Whether the polysaccharide nucleic acid fraction of bacillus Calmette-Guérin (BCG-PSN), which possesses multiple immunomodulatory properties, has that potential, remains to be elucidated. In this study, BCG-PSN was used on lymphocytes isolated from CIU patients, with healthy donors used as controls. Immunocytochemistry and ELISA were used to detect IL-2 and IL-10 production. It was demonstrated that the IL-2 production by the lymphocytes in the CIU group was significantly lower compared to that in the healthy control group and it increased sequentially with the increase of the concentration of BCG-PSN used. By contrast, the IL-10 production by the lymphocytes in the CIU group was significantly higher compared to that in the healthy control group and decreased sequentially with the increase of the concentration of BCG-PSN used. Thus, it may be concluded that the BCG-PSN has the potential to promote IL-2 and inhibit IL-10 production in the lymphocytes of CIU patients, facilitating the treatment of CIU.

Antihistamines do not inhibit the wheal induced by the intradermal injection of autologous serum in resistant chronic idiopathic urticaria

Some patients with chronic idiopathic urticaria (CIU) are resistant to conventional doses of antihistamines (AHs). This study was designed to check whether the skin wheal and flare reaction produced by the intradermal injection of autologous serum (AS) and by histamine differs in AH-resistant and AH responder CIU patients. CIU patients with treatment failure under fexofenadine at 180 mg q.d. increased their daily dose of AH to 4 tablets daily. Those with significant improvement of urticaria activity score under fexofenadine at 180 mg were included in the CIU group. Subjects with treatment failure despite a full 8-week fourfold fexofenadine treatment were included in the resistant CIU (R-CIU group). The control group consisted of sex- and age-matched patents with allergic rhinitis. The AS skin test and intradermal histamine-induced wheal and flare reaction were performed at baseline (without AH), after 8 and 16 weeks (under AH treatment). Forty-six subjects were included in the CIU group, 21 were in the R-CIU group, and 44 were in the control group. Under AH therapy, the skin reaction to intradermal histamine injection was significantly diminished in all study groups. In the R-CIU group, fexofenadine at 180 mg did not suppress AS-induced wheal reaction (5.96 ± 2.25 mm; p = 0.85), and with a fourfold AH dose some reduction of AS-induced wheal (3.79 ± 1.74 mm; p = 0.008) was observed but remained larger than in the CIU (2.31 ± 1.12; p = 0.006) and control groups (2.52 ± 1.36; p = 0.037). AHs do not inhibit the wheal induced by the intradermal injection of AS in R-CIU.

The Essential Role of Anti-Thyroid Antibodies in Chronic Idiopathic Urticaria

Background. An autoimmune etiology has been suggested in up to one-third of cases of chronic idiopathic urticaria (CIU), in which it has been proposed that a subset of cases are associated with thyroid autoimmunity. The objective of our present study was to verify the prevalence of thyroid antibodies in the patients with CIU. Methods. Sixty patients aged 12–51 years, who met criteria for CIU, and 40 aged-matched healthy controls (18 males and 22 females) were participated in this study. Serum anti-thyroid antibodies (ATAs), thyroid hormones, total immunoglobulin E (IgE), and food allergen-specific IgE antibodies were measured. The CIU group was treated with anti-H1 and anti-H2 histamines for 3 weeks. Results. The total ATA positive rate was 27.3% (33% males and 25% females) in the CIU group. The prevalence of anti-thyroglobulin antibodies, anti-TSH-receptor antibodies, and anti-thyroid peroxidase antibodies were 16.6%, 83.3%, and 8.3%, respectively. The thyroid hormones, T3, and T4, and the TSH were within the normal limits. The radioallergosorbent test was negative for food allergens, and only 18% of the patients had a total IgE concentration >200 IU/mL. Conclusion. ATAs were found in 27% of the patients with CIU, but these antibodies did not dysregulate thyroid hormone secretion nor did they mediate any clinical manifestations.

Auto-antibodies in Chronic Idiopathic Urticaria (CIU) and Non-urticarial Systemic Autoimmune Disorders

T U E S D A Y 841 Auto-antibodies in Chronic Idiopathic Urticaria (CIU) and Non-urticarial Systemic Autoimmune Disorders S. A. Stutes, C. B. Cho, M. Altrich, S. P. Ardoin, P. U. Ogbogu; The Ohio State University Medical Center, Columbus, OH, Viracor-IBT Laboratories, Lee’s Summit, MO. RATIONALE: 30-50% of patients with CIU have ‘‘functional’’ autoantibodies to FceRI or IgE asmeasured by basophil histamine release assay or basophil activation markers. It is unknown if patients with systemic autoimmune diseases have a similar prevalence of these auto-antibodies. METHODS: Adult patients, 26 with CIU, 27 with Rheumatoid Arthritis (RA), and 26 with Systemic Lupus Erythematosus (SLE), were recruited from an allergy clinic and a rheumatology clinic. 20 healthy controls were compared. The patients with RA and SLE did not have chronic urticaria. Atopy history and disease activity were obtained. The CU Index Panel (basophil histamine release assay), anti-IgE, and anti-thyroid antibodies were performed by Viracor-IBT laboratories. RESULTS: CU Index values were significantly higher in the CIU group (mean 15.6) as compared to the RA group (mean 2.31, p50.007), but not in the SLE group (mean 7.6, p50.079). In contrast to patients in the RA and control groups, 11% of SLE and 7.6% of CIU patients had elevated antiIgE antibody levels (>188 ng/mL). Elevated anti-thyroid peroxidase (TPO) levels did not correlate with a positive CU Index. Elevated CU Index and anti-IgE values in the RA and SLE groups were not associated with disease severity. CONCLUSIONS: The CU Index values differentiated CIU patients from RA patients, but not from SLE patients. Interestingly, SLE patients were found to have ‘‘functional’’ auto-antibodies without associated urticaria. The presence of auto-antibodies did not correlate with disease activity or having thyroid antibodies. Functional auto-antibodies may not be useful in distinguishing autoimmune chronic urticaria from non-urticarial autoimmune disorders.

MRNA profiles of cytokine receptor in unstimulated peripheral blood mononuclear cells from patients with chronic idiopathic urticaria

This present study was aimed to investigate the roles of the receptors of Th1/Th2 cytokines and chemokines in the pathogenesis of chronic idiopathic urticaria (CIU). Thirty patients with CIU, 30 patients with dermographism and 30 healthy controls were randomly enrolled. Reverse transcription-PCR (RT-PCR) was used to analyze the mRNA of cytokine receptors in peripheral blood mononuclear cells (PBMCs). The mRNA levels of tumor necrosis factor receptor ( TNFR), interferon-γ receptor ( IFN-γR), and interleukin-10 receptor ( IL-10R) were statistically increased in the CIU group ( P < 0.05), while IL-2R, IL-4R, IL-6R, and IL-13R showed no significant differences between the CIU and other groups. The mRNA levels of CCR3 and CCR6 were statistically increased in the CIU group ( P < 0.05). The toll-like receptor 2 ( TLR2) mRNA level was significantly lower in the CIU group than the healthy control group ( P < 0.05). These findings indicate that the regulation of mRNA of TNFR, IFN-γR, IL-10R, CCR3, CCR6 and TLR2 may be involved in the pathogenesis of CIU.

Serum thyroid autoantibodies in patients with idiopathic either acute or chronic urticaria

In Italy, only one study was conducted on the detection of serum thyroid autoantibodies (ATA) in patients with urticaria. This northern-Italy study reported a 23% rate of ATA positiveness in 52 patients with chronic idiopathic urticaria (CIU). During the years 1998-2006, 688 patients with urticaria were hospitalized at our Division of Allergy and Clinical Immunology. Thyroglobulin and thyroperoxidase autoantibodies (TgAb and TPOAb) were assayed at admission in 144/688 patients. Of the 144 patients (mean age: 42.3+/-15.8 yr, range 17-84), 95 (72 women and 23 men) had an history of CIU (CIU group) and 49 (44 women and 5 men) did not [acute urticaria group or (AU)]. Of the 144 patients, 37 (25.7%) tested positive for at least one ATA: 31 with CIU (32.6%) and 6 with AU (12.2%, chi2=7.037, p=0.008). Positiveness for TPOAb or TgAb was 30/37 (81.1%) or 17/37 (45.9%); 10/37 (27.0%). Pre-hospitalization duration of CIU was longer in the 31 ATA positive patients compared to the 64 ATA negative patients (207.2+/-273.4 vs 81.6+/-106.3 weeks, p=0.015). Pre-hospitalization duration of CIU correlated positively with the log10-transformed serum concentration of TPOAb in the 25 CIU patients who tested TPOAb positive (r=0.42, p=0.039). We conclude that our rate of 31/95 (32.6%) positiveness for at least one type of ATA in CIU is greater than that of 6 representative international studies published between the years 2000 and 2006 (111/488 or 22.7%, range 15-29%, chi2=4.884, p=0.027).

Chronic Idiopathic Urticaria (CIU) Sera Suppresses Basophil FcɛRI Activation

We have shown that chronic idiopathic urticaria (CIU) patients have 2 distinct blood basophil histamine release (BHR) profiles with FcɛRI receptor activation. Approximately 50% show a profile of < 10% BHR (CIU-NR), and the other 50% show > 10% BHR (CIU-R) with optimal anti IgE stimulation. In disease remission, both CIU groups show heightened BHR suggesting active disease is linked to suppressed basophil FcɛRI activation. We therefore investigated the ability of CIU serum to suppress BHR in vitro.

Avaliação da associação entre doença auto-imune de tireóide e urticária crônica idiopática

Several studies found a higher prevalence of Autoimmune Thyroid Disease (ATD) in patients with Chronic Urticaria (CU). This relationship may be due to the possible autoimmune etiology in up to one third of the cases of Chronic Idiopathic Urticaria (CIU). However, the frequency of ATD ranged from 1.14% to 28.6%. The study began by determining whether there is an association between ATD and CU, in a population seen at the same clinic. We compared the frequency of anti-thyroid antibodies and thyroid dysfunction in 49 patients with CIU (group 1) and 112 controls (group 2). In order to support the result found, we studied the prevalence of CIU in 60 patients with ATD (group 3) and compared with 29 patients who had non-immune thyroid disease (NITD) (group 4). We did not find a statistical difference for the presence of anti-thyroid antibodies or thyroid dysfunction between groups 1 and 2 (12.24% x 9.82% and 12.24% x 7.14%, respectively). The same occurred for the presence of CIU among groups 3 and 4 (3.33% x 3.44%). In our study it was not possible to demonstrate a relationship between ATD and CIU, which means that different populations may present a higher or lower degree of association between these illnesses.

Clinical and Laboratory Examinations in the Subgroups of Chronic Urticaria

Background: The aetiology of chronic urticaria is heterogeneous. Physical urticaria (PU) is estimated at around 35%, autoimmune urticaria (AIU) at 25% and chronic idiopathic urticaria (CIU) at 35% of all chronic urticaria cases. Methods: Differences in clinical and laboratory parameters among AIU, PU and CIU groups were examined. AIU was diagnosed if the basophil CD63 assay was positive. Demographic data, severity of symptoms and association with allergic and autoimmune diseases were analysed by the aid of a questionnaire. Immunoassays were carried out and the effectiveness of therapy was also investigated. Results: Concerning the urticaria score, AIU patients had significantly higher total urticaria scores than patients with CIU (p = 0.013), dermatographic urticaria (p = 0.05) or cholinergic urticaria (p = 0.038). Between CIU and dermatographic urticaria and between CIU and cholinergic urticaria patients, we found insignificant differences in the urticaria score (p = 0.707 and p = 0.336, respectively). AIU was more frequently associated with autoimmune diseases in the personal history (p < 0.001) and with other types of urticaria in the family history (p < 0.001). Also, anti-thyroid antibodies were more frequently detected in the AIU group. Antihistamine therapy was less effective in the AIU group (12.8%) than in the PU (70.3%) and CIU groups (68.6%), but there were no significant differences between the CIU and PU groups regarding the effectiveness of antihistamine therapy. Conclusion: The autoimmune subgroup represents the most severe form of chronic urticaria. On the other hand, there were no significant differences between the CIU and PU groups neither in urticaria scores nor in response to antihistamine therapy.

The Role of Helicobacter pylori in Urticaria and Atopic Dermatitis

Helicobacter pylori, a common cause of gastritis and peptic ulcer, has been associated with several extragastrointestinal diseases. Many studies have shown a positive relation between H. pylori infection and both chronic idiopathic urticaria and atopic dermatitis. The study included 20 patients diagnosed with chronic idiopathic urticaria and 20 with atopic dermatitis. A randomized sample of 20 healthy individuals was selected as a control group. H. pylori infection was assessed using the C-urea breath test, and anti-H. pylori IgG antibody titers were determined by enzyme-linked immunosorbent assay. In the chronic idiopathic urticaria group, the urea breath test titer was positive in 75% of patients, and anti-IgG antibodies were also detected in 75% of patients. In the atopic dermatitis group, titer was positive in 70% and antibodies were detected in 65% of patients, while in the control group, the urea breath test titer was positive in 55% and antibodies were seen in 20% of patients. This difference was statistically highly significant (p < 0.001) in the case of anti-H. pylori antibodies in relation to chronic idiopathic urticaria and significant (p < 0.05) in the case of atopic dermatitis. These results provide some evidence of a relationship between H. pylori infection and both chronic idiopathic urticaria and atopic dermatitis. Treatment of infection demonstrated by reduction in C-urea breath test and anti-H. pylori antibody titers resulted in partial improvement of clinical symptoms in patients with atopic dermatitis.

Assessment of platelet activity as expressed by plasma levels of platelet factor 4 and β‐thromboglobulin in patients with chronic idiopathic urticaria

Blood platelet significance in inflammation is recognized but poorly characterized in urticaria. It is known that platelets are activated during inflammatory processes and are involved in modulating inflammatory and immune response via various mediator release. The aim of our study was to investigate the functional state of platelets, expressed by release reaction of C-X-C chemokines such as platelet factor 4 (PF-4) and beta-thromboglobulin (beta-TG) in chronic idiopathic urticaria (CIU). Plasma levels of PF-4 and beta-TG, which are established markers of in vivo platelet activation and which play important role in inflammatory processes, were measured by enzyme-linked immunosorbent assay in 19 patients with CIU and in 25 healthy subjects. Mean plasma PF-4 level in CIU patients and control subjects was 5.01 +/- 1.67 and 4.13 +/- 2.05 IU/ml, respectively, whereas that for beta-TG was 29.3 +/- 14.0 and 25.2 +/- 12.6 IU/ml, respectively. In our small study, there have been no significant differences found between the members of the control and CIU group regarding plasma levels of PF-4 and beta-TG. Further studies should be performed to elucidate whether any systemic platelet activation occurs in CIU.

Allergy-Like Asthma and Rhinitis

Background: Chronic idiopathic urticaria is considered an allergy-like skin disorder, and in some cases an auto-reactivity caused by mast cell degranulating factors has been demonstrated. A positive reaction to the autologous serum skin test (ASST), reflecting the presence of factors capable to degranulate the mast cells, is regarded as a reliable in vivo diagnostic test in chronic urticaria patients. About one out of three patients complaining for rhinitis or asthma does not show sensitization to any allergenic source. No data are available on the application of ASST to respiratory patients. Methods: A cohort of respiratory patients, aged 1 to 80 years, complaining about suspected respiratory symptoms was screened using a panel of inhalant allergens by means of SPT and IgE. Current and past information on skin and respiratory symptoms were recorded for each patient. Patients were divided in ‘allergy’ and ‘allergy-like’ whether or not they react to at least one allergenic source. Age and gender distribution were analyzed. A control group fulfilling criteria for chronic idiopathic urticaria (CIU) was selected as well. The ASST was applied to the control CIU group, to the allergy-like and allergy subsets, and to a group of 58 healthy adult subjects. Results: Allergy and allergy-like patients were differently distributed in relation to age and gender. Allergy-like children were prevalent before age six, whereas the prevalence of allergics steadily increased with age representing the large majority of patients in late childhood. The ratio of allergy/allergy-like subjects continues to increase in adult males, whereas adult females represent the large majority of the adult patients mainly within the allergy-like subset. Fifty-eight percent of CIU control patients reacted to the ASST. Among allergy-like patients ASST was positive in 47% of the adults (male 26%, female 54%), and in 84% of the children (no gender differences). The percentage of reactive subjects increased in the adult allergy-like subset if a CIU was associated (65%). Eighty-six percent of the pediatric patients and 61% of the adults having an allergy respiratory disease associated with an allergy-like condition had a positive ASST reactivity. Pure allergy patients reacted in 73% and 40% of the cases in the children and adults subgroups, respectively. Forty-five percent of healthy controls reacted to the ASST as well, and statistically significant gender differences were still recorded. Conclusions: An ASST reactivity is reported for the first time in allergy-like respiratory patients. A higher prevalence of reactive subjects has been recorded in all the pediatric subsets without gender differences, whereas female reactivity is prevalent among adults. The ASST reactivity seems to parallel the patient distribution within the entire respiratory cohort. Further studies are needed to demonstrate that the serum factors causing the ASST reactivity in respiratory patients are the same as for CIU affected subjects. In the light of recent in vitro findings, the ASST reactivity of healthy subjects could lead to a new interpretation of the autologous serum reactivity.

Autoantibody production in chronic idiopathic urticaria is not associated with Helicobacter pylori infection.

Chronic idiopathic urticaria (CIU) is a dermatological syndrome, characterized by raised erythematous skin lesions, that affects 20% of the general population and has been associated with autoimmunity. However, some reports have also suggested a close relationship between CIU and Helicobacter pylori infection, which is endemic in developing countries and associated with chronic gastritis, peptic ulcer disease, and gastric carcinoma. In the present study, we investigated the occurrence of autoantibodies in sera from 23 CIU subjects infected with H. pylori and from 23 CIU subjects without this infection. The presence of anti-thyroid antibodies was determined by indirect hemagglutination assay and the presence of autoantibodies to IgE and C1INH was determined by ELISA. Antibodies to thyroid antigens were detected at low titers from 100 to 400 in three of 23 (13%) CIU-infected subjects and in four of 23 (17%) CIU-noninfected subjects. The titers of anti-IgE autoantibodies were similar in these CIU groups, presenting absorbances of 1.16 +/- 0.09 and 1.07 +/- 0.16, respectively, while a titer of 1.14 +/- 0.15 was detected in the healthy control group. The concentration of anti-C1INH autoantibodies was the same in the CIU-infected and -noninfected subjects (7.28 +/- 1.31 and 7.91 +/- 2.45 ng/ml, respectively), and was 7.20 +/- 2.25 ng/ml in the healthy control group. However, the serum levels of complexed anti-C1INH antibodies were increased in CIU-infected subjects compared to CIU-noninfected subjects and healthy controls with an absorbance of 1.51 +/- 0.21 vs 1.36 +/- 0.16 and 1.26 +/- 0.23, respectively (P<0.05), indicating an impaired clearance of immune complexes in CIU-infected patients. In conclusion, no correlation was observed between H. pylori infection and autoantibody production in CIU patients consistent with reports of clinical studies.

Dental Caries in Children with Chronic Idiopathic Urticaria in Israel

Most cases of chronic urticaria in children are idiopathic. Chronic focal infections of the sinuses or oral cavity have been mentioned as a cause of chronic urticaria because of the persistent antigenic stimulation. To investigate whether children with chronic idiopathic urticaria (CIU) have a higher prevalence and total experience of dental caries than other children in Israel, oral examination was performed to determine decay, missing, filled-teeth (DMFT) scores in 25 children with CIU (mean age, 11.76 ± 3.84 years) and 50 children with perennial allergic rhinitis (PAR) (mean age, 12.57 ± 3.29 years). The results of both groups were compared with reference data from another study on 12-year-old schoolchildren in Israel (n = 762). DMFT scores were 2.84 ± 3.18 in the CIU group, 1.56 ± 1.77 in the PAR group (p = 0.07), and 2.99 ± 2.7 in the reference group (p = 0.80). The difference between the PAR and reference groups was statistically significant (p = 0.001). Twenty-eight percent of the children with CIU were caries-free, compared with 44% of the children with PAR and 21.2% of the reference group (p = 0.18, 0.41, respectively). The difference between the PAR and the reference groups was statistically significant (p < 0.0001). In summary, children with CIU have a total caries experience similar to that of the nonselected pediatric population in Israel. Their DMFT score is slightly higher than those in children with PAR, but without statistical significance. The results of this study do not support an association between chronic urticaria and dental caries in children.