Etiology Of Chronic Urticaria Research Articles

Chronic urticaria in blacks: Is autoimmunity an important etiological factor?

Background: The etiology and pathophysiology of chronic urticaria is poorly understood with several implicated factors. The role of autoimmunity has been explored by several studies with such studies on chronic urticaria lacking in the black population despite the significant morbidity caused by chronic urticaria. Aim: We assessed the possible contribution of autoimmunity in the etiology of chronic urticaria using autologous serum skin testing (ASST). Materials and Methods: Sixty consecutive patients with chronic spontaneous urticaria (CSU) with age- and sex-matched controls in a ratio of 2:1 had ASST done for comparison. Student's t-test and Chi-square were used to compare means and percentages, respectively. Results: The male:female ratio of CSU was 1:2.5 with females presenting more often. The ASST was noted to be significantly positive in patients compared to controls with a positivity rate of 68.3% in the former compared to 16.7% in the latter (P = 0.0001). A higher incidence of angioedema was also documented in patients with a positive ASST in association with urticaria (23/28, P = 0.04). Conclusion: Overall, we conclude from our study that autoimmunity may be a possible cause of chronic urticaria in Nigerians which may also be extrapolated to other black population. Patients with positive ASST may have more severe disease which may be important when educating and counselling the patients about the course of the disease. This study is the first to assess the possible role of autoimmunity in a predominantly black population and will serve as a baseline for future studies.

Modern Possibilities of Chronic Urticaria Therapy in Children

Chronic urticaria in children is one of the diseases that are underestimated in their severity and impact on the quality of life. The world academic literature data gives very little information on epidemiology, etiology of chronic urticaria, and researches on application of various therapies in children with the studied disease. Second-generation antihistamines are the leading medications in the therapy of chronic urticarial; however, there are not enough studies on the use of other treatment options in children with this pathology. Resistance to standard therapy and to high doses of antihistamines is one of the problems of managing both adult patients and children. Omalizumab is the first generation of biologicals drug for treating chronic urticaria resistant to standard therapy; the pharmaceutical can be administered in children over 12 years. Further research on the drug efficacy in chronic urticaria is required including safety rate evaluation in the pediatric group of patients.

Etiology of Chronic Urticaria in Latin America, Ecuadorian experience

Etiology of Chronic Urticaria in Latin America, Ecuadorian experience

Etiology of chronic urticaria: the Ecuadorian experience

Background The purpose of this study was to identify chronic urticaria (CU) etiologies and treatment modalities in Ecuador. We propose that the sample distribution fits the expected one, and that there is an association between the etiology and its treatment.Methods We performed a retrospective study involving 112 patients diagnosed with CU using a Checklist for a complete chronic urticaria medical history. Demographic and clinical variables were collected. The etiology of CU was classified using the EAACI/GA2LEN/EDF/WAO guideline. Descriptive analyses were performed for demographical and clinical variables. Chi square tests were applied to analyze the fit of distribution and the independence of variables. P values less than 0.05 were considered significant.Results Among all the patients, 76.8% were diagnosed with chronic spontaneous urticaria (CSU), of which 22.3% had a known etiology or possible exacerbating condition. Food allergy was identified as the most common accompanying condition in patients with CSU (10.7%) (p < 0.01). On the other hand, 23.2% inducible urticarias (CIndU) were indentified; dermographism was the most common (10.7%) (p < 0.01).Regarding treatment regimens, sg-H1-antihistamines alone represented the highest proportion (44.6%). The combination of any H1-antihistamine plus other drug was a close second (42.0%) (p < 0.01). Almost 48% of CSUs of unknown etiology were treated with any antihistamine plus another drug. In patients with known etiology, sg-antihistamines alone (44.0%) was the most common management. In addition, 53.8% of CIndUs were treated with sg-antihistamines alone. Though, these associations were not statistically significant.Conclusion CSU is the most frequent subtype of CU. Modern non-sedating antihistamines in licensed doses are the drug of choice. Nevertheless, a great proportion of patients require the addition of another type of medication.

Çocukluk Çağındaki Kronik Ürtikerli Olguların Etiyolojik Açıdan Değerlendirilmesi

Objective: The etiology of chronic urticaria is usually considered idiopathic. There is limited data regarding childhood chronic urticaria in the literature. The aim of the study was to investigate the factors that can play a role in the etiology of chronic urticaria in children and the related clinical and laboratory findings. Material and Methods: We retrospectively evaluated the medical records of 80 children aged under 18 years who attended our clinic and were diagnosed with chronic urticaria. Clinical characteristics, laboratory findings and tests for atopy, infection, autoimmunity and physical urticaria were evaluated. Results: Eighty children with chronic urticaria were enrolled in the study. The mean age of the patients was 10.2±4.1 years. 41 (51.2%) of the patients were female. Of the study population, 46.3% and 53.7% were diagnosed as having chronic spontaneous urticaria and chronic physical urticaria, respectively. The most common comorbid diseases were; autoimmune disease (10%) (5 autoimmune thyroiditis, 1 juvenile rheumatoid arthritis, 1 diabetes, 1 acute rheumatic carditis), chronic gastritis or reflux (8.7%) and nonsteroidal anti-inflammatory drug allergy (5%). Of the patients, 23.7% had atopy, 16.4% had Helicobacter pylori positivity, 20.3% had thyroid autoantibody, 33.3% had antinuclear antibody (ANA) positivity, 25% had food additive related urticaria and 6.7% had positive stool examination for parasites. Autologous serum skin test (ASST) results were positive in 37.8% of the patients. The comparison of patients with positive and negative ASST showed no statistically significant differences in terms of age, gender, presence of atopy, autoimmune disease, ANA positivity, presence of antithyroid antibody and H. pylori positivity. Among the causes of physical urticaria, dermographism, cholinergic urticaria, delayed pressure urticaria, and cold and solar urticaria were found in 45%, 32.4%, 8.7%, 8% and 4.7%, respectively. Conclusion: The etiology of childhood chronic urticaria is mainly related to autoimmunity and physical urticaria. Identification of clinical features and possible causes will contribute to a better management of chronic urticaria in children.

Skin prick test positivity to house dust mites (HDM) in patients with chronic urticaria

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The urticaria lasting for more than 6 weeks is termed chronic urticaria. The etiology of chronic urticaria and angioedema remains uncertain in most of the patients. Aeroallergens can induce or exacerbates chronic urticaria. The common aeroallergens are house dust mites (HDM), pollens, moulds, etc. House dust mites can trigger immunological process through ingestion, inhalation or inoculation. These mite allergens are resistant to high temperatures, and do not lose their antigenic property even on cooking. HDMs can also cause worsening of existing atopic dermatitis. Skin test with HDMs is well known to cause irritation due to their proteolytic enzymes.The study was undertaken with the objective to study the skin prick test positivity to house dust mites in patients with chronic urticaria&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study was done on 56 consecutive patients of clinically diagnosed cases of chronic urticaria attending the OPD. The skin prick test was done according to the standard protocol.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; We had a total of 56 patients with chronic urticaria, of which males were 30 and females were 26 with a male to female ratio of 1:0.8. Of the 56 patients with chronic urticaria skin prick test to HDM was seen in 8 (14.2%) patients. &lt;em&gt;D. pteronysinnus&lt;/em&gt; 6 (10.7%) constituted the majority among the HDM positivity followed by &lt;em&gt;D. farinae&lt;/em&gt; 2(3.5%). We also found skin prick test positivity to pollens, moulds and animal dander in 5, 4 and 2 patients respectively&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; House dust mites can cause or trigger the urticarial symptoms and one should consider to do skin prick test to HDM in identifying the cause and thereby reliving the symptoms of urticaria on its avoidance&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Synergistic Actions of Histamine-Releasing Factor and Histamine Releasing Factor-Reactive IgE in Chronic Urticaria

The etiology of chronic urticaria (CU) remains elusive. Histamine-releasing factor (HRF) is reported to have a proinflammatory role in asthma and immediate hypersensitivity of the skin. The aim of this study was to examine the role of HRF in the pathogenesis of CU. Forty patients with CU were enrolled and their serum HRF concentrations were determined by ELISA. The results demonstrated that the concentrations of HRF and HRF-reactive IgE in the CU group were significantly higher than those in the control group, and there was a significant linear correlation between HRF and HRF-reactive IgE concentrations (r = 0.859, p < 0.001) in CU patients. Additionally, the HRF-reactive IgE concentration was significantly correlated with the disease activity (r = 0.693, p < 0.0001). HRF and HRF-reactive IgE alone failed to activate LAD2 cells. After being primed by the patient sera with the highest IgE concentrations and stimulated by HRF, β-hexosaminidase can be released from LAD2 cells. Our findings suggest that the synergistic actions of HRF and HRF-reactive IgE may play important roles in the pathogenesis of CU.

The Results of Autologous Skin Test in Patients with Chronic Urticaria in Hamadan, Iran

IntroductionThe etiology of chronic urticaria is unknown in many cases. In this study, we demonstrated the presence of autoimmune antibodies in patients with chronic urticaria by using of the Autologous Serum Skin Test (ASST).MethodsWe performed a cross-sectional study to detect the presence of autologous antibodies in the serum of 38 patients (25 females and 13 males) with idiopathic chronic urticaria who were referred to the Hamedan Allergy Clinic in 2014. All of the necessary tests for demonstrating chronic urticaria were performed, including complete blood count (CBC), thyroid and liver functionality tests, and the prick test but they did not confirm the cause of chronic urticaria. We conducted the Autologous Serum Skin Test on the patients and analyzed the results.ResultsIn 15 patients (39%), the ASST was positive. Of the 15 patients with positive autoimmune chronic urticaria, five patients (33%) were males, and 10 patients (67%) were females.ConclusionWe concluded that many patients with chronic urticaria have autoimmune urticaria. It is the reason for the lack of the response to treatment with common medications for urticaria. New ways of treatment must be considered for them.

Hyperlipidemia Is Associated with Chronic Urticaria: A Population-Based Study.

The etiology of chronic urticaria (CU) is diverse, with chronic infections and inflammation being reported as considerable contributing factors. Although the prevalence of metabolic syndrome was found to be significantly elevated in patients with CU, no one has specifically estimated the effects on CU following hyperlipidemia. This study aimed to examine the association between hyperlipidemia and CU using a population-based dataset in Taiwan. This study included 9798 adults with CU as cases and 9798 sex- and age-matched controls. These patients were examined for whether they had received a prior diagnosis of hyperlipidemia. We used conditional logistic regression analyses to calculate the odds ratio (OR) and its corresponding 95% confidence interval (CI) for having been previously diagnosed with hyperlipidemia between cases and controls. In total, 7066 (36.1%) patients had received a prior diagnosis of hyperlipidemia, including 4287 (43.8%) among CU cases and 2779 (28.4%) among controls. The conditional logistic regression revealed that the OR of prior hyperlipidemia for cases was 1.97 (95% CI: 1.85~2.09) compared to the controls. Furthermore, compared to patients without CU, patients with CU independently experienced a 1.65-fold (95% CI = 1.55~1.76; p<0.001) increased risk of having a prior hyperlipidemia diagnosis, after adjustments were made. We concluded that CU was associated with having received a prior diagnosis of hyperlipidemia.

Food Allergy in Korean Patients with Chronic Urticaria.

BackgroundThe etiology of chronic urticaria (CU) remains unknown in most patients. Possible causes in some cases include food, but the role of allergy to food antigens in patients with CU remains controversial.ObjectiveThe aim of this study was to evaluate the association between food allergy and CU.MethodsKorean patients with CU were assessed for a previous history of food allergy that caused symptoms of CU. Blood samples were taken from 350 patients to measure food allergen-specific IgE. Based on history and laboratory results, open oral food challenge (OFC) tests were performed.ResultsOf 350 participants, 46 (13.1%) claimed to have experienced previous food hypersensitivity. Pork (n=16) was the main food mentioned, followed by beef (n=7), shrimp (n=6), and mackerel (n=6). We found that 73 participants (20.9%) had elevated levels of food-specific IgE, with pork (n=30), wheat (n=25), and beef (n=23) being the most common. However, when the open OFC tests were conducted in 102 participants with self-reported food hypersensitivity or raised levels of food-specific IgE, only four participants showed a positive reaction to pork (n=3) or crab (n=1).ConclusionAlthough some participants claimed to have a history of CU related to food intake, when an open OFC test was conducted, few of them had positive results. We therefore conclude that food allergy is an uncommon cause of chronic CU.

A cohort study of the relationship between anger and chronic spontaneous urticaria.

Anger plays a major role in psychodermatological diseases. Researchers have reported that anger and other psychological factors play a role in the etiology of chronic urticaria. This study aimed to examine symptoms of anger, anger-related behavioral patterns, thoughts associated with anger, situations that cause anger and experiences of interpersonal anger in patients with chronic spontaneous urticaria (CSU). The authors hypothesized that patients with CSU react to more situations with anger and experience more anger symptoms as compared to alopecia areata (AA) patients and healthy controls. The cohort study population consisted of literate adult patients aged <65years that were diagnosed with CSU at the outpatient dermatology clinics of Başkent and Gazi University, Ankara, Turkey, between September 2011 and October 2012. The first control group included individuals without any physical or mental disorders and the second one included literate adult patients diagnosed with AA. The patients and controls were matched according to age, gender, and level of education. A sociodemographic data form, and the Hospital Anxiety and Depression Scale and Multi-Dimensional Anger Inventory were administered to the participants. Data were analyzed using SPSS v.17.0 for Windows. The primary outcome was to determine whether there was a relationship between anger and CSU. The CSU group consisted of 30 participants; AA group consisted of 30 participants; and the healthy group consisted of 39 participants. Anxiety and depression scores in the CSU group were significantly higher than those in the healthy control group. Symptoms of anger, situations that cause anger, and thoughts associated with anger were significantly more common in the CSU group compared to AA group and healthy group. More of the CSU patients were observed to respond with excessive anger to most situations, to have high levels of anxiety anger and passive aggressive interpersonal relationships.

The role of protozoa in the etiology of chronic urticaria

Abstract Background Urticaria is a condition characterized by short-lived swellings of the skin, mouth, and genitalia due to transient leakage of plasma from small blood vessels into the surrounding connective tissues. Although infectious agents such as bacteria and virus causing acute urticaria have been reported previously, very little research has been carried out to understand the relationship between parasitosis and urticaria. This study was designed to contribute to the understanding of the relationship between parasitosis and urticaria. Methods A total of 49 patients with chronic urticaria and 36 healthy participants were included in the study. Three stool samples were taken from each patient on different days before treating the patients with antiparasitic drugs. Fecal parasite concentrator and native Lugol's method were used for the microscopic examination of the stool samples. Stain samples were prepared by acid fast and modified trichrome stain methods. Serum immunoglobulin E (IgE) levels of both groups were measured using the nephelometric method. Results Our results revealed that protozoa were detected in 38.8% of patients and in 11.1% of healthy participants. There was a fourfold increase in the total serum IgE levels of patients detected with protozoa when compared with patients in whom protozoa were not detected. Conclusion In patients who have urticaria with undetectable etiology, stool parasite screening would be prudent and identification of parasite-specific IgE in patients with urticaria would be useful in defining the mechanisms by which the parasite causes these lesions.

Blastocystis hominis and allergic skin diseases; a single centre experience

Introduction: Blastocystis hominis in stool samples of individuals with allergic cutaneous symptoms were evaluated to study a possible link between them.Methods: The study was done from June 2010 to December 2011, in dermatology and parasitology department of central laboratory, Alnoor Specialist Hospital, Ministry of Health, Makkah, Saudi Arabia. A total of218 stool sample for patients who attended dermatology clinic and diagnosed as chronic urticaria, atopic dermatitis, or pruritus of unknown origin were included in the study. Standard laboratory tests for the detection of allergic etiology were performed for all patients. Detection of Blastocystis hominis has been made by microscopic examination of stool samples by direct examination and concentration technique.Results: Overall, 30(13.7%) stool samples were infected by Blastocystis hominis with age group (26-35) and male predominace 15(6.9%) and 18(8.2%), respectively. No other allergic cause of urticaria was discovered.Conclusion: Blastocystis hominis could be the etiology of chronic urticaria.

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.

Clinical Evaluation and Treatment of Chronic Urticaria

Chronic urticaria is a common disease characterized by recurrent pruritic wheals with surrounding erythema for > 6 weeks. It is associated with a significant health care burden and affects patient quality of life. The etiology of chronic urticaria is often difficult to elucidate; however, known etiologies include autoimmune urticaria, physical urticarias (eg, cold, cholinergic, and delayed pressure urticaria), and idiopathic urticaria. The etiology is unknown in many patients, leading to a diagnosis of chronic idiopathic urticaria. The diagnosis of chronic idiopathic urticaria can be challenging for the primary care physician because of the disease's chronic symptoms. Diagnosis requires a detailed patient history and comprehensive physical examination, with additional testing tailored to the patient's history. Effective treatments include antihistamines, leukotriene receptor antagonists in combination with antihistamines, and oral immunomodulatory drugs, including corticosteroids, cyclosporine, dapsone, hydroxychloroquine, and sulfasalazine. Newer experimental therapies include intravenous immunoglobulin and omalizumab. This article reviews the pathophysiology, diagnosis, and treatment of chronic urticaria.

Assessment of the role of aeroallergens in patients with chronic urticaria

Background The cause of chronic urticaria (CU) remains unidentified in many patients. It may include medications, food and autoimmunity. However, the possible role of inhalant allergens (aeroallergens) has not been confirmed. Objective The purpose of this study was to investigate the possible role of aeroallergens in patients with chronic idiopathic urticaria (CIU), and without allergic respiratory diseases. Patients and methods Two hundred patients with CU and no associated allergic respiratory diseases were recruited over an eight-month period from the Allergy Outpatient Clinic at Ain Shams University Hospital, Egypt. CU was diagnosed by history, physical examination and laboratory tests, which included tests for autoimmunity. Patients who had no obvious etiological factor for CU were further studied for sensitivity to common aeroallergens by skin prick test (SPT); cases that were positive for aeroallergens were further investigated by a specific IgE study. In addition, 200 healthy controls were also subjected to SPT. Results Twenty-six of 200 patients (13%) had an etiological factor for urticaria, and were excluded from the study. The remaining 174 patients (87%) were diagnosed as CIU, and underwent SPT. Skin test positivity to aeroallergens only was significantly higher among patients with CIU than among controls (17.2% as compared to 3.5%). Among patients with CIU, the most common aeroallergens were mites (13.8%), followed by pollens (5.2%), and mixed molds (4%). All these aeroallergens were significantly more prevalent among cases than among healthy controls. Multiple allergen sensitivity was also significantly more prevalent among cases than controls. Specific IgE level was elevated (superior to 0.35 kU/L) to allergens in all cases with positive SPT. Conclusion Aeroallergens should be considered as a possible etiology of CU, even if not associated with allergic respiratory diseases.

Chronic urticaria: Diagnosis and management

Chronic urticaria (CU) is a common condition faced by the practicing allergist. There is a considerable degree of variation in the evaluation of patients with CU. The intent of this article is to provide the practicing allergist with an appropriate, evidence-based strategy for diagnosis and initial management of patients with CU. A review was performed of pertinent literature of CU pertaining to its natural history, impact on quality of life, subtypes, utility of diagnostic tests, and initial treatment recommendations. The reported duration of CU varies based on the nature of the referring center; however, physical urticarias persist longer than idiopathic CU. CU has adverse effects on quality of life and is comparable with other chronic diseases. Idiopathic urticaria, autoimmune CU, and physical urticarias are the most common types of CU. A detailed history is the best diagnostic tool in determining an etiology of CU and routine laboratory tests are of little value in the evaluation of CU patients. Antihistamines, particularly first-generation antihistamines, are the preferred initial treatment for CU and higher doses may be required for adequate control. Several alternative agents exist for patients who have antihistamine-resistant CU. A detailed history is the best tool for diagnosing the etiology of CU although most patients will not have a specific etiology found. The ultimate goal should be to control urticaria to reduce its impact on the quality of life of the patient, minimize adverse effects of medications, and eliminate chronic or frequent oral corticosteroids.

Etiology of Chronic Urticaria in Latinoamerican people

Etiology of Chronic Urticaria in Latinoamerican people

High prevalence of autoimmune urticaria in children with chronic urticaria

The etiology of chronic urticaria (CU) in childhood often remains unrecognized. Recently, in adults it has been shown that approximately 40% of patients with CU have autoimmune urticaria (AU); however, no data are available in children. To determine the prevalence and possible risk factors for AU in children with CU. Ninety-three consecutive children (52 male; median age, 7.8 years) with CU were evaluated for AU by means of autologous serum skin test (ASST) in all and serum-induced basophil histamine release (HR-urticaria test) in 52. All other known causes of CU were excluded as appropriate. A cause for CU was identified in 44 children (47%), whereas 49 (53%) remained idiopathic. ASST and HR-urticaria test had positive results in 22 of 49 (45%) and in 16 of 31 (52%) children with idiopathic CU compared with 1 of 44 (2%) and 5 of 21 (24%) with CU of a known cause, respectively ( P <.00001; P=.09). Sensitivity, specificity, and positive and negative predictive values of the ASST for diagnosing AU are 78%, 85%, 74%, and 88%. The prevalence of AU in childhood is 31% (15/52; 95% CI, 24%-51%). None of the variables studied were predictive for development of AU. Our results demonstrate for the first time that children have the same ability as adults to produce functionally active autoantibodies directed against IgE or IgE receptor and that AU occurs in children in as many as 30% of cases. The addition of screening for AU dramatically decreases the rate of the idiopathic form from 52% to 20%.

Does Childhood Chronic Urticaria Indicate an Underlying Thyroid Disorder?

Dermatology| September 01 2003 Does Childhood Chronic Urticaria Indicate an Underlying Thyroid Disorder? AAP Grand Rounds (2003) 10 (3): 36–37. https://doi.org/10.1542/gr.10-3-36 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Does Childhood Chronic Urticaria Indicate an Underlying Thyroid Disorder?. AAP Grand Rounds September 2003; 10 (3): 36–37. https://doi.org/10.1542/gr.10-3-36 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: chronic urticaria, thyroid diseases Source: Levy I, Segal N, Weintrob N, et al. Chronic urticaria: association with thyroid autoimmunity. Arch Dis Child. 2003;88:517–519. Chronic urticaria has been defined as the daily occurrence of wheals for greater than 6 weeks.1 The literature regarding childhood chronic urticaria and its autoimmune basis is scant. In adult series, 14–33% of patients have been shown to have autoimmune thyroid disease.2 In this case series, Israeli investigators evaluated children referred to an allergy clinic between 1994 and 2001 for chronic urticaria lasting ≥6 weeks. Patients were included in the study if they had suffered from urticaria. Affected children were comprehensively evaluated for abnormalities in blood chemistry, complete blood count, rheumatologic profiles (antinuclear antibodies, complement levels, erythrocyte sedimentation rates), and tests for possible bacterial and viral infections; skin prick testing for food allergens; testing for cold and physical urticaria; and special autoimmune studies (free thryoxine, thyroidstimulating hormone [TSH], antithryoid peroxidase [anti-TPO] antibodies, antithyroglobulin [anti-Tg] antibodies, and for those with a positive family history of diabetes, anti-islet cell antibodies). Of the 187 children identified (age 6–18 years, male: female ratio 0.92), 8 patients demonstrated abnormal thyroid antibody profiles. Four patients had isolated anti-TPO antibodies, 2 only anti-Tg antibodies, and 2 patients had both autoantibodies. Although 2 had elevated TSH levels, all patients had normal thyroxine values. One patient had known Hashimoto’s thyroiditis with anti-TPO antibodies, but with supplemental medication had normal thyroxine and TSH levels. This patient developed chronic urticaria 3 years after the onset of the thryoiditis. The key observations from the study were: The authors recommend periodic screening of children with chronic urticaria for thyroid autoimmunity and hypothyroidism. The etiology of chronic urticaria is often elusive, with fewer than 25% of cases having identified causes.3 Childhood chronic urticaria has been associated with autoimmune disorders including celiac disease, juvenile rheumatoid arthritis, type I diabetes mellitus, and thyroid autoimmunity.4,5 As with adults, additional cases in children have recently been linked to activation of dermal mast cells by autoantibodies to the high-affinity IgE receptor (anti-FcεRI).1 Although evidence of thyroid autoimmunity was seen in 4.3% of the study population, caution regarding the authors’ conclusion should be exercised because no age-matched control group was provided for comparison. Prior studies cited by the authors report rates of thyroid autoimmunity of 0.35% to 1.6% in 3 very different populations of children who may or may not be directly comparable to their population.6–,8 A recent systematic review evaluated the utility of laboratory testing of adults with chronic urticaria and found little evidence to support routine testing unless patients have clinical evidence of comorbidity.9 Given that hypothyroidism in children with chronic urticaria is rare, it is not altogether clear that routine testing for thyroid autoantibodies is appropriate unless the patient has evidence of a goiter, other clinical manifestations of hypothyroidism, or abnormalities in TSH or thyroxine levels. You do not currently have access to this content.