Negative Autologous Serum Skin Test Research Articles

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

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

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

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

Quality of Life Based on Autologous Serum Skin Test Result in Chronic Spontaneous Urticaria Patients

Several studies regarding the quality of life of chronic spontaneous urticaria patients based on Autologous Serum Skin Test (ASST) results have shown a variety of results. This study aims to determine the correlation between the quality of life and ASST results in chronic spontaneous urticaria patients at Dermatology and Venereology (DV) Outpatient Clinic of Dr. Mohammad Hoesin Hospital Palembang. This analytic observational study with a cross-sectional design used secondary data in the form of medical records. 76 samples met the inclusion criteria from 110 samples of chronic spontaneous urticaria patients at DV outpatient clinic. The distribution of chronic spontaneous urticaria patients was highest in the 17-25 year age group (23.7%) and the female group (64.5%). The majority of chronic spontaneous urticaria patients had negative ASST results (52.6%). The effect of chronic spontaneous urticaria on the decline in quality of life was mostly moderate (35.5%). The bivariate analysis between DLQI score and ASST results with a value of p = 0.307 or p> 0.05 showed no significant correlation between the quality of life and ASST results.

Interleukin-23/ Interleukin -17 Axis in Chronic Spontaneous Urticaria: A Case- Control Study

Background: Chronic Spontaneous Urticaria (CSU) is a common health problem and its clear etiology is not established yet. Several theories have been tried to illustrate its etiology and pathogenesis. Autoantibodies and inflammatory cytokines like IL-23 and IL17 are hypothesized to take part in CSU pathogenesis and outcome. Objectives: To detect serum levels of IL-23 and IL-17A among CSU patients and to determine its correlation with disease severity and its relation to autoreactivity. Methodology: Serum levels of IL-23 and IL-17A were measured in 23 patients with CSU (CSU group) and 23 healthy controls (control group). In CSU group, Weekly Urticaria Activity Score (UAS7) was recorded to assess disease severity. Autologous Serum Skin Test (ASST) was performed to assess autoreactivity. CSU patients᾿ group was subdivided, based on ASST, into positive ASST (ASST+ ) and negative ASST (ASST- ) subgroups. Correlation of serum IL-23 & IL-17A levels, with UAS7 and ASST response were analyzed. Results: CSU group had higher serum IL-17A and IL-23 levels than control group (P=0.000). ASST+ CSU had higher serum IL-17A and IL-23 levels than ASSTones (P=0.000). Additionally, UAS7 was higher in ASST+ subgroup than ASST- subgroup (32+11.7 versus 16.27+ 9.92; P =0.005). There was significant positive correlation between disease severity and serum levels of both IL-17A and IL-23 among CSU patients (r= 0.626 & P= 0.001 and r=0.515 & P= .012, respectively). Conclusion: Increased serum IL-17A and IL-23 levels may constitute two major determinants of CSU pathogenesis and severity.

Minimum effective maintenance omalizumab dose for chronic spontaneous urticaria in an 11 year old girl

Dramatic response to Omalizumab in a girl with severe Chronic Spontaneous Urticaria (CSU) and identification of the minimum effective maintenance dose. An otherwise healthy 11-year-old girl began at 8 months of age with a CSU, in the last 3 years did not respond to antihistamine maximum doses and at presentation had serious adverse effects from prolonged corticosteroid therapy as; Cushing syndrome, obesity with body mass index (BMI) of 27, posterior subcapsular cataract in the right eye and biochemical diagnosis of suppression of the hypothalamic-pituitary-axis (HPA). Had negative tioperoxidase and thyroglobulin autoantibodies and normal thyroid function. IgE levels (400mU/l). Negative Parasitological assay. Normal Red, white cells, differential and platelets. Normal liver and kidney functions. Negative autologous serum skin test. Urticaria activity score of 7 days (UAS7) of 42. Omalizumab in a dose of 300mg every month is started achieving complete resolution of Urticaria in 30 days. Complete withdrawal from glucocorticosteroid therapy is accomplished in seven months after complete recovery of the HPA. After one year of treatment and due to lack of stock of Omalizumab thereafter receives 300mg every 45 days for 3 doses with complete absence of urticarial lesions. Due to the same drawback thereafter received 300 mg every 60 days for 3 doses. Urticarial lesions appeared systematically 48 to 50 days after the 300mg Omalizumab dose. Complete resolution of the lesions occurred when placed again on Omalizumab 300mg every 30 days. One year later on, owing to Omalizumab supply difficulties, she started to receive 150 mg every 30 days. Remained asymptomatic during 5 doses and thereafter urticarial lesions recurred at days 25 or 28 post 150mg doses. Thereafter remained on 300mg every 45 days with excellent response until present time. Currently completed 42 months of treatment without showing any adverse reaction to omalizumab, with complete resolution of posterior subcapsular cataract and achieved a BMI of 18. Any attempt to stop therapy provoked Urticarial lesions. We describe a severe case of CSU in an 11-year-old girl with a complete response to Omalizumab. Due to the high cost of this drug we suffer a lack of provision at different times. The inconvenience urged us to determine the minimum effective dose of Omalizumab for the CSU of this patient. 300mg of Omalizumab every 45 days offers complete control of the disease.

Association of positive and negative autologous serum skin test responses with clinical features of chronic spontaneous urticaria in Asian patients: A systematic review and meta-analysis.

Previous studies on the correlation between positive autologous serum skin test (ASST) responses and the clinical features of patients with chronic spontaneous urticaria (CSU) have provided conflicting results. To evaluate the significance of ASST responses in CSU, a variety of databases were searched from inception to March 2018 to identify relevant studies on CSU. Data were analyzed with use of the Cochrane Collaboration's Review Manager 5.2. Multiple relevant factors of CSU were evaluated by calculating the weighted mean difference, odds ratio and 95% confidence interval. The results indicated that CSU cases with positive ASST responses had higher urticaria activity scores and higher levels of total serum immunoglobulin E than CSU cases with negative responses in the ASST. In addition, a positive ASST response was more likely to be accompanied with the presence of thyroid autoantibodies and angioedema. An increased prevalence of CSU was identified in females, who were more likely to have a positive response in the ASST. It was also indicated that a greater incidence of positive ASST responses was present in CSU patients as compared with that in healthy controls. No statistically significant differences were obtained between positive and negative ASST responses with regard to age and duration of disease. Based on these results, it was concluded that the ASST provides an effective means of predicting urticaria activity and recurrence in CSU patients.

Relevance of the Basophil High-Affinity IgE Receptor in Chronic Urticaria: Clinical Experience from a Tertiary Care Institution

The high-affinity IgE receptor (FcεRI) expression on effector cells has been poorly characterized in patients with chronic urticaria (CU) to date. To investigate the FcεRI expression on blood basophils in a large cohort of patients with CU and its potential relationship with relevant features of the disease. Basophil FcεRI expression was measured by flow cytometry in 287 patients with CU (192 with chronic spontaneous urticaria and 95 with chronic inducible urticaria) at their initial evaluation in our department. A control group of healthy nonatopic individuals was included to provide reference data, and the effect of antihistamine and anti-IgE therapy on the basophil FcεRI expression was also evaluated in a cohort of patients with CU. The median FcεRI expression was found significantly higher in patients with CU compared with healthy controls (P<.0001). A positive correlation was found between serum IgE levels and basophil FcεRI expression (R= 0.422; P < .001). Significantly higher FcεRI levels on basophils were detected in patients with CU who presented with concomitant atopic features (P= .003), negative autologous serum skin test (P=.002), negative autologous plasma skin test (P= .009), or undetected levels of antithyroid antibodies (P= 0.01). Baseline FcεRI expression was not related to the activity and duration of the disease, and was not significantly modified during antihistamine therapy; however, it correlated with the clinical response to omalizumab (P= .003). Although further multicenter studies are needed to corroborate these findings, the assessment of basophil FcεRI levels might be relevant in daily clinical practice supporting an autoimmune pathogenesis and predicting response to anti-IgE treatment.

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.

Basophil Activation Test identifies the patients with Chronic Spontaneous Urticaria suffering the most active disease.

IntroductionThe basophil activation test showing CD63 up regulation could be a specific and sensitive in vitro complementary text to the in vivo autologous serum skin test for the activity assessment of the patients suffering autoimmune chronic spontaneous urticaria. The aim of this study is to define the basophil activation test as a useful tool in clinical practice in order to identify those patients with more active disease.MethodsWe screened 139 patients (96 women) diagnosed of chronic spontaneous urticaria using simultaneously autologous serum skin test and basophil activation test and their relationship with disease activity.ResultsPositive autologous serum skin test was found in 56.8%; from them, 31.6% were basophil activation test positive. Negative autologous serum skin test result was found in the 43.2% of the sample that showed negative CD63 expression results in all cases, except one. Patients with positive autologous serum skin test and positive CD63 by basophil activation test showed significant higher Urticaria Activity Score of 7 days (P = 0.004) and of 3 weeks (P = 0.001) than patients with positive autologous serum skin test and negative CD63 (mean ± standard deviation [SD] 26.57 ± 10.56 versus 18.40 ± 12.05 for the Urticaria Activity Score of 7 days and 56.47 ± 23.78 versus 39.88 ± 25.44 for the Urticaria Activity Score of 3 weeks).ConclusionsThe CD63 expression on basophils appears as a reliable in vitro marker, useful in clinical practice in combination with autologous serum skin test to define chronic spontaneous urticaria patients with the highest urticaria activity that impairs a normal life.

Basophil CD63 expression in chronic spontaneous urticaria: correlation with allergic sensitization, serum autoreactivity and basophil reactivity.

The underlying causes and factors contributing to the disease severity of chronic spontaneous urticaria (CSU) are unknown. Given the important role of basophils in the pathogenesis of urticaria and that CD63 serves as a useful marker for basophil activation and detecting, CD63 expression of basophils is a reliable tool for diagnosing allergy and hypersensitivity reactions to different allergens; the objective of this study was to investigate whether the level of basophil CD63 expression is correlated with allergen sensitization, serum autoreactivity and basophil reactivity in patients with CSU. Basophil-enriched leucocytes were separated from the blood of 64 patients with chronic urticaria (54 CSU patients and 10 symptomatic dermographism patients), 18 healthy control subjects and seven atopic donors without urticaria. Flow cytometry was then used to detect CD63 expression on the cell membrane of basophils from all samples. Analysis was also preformed on basophils incubated with sera from CSU patients with positive or negative autologous serum skin test (ASST). CD63 expression was significantly higher in the basophils from patients with CSU than in those from patients with symptomatic dermographism and the healthy control group. The levels of CD63 expression in CSU patients with ASST+ and/or allergen sensitization were higher than those with ASST- and/or no allergen sensitization patients. Incubation with ASST+ serum resulted in an increased expression of CD63 in the basophils of ASST+ CSU patients, whereas no such response was observed in healthy controls or ASST- CSU patients. The increased CD63 expression in basophils from CSU patients may correlate with allergen sensitization, autoreactivity of serum and basophil reactivity. Our results suggest that CD63 may contribute new insight into the pathogenesis of CSU.

The clinical and laboratory characteristics of acute spontaneous urticaria and its progression to chronic spontaneous urticaria.

The natural history of the progression from acute spontaneous urticaria (ASU) to chronic spontaneous urticaria (CSU), CSU remains poorly understood. To identify clinical and laboratory patient attributes that may be predictive of ASU progression to CSU. We prospectively studied consecutive adult patients (age ≥ 18 years) with a diagnosis of urticaria of <6 weeks' duration. Healthy age- and sex-matched subjects served as controls. At study entry, autologous serum skin test (ASST), complete blood cell count, erythrocyte sedimentation rate, thyroid function tests, antinuclear antibodies, antithyroglobulin and antiperoxidase antibodies, and immunoglobulin E level were assessed in all the subjects. ASST and urticaria activity score assessment were performed in all the patients at baseline and then at weeks 7, 12, 24, and 48. Of 114 patients with acute urticaria and without identifiable causes, 73 patients (64%) were included in the ASU group, 41 patients in the CSU group (36%), and 44 healthy subjects in the control group. At baseline, 26 patients in the CSU group (63.4%) had a positive ASST result, whereas only 17 patients with a positive ASST result (23.3%) were revealed in the ASU group (p < 0.001). Patients with baseline ASST positive results were characterized by more profound basopenia (mean [standard deviation], 0.05 ± 0.08 cell/mm(3)) and more anti-thyroid peroxidase antibodies (18 [41.8%]) than those with the negative baseline ASST result (mean [standard deviation], 0.13 ± 0.09 cell/mm(3), p < 0.001 more profound basopenia; and 13 (18.1%), p = 0.009 more thyroid peroxidase antibodies). We observed the disappearance of ASST positive result in some patients with CSU with baseline positive ASST results, whereas, in some subjects with CSU, baseline negative ASST results came to be positive results throughout the study period. A baseline positive ASST result of patients with ASU was a significant determinant (odds ratio 5.91 [95% confidence interval, 2.57-13.62]; p < 0.001) for a CSU diagnosis at week 7. The patients with ASU who progressed toward CSU were characterized by a positive ASST result, thyroid autoimmunity, and profound basopenia at baseline.

Serum Clusterin as a Prognostic Marker of Chronic Spontaneous Urticaria.

A substantial proportion of patients with chronic spontaneous urticaria (CSU) are refractory to antihistamines. However, identifying the subpopulation whose urticaria is not completely controlled by antihistamines remains difficult. The response of autologous serum skin test (ASST), a clinical test for the detection of basophil histamine-releasing activity upon autoantibodies or autoreactive stimulation, has been suggested as a potential predictor in the control of urticaria. We sought to identify proteins that were differentially expressed in the sera of patients with positive and negative ASST results and to investigate their association with urticaria control.Proteomics analysis was performed using sera from 3 CSU patients with positive ASST results compared with those showing negative ASST results. Seven upregulated and 5 downregulated proteins were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry in the ASST-positive group compared with the ASST-negative group.Proteins that were differentially expressed according to the ASST results in CSU patients were classified into 6 groups: apolipoproteins, glycoproteins, modified albumin, haptoglobulin, plectin, and others. Among these, apolipoprotein J or clusterin was validated using an enzyme-linked immunosorbent assay. Clusterin levels in 69 ASST-positive patients were significantly higher than those in 69 ASST-negative patients and in 86 healthy controls (231.2 ± 44.0 vs 210.2 ± 36.1 vs 118.7 ± 71.9 μg/mL, P < 0.001). Furthermore, clusterin levels differed significantly between patients with responsive and refractory responses to antihistamine treatment within 3 months (231.0 ± 39.1 vs 205.1 ± 40.4 μg/mL, P < 0.001). ASST results and serum clusterin levels can predict 92.7% of CSU patients whose urticaria would be refractory to antihistamines. Serum clusterin can be a prognostic marker to determine the responsiveness to antihistamine treatment in patients with CSU.

Autologous Serum Skin Test in Chronic Idiopathic Urticaria

Background: Urticaria is a short-lived swelling of skin and mucosa due to plasma leakage by immune and non immune mediated activation and released of mediators from mast cell and basophil. Autoimmune urticaria tends to have a high itch and wheal score than other type of urticaria. Its diagnosis is practically relied upon clinical suspicion and autologous serum skin test. Autologous serum skin test (ASST) is the simple and cost effective test to differentiate autoimmune urticaria from the bulk of chronic urticaria patients. Objective: To compare the features of chronic urticaria in patients having positive versus negative autologous serum skin test (ASST).Materials and methods: Cross-sectional hospital based study was conducted among 90 chronic urticaria patients (CIU) attending the outpatient dermatology department of Nepalgunj Medical College, Nepalgunj, during one year period. The study was conducted after ethical approval from the institutional committee. The patients were diagnosed on the basis of the appearance of continuous or recurrent hives with or without angioedema for more than 6 weeks. Patients who suffered from either acute urticaria or urticarial vasculitis or physical urticaria or other systemic diseases known to cause urticaria were excluded. Standard tools and techniques were used to prepare antilogous serum and injection of the serum and interpretation of the result. The test result was Interpreted as positive and negative autologous serum skin test.Results: ASST was positive in 42% of the patients and negative in 58% of the patients. The ASST-positive patients had a higher mean urticaria activity score and median duration of wheals in comparison with the ASST-negative patients. Wheals lasted for significantly longer duration in patients with positive ASST. Patients with positive ASST had more frequent attacks which was statistically significant compared to the ASST-negative group. The mean urticaria activity score was significantly higher in the ASST-positive patients than that in the ASST-negative patients.Conclusions: Autologous serum skin test may be a useful screening test for autoimmune urticaria and may be used as a simple and cost-effective test for the classification of chronic urticaria.JNGMC Vol. 12 No. 2 December 2014, page: 6-10

Comparative Study of Positive Versus Negative Autologous Serum Skin Test in Chronic Spontaneous Urticaria and its Treatment Outcome.

Background:Chronic urticaria (CU) is defined as urticaria persisting daily or almost daily for more than 6 weeks and affecting 0.1% of the population. Mast cell degranulation and histamine release are of central importance in the pathogenesis of CU. About 40-50% of the patients with chronic idiopathic urticaria (CIU) or chronic spontaneous urticaria (CSU) demonstrates an immediate wheal and flare response to intradermal injected autologous serum. This led to the concept of autoimmune urticaria (AIU).Aims:To determine the occurrence, clinical features, associated clinical conditions, comorbidities of AIU, and to compare this with CSU. This study aimed to find the frequency of autologous serum skin test (ASST)-positive patients among patients with CSU and to identify the clinical and laboratory parameters associated with positive ASST and to compare the treatment outcome.Materials and Methods:A prospective correlation study in 110 patients with CSU was conducted, after screening 200 CU patients attending the outpatient Department of Dermatology during from January 2012 to May 2013. Patients were subjected to ASST, complete blood counts, urine routine examination, liver function tests, renal function tests, thyroid function tests (T3, T4, and TSH), and urine analysis.Results:Out of 200 CU patients screened, 90 patients had excludable causes based on detailed history and skin prick test, and the remaining 110 patients were considered to have CSU. These 110 patients were further subjected to ASST, serum immunoglobulin E (IgE), and peripheral blood eosinophilia. ASST was positive in 48 patients and negative in 62 patients. Frequency of urticarial attacks and associated diseases such as abnormal thyroid function tests in both ASST-positive and ASST-negative patients did not show any statistical significance. Only attacks of angioedema in ASST-positive individuals were higher and were statistically significant. In the ASST-positive group, 31 (81.25%) patients showed improvement with first-line antihistamines, along with oral prednisolone and injection Histaglobulin and 10 (10.41%) patients did not show any improvement. Thirty-three (43.54%) patients in the ASST-negative group showed improvement while 13 (30.62%) patients did not show improvement.Conclusion:ASST is considered a screening test for AIU, which decreases the rate of diagnosis of idiopathic form of CU. ASST-positive patients in addition to antihistamines, were treated with short course of oral steroids and weekly Histaglobulin injections for 5 weeks followed by the 3rd and 6th months.

The relation of autologous serum and plasma skin test results with urticarial activity score, sex and age in patients with chronic urticaria.

IntroductionSome previous studies reported autoimmunity as an etiologic factor in chronic urticaria (CU), but the results of some autoimmunity tests in these studies are conflicting.AimTo concretize whether there was any relation of autologous serum skin test (ASST) and autologous plasma skin test (APST) results with sex, age and urticarial activity score (UAS) in patients with CU.Material and methodsFifty patients with CU and twenty healthy subjects admitted to our dermatology clinic were included in the present study. The ASST and APST were applied to all individuals.ResultsThe positiveness rates of ASST and APST were significantly higher in the patient group than controls (p = 0.027, p = 0.001, respectively). Among patients, the APST positiveness rate (72%) was significantly (p < 0.05) higher than ASST (46%). It was seen that 48% of patients with negative ASST results had positive APST. However, no patient with negative APST results had positive ASST. There were significant (p < 0.05) relations of the tests’ positiveness rates with sex and old age but with UAS. The diameter of the erythematous papule was remarkably (p < 0.05) larger in APST than ASST and also significantly (p < 0.05) larger in females compared to males in both tests (p < 0.05). It was positively increased with old age (p < 0.05).ConclusionsWe can suggest that APST is more sensitive than ASST in the assessment of autoimmunity in CU. A high positiveness rate of APST results may be attributed to high numbers of autoantibodies and coagulation factors present in plasma that might probably play a role in etiopathogenesis of CU.

The significance of hypersensitivity to autologous sweat and serum in cholinergic urticaria: cholinergic urticaria may have different subtypes.

The pathogenesis of cholinergic urticaria (ChU) has been unclear except for the involvement of acetylcholine. Attempts to classify ChU according to etiology have rarely been performed. To evaluate the significance of responsiveness to autologous sweat and serum in ChU in relation to their clinical characteristics. This study involved 18 patients diagnosed with ChU between January 2010 and April 2011 in the Catholic Medical Center-St. Paul's Hospital. History taking included symptom duration, association with atopy, decreased sweat secretions, seasonal variation, and response to treatment. Intradermal autologous serum skin test (ASST) and autologous sweat skin test (ASwST) and basophil histamine release test with sweat were done. Sweat hypersensitivity was proven by a positive ASwST and basophil histamine release test in only 37.5% of patients with ChU, and in none of the healthy controls. The weal size of ASwST correlated with percentage basophil histamine release. A positive response to autologous serum was displayed by 38.9% of patients, whereas 10% of healthy controls showed a positive ASST response. Intriguingly, patients with a positive ASwST had a negative ASST, and vice versa. Despite this, there was no difference in the clinical characteristics between positive ASST and positive ASwST groups. The frequency of hypersensitivity to autologous sweat and serum was significantly higher in patients with ChU, compared with healthy controls. This suggests that autoimmunity to an unknown serum factor as well as sweat hypersensitivity may be involved in the pathogenesis of ChU.

Chronic idiopathic urticaria: autologous skin tests and treatment

BackgroundChronic urticaria is defined as urticaria persisting daily or almost daily for more than 6 weeks. It affects 0.1% of the population. Intradermal injection of autologous serum and plasma elicits a cutaneous reactivity in almost 45-60% of patients with chronic idiopathic urticaria (CIU). Activation of coagulation process seems to play an important role in the pathogenesis of CIU. Oral anticoagulant therapy has been shown to be effective in the treatment of CIU.ObjectiveThe aim of this study was to evaluate and compare autologous serum skin test (ASST) and autologous plasma skin test (APST) in the diagnosis of CIU and to determine the effect of treatment with antihistamine (loratadine) and anticoagulant (dipyridamole).Patients and methodsThis study included 30 patients suffering from CIU. All patients were subjected to intradermal testing with their serum (ASST) and their plasma (APST). The patients were classified into three equal groups, according to treatment: 10 patients were treated with loratidine, 10 patients were treated with dipyridamole, and 10 patients were treated with combination of loratidine and dipyridamole for 1 month. Follow-up for the three groups was carried out at the first, second, and fourth week of treatment evaluating the effectiveness and adverse effects of drugs. Assessment of the symptom score reduce index (SSRI) in positive and negative ASST and APST patients was evaluated.ResultsThe ASST was positive in 40% of patients, whereas APST was positive in 90% of patients. Loratadine, dipyridamole, and combination of both were effective in the management of patients with CIU. However, best results occurred with combination of both. No serious side effects of treatment were encountered.ConclusionBoth ASST and APST can be used for diagnostic purposes in patients with CIU. APST is superior to ASST in diagnosis of CIU. Combined treatment with antihistamines and anticoagulants provides an effective management of chronic urticaria in positive autologous serum and plasma skin tests patients.

Evaluation of Autologous Serum Skin Test and Skin Prick Test Reactivity to House Dust Mite in Patients with Chronic Spontaneous Urticaria

BackgroundChronic spontaneous urticaria (CSU) is a common skin disorder with etiology that is not well understood.MethodsIn this study, we evaluated the prevalence of autologous serum skin test (ASST) and skin prick testing (SPT) to house dust mite (HDM) in 862 CSU cases in China. Clinical features, courses and treatment responses were also recorded.ResultsThe prevalence of positive ASST was 46.3%, and patients aged 30–39 years had the highest positive rate (52.1%). Positive SPT to HDM was seen in 153 patients (17.7%) with the highest positive rate (34.2%) in patients aged 20 or less. Patients with positive ASST had higher urticaria activity scores (UAS) (4.18±0.65 vs. 3.67±0.53) but lower positive rates of HDM (24.6% vs. 37.6%), as compared with those with negative ASST (odds ratio (OR) 1.84, 95% CI 1.38–2.47). Patients could be categorized into four groups based on the results of ASST and SPT to HDM and patients with positive ASST and positive SPT to HDM had the highest disease activity scores, experienced higher frequencies of angioedema, diseases duration, and required higher dosage of loratadine every month, compared with other subgroups (P<0.0001).ConclusionsPatients with CSU showed varied responses of positive ASST and varied sensitivity to HDM, Patients with positive ASST and/or positive SPT had more disease activity compared with patients with negative ASST and/or negative SPT. Further classification can be made based on the result of SPT and ASST.

Autologous Serum Skin Test as a Diagnostic Aid in Chronic Idiopathic Urticaria

Background. Chronic urticaria is defined as urticaria persisting daily for more than six weeks. A significant number of patients had autoimmune basis where autologous serum skin test is widely used for detection of chronic autoimmune urticaria. Objectives. To estimate the frequency of autoimmune urticarial in Iraqi patients utilizing the autologous serum skin test and to evaluate its results with the variable clinical features of chronic idiopathic urticaria. Methods. In this prospective study, 54 patients with chronic idiopathic urticaria were investigated with autologous serum skin test where its results were examined with the different clinical parameters of chronic autoimmune urticaria. Results. Twenty two patients (40.7%) out of 54 patients with chronic idiopathic urticarial had positive autologous serum skin test. Statistical analysis of the clinical variables did not show a significant difference between patients with positive and negative autologous serum skin test except for the distribution of wheals on the face and extremities which was significantly associated with positive autologous serum skin test results (P value 0.004). Conclusion. Autologous serum skin test is a simple, office-based test for detecting chronic autoimmune urticaria patients who have no distinctive clinical features differentiating them from chronic idiopathic urticaria patients.

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

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