Comparative study of positive versus negative autologous serum skin test in chronic spontaneous urticaria and its treatment outcome

Abstract

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.

Correlations between disease activity, autoimmunity and biological parameters in patients with chronic spontaneous urticaria

“…In the literature, this association between ASST and disease activity remains controversial (16,(20)(21)(22). In line with previous reports, angioedema was more frequent in patients with positive ASST in our cohort (17,18). This study put forward that personal and familial autoimmune disease history as well as autoimmune serology, especially IgG against TPO, are easy to get and could be interesting to record in patients with CSU.…”

Type 3 autoimmune polyendocrine syndrome (APS) diagnosed in an 87-year-old patient with a concomitant chronic autoimmune urticaria

“…It is a non-specific screening test that evaluates the presence of factors releasing histamine in patient's serum, regardless of their type. The test result is considered positive if the nodule's diameter at the site of patient's serum administration is bigger with at least 1.5 mm from the nodule's diameter at the site of 0.9% NaCl solution administration [16,17]. Having confirmed the autoimmunization background of the chronic urticaria resulted in choosing effective therapeutic preparations.…”

“…Jest to nieswoisty test przesiewowy, który ocenia obecność czynników uwalniających histaminę w surowicy pacjenta niezależnie od ich rodzaju. Wynik testu uznaje się za dodatni, gdy średnica bąbla w miejscu podania surowicy własnej jest większa co najmniej o 1,5 mm od średnicy bąbla w miejscu podania 0,9% roztworu NaCl [16,17]. Potwierdzenie autoimmunizacyjnego podłoża pokrzywki przewlekłej wpłynęło na dobór skutecznych preparatów terapeutycznych.…”

Etiologic Factors in Patients with Chronic Urticaria

“…Kronik spontan ürtikerli hastalarda OSDT pozitif ve negatif gruplar arasında yaş ve cinsiyet dağılımı ile hastalık şiddetiyle ilişkili olabilecek parametreler (hastalık süresi, anjioödem varlığı, ESR-CRP düzeyleri ile 1. basamak tedavisine yanıt verme oranları) yönünden istatistiksel olarak anlamlı fark tespit edilmemiştir. Otolog serum deri testi pozitifliği ve hastalık şiddeti ilişkisinin değerlendirildiği çalışmalarda tartışmalı sonuçlar elde edilmiştir 28,[30][31][32][33][34][35][36][37][38] . Has-Ü.…”