Mediators of urticaria and angioedema

Tumor necrosis factor-alpha release during systemic reaction in cold urticaria

Primary cold urticaria (PCU) characterized by the association of urticaria, angioedema, and sometimes a shock-like reaction after cold exposure, is usually considered to be linked with histamine and prostaglandin D2 release by mast cells. To determine the involvement of cytokines, we studied the release of tumor necrosis factor-alpha (TNF-alpha) in the blood of the efferent vein after immersion of the hand in chilled water. Five patients with PCU were compared with a control population (three patients with nonphysical urticaria and three healthy subjects). Among patients with PCU who underwent the cold immersion test, two exhibited a shock-like reaction with a large urticarial plaque (patients 1 and 2), one had only a mild cutaneous reaction, and two had no reaction. Patient 1 was reevaluated after 6 months of treatment with H1 and H2 antihistamines: he did not respond to this challenge. All controls were strictly negative. Histamine was released within the first minute after the challenge in the three patients with PCU, but at a higher level for the two patients who had a systemic reaction. TNF-alpha was undetectable in the blood of the patient with only a mild cutaneous reaction, whereas TNF-alpha release was observed for the two patients with a systemic reaction, 2 and 6 minutes after the end of the cold immersion test. The two other patients and the control subjects released neither histamine nor TNF-alpha. In parallel, pathologic and immunohistochemical (with a rabbit anti-TNF-alpha antibody) studies were performed on skin biopsy specimens collected 10 minutes after ice-cube test.(ABSTRACT TRUNCATED AT 250 WORDS)

Alpha-fluoromethylhistidine in the treatment of idiopathic cold urticaria

Alpha-fluoromethylhistidine (alpha-FMH), a new irreversible inhibitor of mammalian histidine decarboxylase, was tested in the treatment of idiopathic cold urticaria in 11 patients. In the initial trial with 50 mg b.i.d., a significant decrease (about 30%) in the total blood histamine level was found after 3 weeks of treatment but clinically there was no improvement in the symptoms of ten cold urticaria patients nor in the responses to the ice-cube test. In the second trial with three patients suffering from severe idiopathic cold urticaria, a higher dose of up to 500 mg b.i.d. of alpha-FMH for 3 weeks resulted in a marked decrease in the total blood histamine level as well as in an apparent inhibition of histamine synthesis in the skin previously exposed several times to cold water. The symptoms of cold urticaria and the responses in the ice-cube tests also decreased simultaneously. No clinical side effects nor changes in laboratory analysis were seen during the treatment with alpha-FMH. These results suggest that alpha-FMH may be useful in the treatment of severe cold urticaria especially in combination with histamine exhaustion of mast cells using cold water.

Plasma histamine concentrations in atopic eczema

Plasma histamine concentrations were determined using a radio-enzymatic assay in fifty-four patients suffering from atopic eczema and in thirty-nine controls (contact dermatitis, psoriasis and normal non-atopic healthy volunteers). While in none of the controls histamine levels in plasma exceeded 1 ng/ml, seventeen out of fifty-four patients with atopic eczema showed increased plasma histamine concentrations ranging between 1.2 and 5.2 ng/ml. Elevated plasma histamine levels were found mostly in patients with severe eczema and high serum IgE levels. Longitudinal studies in seven patients revealed normal plasma histamine values during clinical remission.

A hypocomplementemic vasculitic urticarial syndrome. Report of four new cases and definition of the disease

We describe four new patients with a unique syndrome of persistent urticaria, with leukoclastic angiitis, severe angioedema, occasional life-threatening laryngeal edema, arthritis, arthralgia, neurologic abnormalities and pronounced persistent hypocomplementemia. The complement abnormalities involved markedly reduced levels of the Clq subunit of the first component of complement (Cl) in the presence of near normal levels of Clr and Cls subunits of Cl; modest to marked depletion of the fourth component of complement (C4), the second component of complement (C2) and the third component of complement (C3); and normal levels of the fifth through ninth components of complement (C5 through C9) and properdin factors B and D. A striking serologic abnormality found in all patients was the presence of low molecular weight (7S) proteins which precipitated with Clq in agarose gels; these previously were shown to be comprised at least in part of immunoglobulin G. The present experience is offered to help to define the clinical, histopathologic and serologic characteristics of this entity, designated hypocomplementemic vasculitic urticarial syndrome, and to emphasize its distinctiveness and prevalence.

[Histamine levels in interstitial fluid of lesional and perilesional skin in patients with chronic idiopathic urticaria (author's transl)]

In 8 patients with idiopathic chronic urticaria suction blisters were produced simultaneously on lesional and perilesional skin in the periumbilical area without application of heat. The suction pressure was 250 mm Hg, and thus the blister production lasted from 60--120 min. The blister fluid histamine was determined with a modified autoanalyzer technique developed by Siraganian. In this method the extractionof histamine, the condensation of o-phthaldial-dehyde with histamine and the measurement of the fluorochrome is automated. With the described method it is possible to measure values less than 0.5 ng/ml. Histamine levels in perilesional skin were nearly in the same range as in the periumbilical skin of 10 normal persons. The range of the normal tissue fluid histamine levels was 0--15 ng/ml and they did not differ significantly from the plasma levels. In all 8 patients with chronic urticaria the histamine values were higher in lesional than in perilesional skin. In 1 patient the lesional blister fluid histamine value reached 35.5 ng/ml. Four of the patients showed only low differences (less than 3 ng/ml).

Blood histamine levels after exercise testing

Histamine has been measured in whole blood and in the plasma of twenty-three subjects following exercise testing of seventeen asthmatics and six normal controls. Whole blood histamine rose in both asthmatics and controls and was associated with a concomitant rise in the basophil count. Plasma histamine in the peripheral venous blood only rose in one patient who developed urticaria after exercise.

Plasma complement and histamine changes in atopic dermatitis

Fifteen patients with atopic dermatitis were investigated to evaluate the total of complement and histamine. In five patients total serum complement haemolytic activity (CH50) was significantly decreased as was the haemolytic activity of complement components C2 (C2H50) and C3 (C3H50). By counter immunoelectrophoresis split products of C3 were detected. There was no evidence for alternative pathway activation or the presence of an activator of the alternative pathway. In three patients plasma histamine concentrations were elevated. The intensity of the complement and histamine changes observed seemed to be correlated to the severity of the disease.