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Wills S, Chavez J, Grover A, Beck N, Romano M, Bauer C, Gerspach M, Schneider M, Valcour A. PD-BAT: A novel approach of pooling basophil donors for expansion of commercial laboratory testing of Chronic Spontaneous Urticaria. J Immunol Methods 2024; 529:113679. [PMID: 38679364 DOI: 10.1016/j.jim.2024.113679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
The type II autoimmune subtype of Chronic Spontaneous Urticaria (CSU) is characterized by the presence of IgG autoantibodies targeting IgE or the IgE high-affinity receptor (FcεRI) on mast cells and basophils. In evaluation of CSU patients, indirect basophil activation testing (BAT), has been utilized, involving the mixing of patient serum with heterologous peripheral blood donors, followed by flow cytometric assessment of basophil markers. However, the reliability of the indirect BAT results hinges on the quality of the donor basophils utilized. In this study, we introduce an innovative approach where multiple potential basophil donors undergo rigorous BAT characterization alongside control samples. By selecting and pooling donors with optimal performance, we significantly enhance the inter-assay reproducibility of the indirect BAT test.
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Affiliation(s)
| | | | - Ajay Grover
- Labcorp, Burlington, NC, United States of America
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2
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Buono EV, Giannì G, Scavone S, Caffarelli C. Clinical Characteristics, Investigations and Treatment in Children with Chronic Urticaria: An Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:704. [PMID: 38792886 PMCID: PMC11122882 DOI: 10.3390/medicina60050704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/17/2024] [Accepted: 04/21/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: The guidelines for chronic urticaria in children contain recommendations that are often based on adult studies. The diagnostic pathway has not been standardized and the effectiveness of anti-H1, omalizumab, montelukast, and systemic glucocorticoids is rarely reported in the pediatric population. There is a wide variation in the rate of remission of chronic urticaria between studies. The aim of this study is to enhance our understanding of pediatric chronic urticaria. Materials and Methods: This study enrolled 37 children with chronic urticaria aged from 0 to 18 years. Demographic parameters, medical history, clinical features, laboratory data and treatment information were collected. Children were treated with the recommended dosage of second-generation H1-antihistamines, which was increased by up to twofold. Omalizumab was added for refractory anti-H1 patients. A three-day course with systemic glucocorticoids was administered for severe exacerbations. Montelukast was administered to some children. Results: Wheals without angioedema were common. Chronic urticaria was spontaneous in 32 children (86.48%), inducible in 2 (5.41%), induced by a parasite in 1 and vasculitic in 2. Treatment of the potential causes of chronic urticaria was of no benefit, except for eradication of Dientamoeba fragilis. Chronic urticaria was resolved within three years in 45.9% of cases. Allergic diseases were present in nine children (24.32%) and autoimmune diseases were present in three (8.11%). All children were treated with anti-H1 at the licensed dose or at a higher dose. A partial or complete response to anti-H1 was observed in 29 (78.38%) patients. Montelukast showed no benefit. All children treated with omalizumab responded. Systemic glucocorticoids were successfully used to treat exacerbations. Conclusions: Our findings indicate that laboratory tests should not be routinely performed in children with chronic urticaria without clinical suspicion. However, comorbidities such as thyroid autoimmune disease and coeliac disease are suggested to be monitored over the chronic urticaria course. These clinical conditions could be diagnosed from the diagnostic framework of chronic urticaria. Increasing the dosage of anti-H1 and omalizumab was effective in children resistant to standard treatment but we still need further studies to generate a standard patient-centered treatment.
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Affiliation(s)
| | | | | | - Carlo Caffarelli
- Clinica Pediatrica, Azienda Ospedaliero-Universitaria, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (E.V.B.); (G.G.); (S.S.)
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Imamura S, Oda Y, Fukumoto T, Mizuno M, Suzuki M, Washio K, Nishigori C, Fukunaga A. Solar urticaria: clinical characteristics, treatment effectiveness, long-term prognosis, and QOL status in 29 patients. Front Med (Lausanne) 2024; 11:1328765. [PMID: 38435390 PMCID: PMC10904580 DOI: 10.3389/fmed.2024.1328765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Solar urticaria (SU), a relatively rare skin inflammatory and photosensitivity disease, is often resistant to standard urticaria treatment. Quality of life (QOL) among SU patients has not been extensively explored. This study was performed to clarify the clinical features and effectiveness of therapies (e.g., hardening therapy) for SU and to determine QOL among SU patients. Methods The authors examined the characteristics, treatments, and QOL statuses of 29 Japanese SU patients using medical records and a questionnaire approach. Results Among 29 patients, H1 antihistamine therapy (H1) was effective in 22 (75.8%) patients. H2 antihistamine therapy (H2) was effective in three of seven (42.9%) patients. Ultraviolet radiation A (UVA) hardening therapy was effective in eight of nine (88.9%) patients. Visible light (VL) hardening therapy was ineffective in three of three patients. In one patient who underwent both UVA and VL hardening therapy, only UVA hardening therapy was effective. In the questionnaire, 18 patients (90%) reported some improvement compared with disease onset (four had complete remission, six had completed treatment although mild symptoms persisted, and eight were receiving treatment with moderate symptoms), whereas two patients reported exacerbation. Patients in complete remission had a mean disease duration of 4 years, whereas patients not in remission had a mean disease duration of 8.8 years. The mean Dermatology Life Quality Index (DLQI) score for the current status was 7.4. There was a correlation between DLQI and symptom/treatment status. However, neither DLQI and action spectra nor DLQI and treatments exhibited significant differences. Discussion The questionnaire revealed current QOL status and long-term prognosis in SU patients. Compared with disease onset, most patients showed improvement when assessed for this study. Both H1 and H2 should be attempted for all SU patients. UVA hardening therapy may be an option for SU patients with an action spectrum that includes UVA.
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Affiliation(s)
- Shinya Imamura
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Dermatology, Kobe City Hospital Organization, Kobe City Medical Center West Hospital, Kobe, Japan
| | - Yoshiko Oda
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Fukumoto
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mayuko Mizuno
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mariko Suzuki
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken Washio
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Chikako Nishigori
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsushi Fukunaga
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Dermatology, Osaka Medical and Pharmaceutical University, Osaka, Japan
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D’Auria E, Minutoli M, Colombo A, Sartorio MUA, Zunica F, Zuccotti G, Lougaris V. Allergy and autoimmunity in children: non-mutually exclusive diseases. A narrative review. Front Pediatr 2023; 11:1239365. [PMID: 38027278 PMCID: PMC10652575 DOI: 10.3389/fped.2023.1239365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/04/2023] [Indexed: 12/01/2023] Open
Abstract
In last decades a simultaneous increase in the prevalence of atopic and autoimmune disorders in pediatric population has been observed. Despite the Th1-Th2 paradigm, supporting the polarization of the immune system with Th1 response involved in autoimmune diseases and Th2 response leading to hypersensitivity reactions, recent evidence suggests a possible coexistence of common pathogenic pathways as result of shared immune dysregulation. Similar genes and other mechanisms such as epithelial barrier damage, gut microbiota dysbiosis and reduced number of T regs and IL-10 contribute to the onset of allergy and autoimmunity. IgA deficiency is also hypothesized to be the crosslink between celiac disease and allergy by lowering gut mucous membrane protection from antigens and allergens. The present narrative review aims to give an overview of the co-occurrence of allergic and autoimmune disorders (celiac disease, inflammatory bowel diseases, type 1 diabetes mellitus, thyroid disease, juvenile idiopathic arthritis) in pediatric population, based on the available evidence. We also highlighted the common pathogenic pathways that may underpin both. Our findings confirm that allergic and autoimmune diseases are commonly associated, and clinicians should therefore be aware of the possible coexistence of these conditions in order to ameliorate disease management and patient care. Particular attention should be paid to the association between atopic dermatitis or asthma and celiac disease or type 1 diabetes and vice versa, for therapeutic interventions. Further studies are needed to better clarify mechanisms involved in the pathogenesis and eventually identify new therapeutic strategies.
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Affiliation(s)
- Enza D’Auria
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Martina Minutoli
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Alessandra Colombo
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | | | - Fiammetta Zunica
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Vassilios Lougaris
- Department of Clinical and Experimental Sciences, ASST – Spedali Civili di Brescia, Paediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, University of Brescia, Brescia, Italy
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Magen E, Yakov A, Green I, Israel A, Vinker S, Merzon E. Chronic spontaneous urticaria after BNT162b2 mRNA (Pfizer-BioNTech) vaccination against SARS-CoV-2. Allergy Asthma Proc 2022; 43:30-36. [PMID: 34983707 DOI: 10.2500/aap.2022.43.210111] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: The factors that trigger and exacerbate chronic spontaneous urticaria (CSU) are well known, but it is not unclear whether messenger RNA (mRNA) vaccination against severe acute respiratory syndrome coronavirus 2 can trigger new cases of CSU or a relapse of CSU after long-term remission. Objective: To study the clinical cases of patients with new-onset CSU and CSU in remission who relapsed within 3 months after BNT162b2 mRNA vaccination. Methods: All patients with a CSU diagnosis within 12 weeks of BNT162b2 mRNA vaccination were retrospectively identified and included in the new-onset CSU and the relapsed CSU groups. The first control group (CSU control group) retrospectively consisted of patients diagnosed with CSU in complete clinical remission for ≥ 6 months, with no CSU relapse after vaccination. The second control group (healthy control group) consisted of subjects who were fully vaccinated and without CSU, matched 1:2 for age and sex with patients with CSU. Results: Twenty-seven patients were included in the relapsed CSU group, 32 patients in the new-onset CSU group, 179 patients in the CSU control group, and 476 subjects in the healthy control group. The relapsed CSU and new-onset CSU groups had more allergic comorbidities overall (19 [70.4%] and 13 [40.6%], respectively) than the CSU control group and the healthy control group (50 [27.9%] and 110 [23.1%], respectively; p < 0.001). Multiple logistic regression analysis showed that a positive autologous serum skin test result, overall allergic comorbidities, and basopenia were positively associated with the probability of CSU relapse within 3 months after BNT162b2 mRNA vaccination (odds ratio [OR] 5.54 [95% confidence interval {CI}, 2.36-13.02], p < 0.001); OR 6.13 [95% CI, 2.52-14.89], p = 0.001; and OR 2.81 [95% CI, 1.17-6.72, p = 0.020, respectively). Conclusion: It is possible that BNT162b2 mRNA vaccination serves as a provoking and/or relapsing factor of CSU in individuals with allergic diseases and/or predisposed autoimmunity.
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Affiliation(s)
- Eli Magen
- From the Leumit Research Institute and Department of Family Medicine, Leumit Health Services, Ashkelon, Israel
| | - Avi Yakov
- From the Leumit Research Institute and Department of Family Medicine, Leumit Health Services, Ashkelon, Israel
| | - Ilan Green
- From the Leumit Research Institute and Department of Family Medicine, Leumit Health Services, Ashkelon, Israel
| | - Ariel Israel
- From the Leumit Research Institute and Department of Family Medicine, Leumit Health Services, Ashkelon, Israel
| | - Shlomo Vinker
- From the Leumit Research Institute and Department of Family Medicine, Leumit Health Services, Ashkelon, Israel
| | - Eugene Merzon
- From the Leumit Research Institute and Department of Family Medicine, Leumit Health Services, Ashkelon, Israel
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Gold-Olufadi S, Ayanlowo O, Akinkugbe A, Otrofanowei E. Chronic urticaria in blacks: Is autoimmunity an important etiological factor? NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_185_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kolkhir P, Kovalkova E, Chernov A, Danilycheva I, Krause K, Sauer M, Shulzhenko A, Fomina D, Maurer M. Autoimmune Chronic Spontaneous Urticaria Detection with IgG Anti-TPO and Total IgE. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:4138-4146.e8. [PMID: 34363991 DOI: 10.1016/j.jaip.2021.07.043] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Autoimmune chronic spontaneous urticaria (aiCSU) comes with high disease activity and poor response to treatment. Recently, elevated levels of IgG anti-thyroid peroxidase (aTPO) and low levels of total IgE were reported to be common in aiCSU. OBJECTIVE To investigate how high aTPO and low IgE individually and combined are linked to features of aiCSU, including treatment responses. METHODS We analyzed records of patients with CSU from 2 independent cohorts (n = 1120) for demographic, clinical, and laboratory parameters and treatment responses. Total IgE and aTPO were measured, and 4 markers of aiCSU were analyzed: autologous serum skin test, basophil activation test (BAT), and blood eosinophil and basophil counts. Cutoff values were greater than or equal to 34 kU/L (high aTPO) and less than 40 IU/mL (low total IgE). RESULTS One of 10 patients with CSU had both high aTPO and low IgE (aTPO↑IgE↓, 11%, n = 123). aTPO↑IgE↓ was linked to higher age at CSU onset, being female, angioedema, and shorter CSU duration. aTPO↑IgE↓ was associated with markers of aiCSU, that is, BAT and autologous serum skin test positivity, basopenia, and eosinopenia (P < .01 for all). Almost half the patients with aTPO↑IgE↓ (44%, 19 of 43) had a positive BAT result, the best single marker for aiCSU, versus 12% (43 of 344) of patients without aTPO↑IgE↓ (P < .001). Relative risk of showing BAT positivity for a patient with aTPO↑IgE↓ is 3.636 (95% CI, 2.382-5.551). Patients with aTPO↑IgE↓ showed low response rates to antihistamine treatment as compared with patients without aTPO↑IgE↓ (30% vs 47%; P = .01). CONCLUSIONS Our findings suggest that aTPO↑IgE↓ is a useful diagnostic marker for aiCSU in everyday clinical practice.
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Affiliation(s)
- Pavel Kolkhir
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; I.M. Sechenov First Moscow State Medical University (Sechenov University), Division of Immune-mediated Skin Diseases, Moscow, Russia; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Elena Kovalkova
- Center of Allergy and Immunology, Clinical State Hospital 52, Moscow Ministry of Healthcare, Moscow, Russia
| | - Anton Chernov
- Center of Allergy and Immunology, Clinical State Hospital 52, Moscow Ministry of Healthcare, Moscow, Russia
| | - Inna Danilycheva
- National Research Center - Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow, Russia
| | - Karoline Krause
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Merle Sauer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Andrey Shulzhenko
- National Research Center - Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow, Russia
| | - Daria Fomina
- Center of Allergy and Immunology, Clinical State Hospital 52, Moscow Ministry of Healthcare, Moscow, Russia; I.M. Sechenov First Moscow State Medical University (Sechenov University), Department of Clinical Immunology and Allergology, Moscow, Russia
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany.
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Baumann K, Marcelino J, Skov P, Santos M, Wyroslak I, Scheffel J, Altrichter S, Woetmann A, Costa C, Maurer M. Autologous serum skin test reactions in chronic spontaneous urticaria differ from heterologous cell reactions. J Eur Acad Dermatol Venereol 2021; 35:1338-1345. [DOI: 10.1111/jdv.17131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/08/2021] [Indexed: 12/25/2022]
Affiliation(s)
- K. Baumann
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
- RefLab ApS Copenhagen Denmark
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology University of Copenhagen Copenhagen Denmark
| | - J. Marcelino
- Immunoallergology Department, Hospital Santa Maria Centro Hospitalar Universitário Lisboa Norte E.P.E Lisbon Portugal
| | - P.S. Skov
- RefLab ApS Copenhagen Denmark
- Odense Research Center for Anaphylaxis (ORCA), Urticaria Center of Reference and Excellence (UCARE) Odense University Hospital Odense Denmark
| | - M.C.P. Santos
- Laboratory of Clinical Immunology Faculdade de Medicina, Instituto de Medicina Molecular Universidade de Lisboa Lisbon Portugal
| | - I. Wyroslak
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - J. Scheffel
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - S. Altrichter
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - A. Woetmann
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology University of Copenhagen Copenhagen Denmark
| | - C. Costa
- Immunoallergology Department, Hospital Santa Maria Centro Hospitalar Universitário Lisboa Norte E.P.E Lisbon Portugal
| | - M. Maurer
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
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Brzoza Z, Rymarczyk B, Grzeszczak W, Trautsolt W, Pluta-Kubicz M, Moczulski D. Interleukin 1 Gene Polymorphisms Presumably Participate in the Pathogenesis of Chronic Spontaneous Autoreactive Urticaria. J Interferon Cytokine Res 2020; 40:497-500. [PMID: 33064598 DOI: 10.1089/jir.2020.0103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Recent studies underline a potential role of autoimmune and genetic disturbances in this disorder pathogenesis. Variants in genes related to inflammatory processes may possibly predispose to chronic spontaneous urticaria (CSU) occurrence. The objective of this study was to search for an association of Il1 genes polymorphisms with the pathogenesis of CSU. The examined group consisted of 153 unrelated chronic spontaneous autoreactive urticaria patients. The control group consisted of 104 unrelated healthy volunteers. In all studied subjects, IL1 rs1304037 and rs180058 polymorphisms were examined. The Urticaria Activity Score was used to assess disease intensity. The age of disease onset was also analyzed. Statistically significantly higher prevalence of Il1 rs1304037 TT genotype and T allele among CSU was proved. Similarly, the prevalence of Il1 rs1800587 GG genotype and G allele was statistically significantly higher in the CSU group. Haplotype combination rs1304037C/rs1800587G was statistically significantly more frequent in CSU, whereas rs1304037C/rs1800587A revealed statistically significantly less frequent occurrence in CSU. We did not observe any relationship between Il1 genotypes and the disease severity or age of disease onset. We are the first to suggest a significant role of IL1 gene polymorphisms in the susceptibility to CSU. This observation may lead to a better pathogenesis understanding and more effective treatment. We recommend further studies on other polymorphisms in chronic urticaria to analyze the role of the genetic mechanisms in the pathogenesis of this disorder.
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Affiliation(s)
- Zenon Brzoza
- Department of Internal Diseases and Allergology, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Barbara Rymarczyk
- Department of Internal Diseases, Allergology and Clinical Immunology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Wladyslaw Grzeszczak
- Department of Internal Diseases, Diabetology and Nephrology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Wanda Trautsolt
- Department of Internal Diseases, Diabetology and Nephrology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Marzena Pluta-Kubicz
- Department of Internal Diseases, Allergology and Clinical Immunology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Dariusz Moczulski
- Department of Internal Diseases and Nephrodiabetology, Medical University of Lodz, Lodz, Poland
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Akdag S, Ozmen S, Ercan N, Bostanci I, Neselioglu S. Assessment of thiol/disulphide homoeostasis and ischaemia-modified albumin and their relationship with disease severity in children with chronic urticaria. Cutan Ocul Toxicol 2020; 39:269-273. [PMID: 32613866 DOI: 10.1080/15569527.2020.1790589] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The pathogenesis chronic urticaria (CU) hasn't been fully understood. In recent years, it has been shown that thiol-disulphide homoeostasis, as an antioxidant system, plays important roles in both healthy individuals and various diseases. In different ischaemia-reperfusion states, high oxidative stress causes ischaemia-modified albumin (IMA) generation. AIM To investigate thiol/disulphide balance and IMA level in children with CU and their association with disease severity. METHODS Thirty children with CU and 20 healthy children as controls, aged 1-18 years, were included in this cross-sectional study. In all subjects, total thiol, native thiol, disulphide levels and IMA levels were measured in plasma by spectrophotometry. Disulphide/native thiol, disulphide/total thiol and native thiol/total thiol ratios were calculated. The disease severity was rated by Urticaria Activity Score (UAS). RESULTS In the children with CU, the levels of native thiol (375.56 ± 56.22 μmol/L) and total thiol (415.69 ± 54.75 μmol/L) were significantly lower than the control group (475.20 ± 71.87 and 511.20 ± 73.73 μmol/L, respectively) (p = 0.000, p = 0.000). The ratio of native/total thiol * 100 was lower in patients than the control group (p = 0.002). IMA was significantly higher in the patient group than control group (p = 0.000). No significant correlation was found between UAS and thiol/disulphide homoeostasis (p > 0.05). The disulphide levels, disulphide/native thiol and disulphide/total thiol levels were found to be higher in patients with positive family history for autoimmune disorders than those without (p < 0.05). CONCLUSION In children with CU, impaired thiol/disulphide homoeostasis and increased IMA suggest that oxidative stress may play role in the disease pathogenesis.
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Affiliation(s)
- Songul Akdag
- Pediatrics, Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Serap Ozmen
- Pediatric Allergy and Immunology, Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Nazli Ercan
- Pediatric Allergy and Immunology, Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ilknur Bostanci
- Pediatric Allergy and Immunology, Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Salim Neselioglu
- Department of Biochemistry, Yildirim Beyazit University, Faculty of Medicine, Ankara, Turkey
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11
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Ozceker D, Dilek F, Yucel E, Tamay Z, Ozkaya E, Guler N. Can allergy patch tests with food additives help to diagnose the cause in childhood chronic spontaneous urticaria? Postepy Dermatol Alergol 2020; 37:384-389. [PMID: 32792880 PMCID: PMC7394169 DOI: 10.5114/ada.2020.96909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/24/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Chronic spontaneous urticaria (CSU) is characterized by the onset of symptoms which are not induced by specific triggers, but are rather spontaneous. A considerable number of patients report that foods or food additives might be responsible for their chronic urticaria. AIM To determine the prevalence of sensitization to food additives in children with CSU using atopy patch tests (ATP). MATERIAL AND METHODS Atopy patch tests for 23 different food additives were applied to 120 children with CSU and 61 healthy controls. RESULTS Seventeen (14.1%) children with CSU were sensitized with food additives. None of the control group had positive APT. Azorubine and Cochineal red were the food additives detected with the highest sensitization rates (5.8% (n = 7) and 6.7% (n = 8), respectively). CONCLUSIONS There can be an association between food additives and CSU. APT tests may be a helpful tool in the assessment and management of CSU so that easier to follow diets and effective treatments can be offered to families.
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Affiliation(s)
- Deniz Ozceker
- Department of Paediatric Allergy and Immunology, Saglik Bilimleri University, Okmeydani Education and Research Hospital, Istanbul, Turkey
| | - Fatih Dilek
- Department of Paediatric Allergy and Immunology, Medical Faculty, Bezmi Alem University, Istanbul, Turkey
| | - Esra Yucel
- Department of Paediatric Allergy and Immunology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Zeynep Tamay
- Department of Paediatric Allergy and Immunology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Emin Ozkaya
- Department of Paediatric Allergy and Immunology, Medical Faculty, Bezmi Alem University, Istanbul, Turkey
| | - Nermin Guler
- Department of Paediatric Allergy and Immunology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
- Department of Paediatrics, Medical Faculty, Istanbul Bilim University, Istanbul, Turkey
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12
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Nettis E, Foti C, Ambrifi M, Baiardini I, Bianchi L, Borghi A, Caminati M, Canonica GW, Casciaro M, Colli L, Colombo G, Corazza M, Cristaudo A, De Feo G, De Pita’ O, Di Gioacchino M, Di Leo E, Fassio F, Gangemi S, Gatta A, Hansel K, Heffler E, Incorvaia C, Napolitano M, Patruno C, Peveri S, Pigatto PD, Quecchia C, Radice A, Ramirez GA, Romita P, Rongioletti F, Rossi O, Savi E, Senna G, Triggiani M, Zucca M, Maggi E, Stingeni L. Urticaria: recommendations from the Italian Society of Allergology, Asthma and Clinical Immunology and the Italian Society of Allergological, Occupational and Environmental Dermatology. Clin Mol Allergy 2020; 18:8. [PMID: 32390768 PMCID: PMC7201804 DOI: 10.1186/s12948-020-00123-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 04/25/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Urticaria is a disorder affecting skin and mucosal tissues characterized by the occurrence of wheals, angioedema or both, the latter defining the urticaria-angioedema syndrome. It is estimated that 12-22% of the general population has suffered at least one subtype of urticaria during life, but only a small percentage (estimated at 7.6-16%) has acute urticaria, because it is usually self-limited and resolves spontaneously without requiring medical attention. This makes likely that its incidence is underestimated. The epidemiological data currently available on chronic urticaria in many cases are deeply discordant and not univocal, but a recent Italian study, based on the consultation of a national registry, reports a prevalence of chronic spontaneous urticaria of 0.02% to 0.4% and an incidence of 0.1-1.5 cases/1000 inhabitants/year. METHODS We reviewed the recent international guidelines about urticaria and we described a methodologic approach based on classification, pathophysiology, impact on quality of life, diagnosis and prognosis, differential diagnosis and management of all the types of urticaria. CONCLUSIONS The aim of the present document from the Italian Society of Allergology, Asthma and Clinical Immunology (SIAAIC) and the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA) is to provide updated information to all physicians involved in diagnosis and management of urticaria and angioedema.
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Affiliation(s)
- Eustachio Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy
| | - Caterina Foti
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, Bari, Italy
| | - Marina Ambrifi
- San Gallicano Dermatological Institute -IRCCS, Rome, Italy
| | - Ilaria Baiardini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Leonardo Bianchi
- Section of Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Alessandro Borghi
- Section of Dermatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Marco Caminati
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas, Rozzano, Milan, Italy
| | - Marco Casciaro
- School and Division of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Laura Colli
- Department of Biomedical, Surgical and Dental Sciences, Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, University of Milan, Milan, Italy
| | - Giselda Colombo
- Unit of Immunology, Rheumatology Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Monica Corazza
- Section of Dermatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Giulia De Feo
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Ornella De Pita’
- Clinical Pathology and Immune Inflammatory Disease of the Skin, Cristo Re Hospital, Rome, Italy
| | - Mario Di Gioacchino
- Department of Medicine and Science on Ageing, School of Medicine, G. d’Annunzio University, Chieti-Pescara, Italy
| | - Elisabetta Di Leo
- Section of Allergy and Clinical Immunology, Unit of Internal Medicine, “F. Miulli” Hospital, Strada Provinciale per Santeramo Km 4.100, Acquaviva Delle Fonti (BA), Italy
| | - Filippo Fassio
- Allergy and Clinical Immunology Unit, Azienda USL Toscana Centro, Florence, Italy
| | - Sebastiano Gangemi
- School and Division of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alessia Gatta
- Department of Medicine and Science on Ageing, School of Medicine, G. d’Annunzio University, Chieti-Pescara, Italy
| | - Katharina Hansel
- Section of Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas, Rozzano, Milan, Italy
| | | | - Maddalena Napolitano
- Section of Dermatology, Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Silvia Peveri
- Allergy Department Unit, Piacenza Hospital, Piacenza, Italy
| | - Paolo Daniele Pigatto
- Department of Biomedical, Surgical and Dental Sciences, Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, University of Milan, Milan, Italy
| | - Cristina Quecchia
- Centro “Io e l’Asma”, Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy
| | - Anna Radice
- Immunoallergology Unit, Careggi University Hospital, Florence, Italy
| | - Giuseppe Alvise Ramirez
- Unit of Immunology, Rheumatology Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Romita
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, Bari, Italy
| | - Franco Rongioletti
- Dermatological Clinic/UC of Dermatology, Department of Medical Science and Public Health, AOU Cagliari, Cagliari, Italy
| | - Oliviero Rossi
- Immunoallergology Unit, Careggi University Hospital, Florence, Italy
| | - Eleonora Savi
- Allergy Department Unit, Piacenza Hospital, Piacenza, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Myriam Zucca
- Dermatological Clinic/UC of Dermatology, Department of Medical Science and Public Health, AOU Cagliari, Cagliari, Italy
| | - Enrico Maggi
- Department of Experimental and Clinical Medicine and Center of Excellence for Research, Transfer and High Education DENOTHE of the University of Florence, Florence, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
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Bhunia D, Saha P, Ranjan R, Kundu S, Datta P. Autologous serum skin test as an indicator of chronic urticaria in comparison with serum IgE level at a tertiary care center in North-Eastern India. JOURNAL OF CURRENT RESEARCH IN SCIENTIFIC MEDICINE 2020. [DOI: 10.4103/jcrsm.jcrsm_19_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rationale for the autologous serum skin test in acute versus chronic urticaria. Postepy Dermatol Alergol 2019; 36:703-706. [PMID: 31997998 PMCID: PMC6986284 DOI: 10.5114/ada.2019.91421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/11/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Autologous serum skin test (ASST) is a rapid, in-vivo clinical test to detect functional autoantibodies in patients with chronic spontaneous urticaria (CSU), but the rationale for its use in acute urticaria (AU) is unknown. Aim To evaluate the efficacy of ASST among patients with AU or CSU. Material and methods Treatment-naïve adult (age ≥ 18 years) patients with a diagnosis of AU (< 6 weeks’ duration) and CSU were enrolled prospectively in a cross-sectional study. Healthy age- and sex-matched subjects served as controls. Besides a detailed history and physical examination, ASST, total immunoglobulin E (IgE), freeT3 (fT3), freeT4 (fT4), anti-thyroglobulin, and anti-TPO levels were assessed in all subjects. Results Of 101 subjects, mean age was 34.35 ±12.68 years and the study comprised 58.4% of females with no difference between AU (n = 27), CSU (n = 46), and control groups (n = 28). The ratio of positivity in ASST was similar between AU (25.9%) and CSU groups (21.7%), but higher than in controls (10.7%, p = 0.33 for all). The ratio of patients with high total IgE levels (> 100 IU/ml) in AU (85.2%) and CSU (65.2%) groups was similar (p = 0.06), but significantly higher than in the control group (10.7%) (p< 0.001 and p< 0.001). The CSU group had significantly higher abnormal thyroid test results (45.7%) than AU (14.8%) and control groups (3.6%) (p = 0.01 and p< 0.001), whereas patients with clinically diagnosed thyroiditis were only in the CSU group (6.5%). In logistic regression analysis, there was no relation found among the possible risk factors for ASST, even if analysed separately as AU, CSU and control groups. Conclusions Even though thyroid function test levels were found to be related with CSU, and total IgE was associated with urticaria, ASST was found to be of importance. This study confirms that ASST was insufficient to demonstrate autoimmunity and acute-chronic urticaria nature. Further tests indicating auto-antibodies in AU and CSU are needed.
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Schoepke N, Asero R, Ellrich A, Ferrer M, Gimenez‐Arnau A, E. H. Grattan C, Jakob T, Konstantinou GN, Raap U, Skov PS, Staubach P, Kromminga A, Zhang K, Bindslev‐Jensen C, Daschner A, Kinaciyan T, Knol EF, Makris M, Marrouche N, Schmid‐Grendelmeier P, Sussman G, Toubi E, Church MK, Maurer M. Biomarkers and clinical characteristics of autoimmune chronic spontaneous urticaria: Results of the PURIST Study. Allergy 2019; 74:2427-2436. [PMID: 31228881 DOI: 10.1111/all.13949] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/23/2019] [Accepted: 04/30/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Autoimmune chronic spontaneous urticaria (aiCSU) is an important subtype of chronic spontaneous urticaria (CSU) in which functional IgG autoantibodies to IgE or its high-affinity receptor (FcεRI) induces mast cell degranulation and subsequent symptom development. However, it has not been tightly characterized. This study aimed to better define the clinical and immunological features and to explore potential biomarkers of aiCSU. METHODS This was a multinational, multicenter study of 182 CSU patients. The clinical features studied included: urticaria activity and impact (UAS7 and quality of life); autologous serum skin test (ASST); IgG anti-FcεRI and IgG anti-IgE; IgG-anti-thyroperoxidase (IgG anti-TPO); total serum IgE; and basophil reactivity (BASO) using the basophil activation test (BAT) and basophil histamine release assay (BHRA). RESULTS Of the 182 patients, 107 (59%) were ASST+, 46 (25%) were BASO+, and 105 (58%) were IgG anti-FcεRI+/IgE+. Fifteen patients (8%) fulfilled all three criteria of aiCSU. aiCSU patients appeared more severe (UAS7 21 vs 9 P < 0.016) but showed no other clinical or demographic differences from non-aiCSU patients. aiCSU patients also had markedly lower total IgE levels (P < 0.0001) and higher IgG anti-TPO levels (P < 0.001). Of biomarkers, positive BAT and BHRA tests were 69% and 88% predictive of aiCSU, respectively. CONCLUSIONS aiCSU is a relatively small but immunologically distinct subtype of CSU that cannot be identified by routine clinical parameters. Inclusion of BHRA or BAT in the diagnostic workup of CSU patients may aid identification of aiCSU patients, who may have a different prognosis and benefit from specific management.
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Affiliation(s)
- Nicole Schoepke
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - Riccardo Asero
- Department of Allergology Clinica San Carlo Paderno Dugnano (MI) Italy
| | - André Ellrich
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - Marta Ferrer
- Department of Allergy and Clinical Immunology, Clinica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), RETIC de Asma Reacciones adversas y Alérgicas (ARADYAL) Pamplona Spain
| | - Ana Gimenez‐Arnau
- Department of Dermatology Hospital del Mar, IMIM, Universitat Autònoma Barcelona Barcelona Spain
| | | | - Thilo Jakob
- Department of Dermatology and Allergology, University Medical Center Giessen and Marburg Justus‐Liebig University Gießen Gießen Germany
- Allergy Research Group, Medical Center University of Freiburg Freiburg Germany
| | - George N. Konstantinou
- Department of Allergy and Clinical Immunology 424 General Military Training Hospital Thessaloniki Greece
| | - Ulrike Raap
- Department of Human Medicine and Health Sciences, University Clinic of Dermatology and Allergy University of Oldenburg Oldenburg Germany
| | - Per Stahl Skov
- RefLab ApS Copenhagen Denmark
- Odense Research Center of Anaphylaxis, ORCA Odense Denmark
| | - Petra Staubach
- Department of Dermatology University Medical Center Mainz Mainz Germany
| | - Arno Kromminga
- Bioagilytix Europe GmbH Hamburg Germany
- Institute of Immunology University of Kiel Kiel Germany
| | - Ke Zhang
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics David Geffen School of Medicine at UCLA Los Angeles California USA
| | - Carsten Bindslev‐Jensen
- Department of Dermatology and Allergy Centre Odense University Hospital, University of Southern Denmark Odense Denmark
| | - Alvaro Daschner
- Servicio de Alergia Instituto de Investigación Sanitaria (IIS)‐ Hospital Universitario de la Princesa Madrid Spain
| | - Tamar Kinaciyan
- Department of Dermatology Medical University of Vienna Vienna Austria
| | - Edward F. Knol
- Departments of Immunology and Dermatology/Allergology University Medical Center Utrecht Utrecht The Netherlands
| | - Michael Makris
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School National and Kapodistrian University of AthensAttikon” University Hospital Athens Greece
| | - Nadine Marrouche
- Department of Dermatology Norfolk and Norwich University Hospital Norwich UK
| | - Peter Schmid‐Grendelmeier
- Allergy Unit, Department of Dermatology University Hospital Zürich Switzerland
- Christine Kühne Center for Allergy Research and Education CK‐CARE Davos Switzerland
| | - Gordon Sussman
- Division of Allergy and Clinical Immunology University of Toronto Toronto Ontario Canada
| | - Elias Toubi
- Faculty of Medicine, Bnai‐Zion Medical Center Technion Haifa Israel
| | - Martin K. Church
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - Marcus Maurer
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
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16
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Kolkhir P, Church MK, Altrichter S, Skov PS, Hawro T, Frischbutter S, Metz M, Maurer M. Eosinopenia, in Chronic Spontaneous Urticaria, Is Associated with High Disease Activity, Autoimmunity, and Poor Response to Treatment. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:318-325.e5. [PMID: 31472293 DOI: 10.1016/j.jaip.2019.08.025] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is characterized by the degranulation of skin mast cells and the influx of basophils and eosinophils to affected skin sites. Blood basopenia has been linked to severe antihistamine-resistant CSU and type IIb autoimmunity, whereas the role of eosinophils in CSU is largely unknown. OBJECTIVE To analyze data from 1613 patients with CSU from 2 centers to study the prevalence, role, and relevance of eosinopenia in CSU. METHODS Peripheral blood eosinophil and basophil counts were measured by automated hematology analyzers. Patient files were screened for clinical characteristics, results of laboratory tests, the autologous serum skin test, the serum-induced basophil histamine release assay, and response to second-generation H1-antihistamines and omalizumab. RESULTS Ten percent of patients with CSU had eosinopenia. Eosinopenia was associated with the female sex, high disease activity, autologous serum skin test and basophil histamine release assay positivity, low total IgE, and high levels of C-reactive protein and IgG-antithyroperoxidase (P ≤ .007). Nonresponders to second-generation H1-antihistamines or omalizumab had significantly lower eosinophils as compared with responders (P < .05 and P < .01, respectively). Blood eosinophil counts correlated with basophil counts (r = 0.396; P < .001), and 81% of patients with CSU with undetectable eosinophils had basopenia. The combination of eosinopenia and basopenia is a better predictor of nonresponse to second-generation H1-antihistamines than eosinopenia alone (odds ratio of 9.5 vs 4.8). CONCLUSIONS Eosinopenia in patients with CSU is associated with type IIb autoimmunity, high disease activity, and poor response to treatment. Eosinophils should be explored as biomarkers and investigated for their contribution to the pathogenesis of CSU.
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Affiliation(s)
- Pavel Kolkhir
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Division of Immune-Mediated Skin Diseases, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Martin K Church
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sabine Altrichter
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Per Stahl Skov
- Dermatological Department, University Hospital of Southern Denmark, Odense, Denmark; RefLab ApS, Copenhagen, Denmark
| | - Tomasz Hawro
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Stefan Frischbutter
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martin Metz
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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17
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Caffarelli C, Paravati F, El Hachem M, Duse M, Bergamini M, Simeone G, Barbagallo M, Bernardini R, Bottau P, Bugliaro F, Caimmi S, Chiera F, Crisafulli G, De Ranieri C, Di Mauro D, Diociaiuti A, Franceschini F, Gola M, Licari A, Liotti L, Mastrorilli C, Minasi D, Mori F, Neri I, Pantaleo A, Saretta F, Tesi CF, Corsello G, Marseglia GL, Villani A, Cardinale F. Management of chronic urticaria in children: a clinical guideline. Ital J Pediatr 2019; 45:101. [PMID: 31416456 PMCID: PMC6694633 DOI: 10.1186/s13052-019-0695-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/01/2019] [Indexed: 12/12/2022] Open
Abstract
The aim of this guidance is to provide recommendations to clinicians and other interested parties on chronic urticaria in children. The Italian Society for Pediatrics (SIP), the Italian Society for Allergy and Immunology (SIAIP), the Italian Society for Pediatric dermatology (SIDerP) convened a multidisciplinary panel that prepared clinical guidelines for diagnosis and management of chronic urticaria in childhood. Key questions on epidemiology, natural history, diagnosis, and management were developed. The literature was systematically searched and evaluated, recommendations were rated and algorithms for diagnosis and treatment were developed. The recommendations focus on identification of diseases and comorbidities, strategies to recognize triggering factors, improvement of treatment by individualized care.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Dipartimento Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Francesco Paravati
- Pediatric Unit, Maternal Infant Department, Azienda Sanitaria Provinciale Crotone, Crotone, Italy
| | - Maya El Hachem
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marzia Duse
- Department of Pediatrics, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Giovanni Simeone
- Primary care Pediatrician, Local Health Unit of Brindisi, Brindisi, Italy
| | - Massimo Barbagallo
- Pediatric Unit, Azienda di rilievo nazionale ARNAS "GARIBALDI", Catania, Italy
| | | | - Paolo Bottau
- Pediatric and Neonatology Unit, Imola Hospital, Imola, BO, Italy
| | - Filomena Bugliaro
- FEDERASMA e Allergie Onlus - Federazione Italiana Pazienti, Prato, Italy
| | - Silvia Caimmi
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Fernanda Chiera
- Pediatric Unit, Maternal Infant Department, Azienda Sanitaria Provinciale Crotone, Crotone, Italy
| | - Giuseppe Crisafulli
- UO Allergologia, Dipartimento di Pediatria, Università di Messina, Messina, Italy
| | | | - Dora Di Mauro
- Clinica Pediatrica, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andrea Diociaiuti
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Massimo Gola
- Allergological and Pediatric Dermatology Unit, AUTC and University of Florence, Florence, Italy
| | - Amelia Licari
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Lucia Liotti
- Department of Pediatrics, Senigallia Hospital, Senigallia, Italy
| | - Carla Mastrorilli
- Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - Domenico Minasi
- UOC di Pediatria Azienda Ospedaliera "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Francesca Mori
- Allergy Unit, Department of Pediatric Medicine, Anna Meyer Children's University Hospital, Florence, Italy
| | - Iria Neri
- Dermatology Unit, University of Bologna, Bologna, Italy
| | - Aurelia Pantaleo
- Clinica Pediatrica, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Francesca Saretta
- Pediatric Department, AAS2 Bassa Friulana-Isontina, Palmanova-Latisana, Italy.,Pediatric Allergy Unit, Department of Medicine, Udine, Italy
| | - Carlo Filippo Tesi
- FEDERASMA e Allergie Onlus - Federazione Italiana Pazienti, Prato, Italy
| | - Giovanni Corsello
- Clinica Pediatrica Università degli Studi di Palermo, Palermo, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alberto Villani
- UOC di Pediatria Generale e Malattie Infettive, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Fabio Cardinale
- Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy.
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18
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Doña I, Jurado‐Escobar R, Perkins JR, Ayuso P, Plaza‐Serón MC, Pérez‐Sánchez N, Campo P, Bogas‐Herrera G, Bartra J, Torres MJ, Sanak M, Cornejo‐García JA. Eicosanoid mediator profiles in different phenotypes of nonsteroidal anti-inflammatory drug-induced urticaria. Allergy 2019; 74:1135-1144. [PMID: 30667070 DOI: 10.1111/all.13725] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/26/2018] [Accepted: 12/28/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND The role of arachidonic acid metabolites in NSAID-induced hypersensitivity has been studied in depth for NSAID-exacerbated respiratory disease (NERD) and NSAID-exacerbated cutaneous disease (NECD). However, no information is available for NSAID-induced urticarial/angioedema (NIUA), despite it being the most frequent clinical entity induced by NSAID hypersensitivity. We evaluated changes in leukotriene and prostaglandin metabolites for NIUA patients, using patients with NECD and single-NSAID-induced urticaria/angioedema or anaphylaxis (SNIUAA) for comparison. METHODS Urine samples were taken from patients with confirmed NSAID-induced urticaria and healthy controls, at baseline and at various time intervals after ASA administration. Eicosanoid measurement was performed using high-performance liquid chromatography-tandem mass spectrometry and gas chromatography-mass spectrometry. RESULTS No differences were found between groups at baseline. Following ASA administration, LTE4 and 9α,11β-PGF2 levels were increased in both NIUA and NECD patients compared to baseline, rising initially, before decreasing toward initial levels. In addition, the levels of these metabolites were higher in NIUA and NECD when compared with the SNIUAA and control groups after ASA administration. No changes were found with respect to baseline values for SNIUAA and control groups. CONCLUSIONS We present for the first time data regarding the role of COX-1 inhibition in NIUA. Patients with this entity show a similar pattern eicosanoid levels following ASA challenge to those with NECD. Further studies will help ascertain the cell populations involved and the underlying molecular mechanisms.
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Affiliation(s)
- Inmaculada Doña
- Allergy Unit IBIMA Regional University Hospital of Malaga UMA Malaga Spain
- ARADyAL Network RD16/0006/0001 Carlos III Health Institute Madrid Spain
| | | | - James R. Perkins
- Research Laboratory IBIMA Regional University Hospital of Malaga UMA Malaga Spain
| | - Pedro Ayuso
- Research Laboratory IBIMA Regional University Hospital of Malaga UMA Malaga Spain
| | | | | | - Paloma Campo
- Allergy Unit IBIMA Regional University Hospital of Malaga UMA Malaga Spain
- ARADyAL Network RD16/0006/0001 Carlos III Health Institute Madrid Spain
| | | | - Joan Bartra
- ARADyAL Network RD16/0006/0007 Carlos III Health Institute Madrid Spain
- Unitat d′Allergia Servei de Pneumologia Hospital Clinic Universitat de Barcelona Barcelona Spain
- Institut d′Investigacions Biomediques August Pi I Sunyer (IDIBAPS) Barcelona Spain
| | - María José Torres
- Allergy Unit IBIMA Regional University Hospital of Malaga UMA Malaga Spain
- ARADyAL Network RD16/0006/0001 Carlos III Health Institute Madrid Spain
| | - Marek Sanak
- Department of Medicine Jagiellonian University Medical College Krakow Poland
| | - José Antonio Cornejo‐García
- ARADyAL Network RD16/0006/0001 Carlos III Health Institute Madrid Spain
- Research Laboratory IBIMA Regional University Hospital of Malaga UMA Malaga Spain
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Filiz S, Kutluk MG, Uygun DFK. Headache deteriorates the quality of life in children with chronic spontaneous urticaria. Allergol Immunopathol (Madr) 2019; 47:254-259. [PMID: 30686612 DOI: 10.1016/j.aller.2018.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 09/18/2018] [Accepted: 09/20/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Quality of life, which is impaired in patients with chronic spontaneous urticaria (CSU), is influenced by comorbid mental disorders. Headaches could be another comorbid mental disorder that affects quality of life in children with CSU. OBJECTIVES To investigate the effect of headaches on urticaria symptoms, disease activity and quality of life in children with CSU. METHODS A total of 83 patients with CSU were enrolled in the study and were separated into two groups as those with or without headache. Demographic and clinical characteristics were studied with the Urticaria Activity Score (UAS7), Urticaria Control test (UCT) and Chronic Urticaria Quality of Life Questionnaire (CU-Q2QoL). The headache questionnaire designed according to the Department of International Classification of Headache Disorders, second edition (ICHD-II) was used and VAS (Visual Analogue Scale) and NRS (Numerical Rating Scale) were used to assess the pain measurement. In patients diagnosed with migraine, the paediatric Migraine Disability Assessment Scale (PedMIDAS) was applied. RESULTS CU-QoL total scores were significantly higher in patients with CSU with headache than in those without headache (p=0.015). In the five domains of CU-QoL, impact of daily life activities domain and sleep problems domain had higher scores in CSU with headache (p=0.008, 0.028, respectively). There was no significant relationship between UCT, UAS and CU-QoL and headache severity (p<0.05). No differences were found between the groups in respect of duration of urticaria, UAS7 and UCT. CONCLUSION Headache may be an important factor that affects and impairs quality of life in children with chronic urticaria.
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Affiliation(s)
- S Filiz
- Training and Research Hospital, Department of Pediatric Allergy and Immunology, Antalya, Turkey.
| | - M G Kutluk
- Training and Research Hospital, Department of Pediatric Neurology, Antalya, Turkey
| | - D F K Uygun
- Akdeniz University, Department of Pediatric Allergy and Immunolgy, Antalya, Turkey
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Niu XL, Zhu LL, Shi MH, Zhang YJ, Gao XH, Qi RQ. 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. Exp Ther Med 2019; 17:2603-2613. [PMID: 30906452 PMCID: PMC6425266 DOI: 10.3892/etm.2019.7266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 10/03/2018] [Indexed: 01/25/2023] Open
Abstract
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.
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Affiliation(s)
- Xue Li Niu
- Department of Dermatology, No. 1 Hospital of China Medical University and Key Laboratory of Immunodermatology, Ministry of Health and Ministry of Education, Shenyang, Liaoning 110001, P.R. China
| | - Li Li Zhu
- Department of Dermatology, The People's Hospital of Liaoning Province, Shenyang, Liaoning 110016, P.R. China
| | - Mei Hui Shi
- Department of Dermatology, No. 1 Hospital of China Medical University and Key Laboratory of Immunodermatology, Ministry of Health and Ministry of Education, Shenyang, Liaoning 110001, P.R. China
| | - Yu Jing Zhang
- Department of Dermatology, No. 1 Hospital of China Medical University and Key Laboratory of Immunodermatology, Ministry of Health and Ministry of Education, Shenyang, Liaoning 110001, P.R. China
| | - Xing Hua Gao
- Department of Dermatology, No. 1 Hospital of China Medical University and Key Laboratory of Immunodermatology, Ministry of Health and Ministry of Education, Shenyang, Liaoning 110001, P.R. China
| | - Rui Qun Qi
- Department of Dermatology, No. 1 Hospital of China Medical University and Key Laboratory of Immunodermatology, Ministry of Health and Ministry of Education, Shenyang, Liaoning 110001, P.R. China
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D'Auria E, De Amici M, Licari A, Caimmi S, Mantegazza C, Zuccotti G, Marseglia G. Basophil activation test in children with autoimmune chronic spontaneous urticaria: Is it ready for clinical practice? Immunobiology 2019; 224:30-33. [DOI: 10.1016/j.imbio.2018.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 11/04/2018] [Accepted: 11/04/2018] [Indexed: 01/18/2023]
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Cao Y, Xu S, Kong W, Cai H, Xu Y. Identification and validation of differentially expressed proteins in serum of CSU patients with different duration of wheals using an iTRAQ labeling, 2D-LC-MS/MS. Exp Ther Med 2018; 16:4527-4536. [PMID: 30542401 PMCID: PMC6257644 DOI: 10.3892/etm.2018.6818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 09/14/2018] [Indexed: 11/28/2022] Open
Abstract
Chronic spontaneous urticaria (CSU) is one of the most common types of chronic urticaria (CU), with symptoms that recur easily, migrate and are refractory. It is unclear whether association between the differentiation of protein expression levels in the serum of CSU patients and the different duration of wheals exists. In the present study the samples were divided according to the duration of the wheals into group A (wheal duration <2 h) and group B (wheal duration 12–24 h). Differentially expressed proteins in sera of CSU patients with different durations of wheals were identified and validated with isobaric tags for relative and absolute quantitation (iTRAQ) in combination with two-dimensional liquid chromatography/tandem mass spectrometry (2D-LC-MS/MS). Three hundred and seventy CSU serum-related proteins were initially identified. Among these proteins, ~30 had significant differences between the groups. According to the classification of biological functions and upregulated/downregulated values, serum amyloid A (SAA), CFL1, TPM4 and monocyte differentiation antigen (CD14) were chosen and validated by enzyme-linked immunosorbent assay (ELISA). The expression levels of CD14 in sera were not significantly different among the groups. SAA, CFL1 and TPM4 were associated with the wheal duration in CSU patients and therefore could be considered as new potential inflammatory biomarkers associated with CSU.
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Affiliation(s)
- Yanyun Cao
- Department of Dermatology, Pudong New Area People's Hospital, Shanghai 201299, P.R. China
| | - Shunming Xu
- Department of Dermatology, Pudong New Area People's Hospital, Shanghai 201299, P.R. China
| | - Wei Kong
- Department of Dermatology, Pudong New Area People's Hospital, Shanghai 201299, P.R. China
| | - Haibin Cai
- Department of Dermatology, Pudong New Area People's Hospital, Shanghai 201299, P.R. China
| | - Yang Xu
- Department of Dermatology, Pudong New Area People's Hospital, Shanghai 201299, P.R. China
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Acute-phase response and its biomarkers in acute and chronic urticaria. Postepy Dermatol Alergol 2018; 35:400-407. [PMID: 30206455 PMCID: PMC6130146 DOI: 10.5114/ada.2018.77672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 07/12/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Since urticaria is a persisting inflammatory disease it is important to establish the prognostic factors for the duration and severity of the disease. Aim To evaluate serum concentrations of selected acute-phase proteins (APP) in patients with various forms of urticaria as compared to healthy volunteers and also to analyze these concentrations in different types of urticaria. Additionally, to evaluate the correlation between serum levels of selected APP and disease activity. Material and methods Serum concentrations of C-reactive protein (CRP), α1-acid glycoprotein (AGP), α1-antichymotrypsin (ACT), α1-antitrypsin (AT), ceruloplasmin (Cp), transferrin (Tf), α2-macroglobulin (α2M) and haptoglobin (Hp) were measured. Quantitative measurement was conducted using the rocket immunoelectrophoresis. Disease activity was assessed with the use of total symptom score. Results Analysis of serum APP concentrations revealed statistically higher serum concentrations of CRP, AGP and ACT in the entire group of patients with urticaria in comparison with the control group. In the entire group of patients with urticaria, CRP, AGP, ACT, Cp and Hp correlated positively with disease activity, intensity of pruritus and the number and size of urticarial wheals. Statistically lower serum concentrations of CRP, ACT, Cp and Hp were detected in the group of patients with acute urticaria (AU) and angioedema together, compared to the patients suffering from AU only. Conclusions Patients with symptoms of various forms of urticaria present a distinct profile of serum APP concentrations. A significant correlation observed between CRP, AGP, ACT, Cp, Hp and clinical activity score points to the potential role of APP as markers of the urticarial activity.
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Baioumy SA, Esawy MM, Shabana MA. Assessment of circulating FCεRIa in Chronic Spontaneous Urticaria patients and its correlation with clinical and immunological variables. Immunobiology 2018; 223:807-811. [PMID: 30144948 DOI: 10.1016/j.imbio.2018.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/14/2018] [Accepted: 08/19/2018] [Indexed: 11/30/2022]
Abstract
Chronic spontaneous urticaria (CSU) is a chronic type characterized by episodes of wheals with or without angioedema. Autoantibody against the alpha subunit of Fc epsilon receptor (FcεRIa) was detected in CSU patients' sera. The study aims to evaluate the clinical utility of skin tests in CSU patients. In addition, it assesses the presence of circulating FcεRIa in CSU patients and their correlation with other clinical and immunological variables. The study includes 40 healthy controls and 40 CSU patients who had urticaria symptoms for at least 8 weeks. All subjects underwent the following tests: autologous serum skin test (ASST), autologous plasma skin test (APST), immunoglobulin E (IgE), antinuclear antibodies (ANA), antithyroid antibodies (ATA). An in-house enzyme-linked immunosorbent assay was used for FcεRIa detection. The prevalence of ANA and ATA in CSU was 7.5% and 20% respectively. Total IgE was significantly higher in CSU than in controls (p < 0.0001). The study detected circulating antibody to FcεRIα in 2.5% of controls and 52.5% of CSU patients (p < 0.0001). The prevalence of antibody to FcεRIa was 27.3% and 83.3% of ASST negative and positive patients respectively (p = 0.0004). But the prevalence was 17.6% and 78.3% of APST negative and positive patients respectively (p = 0.0002). In conclusion, Circulating antibody to FcεRIa has a role in the pathogenic mechanisms of CSU.
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Affiliation(s)
- Shereen A Baioumy
- Department of Microbiology and Immunology, Faculty of Human Medicine, Zagazig University, Egypt
| | - Marwa M Esawy
- Department of Clinical Pathology, Faculty of Human Medicine, Zagazig University, Egypt.
| | - Marwa A Shabana
- Department of Clinical Pathology, Faculty of Human Medicine, Zagazig University, Egypt
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Altrichter S, Hawro T, Liedtke M, Holtappels G, Bachert C, Skov PS, Maurer M. In chronic spontaneous urticaria, IgE against staphylococcal enterotoxins is common and functional. Allergy 2018; 73:1497-1504. [PMID: 29315616 DOI: 10.1111/all.13381] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is a frequent disorder with recurrent itchy wheals and/or angioedema. Despite the known effectiveness of omalizumab therapy, the relevant IgE antigens are largely unknown. Recently, increased rates of elevated levels of IgE towards Staphylococcus aureus enterotoxins (SEs) were described in CSU. AIM To assess the prevalence and functional relevance of IgE to SEs in CSU. METHOD We investigated serum levels of IgE against SEs in 49 CSU patients and in 15 CSU patients additional specific IgE to SE components and basophil histamine release (BHR). Sera of 15 healthy controls (HCs) served as control group. RESULTS Twenty-five (51%) of the CSU patients had detectable levels of SE-IgE as compared to 5 (33%) of HCs. Specific IgE to one of the SEs, Staphylococcus enterotoxin B (SEB), was present in 5 (33%) of 15 randomly selected CSU patients vs 3 (20%) of HC. Total IgE serum levels in CSU patients were significantly correlated with SE-IgE (r = .52, P < .001) and SEB-IgE (r = .54, P = .04) serum concentrations. Interestingly, SEB-IgE levels were strongly correlated with disease activity (UASday) in CSU patients (r = .657, P = .01). Furthermore, BHR in response to SEB was significantly higher in basophils loaded with the serum of CSU patients compared to HC (P < .05) and was clinically correlated with duration of disease (r > .51, P < .05). DISCUSSION IgE against SEs may contribute to the pathogenesis of CSU in a subpopulation of patients. Its role and relevance in the pathophysiology of CSU need to be further analysed.
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Affiliation(s)
- S. Altrichter
- Department of Dermatology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - T. Hawro
- Department of Dermatology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - M. Liedtke
- Department of Dermatology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - G. Holtappels
- Upper Airways Research Laboratory; Department of Oto-Rhino-Laryngology; Ghent University Hospital; Ghent Belgium
| | - C. Bachert
- Upper Airways Research Laboratory; Department of Oto-Rhino-Laryngology; Ghent University Hospital; Ghent Belgium
| | | | - M. Maurer
- Department of Dermatology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
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Abstract
Chronic spontaneous urticaria (CSU) is a common skin disease characterised by intermittent weals (hives), angioedema or both lasting for at least 6 weeks.1-3 Second-generation antihistamines are widely used to manage symptoms but are not completely effective in many patients at licensed doses.4 Some guidelines recommend off-label use of high-dose antihistamines as the next therapeutic step.2,3 Here, we review the evidence supporting this recommendation.
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Syrigos N, Grapsa D, Zande M, Tziotou M, Syrigou E. Treatment response to omalizumab in patients with refractory chronic spontaneous urticaria. Int J Dermatol 2018; 57:417-422. [PMID: 29399789 DOI: 10.1111/ijd.13935] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/31/2017] [Accepted: 01/09/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous clinical trials have demonstrated the efficacy and safety of the anti-IgE monoclonal antibody omalizumab in chronic spontaneous urticaria (CSU) not responding to antihistamine treatment. The primary aim of our study was to describe the response patterns of patients with refractory CSU treated with omalizumab in a real-world clinical setting. METHODS A retrospective analysis of medical records of 20 patients with refractory CSU was performed. Demographic, clinical, and laboratory features were retrieved and analyzed in correlation with treatment data. RESULTS Mean age of our patient population was 54.5 years, while the majority were females (15/20 cases, 75%). Mean disease duration prior to omalizumab administration was 21.8 months. All patients had a history of chronic urticaria, refractory to high antihistamine and corticosteroid treatment, and responded favorably to omalizumab after administration of 1-5 doses of omalizumab; complete response was observed in 17/20 patients (85%) and well-controlled disease in the remaining 3/20 patients (15%). In a subset of cases (6/20, 30%), best response to omalizumab was achieved after interval administration of a 9-day course of methylprednisolone (total dose of 188 mg). Late response to omalizumab (after three-month treatment) was significantly correlated (P = 0.026) with shorter disease duration before initiation of omalizumab. CONCLUSION In the present series, omalizumab, either alone or in combination with a short-term course of corticosteroids, was highly effective in resolution of refractory CSU. Furthermore, disease duration prior to omalizumab had a significant effect on timing of response.
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Affiliation(s)
| | - Dimitra Grapsa
- 3rd Department of Medicine, University of Athens, School of Medicine, Athens, Greece
| | - Maria Zande
- Allergy Department, "Sotiria" General Hospital, Athens, Greece
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Dar SA, Rai G, Ansari MA, Akhter N, Gupta N, Sharma S, Haque S, Ramachandran VG, Wahid M, Rudramurthy SM, Chakrabarti A, Das S. FcɛR1α gene polymorphism shows association with high IgE and anti‐FcɛR1α in Chronic Rhinosinusitis with Nasal Polyposis. J Cell Biochem 2018; 119:4142-4149. [DOI: 10.1002/jcb.26619] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/12/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Sajad A. Dar
- Department of MicrobiologyUniversity College of Medical Sciences (University of Delhi) & Guru Teg Bahadur HospitalDelhiIndia
- Research and Scientific Studies UnitCollege of Nursing & Allied Health SciencesUniversity of JazanJazanSaudi Arabia
| | - Gargi Rai
- Department of MicrobiologyUniversity College of Medical Sciences (University of Delhi) & Guru Teg Bahadur HospitalDelhiIndia
| | - Mohammad A. Ansari
- Department of MicrobiologyUniversity College of Medical Sciences (University of Delhi) & Guru Teg Bahadur HospitalDelhiIndia
| | - Naseem Akhter
- Department of Laboratory MedicineFaculty of Applied Medical SciencesAlbaha UniversityAlbahaSaudi Arabia
| | - Neelima Gupta
- Department of OtorhinolaryngologyUniversity College of Medical Sciences (University of Delhi) & Guru Teg Bahadur HospitalDelhiIndia
| | - Sonal Sharma
- Department of PathologyUniversity College of Medical Sciences (University of Delhi) & Guru Teg Bahadur HospitalDelhiIndia
| | - Shafiul Haque
- Research and Scientific Studies UnitCollege of Nursing & Allied Health SciencesUniversity of JazanJazanSaudi Arabia
- Department of BiosciencesFaculty of Natural SciencesJamia Millia Islamia (A Central University)New DelhiIndia
| | - Vishnampettai G. Ramachandran
- Department of MicrobiologyUniversity College of Medical Sciences (University of Delhi) & Guru Teg Bahadur HospitalDelhiIndia
| | - Mohd Wahid
- Research and Scientific Studies UnitCollege of Nursing & Allied Health SciencesUniversity of JazanJazanSaudi Arabia
- Department of BiosciencesFaculty of Natural SciencesJamia Millia Islamia (A Central University)New DelhiIndia
| | - Shivprakash M. Rudramurthy
- Department of Medical MicrobiologyPost Graduate Institute of Medical Education & ResearchChandigarhIndia
| | - Arunaloke Chakrabarti
- Department of Medical MicrobiologyPost Graduate Institute of Medical Education & ResearchChandigarhIndia
| | - Shukla Das
- Department of MicrobiologyUniversity College of Medical Sciences (University of Delhi) & Guru Teg Bahadur HospitalDelhiIndia
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Vas K, Altmayer A, Mihályi L, Garaczi E, Kinyó Á, Jakobicz E, Husz S, Kemény L, Bata-Csörgő Z. Successful Treatment of Autoimmune Urticaria with Low-Dose Prednisolone Therapy Administered for a Few Months: A Case Series of 42 Patients. Dermatology 2018; 233:419-424. [PMID: 29339636 DOI: 10.1159/000484085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/25/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is defined as symptoms of urticaria persisting for 6 weeks or more without obvious cause. Autologous serum skin test (ASST) positivity in patients with CSU is considered to be associated with autoimmune urticaria (AIU). METHODS In this retrospective study we retrieved the medical records of 1,073 urticaria patients seen at the Department of Dermatology and Allergology of Szeged University between January 2005 and February 2014. Forty-two patients (36 female and 6 male) met the study criteria by having CSU and giving positive results in the ASST. Our aim was to assess the clinical efficacy and safety of low-dose oral prednisolone therapy administered to patients with antihistamine-refractory ASST-positive CSU for a few months. Patients were given an initial dose (40 mg/day) of prednisolone until the complete resolution of the symptoms, usually 7-10 days, and then the dose was gradually decreased, as in other autoimmune diseases. RESULTS Prednisolone therapy lasted for an average of 3.6 months and a complete long-lasting response was achieved in 35 of 42 AIU patients (83.3%). The follow-up period was at least 36 months (3 years) for each AIU patient; the longest follow-up time was 139 months (11.5 years). None of the patients reported any considerable side effects. CONCLUSION Based on our results, we suggest that the use of this treatment could be an alternative for the treatment of AIU. Our present results also highlight the need for other therapies in a small percentage of AIU patients. Our results suggest that AIU represents a transient autoimmunity that can be successfully treated with low-dose steroid therapy administered for a few months.
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Affiliation(s)
- Krisztina Vas
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
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Cherrez Ojeda I, Vanegas E, Felix M, Mata V, Cherrez S, Simancas-Racines D, Greiding L, Cano J, Cherrez A, Calderon JC. Etiology of chronic urticaria: the Ecuadorian experience. World Allergy Organ J 2018; 11:1. [PMID: 29308115 PMCID: PMC5753451 DOI: 10.1186/s40413-017-0181-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 12/07/2017] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- I Cherrez Ojeda
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Código postal: 0901-952 Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - E Vanegas
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Código postal: 0901-952 Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - M Felix
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - V Mata
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - S Cherrez
- School of Medicine, University of Heidelberg, Heidelberg, Germany
| | - D Simancas-Racines
- Centro de Investigación en Salud Pública y Epidemiología Clínica. Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito, Ecuador
| | - L Greiding
- Instituto Argentino de Alergia e Inmunología, Buenos Aires, Argentina
| | - J Cano
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Código postal: 0901-952 Samborondón, Ecuador
| | - A Cherrez
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador.,University Hospital, Dermatology Department, Rostock, Germany
| | - Juan Carlos Calderon
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Código postal: 0901-952 Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
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Kasperska-Zając A, Damasiewicz-Bodzek A, Bieniek K, Skrzypulec-Frankel A, Tyrpien-Golder K, Grzanka A. Elevated circulating heat shock protein 70 and its antibody concentrations in chronic spontaneous urticaria. Int J Immunopathol Pharmacol 2017; 31:394632017750440. [PMID: 29268639 PMCID: PMC5849219 DOI: 10.1177/0394632017750440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Heat shock proteins (Hsp) play a complex role in cytoprotection, inflammation,
and function of the immune system. They may be involved in pathogenesis of
various diseases. Our aim was to determine circulating Hsp70 and anti-Hsp70
antibodies concentrations in patients with chronic spontaneous urticaria (CSU).
Concentrations of Hsp70 in plasma and anti-Hsp70 antibodies in serum as well as
serum C-reactive protein (CRP) were measured in CSU patients and in the
controls. Plasma Hsp70 concentrations were significantly higher in CSU (all) and
mild CSU patients as compared with the controls. Moderate–severe CSU patients
tended to show higher Hsp70 concentration as compared with the controls, but not
with mild activity of the disease. There were no significant differences in
Hsp70 concentration between moderate–severe and mild CSU patients. Serum
anti-Hsp70 antibodies concentrations were significantly higher in CSU (all) and
mild CSU in comparison to the controls. Association was observed between
anti-Hsp70 antibodies and increased CRP concentration; however, no correlation
between anti-Hsp70 and Hsp70 concentrations was seen in the patients. It seems
that up-regulation of Hsp70 in CSU may induce marked increase in anti-Hsp70
antibodies production, which are accompanied by parallel changes in CRP
concentration. We suggest that Hsp may be released in CSU in response to
stressful stimuli, such as inflammation.
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Affiliation(s)
- Alicja Kasperska-Zając
- 1 Department of Internal Diseases, Dermatology and Allergology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland.,2 European Center for Diagnosis and Treatment of Urticaria, Zabrze, Poland
| | - Aleksandra Damasiewicz-Bodzek
- 3 Department of Chemistry, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Bieniek
- 1 Department of Internal Diseases, Dermatology and Allergology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland.,2 European Center for Diagnosis and Treatment of Urticaria, Zabrze, Poland
| | - Agnieszka Skrzypulec-Frankel
- 1 Department of Internal Diseases, Dermatology and Allergology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland.,2 European Center for Diagnosis and Treatment of Urticaria, Zabrze, Poland
| | - Krystyna Tyrpien-Golder
- 3 Department of Chemistry, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Alicja Grzanka
- 1 Department of Internal Diseases, Dermatology and Allergology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland.,2 European Center for Diagnosis and Treatment of Urticaria, Zabrze, Poland
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Ulambayar B, Chen YH, Ban GY, Lee JH, Jung CG, Yang EM, Park HS, Ye YM. Detection of circulating IgG autoantibody to FcεRIα in sera from chronic spontaneous urticaria patients. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 53:141-147. [PMID: 29169972 DOI: 10.1016/j.jmii.2017.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 09/27/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUNDS Chronic spontaneous urticaria (CSU) is a common skin disorder characterized by itchy wheals of at least 6 weeks in duration, wherein the autoimmune mechanism is involved to activate IgE receptors (FcεRIα) on mast cells. We aimed to assess levels of IgG autoantibody against FcεRIα in sera from CSU patients using dot-blot immunoassay. METHODS We performed a hospital-based cross-sectional study of 125 CSU patients (64 ASST-positive, 61 ASST-negative) and 64 age-and sex-matched healthy controls. The cut-off value of IgG FcεRIα autoantibody was determined as the mean intensity plus two standard deviations of values in controls. Positivity for IgG autoantibody to FcεRIα was analyzed according to clinical parameters of disease duration, urticaria activity score (UAS), ASST, response to antihistamine treatment, complement levels, and the presence of other autoantibodies. Nonparametric tests were applied for statistical analyses. RESULTS IgG positivity to FcεRIα was noted in 24.8% of CSU patients and was significantly more frequent in ASST-positive patients than in ASST-negative patients (32.8% vs 16.4%, P = 0.040). Only 3.1% of healthy controls had this autoantibody. Complement 3 levels were significantly lower in anti-FcεRIα antibody-positive patients than antibody-negative patients (109.8 ± 19.9 vs 123.1 ± 30.9, P = 0.035). No significant associations were found between IgG positivity to FcεRIα and UAS, serum total IgE levels, atopic status, clinical responses to antihistamines, or the presence of anti-thyroid and anti-nuclear antibodies. CONCLUSION These findings suggest that circulating IgG autoantibody to FcεRIα in a subset of patients may be involved in the autoimmune mechanism of CSU. Further studies are needed to clarify its clinical significance.
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Affiliation(s)
- Bastsetseg Ulambayar
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ga-Young Ban
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - Ji-Ho Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - Chang-Gyu Jung
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - Eun-Mi Yang
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - Young-Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea.
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Involvement of new oxidative stress markers in chronic spontaneous urticaria. Postepy Dermatol Alergol 2017; 34:448-452. [PMID: 29507559 PMCID: PMC5831279 DOI: 10.5114/ada.2017.71110] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/29/2016] [Indexed: 12/16/2022] Open
Abstract
Introduction Oxidative stress is a result of an imbalance between endogenous production of free reactive oxygen species and reduced effectiveness of antioxidant defence mechanisms. Advanced glycation end products (AGEs) and advanced oxidation protein products (AOPPs) are compounds formed by transformation of macromolecules, including proteins which can serve as markers of oxidative stress and inflammation in several diseases. Aim To investigate the role of AGEs and AOPPs as new markers of oxidative stress and inflammation in patients with chronic spontaneous urticaria (CSU). Material and methods Advanced glycation end products and AOPP levels were determined in the sera of 85 patients with CSU and 64 healthy controls, using spectrofluorimetry and spectrophotometry, respectively. Results Advanced oxidation protein products levels in patients were statistically higher than those in controls. These levels were not affected by the presence of positive autologous serum test results or autologous plasma test results. No statistically significant differences were found between AGE levels in patients and controls. Conclusions Formation of AGEs and AOPPs may be accelerated in immunological and allergic disorders. Depending on the sites evaluated, the presence or absence of oxidative stress in chronic urticaria is controversial. To our knowledge, this is the first study showing the possible involvement of AOPPs in CSU. The different behaviour observed for these two biomarkers is very likely due to the activation of specific related biochemical pathways associated with the condition under study.
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Hajdu K, Irinyi B, Gyimesi E, Kapitány A, Dajnoki Z, Bata‐Csörgő Z, Kinyó Á, Kiss F, Gáspár K, Szegedi A. A simple, combined test can improve the diagnosis of autoimmune urticaria. Br J Dermatol 2017; 177:864-866. [DOI: 10.1111/bjd.15175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- K. Hajdu
- Division of Dermatological Allergology Faculty of Medicine University of Debrecen Debrecen Hungary
- Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - B. Irinyi
- Division of Dermatological Allergology Faculty of Medicine University of Debrecen Debrecen Hungary
- Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - E. Gyimesi
- Department of Laboratory Medicine Faculty of Medicine University of Debrecen Debrecen Hungary
| | - A. Kapitány
- Division of Dermatological Allergology Faculty of Medicine University of Debrecen Debrecen Hungary
- Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - Zs. Dajnoki
- Division of Dermatological Allergology Faculty of Medicine University of Debrecen Debrecen Hungary
- Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - Zs. Bata‐Csörgő
- Department of Dermatology and Allergology Albert Szent‐Györgyi Medical Center University of Szeged Szeged Hungary
| | - Á. Kinyó
- Department of Dermatology, Venereology and Oncodermatology University of Pécs Pécs Hungary
| | - F. Kiss
- Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
- Center for Medical Education Cardiff University Cardiff U.K
| | - K. Gáspár
- Division of Dermatological Allergology Faculty of Medicine University of Debrecen Debrecen Hungary
- Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - A. Szegedi
- Division of Dermatological Allergology Faculty of Medicine University of Debrecen Debrecen Hungary
- Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
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Chen T, Guo ZP, Wang WJ, Fu LX, Sun QM, Zhou PM. Increased serum soluble vascular endothelial cadherin levels in patients with chronic spontaneous urticaria. Ann Allergy Asthma Immunol 2017; 118:704-709. [PMID: 28583263 DOI: 10.1016/j.anai.2017.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 04/12/2017] [Accepted: 04/18/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is a common skin disease characterized by recurrent itchy wheals with or without angioedema that lasts longer than 6 weeks. Vascular endothelial (VE)-cadherin is an endothelial cell-specific adhesion molecule that plays critical roles in angiogenesis and endothelial permeability. OBJECTIVE To investigate serum levels of soluble VE (sVE)-cadherin in patients with CSU. METHODS Serum levels of sVE-cadherin in patients with CSU, patients with atopic dermatitis, and healthy controls were determined by enzyme-linked immunosorbent assay. In addition, changes in sVE-cadherin serum levels were compared in patients with CSU before and after H1 antihistamine treatment. Furthermore, the effects of histamine on sVE-cadherin release by HMEC-1 cells were determined by enzyme-linked immunosorbent assay. The inhibition effects of H1 antihistamine and H2 antihistamine on sVE-cadherin release, VE-cadherin phosphorylation, and VE-cadherin disruption were evaluated in histamine-treated HMEC-1 cells by western blot and immunofluorescence. RESULTS Serum levels of sVE-cadherin in patients with CSU were significantly higher than those in patients with atopic dermatitis and healthy controls. Serum sVE-cadherin levels in patients with CSU were correlated with the severity of CSU according to Urticaria Activity Scores. Furthermore, serum sVE-cadherin levels in patients with CSU at pretreatment decreased after H1 antihistamine treatment. In addition, histamine markedly induced sVE-cadherin release in HMEC-1 cells. Moreover, H1 antihistamine, but not H2 antihistamine, significantly inhibited sVE-cadherin release in histamine-treated HMEC-1 cells. Western blot data showed that histamine induced phosphorylation of VE-cadherin in HMEC-1 cells, which was blocked by H1 antihistamine. CONCLUSION The present data showed serum levels of sVE-cadherin are increased in patients with CSU. Histamine-induced sVE-cadherin release from endothelial cells could play a role in the pathogenesis of CSU.
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Affiliation(s)
- Tao Chen
- Department of Dermato-Venereology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Zai-Pei Guo
- Department of Dermato-Venereology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Wen-Ju Wang
- Department of Dermato-Venereology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Li-Xin Fu
- Department of Dermato-Venereology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Qiao-Mei Sun
- Department of Dermato-Venereology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Pei-Mei Zhou
- Department of Dermato-Venereology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
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Autoimmune chronic spontaneous urticaria: What we know and what we do not know. J Allergy Clin Immunol 2017; 139:1772-1781.e1. [DOI: 10.1016/j.jaci.2016.08.050] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/02/2016] [Accepted: 08/12/2016] [Indexed: 11/19/2022]
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Grzanka A, Damasiewicz-Bodzek A, Kasperska-Zajac A. The relationship between circulating concentrations of interleukin 17 and C reactive protein in chronic spontaneous urticaria. Allergy Asthma Clin Immunol 2017; 13:25. [PMID: 28491102 PMCID: PMC5424388 DOI: 10.1186/s13223-017-0197-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/05/2017] [Indexed: 01/12/2023] Open
Abstract
Background Up-regulation of interleukin 17 (IL-17) family cytokines and acute phase response have been observed in patients with chronic spontaneous urticaria (CSU). It has been demonstrated that IL-17 stimulates C-reactive protein (CRP) expression. Aim To determine relationship between circulating concentrations of IL-17 and CRP in CSU. Methods Concentrations of IL-17 in plasma and CRP in serum were measured in patients with CSU of varying severity and in the healthy subjects. Results IL-17 and CRP concentrations were significantly higher in CSU patients as compared to the healthy subjects. In addition, there were significant differences in IL-17 and CRP concentrations between CSU patients with mild, moderate-severe symptoms and the healthy subjects. CRP did not correlate significantly with IL-17. Conclusions Increased circulating IL-17 concentration may represent an independent index of systemic inflammatory response in CSU, which is not related to increased CRP concentration.
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Affiliation(s)
- A Grzanka
- Department of Internal Diseases, Dermatology and Allergology, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - A Damasiewicz-Bodzek
- Department of Chemistry, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - A Kasperska-Zajac
- Department of Internal Diseases, Dermatology and Allergology, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
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Fukunaga A, Washio K, Hatakeyama M, Oda Y, Ogura K, Horikawa T, Nishigori C. Cholinergic urticaria: epidemiology, physiopathology, new categorization, and management. Clin Auton Res 2017; 28:103-113. [PMID: 28382552 DOI: 10.1007/s10286-017-0418-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/29/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to review the evidence on the epidemiology, physiopathology, categorization, and management of cholinergic urticaria. We specifically focused on several subtypes of cholinergic urticaria and investigated the relationship between cholinergic urticaria and idiopathic anhidrosis. METHODS Using an integrative approach, we reviewed publications addressing the epidemiology, clinical features, diagnostic approach, physiopathology, subtype classification, and therapeutic approach to cholinergic urticaria. RESULTS Multiple mechanisms were found to contribute to the development of cholinergic urticaria. This disorder should be classified based on the pathogenesis and clinical characteristics of each subtype. Such a classification system would lead to better management of this resistant condition. In particular, sweating function should be given more attention when examining patients with cholinergic urticaria. CONCLUSIONS Because cholinergic urticaria is not a homogeneous disease, its subtype classification is essential for selection of the most suitable therapeutic method.
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Affiliation(s)
- Atsushi Fukunaga
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Ken Washio
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
- Division of Dermatology, Nishi-Kobe Medical Center, 5-7-1 Koji-Dai, Nishi-ku, Kobe, 651-2273, Japan
| | - Mayumi Hatakeyama
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yoshiko Oda
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kanako Ogura
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tatsuya Horikawa
- Ueda Dermatology Clinic, 1654-5 Harima-cho Nozoe, Nishi-ku, Kako-Gun, 675-0151, Japan
| | - Chikako Nishigori
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Kim Z, Choi BS, Kim JK, Won DI. Basophil markers for identification and activation in the indirect basophil activation test by flow cytometry for diagnosis of autoimmune urticaria. Ann Lab Med 2017; 36:28-35. [PMID: 26522756 PMCID: PMC4697340 DOI: 10.3343/alm.2016.36.1.28] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 07/02/2015] [Accepted: 08/27/2015] [Indexed: 11/19/2022] Open
Abstract
Background The indirect basophil activation test using flow cytometry is a promising tool for autoimmune urticaria diagnosis. We aimed to identify better donor basophils (from atopic vs. non-atopic donors and interleukin-3 primed vs. unprimed basophils) and improve basophil identification and activation markers (eotaxin CC chemokine receptor-3 [CCR3] vs. CD123 and CD63 vs. CD203c). Methods Donor basophils were obtained from non-atopic and atopic group O donors. Positive control sera were artificially prepared to simulate autoimmune urticaria patients' sera. Patient sera were obtained from nine children with chronic urticaria. Assay sensitivity was compared among each variation by using positive control sera (n=21), applying cutoff values defined from negative control sera (n=20). Results For basophil identification, a combination of CCR3 and CD123 markers revealed a higher correlation with automated complete blood count (r=0.530) compared with that observed using CD123 (r=0.498) or CCR3 alone (r=0.195). Three activation markers on the atopic donor basophils attained 100% assay sensitivity: CD203c on unprimed basophils, CD63+CD203+ or CD63 alone on primed basophils; however, these markers on the non-atopic donor basophils attained lower assay sensitivity. Conclusions For basophil identification markers, a combination of CD123 and CCR3 is recommended, while CD123 alone may be used as an alternative. Donor basophils should be obtained from an atopic donor. For basophil activation markers, either CD203c alone on unprimed basophils or CD203c and CD63 on primed basophils are recommended, while CD63 alone on primed basophils may be used as an alternative.
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Affiliation(s)
- Zehwan Kim
- Department of Clinical Pathology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Bong Seok Choi
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jong Kun Kim
- Department of Emergency Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Dong Il Won
- Department of Clinical Pathology, Kyungpook National University School of Medicine, Daegu, Korea.
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Analysis of the association of chronic spontaneous urticaria with interlekin-4, -10, transforming growth factor-β1, interferon-γ, interleukin-17A and -23 by autologous serum skin test. Postepy Dermatol Alergol 2017; 34:70-76. [PMID: 28261034 PMCID: PMC5329100 DOI: 10.5114/pdia.2016.57679] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 01/26/2016] [Indexed: 01/05/2023] Open
Abstract
Aim To contribute to the understanding of the pathogenesis of chronic spontaneous urticaria (CSU) by identifying its relationship with autoimmunity and cytokines using the autologous serum skin test (ASST) and peripheral blood mononuclear cell culture (PBMC) method. Material and methods Interleukins (IL)-4, IL-10, transforming growth factor (TGF-β1), interferon (IFN)-γ, IL-17A, and IL-23 levels in cell supernatants obtained by the PBMC method were measured using ELISA. Disease activity was assessed by determining the urticaria activity score (UAS). Results A total of 40 patients diagnosed with CSU participated in this study. Twenty patients had positive ASST results, and 20 had negative results. The control group included 20 healthy volunteers. We found that the IL-23 (p = 0.01), IL-10 (p = 0.04) and IL-4 (p = 0.04) levels of the patient groups were significantly lower compared with those of the control group. The IL-23 (p = 0.009), IL-10 (p = 0.009), IL-4 (p = 0.001), and IL-17 (p = 0.05) levels of the ASST(–) patient group were significantly lower compared with those of the control group. In addition, the IL-4 (p = 0.03) and IFN-γ (p = 0.05) levels of the ASST(+) patient group were significantly lower compared with those of the control group, and the ASST(+) patients had a significantly higher UAS than the ASST(–) patients (p = 0.021). Conclusions These results, when considered together with current reports in the literature, indicate that immune dysregulation occurs in the pathogenesis of CSU, causing cytokine imbalance.
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Kasperska-Zając A, Grzanka A, Mazur B, Gwóźdź A, Zamłyński J. Lower serum B12 vitamin concentrations are not accompanied by hyperhomocysteinaemia in chronic spontaneous urticaria. Clin Exp Dermatol 2017; 42:36-40. [DOI: 10.1111/ced.12985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2016] [Indexed: 11/28/2022]
Affiliation(s)
- A. Kasperska-Zając
- Department of Internal Diseases, Dermatology and Allergology; Medical University of Silesia in Katowice; Zabrze Poland
| | - A. Grzanka
- Department of Internal Diseases, Dermatology and Allergology; Medical University of Silesia in Katowice; Zabrze Poland
| | - B. Mazur
- Department of Microbiology and Immunology; Medical University of Silesia in Katowice; Zabrze Poland
| | - A. Gwóźdź
- Department of Gynaecology, Obstetrics and Oncological Gynaecology; SMDZ Zabrze; Medical University of Silesia in Katowice; Zabrze Poland
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Kumaran MS, Mangal S, Narang T, Parsad D. Autologous Serum and Plasma Skin Tests in Chronic Spontaneous Urticaria: A Reappraisal. Indian Dermatol Online J 2017; 8:94-99. [PMID: 28405547 PMCID: PMC5372454 DOI: 10.4103/2229-5178.202266] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM The objective of this study was to assess autologous serum skin test (ASST) vs autologous plasma skin test (APST) response in chronic spontaneous urticaria (CSU) patients and study the significance of intensity of positive responses in relation to clinicoepidemiological parameters. MATERIALS AND METHODS One hundred CSU patients and 100 age and sex-matched controls were recruited. The demographic and clinical features were recorded in all patients and routine investigations were performed. ASST and APST tests were performed as per the standard guidelines. RESULTS The mean duration of illness was 4.85 ± 5.07 years, 90% patients were APST (+), 68% ASST (+), and 22 patients were only APST (+). Positive predictive value (PPV) of ASST and APST was 90.7% and 95.7%, respectively. A significant inverse association was seen between thyroid status and serum IgE levels with APST and ASST positivity. CONCLUSION APST appears to have better PPV and high intensity of positive response on autologous tests, and correlates with ANA positivity and angioedema.
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Affiliation(s)
- Muthu Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sonia Mangal
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarun Narang
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Davinder Parsad
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Netchiporouk E, Moreau L, Rahme E, Maurer M, Lejtenyi D, Ben-Shoshan M. Positive CD63 Basophil Activation Tests Are Common in Children with Chronic Spontaneous Urticaria and Linked to High Disease Activity. Int Arch Allergy Immunol 2016; 171:81-88. [PMID: 27846634 DOI: 10.1159/000451084] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/27/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The basophil activation test (BAT) using CD63 expression is a sensitive and specific tool for the diagnostic workup of autoimmune chronic spontaneous urticaria (CSU). The definition of a positive BAT is directly dependent on the reference range and the cutoff values established in control populations. As of now, the pediatric reference range and cutoff values of the CD63 BAT remain to be established. METHODS In this study, we analyzed CD63 expression in 80 children (1-17 years old) without chronic urticaria (i.e., controls) and compared the values to those of a pediatric cohort of 105 CSU patients and 23 physical urticaria (PU) patients. RESULTS Based on the log-normal distribution of CD63 values in control subjects, the reference range and the cutoff for positive CD63 BAT values was established to be 1.2-1.8% (95% CI) and 1.8%, respectively. Children with CSU showed significantly elevated and significantly increased BAT values compared to healthy controls (Wilcoxon rank test p value <0.001). In contrast, no difference was found between BAT results in controls and PU patients. In pediatric CSU patients, a higher disease activity was associated with higher BAT values. CONCLUSIONS Our study provides, for the first time, reference and cutoff values for the CD63 BAT in children. Our findings show that positive CD63 BAT are common in children with CSU and linked to a high disease activity.
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Affiliation(s)
- Elena Netchiporouk
- Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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Boonpiyathad T, Sangasapaviliya A. Autologous serum and plasma skin test to predict 2-year outcome in chronic spontaneous urticaria. Asia Pac Allergy 2016; 6:226-235. [PMID: 27803883 PMCID: PMC5088259 DOI: 10.5415/apallergy.2016.6.4.226] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/14/2016] [Indexed: 12/05/2022] Open
Abstract
Background Autologous serum skin test (ASST) and autologous plasma skin test (APST) are simple methods to diagnose autoimmune chronic urticaria. However, the association data of ASST or APST with disease severity and long-term outcome are still unclear. Objective The results of ASST and APST might be used to predict urticaria symptom severity and long-term outcomes among chronic spontaneous urticaria (CSU) patients. Methods We evaluated the prevalence of reactive ASST and APST in 128 CSU patients. The patients were characterized by 4 groups: negative, ASST positive, APST positive, and both ASST and APST positive. We observed remission rate among the CSU patients during 2 years. Results Forty-four of 128 CSU patients (34%) had negative autologous skin test. The CSU patients with positive ASST, positive APST, and both positive ASST and APST were 47 (37%), 6 (5%), and 31 (24%), respectively. No significant difference was found between the groups according to urticaria severity score (USS) and dermatology life quality index (DLQI). Mean wheal diameter of ASST showed positive correlation with DLQI. Also, mean wheal diameter of APST showed positive correlation with USS and DLQI. Both the positive ASST and APST groups had a high proportion of 4-fold dose of H1-antihistamine than the positive ASST (p = 0.03) and negative groups (p = 0.0009). The rate of remission over 2 years in the negative, positive ASST, positive APST, and both positive ASST and APST groups were 81.1%, 62.3%, 60%, and 46.1%, respectively. The urticaria remission rate in patients in the negative group was significantly higher compared with both positive ASST and APST groups (odds ratio, 5.0; 95% confidence interval, 1.61–15.44; p = 0.006). Conclusion ASST and APST results could predict remission rates among patients with CSU. Our results suggested investigating ASST and APST among CSU patients before starting treatment.
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Affiliation(s)
- Tadech Boonpiyathad
- Division of Allergy and Clinical Immunology, Department of Medicine, Phramongkutklao Hospital, Bangkok 10400, Thailand
| | - Atik Sangasapaviliya
- Division of Allergy and Clinical Immunology, Department of Medicine, Phramongkutklao Hospital, Bangkok 10400, Thailand
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Curto-Barredo L, Yelamos J, Gimeno R, Mojal S, Pujol RM, Giménez-Arnau A. Basophil Activation Test identifies the patients with Chronic Spontaneous Urticaria suffering the most active disease. IMMUNITY INFLAMMATION AND DISEASE 2016; 4:441-445. [PMID: 27980778 PMCID: PMC5134723 DOI: 10.1002/iid3.125] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/31/2016] [Accepted: 08/15/2016] [Indexed: 12/04/2022]
Abstract
Introduction The 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. Methods We 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. Results Positive 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). Conclusions The 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.
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Affiliation(s)
- Laia Curto-Barredo
- Department of Dermatology Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma Barcelona Spain
| | - Jose Yelamos
- Department of Immunology Institut Hospital del Mar d'Investigacions Mèdiques (IMIM) Barcelona Spain
| | - Ramon Gimeno
- Department of Immunology Institut Hospital del Mar d'Investigacions Mèdiques (IMIM) Barcelona Spain
| | - Sergi Mojal
- Department of Statistics Institut Hospital del Mar d'Investigacions Mèdiques (IMIM) Barcelona Spain
| | - Ramon M Pujol
- Department of Dermatology Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma Barcelona Spain
| | - Ana Giménez-Arnau
- Department of Dermatology Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma Barcelona Spain
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Dilek F, Ozceker D, Ozkaya E, Tamay Z, Yazici M, Kesgin S, Kocyigit A, Guler N. Plasma Levels of Matrix Metalloproteinase-9 in Children With Chronic Spontaneous Urticaria. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2016; 8:522-6. [PMID: 27582403 PMCID: PMC5011052 DOI: 10.4168/aair.2016.8.6.522] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/19/2016] [Accepted: 03/23/2016] [Indexed: 01/04/2023]
Abstract
Purpose Chronic spontaneous urticaria (CSU) is a disease that is primarily seen in adults and is comparatively rare in children. Consequently, only a few studies have focused on the pathogenesis of the disease in children. This study investigated the possible role of metalloproteinase-9 (MMP-9) in the pathogenesis of CSU in children. Methods The study group was composed of 54 children with CSU; 34 healthy children comprised the control group. The demographic and clinical features of the study group were extensively evaluated, and laboratory assessments were also performed. An enzyme-linked immunosorbent assay was used to evaluate levels of plasma MMP-9. Disease activity was quantified using the urticaria activity score (UAS). Results The median value of plasma MMP-9 was 108.9 ng/mL (interquartile range, 93.3-124.1) in the CSU group and 87.8 ng/mL (69.4-103.0) in the control group. The difference between the 2 groups was statistically significant (P<0.001). Also, MMP-9 levels showed a significant positive correlation with UAS (rho=0.57, P<0.001). Twenty-six percent of patients had positive autologous serum skin test (ASST) results. Neither UAS nor plasma MMP-9 levels were significantly different between ASST-positive and -negative patients (P>0.05). Conclusions Plasma MMP-9 levels were elevated in children with CSU and were positively correlated with disease activity. MMP-9 may be both a good biomarker of disease activity and a potential therapeutic target in CSU.
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Affiliation(s)
- Fatih Dilek
- Department of Pediatric Allergy and Immunology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey.
| | - Deniz Ozceker
- Department of Pediatric Allergy, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Emin Ozkaya
- Department of Pediatric Allergy and Immunology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Zeynep Tamay
- Department of Pediatric Allergy, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Mebrure Yazici
- Department of Pediatric Allergy and Immunology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Siddika Kesgin
- Department of Clinical Biochemistry, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Abdurrahim Kocyigit
- Department of Clinical Biochemistry, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Nermin Guler
- Department of Pediatrics, Istanbul Bilim University, Istanbul, Turkey
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Fine LM, Bernstein JA. Guideline of Chronic Urticaria Beyond. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2016; 8:396-403. [PMID: 27334777 PMCID: PMC4921693 DOI: 10.4168/aair.2016.8.5.396] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/13/2015] [Indexed: 11/20/2022]
Abstract
Urticaria is a relatively common condition that if chronic can persist for weeks, months or years and affect quality of life significantly. The etiology is often difficult to determine, especially as it becomes chronic. Many cases of chronic urticaria are thought to be autoimmune, although there is no consensus that testing for autoimmunity alters the diagnostic or management strategies or outcomes. Many times, urticaria is easily managed with antihistamines and/or short courses of oral corticosteroids, but too often control is insufficient and additional therapies must be added. For years, immune modulating medications, such as cyclosporine and Mycophenolate Mofetil, have been used in cases refractory to antihistamines and oral corticosteroids, although the evidence supporting their efficacy and safety has been limited. Omalizumab was recently approved for the treatment of chronic urticaria unresponsive to H1-antagonists. This IgG anti-IgE monoclonal antibody has been well demonstrated to safely and effectively control chronic urticaria at least partially in approximately 2/3 of cases. However, the mechanism of action and duration of treatment for omalizumab is still unclear. It is hoped that as the pathobiology of chronic urticaria becomes better defined, future therapies that target specific mechanistic pathways will be developed that continue to improve the management of these often challenging patients.
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Affiliation(s)
- Lauren M Fine
- Department of Medicine, University of Miami Miller School of Medicine, Department of Internal Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Miami, FL, USA
| | - Jonathan A Bernstein
- Department of Medicine, University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology/Allergy Section, Cincinnati, Ohio, USA.
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Tosoni C, Cinquini M. Diagnostic and Therapeutic Iter in Chronic Urticaria Patients. Int J Immunopathol Pharmacol 2016; 19:265-9. [PMID: 16831293 DOI: 10.1177/039463200601900203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We describe a diagnostic and therapeutic protocol for the management of chronic urticaria. It is derived from an extensive review of current literature, with a cost-effective evaluation of laboratory investigations and therapeutic approaches. Our protocol may not represent a cornerstone for chronic urticaria: much has in fact to be clarified on pathogenetic mechanisms and aetiological factors. Nevertheless, its application should be able, in our opinion, to identify what is useful or not in the everyday management of chronic urticaria patients.
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Affiliation(s)
- C Tosoni
- Servizio di Reumatologia, Allergologia e Immunologia Clinica, Spedali Civili Brescia, Piazzale Spedali Civili 1, 25100 Brescia, Italy.
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Caproni M, Giomi B, Melani L, Volpi W, Antiga E, Torchia D, Fabbri P. Cellular Infiltrate and Related Cytokines, Chemokines, Chemokine Receptors and Adhesion Molecules in Chronic Autoimmune Urticaria: Comparison between Spontaneous and Autologous Serum Skin Test Induced Wheal. Int J Immunopathol Pharmacol 2016; 19:507-15. [PMID: 17026835 DOI: 10.1177/039463200601900306] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
In recent years, the demonstration of circulating functional autoantibodies against the high affinity IgE receptor or against IgE themselves in about one-third of patients with chronic idiopathic urticaria has suggested that an autoimmune mechanism might be involved in the pathogenesis of the disease [the so-called chronic autoimmune urticaria (CAIU)]. In this study we compare findings from serum-induced and spontaneous wheals with regard to immunohistochemical markers of disease activity and discuss whether autologous serum skin test (ASST) may be regarded as an in vivo experimental model of the physiological stimulus causing urticaria skin condition, or if it does not reproduce the whole of the mechanisms operating in the development of spontaneous wheals. By means of immunohistochemical technique, we analyzed specimens from just-developed spontaneous wheals and from serum-evoked wheals of six CAIU patients, to glean information on cellular infiltrate and related cytokines, chemokines, chemokine receptors and adhesion molecules. According to the results of our study, spontaneous urticaria lesions seem to be sustained by a characteristic inflammation pattern where neutrophils, adhesion molecules, IL-8 and chemokine receptors play a main role in flogosis triggering and, consequently, disease development. On the contrary, ASST-induced wheals seem to imply different activities mainly represented by basophil granulocytes and related molecules, i.e. IL-4. Although it represents an efficacious diagnostic instrument to screen CAIU patients, ASST is not an exhaustive model of the many immunopathogenic pathways operating in the development of urticaria lesions, especially with regard to systemic activation networks.
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Affiliation(s)
- M Caproni
- Department of Dermatological Sciences, University of Florence, Italy
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