DOI: http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20192226

Autologous serum skin test in 250 patients of chronic spontaneous urticaria at tertiary care hospital in Gujarat

Sonal Gaurang Patel, Rima Rakesh Joshi, Raksha Maganlal Patel

Abstract


Background: Chronic urticaria (CU) is defined as urticaria persisting daily as or almost daily for more than 6 weeks and affecting 0.1% of the population. In chronic autoimmune urticaria, immunoglobulin G (lgG) auto antibodies react to the alpha subunit of the high-affinity lgE receptor (FceR1) on dermal mast cells and basophils, leading to chronic stimulation of these cells. This results in the release of histamine and other inflammatory mediators which cause urticaria and angioedema. More than half of the patients have autoimmune urticaria. ASST is the only in vivo test to detect autoimmune urticaria. The aim was to study the frequency of ASST positivity among patients with chronic spontaneous urticaria and to identify the clinical and laboratory parameters associated with positive ASST.

Methods: The present study is prospective observational study of chronic spontaneous urticaria. ASST was performed in 250 patients fulfilling exclusion and inclusion criteria. Baseline investigations (CBC, ESR, urine, stool, RBS and CRP) were done for all the patients whereas specific investigations (ANA, Thyroid Profile, IgE, Anti H.Pylori IgG and skin biopsy) were done in selected cases.

Results: Out of 250 patients examined, 60% had positive autologous serum skin test suggestive of autoimmune urticaria. H. pylori antibodies were significantly higher (29%) in ASST positive patients. While antinuclear antibody (ANA) was positive in 4% and thyroid antibodies were present in 7% of patients with positive ASST. Serum IgE was elevated in 32% ASST positive patients.

Conclusions: ASST is an easy, simple and cost effective screening test for chronic autoimmune urticaria.


Keywords


Chronic spontaneous urticaria, ASST

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References


Zuberbier T.A summary of the New International EAACI/GA2LEN/EDF/WAO Guidelines in Urticaria. WAO J. 2012;5:S1-S5.

Powell RJ. BASCI guidelines for management of chroinic urticarial and angio-oedema. Clin Experimental Allergy. 2007;37:631-50.

Kanani A. Urticarial and angioedema. Allergy Asthma Clin Immunol. 2011;7(suppl);S9.

Zuberbier T, Grattan C, Maurer M (Eds.). Urticaria and angioedema, Springer Verlag Berlin Heidelberg 2010.

Grattan CE, Wallington TB, Warin RP, Kennedy CT, Bradfield JW. A serological mediator in chronic idiopathic urticaria: A clinical Immunologicalal and histological evaluation. Br J Dermatol. 1986;114:583-90.

Ghosh S. What’s new in urticarial? Indian J Dermatlol. 2009;54(3):280-2.

Sabroe RA, Grattan CE, Francis DM, Barr RM, Kobza Black A, Greaves MW. The autologous serum skin test: Screening test for auto antibodies in chronic idiopathic urticaria. Br J Dermatol. 1999;140:446-52.

Zuberbier T. EAACI/GA2LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria. Allergy. 2009;64:1417-26.

Kaplan AP. Chronic urticaria and angioedema. N Engl J Med. 2002;246:175-9.

George M, Balachandran C, Prabhu S. Chronic idiopathic urticaria: Comparison of clinical feature with positive autologous serum skin test, KMC. Manipal. J Dermatol Venereol Leprol. 2008;74:105-8.

Krupa Shankar DS, Ramnane M, Rajouria EA. Etiological approach to chronic urticaria. Indian J Dermatol. 2010;55:33-8.

Ozkaya-Bayazit E, Demir K, Ozgüroðlu E, Kaymakoðlu S, Ozarmaðan G. H. pylori eradication in patients with chronic urticaria. Arch Dermatol 1998;134:1165-6.

Appelmelk BJ, Simoons-Smit I, Negrini R, Moran AP, Aspinall GO, Forte JG, et al. Potential role of molecular mimicry between H. pylori lipopolysaccharide and host blood group antigen in autoimmunity. Infect Immun. 1996;64:2031-40.

Sabroe RA, Seed PT, Francis DM, Barr RM, Black AK, Greaves MW. Chronic idiopathic urticaria: comparison of the clinical features of patients with and without anti FCåR1 or anti IgE auto antibodies. J Am Acad Dermatol. 1999;40:443-50.

Buss YA, Garrelfs UC, Sticherling M. Chronic urticaria which clinical parameters are pathogenetically relevant? Aretrospective investigation of 339 patients. J Dtsch Dermatol Ges. 2007;5:22-9.