Chronic urticaria: a clinico-etiological study and autologous serum skin test role in chronic idiopathic urticaria

Background: Appearance of wheals daily for more than six weeks is chronic urticarial (CU). No cause is identified in about 50-70% of chronic urticaria patients and are labelled as chronic idiopathic urticaria (CIU). The aim of the present study is to study the clinical and etiological pattern of chronic urticaria and to find out the incidence of autoimmune urticaria by performing autologous serum skin test (ASST) in patients with CIU.Methods: This was a cross sectional study enrolling 100 chronic urticaria patients satisfying including and excluding criteria. The study was done for a period of 1 year. ASST was done in all the CIU patients after recording detailed history, complete physical and systemic examination.Results: Most of the patients (33%) were in 21-30 years age group with female preponderance (66%). Students (38%) followed by house wives (27%) were majorly involved. 21% patients had history of atopy and 8% had abnormal thyroid function tests. Causative factors noticed in 46% patients and remaining were idiopathic (54%). Infections (32.6%) constituted the major etiological factor followed by physical urticaria (30.4%), food (23.9%), medication (11%) and inhalants (2.1%). In infective agents, 46.6% were bacterial followed by helminthic (33.3%). In 29.6% of CIU patients, the ASST was positive indicating auto-immune urticaria.Conclusions: The etiology cannot be identified in most number of patients and hence they were labelled as CIU and the common causative agents observed were infections followed by physical urticaria, food and medication. ASST is considered as the relevant screening test to detect autoimmune urticaria.

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Association between Clinico-epidemiological Features in Chronic Urticaria with Autologous Serum Skin Test: A Cross-sectional Observational Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/48816.15109 ◽

2021 ◽

Author(s):

Usha Rani Tirupathi ◽

Bhagya Rekha Manchiryala ◽

Sruthi Kareddy

Keyword(s):

Skin Test ◽

Chronic Urticaria ◽

Autologous Serum ◽

Clinical Test ◽

Cross Sectional ◽

Autologous Serum Skin Test ◽

Epidemiological Features ◽

Chronic Inducible Urticaria ◽

Autoimmune Urticaria ◽

Significant Difference

Introduction: Urticaria is a frequent and heterogeneous skin disease characterised by the development of wheals (hives), angioedema, or both. Chronic urticaria is characterised by the occurrence of wheals lasting less than 24 hours, with or without angioedema occurring daily or almost daily lasting more than six weeks. The two subtypes of chronic urticaria are Chronic Spontaneous Urticaria (CSU) and Chronic Inducible Urticaria (CIU). Autologous Serum Skin Test (ASST) is the simplest and the best in-vivo clinical test for the detection of basophil histamine- releasing activity. ASST has a sensitivity of approximately 70% and a specificity of 80%. Aim: To study the association between clinico-epidemiological features of CSU with positive and negative ASST. Materials and Methods: The cross-sectional study was conducted on 80 clinically diagnosed cases of CSU attending the Department of Dermatology Venereology Leprology Outpatient Department at Mahatma Gandhi Memorial Hospital (Kakatiya Medical College), Warangal, Telangana, India; during the period of January 2016 to September 2017. The detailed history was taken; complete physical and cutaneous examination and laboratory investigations like Complete Blood Picture (CBP), Absolute Eosinophil Count (AEC), Erythrocytic Sedimentation Rate (ESR), Thyroid Function Test (TFT) were carried out. ASST was done and read after 30 minutes. Chi- square test was applied and the results analysed using Statistical Package for the Social Sciences (SPSS) version 10.0. Results: Out of total 80 patients included in the study, ASST was positive in 36 (45%) and negative in 44 (55%). ASST positive patients showed longer duration of the disease with increased frequency of attacks and longer duration of wheals. However, both ASST positive and negative groups did not show statistically significant difference in the age of occurrence, gender, angioedema, dermographism. Conclusion: Autoimmune urticaria has no distinctive clinical features. ASST positive, autoimmune urticaria patients have more severe disease with greater impact on quality of life. Thus, they may need more aggressive treatment.

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

ISRN Dermatology ◽

10.1155/2013/291524 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

Hayder R. Al-Hamamy ◽

Ammar F. Hameed ◽

Asaad S. Abdulhadi

Keyword(s):

Skin Test ◽

Clinical Features ◽

Chronic Idiopathic Urticaria ◽

Autologous Serum ◽

Test Results ◽

Autologous Serum Skin Test ◽

Autoimmune Urticaria ◽

Number Of Patients ◽

Significant Difference ◽

The Face

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

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Autologous Serum Skin Test in Chronic Idiopathic Urticaria

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v12i2.14468 ◽

2016 ◽

Vol 12 (2) ◽

pp. 6-10 ◽

Cited By ~ 1

Author(s):

Kumar Pokhrel ◽

S. Subedi ◽

S. Acharya

Keyword(s):

Skin Test ◽

Chronic Urticaria ◽

Cost Effective ◽

Activity Score ◽

Autologous Serum ◽

Cross Sectional ◽

Dermatology Department ◽

Autologous Serum Skin Test ◽

Autoimmune Urticaria ◽

Urticaria Activity Score

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

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Autologous Serum Skin Test for Initial Identification of Auto- Antibodies in Chronic Urticaria

Journal of Medicine ◽

10.3329/jom.v19i2.37228 ◽

2018 ◽

Vol 19 (2) ◽

pp. 100-103

Author(s):

Mohammad Nura Alam ◽

Mohammad Ali ◽

Mohammad Moniruzzaman Khan ◽

Keya Tarafder ◽

Goutam Kumar Acherjya ◽

...

Keyword(s):

Skin Test ◽

Chronic Urticaria ◽

Cost Effective ◽

Autologous Serum ◽

P Value ◽

Effective Measure ◽

Autologous Serum Skin Test ◽

Physical Urticaria ◽

Retrospective Data Analysis ◽

Initial Identification

Background: Autologous serum skin test (ASST) is easy to perform, cost effective measure for initial identification of auto-antibody in patients suffering from chronic urticaria which may occur due to autoimmune trigger by spontaneously developed auto-antibodies against FcμRI receptor of skin mast cells.Objective: This review is designed to see the positivity of ASST in patients suffering from chronic urticaria.Materials & Methods: This a retrospective data analysis conducted from the records of patients suffered from at least two episodes of urticaria or more in a week for 6 weeks and who did ASST aged more than 10 years between July 2015 to June 2017. These subjects were not pregnant or lactating mother, did not had urticarial vasculitis, predominant co-existing physical urticaria and had negative Hepatitis B antigen and anti-nuclear antibody reports.Results: Total 53 were included in this study of them 33 were female. Mean age was 32 years with a standard deviation (SD) of 11 years. Among study patients 16 (30.2% of total) had a positive ASST result. No age or sex difference was observed in positive ASST cases. In positive cases significant (p-value:<0.001) mean induration difference of 2.75mm with a SD of 1.00 mm observed than induration produced by negative control.Conclusion: ASST is easy and effective tool for initial identification of auto-reactive urticaria.J MEDICINE JUL 2018; 19 (2) : 100-103

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Autologous Serum Skin Test versus Autologous Plasma Skin Test in Patients with Chronic Spontaneous Urticaria

Dermatology Research and Practice ◽

10.1155/2013/267278 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Aysegul Alpay ◽

Nilgün Solak Tekin ◽

Ishak Özel Tekin ◽

H. Cevdet Altinyazar ◽

Rafet Koca ◽

...

Keyword(s):

Skin Test ◽

Chronic Spontaneous Urticaria ◽

Autologous Serum ◽

Thyroid Autoantibodies ◽

Thyroid Function Tests ◽

Control Groups ◽

Autologous Plasma ◽

Autologous Serum Skin Test ◽

Autoimmune Urticaria ◽

And Control

Previous studies indicate that 25–45% of chronic urticaria patients have an autoimmune etiology. Autologous serum skin test (ASST) and autologous plasma skin test (APST) are simple tests for diagnosing chronic autoimmune urticaria (CAU). However, there are still some questions about the specificity of these tests. This study consisted of 50 patients with chronic spontaneous urticaria (CSU) and 50 sex- and age-matched healthy individuals aged 18 years, and older. A total of 31 (62%) patients and 5 (10%) control patients had positive ASST; 21 (42%) patients and 3 (6%) control patients had positive APST. Statistically significant differences were noted in ASST and APST positivity between the patient and control groups (ASSTP<0.001; APSTP<0.001). Thirteen (26%) patients and 5 (10%) control patients had antithyroglobulin antibodies or antithyroid peroxidase antibody positivity. No statistically significant differences were noted in thyroid autoantibodies between the patient and control groups (anti-TGP=0.317; anti-TPOP=0.269). We consider that the ASST and APST can both be used asin vivotests for the assessment of autoimmunity in the etiology of CSU and that thyroid autoantibodies should be checked even when thyroid function tests reveal normal results in patients with CSU.

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Diagnostic value of autologous serum skin test in chronic auto immune urticaria

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20172019 ◽

2017 ◽

Vol 3 (2) ◽

pp. 219 ◽

Cited By ~ 1

Author(s):

Saleena Beevi A. R. ◽

George Kurien ◽

Mary Vineetha

Keyword(s):

Skin Test ◽

Chronic Urticaria ◽

Reliable Method ◽

Life Time ◽

Diagnostic Value ◽

Autologous Serum ◽

Autologous Serum Skin Test ◽

Autoimmune Urticaria ◽

Almost All ◽

Wheal And Flare

Background: Urticaria affects up to 20% of the population during their life time. Urticaria occurring on almost all days for more than 6 weeks is classified as chronic urticaria. Chronic urticaria is one of the most vexing management problems the dermatologists face. Chronic urticaria cases in which no etiology can be found are labelled chronic idiopathic urticarial (CIU). In most cases of idiopathic urticaria, autoimmunity may be the initiating factor- chronic autoimmune urticaria. Autologous serum skin test (ASST) is a simple and reliable method to detect autoimmune urticaria.Methods: Among patients with chronic idiopathic urticaria, ASST is done to detect ASST positivity and thereby chronic autoimmune urticaria. Patient’s serum is separated and 0.05 ml injected intradermally on left forearm. Normal saline is injected intradermally at least 5 cm away as control. Wheal and flare at serum site which is 1.5 mm more than that of control is taken as positive. Results were analyzed using Microsoft excel and Epi info7.Results: 49 patients were studied and 34 (69.4%) showed ASST positivity, which is an indicator of autoimmune urticaria. Moreover, it was seen that ASST positive patients had more episodes of urticaria per week, compared to ASST negative patients. Conclusions: ASST is a simple and reliable method to detect chronic autoimmune urticaria. ASST positive patients have more episodes of urticaria compared to ASST negative patients.

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Autologous serum skin test and skin prick test in patients with chronic urticaria: a cross sectional study

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20164519 ◽

2017 ◽

Vol 3 (1) ◽

pp. 46

Author(s):

Mounika K. ◽

Shivaswamy K. N.

Keyword(s):

Skin Prick Test ◽

Skin Test ◽

Cross Sectional Study ◽

Chronic Idiopathic Urticaria ◽

Autologous Serum ◽

Chi Square ◽

Cross Sectional ◽

Autologous Serum Skin Test ◽

Prick Test ◽

History Of

Background: Urticaria is an allergic skin disorder characterized by wheals. Though the diagnosis is easy, it is difficult to identify the cause for the episodes. Autologous serum skin test (ASST) and skin prick test (SPT) help in the identification of the cause. The objective of the study was to determine the frequency of ASST and SPT positivity in patients with chronic idiopathic urticaria (CIU).Methods: Fifty-six patients attending the dermatology OPD with chronic idiopathic urticaria were evaluated and taken up for the study. ASST and SPT were performed on all the patients and the obtained results were documented. Data was analyzed using Chi square test.Results: Among the 56 patients studied, males (53.57%) outnumbered females and the majority was in the age group 21 to 30 years (33.9%). One third of the study patients gave history of known food allergy and 10.7% gave history of dust allergy. ASST positivity was seen in 30.3% and SPT positivity was seen in 64.3%. Ten of our patients (17.8%) were positive to both ASST and SPT. Amongst the SPT positives 33.3% showed positivity to food allergens, 19.4% showed positivity to aeroallergens and 47.2% showed positivity to both. Conclusions: ASST and SPT are two reliable tools in identifying the cause for urticaria and this in turn helps in avoidance of possible causes and providing proper treatment.

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