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

Author(s):  
Usha Rani Tirupathi ◽  
Bhagya Rekha Manchiryala ◽  
Sruthi Kareddy

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.

2016 ◽  
Vol 12 (2) ◽  
pp. 6-10 ◽  
Author(s):  
Kumar Pokhrel ◽  
S. Subedi ◽  
S. Acharya

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


Author(s):  
Purnachandra Badabagni ◽  
Sruthi Thammineedi ◽  
Ramadevi Birudala

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.</p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>


Author(s):  
Dharani D. ◽  
Krishnan S. ◽  
Manobalan K.

<p class="abstract"><strong><span lang="EN-US">Background:</span></strong><span lang="EN-US"> Urticaria persisting daily for more than six weeks is termed as chronic urticaria. A significant number of them have an autoimmune basis, where ASST is </span>used for detection of chronic autoimmune urticaria (CAU). <span lang="EN-US">The aim and objective of the study was </span>to determine the frequency of autoimmunity with ASST in chronic urticaria patients.</p><p class="abstract"><strong><span lang="EN-US">Methods:</span></strong>This was a hospital based cross sectional study, 100 patients with chronic urticaria fulfilling the inclusion and exclusion criteria were enrolled in the study. Detailed history, physical examination and routine investigations were recorded and ASST was done for all patients.</p><p class="abstract"><strong><span lang="EN-US">Results:</span></strong>Thirty seven (37%) out of 100 CU patients were ASST positive. Statistical analysis of the clinical variables did not show significant difference between ASST positive and negative patients except for dermographism and mean duration of the disease.</p><p class="abstract"><strong><span lang="EN-US">Conclusions:</span></strong>ASST is a simple <em>invivo</em> clinical test for detection of basophil histamine releasing activity. Diagnosing CAU is important as these patients may need high doses of anti-histamines, systemic corticosteroids and/or immunomodulatory drugs. Autologous serum therapy itself has a therapeutic role in treatment of CAU patients.</p>


2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Hayder R. Al-Hamamy ◽  
Ammar F. Hameed ◽  
Asaad S. Abdulhadi

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.


Author(s):  
Saleena Beevi A. R. ◽  
George Kurien ◽  
Mary Vineetha

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">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.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">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</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">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. </span></p><p class="abstract"><strong>Conclusions:</strong> ASST is a simple and reliable method to detect chronic autoimmune urticaria. <span lang="EN-IN">ASST positive patients have more episodes of urticaria compared to ASST negative patients.</span></p>


Allergy ◽  
2005 ◽  
Vol 60 (2) ◽  
pp. 256-258 ◽  
Author(s):  
A. Fusari ◽  
C. Colangelo ◽  
F. Bonifazi ◽  
L. Antonicelli

2018 ◽  
Vol 19 (2) ◽  
pp. 100-103
Author(s):  
Mohammad Nura Alam ◽  
Mohammad Ali ◽  
Mohammad Moniruzzaman Khan ◽  
Keya Tarafder ◽  
Goutam Kumar Acherjya ◽  
...  

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


Dermatology ◽  
2006 ◽  
Vol 212 (2) ◽  
pp. 150-159 ◽  
Author(s):  
P. Staubach ◽  
K. Onnen ◽  
A. Vonend ◽  
M. Metz ◽  
F. Siebenhaar ◽  
...  

2012 ◽  
Vol 87 (4) ◽  
pp. 578-583 ◽  
Author(s):  
Zamir Calamita ◽  
Andrea Bronhara Pelá ◽  
Márcia Gamberini ◽  
Wilson Baleotti Júnior ◽  
Odilon Marques de Almeida Filho ◽  
...  

BACKGROUND: An association between class I and II alleles of the major histocompatibility complex and idiopathic chronic urticaria has previously been observed in different populations, but there are still no studies on Brazilian populations in this regard. OBJECTIVE: The involvement of the major histocompatibility complex classes I and II (loci A, B and DR) in Brazilian patients with idiopathic chronic urticaria and a positive autologous serum skin test was investigated and compared with a healthy population group. METHODS: DNA was extracted from the blood of 42 patients with idiopathic chronic urticaria and major histocompatibility complex classes I and II alleles were determined using the polymerase chain reaction and a laboratory test for oligonucleotide hybridization using a single-filament probe. The frequencies of these alleles in patients with chronic urticaria were compared with the frequencies in 1000 genetically unrelated voluntary blood donors from the same region of Brazil. The diagnosis of idiopathic chronic urticaria was based on the patients' clinical history and routine laboratory tests. Only the patients with positive autologous serum skin test were selected. The allele distribution resulted from the patient and control groups were analyzed using odds ratios and 95% confidence intervals. RESULTS: No statistically significant differences were found between the positive autologous serum skin test patients with chronic urticaria and the control group. CONCLUSIONS: We found that in this population group, there was no specific association between the HLA alleles studied and chronic urticaria. We believe that further population studies are needed in order to investigate the possible existence of this association.


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