Pattern of chronic urticaria and value of autologous serum skin test in Sohag Province, Upper Egypt
Keywords:
Severity score, Skin test, UrticariaAbstract
Background: Chronic urticaria (CU) is a debilitating disorder with variable clinical course. It is characterized by hives occurring for at least 6 weeks, and is classified as spontaneous or inducible. Objective: The aim of this study was to detect the pattern of CU, to study association between results of autologous serum skin test (ASST) and urticaria severity score (USS), and to detect serum levels of anti IgE receptors antibodies. Methods: This study included all patients attending the Dermatology Outpatient Clinic, Sohag University Hospital, who were diagnosed as CU from April 2015 to March 2016. ASST and serum level of anti IgE receptor antibodies was assessed using ELISA. Data were analyzed by SPSS version 16, using descriptive statistics, Kruskal-Wallis and Mann-Whitney U test. Results: A total of 108 patients with CU were included in the study. Females with mean age 33±12.4 years were more affected. A total of 58.3% complained of CSU, 6.5% physical urticaria and 35.2% mixed type of CU. According to USS, mild score represented 20.4%, moderate 46.3% and severe in 33.3%. ASST showed positive in 38% of patients. There was a statistically significant relation between ASST and USS and duration of CU. This indicates that more severe symptoms and prolonged duration of CU are observed in positive ASST (autoreactive type). In all, 91% of the anti IgE receptor antibodies positive patients had positive ASST. Conclusion: In conclusion, chronic urticaria is not an uncommon disease in our locality which represented 1.13% of our patients. Urticaria severity score and duration of urticaria was higher in positive ASST patients and hence the autoreactive type.References
Ferrer M, Kaplan AP. Progress and Challenges in the Understanding of Chronic Urticaria. Allergy Asthma
Clin Immunol. 2007; 3 (1): 31–5 doi: 10.2310/7480.2006.00016. PMID: 20525151, PMCID:
PMC2873630.
Losol P, Yoo HS, Park HM. Molecular Genetic Mechanisms of Chronic Urticaria. Allergy Asthma
Immunol Res. 2014; 6 (1): 13-21. doi: 10.4168/aair.2014.6.1.13. PMID: 24404388, PMCID: PMC3881394.
Maurer M, Bindslev-Jensen C, Gimenez-Arnau A, Godse K, Grattan CE, Hide M, et al. Chronic idiopathic
urticaria (CIU) is no longer idiopathic: time for an update. Br J Dermatol. 2013; 168(2): 455-6. doi:
1111/j.1365-2133.2012.11171.x. PMID: 22835147.
Khan DA. Chronic urticaria: Diagnosis and management. Allergy Asthma Proc. 2008; 29: 439–46. doi:
2500/aap.2008.29.3151. PMID: 18926051.
Kaplan AP. Treatment of Chronic Spontaneous Urticaria. Allergy Asthma Immunol Res. 2012; 4(6): 326- 31. doi: 10.4168/aair.2012.4.6.326. PMID: 23115728, PMCID: PMC3479225.
Criado PR, Criado RF, Maruta CW, Reis VM. Chronic urticaria in adults: state-of-the-art in the new
millennium. An Bras Dermatol. 2015; 90(1): 74-89. doi: 10.1590/abd1806-4841.20153509. PMID:
, PMCID: PMC4323701.
Abd El-Azim M, Abd El-Azim S. Chronic Autoimmune Urticaria: Frequency and Association With
Immunological Markers. J Investig Allergol ClinImmunol. 2011; 21(7): 546-50.
George M, Balachandran C, Prabhu S. Chronic idiopathic urticaria: comparison of clinical features with
positive autologous serum skin test. Indian J Dermatol Venereol Leprol. 2008; 74(2): 105-8. doi:
4103/0378-6323.39690. PMID: 18388365.
Asero R, Orsatti A, Tedeschi A, Lorini M. Autoimmune chronic urticaria associated with type 1 diabetes
and Graves’ disease. J Allergy ClinImmunol. 2005; 115: 1088–9. doi: 10.1016/j.jaci.2004.12.009. PMID:
Confino-Cohen R, Chodick G, Shalev V, Leshno M, Kimhi O, Goldberg A. Chronic urticaria and
autoimmunity: Associations found in a large population study. J Allergy ClinImmunol. 2012; 129: 1307- 13. doi: 10.1016/j.jaci.2012.01.043. PMID: 22336078.
Greaves MW. Chronic idiopathic urticaria. Curr Opin Allergy ClinImmunol. 2003; 3(5): 363-8. doi:
1097/00130832-200310000-00008.
Al-Hamamy HR, Hameed AF, Abdulhadi AS. Autologous Serum Skin Test as a Diagnostic aid in Chronic
Idiopathic Urticaria. ISRN Dermatol. 2013; 18: 291524. doi: 10.1155/2013/291524.
Al-Ahmad M, Alowayesh MS, Carroll NV. Economic burden of refractory chronic spontaneous urticaria
on Kuwait’s health system. Clinico Econ Outcomes Res. 2016; 8: 163–9 doi: 10.2147/CEOR.S98848.
PMID: 27274290, PMCID: PMC4869626.
Krupa Shankar DS, Ramnane M, Rajouria EA. Etiological approach to chronic urticaria. Indian J Dermatol.
; 55: 33‑8. doi: 10.4103/0019-5154.60348. PMID: 20418974, PMCID: PMC2856370.
Lapi F, Cassano N, Pegoraro V, Cataldo N, Heiman F, Cricelli I, et al. Epidemiology of chronic
spontaneous urticaria: results from a nationwide, population-based study in Italy. Br J Dermatol. 2016;
(5): 996-1004. doi: 10.1111/bjd.14470. PMID: 26872037.
Lee HC, Hong JB, Chu CY. Chronic Idiopathic Urticaria in Taiwan: A Clinical Study of Demographics,
Aggravating Factors, Laboratory Findings, Serum Autoreactivity and Treatment Response. Journal of the
Formosan Medical Association. 2011; 110(3): 175–82. doi: 10.1016/S0929-6646(11)60028-4.
Choi WS, Lim ES, Ban GY, Kim JH, Shin YS, Park HS, et al. Disease-specific impairment of the quality
of life in adult patients with chronic spontaneous urticaria. Korean J Intern Med. 2018; 33(1): 185-92. doi:
3904/kjim.2015.195. PMID: 27243229 PMCID: PMC5768532.
Heng JK, Koh LJ, Toh MP, Aw DC. A study of treatment adherence and quality of life among adults with
chronic urticaria in Singapore. Asia Pac Allergy. 2015; 5(4): 197–202. doi:
5415/apallergy.2015.5.4.197. PMID: 26539401, PMCID: PMC4630457.
Vikramkumar AG, Kuruvila S, Ganguly S. Autologous serum skin test as an indicator of chronic
autoimmune urticaria in a tertiary care hospital in South India. Indian Dermatol Online J. 2014; 5:87-91.
doi: 10.4103/2229-5178.146166. PMID: 25593814, PMCID: PMC4290187.
Ue AP, Souza PK, Rotta O, Furlani WJ, Lima AR, Sabbag DS. Quality of life assessment in patients with
chronic urticaria. An Bras Dermatol. 2011; 86(5): 897-904. PMID: 22147026.
Abd El-Azim Z, El Mongy S, Salem H. Autologous Serum Skin Test in Chronic Idiopathic Urticaria:
Comparative Study in Patients with Positive versus Negative Test. J Egypt Women Dermatol Soc. 2010; 7:
–33.
Vichyanond P, Sunthornchart S, Singhirannusorn V, Ruangrat S, Kaewsomboon S, Visitsunthorn N.
Prevalence of asthma, allergic rhinitis and eczema among university students in Bangkok. Respir Med.
; 96: 34–8. doi: 10.1053/rmed.2001.1202. PMID: 11863208.
Yadav MK, Rishi JP, Nijawan S. Chronic urticaria and Helicobacter pylori. Indian J Med Sci. 2008; 62:
-62. doi: 10.4103/0019-5359.40579.
Moreiraa A, Rodriguesa J, Delgadoa L, Fonsecaa J, Vaza M. Is Helicobacter pylori infection associated
with chronic idiopathic urticaria? Allergol Immunopathol. 2003; 31(4): 209-14. doi: 10.1016/S0301
Criado PR, Criado RF, Maruta CW, Reis VM. Chronic urticaria in adults: state-of-the-art in the new
millennium. An Bras Dermatol. 2015; 90(1): 74-89. doi: 10.1590/abd1806-4841.20153509. PMID:
, PMCID: PMC4323701.
Bhatt TA. Chronic urticaria: Are hepatotropic viruses B&C to blame? Egyptian Dermatology Online
Journal. 2010; 7(1): 3.
Malik LM, Mufti S, Saeed S, Ahmed S, Hussain I. Hepatitis C seropositivity in patients with acute and
chronic urticaria. Journal of Pakistan Association Dermatologist. 2008; 18: 144-8.
Dilek AR, Dilek N, Saral Y, Eks S. The role of protozoa in the etiology of chronic urticaria. Dermatologica
Sinica. 2012; 30: 90-2. doi: 10.1016/j.dsi.2012.06.001.
Kulthanan K, Jiamton S, Thumpimukvatana N, Pinkaew S. Chronic idiopathic urticaria: prevalence and
clinical course. J Dermatol. 2007; 34 (5): 294-301. doi: 10.1111/j.1346-8138.2007.00276.x. PMID:
Sussman G, Hebert J, Gulliver W, Lynde C, Waserman S, Kanani A, et al. Insights and advances in chronic
urticaria: a Canadian perspective. Allergy Asthma ClinImmunol. 2015; 11: 7. doi: 10.1186/s13223-015- 0072-2.
Kozel MM, Bossuyt PM, Mekkes JR, Bos JD. Laboratory tests and identified diagnoses in patients with
physical and chronic urticaria and angioedema: A systemic review. J Am Acad Dermatol. 2003; 48: 409–
doi: 10.1067/mjd.2003.142. PMID: 12637921.
Toubi E, Kessel A, Avshovich N, Bamberger E, SaboE, Nusem D, et al. Clinical and laboratory parameters
in predicting chronic urticaria duration: a prospective study of 139 patients. Allergy. 2004: 59: 869–73. doi:
1111/j.1398-9995.2004.00473.x. PMID: 15230821.
Asero R, Tedeschi A, Lorini M, Salimbeni R, Zanoletti T, Miadonna A. Chronic urticaria: novel clinical
and serological aspects. Clin Exp Allergy. 2001; 31(7): 1105-10. doi: 10.1046/j.1365-2222.2001.01131.x.
PMID: 11468002.
Caproni M, Volpi W, Giomi B, Cardinali C, Antiga E, Melani L, et al. Chronic idiopathic and chronic
autoimmune urticaria: Clinical and immunopathological features of 68 subjects. Acta DermVenereol. 2004;
: 288-90. doi: 10.1080/00015550410026939.
Kessel A, Helou W, Bamberger E, Sabo E, Nusem D, Panassof J, et al. Elevated serum total IgE--a
potential marker for severe chronic urticaria. Int Arch Allergy Immunol. 2010; 153(3): 288-93. doi:
1159/000314370. PMID: 20484928.
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