Biomarkers of Autologous Whole Blood Injection Efficacy in Patients with Chronic Spontaneous Urticaria with Autoreactivity: A Preliminary Study.

INTRODUCTION: Chronic spontaneous urticaria (CSU) with autoreactivity is often resistant to antihistamines. Autologous whole blood injection (AWBI) has shown potential efficacy in the treatment of this disease, but it is controversial. It is necessary to screen patients who are suitable for this therapy in advance. This study aimed to identify biomarkers that predict the efficacy of AWBI treatment in CSU patients with autoreactivity. METHODS: A total of 30 patients with autologous serum skin test-positive CSU treated with AWBI were included in this study; urticaria activity score (UAS7) was recorded and the treatment response was judged based on it. Levels of total serum IgE, anti-high-affinity IgE receptor (FcεRI) IgG, and basophils CD63 and FcεRI expressions, and D-dimer of all patients were determined and analyzed. RESULTS: Baseline levels of total IgE, D-dimer, basophil FcεRI and CD63 expressions showed good correlations with UAS7 variations. D-dimer, basophil FcεRI and CD63 expressions changed significantly before and after AWBI treatment in AWBI responders, and the basophil FcεRI and CD63 expressions consistently and dynamically decreased in AWBI responders during the treatment. Baseline levels of total IgE, D-dimer, basophil FcεRI and CD63 expressions showed certain predictive values for AWBI response. CONCLUSIONS: Baseline levels of total IgE, D-dimer, basophil FcεRI and CD63 expressions could be biomarkers of predicting AWBI efficacy in patients with CSU with autoreactivity.

The autologous serum skin test (ASST) predicts the response to anti-IgE treatment in Chronic Spontaneous Urticaria patients: a prospective study.

Summary: Background. Chronic spontaneous urticaria (CSU), characterized by recurrent itchy wheals and angioedema for > 6 weeks, is a quite common disease that may heavily impair the quality of life. Omalizumab, an anti-IgE mAb, has much improved the management of CSU but patients' response to the drug may vary and predictive markers are still largely missing. We investigated the predictive value of the autologous serum skin test (ASST) on omalizumab response. Methods. 15 patients with severe CSU eligible for omalizumab treatment were prospectively studied submitting them to ASST and to complete blood count, D-dimer, anti-thyroid peroxidase antibodies, and total IgE measurement before the start of the treatment. Results. 14/15 (93%) responded brilliantly to omalizumab at 3 months assessment. 7 responded in less than 1 month ("early responders") and 7 only after multiple administrations ("late responders"). Of 9 patients scoring positive on ASST, 7 (78%) were late, and 2 (22%) early responders to omalizumab (p = 0.021). Of 6 patients scoring negative on ASST, 5 were early omalizumab responders and 1 did not respond. The PPV and NPV of the ASST for a "late" response to omalizumab were 78% and 100%, respectively. Total IgE were significantly higher in early responders. Conclusions. Although larger prospective studies are needed to confirm these results, this study confirms previous retrospective investigations that the positive ASST appears to predict a slow response to omalizumab in CSU patients.

Consecutive injections of low-dose interleukin-2 improve symptoms and disease control in patients with chronic spontaneous urticaria.

PURPOSE: To describe the effectiveness and tolerability of low-dose interleukin (IL)-2 in treating patients with chronic spontaneous urticaria (CSU) refractory to H1-antihistamines. METHODS: This retrospective study included CSU patients who received treatment with at least one cycle of IL-2, injected intramuscularly at a dose of 1.0 million international units daily for 7 consecutive days, after failing treatment with H1-antihistamines. Patients were followed up for ≥12 weeks. RESULTS: Of the 15 patients, 7 (46.7%) and 11 (73.3%) achieved complete response at Week 2 and Week 12, respectively. The mean change of urticaria control test (UCT) and weekly urticaria activity score (UAS7) from baseline was 6.6 (95% CI, 4.2 to 8.9) and - 16.9 (95% CI, -24.0 to -9.8), respectively, at Week 12. Local injection-site reactions were the most common adverse events. No serious adverse events were reported. CONCLUSION: Low-dose IL-2 treatment improves symptoms and disease control for CSU patients refractory to H1-antihistamines.

35 years of autologous serum skin test in chronic spontaneous urticaria: what we know and what we do not know.

Summary: The autologous serum skin test (ASST) has been used in patients with chronic spontaneous urticaria (CSU) as a means to detect an autoreactivity state for thirty-five years now. Nonetheless, several aspects of this old diagnostic test are still insufficiently defined. Particularly, the nature of the factor(s) responsible for the appearance of the wheal-and-flare skin reaction is still poorly characterized. This article will review our current knowledge about the clinical significance of the ASST and the factors possibly associated with the occurrence of the skin reaction following the intradermal administration of autologous serum that are known so far.

Autologous serum therapy reduces the symptoms and antihistamine burden in patients with chronic urticaria.

Introduction: Autologous serum therapy (AST) is considered a potentially curative therapeutic option in the treatment of chronic urticaria, especially in the autoreactive type. Aim: To determine the ratio of patients with a positive autologous serum skin test (ASST) in chronic urticaria and the efficacy of AST. Material and methods: A total of 77 (29 male and 48 female) patients with chronic urticaria were enrolled in the study. The autologous serum skin test (ASST) was performed for all patients and the patients were classified into two groups: ASST positive and ASST negative. Intramuscular injection of AST was administered and the total severity score (TSS) of the urticaria was calculated weekly for ten weeks. The TSS was calculated for another ten weeks without AST. Results: There were 34 patients (11 men and 23 women) in the positive group and 43 (18 men and 25 women) in the negative group. Reduction of symptoms of urticaria begins in the fourth week of the study in both groups. At week 20, 21 (61.7%) patients of the ASST (+) group and 12 (27.2%) patients of the ASST (-) group showed complete clearance. The use of antihistamines decreased from 100% at baseline in both groups to 8.82% and 25.58% in the ASST (+) and ASST (-) groups, respectively, at the end of the study. Conclusions: AST is a low-cost, cost-effective and potentially curative treatment with no adverse effects in these patients. It can reduce the burden of antihistamines.

Evaluation of the Autoimmunity and Preexisting Risky Conditions for Hypersensitivity Reactions to COVID-19 Vaccines.

INTRODUCTION: The role of autoimmunity and other preexisting risky conditions in hypersensitivity reactions (HSRs) to COVID-19 vaccines seems unclear. The aim of the study was to investigate the autoimmunity and preexisting risky conditions in HSRs to COVID-19 vaccines. METHODS: The patients aged ≥18 years with a history of HSR to CoronaVac or Pfizer-BioNTech COVID-19 vaccines within 24 h in 2 tertiary centers were assessed. The patients were divided according to the type of vaccine which they showed immediate-type (<4 h) HSR to (group A1 for CoronaVac and group B1 for Pfizer-BioNTech). Equal number of subjects who did not show HSR to two doses of either CoronaVac or Pfizer-BioNTech was recruited into the study as control groups (group A2 for CoronaVac and group B2 for Pfizer-BioNTech). The autologous serum skin test (ASST) was performed on patient and control groups. Later, the demographic, clinical, and laboratory features were compared between groups. RESULTS: A total number of 27 patients were included in the study. Subjects with chronic spontaneous urticaria (CSU) were more frequent in group B1 than in group B2 (p:0.041). In addition to CSU, the presence of HSRs to drugs was higher in group A1 than in A2 (both p:0.007). The presence of autoimmunity and autoimmune diseases, positivity of antithyroid peroxidase antibody, and ASST were less in group A2 than in A1 (p:0.015, p:0.048, p:0.048, and p:0.037). Additionally, COVID-19 infection history was less in group A2 than in A1 (p:0.037). DISCUSSION/CONCLUSION: Type IIb autoimmunity seems to play a role in immediate type HSRs to the CoronaVac vaccine as previously shown in autoimmune CSU and multidrug hypersensitivity.

Correlations between disease activity, autoimmunity and biological parameters in patients with chronic spontaneous urticaria.

Summary: Background. Biomarkers of disease activity/severity and criteria of autoimmune chronic spontaneous urticaria (CSU) are still a matter of debate. Objective. To investigate possible correlations between clinical and biological markers and their associations with: 1) disease activity, 2) resistance to H1-antihistamines, 3) autoimmunity and 4) autologous serum skin test (ASST) in patients with CSU. To also analyze biological parameter modifications in patients with CSU treated with omalizumab. Materials and methods. Disease activity, H1-antihistamines response and presence of concomitant autoimmune disease were prospectively recorded in 95 patients with CSU. For 60 of them, ASST was performed. Broad biological analysis were performed. Results. C-reactive protein (CRP) serum levels were higher in H1-antihistamines unresponders (p less-than 0.0001) and in more active diseases (p = 0.033). D-dimer plasma levels were higher in H1-antihistamines unresponders (p = 0.008) and in patients with autoimmune status (concomitant autoimmune disease and/or with autoantibodies) (p = 0.016). Total immunoglobuline E (IgE) serum level was lower in patients with positive ASST. Blood basophil counts were lower in patients with CSU and especially in H1-antihistamines unresponders (p = 0.023), in patients with more active disease (p = 0.023), with positive ASST (p = 0.001), and with autoimmune status (p = 0.057). Conversely, under omalizumab, a decrease of CRP (p = 0.0038) and D-dimer serum/plasma levels (p = 0.0002) and an increase of blood basophil counts (p = 0.0023) and total IgE serum levels (p = 0.0007) were observed. Conclusions. This study brings additional evidences of interest to investigate IgE, D-dimer serum/plasma levels and basophil blood counts in patients with CSU as they could be correlated to disease activity, response to treatment and/or autoimmunity.

Comparison of tyrosinase antibody, tyrosinase-related protein-1 and -2 antibodies, melanin-concentrating hormone receptor antibody levels with autologous serum skin test and autologous plasma skin test results in patients with vitiligo.

INTRODUCTION: Although the exact etiopathogenesis of vitiligo is unknown, the autoimmunity hypothesis is much in evidence. The autologous serum skin test (ASST) and autologous plasma skin test (APST) are in vivo methods used in the diagnosis of some autoimmune diseases, which are easy and inexpensive to perform. AIM: In this study, we investigated whether or not ASST and APST could determine autoimmunity in patients with vitiligo. MATERIAL AND METHODS: In this study, 30 vitiligo patients presenting to the dermatology outpatient clinic and 30 healthy volunteers without any known autoimmune diseases were included. Antibodies such as tyrosinase, tyrosinase-related protein-1 (TYRP1), tyrosinase-related protein-2 (TYRP2) and melanin-concentrating hormone receptor 1 (MCHR1) antibodies determined to be associated with vitiligo were examined. In addition, the association of these antibodies with the positivity of ASST and APST, which were suggested to be associated with autoimmunity, were examined. RESULTS: In our study, tyrosinase antibody was found to be significantly higher in vitiligo patients. ASST was positive in 12 (40%) patients with vitiligo and 8 (26.6%) control subjects. APST was positive in 8 (26.6%) of the patients with vitiligo and in 2 (6.6%) of the controls, and there was a significant difference between the groups in terms of APST positivity (p = 0.032). In addition, in our study, a significant correlation was found between TYRP1 antibody positivity and APST positivity in the patient group (p = 0.005). CONCLUSIONS: These findings suggest that we may use APST to investigate the autoimmune etiopathogenesis of vitiligo.

Biomarkers and clinical characteristics of autoimmune chronic spontaneous urticaria: Results of the PURIST Study.

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.

Rationale for the autologous serum skin test in acute versus chronic urticaria.

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.

Effectiveness of Autologous Whole-Blood Injections in Patients with Refractory Chronic Spontaneous Urticaria.

BACKGROUND: Nonsedating antihistamines are the treatment of choice for chronic spontaneous urticaria (CSU), while omalizumab and immunosuppressants have also been approved as an add-on treatment. Autologous whole-blood injection (AWBI) has been used in previous studies with ambiguous results. The aim of our study was to evaluate changes in the Urticaria Activity Score (UAS7), Dermatology Life Quality Index (DLQI), and Chronic Urticaria Quality of Life (CU-Q2oL) score, and also the association of serologic markers with disease severity measures after AWBI. METHODS: In this observational study, AWBIs were performed (8 courses on a weekly basis) in adults with refractory CSU, who refused an add-on treatment with either omalizumab or immunosuppressants. UAS7, DLQI, and CU-Q2oL questionnaires and serum concentrations of total IgE, C-reactive protein (CRP), and D-dimer were evaluated before and after the intervention. RESULTS: Nineteen patients (12 females; mean age 54 ± 20.8 years) completed the protocol. Following AWBI, significant improvements in the UAS7 (34.26 ± 8.04 vs. 12.52 ± 10.83, p < 0.001), DLQI (11.63 ± 5.51 vs. 3.47 ± 2.85, p < 0.001), and CU-Q2oL score (32.97 ± 18.71 vs. 10.94 ± 7.71, p < 0.001) were recorded. A negative correlation between the baseline D-dimer levels and UAS7 and DLQI variations (p = 0.002 and p = 0.001, respectively) was noted. D-dimer levels ≥292 ng/mL have been associated with poor responsiveness (sensitivity 75%; specificity 83.3%). No correlation with either total immunoglobulin E or CRP levels was observed. CONCLUSION: AWBI appears to be a safe, alternative, add-on therapeutic option in refractory CSU, particularly in patients with low plasma levels of D-dimer.

Histamine release positive test associates with disease remission in chronic spontaneous urticaria: a proof-of-concept study.

SUMMARY: Background. Histamine release (HR) test has previously been shown to predict the presence of endogenous histamine-releasing factors in chronic spontaneous urticaria (CSU). Objectives and methods. Twenty CSU patients unresponsive to antihistamine treatment were enrolled in order to evaluate the correlations between HR test results and demographic features, quality of life, disease activity, clinical course, and autologous serum and plasma skin tests (ASST and APST). Results. All patients with positive HR test (9/9, 100%) had a more severe disease activity at onset (urticaria activity score, UAS > 2) when compared to negative HR test patients (5/11; p = 0.04). Quality of life questionnaire's results were not substantially different between HR positive and negative subgroups at baseline (p > 0.05), and results of HR test and ASST/APST did not co-segregate (p > 0.05). After 12 months, patients with a positive HR test had a significant reduction of disease activity (p = 0.003) whereas patients with a negative HR test did not (p > 0.05), leading to disease remission and antihistamine treatment withdrawal in 67% (6/9) of positive HR test patients versus 18% (2/11) of negative HR test patients (p = 0.027). Conclusions. Positive HR test may predict spontaneous CSU remission at 12 months.

Analysis of the association of chronic spontaneous urticaria with interlekin-4, -10, transforming growth factor-ß1, interferon-γ, interleukin-17A and -23 by autologous serum skin test.

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-ß1), 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.

Chronic Spontaneous Urticaria: A Questionnaire Survey.

BACKGROUND: Chronic spontaneous urticaria (CSU) is urticaria persisting for more than 6 weeks with no identifiable provoking cause and associated with significant disability. OBJECTIVES: The aim of this study was to survey patients with CSU with a view to establishing prognosis, efficacy of treatments, suspected causality, and effects on lifestyle. METHODS: One hundred seventy-four patients with CSU were seen between 2003 and 2013. A questionnaire was sent to all, and 101 participated. RESULTS: The ratio of female to male participants was 4:1. The mean age of onset was 36 years. The average duration of symptoms was 8.8 years, with a range of 0.33 to 55 years. Seven percent of participants had autoimmune thyroiditis, and another 17% had various other autoimmune diseases. Common symptoms were pruritus, disturbed sleep, and anxiety. Slightly more than 70% had missed work or school. Most were frustrated at the lack of efficacy of treatments. CONCLUSIONS: CSU is frequently associated with a history of autoimmune diseases. It may persist for decades and causes significant disruption to lifestyle.

IgE FcɛR1ß polymorphism and risk of developing chronic spontaneous urticaria: A study in an ethnic Kashmiri population.

BACKGROUND: The pathogenesis of chronic spontaneous urticaria involves interplay between the genetic and environmental factors, most of which is still poorly understood. It is well-recognized that 30-40% of chronic spontaneous urticaria is autoimmune in nature. Chronic autoimmune urticaria is caused by anti-FcɛR1ß and less frequently, by anti-IgE auto antibodies that lead to mast cell and basophil activation, thereby giving rise to the release of histamine and other proinflammatory mediators. We investigated the association between SNP loci in FcɛR1ß and chronic spontaneous urticaria and to see its relation with serum IgE levels in Kashmiri population. METHODS: The autologous serum skin test was used as a screening test for chronic autoimmune urticaria. PCR-RFLP was used to detect the genotype of the SNP loci. Serum IgE levels were assessed by ELISA kit. RESULTS: No significant difference was found between the study population and control group in genotype distribution (wild and variant) among FcɛR1ß loci (P value=0.06, odds ratio=0.29). The frequency of FcɛR1ß (C109T) in autologous serum skin test positive chronic autoimmune urticaria patients with the CT genotype was found to be statistically non-significant when compared with the wild genotype (P=0.35). Carriers of FcɛR1ß (T allele) had a more significant risk of developing CAU than those with C allele (P=0.01). In our population serum total IgE levels did not find any statistical significance with regard to ASST positive & ASST negative patients (P=0.26). CONCLUSIONS: There is statistically no significant association between FcɛR1ß gene polymorphism and CSU in Kashmiri population; however, there is a probability of developing CSU in patients carrying FcɛR1ß T allele. Furthermore, serum total IgE levels had no significant association with the development of CAU.

The relation of autologous serum and plasma skin test results with urticarial activity score, sex and age in patients with chronic urticaria.

INTRODUCTION: Some previous studies reported autoimmunity as an etiologic factor in chronic urticaria (CU), but the results of some autoimmunity tests in these studies are conflicting. AIM: To concretize whether there was any relation of autologous serum skin test (ASST) and autologous plasma skin test (APST) results with sex, age and urticarial activity score (UAS) in patients with CU. MATERIAL AND METHODS: Fifty patients with CU and twenty healthy subjects admitted to our dermatology clinic were included in the present study. The ASST and APST were applied to all individuals. RESULTS: The positiveness rates of ASST and APST were significantly higher in the patient group than controls (p = 0.027, p = 0.001, respectively). Among patients, the APST positiveness rate (72%) was significantly (p < 0.05) higher than ASST (46%). It was seen that 48% of patients with negative ASST results had positive APST. However, no patient with negative APST results had positive ASST. There were significant (p < 0.05) relations of the tests' positiveness rates with sex and old age but with UAS. The diameter of the erythematous papule was remarkably (p < 0.05) larger in APST than ASST and also significantly (p < 0.05) larger in females compared to males in both tests (p < 0.05). It was positively increased with old age (p < 0.05). CONCLUSIONS: We can suggest that APST is more sensitive than ASST in the assessment of autoimmunity in CU. A high positiveness rate of APST results may be attributed to high numbers of autoantibodies and coagulation factors present in plasma that might probably play a role in etiopathogenesis of CU.

The natural history of chronic urticaria in childhood: a prospective study.

BACKGROUND: There are few prospective studies on the natural course of chronic urticaria (CU) in children. OBJECTIVE: We sought to examine the natural history of CU in children and to identify predictors for remission. METHODS: Children 4 to 15 years of age with CU were investigated with a complete blood cell count, erythrocyte sedimentation rate, antinuclear antibody titer, complement CH50 level, thyroid studies, autologous serum skin test, skin-prick tests, food challenges, and stool examination for parasites. They were considered to be in remission if symptoms did not recur for at least 12 months without medication. RESULTS: In all, 92 children (53.3% female) with CU were recruited and followed up for a median duration of 4.3 years (range 2.5-5.8 years). Chronic autoimmune urticaria (CAU) was identified in 40% of the patients. Food allergy was found in 8.7% and parasitic infestations in 5.4%. Remission rates at 1, 3, and 5 years after the onset of CU symptoms were 18.5%, 54%, and 67.7%, respectively. The remission rate did not differ in CAU compared with non-CAU. No predictor of CU remission was identified. LIMITATIONS: The basophil histamine release assay was not performed. CONCLUSION: Children with CU have a favorable outcome. CAU did not have an intractable course.

Efficacy of autologous serum therapy in positive and negative autologous serum skin test patients in chronic urticaria in a tertiary care centre.

Autologous serum therapy (AST) has been a recent therapeutic choice for a variety of chronic diseases such as allergic, inflammatory, infectious, and autoimmune disorders. However, evidence were not convincing of the beneficial effects of autologous serum therapy in treatment of Chronic urticaria (CU). CU is a common dermatological condition that is very disturbing to the patient as well as to the physician. A new observation was made about the abnormal type 1 reactions to intradermal autologous serum injections in some CU patients. This has led to the new subgroup of autoimmune chronic urticaria. The autologous serum skin test (ASST) is an intradermal test result in immediate hypersensitivity-type skin reactions in a subpopulation of CU patients and it's giving promising evidence of therapeutic and diagnostic benefit. Autologous whole blood injection has already been used as one of the old treatment modalities for chronic urticaria. The objectives of this study/reasearch are to analyse the efficacy of autologous serum therapy in patients with chronic urticaria and compare its results in ASST(+) and ASST(-) chronic urticaria patients. Approximately 5 mL of patients' blood was drawn in a plain vacutainer and centrifuged at 3000 r.p.m. for 10 min, separated 2.5 mL serum injected deep intramuscularly into gluteus muscle. Injections were repeated every week for about 9 weeks and a repeat follow up at 20 weeks was done. Out of a total of 20 patients, excellent improvement in terms of decrease in Urticaria assessment severity score was seen in 6 patients; whereas, 10 patients showed partial response, 2 patients showed no response and 2 patients lost the follow up. 10 patients with ASST(+) and 6 patients of ASST(-) showed little improvement in urticaria severity score. AST therapy is a cost-effective adjuvant modality to reduce the severity of symptoms of chronic urticaria. In some patients it's giving long term remission period and it decreases the updosing of antihistamines.

Increased serum free IgE levels in patients with chronic spontaneous urticaria (CSU).

Background: IgE bound on the surface of mast cells contributes to the pathogenesis of chronic spontaneous urticaria (CSU). Atopy is a predisposing factor for CSU, where omalizumab is a widely used monoclonal antibody to control urticaria symptoms via capturing serum free IgE. However, the role of serum free IgE is not clarified in CSU. The present study evaluated the clinical relevance of serum free IgE in patients with CSU. Methods: Eighty-eight patients with CSU and 76 healthy controls (HCs) were enrolled in this study. Serum total and Dermatophagoides pteronyssinus (Der p)-specific IgE levels were measured by ImmunoCAPs. The serum free IgE levels were measured by ELISA using a novel IgETRAP, and their associations with clinical parameters, including urticaria activity score (UAS), were evaluated. Changes in serum free and total IgE levels after omalizumab treatment were observed in 23 CSU patients in comparison between responders (≥50% reduction in UAS) and non-responders (<50% reduction). Results: Significantly higher serum free/total IgE levels were noted in CSU patients than in HCs with a positive correlation between the 2 values (rho = 0.87, P < 0.001). Among CSU patients, atopics had significantly higher serum free IgE levels than non-atopics, while no associations were noted with UAS, urticaria duration, or the results of serum ANA or autologous serum skin tests. In addition, there were no significant changes in serum free IgE levels during 12 months of omalizumab treatment. No significant differences were noted in serum free/total IgE levels or clinical parameters between responders and non-responders, while responders have higher serum Der p-specific IgE level and its ratio to serum free/total IgE level than non-responders (P < 0.05, respectively). Conclusions: These findings suggest that increased serum free IgE may be involved in the development of CSU by activating mast cells, especially in atopics. High Der p-specific IgE level and its ratio to serum free IgE level may be a potential biomarker for predicting favorable responses to omalizumab in CSU.

What Basophil Testing Tells Us About CSU Patients - Results of the CORSA Study.

Basophil testing is the most effective single approach for diagnosing type-IIb autoimmune chronic spontaneous urticaria (TIIbaiCSU). A positive basophil test has been linked to long disease duration, higher disease activity, a poor response to antihistamines and omalizumab, and a better response to cyclosporine and fenebrutinib. As of now it is unclear what other features are connected to a positive basophil test in chronic spontaneous urticaria (CSU). We aimed to identify features of basophil test-positive CSU patients. We performed a cross-sectional study of 85 CSU patients. Basophil testing was done with the basophil activation test (BAT) and the basophil histamine release assay (BHRA). Data were analysed using SPSS: Student's t-test, Chi-square test, Odds Ratio, Spearman's correlation test. Of 85 CSU patients, 44% and 28% tested positive with the BAT and BHRA, respectively. These patients showed higher disease activity and impact, lower levels of disease control and total serum IgE, as well as higher rates of having a positive autologous serum skin test (ASST), angioedema, nocturnal symptoms, symptoms for >5 days/week, and thyroid autoantibodies. The ASST, by itself, was not a good predictor of basophil test results, but it predicted a positive basophil test in up to 100% of cases when combined with angioedema, thyroid autoantibodies or low IgE. In conclusion, a positive basophil test is linked to known features of TIIbaiCSU and novel characteristics including nocturnal symptoms. Further studies on basophil test-positive and -negative CSU patients can help to better understand CSU endotypes and to develop better management approaches.