Serum interleukin-18 in patients with chronic ordinary urticaria: association with disease activity.

Interleukin (IL)-18 is a pleiotropic cytokine, which may play a role in autoimmune and allergic disorders. Serum IL-18 levels were measured in 34 patients with chronic ordinary urticaria (COU) and 17 normal subjects. In vivo and in vitro assays for histamine-releasing factors, an autologous serum skin test (ASST) and a basophil histamine release assay were also performed for all patients with COU. Serum IL-18 concentration was not significantly different between patients with COU and normal subjects (mean+/-standard error of the mean 246.47+/-18.40 pg/mL vs. 213.88+/-22.24 pg/mL), and no significant difference was found between ASST-positive and ASST-negative patients. However, in ASST-positive patients, IL-18 levels paralleled clinical severity scores and showed a tendency to correlate with in vitro histamine release. The increased IL-18 levels in the ASST-positive patients with most active chronic urticaria may reflect stronger immune system activation and possibly an involvement of IL-18 as a direct histamine-releasing factor.

Detection of serum histamine-releasing factors in a patient with idiopathic anaphylaxis and multiple drug allergy syndrome.

We describe the case of a 30-year-old woman who reported several episodes of anaphylaxis with angioedema and relapsing urticaria. Some events were related to nonsteroidal anti-inflammatory drug intake and one episode followed alcohol ingestion, but in most cases no triggers could be identified. Specific immunoglobulin E determination was negative for food and drug allergens, C3 and C4 were in the normal range, C1 inhibitor was slightly reduced and serum tryptase was undetectable. In vivo autologous serum skin test and in vitro basophil histamine release assay were positive indicating the presence of circulating histamine-releasing factors. When oral tolerance tests were performed, only doxycycline was tolerated whereas levofloxacin, clarithromycin, nimesulide and tramadol caused mild urticaria. Premedication with cetirizine allowed the patient to tolerate levofloxacin, clarithromycin and nimesulide. The demonstration of circulating histamine-releasing factors in a patient with idiopathic anaphylaxis and multiple drug allergy syndrome provides a new mechanistic insight and might open the way to new therapeutic approaches.

Serum histamine-releasing activity in a patient with idiopathic pulmonary haemosiderosis

Background: idiopathic pulmonary haemosiderosis (IPH) is a rare disorder characterized by intermittent, diffuse alveolar bleeding. The pathogenesis of the diseases is unclear, although an association with milk or gluten hypersensitivity has been described, and an immune-mediated damage of alveolar capillaires has been suggested. A previous report showed the release of histamine after cow's milk intake in a newborn with cow's milk intolerance and IPH. Methods and results: here, we report the detection of serum histamine-releasing activity (HRA) in a 30-year-old woman with IPH. The serum taken during an active phase of the disease induced histamine release from basophils of two normal donors; conversely, when the patient was receiving prednisone and azathioprine, and the disease was in remission, the serum HRA was reduced. Serum fractions with a MW lower than 100 kDa displayed an enhanced HRA; in contrast, serum fractions with MW above 100 kDa were not able to induce histamine release, suggesting that the activity was due to a cytokine and not to an immunoglobulin. Conclusions: the detection of serum HRA provides further evidence that the immune system is activated in the course of IPH and supports an immunologic basis for the alveolar capillary damage, which is responsible for alveolar bleeding (AU)

Antecedentes: la hemosiderosis pulmonar idiopática (IPH) es un raro trastorno caracterizado por un sangrado alveolar intermitente y difuso. La patogénesis de esta enfermedad no es clara, no obstante ha sido descrita una asociación con hipersensibilidad a la leche o al gluten, sugiriendo un daño en los capilares alveolares inmunomediado. Una previa comunicación señala la liberación de histamina después del consumo de leche de vaca en un recién nacido con intolerancia a la leche de vaca y IPH. Métodos y resultados: a continuación, referimos la detección de la actividad de liberación de histamina (HRA) en el suero de una mujer de 30 años con IPH.El suero tomado durante la fase activa de la enfermedad indujo la liberación de histamina de los basófilos de dos donantes normales; inversamente, cuando el paciente recibió prednisona y azatioprina, y la enfermedad estaba en remisión, la HRA del suero se redujo. Las fracciones del suero con peso molecular (MW) por debajo de 100 kDa presentaron un aumentado HRA; en contraste, las fracciones del suero con MW por encima del 100 kDa no fueron capaces de inducir la liberación de histamina, sugiriendo que la actividad era debida a citocinas y no a inmunoglobulinas. Conclusiones: la detección en el suero de HRA provee ulteriores evidencias que el sistema inmune es activado en el curso de IPH y sostiene una base inmunológica del daño capilar alveolar, responsable del sangrado alveolar (AU)

NSAID intolerance in chronic idiopathic urticaria: A study of its relationship with histamine-releasing activity of patients' sera.

BACKGROUND: about one fourth of patients with chronic idiopathic urticaria (CIU) experience flares of hives after taking chemically unrelated nonsteroidal anti-inflammatory drugs (NSAID). The reasons for such intolerance are still elusive. OBJECTIVE: this study aimed to investigate NSAID intolerance in patients with CIU in view of the in vivo and in vitro histamine releasing activity of their sera. METHODS: 117 adults (M/F 41/76) with CIU underwent intradermal test with autologous serum, and the ability of their sera to induce histamine release from normal blood donors was evaluated. NSAID intolerance was ascertained by careful interview. RESULTS: overall, 32/117 (27 %) patients reported NSAID intolerance. The prevalence on NSAID intolerance did not differ in the three subgroups: negative on both in vivo and in vitro tests (9/36; 25 %), positive or intradermal test but negative on basophil histamine release assay (16/58; 28 %), or positive on both in vivo and in vitro tests (7/23; 30 %). CONCLUSION: in patients with CIU intolerance to NSAID does not depend on the mechanism of histamine release.

NSAID intolerance in chronic idiopathic urticaria: A study of its relationship with histamine-releasing activity of patients' sera

Background: about one fourth of patients with chronic idiopathic urticaria (CIU) experience flares of hives after taking chemically unrelated non steroidal anti-inflammatory drugs (NSAID). The reasons for such intolerance are still elusive. Objective: this study aimed to investigate NSAID intolerance in patients with CIU in view of the in vivo and in vitro histamine releasing activity of their sera. Methods: 117 adults (M/F 41/76) with CIU underwent intradermal test with autologous serum, and the ability of their sera to induce histamine release from normal blood donors was evaluated. NSAID intolerance was ascertained by careful interview. Results: overall, 32/117 (27 %) patients reported NSAID intolerance. The prevalence on NSAID intolerance did not differ in the three subgroups: negative on both in vivo and in vitro tests (9/36; 25 %), positive or intradermal test but negative on basophil histamine release assay (16/58; 28 %), or positive on both in vivo and in vitro tests (7/23; 30 %). Conclusion: in patients with CIU intolerance to NSAID does not depend on the mechanism of histamine release (AU)

Fundamento: cerca de un cuarto de pacientes con urticaria crónica idiopática (CIU) experimenta un enrojecimiento de las pápulas después de la suministración de fármacos antiinflamatorios no esteroideos químicamente no relacionados (NSAID). Las razones de dicha intolerancia son todavía incomprensibles.Objetivos: este estudio se propone investigar la intolerancia a los NSAID en pacientes con CIU examinando la capacidad de liberación de histamina in vivo e in vitro del suero de estos pacientes.Métodos: a 117 adultos (M/F 41/76) con CIU se les practicó un test intradérmico con suero autólogo y se evaluó la capacidad del suero de inducir la liberación de histamina en la sangre de donadores sanos. La intolerancia a NSAID fue indagada a través de un cuidadoso interrogatorio.Resultados: 32/117 (27 por ciento) pacientes reportaron intolerancia a NSAID. No se encontró diferencia en cuanto a la prevalencia de la intolerancia a NSAID en los tres subgrupos: negativos en ambos tests in vivo e in vitro (9/36; 25 por ciento), positivo en el test intradérmico pero negativo en el test de liberación de histamina (16/58; 28 por ciento), o positivos en ambos tests in vivo e in vitro (7/23; 30 por ciento).Conclusiones: en pacientes con CIU la intolerancia a NSAID no depende del mecanismo de liberación de histamina (AU)

Serum histamine-releasing activity in a patient with idiopathic pulmonary haemosiderosis.

BACKGROUND: idiopathic pulmonary haemosiderosis (IPH) is a rare disorder characterized by intermittent, diffuse alveolar bleeding. The pathogenesis of the diseases is unclear, although an association with milk or gluten hypersensitivity has been described, and an immune-mediated damage of alveolar capillaries has been suggested. A previous report showed the release of histamine after cow's milk intake in a newborn with cow's milk intolerance and IPH. METHODS AND RESULTS: here, we report the detection of serum histamine-releasing activity (HRA) in a 30-year-old woman with IPH. The serum taken during an active phase of the disease induced histamine release from basophils of two normal donors; conversely, when the patient was receiving prednisone and azathioprine, and the disease was in remission, the serum HRA was reduced. Serum fractions with a MW lower than 100 kDa displayed an enhanced HRA; in contrast, serum fractions with MW above 100 kDa were not able to induce histamine release, suggesting that the activity was due to a cytokine and not to an immunoglobulin. CONCLUSIONS: the detection of serum HRA provides further evidence that the immune system is activated in the course of IPH and supports an immunologic basis for the alveolar capillary damage, which is responsible for alveolar bleeding.