Role of immunoglobulin E autoantibodies in autoimmune skin diseases / 中华皮肤科杂志

A large number of studies have shown that immunoglobulin E (IgE) not only participates in the occurrence and development of allergic reactions, but also induces and aggravates autoimmune reactions through various mechanisms. IgE autoantibodies have been confirmed to be present in a variety of autoimmune skin diseases, and may be involved in the occurrence and development of related diseases by affecting multiple immune cells such as dendritic cells, mast cells, and basophils via binding to autoantigens. This review summarizes the role and possible mechanism of action of IgE in the induction and exacerbation of autoimmune skin diseases such as systemic lupus erythematosus, bullous pemphigoid and chronic idiopathic urticaria, and provides a theoretical basis for clinical diagnosis and treatment.

A study of Allergy pattern in Chronic Idiopathic Urticaria

Introduction: Urticaria is a common disease with many different clinical presentations. Urticaria is traditionally classified into acute and chronic urticaria with acute off time of 6 weeks. The aim of study is to find the common allergens involved in chronic idiopathic urticaria. Aim of the study: To find common allergens involved in patients of Chronic Idiopathic Urticaria. Materials and methods: A total of 100 patients with chronic idiopathic urticaria were included in the study and allergy test was done using chemiluminescence method. Conclusion: Allergy test are useful diagnostics test in the management of chronic idiopathic urticaria.

System Evaluation of Glucoside Tripterygium Total Combined with Antihistamine Medicine for Chronic Idiopathic Urticaria / 中国中医药信息杂志

Objective To systematically evaluate the effectiveness and safety of glucoside tripterygium total (GTT) combined with antihistamine medicine for chronic idiopathic urticaria (CIU). Methods All randomized or semi-randomized controlled trials (RCTs or semi-RCTs) of GTT in treating CIU were collected from CNKI, VIP, WanFang Data, CBM, Embase, PubMed and Cochrane Library clinical controlled trials database. After two researchers conducted screening and data extraction independently, the quality of the included literature research was evaluated according to the risk of bias tool described in the Cochrane Handbook version 5.1.0, and then RevMan 5.3 was used to undertake Meta analysis. Results A total of 21 articles about RCTs and semi-RCTs were obtained, including 2194 patients. Meta analysis indicated that GTT combined with antihistamine medicine treatment showed higher effective rates compared with the control group [RR=1.33, 95%CI (1.26, 1.40), P<0.000 01], with obviously lower recurrence rate [RR=0.45, 95%CI (0.33, 0.62), P<0.000 01]. There was no statistical significance in adverse reactions. Conclusion GTT combined with antihistamine medicine for CIU has definite efficacy, and is relatively safe. Whether apply GTT combined with antihistamine medicine for CIU should be verified through randomized controlled trial with large-scale samples, multiple centers and high quality.

Clinical effect of autohemotherapy combined loratadine on 120 cases of ASST positive chronic idiopathic urticaria / 重庆医学

Objective To investigate the efficacy and safety of autohemotherapy therapy in ASST positive chronic idiopathic ur‐ticaria .Methods One hundred and twenty cases of chronic idiopathic urticaria treated in our department from April ,2012 to Janu‐ary ,2013 were divided into treatment group and control group ,60 cases in each group .Patients in treatment group were given oral ioratadine (10 mg/d) ,supplemented by autohemotherapy ;patients in control group were only given oral ioratadine (10 mg/d) .Both of the two groups were treated with twelve weeks ,then observed the effectiveness and safety of two kinds of treatment .Results The effective rate of treatment group and control group were 68 .33% and 48 .33% respectively ,and there was significant difference between the two groups (P<0 .01) .Conclusion Autohemotherapy combined antihistamine was of high efficiency and safety in the treatment of ASST positive chronic idiopathic urticaria ,while the long‐term curative effect remains to be observed .

A randomized placebo-controlled double-blind pilot study of methotrexate in the treatment of H1 antihistamine-resistant chronic spontaneous urticaria.

Background: Chronic urticaria not responsive to antihistamines is a diffi cult disease to manage. Methotrexate has been used in diffi cult chronic urticarias with some benefi t. Objective: To evaluate the effi cacy of methotrexate in the treatment of chronic spontaneous urticaria poorly responsive to H1 antihistaminics. Methods: In a randomized double-blind trial at the Department of Dermatology and Venereology of a tertiary care centre, 29 patients with chronic spontaneous urticaria not responding well to H1 antihistaminics were recruited. Patients were randomly allocated to receive either a weekly dose of oral methotrexate 15 mg or placebo (calcium carbonate) for a total duration of 12 weeks, after which treatment was stopped and patients were followed up for relapse of urticaria. Each group also received levocetrizine 5 mg once daily for symptom control. Primary outcome measured was a reduction by >2/3rd of baseline urticaria scores after 12 week therapy. Secondary outcome was a reduction in antihistamine requirement after stopping therapy. Results: Fourteen patients were randomized to the methotrexate group and fi fteen patients to the placebo group. Out of 17 patients who completed therapy, the primary outcome was achieved by 3.5 ± 1.9 (out of 10) patients in the methotrexate group and by 3.67 ± 1.03 (out of 7) patients in the placebo group (P > 0.05). Ten patients followed up, after stopping therapy, for a mean period of 3.5 ± 2.4 months; 3 remained in remission and 7 had relapsed. One patient had uncontrollable nausea and vomiting after taking methotrexate and was withdrawn from the study. The placebo group did not experience any side effects. Conclusions: Methotrexate 15 mg weekly for 3 months did not provide any additional benefi t over H1 antihistamines in this study but an adequately powered study with longer follow up is required to assess its utility.

Usefulness of the Autologous Serum Test for the Diagnosis of Chronic Idiopathic Urticaria

BACKGROUND: The majority of chronic urticaria cases are chronic idiopathic urticaria (CIU) with no specific identifiable etiology. The role of autoantibodies in such cases remains controversial. OBJECTIVE: This study determined the positivity rate of autologous serum tests in CIU patients. METHODS: This study was performed on 30 patients with CIU and 30 individuals without any systemic or dermatologic disease. After the volar parts of right and left forearms were cleansed, 0.05 ml serum physiologic and 0.05 ml autologous serum were injected intradermally on the right forearm 5 cm apart from each other, resulting in the formation of small papules; meanwhile, 0.05 ml histamine alone was injected to the left forearm. The test results were evaluated after 30 minutes as positive in positive cases. RESULTS: The autologous serum test produced significant and non-significant results in patients with CIU and controls, respectively. The positivity rates of the autologous serum test in the CIU and control groups were 53.3% and 26.6%, respectively. There was no relationship between autologous serum test positivity and sex in either group. In male patients with CIU, positive results ranged widely with age, while in female patients, positive results were mainly observed at younger ages with a narrow age range. CONCLUSION: The autologous serum test is a useful test in the diagnosis and treatment of CIU as well as the selection of immunotherapy, especially in patients refractory to classic therapy.

Correlations between Anti-Mast Cell Autoantibodies and Chronic Idiopathic Urticaria

BACKGROUND: The etiology of chronic idiopathic urticaria (CIU) is not completely clear. There are a few antibodies were reported to correlate with CIU. OBJECTIVE: To investigate the correlation these antibodies and CIU. METHODS: The autologous serum skin test (ASST) and allergens were performed. Serum levels of immunoglobulin E (IgE), anti-FcepsilonRI and anti-IgE, anti-Helicobacter pylori (HP) antibodies and anti-thyroglobulin antibody (TGAb) were measured in 100 patients with CIU, acute urticaria (AU) and normal controls respectively. RESULTS: Eighty-six percent food or inhalant allergens were detected in AU patients, but no allergens were detected in CIU patients and normal controls. Serum anti-FcepsilonRI antibody and anti-IgE antibody levels were higher in the CIU than that in the AU patients and normal controls (p<0.05, respectively). IgE level was lower in the CIU patients (T=190.00, p< 0.05), but increased in the AU patients (T=226.00, p<0.05) compared with the normal controls. The ASST positive rates in the CIU and the AU patients were 53.4% and 12.6% respectively, but all normal controls were negative. The anti-FcepsilonRI antibody level was higher in the ASST-positive CIU patients than those negative ones (T=101.73, p<0.05). In anti-HP antibody positive and TGAb positive CIU patients, anti-FcepsilonRI antibody positive rate was higher than AU patients (p<0.01) and normal controls (p<0.01). CONCLUSION: The anti-FcepsilonRI and anti-IgE antibodies play a key role in CIU, but anti-HP antibody and TGAb have an indirect correlation with CIU.

Study of serum interleukin (IL) 18 and IL-6 levels in relation with the clinical disease severity in chronic idiopathic urticaria patients of Kashmir (North India)

BACKGROUND: Chronic urticaria is termed as idiopathic if there is an absence of any identifiable causes of mast cell and basophil degranulation. Various cytokines have been found to be involved in inflammatory processes associated with chronic idiopathic urticaria, including interleukin (IL) 18 and IL-6. OBJECTIVE: To evaluate any possible correlation of IL-18 and IL-6 cytokines with the clinical disease severity in chronic idiopathic urticaria (CIU). METHODS: IL-18 and IL-6 levels of CIU patients (n = 62) and healthy controls (n = 27) were assessed by commercially available enzyme linked immunosorbent assay kits following the manufacturer's protocols. RESULTS: Serum IL-18 concentration (mean ± standard deviation [SD], 62.95 ± 36.09 pg/mL) in CIU patients and in healthy controls (54.35 ± 18.45 pg/mL) showed no statistical significance (p > 0.05). No statistically significant difference (p > 0.05) was observed between autologous serum skin test (ASST) positive and ASST negative patients with regard to the serum IL-18 levels either. Similarly, serum IL-6 concentration (0.82 ± 4.6 pg/mL) in CIU patients and in healthy controls (0.12 ± 1.7 pg/mL), showed no statistical significance (p > 0.05). Also, comparison between positive and ASST negative patients with regard to the serum IL-6 levels was statistically nonsignificant (p > 0.05). However, statistical significance was found both in IL-18 and IL-6 concentrations in certain grades with regard to the clinical disease severity of urticaria. CONCLUSION: There is no significant association as such found between IL-18 and IL-6 levels with CIU, however, these cytokines may help in predicting the clinical disease severity in CIU. Hence, these cytokines may indicate a potential role as a biomarker to assess the disease severity in CIU.

Clinical Study of Itch in Korean Patients with Chronic Idiopathic Urticaria / 대한피부과학회지

BACKGROUND: Although itch is a cardinal symptom of urticaria, its clinical characteristics are not well elucidated in Korean urticaria patients. OBJECTIVE: To characterize the clinical patterns and sensory, affective and therapeutic dimensions of itch in Korean patients with chronic idiopathic urticaria (CIU). METHODS: A face-to-face structured questionnaire based on the McGill pain questionnaire was given to 83 patients with CIU. RESULTS: All of the 83 patients recruited in the study have fully filled-out the questionnaire. In 71.1 percent of the total CIU patients, itch appeared on a daily basis. Patients experienced exacerbation of itch during winter (41.0%) and at night (37.3%). The buttock (50.6%) and front of the thigh (50.6%) were major sites of involvement with itchiness. Patients perceived itch as burning (62.7%), stinging (44.6%) and crawling sensations (42.2%), rather than stabbing (25.3%), tickling (24.1%) and pinching (10.8%). The main associated symptom was heating sensation (60.2%). The majority of the patients answered that itch was annoying (84.3%), worrisome (80.7%) and bothersome (78.3%). Korean CIU patients answered that stress (36.1%) and hot climate (33.7%) aggravated the itch, and medications (55.4%) alleviated it. Among antihistamines, systemic corticosteroids and topical corticosteroids, antihistamines were the most effective treatment for management of itch in patients with CIU. CONCLUSION: This study highlights the detailed description and characteristics of itch in Korean CIU patients. Moreover, we tried to emphasize the clinical differences of itch in CIU patients in comparison with that in atopic dermatitis patients.

The Impact of Chronic Idiopathic Urticaria on Quality of Life in Korean Patients

BACKGROUND: Chronic idiopathic urticaria (CIU) is a relatively common disease, and yet not much is known about the causative factors or its pathophysiology, which makes it difficult to cure. Due to its chronic nature, many patients have significantly reduced quality of life (QOL). OBJECTIVE: The purpose of this study was to assess the impact of CIU on QOL of Korean patients, and to determine whether a relationship exists between QOL and the severity of disease. METHODS: One hundred sixty three patients with CIU, who first visited our out-patient clinic between August 2005 and July 2007, were asked to complete two questionnaires: one designed to assess the clinical features of their disease; the other on the influences of CIU on their daily lives. QOL was divided into six categories: mental status (MS), daily living activities (DLA), leisure activities (LA), self-perception (SP), treatment-induced restrictions (TIR), and social functions (SF). All of the QOL scores were recalibrated to a 0~100 scale, with 100 indicating the worst QOL, and 0 the best. RESULTS: The average QOL scores obtained from the questionnaire were as follows: SP (13.1+/-4.6), DLA (12.0+/-4.3), MS (10.3+/-3.3), SF (8.5+/-3.4), LA (6.1+/-3.0), and TIR (5.5+/-2.6). SP was the domain that was most affected; TIR the least. There were positive correlations between pairs of the six different QOL categories (p<0.001). These results demonstrate that CIU exerts an influence on many aspects of QOL. TIR was significantly affected in longer term CIU cases (p<0.05), while SP, MS, DLA, SF, and SR scores did not correlate with disease duration. Disease severity was found to have a significant impact on SP, MS, SF, and LA (p<0.05). In patients with concurrent physical urticaria, DLA and SF scores were significantly affected (p<0.05). CONCLUSION: Based on these results, it is suggested that CIU has a negative impact on QOL in Korean patients. Therefore, it is important to recognize the effects CIU can have on QOL and consider them in evaluating the response to treatment.

Perfil de ativação de basófilos e evidência de fatores liberadores de histamina na urticária crônica idiopática / Basophils activation profile and evidence of histamine release factor in chronic idiopathic urticaria

INTRODUÇÃO: A Urticária Crônica é caracterizada pelo aparecimento de pápulas eritematosas, pruriginosas recorrentes e transitórias que duram por mais de seis semanas. Na maioria dos pacientes a causa é indeterminada, definida como idiopática (UCI), entretanto, um sub-grupo apresentam autoanticorpos contra a cadeia alfa do receptor de alta afinidade para IgE (FceRI), que são expressos na superfície de mastócitos e basófilos, tornando-os células alvo nesta doença. OBJETIVOS: Avaliar em pacientes com UCI, submetidos ao teste intradérmico de soro autólogo (ASST), o perfil de ativação dos basófilos, pela intensidade de expressão de marcadores de ativação/desgranulação e pela capacidade dos basófilos em responder aos estímulo com a IL-3 e anticorpo anti-IgE. Além disto, a presença de fator liberador de histamina foi avaliado nos soros dos pacientes. METODOLOGIA: Pacientes com UCI (n= 37) foram selecionados no Ambulatório de Urticária do Departamento de Dermatologia do Hospital das Clínicas da Faculdade de Medicina da USP e submetidos ao ASST. O grupo controle foi constituído por indivíduos saudáveis (n=38). A análise da expressão de FceRI, CD63, CD123 e CD203c em basófilos de sangue periférico foi realizada por citometria de fluxo. No ensaio in vitro de estimulação dos basófilos com anti-IgE, as células foram previamente incubadas com IL-3. O ensaio de liberação de histamina mediada por soros de pacientes com UCI foi realizado com três diferentes doadores de leucócitos e a histamina liberada dosada por ELISA de competição. RESULTADOS: Há um baixo número de basófilos no sangue periférico nos pacientes com UCI, coincidente com o baixo nível sérico de histamina. Os escassos basófilos no sangue periférico mostram elevada expressão de FceRI e uma regulação positiva da expressão de CD203c e CD63, independentemente do ASST. A análise funcional dos basófilos, mostra que somente a incubação com IL-3 recombinante já induz aumento significante da expressão de CD203c...

INTRODUCTION: Chronic Urticaria is characterized by recurrent, transitory, pruritic and erythematous wheals present for at least six weeks. In most patients the cause is unknown, defined as idiopathic (CIU), however, a sub-group has autoantibodies against the alfa chain of the high affinity IgE receptor (FceRIa) expressed on mast cells and basophils surface making it the target cells in this disease. OBJECTIVES: To evaluate in CIU patients, undergone autologous serum skin test (ASST), the activation profile of the basophils assessed by the expression of activation/degranulation markers and by the ability to release histamine in response to IL-3 priming and cross-linking with anti-IgE antibodies. Furthermore, the presence of histamine releasing factor in sera of patients was evaluated. METHODS: CIU patients (n = 37) were selected from the Dermatological Outpatient Clinic of the Hospital das Clínicas de São Paulo (HC-FMUSP) and submitted to the ASST. The control group consisted of healthy subjects (n=38). The analysis of the expression of FceRI, CD63, CD123 and CD203c on basophils from peripheral blood was assessed by flow cytometry. For the in vitro stimulation with anti-IgE antibodies, the cells were previously primed with human recombinant IL-3. The histamine release assay mediated by sera from patients with CIU was performed with three different donors of leukocytes and released histamine measured by competition ELISA. RESULTS: There is a low number of basophils in peripheral blood of patients with CIU, reflecting a low serum levels of histamine. The scarce basophils in peripheral blood show high expression of FceRI and an up-regulation of CD203c and CD63 marker expression, independently of the ASST. The functional analysis of basophils, revealed that recombinant IL-3 per se induces a significant increase in CD203c expression and the histamine release from basophils of patients with CIU, which are enhanced followed for 15 and 40 minutes...

The Efficacy, Safety and Long-term Effect of Cyclosporine for Treating Chronic Idiopathic Urticaria / 대한피부과학회지

BACKGROUND: The efficacy and safety of cyclosporine for the treatment of chronic idiopathic urticaria (CIU) have been studied in numerous trials, but there have been few studies on the long-term effect of cyclosporine. OBJECTIVE: This study was aimed to assess the efficacy and safety of low-dose cyclosporine for treating CIU. Furthermore, its long-term effect on the natural course of CIU was investigated. METHODS: Thirty patients who suffered from persistent CIU despite conventional treatments received 2~3 mg/kg/day of cyclosporine for 12 weeks. The severity score was assessed by means of the urticaria activity score and the visual analogue score at baseline and at weeks 2, 4, 8 and 12. The safety assessments consisted of reporting the side effects and monitoring the laboratory parameters. After a follow-up period of at least 1 year, the patients were asked whether they had any remaining or new symptoms and whether they still used antihistamines or any other drugs. RESULTS: Twenty seven patients completed the trial medication, and the respective symptom scores significantly improved after 12 weeks. Four (14.8%) patients reported adverse events during the trial period, but the events were not severe enough to require withdrawal from the study. Of the twenty one patients who were followed for at least 1 year (range: 12~45 months) after the completion of cyclosporine administration, eight patients (38.1%) were symptom free, and seven patients (33.3%) used only antihistamines. CONCLUSION: This study shows that low-dose cyclosporine is an efficacious and safe treatment option for treating CIU. In addition, the preliminary results suggest that low-dose cyclosporine might be helpful for the long-term control of this disease.

A Study of an Autologous Serum Skin Test and Helicobacter pylori Infection in Patients with Chronic Idiopathic Urticaria / 대한피부과학회지

BACKGROUND: Although the pathogenesis of chronic idiopathic urticaria (CIU) has not yet been fully elucidated, previous studies have identified functional histamine-releasing autoantibodies against the alphasubunit of the high affinity IgE receptor (Fcepsilon I) and Helicobacter pylori (H. pylori) infection. OBJECTIVE: To investigate a possible association of autoimmunity and H. pylori infection with chronic idiopathic urticaria. METHODS: We prospectively performed autologous serum skin tests (ASST) and urea-breath tests (UBT) on patients with CIU. We also checked clinical features. Amoxicillin and clarithromycin combined with a proton pump inhibitor was administrated as therapy for 1 week to patients that were UBT positive. We rechecked the UBT test 4 weeks later and rechecked the clinical features 6 weeks after eradication of the infection. RESULTS: A positive result to the ASST was experienced by 56 patients (39.2%) with CIU; UBT was found in 48 patients (62.5%) with CIU. There were no significant differences in clinical features between patients with positive tests and those with negative tests. After eradication, 26 of 30 (86.7%) patients that were UBT positive showed significant clinical remission of the urticaria. CONCLUSION: According to our results, ASST is not helpful for predicting the severity or clinical course of CIU, but eradication of H. pylori in patients with chronic urticaria induces clinical remission of the urticaria.

The Efficacy, Safety and Long-term Effect of Cyclosporine for Treating Chronic Idiopathic Urticaria / 대한피부과학회지

BACKGROUND: The efficacy and safety of cyclosporine for the treatment of chronic idiopathic urticaria (CIU) have been studied in numerous trials, but there have been few studies on the long-term effect of cyclosporine. OBJECTIVE: This study was aimed to assess the efficacy and safety of low-dose cyclosporine for treating CIU. Furthermore, its long-term effect on the natural course of CIU was investigated. METHODS: Thirty patients who suffered from persistent CIU despite conventional treatments received 2~3 mg/kg/day of cyclosporine for 12 weeks. The severity score was assessed by means of the urticaria activity score and the visual analogue score at baseline and at weeks 2, 4, 8 and 12. The safety assessments consisted of reporting the side effects and monitoring the laboratory parameters. After a follow-up period of at least 1 year, the patients were asked whether they had any remaining or new symptoms and whether they still used antihistamines or any other drugs. RESULTS: Twenty seven patients completed the trial medication, and the respective symptom scores significantly improved after 12 weeks. Four (14.8%) patients reported adverse events during the trial period, but the events were not severe enough to require withdrawal from the study. Of the twenty one patients who were followed for at least 1 year (range: 12~45 months) after the completion of cyclosporine administration, eight patients (38.1%) were symptom free, and seven patients (33.3%) used only antihistamines. CONCLUSION: This study shows that low-dose cyclosporine is an efficacious and safe treatment option for treating CIU. In addition, the preliminary results suggest that low-dose cyclosporine might be helpful for the long-term control of this disease.

A Study of an Autologous Serum Skin Test and Helicobacter pylori Infection in Patients with Chronic Idiopathic Urticaria / 대한피부과학회지

BACKGROUND: Although the pathogenesis of chronic idiopathic urticaria (CIU) has not yet been fully elucidated, previous studies have identified functional histamine-releasing autoantibodies against the alphasubunit of the high affinity IgE receptor (Fcepsilon I) and Helicobacter pylori (H. pylori) infection. OBJECTIVE: To investigate a possible association of autoimmunity and H. pylori infection with chronic idiopathic urticaria. METHODS: We prospectively performed autologous serum skin tests (ASST) and urea-breath tests (UBT) on patients with CIU. We also checked clinical features. Amoxicillin and clarithromycin combined with a proton pump inhibitor was administrated as therapy for 1 week to patients that were UBT positive. We rechecked the UBT test 4 weeks later and rechecked the clinical features 6 weeks after eradication of the infection. RESULTS: A positive result to the ASST was experienced by 56 patients (39.2%) with CIU; UBT was found in 48 patients (62.5%) with CIU. There were no significant differences in clinical features between patients with positive tests and those with negative tests. After eradication, 26 of 30 (86.7%) patients that were UBT positive showed significant clinical remission of the urticaria. CONCLUSION: According to our results, ASST is not helpful for predicting the severity or clinical course of CIU, but eradication of H. pylori in patients with chronic urticaria induces clinical remission of the urticaria.

A Study of Diet Restriction in Chronic Idiopathic Urticaria / 대한피부과학회지

BACKGROUND: Although the pathogenesis of chronic idiopathic urticaria (CIU) has not yet been fully elucidated, several previous studies have identified food additives or high amounts of histamine containing foods as possible eliciting factors of chronic idiopathic urticaria (CIU). OBJECTIVE: The aim of this study was to evaluate the effect of restricting pseudoallergens and histamines from the diets of patients affected with CIU. METHODS: Fourteen CIU patients with Acetylsalicylic acid (ASA) intolerance were prescribed a pseudoallergen restricted diet, whilst, fifteen CIU patients with ASA tolerance were prescribed a histamine restricted diet for 4 weeks. A control group of thirty nine CIU patients were not given a restricted diet. After 4 weeks, we estimated the improvement of symptoms and the change in the number of antihistamine tablets taken in each of the three groups. RESULTS: Neither of the restricted diets induced a significant improvement of symptoms compared with the control group (p>0.05). Furthermore, there was no significant decrease in the number of antihistamine tablets taken in the restricted diet groups compared with the control group as well (p>0.05) CONCLUSION: According to our results, we suggest that pseudoallergen or histamine restricted diets are not necessary in CIU patients.

Therapeutic Efficacy of Low-dose Cyclosporine in Chronic Idiopathic Urticaria / 대한피부과학회지

BACKGROUND: Chronic idiopathic urticaria (CIU) has a major impact on patients' quality of life. However the management of CIU has sometimes been challenging to physicians, with little response to conventional therapy like antihistamines. OBJECTIVE: This study was aimed to determine the effectiveness and safety of low-dose cyclosporine for the treatment of recalcitrant CIU with a positive autologous serum skin test (ASST). METHODS: Thirty CIU patients who were unresponsive to conventional antihistamine therapy were treated for 3 consecutive months with low-dose cyclosporine (2~3 mg/kg/day) and fexofenadine (180 mg/day). The clinical efficacy was measured at baseline, week 1, 2, and month 1, 2 and 3. CIU sign and symptom scores were assessed using 4-point scales for pruritus, number of hives, size of largest hive, interference with sleep, and interference with daily activities. Global assessment of the severity by patients and any side effects were also measured at every visit. RESULTS: Low-dose cyclosporine significantly improved the total CIU scores. In addition, the interference with sleep was reduced and the performance of daily activities improved in accordance with patient's global assessment of urticaria severity after 3 month of treatment. Moreover there were no significant side effects to suggest stopping cyclosporine administration. CONCLUSION: These results show that low-dose cyclosporine therapy might be a good therapeutic alternative in CIU patients who are unresponsive to conventional treatments.

Reactivity to Autologous Serum Skin Test and Clinical Features in Chronic Idiopathic Urticaria / 대한피부과학회지

BACKGROUND: Although the pathogenesis of chronic idiopathic urticaria (CIU) has not yet been fully elucidated, previous studies have identified functional, histamine-releasing autoantibodies against either alpha subunit of the high affinity IgE receptor (Fc epsilon RI alpha) or IgE in the serum of some patients with CIU. Therefore an autologous serum skin test (ASST) can be used as a predictive clinical test to determine the presence of circulating histamine-releasing factors in the serum of CIU patients, and there are some reports stating that patients with positive ASST tend to have more severe symptoms of urticaria than patients with a negative result. OBJECTIVE: This study was designed to determine the incidence of positive ASST in CIU patients and examine whether there are significant differences in the clinical features and laboratory findings between groups of positive and negative responses to ASST. METHOD: We prospectively performed ASST and laboratory tests on 70 patients with CIU, and also checked clinical features. RESULTS: Intradermal injection of autologous serum or plasma induced a wheal and flare response in 44 out of 70 CIU patients (62.9%). However, no significant difference in the clinical features and laboratory findings, other than angioedema, was noted between ASST-positive and negative groups. CONCLUSION: According to our results, the incidence of positive ASST was high in CIU patients, but ASST is not helpful to predict the severity or clinical course of CIU.

A Case of Chronic Idiopathic Urticaria Treated with Cyclosporine / 대한피부과학회지

The beneficial effects of cyclosporine in severe chronic urticaria are well described. A 20-year-old woman suffered from chronic urticaria for 3 years, had been treated with oral antihistamines and glucocorticoids, but her symptoms were uncontrolled. Laboratory examination including eosinophil count, IgE total value, complement level, anti-nuclear antibodies, hepatic, and renal function test and esophagogastroscopic study, revealed no abnormalities. Since she was treated with cyclosporine 6mg/kg/day for 3months, no erythema and wheals with itching have not developed. Herein we report a case of chronic idiopathic urticaria treated with cyclosporine in a 20-year-old woman.

Cost-Effectiveness Analysis of Desloratadine and Mizolastine in Treatment of Chronic Idiopathic Urticaria / 中国药房

0.05).The C/E were0.456and0.622,respectively.?C/?E was15.9.CONCLUSIONS:Deslo-ratadine has pharmacoeconomical advantages over mizolastine in treating chronic idiopathic urticaria.