Kounis Syndrome Caused by Chronic Autoimmune Urticaria: A Case Report.

BACKGROUND: Coincidental occurrence of acute coronary syndrome with symptoms associated with an allergic reaction is called Kounis syndrome (KS). Although KS has been recognized for several years and has been reported in many documents, KS induced by chronic autoimmune urticaria (CAU), to the authors' knowledge, has not been reported. CASE REPORT: The patient was a 31-year-old woman who suffered from chronic urticaria for nearly 3 years. Her urticaria became more serious 1 week before this visit and was accompanied by repeated attacks of cardiac symptoms. Autologous serum skin test and serum anti-high affinity immunoglobulin E receptor antibody test were positive for CAU. Her coronary artery pathological changes were confirmed by electrocardiogram (ECG), cardiac troponin T (cTnT) value, and angiocardiography. The patient was diagnosed with KS. After being treated with cetirizine, glucocorticoids, and azathioprine, the patient did not relapse during the first year of follow-up. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: When seeing a patient with intermittent exacerbations of chronic urticaria accompanied by repeated attacks of cardiac symptoms, emergency physicians should consider the diagnosis of KS. It is important to monitor changes in the ECG and cTnT value. Angiocardiography is necessary to eliminate myocardial infarction or unstable angina. Second-generation antihistamines and glucocorticoids are effective in the treatment of CAU and also alleviate coronary spasm. Another important consideration for the emergency physician is the fact that some first-generation antihistamines have the side effect of ventricular tachycardia or fibrillation, so it is better not to use these drugs to treat urticaria if KS is suspected.

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-FcεRI 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-FcεRI 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-FcεRI 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-FcεRI antibody positive rate was higher than AU patients (p<0.01) and normal controls (p<0.01). CONCLUSION: The anti-FcεRI and anti-IgE antibodies play a key role in CIU, but anti-HP antibody and TGAb have an indirect correlation with CIU.

Effect of sera from chronic urticaria patients with anti-Helicobacter pylori antibodies on the release of histamine by human mast cells / 中华皮肤科杂志

Objective To investigate the relationship between anti-Helicobacter pylori (Hp) antibodies and development of chronic urticaria (CU).Methods Fifty CU patients with positive 13C-urea breath test and anti-Hp antibodies,as well as 50 healthy human controls were recruited in this study.Serum samples were collected from all the subjects.The samples from the patients were subjected to tests for anti-high affinity IgE receptor (anti-FcεRI) and-IgE antibodies.Human mast cells (HMCs) were classified into several parts to be incubated with the sera of patients with CU,the sera of healthy controls with anti-IgE and-FcεRI antibodies respectively for 20 minutes.Those incubated with the sera of healthy controls without these antibodies served as the control.Subsequently,the levels of histamine released by HMCs were measured by enzyme-linked immunosorbent assay (ELISA).Results The sera of CU patients showed a stronger ability to activate HMCs to release histamine than those of healthy controls ((3.13 ± 0.93) μg/L vs (2.92 ± 0.75) μg/L,t =2.39,P ＜ 0.05).Anti-FcεRI antibodies were detected in 4 patients,and antiIgE antibodies in 3 patients.A significant increase was observed in the levels of histamine released by HMCs incubated with anti-FcεRI antibody-positive and anti-IgE antibody-positive patient-derived sera (t =4.82,6.34,respectively,both P ＜ 0.01),but not in those incubated with patient-derived sera only positive for anti-Hp antibodies (t =1.74,P ＞ 0.05) compared with those incubated with healthy control-derived sera.In comparison with the antibody-free healthy control-derived sera,those with anti-Hp IgG antibodies showed no significant effect on the release of histamines by HMCs (t =1.95,P ＞ 0.05),whereas those with anti-FcεRI antibodies and anti-IgE antibodies exhibited an obvious promoting effect (t =3.72,3.02,respectively,both P ＜ 0.01).Conclusions The anti-Hp antibodies appears to have no role in the pathogenesis of CU,but the presence of anti-FcεRI and anti-IgE antibodies may contribute to the initiation of CU in patients with Hp infection.

Influence of B lymphocyte stimulator on the production of anti-FcεRI and anti-IgE antibodies by B lymphocytes from patients with chronic idiopathic urticaria / 中华皮肤科杂志

Objective To explore if B lymphocyte stimulator (BlyS) stimulates B lymphocytes from patients with chronic idiopathic urticaria (CIU) to produce anti-high affinity IgE receptor (FcεRI) or anti-IgE antibodies.Methods Totally,300 CIU patients and 300 health controls were enrolled in this study.Blood samples were obtained from these subjects.Peripheral blood B lymphocytes were isolated and cultured in vitro for 72 hours.Then,BlyS of various concentrations (2,4,8,16 ng/ml) was added to the culture medium of B lymphocytes followed by another 72-hour culture.Enzyme-linked immunosorbent assay was performed to determine the serum levels of BlyS,anti-FcεRI and anti-IgE antibodies,as well as the supernatant levels of anti-FcεRI and anti-IgE antibodies.The relationship between BlyS and anti-FcεRI and anti-IgE antibody production was assessed.SPSS software version 16.0 was used for statistical analysis.Chi-square test was performed to compare the positivity rate of antibodies,and analysis of variance and least significance difference-t test to assess numerical data.Results The CIU patients showed higher levels of serum BlyS (t =3.04,P ＜ 0.01),anti-FcεRI antibodies (t =3.51,P ＜ 0.01),and anti-IgE antibodies (t =3.29,P ＜ 0.01) compared with the health controls.The serum level of BlyS was positively correlated with that of anti-FcεRI antibodies (r =0.93,P ＜ 0.01) and anti-IgE antibodies (r =0.91,P ＜ 0.01).The levels of anti-FcεRI antibodies and anti-IgE antibodies were significantly increased in the culture supematant of patient-derived B lymphocytes treated with BlyS compared with those remaining untreated (t =3.67,3.56,respectively,both P ＜ 0.01),and the concentration of BlyS was positively correlated with the levels of both anti-FcεRI antibodies and anti-IgE antibodies (r =0.96,0.91,respectively,both P ＜ 0.01).The coincidence rate between the serum and supernatant was 94.76％ and 87.84％ in the detection of anti-FcεRI antibodies and anti-IgE antibodies respectively.Conclusions BlyS level is upregulated in the serum of patients with CIU,which may play an important role in the pathogenesis of CIU by stimulating B lymphocytes to produce anti-FcεRI antibodies or anti-IgE antibodies.

Correlations between interrelated autoantibodies and the development of chronic idiopathic urticaria / 中华皮肤科杂志

Objective To estimate the correlations between chronic idiopathic urticaria (CIU) development and interrelated autoantibodies,including anti-high affinity immunoglobulin E receptor (anti-FcεRI) antibody,anti-immunoglobulin E (anti-IgE) antibody,anti-Helicobacter pylori (HP) antibody and antithyroglobulin antibody (TGAb).Methods This study included 100 patients with CIU,100 patients with acute urticaria (AU) and 100 healthy controls.Autologous serum skin test (ASST) was performed and allergens were detected by fluorescence-based enzyme linked immunosorbent assay (ELISA) in each subject.Serum levels of total IgE,anti-FcεRI antibody,anti-IgE antibody,anti-HP antibody and TGAb were measured.Chi-square test,analysis of variance,and Wilcoxon rank sum test were conducted for statistical analysis.Results The positivity rate of ASST was 53％,12％ and 0 respectively in patients with CIU,patients with AU and healthy controls,respectively.Food or inhalant allergens were detected in 86％ of the patients with AU,but not detected in any of the patients with CIU or healthy controls.Patients with CIU showed significantly higher levels of anti-FcεRI antibody and anti-IgE antibody compared with patients with AU and healthy controls (all P ＜ 0.05).The serum IgE level in healthy controls was statistically lower than that in patients with AU (T =226.00,P ＜ 0.05),but higher than that in patients with CIU (T =190.00,P ＜ 0.05).ASST-positive patients with CIU had a higher level of serum anti-FcεRI antibody (T =101.73,P ＜ 0.05),but a similar level of serum anti-IgE antibody compared with ASST-negative patients with CIU (T =312.04,P ＞ 0.05).No significant differences were observed in the positivity rate of anti-HP antibody (29％,19％ and 23％,P ＞ 0.05) or TGAb (18％,15％ and 11％,P ＞ 0.05) between the patients with CIU,patients with AU and healthy controls.Both anti-HP antibody-positive patients and TGAb-positive patients with CIU showed a significantly higher positivity rate of anti-FcεRI antibody (all P ＜ 0.01),but a similar positivity rate of anti-IgE antibody compared with the patients with AU and healthy controls (all P ＞ 0.05).Conclusions Anti-FcεRI antibody and anti-IgE antibody are present in patients with CIU,and may play a certain role in the pathogenesis of CIU.

The Effects of Keratinocyte Growth Factor and Its Receptors Antisense Oligonucleotide on Prolifera- tion of HaCat Cells / 中华皮肤科杂志

Objective To investigate the effects of keratinocyte growth factor (KGF) and KGF receptor (KGFR) antisense oligonucleotide (ASODN) on cell cycle and apoptosis of HaCat cells. Methods HaCaT cell, an immortalized keratinocyte cell strain, was cultured in vitro. Flow cytometry was used to measure the cell cycle and apoptosis mediated by KGF and ASODN. Results The rates of S phase and apoptosis in the group treated with KGF increased significantly than those in the control group (both P