Autologous serum therapy in chronic urticaria patients
Keywords:Urticaria, Autologous serum therapy, Autologous serum skin test, MUTSS, Pruritus
Background: Chronic urticaria is very common distressing dermatoses. CU is caused by autoimmune mechanisms in approximately 30-50% of patients. Repeated injection of autologous whole blood or autologous serum, a form of therapy also known as autohaemotherapy, can be very effective in CAU patients. Aim was to assess the effectiveness of autologous serum therapy in chronic urticaria patients.
Methods: All patients with CU attending the dermatology OPD of age >18 years, and urticaria of duration >6 weeks. After autologous serum skin test, autologous serum therapy was administered using autologous serum in a dose of 0.05 ml per kg body weight, injected IM in gluteus muscle weekly for nine weeks in all patients. Parameters of disease activity and severity were recorded at baseline and every week during treatment. End point of study was improvement in chronic modified urticaria total severity score after ninth dose of AST which was recorded at baseline and at 10th week.
Results: Mean of MUTSS for ASST positive group and ASST negative group was 13.27±2.050 and 12.04±3.212 respectively which is statistically significant (p=0.043). Mean MUTSS post treatment in ASST positive group was 3.87±4.57 whereas in negative group it was 6.46±4.418 which was statistically significant (p=0.019).
Conclusions: 42.3% patients of chronic urticaria were of autoimmune type and approximately half of them responded well to autologous serum therapy. This study found that serum therapy is effective in ASST positive patients with CU.
Hide M, Francis DM, Grattan CE, Hakimi J, Kochan JP, Greaves MW. Autoantibodies against the high affinity IgE receptor as a cause of histamine release in chronic urticaria. N Engl J Med. 1993;328(19):1599-604.
Sabroe RA, Grattan CE, Francis DM, Barr RM, Kobza Black A, Greaves MW. The autologous serum skin test: A screening test for autoantibodies in chronic idiopathic urticaria. Br J Dermatol. 1999;140(3):446-52.
Bocci V. Autohaemotherapy after treatment of blood with ozone: A reappraisal. J Int Med Res. 1994;22(3): 131-44.
Bajaj AK, Saraswat A, Upadhyay A, Damisetty R, Dhar S. Autologous serum therapy in chronic urticaria: Old wine in a new bottle. Indian J Dermatol Venereol Leprol. 2008;74(2):109-13.
Maurer M, Ortonne JP, Zuberbier T. Chronic urticaria: A patient survey on quality of life, treatment usage and doctor-patient relation. Allergy. 2009;64(4):581-8.
Grob JJ, Gaudy-Marqueste C. Urticaria and quality of life. Clin Rev Allergy Immunol. 2006;30(1):47-51.
Godse KV. Autologous serum skin test in chronic idiopathic urticaria. Indian J Dermatol Venereol Leprol. 2004;70(4):283-4.
Fiebiger E, Maurer D, Holus H, Reininger B, Hartmann G, Woisetschläger M, et al. Serum IgG autoantibodies directed against the alpha chain of Fc epsilon RI: A selective marker and pathogenetic factor for a distinct subset of chronic urticaria patients? J Clin Invest. 1995;96(6):2606-12.
Ferrer M, Kinet JP, Kaplan AP. Comparative studies of functional and binding assays for IgG anti Fc epsilon Riα (αsubunit) in chronic urticaria. J Allergy Clin Immunol. 1998;101(5):672-8.
Piconi S, Trabattoni D, Iemoli E, Fusi ML, Villa ML, Milazzo F, et al. Immune profile of patients with chronic idiopathic urticaria. Int Arch Allergy Immunol. 2002;128(1):59-66.
Sabroe RA, Fiebiger E, Francis DM, Maurer D, Seed PT, Grattan CE, et al. Classification of anti-Fc-RI and anti-IgE autoantibodies in chronic idiopathic urticaria and correlation with disease severity. J Allergy Clin Immunol. 2002;110(3):492-9.
Toubi E, Kessel A, Avshovich N, Bamberger E, Sabo E, Nusem D, et al. Clinical and laboratory parameters in predicting chronic urticaria duration: A prospective study of 139 patients. Allergy. 2004;59(8):869-73.
O’Donnell BF, Francis DM, Swana GT, Seed PT, Black AK, Greaves MW. Thyroid autoimmunity in chronic urticaria. Br J Dermatol. 2005;153(2):331-5.
Bakos N, Hillander M. Comparison of chronic autoimmune urticaria with chronic idiopathic urticaria. Int J Dermatol. 2003;42(8):613-5.
Mamatha G, Balachandran C, Smitha P. Chronic idiopathic urticaria: Comparison of clinical features with positive autologous serum skin test. Indian J Dermatol Venereol Leprol. 2008;74(2):105-8.
Nettis E, Dambra P, D’Oronzio L, Cavallo E, Loria MP, Fanelli M, et al. Reactivity to autologous serum skin test and clinical features in chronic idiopathic urticaria. Clin Exp Dermatol. 2002;27(1):29-31.
Fusari A, Colangelo C, Bonifazi F, Antonicelli L. The autologous serum skin test in the follow-up of patients with chronic urticaria. Allergy. 2005;60(2):256-8.
Godse K. Methotrexate in autoimmune urticaria. Indian J Dermatol Venereol Leprol. 2004;70(6):377.
Baskan EB, Turker T, Gulten M, Sukran T. Lack of correlation between Helicobacter pylori infection and autologous serum skin test in chronic idiopathic urticaria. Int J Dermatol. 2005;44(12):993-5.
Swerdt AD, Keybus CV, Kasran A, Cadot P, Neyens K, Coorevits L, et al. Detection of basophil-activating IgG autoantibodies in chronic idiopathic urticaria by induction of CD63. J Allergy Clin Immunol. 2005; 116(3):662-7.
Sabroe RA, Seed PT, Francis DM, Barr RM, Black AK, Greaves MW. Chronic idiopathic urticaria: Comparison of the clinical features of patients with and without anti-Fc-RI or anti-IgE autoantibodies. J Am Acad Dermatol. 1999;40(3):443-50.
Vohra S, Sharma NL, Mahajan VK, Shanker V. Clinicoepidemiologic features of chronic urticaria in patients having positive versus negative autologous serum skin test: A study of 100 Indian patients. Indian J Dermatol Venereol Leprol. 2011;77(2):156-9.
Stanbach P, Onnen K, Vonend A, Metz M, Siebenhaar F, Tschentscher I, et al. Autologous whole blood injections to patients with chronic urticaria and a positive autologous serum skin test: A placebo-controlled trial. Dermatology. 2006;212(2):150-9.