Four cases of acute infectious urticaria showing significant elevation of plasma D‐dimer level

D‐dimer, a fibrinolytic end‐product, has been regarded as a biomarker indicating the severity of urticaria, especially in chronic urticaria. Regarding acute urticaria, D‐dimer level is also suggested to be elevated, which may be significant in comparison with chronic urticaria. However, the clinical features of acute urticaria with concomitant significant elevation of D‐dimer level have not been investigated in detail so far. We present four cases of acute urticaria fulfilling the proposed diagnostic criterion of acute infectious urticaria, in which significant elevation of D‐dimer level and rapid spontaneous normalization in parallel with the resolution of fever and urticaria occurs. No cases had deep vein thrombosis, disseminated intravascular coagulation and malignancy. All cases responded well to antihistaminic treatment in combination with antibiotics, and their fever and urticaria resolved within 10 days. All cases showed severe wheals persistent for several days resolving with hyperpigmentation. Histologically, infiltration into blood vessel walls and interstitial infiltration of lymphocytes and polymorphonuclear cells were marked in the dermis. In our cases, clinical features accorded with acute infectious urticaria, and their histological features were similar to those of neutrophilic urticaria as described previously. In conclusion, there is a certain group of acute urticaria associated with significant elevation of D‐dimer level. These common features of our cases may be characteristic in acute urticaria showing the coagulative and fibrinolytic abnormalities.     

136例慢性荨麻疹自体血清皮肤试验及实验室检测

目的：分析自体血清皮肤试验（ASST）及部分实验室检查指标与慢性荨麻疹（CSU）临床严重性？的相关性。方法：收集136 例CSU患者的临床资料,并进行ASST、血清总IgE、血浆D-二聚体、甲状腺功能及甲状腺抗体检测。结果：136例患者中总IgE升高37例,ASST阳性54例（39.7%）,其中ASST阳性患者病程45.27±65.67个月,明显长于ASST阴性患者的35.24±42.54个月（P＜0.01）。血浆D-二聚体升高49例（36%）,且与活动度评分（英文全称UAS）成正相关（P＜0.01, r=0.469）。患者抗甲状腺球蛋白抗体阳性24例(17.6%);甲状腺过氧化物酶抗体阳性14例(10.6%)。25例甲状腺功能异常患者中有9例ASST阳性。结论：ASST、血浆D-二聚体与CSU患者病情相关,而血清总IgE水平与病情无关。     

Gallstones at chronic spontaneous urticaria patients: A retrospective clinical study

Chronic spontaneous urticaria (CSU) is a chronic, inflammatory skin disease can be triggered by many factors such as inflammatory process. To assess accompanying gallstone in CSU patients and to evaluate laboratory test results. We retrospectivelyscanned the files of the 108 patients with CSU who had been diagnosed CSU in September 2017–September 2019. Accompanied gallstone cases by detecting transabdominal ultrasound (TUS) or were 11 patients. Nine patients had also had cholecystectomy history. We seperated these 20 patients as Group A than the rest. WBC count is 9.38 ± 2.37 in Group A and 8.03 ± 2.04 in Group B. Platelet count was also differ between two groups significantly (Group A = 328.70 ± 85.62 × 10³/mm³ vs. Group B = 287.12 ± 72.77 × 10³/mm³). Neutrophil count was more in Group A (5.87 ± 1.65) than Group B (4.76 ± 1.75). Gallstone history of family was significantly higher in Group A (n = 12 positive/8 negative) than Group B. These findings were significant statistically p < .05. CSU can be associated with inflammation and gallstones. It is needed to perform further investigations to detect these relations and pathways.     

178例急性自发性荨麻疹转归为慢性的危险因素回顾性分析

目的：分析影响急性自发性荨麻疹（ASU）转归为慢性自发性荨麻疹（CSU）的危险因素。方法：回顾性分析本院2018年11月至2019年10月178例ASU患者的人口学信息、发病季节、初发病程、自诉可疑过敏原、自体血清皮肤试验（ASST）、7日荨麻疹活动度评分（UAS7）、血常规、血清总IgE测定、治疗药物,Logistic回归分析ASU转归为CSU的危险因素。结果：178例ASU中42例（23.60%）转归为CSU,单因素分析自诉食物过敏（P<0.001）、 ASST试验阳性（P<0.001）、初发病程（P＜0.001）与ASU患者转归为CSU具有相关性;多因素Logistics回归分析示自诉食物过敏（P=0.029）、ASST试验阳性（P=0.043）、初发病程长（P＜0.001）均是影响ASU转归为CSU的独立危险因素。结论：食物过敏、ASST试验阳性、初发病程长是ASU患者转归为CSU的危险因素。     

Detection of CD4+ CD25+ FOXP3+ regulatory T cells in peripheral blood of patients with chronic autoimmune urticaria

Background/Objectives: Compelling evidence indicates a significant role for a population of CD4⁺ T regulatory cells in suppressing immune responses and in maintaining immunological homeostasis. This study aims to investigate the potential role of CD4⁺CD25^HIGHFOXP3⁺ T regulatory cells in patients with chronic autoimmune urticaria and to define the characteristics of CD4⁺CD25^HIGHFOXP3⁺ cells in chronic urticaria. Methods: We used flow cytometry to assess the expression of CD4⁺CD25^HIGHFOXP3⁺ cells in the peripheral blood mononuclear cells of patients with chronic autoimmune urticaria. Results: In this study, we found that patients with chronic autoimmune urticaria have a significantly reduced frequency of CD4⁺CD25^HIGHFOXP3⁺ cells (1.39 ± 0.27% vs 2.09 ± 0.34%; P = 0.001) in their peripheral blood, accompanied by a decreased intensity of FOXP3 expression (50.13 ± 9.79 vs 68.19 ± 6.40; P < 0.001). Notably, although patients with chronic idiopathic urticaria had a reduced frequency of CD4⁺CD25^HIGHFOXP3⁺ cells (1.85 ± 0.46% vs 3.64 ± 0.48%; P < 0.001), their FOXP3 expression levels did not differ from those in healthy controls. Conclusions: Patients with chronic autoimmune urticaria displayed a reduced percentage of CD4⁺CD25⁺FOXP3⁺ regulatory T cells. The results imply CD4⁺CD25⁺FOXP3⁺ regulatory T cells may contribute to the autoimmune pathological process of chronic autoimmune urticaria.     

165例慢性荨麻疹患者食物过敏原检测结果分析

目的探讨食物过敏原与慢性荨麻疹的相关性。方法对我科165例慢性荨麻疹病人进行食物过敏原半定量检测。结果引起慢性荨麻疹的前3位食物依次为蟹、蛋、虾,阳性率分别是67.95%、64.11%、52.56%。结论检测食物过敏原在慢性荨麻疹的诊治中有重要意义。     

Chronic idiopathic urticaria: prevalence and clinical course

The purpose of our study was to assess the prevalence and clinical course of patients with chronic idiopathic urticaria (CIU), as well as possible causes or associated findings, laboratory findings and the duration of the disease in patients with chronic urticaria (CU). We retrospectively reviewed the 450 case record forms of patients with CU and/or angioedema who attended the Department of Dermatology, Siriraj Hospital, during the period 2000-2004. Of 450 patients with CU, 337 patients (75%) were diagnosed as CIU. Forty-three patients (9.5%) had physical urticaria, while 17 patients (3.8%) had infectious causes. Other possible causes were food, thyroid diseases, atopy, drugs, dyspepsia and collagen vascular diseases. In eighty-nine percent of patients, no abnormalities were detected at the time of physical examination. The most common abnormal laboratory finding was minimal elevation of the erythrocyte sedimentary rate (42%). In 61 patients, autologous serum skin tests had been done. Fifteen patients (24.5%) had positive results i.e. autoimmune urticaria. Anti-thyroglobulin and anti-microsomal antibodies were positive in 16 % and 12% of CIU patients respectively. After 1 year from the onset of the symptoms, 34.5% of CIU patients were free of symptoms and after 1.2 years from the onset of the symptoms, 56.5% of autoimmune urticaria patients were free of symptoms. The median disease duration of CIU and autoimmune urticaria were 390 days and 450 days respectively. Our study provided an overview of CU and CIU in a large series of Thai patients, based on etiological aspects and clinical courses.     

慢性荨麻疹患者血清IL-31水平测定及其临床意义

目的:探讨慢性荨麻疹(chronic urticaria,CU)患者血清中白介素(IL)-31水平及其临床意义。方法:采用酶联免疫吸附法(ELISA)检测64例CU患者(其中sIgE阳性和阴性各32例)和32例正常人对照组血清中IL-31水平。结果:CU sIgE(+)组血清IL-31水平均值为(18.8±9.1)ng/L,slgE(-)组为(19.1±7.9)ng/L,分别与正常人对照组比较[(12.9±5.8)ng/L],二组间差异均有统计学意义(P0.01);CU slgE(+)组中,14例螨虫过敏组患者的IL-31水平均值为(21.4±6.3)ng/L,高于正常人对照组(P0.05)。结论:CU患者体内IL-31水平升高,可能参与CU发病过程。     

荨麻疹患者血清特异性IgE过敏原检测及两种氯雷他定的疗效比较

目的:了解322例荨麻疹患者的致病因素及各种因素之间的相互关系,比较2种氯雷他定治疗84例慢性特发性荨麻疹患者的疗效。方法:采用德国“敏筛”定量过敏原检测系统对322例荨麻疹患者进行了特异性IgE及过敏原的检测和分析,应用2种氯雷他定片治疗84例慢性特发性荨麻疹患者,并进行疗效对比和随访观察。结果:322例患者中有159例至少对1项过敏原阳性,阳性率为49.4%。平均阳性过敏原为(1.36±1.70)项;78例患者血清特异性总IgE阳性,阳性率为24.2%。2种氯雷他定片治疗前后患者症状和体征评分指数下降差异无统计学意义。治疗后,治疗组基愈率为37.2%,有效率为72.2%;对照组基愈率为39.0%,有效率为78.0%,两组疗效比较差异无统计学意义。结论:德国“敏筛”定量过敏原检测系统能较简便地检测特异性IgE和过敏原;国产氯雷他定治疗慢性特发性荨麻疹安全有效。     

The clinical and photobiological characteristics of solar urticaria in 40 patients

Forty patients with solar urticaria, 16 male and 24 female, were examined personally during the past 25 years. The median age at onset of symptoms was 32 years, ranging from 13 to 76 years. Most commonly (45%) solar urticaria first appeared during the third decade. The mean duration of the disease was 3.6 years at presentation. The action spectrum was found in the visible light range in 24 patients (60%), in the ultraviolet (UV) A range in four, in the UVB in four, from the UVA to UVB in three, from the UVA to visible light in one and in a broad range from UVB to visible light in four patients. An inhibition spectrum was detected in 13 of 19 patients (68%), occurring at longer wavelengths than the action spectrum in 12 of these cases. The augmentation spectrum was found in only four of 14 patients (29%) examined. Twenty-four of 31 patients (77%) developed an urticarial reaction to autologous serum, which had been previously irradiated in vitro at the action spectrum for that patient. In a single patient, solar urticaria was caused by a drug, namely chlorpromazine. In two patients, polymorphic light eruption occurred in association with solar urticaria. No single modality of treatment was satisfactory, but combined use of antihistamines, sunbathing, psoralen UVA photochemotherapy and/or sunscreening agents partially suppressed the symptoms.     

Real life management of chronic urticaria: Multicenter and cross sectional study on patients and dermatologists in Iran

Recently, advances in understanding the etiology of urticaria and updates of diagnostic and therapeutic management guidelines have drawn attention to chronic urticaria (CU) morbidity. The present study aimed to evaluate Iranian dermatologists' practice and real life management of CU patients. A total of 35 dermatologists and 443 patients were included in the study. Number of female patients was 321 (72.5%). Mean (standard deviation) age of the study patients was 38 (13) years and the median (inter quartile range) of disease duration was 12 (6–48) months. Severity of patients' symptoms was mild for 32.1%, moderate for 38.7%, severe for 18.8%, and 10.4% of them had no evident signs or symptoms. The most common diagnostic methods were physical examination (96.6%), differential blood count (83.5%), erythrocyte sedimentation rate (77.4%), and C‐reactive protein (62.8%). The number of dermatologists prescribed nonsedating antihistamines (nsAH) in regular dose and high dose mono therapy were 26 (74%) and 6 (17%), respectively. About 66% of dermatologists were familiar with British Association of Dermatologists (BAD) guideline. The most common first‐line treatment for CU by Iranian dermatologists was nonsedating antihistamines in regular or high doses. The real‐life management of patients with CU in Iran was in accordance with the available practice guidelines.     

Management of urticaria in COVID‐19 patients: A systematic review

The global pandemic COVID‐19 has resulted in significant global morbidity, mortality and increased healthcare demands. There is now emerging evidence of patients experiencing urticaria. We sought to systematically review current evidence, critique the literature, and present our findings. Allowing PRISMA guidelines, a comprehensive literature search was carried out with Medline, EMBASE, Scopus, Cochrane, and Google Scholar, using key MeSH words, which include “COVID‐19,” “Coronavirus,” “SARS‐Cov‐2,” “Urticaria,” “Angioedema,” and “Skin rash” up to 01 August 2020. The key inclusion criteria were articles that reported on urticaria and/or angioedema due to COVID‐19 infection and reported management and outcome. Studies were excluded if no case or cohort outcomes were observed. Our search returned 169 articles, 25 of which met inclusion criteria. All studies were case reports, reporting 26 patients with urticaria and/or angioedema, COVID‐19 infection and their management and/or response. ajority of patients (n = 16, 69%) were over 50 years old. However, urticaria in the younger ages was not uncommon, with reported case of 2 months old infant. Skin lesions resolved from less than 24 hours to up to 2 weeks following treatment with antihistamines and/or steroids. There have been no cases of recurrent urticaria or cases nonresponsive to steroids. Management of urticarial in COVID‐19 patients should involve antihistamines. Low dose prednisolone should be considered on an individualized basis. Further research is required in understanding urticarial pathogenesis in COVID‐19. This will aid early diagnostic assessment in patients with high index of suspicion and subsequent management in the acute phase.     

地震灾区跳蚤叮咬引起丘疹性荨麻疹的临床研究

2008年5月12日汶川大地震后,四川彭州龙门山镇地区有多起跳蚤叮咬引起的丘疹性荨麻疹出现,现分析如下. 一、一般资料 龙门山镇及其属5村均位于龙门山山区,早晚温差大,空气潮湿,5月后进入雨季,阴雨天气较多(5-7月占60%).震区灾民居住多为帐篷,抗震救灾官兵住宿简陋,衣物不能及时更换,卫生条件差.地震后,共诊治416例跳蚤叮咬引起的丘疹性荨麻疹,5月13日到6月13日就诊237例,6月14日到7月25日就诊179例;其中地方居民303例,部队官兵113例;男314例,女102例.     

咪唑斯汀、雷尼替丁和潘生丁联合治疗慢性荨麻疹157例疗效观察

目的观察咪唑斯汀、雷尼替丁和潘生丁联合应用治疗157例慢性荨麻疹的疗效。方法278例慢性荨麻疹患者被随机分为咪唑斯汀组（12l例）和联合治疗组（157例），分别给予咪唑斯汀10mg，每日1次，或眯唑斯汀10mg，每日1次，加雷尼替丁300mg，每日2次和潘生丁50mg，每日3次，连用4周。结果联合治疗组显效率和总有效率分别为79．0％和91．7％，咪唑斯汀单用组显效率和总有效率分别为51．2％和74．4％，两组比较差异有非常显著性（P〈0．001）。不良反应嗜睡和口干的发生率咪唑斯汀分别为7．4％和9．9％，联合治疗组分别为8．9％和10．8％，经统计学检验两者差异无显著性（P〉0．05）。结论本文提示三种药联合应用是治疗慢性荨麻疹安全和有效的方法。     

Delayed pressure urticaria: response to treatment with sulfasalazine in a case series of seventeen patients

We retrospectively identified 17 patients with delayed pressure urticaria (DPU), diagnosed by history and confirmed with provocative pressure testing. The average age in the cohort was 42.6 years with 10 women and seven men. The mean duration of disease before diagnosis was 19.7 months (range, 1–60 months). The diagnosis of DPU was not included in the differential diagnosis of referring physicians and was not a diagnostic consideration in any of seven biopsies obtained. None of the patients responded adequately to treatment with antihistamines, but all 17 responded transiently when treated with either oral or intramuscular steroids. Eleven patients experienced complete or near complete resolution of DPU with treatment with sulfasalazine (SZ). Four patients had a partial response while two were unable to continue therapy because of drug intolerance. SZ appears to be a low cost and effective treatment for DPU.     

Low-dose and short-term cyclosporine treatment in patients with chronic idiopathic urticaria: a clinical and immunological evaluation

The present study aimed to evaluate the effectiveness of 2.5 mg/kg/day cyclosporin (CsA) treatment in patients with severe chronic idiopathic urticaria (CIU) and the impact of CsA treatment on several cytokines involved in the etiopathogenesis of CIU. Twenty-seven CIU patients and 24 healthy control subjects were included in the study. The autologous serum skin test (ASST) for autoantibodies and urticaria activity scoring (UAS) were measured for the evaluation of the clinical severity and the response to therapy, and the serum levels of interleukin (IL)-6, IL-8, IL-2 receptor, IL-1beta, tumor necrosis factor (TNF)-alpha and IL-5 were measured. The mean UAS score was 32.07 +/- 7.05 and 6.22 +/- 3.84 before and after CsA treatment, respectively. The serum IL-2 receptor, TNF-alpha and IL-5 levels of patients before CsA treatment were statistically higher than those of the control group (P = 0.001), and after 4 weeks of CsA therapy the mean IL-2R, TNF-alpha and IL-5 levels were significantly decreased. The data from this study demonstrate that CsA therapy is efficient and safe for CIU patients. Increase in clinical efficacy and marked decreases in serum cytokine levels suggest that inhibition of cytokine generation is involved in the action of the drug in this clinical setting.     

Analysis of plasma d‐dimer concentration in patients with delayed pressure urticaria

Background Activation of fibrinolysis system has been observed in spontaneous urticaria. Aim To investigate the haemostatic activation in DPU, expressed by plasma d ‐dimer concentration, the index of active fibrinolysis. Methods Plasma d ‐dimer concentrations were measured in eight patients with pure DPU of varying severity as well as in 30 healthy subjects. Results The analysis of individual results indicated that three patients of the eight show d ‐dimer concentration higher than the upper limit of the normal range. All the patients had severe DPU and manifested extensive lesions. The remaining five milder cases showed values within the normal range. Conclusions Our analysis revealed that DPU patients may differ in their haemostatic activation state depending on severity of the disease. In severe DPU cases hyperfibrinolysis may occur, manifested by elevated plasma d ‐dimer concentration, probably as a consequence of the systemic inflammatory response.