慢性荨麻疹患者的甲状腺功能及自身抗体水平分析

目的：检测甲状腺功能和自身抗体与慢性荨麻疹发病及病情严重性的相关性。方法：收集91例慢性荨麻疹患者和78例健康志愿者的临床资料,用直接化学发光法测定血清中慢性荨麻疹患者及健康志愿者甲状腺功能及TGAb、TPOAb自身抗体。结果：慢性荨麻疹患者甲状腺自身抗体阳性率分别为13.19%及15.38%,明显高于健康对照组的2.56%及10.26%,差异有统计学意义（P <0.05）。甲状腺功能异常者较功能正常者风团每日发作频率高（P <0.05）。结论：甲状腺自身免疫的异常可能与慢性荨麻疹的发病有关,甲状腺功能可能与慢性荨麻疹的发作频率相关     

Tissue parasites in patients with chronic urticaria

Chronic urticaria is an important diagnostic and therapeutic problem. We aimed to investigate the sero-prevalence of tissue parasites causing toxocariasis and fasciolosis in patients with chronic urticaria. All cases were analyzed for antibodies against Toxocara canis and Fasciola hepatica by modified (homemade) ELISA. The excretory/secretory products of Toxocara and Fasciola were used as antigens (ES-ELISA) in the test. In this study, the highest toxocariasis seropositivity (29.0%) rate and the highest fasciolosis seropositivity (14.5%) rate were found in patients with chronic urticaria. Fasciolosis seropositivity and total seropositivity of toxocariasis and fasciolosis in patients with chronic urticaria was significantly higher than in healthy controls (p<0.05). Toxocariasis seropositivity in patients with chronic urticaria was not significantly higher than that in healthy controls (p>0.05). We suggest that parasitic infections should be considered as an important cause of chronic urticaria. Serological methods should be used to expose the diagnosis of tissue parasites in such cases.     

Blood rheological profiles in patients with chronic urticaria

Psychological factors, such as stress, anxiety, depression, as well as immuno-inflammatory processes may influence blood rheology. On the other hand, these factors may be involved in triggering, aggravating or maintenance of urticaria symptoms. The present study was designed to compare blood rheological properties of patients with chronic urticaria with positive response to autologous serum skin test (ASST) and negative response to ASST. The study comprised 15 female patients with chronic urticaria showing positive response to ASST, 14 female patients with chronic urticaria showing negative response to ASST and 15 healthy subjects. Rheological properties of erythrocytes, such as deformability and aggregation, were measured. Overall blood viscosity measurements were performed with the use of cone-plate Brookfield’s viscometer, and plasma viscosity measurement employed capillary Ubbelohd’s viscometer. The hemorheological parameters did not differ significantly between the groups. It seems that blood rheological properties do not alter in patients with chronic urticaria, irrespective of their response to ASST.     

Not all chronic urticaria is "idiopathic"

Abstract: The aetiology of chronic urticaria in the majority of patients is elusive. The cause of physical urticarias (dermographism, delayed pressure urticaria, cold urticaria) is unkonown. We have identified a subset of chronic "idiopathic" urticaria patients, representing approximately 30% of the total in which the disease is caused by the presence of IgG autoantibodies against the high affinity IgE receptor (FcœRIα). This functional autoantibody stimulates normal (albeit vicarious) activation of mast cells and basophils via FcœRI, causing whealing and angioedema. Anti-FcœRI-positive patients are recognized by a combination of autologous serum skin testing and evoked histamine release from basophils of normal human donors. Autoantibody-positive and -negative patients are clinically indistinguishable and are treated routinely by combinations of H₁ and occasionally H₂-antihistamines in both cases. However, severely affected patients who are anti-FcœRI-positive can also be treated by non-specific immunotherapy (plasma pheresis, intravenous immunoglobulin, cyclosporin.     

Psychological status of patients with chronic urticaria

Although chronic urticaria is the most common cutaneous disorder seen in our outpatient allergy clinics, to our knowledge, no study of psychiatric morbidity in allergy departments has been carried out in our country. For the present study, we used the Minnesota Multiphasic Personality Inventory (MMPI) to evaluate the personality traits and psychological status of patients with chronic idiopathic urticaria (CIU). Fifty-nine outpatients with CIU and 59 healthy control subjects were enrolled in the study. Patients were included if no specific cause for their urticaria could be identified by detailed history and appropriate investigations. Psychiatric evaluation for all patients and controls was conducted at the Department of Psychiatry by using MMPI. Analysis of the MMPI profile showed that the scores for hypochondriasis, depression, hysteria, psychopathic deviance, paranoia, psychasthenia, schizophrenia, and social introversion were higher in patients with CIU compared to the control group (P < 0.05). The mean score of hysteria was significantly higher in women. There were no significant correlations between the scores of MMPI and duration of the disease. These data indicate that our patients with CIU seem to have more depressive, hysteric, touchy and suspicious personality traits with hypochondriac tendencies and in more conflict with their social environment. Attitudes such as perfectionism, need for approval, external control and need to be loved were also characteristics of the patient group. We believe that psychological status should be considered for effective management of patients with CIU.     

House dust mite sensitivity is a factor in chronic urticaria

BACKGROUND: Chronic urticaria is one of the perplexing problems faced by clinicians. There are a few reports associating house dust mite sensitivity with chronic urticaria, based upon the patient's history as well as intradermal skin testing and in vitro analysis. AIMS: To investigate the possible association between house dust mite sensitivity and chronic urticaria. METHODS: In this case control study three groups of patients were enrolled. Group I: Chronic urticaria (73 subjects). Group II: Chronic urticaria with collateral allergic disorders (49 subjects). Group III: Normal subjects without chronic urticaria or other allergies (25 subjects). All the patients underwent skin prick testing with antigens of the house dust mite, Dermatophagoides pteronyssinus (DP) and Dermatophagoides farinae (DF), with positive and negative controls. RESULTS: Among the patients with chronic urticaria, 78/122 (64%) patients had skin sensitivity to house dust mites. Out of these, 39/73 (53%) had chronic urticaria alone and 39/49 (79%) had chronic urticaria with other associated allergies. Among the normal control subjects, 7/25(28%) reacted positively to house dust mites. CONCLUSION: This study suggests a possible association of house dust mite sensitivity with chronic urticaria.     

慢性荨麻疹患者多种因素致敏状态研究

慢性荨麻疹是指病程超过6周的荨麻疹,多迁延难愈,对常规抗组胺药有时治疗效果不显著.为了了解慢性荨麻疹患者的致敏状态,我科对193例慢性荨麻疹患者进行了食物、吸入物特异性IgE检测、自体血清皮肤试验及斑贴试验.     

Monoclonal gammopathies and malignancies in patients with chronic urticaria

BACKGROUND: Monoclonal gammopathy of undetermined significance (MGUS) has been described in association with chronic urticaria (CU) in patients with Schnitzler syndrome. Chronic urticaria may be a manifestation of hematologic malignancies. METHODS: This study was conducted to evaluate the frequency and characteristics of MGUS or malignancy in patients with CU. The Mayo Clinic electronic database was reviewed to identify patients with the diagnosis of CU. RESULTS: Of the 1639 patients presenting with CU between 1994 and 2001, 797 (49%) underwent laboratory evaluation for the presence of a coexisting monoclonal protein. Forty-seven CU patients had MGUS, 142 had a malignancy, and 24 had both. Fifteen percent of CU patients with MGUS had a hematologic malignancy compared with 0.9% of CU patients without MGUS (P < 0.001). Patients presenting with a new diagnosis of CU at an older age (> 56 years) were more likely to have associated underlying MGUS. The occurrence of MGUS in this group was higher than the reported incidence of MGUS in the general population. CONCLUSIONS: Patients with CU younger than 43 years were unlikely to have associated MGUS or malignancy. A higher percentage of patients with CU and MGUS had an associated diagnosis of hematologic malignancy.     

124例慢性荨麻疹患者皮肤变应原点刺试验结果分析

目的：探讨各种变应原与慢性荨麻疹发病的关系，为临床防治提供指导依据。方法：采用国际标准的皮肤点刺试验对124例慢性荨麻疹患者进行27种变应原的检测。结果：124例慢性荨麻疹患者的变应原检测阳性率达83．8％。屋尘螨、粉尘螨是慢性荨麻疹的主要变应原，各占58．10％、59．70％：其次是虾、杂草、松属、谷类和花粉（禾本科），分别占25．8％、23．4％、22．60％、17．70％和16．9％。其中对一种变应原呈阳性反应9例（7．26％），对两种变应原呈阳性反应为8例（6．45％），对三种及以上变应原呈阳性反应为65例（52．4％）。结论：慢性荨麻疹患者皮肤点刺试验有较高的变应原检出率，能为疾病的预防和进一步脱敏治疗提供可靠依据。     

负性急性时相蛋白在慢性荨麻疹患者的研究

目的 探讨急性时相反应与慢性荨麻疹的关系。 方法 慢性荨麻疹患者50例,按症状分为轻型（1级）、中型（2级）、重型（3级）3组,同时选取健康体检者28例,用免疫比浊法测定血清前白蛋白（PA）、转铁蛋白（TRF）水平,采用酶联免疫吸附法测定胰岛素样生长因子1（IGF-1）和肿瘤坏死因子α（TNF-α）水平;比较两组之间的差异、各检测项目之间的相关性及与病情分级的关系。 结果 慢性荨麻疹患者PA（229.99 ± 54.16） mg/L、IGF-1（177.23 ± 46.48） μg/L均明显低于健康对照组,两组差异有统计学意义（均P < 0.05）。TNF-α（25.39 ± 11.01） ng/L高于健康对照组（14.13 ± 6.12） ng/L,差异有统计学意义（P < 0.05）。TRF水平（2.48 ± 0.49） g/L与健康对照组（2.48 ± 0.25） g/L比较,差异无统计学意义（P > 0.05）。血清PA与TNF-α呈显著负相关（P < 0.05）,并与病情严重程度呈显著负相关（P < 0.01）,而TNF-α则与病情严重程度呈显著正相关（P < 0.01）;其余各指标之间无明显相关性（均P > 0.05）。 结论 在慢性荨麻疹患者中,部分急性时相反应负性蛋白水平降低且与病情呈负相关,急性时相反应可能参与慢性荨麻疹的发病。     

The frequency of nasal carriage in chronic urticaria patients

OBJECTIVE: Chronic urticaria is characterized by oedema of the skin and mucous membranes. Although many agents have been implicated, aetiology is unknown in 70 to 75% of patients. Infections and foci of chronic infections are most commonly held responsible for chronic urticaria. In this study, the frequency of nasal carriage as the occult focus of infection and sensitivity to antimicrobials are explored in patients with chronic urticaria. MATERIAL AND METHOD: Ninety-four patients with chronic urticaria and 30 controls participated in the study, which was carried out at the Ege university medical faculty, department of dermatology between January 2004 and January 2005. Nasal swab specimens were taken from the patients and controls and incubated at 37 degrees C degrees for 48 h, and inoculated on standard bacterial medium (blood agar). Antimicrobial susceptibility of a growth from isolates of the nasal swab specimens was conducted. Data were analysed statistically using chi-square and Mann-Whitney U-tests. RESULTS: Ninety-four patients with chronic urticaria (72.3% female and 27.7% male) and 30 controls (63.3% female and 36.7% male) comprised the study group. Mean age of the patients and controls were 42.6 and 33.8 years, respectively. Staphylococcus aureus was detected in swab specimens from the nasal cavity in 50 of the 94 patients (53.2%) with chronic urticaria and four of the 30 controls (13.3%). Testing revealed that the most susceptible antibiotics were cefaclor, ceftriaxone, amoxycillin-clavulanic acid, amikacin, netilmicin, and fucidic acid. CONCLUSION: Growth on cultures prepared from nasal swab specimens of chronic urticaria patients was statistically higher than the control group. We detected resistance to growth against mupirocin, an antibiotic frequently used in nasal carriage. High nasal carriage of Staphylococcus aureus in patients with chronic urticaria compared to controls suggests that nasal carriage as a focus of infection should be kept in mind as aetiology.     

台州市531例慢性荨麻疹过敏原检测

目的:筛选台州市531例慢性荨麻疹患者过敏原。方法:采用免疫印迹法对531例慢性荨麻疹患者进行过敏原测定。结果:吸入性过敏原阳性率为25.24%(134例),其中尘螨阳性率22.41%(119例);食人性过敏原阳性率为29.0%(154例),其中蟹抗体阳性率13.75%(73例)。结论:本地区常见过敏原为尘螨。     

Most chronic urticaria is food-dependent, and not idiopathic

Abstract: Although chronic urticaria is generally thought to be mostly idiopathic, we have recently provided convincing evidence that in the majority of patients, food ingredients provoke the symptoms and sustain the disease. On a diet largely avoiding preservatives, dyes and natural pseudoallergens, 73% of patients experienced remission of more than 6 months duration, starting within the first 3 weeks after initiation of the diet. This response rate is clearly higher than the reported 24% spontaneous remission rate over the same time period. The specificity of the dietary effect was proven 1) by double-blind provocation with pureed pseudoallergen-low versus -rich food and 2) by induction of a clinical response to a 3-week diet low in pseudoallergens, but not to a standard diabetes diet in 3 patients studied in a double-blind crossover design. On double-blind, placebo controlled oral provocation, only 18% of diet-responsive patients reacted to known food preservatives and dyes, but 71% to pureed tomatoes and 44% to their steem extracts. These findings identify naturally occurring pseudoallergens in food as major elicitors of chronic urticaria. In contrast, autoantibodies against Fc-RIα have been identified in only about 30% of chronic urticaria patients, and evidence for their truly causative role is still lacking since therapeutic measures work in patients irrespective of the presence or absence of the autoantibodies. For both food intolerance and Fc-RIα-autoantibodies in chronic urticaria, the associated pathomechanisms are however still in need of clarification. Meanwhile, the diet-responsiveness in the majority of patients opens new perspectives for the management of chronic urticaria.