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159 Outcome of patients with chronic urticaria and angioedema
157 COMPARISON OF BETA, ALPHA,-RECEPTORS AND c-AM? FUNCTIONS BETWEEN ASTIXMATfCS AND NORMALS. T.Sato
159 OUTCOME OF PATIENTS WITH CHRONIC IJRTICARIA Am ANGIOEDEMA. L. Smith, M.D., B.B. Iiray, M.D,
M.D..
R. Townley, M.D., Omaha, NE To assess the adrenergic receptor system in bronchial asthma, beta receptors of mononuclear cell membranes, alpha receptors of platelet membranes and c-AMP responses in these cell types to different stimuli were measured in 9 asthmatic subjects (age+S.E.M., 25.7C1.5) off beta2 agonist for 2 weeks and 10 normal subjects (24.2 ?l.l). The densities and affinities of beta and alpha receptors were determined by Scatchard analysis using 1251-Hydroxybenzylpindolol and (3H) Yohimbine, respectively. Asthmatics showed a significantly lower number of beta receptors (32.822.3 f mol/mg) as compared to normal subjects (48.3k3.3) (p
‘58
and
C.T. Stafford, M.D., Augusta, GeorgiaMedical records of one hundred nari&ts from ages 2-73 years with chronic urticaria/angioedema were reviewed for etioiogy (1~ precipitating factors, and thev were contactLi; : +CW r' months to 14 years later for outcOmc, Of the 46 patients who had sympt,,,ns h months or less at the time 01 presentat*L)r>, '11 had c.>mplete resolution of their urticaria. b::it!! 10 others having only occasional exacerbation, and 5 were unresolved. Qf the 38 witii i:ym!itiims h24 months after the time oi initia? evaluation, 18 had resolution, 7 partial remission. and 1:; were unresolved. Of the 16 patient!: vhose s:mptams had been present per 24 mtjntl:::, L:n':y :j had resolved completely. Seventy-four percent had no proviic etiology, although certain factors were suspectted in 133 of these. Foods and/or preservatives and additives were common causes in all age:;. Othelfactors included cold, lleal., exercise, m&i;:rheumatoid arthrit i 9, nancy, drugs, perfumes, parasites, inhalants, and emotionai ~lpsets. DC?finite etiologies were established ir. onI:; 26;:. In conclusion, outcome was somewhat be:::-r in younger patients and in patient-; wilrh atopic disease. 'Those with deiinite etiologies or precipitating factors were more likel\ LC have cm-plete resolution of symptoms, allii~~al; some with idiopathic urticaria and/or vascuiitix rc,+olved after years of symptoms.
160
CHRONIC URTICARIA IN PATIENTS WITH HIGH TITER ANT~MICROS~M~ AtmBoDIEs. A.K.Jesai, M.I),, B.R L----Adelsbs.M.D_.., && Young, M.D.,-D.,!. Berqman, M,D. New York, N.Y. Chronic urticaria and angioedema have been occassionally reported as being associated with hyperthyroidism and hypothyroidism but there is no etiologic relationship established as to the type of thyroid disease especially autoimmune thyroid disease. We recently saw a patient who presented with chronic urticaria and angioedema 3 months prior to development of clinically evident hyperthyroidism. Initial evaluation revealed normal levels of IgE,C3,C4,ClINH,T3,T4,TSH & TRF.Antithyroid microsomal antibody titers were remarkably elevated. This alerted us to the oossibility that some of our patients with chronic urticaria and angioedema might have underlying autoimmune thyroid disease. We subsequently studied 100 other patients Their with chronic urticaria and angioedema. physical examinations were unremarkable except for the presence of urticaria. Standard evaluations were unrevealing as to the etiology of their urticaria. 5 of them had high titers of antithyroid microsomal antibody. The interesting common features in these 5 patients were their relative resistance to antihistaminic therapy and that all of them required corticosteroids for relief of their symptoms. We believe that evaluation in patients with chronic urticaria and angioedema should include measurement of autoantibodies to thyroid microsomal antigen and this may be a clue to the therapy of patients with chronic urticaria and angioedema.
OUTCOME OF ANGIOEDEMA.
83
ADULTS WITH A.R. PC?coud,
CHRONIC URTJCARIA M.D., C. Geriton,
Switzerland. 89 patients (p) referred chronic urticaria (U) or angioedema 1975 and 1980, 83 were interviewed
AND M.D.,
Lausanne, Of
the
to
us
(A)
for
between
by telephone. The sex distribution was 56 f and 27 M; when Pnvestigated, the mean age was 40 years (range 16-75) and the mean duration of symptoms 36 months (range: 2 to 317). 21% of t.he p had A alone, 32% U alone and 47% U and A. ‘28% gave a personal history of atopy and 30% a history ivf
acute intolerance reactions Sixty-five F said they proved; in the remaining
to were
analgesics.
cured? 6% im-. 29% the disease was unchanged after a mean duration of 62 rnonths (range 15 to 236). Two p had died from cancer (breast, lung). Among the cured p the disappearance of the symptoms was spontaneous in 43 (52%) (mean duration of the disease: 31 months, and of the period without symptoms: 32 months); ln 11 (13%) the cure occurred within 3 days after starting the proposed treatment; this consisted of discontinuing the chronic use of analgesics (5 pj, food-additives (4 p), laxatives (1 p) and milk (1 p) (mean duration of the disease and of the period without symptoms: 28 months). Outcome was not affected by age, sex, history of atnpy, skin tests and laboratory data (eosinophils, IgE, RAST). In summary a) U/A even of lony duration was often a self limiting disease, b) successful therapy was mainly linked to the dlscovery of intolerance to analgesics and/or food additives and c) results of allergic investigations wrre not predictive of the outcome.
128
159 OUTCOME OF PATIENTS WITH CHRONIC IJRTICARIA Am ANGIOEDEMA. L. Smith, M.D., B.B. Iiray, M.D,
M.D..
R. Townley, M.D., Omaha, NE To assess the adrenergic receptor system in bronchial asthma, beta receptors of mononuclear cell membranes, alpha receptors of platelet membranes and c-AMP responses in these cell types to different stimuli were measured in 9 asthmatic subjects (age+S.E.M., 25.7C1.5) off beta2 agonist for 2 weeks and 10 normal subjects (24.2 ?l.l). The densities and affinities of beta and alpha receptors were determined by Scatchard analysis using 1251-Hydroxybenzylpindolol and (3H) Yohimbine, respectively. Asthmatics showed a significantly lower number of beta receptors (32.822.3 f mol/mg) as compared to normal subjects (48.3k3.3) (p
‘58
and
C.T. Stafford, M.D., Augusta, GeorgiaMedical records of one hundred nari&ts from ages 2-73 years with chronic urticaria/angioedema were reviewed for etioiogy (1~ precipitating factors, and thev were contactLi; : +CW r' months to 14 years later for outcOmc, Of the 46 patients who had sympt,,,ns h months or less at the time 01 presentat*L)r>, '11 had c.>mplete resolution of their urticaria. b::it!! 10 others having only occasional exacerbation, and 5 were unresolved. Qf the 38 witii i:ym!itiims h24 months after the time oi initia? evaluation, 18 had resolution, 7 partial remission. and 1:; were unresolved. Of the 16 patient!: vhose s:mptams had been present per 24 mtjntl:::, L:n':y :j had resolved completely. Seventy-four percent had no proviic etiology, although certain factors were suspectted in 133 of these. Foods and/or preservatives and additives were common causes in all age:;. Othelfactors included cold, lleal., exercise, m&i;:rheumatoid arthrit i 9, nancy, drugs, perfumes, parasites, inhalants, and emotionai ~lpsets. DC?finite etiologies were established ir. onI:; 26;:. In conclusion, outcome was somewhat be:::-r in younger patients and in patient-; wilrh atopic disease. 'Those with deiinite etiologies or precipitating factors were more likel\ LC have cm-plete resolution of symptoms, allii~~al; some with idiopathic urticaria and/or vascuiitix rc,+olved after years of symptoms.
160
CHRONIC URTICARIA IN PATIENTS WITH HIGH TITER ANT~MICROS~M~ AtmBoDIEs. A.K.Jesai, M.I),, B.R L----Adelsbs.M.D_.., && Young, M.D.,-D.,!. Berqman, M,D. New York, N.Y. Chronic urticaria and angioedema have been occassionally reported as being associated with hyperthyroidism and hypothyroidism but there is no etiologic relationship established as to the type of thyroid disease especially autoimmune thyroid disease. We recently saw a patient who presented with chronic urticaria and angioedema 3 months prior to development of clinically evident hyperthyroidism. Initial evaluation revealed normal levels of IgE,C3,C4,ClINH,T3,T4,TSH & TRF.Antithyroid microsomal antibody titers were remarkably elevated. This alerted us to the oossibility that some of our patients with chronic urticaria and angioedema might have underlying autoimmune thyroid disease. We subsequently studied 100 other patients Their with chronic urticaria and angioedema. physical examinations were unremarkable except for the presence of urticaria. Standard evaluations were unrevealing as to the etiology of their urticaria. 5 of them had high titers of antithyroid microsomal antibody. The interesting common features in these 5 patients were their relative resistance to antihistaminic therapy and that all of them required corticosteroids for relief of their symptoms. We believe that evaluation in patients with chronic urticaria and angioedema should include measurement of autoantibodies to thyroid microsomal antigen and this may be a clue to the therapy of patients with chronic urticaria and angioedema.
OUTCOME OF ANGIOEDEMA.
83
ADULTS WITH A.R. PC?coud,
CHRONIC URTJCARIA M.D., C. Geriton,
Switzerland. 89 patients (p) referred chronic urticaria (U) or angioedema 1975 and 1980, 83 were interviewed
AND M.D.,
Lausanne, Of
the
to
us
(A)
for
between
by telephone. The sex distribution was 56 f and 27 M; when Pnvestigated, the mean age was 40 years (range 16-75) and the mean duration of symptoms 36 months (range: 2 to 317). 21% of t.he p had A alone, 32% U alone and 47% U and A. ‘28% gave a personal history of atopy and 30% a history ivf
acute intolerance reactions Sixty-five F said they proved; in the remaining
to were
analgesics.
cured? 6% im-. 29% the disease was unchanged after a mean duration of 62 rnonths (range 15 to 236). Two p had died from cancer (breast, lung). Among the cured p the disappearance of the symptoms was spontaneous in 43 (52%) (mean duration of the disease: 31 months, and of the period without symptoms: 32 months); ln 11 (13%) the cure occurred within 3 days after starting the proposed treatment; this consisted of discontinuing the chronic use of analgesics (5 pj, food-additives (4 p), laxatives (1 p) and milk (1 p) (mean duration of the disease and of the period without symptoms: 28 months). Outcome was not affected by age, sex, history of atnpy, skin tests and laboratory data (eosinophils, IgE, RAST). In summary a) U/A even of lony duration was often a self limiting disease, b) successful therapy was mainly linked to the dlscovery of intolerance to analgesics and/or food additives and c) results of allergic investigations wrre not predictive of the outcome.
128