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Association of acute urticaria in children with respiratory tract infections
165 A CROSS SECTIONAL INVESTIGATION OF WORKERS EXPOSED TO PLATINUM SALTS. J.S. Gallagher, Ph.D., D. Baker~ M.D., P.H. Gannp M.D., A.M. Jarabek, B.S., S.M. Brooks, M.D. and I.L. Bernsteln~M.D., Cincinnati, OH, New York, N.Y. and Trenton, N.J. Possible health effects of platinum (Pt) salts were investigated in employees of a platinum refinery. Medical questionnaires, physical examinations, pre and post shift spirometry, cold air challenges, skln prick tests and total IgE were performed in 107 workers currently working at the plant and 30 workers whose jobs had been terminated because of platinum related health problems. Of the 107 currently exposed workers, 15 or 14% had positive skin tests to (NH4)2 PtCI 6 and Na2PtCl, at concentrations ranging from 10 -8 to i0-~ M. Eight or 26% of the 30 terminated workers had positive skin tests to the Pt salts at concentrations of 10-9 to 10 -3 M. Of the 23 workers who had positive skin tests to Pt salts, 9 of the 15 (60%) currently exposed workers and 5 of the 8 (63%) of the terminees, had positive cold air challenges. The mean IgE level of the workers who had negative skin tests to Pt salts was 173 U/ml while the mean IgE level of the workers who had positive skin tests was 318 U/ml. IgE levels of 250 U/ml or greater were observed in 13% of the skin test negative workers and 39% of the skin test positive workers. All 23 of the workers exhibiting skin test sensitivity to Pt salts had clinical symptoms ranging from upper and/or lower respiratory problems to skin involvement. Physiologic and immunological parameters appeared to correlate with clinical sensitivity to Pt salts in these workers.
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ASSOCIATION OF ACUTE URTICARIA IN CHILDREN WITH RESPIRATORY TRACT INFECTIONS. Martin J. Voss~ M.D. t Edward J. O'Connell ~ M.D., John F. Hick t M.D. and Thomas F. Smith, Ph.D., Rochester, MN The etiology of'acute urticaria in childhood frequently is obscure. It has been suggested that respiratory tract infections (URI's) in childhood may be a causative factor. This study was designed to determine if viral URI's were associated with acute urticaria in children. Acute urticaria patients presenting to the Community Pediatric Service of Mayo over a I year span had throat cultures done for respiratory viruses, mycoplasma, and beta hemolytic streptococcus. Age-matched well controls were cultured in the same manner for the same organism. Thirty-one pairs of urticaria patients and controls, ages 6 months to 14 years, were entered in the study over the I year period. Four patients with URI's and positive viral cultures were obtained in the urticaria group and none in the asymptomatic controls (I patient enterovirus, I patient adenovirus, and 2 patients influenza B). Four positive cultures for Group A beta hemolytic streptococcus were obtained in the urticaria group compared to 3 in the controls. Mycoplasma was not found in patients or controls. Fever and URI symptoms were present in 6 urticaria patients with negative cultures. In summary, while not yet statistically significant, there appears to be an association of viral URI's with acute urticaria, and 3 viruses not previously associated with acute urticaria in children are reported.
167 HISTOLOGIC STUDIES OF IDIOPATHIC CHRONIC URTICARIA. S h e i l a Nat.bony, J u l e s E l i a s , M i l d r e d P h i l i p s , Henr~ ' Godfrey a n d A l l e n P . Kaplan. SUNY-Stony Brook, Stony Brook, N.Y. 11794 We have compared s k i n b i o p s y specimens o f 45 p a t i e n t s w i t h c h r o n i c u r t i c a r i a and 8 normals i n o r d e r t o d e f i n e t h e t y p e of c e l l u l a r infiltrate that characterizes chronic urticaria. Two 4 nun punch b i o p s i e s were o b t a i n e d and each was b i sected. Specimens were a s s e s s e d by r o u t i n e H & E, i m m u n o f l u o r e s c e n c e , s t a i n s f o r b a s o p h i l s and mast c e l l s , and h i s t o c h e m i c a l s t a i n s f o r n e u t r o p h i l s , macrophages, and mast c e l l s . One p a t i e n t had v a s c u l i t i s w i t h a n e u t r o p h i l i c i n f i l t r a t e , n e c r o t i z i n g a n g i i t i s and d e p o s i t i o n o f immunog l o b u l i n and complement. A l l o t h e r s had a nonnecrotizing perivascular infiltrate o f mononuc l e a r c e l l s , were i m m u n o f l o u r e s c e n t n e g a t i v e and had no i n c r e a s e i n n e u t r o p h i l s o r b a s o p h i l s . C e l l c o u n t s i n 44 p a t i e n t s e x p r e s s e d as t o t a l c e l l s / 5 r e t i c u l e s r e v e a l e d o n l y t h r e e w i t h an increase in eosinophils. Mononuclear c e l l s r a n g e d from 33-200 (mean o f 73) v s . a normal r a n g e o f 14-75 (mean 4 4 ) . There were 3-26 mast c e l l s (mean 8.0) i n c h r o n i c u r t i c a r i a w h i l e normal s k i n b i o p s i e s had 0-3 mast c e l l s (mean 1.4). Chronic urticaria therefore presents a histologic picture of a non-necrotizing perivenular infiltrate c o n s i s t i n g p r i m a r i l y o f monon u c l e a r c e l l s which r e s e m b l e s t h a t s e e n i n normal s k i n b u t i s q u a n t i t a t i v e l y i n c r e a s e d . The 6 - f o l d i n c r e a s e i n mast c e l l s may r e l a t e t o t h e i n c r e a s e d b l i s t e r f l u i d h i s t a m i n e and t o t a l skin histamine reported in chronic urticaria. T h i s s u g g e s t s t h a t mast c e l l a c c u m u l a t i o n v i a p r o l i f e r a t i o n or c h e m o t r a c t i c a t t r a c t i o n may be an i m p o r t a n t f e a t u r e o f t h e d i s e a s e .
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DELAYED PRESSURE URTICARIA. G.L. Sussman~ H.D., R.P. Harvey, H.D. and A.L. Schocket, H.D., Denver, Colorado Delayed pressure u r t i c a r i a (DPU) is a p o o r l y understood disease. We describe 17 p a t i e n t s with DPU. Average age at onset was 30 years (20-44) with a male/female r a t i o o f i . 8 : 1 and average d u r a t i o n o f pressure symptoms o f 8 years (1-18). Family h i s t o r i e s were n e g a t i v e . Chronic u r t i c a r i a was present in 94.1%. A l l had n e g a t i v e challenges f o r immediate dermographism, cold and local heat. Diagnosis was made with a pressure challenge on the shoulder of 15 lb. w t . x 15 minutes. Average onset o f pressure lesions a f t e r challenge was 6.5 hours (4-12). Lesions were p a i n f u l , not p r u r i t i c , peaked at 9 hours and disappeared by 24-48 hours. Fever, c h i l l s and a r t h r a l g i a s occurred in 75.5~, 20% had § (>!1,O00), 37.5~ § 7% had a p o s i t i v e ANA. No c r y o g i o b u l i n s or hypocomplementemia was found. Skin biopsies (7) of lesions showed periv a s c u l a r lymphocytic i n f i l t r a t e and negative i mmunofluorescence. U r t i c a r i a responded to a n t i h i s t a m i n e s , but not a s p i r i n , in 100~, w h i l e pressure lesions improved with n o n s t e r o l d a l a n t i - i n f l a m m a t o r y agents, but not antihistamines, in 80%. Both u r t i c a r i a and DPU were c o n t r o l l e d w i t h prednisone which was necessary in 87.5%. A severe n o n r e m i t t i n g course was noted in 6.6r 40~ had a moderate r e m i t t i n g course r e q u i r i n g i n t e r m i t t e n t prednlsone, and 53.3% had a m i l d r e m i t t i n g disease r e q u i r i n g a n t i h i s t a m i n e s (H1, H2) and/or ASA o n l y . We conclude that DPU is more common than p r e v i o u s l y a p p r e c i a t e d and l i k e l y involves mediators o t h e r than histamine, p o s s i b l y the p r o s t a g l a n d i n system.
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ASSOCIATION OF ACUTE URTICARIA IN CHILDREN WITH RESPIRATORY TRACT INFECTIONS. Martin J. Voss~ M.D. t Edward J. O'Connell ~ M.D., John F. Hick t M.D. and Thomas F. Smith, Ph.D., Rochester, MN The etiology of'acute urticaria in childhood frequently is obscure. It has been suggested that respiratory tract infections (URI's) in childhood may be a causative factor. This study was designed to determine if viral URI's were associated with acute urticaria in children. Acute urticaria patients presenting to the Community Pediatric Service of Mayo over a I year span had throat cultures done for respiratory viruses, mycoplasma, and beta hemolytic streptococcus. Age-matched well controls were cultured in the same manner for the same organism. Thirty-one pairs of urticaria patients and controls, ages 6 months to 14 years, were entered in the study over the I year period. Four patients with URI's and positive viral cultures were obtained in the urticaria group and none in the asymptomatic controls (I patient enterovirus, I patient adenovirus, and 2 patients influenza B). Four positive cultures for Group A beta hemolytic streptococcus were obtained in the urticaria group compared to 3 in the controls. Mycoplasma was not found in patients or controls. Fever and URI symptoms were present in 6 urticaria patients with negative cultures. In summary, while not yet statistically significant, there appears to be an association of viral URI's with acute urticaria, and 3 viruses not previously associated with acute urticaria in children are reported.
167 HISTOLOGIC STUDIES OF IDIOPATHIC CHRONIC URTICARIA. S h e i l a Nat.bony, J u l e s E l i a s , M i l d r e d P h i l i p s , Henr~ ' Godfrey a n d A l l e n P . Kaplan. SUNY-Stony Brook, Stony Brook, N.Y. 11794 We have compared s k i n b i o p s y specimens o f 45 p a t i e n t s w i t h c h r o n i c u r t i c a r i a and 8 normals i n o r d e r t o d e f i n e t h e t y p e of c e l l u l a r infiltrate that characterizes chronic urticaria. Two 4 nun punch b i o p s i e s were o b t a i n e d and each was b i sected. Specimens were a s s e s s e d by r o u t i n e H & E, i m m u n o f l u o r e s c e n c e , s t a i n s f o r b a s o p h i l s and mast c e l l s , and h i s t o c h e m i c a l s t a i n s f o r n e u t r o p h i l s , macrophages, and mast c e l l s . One p a t i e n t had v a s c u l i t i s w i t h a n e u t r o p h i l i c i n f i l t r a t e , n e c r o t i z i n g a n g i i t i s and d e p o s i t i o n o f immunog l o b u l i n and complement. A l l o t h e r s had a nonnecrotizing perivascular infiltrate o f mononuc l e a r c e l l s , were i m m u n o f l o u r e s c e n t n e g a t i v e and had no i n c r e a s e i n n e u t r o p h i l s o r b a s o p h i l s . C e l l c o u n t s i n 44 p a t i e n t s e x p r e s s e d as t o t a l c e l l s / 5 r e t i c u l e s r e v e a l e d o n l y t h r e e w i t h an increase in eosinophils. Mononuclear c e l l s r a n g e d from 33-200 (mean o f 73) v s . a normal r a n g e o f 14-75 (mean 4 4 ) . There were 3-26 mast c e l l s (mean 8.0) i n c h r o n i c u r t i c a r i a w h i l e normal s k i n b i o p s i e s had 0-3 mast c e l l s (mean 1.4). Chronic urticaria therefore presents a histologic picture of a non-necrotizing perivenular infiltrate c o n s i s t i n g p r i m a r i l y o f monon u c l e a r c e l l s which r e s e m b l e s t h a t s e e n i n normal s k i n b u t i s q u a n t i t a t i v e l y i n c r e a s e d . The 6 - f o l d i n c r e a s e i n mast c e l l s may r e l a t e t o t h e i n c r e a s e d b l i s t e r f l u i d h i s t a m i n e and t o t a l skin histamine reported in chronic urticaria. T h i s s u g g e s t s t h a t mast c e l l a c c u m u l a t i o n v i a p r o l i f e r a t i o n or c h e m o t r a c t i c a t t r a c t i o n may be an i m p o r t a n t f e a t u r e o f t h e d i s e a s e .
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DELAYED PRESSURE URTICARIA. G.L. Sussman~ H.D., R.P. Harvey, H.D. and A.L. Schocket, H.D., Denver, Colorado Delayed pressure u r t i c a r i a (DPU) is a p o o r l y understood disease. We describe 17 p a t i e n t s with DPU. Average age at onset was 30 years (20-44) with a male/female r a t i o o f i . 8 : 1 and average d u r a t i o n o f pressure symptoms o f 8 years (1-18). Family h i s t o r i e s were n e g a t i v e . Chronic u r t i c a r i a was present in 94.1%. A l l had n e g a t i v e challenges f o r immediate dermographism, cold and local heat. Diagnosis was made with a pressure challenge on the shoulder of 15 lb. w t . x 15 minutes. Average onset o f pressure lesions a f t e r challenge was 6.5 hours (4-12). Lesions were p a i n f u l , not p r u r i t i c , peaked at 9 hours and disappeared by 24-48 hours. Fever, c h i l l s and a r t h r a l g i a s occurred in 75.5~, 20% had § (>!1,O00), 37.5~ § 7% had a p o s i t i v e ANA. No c r y o g i o b u l i n s or hypocomplementemia was found. Skin biopsies (7) of lesions showed periv a s c u l a r lymphocytic i n f i l t r a t e and negative i mmunofluorescence. U r t i c a r i a responded to a n t i h i s t a m i n e s , but not a s p i r i n , in 100~, w h i l e pressure lesions improved with n o n s t e r o l d a l a n t i - i n f l a m m a t o r y agents, but not antihistamines, in 80%. Both u r t i c a r i a and DPU were c o n t r o l l e d w i t h prednisone which was necessary in 87.5%. A severe n o n r e m i t t i n g course was noted in 6.6r 40~ had a moderate r e m i t t i n g course r e q u i r i n g i n t e r m i t t e n t prednlsone, and 53.3% had a m i l d r e m i t t i n g disease r e q u i r i n g a n t i h i s t a m i n e s (H1, H2) and/or ASA o n l y . We conclude that DPU is more common than p r e v i o u s l y a p p r e c i a t e d and l i k e l y involves mediators o t h e r than histamine, p o s s i b l y the p r o s t a g l a n d i n system.