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Chronic Spontaneous Urticaria-The Saskatchewan Experience and Questionnaire Survey
AB122 Abstracts
429
SUNDAY
Altered Systemic Adipokine Levels In Patients With Chronic Idiopathic Urticaria Dr. Young Min Ye, MD, Dr. Ga Young Ban, MD, Eun-Mi Yang, Dr. HyeSoo Yoo, MD, Yoo Seob Shin, MD, PhD, Prof. Hae-Sim Park, MD, PhD; Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea. RATIONALE: It becomes increasingly evident that adipokines play a key role in immune response and inflammation. Chronic idiopathic urticaria (CIU) is associated with an altered immune response connecting to chronic systemic inflammation. METHODS: To investigate the circulating adipokines in patients with CIU and to determine possible mediators of severe CIU or aspirin sensitivity, serum adiponectin, leptin, lipocalin2, interlukin (IL)-10, IL-6 and tumor necrosis factor (TNF)-a concentrations were measured by enzyme-linked immunosorbent assays in 191 (59 with aspirin intolerance) CIU patients and 50 healthy controls (NC). The disease activity of CIU was assessed by the urticarial activity score (UAS), a total score of 0–15. RESULTS: The mean levels of serum leptin, lipocalin2, TNF-a, IL-6 and IL-10 were significantly higher in CIU patients as compared to NC. Adiponectin, an anti-inflammatory adipokine, was measured at a significantly lower level in the sera of patients with CIU. IL-6 and TNF-a were _13. The level of lipocalin2, significantly higher in patients with a UAS> known as a neutrophil activation marker, was found to be significantly different according to the presence of aspirin intolerance (45.2642.4 in aspirin-intolerant chronic urticaria vs. 80.4638.8 in aspirin-tolerant chronic urticaria) and anti-thyroid antibody (50.8630.8 vs. 76.0642.7) after adjusting age, gender and atopy. CONCLUSIONS: CIU patients have an imbalance of pro- and antiinflammatory adipokines compared to NC. The modulation of systemic inflammation can be targeted for some subpopulations of CU patients with severe, aspirin tolerant and thyroid autoimmunity.
430
Predicting Clinical Responsiveness To Dapsone In The Treatment Of Chronic Idiopathic Urticaria (CIU) Dr. Ryan A. Steele, DO, MS1, Dr. Janelle Sher, MD2, Dr. Mark DavisLorton, MD, FAAAAI2, Dr. Marcella R. Aquino, MD, FAAAAI2, Dr. Luz S. Fonacier, MD, FAAAAI3; 1Allergy & Immunology, Winthrop University Hospital, Mineola, NY, 2Winthrop University Hospital, Allergy & Immunology, Mineola, NY, 3Section of Allergy and Clinical Immunology, Department of Medicine, Winthrop University Hospital, Mineola, NY. RATIONALE: In our office, dapsone has been used successfully to treat patients with CIU unresponsive to antihistamines. Serologic and clinical screening tools may help to determine which patients may benefit from its use. METHODS: The charts of 19 patients with CIU treated with dapsone were reviewed. Clinical responsiveness (none, partial, or complete) was assessed at 1, 2, 4, 6, 8, 12, 16, and 20 weeks. Records were examined for serologic markers (anti-thyroid antibodies, ANA, CU index) and the presence of angioedema. Predictiveness and time to maximal responsiveness (TMR) were evaluated. RESULTS: Eighteen females and 1 male (mean age of 46.89 years) were examined, with 2 lost to follow up. Seventeen patients obtained a complete response. 4/17 patients (24%) had a history of angioedema with the average TMR of 4 weeks vs. 6.73 weeks in those without angioedema. 4/15 (27%) patients had elevated CU index values. TMR was 9 weeks in those with elevated CU indexes vs. 5 weeks in those with normal CU indexes. 4/17 (24%) patients had anti-thyroid antibodies, with a TMR of 4 weeks vs. 6.3 weeks in those without. Only one patient had an elevated ANA but was lost to follow-up. CONCLUSIONS: Angioedema, a normal CU index, and elevated antithyroid antibodies were associated with a shorter TMR in our CIU patients treated with dapsone. Further studies examining screening criteria for patients treated with dapsone in CIU are warranted to determine which patients are likely to benefit from this therapy.
J ALLERGY CLIN IMMUNOL FEBRUARY 2014
431
Chronic Urticaria/Angioedema and Auto-Immunity: Diagnostic Profile Among Patients Attending a Reference Clinic In Brazil Dr. Daniel L. Cordeiro, MD1, Dr. Janaina Fernandes de Melo Sousa, MD1, Dr. Karine Boufleur, MD1, Dr. Priscila Botelho Palhas, MD1, Dr. Thaıs Mendonc¸a, MD1, Dr. Janaina Michele de Lima Melo, MD1, Dr. Luisa Karla P. Arruda, MD, PhD, FAAAAI2; 1Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil, 2 School of Medicine of Ribeirao Preto, Ribeirao Preto, Brazil. RATIONALE: Chronic urticaria/angioedema is a challenge to the Allergist/Immunologist. We aimed to evaluate the diagnostic profile among patients with chronic urticaria/angioedema. METHODS: Two hundred patients with ages 13-80 years-old (161 females, 80.5%), with chronic urticaria/angioedema attending a specialty clinic were evaluated prospectively. Autoimmune basis was suspected by presence of positive autologous test, anti-thyroid or antinuclear antibodies(ANA). Patients were evaluated for triggering of symptoms by medications and/or physical agents, anaphylaxis, skin testing, eosinophilia, IgE, and hepatitis serology. When indicated, a skin biopsy was performed. Use of medications for urticaria was analysed. RESULTS: Duration of disease ranged from 6 months to 36 years. Fifty-six patients (28%) had urticaria only;130(65%) urticaria and angioedema; and 14(7%) angioedema. Of the 86 patients who underwent autologous skin testing, 36(41.8%) had positive results. Anti-thyroid antibodies and ANAwere positive in 12.4% and 12.2% of patients, respectively. Sixty-seven(33.5%) patients reported triggering of symptoms by medications, mostly ASA/ NSAIDs(26.5%). Thirty percent of patients reported worsening of symptoms by physical agents. Eight patients had anaphylaxis. Biopsy carried out in 19 patients revealed 4 urticaria vasculitis, 4 eosinophilic infiltrate and 11 nonspecific. Sixty-four percent of patients had total IgE>100kU/L; positive skin test were more frequent to mites(44%), cockroach(30%) and shellfish(16%). Ninety-two percent were in use of at least one daily medication, mostly antihistamines (88%); 13/184(7%) took oral corticosteroids. CONCLUSIONS: Sixty-nine patients (34%) presented features of autoimmune urticaria/angioedema. Other causes were physical, foodinduced, and NSAIDs-induced urticaria. Hereditary and iECA angioedema were diagnosed in 2 and 4 patients, respectively. Despite extensive investigation, 83 patients(41.4%) remained diagnosed as spontaneous urticaria/angioedema.
432
Chronic Spontaneous Urticaria-The Saskatchewan Experience and Questionnaire Survey Ms. Natasha Gattey; University of Saskatchewan, Saskatoon, SK, Canada. RATIONALE: In this questionnaire study, we examined responses to treatment, effect on lifestyle, beliefs of causation, and satisfaction with treatment method for Chronic Spontaneous Urticaria. METHODS: 173 patients with CSU had been seen between 2003 and 2013. An autologous serum skin test (ASST) had been performed on 138 patients. 101 participants responded. RESULTS: Of the respondents, 80 were women and 21 men. The age range was 1 year to 81. The mean age was 36 years. The average duration of symptoms was 9.3 years. They included 40 patients who were ASST positive (M: F; 8:32) and 49 negative M:F; 12:37). 50 participants no longer had hives. Patients reported being most bothered by pruritus, disturbed sleep, anxiety and their physical appearance including facial swelling. Many (71.2%) had missed work or school because of the urticaria. Twentynine patients found antihistamines alone gave adequate relief of urticaria. Twenty ASST positive patients with severe uncontrollable hives were treated with intravenous immunoglobulin (IVIG). 85.0% of these patients had improved quality of life, with 13 of these patients now free of urticaria and no longer receiving IVIG. Three patients who did not benefit from IVIG did respond to methotrexate. No ASST negative patients received IVIG. CONCLUSIONS: Approximately 30% of patients found antihistamines gave effective control. Half the patients had been free of urticaria for at least 3 months. About 40% of patients with CSU had an autoimmune basis as assessed by the ASSTand IVIG was a highly effective treatment for this group.
429
SUNDAY
Altered Systemic Adipokine Levels In Patients With Chronic Idiopathic Urticaria Dr. Young Min Ye, MD, Dr. Ga Young Ban, MD, Eun-Mi Yang, Dr. HyeSoo Yoo, MD, Yoo Seob Shin, MD, PhD, Prof. Hae-Sim Park, MD, PhD; Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea. RATIONALE: It becomes increasingly evident that adipokines play a key role in immune response and inflammation. Chronic idiopathic urticaria (CIU) is associated with an altered immune response connecting to chronic systemic inflammation. METHODS: To investigate the circulating adipokines in patients with CIU and to determine possible mediators of severe CIU or aspirin sensitivity, serum adiponectin, leptin, lipocalin2, interlukin (IL)-10, IL-6 and tumor necrosis factor (TNF)-a concentrations were measured by enzyme-linked immunosorbent assays in 191 (59 with aspirin intolerance) CIU patients and 50 healthy controls (NC). The disease activity of CIU was assessed by the urticarial activity score (UAS), a total score of 0–15. RESULTS: The mean levels of serum leptin, lipocalin2, TNF-a, IL-6 and IL-10 were significantly higher in CIU patients as compared to NC. Adiponectin, an anti-inflammatory adipokine, was measured at a significantly lower level in the sera of patients with CIU. IL-6 and TNF-a were _13. The level of lipocalin2, significantly higher in patients with a UAS> known as a neutrophil activation marker, was found to be significantly different according to the presence of aspirin intolerance (45.2642.4 in aspirin-intolerant chronic urticaria vs. 80.4638.8 in aspirin-tolerant chronic urticaria) and anti-thyroid antibody (50.8630.8 vs. 76.0642.7) after adjusting age, gender and atopy. CONCLUSIONS: CIU patients have an imbalance of pro- and antiinflammatory adipokines compared to NC. The modulation of systemic inflammation can be targeted for some subpopulations of CU patients with severe, aspirin tolerant and thyroid autoimmunity.
430
Predicting Clinical Responsiveness To Dapsone In The Treatment Of Chronic Idiopathic Urticaria (CIU) Dr. Ryan A. Steele, DO, MS1, Dr. Janelle Sher, MD2, Dr. Mark DavisLorton, MD, FAAAAI2, Dr. Marcella R. Aquino, MD, FAAAAI2, Dr. Luz S. Fonacier, MD, FAAAAI3; 1Allergy & Immunology, Winthrop University Hospital, Mineola, NY, 2Winthrop University Hospital, Allergy & Immunology, Mineola, NY, 3Section of Allergy and Clinical Immunology, Department of Medicine, Winthrop University Hospital, Mineola, NY. RATIONALE: In our office, dapsone has been used successfully to treat patients with CIU unresponsive to antihistamines. Serologic and clinical screening tools may help to determine which patients may benefit from its use. METHODS: The charts of 19 patients with CIU treated with dapsone were reviewed. Clinical responsiveness (none, partial, or complete) was assessed at 1, 2, 4, 6, 8, 12, 16, and 20 weeks. Records were examined for serologic markers (anti-thyroid antibodies, ANA, CU index) and the presence of angioedema. Predictiveness and time to maximal responsiveness (TMR) were evaluated. RESULTS: Eighteen females and 1 male (mean age of 46.89 years) were examined, with 2 lost to follow up. Seventeen patients obtained a complete response. 4/17 patients (24%) had a history of angioedema with the average TMR of 4 weeks vs. 6.73 weeks in those without angioedema. 4/15 (27%) patients had elevated CU index values. TMR was 9 weeks in those with elevated CU indexes vs. 5 weeks in those with normal CU indexes. 4/17 (24%) patients had anti-thyroid antibodies, with a TMR of 4 weeks vs. 6.3 weeks in those without. Only one patient had an elevated ANA but was lost to follow-up. CONCLUSIONS: Angioedema, a normal CU index, and elevated antithyroid antibodies were associated with a shorter TMR in our CIU patients treated with dapsone. Further studies examining screening criteria for patients treated with dapsone in CIU are warranted to determine which patients are likely to benefit from this therapy.
J ALLERGY CLIN IMMUNOL FEBRUARY 2014
431
Chronic Urticaria/Angioedema and Auto-Immunity: Diagnostic Profile Among Patients Attending a Reference Clinic In Brazil Dr. Daniel L. Cordeiro, MD1, Dr. Janaina Fernandes de Melo Sousa, MD1, Dr. Karine Boufleur, MD1, Dr. Priscila Botelho Palhas, MD1, Dr. Thaıs Mendonc¸a, MD1, Dr. Janaina Michele de Lima Melo, MD1, Dr. Luisa Karla P. Arruda, MD, PhD, FAAAAI2; 1Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil, 2 School of Medicine of Ribeirao Preto, Ribeirao Preto, Brazil. RATIONALE: Chronic urticaria/angioedema is a challenge to the Allergist/Immunologist. We aimed to evaluate the diagnostic profile among patients with chronic urticaria/angioedema. METHODS: Two hundred patients with ages 13-80 years-old (161 females, 80.5%), with chronic urticaria/angioedema attending a specialty clinic were evaluated prospectively. Autoimmune basis was suspected by presence of positive autologous test, anti-thyroid or antinuclear antibodies(ANA). Patients were evaluated for triggering of symptoms by medications and/or physical agents, anaphylaxis, skin testing, eosinophilia, IgE, and hepatitis serology. When indicated, a skin biopsy was performed. Use of medications for urticaria was analysed. RESULTS: Duration of disease ranged from 6 months to 36 years. Fifty-six patients (28%) had urticaria only;130(65%) urticaria and angioedema; and 14(7%) angioedema. Of the 86 patients who underwent autologous skin testing, 36(41.8%) had positive results. Anti-thyroid antibodies and ANAwere positive in 12.4% and 12.2% of patients, respectively. Sixty-seven(33.5%) patients reported triggering of symptoms by medications, mostly ASA/ NSAIDs(26.5%). Thirty percent of patients reported worsening of symptoms by physical agents. Eight patients had anaphylaxis. Biopsy carried out in 19 patients revealed 4 urticaria vasculitis, 4 eosinophilic infiltrate and 11 nonspecific. Sixty-four percent of patients had total IgE>100kU/L; positive skin test were more frequent to mites(44%), cockroach(30%) and shellfish(16%). Ninety-two percent were in use of at least one daily medication, mostly antihistamines (88%); 13/184(7%) took oral corticosteroids. CONCLUSIONS: Sixty-nine patients (34%) presented features of autoimmune urticaria/angioedema. Other causes were physical, foodinduced, and NSAIDs-induced urticaria. Hereditary and iECA angioedema were diagnosed in 2 and 4 patients, respectively. Despite extensive investigation, 83 patients(41.4%) remained diagnosed as spontaneous urticaria/angioedema.
432
Chronic Spontaneous Urticaria-The Saskatchewan Experience and Questionnaire Survey Ms. Natasha Gattey; University of Saskatchewan, Saskatoon, SK, Canada. RATIONALE: In this questionnaire study, we examined responses to treatment, effect on lifestyle, beliefs of causation, and satisfaction with treatment method for Chronic Spontaneous Urticaria. METHODS: 173 patients with CSU had been seen between 2003 and 2013. An autologous serum skin test (ASST) had been performed on 138 patients. 101 participants responded. RESULTS: Of the respondents, 80 were women and 21 men. The age range was 1 year to 81. The mean age was 36 years. The average duration of symptoms was 9.3 years. They included 40 patients who were ASST positive (M: F; 8:32) and 49 negative M:F; 12:37). 50 participants no longer had hives. Patients reported being most bothered by pruritus, disturbed sleep, anxiety and their physical appearance including facial swelling. Many (71.2%) had missed work or school because of the urticaria. Twentynine patients found antihistamines alone gave adequate relief of urticaria. Twenty ASST positive patients with severe uncontrollable hives were treated with intravenous immunoglobulin (IVIG). 85.0% of these patients had improved quality of life, with 13 of these patients now free of urticaria and no longer receiving IVIG. Three patients who did not benefit from IVIG did respond to methotrexate. No ASST negative patients received IVIG. CONCLUSIONS: Approximately 30% of patients found antihistamines gave effective control. Half the patients had been free of urticaria for at least 3 months. About 40% of patients with CSU had an autoimmune basis as assessed by the ASSTand IVIG was a highly effective treatment for this group.