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Clinical Characteristics Of Elderly Chronic Urticaria
AB120 Abstracts
421
SUNDAY
Relation Between Environmental Allergen Exposure and Chronic Urticaria Dr. Denisa Ferastraoaru, MD, MSc1, Dr. Sunit Jariwala, MD2, Dr. Golda Hudes, MD, PhD3, Dr. David L. Rosenstreich, MD, FAAAAI4; 1Allergy Immunology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, 2Albert Einstein/Montefiore Medical Center, New York, NY, 3Albert Einstein/ Montefiore Medical Center, New York, NY, 4 Albert Einstein/Montefiore Medical Center, Bronx, NY. RATIONALE: The definitive cause or trigger is not usually identified in most patients with chronic urticaria (CU). We sought to investigate a potential role of environmental allergens in these patients. METHODS: Following IRB approval, 36 patients with CU were enrolled. All patients had skin tests (ST) to 14 environmental allergens: tree, grass, weed, ragweed and English plantain pollens, dust mites, feathers, cat and dog epithelium, cockroach, mouse, and three mold spore mixtures. The ST was considered positive if the wheal diameter was 3 millimeters or larger than the negative control. The urticaria severity was assessed using the Urticaria Severity Score (USS). RESULTS: In the study group, the mean USS was 44. Fifteen patients (Group 1) had more severe urticaria (USS >44). The rate of positive ST to some perennial allergens was higher in Group 1 compared with milder urticaria patients (Group 2) (mouse – 20% vs 10%, mold spores – 13% vs 5%, A. fumigatus- 7% vs 5%). Group 1 had significantly higher exposure to both cats and dogs (33% vs 9.5%, p50.03), but Group 2 had higher rate of positive ST to tree pollen (76% vs 47%, p50.03) and dust mites (43% vs 7%, p50.01). CONCLUSIONS: The patients with more severe CU were more allergic to perennial allergens such as mouse and mold spores, and had greater pet exposure. Our data suggest that environmental allergens may represent potential additional triggers for urticaria and may contribute to the severity of symptoms. Strict environmental control and decreased pet exposure might be beneficial for patients with severe CU.
422
Relationship Of Clinical Characteristics Of Chronic Urticaria In Children To Treatment Outcome Lisa Neverman, BS, Prof. Miles M. Weinberger, MD, FAAAAI; University of Iowa, Iowa City, IA. RATIONALE: Functionally active auto-antibodies have been identified in patients with chronic urticaria against the high-affinity IgE receptor and IgE. This was the rationale for controlled clinical trials demonstrating efficacy of cyclosporine in adults with chronic urticaria not responsive to antihistamines. METHODS: To evaluate chronic urticaria in children, sequential patients from our Pediatric Allergy Clinic with chronic idiopathic urticaria were identified from our electronic medical record from 2009 through 2012. The urticaria index was examined in those unresponsive to even high doses of either cetirizine or hydroxyzine. Low dose cyclosporine was begun for those found to be antihistamine resistant. Safety measures included cyclosporine blood levels, serum creatinine, and regular examinations of blood pressure. RESULTS: 46 patients were identified, median age 11.5 years, gender ratio 26:10 with female preponderance; mean duration of hives prior to referral was 14.8 months. 16 of the 47(34%), 12 females and 4 males, median age 12.5 years, were antihistamine-resistant and started on cyclosporine. Antihistamine resistant children were significantly older (p 5 0.0001). Of the 16, presence of autoantibodies was examined in 12, of whom 5 were positive and 7 were negative. All who started on cyclosporine had complete suppression of their hives after 2 days to 3 months. Serum cyclosporine levels measured at time of resolution ranged from 66 to 200 ng/ml. No effects on renal function or blood pressure were seen. CONCLUSIONS: Antihistamine resistant chronic urticaria significantly correlated with older age children but not with the presence of autoantibodies. Cyclosporine was highly effective and safe in inducing remissions of even long-standing chronic urticaria in children.
J ALLERGY CLIN IMMUNOL FEBRUARY 2014
423
Clinical Characteristics Of Elderly Chronic Urticaria Dr. Ga Young Ban, MD1, Ji Hye Kim, MD2, Mi-Yea Kim, MD1, Dr. Hye-Soo Yoo, MD1, Dong-Ho Nahm, MD, PhD1, Dr. Young Min Min Ye, MD1, Yoo Seob Shin, MD, PhD1, Prof. HaeSim Park, MD, PhD1; 1Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea, 2Department of Internal medicine, Konyang University College of Medicine, Daejeon, South Korea. RATIONALE: Chronic urticaria (CU) is defined as itchy wheals lasting for at least 6 weeks. It is a common disabling disorder occurring in about 0.5–1% of the population. Recently, the aged population is increasing worldwide. Therefore, it is essential to identify the specific features of disease in aged group. We investigated the prevalence and clinical features of elderly CU in comparison with nonelderly CU. METHODS: We retrospectively analyzed the medical records of 827 CU patients who were followed in the outpatient Allergy Clinic of Ajou University Hospital, South Korea. According to the EAACI/GA2LEN/ EDF/WAO guideline chronic spontaneous urticarial patients were included. Elderly was defined as older than 60 years. Severe CU was _13 at initial visit. defined when urticaria activity score was > RESULTS: Of the total 827 patients, 37 (4.5%) were elderly. Among comorbid conditions, the prevalence of atopic dermatitis (AD) was significantly higher (37.8% vs. 21.7%, p50.022), while that of aspirin sensitivity was lower (18.9% vs. 43.6%, p50.003) in elderly CU. Other clinical and laboratory findings were found to have no significant differences between the two groups. However the prevalences of serum specific IgE to staphylococcal enterotoxin A (SEA) and staphylococcal enterotoxin B (SEB) were considerably higher in elderly CU with AD than in those without AD (37.5% vs. 0%, respectively). CONCLUSIONS: Considering the higher prevalence of AD in elderly CU, it is needed to observe the coexistence of AD in elderly CU. Specific IgE to SEA/SEB may play a role in the pathogenesis of elderly CU, especially who are accompanied by AD.
424
Decreased Serum Vitamin D Level In Patients With Chronic Spontaneous Urticaria Dr. Tadech Boonpiyathad, MD, Dr. Panitan Pradappongsa, Dr. Atik Sangasapaviriya; Phramonkutklao Hospital, Bangkok, Thailand. RATIONALE: Vitamin D is important role in immune system and decreased serum vitamin D level linked to autoimmune diseases. Autoimmune is major caused in chronic urticaria. This study aimed to find vitamin D status in patients with chronic spontaneous urticaria (CSU). METHODS: A prospective case control study of 60 subjects with CSU compared with 20 healthy subjects. Serum 25(OH)D was measured in all subjects. Urticaria symptom severity and quality of life were assessed as Urticaria Activity Score 7(UAS7) and Dermatology Life Quality Index (DLQI). Serum number of eosinophil and erythrocyte sediment rate (ESR) test were performed in the patients with CSU. RESULTS: This study was predominately women, 53/80 subjects. The mean age was significantly different between CSU group and controls, 37.17610.15 VS 62.9617.07 years (p < 0.001). The mean duration of urticaria was 29.88613.45 weeks. The mean serum 25(OH) D levels were significantly decreased in subjects with CSU (20.57610.80) compared with controls (31.9766.56), p < 0.001. Vitamin D status in CSU group, 10 subjects, 16.67% were normal, 17 subjects, 28.33% were insufficiency and 33 subjects, 55% were deficiency. Vitamin D levels did not correlate with duration, age, number of eosinophil, UAS7 and DLQI but positive correlated with ESR, r 5 0.43 (p 5 0.001). CONCLUSIONS: This study showed vitamin D deficiency was common in patients with CSU. However, serum 25(OH)D levels cannot use to be biomarker for monitor symptom and severity in CSU.
421
SUNDAY
Relation Between Environmental Allergen Exposure and Chronic Urticaria Dr. Denisa Ferastraoaru, MD, MSc1, Dr. Sunit Jariwala, MD2, Dr. Golda Hudes, MD, PhD3, Dr. David L. Rosenstreich, MD, FAAAAI4; 1Allergy Immunology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, 2Albert Einstein/Montefiore Medical Center, New York, NY, 3Albert Einstein/ Montefiore Medical Center, New York, NY, 4 Albert Einstein/Montefiore Medical Center, Bronx, NY. RATIONALE: The definitive cause or trigger is not usually identified in most patients with chronic urticaria (CU). We sought to investigate a potential role of environmental allergens in these patients. METHODS: Following IRB approval, 36 patients with CU were enrolled. All patients had skin tests (ST) to 14 environmental allergens: tree, grass, weed, ragweed and English plantain pollens, dust mites, feathers, cat and dog epithelium, cockroach, mouse, and three mold spore mixtures. The ST was considered positive if the wheal diameter was 3 millimeters or larger than the negative control. The urticaria severity was assessed using the Urticaria Severity Score (USS). RESULTS: In the study group, the mean USS was 44. Fifteen patients (Group 1) had more severe urticaria (USS >44). The rate of positive ST to some perennial allergens was higher in Group 1 compared with milder urticaria patients (Group 2) (mouse – 20% vs 10%, mold spores – 13% vs 5%, A. fumigatus- 7% vs 5%). Group 1 had significantly higher exposure to both cats and dogs (33% vs 9.5%, p50.03), but Group 2 had higher rate of positive ST to tree pollen (76% vs 47%, p50.03) and dust mites (43% vs 7%, p50.01). CONCLUSIONS: The patients with more severe CU were more allergic to perennial allergens such as mouse and mold spores, and had greater pet exposure. Our data suggest that environmental allergens may represent potential additional triggers for urticaria and may contribute to the severity of symptoms. Strict environmental control and decreased pet exposure might be beneficial for patients with severe CU.
422
Relationship Of Clinical Characteristics Of Chronic Urticaria In Children To Treatment Outcome Lisa Neverman, BS, Prof. Miles M. Weinberger, MD, FAAAAI; University of Iowa, Iowa City, IA. RATIONALE: Functionally active auto-antibodies have been identified in patients with chronic urticaria against the high-affinity IgE receptor and IgE. This was the rationale for controlled clinical trials demonstrating efficacy of cyclosporine in adults with chronic urticaria not responsive to antihistamines. METHODS: To evaluate chronic urticaria in children, sequential patients from our Pediatric Allergy Clinic with chronic idiopathic urticaria were identified from our electronic medical record from 2009 through 2012. The urticaria index was examined in those unresponsive to even high doses of either cetirizine or hydroxyzine. Low dose cyclosporine was begun for those found to be antihistamine resistant. Safety measures included cyclosporine blood levels, serum creatinine, and regular examinations of blood pressure. RESULTS: 46 patients were identified, median age 11.5 years, gender ratio 26:10 with female preponderance; mean duration of hives prior to referral was 14.8 months. 16 of the 47(34%), 12 females and 4 males, median age 12.5 years, were antihistamine-resistant and started on cyclosporine. Antihistamine resistant children were significantly older (p 5 0.0001). Of the 16, presence of autoantibodies was examined in 12, of whom 5 were positive and 7 were negative. All who started on cyclosporine had complete suppression of their hives after 2 days to 3 months. Serum cyclosporine levels measured at time of resolution ranged from 66 to 200 ng/ml. No effects on renal function or blood pressure were seen. CONCLUSIONS: Antihistamine resistant chronic urticaria significantly correlated with older age children but not with the presence of autoantibodies. Cyclosporine was highly effective and safe in inducing remissions of even long-standing chronic urticaria in children.
J ALLERGY CLIN IMMUNOL FEBRUARY 2014
423
Clinical Characteristics Of Elderly Chronic Urticaria Dr. Ga Young Ban, MD1, Ji Hye Kim, MD2, Mi-Yea Kim, MD1, Dr. Hye-Soo Yoo, MD1, Dong-Ho Nahm, MD, PhD1, Dr. Young Min Min Ye, MD1, Yoo Seob Shin, MD, PhD1, Prof. HaeSim Park, MD, PhD1; 1Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea, 2Department of Internal medicine, Konyang University College of Medicine, Daejeon, South Korea. RATIONALE: Chronic urticaria (CU) is defined as itchy wheals lasting for at least 6 weeks. It is a common disabling disorder occurring in about 0.5–1% of the population. Recently, the aged population is increasing worldwide. Therefore, it is essential to identify the specific features of disease in aged group. We investigated the prevalence and clinical features of elderly CU in comparison with nonelderly CU. METHODS: We retrospectively analyzed the medical records of 827 CU patients who were followed in the outpatient Allergy Clinic of Ajou University Hospital, South Korea. According to the EAACI/GA2LEN/ EDF/WAO guideline chronic spontaneous urticarial patients were included. Elderly was defined as older than 60 years. Severe CU was _13 at initial visit. defined when urticaria activity score was > RESULTS: Of the total 827 patients, 37 (4.5%) were elderly. Among comorbid conditions, the prevalence of atopic dermatitis (AD) was significantly higher (37.8% vs. 21.7%, p50.022), while that of aspirin sensitivity was lower (18.9% vs. 43.6%, p50.003) in elderly CU. Other clinical and laboratory findings were found to have no significant differences between the two groups. However the prevalences of serum specific IgE to staphylococcal enterotoxin A (SEA) and staphylococcal enterotoxin B (SEB) were considerably higher in elderly CU with AD than in those without AD (37.5% vs. 0%, respectively). CONCLUSIONS: Considering the higher prevalence of AD in elderly CU, it is needed to observe the coexistence of AD in elderly CU. Specific IgE to SEA/SEB may play a role in the pathogenesis of elderly CU, especially who are accompanied by AD.
424
Decreased Serum Vitamin D Level In Patients With Chronic Spontaneous Urticaria Dr. Tadech Boonpiyathad, MD, Dr. Panitan Pradappongsa, Dr. Atik Sangasapaviriya; Phramonkutklao Hospital, Bangkok, Thailand. RATIONALE: Vitamin D is important role in immune system and decreased serum vitamin D level linked to autoimmune diseases. Autoimmune is major caused in chronic urticaria. This study aimed to find vitamin D status in patients with chronic spontaneous urticaria (CSU). METHODS: A prospective case control study of 60 subjects with CSU compared with 20 healthy subjects. Serum 25(OH)D was measured in all subjects. Urticaria symptom severity and quality of life were assessed as Urticaria Activity Score 7(UAS7) and Dermatology Life Quality Index (DLQI). Serum number of eosinophil and erythrocyte sediment rate (ESR) test were performed in the patients with CSU. RESULTS: This study was predominately women, 53/80 subjects. The mean age was significantly different between CSU group and controls, 37.17610.15 VS 62.9617.07 years (p < 0.001). The mean duration of urticaria was 29.88613.45 weeks. The mean serum 25(OH) D levels were significantly decreased in subjects with CSU (20.57610.80) compared with controls (31.9766.56), p < 0.001. Vitamin D status in CSU group, 10 subjects, 16.67% were normal, 17 subjects, 28.33% were insufficiency and 33 subjects, 55% were deficiency. Vitamin D levels did not correlate with duration, age, number of eosinophil, UAS7 and DLQI but positive correlated with ESR, r 5 0.43 (p 5 0.001). CONCLUSIONS: This study showed vitamin D deficiency was common in patients with CSU. However, serum 25(OH)D levels cannot use to be biomarker for monitor symptom and severity in CSU.