Staubach P, Onnen K, Vonend A, Metz M, Siebenhaar F, Tschentscher I, Opper B, Magerl M, Lüdtke R, Kromminga A, Maurer M
Department of Dermatology, University of Mainz, Mainz, Germany.
Dermatology. 2006;212(2):150-9. doi: 10.1159/000090656.
Patients with chronic urticaria (CU) frequently exhibit positive skin test reactions to autologous serum (ASST). Therapies aimed at inducing tolerance to circulating histamine-releasing factors in ASST+ CU patients, e.g. by treatment with autologous whole blood (AWB), have not yet been tested.
To test whether ASST+ CU patients can benefit from repeated low-dose intramuscular injections of AWB.
We characterized CU severity and duration, anti-Fc(epsilon)RI and anti-IgE expression, use of antihistamines, and quality of life in 56 CU patients (ASST+: 35, ASST-: 21) and assessed the therapeutic effects of 8 weekly AWB injections in a randomized, placebo-controlled, single-blind, parallel-group trial.
Numbers, size, intensity, and/or duration of CU symptoms, quality of life, as well as expression of anti-Fc(epsilon)RI or anti-IgE were similar in ASST+ and ASST- CU patients. However, CU in ASST+ patients was of longer duration and required markedly more antihistaminic medication. Interestingly, ASST+ patients, but not ASST- patients, showed significantly (1) reduced CU activity, (2) decreased use of antihistamines, and (3) improved quality of life after AWB treatment. Placebo treatment was ineffective in both groups, but differences of AWB and placebo treatment responses did not achieve statistical significance in either group, most likely due to the limited number of patients treated.
Our findings suggest that ASST+ CU is clinically different from other CU subforms and that ASST+ CU patients can benefit from AWB therapy.
慢性荨麻疹（CU）患者对自体血清（ASST）皮肤试验常呈阳性反应。旨在诱导ASST阳性的CU患者对循环中组胺释放因子产生耐受的疗法，如自体全血（AWB）治疗，尚未得到验证。
测试ASST阳性的CU患者能否从重复低剂量肌肉注射AWB中获益。
我们对56例CU患者（ASST阳性：35例，ASST阴性：21例）的CU严重程度和病程、抗Fc(ε)RI和抗IgE表达、抗组胺药使用情况及生活质量进行了评估，并在一项随机、安慰剂对照、单盲、平行组试验中评估了每周1次共8次AWB注射的治疗效果。
ASST阳性和ASST阴性的CU患者在CU症状的数量、大小、强度和/或持续时间、生活质量以及抗Fc(ε)RI或抗IgE表达方面相似。然而，ASST阳性患者的CU病程更长，需要显著更多的抗组胺药物。有趣的是，AWB治疗后，ASST阳性患者而非ASST阴性患者显示出（1）CU活动度降低，（2）抗组胺药使用减少，以及（3）生活质量改善。两组中安慰剂治疗均无效，但AWB与安慰剂治疗反应的差异在两组中均未达到统计学意义，很可能是由于治疗的患者数量有限。
我们的研究结果表明，ASST阳性的CU在临床上与其他CU亚型不同，且ASST阳性的CU患者可从AWB治疗中获益。
