Allergy and Clinical Immunology Department, NIMTS, Army Hospital and Allergy Research Center National & Kapodistrian University of Athens, Greece.
Allergy. 2009 Sep;64(9):1256-68. doi: 10.1111/j.1398-9995.2009.02132.x. Epub 2009 Jul 24.
Injection of autologous serum collected during disease activity from some patients with chronic spontaneous urticaria (CU) into clinically normal skin elicits an immediate weal and flare response. This observation provides a convincing demonstration of a circulating factor or factors that may be relevant to the understanding of the pathogenesis and management of the disease. This test has become known as the autologous serum skin test (ASST) and is now widely practised despite incomplete agreement about its value and meaning, the methodology and the definition of a positive response. It should be regarded as a test for autoreactivity rather than a specific test for autoimmune urticaria. It has only moderate specificity as a marker for functional autoantibodies against IgE or the high affinity IgE receptor (FcepsilonRI), detected by the basophil histamine release assay, but high negative predictive value for CU patients without them. It is usually negative in other patterns of CU, including those that are physically induced. Positive ASSTs have been reported in some subjects without CU, including those with multiple drug intolerance, patients with respiratory allergy and healthy controls, although the clinical implications of this are uncertain. It is essential that failsafe precautions are taken to ensure that the patient's own serum is used for skin testing and aseptic procedures are followed for sample preparation and handling. CU patients with a positive ASST (ASST(+)) are more likely to be associated with HLADR4, to have autoimmune thyroid disease, a more prolonged disease course and may be less responsive to H1-antihistamine treatment than those with a negative ASST (ASST(-)) although more evidence is needed to confirm these observations conclusively.
在一些慢性自发性荨麻疹 (CU) 患者的疾病活动期采集的自体血清注射到临床正常的皮肤中会引起即刻的风团和红斑反应。这一观察结果提供了一个令人信服的证据，证明存在一种循环因子或多种因子，这些因子可能与疾病的发病机制和治疗有关。该试验被称为自体血清皮肤试验 (ASST)，尽管其价值和意义、方法学以及阳性反应的定义尚未达成完全共识，但目前已得到广泛应用。它应该被视为一种自身反应性测试，而不是针对自身免疫性荨麻疹的特异性测试。它作为针对 IgE 或高亲和力 IgE 受体 (FcepsilonRI) 的功能性自身抗体的标志物，特异性只有中等程度，通过嗜碱性粒细胞组胺释放试验检测，但对于没有这些抗体的 CU 患者具有很高的阴性预测值。它在其他 CU 模式中通常为阴性，包括那些由物理因素诱导的 CU。在一些没有 CU 的患者中，包括那些有多药不耐受、呼吸道过敏和健康对照者，也有报道称存在阳性 ASST，但这一现象的临床意义尚不确定。为确保用于皮肤测试的是患者自身的血清，并遵循无菌程序进行样本制备和处理，必须采取万无一失的预防措施。与 ASST 阴性 (ASST(-)) 的 CU 患者相比，ASST 阳性 (ASST(+)) 的 CU 患者更有可能与 HLADR4 相关，更有可能患有自身免疫性甲状腺疾病，疾病持续时间更长，并且可能对 H1 抗组胺治疗的反应性较低，尽管还需要更多的证据来明确证实这些观察结果。
