Leumit Health Services, Tel Aviv, Israel.
Allergy Asthma Proc. 2011 Nov-Dec;32(6):460-6. doi: 10.2500/aap.2011.32.3483.
Chronic idiopathic (spontaneous) urticaria (CIU) is sometimes resistant to the conventional and high doses of antihistamines (AHs). This study compares the clinical and laboratory characteristics of AH responsive and AH-resistant CIU subjects. Clinical and laboratory data were retrospectively collected from 385 CIU patients. Urticaria activity score (UAS), concomitant angioedema, dermatographism, positive autologous serum skin (ASST), and laboratory data were collected. The control group consisted of 44 sex- and age-matched healthy individuals. Two hundred forty-five CIU patients controlled with AH medications were included in the CIU group. Forty-six patients failed to show clinical improvement during 8 weeks of treatment with fourfold AH doses and were included in the resistant CIU (R-CIU) group. The R-CIU group was characterized with a higher incidence (58.7%) of angioedema than the CIU group (28.5%; p < 0.001), more cases concomitant physical urticaria (23.9% in R-CIU versus 12.2% in CIU; p = 0.014), more positive ASST (73.9% in R-CIU versus 45.4% in CIU; p < 0.001), and higher baseline UAS (5.28 ± 0.81 in R-CIU versus 3.32 ± 1.25 in CIU; <0.001). R-CIU was characterized with more severe basopenia (0.04 ± 0.07 cell/mm(3) versus 0.16 ± 0.13 cell/mm(3); p < 0.001), higher mean platelet volume (10.87 ± 2.21 femtoliter (fl) versus 8.65 ± 1.74 fl; p < 0.001), higher levels of C-reactive protein (8.62 ± 3.91 mg/L versus 2.49 ± 1.34 mg/L; <0.001), and higher levels of serum C3 (1.66 ± 0.36 g/L versus 1.19 ± 0.35 g/L; p < 0.001. R-CIU is a clinically more severe disease with laboratory features of low-grade inflammation and platelet activation.
慢性特发性（自发性）荨麻疹（CIU）有时对抗组胺药（AHs）的常规和高剂量治疗有抵抗。本研究比较了 AH 反应性和 AH 抵抗性 CIU 患者的临床和实验室特征。从 385 例 CIU 患者中回顾性收集临床和实验室数据。收集荨麻疹活动评分（UAS）、并发血管性水肿、皮肤划痕症、自体血清皮肤试验（ASST）阳性和实验室数据。对照组由 44 名性别和年龄匹配的健康个体组成。245 例 CIU 患者接受 AH 药物治疗控制，纳入 CIU 组。46 例患者在接受 4 倍 AH 剂量治疗 8 周后未能显示临床改善，纳入难治性 CIU（R-CIU）组。R-CIU 组血管性水肿发生率（58.7%）高于 CIU 组（28.5%；p < 0.001），并发物理性荨麻疹的病例更多（R-CIU 组为 23.9%，CIU 组为 12.2%；p = 0.014），ASST 阳性更多（R-CIU 组为 73.9%，CIU 组为 45.4%；p < 0.001），基线 UAS 更高（R-CIU 组为 5.28 ± 0.81，CIU 组为 3.32 ± 1.25；<0.001）。R-CIU 表现为更严重的 basopenia（0.04 ± 0.07 细胞/mm3 对 0.16 ± 0.13 细胞/mm3；p < 0.001），更高的平均血小板体积（10.87 ± 2.21 飞升（fl）对 8.65 ± 1.74 fl；p < 0.001），更高的 C 反应蛋白水平（8.62 ± 3.91 mg/L 对 2.49 ± 1.34 mg/L；<0.001），以及更高的血清 C3 水平（1.66 ± 0.36 g/L 对 1.19 ± 0.35 g/L；p < 0.001）。R-CIU 是一种更严重的临床疾病，具有低度炎症和血小板激活的实验室特征。
