O'Donnell B F, Barr R M, Black A K, Francis D M, Kermani F, Niimi N, Barlow R J, Winkelmann R K, Greaves M W
St John's Institute of Dermatology, United Medical and Dental School, St Thomas' Hospital, London.
Br J Dermatol. 1998 Jan;138(1):101-6. doi: 10.1046/j.1365-2133.1998.02033.x.
Histamine releasing autoantibodies play a central role in the pathogenesis of chronic urticaria (CU) in approximately 30% of affected patients. We investigated the therapeutic effect of high-dose intravenous immunoglobulin (IVIG) on disease activity in patients with severe CU of autoimmune aetiology. Autoimmune urticaria was diagnosed by the development of a weal-and-flare reaction to the intradermal injection of autologous serum and by serum-induced histamine release from the basophil leucocytes of healthy donors in vitro. Ten patients with severe, autoimmune CU, poorly responsive to conventional treatment, were treated with IVIG 0.4 g/kg per day for 5 days. The outcome on cutaneous wealing and itch was monitored using urticaria activity scores, visual analogue scales and autologous intradermal serum tests. Clinical benefit was noted in nine of 10 patients: three patients continue in prolonged complete remissions (3 years follow-up), two had temporary complete remissions, and symptoms in four patients improved subsequent to treatment. There was significant improvement in the urticaria activity scores and visual analogue scores at 2 (P < 0.01) and 6 weeks (P < 0.01) post-IVIG compared with the baseline values (Wilcoxon matched pairs). The diminution in urticarial activity in the majority of patients corresponded with a reduced weal-and-flare response to the intradermal injection of autologous post-treatment serum compared with the pretreatment serum. Minor side-effects were common, but there were no serious or long-term adverse effects. IVIG represents a novel therapeutic option in selected patients with recalcitrant CU associated with histamine releasing autoantibodies.
在大约30%的慢性荨麻疹（CU）患者中，组胺释放自身抗体在其发病机制中起核心作用。我们研究了大剂量静脉注射免疫球蛋白（IVIG）对自身免疫病因所致重度CU患者疾病活动度的治疗效果。通过对皮内注射自体血清出现风团和潮红反应以及体外血清诱导健康供体嗜碱性白细胞释放组胺来诊断自身免疫性荨麻疹。10例对传统治疗反应不佳的重度自身免疫性CU患者接受了每天0.4 g/kg的IVIG治疗，共5天。使用荨麻疹活动评分、视觉模拟量表和自体皮内血清试验来监测皮肤风团和瘙痒情况。10例患者中有9例有临床获益：3例患者持续长期完全缓解（随访3年），2例有暂时完全缓解，4例患者治疗后症状改善。与基线值相比，IVIG治疗后2周（P < 0.01）和6周（P < 0.01）时荨麻疹活动评分和视觉模拟评分有显著改善（Wilcoxon配对检验）。与治疗前血清相比，大多数患者荨麻疹活动度的降低与皮内注射治疗后自体血清的风团和潮红反应减弱相对应。轻微副作用常见，但无严重或长期不良反应。IVIG是治疗与组胺释放自身抗体相关的顽固性CU患者的一种新的治疗选择。
