Characteristics of histamine-releasing activity in the sera of patients with chronic idiopathic urticaria

Zweiman, Burton; Valenzano, Mary Carmen; Atkins, Paul C.; Tanus, Tonny; Getsy, John

doi:10.1016/s0091-6749(96)70230-0

Cited by 84 publications

(52 citation statements)

References 18 publications

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“…The nature of factors responsible for positive ASST is still unclear. Studies of chronic idiopathic urticaria concluded that histamine release is caused by circulating IgG autoantibodies specific either for the high-affinity IgE receptor, FcεRI, or for IgE [9, 11, 12, 13, 14, 15], but the clinical significance of such autoantibodies has recently been questioned after it was found that IgG-depleted sera from urticaria patients are still able to induce wheal-and-flare reactions on ASST [25]. Such findings, along with the marked discrepancy between positive ASST and positive HRA that has been observed both in this study and in previous studies of chronic urticaria [10], suggest the possible involvement of mast cell-specific histamine-releasing factors of a different nature [26].…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies demonstrated that a high proportion (up to 60%) of patients with chronic idiopathic urticaria show a wheal-and-flare reaction upon intradermal injection of autologous serum [9, 10]. Such histamine-releasing activity has been ascribed to the presence of circulating IgG autoantibodies specific either for the high-affinity IgE receptor, FcεRI, or for IgE that would be responsible for histamine release from both basophils and mast cells [9, 11, 12, 13, 14, 15]. Moreover, we recently found that patients with a history of acute urticaria induced by multiple, chemically unrelated NSAIDs but without a history of chronic urticaria show a high prevalence of wheal-and-flare reaction upon intradermal injection of autologous serum [16].…”

Section: Introductionmentioning

confidence: 99%

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Sera from Patients with Multiple Drug Allergy Syndrome Contain Circulating Histamine-Releasing Factors

Asero

Tedeschi

Lorini

et al. 2003

Int Arch Allergy Immunol

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Background: A subset of drug-intolerant patients show a marked propensity to react to several chemically unrelated antibacterial drugs. This condition is termed multiple drug allergy syndrome (MDAS). The pathogenesis of MDAS is still unclear. A possible mechanism is that a nonspecific patient-related factor leading to direct histamine release from mast cells and basophils is involved. We investigated whether a patient-related facilitating factor such as the clinically unapparent presence of circulating histamine-releasing factors may represent a nonspecific mechanism underlying drug-induced histamine release in patients with MDAS. Methods: 38 otherwise healthy adults with a history of acute urticaria following the ingestion of antibacterial drugs [18 subjects with MDAS (patients) and 20 monosensitive subjects (drug-allergic controls) on the basis of both clinical history and single-blind peroral challenges with alternative substances] and 20 subjects without a history of drug allergy (normal controls) underwent an autologous serum skin test (ASST). IgE specific for β-lactams was measured in sera from 25 subjects (11 patients and 14 drug-allergic controls) with a history of amoxicillin intolerance. Sera from 13 patients and 5 drug-allergic controls (all positive on ASST) were used in the in vitro histamine release assay using basophils from 3 normal donors. Results: 17 of 18 patients (94%) versus 8 of 20 drug-allergic controls (40%) showed an unequivocal wheal-and-flare reaction on ASST (p < 0.05). Skin reactions were generally more intense in the patient group. In one MDAS patient, the ASST was not assessable due to dermographism. No normal control was positive on ASST. Sera from 3 of 13 patients (23%) versus 0 of 6 drug-allergic controls (not significant) induced significant histamine release from basophils of normal donors. IgE specific for β-lactams was detected in sera from 1 of 11 patients (9%) versus 5 of 14 drug-allergic controls (36%) (not significant). Conclusion: Most patients with MDAS and more than one third of subjects with a history of hypersensitivity to a single antibacterial drug were characterized by the presence of circulating histamine-releasing factors. Such factors might play a role in drug-induced adverse reactions observed in these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sera from Patients with Multiple Drug Allergy Syndrome Contain Circulating Histamine-Releasing Factors

Asero

Tedeschi

Lorini

et al. 2003

Int Arch Allergy Immunol

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“…We subsequently characterized this factor which turned out to be an IgG autoantibody directed against the α-chain of the high-affinity IgE receptor, FcεR1, or, less commonly, against IgE itself [39]. Subsequent studies by ourselves [45]and others [46, 47, 48]confirmed these observations and established that these autoantibodies were functional and causative in CIU. They cause whealing and itching upon autologous injection in patients’ skin and release histamine from human donor basophils and mast cells, and their serum levels reflect disease activity [49, 50].…”

Section: Chronic Idiopathic Urticariamentioning

confidence: 99%

Pathophysiology of Chronic Urticaria

Greaves¹

2002

Int Arch Allergy Immunol

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Chronic urticaria includes several different subsets with distinct pathophysiologies, and with important implications for investigation and treatment. Chronic ‘idiopathic’ urticaria represents a special challenge, which, until recently, was not taken up by dermatological or immunological investigators. However, it has now emerged that at least 30% of patients possess histamine-releasing autoantibodies against FcΕR1, or less commonly IgE itself. These autoantibodies are causative. Recent work implicates complement activation in most cases. Functional (i.e. histamine releasing) autoantibodies are specific to chronic urticaria. However, immunoreactive (non-histamine-releasing) anti-FcΕR1 autoantibodies can be found in sera of patients with physical urticarias and with autoimmune connective tissue and bullous diseases. The reason for the occurrence of this disease type in some individuals but not others is unclear. One possibility is the development, in genetically predisposed persons, of autoantibodies by molecular mimicry – perhaps against lipopolysaccharide of Helicobacter pylori, an organism frequently infecting the upper gastrointestinal tract of chronic urticaria patients.

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“…However, not all studies have shown a significant difference in UAS between the ASST-positive and the ASST-negative 21,26 groups , signifying variable UAS presentation among these patients .…”

Section: Procedures and Interpretationmentioning

confidence: 88%

Autologous Serum Skin Test in Chronic Idiopathic Urticaria

Pokhrel

Subedi

Acharya

2016

J. Nepalgunj Med. College

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Background: Urticaria is a short-lived swelling of skin and mucosa due to plasma leakage by immune and non immune mediated activation and released of mediators from mast cell and basophil. Autoimmune urticaria tends to have a high itch and wheal score than other type of urticaria. Its diagnosis is practically relied upon clinical suspicion and autologous serum skin test. Autologous serum skin test (ASST) is the simple and cost effective test to differentiate autoimmune urticaria from the bulk of chronic urticaria patients. Objective: To compare the features of chronic urticaria in patients having positive versus negative autologous serum skin test (ASST).Materials and methods: Cross-sectional hospital based study was conducted among 90 chronic urticaria patients (CIU) attending the outpatient dermatology department of Nepalgunj Medical College, Nepalgunj, during one year period. The study was conducted after ethical approval from the institutional committee. The patients were diagnosed on the basis of the appearance of continuous or recurrent hives with or without angioedema for more than 6 weeks. Patients who suffered from either acute urticaria or urticarial vasculitis or physical urticaria or other systemic diseases known to cause urticaria were excluded. Standard tools and techniques were used to prepare antilogous serum and injection of the serum and interpretation of the result. The test result was Interpreted as positive and negative autologous serum skin test.Results: ASST was positive in 42% of the patients and negative in 58% of the patients. The ASST-positive patients had a higher mean urticaria activity score and median duration of wheals in comparison with the ASST-negative patients. Wheals lasted for significantly longer duration in patients with positive ASST. Patients with positive ASST had more frequent attacks which was statistically significant compared to the ASST-negative group. The mean urticaria activity score was significantly higher in the ASST-positive patients than that in the ASST-negative patients.Conclusions: Autologous serum skin test may be a useful screening test for autoimmune urticaria and may be used as a simple and cost-effective test for the classification of chronic urticaria.JNGMC Vol. 12 No. 2 December 2014, page: 6-10

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Characteristics of histamine-releasing activity in the sera of patients with chronic idiopathic urticaria

Cited by 84 publications

References 18 publications

Sera from Patients with Multiple Drug Allergy Syndrome Contain Circulating Histamine-Releasing Factors

Sera from Patients with Multiple Drug Allergy Syndrome Contain Circulating Histamine-Releasing Factors

Pathophysiology of Chronic Urticaria

Autologous Serum Skin Test in Chronic Idiopathic Urticaria

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