Localized heat urticaria in a patient is associated with a wealing response to heated autologous serum

Abstract

We report a case of localized heat urticaria in a 71-year-old woman who developed weals and loss of consciousness after taking a bath. Exposing her skin to heat at 40 degrees C or immersing her hands in water at 40 degrees C produced urticarial lesions and increased her plasma histamine level. Desensitization with hot water improved her symptoms and normalized her plasma histamine level after heat challenge. An intracutaneous injection of her serum produced no reaction, while an injection of her serum that had been heated at 40 degrees C for 15 min induced a weal flare response. Further examination revealed that the weal-inducing activity of her heated serum remained for at least for 6 h and that treatment of her serum at 60 degrees C for 2 h did not abrogate its weal-inducing activity. These findings indicate that certain materials in her serum that are activated by heat are responsible for the development of her anaphylactic and urticarial reactions and that these reactions may be mediated by histamine.

Preheated autologous serum skin test in localized heat urticaria

“…demonstrated that heat‐decomplemented or IgG‐depleted serum of patients with CU was unable to induce basophil degranulation in vitro , but retained the ability to induce weal and flare reactions in vivo . A weal and flare skin reaction to ASST was observed in a patient with LHU when her serum was heated to 40 and 60 °C for 15 and 30 min, respectively, then injected at RT . Similarly in our patient, ASST gave a positive response, but only when serum previously heated to 56 °C for 30 min (conditions for IgE denaturation and permanent complement inactivation) was used.…”

“…Autologous venous blood (5 mL) was kept at room temperature (RT) for 30 min, then serum and plasma were extracted by standard centrifugation and divided into aliquots. Some of the aliquots were kept at RT, while some were partially heated to 40 or 45 °C for 15 min (as described in previous papers about LHU) or to 56 °C for 30 min (to obtain complement inactivation), before being cooled back down to RT. We then injected 0.05 mL of sterile 0.9% saline solution (as negative control), histamine phosphate 10 μg/mL (as positive control), serum (preheated or not) and plasma (preheated or not) intradermally into the patient's volar forearm.…”

Physikalische Urtikaria

“…In einer Untersuchung wurde bei einem Patienten mit lokalisierter Wärme-urtikaria eine positive Reaktion beim Intrakutantest mit erhitztem autologen Serum, aber nicht nach Injektion des unbehandelten Serums festgestellt.Weitere Untersuchungen ließen vermuten, dass der Auslöser ein wärmeverändertes,aber hitzestabiles Protein ist [5].…”

Influence of narrowband UVB irradiation of serum on autologous serum skin test results

“…It was experienced that performing several procedures on patient’s serum may enhance the ASST results. While ASST was negative in a patient with heat urticaria, the second ASST performed with heated serum resulted in a positive reaction 2 . In addition, the ASST result of a patient with solar urticaria turned to positive when performed after exposing serum to visible light, as well 3 .…”

“…It does not prove the presence of antibodies, it rather shows histamine‐releasing properties of the tested serum 1 . It was observed that while the ASST result was negative in a patient with localized heat urticaria, the result turned to positive when ASST was performed with heated serum, indicating that the patient’s serum may have contained some urticaria‐inducing factors that can be modified by heat 2 . Additionally, visible light‐irradiated serum induced a positive reaction in an ASST‐negative (ASST−) solar urticaria patient, which was inhibited with exposition of inhibition spectrum light 3 .…”