Kronik Ürtikerli Hastalarda Etyolojik Faktörlerin Değerlendirilmesi

Abstract

Çalışmamızda kronik ürtiker (KÜ)’e neden olabilecek faktörlerin tespitinde anamnez, klinik bulgular, rutin tanısal testler ile otolog serum ve plazma deri testlerinin (OSDT ve OPDT) yeterliliği ve gerekliliğininin değerlendirilmesi amaçlandı. Çalışmaya altı haftadan uzun süre ürtiker ve/veya anjioödem semptomları tarifleyen 52 erişkin hasta dahil edildi. Tüm hastalar allerjik, otoimmün, enfeksiyöz ve dahili hastalıklar açısından tetkik edildi. Ürtiker- ürtikeryal vaskülit (ÜV) ayrımında kesin tanı histolopatolojik değerlendirme ile konuldu. Otolog serum ve plazma deri testi 51 hasta ve 28 sağlıklı  gönüllüye uygulandı. Hastaların %32,7’sinde fiziksel ürtiker (FÜ) tespit edildi. Emosyonel stres, en sık (%75) tetikleyici olarak belirlendi. Kronik spontan ürtiker (KSÜ)’li hastalarda OSDT ve OPDT sırasıyla %55,5 ve %16 oranında pozitif bulundu ve aradaki fark istatistiksel olarak anlamlı idi (p=0,021). Tiroid otoantikorları ile OSDT pozitifliği arasında istatistiksel olarak anlamlı ilişki tespit edildi (p=0,031). Fiziksel ürtiker, kronik ürtikeryal semptomlarla başvuran hastalarda öncelikle dışlanması gereken ürtiker alt tipidir. Hastalığın yönetiminde emosyonel stres kontrolü göz önünde bulundurularak hastalara gereken psikososyal destek sağlanmalıdır. Otolog serum deri testi pozitif olan hastaların tiroid otoimmünitesi açısından değerlendirilmesi gerekmektedir. Rutin ve geniş laboratuvar incelemelerinin yerine anamnez ve fizik muayene ile elde edilmiş verilere dayanılarak etyolojik araştırmalar planlanmalıdır. 

Keywords

• kronik ürtiker,etyoloji,tanısal testler,otolog serum deri testi,otolog plazma deri testi

Etiologic Factors in Patients with Chronic Urticaria

Abstract

In our study, we aimed to evaluate the sufficiency and necessity of anamnesis, clinical findings, routine diagnostic tests, and autologous serum and plasma skin tests (ASST and APST) in determining the factors that may cause chronic urticaria. Fifty-two adult patients with urticaria and/or angioedema symptoms for more than six weeks were included in the study. All patients were investigated for allergic, autoimmune, infectious and internal diseases. Differential diagnosis of urticaria and urticarial vasculitis was made by histopathological evaluation. Autologous serum and plasma skin tests were applied to 51 patients and 28 healthy volunteers. Physical urticaria was detected in 32.7% of all patients. Emotional stress was the most frequent (75%) trigger. Autologous serum and plasma skin tests were found positive in 55.5% and 16% respectively in patients with chronic spontaneous urticaria and the difference was statistically significant (p = 0.021). There was a statistically significant relationship between thyroid autoantibodies and ASST positivity (p=0.031). Physical urticaria is the subtype of urticaria that should be excluded primarily in patients presenting with chronic urticarial symptoms. Psychosocial support should be provided to patients by taking emotional stress control into consideration in management of the disease. Patients with positive ASST should be evaluated for thyroid autoimmunity. Instead of routine and extensive laboratory studies, etiologic investigations should be planned based on the data obtained by anamnesis and physical examination.

Keywords

• chronic urticaria,etiology,diagnostic tests,autologous serum skin test,autologous plasma skin test

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