Kronik Spontan Ürtikerli Çocuklarda Otoimmün Tiroid Hastalığı için Risk Faktörleri

Öz

Kronik spontan ürtikerin (KSÜ) etiyolojisi çoğunlukla idiyopatik olmakla birlikte, hastaların bir kısmında patogenezde otoimmünitenin rol oynadığını destekleyen çalışmalar vardır. KSÜ ve tiroid otoimmünitesi birlikteliği çoğunlukla erişkinlerde araştırılmıştır; ancak, çocuklarda veriler sınırlıdır. Bu çalışmada, KSÜ tanısı almış çocuklarda anti tiroid peroksidaz (anti-TPO) antikor pozitifliği sıklığının saptanması ve otoimmun tiroid hastalığı için risk faktörlerinin belirlenmesi amaçlanmıştır. Bu retrospektif tanımlayıcı çalışmada, iki farklı merkezde KSÜ tanısı ile izlenen 126 hasta değerlendirilmiştir. Hastaların demografik ve klinik özellikleri, eşlik eden bağ doku hastalığı, otoimmün hastalık ve/veya allerjik hastalıkları ile her iki merkezde KSÜ hastalarında rutin olarak yapılan tam kan sayımı, total IgE, antinükleer antikor (ANA), anti-TPO antikor, serbest tiroksin (sT4) ve tirotiropin (TSH) düzeylerini içeren laboratuvar sonuçları; deri prick testi ve otolog serum deri testi (OSDT) sonuçları dosya verilerinden elde edildi. Anti-TPO pozitifliği saptanan hastaların tiroid ultrasanografisi bulguları da kaydedildi. Çalışmamızda 5 (%4.0) hastada anti-TPO pozitifliği saptandı. Bu hastaların 3’ünde tiroid US’de parankim heterojenitesi mevcuttu. ANA pozitifliği hastaların %10.2’sinde saptanmıştı. Anti-TPO pozitifliği olan hastalarda ANA pozitifliği anlamlı olarak yüksek idi (sırasıyla %60 ve %7.4, p=0.003). Dört hastada vitiligo tanısı mevcuttu ve bu hastalarda anti-TPO pozitifliği, vitiligo tanısı olmayan KSÜ tanılı hastalara göre istatistiksel olarak anlamlı olmamakla birlikte daha fazla saptandı (sırasıyla %20 ve %2.5, p=0.151) Kronik spontan ürtikerli çocuklarda ANA pozitifliği otoimmün tiroid hastalığı için risk faktörü olabilir. KSÜ’lü çocuklarda vitiligo ve otoimmun tiroid hastalığı ilişkisi daha geniş kohortlarda araştırılmalıdır.

Anahtar Kelimeler

• kronik ürtiker
• anti tiroid peroksidaz antikoru
• tiroid otoimmünitesi
• sistemik lupus eritematozus
• vitiligo

The Risk Factors for Autoimmune Thyroid Disorder in Children with Chronic Spontaneous Urticaria

Öz

Although the etiology of chronic spontaneous urticaria (CSU) in children is mostly idiopathic, there are studies supporting the autoimmune pathogenesis of disease in a subset of patients. CSU and autoimmune thyroid disease coexistence has been explored mostly in adults; however data in children is scarce. The aim of this study was to verify frequency of anti thyroid peroxidase (anti-TPO) antibody positivity and risk factors for autoimmune thyroid disorder in the children with CSU. In this retrospective descriptive study, a total of 126 children with CSU in two different centers were evaluated. The demographic and clinical features, coexisting connective tissue diseases, autoimmune and/or allergic diseases and complete blood count, total IgE, antinuclear antibody (ANA), anti-TPO antibody, free thyroxine (fT4), thyroid-stimulating hormone (TSH), skin prick test and autologous serum skin test (ASST) results that routinely performed for CSU in both centers were collected from medical records. Thyroid ultrasonography findings were also recorded in the patients with positive anti-TPO. Anti-TPO was positivite in 5 (4.0%) patients. Heterogenous paranchyme on thyroid US was detected in 3 of those. ANA was positive 10.1% of the patients. In anti-TPO positive patients, ANA positivity was significantly higher (60% vs 7.4%, respectively; p=0.003). Vitiligo was detected in 4 (3.2%) of patients and although it is not significant statistically, these patients had higher frequency of anti-TPO positivity compare to those without vitiligo (20% vs 2.5%, respectively; p=0.151). ANA positivity may be a risk factor for autoimmune thyroid disorder in patients with chronic spontaneous urticaria. Relationship between vitiligo and autoimmun thyroid disorder should also be investigated in patients with CSU in larger cohorts

Anahtar Kelimeler

• Chronic urticaria
• anti thyroid peroxidase antibody
• thyroid autoimmunity
• systemic lupus erythematosus
• vitiligo

Kaynakça

1. 1. Zuberbier T, Aberer W, Asero R, et al. The EAACI/GA(2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2017 revision and update. Allergy 2018; 73: 1393-1414.
2. 2. Sabroe RA, Graves MW. The pathogenesis of chronic idiopatic urticaria. Arch Dermatol 1997; 133: 1003-1008.
3. 3. Graves MW. Chronic urticaria in childhood. Allergy 2000; 55: 309-320.
4. 4. Pearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med 2003; 348: 2646-2655.
5. 5. Hollowell GJ, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002; 87: 489-499.
6. 6. Kolkhir P, Metz M, Altrichter S, et al. Comorbidity of chronic spontaneous urticaria and autoimmune thyroid disease: a systematic review. Allergy 2017; 72: 1440-1460.
7. 7. Leznoff A, Sussman G. Syndrome of idiopathic chronic urticaria and angioedema with thyroid autoimmunity: a study of 90 patients. J Allergy Clin Immunol 1989; 84: 66-71.
8. 8. Confino-Cohen R, Chodick G, Shalev V, et al.Chronic urticaria and autoimmunity: associations found in a large population study. J Allergy Clin Immunol 2012; 129: 1307-1313.

9. 9. Konstantinou GN, Asero R, Maurer M et al. EAACI/GA(2)LEN task force consensus report: the autologous serum skin test in urticaria. Allergy 2009; 64: 1256-1268.
10. 10. Kaloumenou I, Mastorakos G, Alevizaki M, et al. Thyroid autoimmunity in school children in an area with long-standing iodine sufficiency: correlation with gender, pubertal stage, and maternal thyroid autoimmunity. Thyroid 2008; 18: 747-754.
11. 11. Kabelitz M, Liesenkötter KP, Stach B, et al.The prevalence of anti-thyroid peroxidase antibodies and autoimmune thyroiditis in children and adolescents in an iodine replete area. Eur J Endocrinol. 2003; 148: 301-307.
12. 12. Loviselli A,Velluzzi F, Mossa P, et al. The Sardinian Autoimmunity Study: 3. Studies on circulating antithyroid antibodies in Sardinianschool children: relationship to goiter prevalence and thyroid function. Thyroid 2001; 11: 849-857.
13. 13. Bakos N, Highlander M. Comparison of chronic autoimmune urticaria with chronic idiopathic urticaria. Int J Dermatol 2003: 42: 613-615.
14. 14. Sackesen C, Sekerel BE, Orhan F, et al. The etiology of different forms of urticaria in childhood. Pediatr Dermatol 2004; 21: 102-108.
15. 15. Levy Y, Segal N, Weintrob N, et al. Chronic urticaria: association with thyroid autoimmunity. Arch Dis Child 2003: 88: 517-519.
16. 16. Sahiner UM, Civelek E, Tuncer A, et al. Chronic urticaria; natural course in children. Int Arch Allergy Immunol 2011; 156: 224-230.
17. 17. Chansakulporn S, Pongpreuksa S, Sangacharoenkit P, et al. The natural history of chronic urticaria in childhood: a prospective study. J Am Acad Dermatol 2014;71: 663-668.
18. 18. Karagol HI, Yılmaz O, Topal E, et al. Association between thyroid autoimmunity and recurrent angioedema in children. Allergy Asthma Proc 2015; 36: 468-472.
19. 19. Pedullà M, Fierro V, Marzuillo P, et al. Skin disease and thyroid autoimmunity in atopic South Italian children. World J Clin Pediatr 2016; 5: 288-292.
20. 20. Kakourou T, Kanaka-Gantenbein C, Papadopoulou A, et al. Increased prevalence of chronic autoimmune (Hashimoto's) thyroiditis in children and adolescents with vitiligo. J Am Acad Dermatol 2005; 53: 220-223.
21. 21.Tan EM, Feltkamp TE, Smolen J, et al. Range of antinuclear antibodies in healthy individuals. Arthritis Rheum 1997; 40: 1601–1611.
22. 22. Ferriani MP, Silva MF, Pereira RM, et al. Chronic spontaneous urticaria: a survey of 852 cases of childhood-onset systemic lupus erythematosus. Int Arch Allergy Immunol 2015; 167: 186-192.