Kronik Ürtikerli Hastalarda Etyolojik Faktörlerin Değerlendirilmesi

Yıl 2019, Cilt: 45 Sayı: 1, 33 - 40, 01.04.2019

Ümmühan Şeker Esra Özsoy Adışen

https://doi.org/10.32708/uutfd.472383

Öz

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. 

Anahtar Kelimeler

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

Etiologic Factors in Patients with Chronic Urticaria

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• KAYNAKLAR1. Başkan EB. Etiology and pathogenesis of chronic urticaria. Turkiye Klinikleri J Dermatol-Special Topics 2015;8(1):13-9.
• 2. Göncü EK, Aktan S, Atakan N, et al. The Turkish guideline for the diagnosis and management of urticaria-2016. Turkderm 2016; 50(3): 82-98.
• 3. Zuberbier T, Aberer W, Asero R, et al. The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy 2014;69(7):868-87.
• 4. Magerl M, Borzova E, Giménez-Arnau A, et al. The definition and diagnostic testing of physical and cholinergic urticarias-EAACI/GA2LEN/EDF/UNEV consensus panel recommendations. Allergy 2009;64(12):1715-21.
• 5. Asero R, Tedeschi A, Riboldi P, et al. Plasma of patients with chronic urticaria shows signs of thrombin generation, and its intradermal injection causes wheal-and-flare reactions much more frequently than autologous serum. J Allergy Clin Immunol 2006;117(5):1113-7.
• 6. Kozel MM, Mekkes JR, Bossuyt PM, et al. The effectiveness of a history-based diagnostic approach in chronic urticaria and angioedema. Arch Dermatol 1998;134(12):1575-80.
• 7. Silvares MR, Coelho KI, Dalben I, et al. Sociodemographic and clinical characteristics, causal factors and evolution of a group of patients with chronic urticaria-angioedema. Sao Paulo Med J 2007;125(5):281-5.
• 8. Buss YA, Garrelfs UC, Sticherling M. Chronic urticaria-which clinical parameters are pathogenetically relevant? A retrospective investigation of 339 patients. J Dtsch Dermatol Ges 2007;5(1):22-9.
• 9. Humphreys F, Hunter JA. The characteristics of urticaria in 390 patients. Br J Dermatol 1998;138(4):635-8.
• 10. Irinyi B, Széles G, Gyimesi E, et al. Clinical and laboratory examinations in the subgroups of chronic urticaria. Int Arch Allergy Immunol 2007;144(3):217-25.
• 11. Sibbald RG, Cheema AS, Lozinski A, et al. Chronic urticaria. Evaluation of the role of physical, immunologic, and other contributory factors. Int J Dermatol 1991;30(6):381-6.
• 12. Kozel MM, Mekkes JR, Bossuyt PM, et al. Natural course of physical and chronic urticaria and angioedema in 220 patients. J Am Acad Dermatol 2001;45(3):387-91.
• 13. Venzor J, Lee WL, Huston DP. Urticarial vasculitis. Clin Rev Allergy Immunol 2002;23(2):201-16.
• 14. Wedi B, Raap U, Wieczorek D, et al. Urticaria and infections. Allergy Asthma Clin Immunol 2009;5(1):10.
• 15. Minciullo PL, Cascio A, Barberi G, et al. Urticaria and bacterial infections. Allergy Asthma Proc 2014;35(4):295-302.
• 16. Imbalzano E, Casciaro M, Quartuccio S, et al. Association between urticaria and virus infections: A systematic review. Allergy Asthma Proc 2016;37(1):18-22.
• 17. Al FD, Adışen E, Kuştimur S, et al. The role of protozoan parasites in etiology of urticaria. Turkiye Parazitol Derg 2009; 33(2): 136-139.
• 18. Cribier B. Urticaria and hepatitis. Clin Rev Allergy Immunol 2006;30(1):25-9.
• 19. Wedi B, Raap U, Kapp A. Chronic urticaria and infections. Curr Opin Allergy Clin Immunol 2004;4(5):387-96.
• 20. Konen E, Faibel M, Kleinbaum Y, et al. The value of the occipitomental (Waters') view in diagnosis of sinusitis: a comparative study with computed tomography. Clin Radiol 2000;55(11):856-60.
• 21. Demirdağ HG, Karıncaoğlu Y, Çaylı S, et al. Relationship between periodontal findings and chronic urticaria. İnönü Üniversitesi Tıp Fakültesi Dergisi 2011;18(4):232-5.
• 22. Ozkan M, Oflaz SB, Kocaman N, et al. Psychiatric morbidity and quality of life in patients with chronic idiopathic urticaria. Ann Allergy Asthma Immunol 2007;99(1):29-33.
• 23. Chung MC, Symons C, Gilliam J, et al. Stress, psychiatric co-morbidity and coping in patients with chronic idiopathic urticaria. Psychol Health 2010;25(4):477-90.
• 24. Gupta MA, Gupta AK. Psychiatric and psychological co-morbidity in patients with dermatologic disorders: epidemiology and management. Am J Clin Dermatol 2003;4(12):833-42.
• 25. Sabroe RA, Grattan CE, Francis DM, et al. The autologous serum skin test: a screening test for autoantibodies in chronic idiopathic urticaria. Br J Dermatol 1999;140(3):446-52.
• 26. Emre S, Özçelik S, Akyol M. The relationship between autologous serum skin test and thyroid antibodies in patients with chronic idiopathic urticaria. Turkiye Klinikleri J Dermatol 2004;14(3):149-55.
• 27. Taskapan O, Kutlu A, Karabudak O. Evaluation of autologous serum skin test results in patients with chronic idiopathic urticaria, allergic/non-allergic asthma or rhinitis and healthy people. Clin Exp Dermatol 2008;33(6):754-8.
• 28. Alpay A, Solak Tekin N, Tekin IÖ, et al. Autologous serum skin test versus autologous plasma skin test in patients with chronic spontaneous urticaria. Dermatol Res Pract 2013;2013:267278. doi: 10.1155/2013/267278.
• 29. Yıldız H, Karabudak O, Doğan B, et al. Evaluation of autologous plasma skin test in patients with chronic idiopathic urticaria. Br J Dermatol 2011;165(6):1205-9.
• 30. Kocatürk E, Kavala M, Kural E, et al. Autologous serum skin test vs autologous plasma skin test in patients with chronic urticaria: evaluation of reproducibility, sensitivity and specificity and relationship with disease activity, quality of life and anti-thyroid antibodies. Eur J Dermatol 2011;21(3):339-43.
• 31. Nettis E, Dambra P, D'Oronzio L, et al. Reactivity to autologous serum skin test and clinical features in chronic idiopathic urticaria. Clin Exp Dermatol 2002;27(1):29-31.
• 32. Kulthanan K, Jiamton S, Gorvanich T, et al. Autologous serum skin test in chronic idiopathic urticaria: prevalence, correlation and clinical implications. Asian Pac J Allergy Immunol 2006;24(4):201-6.
• 33. Caproni M, Volpi W, Giomi B, et al. Chronic idiopathic and chronic autoimmune urticaria: clinical and immunopathological features of 68 subjects. Acta Derm Venereol 2004;84(4):288-90.
• 34. Kumaran MS, Mangal S, Narang T, et al. Autologous serum and plasma skin tests in chronic spontaneous urticaria: A reappraisal. Indian Dermatol Online J 2017;8(2):94-99. doi: 10.4103/2229-5178.202266.
• 35. Kumar YH, Bhaskar S, Shankar K. Comparative study of positive versus negative autologous serum skin test in chronic spontaneous urticaria and its treatment outcome. N Am J Med Sci 2016;8(1):25-30.
• 36. Staubach P, Onnen K, Vonend A, et al. Autologous whole blood injections to patients with chronic urticaria and a positive autologous serum skin test: a placebo-controlled trial. Dermatology 2006;212(2):150-9.
• 37. Boonpiyathad T, Sangasapaviliya A. Autologous serum and plasma skin test to predict 2-year outcome in chronic spontaneous urticaria. Asia Pac Allergy 2016;6(4):226-235.
• 38. Sajedi V, Movahedi M, Aghamohammadi A, et al. Comparison between sensitivity of autologous skin serum test and autologous plasma skin test in patients with chronic idiopathic urticaria for detection of antibody against IgE or IgE receptor (FcεRIα). Iran J Allergy Asthma Immunol 2011;10(2):111-7.
• 39. Asero R. Sex differences in the pathogenesis of chronic urticaria. J Allergy Clin Immunol 2003;111(2):425-6.
• 40. Bakos N, Hillander M. Comparison of chronic autoimmune urticaria with chronic idiopathic urticaria. Int J Dermatol 2003;42(8):613-5.
• 41. Konstantinou GN, Asero R, Ferrer M, et al. EAACI taskforce position paper: evidence for autoimmune urticaria and proposal for defining diagnostic criteria. Allergy 2013;68(1):27-36.
• 42. Metz M, Giménez-Arnau A, Borzova E, et al. Frequency and clinical implications of skin autoreactivity to serum versus plasma in patients with chronic urticaria. J Allergy Clin Immunol 2009;123(3):705-6.
• 43. Cugno M, Cicardi M, Bottasso B, et al. Activation of the coagulation cascade in C1-inhibitor deficiencies. Blood 1997;89(9):3213-8.
• 44. Marzano AV, Tedeschi A, Fanoni D, et al. Activation of blood coagulation in bullous pemphigoid: role of eosinophils, and local and systemic implications. Br J Dermatol 2009;160(2):266-72.
• 45. Kozel MM, Bossuyt PM, Mekkes JR, et al. Laboratory tests and identified diagnoses in patients with physical and chronic urticaria and angioedema: A systematic review. J Am Acad Dermatol 2003;48(3):409-16.