Allergy Asthma Immunol Res.  2012 Jul;4(4):245-247. 10.4168/aair.2012.4.4.245.

Plasmapheresis in a Patient With "Refractory" Urticarial Vasculitis

• Kartal O
• Gulec M
• Caliskaner Z
• Nevruz O
• Cetin T
• Sener O

• KMID: 1970714
• DOI: http://doi.org/10.4168/aair.2012.4.4.245

Abstract

Immune complexes are found in the circulation of 30%-75% of patients with urticarial vasculitis and much evidence supports the role of these immune complexes in the pathogenesis of urticarial vasculitis. Plasmapheresis is effective for removing these immune complexes; however, there are few reports on the use of plasmapheresis in the treatment of urticarial vasculitis. We describe a case of "refractory" urticarial vasculitis in which the symptoms improved after plasmapheresis treatment. We suggest that plasmapheresis be considered as an option in patients with severe or treatment-resistant urticarial vasculitis.

Keyword

Plasmapheresis; treatment; urticarial vasculitis

MeSH Terms

Antigen-Antibody Complex
Humans
Plasmapheresis
Vasculitis
Antigen-Antibody Complex

Reference

1. Hide M, Francis DM, Grattan CE, Hakimi J, Kochan JP, Greaves MW. Autoantibodies against the high-affinity IgE receptor as a cause of histamine release in chronic urticaria. N Engl J Med. 1993. 328:1599–1604.

2. Platzer MH, Grattan CE, Poulsen LK, Skov PS. Validation of basophil histamine release against the autologous serum skin test and outcome of serum-induced basophil histamine release studies in a large population of chronic urticaria patients. Allergy. 2005. 60:1152–1156.

3. Davis MD, Brewer JD. Urticarial vasculitis and hypocomplementemic urticarial vasculitis syndrome. Immunol Allergy Clin North Am. 2004. 24:183–213. vi

4. Zuberbier T, Asero R, Bindslev-Jensen C, Walter Canonica G, Church MK, Giménez-Arnau AM, Grattan CE, Kapp A, Maurer M, Merk HF, Rogala B, Saini S, Sánchez-Borges M, Schmid-Grendelmeier P, Schünemann H, Staubach P, Vena GA, Wedi B. Dermatology Section of the European Academy of Allergology and Clinical Immunology. Global Allergy and Asthma European Network. European Dermatology Forum. World Allergy Organization. EAACI/GA(2)LEN/EDF/WAO guideline: management of urticaria. Allergy. 2009. 64:1427–1443.

5. Grattan CE, Francis DM, Slater NG, Barlow RJ, Greaves MW. Plasmapheresis for severe, unremitting, chronic urticaria. Lancet. 1992. 339:1078–1080.

6. Jiang X, Lu M, Ying Y, Feng J, Ye Y. A case report of double-filtration plasmapheresis for the resolution of refractory chronic urticaria. Ther Apher Dial. 2008. 12:505–508.

7. Alexander JL, Kalaaji AN, Shehan JM, Yokel BK, Pittelkow MR. Plasmapheresis for refractory urticarial vasculitis in a patient with B-cell chronic lymphocytic leukemia. J Drugs Dermatol. 2006. 5:534–537.

8. Jones RR, Bhogal B, Dash A, Schifferli J. Urticaria and vasculitis: a continuum of histological and immunopathological changes. Br J Dermatol. 1983. 108:695–703.

9. Basic-Jukic N, Kes P, Glavas-Boras S, Brunetta B, Bubic-Filipi L, Puretic Z. Complications of therapeutic plasma exchange: experience with 4857 treatments. Ther Apher Dial. 2005. 9:391–395.

10. Owen HG, Brecher ME. Atypical reactions associated with use of angiotensin-converting enzyme inhibitors and apheresis. Transfusion. 1994. 34:891–894.

11. De Luca G, Lugaresi A, Iarlori C, Marzoli F, Di Iorio A, Gambi D, Uncini A. Prednisone and plasma exchange improve suppressor cell function in chronic inflammatory demyelinating polyneuropathy. J Neuroimmunol. 1999. 95:190–194.