Asia Pac Allergy.  2016 Oct;6(4):226-235. 10.5415/apallergy.2016.6.4.226.

Autologous serum and plasma skin test to predict 2-year outcome in chronic spontaneous urticaria

• Boonpiyathad T
• Sangasapaviliya A

• KMID: 2397019
• DOI: http://doi.org/10.5415/apallergy.2016.6.4.226

Abstract

BACKGROUND
Autologous serum skin test (ASST) and autologous plasma skin test (APST) are simple methods to diagnose autoimmune chronic urticaria. However, the association data of ASST or APST with disease severity and long-term outcome are still unclear.
OBJECTIVE
The results of ASST and APST might be used to predict urticaria symptom severity and long-term outcomes among chronic spontaneous urticaria (CSU) patients.
METHODS
We evaluated the prevalence of reactive ASST and APST in 128 CSU patients. The patients were characterized by 4 groups: negative, ASST positive, APST positive, and both ASST and APST positive. We observed remission rate among the CSU patients during 2 years.
RESULTS
Forty-four of 128 CSU patients (34%) had negative autologous skin test. The CSU patients with positive ASST, positive APST, and both positive ASST and APST were 47 (37%), 6 (5%), and 31 (24%), respectively. No significant difference was found between the groups according to urticaria severity score (USS) and dermatology life quality index (DLQI). Mean wheal diameter of ASST showed positive correlation with DLQI. Also, mean wheal diameter of APST showed positive correlation with USS and DLQI. Both the positive ASST and APST groups had a high proportion of 4-fold dose of H1-antihistamine than the positive ASST (p = 0.03) and negative groups (p = 0.0009). The rate of remission over 2 years in the negative, positive ASST, positive APST, and both positive ASST and APST groups were 81.1%, 62.3%, 60%, and 46.1%, respectively. The urticaria remission rate in patients in the negative group was significantly higher compared with both positive ASST and APST groups (odds ratio, 5.0; 95% confidence interval, 1.61-15.44; p = 0.006).
CONCLUSION
ASST and APST results could predict remission rates among patients with CSU. Our results suggested investigating ASST and APST among CSU patients before starting treatment.

Keyword

Autologous serum skin test; Autologous plasma skin test; Chronic spontaneous urticaria; Disease severity; Quality of life; House dust mite

MeSH Terms

Dermatology
Humans
Plasma*
Prevalence
Pyroglyphidae
Quality of Life
Skin Tests*
Skin*
Urticaria*

Figure

• 

  Fig. 1 (A) Distribution of chronic spontaneous urticaria based on the result of autologous serum skin test (ASST) and autologous plasma skin test (APST) (n = 128). Box and whiskers plot 10th–90th percentile revealed a comparison of urticaria severity score (USS) (B) and dermatology life quality index (DLQI) (C) among negative, positive ASST, positive APST, and both positive ASS and APST groups.

• 

  Fig. 2 (A) Correlation graph between urticaria severity score (USS) and dermatology life quality index (DLQI) among chronic spontaneous urticaria patients (n = 128). Representative correlation graphs between diameters of positive autologous serum skin test (ASST) with USS (B) and DLQI (C). The correlation graphs show diameters of positive autologous plasma skin test (APST) correlated with USS (D) and DLQI (E). Spearman's test was used to analyze the data. NS, not significant.

• 

  Fig. 3 Proportion of the patients with chronic urticaria compare among negative, positive autologous serum skin test (ASST), positive autologous plasma skin test (APST), and both positive ASST and APST groups. Four-fold dose of H1- antihistamine during 4 weeks of treatment (A), short-course oral prednisolone (B), and third-line drug treatment during 2 years (C) were observed. (D) A Kaplan-Meier curve graph demonstrates the remission rate among the groups (n = 107). Statistical analysis was performed by Fisher exact test. *p < 0.05. **p < 0.01. ***p < 0.001.

• 

  Fig. 4 Correlation of remission time and dermatology life quality index (DLQI) (A), urticaria severity score (USS) (B), wheal diameter of autologous serum skin test (ASST) (C), and wheal diameter of autologous plasma skin test (APST) (D). Spearman test was used to analyze the data. NS, not significant.

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