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Autoimmune Urticaria


Presentation

  • Among the hypothyroidism cases, 17 presented HT; while among the hyperthyroidism cases, five were diagnosed as presenting GD. There were 70 cases of angioedema (60.9%).[scielo.br]
  • A 38-year-old white female initially presented to our clinic with a 1-year history of an itchy rash all over her body, with facial swelling.[jddonline.com]
  • Histamine releasing antibody positive, maximum histamine release 27% ( 6 months after presentation she developed vitiligo. 5 years later, she was hypothyroid. By 3 years, the urticaria was in complete remission without medications.[ncbi.nlm.nih.gov]
  • Design, Setting, and Participants This retrospective medical record review included 79 patients with CSU treated with dapsone who presented to the tertiary care academic medical center at the New York University School of Medicine, New York, New York,[jamanetwork.com]
Euthyroid
  • Most of these patients are euthyroid, but occasionally, they are hyper- or hypothyroid.[ 33 ] Although claims have been made that correcting thyroid dysfunction, if present, also ameliorated the associated urticaria, the evidence is not convincing.[ncbi.nlm.nih.gov]
Recurrent Otitis Media
  • A case report revealed a 12-year-old boy with a history of recurrent otitis media and pneumonia who presented with CU and intermittent facial angioedema, only partially responsive to oral desloratadine. 3 The patient was given four infusions of rituximab[jddonline.com]
Pneumonia
  • A case report revealed a 12-year-old boy with a history of recurrent otitis media and pneumonia who presented with CU and intermittent facial angioedema, only partially responsive to oral desloratadine. 3 The patient was given four infusions of rituximab[jddonline.com]
Chronic Urticaria
  • Assessment of autoimmunity in patients with chronic urticaria. J Clin Immunol. 1997 ;99: 461 - 465. Google Scholar Crossref 4. Konstantinou, GN, Asero, R, Ferrer, M.[journals.sagepub.com]
  • Thyroid autoimmunity in chronic urticaria. Br J Dermatol. 2005; 153 :331–5. [ PubMed ] [ Google Scholar ] 34. Kaplan AP, Finn A. Autoimmunity and the etiology of chronic urticaria.[ncbi.nlm.nih.gov]
  • The autologous serum skin test in the follow-up of patients with chronic urticaria. Allergy. 2005;60(2):256-8. [ Links ] 5. O'Donnell BF, Francis DM, Swana GT, et al. Thyroid autoimmunity in chronic urticaria.[scielo.br]
Facial Swelling
  • A 38-year-old white female initially presented to our clinic with a 1-year history of an itchy rash all over her body, with facial swelling.[jddonline.com]
Facial Edema
  • Facial edema associated with thyroid autoimmunity.[scielo.br]
Suggestibility
  • Two randomized clinical trials suggest that dapsone may be a successful second-line therapy. Objective To evaluate the efficacy and safety of dapsone therapy in patients with CSU.[jamanetwork.com]
  • However, clinical-laboratory 4,5 and histopathological studies 6,7 have suggested that CU has autoimmune etiology at least in a subset of patients.[scielo.br]
  • That basopenia is a feature of CAU has long been recognized.[ 4 ] Histological studies of wheals suggest that one reason for these low values may be the sequestration of basophils within the affected skin.[ 28 ] Enumeration of blood basophils, possibly[ncbi.nlm.nih.gov]

Workup

  • However, the association between thyroid disease and CU is sufficiently strong, to prompt adding measurement of the plasma level of thyroid stimulating hormone level (as a screen for thyroid dysfunction) and thyroid autoantibodies to the routine workup[ncbi.nlm.nih.gov]
Skin Test Positive
  • test positivity.[ 30 ] Expression of these basophil activation markers can be detected using flow cytometry.[ncbi.nlm.nih.gov]

Treatment

  • Meaning Dapsone is an effective and well-tolerated second-line therapy for the treatment of chronic spontaneous urticaria.[jamanetwork.com]
  • The presence of autoantibodies may be important clinically in a small group of severely affected, treatment-resistant patients, where immunomodulatory treatments may be helpful.[ncbi.nlm.nih.gov]
  • Successful treatment of chronic idiopathic urticaria associated with thyroid autoimmunity. J Investig Allergol Clin Immunol. 2000;10(6):342-5. [ Links ] 24. Bansal AS, Hayman GR.[scielo.br]
  • […] conducted to support the use of rituximab in CU, though a small number of case reports reveal remission of recalcitrant CU following the use of rituximab. 1 Further studies are indicated to determine the exact efficacy and optimal dosing of rituximab in the treatment[jddonline.com]
  • The principal treatment is avoidance of vibratory stimulants.[en.wikipedia.org]

Etiology

  • However, clinical-laboratory 4,5 and histopathological studies 6,7 have suggested that CU has autoimmune etiology at least in a subset of patients.[scielo.br]
  • Autoimmunity and the etiology of chronic urticaria. Canad J Allergy Clin Immunol. 1999; 4 :286–92. [ Google Scholar ] 35. Kozel MM, Bossuyt PM, Mekkes JR, Bos JD.[ncbi.nlm.nih.gov]

Pathophysiology

  • Chronic urticaria: pathophysiology and etiology, or the what and why. Allergy Asthma Proc. 2006;27(2):90-5. [ Links ] 14. Raza SA, Salam Z, Blank RD, Jaume J, Drezner MK. Severe angioedema and urticaria related to thyroid antigenicity.[scielo.br]
  • Pathophysiology : the biologic basis for disease in adults and children (Seventh ed.). Elsevier – Health Sciences Division. ISBN 9780323088541. CS1 maint: Extra text: authors list ( link ) "Scombroid fish poisoning. DermNet NZ".[en.wikipedia.org]

Prevention

  • […] case report revealed a 51-year-old white woman with refractory autoimmune urticaria and associated abdominal pain, nausea, vomiting, and diarrhea who received 4 weekly infusions of rituximab 375 mg/m2 and methotrexate 15-25 mg/week subcutaneously to prevent[jddonline.com]
  • Ketotifen is acknowledged to stabilise mast cells and prevent histamine release, and has been effective in treating this hives disorder. Avoiding exercise or foods that cause the mentioned symptoms is very important.[en.wikipedia.org]

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