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PDF Full-Text 50 Z. Caliskaner et al. Original Article Skin test positivity to aeroallergens in the patients with chronic urticaria without allergic respiratory disease Z. Caliskaner1, S. Ozturk1, M. Turan2, M. Karaayvaz1 Gülhane Military Medical Academy and Medical Faculty, 1 Department Allergy and 2 Department of Hydroclimatology and Medical Ecology, Ankara, Türkiye (www.gata.edu.tr/dahilibilimler/allerji/index.htm) Summary. The etiology of chronic urticaria and angioedema remains uncertain in most of the patients. There are several agents and factors including medications, foods and food additives, infections, contactants, inhalants, physical factors and autoimmunity that implicated in provoking urticaria symptoms. In addition, the possible role of house dust mites has been considered in a few reports. We investigated skin test positivity to house dust mites and other inhalants in 259 patients with chronic idiopathic urticaria and angioedema but without allergic rhinitis and/or asthma. Results were compared with both 300 healthy controls and 300 atopic patients. Immediate cutaneous reactivity to one or more allergens was detected in 71 patients in the study group (27.4 %). The most common allergens were house dust mites (24.7 %). Skin prick test sensitivity to other inhalant allergens including pollens, molds and cockroach were 7.7 %, 0.4 % and 0.8 %, respectively. In the healthy control group 7 % of patients were found as atopic with respect to skin prick test results. The most common allergens in healthy controls were pollens (6 %), and house dust mites (4.7 %). In atopic control group, pollens and mites are also the most common allergens detected in skin prick test (62 % and 50.3 %, respectively). The difference between study and healthy control group was statistically significant with respect to presence of atopy and mite sensitivity (p<0.001). Similar differences were not established in other inhalant allergens. Significant mite sensitivity in the study group is not a coincidence. Because, ratio of skin test positivity to house dust mites in the study group was higher than the healthy controls, but was not as high as atopic patients. Furthermore, the rate of skin reactivity to other aeroallergens was not different from healthy controls. Urticaria as a sole clinical manifestation in mite sensitive patients was unusual. Keywords: urticaria, dermatophagoides, mites Introduction advances in diagnostic immunology, the etiology of CUA remains uncertain in most of the cases. Troubles in Chronic urticaria and angioedema (CUA) is a common determining the etiology makes the treatment difficult. disorder that affects 15-20 % of the general population Dietary eliminations, antihistamines and corticosteroids during their lifetime. CUA negatively affects both work are providing only symptomatic relief, and CUA usually and social life of the patients because of its chronic recurs soon after discontinuation of the treatments. relapsing course and poor response to therapy. Despite Up to date, there are several agents and factors have J Invest Allergol Clin Immunol 2004; Vol. 14(1): 50-54 © 2004 Esmon Publicidad Mite allergens in chronic urticaria 51 been implicated in provoking CUA including medications, molds, 10.000 AU/ml for mites and dander, Greer Lab, foods and food additives, infections, contactants, Lenoir, USA). SPT was performed using disposable inhalants, physical factors and in the most of the cases, lancets and the reactions were recorded 15 minutes after autoimmunity [1, 2, 3]. In addition, there are few reports the test. Reactions with a wheal diameter greater than 3 about the relation between dermatophagoides and CUA mm with surrounding erythema were considered as [4, 5, 6, 7]. positive, if the positive control histamine was positive In the present study, we investigated skin test positivity and negative control was negative. The wheal without to house dust mites and other inhalants in the patients erythema was accepted as irritant reaction and was with idiopathic CUA without allergic rhinitis and/or excluded. In addition, to differentiate dermographic and asthma. irritant reactions, test with negative control solution (diluent with 0.9% saline and 0.4% phenol) was particularly performed to all patients. Material and methods Study protocol and patient selection: Control groups Three hundred and twenty-five consecutive patients with Two control groups were formed: CUA without allergic rhinitis and/or asthma, which were Control group I: Healthy control group consisted of evaluated at GATA Allergy Clinic, Turkey, on outpatient 300 individuals (150 male and 150 female) who have not basis were included in this prospective study. Diagnosis history of atopy, allergic rhinitis and/or asthma. These of CUA was defined as recurrent episodes of hives with controls were used to establish asymptomatic skin test or without angioedema of at least 6 weeks duration [8]. positivity to aeroallergens in normal population. Physical urticarias such as dermographism or pressure Control group II: Atopic control group consisted of urticaria were not included. Etiology of CUA was 300 patients (165 male and 135 female) with allergic evaluated by medical history, physical examination and rhinitis and/or asthma who previously underwent SPT laboratory tests. After a throughout physical examination, with the same procedure. laboratory investigations were performed to define CUA etiology, including complete blood count (Coulter STKS Counter, Coulter Electronics, Miami, Florida, USA), Statistical analysis erythrocyte sedimentation rate (Westergren Method), urine and stool microscopy, peripheral blood smear, serum total Statistical analyses were performed by microprocessor eosinophil count, BUN, creatinine, AST, ALT, ALP, using a statistical software package (SPSS for windows, bilirubins, total protein, albumin (Technicon Dax 48 SPSS Inc., USA). Differences between the groups were autoanalyser, Bayer, Berkeley, California, USA), investigated using chi-square test and Mann-Whitney U complement levels, CRP, RF (nephelometric assay), test. Fisher’s Exact Test was applied as appropriate. Data HbsAg, anti HCV, ANA, anti dsDNA, chest and sinus x- were expressed as mean ± standard deviation in the text. rays, free T3, free T4, thyroid stimulating hormone (TSH), The alpha was set to 0.05 in all calculations. antithyroglobuline antibody(anti-TG Ab) and antithyroid peroxidase antibody (anti-TPO Ab) (chemiluminescence method by using DPC, Diagnostic Products corp., Los Results Angeles, California, USA). In addition to these tests, helicobacter pylori infection was investigated in those The mean age was 27.96 ± 9.82 years in the study group, patients with chronic gastric complaints. 25.51 ± 12.72 years in the atopic control group and 25.76 At the end of these investigations 66 patients who were ± 11.30 years in the healthy control group. positive for any etiological factor that may cause CUA Immediate cutaneous reactivity to one or more were excluded from the study. The remaining 259 patients allergens was detected in 71 patients in the study group with chronic idiopathic urticaria and angioedema were (27.4 %). The most common allergens were house dust further studied for inhalant allergen sensitivity and served mites (24.7 %). SPT sensitivity to other inhalant allergens as study group. As previously described, none of the including pollens, molds and cockroach were 7.7 %, 0.4 patients in study group has either history or symptoms of % and 0.8 %, respectively. allergic rhinitis and/or asthma. In the healthy control group 7 % of patients found as The patients in study and control groups underwent atopic with respect to SPT results. This ratio was similar allergy skin prick test (SPT). SPTs was performed when to a previously reported study from our country [9]. The the patients were asymptomatic and at least 7 days most common allergens in this group were pollens (6 %), antihistamine-free period after the last dose of and house dust mites (4.7 %). Other allergens including antihistamines. Fifty-six common aeroallergens (pollens molds, animal dander and cockroach were detected in found in Turkey’s atmosphere, molds, house dust mites only 2, 1 and 1 patients, respectively. and animal dander) were used (1/20 w/v for pollens and Pollens and mites are also the most common allergens © 2004 Esmon Publicidad J Invest Allergol Clin Immunol 2004; Vol. 14(1): 50-54 52 Z. Caliskaner et al. detected in SPT in our atopic controls (62 % and 50.3 cockroach sensitivity in the study group was not as high %). Mold sensitivity was 4.3 %, animal dander sensitivity as in atopic patients. However, there is a clear association was 4.7 % and cockroach sensitivity was 3.3 % in the between mite sensitivity and chronic urticaria. atopic control group. Skin test results obtained from each group and The difference between study and healthy control comparison of the results were summarized in Table 1 group was statistically significant with respect to presence and Table 2. of atopy (p<0.001). In addition, the significant immediate Mite positive patients in the study group were similar cutaneous reactivity to one or more mites in patients with to mite negative patients with respect to age and gender. chronic urticaria was exposed. The difference between The mean age was 26.52 ± 8.35 years in the mite sensitive the mite positivity of the study group and healthy control patients and 28.44 ± 10.23 years in mite insensitive patients. group was statistically significant (p<0.001). Similar There is a slight gender
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