J ALLERGY CLIN IMMUNOL

FEBRUARY 2014

AB120 Abstracts

SUNDAY

421 Relation Between Environmental Allergen Exposure andChronic Urticaria

Dr. Denisa Ferastraoaru,MD,MSc1, Dr. Sunit Jariwala, MD2, Dr. Golda

Hudes, MD, PhD3, Dr. David L. Rosenstreich, MD, FAAAAI4; 1Allergy -

Immunology, Albert Einstein College of Medicine/Montefiore Medical

Center, Bronx, NY, 2Albert Einstein/Montefiore Medical Center, New

York, NY, 3Albert Einstein/ Montefiore Medical Center, New York, NY,4Albert Einstein/Montefiore Medical Center, Bronx, NY.

RATIONALE: The definitive cause or trigger is not usually identified in

most patients with chronic urticaria (CU). We sought to investigate a

potential role of environmental allergens in these patients.

METHODS: Following IRB approval, 36 patients with CUwere enrolled.

All patients had skin tests (ST) to 14 environmental allergens: tree, grass,

weed, ragweed and English plantain pollens, dust mites, feathers, cat and

dog epithelium, cockroach, mouse, and three mold spore mixtures. The ST

was considered positive if the wheal diameter was 3 millimeters or larger

than the negative control. The urticaria severity was assessed using the

Urticaria Severity Score (USS).

RESULTS: In the study group, the mean USS was 44. Fifteen patients

(Group 1) had more severe urticaria (USS >44). The rate of positive ST to

some perennial allergens was higher in Group 1 compared with milder

urticaria patients (Group 2) (mouse – 20% vs 10%, mold spores – 13% vs

5%, A. fumigatus- 7% vs 5%). Group 1 had significantly higher exposure to

both cats and dogs (33% vs 9.5%, p50.03), but Group 2 had higher rate of

positive ST to tree pollen (76% vs 47%, p50.03) and dust mites (43% vs

7%, p50.01).

CONCLUSIONS: The patients with more severe CU were more allergic

to perennial allergens such as mouse and mold spores, and had greater pet

exposure. Our data suggest that environmental allergens may represent

potential additional triggers for urticaria and may contribute to the severity

of symptoms. Strict environmental control and decreased pet exposure

might be beneficial for patients with severe CU.

422 Relationship Of Clinical Characteristics Of Chronic UrticariaIn Children To Treatment Outcome

Lisa Neverman, BS, Prof. Miles M. Weinberger, MD, FAAAAI; Univer-

sity of Iowa, Iowa City, IA.

RATIONALE: Functionally active auto-antibodies have been identified in

patients with chronic urticaria against the high-affinity IgE receptor and

IgE. This was the rationale for controlled clinical trials demonstrating

efficacy of cyclosporine in adults with chronic urticaria not responsive to

antihistamines.

METHODS: To evaluate chronic urticaria in children, sequential patients

from our Pediatric Allergy Clinic with chronic idiopathic urticaria were

identified from our electronicmedical record from 2009 through 2012. The

urticaria index was examined in those unresponsive to even high doses of

either cetirizine or hydroxyzine. Low dose cyclosporine was begun for

those found to be antihistamine resistant. Safety measures included

cyclosporine blood levels, serum creatinine, and regular examinations of

blood pressure.

RESULTS: 46 patients were identified, median age 11.5 years, gender

ratio 26:10 with female preponderance; mean duration of hives prior to

referral was 14.8 months. 16 of the 47(34%), 12 females and 4 males,

median age 12.5 years, were antihistamine-resistant and started on

cyclosporine. Antihistamine resistant children were significantly older (p

5 0.0001). Of the 16, presence of autoantibodies was examined in 12, of

whom5were positive and 7were negative. All who started on cyclosporine

had complete suppression of their hives after 2 days to 3 months. Serum

cyclosporine levels measured at time of resolution ranged from 66 to 200

ng/ml. No effects on renal function or blood pressure were seen.

CONCLUSIONS: Antihistamine resistant chronic urticaria significantly

correlated with older age children but not with the presence of autoanti-

bodies. Cyclosporine was highly effective and safe in inducing remissions

of even long-standing chronic urticaria in children.

423 Clinical Characteristics Of Elderly Chronic UrticariaDr. Ga Young Ban, MD1, Ji Hye Kim, MD2, Mi-Yea

Kim, MD1, Dr. Hye-Soo Yoo, MD1, Dong-Ho Nahm, MD, PhD1,

Dr. Young Min Min Ye, MD1, Yoo Seob Shin, MD, PhD1, Prof. Hae-

Sim Park, MD, PhD1; 1Department of Allergy & Clinical Immunology,

Ajou University School of Medicine, Suwon, South Korea, 2Department

of Internal medicine, Konyang University College of Medicine, Daejeon,

South Korea.

RATIONALE: Chronic urticaria (CU) is defined as itchy wheals

lasting for at least 6 weeks. It is a common disabling disorder

occurring in about 0.5–1% of the population. Recently, the aged

population is increasing worldwide. Therefore, it is essential to identify

the specific features of disease in aged group. We investigated the

prevalence and clinical features of elderly CU in comparison with non-

elderly CU.

METHODS: We retrospectively analyzed the medical records of 827 CU

patients who were followed in the outpatient Allergy Clinic of Ajou

University Hospital, South Korea. According to the EAACI/GA2LEN/

EDF/WAO guideline chronic spontaneous urticarial patients were

included. Elderly was defined as older than 60 years. Severe CU was

defined when urticaria activity score was >_13 at initial visit.

RESULTS: Of the total 827 patients, 37 (4.5%) were elderly. Among co-

morbid conditions, the prevalence of atopic dermatitis (AD) was signif-

icantly higher (37.8%vs. 21.7%, p50.022), while that of aspirin sensitivity

was lower (18.9% vs. 43.6%, p50.003) in elderly CU. Other clinical and

laboratory findings were found to have no significant differences between

the two groups. However the prevalences of serum specific IgE to staphy-

lococcal enterotoxin A (SEA) and staphylococcal enterotoxin B (SEB)

were considerably higher in elderly CU with AD than in those without

AD (37.5% vs. 0%, respectively).

CONCLUSIONS: Considering the higher prevalence of AD in elderly

CU, it is needed to observe the coexistence of AD in elderly CU. Specific

IgE to SEA/SEB may play a role in the pathogenesis of elderly CU,

especially who are accompanied by AD.

424 Decreased Serum Vitamin D Level In Patients With ChronicSpontaneous Urticaria

Dr. Tadech Boonpiyathad, MD, Dr. Panitan Pradappongsa, Dr. Atik San-

gasapaviriya; Phramonkutklao Hospital, Bangkok, Thailand.

RATIONALE: Vitamin D is important role in immune system

and decreased serum vitamin D level linked to autoimmune

diseases. Autoimmune is major caused in chronic urticaria. This study

aimed to find vitamin D status in patients with chronic spontaneous

urticaria (CSU).

METHODS: A prospective case control study of 60 subjects with CSU

compared with 20 healthy subjects. Serum 25(OH)D was measured in all

subjects. Urticaria symptom severity and quality of life were assessed as

Urticaria Activity Score 7(UAS7) and Dermatology Life Quality Index

(DLQI). Serum number of eosinophil and erythrocyte sediment rate (ESR)

test were performed in the patients with CSU.

RESULTS: This study was predominately women, 53/80 subjects.

The mean age was significantly different between CSU group and

controls, 37.17610.15 VS 62.9617.07 years (p < 0.001). The mean

duration of urticaria was 29.88613.45 weeks. The mean serum 25(OH)

D levels were significantly decreased in subjects with CSU

(20.57610.80) compared with controls (31.9766.56), p < 0.001.

Vitamin D status in CSU group, 10 subjects, 16.67% were normal, 17

subjects, 28.33% were insufficiency and 33 subjects, 55% were

deficiency. Vitamin D levels did not correlate with duration, age,

number of eosinophil, UAS7 and DLQI but positive correlated with

ESR, r 5 0.43 (p 5 0.001).

CONCLUSIONS: This study showed vitamin D deficiency was common

in patients with CSU. However, serum 25(OH)D levels cannot use to be

biomarker for monitor symptom and severity in CSU.