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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.