Background: Patients with chronic urticaria (CU) frequently exhibit positive skin test reactions to autologous serum (ASST). Therapies aimed at inducing tolerance to circulating histamine-releasing factors in ASST+ CU patients, e.g. by treatment with autologous whole blood (AWB), have not yet been tested. Objective: To test whether ASST+ CU patients can benefit from repeated low-dose intramuscular injections of AWB. Methods: We characterized CU severity and duration, anti-FcΕRI and anti-IgE expression, use of antihistamines, and quality of life in 56 CU patients (ASST+: 35, ASST–: 21) and assessed the therapeutic effects of 8 weekly AWB injections in a randomized, placebo-controlled, single-blind, parallel-group trial. Results: Numbers, size, intensity, and/or duration of CU symptoms, quality of life, as well as expression of anti-FcΕRI or anti-IgE were similar in ASST+ and ASST– CU patients. However, CU in ASST+ patients was of longer duration and required markedly more antihistaminic medication. Interestingly, ASST+ patients, but not ASST– patients, showed significantly (1) reduced CU activity, (2) decreased use of antihistamines, and (3) improved quality of life after AWB treatment. Placebo treatment was ineffective in both groups, but differences of AWB and placebo treatment responses did not achieve statistical significance in either group, most likely due to the limited number of patients treated. Conclusion: Our findings suggest that ASST+ CU is clinically different from other CU subforms and that ASST+ CU patients can benefit from AWB therapy.

1.
Bindslev-Jensen C, Finzi A, Greaves M, Camarasa J, Ortonne JP, Schopf E, Tennstedt D: Chronic urticaria: diagnostic recommendations. J Eur Acad Dermatol Venereol 2000;14:175–180.
2.
Verneuil L, Leconte C, Ballet JJ, Coffin C, Laroche D, Izard JP, Reznik Y, Leroy D: Association between chronic urticaria and thyroid autoimmunity: a prospective study involving 99 patients. Dermatology 2004;208:98–103.
3.
Hide M, Francis DM, Grattan CE, Hakimi J, Kochan JP, Greaves MW: Autoantibodies against the high-affinity IgE receptor as a cause of histamine release in chronic urticaria. N Engl J Med 1993;328:1599–1604.
4.
Nettis E, Dambra P, D’Oronzio L, Cavallo E, Loria MP, Fanelli M, Ferrannini A, Tursi A: Reactivity to autologous serum skin test and clinical features in chronic idiopathic urticaria. Clin Exp Dermatol 2002;27:29–31.
5.
Asero R, Tedeschi A, Lorini M, Salimbeni R, Zanoletti T, Miadonna A: Chronic urticaria: novel clinical and serological aspects. Clin Exp Allergy 2001;31:1105–1110.
6.
Niimi N, Francis DM, Kermani F, O’Donnell BF, Hide M, Kobza-Black A, Winkelmann RK, Greaves MW, Barr RM: Dermal mast cell activation by autoantibodies against the high affinity IgE receptor in chronic urticaria. J Invest Dermatol 1996;106:1001–1006.
7.
Piconi S, Trabattoni D, Iemoli E, Fusi ML, Villa ML, Milazzo F, Clerici M: Immune profiles of patients with chronic idiopathic urticaria. Int Arch Allergy Immunol 2002;128:59–66.
8.
Greaves M: Autoimmune urticaria. Clin Rev Allergy Immunol 2002;23:171–183.
9.
O’Donnell BF, Barr RM, Black AK, Francis DM, Kermani F, Niimi N, Barlow RJ, Winkelmann RK, Greaves MW: Intravenous immunoglobulin in autoimmune chronic urticaria. Br J Dermatol 1998;138:101–106.
10.
Grattan CE, Francis DM, Slater NG, Barlow RJ, Greaves MW: Plasmapheresis for severe, unremitting, chronic urticaria. Lancet 1992;339:1078–1080.
11.
Sabroe RA, Seed PT, Francis DM, Barr RM, Black AK, Greaves MW: Chronic idiopathic urticaria: comparison of the clinical features of patients with and without anti-FcepsilonRI or anti-IgE autoantibodies. J Am Acad Dermatol 1999;40:443–450.
12.
Fleck M: Urticaria; in Gottron H, Schönfeld W (eds): Dermatologie und Venerologie. Stuttgart, Thieme, 1959, vol 3, pp 265–298.
13.
Illig L: Urtikaria und Quincke-Ödem; in Korting G (ed): Dermatologie in Praxis und Klinik. Stuttgart, Thieme, 1980, vol 2, p 16. 1–30.
14.
Keller P: Die Behandlung der Haut- und Geschlechtskrankheiten in der Sprechstunde. Berlin, Springer, 1948.
15.
Bocci V: Autohaemotherapy after treatment of blood with ozone. A reappraisal. J Int Med Res 1994;22:131–144.
16.
Pittler MH, Armstrong NC, Cox A, Collier PM, Hart A, Ernst E: Randomized, double-blind, placebo-controlled trial of autologous blood therapy for atopic dermatitis. Br J Dermatol 2003;148:307–313.
17.
Olwin JH, Ratajczak HV, House RV: Successful treatment of herpetic infections by autohemotherapy. J Altern Complement Med 1997;3:155–158.
18.
Sabroe RA, Grattan CE, Francis DM, Barr RM, Kobza Black A, Greaves MW: The autologous serum skin test: a screening test for autoantibodies in chronic idiopathic urticaria. Br J Dermatol 1999;140:446–452.
19.
Grattan CE, O’Donnell BF, Francis DM, Niimi N, Barlow RJ, Seed PT, Kobza-Black A, Greaves MW: Randomized double-blind study of cyclosporin in chronic ‘idiopathic’ urticaria. Br J Dermatol 2000;143:365–372.
20.
Kromminga A, Scheckenbach C, Georgi M, Hagel C, Arndt R, Christophers E, Brocker EB, Zillikens D: Patients with bullous pemphigoid and linear IgA disease show a dual IgA and IgG autoimmune response to BP180. J Autoimmun 2000;15:293–300.
21.
Sanger F: Determination of nucleotide sequences in DNA. Science 1981;214:1205–1210.
22.
Mori O, Hashimoto T: Autologous whole blood intramuscular injection as a cure for chronic urticaria: report of a patient in whom intradermal injection of autologous serum continued to cause a weal-and-flare response. Br J Dermatol 1999;140:1192–1193.
23.
Poon E, Seed PT, Greaves MW, Kobza-Black A: The extent and nature of disability in different urticarial conditions. Br J Dermatol 1999;140:667–671.
24.
Finlay AY, Khan GK: Dermatology Life Quality Index (DLQI) – a simple practical measure for routine clinical use. Clin Exp Dermatol 1994;19:210–216.
25.
Sabroe RA, Fiebinger E, Francis DM, Maurer D, Seed PT, Grattan CEH, Kobza Black A, Stingl G, Greaves MW, Barr RM: Classification of anti-FceRI and anti-IgE autoantibodies in chronic idiopathic urticaria and correlation with disease severity. J Allergy Clin Immunol 2002;110:492–499.
26.
Fagiolo U, Kricek F, Ruf C, Peserico A, Amadori A, Cancian M: Effects of complement inactivation and IgG depletion on skin reactivity to autologous serum in chronic idiopathic urticaria. J Allergy Clin Immunol 2000;106:567–572.
27.
Horn MP, Pachlopnik JM, Vogel M, Dahinden M, Wurm F, Stadler BM, Miescher SM: Conditional autoimmunity mediated by human natural anti-Fc(epsilon)RIalpha autoantibodies? FASEB J 2001;15:2268–2274.
28.
Miescher SM, Horn MP, Pachlopnik JM, Baldi L, Vogel M, Stadler BM: Natural anti-FcepsilonRIalpha autoantibodies isolated from healthy donors and chronic idiopathic urticaria patients reveal a restricted repertoire and autoreactivity on human basophils. Hum Antibodies 2001;10:119–126.
29.
Horn MP, Gerster T, Ochensberger B, Derer T, Kricek F, Jouvin MH, Kinet JP, Tschernig T, Vogel M, Stadler BM, Miescher SM: Human anti-FcepsilonRIalpha autoantibodies isolated from healthy donors cross-react with tetanus toxoid. Eur J Immunol 1999;29:1139–1148.
30.
Yang X: Does allergen immunotherapy alter the natural course of allergic disorders? Drugs 2001;61:365–374.
31.
Birnbaum G, Weksler ME, Siskind GW: Demonstration of an antibody-mediated tolerance state and its effect on antibody affinity. J Exp Med 1975;141:411–426.
32.
Alvarado-Flores E, Avalos-Diaz E, Diaz L, Herrera-Esparza R: Anti-idiotype antibodies neutralize in vivo the blistering effect of pemphigus foliaceus IgG. Scand J Immunol 2001;53:254–258.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.