European Journal of Pediatrics

, Volume 172, Issue 4, pp 569–569 | Cite as

Autoimmune chronic urticaria: transferability of autologous serum skin test

Images in Pediatrics

Abstract

At least 30 % of children with chronic urticaria have an autoimmune aetiology with a positive autologous serum skin test (ASST). ASST is cheap, easy to perform and has good sensibility and specificity in detecting autoantibodies. In case of concern about reliability of ASST because of antihistamine medications, test transferability seems to be feasible.

Keywords

Chronic urticaria Autoimmune urticaria ASST Antihistamine 

A 13-year-old female presented with a 4-month history of worsening urticaria frequently associated with angioedema and hardly controlled by high doses of antihistamine (10 mg daily). Urticaria did not seem to be triggered by physical stimuli.

Specific IgE against common foods and aeroallergens were negative; full blood count, C3 and C4 complement fractions, ESR and thyroid function were normal. Main autoantibodies were absent. Since every attempt to slow down the antihistamine dosage had led to immediate and severe urticaria/angioedema relapse, we decided to perform an intradermal injection of the patient's serum also in her own mother. After 15 min, a little weal appeared on the patient's forearm, and a large weal appeared on her mother (Fig. 1). We diagnosed chronic autoimmune urticaria (CAU).
Fig. 1

Autologous serum skin test: a little weal (diameter, 10 mm) appeared on the patient's forearm, and a large weal (diameter, 18 mm) appeared on her mother's forearm 15 min after intradermal injection of the patient's own serum

Overall, 0.1–3 % of children are diagnosed with chronic urticaria (CU) [2]. In nearly 30 % of patients with CU, active autoantibodies against IgE or its receptor have been identified [2, 3]. The autologous serum skin test is an in vivo clinical test which has been suggested as a screening tool for CAU [2, 3]. Interestingly, despite full antihistamine therapy, the patient test resulted positive, although much less pronounced. This incomplete test inhibition by antihistamine therapy has already been reported in the literature [1].

Notes

Conflict of interest

None to declare.

References

  1. 1.
    Asero R, Tedeschi A, Lorini M, Cugno M (2009) Antihistamines do not inhibit the flare induced by the intradermal injection of autologous plasma in chronic urticaria patients. Eur Ann Allergy Clin Immunol 41(6):181–186PubMedGoogle Scholar
  2. 2.
    Brunetti L, Francavilla R, Miniello VL et al (2004) High prevalence of autoimmune urticaria in children with chronic urticaria. J Allergy Clin Immunol 114(4):922–927PubMedCrossRefGoogle Scholar
  3. 3.
    Zitelli KB, Cordoro KM (2011) Evidence-based evaluation and management of chronic urticaria in children. Pediatr Dermatol 28(6):629–639PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.University of TriesteTriesteItaly
  2. 2.Institute of Maternal and Child Health, IRCCS Burlo GarofoloTriesteItaly

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