R Asero1, M Cugno, A Tedeschi. 1. Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano (MI), Italy. r.asero@libero.it
Abstract
BACKGROUND: Skin reactivity to the intradermal injection of autologous serum (autologous serum skin test - ASST) and/or plasma (autologous plasma skin test - APST) is thought to identify chronic urticaria (CU) patients with an autoimmune/autoreactive disease. Immune-mediated inflammation and coagulation are strictly linked, and coagulation activation has been described in CU patients as shown by the elevation of plasma prothrombin fragment F1+2 and, in severe cases, of d-dimer as well. OBJECTIVE: The aim of this study was to evaluate whether the coagulation cascade is activated in APST-negative CU patients as it has been described in CU patients with an autoreactive disease. METHODS: A total of 43 adults with CU (M/F 15/28; mean age 43.5 years; 16 APST-negative patients and 27 APST-positive) and 30 healthy subjects were studied. Prothrombin fragment F1+2, d-dimer and C-reactive protein (CRP) plasma levels were measured by ELISA. RESULTS: Prothrombin fragment F1+2 and d-dimer were elevated in seven of 16 APST-negative CU patients. The activation of the coagulation cascade was associated with disease severity. Men were more prevalent in idiopathic than in autoreactive CU patients (M/F: 10/6 vs. 5/22; P<0.001). In patients with APST-negative CU, mean F1 + 2 level [242.8 ± 33.7 pmol/L (ESM)] was higher than in normal controls (151.8 ± 9.09 pmol/L; P=0.002) but lower than in autoreactive patients (526.2 ± 97.8 pmol/L; P=0.05). Similarly, mean d-dimer level was higher than in normal controls (484.2 ± 148.3 ng/mL vs. 229.5 ± 16.7 ng/mL; P=0.03) but lower than in autoreactive patients (1142.2 ± 317.4 ng/mL; P=0.05). In contrast, mean CRP was lower than in autoreactive patients (1.06 ± 0.32 μg/mL vs. 3.09 ± 0.74 μg/mL; P=0.02) but not different from normal subjects (0.78 ± 0.09 μg/mL; NS). CONCLUSION: Autologous plasma skin test-negative CU prevails in men; in these patients the coagulation cascade is activated although with a lower intensity than in patients with autoreactive disease.
BACKGROUND: Skin reactivity to the intradermal injection of autologous serum (autologous serum skin test - ASST) and/or plasma (autologous plasma skin test - APST) is thought to identify chronic urticaria (CU) patients with an autoimmune/autoreactive disease. Immune-mediated inflammation and coagulation are strictly linked, and coagulation activation has been described in CUpatients as shown by the elevation of plasma prothrombin fragment F1+2 and, in severe cases, of d-dimer as well. OBJECTIVE: The aim of this study was to evaluate whether the coagulation cascade is activated in APST-negative CUpatients as it has been described in CUpatients with an autoreactive disease. METHODS: A total of 43 adults with CU (M/F 15/28; mean age 43.5 years; 16 APST-negative patients and 27 APST-positive) and 30 healthy subjects were studied. Prothrombin fragment F1+2, d-dimer and C-reactive protein (CRP) plasma levels were measured by ELISA. RESULTS: Prothrombin fragment F1+2 and d-dimer were elevated in seven of 16 APST-negative CUpatients. The activation of the coagulation cascade was associated with disease severity. Men were more prevalent in idiopathic than in autoreactive CUpatients (M/F: 10/6 vs. 5/22; P<0.001). In patients with APST-negative CU, mean F1 + 2 level [242.8 ± 33.7 pmol/L (ESM)] was higher than in normal controls (151.8 ± 9.09 pmol/L; P=0.002) but lower than in autoreactive patients (526.2 ± 97.8 pmol/L; P=0.05). Similarly, mean d-dimer level was higher than in normal controls (484.2 ± 148.3 ng/mL vs. 229.5 ± 16.7 ng/mL; P=0.03) but lower than in autoreactive patients (1142.2 ± 317.4 ng/mL; P=0.05). In contrast, mean CRP was lower than in autoreactive patients (1.06 ± 0.32 μg/mL vs. 3.09 ± 0.74 μg/mL; P=0.02) but not different from normal subjects (0.78 ± 0.09 μg/mL; NS). CONCLUSION: Autologous plasma skin test-negative CU prevails in men; in these patients the coagulation cascade is activated although with a lower intensity than in patients with autoreactive disease.
Authors: Alicja Kasperska-Zajac; Alicja Grzanka; Jacek Kowalczyk; Magdalena Wyszyńska-Chłap; Grażyna Lisowska; Jacek Kasperski; Jerzy Jarząb; Maciej Misiołek; Zbigniew Kalarus Journal: Int J Immunopathol Pharmacol Date: 2015-12-03 Impact factor: 3.219
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