Autologous Serum Therapy in Chronic Idiopathic Urticaria

Author(s): Arun Peedika Valapil1 , Celine Machiyanickal Issac2 , Mary Vineetha3

BACKGROUND Chronic Urticaria (CU) is a common and distressing dermatosis and its treatment is challenging to the clinician. Autologous Serum Skin Test (ASST) is the simplest screening method to identify the immune response in chronic idiopathic urticaria. Autologous Serum Therapy (AST) is a modified form of autohemotherapy found to be effective in chronic idiopathic urticaria. We wanted to evaluate the effectiveness of autologous serum therapy in both ASST positive and ASST negative patients with chronic idiopathic urticaria. METHODS This study included 110 patients diagnosed to have chronic idiopathic urticaria who attended Dermatology outpatient department, Government Medical College, Kottayam, Kerala, from October 2016 to September 2017. Detailed history was taken and clinical examination was done along with relevant investigations in all cases. ASST was done, and patients were categorized into ASST positive and negative patients. All patients were given AST weekly once for a continuous period of 9 weeks and were followed up for 3 months. Total Severity Score (TSS) were recorded and the response was categorized into significant, moderate, and poor response, based on 6 parameters which were number of wheals, size of wheals, intensity of pruritus, duration of wheals, frequency of appearance of symptoms and frequency of antihistamine use. RESULTS Majority of patients were in the fourth decade with a female preponderance. Out of 110 patients, 32 were ASST positive and 78 were ASST negative. In ASST positive patients, thyroid antibodies were found in 46.9% and 10.3% in ASST negative patients. 6 parameters of TSS score were gradually reduced in both groups till the end of follow up period. Better and earlier response of TSS score to AST was noted in ASST positive patients. The difference in response to AST between ASST positive and negative groups was not statistically significant. Out of 32 ASST positive patients 20 (62.5%) showed significant response whereas out of 78 ASST negative patients 32 (41%) showed significant response. Only 4 (12.5%) out of 32 ASST positive patients showed poor response compared to 25 (22.7%) in ASST negative patients. CONCLUSIONS Autologous serum therapy is a safe and effective mode of treatment in the management of chronic idiopathic urticaria. ASST positive as well as negative patients showed response to AST but it tends to be more effective and earlier in ASST positive patients.