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Plasmapheresis for severe, unremitting, chronic urticaria
C E Grattan1, D M Francis, N G Slater
1St John's Institute of Dermatology, UMDS, London, UK.
Lancet (London, England)
|May 2, 1992
Summary
Histamine-releasing autoantibodies in chronic idiopathic urticaria (CIU) patients were targeted with plasmapheresis. This treatment offered significant symptom relief in some, suggesting autoantibodies play a key role in CIU pathogenesis.
Area of Science:
- Immunology
- Dermatology
- Allergy
Background:
- Histamine-releasing autoantibodies are implicated in chronic idiopathic urticaria (CIU).
- Severe CIU cases often exhibit histamine-releasing activity in serum.
Purpose of the Study:
- To investigate the therapeutic effect of plasmapheresis on CIU patients with severe disease.
- To explore the role of histamine-releasing autoantibodies in CIU pathogenesis.
Main Methods:
- Plasmapheresis was performed on 8 patients with severe CIU and histamine-releasing serum activity.
- Skin-test responses to autologous sera and intradermal histamine were assessed pre- and post-plasmapheresis.
- Blood cellular histamine and in-vitro serum histamine-releasing activity were measured.
Main Results:
- Symptom relief varied, with complete resolution in 2 patients, temporary relief in 2, and minimal change in 2.
- Post-plasmapheresis sera showed reduced skin-test responses compared to pre-exchange sera.
- Blood histamine levels increased, while in-vitro serum histamine-releasing activity decreased post-procedure.
Conclusions:
- Plasmapheresis can provide significant, albeit variable, symptom relief in severe CIU.
- The findings support a pathogenetic role for histamine-releasing autoantibodies in chronic urticaria.
- Further research into autoantibody-targeted therapies for CIU is warranted.
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