Association of positive and negative autologous serum skin test responses with clinical features of chronic spontaneous urticaria in Asian patients: A systematic review and meta-analysis

Abstract

Previous studies on the correlation between positive autologous serum skin test (ASST) responses and the clinical features of patients with chronic spontaneous urticaria (CSU) have provided conflicting results. To evaluate the significance of ASST responses in CSU, a variety of databases were searched from inception to March 2018 to identify relevant studies on CSU. Data were analyzed with use of the Cochrane Collaboration's Review Manager 5.2. Multiple relevant factors of CSU were evaluated by calculating the weighted mean difference, odds ratio and 95% confidence interval. The results indicated that CSU cases with positive ASST responses had higher urticaria activity scores and higher levels of total serum immunoglobulin E than CSU cases with negative responses in the ASST. In addition, a positive ASST response was more likely to be accompanied with the presence of thyroid autoantibodies and angioedema. An increased prevalence of CSU was identified in females, who were more likely to have a positive response in the ASST. It was also indicated that a greater incidence of positive ASST responses was present in CSU patients as compared with that in healthy controls. No statistically significant differences were obtained between positive and negative ASST responses with regard to age and duration of disease. Based on these results, it was concluded that the ASST provides an effective means of predicting urticaria activity and recurrence in CSU patients.

Keywords: angioedema; autologous serum skin test; chronic urticaria; meta-analysis; urticaria activity score.

Figure 1.

Flow diagram depicting the process of the selection of studies for the present meta-analysis. NOS, Newcastle-Ottawa scale.

Figure 2.

Probability of a positive autologous serum skin test response for subjects with chronic spontaneous urticaria vs. healthy controls. Blue square, weight of each study; black diamond, weighted mean difference; horizontal lines, 95% CI of each study; CI, confidence interval; M-H, Mantel-Haentzel; df, degrees of freedom.

Figure 3.

Difference in age between chronic spontaneous urticaria cases with positive vs. negative ASST responses. Green square, weight of each study; black diamond, weighted mean difference; horizontal lines, 95% CI of each study; SD, standard deviation; IV, inverse variance; CI, confidence interval; ASST, autologous serum skin test; df, degrees of freedom.

Figure 4.

Differences in duration of chronic spontaneous urticaria in cases with positive vs. negative ASST responses. Green square, weight of each study; black diamond, weighted mean difference; horizontal lines, 95% CI of each study; SD, standard deviation; IV, inverse variance; CI, confidence interval; ASST, autologous serum skin test; df, degrees of freedom.

Figure 5.

Differences in UAS in chronic spontaneous urticaria cases with positive vs. negative ASST responses. Green square, weight of each study; black diamond, weighted mean difference; horizontal lines, 95% CI of each study; SD, standard deviation; IV, inverse variance; CI, confidence interval; ASST, autologous serum skin test; df, degrees of freedom; UAS, urticaria activity scores.

Figure 6.

Differences in serum total immunoglobulin E levels in chronic spontaneous urticaria cases with positive vs. negative ASST responses. Green square, weight of each study; black diamond, weighted mean difference; horizontal lines, 95% CI of each study; SD, standard deviation; IV, inverse variance; CI, confidence interval; ASST, autologous serum skin test; df, degrees of freedom.

Figure 7.

Probability of the presence of anti-thyroid antibodies in chronic spontaneous urticaria cases with positive vs. negative ASST responses. Blue square, weight of each study; black diamond, weighted mean difference; horizontal lines, 95% CI of each study; M-H, Mantel-Haentzel; CI, confidence interval; ASST, autologous serum skin test; df, degrees of freedom.

Figure 8.

Probability of angioedema in chronic spontaneous urticaria cases with positive vs. negative ASST responses. Blue square, weight of each study; black diamond, weighted mean difference; horizontal lines, 95% CI of each study; M-H, Mantel-Haentzel; CI, confidence interval; ASST, autologous serum skin test; df, degrees of freedom.

Figure 9.

Probability of a positive autologous serum skin test response in males vs. females with chronic spontaneous urticaria. Blue square, weight of each study; black diamond, weighted mean difference; horizontal lines, 95% CI of each study; M-H, Mantel-Haentzel; CI, confidence interval; df, degrees of freedom.

Figure 10.

Funnel plot of studies on anti-thyroid autoantibodies for chronic spontaneous urticaria cases with positive and negative autologous serum skin test responses. OR, odds ratio; SE, standard error; log OR, logarithm of OR.