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. 2022 Jan-Feb;67(1):92.
doi: 10.4103/ijd.ijd_851_21.

Chronic Spontaneous Urticaria: An Etiopathogenic Study

Apoorva Maheshwari  1 , Taru Garg  1 , Ram Chander  2 , Ekta Debnath  3
Affiliations

Chronic Spontaneous Urticaria: An Etiopathogenic Study

Apoorva Maheshwari et al. Indian J Dermatol. 2022 Jan-Feb.

Abstract

Importance: Exact etiopathogenesis of chronic spontaneous urticaria (CSU) remains elusive. Infections, pseudoallergens, autoimmunity, and contact sensitization are various postulated factors. Few studies are available measuring cytokine levels in CSU.

Objectives: The aim was to study various etiological factors of CSU and levels of IL-6 and IFN-ϒ in cases and controls, and correlation between various etiologies with the levels of the abovementioned interleukins in the cases.

Design: Case-control study performed over 2 years with no follow-up of the participants.

Setting: It was a referral-center-based study.

Participants: Sixty patients of CSU and equal age and sex-matched healthy controls were recruited on the basis of convenience sampling.

Exposures: Biochemical and hematological investigations with hepatitis serology, thyroid function tests, anti-thyroid antibodies, and levels IL-6 and IFN-ϒ were performed in all cases and controls. All cases were subjected to ASST. Cases with all above negative tests were patch-tested with Indian standard series. Urticaria activity score (UAS7) was calculated for all the cases and repeated in patients with positive etiological factor after 3 weeks (improvement after allergen or drug avoidance, treatment of infection).

Outcomes: To study the various etiological factors (food, infection, autoimmunity, autoreactivity, and contact sensitization) and the levels of IL-6 and IFN- γ in patients of chronic spontaneous urticaria.

Results: Etiology was ascertained in 75% of patients (autoimmunity: 50%, contact sensitization: 21.67%, food and drug allergy: 1.67% each). Mean values of the interleukins and anti-thyroid antibodies were significantly higher in cases versus controls. Levels of IFN-ϒ were significantly elevated in patients with higher UAS7 scores.

Conclusion: Antithyroid antibodies, ASST, and patch testing are important tools and should be considered in patients of CSU after a thorough history and history-based workup. Elevated levels of IL-6 and IFN- ϒ in cases suggest that both Th1 and Th2 type of immune responses are implicated in pathogenesis of CSU.

Keywords: ASST; IFN-gamma; IL-6; UAS7; chronic spontaneous urticaria.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Distribution of etiology on basis of history
Figure 2
Figure 2
Distribution of associated illnesses based on history
Figure 3
Figure 3
Distribution of ASST results
Figure 4
Figure 4
Proportion of various etiological factors after evaluations and investigations
Figure 5
Figure 5
Mean levels of IL-6 in cases as compared to controls
Figure 6
Figure 6
Mean levels of IFN-ϒ in cases as compared to controls
See this image and copyright information in PMC

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