PDF(Pubmed)
Abstract：
BACKGROUND: Panic disorder and panic attacks are two of the most common problems in psychiatry. A psychoimmunological correlation between allergic diseases and panic disorder has been strongly suggested. Histamine H1 receptor antagonists have been suggested as alternative drugs for the treatment of panic disorder. Chronic spontaneous urticaria (CSU) and panic disorder improved simultaneously with selective serotonin reuptake inhibitor antidepressants. Panic disorder has also been treated with the antihistamine chlorpheniramine. The immunoglobulin/histamine complex is a histamine-fixed immunoglobulin preparation that was reported to be effective in treating CSU. This case report describes the successful treatment of a patient with concomitant panic disorder and CSU for 23 years using immunoglobulin/histamine complex therapy.
METHODS: This report describes a 52-year-old female Korean patient who suffered from CSU with panic disorder for 23 years. Basic allergy tests (blood tests and skin prick tests) were conducted before and after treatment for the evaluation of allergic conditions. A multiple allergosorbent test (MAST) for the detection of allergen-specific IgE levels was also performed. The clinical severity of CSU was evaluated using the urticaria severity score system. Diagnostic interviews systematically assessed the diagnostic criteria outlined by the DSM-V, and the patient was evaluated before, during and after treatment using the Beck Depression Inventory (BDI-2) for depression, the State-Trait Anxiety Inventory (STAI) for anxiety and the Beck Hopelessness Score (BHS) for hopelessness. The patient received 2 ml of Histobulin™ (12 mg human immunoglobulin/0.15 µg histamine complex) once a week by subcutaneous injection for the treatment of CSU. Initial improvement of CSU was achieved after the third injection. After the twenty-seventh injection of Histobulin™, she showed no symptoms or signs and ceased allergic medication use. With the remission of CSU, allergic rhinitis was also completely resolved. The frequency of the common cold was significantly decreased during and after treatment. The medication frequency and development of clinical manifestations of panic disorder changed in parallel with the clinical severity of CSU. Moreover, the patient exhibited no clinical manifestations and ceased medication for panic disorder and sleeping pills for insomnia simultaneously with the remission of CSU. In the psychological evaluation, the BDI, STAI and BHS scores improved accordingly.
CONCLUSIONS: The immunoglobulin/histamine complex was effective in treating CSU and concomitant panic disorder in this patient and could be effective in treating some types of panic disorder. Considering the mechanisms of action of histamine and the immunoglobulin/histamine complex together with the patient\'s clinical progress, histamine seemed to be related to panic disorder in this case. The concept of histamine-mediated syndromes, including allergies and psychiatric disorders, shows that a wider disease identity may be needed. Further studies on the immunopathogenesis of panic disorder and the mechanisms of action of the immunoglobulin/histamine complex are necessary.
METHODS: This report describes a 52-year-old female Korean patient who suffered from CSU with panic disorder for 23 years. Basic allergy tests (blood tests and skin prick tests) were conducted before and after treatment for the evaluation of allergic conditions. A multiple allergosorbent test (MAST) for the detection of allergen-specific IgE levels was also performed. The clinical severity of CSU was evaluated using the urticaria severity score system. Diagnostic interviews systematically assessed the diagnostic criteria outlined by the DSM-V, and the patient was evaluated before, during and after treatment using the Beck Depression Inventory (BDI-2) for depression, the State-Trait Anxiety Inventory (STAI) for anxiety and the Beck Hopelessness Score (BHS) for hopelessness. The patient received 2 ml of Histobulin™ (12 mg human immunoglobulin/0.15 µg histamine complex) once a week by subcutaneous injection for the treatment of CSU. Initial improvement of CSU was achieved after the third injection. After the twenty-seventh injection of Histobulin™, she showed no symptoms or signs and ceased allergic medication use. With the remission of CSU, allergic rhinitis was also completely resolved. The frequency of the common cold was significantly decreased during and after treatment. The medication frequency and development of clinical manifestations of panic disorder changed in parallel with the clinical severity of CSU. Moreover, the patient exhibited no clinical manifestations and ceased medication for panic disorder and sleeping pills for insomnia simultaneously with the remission of CSU. In the psychological evaluation, the BDI, STAI and BHS scores improved accordingly.
CONCLUSIONS: The immunoglobulin/histamine complex was effective in treating CSU and concomitant panic disorder in this patient and could be effective in treating some types of panic disorder. Considering the mechanisms of action of histamine and the immunoglobulin/histamine complex together with the patient\'s clinical progress, histamine seemed to be related to panic disorder in this case. The concept of histamine-mediated syndromes, including allergies and psychiatric disorders, shows that a wider disease identity may be needed. Further studies on the immunopathogenesis of panic disorder and the mechanisms of action of the immunoglobulin/histamine complex are necessary.
摘要：
背景：恐慌症和惊恐发作是精神病学中最常见的两个问题。已经强烈建议过敏性疾病和恐慌症之间的心理免疫相关性。组胺H1受体拮抗剂已被建议作为治疗惊恐障碍的替代药物。选择性5-羟色胺再摄取抑制剂抗抑郁药同时改善了慢性自发性荨麻疹（CSU）和恐慌症。恐慌症也已经用抗组胺药扑尔敏治疗。免疫球蛋白/组胺复合物是组胺固定的免疫球蛋白制剂，据报道可有效治疗CSU。该病例报告描述了使用免疫球蛋白/组胺复合疗法成功治疗伴有惊恐障碍和CSU的患者23年。
方法：本报告描述了一名52岁的韩国女性患者，患有患有惊恐障碍的CSU长达23年。在治疗前后进行基本的过敏测试（血液测试和皮肤点刺测试），以评估过敏状况。还进行了用于检测变应原特异性IgE水平的多重变应原吸附剂测试(MAST)。使用荨麻疹严重程度评分系统评估CSU的临床严重程度。诊断性访谈系统地评估了DSM-V概述的诊断标准，之前对病人进行了评估，在使用贝克抑郁量表(BDI-2)治疗抑郁症期间和之后，焦虑的状态特质焦虑量表（STAI）和绝望的贝克绝望评分（BHS）。患者通过皮下注射每周一次接受2mlHistobulin™（12mg人免疫球蛋白/0.15μg组胺复合物）治疗CSU。在第三次注射后实现了CSU的初步改善。在第二十七次注射Histobulin™后，她没有表现出症状或体征，并停止使用过敏药物。随着CSU的缓解，过敏性鼻炎也完全解决。治疗期间和治疗后，普通感冒的频率显着降低。惊恐障碍的用药频率和临床表现的发展与CSU的临床严重程度平行。此外，患者没有临床表现，在CSU缓解的同时停止了惊恐障碍药物和失眠安眠药。在心理评估中，BDI,STAI和BHS得分相应提高。
结论：免疫球蛋白/组胺复合物可有效治疗该患者的CSU和伴发惊恐障碍，并可有效治疗某些类型的惊恐障碍。考虑到组胺和免疫球蛋白/组胺复合物的作用机制以及患者的临床进展，在这种情况下，组胺似乎与恐慌症有关。组胺介导综合征的概念，包括过敏和精神疾病，表明可能需要更广泛的疾病身份。对惊恐障碍的免疫发病机制和免疫球蛋白/组胺复合物的作用机制的进一步研究是必要的。
方法：本报告描述了一名52岁的韩国女性患者，患有患有惊恐障碍的CSU长达23年。在治疗前后进行基本的过敏测试（血液测试和皮肤点刺测试），以评估过敏状况。还进行了用于检测变应原特异性IgE水平的多重变应原吸附剂测试(MAST)。使用荨麻疹严重程度评分系统评估CSU的临床严重程度。诊断性访谈系统地评估了DSM-V概述的诊断标准，之前对病人进行了评估，在使用贝克抑郁量表(BDI-2)治疗抑郁症期间和之后，焦虑的状态特质焦虑量表（STAI）和绝望的贝克绝望评分（BHS）。患者通过皮下注射每周一次接受2mlHistobulin™（12mg人免疫球蛋白/0.15μg组胺复合物）治疗CSU。在第三次注射后实现了CSU的初步改善。在第二十七次注射Histobulin™后，她没有表现出症状或体征，并停止使用过敏药物。随着CSU的缓解，过敏性鼻炎也完全解决。治疗期间和治疗后，普通感冒的频率显着降低。惊恐障碍的用药频率和临床表现的发展与CSU的临床严重程度平行。此外，患者没有临床表现，在CSU缓解的同时停止了惊恐障碍药物和失眠安眠药。在心理评估中，BDI,STAI和BHS得分相应提高。
结论：免疫球蛋白/组胺复合物可有效治疗该患者的CSU和伴发惊恐障碍，并可有效治疗某些类型的惊恐障碍。考虑到组胺和免疫球蛋白/组胺复合物的作用机制以及患者的临床进展，在这种情况下，组胺似乎与恐慌症有关。组胺介导综合征的概念，包括过敏和精神疾病，表明可能需要更广泛的疾病身份。对惊恐障碍的免疫发病机制和免疫球蛋白/组胺复合物的作用机制的进一步研究是必要的。
