PDF(Pubmed)
Abstract：
BACKGROUND: Current classification of chronic urticaria is primarily based on clinical presentation of skin manifestations. Hence, therapeutic treatment is primarily aimed locally for immediate symptom relief. We reason that limiting therapeutic strategies to the skin pathology might be inadequate since cellular activation and inflammation might be triggered remotely.
METHODS: In this series two patients had exhausted all current treatments for recalcitrant urticaria but remained symptomatic. The first case was 26-year-old Caucasian female and the second was 63-year-old African American female. Both cases had frequent breakthrough urticaria requiring frequent pulsating courses of prednisone to control urticaria despite treatment with omalizumab and antihistamines. When inflammatory airway disease was discovered and managed with inhaled corticosteroid, urticaria is controlled much faster without the need of high dose immunosuppression over several years of observation. Coincidentally, autoimmune thyroiditis and anti-immunogobulin-E immunoglobulin-G titers dropped significantly in one case with sustained inhaled corticosteroid therapy.
CONCLUSIONS: We suggest a novel approach of controlling remote epithelial site inflammation in these two cases that resulted in sustained-control of urticaria symptoms without the need for systemic corticosteroids or immunosuppressant. The changes of autoimmune antibodies might be the consequences of tolerance breaking from chronic lower airway inflammation as observed in other epithelial inflammatory condition like in celiac disease and rheumatoid arthritis.
METHODS: In this series two patients had exhausted all current treatments for recalcitrant urticaria but remained symptomatic. The first case was 26-year-old Caucasian female and the second was 63-year-old African American female. Both cases had frequent breakthrough urticaria requiring frequent pulsating courses of prednisone to control urticaria despite treatment with omalizumab and antihistamines. When inflammatory airway disease was discovered and managed with inhaled corticosteroid, urticaria is controlled much faster without the need of high dose immunosuppression over several years of observation. Coincidentally, autoimmune thyroiditis and anti-immunogobulin-E immunoglobulin-G titers dropped significantly in one case with sustained inhaled corticosteroid therapy.
CONCLUSIONS: We suggest a novel approach of controlling remote epithelial site inflammation in these two cases that resulted in sustained-control of urticaria symptoms without the need for systemic corticosteroids or immunosuppressant. The changes of autoimmune antibodies might be the consequences of tolerance breaking from chronic lower airway inflammation as observed in other epithelial inflammatory condition like in celiac disease and rheumatoid arthritis.
摘要：
背景：目前慢性荨麻疹的分类主要基于皮肤表现的临床表现。因此，治疗性治疗主要针对局部症状的即时缓解。我们认为，将治疗策略限制在皮肤病理学上可能是不够的，因为细胞激活和炎症可能是远程触发的。
方法：在本系列中，两名患者用尽了目前治疗顽固性荨麻疹的所有方法，但仍有症状。第一个病例是26岁的白人女性，第二个病例是63岁的非洲裔美国女性。尽管使用了奥马珠单抗和抗组胺药治疗，但这两种情况下都有频繁的突发性荨麻疹，需要频繁的泼尼松脉冲疗程来控制荨麻疹。当发现炎症性气道疾病并使用吸入性皮质类固醇治疗时，在几年的观察中，无需高剂量免疫抑制即可更快地控制荨麻疹。巧合的是,在持续吸入糖皮质激素治疗的一例中，自身免疫性甲状腺炎和抗免疫球蛋白E免疫球蛋白G滴度显着下降。
结论：我们提出了一种新的方法来控制这两种情况下的远端上皮部位炎症，从而在不需要全身性皮质类固醇或免疫抑制剂的情况下持续控制荨麻疹症状。如在乳糜泻和类风湿性关节炎等其他上皮炎症中观察到的，自身免疫抗体的变化可能是慢性下气道炎症引起的耐受性破坏的后果。
方法：在本系列中，两名患者用尽了目前治疗顽固性荨麻疹的所有方法，但仍有症状。第一个病例是26岁的白人女性，第二个病例是63岁的非洲裔美国女性。尽管使用了奥马珠单抗和抗组胺药治疗，但这两种情况下都有频繁的突发性荨麻疹，需要频繁的泼尼松脉冲疗程来控制荨麻疹。当发现炎症性气道疾病并使用吸入性皮质类固醇治疗时，在几年的观察中，无需高剂量免疫抑制即可更快地控制荨麻疹。巧合的是,在持续吸入糖皮质激素治疗的一例中，自身免疫性甲状腺炎和抗免疫球蛋白E免疫球蛋白G滴度显着下降。
结论：我们提出了一种新的方法来控制这两种情况下的远端上皮部位炎症，从而在不需要全身性皮质类固醇或免疫抑制剂的情况下持续控制荨麻疹症状。如在乳糜泻和类风湿性关节炎等其他上皮炎症中观察到的，自身免疫抗体的变化可能是慢性下气道炎症引起的耐受性破坏的后果。
