Autologous Serum Therapy - a Newer Approach in Management of Chronic Urticaria

What Is Urticaria?

• Urticaria is also called hives. These hives can change in size and shape and appear anywhere on the skin.

• They are usually mild or severe and can last from a few minutes to a few days.

• Hives can also be a sign of a serious allergic reaction called anaphylaxis that requires immediate treatment.

• Urticaria that lasts more than six weeks is considered to be a chronic condition that needs long-term treatment.

What Can Be The Signs and Symptoms of Urticaria?

The Signs and symptoms of urticaria may include:

• Pruritis or burning sensation.

• Angioedema.

• Fever.

• Weight loss.

• Joint pain.

• Abdominal pain.

What Are The Types Of Urticaria?

The types of urticaria can be:

• Ordinary urticaria.

• Acute urticaria.

• Chronic urticaria.

• Physical urticaria.

• Urticarial vasculitis.

What Causes Urticaria?

Hives are usually caused due to an immune system reaction. Few causes can be:

• Bug bites.

• Pets, plants, or latex.

• Food dyes, additives, or preservatives.

• Allergy to foods like nuts, eggs, or shellfish.

• Allergy to medications like Ibuprofen or antibiotics.

• Infections, such as a cold or infectious mononucleosis.

• Stress.

What Is Chronic Urticaria?

Chronic urticaria (CU), also called hives, is a disturbing allergic condition of the skin. It occurs as red, itchy welts as a result of a skin reaction. The causes of CU are many like physical, psychological, infective, vasculitic, and idiopathic. It is a transient weal that comes and goes in 6 weeks. The welts vary in size, appear and frequently fade as the reaction runs its course. If the welts are present in the skin for more than 6 weeks and frequently recur over months or years, they are considered chronic hives. It can be very painful and may interfere with sleep and daily activities. Even though it often occurs as a benign condition, it may sometimes be a red flag sign of severe internal disease.

What Are The Aggravating Factors For Chronic Urticaria?

Several aggravating factors can cause chronic urticaria. But still, it can be avoided by simple measures. The physician will identify the aggravating factors with careful history taking. Such triggers factors include,

• Diet, alcohol, drugs, viral infections, local heat and friction, and mental stress.

• Pseudoallergens may be an important cause in some patients. Pseudoallergic reactions to some additives, natural salicylates, and aromatic compounds are almost certainly dose-related because we do not know how much is to be ingested to precipitate an attack.

• Aspirin is the most familiar drug to aggravate urticaria.

• NSAIDs (nonsteroidal anti-inflammatory drugs).

• Overheating and local pressure of belts and clothing.

• Alcohol or caffeine.

• Emotional stress.

• Warm temperature.

What Are The Methods To Manage Chronic Urticaria?

There is no standard method for the treatment of chronic urticaria. The options include:

• Omalizumab.

• Anti-inflammatory.

• Immunosuppressants.

The treatment for chronic urticaria includes taking first generation antihistamines at a maximal dose before restoring to corticosteroids or Cyclosporine. However, corticosteroids and Cyclosporine have their own disadvantages. In order to avoid the various side effects of steroids and the expensiveness of Cyclosporine, there is a cost-effective method with no side effects known as autologous serum therapy. In this therapy, we inject the patient's blood repeatedly at weekly intervals to treat chronic urticaria or use whole blood as a part of treatment.

This therapy is very effective in the treatment of chronic urticaria. This procedure is also widely used to treat various diseases like atopic dermatitis, allergies, chronic inflammation, vascular diseases, osteoarthritis, and various other skin diseases.

What Is Autologous Serum Therapy?

The autologousserum therapy (AST) is a promising treatment for many autoimmune diseases, like chronic urticaria. In the process of AST, the patient's blood is first collected and then centrifuged to produce a serum which is then injected intramuscularly every fortnight for eight weeks.

Mechanism of Action:

AST - Autologous serum therapy works on the principle of inducing desensitization or tolerization to pro-inflammatory signals expressed in the patient's circulation.

Instruments to Be Used in the Procedure:

1. Centrifuge digital machine.

2. Syringe and needle.

3. Vacutainers with 21 gauge needles.

4. ASST (autologous serum skin test).

What Is ASST?

Autologous serum skin testing (ASST) is an investigative test done for autoimmune urticaria, a type of chronic urticaria. It is undertaken in specialist centers for some patients with chronic urticaria. Normal immunoglobulin-E antibodies (IgE) activate IgE receptors (FceRI) on mast cells and basophils.

The autologous serum skin test (ASST) is an in vivo test used to assess autoreactivity. This test involves the intradermal injection of autologous serum into the body. Antihistamines should be stopped at least 2 to 3 days before the test.

Procedure:

In this therapy doctor always takes your written informed consent, and he will collect your blood in a red top vacutainer. Then, he centrifuges (spins) your blood at 3000 revolutions per minute for 10 minutes to separate serum. The freshly prepared serum will be separated in a 5 cc syringe. He will inject 2.5 mL of serum deep intramuscularly in gluteal muscles with the help of a 22 gauge needle at a weekly interval for 9 weeks. Later, it can be given fortnightly for maintenance therapy.

This therapy is gaining popularity because of its cost-effectiveness and not involving various expensive drugs like biologics such as Omalizumab and Cyclosporine.

Conclusion:

In patients with chronic urticaria, autologous serum therapy is a useful adjunct that decreases the pill burden and enhances the quality of life. The effect of nine weekly injections of autologous serum was found to be effective even four months after cessation of therapy. Autoreactive urticaria patients are also benefited from this method, and thus AST finds its place in the therapeutic armamentarium of clinicians treating chronic urticaria. Not considering the autologous skin prick test results, autologous serum therapy showed significant improvement in patients with chronic idiopathic urticaria. AST can, thus, be an effective treatment method for it.