Responsiveness to autologous sweat and serum in cholinergic urticaria classifies its clinical subtypes
Responsiveness to autologous sweat and serum in cholinergic urticaria classifies its clinical subtypes
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DOI：
10.1016/j.jaci.2005.05.024
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发表时间：
2005-08-01
影响因子：
14.2
通讯作者：
Horikawa, T
中科院分区：
文献类型：
--
作者：
Fukunaga, A;Bito, T;Horikawa, T
背景：有报道称胆碱能性荨麻疹患者对自身汗液有I型过敏；然而，这种疾病的发病机制尚未完全阐明。目的：探讨胆碱能性荨麻疹患者对自体汗液和血清的反应性与临床特征的关系。我们进一步对临床亚型进行了分类，这些亚型通过体内和体外试验的反应性以及它们的临床特征来明确表征。方法：对18例胆碱能性荨麻疹患者进行自体汗液和血清皮内试验。测定了自体汗液诱导的外周血嗜碱性粒细胞组胺释放量。结果：17例胆碱能性荨麻疹患者中，有11例自行稀释汗液皮肤试验阳性反应。在17例患者中，有10例观察到大量由自体嗜碱性粒细胞引起的汗液诱导的组胺释放。15例胆碱能性荨麻疹患者中8例自体血清皮肤试验阳性反应。乙酰胆碱试验后出现卫星轮的6例患者均表现出对汗液过敏。此外，皮疹与毛囊一致的患者对自体血清皮肤试验表现出阳性反应，而与毛囊不一致的患者则没有反应。结论：基于这些发现，我们建议将胆碱能性荨麻疹分为两个不同的亚型。第一种（非滤泡）亚型对自体汗液表现出强烈的阳性反应，对自体血清表现出阴性反应。第二种（滤泡）亚型对自体汗液反应弱，对自体血清反应阳性。
Background: It has been reported that patients with cholinergic urticaria have a type I allergy to autologous sweat; however, the pathogenesis of that disorder has not been fully elucidated. Objective: We investigated the responsiveness to autologous sweat and serum in patients with cholinergic urticaria in relation to their clinical characteristics. We further classified the clinical subtypes that are clearly characterized by responsiveness to in vivo and in vitro tests as well as their clinical features.Methods: Intradermal tests with autologous sweat and serum were performed in 18 patients with cholinergic urticaria. Histamine release from peripheral blood basophils induced by autologous sweat was measured.Results: Eleven of 17 patients with cholinergic urticaria showed positive reactions in skin tests with their own diluted sweat. Substantial amounts of sweat-induced histamine release from autologous basophils were observed in 10 of 17 patients. Eight of 15 patients with cholinergic urticaria showed positive reactions in the autologous serum skin tests. All 6 patients who developed satellite wheals after the acetylcholine test showed hypersensitivity to sweat. Further, patients whose eruptions were coincident with hair follicles showed positive responses to the skin test with autologous serum, whereas patients whose eruptions were not coincident with hair follicles did not.Conclusion: On the basis of these findings, we propose that cholinergic urticaria should be classified into 2 distinct subtypes. The first (nonfollicular) subtype shows strong positive reactions to autologous sweat and negative reactions to autologous serum. The second (follicular) subtype shows weak reactions to autologous sweat and positive reactions to autologous serum.