Evaluation of D-dimer serum levels among patients with chronic urticaria, psoriasis and urticarial vasculitis

Anais Brasileiros de Dermatologia

Print version ISSN 0365-0596

An. Bras. Dermatol. vol.88 no.3 Rio de Janeiro May/June 2013

http://dx.doi.org/10.1590/abd1806-4841.20131532 

INVESTIGATION

Evaluation of D-dimer serum levels among patients with chronic urticaria, psoriasis and urticarial vasculitis*

Paulo Ricardo Criado1, Lidi Che Leon Antinori2, Celina Wakisaka Maruta3, Vitor Manoel Silva dos Reis4

¹ Doctor in Science (Dermatology), Department of Dermatology, School of Medicine, Sao Paulo University (USP) - Physician, Division of Dermatology, Hospital das Clínicas (HC-FMUSP) - Sao Paulo (SP), Brazil.

Division of Dermatology, Hospital das Clínicas, Sao Paulo, SP, Brazil

² Physician, Medical foreign trainee, Division of Dermatology, Hospital das Clínicas (HC-FMUSP) - Sao Paulo (SP), Brazil.

³ Doctor in Dermatology, Department of Dermatology, School of Medicine, Sao Paulo University (USP) - Professor of Dermatology, Department of Dermatology, School of Medicine, Sao Paulo University (USP) - Sao Paulo, Brazil.

⁴ Full Professor (Habilitation) at the Department of Dermatology, School of Medicine, Sao Paulo University (USP) - Physician, Division of Dermatology, Hospital das Clínicas (HC-FMUSP) - Sao Paulo (SP), Brazil.

Division of Dermatology, Hospital das Clínicas, Sao Paulo, SP, Brazil

ABSTRACT

BACKGROUND:

It has been demonstrated that neutrophils, eosinophils and monocytes, under appropriated stimulus, may express tissue factor and therefore, activate the extrinsic pathway of coagulation. We performed a transversal and case-control study of patients with chronic urticaria and patients with psoriasis, in our outpatient clinic to evaluate the production of D-dimer.

OBJECTIVE:

To evaluate D-dimer serum levels in patients with chronic urticaria and its possible correlation with disease activity.

PATIENTS AND METHODS:

The study was conducted from October 2010 until March 2011. We selected 37 consecutive patients from our Allergy Unit and Psoriasis Unit, and divided them into three groups for statistical analysis: (i) 12 patients with active chronic urticaria (CU); (ii) 10 patients with chronic urticaria under remission and (iii) 15 patients with psoriasis (a disease with skin inflammatory infiltrate constituted by neutrophils, lymphocytes and monocytes). Another five patients with urticarial vasculitis were allocated in our study, but not included in statistical analysis. The serum levels of D-dimer were measured by Enzyme Linked Fluorescent Assay (ELFA), and the result units were given in ng/ml FEU.

RESULTS:

Patients with active chronic urticaria had the highest serum levels of D-dimer (p<0 .01="" and="" compared="" control="" cu="" group="" p="" patients="" psoriasis="" remission="" the="" to="" under="" when="" with="">

CONCLUSIONS:

Patients with active chronic urticaria have higher serum levels of D-dimer, when compared to patients with chronic urticaria under remission and patients with psoriasis. We found elevated serum levels of D-dimer among patients with urticarial vasculitis.

Keywords: Angioedema; Psoriasis; Urticaria; Vasculitis; Vasculitis, leukocytoclastic, cutaneous

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A case of idiopathic anaphylaxis followed by acute liver injury.

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Case Report  Open Access

|    Allergy Asthma Immunol Res. 2013 Jul;5(4):245-247. English. Published online 2013 May 07.  http://dx.doi.org/10.4168/aair.2013.5.4.245  Copyright © 2013 The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease A Case of Idiopathic Anaphylaxis Followed by Acute Liver Injury Sujeong Kim, Sun-Young Yoon, So Young Park, Hyouk-Soo Kwon, You Sook Cho, Hee-Bom Moon and Tae-Bum Kim Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.  Correspondence to: Tae-Bum Kim, MD, PhD, Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3287; Fax: +82-2-3010-6969; Email: allergy@medimail.co.kr  Received September 26, 2012; Revised November 27, 2012; Accepted December 04, 2012. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Idiopathic anaphylaxis is characterized by recurrent anaphylaxis without a known trigger. The coexistence of acute liver injury with idiopathic anaphylaxis is rare, even in cases of severe anaphylaxis such as shock. An unusual case involving repeated episodes of anaphylactic shock accompanied by acute liver injury is described here. A 36-year-old woman who experienced anaphylaxis due to an unknown cause was referred to our hospital because of marked elevations in her liver enzyme levels. After a thorough evaluation to determine the cause of the acute liver injury, viral infection, drug use, and autoimmune hepatitis were excluded. The episodes were accompanied by elevated liver enzymes, which suggested that this was a case of anaphylaxis followed by acute liver injury. The patient will have to use self-injectable epinephrine to prevent future hepatic failure. Keywords: Idiopathic anaphylaxis, acute liver injury.

The Rare Case of a Probably True IgE-Mediated Allergy to Local Anaesthetics

Case Reports in Medicine
Volume 2013 (2013), Article ID 201586, 3 pages
http://dx.doi.org/10.1155/2013/201586

Case Report

The Rare Case of a Probably True IgE-Mediated Allergy to Local Anaesthetics

Christina Fellinger, Felix Wantke, Wolfgang Hemmer, Gabriele Sesztak-Greinecker, and Stefan Wöhrl

Floridsdorf Allergy Centre (FAZ), Franz Jonas Platz 8/6, 1210 Vienna, Austria

Received 8 March 2013; Accepted 20 May 2013

Academic Editor: Ting Fan Leung

Copyright © 2013 Christina Fellinger et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The majority of immediate type adverse reactions to local anaesthetics seem to be non-IgE-mediated. We report a case of a 31-year-old woman, who developed conjunctivitis and conjunctival erythema immediately after intrauterine application of a local anaesthetic. Skin prick testing and intradermal testing were done with lidocaine, mepivacaine, and procaine. Intradermal testing showed positive reactions to mepivacaine (1 : 10), undiluted lidocaine, and procaine (1 : 10 and undiluted). Specific IgE could be detected against mepivacaine, but not against latex. Serum tryptase was in the normal range. In order to rule out the exceptional case of a true IgE-mediated reaction, allergy testing with local anaesthetics is still required in the workup of patients.

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Study protocol

Putting health status guided COPD management to the test: protocol of the MARCH study

Janwillem Kocks, Corina de Jong, Marjolein Y Berger, Huib AM Kerstjens and Thys van der Molen

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BMC Pulmonary Medicine 2013, 13:41 doi:10.1186/1471-2466-13-41

Published: 4 July 2013

Abstract (provisional)

Background

Chronic Obstructive Pulmonary Disease (COPD) is a disease state characterized by airflow limitation that is not fully reversible and usually progressive. Current guidelines, among which the Dutch, have so far based their management strategy mainly on lung function impairment as measured by FEV1, while it is well known that FEV1 has a poor correlation with almost all features of COPD that matter to patients. Based on this discrepancy the GOLD 2011 update included symptoms and impact in their treatment algorithm proposal. Health status measures capture both symptoms and impact and could therefore be used as a standardized way to capture the information a doctor could otherwise only collect by careful history taking and recording. We hypothesize that a treatment algorithm that is based on a simple validated 10 item health status questionnaire, the Clinical COPD Questionnaire (CCQ), improves health status (as measured by SGRQ) and classical COPD outcomes like exacerbation frequency, patient satisfaction and health care utilization compared to usual care based on guidelines.

Methods

This hypothesis will be tested in a randomized controlled trial (RCT) following 330 patients for two years. During this period general practitioners will receive treatment advices every four months that are based on the patient's health status (in half of the patients, intervention group) or on lung function (the remaining half of the patients, usual care group).

Discussion

During the design process, the selection of outcomes and the development of the treatment algorithm were challenging. This is discussed in detail in the manuscript to facilitate researchers in designing future studies in this changing field of implementation research.

Trial registration Number: NTR2643

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

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Origins of increased airway smooth muscle mass in asthma

Rachid Berair, Ruth Saunders and Christopher E Brightling^*

• *Corresponding author: Christopher E Brightling ceb17@le.ac.uk

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BMC Medicine 2013, 11:145 doi:10.1186/1741-7015-11-145

Published: 6 June 2013

Abstract

Asthma is characterized by both chronic inflammation and airway remodeling. Remodeling - the structural changes seen in asthmatic airways - is pivotal in the pathogenesis of the disease. Although significant advances have been made recently in understanding the different aspects of airway remodeling, the exact biology governing these changes remains poorly understood. There is broad agreement that, in asthma, increased airway smooth muscle mass, in part due to smooth muscle hyperplasia, is a very significant component of airway remodeling. However, significant debate persists on the origins of these airway smooth muscle cells. In this review article we will explore the natural history of airway remodeling in asthma and we will discuss the possible contribution of progenitors, stem cells and epithelial cells in mesenchymal cell changes, namely airway smooth muscle hyperplasia seen in the asthmatic airways.

Keywords: 

Airway remodeling; Airway smooth muscle; Asthma; Fibrocytes; Mesenchymal stem cells

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Peripheral Blood Eosinophil Counts Predict the Prognosis of Drug Eruptions

Original Article

Peripheral Blood Eosinophil Counts Predict the Prognosis of Drug Eruptions

J Yang,1 X Yang,2,3 M Li1

1Department of Dermatology, Zhongshan Hospital, Fudan University, Shanghai, China 2Divison of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China 3Institute of Rheumatology, Immunology and Allergy, Fudan University, Shanghai, China

J Investig Allergol Clin Immunol 2013; Vol. 23(4): 248-255

Abstract Background: Previous studies indicated that eosinophils infiltrate the skin during drug eruptions and that counts may become elevated in circulation. However, little is known about the role of eosinophils in the prognosis of patients with drug eruption. Objective: This study aims to investigate the correlation between circulating eosinophil counts and the prognosis of patients with drug eruption. Methods: A total of 113 patients were enrolled in this study. Clinical features, peripheral blood eosinophil counts, and liver function were analyzed in patients and controls. Results: Our study indicated that eosinophils changed dynamically in different types of drug eruption and that mean eosinophil counts in patients with erythema multiforme–type drug eruption were significantly higher than in patients with other types of eruption. Most patients with eosinophilia had poor liver function, prolonged corticosteroid use, and extended hospitalization, all of which indicate severe disease. Conclusions: Our data suggest that circulating eosinophil counts were positively correlated with the severity of the drug eruption. Therefore, corticosteroids may be needed to treat patients with eosinophilia in clinical practice. Key words: Drug eruptions. Prognosis. Eosinophils.   Free Full-Text (PDF)   How to use PDF documents

Immunopathogenesis of Allergic Asthma: More Than the Th2 Hypothesis

Review  Open Access

|    Allergy Asthma Immunol Res. 2013 Jul;5(4):189-196. English. Published online 2013 April 12.  http://dx.doi.org/10.4168/aair.2013.5.4.189  Copyright © 2013 The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease Immunopathogenesis of Allergic Asthma: More Than the Th2 Hypothesis You-Me Kim, You-Sun Kim, Seong Gyu Jeon and Yoon-Keun Kim Department of Life Science, Pohang University of Science and Technology (POSTECH), Pohang, Korea.  Correspondence to: Yoon-Keun Kim, MD, PhD, POSTECH Biotech Center, 55 Jigok-ro, Nam-gu, Pohang 790-834, Korea. Tel: +82-54-279-2125; Fax: +82-54-279-8449; Email: juinea@postech.ac.kr  Received September 15, 2012; Accepted October 10, 2012. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Asthma is a chronic obstructive airway disease that involves inflammation of the respiratory tract. Biological contaminants in indoor air can induce innate and adaptive immune responses and inflammation, resulting in asthma pathology. Epidemiologic surveys indicate that the prevalence of asthma is higher in developed countries than in developing countries. The prevalence of asthma in Korea has increased during the last several decades. This increase may be related to changes in housing styles, which result in increased levels of indoor biological contaminants, such as house dust mite-derived allergens and bacterial products such as endotoxin. Different types of inflammation are observed in those suffering from mild-to-moderate asthma compared to those experiencing severe asthma, involving markedly different patterns of inflammatory cells and mediators. As described in this review, these inflammatory profiles are largely determined by the involvement of different T helper cell subsets, which orchestrate the recruitment and activation of inflammatory cells. It is becoming clear that T helper cells other than Th2 cells are involved in the pathogenesis of asthma; specifically, both Th1 and Th17 cells are crucial for the development of neutrophilic inflammation in the airways, which is related to corticosteroid resistance. Development of therapeutics that suppress these immune and inflammatory cells may provide useful asthma treatments in the future. Keywords: Allergic asthma, endotoxin, immunopathogenesis, T helper cell.

In Vitro Methods for Diagnosing Nonimmediate Hypersensitivity Reactions to Drugs

Reviews

In Vitro Methods for Diagnosing Nonimmediate Hypersensitivity Reactions to Drugs

C Mayorga,1 ML Sanz,2 P Gamboa,3 MC Garcia-Aviles,4 J Fernandez,5 MJ Torres,1 on behalf of the Spanish Society of Allergy and Clinical Immunology (SEAIC) Immunology and Drug Allergy Committee

1Allergy Service, Carlos Haya Hospital, Malaga, Spain 2Department of Allergology and Clinical Immunology, Navarra University Clinic, Pamplona, Spain 3Allergy Service, Basurto Hospital, Bilbao, Spain 4Allergy Service, Moncloa Hospital, Madrid, Spain 5Allergy Service, Alicante General Hospital, Alicante, Spain

J Investig Allergol Clin Immunol 2013; Vol. 23(4): 213-225

Abstract Nonimmediate drug hypersensitivity reactions (DHRs) are difficult to manage in daily clinical practice, mainly owing to their heterogeneous clinical manifestations and the lack of selective biological markers. In vitro methods are necessary to establish a diagnosis, especially given the low sensitivity of skin tests and the inherent risks of drug provocation testing. In vitro evaluation of nonimmediate DHRs must include approaches that can be applied during the different phases of the reaction. During the acute phase, monitoring markers in both skin and peripheral blood helps to discriminate between immediate and nonimmediate DHRs with cutaneous responses and to distinguish between reactions that, although they present similar clinical symptoms, are produced by different immunological mechanisms and therefore have a different treatment and prognosis. During the resolution phase, in vitro testing is used to detect the response of T cells to drug stimulation; however, this approach has certain limitations, such as the lack of validated studies assessing sensitivity. Moreover, in vitro tests indicate an immune response that is not always related to a DHR. In this review, members of the Immunology and Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC) provide an overview of the most widely used in vitro tests for evaluating nonimmediate DHRs. Key words: Nonimmediate. Drug hypersensitivity. Diagnosis. Lymphocyte. In vitro.   Free Full-Text (PDF) Continual Medical Education   How to use PDF documents