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CORRESPONDENCE
Year : 2020  |  Volume : 65  |  Issue : 1  |  Page : 67-68
Combinatorial assessment of serum inflammation reactants in patients with acute urticaria accompanied by systemic symptoms


1 Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China; Charles Institute of Dermatology, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
2 Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China

Date of Web Publication13-Jan-2020

Correspondence Address:
Shengxiu Liu
Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_286_18

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How to cite this article:
Zeng M, Shen S, Zhang Y, Liu S. Combinatorial assessment of serum inflammation reactants in patients with acute urticaria accompanied by systemic symptoms. Indian J Dermatol 2020;65:67-8

How to cite this URL:
Zeng M, Shen S, Zhang Y, Liu S. Combinatorial assessment of serum inflammation reactants in patients with acute urticaria accompanied by systemic symptoms. Indian J Dermatol [serial online] 2020 [cited 2020 Jan 27];65:67-8. Available from: http://www.e-ijd.org/text.asp?2020/65/1/67/275761




Sir,

Acute urticaria (AU) is a spontaneous mast-cell-driven cutaneous disease accompanied by release of histamine and other cytokines from active mast cells, with occurrence of wheals and/or angioedema and other systemic symptoms of <6 weeks duration. Bacterial infection was considered as one of the causative factors in AU. Procalcitonin (PCT) and interleukin-6 (IL-6) are important biomarkers in the diagnosis or prognosis of bacterial diseases.[1],[2] Our previous study has demonstrated that PCT and IL-6 are critical inflammation markers in the evaluation of bacteria-induced dermatosis.[3] In AU, there are evidences that laryngeal angioedema, acute intestinal, and stomach swelling are medical emergencies requiring prompt assessment and a period of symptomatic therapy. It has always been a challenge to ascertain the pathogenesis during the early disease onset, and plenty of causative factors including the potential allergic exposure, recent infection, history of concurrent medications, and ingestion of foods can induce AU. Data concerned on multiple inflammatory biomarkers in AU are limited. Thereby, we facilely performed combinatorial assessments of serum reactants and immunoglobulin E (IgE) to explore the potential etiology in AU patients with systemic symptoms.

All patients were diagnosed as AU following the EAACI/GA2 LEN/EDF/WAO guideline.[4] After obtaining informed consent, 42 adults and 23 children were enrolled to meet at least two or more of the following clinical presentations (generalized lesions, fever [>38°C], laryngeal angioedema, chest tightness, and abdominal pain) in our study from June to September, 2015. Patients received systemic therapies including anti-histamine, glucocorticoid, and/or antibiotic when necessary for 5–7 days. Data were presented as median (25-75% percentiles). Differences between two variables were analyzed by Mann–Whitney U-test. P< 0.05 was considered significant.

As demonstrated in [Table 1], in both adult and child groups, there were significant elevations of serum D-dimer, PCT, IL-6, C-reactive protein (CRP), and white blood cell count (WBC) levels in the early stage group, with the median value of at least 140% (WBC) and up to about 20-fold change (CRP) of their maximum laboratory reference values. The values of these markers decreased remarkably after treatment. Furthermore, there were significant differences of these biomarkers between fever group and nonfever group during the early stage. These results indicate that D-dimer, PCT, IL-6, CRP, and WBC can be used as crucial biomarkers to monitor the disease severity and activity of AU with systemic symptoms. Whereas, IgE and anti-streptolysin O levels did not differ before and after the treatment as well as between fever and nonfever group, indicating that IgE-mediated allergy and streptococcal infection are less likely to cause the urticaria lesion in this study. Normally, traditional markers of CRP and WBC are not specific for indication of bacterial infections. PCT below 0.1 ng/mL signifies the endpoint of bacterial infection that determines the discontinuation of antibiotic therapy.[5] Consequently, PCT levels help guide the antibiotic administration in our work. Sustained low serum levels of IL-6 have been shown to predict effective therapy.[2] Elevated D-dimer levels suggest that a tissue factor pathway would lead to the activation of coagulation. This combinatorial and comparable study of these serum reactants allows clinicians to monitor the clinical outcome and guide the antibiotic management in AU patients.
Table 1: Values of serum D-dimer, procalcitonin, interleukin-6, C-reactive protein, anti-streptolysin O, white blood cell count and total immunoglobulin E in patients with acute urticaria accompanied by systemic symptoms

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Acknowledgment

This research was supported by the fund for youth of theFirst Affiliated Hospital of Anhui Medical University (2013KJ17, 2013KJ18). We thank Professor Pei Guang Wang for many helpful discussions.

Financial support and sponsorship

The fund for youth of theFirst Affiliated Hospital of Anhui Medical University (2013KJ17, 2013KJ18).

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Lee H. Procalcitonin as a biomarker of infectious diseases. Korean J Intern Med 2013;28:285-91.  Back to cited text no. 1
    
2.
Jekarl DW, Lee SY, Lee J, Park YJ, Kim Y, Park JH, et al. Procalcitonin as a diagnostic marker and IL-6 as a prognostic marker for sepsis. Diagn Microbiol Infect Dis 2013;75:342-7.  Back to cited text no. 2
    
3.
Zeng M, Guo Z, Shen S, Liu S. Value of serum procalcitonin and interleukin-6 in patients with bullous impetigo and staphylococcal scalded skin syndrome. J Dermatol 2014;41:1028-9.  Back to cited text no. 3
    
4.
Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, et al. The EAACI/GA (2) LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria: The 2013 revision and update. Allergy 2014;69:868-87.  Back to cited text no. 4
    
5.
Kopterides P, Siempos II, Tsangaris I, Tsantes A, Armaganidis A. Procalcitonin-guided algorithms of antibiotic therapy in the Intensive Care Unit: A systematic review and meta-analysis of randomized controlled trials. Crit Care Med 2010;38:2229-41.  Back to cited text no. 5
    



 
 
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