Autologous serum injection versus autologous blood in the treatment of chronic autoreactive urticaria

Background A subset of patients with chronic urticaria (CU) has been shown to react to an autologous serum injection (ASI) by a wheal and flare response [autologous serum skin test (ASST)]. Histamine-releasing antibodies directed against IgE and high-affinity IgE receptors (anti-FceRI) have been identified in some of the ASST-positive patients. In an attempt to induce tolerance, treatment with an autologous whole blood (AWB) injection and ASI has been reported to be beneficial in ASST-positive patients. Objectives To confirm and compare the efficacy of AWB and ASI among ASST-positive CU patients. Patients and methods Sixty-eight CU patients were recruited. Thirty patients (44.12%) were found to be ASST positive and were divided into two groups, 15 patients each. Group I received AWB, whereas group II received ASI. The treatment was performed weekly for a total of 8 weeks. Urticaria total severity score (TSS) was used to evaluate treatment efficacy at baseline, weeks 8, and 12. Results In group I, eight out of 15 patients (53.33%) showed complete remission or had mild urticaria on week 12. Two and five patients still had severe and moderate urticaria, respectively. The mean TSS declined from 15.72 on baseline to 4.8 and 6.2 in weeks 8 and 12, respectively. In group II, nine out of 15 (60%) were cured or had mild urticaria in week 12. Two and four patients still had severe and moderate urticaria, respectively. The mean TSS declined from 15.93 on baseline to 6.87 and 6.2 in weeks 8 and 12, respectively. The decline in the mean TSS from baseline to week 12 was highly significant in both groups. When compared, the percent change of TSS on baseline, week 8 and week 12 was not different among both groups. Conclusion AWB and ASI are effective in controlling urticaria in a significant number of ASSTpositive patients. When compared, both modalities were found to be equally effective.