الفهرس | Only 14 pages are availabe for public view |
Abstract Chronic urticaria is a common disorder presenting as cutaneous wheals with or without angioedema for more than 6 weeks, caused by release of vasoactive mediators from mast cells within the dermis, occurring on a continuous or recurrent basis over prolonged periods of time. The majority of patients have no definable underlying disease or specific physical precipitants, and can be termed ’chronic idiopathic urticaria’ (CIU). The etiology and pathogenesis of chronic idiopathic urticaria are poorly understood. However, in 30–50% of cases, autoimmune processes have been suggested as causative factors. It has been reported that mast cells may show profibrinolytic activity. Extensive evidence suggests that, abnormalities in sex hormones metabolism and/or secretion may modulate activity of some immunologic diseases. Dehydroepiandrosterone sulfate (DHEA-S) and prolactin exert multiple immunomodulatory effects and their circulating levels change in a contrasting manner in the course of some immune-inflammatory diseases. It was found that DHEA-S levels are lower in patients suffering from chronic idiopathic urticaria compared to normal controls, whereas only some scarce information is available on the prolactin levels in these patients. Whether the changes in the level of these hormones in CIU is a cause or a result is still debatable. In our study, the role of DHEA-S and prolactin was evaluated by estimating the plasma level of these two hormones in patients with CIU in correlation with disease severity. Sixty female patients with CIU were diagnosed by disease history, clinical picture and investigations to exclude any other possible causes of CU. Patients were divided into 2 groups based on their autologous serum skin test (ASST) results into 30 patients with positive ASST(ASST+ve) and 30 patients with negative ASST(ASST -ve). Thirty apparently healthy subjects group matched for age were included as controls. At presentation, all patients were subjected to full history taking, full general examination, as well as estimation of DHEA-S and Prolactin using the commercially available ELISA kits. Age was comparable between the 3 study groups with no significant difference between them. Disease duration was comparable between ASST +ve and ASST – ve patients with CIU, with no significant difference between them. However, CIU patients with a positive ASST reaction showed a significantly greater degree of disease severity than those with a negative ASST reaction. There was a highly significant difference in levels of DHEA-S across the 3 study groups. DHEA-S was significantly higher among controls than among CIU patients with positive or negative ASST reactions. However, there was no significant difference in DHEA-S levels between CIU patients with a positive ASST reaction and those with a negative ASST reaction. DHEA-S levels did not differ significantly according to the severity of disease among any group. DHEA-S levels were significantly and inversely correlated with age among all CIU patients combined, and among ASST +ve CIU patients, but not among ASST -ve CIU patients or controls. Furthermore, DHEA-S did not correlate significantly with disease duration or prolactin levels among any of the groups. There was no significant difference in levels of prolactin between patients with CIU and controls. Prolactin was significantly higher among CIU patients with a positive ASST reaction than among ASST negative CIU patients and controls. However, there was no significant difference in prolactin levels between CIU patients with a negative ASST reaction and controls. Prolactin levels were significantly associated with disease severity among ASST +ve CIU patients, but not among ASST –ve CIU patients. Prolactin levels showed no significant correlations with age or disease duration among any of the groups. |