Diagnosis and Treatment Issues in Chronic Idiopathic Urticaria

Urtikarija je jedna od najčešćih alergijskih bolesti na koži (do 15% populacije). Otprilike trećina bolesnika ima kroničnu idiopatsku urtikariju (CIU) i autoantitijela usmjerena protiv visoko afi nitetnih IgE-receptora ili rjeđe protiv IgE. U svezi s tim autoantitijelima u CIU postoje neriješeni problemi. Zbog toga nije razjašnjeno može li se CIU s autoantitijelima klasifi cirati kao autoimunosna bolest. Utvrđivanje autoantitijela u bolesnika s CIU je izazov. Metoda in vivo, kožni test autolognim serumom osjetljiv je i specifi čan. U njemu se rabi in vitro otpušten histamin iz bazofi la. Od dijagnostičkih postupaka važno je istaknuti dokaz H. pylori, pozitivnu stolicu na kandidu i pozitivna antitiroidna antitijela. U liječenju CIU važni su eliminacijska ili hipoalergena dijeta, antihistaminici (sedirajući i nesedirajući), triciklički antidepresiv (doksepin), dapson i pentoksifi lin u kombinaciji, azatioprin, metotreksat, leukotrienski antagonisti (npr. montelukast), sulfasalazin, ciklosporin, PUVA-terapija, plazmafereza, imunoglobulini, kumarin, monoklonska antitijela usmjerena na CD20-antigene (rituksimab i omalizumab).Urticaria is one of the most frequent allergic skin diseases (up to 15% of population). Approximately one third of patients with chronic idiopathic urticaria (CIU) have autoantibodies directed against either the high-affi nity IgE receptor or, less frequently, against IgE. However, there are several unsolved problems relating to the role of such autoantibodies in the disease. Additionally, it is not clear whether CIU with autoantibodies can be classifi ed as an autoimmune disease. The detection of patients with autoantibodies also poses challenges. The in vivo method, the autologous serum skin test, is at best 80% sensitive and specifi c using in vitro basophil histamine release assays. The H. pylori assay, Candida-positive stool culture, and antithyroid antibodies are important diagnostic methods. The important elements of the CIU treatment include elimination and hypoallergenic diet, antihistamines (sedative and not sedative), tricyclic antidepressants (doxepin), dapson and pentoxifylline in combination, azathioprine, methotrexate, leukotriene antagonists (e.g. montelukast), sulphasalazine, cyclosporine, PUVA therapy, plasmapheresis, immunoglobulins, coumarin, and monoclonal antibodies against CD 20 antigens (rituximab and omalizumab)