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Title: Clinical and biochemical distant observation in patients with skin type of aspirin hypersensitive reaction

Abstract:

Introduction: Aspirin-induced urticaria (AIU) is along with aspirin-induced asthma (AIA), one of the most frequent types of aspirin hypersensivity reactions. The role of cysteinyl leukotrienes and prostaglandin D2 (PGD2) in the aspirin sensitivity reaction was the subject of research in both AIU and AIA. Prostaglandin E2 (PGE2) seems to be of importance in the pathogenesis of aspirin hypersensivity. However, the results of its role in AIA are diverse. Objective: In the present thesis a clinical course of AIU was analyzed during four years of clinical observation and taken twice: oral aspirin challenge tests and laboratory tests (LTE4 i PGD2-M in urine). The point of interest was also to find if aspirin has an impact on systemic PGE2 production in AIU. Methods: The study was performed in 22 AIU patients. The study was divided into two parts. In the first part: on the basis of control appointments and questionnaires the beginnings of acetyl salicylic acid (ASA) hypersensivity was analyzed and clinical observation of AIU (2002-2006) was conducted. In the second part: (in 2006) an aspirin oral challenge test was performed once again. Urine for LTE4, PGD2 and PGE2 metabolites was collected at baseline; at the time of the end of the challenge and 2 and 4 hrs later. Moreover, base levels of urinary PGE2 - metabolite was evaluated in 22 healthy volunteers. For the assessment of the severity of skin eruptions two scores (PASI and USI) were used. Results: The first aspirin hypersensivity reaction in AIU patients was preceded by using ASA or non-steroidal anti-inflammatory drugs (NSAIDS) for a few years and urticaria type skin eruptions. No patients used these drugs during 4 years of observation, half underwent an eliminative diet. The frequency and severity of spontaneous urticarias has decreased as a result. 14 of 22 patients (63,6 %) (AIU++) produced a positive aspirin oral challenge test once again. The severity of their skin eruptions (PASImax) as assessed in 2006 was lower than in 2002. 8 patients (36,4 %) (AIU+-) produced a negative aspirin oral challenge test. The mean LTE4 concentrations in urine did not differ between placebo and ASA in the AIU group and there was no change in LTE4 concentrations after ASA. There was a tendency for increased urinary LTE4 excretion after aspirin challenge in the AIU++ group. LTE4 levels in urine decreased after placebo and aspirin challenge in AIU+- group. The dose of aspirin had an effect on LTE4 excretion and there was a correlation between LTE4 excretion and maximal intensity of skin eruptions expressed as PASImax. After aspirin challenge PGD2-M concentrations in urine rose significantly in the groups: AIU, AIU++ and AIU+-. The mean PGD2-M concentration in urine after aspirin challenge in 2006 was lower than in 2002. The dose of aspirin had an effect on PGD2-M excretion and there was no correlation between PGD2-M excretion and maximal intensity of skin eruptions expressed as PASImax. Baseline urinary PGE2-M concentrations did not differ between groups: AIU, AIU++, AIU+- and healthy controls. After aspirin challenge PGE2-M concentrations in urine decreased significantly irrespectively of aspirin challenge results. Conclusion: Aspirin hypersensivity manifests as only skin symptoms in patients with chronic idiopathic urticaria and is characterized by fluctuations. Nevertheless, aspirin hypersensivity is still observed in around 2/3 patients after four years follow-up. The persistence of aspirin hypersensivity is determined by the degree of its intensity. Those patients who react lively even after small doses of aspirin have the highest probability of a persistent reaction during four years. The LTE4 concentration in urine after the aspirin challenge is increased almost significantly higher (p) than the baseline values in AIU patients. There is correlation between the LTE4 concentration in urine after aspirin challenge and intensity of skin eruptions expressed as PASImax. ; Measurement of PGD2-M concentration in urine does not differentiate the patient’s response to aspirin. Aspirin decreases systemic PGE2 production in aspirin-induced urticaria, independent of the result of the aspirin challenge test.

Level of degree:

2 - studia doktoranckie

Degree discipline:

alergologia ; dermatologia

Degree grantor:

Wydział Lekarski

Promoter:

Lucyna Mastalerz

Date issued:

2007

Format:

application/pdf

Identifier:

oai:dl.cm-uj.krakow.pl:993

Call number:

ZB-107470

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Access rights:

tylko w bibliotece

Location of original object:

Biblioteka Medyczna Uniwersytetu Jagiellońskiego - Collegium Medicum

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Last modified:

Jun 25, 2019

In our library since:

Nov 21, 2012

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All available object's versions:

http://dl.cm-uj.krakow.pl:8080/publication/993

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