Turkderm-Turk Arch Dermatol Venereol. 2002; 36(1): 24-28

Kronik ürtiker etyopatogenezinde algoritmik yaklaþýmýn pratikte saðladýðý yararlar

Özlem Su¹, Nahide Onsun¹, Ulviye Atýlganoðlu¹, Yasemin Balsever Kural¹, Serkan Aygýn¹, Emel Konuk¹
SSK Vakýf Gureba Hastanesi Deri ve Zührevi Hastalýklar Kliniði

Kronik ürtikerin etyolojisi ve yapýlacak araþtýrmalar halen çok önemli bir problemdir. Büyük grubu oluþturan fizik ürtikerlerin ayýrt edilmesine yönelik uygun "challenge" testler ve fonksiyonel otoantikorlarýn tespitine dayalý otolog serum testi etyolojiyi aydýnlatabilecek yöntemlerdir. Buradan yola çýkarak kronik ürtiker tanýsý alan 88 olguya belli bir algoritmik yaklaþým dahilinde kan, idrar, gayta incelemeleri ve sýk görülen fizik ürtikerler için uygun "challenge" testler uygulandý. Olgularýn 73'ünde (%83,3) fizik ürtiker saptandý. En sýk kolinerjik ürtiker (29 olgu, %39,72) görüldü. Fizik ürtikerli olgularýn 27'sinde (%36,98) birden fazla fizik ürtiker mevcuttu. Tüm olgularýn 38'ine otolog serum testi uygulandý. Yirmidördünde (%63,15) test pozitif idi. Bu sonuçlar fizik uyaranlar ile otoimmun mekanizmanýn kronik ürtiker etyolojisindeki önemini ortaya koyarak, pahalý ve ayrýntýlý araþtýrmalarýn gereksizliðini gösterdi.

Anahtar Kelimeler: Kronik ürtiker, etyopatogenez, algoritmik yaklaþým, pratik yararlar

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Algorhythmic approach to the etiopathogenesis of chronic urticaria: practical benefits

Özlem Su¹, Nahide Onsun¹, Ulviye Atýlganoðlu¹, Yasemin Balsever Kural¹, Serkan Aygýn¹, Emel Konuk¹

Background and Design: Chronic urticaria remains a major problem in terms of etiology and investigation. Physical stimuli and functional autoantibodies are main causes of chronic urticaria. Appropriate challenge tests to identify patient whom physical urticaria and autologous serum skin test to identify patients who have functional autoantibodies are most important tests to show the etiology of chronic urticaria. Materials and Methods: Basic blood, urine and stool examinations and appropriate challenge tests to determine physical urticaria had been performed in 88 patients with
chronic urticaria. The patients associated with angioedema were investigated for the level of C4. The patients who had cholinergic urticaria were examined for atopic dermatitis, allergic asthma, allergic rhinitis and investigated for the level of total IgE /specific IgE. The patients with cold urticaria evaluated for cryoglobulin, cold agglutinin and cryofibrinogen. Autolog serum skin test was performed in 35 patients with chronic urticaria. Results and Conclusion: Challenge tests to determine physical urticaria were positive in 73 (%83,3) of the 88 patients. Cholinergic urticaria was present in 29 (%39,72) of the 73 patients and was the most common of all the physical urticaria. Twenty- seven patients (%36,98) had physical urticaria types concurrently. Autologous serum skin test was positive in 24 (%63,15) of 35 patients with chronic urticaria. We suggest that
physical stimuli and autoimmune antibodies play the most important role in the etiopathogenesis of chronic urticaria.

Keywords: Chronic urticaria, etiopathogenesis, algorhytmic approach, practical benefits

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ATIF KOPYALA