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AND THE ANSWERS ARE . . .

  1. In almost all cases of CIU the urticaria remits completely within 5 years of onset.
    False
  2. There is an increased incidence of thyroid autoimmunity in patients with CIU.
    True
  3. The skin wheals which are prominent in CIU are due to of anti-desmosome antibodies at the dermal-epidermal junction.
    False
  4. In a sizable percentage of patients with CIU the serum contains antibodies which react with the high-affinity IgE. receptor
    True
  5. Cyclosporine treatment frequently controls CIU, which has not responded to anti-histamine therapy.
    True

Discussion
CIU can be quite long lasting, persisting for at least 10 years in 25% of cases. Anti-thyroid antibodies (generally directed against thyroid peroxidase) are present in the serum of about 20% of patients with CIU (vs about 3% in age-matched normal controls). However, most of the CIU patients with anti-thyroid antibodies are euthyroid. It is still debated whether (and how often) thyroxine therapy improves the associated CIU in these euthyroid patients with anti-thyroid antibodies.

In about 30-40% of CIU patients, intradermal injection of autologous serum induces a slightly delayed onset wheal, which resembles an urticaria lesion. Most of such wheal-inducing sera contain antibodies which bind to the alpha chain of the high affinity IgE receptor present mainly on mast cells and basophils. As a result there is liberation of mediators from basophils and mast cells, particularly histamine. Indirect evidence suggests that such antibodies are pathogenic in CIU.

In some patients with CIU, trials of a variety of H1 antihistamines are not sufficiently helpful in controlling the skin manifestations. Several small trials have shown that systemic cyclosporine treatment can often control the CIU in such cases. A recent study showed a similar degree of success during systemic treatment with tacrolimus, another calcineurin inhibitor. However, such therapy is often limited by dose-dependent toxicity.

References
J Allergy Clin Immunol. 2004 ;114:465-74
Br J Dermatol. 2006;154:813-9
Allergy. 2006;61:316-20
Allergy. 2006;61:321-31

 



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