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Autologous serum therapy benefits chronic spontaneous urticaria

Presented by
Dr Akash Agarwal, IMS and SUM Hospital Bhubaneswar, India
ICD 2021
Autologous serum therapy (AST) is a promising therapy for the treatment of urticaria that does not respond to antihistaminic treatment. The current study showed that it is effective and safe in children. Moreover, it reduces the pill burden and improves the quality of life.

Chronic urticaria is an allergic condition of the skin causing itchy wheals and is mostly spontaneous in onset. Treatment includes long-term antihistaminic therapy, but insufficient response or non-response can occur. For that reason, Dr Akash Agarwal (IMS and SUM Hospital Bhubaneswar, India) conducted a prospective, open-label, pilot study to determine the efficacy and safety of AST in paediatric patients with chronic spontaneous urticaria (CSU) [1].

Children aged between 6 and 16 years old were included when diagnosed with CSU and when itching and wheals occurred daily or nearly daily for more than 3 times per week for more than 6 weeks. Clinical and demographical characteristics were extracted from medical records. Autologous serum skin test (ASST) was performed at baseline to control for autoreactive urticaria (AU). AST was given, every 2 weeks for a total of 8 visits, together with levocetrizine (5 mg) on an on-demand basis. The primary efficacy outcome was urticaria activity score (UAS) and a secondary efficacy outcome was pill burden.

Included were 22 patients: 14 patients in the ASST positive group, and 8 patients in the ASST negative group. The mean age of the patients included was 12.2 ± 2.3 years with a mean chronic urticaria duration of 6.7 ± 2.0 months. Significant improvement of UAS was seen in the period of time between the 5th visit and the 8th visit (median UAS 9.5 vs 2; P<0.0001). ASST-positive patients showed fewer months of chronic urticaria than ASST-negative patients (6.2 ± 2.1 vs 7.8 ± 1.4; P=0.085). Pill burden was significantly decreased (p-value not mentioned). No adverse events were reported and laboratory parameters at baseline and final visit were comparable.

This first pilot study exploring efficacy and safety of AST concluded that 2-weekly AST could be a feasible option for children with CSU who do not respond to antihistaminic therapy. AST seemed to be safe and associated with decreased pill burden. Limitations of the study were a lack of control group and lack of follow-up.

    1. Agarwal A, et al. Efficacy and safety of autologous serum therapy in chronic spontaneous urticaria in the paediatric population: a prospective, open label, pilot study. Abstract 177, ICD 2021, 10–13 November 2021.

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