CASE STUDY OF CHRONIC URTICARIA PATIENTS ATTENDING OPD IN SKIMS SOURA SRINAGAR KASHMIR

e-ISSN: 2582-5208 International Research Journal of Modernization in Engineering Technology and Science Volume:03/Issue:03/March-2021

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A CASE STUDY OF CHRONIC URTICARIA PATIENTS ATTENDING OPD IN SKIMS SOURA SRINAGAR KASHMIR Naveeda Zehra*1, Pragya Shrivastava*2 *1,2Department

of Life Science, Rabindranath Tagore University Raisen (M.P) India.

ABSTRACT Chronic urticaria is manifest as a widespread, short-lived marks occurring daily or almost daily for at least six weeks and where a major physical cause has been excluded. Chronic Urticaria is immensely disabling in its severe form and can be problematic to treat. According to a statement which has been published in the year of 2017 it was found that urticarial is a common disease in skin having a life time prevalence of 22 percent and point prevalence of 1 percent. The aim of the study is to study the chronic urticaria patients who are attending OPD in SKIMS in Kashmir. This study has taken a sample size of 100 patients out of which 35 were males and 65 were females. The study found that the incidence of chronic uticaria is high in females as compared to males.

Key words: Skin test, Blood test, Autologous serum skin test, Chronic Idiopathic urticaria.

I.

INTRODUCTION

Urticaria has been predictable since the days of Hippocrates. The term dates back to the 18th century, when the stinging and burning was likened to the sting of a nettle (Urtica dioica). chronic urticaria is most commonly termed as a "Cinderella" disease having a capricious course and gives a demoralizing response whenever it is being treated. In order to control it there is not any guaranteed means of controlling attacks. It is very hard to give an appropriate medication, as the situation becomes intermittent and outbreaks also generally clear up without any kind of treatment.

The opinions which goes on changing on pathogenesis and management of urticaria gives a fascinating reflection regarding changing fashions in terms of medical thought (Rook, 1974 and Czarnetzki, 1989). It is a frustrating condition for both the patient and the physician (Krupa et al., 2010). Chronic urticaria is a major problem in terms of aetiology, investigation and management. It is a debilitating skin disease that affects the patient’s quality of life (Godse, 2006). It causes considerable distress and goes for years but mostly it is to be alleviated by appropriate management (Yadav et al., 2006).

Autologous Serum Skin Test (ASST) is an easy, inexpensive investigation in chronic urticaria which helps to classify chronic urticaria into chronic idiopathic urticaria and chronic autoimmune urticaria. Thus, the aim of this study is to identify Chronic autoimmune urticaria amongst the group and study its clinical pattern and association (Ferrer and Kaplan 2007).

II.

METHODOLOGY

Two millilitres of venous blood was taken from the vein and the blood was allowed to undergo clot at room temperature. Serum was separated by centrifugation (2000 rpm for 15-20 minutes). Approximately 0.05 ml of serum was injected intradermally into the volar aspect of the forearm. Usually an equal proportion of normal saline [negative control] and histamine (10 µg/ml) [positive control] is being injected intradermally 3 to 5 cm apart in volar aspect of same forearm. After an interval of 30 minutes Wheal and flare responses are being measured. As erythema is contributed exclusively histamine, omitting histamine control found in patients of dark skin does not modify the result much. wheal is much more relied upon in case of assessment of the ASST result.

III.

RESULT AND DISCUSSION

A sample of 100 patients was taken, out of the total 100 patients, 35 were males and 65 were females (Fig. 1).

The incidence of chronic urticaria was higher in females as compared to males. Chronic urticaria was predominantly seen in the age group of 11to 20years, 21 to 30 years and 31 to 40 years. Only 4 patients (4%) were aged more than 60years. Majority of the ASST positive patients were in the 21 to 30 years age group (34.09%). ASST positively was also common in females. ASST positive patients had significantly frequent and www.irjmets.com

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long lasting attacks, more number of wheals and higher concentration of itching and a higher occurrence of associated systemic symptoms. The results obtained after compiling the data were compared and similar studies were found by (Ferre, 2009 and Vohra et al., 2011). In the present study an attempt is made to identify autoimmune urticaria amongst the group and study the clinical aspects of chronic urticaria. Associated systemic symptoms were present only in 9.09% of ASST positive and 5.3% of ASST negative patients (Fig. 2), as compared to 52% and 37% in ASST positive and negative patients respectively in the study by Vohra et al. 2011. Arthralgia was the most common symptom encountered in our ASST positive patients while the study by Vohra et al. 2011 showed headache and malaise as the predominant symptom. In our ASST negative group patients, headache was more common compared to flushing in the study by Vohra et al. 2011. The systemic symptoms in autoimmune urticaria vary depending on the immune response of the body to autoantibodies. Majority of patients with autoimmune urticaria have a higher mean urticaria score. In the present study, the mean urticaria activity score was 5.11 in ASST positive patients compared to 4.39 in ASST negative patients. This value is higher when compared to the study by Azim et al. 2010 with 4.5 and 3.9 in ASST positive and negative groups respectively. Our values were lower compared to study by Vohra et al. 2011 with 6.13 and 5.13 in ASST positive and negative groups respectively. These differences may be due to the difference in recording the intensity of itching as it is a subjective symptom.

70 60 50 40 30 20 10 0 males

females

Fig. 1: Shows number of Males and females

FIG. 2: SHOWS PERCENTAGE OF POSITIVE AND NEGATIVE PATIENTS.

positive 5.3%

negative

[VALUE]%

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IV.

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CONCLUSION

Chronic urticaria is a therapeutic challenge to the treating physician. ASST cab be used as a simple and less cost effective and decide the treatment strategy for the patient. Autologous serum skin test can be considered as a screening test for autoimmune urticaria. It helps in the identification of a subgroup of patients who are likely to have more severe disease and require more aggressive treatment.

V. [1] [2] [3] [4] [5] [6] [7] [8]

[9]

REFERENCES

Czarnetzki, B.M. (1989). The history of urticaria. Int J Dermatol; 28: 52–7.

Rook, A.J. ( 1974). The historical background. In: Warin RP, Champion RH,eds. Urticaria. London: Saunders,: 1–2.

Krupa, D.S., Ramnane, M. and Rajouria, E.A. (2010). Etiological approach to chronic urticaria. Indian J Dermatol. 55(1):33-8.

Godse, K.V. (2006). Diagnosis of delayed pressure urticaria. Indian J Dermatol Venereol Leprol.72:155-6.

Yadav, S., Upadhyay, A. and Bajaj, A.K. (2006). Chronic urticaria: An overview. Indian J Dermatol ;51:171-7.

Ferrer, M. and Kaplan, A. (2007). Progress and Challenges in the Understanding of Chronic Urticaria.

Allergy, Asthma, and Clinical Immunology,3(1):31.

Ferrer M. (2009). Epidemiology, healthcare, resources, use and clinical features of different types of urticaria. Alergológica. J Investig Allergol Clin Immunol 19(2):21-6.

Vohra, S., Sharma, N.L., Mahajan, V.K. and Shanker, V. (2011). Clinicoepidemiologic features of chronic urticaria in patients having positive versus negative autologous serum skin test. Indian J Dermatol Venereol Leprol. 77:156-9.

Azim, Z.A., Mongy, S.E. and Salem, H. 2010. Autologous Serum Skin Test in Chronic Idiopathic Urticaria: Comparative Study in Patients with Positive versus Negative Test. J Egypt Women Dermatol Soc.7:12933.

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