Allergic sensitization in patients with pruritus sine materia in the absence of a somatic cause
Allergic sensitization in patients with pruritus sine materia in the absence of a somatic cause
Aim: Pruritus sine materia in the absence of a somatic cause is generally attributed to psychogenic factors, but it is also well knownthat psychological stress may affect skin through its impacts on immune response. In this three-year retrospective study we aimedto reveal the allergic sensitization of patients with chronic pruritus without a somatic cause.Material and Methods: Three hundred and sixty five male and female patients with widespread chronic pruritus between 6 and75 years old were retrospectively recruited. In addition to routine hematologic examination, skin prick test and serum total IgEmeasurement were performed on each patient.Results: In cutaneous examination, the patients had no visible manifestation except self excoriations in some, and all had normalvalues in hematologic laboratory examination. Altogether 10% of patients had positive results for both skin prick test and serumtotal IgE, and 42% of patients had positive results for either skin prick test and/or serum total IgE, which may be regarded as apresentation of immediate type hypersensitivity.Conclusion: Considering the quite high positive ratios obtained for both skin prick test and serum total IgE, it may be encouraging toperform these tests routinely on the patients with pruritus sine materia, both for revealing a probable allergic tendency and for betterhandling the treatment modalities.
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- 1. Frese T, Herrmann K, Sandholzer H. Pruritus as reason for encounter in general practice. J Clin Med Res 2011;3:223-9.
- 2. Misery L, Dutray S, Chastaing M, et al. Psychogenic itch. Transl Psychiatry 2018;8:52.
- 3. Yonova D. Pruritus in certain internal diseases. Hippokratia 2007;11:67-71.
- 4. Rubegni P, Poggiali S, Nami N, et al. Skin diseases in geriatric patients: our experience from a public skin outpatient clinic in Siena. G Ital Dermatol Venereol 2012;147:631-6.
- 5. Misery L, Alexandre S, Dutray S, et al. Functional itch disorder or psychogenic pruritus: suggested diagnosis criteria from the French psychodermatology group. Acta Derm Venereol 2007;87:341-4.
- 6. Misery L, Chastaing M. Joint consultation by a psychiatrist and a dermatologist. Dermatol Psychosom 2003;4:160-4.
- 7. Weisshaar E, Fleischer AB, Bernhard JD, Cropley TG. Pruritus and dysesthesia. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd edition. New Haven: Elsevier Saunders; 2012. p.111-25.
- 8. Koblenzer CS. Psychosomatic concepts in dermatology. Arch Dermatol 1983;119:501-12.
- 9. Solomon I, Ilie MA, Draghici C, et al. The impact of lifestyle factors on evolution of atopic dermatitis: an alternative approach. Exp Ther Med 2019;17:1078-84.
- 10. Haahtela T, Burbach GJ, Bachert C, et al. Clinical relevance is associated with allergen specific wheal size in skin prick testing. Clin Exp Allergy 2014;44:407- 16.
- 11. Hostetler SG, Kaffenberger B, Hostetler T, et al. The role of airborne proteins in atopic dermatitis. J Clin Aesthet Dermatol 2010;3:22-31.
- 12. Burbach GJ, Heinzerling LM, Edenharter G, et al. GA(2)LEN skin test study II: clinical relevance of inhalant allergen sensitizations in Europe. Allergy 2009;64:1507-15.
- 13. Hamilton RG. Clinical laboratory assessment of immediate-type hypersensitivity. J Allergy Clin Immunol 2010;125:284-96.
- 14. Droste JH, Kerhof M, de Monchy JG, et al. Associaton of skin test reactivity, specific IgE, total IgE, and eosinophils with nasal symptoms in a communitybased population study. The Dutch ECRHS group. J Allergy Clin Immunol 1996;97:922-32.
- 15. Bener A, Safa W, Abdulhalik S, et al. An analysis of skin prick test reactions in asthmatics in a hot climate and desert environment. Allerg Immunol (Paris) 2002;34:281-6.
- 16. Ramos E, Orea Solano M, Flores Sandoval G, et al. [Correlation between the concentrations of total serum IgE and skin tests]. Rev Alerg Mex 1994;41:94- 7.
- 17. Kerkhof M, Droste JH, de Monchy JG, et al. Distribution of total serum IgE and specific IgE, to common aeroallergens by sex and age, and their relationship to each other in a random sample of the Dutch general population aged 20-70 years. Allergy 1996;51:770-6.
- 18. Settipane RJ, Hagy GW, Settipane GA. Long-term risk factors for developing asthma and allergic rhinitis: a 23-year follow-up study of college students. Allergy Proc 1994;15:21-5.
- 19. Hon KL, Wang SS, Wong WL, et al. Skin prick testing in atopic eczema: atopic to what and at what age. World J Pediatr 2012;8:164-8.
- 20. Barbee RA, Lebowitz MD, Thompson HC, et al. Immediate skin-test reactivity in a general population sample. Ann Intern Med 1976;84:129-33.
- 21. Song WJ, Lee SM, Kim MH, et al. Histamine and allergen skin reactivity in the elderly population: results from the Korean longitudinal study on health and aging. Ann Allergy Asthma Immunol 2011;107:344-52.
- 22. Nam YH, Lee SK. Comparison between skin prick test and serum immunoglobulin E by CAP system to inhalant allergens. Ann Allergy Asthma Immunol 2017;118:608-13.
- 23. Simola M, Holopainene E, Malmberg H. Changes in skin and nasal sensitivity to allergens and the course of rhinitis; a long-term follow-up study. Ann Allergy Asthma Immunol 1999;82:152-6.
- 24. Di Lorenzo G, Leto-Barone MS, La Piana S, et al. Clinical course of rhinitis and changes in vivo and in vitro of allergic parameters in elderly patients: a longterm follow-up study. Clin Exp Med 2013;13:67-73.
- 25. Scichilone N, Callari A, Agugliaro G, et al. The impact of age on prevalence of positive skin prick tests and specific IgE tests. Respir Med 2011;105:651-8.
- 26. Karakaya G, Kalyoncu AF. The natural course of atopy determined by skin prick tests in patients with bronchial asthma and/or rhinitis. Allergol Immunopathol (Madrid) 2006;34:257-62.
- 27. Gergen PJ, Turkeltaub PC, Kovar MG. The prevalence of allergic skin test reactivity to eight common aeroallergens in the US population: results from the second national health and nutrition examination survey. J Allergy Clin Immunol 1987;80:669-79.
- 28. Wüthrich B, Schindler C, Medici TC, et al. IgE levels, atopy markers and hay fever in relation to age, sex and smoking status in a normal adult Swiss population. SAPALDIA (Swiss study on air pollution and lung diseases in adults) team. Int Arch Allergy Immunol 1996;111:396-402.
- 29. Amaral AFS, Newson RB, Abramson MJ, et al. Changes in IgE sensitization and total IgE levels over 20 years of follow-up. J Allergy Clin Immunol 2016;137:1788- 95.