Investigation of the relationship between anti-nuclear antibody profin and positive / negative anti-nuclear antibody response in treatment of patients with biologic agents planned chronic urticaria patients

Aim: The aim of this study was to investigate the positivity of autolog serum skin test (ASST) and anti-nuclear antibody (ANA)in patients with refractory chronic spontaneous urticaria (CSU) who were planned to receive biological agent [Anti-IgE(Omalizumab)]therapy, and to investigate the effect of ANA profile positivity / negativity on the symptoms assessed after the treatment by using urticaria activity score (UAS). Material and Method: One hundered patients (28 male and 72 female) with CSUfollowed by outpatient clinic of Celal Bayar University, Allergy and Immunology Division were included to the study according to the current guidelines of EAACI / GALEN / DF / WAO whose treatment were planned to switch to omalizumab as the result of in sufficient remission with quadrupled dose of antihistaminic treatment. Autolog serum skin test and ANA tests were performed before omalizumab treatment. ANA profiles were also performed from the blood serum of the patients who were positive for ANA test. Patients' response to the treatment was evaluated by comparing the UASs at the beginning of the study and after 6 months of treatment. Results: The mean age of the patients was 38.9(18-71) years.The mean initial UAS of all patients was 37.25 ± 6.59 and after 6 months of omalizumab treatment mean UAS was 10.55 ± 10.07. There was a statistically significant difference between pre- and post-treatment UASs by using t-test (p <0.001). 44 patients were ASST positive and 56 patients were ASST negative. Anti-nuclear antibody test was positive in 14 of 44 patients with positive ASST and in 16 of 56 patients with negative ASST. There was no statistical significance between ASST positivity/negativity together with ANA positivity (p = 0.273). Anti-nuclear antibody profile distribution were determined 9.9% Anti-SS-A, 3.3% Anti-SS-B, 6.6% Anti-Ro-52, 3.3% CENP-B, 3.3% Anti ds-DNA, 3.3% Anti-Histone, 3.3% Anti-nRNP / SM, 6.6% Anti ribosomal P-protein, 3.3% Anti AMA M2 40% Anti DFS70 in ANA positive CSU patients. Other antibody tests of ANA profilewereresulted negative. There were no significant correlations between evaluation of UASs of 12 patients with anti-DFS70 positivity before and after treatment. Since there were not enough positive cases in other ANA profiles, the response could not be evaluated after treatment. Urticaria activity scores of ASST positive (44%) patients were significantly higher than ASST negative (56%) patients. (p=0.006, p=0.0012). UASs of ANA positive (30%) patients were compared to patients with negative ANA (70%), no significant difference was found (p=0.565, p=0. 370). Conclusion: Symptoms of ASST positive patients with CSU were more severe before treatment and more resistant to treatment. There was no correlation between ANA positivity and post-treatment response. In patients with CSU, ASST may be recommended as a predictor of the treatment response. Keywords: Chronic spontaneous urticaria, Autologous serum skin test, Anti-nuclear antibody, ANA profile