Title : Comparative study of injection autologous serum therapy (AST) and histamine-immunoglobulin E (IgE) therapy in patients with chronic idiopathic urticaria

Background: Chronic Idiopathic Urticaria (CIU) is a distressing condition characterized by recurrent wheals and pruritus with significant impact on quality of life. Among emerging therapies, Injection Autologous Serum Therapy (AST) and Histamine–Immunoglobulin (HIS–IgE) therapy have shown promising results.

Aim of the study: To compare the efficacy, safety, and durability of response between AST and HIS–IgE therapy in patients with CIU.

Methods: A prospective, comparative study was conducted at the Department of Dermatology and Venereology, Enam Medical College and Hospital and Ibn Sina Diagnostic and Consultation Centre Lalbagh, Dhaka, Bangladesh, enrolling 76 patients with CIU. Patients were equally assigned to receive either AST (n = 38) or HIS–IgE therapy (n = 38). Baseline demographic, clinical, and laboratory data were recorded. Autologous serum therapy was administered using autologous serum in a dose of 3ml IM in gluteus muscle weekly for six weeks then monthly for three months and Histamine-Immunoglobulin Therapy (HIS-IgE) was administered 1 mL intradermal, weekly for three weeks then monthly for three months one booster dosage, one year after first dosage. Primary outcomes included reduction in Urticaria Activity Score over 7 days (UAS7), with ≥50%, ≥75%, and complete response rates. Secondary outcomes included changes in Dermatology Life Quality Index (DLQI), sleep disturbance, rescue medication use, and antihistamine requirements. Safety and durability, including relapse rates at 3 and 6 months, were also evaluated.

Results: Both therapies demonstrated substantial clinical improvement. Although AST showed numerically higher rates of complete response (47.37% vs 36.84%) and ≥75% UAS7 reduction (68.42% vs 57.89%), HIS–IgE therapy exhibited comparable efficacy with consistent improvements across multiple clinical parameters. HIS–IgE showed favorable trends in relapse outcomes, with acceptable relapse rates at 3 months (18.42%) and 6 months (28.95%), and comparable sustained remission (39.47%). Improvements in DLQI, sleep disturbance, and antihistamine use were similar between groups. Adverse events were mild and comparable (18.42% vs 15.79%), indicating good tolerability.

Conclusion: Both AST and HIS–IgE therapies are effective and safe in CIU. Despite slightly higher early response rates with AST, HIS–IgE therapy demonstrated comparable overall efficacy with stable clinical improvement and acceptable durability, making it a viable and potentially preferable alternative in long-term management.

Keywords: Chronic Idiopathic Urticaria, Autologous Serum Therapy, Histamine–Immunoglobulin, UAS7, DLQI, Bangladesh

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