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Clinical & Experimental Allergy

Autologous serum skin test reactivity in patients with non-allergic asthma


Dr A. Miadonna, Division of Internal Medicine and Respiratory Disease, Ospedale Fatebenefratelli, Corso di Porta Nuova 23, 20121 Milano, Italy.


Background Inflammatory alterations of respiratory airways have been found in patients with non-allergic asthma, but the triggering event has not been defined. An autoimmune activation of inflammatory cells has been hypothesized.

Objective To evaluate whether histamine-releasing factors are present in sera from non-allergic asthmatics.

Methods Twenty-four patients with non-allergic asthma underwent in vivo autologous serum skin test (ASST) and in vitro basophil histamine release assay using autologous basophils as well as basophils from normal donors. Twenty-seven subjects with respiratory allergy and three normal subjects were chosen as control.

Results ASST was positive in 14/24 non-allergic asthmatics (58%) whereas it was negative in all 30 control subjects (P<0.001). The serum of only one ASST-positive patient out of 12 (8.4%) induced in vitro histamine release from autologous basophils. The serum from another ASST-positive patient induced histamine release from membrane IgE-stripped autologous basophils. Sera from either non-allergic asthmatics or from control subjects did not provoke significant histamine release from basophils from three normal donors.

Conclusion Skin reactivity to autologous serum is common among non-allergic asthmatics, indicating the presence of circulating histamine-releasing factors. However, only in a minority of patients in vitro functional evidence of histamine-releasing autoantibodies (anti-FcɛRI or anti-IgE) was obtained. The presence of circulating histamine-releasing factors might contribute to initiation/maintenance of inflammation in respiratory airways of non-allergic asthmatics.

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