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Yavuz Havlucu*, Deniz Yurtman Havlucu**, Serap Öztürkcan**, Arzu Yorgancıoğlu*

ASSESSMENT OF BRONCHOPROVOCATION TEST POSITIVITY AND RESPONSE TO MONTELUKAST THERAPHY IN CHRONIC URTICARIA PATIENTS. Yavuz Havlucu*, Deniz Yurtman Havlucu**, Serap Öztürkcan**, Arzu Yorgancıoğlu* Celal Bayar University Medical Faculty Department Of *Chest Disease and **Dermatology.

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Yavuz Havlucu*, Deniz Yurtman Havlucu**, Serap Öztürkcan**, Arzu Yorgancıoğlu*

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  1. ASSESSMENT OF BRONCHOPROVOCATION TEST POSITIVITY AND RESPONSE TO MONTELUKAST THERAPHY IN CHRONIC URTICARIA PATIENTS Yavuz Havlucu*, Deniz Yurtman Havlucu**, Serap Öztürkcan**, Arzu Yorgancıoğlu* Celal Bayar University Medical Faculty Department Of *Chest Disease and **Dermatology

  2. CLASSIFICATION • Acute urticaria • Chronic urticaria

  3. PATHOGENESIS • Mast cell → Histamine →Leukotriene → Prostaglandin D2 → IL-2, IL-3, IL-4, IL-5, IL-6, IL-8 → Bradykinin → TNF- → ……. Champion RH. Br J Dermatol 1988;119:427-436.

  4. PATHOGENESIS • After antigen stimulation  within first hour (due to mast cell degranulation)  after 11-12 hours (from basophils) Histamine reaches peak level Sabroe RA. Arch Dermatol 1997;133:1003-1008.

  5. PATHOGENESIS • Presence of mast cell in skin without urticarial lesion was shown Sabroe RA. Arch Dermatol 1997;133:1003-1008.

  6. PATHOGENESIS • Exacerbations • Chronicity • Presence of late-phase response • Presence of inflammation in the skin without lesion CHRONIC-SYSTEMIC INFLAMMATION

  7. PURPOSE • To determine the frequency of bronchial hypereactivity in patients with chronic urticaria • To determine the effect of leukotriene receptor antagonists on inflammation seen in patients with chronic urticaria by bronchial provocation test indirectly

  8. MATERIALS AND METHODS • Inclusion Criteria;  Duration of chronic urticaria more than one year  No urticarial exacerbation within two months

  9. MATERIALS AND METHODS • Exclusion Criteria;  Presence of respiratory symptoms and asthma  Abnormal pulmonary function test  Usage of anihistamines and corticosteroid within one month

  10. MATERIALS AND METHODS • Exclusion Criteria;  Presence of any condition that causing methacholine challenge test positivity  Any contrindication to application of methacholine challenge test

  11. MATERIALS AND METHODS • 156 patients • Pulmonary function test → methacholine challenge test • Methacholine challenge test (+) → Montelukast 10 mg/day • After 8 weeks methacholine challenge test was repeated

  12. RESULTS • 48 (30,8%) men, 108 (69,2%) women • Mean age 42,54  13,19 years (18-70) • Duration of disease 6,05  4,33 years (1-25) • 41 (26,3%) methacholine challenge test (+)

  13. RESULTS

  14. RESULTS • Methacholine challenge test (+); mean provocative dose 2,64  3,36 mg/ml (at the beginning) • End of the study → 4,57  4,87 mg/ml

  15. RESULTS • End of the study Provocative dose increased in 30 patients (73,2%) It was same in 11 patients (26,8%)

  16. Asero found that presence of bronchial hyperreactivity was 85% and claimed that it was due to the systemic inflammation Asero R, Madonini E. J Investig Allergol Clin Immunol 2006

  17. Response to the treatment was better in patients under leukotriene receptor antagonist + conventional treatment than patients under only conventional treatment Sanada s. Arch Dermatol Res. 2005 Sep;297(3):134-8. Nettis E. Clin Exp Allergy. 2004 Sep;34(9):1401-7. Sekerel BE. Pediatr Alergy Immunol. 2003;14:212-215. Erbagci Z. Allergy Clin Immunol. 2002 Sep;110(3):484-8. Pacor ML. Clin Exp Allergy. 2001 Oct;31(10):1607-14.

  18. RESULT • Methacholine challenge test can be positive in patients with chronic urticaria

  19. RESULT • Provocative dose can be increased with the medication against leukotrienes in patients with chronic urticaria

  20. RESULT • These may be result of mediators that causing atopy

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