汗の減感作療法が奏効したコリン性蕁麻疹の1例  [in Japanese] CHOLINERGIC URTICARIA SUCCESSFULLY TREATED BY IMMUNOTHERAPY WITH PARTIALLY PURIFIED SWEAT ANTIGEN  [in Japanese]

24歳,男性.初診1年半前から運動や精神的緊張によって多発する小円形膨疹を主訴に来院した.皮疹は激しい痒みをともなっていた.コリン性蕁麻疹と診断し,種々の抗ヒスタミン薬を投与したが皮疹は改善しなかった.サウナ浴によって同様の皮疹が誘発され,回収した本人の汗による皮内テストで陽性を示した.また健常人および本人の汗から精製した汗抗原で末梢血好塩基球からの著明なヒスタミン遊離が生じ,汗の中の抗原にIgE感作されていることが明らかとなった.本人の汗から回収した抗原による減感作療法を行ったところ皮疹の程度が軽減し,本人のQOLも徐々に改善した.末梢血好塩基球の汗抗原に対するヒスタミン遊離の反応性も経時的に低下し,汗抗原による減感作療法が奏効したと考えられた.

A 24-years-old man was referred to our University Hospital because of one and a half-year history of disabling symptoms related to physical exertion. Multiple small round-shaped wheals with severe itch were induced by exercise, warmth and psychological stress. These symptoms were resistant to histamine Hi-receptor antagonists. Similar eruptions were induced by sauna-bathing, and skin test with autologous sweat showed a flare and wheal reaction. Incubation of his peripheral-blood leukocytes with partially purified sweat antigen evoked marked histamine release, indicating that he has been IgE-sensitized to an antigen(s) in human sweat. Specific immunotherapy using partially purified sweat antigen was performed every other week. Both pruritus and wheals improved gradually, and the reactivity of his peripheral blood leukocytes against sweat antigen decreased as immunotherapy was proceeded. Specific immunotherapy using sweat antigen may be valuable for patients with cholinergic urticaria with type I hypersensitivity to sweat antigen(s).