Evaluation of serum levels of C-reactive protein, D-Dimer and Autologous Serum Skin Test in patients with Chronic Spontaneous Urticaria in a Brazilian tertiary center : a cross-sectional study

Abstract

Background The pathophysiology of urticaria is still poorly understood. Recent studies demonstrate that the activation of coagulation is correlated with the clinical activity of Chronic Spontaneous Urticaria. Coagulation and inflammation are strongly linked. Objectives To correlate the severity and activity of Chronic Spontaneous Urticaria with the levels of D-dimer, C-reactive protein, and autologous serum test in patients with Chronic Spontaneous Urticaria. Methods The study included 55 patients diagnosed with chronic spontaneous urticaria. D-dimer levels were measured using enzyme-linked fluorescent assay and C-reactive protein levels were measured using the nephelometric method; autologous serum testing was performed on patients who discontinued antihistamine therapy. The severity of the disease was assessed using the urticaria activity score. Results patients with severe, spontaneous, and difficult-to-control chronic urticaria had elevated serum levels of D-dimer, as well as a positive autologous serum test. Little correlation was demonstrated between the severity of chronic spontaneous urticaria and the levels of C-reactive protein. Conclusion The authors concluded that patients with severe Chronic Spontaneous Urticaria showed signs of activated fibrinolysis. Most patients with high clinical scores had high D-dimer values. Patients with positive results for the autologous serum test also had more severe Chronic Spontaneous Urticaria and needed more drugs to control the disease. Finally, little correlation was found between C-reactive protein levels and disease severity. Study limitations The main limitation was the small sample of patients. In the present patients, it was demonstrated that serum D-dimer levels and the autologous serum test can act as predictive markers of severity and activity of Chronic Spontaneous Urticaria.

Potential Immunological Biomarkers in Chronic Spontaneous Urticaria Patients Receiving Omalizumab Treatment

“…This activation of platelets is thought to be related to the chemokines IL-8, GROα, and ENA-78 [14]. A few studies have reported that platelet indices such as D-Dimer show signi cant changes in CSU patients in correlation with clinical severity, autoreactivity, and/or in ammatory status [24]. In our data, a decrease in IL-8, GROα, and ENA-78 in correlation with treatment and their correlation with D-dimer value suggest that platelet activation could be more involved in the CSU pathogenesis in cases over 45 years of age.…”

C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians

“…CRP may show divergent values in chronic spontaneous urticaria (median 4.5 mg/L, and approx. 36 mg/L in another study); it can be elevated in 1/3 of cases, and it can also be correlated with treatment efficacy, while other authors have demonstrated that CRP levels were higher in those with a positive autologous serum skin test, concluding that autoimmune urticaria is characterized by low-grade inflammation, while other data have found no association between CRP and the condition [ 463 , 464 , 465 , 466 , 467 ]. Moreover, a study reported a significant association between hsCRP and uremic pruritus in chronic hemodialysis patients [ 468 ].…”

Biomarkers of chronic urticaria: what are their role?

“…It was observed that 32.7% of patients required 3 or more medications to achieve CSU remission during follow-up. 15 CRP is produced by the liver and is a sensitive serum marker of inflammation. It is elevated in several diseases, including infections, neoplasms, autoimmune diseases, cardiovascular diseases, and gastrointestinal diseases.…”

“…Positive ASST is correlated with the presence of IgG anti-FcεRI and IgG anti-IgE antibodies, responsible for type IIb autoimmune CSU (aiCSU), whose diagnostic criteria are as follows: (a) a positive in vitro bioassay demonstrating autoantibody functionality (basophil histamine release assay [BHRA] or basophil activation marker expression, such as CD63 or CD203c by flow cytometry); (b) positive autoreactivity (a positive ASST) demonstrating the in vivo relevance of mast cell degranulation and increased capillary permeability; and (c) a positive immunoassay for autoantibodies against FcεRIα (Western blot or ELISA) demonstrating autoantibody specificity. 25 Positive ASST has been associated with greater disease activity, longer duration, and basopenia, 15,26,27 but further studies are needed. A systematic review of parameters associated with CSU duration and severity found 8 studies demonstrating an association between positive ASST and CSU severity, and 8 studies reporting no association.…”