Activation of coagulation in chronic urticaria in relation to disease severity and activity

Farres, Mohamed Nazmy; Refaat, Maged; Melek, Nermine A; Ahmed, Eman A.; Shamseldine, M.G.; Arafa, Naglaa

doi:10.1016/j.aller.2014.04.002

Cited by 24 publications

(21 citation statements)

References 31 publications

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“…observed an increase in prothrombin fragment 1 + 2, D‐dimer and CRP in patients with CSU and proposed that these markers correlate with disease severity. The activation of coagulation/fibrinolysis in patients with CU parallels disease activity and decreases during remission . These findings should prompt further studies that aim to investigate the predictive value of these markers for CSU severity and prognosis.…”

Section: Resultsmentioning

confidence: 91%

“…The activation of coagulation/ 89 75 ASST positivity is a significant predictor of better response to treatment fibrinolysis in patients with CU parallels disease activity 72,74 and decreases during remission. 72,75 These findings should prompt further studies that aim to investigate the predictive value of these markers for CSU severity and prognosis.…”

Section: Laboratory Markers Of Severity and Prognosismentioning

confidence: 99%

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Factors linked to disease severity and time to remission in patients with chronic spontaneous urticaria

Sánchez‐Borges

Caballero‐Fonseca

Capriles‐Hulett

et al. 2017

Acad Dermatol Venereol

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Biomarkers useful for the evaluation and management of patients with chronic spontaneous urticaria (CSU) are not currently available. A review of various clinical and laboratory markers that have been studied to assess their value for determining the severity or predicting the evolution of disease in adult patients with CSU was carried out. A search of the medical literature on PubMed and MEDLINE including the terms urticaria, chronic urticaria, chronic idiopathic urticaria, CSU, severity, prognosis and treatment was performed. Based on our review of the literature, among the clinical markers studied, higher age at onset, being female, long disease duration and aspirin/NSAID hypersensitivity may be linked to both severe CSU and a long time to spontaneous remission. In addition, a positive autologous serum skin test (ASST) may be associated with severe CSU, and comorbidity of inducible urticaria and concomitant recurrent angio-oedema may be linked to longer CSU duration. Potential biomarkers of CSU severity and/or duration include basophil numbers and susceptibility to activation, inflammatory markers, markers of activation of the extrinsic coagulation pathway, immunoglobulin E and vitamin D. Although the described markers are promising, further studies on representative and well-characterized patient populations are needed to determine the value of these clinical and biological markers for predicting the severity and course of disease in patients with CSU.

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Section: Resultsmentioning

confidence: 91%

Section: Laboratory Markers Of Severity and Prognosismentioning

confidence: 99%

Factors linked to disease severity and time to remission in patients with chronic spontaneous urticaria

Sánchez‐Borges

Caballero‐Fonseca

Capriles‐Hulett

et al. 2017

Acad Dermatol Venereol

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“…Such phenomenon, which is clearly associated with disease severity (2), seems to occur via the activation of the extrinsic pathway of the coagulation cascade (1). This finding was confirmed over time by several research groups (3)(4)(5)(6), one of whom also showed that the activation of the extrinsic pathway of the coagulation might in turn activate the intrinsic pathway also, eventually producing a hyper-coagulable pattern (7). The activation of the coagulation / fibrinolysis system is possibly a consequence of the hyper-expression of tissue factor by activated eosinophils (8), although also endothelial cells seem able to play a role in this sense (9).…”

Section: Introductionmentioning

confidence: 79%

Severe CSU and activation of the coagulation/fibrinolysis system: clinical aspects

Asero

2020

Eur Ann Allergy Clin Immunol

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Background. About 50% of patients with severe chronic spontaneous urticaria (CSU) show signs of activation of the coagulation/fibrinolysis system, but the clinical significance of this phenomenon is unclear. Objective. The present study compared patients with severe CSU showing and not showing elevated D-dimer plasma levels. Methods. 132 adult patients (m/f 44/88; mean age 51, 5 years; range 14-89 years) with severe CSU (UAS-7 > 30) were included in a cross-sectional, real life study. The study group was divided based on baseline D-dimer plasma levels, and compared for age, sex, disease duration, disease activity, CRP, thyroid autoimmunity, total IgE, and atopic status. Results. Identical numbers of patients showed elevated and normal D-dimer plasma levels (50% and 50%, respectively). Patients showing elevated D-dimer levels were slightly older (p < 0.05), were more frequently females (p < 0.05), had a longer disease duration (p < 0.01), and had a significantly higher prevalence of elevated PCR (26/66 vs 4/66; p < 0.001). Conclusions. Only 50% of patients with severe CSU show elevated D-dimer plasma levels. The activation of the coagulation/fibrinolysis system is associated with a systemic inflammatory milieu, suggesting the existence of a specific phenotype. Whether this reflects the existence of different endotypes in patients showing and not showing the activation of the coagulation cascade has still to be established. of D-dimer are not predictive of CSU patients' response to the humanized anti-IgE mAb, omalizumab (12), it nonetheless parallels the clinical response to this drug (13). Patients with severe CSU show a detectable activation of the coagulation cascade in about 50% of cases (12). What differentiates patients with severe CSU showing and not showing the activation of the coagulation / fibrinolysis system has not been established so far. The present study compared the clinical features in these two subsets of patients with CSU. Patients and methods Patients This cross-sectional, real life study included 132 patients (m/f 44/88; mean age 51, 5 years; range 14-89 years) with severe CSU (UAS-7 > 30) unresponsive to antihistamine treatment. The study group was divided based on baseline D-dimer plasma levels, which were measured by ELISA and expressed as ng/

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“…The pathogenesis of chronic urticaria involves both the intrinsic and extrinsic coagulation pathway [13,19,20], although the precise underlying pathogenetic mechanisms are largely unknown. It is well established that thrombin enhances vascular permeability, and activates and degranulates mast cells, thus generating anaphylatoxin C5a [21].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Autologous Whole-Blood Injections in Patients with Refractory Chronic Spontaneous Urticaria

Kitsioulis

Xepapadaki

Roussaki-Schulze

et al. 2017

Int Arch Allergy Immunol

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Background: Nonsedating antihistamines are the treatment of choice for chronic spontaneous urticaria (CSU), while omalizumab and immunosuppressants have also been approved as an add-on treatment. Autologous whole-blood injection (AWBI) has been used in previous studies with ambiguous results. The aim of our study was to evaluatechanges in the Urticaria Activity Score (UAS7), Dermatology Life Quality Index (DLQI), and Chronic Urticaria Quality of Life (CU-Q₂oL) score, and also the association of serologic markers with disease severity measures after AWBI. Methods: In this observational study, AWBIs were performed (8 courses on a weekly basis) in adults with refractory CSU, who refused an add-on treatment with either omalizumab or immunosuppressants. UAS7, DLQI, and CU-Q₂oL questionnaires and serum concentrations of total IgE, C-reactive protein (CRP), and D-dimer were evaluated before and after the intervention. Results: Nineteen patients (12 females; mean age 54 ± 20.8 years) completed the protocol. Following AWBI, significant improvements in the UAS7 (34.26 ± 8.04 vs. 12.52 ± 10.83, p < 0.001), DLQI (11.63 ± 5.51 vs. 3.47 ± 2.85, p < 0.001), and CU-Q₂oL score (32.97 ± 18.71 vs. 10.94 ± 7.71, p < 0.001) were recorded. A negative correlation between the baseline D-dimer levels and UAS7 and DLQI variations (p = 0.002 and p = 0.001, respectively) was noted. D-dimer levels ≥292 ng/mL have been associated with poor responsiveness (sensitivity 75%; specificity 83.3%). No correlation with either total immunoglobulin E or CRP levels was observed. Conclusion: AWBI appears to be a safe, alternative, add-on therapeutic option in refractory CSU, particularly in patients with low plasma levels of D-dimer.

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Activation of coagulation in chronic urticaria in relation to disease severity and activity

Cited by 24 publications

References 31 publications

Factors linked to disease severity and time to remission in patients with chronic spontaneous urticaria

Factors linked to disease severity and time to remission in patients with chronic spontaneous urticaria

Severe CSU and activation of the coagulation/fibrinolysis system: clinical aspects

Effectiveness of Autologous Whole-Blood Injections in Patients with Refractory Chronic Spontaneous Urticaria

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