Acute‐phase response in chronic urticaria

Abstract

The patterns of acute-phase response (APR) biomarkers differ upon various inflammatory conditions. Little information is available on the systemic inflammatory response in urticaria/angio-oedema. It has been shown that concentrations of circulating APR biomarkers, IL-6 and C-reactive protein (CRP), are elevated more in severe chronic urticaria (CU) than in patients showing milder urticarial symptoms. It is not clear whether the increase of IL-6 and CRP is merely an epiphenomenon or may contribute to the pathogenesis of CU. It is tempting to speculate that mediators of APR may enhance urticarial inflammation. In addition, there is some association between APR and activation of coagulation/fibrinolysis in CU. It is well known that even slight elevation in CRP baseline concentration is enough to produce significant increase in cardiovascular risk. In this light, one should ask whether CU patients, in particular those showing stronger systemic inflammatory response and long-lasting course are more vulnerable to the cardiovascular events. Apart from highly troublesome symptoms and low quality of life, CU may then involve some remote, serious systemic consequences. Taken together, CU can be identified as a mast cell- and basophil-dependent inflammatory disorder of the skin, which is accompanied by APR. Characterization of APR in CU may appear essential for an insight into the activity of this disease and for assessment of the inflammation degree. Moreover, measurement of these biomarkers might be particularly relevant while assessing CU patients demanding an anti-inflammatory or immunosuppressive therapy. This review summarizes information regarding APR in the course of urticaria/angio-oedema.

Serum C-Reactive Protein, Neutrophil-Lymphocyte Ratio and Uric Acid Levels in Chronic Spontaneous Urticaria

“…So far as this study has found, there is no information in the literature describing whether or not higher CRP and NLR levels in CSU patients are associated with any cardiovascular disease risks. 1 It can still not yet be concluded if CSU is a disease just affecting the skin, or one with systemic comorbidities. To confirm these findings, larger studies are required in the future.…”

“…1 Although systemic inflammation and infiltration of the skin with these inflammatory cells contribute to the development of CSU, little is known about the underlying pathogenic mechanisms.…”

“…Elevated serum CRP levels have already been shown in CSU patients. 1 The neutrophil-lymphocyte ratio (NLR) is a simple hemogram test which is the division of total neutrophil count by the total lymphocyte count. Recently, NLR has been found to be elevated in many inflammatory diseases, such as myocardial infarction (MI), diabetes mellitus (DM), hypertension (HT), ulcerative colitis (UC) and psoriasis.…”

“…Yükselmiş NLO ve CRP değerlerine kronik ürtikere eşlik edebilecek kardiyovasküler komorbiditeler açısından dikkat edilmelidir. 1 The urticaria activity score (UAS), based on the urticarial symptoms of the patient such as wheals and pruritus, is used to evaluate the disease activity. 2 This scoring system depends on the patients' documentations of their symptoms and, therefore lacks objectivity.…”

Coagulation in Chronic Urticaria

“…This might be due in part not only to the presence of an efficient thombolytic system but also to a predominant extravascular location of fibrin deposition, suggesting that the coagulation cascade observed in CSU occurs extravascularly [21]. It has been suggested that patients with long-term CSU, accompanied by systemic inflammation, particularly with raised blood levels of CRP, may have an increased risk of cardiovascular disorders [45] although other observations indicated that the hypercoagulation occurring in CSU and AE is unlikely to be associated with an increased risk of thrombosis, in contrast to patients with acute urticaria [8] or with other skin diseases such as bullous pemphigoid [46].…”