Advanced Biomarkers: Therapeutic and Diagnostic Targets in Urticaria

Abstract

Urticaria is a type of skin disease characterized by rapid onset of hives (superficial dermis edema, erythema, pruritus, or burning sensation). According to whether the natural course exceeds 6 weeks, urticaria can be divided into acute and chronic urticaria (CU). At present, the evaluation of CU activity mainly depends on the Urticaria Activity Score (UAS), but the evaluation indicators are relatively single, and we need more reliable experimental data for evaluation. We typically summarize advanced biomarkers and several related pathogenic pathways discovered in recent years on urticaria, including the cell adhesion/chemotaxis pathway, interleukin (IL)-6/Janus tyrosine kinase/STAT pathway, IL-17/IL-23 pathway, basophil- and mast cell-related pathway, coagulation/fibrinolysis-related pathways, single-nucleotide polymorphism, and some other pathways. This review aims to find appropriate biomarkers so that we can evaluate disease activity, discover novel therapeutic targets, and predict the patients’ response more accurately to therapeutic agents.

Assessment of selected interleukins (IL-6, IL-17A, IL-18, IL-23) and chemokines (RANTES, IP-10) in children with acute and chronic urticaria

“…In our study, similar to previous reports, we noted higher IL-6 levels in AU [5] and CU [6] patients. This increase was previously found in patients with antihistamine-resistant urticaria [9] and in severe CU compared to patients with mild CU [16]. We did not con rm the correlation of IL-6 levels with disease activity; however, this correlation has been documented in previous work [16][17][18].…”

“…In predicting the occurrence of skin lesions, this index with a relatively high speci city showed a lower sensitivity than most of the cytokines tested (88% and 78%, respectively, cut-off point 38.2). So far, most reports, like our work have shown higher IL-17 levels in CU patients [3,9] compared to CG. Additionally, this increase was found in patients with CU and a positive autologous serum skin test (ASST) [20].…”

“…It stimulates the production of tissue factor linking coagulation and in ammation [6]. The expression of IL-6 is dependent on many factors such as coexisting chronic diseases, stress factors, trauma or infections [9], its concentration is also subject to circadian uctuations [17].…”

“…Together with IL-17, IL-23 forms a common axis coordinating the action of congenital and acquired immune responses [8]. Alterations in IL-17 and IL-23 expression in patients with urticaria contribute to a disturbed pattern of Th17 lymphocyte activity, which is also observed in other autoimmune and allergic diseases such as psoriasis and atopic dermatitis [4,9]. IL-18 plays an important role in the congenital and acquired immune response [10].…”

Analysis of the Transcriptional Activity of Immune Response Genes in the Blood of Patients with Acute Urticaria

“…Non-invasive markers of the transcriptional activity of immune response genes are significant in a specific environment: (1) As a possible treatment target, (2) in the prediction of the disease severity and activity, and (3) in the evaluation of drug efficacy [19]. Different markers have been investigated in earlier studies where IgE is defined as clearly related to the severity of urticaria.…”