Chronic urticaria and inflammatory bowel disease — is it worth looking further?

Abstract

Chronic urticaria is a common disease that also occurs against the background of inflammatory bowel disease. This case draws attention to the common pathophysiology between autoimmune and autoinflammatory diseases and the need for careful differential diagnosis and further research, which can significantly influence the choice of treatment tactics. Clinical case. An 9-year-old girl with chronic urticaria from birth and recurrent episodes of fever and conjunctivitis was examined at the pediatric ward of the National Children's Specialized Hospital «OKHMATDYT». On the basis of negative results of determination of serum level of immunoglobulins A to gliadin and endomysia celiac disease is excluded, and also by means of modern methods of allergodiagnostics (skin prick-tests, cold test, molecular allergodiagnostics, elimination dietodiagnostics) influence of various is excluded. The girl was diagnosed with chronic idiopathic urticaria with inflammatory bowel disease with trial treatment with ketatifen, bilastine and mesalazine. Due to complaints of recurrent rashes and fever on the background of this therapy, the anamnesis of the disease was re-analyzed and the material was sent for genetic sequencing, which allowed to change the diagnosis to auto-inflammatory disease and prescribed therapy — daily administration of anakinra. Since then, she no longer has recurrent febrile fever or urticaria, and the level of markers of inflammation has returned to normal. Conclusions. This clinical example is interesting for a complex diagnostic search, when a combination of chronic urticaria and inflammatory bowel disease was observed without effect on therapy, which forced to reconsider the diagnosis, which turned out to be even rarer and was finally confirmed by genome sequencing. But despite the fact that the diagnosis was different, it is interesting that on the background of taking mesalazine the girl's condition still improved slightly: became less likely to bother urticarial rash and fever on the background of the rash, which may indicate some common pathogenetic features of inflammation in intestines and chronic idiopathic urticaria, which has an indisputable scientific and practical interest. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: urticaria, inflammatory bowel disease, autoinflammatory diseases, interleukinE1, Biologics, anakinra.