Do Antinuclear Antibodies Influence the Clinical Features of Chronic Spontaneous Urticaria?: A Retrospective Cohort Study

Abstract

Background. Antinuclear antibody (ANA) is often used as a screening test for autoimmune comorbidities in patients with chronic spontaneous urticaria (CSU). However, the relationship of ANA status and the clinical course of the disease have not been fully described. Objectives. To compare clinical features of CSU patients who are positive and negative for ANA. Methods. This was a retrospective cohort study that enrolled CSU patients attending the Urticaria Clinic at Siriraj Hospital from 2013 to 2019. Demographics, clinical characteristics, laboratory investigations, and treatments were collected until July 2021. All patients were investigated for ANA. Clinical feature data was compared between CSU patients with positive ANA and negative ANA groups using the 2-sample t -test and the Mann–Whitney U test for quantitative variables. The chi-squared test or Fisher’s exact test was conducted to explore the association of qualitative variables. Disease relapse and remission were analysed via Kaplan-Meier survival analysis. Results. Of 323 CSU patients, 31% had positive ANA. There were no significant differences in disease severity or impairment in quality of life. Patients with a positive ANA test had significantly lower prevalence of allergic rhinitis ( p = .048 ) and significantly higher level of erythrocyte sedimentation rate ( p = 0.007 ). Kaplan-Meier survival analysis showed that 2% of ANA positive CSU patients achieved remission status after one year and 28% did so after five years. There was no statistically significant difference in time to remission and time to relapse between ANA-positive and negative groups. Conclusion. Positive ANA in CSU patients could not indicate the differences in main disease characteristics from the ANA-negative CSU patients. Investigation for ANA may be useful in CSU patients who are suspected of having autoimmune diseases.

Clinical Significance of Dense Fine Speckled Pattern: Association with Inflammatory State

“…There has been no previous study regarding allergic rhinitis and DFS positivity, and a low rate of ANA positivity in allergic rhinitis was reported [14]. The relation between atopic dermatitis with DFS negativity observed in this study is contrary to that reported in other reports [5,13].…”

A Practical Approach to Diagnosing and Managing Chronic Spontaneous Urticaria

“…Additional tests, including extensive food/inhalant allergy testing, are rarely needed and should only be performed if indicated by the patient’s history and physical examination [ 1 , 5 ]. Although there is no specific guideline-based recommendation to routinely test for antinuclear antibodies (ANA), individual patient factors and clinical judgement can influence the decision to test for ANA or other autoimmune markers [ 53 ].…”