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

Abstract

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.

Angioedema in chronic spontaneous urticaria is underdiagnosed and has a substantial impact: Analyses from ASSURE‐CSU

“…Patients who experience CSU as concurrent hives and angioedema often experience a longer duration of disease than patients who experience only hives . Angioedema may be disfiguring or painful, may limit daily activities and may have a significant impact on quality of life .…”

Omalizumab in Chronic Urticaria: An Italian Survey

“…Despite the common manifestations including itch, wheals and/or angioedema that last for more than 6 weeks, these entities are triggered by different stimuli and display different pathogenic mechanisms [1]. Furthermore, CIndU has been demonstrated to be a predictor of severe CSU [2]. …”

C‐reactive protein (CRP) rs3093059C predicts poor mizolastine response in chronic spontaneous urticaria patients with elevated serum CRP level

“…Previous studies pointed out that mast cells and basophils play significant roles in the pathogenesis of CSU . For instance, it has been reported that the coagulation system and complement system participate in the mast cell activation in CSU patients . C‐reactive protein (CRP), encoded by the CRP gene, is greatly increased during infection, acute injury and autoimmune‐related diseases .…”

“…[13,14] For instance, it has been reported that the coagulation system and complement system participate in the mast cell activation in CSU patients. [15,16] C-reactive protein (CRP), encoded by the CRP gene, is greatly increased during infection, acute injury and autoimmune-related diseases. [17] CRP is regarded as an acute phase protein (APP) in the course of mast cell degranulation and complement system activation in the coagulation system.…”