The Relationship Between Gut Microbiota and Chronic Spontaneous Urticaria

Abstract

This study evaluated the effectiveness, proper dosage and possible response of OMALIZUMAB (Biologics) for Chronic Idiopathic Urticaria (CIU) patients in KSA with antihistamine refractory CIU disease related quality of life. METHODS: The study was prospective and descriptive in nature. Omalizumab was used in those patients who did not respond to up dosing of Antihistamine, steroids and cyclosporine. Omalizumab is recombinant humanized monoclonal antibody against human IgE and has good safety profile due to biological nature of the drug. All patients administered omalizumab must be observed for 2 hours for adverse effects. Six month's trial of omalizumab 300 mg every 4 weeks, among patients with CIU. Total 26 patients with mean age 48 including both sexes. RESULTS: Out of 26 patients, 22 patients (84%) responded well to 300 mg omalizumab injection every month, whereas 4 patients need up dosing more than 300 mg .In 300 mg group eight patients achieved complete symptoms control without antihistamine intake and others required antihistamine without prednisolone and cyclosporine .Though 3 patients didn't achieved complete absence of symptoms, cyclosporine and oral corticosteroids could be discontinued. Only 1 patient reported adverse effect like Headache, Dizziness and fatigue CONCLUSIONS: Omalizumab at an initial dosage of 150 mg was not effective treatment in CIU up dosing to 300 mg was required to achieve satisfactory outcomes. It can be used after failure of other therapies. Omalizumab binds with free IgE antibodies and reduces the circulating levels of free IgE. This reduction in free IgE prevents mast cell degranulation.

Salivary Microbiota Is Significantly Less Diverse in Patients with Chronic Spontaneous Urticaria Compared to Healthy Controls: Preliminary Results

“…CSU Patients (n = 13) UAS score Mild (7)(8)(9)(10)(11)(12)(13)(14)(15) 1 (8%) Moderate (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) 6 (46%) Severe (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42) 6 (46%)…”

“…Autoimmunity type I (IgE autoantibodies to IL-24, thyroperoxidase, double-stranded DNA, and other autoallergens) or type IIb (IgG antibodies to the patient's own IgE or its high-affinity receptor-FcεRI) are involved in a large proportion of CSU cases [8], but also other factors have been elucidated: infections, pseudoallergic reactions, coagulation, stress, vitamin D [9]. Several recent studies have been identified altered gut microbiota as a possible underlying cause of CSU [6,[10][11][12][13][14].…”

The Link Between the Altered gut Microbiota and Chronic Spontaneous Urticaria

“…The gastrointestinal microbiota provides a vast and continuous stimulation for the immune system. Chronic spontaneous urticaria seems to be associated with low-level systemic or intestinal inflammation (7,8).…”

“…The gut microbiota of patients with chronic spontaneous urticaria and healthy individuals were obtained by 16s rRNA massive sequencing.In this review, we discuss the different factors that can exacerbate established chronic spontaneous urticaria, prolong the duration of the condition and encourage the need for second and third line therapy.However, about 50% of patients are resistant to second-generation nonsedating H1-antihistamines, and the precise pathogenesis remains largely unknown but seems to be associated with low-level systemic or intestinal inflammation(6).The gastrointestinal microbiota provides a vast and continuous stimulation for the immune system. Chronic spontaneous urticaria seems to be associated with low-level systemic or intestinal inflammation(7,8).Intestinal permeability was reported to be increased in chronic spontaneous urticaria and this was partly reversed by 24 days on a reduced pseudoallergen diet.Increasing evidence suggests that the gut microbiome plays a role in the pathogenesis of allergy and autoimmunity(9).…”