Clinical and laboratory characteristics of patients with severe chronic spontaneous urticaria with assessment of the effectiveness of therapy (analysis of own observations)

BACKGROUND: The problem of chronic spontaneous urticaria is relevant to study due to its prevalence primarily among people of working age, the reduced quality of life of patients, and the high costs to the government. Managing patients with severe form of this disease might be challenging and requires a personalized approach.

AIM: To characterize the clinical and laboratory features and the effectiveness of therapy in patients with severe chronic spontaneous urticaria in real-world clinical practice.

METHODS: An observational, single-center, retrospective, uncontrolled randomized study was conducted with analysis of medical records of patients with severe chronic spontaneous urticaria (n = 58). The created database included clinical data (patient age, phenotype of urticaria, presence of comorbidities, type and effectiveness of therapy) and laboratory data (complete blood count, C-reactive protein, total immunoglobulin E, immunoglobulin G antibodies to thyroid peroxidase).

RESULTS: An analysis of a database of these patients revealed certain clinical features that may predict a severe course of the disease. These are age between 40 and 60 years (50 % cases), female gender (74 %), a combination of urticaria and angioedema (86 %), the presence of comorbidities (75 %), and insufficient efficacy of second-generation antihistamine therapy, in which only 29 % of patients achieved good control in symptoms. In 71 % of cases, the addition of omalizumab was required, which resulted in a complete and rapid response in 78 % of patients. Laboratory tests revealed elevated immunoglobulin E levels in this group, which may indirectly indicate an autoallergic endotype of the disease. In the group of patients with an incomplete response to omalizumab, the level of total immunoglobulin E was lower or within the reference range, while the immunoglobulin G level to thyroid peroxidase was higher, which may indicate the presence of an endotype associated with type IIb hypersensitivity.

CONCLUSION: A combination of clinical and laboratory characteristics could help to determine the severity of the disease and its potential endotype. However, further research is needed to identify reliable markers that can differentiate the various pathogenetic variants of severe chronic spontaneous urticaria. The patients we examined likely had a predominantly autoallergic endotype, for which omalizumab was highly effective.