Clinical predictors of antihistamine resistance in patients with chronic spontaneous urticaria

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Abstract

BACKGROUND: Сhronic spontaneous urticaria is characterized by itchy wheals and/or angioedema on the skin for ≥6 weeks. A large-scale international AWARE study by Russian researchers indicated the ineffectiveness of therapy with standard doses of second-generation antihistamines in >50% of patients with chronic spontaneous urticaria. Clinical predictors of antihistamine resistance include low quality of life based on CU-Q2oL, baseline urticaria activity score for 7 days (UAS7) >16, combination with chronic inducible urticaria, and autoimmune comorbidity. Currently, research into the clinical predictors of antihistamine resistance, including body mass index, in patients with chronic spontaneous urticaria is ongoing.

AIM: To examine the degree of symptom control based on body mass index and physical activity in patients with chronic spontaneous urticaria treated with second-generation antihistamines.

MATERIALS AND METHODS: The examination of patients with сhronic spontaneous urticaria (n=34) included the clinical history and use of the following international questionnaires: UAS7, urticaria control test, dermatology quality of life index, and global physical activity questionnaire of the World Health Organization. The questionnaires were analyzed in subgroups of patients with controlled and uncontrolled chronic spontaneous urticaria and subgroups of patients with chronic spontaneous urticaria having normal weight, overweight, and obesity.

RESULTS: Uncontrolled symptoms were observed in 24 (70.6%) patients with chronic spontaneous urticaria, including 11 (45.8%) with resistance to fourfold doses of second-generation antihistamines. In 52.9% of patients with chronic spontaneous urticaria, the body mass index exceeded normal values. In this study, an inverse correlation was found between the body mass index and the degree of control of chronic spontaneous urticaria symptoms.

CONCLUSIONS: Owing to the negative correlation between body mass index and the degree of symptom control, further research into the role of body mass index as a clinical predictor of antihistamine-resistant chronic spontaneous urticaria is needed. In the future, personalized therapy for chronic spontaneous urticaria may consider the degree of disease control, clinical predictors of antihistamine resistance, and proinflammatory biomarkers.

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About the authors

Christina Yu. Popova

The First Sechenov Moscow State Medical University (Sechenov University)

Email: popova.derm@gmail.com
ORCID iD: 0000-0002-7855-6207
SPIN-code: 5794-9317

MD

Russian Federation, Moscow

Victoria A. Zaborova

The First Sechenov Moscow State Medical University (Sechenov University)

Email: vaz111v@gmail.com
ORCID iD: 0000-0001-5044-1152
SPIN-code: 5969-8486

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Vladislav V. Kurshev

The First Sechenov Moscow State Medical University (Sechenov University)

Email: kurshevvlad@gmail.com
ORCID iD: 0000-0002-1729-0513
SPIN-code: 2766-3925

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Elena V. Kovalkova

Moscow City Hospital 52, Moscow City Scientific and Practical Centre of Allergology and Immunology

Email: kovalkova@ya.ru
ORCID iD: 0000-0002-1212-3767
SPIN-code: 3078-0976
Russian Federation, Moscow

Sofia A. Serdotetskova

Moscow City Hospital 52, Moscow City Scientific and Practical Centre of Allergology and Immunology

Email: darklynx813@gmail.com
ORCID iD: 0000-0001-8472-1152
SPIN-code: 6644-6715
Russian Federation, Moscow

Daria S. Fomina

The First Sechenov Moscow State Medical University (Sechenov University); Moscow City Hospital 52, Moscow City Scientific and Practical Centre of Allergology and Immunology

Email: daria_fomina@mail.ru
ORCID iD: 0000-0002-5083-6637
SPIN-code: 3023-4538
Russian Federation, Moscow; Moscow

Elena Yu. Borzova

The First Sechenov Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: eborzova@gmail.com
ORCID iD: 0000-0003-1587-9137
SPIN-code: 4779-7664

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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2. Fig. 1. Dosing of antihistamines in subgroups with controlled and uncontrolled symptoms in patients with chronic spontaneous urticaria. ХСК ― chronic spontaneous urticaria; UCT ― Urticaria Control Test.

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3. Fig. 2. Correlation between body mass index and urticaria control test (UCT) in patients with chronic spontaneous urticaria. ИМТ― Body Mass Index.

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4. Fig. 3. The results of questionnaires in patients with сhronic spontaneous urticaria depending on the degree of symptoms control. UCT ― Urticaria Control Test; UAS7 ― Urticaria Activity Score 7; DLQI ― Dermatology Life Quality Index.

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5. Fig. 4. Body mass index in patients with chronic spontaneous urticaria.

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6. Fig. 5. Dosing of antihistamines in normal, overweight, and obese subgroups in patients with chronic spontaneous urticaria.

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7. Fig. 6. The results of questionnaires and doses of antihistamines in patients with сhronic spontaneous urticaria depending on the body mass index. UCT ― Urticaria Control Test; UAS7 ― Urticaria Activity Score 7; DLQI ― Dermatology Life Quality Index.

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