Clinical variables of severe chronic spontaneous urticaria from total IgE standpoint: a retrospective study

Asero, Riccardo

doi:10.23822/eurannaci.1764-1489.191

Cited by 20 publications

(18 citation statements)

References 9 publications

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“…4,6,7 A recent study documented a threshold of 18 IU/ml to have 93% sensitivity and 63.3% specificity for omalizumab response, while thyroid disorders had no impact on treatment response. 9 Similar observations were noted in our study, neither thyroid disorders nor anti-thyroid autoantibodies were associated with treatment response to omalizumab. A strong positive correlation has been observed between positive basophil histamine release assay/chronic urticaria index and cyclosporine response.…”

Section: Methodssupporting

confidence: 91%

“…Low IgE levels are well established as a predictor of non‐response to omalizumab 2–4 while an inconsistent relationship has been observed with concomitant inducible urticarias, angioedema, allergic diseases, disease duration, previous immunosuppressive use, high baseline UAS7, and ANA positivity 4,6,7 . A recent study documented a threshold of 18 IU/ml to have 93% sensitivity and 63.3% specificity for omalizumab response, while thyroid disorders had no impact on treatment response 9 . Similar observations were noted in our study, neither thyroid disorders nor anti‐thyroid autoantibodies were associated with treatment response to omalizumab.…”

Section: Discussionmentioning

confidence: 99%

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Clinical and laboratory parameters associated with treatment response to third‐line therapies in chronic refractory urticaria: A real world study from northern India

Mehta

Bishnoi

Parsad

et al. 2022

Dermatologic Therapy

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Current guidelines recommend omalizumab and cyclosporine for management of chronic spontaneous urticaria (CSU) refractory to anti-histamines. Identification of clinico-epidemiological characteristics predictive of treatment response with both modalities which will aid therapy selection. Clinical records of CSU patients receiving omalizumab and cyclosporine from May 1, 2016 to December 31, 2020 were reviewed retrospectively. Patients with a minimum follow-up duration of 4 months were included in the analysis. Treatment response was defined as >90% recorded reduction in Urticaria Activity Score-7 (UAS7) as compared to baseline 4 months after treatment initiation. Records of 1364 CSU patients were reviewed. A total of 56 patients who received omalizumab and 132 patients who received cyclosporine fulfilled the inclusion criteria. Treatment response was observed in 46 out of 56 (82.1%) patients in the omalizumab cohort and 106 out of 132 (80.3%) patients in the cyclosporine cohort (P = 0.76). Factors significantly associated with response to omalizumab included high baseline serum IgE levels (P = 0.028), lesser disease duration (P = 0.001), and absence of prior immunosuppressant use (P = 0.024). Factors predictive of cyclosporine response included high baseline UAS7 (P = 0.048), low baseline IgE levels (P = 0.047), and normal baseline D-dimer levels (P = 0.027).Concomitant inducible urticaria, atopy, and angioedema were associated with nonresponse in both groups (P ≤ 0.05). Incidence of adverse events was slightly higher in cyclosporine group (28.7%) as compared to omalizumab group (19.5%, P = 0.19). This study highlights several clinical parameters and laboratory markers that may be utilized to predict treatment response and aid in prognostication of patients with CSU.

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Section: Methodssupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Clinical and laboratory parameters associated with treatment response to third‐line therapies in chronic refractory urticaria: A real world study from northern India

Mehta

Bishnoi

Parsad

et al. 2022

Dermatologic Therapy

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“…In contrast, it showed that atopic status cannot be adopted as a marker of Type I CSU or as a predictor of omalizumab response in CSU patients. Similarly, although confirming the well-known association between CSU and thyroid autoimmunity, the study shows that thyroid autoimmunity per se cannot be considered as a marker of Type IIb CSU or a predictive marker of poor response to omalizumab M a n u s c r i p t a c c e p t e d f o r p u b l i c a t i o n (15). Altogether, the detection of type IIb CSU patients requires the concordance of a series of different tests, including the autologous serum skin test, in-vitro basophil activation tests, and positive IgG anti-FcεRI or anti-IgE (3).…”

supporting

confidence: 82%

Atopic status and thyroid autoimmunity do not predict omalizumab response in severe chronic spontaneous urticaria patients

Asero

2024

Eur Ann Allergy Clin Immunol

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To the Editor Chronic spontaneous urticaria (CSU) is a rather frequent disease of variable severity characterized by recurrent wheals with or without angioedema for more than 6 weeks. Some patients show a continuous and very severe disease refractory to antihistamine treatment which worsens dramatically their quality of life. The anti-IgE mAb omalizumab is indicated as second line treatment in these cases. The clinical response largely depends on the endotype (either IgG-mediated autoimmune [type IIb] or IgE-mediated "autoallergic" [type I]) of the disease. Positive in-vitro tests of basophil activation (either BAT or BHRA), antinuclear antibodies, autologous serum skin test (ASST) and low total IgE levels have been associatedwith a slow or absent response to the drug (1-5). Conversely, elevated total IgE are generally associated with a prompt response to omalizumab (5-12). Atopic diseases are a well-known cause of elevated IgE, but whether atopic status may be used as a marker of Type I CSU, thus predicting a rapid response to omalizumab, is still unclear (11). The association between CSU and thyroid autoimmunity has been known for almost 30 years (12) but, although typical type IIb CSU patients frequently show low IgE and autoimmune thyroiditis (14), whether thyroid autoimmunity may alone predict a poor or absent response to omalizumab is still undefined. In one study, the prevalence of thyroid autoimmunity was similar in CSU patients with different levels of total IgE (15). The present study investigated whether atopic status and thyroid autoimmunity may be practically useful to discriminate type I and type IIb CSU.

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“…Basophil functional assays are the only currently available method to evaluate functional autoantibodies, however they are difficult to conduct in outpatient clinics due to technical difficulties and costs. Both tests for ANA and ASST are poor surrogate markers for a risk of false positivity and a possibility of the co-existence of atopic status [13,34]. Nonetheless, they are potential alternatives to evaluate autoimmunity which is clinically relevant in CSU patients [13,23,35].…”

Section: Plos Onementioning

confidence: 99%

Detection of serum IgG autoantibodies to FcεRIα by ELISA in patients with chronic spontaneous urticaria

Jang

Moon²,

Yang³

et al. 2022

PLoS ONE

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Background Mast cells are a key effector cell in the pathogenesis of chronic spontaneous urticaria (CSU) and activated by circulating FcεRI-specific IgG as well as IgE. This study evaluated the prevalence of circulating autoantibodies to FcεRIα in the sera of CSU patients. Methods Eighty-eight patients with CSU and 76 healthy controls (HCs) were enrolled. To detect circulating autoantibodies (IgG/IgA/IgM) to FcεRIα, ELISA was done using YH35324 (as a solid phase antigen), and its binding specificity was confirmed by the ELISA inhibition test. The antibody levels were presented by the ratio of YH35324-preincubated to mock-preincubated absorbance values. Clinical and autoimmune parameters, including atopy, urticaria activity score (UAS), serum total/free IgE levels, serum antinuclear antibody (ANA) and autologous serum skin test (ASST) results, were assessed. The autoimmune group was defined if CSU patients had positive results to ASST and/or ANA. Results The ratio of serum IgG to FcεRIα was significantly lower in CSU patients than in HCs (P<0.05), while no differences were noted in serum levels of IgG to recombinant FcεRIα or IgA/IgM autoantibodies. The autoimmune CSU group had significantly lower ratios of IgG/IgA (not IgM) autoantibodies to FcεRIα than the nonautoimmune CSU group (P<0.05 for each). No significant associations were found between sex, age, atopy, urticaria duration, UAS, or serum total/free IgE levels according to the presence of IgG/IgA/IgM antibodies. Conclusions This study confirmed the presence of IgG to FcεRIα in the sera of CSU patients, especially those with the autoimmune phenotype.

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Clinical variables of severe chronic spontaneous urticaria from total IgE standpoint: a retrospective study

Cited by 20 publications

References 9 publications

Clinical and laboratory parameters associated with treatment response to third‐line therapies in chronic refractory urticaria: A real world study from northern India

Clinical and laboratory parameters associated with treatment response to third‐line therapies in chronic refractory urticaria: A real world study from northern India

Atopic status and thyroid autoimmunity do not predict omalizumab response in severe chronic spontaneous urticaria patients

Detection of serum IgG autoantibodies to FcεRIα by ELISA in patients with chronic spontaneous urticaria

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