COVID-19 Disease Leading to Chronic Spontaneous Urticaria Exacerbation: A Romanian Retrospective Study

Abstract

(1) Background: The COVID-19 pandemic has resulted in the exacerbation of various chronic diseases. Due to the potential impact of SARS-CoV-2 on mast cells, we aimed to analyze the relevance of COVID-19 disease on chronic spontaneous urticaria (CSU) clinical presentation and biological profile. (2) Methods: This study is a retrospective case series of patients with CSU diagnosed and treated in the Allergy Department of the Professor Doctor Octavian Fodor RIGH, (Cluj-Napoca, Romania). Patients were assessed for disease activity and level of control with the weekly urticaria activity score and the visual analogue scale. Results were correlated with COVID-19 severity and with nonspecific markers of inflammation during and after the SARS-CoV-2 infection. (3) Results: SARS-CoV-2 impacted a significant proportion (33%) of the CSU patients, of which 71% developed a moderate-severe form of COVID-19. Most of the patients (68%) had moderate-severe forms of CSU and 65% took AH1 treatment (one dose, two-fold dose or four-fold dose). The rest of them (35%) received the second-line treatment (40.3% Omalizumab, 53% Prednisolone and 4.8% Cyclosporine). In Omalizumab treated group of UCS patients we observed that COVID-19 disease was not severe. We established a positive correlation between the severity of the infection and that of the CSU clinical presentation, with most bothersome symptoms of urticaria being experienced by moderate to severe COVID-19 CSU patients (47%). Inflammatory markers were positively correlated (p = 0.01) with a more severe clinical profile of CSU, in accordance with our hypothesis that the level of inflammation triggered by COVID-19 disease has a role in CSU exacerbation. The non-specific inflammatory markers, such as CRP, were positively associated with the UAS7 score (R2 = 0.363; p = 0.001). An increased rate of exacerbation of CSU was observed in moderate-severe COVID-19 infection. 4) Conclusions: COVID-19 disease can result in the exacerbation of chronic spontaneous urticaria, more likely in moderate to severe forms of infection.

Impact of Anti-Type 2 Inflammation Biologic Therapy on COVID-19 Clinical Course and Outcome

“…Notably, the percentage of moderate-severe COVID-19 was 9.8% (n=5) in completely untreated CSU patients. 21 …”

“…Notably, the percentage of moderate-severe COVID-19 was 9.8% (n=5) in completely untreated CSU patients. 21 As regards omalizumab and asthma, Aksu et al (online publication: September 2021) reviewed their case series of adult severe patients using biological agents, which also included 62 patients treated with omalizumab. Among these, 9 patients were diagnosed with COVID-19 and, notably, no one showed a severe course.…”

Relapse or worsening of chronic spontaneous urticaria during SARS-CoV-2 infection and vaccination in children: A telemedicine follow-up

“…So far, a few studies focused on children show that acute urticaria as a skin manifestation resulting from COVID-19 has been reported in about 30% of patients. 10,11 Severe COVID-19 is characterized by elevated levels of proinflammatory cytokines, many of which are produced and released by mast cells. 12,13 There is evidence that COVID-19 activates mast cells, which are critical effector cells of the CU, along with other immune cells such as basophils, neutrophils, monocytes or macrophages, and natural killer cells.…”

The relationship of skin disorders, COVID-19, and the therapeutic potential of ginseng: a review

“…Ginsenoside Rg3-enriched RGE has been shown to significantly suppress matrix MMP9 activity, COX-2 expression, and the production of pro-inflammatory cytokines including TNF-α, IL-1 β, and IL-6. In addition, ginsenoside Rf indicates an inhibitory effect on the inflammatory mediators downstream of p38/NF-kB activation, including the downregulation of IL-1 β, IL-6, TNF-α, NO, and reactive oxygen species production [ 118 ]. Therefore, substances extracted from ginseng are effective in reducing the levels of cytokines induced by COVID-19.…”