Predictors of Response to Oral Medications and Low-Histamine Diet in Patients with Chronic Urticaria

Abstract

Background. Chronic urticaria (CU) is comprised of diverse phenotypes, and thus, a shift towards a precision medical approach is warranted in its management. Methods. This study enrolled 78 patients with CU. Serum erythrocyte sedimentation rate, hemoglobin, hematocrit, eosinophil count, IgE, antinuclear antibody (ANA), and serum diamine oxidase (DAO) levels of the patients were measured and were compared according to the patient’s response to second-generation antihistamines (sgAH), corticosteroids, leukotriene receptor antagonist (LTRA), H2 blockers, and low-histamine diet. Results. Age- and sex-adjusted logistic regression analysis showed that patients with duration of CU > 3 years (adjusted odd ratio aOR = 4.39 ) and a DAO level < 10 U / mL ( aOR = 3.90 ) were significantly associated with a good sgAH response. Age > 50 years ( aOR = 0.02 ), duration of chronic urticaria > 3 years (aOR =0.06), and an ANA titer ≥ 1 : 80 ( aOR = 0.03 ) were significantly and inversely associated with corticosteroid response. A low-histamine diet response was significantly associated with LTRA response ( aOR = 67.29 ). In addition, a DAO level < 5.4 U / mL ( aOR = 71.95 ) was significantly associated with H2 blocker response. Furthermore, concomitant angioedema ( aOR = 10.56 ), multiple food triggers ( aOR = 11.69 ), and a DAO level < 5.4 U / mL ( aOR = 3.78 ) were significantly associated with a low-histamine diet response. Conversely, dermatographic urticaria and a hematocrit level < 36 % were significantly and inversely associated with low-histamine diet response. Conclusions. Several promising biomarkers were identified in this study to predict the efficacy of chronic urticaria treatment. DAO could be a novel biomarker for predicting the efficacy not only of dietary intervention but also for antagonists of H1 and H2 receptors.

Comprehensive Assessment of Nutrition and Dietary Influences in Hypermobile Ehlers-Danlos Syndrome—A Cross-sectional Study

“…At present, the low-histamine diet cannot be routinely recommended in hEDS/HSD despite its apparent efficacy (Figure 2a) for reasons including lack of evidence in DGBI and risks of disordered eating behaviors with elimination diets (35). A recent study demonstrated that deficiency of diamine oxidase, an enzyme that breaks down histamine, is a good biomarker for response to a low-histamine diet, in patients with chronic urticaria (36). Further research is required in patients with hEDS/HSD to investigate the efficacy of the low-histamine diet and whether diamine oxidase may be a good biomarker of its efficacy.…”

IgG food hypersensitivity: A potential hidden precipitant for chronic spontaneous urticaria A case report

“…8 Several promising biomarkers are under focus to predict the efficacy of dietary intervention for the treatment of CSU. 9 A study of 240 children with CSU has shown that food sensitization could predict inadequate treatment response. 10 There are limited references in the literature about IgG food testing in CSU.…”