Relationship between changes in the 7-day urticaria activity score after treatment with omalizumab and the responsiveness of basophils to FcεRI stimulation in patients with chronic spontaneous urticaria

The recommended dose of omalizumab for the treatment of chronic spontaneous urticaria (CSU) is 300 mg every 4 weeks, but there is no recommendation for patients who do not benefit from this dose. Our aim is to present the experiences on the use of doses of omalizumab higher than those recommended for CSU patients and to propose a protocol for updosing. This was a retrospective analysis of patients treated with omalizumab for CSU from 2 urticaria centers in Istanbul and Barcelona. The weekly urticaria activity score and/or the Urticaria Control Test (UCT) were used to monitor response. In Barcelona, a stepwise updosing regimen was preferred (450 mg first, then increasing to 600 mg), while in Istanbul, direct updosing to 600 mg was chosen. In Istanbul, 81 (88%) patients were treated with 300 mg, while 11 (12%) received 600 mg of omalizumab. In Barcelona, 7 (8.8%), 45 (56.3%), 17 (21.3%), and 11 (13.8%) patients received 150, 300, 450, and 600 mg of omalizumab, respectively. Urticaria control was achieved in 82.6% of the patients with 300 mg and in 8.7% of the patients with 600 mg in Istanbul, while it was achieved with 150 mg in 10%, with 300 mg in 48.8%, with 450 mg in 16.3%, and with 600 mg in 6.3% of the patients in Barcelona. In total, 123 (71.5%) patients responded to 150-300 mg and 26 (15.1%) to 450-600 mg. When responders to 150-300 mg (n = 123) were compared with responders to 450-600 mg (n = 26), BMI was found to be higher, and pre-omalizumab UCT was found to be lower in patients receiving updosed omalizumab (p = 0.029). Baseline data of the patients, especially BMI and pre-oma UCT, might be useful to determine if the patient will require higher doses of omalizumab. We recommend a stepwise approach starting from 450 mg and then updosing to 600 mg in CSU patients who do not respond or partially respond to 300 mg of omalizumab after 3-6 months of treatment.

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The persistence of chronic spontaneous urticaria in childhood is associated with the urticaria activity score

Allergy and Asthma Proceedings ◽

10.2500/aap.2017.38.4029 ◽

2017 ◽

Vol 38 (2) ◽

pp. 136-142 ◽

Cited By ~ 11

Author(s):

Ebru Arik Yilmaz ◽

Betul Karaatmaca ◽

Pinar Gur Cetinkaya ◽

Ozge Soyer ◽

Bulent E. Sekerel ◽

...

Keyword(s):

Chronic Spontaneous Urticaria ◽

Activity Score ◽

Urticaria Activity Score

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Angioedema Coexisting Chronic Spontaneous Urticaria Negatively Influences Patients’ Sense of Coherence, What Results in Susceptibility to Anxiety Symptoms Occurrence

Journal of Clinical Medicine ◽

10.3390/jcm10132852 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2852

Author(s):

Karina Badura-Brzoza ◽

Zenon Brzoza

Keyword(s):

Sense Of Coherence ◽

Anxiety Symptoms ◽

Chronic Spontaneous Urticaria ◽

Patient Anxiety ◽

Specific Group ◽

Coping With Stress ◽

Urticaria Activity Score ◽

T Values ◽

Susceptibility Patterns ◽

Assessment Questionnaire

Background: Angioedema coexisting chronic spontaneous urticaria (CSU) is proved to result in patient anxiety occurrence, but the mechanisms and susceptibility patterns are unknown. Sense of coherence (SOC) is one of methods of coping with stress and is defined as a person’s general orientation toward life. We decided to assess SOC disturbances in CSU patients in the context of possible angioedema association. Methods: The study comprised 71 CSU subjects. To analyze disease activity, the Urticaria Activity Score seven-day assessment questionnaire (UAS7) was used. For anxiety assessment, the STAI questionnaire was used. The SOC-29 questionnaire, consisting of questions related to comprehensibility (SOC-C), manageability (SOC-M), and meaningfulness (SOC-Mf), was used to analyze SOC parameters (SOC-T). Results: In patients with coexisting angioedema, we observed statistically significantly lower values of SOC-Mf and SOC-T in comparison to the wheals only group. In the angioedema group, we noticed significant negative correlations between SOC-M and SOC-Mf, as well as SOC-T values and anxiety. In the wheals only group, we proved statistically significant correlations between SOC-Mf and SOC-T and anxiety assessed as a state. Conclusions: It is necessary to identify CSU patients manifesting angioedema as they are more likely to have impaired SOC. Lower SOC in this specific group of patients can be related to anxiety symptoms occurrence and should probably be an indication for psychological support.

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Combination therapy of omalizumab with house dust mite immunotherapy in chronic spontaneous urticaria associated with sensitization to dust mites-case series

Indian Journal of Case Reports ◽

10.32677/ijcr.v7i11.3107 ◽

2021 ◽

pp. 469-472

Author(s):

P C Kathuria ◽

Manisha Rai

Keyword(s):

Combination Therapy ◽

Disease Control ◽

House Dust ◽

House Dust Mite ◽

Immunoglobulin E ◽

Combined Therapy ◽

Case Series ◽

Chronic Spontaneous Urticaria ◽

Dust Mite ◽

Urticaria Activity Score

Chronic spontaneous urticaria (CSU) is a heterogeneous disorder with recurrent pruritic wheals and/or angioedema. The anti-immunoglobulin E (omalizumab) is used in CSU patients resistant to four-fold second-generation anti-histamines. Most clinical trials have experienced relapse after stopping omalizumab treatment. Here, we present a case series of five cases of chronic atopic urticarial concomitant allergic rhinitis and asthma which have shown immunologically significant positivity to Dermatophagoides pteronyssinus and Dermatophagoides farinae. Disease control was achieved (Urticaria Activity Score 7 <6) in four cases by combination therapy of omalizumab with house dust mite (HDM) Allergen Immunotherapy (AIT) and remained sustained for three years on follow-up even after discontinuation of AIT for one year. We hypothesize that this combined therapy may contribute to enhanced clinical efficacy, safety, and faster achievement of disease control in CSU.

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

Healthcare ◽

10.3390/healthcare9091144 ◽

2021 ◽

Vol 9 (9) ◽

pp. 1144

Author(s):

Ioana Adriana Muntean ◽

Irena Pintea ◽

Ioana Corina Bocsan ◽

Carmen Teodora Dobrican ◽

Diana Deleanu

Keyword(s):

Inflammatory Markers ◽

Clinical Presentation ◽

Significant Proportion ◽

Case Series ◽

Treated Group ◽

Severe Form ◽

Chronic Spontaneous Urticaria ◽

Retrospective Case ◽

Markers Of Inflammation ◽

Urticaria Activity Score

(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.

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