Chronic spontaneous urticaria after BNT162b2 mRNA (Pfizer-BioNTech) vaccination against SARS-CoV-2

Background: The factors that trigger and exacerbate chronic spontaneous urticaria (CSU) are well known, but it is not unclear whether messenger RNA (mRNA) vaccination against severe acute respiratory syndrome coronavirus 2 can trigger new cases of CSU or a relapse of CSU after long-term remission. Objective: To study the clinical cases of patients with new-onset CSU and CSU in remission who relapsed within 3 months after BNT162b2 mRNA vaccination. Methods: All patients with a CSU diagnosis within 12 weeks of BNT162b2 mRNA vaccination were retrospectively identified and included in the new-onset CSU and the relapsed CSU groups. The first control group (CSU control group) retrospectively consisted of patients diagnosed with CSU in complete clinical remission for ≥ 6 months, with no CSU relapse after vaccination. The second control group (healthy control group) consisted of subjects who were fully vaccinated and without CSU, matched 1:2 for age and sex with patients with CSU. Results: Twenty-seven patients were included in the relapsed CSU group, 32 patients in the new-onset CSU group, 179 patients in the CSU control group, and 476 subjects in the healthy control group. The relapsed CSU and new-onset CSU groups had more allergic comorbidities overall (19 [70.4%] and 13 [40.6%], respectively) than the CSU control group and the healthy control group (50 [27.9%] and 110 [23.1%], respectively; p < 0.001). Multiple logistic regression analysis showed that a positive autologous serum skin test result, overall allergic comorbidities, and basopenia were positively associated with the probability of CSU relapse within 3 months after BNT162b2 mRNA vaccination (odds ratio [OR] 5.54 [95% confidence interval {CI}, 2.36‐13.02], p < 0.001); OR 6.13 [95% CI, 2.52‐14.89], p = 0.001; and OR 2.81 [95% CI, 1.17‐6.72, p = 0.020, respectively). Conclusion: It is possible that BNT162b2 mRNA vaccination serves as a provoking and/or relapsing factor of CSU in individuals with allergic diseases and/or predisposed autoimmunity.

Oral mini-pulse steroid therapy in severe chronic urticaria

Background: Treatment of chronic urticaria can be difficult at times. The present study aimed to evaluate the efficacy of oral mini-pulse (OMP) therapy with methylprednisolone in management of severe chronic urticaria (CU). Methods and material: 100 patients with severe chronic urticaria, not controlled with maximum dose of a second generation antihistamine, were enrolled in the study after an informed written consent. All patients were treated with methylprednisolone 16 mg tablet on two consecutive days of a week for 2 months along with levocetirizine 5 mg tablet once daily. All patients were reviewed at 0, 2, 4, and 8 weeks with urticaria activity score (UAS). Results: The study comprised of 100 patients (33 males and 67 females) with severe chronic urticaria. 29 patients (29%) had raised TSH levels while Autologous Serum Skin Test was positive in 37 patients. Mean UAS in patients treated with OMP was 5.76 at baseline which reduced to 0.6 at the end of treatment period. Conclusion: Mean UAS showed a significant decline following OMP therapy with methylprednisolone. Most of the patients maintained the benefits of therapy at the end of follow up period of 4 months.

What Basophil Testing Tells Us About CSU Patients – Results of the CORSA Study

Basophil testing is the most effective single approach for diagnosing type-IIb autoimmune chronic spontaneous urticaria (TIIbaiCSU). A positive basophil test has been linked to long disease duration, higher disease activity, a poor response to antihistamines and omalizumab, and a better response to cyclosporine and fenebrutinib. As of now it is unclear what other features are connected to a positive basophil test in chronic spontaneous urticaria (CSU). We aimed to identify features of basophil test-positive CSU patients. We performed a cross-sectional study of 85 CSU patients. Basophil testing was done with the basophil activation test (BAT) and the basophil histamine release assay (BHRA). Data were analysed using SPSS: Student’s t-test, Chi-square test, Odds Ratio, Spearman’s correlation test. Of 85 CSU patients, 44% and 28% tested positive with the BAT and BHRA, respectively. These patients showed higher disease activity and impact, lower levels of disease control and total serum IgE, as well as higher rates of having a positive autologous serum skin test (ASST), angioedema, nocturnal symptoms, symptoms for &gt;5 days/week, and thyroid autoantibodies. The ASST, by itself, was not a good predictor of basophil test results, but it predicted a positive basophil test in up to 100% of cases when combined with angioedema, thyroid autoantibodies or low IgE. In conclusion, a positive basophil test is linked to known features of TIIbaiCSU and novel characteristics including nocturnal symptoms. Further studies on basophil test-positive and -negative CSU patients can help to better understand CSU endotypes and to develop better management approaches.

Chronic urticaria: a clinico-etiological study and autologous serum skin test role in chronic idiopathic urticaria

<p class="abstract"><strong>Background:</strong> Appearance of wheals daily for more than six weeks is chronic urticarial (CU). No cause is identified in about 50-70% of chronic urticaria patients and are labelled as chronic idiopathic urticaria (CIU). The aim of the present study is to study the clinical and etiological pattern of chronic urticaria and to find out the incidence of autoimmune urticaria by performing autologous serum skin test (ASST) in patients with CIU.</p><p class="abstract"><strong>Methods:</strong> This was a cross sectional study enrolling 100 chronic urticaria patients satisfying including and excluding criteria. The study was done for a period of 1 year. ASST was done in all the CIU patients after recording detailed history, complete physical and systemic examination.</p><p class="abstract"><strong>Results:</strong> Most of the patients (33%) were in 21-30 years age group with female preponderance (66%). Students (38%) followed by house wives (27%) were majorly involved. 21% patients had history of atopy and 8% had abnormal thyroid function tests. Causative factors noticed in 46% patients and remaining were idiopathic (54%). Infections (32.6%) constituted the major etiological factor followed by physical urticaria (30.4%), food (23.9%), medication (11%) and inhalants (2.1%). In infective agents, 46.6% were bacterial followed by helminthic (33.3%). In 29.6% of CIU patients, the ASST was positive indicating auto-immune urticaria.</p><p class="abstract"><strong>Conclusions:</strong> The etiology cannot be identified in most number of patients and hence they were labelled as CIU and the common causative agents observed were infections followed by physical urticaria, food and medication. ASST is considered as the relevant screening test to detect autoimmune urticaria.</p>

Serum Human β-Defensin 2 Is Increased in Angioedema Accompanying Chronic Spontaneous Urticaria

<b><i>Introduction:</i></b> Chronic spontaneous urticaria (CSU) is a common cutaneous disease caused by mast-cell degranulation. Human β-defensin 2 (HBD2) is a well-known antimicrobial peptide that is also a pruritogen inducing vascular permeability via non-IgE-mediated mast-cell degranulation. <b><i>Objective:</i></b> We investigated the associations between serum HBD2 levels and the clinical characteristics of CSU patients. <b><i>Methods:</i></b> Serum samples from 124 CSU patients and 56 healthy controls were screened for the levels of HBD2 and translationally controlled tumor protein (TCTP)_ by using ELISA. The urticaria activity score over 7 days (UAS7) was used to measure disease activity in CSU patients. Accompanying angioedema was self-reported. <b><i>Results:</i></b> Serum HBD2 levels were higher in the CSU group than in healthy subjects (median [interquartile range], 84.1 [43.5, 142.5] vs. 59.5 [26.7, 121.5], <i>p</i> = 0.034). In CSU patients, serum HBD2 level was negatively correlated with the peripheral basophil percentages (Spearman’s rho = −0.229, <i>p</i> = 0.01) and vitamin D levels (−0.262, <i>p</i> = 0.02), but positively correlated with TCTP levels (0.252, <i>p</i> = 0.006). In CSU patients, HBD2 level was higher in those with than without angioedema (101.7 [50.9, 184.2] vs. 66.7 [37.9, 132.0], <i>p</i> = 0.019). It did not differ by aspirin hypersensitivity or atopy status, or autologous serum skin test positivity. <b><i>Conclusion:</i></b> A known mast-cell degranulator, HBD2 was elevated in the sera from CSU patients compared to healthy controls and may be involved in the pathogenesis of accompanying angioedema.

Quality of Life Based on Autologous Serum Skin Test Result in Chronic Spontaneous Urticaria Patients

Several studies regarding the quality of life of chronic spontaneous urticaria patients based on Autologous Serum Skin Test (ASST) results have shown a variety of results. This study aims to determine the correlation between the quality of life and ASST results in chronic spontaneous urticaria patients at Dermatology and Venereology (DV) Outpatient Clinic of Dr. Mohammad Hoesin Hospital Palembang. This analytic observational study with a cross-sectional design used secondary data in the form of medical records. 76 samples met the inclusion criteria from 110 samples of chronic spontaneous urticaria patients at DV outpatient clinic. The distribution of chronic spontaneous urticaria patients was highest in the 17-25 year age group (23.7%) and the female group (64.5%). The majority of chronic spontaneous urticaria patients had negative ASST results (52.6%). The effect of chronic spontaneous urticaria on the decline in quality of life was mostly moderate (35.5%). The bivariate analysis between DLQI score and ASST results with a value of p = 0.307 or p> 0.05 showed no significant correlation between the quality of life and ASST results.