Materiały źródłowe

• #1 Clinical Features of Chronic Spontaneous Urticaria that Predict Disease Prognosis and Refractoriness to Standard Treatment | HTML | Acta Dermato-Venereologica

  https://www.medicaljournals.se/acta/content/html/10.2340/00015555-2941

  Chronic spontaneous urticaria (CSU) is characterized by heterogeneous activity, evolution, associated comorbidities and response to treatment. The aim of this study was to identify prognostic factors in patients with CSU that predict disease course and response to standard treatments. […] The factors associated with a worse prognosis in terms of duration and/or CSU activity and its episodes were: multiple episodes of CSU, late-onset, concomitant CIndU and functional serum auto-reactivity. […] Baseline CSU activity is the only factor found to be predictive for refractoriness to treatment with H1-antihistamines. […] Clinical predictors of longer course of CSU include late-onset, a concomitant chronic inducible urticaria (CIndU) and a relapsing course showing multiple episodes of CSU along the life.

• #2 Outcome measures in chronic urticaria: A comprehensive review – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/outcome-measures-in-chronic-urticaria-a-comprehensive-review/

  Chronic urticaria, characterised by pruritic wheals, angioedema or both significantly impacts individuals quality of life. […] This review article examines the patient-reported outcome measures (PROMs) in chronic urticaria assessment, aiming to enhance understanding and management of this condition. […] Within this framework, PROMs have become useful tools for assessing the subjective experiences and viewpoints of people who have chronic urticaria. […] Studies have demonstrated correlations between urticaria activity score and various aspects of chronic urticaria, providing valuable insights into predicting treatment responses and disease outcomes. […] The urticaria activity score has proven effective in predicting treatment outcomes and prognosis. […] The integration of these measures in both clinical trials and routine practice is essential for a holistic evaluation of urticaria patients. […] PROMs play a pivotal role in identifying the overall impact of this skin disease. […] They offer a better understanding of the profound impact of urticaria on patients lives, guiding the physician regarding the effectiveness of treatment.

• #3 Clinical Features of Chronic Spontaneous Urticaria that Predict Disease Prognosis and Refractoriness to Standard Treatment | HTML | Acta Dermato-Venereologica

  https://www.medicaljournals.se/acta/content/html/10.2340/00015555-2941

  The baseline UAS7 has been demonstrated to be the unique parameter able to predict refractoriness to H1-antihistamines. […] Almost 90% of patients with baseline UAS716 needed cyclosporin A or omalizumab combined with antihistamines in order to control CSU symptoms. […] Despite some limitations based on the retrospective and single-centre character of this study, we conclude that the following factors indicate the worst prognosis, in terms of duration and/or activity of the disease and its episodes: multiple episodes of CSU; late-onset; concomitant CIndU; and functional serum autoreactivity.

• #4

  https://link.springer.com/article/10.1007/s13555-022-00827-6

  The observed median time to clinical remission was 336 days, a value that is generally consistent with prior published studies that used a similar definition of clinical remission (i.e., 12 months free of CU diagnosis/CU-related treatment). […] Multiple relevant factors were identified that had predictive power for longer time to clinical remission, including older age at diagnosis, longer time to diagnosis, higher prevalence of comorbidities, particularly asthma and allergic rhinitis, higher BMI, smoking, polypharmacy, and increased laboratory tests in the year preceding or during the first 6 weeks following the first CU diagnosis. […] The important features identified through the predictive machine learning model reveal that there might be complex interactions among variables, which are difficult to identify and interpret through clinical judgment alone. […] Ongoing work aims to translate this predictive model into real-world application(s) that could support clinicians in better assessing patients’ time to clinical remission based on collectable information and support better disease management.

• #5 Predictors of treatment response in chronic spontaneous urticaria – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33539587/

  The current therapeutic algorithm for chronic spontaneous urticaria (CSU), endorsed by the international guideline, entails treatment escalation from second-generation H1 -antihistamines (sgAHs) to omalizumab and cyclosporine until complete response is achieved. Recently, several predictors of response to these treatment options have been described. […] High disease activity, high levels of C-reactive protein and D-dimer are robust predictors for a poor or no response to sgAHs. Poor or no response to omalizumab is robustly predicted by low serum levels of total IgE. A good response to cyclosporine is robustly predicted by a positive basophil histamine release assay, whereas low total IgE is an emerging predictor. The response to treatment with sgAHs, omalizumab and cyclosporine can be predicted by the use of markers that are readily available in routine clinical practice. Further studies are needed to confirm these predictors.

• #6 The predictive factors for remission of chronic spontaneous urticaria in childhood: Outcome from a prospective study | Allergologia et Immunopathologia

  https://www.elsevier.es/en-revista-allergologia-et-immunopathologia-105-articulo-the-predictive-factors-for-remission-S0301054616300738

  The remission rates at 12 months and 36 months were 32.7% and 48.1%. […] Our study indicates that urticaria controlled by a standard dose of antihistamine can predict a good prognosis independently from disease duration at first visit. […] The remission rates in this study were 32.7% and 46.1% at one and three years, respectively. […] The remission rate of the patients who had taken standard dose antihistamine was higher than that of patients who had been treated with high-dose antihistamine or combination medications in logistic regression analysis. […] This finding may help to increase patient compliance with treatment. Thus, further studies about treatment response and the natural course of CSU in childhood should be performed.

• #7 The Effectiveness of Omalizumab Treatment in Real-Life is Lower in Patients with Chronic Urticaria Longer than 18 Months’ Evolution and Prior Immunosuppressive Treatment | Actas Dermo-Sifiliográficas

  https://www.actasdermo.org/en-the-effectiveness-omalizumab-treatment-in-articulo-S1578219018303998

  La efectividad del tratamiento con omalizumab en la vida real es menor en pacientes con urticaria crónica de más de 18 meses de evolución y tratamiento inmunosupresor previo […] La eficacia del omalizumab en el tratamiento de la urticaria crónica espontánea ha sido demostrada en ensayos clínicos de fase iii, pero la información disponible sobre la efectividad en la vida real utilizando la puntuación de actividad urticarial semanal (UAS7) es escasa. […] La duración de la enfermedad, la terapia inmunosupresora previa y el requerimiento de tratamiento concomitante con antihistamínicos H1 pueden ayudar a predecir la respuesta al tratamiento con omalizumab. […] Los pacientes con urticaria de larga duración (18 meses) tuvieron menor probabilidad de lograr una respuesta clínica en la semana 12. […] El tratamiento inmunosupresor previo tendía a asociarse con una menor probabilidad de respuesta completa en la semana 12. […] La eficiencia y la seguridad del omalizumab en la vida real son similares a la eficacia y la seguridad en los ensayos clínicos.

• #8 Prognostic Factors for Chronic Spontaneous Urticaria: A 6-Month Prospective Observational Study

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4713874/

  Chronic urticaria (CU) has a substantial impact on the quality of life. Little clinical data on the prognosis of CU has been reported. This study aimed to investigate the control status and remission rate of CU and to explore potential predictors of good responses to the treatment during a 6-month treatment period. […] The proportion of CSU patients that achieved remission or a well-controlled state was 39% for the 6 months of stepwise treatment. Longer observations are necessary to assess the exact prognosis of CSU. ASST results may be a useful parameter for predicting a better response to treatment and both UAS and CU-QoL are helpful to monitor therapeutic response. […] After 6 months of prospective observation, 2 (3.4%) and 21 (35.6%) of the 59 patients were determined to have their urticaria in remission and well-controlled states, respectively. […] This study suggests a potential use of ASST to predict the control status of CU over a 6-month period of stepwise treatment. […] Multivariate regression analysis revealed that a positive ASST was a significant independent predictor of urticaria control over 6 months of stepwise treatment.

• #9

  https://link.springer.com/article/10.1007/s13555-022-00827-6

  The time required to reach clinical remission varies in patients with chronic urticaria (CU). […] The objective of this study is to develop a predictive model using a machine learning methodology to predict time to clinical remission for patients with CU. […] Clinical remission was defined as a period of 12 months free of CU (i.e., no CU diagnosis and/or any CU-related treatment), with the remission date being the start date of this period. […] The model predicted the median time to clinical remission to be 318 days with a concordance of 0.62, as measured by the OOB c-index. […] A predictive machine learning model was developed to predict time to clinical remission among patients with CU using real-world medical data with a high degree of agreement between the observed and predicted time to clinical remission.

• #10 Urticaria and angioedema | Allergy, Asthma & Clinical Immunology | Full Text

  https://aacijournal.biomedcentral.com/articles/10.1186/s13223-018-0288-z

  Urticaria is generally classified as acute or chronic, depending on the duration of symptoms and the presence or absence of inducing stimuli. […] Although acute urticaria can generally be easily managed and is associated with a good prognosis, chronic, severe urticaria is often associated with significant morbidity and diminished quality of life (QOL). […] The work-up and management of HAE and AAE vary considerably from that of angioedema associated with urticaria. […] Although the angioedema associated with these disorders is often self-limited, laryngeal involvement can lead to fatal asphyxiation. […] The diagnosis of HAE and AAE should include the assessment of C4, C1q, and C1-INH function and antigenic levels. […] The management of these disorders involves an approach to acute treatment, short-term and long-term prophylaxis that is evidence-based and follows national and international guideline recommendations.

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