Abstract
Clinical and laboratory factors associated with antihistamine refractoriness in chronic spontaneous urticaria: a real-life study
Division of Immunology and Allergy, Department of Chest Diseases, Ankara Atatürk Sanatoryum Education and Research Hospital, University of Health Sciences, Ankara, Türkiye
Adv Dermatol Allergol 2026; XLIII (5): 527-534
Introduction
Chronic spontaneous urticaria (CSU) is a prevalent dermatologic disease that markedly impairs quality of life. Guidelines recommend standard-dose second-generation H1 antihistamines (sgH1-AHs) as first-line treatment, with updosing in patients who remain symptomatic. Nevertheless, the literature provides insufficient evidence regarding predictors of disease control in CSU.
Aim
To determine clinical and laboratory parameters related to AH-refractory CSU and to evaluate factors of inadequate response to standard-dose sgH1-AHs.
Material and methods
In this retrospective cohort study, adult patients who were followed in the Department of Immunology and Allergy between 1 January 2020, and 30 June 2024, with a diagnosis of CSU and treated with sgH1-AHs were included. Patients with chronic inducible urticaria (CIU) were excluded. Clinical parameters, including hypertension, asthma, angioedema, and systemic corticosteroid use, as well as laboratory parameters, including anti-nuclear antibody (ANA), rheumatoid factor (RF), complete blood count, C-reactive protein (CRP), total immunoglobulin E (IgE), thyroid-stimulating hormone (TSH), anti-thyroid peroxidase antibody (anti-TPO), uric acid, and albumin, were compared between sgH1-AH responders/responsive and refractory patients, with additional dose-based analyses performed among responders.
Results
A total of 208 patients with CSU met the study criteria. Disease control was achieved with standard-dose sgH1-AHs in 127 (61.1%) patients, while 37 (17.7%) required updosing and 44 (21.2%) were AH-refractory. Omalizumab was initiated in all refractory patients, with 41 (93.2%) achieving disease control under the standard regimen. Hypertension, angioedema, and systemic corticosteroid use were more frequent in the refractory group. Anti-thyroid peroxidase, platelet count, and CRP levels were significantly higher, whereas total basophil count and mean platelet volume were lower. Multivariate analysis identified systemic corticosteroid use (OR = 9.74, 95% CI: 4.07–23.30, p < 0.001) and CRP (OR = 1.10, 95% CI: 1.02–1.19, p = 0.01) as independent factors associated with AH-refractoriness. Total basophil count showed a tendency to predict higher-dose treatment need among AH-responsive patients (p = 0.03).
Conclusions
Systemic corticosteroid use and CRP were found as clinically relevant factors associated with AH-refractory CSU.
Keywords
chronic spontaneous urticaria, antihistamines, refractoriness, biomarker, updosing
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