Full text
5/2026
vol. 43
Original article
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
Data publikacji online: 2026/10/22
- Zuberbier T, Abdul Latiff AH, Abuzakouk M, et al. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy 2022; 77: 734-66.
- Fricke J, Ávila G, Keller T, et al. Prevalence of chronic urticaria in children and adults across the globe: systematic review with meta-analysis. Allergy 2020; 75: 423-32.
- Curto-Barredo L, Archilla LR, Vives GR, et al. Clinical features of chronic spontaneous urticaria that predict disease prognosis and refractoriness to standard treatment. Acta Derm Venereol 2018; 98: 641-7.
- Fok JS, Kolkhir P, Church MK, Maurer M. Predictors of treatment response in chronic spontaneous urticaria. Allergy 2021; 76: 2965-81.
- Maurer M, Abuzakouk M, Bérard F, et al. The burden of chronic spontaneous urticaria is substantial: real-world evidence from ASSURE-CSU. Allergy 2017; 72: 2005-16.
- Guillén-Aguinaga S, Jáuregui Presa I, Aguinaga-Ontoso E, et al. Updosing nonsedating antihistamines in patients with chronic spontaneous urticaria: a systematic review and meta-analysis. Br J Dermatol 2016; 175: 1153-65.
- Metz M, Vadasz Z, Kocatürk E, Giménez-Arnau AM. Omalizumab updosing in chronic spontaneous urticaria: an overview of real-world evidence. Clin Rev Allergy Immunol 2020; 59: 38-45.
- Zuberbier T, Aberer W, Asero R, et al. The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy 2018; 73: 1393-414.
- Mouliou DS. C-reactive protein: pathophysiology, diagnosis, false test results and a novel diagnostic algorithm for clinicians. Diseases 2023; 11: 132.
- Ayse Ornek S, Orcen C, Church MK, Kocaturk E. An evaluation of remission rates with first and second line treatments and indicators of antihistamine refractoriness in chronic urticaria. Int Immunopharmacol 2022; 112: 109198.
- Wongjirattikarn R, Chaowattanapanit S, Foocharoen C, et al. Factors associated with refractoriness to an up to fourfold dosage of antihistamines in isolated chronic spontaneous urticaria. J Cutan Med Surg 2022; 26: 593-9.
- Kolkhir P, Altrichter S, Hawro T, Maurer M. C-reactive protein is linked to disease activity, impact, and response to treatment in patients with chronic spontaneous urticaria. Allergy 2018; 73: 940-8.
- de Montjoye L, Darrigade AS, Giménez-Arnau A, et al. Correlations between disease activity, autoimmunity and biological parameters in patients with chronic spontaneous urticaria. Eur Ann Allergy Clin Immunol 2021; 53: 55-66.
- Tedeschi A, Asero R, Lorini M, et al. Plasma levels of matrix metalloproteinase-9 in chronic urticaria patients correlate with disease severity and C-reactive protein but not with circulating histamine-releasing factors. Clin Exp Allergy 2010; 40: 875-81.
- Magen E, Waitman DA, Kahan NR. Hematologic parameters as biomarkers for antihistamine and omalizumab resistance in chronic spontaneous urticaria. Allergy Asthma Proc 2021; 42: e17-24.
- Gimenez-Arnau AM, Salman A, Podder I. Biomarkers to predict therapeutic response in chronic spontaneous urticaria: a review. Eur J Dermatol 2024; 34: 3-12.
- Kolkhir P, Pogorelov D, Olisova O. CRP, D-dimer, fibrinogen and ESR as predictive markers of response to standard doses of levocetirizine in patients with chronic spontaneous urticaria. Eur Ann Allergy Clin Immunol 2017; 49: 189-92.
- Ulambayar B, Yang EM, Cha HY, et al. Increased platelet activating factor levels in chronic spontaneous urticaria predicts refractoriness to antihistamine treatment: an observational study. Clin Transl Allergy 2019; 9: 33.
- Trinh HK, Pham DL, Ban GY, et al. Altered systemic adipokines in patients with chronic urticaria. Int Arch Allergy Immunol 2016; 171: 102-10.
- Sánchez-Borges M, Capriles-Hulett A, Caballero-Fonseca F, González-Aveledo L. Biomarkers of treatment efficacy in patients with chronic spontaneous urticaria. Eur Ann Allergy Clin Immunol 2018; 50: 5-9.
- Nebiolo F, Bergia R, Bommarito L, et al. Effect of arterial hypertension on chronic urticaria duration. Ann Allergy Asthma Immunol 2009; 103: 407-10.
- Maurer M, Staubach P, Raap U, et al. H1-antihistamine-refractory chronic spontaneous urticaria: it’s worse than we thought – first results of the multicenter real-life AWARE study. Clin Exp Allergy 2017; 47: 684-92.
- Kasperska-Zaj¹c A, Grzanka A, Jarzab J, et al. The association between platelet count and acute phase response in chronic spontaneous urticaria. Biomed Res Int 2014; 2014: 650913.
- Magen E, Mishal J, Zeldin Y, Schlesinger M. Clinical and laboratory features of antihistamine-resistant chronic idiopathic urticaria. Allergy Asthma Proc 2011; 32: 460-6.
- Vena GA, Cassano N, Marzano AV, Asero R. The role of platelets in chronic urticaria. Int Arch Allergy Immunol 2016; 169: 71-9.
- Maurer M, Zuberbier T, Siebenhaar F, Krause K. Chronic urticaria – what does the new guideline tell us? J Dtsch Dermatol Ges 2018; 16: 584-93.
- Schoepke N, Asero R, Ellrich A, et al. Biomarkers and clinical characteristics of autoimmune chronic spontaneous urticaria: results of the PURIST Study. Allergy 2019; 74: 2427-36.
- Lang DM, Sheikh J, Joshi S, Bernstein JA. Endotypes, phenotypes, and biomarkers in chronic spontaneous urticaria: evolving toward personalized medicine. Ann Allergy Asthma Immunol 2025; 134: 408-17.e3.
- Toubi E, Kessel A, Avshovich N, et al. Clinical and laboratory parameters in predicting chronic urticaria duration: a prospective study of 139 patients. Allergy 2004; 59: 869-73.
- Gangemi S, Saitta S, Lombardo G, et al. Serum thyroid autoantibodies in patients with idiopathic either acute or chronic urticaria. J Endocrinol Invest 2009; 32: 107-10.
- Magen E, Waitman DA, Dickstein Y, et al. Clinical-laboratory characteristics of ANA-positive chronic idiopathic urticaria. Allergy Asthma Proc 2015; 36: 138-44.
- Kolkhir P, Church MK, Altrichter S, et al. Eosinopenia, in chronic spontaneous urticaria, is associated with high disease activity, autoimmunity, and poor response to treatment. J Allergy Clin Immunol Pract 2020; 8: 318-25.e5.
- Weissmann S, Burrack N, Golan-Tripto I, Horev A. Increased neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in chronic and severe urticaria. Acta Derm Venereol 2024; 104: adv23932.
- Akca HM, Tuncer Kara K. Correlation of urticaria activity score in chronic spontaneous urticaria with serum C-reactive protein level and neutrophil/lymphocyte ratio. Dermatol Ther 2020; 33: e14532.
- Ertaş R, Özyurt K, Karakükçü Ç, et al. Evaluation of platelet parameters and neutrophil/lymphocyte ratio during omalizumab treatment in patients with severe chronic spontaneous urticaria. Turk J Med Sci 2018; 48: 1255-62.
- Oflar E, Yıldız C, Koyuncu A, et al. Relationship between uric acid albumin ratio and peripheral artery disease complexity. Eur Rev Med Pharmacol Sci 2023; 27: 11472-8.
- Maurer M, Rosén K, Hsieh HJ, et al. Omalizumab for the treatment of chronic idiopathic or spontaneous urticaria. N Engl J Med 2013; 368: 924-35.
- Saini SS, Bindslev-Jensen C, Maurer M, et al. Efficacy and safety of omalizumab in patients with chronic idiopathic/spontaneous urticaria who remain symptomatic on H1 antihistamines: a randomized, placebo-controlled study. J Invest Dermatol 2015; 135: 67-75.
- Bernstein JA, Kavati A, Tharp MD, et al. Effectiveness of omalizumab in adolescent and adult patients with chronic idiopathic/spontaneous urticaria: a systematic review of ‘real-world’ evidence. Expert Opin Biol Ther 2018; 18: 425-48.
- Ohanyan T, Schoepke N, Bolukbasi B, et al. Responsiveness and minimal important difference of the urticaria control test. J Allergy Clin Immunol 2017; 140: 1710-3.e11.
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