Markers of systemic inflammation in delayed pressure urticaria

Long-term follow-up effect of omalizumab in chronic spontaneous urticaria and its association with serum C-reactive protein levels

This study aims to determine the efficacy of omalizumab, a humanized monoclonal anti-immunoglobulin E antibody, in patients with chronic spontaneous urticaria (CSU) refractory to conventional therapy, together with the evaluation of serum CRP levels. All the patients with a diagnosis of CSU who were continuously treated with omalizumab (300 mg/mo) for at least 3 months between June 2016 and July 2019 were included in this study. Urticaria activity score (UAS-7) was used for assessment of disease activity. Serum CRP levels were also retrospectively analyzed. When UAS-7 scores before the initiation of therapy were compared to the week 4, 12, 24, and 36 scores after the treatment, each were significantly different from the pretreatment results (P < .01). CRP level prior to treatment was found to be strongly correlated with baseline UAS scores of the patients' (P = .00). At the 12th week of treatment, decline of CRP level was positively and strongly correlated with the decline of UAS (P = .037). In this study, mean UAS decreased, mean rescue medication use declined, and overall therapeutic response improved with omalizumab treatment. Additionally, significant correlation between the decline of CRP levels and treatment response was found.

Acute-phase response and its biomarkers in acute and chronic urticaria

Introduction

Since urticaria is a persisting inflammatory disease it is important to establish the prognostic factors for the duration and severity of the disease.

Aim

To evaluate serum concentrations of selected acute-phase proteins (APP) in patients with various forms of urticaria as compared to healthy volunteers and also to analyze these concentrations in different types of urticaria. Additionally, to evaluate the correlation between serum levels of selected APP and disease activity.

Material and methods

Serum concentrations of C-reactive protein (CRP), α₁-acid glycoprotein (AGP), α₁-antichymotrypsin (ACT), α₁-antitrypsin (AT), ceruloplasmin (Cp), transferrin (Tf), α₂-macroglobulin (α₂M) and haptoglobin (Hp) were measured. Quantitative measurement was conducted using the rocket immunoelectrophoresis. Disease activity was assessed with the use of total symptom score.

Results

Analysis of serum APP concentrations revealed statistically higher serum concentrations of CRP, AGP and ACT in the entire group of patients with urticaria in comparison with the control group. In the entire group of patients with urticaria, CRP, AGP, ACT, Cp and Hp correlated positively with disease activity, intensity of pruritus and the number and size of urticarial wheals. Statistically lower serum concentrations of CRP, ACT, Cp and Hp were detected in the group of patients with acute urticaria (AU) and angioedema together, compared to the patients suffering from AU only.

Conclusions

Patients with symptoms of various forms of urticaria present a distinct profile of serum APP concentrations. A significant correlation observed between CRP, AGP, ACT, Cp, Hp and clinical activity score points to the potential role of APP as markers of the urticarial activity.

Comparative Efficacy and Safety of Ebastine 20 mg, Ebastine 10 mg and Levocetirizine 5 mg in Acute Urticaria

INTRODUCTION

Acute and chronic urticaria can result in severely impaired quality of life from pruritus and associated sleep lessness, as well as anxiety and depression. Various treatment modalities are available out of which second generation non sedating H1 antihistamines e.g., fexofenadine, loratidine, desloratadine, cetirizine, levocetirizine, ebastine etc., are used as the first line treatment.

AIM

To compare the safety and efficacy of ebastine 20 mg, ebastine 10 mg and levocetirizine 5 mg in the patients of urticaria.

MATERIALS AND METHODS

A longitudinal study was conducted in dermatology Outpatient Department (OPD) of Adesh Institute of Medical Sciences and Research, Bathinda, India. A total of 150 patients between the age group 10-70 years, both men and women having urticaria were enrolled and divided into three groups of 50 each. Group A was given ebastine 20 mg OD, Group B was given ebastine 10 mg OD and Group C was given levocetirizine 5 mg OD. The patients were asked to scale their severity of disease over a period of follow up based on Urticarial Activity Score 7 (UAS7).

RESULTS

The mean age of patients was 32.82 years. The mean UAS 7 score at the end of 4th week was 1.08 with ebastine 20 mg, 1.98 with levocetirizine 5 mg and 3.98 with ebastine 10 mg. In group A, 40 out of 50 patients (i.e., 80%), in Group B 25 out of 50 (i.e., 50%) get UAS7=0 and in Group C, 35 (i.e., 70%) patients who got relieved of symptoms at the end of treatment. When the scores were redefined and categorized under relieved and not relieved, and comparison done between all three groups, then there was a significant difference in the number of patients getting relieved, with p<0.001 (highly significant). Levocetirizine 5 mg had shown more side effects like dryness of mouth and sedation as compare to ebastine irrespective of dosage. The comparison made between the number of patients developing side effects among the groups was highly significant (p<0.001) for all the side effects.

CONCLUSION

Ebastine 20 mg is found to have superior efficacy for treatment of Urticaria as compared to ebastine 10 mg but with levocetirizine 5 mg the results were almost similar. Tolerability of ebastine 20 mg is similar to ebastine 10 mg but with levocetirizine 5 mg there were more side effects and less tolerability.

Serotonin and interleukin-6: Association with pruritus severity, sleep quality and depression severity in Prurigo Nodularis

Prurigo Nodularis (PN) is a chronic skin condition of unknown etiology. It is said to be associated with psychological factors. However, studies to identify the same are few. Hence, we undertook to assess the association between quality of sleep, depression, pruritus severity in cases of PN and to assess association of serum serotonin, interleukin (IL)-6 with sleep, depression and pruritus severity. This cross-sectional study involves 39 patients with PN and 39 age and gender matched healthy controls. Subjective quality of sleep, depressive symptom severity and pruritus severity were collected through clinician based interview. Serum serotonin and serum IL-6 were estimated by ELISA. Spearman correlation was used to assess the strength of association between biochemical parameters and clinical parameters. Cases had significantly higher percentage of depression, a higher score of depression severity, higher serum IL-6 level and lower serum serotonin levels. Serum serotonin and serum IL-6 showed significant correlation with the severity of pruritus (r=-0.66, p<0.01 and r=0.60, p<0.01). However, both these parameters showed a significantly negative correlation between them (r=-0.92, p<0.01). Though cause and effect cannot be established in this type of study, there is a disturbance of the inflammatory-neuroendocrine axis (interleukins-serotonin). PN is characterized by higher IL-6 and lower serotonin and greater depression severity than healthy controls. Findings of this study may have an influence on the treatment of PN.

Plasma soluble CD40 concentration in patients with delayed pressure urticaria

Very little is known about the immune-inflammatory cascade in delayed pressure urticaria (DPU). It has been suggested that increased activation/expression of CD40 may result in enhanced release of soluble CD40 (sCD40) in chronic urticaria. To investigate release of sCD40 in the course of DPU, plasma sCD40 concentration was measured using ELISA method in 18 adult patients with DPU and 27 age- and sex-matched healthy controls. Plasma sCD40 concentration did not differ significantly in the DPU group as compared to healthy subjects. The present study as well as the earlier contributions, suggest that distinct CD40-signalling activity manifested by sCD40 release may be identified in different types of urticaria. Delayed pressure urticaria is not associated with increased circulating sCD40 concentration, contrary to chronic spontaneous urticaria with positive response to autologous serum skin test.

Is delayed pressure urticaria associated with increased systemic release of sCD40L?

BACKGROUND

Elevated levels of soluble CD40 Ligand (sCD40L) were found in serum but not in plasma of patients with chronic spontaneous urticaria (CU). What is important is that sCD40L has proinflammatory properties, and its elevated plasma level may indicate increased risk of cardiovascular events. These observations should stimulate further evaluation of sCD40L in different forms of urticaria.

AIM

In the present study, sCD40L plasma level was investigated in delayed pressure urticaria (DPU).

METHODS

As platelets are predominant and variable sources of sCD40L, we investigated sCD40L concentration in platelet-poor plasma (PPP), which seems the best way to minimize the potential contribution of these cells to the ligand level.

RESULTS

Plasma sCD40L concentration was significantly increased in the DPU group compared to the healthy controls.

CONCLUSIONS

It seems that DPU is associated with increased systemic release of sCD40L, which is believed to derive predominantly from activated platelets. The present study as well as the earlier contributions suggest that distinct cells activity, including platelets, may be identified in different types of urticaria.