Clinical factors as predictors of the development of severe recurrence of chronic spontaneous urticaria after completion of omalizumab therapy

Abstract

Chronic spontaneous urticaria (CSU) affects about 1% of population, and its prevalence is increasing. The disease occurs in both children and adults, with predominance among women. At least two possible causes of CSU have been identified, two autoimmune endotypes, with different types of autoantibodies associated with activation of skin mast cells. In clinical practice, patients with CSU receive therapy accordance the clinical recommendations of the Ministry of Health of Russia for treatment of urticaria, according to the doctor’s algorithm of actions. In patients with CSU, symptoms are difficult to relieve due to special mechanisms of development this variant of disease. In recent years, specific markers, including clinical and laboratory parameters, have been described that can predict response to treatment patients with CSU. In clinical practice, we encounter difficulties in managing these patients. One of these is recurrence of urticaria symptoms after cessation of omalizumab treatment, which negatively affects compliance of patients and its psycho-emotional background. A retrospective analysis of 14 patients with CSU with resumption symptoms after completion of omalizumab treatment was carried out. Patients were divided into two groups: 1 group – 10 patients that symptoms began controlled with antihistamines (go to 1st therapy stage); and 2 group – 4 patients who need re-prescription of omalizumab (stay on 3rd treatment stage). The duration of CSU, activity according to UAS7, combination with development of angioedema, presence of concomitant allergic and autoimmune pathologies, level of CRP, total IgE, and presence of TPO antibodies were analyzed. There was no tendency relapses severity CSU after omalizumab discontinuation with age, gender, duration of the disease, presence of concomitant allergic diseases and drug hypersensitivity. In patients with high disease activity was tendency toward more severe relapses of CSU. The search and study of predictors response to treatment of CSC remains actual task. Further research to identify predictors of response to treatment and relapses severity help identify groups of patients for early transition to more effective treatment methods, which optimize and personalize management of patients with CSU.