Abstract
(1) Background: The COVID-19 pandemic has resulted in the exacerbation of various chronic diseases. Due to the potential impact of SARS-CoV-2 on mast cells, we aimed to analyze the relevance of COVID-19 disease on chronic spontaneous urticaria (CSU) clinical presentation and biological profile. (2) Methods: This study is a retrospective case series of patients with CSU diagnosed and treated in the Allergy Department of the Professor Doctor Octavian Fodor RIGH, (Cluj-Napoca, Romania). Patients were assessed for disease activity and level of control with the weekly urticaria activity score and the visual analogue scale. Results were correlated with COVID-19 severity and with nonspecific markers of inflammation during and after the SARS-CoV-2 infection. (3) Results: SARS-CoV-2 impacted a significant proportion (33%) of the CSU patients, of which 71% developed a moderate-severe form of COVID-19. Most of the patients (68%) had moderate-severe forms of CSU and 65% took AH1 treatment (one dose, two-fold dose or four-fold dose). The rest of them (35%) received the second-line treatment (40.3% Omalizumab, 53% Prednisolone and 4.8% Cyclosporine). In Omalizumab treated group of UCS patients we observed that COVID-19 disease was not severe. We established a positive correlation between the severity of the infection and that of the CSU clinical presentation, with most bothersome symptoms of urticaria being experienced by moderate to severe COVID-19 CSU patients (47%). Inflammatory markers were positively correlated (p = 0.01) with a more severe clinical profile of CSU, in accordance with our hypothesis that the level of inflammation triggered by COVID-19 disease has a role in CSU exacerbation. The non-specific inflammatory markers, such as CRP, were positively associated with the UAS7 score (R2 = 0.363; p = 0.001). An increased rate of exacerbation of CSU was observed in moderate-severe COVID-19 infection. (4) Conclusions: COVID-19 disease can result in the exacerbation of chronic spontaneous urticaria, more likely in moderate to severe forms of infection.
Highlights
(4) Conclusions: COVID-19 disease can result in the exacerbation of chronic spontaneous urticaria, more likely in moderate to severe forms of infection
Chronic spontaneous urticaria (CSU) is a disease characterized by the recurrence of pruritic wheals, occurring on most days of the week, for longer than six weeks, and accompanied by angioedema in more than 50% of the cases
Our study shows that systemic inflammation evaluated by nonspecific markers is statistically significantly higher in moderate to severe COVID-19 than in mild forms of disease
Summary
Chronic spontaneous urticaria (CSU) is a disease characterized by the recurrence of pruritic wheals, occurring on most days of the week, for longer than six weeks, and accompanied by angioedema in more than 50% of the cases. Active chronic spontaneous urticaria is a debilitating disorder, which has a major impact on the quality of life of affected individuals and is a substantial global burden [3]. The current CSU treatment algorithm follows a stepwise approach, starting with standard doses of second-generation non-sedative H1 antihistamines as the first line treatment. Up-dosing of up to a 4-fold increase of H1 antihistamines in cases non-responsive after 2–4 weeks of first line treatment, or earlier. In antihistamine-resistant patients, treatment with Omalizumab and, if this fails, Cyclosporine is the current guideline-recommended therapy of choice [1,2,3]
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