Non-sedating H1-antihistamines Research Articles

Treatment options in refractory chronic spontaneous urticaria.

Chronic spontaneous urticaria (CSU) patients sometimes do not respond to second-generation antihistamine, and 10-50% patients do not even respond to four-fold the usual dose of nonsedating H1 antihistamine, which further leads to repeated courses of oral corticosteroids to abate the symptoms. There are third-line agents approved by EAACI guidelines, which include omalizumab and cyclosporine. Certain patients are even resistant to the third-line agents. In this review, various other treatment options will be discussed in patients of refractory CSU. Recently, we demonstrated azathioprine as a possible third-line option, which was found noninferior to cyclosporine in antihistamine refractory CSU. There have been trials, studies, case series and reports, which suggest other putative options for refractory CSU management. Studies on the management of refractory CSU are accumulating thereby expanding the armamentarium of dermatologists and allergologist against difficult-to-treat urticaria patients.

Shedding light on dermographism: a narrative review.

Dermographism is a common subtype of chronic urticaria. It generally manifests as a linear wheal after scratching or friction, with or without angioedema. The pathophysiology is not clear, but currently, we believe that the stimulation of the skin by mechanical stress leads to the activation of mast cells, which provoke the release of histamine and pro-inflammatory mediators, ultimately forming wheal along the stressed area. The gold standard for diagnosis is a medical history and provocation test or dermatographic test. As one of the subtypes of chronic urticaria, the Urticaria Control Test (UCT), Chronic Urticaria Quality of Life questionnaire (CU-Q2oL), and Dermatology Life Quality Index (DLQI) are also effective tools for evaluating disease control in dermographism patients. In addition to avoiding triggers, nonsedating H1 antihistamines are the first-line medications recommended by EAACI and other guidelines; for those who do not respond to standard doses, the recommended dosage can be increased up to 4 times. When necessary, the off-label use of omalizumab can be considered, and some drugs with potential therapeutic effects are still being explored. However, there is still a lack of biomarkers for predicting disease severity, efficacy, and prognosis. Here, we review what we know about dermographism and some points that need exploration in the future.

Managing hyperglycemia and rash associated with alpelisib: expert consensus recommendations using the Delphi technique

Hyperglycemia and rash are expected but challenging adverse events of phosphatidylinositol-3-kinase inhibition (such as with alpelisib). Two modified Delphi panels were conducted to provide consensus recommendations for managing hyperglycemia and rash in patients taking alpelisib. Experts rated the appropriateness of interventions on a 1-to-9 scale; median scores and dispersion were used to classify the levels of agreement. Per the hyperglycemia panel, it is appropriate to start alpelisib in patients with HbA1c 6.5% (diabetes) to <8%, or at highest risk for developing hyperglycemia, if they have a pre-treatment endocrinology consult. Recommend prophylactic metformin in patients with baseline HbA1c 5.7% to 6.4%. Metformin is the preferred first-line anti-hyperglycemic agent. Per the rash panel, initiate prophylactic nonsedating H1 antihistamines in patients starting alpelisib. Nonsedating H1 antihistamines and topical steroids are the preferred initial management for rash. In addition to clinical trial evidence, these recommendations will help address gaps encountered in clinical practice.

Therapy of acute rhinosinusitis in patients with allergic rhinitis: possibilities for implementing advanced control of inflammation

Introduction. Allergic rhinitis (AR) in conjunction with acute infectious rhinosinusitis (ARS) can lead to increased inflammation and contributes to a more severe course of ARS.Aim. To study the effect of some non-sedating H1-antihistamines on the severity of clinical presentations in adult patients with ARS and underlying AR as part of routine medical practice.Materials and methods. Group 1 (75 patients) and Group 2 (85 patients) were generated through simple randomization from the patient population with ARS and underlying AR, who were prescribed benzhydryl-piperazinyl-butylmethylxanthine succinate (Teoritin® MF, 4 mg/day) or desloratadine (INN, 5 mg/day), respectively. The course of therapy was 14 days. The estimated parameters included changes in indices of nasal symptoms, rhinoscopic and non-nasal symptoms during follow-up visits, time to reach zero indices, the proportions of patients, whose symptoms reduced after 3 and 7 days of treatment, the need for the use of nasal decongestants and changes in quality of life measures.Results and discussion. During the first 3 days of treatment, nasal breathing improved in 91% (95% CI 81–96%) of patients in Group 1 vs 56% (95% CI 45–67%) in Group 2, p &lt; 0.001; rhinorrhea was relieved in 76% (95% CI 65–85%) and 62% (95% CI 51–72%) in Groups 1 and 2, respectively. By Day 7 of treatment, complete restoration of nasal breathing was observed in 71% of patients in Group 1 (95% CI 59–80%), and in 41% (95% CI 31–52%) in Group 2 (p = 0.014); rhinorrhea was relieved in 61%(95% CI 49–72%) of patients in Group 1 and 37% (95% CI 27–48%) in Group 2, p = 0.001. Decongestants were used by 20%(95% CI 12–31%) of patients in Group 1, and by 35% (95% CI 25–47%) of patients in Group 2, p = 0.031. The between-group difference was significant in terms of duration and frequency of adjuvant therapy, p &lt; 0.05.Conclusion. In comparison with desloratadine, it provided a more pronounced reduction of nasal and non-nasal symptoms, as well as relief of rhinoscopic signs of inflammation in a shorter time. The use of Teoritin® MF contributed to the reduction in the need (duration and frequency) for nasal decongestants.

Designing and evaluation of ebastine–benzamide cocrystals

Background: Ebastine (EB) is a selective nonsedating H1 antihistamine belonging to Class II(BCS); it has inadequate oral bioavailability due to its poor water solubility. Cocrystal is one of the most recent methods that has been utilized to improve some physicochemical characteristics of a drug, such as solubility and dissolution rate. This research's main objective was to design and evaluate EB cocrystal as a trial to enhance its solubility. Methods: Various techniques were employed to formulate cocrystals, such as solvent evaporation, slurry, and drop asset grinding using benzamide (BENZ) as a co-former in different molar ratios. The prepared formulas were characterized by percentage yield, drug content, saturation solubility, in vitro dissolution studies, infrared spectroscopy (FTIR), Raman spectroscopy, powder X-ray diffraction (PXRD), and differential scanning calorimetry (DSC), Results: Solubility enhanced by 347 fold in distilled water with enhanced dissolution profile. Conclusions: Co-crystallization is a potential solid formation method due to its ability to enhance physicochemical and mechanical characteristics. Co-crystals have been successfully formed from a variety of medicines and co-former, using distinct hydrogen bond synthon motifs.

Urticária crônica: Tratamento farmacológico

Introduction: Chronic urticaria is a skin condition characterized by recurrent episodes of itching and rashes that persist for more than six weeks. Its effective management is essential for improving patients' quality of life. This study aims to evaluate best practices in the management of chronic urticaria. Objectives: To evaluate the most effective treatment options available for patients with chronic urticaria. Methodology: A literature review was carried out, including clinical studies and recent medical guidelines. Treatment options, diagnosis, drug safety and efficacy, and management strategies in different age groups were analyzed. Results: The results of this review highlight that non-sedating H1 antihistamines are the first line of treatment for chronic urticaria. In cases of treatment resistance, other options such as systemic corticosteroids and immunosuppressants can be considered, although with caution due to potential side effects. In elderly patients, liver and kidney function should be considered when choosing medications. In addition, identifying possible underlying causes is crucial for the effective management of chronic urticaria. Conclusion: The management of chronic urticaria requires a personalized approach based on an assessment of the patient's needs, considering age, comorbidities and drug safety. Identifying and treating the underlying causes, where possible, is essential. With current guidelines and therapeutic options, it is possible to significantly improve the quality of life of patients with chronic urticaria.

Acute urticaria—what to do?

SummaryAcute urticaria (AU) is the most common cause of wheal formation. By definition, it does not persist for more than 6 weeks. It can occur at any age and is more commonly seen in atopic diathesis. Acute spontaneous urticaria is distinguished from inducible forms. This review highlights the clinical presentation, differential diagnosis, possible triggers, and therapeutic strategies. In childhood as in adulthood, viral infections are very frequently associated with acute urticaria, whereas drugs and food are less frequently described as triggers. However, it is not uncommon for multiple triggers to be present simultaneously. Therapeutically, oral nonsedating H1 antihistamines are mainly used. In some patients, concomitant short-term administration of glucocorticosteroids is also necessary.

Effects of bepotastine, a nonsedating H1-antihistamine, for the treatment of persistent cough and allergic rhinitis: a randomised, double-blind, placebo-controlled trial.

Empirical therapy with oral histamine-1 receptor antagonists (H1RAs) is often used for patients with suspected upper airway cough syndrome. No placebo-controlled trials with nonsedating H1RAs (nsH1RAs) have evaluated validated cough outcomes. The objective of the present study was to assess the effect of an nsH1RA, bepotastine, on cough outcomes in patients with allergic rhinitis and persistent cough. A randomised, double-blind, placebo-controlled trial was conducted. Adult patients with persistent cough (>3 weeks in duration) and symptomatic allergic rhinitis were recruited and randomly assigned to receive either bepotastine or placebo at a 1:1 ratio. The primary outcome was cough-specific quality of life assessed using the Leicester Cough Questionnaire (LCQ). Secondary outcomes included cough severity visual analogue scale (VAS), throat VAS, Cough Hypersensitivity Questionnaire, Sinonasal Outcome Test-22 score and drug adverse events. Between October 2021 and September 2022, 50 participants (43 females; mean age 46.28 years; median cough duration 3 months) were assigned to either the bepotastine 10 mg twice daily or placebo group in a 1:1 ratio. After 2 weeks of treatment, both bepotastine and placebo groups showed significant improvements in the LCQ scores, but there was no significant difference in the magnitude of change between the groups (3.45±2.10 versus 3.04±2.94, p=0.576). Secondary outcomes were also comparable. Despite the relatively small sample size, our study clearly demonstrated that a 2-week treatment with bepotastine did not provide therapeutic benefits for cough outcomes. These findings suggest against the use of nsH1RAs with the intention of improving cough outcomes, even in patients with persistent cough and allergic rhinitis.

An international Delphi study on the burden of allergic rhinoconjunctivitis and urticaria and the role of bilastine among current treatment options

ABSTRACT Background Allergic rhinoconjunctivitis and chronic urticaria are common histamine-driven diseases, exerting detrimental effects on cognitive functions, sleep, daily activities, and quality of life. Non-sedating second-generation H1-antihistamines are the first-line treatment of choice. Aim of the study was to define the role of bilastine among second-generation H1-antihistamines in the treatment of allergic rhinoconjunctivitis and urticaria in patients of different ages. Methods An international Delphi study was carried out to assess consensus among experts from 17 European and extra-European countries on three main topics: 1) Burden of disease; 2) Current treatment options; 3) Specific characteristics of bilastine among second-generation antihistamines. Results Here, we present the results obtained for a selection of 15 out of 27 consensus statements, focused on disease burden, role of second-generation antihistamines and bilastine profile. The rate of concordance was ≥98% for 4 statements, ≥ 96% for 6, ≥ 94% for 3, and ≥90% for 2. Conclusions The high degree of agreement obtained suggests a wide awareness of the burden of allergic rhinoconjunctivitis and chronic urticaria among experts from all over the world and reflects a broad consensus on the role of second-generation antihistamines in general and of bilastine in particular for their management.

Bacterial DNA promoting inflammation via the Sgk1/Nedd4L/Syk pathway in mast cells contributes to antihistamine-nonresponsive CSU.

Inflammation centered on non-IgE-mediated mast cell activation characterizes chronic spontaneous urticaria resistant to nonsedating H1-antihistamines. We recently uncovered a strong positive association between inflammation and the fecal Escherichia. To further explore the actions of bacterial DNA derived from Escherichia on mast cells, intestinal permeability of patients with chronic spontaneous urticaria with or without nonsedating H1-antihistamine resistance and healthy controls were determined, and LAD2 cells with knockdown of Syk, Nedd4L, or Sgk1 or with incubation of inhibitors GS9973, GSK650394, and MG132 were posttreated with btDNA. We found that (i) serum intestinal permeability indices and bacterial DNA markedly increased in patients with chronic spontaneous urticaria with nonsedating H1-antihistamine resistance compared with those without (all P < 0.001), and bacterial DNA positively correlated with the degree of inflammation; (ii) IL-6 and TNF-α levels were time- and dose-dependently upregulated in bacterial DNA-stimulated LAD2 cells, which relied on unmethylated CpG in bacterial DNA and Toll-like receptor 9 protein in cells; (iii) Syk knockdown or inhibition of Syk Tyr525/526 phosphorylation blocked bacterial DNA-initiated cytokine production; (iv) Nedd4L interacted with Tyr525/526-phosphorylated Syk, and inhibition of Nedd4L Ser448 phosphorylation induced by bacterial DNA-activated Sgk1 was mandatory for bacterial DNA's proinflammatory property; and (v) Sgk1 suppression showed an inhibitory effect on bacterial DNA-induced inflammation by ensuring Nedd4L-mediated ubiquitination of Tyr525/526-phosphorylated Syk. Collectively, we identified previously unknown contributory roles of bacterial translocation and serum bacterial DNA on the inflammation phenotype in patients with chronic spontaneous urticaria with nonsedating H1-antihistamine resistance and further uncovered a vital negative regulatory role for the Sgk1/Nedd4L/Syk pathway in bacterial DNA-induced inflammation in LAD2 cells.

S3 Guideline Urticaria. Part 2: Treatment of urticaria - German-language adaptation of the international S3 guideline.

This publication is the second part of the German-language S3 guideline on urticaria. It covers the management of urticaria and should be used together with Part 1 of the guideline on classification and diagnosis. This publication was prepared according to the criteria of the AWMF on the basis of the international English-language S3 guideline with special consideration of health system conditions in German-speaking countries. Chronic urticaria has a high impact on the quality of life and daily activities of patients. Therefore, if causal factors cannot be eliminated, effective symptomatic treatment is necessary. The recommended first-line treatment is to administer new generation, non-sedating H1 antihistamines. If the standard dose is not sufficiently effective, the dose should be increased up to fourfold. For patients who do not respond to this treatment, the second-line treatment in addition to antihistamines in the treatment algorithm is omalizumab and, if this treatment fails, ciclosporin. Other low-evidence therapeutic agents should only be used if all treatments in the treatment algorithm agreed upon by the guideline group fail. Both the benefit-risk profile and cost should be considered. Corticosteroids are not recommended for long-term treatment due to their inevitable severe side effects.

Biologicals in Treatment of Chronic Urticaria: A Narrative Review.

Chronic urticaria is a common inflammatory skin disease affecting around 0.5-1% of the world's population. The disease has a chronic indolent course which significantly affects the patient's quality of life. Urticaria pathogenesis involves cross-linking of immunoglobulin E (IgE) on mast cells causing degranulation which occurs by various pathways which leads to development of wheals and angioedema. The first-line treatment for chronic urticaria is non-sedating second-generation H1 antihistamines (AHs). After the advent of anti-IgE monoclonal antibody omalizumab, the response rate in resistant urticaria has improved significantly without any major adverse events. Other biologicals such as anti-IgE, anti-IL-5, anti-IL-1, anti-IL-17, and anti-CD20 monoclonal antibodies are under trial. These biologicals have better efficacy and safety profile as compared to conventional immunosuppressants. Even with the advances in the last decade, recurrence after stopping the therapy is common, and there is a need for better understanding of the pathogenesis and the drugs acting on the key pathways involved in urticaria. In this review, we provide the role of several biologicals in the treatment of chronic urticaria.

Fexofenadine: A review of its use in the treatment of urticaria in pediatric and adult populations

Urticaria is an inflammatory skin disorder primarily resulting from activation of cutaneous mast cells. The released inflammatory mediators and histamine are responsible for the development of wheals and/or angioedema. Current guidelines recommend non-sedating second generation H1 antihistamines such as fexofenadine hydrochloride as first-line therapy. A recent review by Ansotegui et al. provides an update on urticaria, both in adult and pediatric populations, and on the safety and efficacy of fexofenadine hydrochloride as a treatment option.

Efficacy of Second-Line Treatments in Chronic Urticaria Refractory to Standard Dose Antihistamines.

The prevalence of chronic urticaria (CU) is increasing worldwide, and it imposes a major burden on patients. Few studies have evaluated the efficacy of second-line treatments of CU, particularly for patients being considered for costly third-line treatments such as omalizumab. We compared the efficacy and safety of second-line treatments of CU refractory to standard doses of nonsedating H1-antihistamines (nsAHs). This 4-week, prospective, randomized, open-label trial divided patients into 4 treatment groups: 4-fold updosing of nsAHs, multiple combination of 4 nsAHs, switching to other nsAHs, and adjunctive H2-receptor antagonist. The clinical outcomes included urticaria control status, symptoms, and rescue medication use. This study included 109 patients. After 4 weeks of second-line treatment, urticaria was well-controlled, partly controlled, and uncontrolled in 43.1%, 36.7%, and 20.2% of patients, respectively. Complete control of CU was achieved in 20.4% of patients. Among the patients with high-dose nsAHs, the proportion with well-controlled status was higher compared to the patients who received standard doses (51.9% vs. 34.5%, P = 0.031). No significant difference was observed in the proportion of well-controlled cases between the updosing and combination treatment groups (57.7% vs. 46.4%, P = 0.616). However, increasing the dose of nsAHs 4-fold was associated with a higher rate of complete symptom control compared to multiple combination treatment with 4 nsAHs (40.0% vs. 10.7%, P = 0.030). Logistic regression analysis confirmed the higher efficacy of updosing of nsAHs for complete control of CU compared to the other treatment strategies (odds ratio, 0.180; P = 0.020). In patients with CU refractory to standard doses of nsAHs, both updosing of nsAHs 4-fold and multiple combination treatment with 4 nsAHs increased the rate of well-controlled cases without causing significant adverse effects. Updosing of nsAHs is more effective for complete CU control than combination treatment.

RWD83 Real-World Treatment Patterns in Chronic Spontaneous Urticaria in the United States

Treatment of chronic spontaneous urticaria (CSU) in the US is a stepwise approach recommended by local guidelines. First line: non-sedating H1-antihistamines (ns-H1AH); 2nd line & 3rd line: increased licensed dose ns-H1AH or change of H1AH or add H2-antihistamines (H2AH) or leukotriene inhibitor (LTRA) or sedating H1AH or doxepin; 4th line: add omalizumab or cyclosporine. Rescue medication with short-course oral corticosteroids (OCS), in case of exacerbations. The objective of the study was to assess real-world treatment patterns in adult patients with CSU.

Diagnosis and Management of Urticaria in Indian Settings: Skin Allergy Research Society's Guideline-2022.

Urticaria is a common skin disorder. Chronic urticaria, i.e., the presence of symptoms for more than six weeks, is associated with a significant adverse impact on sleep, performance, quality of life, and financial status of the patients. Although several treatment options are available, the condition can be challenging to treat for many clinicians. Several updates have been published on the subject of urticaria and its management since the publication of an updated consensus statement in 2018 by Indian experts. The objective of this consensus statement is to summarize the updates and provide concise information, including classification, diagnosis, and management of urticaria. Understanding and elimination of the underlying eliciting trigger are essential in all possible cases. The goal of pharmacological treatment is to provide symptomatic relief. Second-generation nonsedating H1 antihistamine continue to be recommended as the first-line treatment, the dose of which can be increased up to four times in patients not responding satisfactorily, in the second step. The role of omalizumab, cyclosporine, H2 antihistamines, and other options is also discussed.

OMALIZUMAB FOR SKEETER SYNDROME: THREE SUCCESSFULLY TREATED PATIENTS

<h3>Introduction</h3> Skeeter syndrome is a rare disease associated with an overwhelming immunologic response to proteins in mosquito saliva. Typical symptoms include large local reactions, hives, swelling, blisters, fever, malaise and rarely anaphylaxis. Prevention measures include mosquito avoidance, use of insect repellants and prophylaxis with oral nonsedating H1 antihistamines. Systemic steroids are often required for severe cases. To date there is no FDA-approved treatment for Skeeter syndrome. Thousands of patients in Skeeter syndrome support groups express dissatisfaction with the lack of treatment options. Allergists have similarly been frustrated by the lack of options available for their Skeeter syndrome patients. Case reports have demonstrated the efficacy of omalizumab in treating other blistering disorders such as bullous pemphigoid. I hypothesized that omalizumab would be effective for reducing the severity of these reactions in patients who continue to suffer despite avoidance measures and standard of care. <h3>Case Description</h3> I treated three adult patients with Skeeter syndrome with 300 mg of omalizumab every four weeks initiated one month prior to the onset of summer. Treatment was continued throughout the duration of summer months when mosquito exposure remained highest. Among the three patients treated with omalizumab, over 100 bites were sustained during therapy. All three patients demonstrated a rapid improvement in the size of their local reactions with no further development of bullae after the first dose of omalizumab. <h3>Discussion</h3> This report highlights a potential therapeutic option for a rare disease and calls for further studies to demonstrate the efficacy of omalizumab for Skeeter syndrome.

THE USE OF CETIRIZINE AND LEVOCETIRIZINE IN PATIENTS WITH CHRONIC URTICARIA AND OTHER ALLERGIC DERMATOSES: ISSUES OF DOSAGE INCREASING AND LONG-TERM USE&#x0D; RESOLUTION OF THE ADVISORY BOARD

The article reflects the main issues discussed at the Advisory board with the participation of leading dermatovenereologists, allergists and immunologists. The Advisory board has become a platform for discussing the accumulated clinical and organizational problems in the field of managing patients with chronic urticaria and other allergic dermatoses. The Board also discussed the possibility of long-term use of cetirizine and levocetirizine and the use of high doses of these drugs in clinical practice. The subject of discussion was the question of the algorithm for escalation and subsequent de-escalation of the dose of non-sedating H1 antihistamines. Based on the results of the discussion, an algorithm for escalation and de-escalation of doses of antihistamines was created, which can be recommended for use in clinical practice.

Urticaria in Pregnancy and Lactation.

Chronic urticaria (CU) is a mast cell-driven chronic inflammatory disease with a female predominance. Since CU affects mostly females in reproductive age, pregnancy is an important aspect to consider in the context of this disease. Sex hormones affect mast cell (MC) biology, and the hormonal changes that come with pregnancy can modulate the course of chronic inflammatory conditions, and they often do. Also, pregnancy-associated changes in the immune system, including local adaptation of innate and adaptive immune responses and skewing of adaptive immunity toward a Th2/Treg profile have been linked to changes in the course of inflammatory diseases. As of now, little is known about the effects of pregnancy on CU and the outcomes of pregnancy in CU patients. Also, there are no real-life studies to show the safety of urticaria medications during pregnancy. The recent PREG-CU study provided the first insights on this and showed that CU improves during pregnancy in half of the patients, whereas it worsens in one-third; and two of five CU patients experience flare-ups of their CU during pregnancy. The international EAACI/GA2LEN/EuroGuiDerm/APAAACI guideline for urticaria recommends adopting the same management strategy in pregnant and lactating CU patients; starting treatment with standard doses of second-generation (non-sedative) H1 antihistamines, to increase the dose up to 4-folds in case of no response, and to add omalizumab in antihistamine-refractory patients; but also emphasizes the lack of evidence-based information on the safety and efficacy of urticaria treatments during pregnancy. The PREG-CU study assessed treatments and their outcomes during pregnancy. Here, we review the reported effects of sex hormones and pregnancy-specific immunological changes on urticaria, we discuss the impact of pregnancy on urticaria, and we provide information and guidance on the management of urticaria during pregnancy and lactation.

Altered Gut Microbiota in H1-Antihistamine-Resistant Chronic Spontaneous Urticaria Associates With Systemic Inflammation.

Background and ObjectiveChronic spontaneous urticaria (CSU) is a histamine-mediated inflammatory skin disease, and second-generation non-sedating H1-antihistamines (nsAH) at licensed doses have long been the first-line therapy in CSU. However, about 50% of patients are resistant to nsAH, and the precise pathogenesis remains largely unknown but seems to be associated with low-level systemic or intestinal inflammation. We aim to determine the fecal microbial composition and clarify its correlation with the clinical profiles og CSU with nsAH resistance.MethodsA total of 25 CSU patients with or 19 CSU patients without nsAH resistance and 19 healthy controls (HC) were enrolled in this study. The intestinal microbiome was detected by 16S rRNA sequencing. The data were analyzed using R language software.ResultsSignificantly higher urticarial activity score for 7 days, stool calprotectin, erythrocyte sedimentation rate, serum C-reactive protein, and interleukin-6, but much lower alpha-diversity and evenness of fecal bacterial community were observed in CSU patients with nsAH resistance than in those without (P <0.05 for all variables). Compared to patients with nsAH-responsiveness, the abundance of fecal genera Prevotella, Megamonas, and Escherichia were significantly increased, while that of Blautia, Alistipes, Anaerostipes, and Lachnospira were remarkably reduced in nsAH-resistant patients (uncorrected P <0.05 for all variables). Finally, systemic not intestinal inflammation degree was positively correlated with genera Escherichia, while negatively with genera Blautia, Dorea, Lactobacillus, Eubacterium_hallii_group, and Roseburia. CSU without nsAH resistance and HC individuals showed almost unchanged genera bacterium.ConclusionsAmong CSU patients, pro-inflammation phenotype relating to enteric dysbacteriosis features nsAH resistance in CSU patients. The results provide clues for future microbial-based or anti-inflammatory therapies on nsAH resistant CSU.