Severity Of Chronic Urticaria Research Articles

Urticaria in Patients with COVID -19 Infections

Introduction: The relationship between viral infections and acute or chronic urticaria is rarely reported in some articles. But its exact mechanisms are not known. There is evidence of urticaria in the patients with covid-19 infection. Therefore, there was no structured research to clarify the role of the corona virus in the pathogenesis of urticaria. Methods: The articles that were published from January 2020 to October 2022 were reviewed by "PubMed" and "Google scholar" databases using the keywords acute urticarial urticaria, chronic urticaria along with COVID-19. Inclusion criteria were articles reporting acute or chronic urticaria in the patients with confirmed COVID-19 infection in English. Review articles and studies that reported suspected corona infection and in which urticaria were related to drug hypersensitivity and other allergic diseases were considered as exclusion criteria. Results: In this search, 43 articles were reviewed that were related to our goals. Among these articles, 27 studies that met the inclusion criteria were selected. 16 articles were case reports, case series, letters to the editor and 7 original articles. In this review, it was reported 17 patients in 16 case reports and case series with urticaria associated with COVID-19. Conclusion: The severity of chronic urticaria may increase with corona infection. Acute urticaria may be a precursor symptom of COVID-19 infection. Finally, due to the small number of articles and some contradictory results, more studies are suggested in this field.

The role and relationship of the serum D-dimer level and autologous serum skin test response in chronic spontaneous urticaria

Background: The severity of chronic urticaria (CU) may be associated with the D-dimer level, and CU patients often have other autoimmune disorders. The autologous serum skin test (ASST) is believed to identify autoimmune/autoreactive diseases in CU patients. Aim: This study evaluated whether the levels of D-dimer, total immunoglobulin E (IgE), and autoimmune markers, such as antithyroid peroxidase (TPO) and antithyroglobulin (TG), differ between ASST-positive and ASST-negative patients among CU patients. In addition, the study assessed whether these laboratory findings were related to CU severity. Methods: The study enrolled 54 adults with CU (16 ASST positive, 38 ASST negative). D-dimer, total IgE, autoimmune marker (anti-TPO and anti-TG), and thyroid hormone levels and the urticaria activity score (UAS) were measured. Results: The levels of D-dimer, total IgE, anti-TPO, and anti-TG and the thyroid function test result showed no difference between the ASST-positive and ASST-negative groups. The UAS was higher in the ASST-positive group than in the ASST-negative group, but the ASST-positive group showed a better treatment response. The UAS was higher in patients with an elevated D-dimer level than in those with a normal level. Total IgE was related to the UAS in only the ASST-negative group, and anti-TPO and anti-TG levels were not related to the UAS. Conclusions: There were no associations between the ASST response and the D-dimer level, total IgE level, thyroid function test results, and thyroid autoantibody levels. However, our findings suggest that the ASST response, D-dimer level, and total IgE level are potential predictors of CU severity.

Correlation of mean platelet volume levels with severity of chronic urticaria

BackgroundChronic urticaria (CU) is a multifactorial disease, however, in a majority of patients, it is not possible to ascribe a specific aetiology, which is termed ‘idiopathic’. Although autoimmunity has been implicated as a principal cause in 30–50% of these idiopathic cases, activation of coagulatory and inflammatory cascades has gained attention in last few years. AimsTo evaluate levels of mean platelet volume, an indicator of platelet activity, in patients with chronic urticaria and determine its correlation with its severity. MethodsMean platelet volume levels were assessed in 194 patients with chronic urticaria and were compared with equal number of age and sex matched controls. Its levels were also correlated with the severity of urticaria and results of autologous serum skin test. ResultMean platelet volume (MPV) levels were found to be higher in patients with ASST positive chronic urticaria compared to patients with ASST negative chronic urticaria and controls. MPV levels also showed a positive correlation with the severity of chronic urticaria. ConclusionAs platelets secrete and express a number of crucial mediators of coagulation and inflammation, coagulation and inflammatory cascades may play a positive role in chronic urticaria, paving the way for better understanding of pathogenesis and introduction of newer drugs.

Correlation of C-reactive protein levels with severity of chronic urticaria.

Correlation of C-reactive protein levels with severity of chronic urticaria.

Elevated Serum Total IgE – A Potential Marker for Severe Chronic Urticaria

Background: Elevated IgE levels in patients with chronic urticaria have been noted previously, but the significance of these findings has not been appreciated. Objective: To measure the IgE levels in such patients and to examine the relationship between these levels and urticarial severity, autologous serum skin test, anti-thyroid antibodies and duration. Methods: Serum total IgE levels from 203 patients with chronic urticaria were measured and compared with nonatopic individuals. Additionally, patients were assessed for urticarial severity, the presence of autologous serum skin test and anti-thyroid antibodies. Results: Of the chronic urticaria patients, 47 (23.2%) were classified as mild, whereas 67 (33%) were classified as having moderate and 89 (43.8%) as having severe chronic urticaria. Total IgE levels were elevated, above 175 U/ml, in 69/203 (34%) of patients, compared with 7/81 (8.6%) of healthy controls (p < 0.001). A significant association between increased total IgE and chronic urticaria severity was found. Whereas 93% of patients with increased level of total IgE suffered from moderate-to-severe chronic urticaria, this was observed in only 69% of patients with normal IgE (p < 0.0001). Autologous serum skin test and anti-thyroid antibodies were positive in 59/163 (36%) and 28/189 (15%) patients, respectively. A significant association between increased total IgE levels and the presence of autologous serum skin test, anti-thyroid antibodies and urticarial duration lasting more than 25 months (p < 0.0001, p < 0.0001 and p = 0.021, respectively) was also detected. Conclusions: Total serum IgE levels are frequently elevated in patients with chronic urticaria and these are associated with disease severity and duration.

Increased plasma levels of matrix metalloproteinase-9 are associated with the severity of chronic urticaria

Matrix metalloproteinase (MMP)-9 is produced by many inflammatory cells such as macrophages, neutrophils, mast cells, eosinophils and T lymphocytes. Activated T cells are capable, through cell-cell contact, of inducing MMP-9 expression in human mast cells. To investigate the activation status of peripheral CD4+ T cells and the level of MMP-9 in the plasma of patients with chronic urticaria (CU), and whether MMP-9 levels are in association with CU severity. Study subjects included 29 patients with CU and 30 healthy control subjects. At the time of assessment, patients were divided into subgroups according to urticarial severity. Plasma levels of total MMP-9 (free pro-MMP-9 and free MMP-9) were determined by ELISA. CD4+ lymphocytes were positively selected with magnetic microbeads. After 48 h of activation, CD4+ T cells were assayed for both nuclear factor-kappa B (NF-kappa B) expression and proliferation. Plasma levels of MMP-9 were found to be significantly higher in 29 CU patients compared with 18 healthy controls (186 +/- 174 vs. 31 +/- 21 ng/mL, P<0.0001). We also found a significant correlation between MMP-9 levels and urticarial severity (r = 0.92, P<0.001). In addition, CD4+ T cells from CU patients expressed higher levels of NF-kappa B than CD4+ T cells from healthy controls (82 +/- 30 vs. 69 +/- 20 optical density, P = 0.007). Finally, as compared with seven healthy individuals, DNA synthesis in CD4+ T cells from seven CU patients was found to be significantly elevated (1000 +/- 240 vs. 751 +/- 166 counts per minute, P = 0.01). Increased levels of MMP-9 are found in CU patients, and particularly among those with severe disease. We also demonstrated that CD4+ T cells from such patients are highly activated.