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D-Dimer as future biomarker in CSU management?

Presented By
Dr Antonio Cristaudo, San Gallicano Dermatological Institute, Italy
EADV 2019

An Italian study investigated coagulation cascade activation in the context of chronic spontaneous urticaria [CSU]. The identified D-Dimer values were correlated to disease activity.

The exact pathogenesis of mast cell activation in CSU is still not entirely clear [1]. Recent findings imply a role not only of the immune system dysregulation and activation of the inflammatory cascade, but also of the coagulation pathway in CSU pathogenesis. Dr Antonio Cristaudo (San Gallicano Dermatological Institute, Italy) and his colleagues looked into the involvement of coagulation factors [2]. They were particularly interested in a possible capacity of D-dimers and/or prothrombin fragments F1+2 to anticipate treatment response to omalizumab in CSU patients. 40 patients were included into the trial. Prerequisite for enrolment was the presence of wheals with or without presence of angioedema for ≥ 6 weeks. Laboratory testing was performed for activation markers of complement C3 and C4, prothrombin and partial thromboplastin time together with markers of coagulation activation and D-dimers in the plasma.

The assessment revealed a direct correlation of the amount of D-dimer with severity of CSU. Of ther participants, 20% were being treated with omalizumab due to their inadequate disease control with antihistamines. In a preliminary analysis, the investigators found a reduction in D-dimer plasma values in those who had good response to omalizumab therapy. They estimate that D-dimers may qualify as predictor of clinical response to omalizumab treatment and as a biomarker for CSU severity.

    1. Puxeddu I, et al. J Asthma Allergy. 2019;12:285-295.
    2. Cristaudo A, et al. P1978, EADV 2019, 9-13 Oct, Madrid, Spain.


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