Biomarkers predicting response of different CSU treatments in children

Assessment of mean platelet volume, tryptase, and age may help to pick the right treatment for paediatric patients with chronic spontaneous urticaria (CSU). The authors of this single-centre retrospective study emphasised that this result should be confirmed in a larger trial. Despite this limitation, the study won the second poster prize at the AAD 2023 meeting.

Until present, there are very few studies on biomarkers for CSU in children. Therefore, Mr Alex Nguyen (McGill University, Canada) aimed to better understand the role of different biomarkers in treatment response and disease resolution in children with CSU.

Data was obtained from 109 children from the Montreal Children’s Hospital Allergy and Immunology Clinic who reported hives for at least 6 weeks from 2013 to 2022. The mean age of the children was 9 years and 55% of the study population were girls. The researchers obtained levels of thyroid stimulating hormone (TSH), anti-thyroxine peroxidase (anti-TPO), total immunoglobulin E (IgE), CD63, tryptase, eosinophils, mean platelet volume (MPV), and platelets. Diseases activity was recorded at study entry using the weekly urticaria activity score (UAS7).

Univariate and multivariate logistic regressions were compared to determine factors associated with different treatment levels, namely antihistamines at the standard dose, at 4 times the standard dose, omalizumab, and resolution of treatment.

According to the results of the univariate analysis, elevated levels of MPV were associated with use of 4 times the standard dose of antihistamines treatment level, whereas younger age was associated with disease resolution. In the multivariate logistic analysis adjusted for age, sex TSH, anti-TPO, total IgE, CD63, eosinophils, MPV, and platelets, elevated tryptase levels were associated with antihistamines use at the standard dose (OR 1.15; 95% CI 1.02–1.30) and lower tryptase levels with disease resolution (OR 0.86; 95% CI 0.78‒0.96).

Although these results should be confirmed in a larger study, the authors conclude that the underlying mechanisms of tryptase may help identify paediatric patients with CSU who will respond to different treatment options.

1. Nguyen A, et al. Association of Biomarkers with Treatment and Disease Resolution of Chronic Spontaneous Urticaria in Children. P43608, AAD 2023 Annual Meeting, 17–21 March, New Orleans, USA.

Posted on 15 May, 2023