CSU is a mast cell-driven disease characterised by the presence and recurrence of wheals and angioedema [1]. “In patients with high disease severity, angioedema, positivity of the autologous serum skin test [autoreactivity] or a combination with physical urticaria, the overall duration of CSU tends to be longer,” said Prof. Ana Giménez-Arnau (Autonomous University of Barcelona, Spain). In her presentation, Prof. Giménez-Arnau shed light on the long list of potential biomarkers.
Bench-to-bedside
Prof. Giménez-Arnau listed a seemingly limitless list of potential biomarkers including: TAT, fibrinogen, FVIIa, FXIIa, FVIII, FIX, FII, C-reactive protein (CRP), vitamin D, B12, prolactin, DHEA-S, cortisol, histamine, anti-IgE, IgG, IFNγ, TNF, histamine, tryptase, platelet, and basophil or eosinophil count [2]. Today, the most widely accepted biomarkers of disease activity with great potential are D-dimers, IL-6, and CRP [1,3].
Besides biomarkers of disease activity, researchers have studied clinical biomarkers of severity and prognosis. For example, the presence of angioedema has been associated with a less favourable prognosis. Prof. Giménez-Arnau pointed out that angioedema has a substantial impact on the afflicted who seem to be suffering from a more active disease. She further stressed that angioedema is underdiagnosed in patients with CSU, which was shown in analyses of the ASSURE-CSU study [4].
Other scientists have looked at a subtype of CSU, namely autoimmune CSU, in which functional IgG autoantibodies to IgE or its high-affinity receptor (i.e. FceRI) induce mast cell degranulation, leading to subsequent symptoms [5]. These patients had significantly higher IgG anti-TPO levels and lower total IgE levels as demonstrated by the authors of the PURIST trial (NCT01637116). This trial showed that a positive basophil activation test was 69% predictive of autoimmune CSU and a positive basophil histamine release assay was 88% predictive. Thus, including these tests in the diagnostic workup may help identify patients with this condition who would have remained undetected by routine clinical parameters. The afflicted have a different prognosis and may benefit from specific management [5].
- Giménez-Arnau A. Phenotypes of CSU and their biomarkers. D2T05.1A, EADV 2020 Virtual Congress, 29-31 Oct.
- Kolkhir P, et al. Clin Exp Allergy 2017;47:19-36.
- Folci M, et al. J Immunol Res 2018;2018;5615109.
- Sussman G, et al. Allergy 2018;73:1724-34.
- Schoepke N, et al. Allergy 2019;74:2427-36.
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Table of Contents: EADV 2020
Featured articles
Late-Breaking News
Selective IL-23 blocker shows potential in psoriasis treatment
Promising results with nanobody treatment in psoriasis
Light at the end of the tunnel for chronic hand eczema
Epidermolysis bullosa: Novel wound treatment on the horizon
Efficacious non-steroidal topical for psoriasis
Oral JAK 1 inhibitor leads to fast itch relieve and remarkable skin clearance in AD
COVID-19: What Dermatologists Need to Know
Biologic psoriasis treatment and COVID-19 risk: Contradictory results
Much to be learned about COVID-19 and the skin
JAK Inhibitors – A Fascinating Novel Drug Class
JAK inhibitors in AA: re-establishing the immune privilege of hair follicles
JAK1 inhibition successful in hidradenitis suppurativa
Topical JAK inhibition: a novel treatment option for patients with mild-to-moderate AD
Urticaria – What’s new
Chronic inducible urticaria can require some detective work
Chronic spontaneous urticaria: hives, wheals & biomarkers
Ligelizumab for chronic spontaneous urticaria: a new star on the horizon
Infectious Diseases: Novel Developments
Bacterial resistance in skin infections – a challenging threat
Borreliosis: A multifaceted disease
Scabies – A global health challenge
Upcoming Treatments
Meaningful sleep improvement with IL-13 inhibition
Preventing foot odour with zinc oxide coated socks
Baricitinib in AD: Efficacy paired with consistent long-term results
Best of the Posters
Real-world data on brodalumab affirms efficacy and fast onset of action
Heightened risk for psychiatric comorbidities in hidradenitis suppurativa patients
Effects IL-13 blocker improves with longer treatment duration
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