Biomarkers in Chronic Spontaneous Urticaria
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.29021/spdv.79.2.1394 |
Resumo: | Introduction: At present, the understanding about chronic spontaneous urticarial (CSU) is relatively scarce, particularly with regard to its etiopathogenesis. Due to the lack of data on etiology, the available treatment is only aimed at symptomatic control, with the majority of patients being resistant both to the first and second lines of therapy. Taking into account the impact that CSU may have on the patient and the current difficulties in its control, investigation of biomarkers that predict response to treatment if highly needed. Methods: A review was conducted on biomarkers that allow guiding the therapeutic escalation of these patients in clinical practice, allowing a more effective and early control of urticaria. Results: Many biomarkers are being studied to predict response to therapy, but definitive results are still missing. Nevertheless, most studies point out that a high C-reactive protein or D-dimer, as well as autoimmune-based urticaria, are usually linked to a poor response to anti-H1. In which concerns the two subtypes of auto-immunity involved in CSU, if IgG anti-FcεRI or anti-IgE predominates (autoimmunity type IIb), patients usually have a positive autologous serum skin test (ASST), a positive basophil activation test (BAT), basopenia, eosinopenia and low or very-low total serum IgE, and response to omalizumab will be slow and/or poor, but there is tendency to a favourable outcome on cyclosporine. If IgE anti-self predominates (autoimmunity type I or autoallergy), response to cyclosporine will be poor, but positive and rapid to omalizumb, and these patients usually have a normal or high IgE that will increase after omalizumab therapy, whereas the other parameters typical of type IIb are absent. High D-dimer predicts an unfavourable response to the three therapies. Conclusion: In CSU resistant to second-generation antihistamines, patients who respond favourably to cyclosporine and slowly to omalizumab have mostly underlying type IIb autoimmunity, whereas patients refractory to cyclosporine therapy, but who respond rapidly to omalizumab, have underlying type I or auto-allergic autoimmunity. These subtypes can be indirectly evaluated by total serum IgE, blood cell count, ASST and BAT, but more studies with large cohorts are needed to have more correct predictive data on patients’ response to therapy in CSU. |
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Biomarkers in Chronic Spontaneous UrticariaBiomarcadores na Urticária Crónica EspontâneaBiomarkersUrticaria/diagnosisUrticaria/drug therapyBiomarcadoresUrticaria/diagnósticoUrticaria /tratamento farmacológicoIntroduction: At present, the understanding about chronic spontaneous urticarial (CSU) is relatively scarce, particularly with regard to its etiopathogenesis. Due to the lack of data on etiology, the available treatment is only aimed at symptomatic control, with the majority of patients being resistant both to the first and second lines of therapy. Taking into account the impact that CSU may have on the patient and the current difficulties in its control, investigation of biomarkers that predict response to treatment if highly needed. Methods: A review was conducted on biomarkers that allow guiding the therapeutic escalation of these patients in clinical practice, allowing a more effective and early control of urticaria. Results: Many biomarkers are being studied to predict response to therapy, but definitive results are still missing. Nevertheless, most studies point out that a high C-reactive protein or D-dimer, as well as autoimmune-based urticaria, are usually linked to a poor response to anti-H1. In which concerns the two subtypes of auto-immunity involved in CSU, if IgG anti-FcεRI or anti-IgE predominates (autoimmunity type IIb), patients usually have a positive autologous serum skin test (ASST), a positive basophil activation test (BAT), basopenia, eosinopenia and low or very-low total serum IgE, and response to omalizumab will be slow and/or poor, but there is tendency to a favourable outcome on cyclosporine. If IgE anti-self predominates (autoimmunity type I or autoallergy), response to cyclosporine will be poor, but positive and rapid to omalizumb, and these patients usually have a normal or high IgE that will increase after omalizumab therapy, whereas the other parameters typical of type IIb are absent. High D-dimer predicts an unfavourable response to the three therapies. Conclusion: In CSU resistant to second-generation antihistamines, patients who respond favourably to cyclosporine and slowly to omalizumab have mostly underlying type IIb autoimmunity, whereas patients refractory to cyclosporine therapy, but who respond rapidly to omalizumab, have underlying type I or auto-allergic autoimmunity. These subtypes can be indirectly evaluated by total serum IgE, blood cell count, ASST and BAT, but more studies with large cohorts are needed to have more correct predictive data on patients’ response to therapy in CSU.Introdução: Atualmente, a compreensão sobre a etiopatogenia da urticária crónica espontânea é escassa. Devido à carência de dados sobre a sua etiologia, o tratamento disponível tem apenas como objetivo o controlo sintomático, com a maioria dos doentes a serem resistentes à primeira e segunda linha terapêutica (anti-H1 de segunda geração). Tendo em conta o seu impacto no doente e o difícil controlo sintomatológico, surgiu a necessidade de investigar marcadores de resposta ao tratamento da urticária crónica espontânea. Métodos: Realizou-se uma revisão sobre biomarcadores que permitem guiar na prática clínica a escalada terapêutica destes doentes, permitindo um controlo mais eficaz e precoce da urticária. Resultados: Na urticária crónica espontânea (UCE) têm sido investigados muitos biomarcadores, mas são ainda escassos e por vezes contraditórios os resultados sobre a sua capacidade de prever a resposta à terapêutica. A maioria dos estudos é concordante na menor reatividade aos anti-H1 perante níveis de PCR ou D-dímeros elevados e nas formas de UCE autoimunes. Neste último caso, se predominarem anticorpos IgG anti-FcεRI ou anti-IgE (autoimunidade tipo IIb), os doentes habitualmente têm o teste do soro autólogo e o teste de ativação dos basófilos positivos, basopenia, eosinopenia e IgE sérica total baixa ou muito baixa, e a resposta ao omalizumab costuma ser pobre e/ou lenta, mas tendencialmente favorável à ciclosporina. Se predominar a IgE anti-self (autoimundade tipo I ou autoalergia) a IgE sérica total é normal ou elevada, na ausência dos marcadores característicos da autoimunidade IIb, e a resposta à ciclosporina é pobre, mas bastante favorável e rápida ao omalizumb. A elevação dos D-dímeros prediz uma reposta desfavorável aos três fármacos. Conclusão: Na UCE resistente aos anti-histamínicos de segunda geração, habitualmente com PCR e D-dímeros elevados, os doentes que respondem favoravelmente à ciclosporina e lentamente ao omalizumab têm normalmente uma autoimunidade tipo IIb subjacente e os doentes refratários à terapêutica com ciclosporina e que respondem rapidamente ao omalizumab têm subjacente uma autoimunidade tipo I ou autoalérgica. Estes subtipos podem ser indiretamente avaliados pelos níveis séricos de IgE total, pelos valores de basófilos e eosinófilos circulantes e pelos testes do soro autólogo e de ativação dos basófilos. Contudo, são ainda necessários mais estudos para estabelecer biomarcadores mais precisos que auxiliem na seleção da escalada terapêutica.Sociedade Portuguesa de Dermatologia e Venereologia2021-06-26T00:00:00Zjournal articleinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://doi.org/10.29021/spdv.79.2.1394oai:ojs.revista.spdv.com.pt:article/1394Journal of the Portuguese Society of Dermatology and Venereology; Vol 79 No 2 (2021): April - June; 147-154Revista da Sociedade Portuguesa de Dermatologia e Venereologia; v. 79 n. 2 (2021): Abril - Junho; 147-1542182-24092182-2395reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttps://revista.spdv.com.pt/index.php/spdv/article/view/1394https://doi.org/10.29021/spdv.79.2.1394https://revista.spdv.com.pt/index.php/spdv/article/view/1394/902Copyright (c) 2021 Journal of the Portuguese Society of Dermatology and Venereologyhttps://creativecommons.org/licenses/by-nc/4.0info:eu-repo/semantics/openAccessPratas Nunes, InêsGonçalo , Margarida2022-10-06T12:35:20Zoai:ojs.revista.spdv.com.pt:article/1394Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:11:21.155283Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Biomarkers in Chronic Spontaneous Urticaria Biomarcadores na Urticária Crónica Espontânea |
title |
Biomarkers in Chronic Spontaneous Urticaria |
spellingShingle |
Biomarkers in Chronic Spontaneous Urticaria Pratas Nunes, Inês Biomarkers Urticaria/diagnosis Urticaria/drug therapy Biomarcadores Urticaria/diagnóstico Urticaria /tratamento farmacológico |
title_short |
Biomarkers in Chronic Spontaneous Urticaria |
title_full |
Biomarkers in Chronic Spontaneous Urticaria |
title_fullStr |
Biomarkers in Chronic Spontaneous Urticaria |
title_full_unstemmed |
Biomarkers in Chronic Spontaneous Urticaria |
title_sort |
Biomarkers in Chronic Spontaneous Urticaria |
author |
Pratas Nunes, Inês |
author_facet |
Pratas Nunes, Inês Gonçalo , Margarida |
author_role |
author |
author2 |
Gonçalo , Margarida |
author2_role |
author |
dc.contributor.author.fl_str_mv |
Pratas Nunes, Inês Gonçalo , Margarida |
dc.subject.por.fl_str_mv |
Biomarkers Urticaria/diagnosis Urticaria/drug therapy Biomarcadores Urticaria/diagnóstico Urticaria /tratamento farmacológico |
topic |
Biomarkers Urticaria/diagnosis Urticaria/drug therapy Biomarcadores Urticaria/diagnóstico Urticaria /tratamento farmacológico |
description |
Introduction: At present, the understanding about chronic spontaneous urticarial (CSU) is relatively scarce, particularly with regard to its etiopathogenesis. Due to the lack of data on etiology, the available treatment is only aimed at symptomatic control, with the majority of patients being resistant both to the first and second lines of therapy. Taking into account the impact that CSU may have on the patient and the current difficulties in its control, investigation of biomarkers that predict response to treatment if highly needed. Methods: A review was conducted on biomarkers that allow guiding the therapeutic escalation of these patients in clinical practice, allowing a more effective and early control of urticaria. Results: Many biomarkers are being studied to predict response to therapy, but definitive results are still missing. Nevertheless, most studies point out that a high C-reactive protein or D-dimer, as well as autoimmune-based urticaria, are usually linked to a poor response to anti-H1. In which concerns the two subtypes of auto-immunity involved in CSU, if IgG anti-FcεRI or anti-IgE predominates (autoimmunity type IIb), patients usually have a positive autologous serum skin test (ASST), a positive basophil activation test (BAT), basopenia, eosinopenia and low or very-low total serum IgE, and response to omalizumab will be slow and/or poor, but there is tendency to a favourable outcome on cyclosporine. If IgE anti-self predominates (autoimmunity type I or autoallergy), response to cyclosporine will be poor, but positive and rapid to omalizumb, and these patients usually have a normal or high IgE that will increase after omalizumab therapy, whereas the other parameters typical of type IIb are absent. High D-dimer predicts an unfavourable response to the three therapies. Conclusion: In CSU resistant to second-generation antihistamines, patients who respond favourably to cyclosporine and slowly to omalizumab have mostly underlying type IIb autoimmunity, whereas patients refractory to cyclosporine therapy, but who respond rapidly to omalizumab, have underlying type I or auto-allergic autoimmunity. These subtypes can be indirectly evaluated by total serum IgE, blood cell count, ASST and BAT, but more studies with large cohorts are needed to have more correct predictive data on patients’ response to therapy in CSU. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-06-26T00:00:00Z |
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journal article info:eu-repo/semantics/article |
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info:eu-repo/semantics/publishedVersion |
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article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.29021/spdv.79.2.1394 oai:ojs.revista.spdv.com.pt:article/1394 |
url |
https://doi.org/10.29021/spdv.79.2.1394 |
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oai:ojs.revista.spdv.com.pt:article/1394 |
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https://revista.spdv.com.pt/index.php/spdv/article/view/1394 https://doi.org/10.29021/spdv.79.2.1394 https://revista.spdv.com.pt/index.php/spdv/article/view/1394/902 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2021 Journal of the Portuguese Society of Dermatology and Venereology https://creativecommons.org/licenses/by-nc/4.0 info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2021 Journal of the Portuguese Society of Dermatology and Venereology https://creativecommons.org/licenses/by-nc/4.0 |
eu_rights_str_mv |
openAccess |
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Sociedade Portuguesa de Dermatologia e Venereologia |
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Sociedade Portuguesa de Dermatologia e Venereologia |
dc.source.none.fl_str_mv |
Journal of the Portuguese Society of Dermatology and Venereology; Vol 79 No 2 (2021): April - June; 147-154 Revista da Sociedade Portuguesa de Dermatologia e Venereologia; v. 79 n. 2 (2021): Abril - Junho; 147-154 2182-2409 2182-2395 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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