Treatment response in chronic urticaria: analysis of clinical and laboratory predictors^☆

Background  Chronic urticaria (CU) compromises quality of life, requiring escalated treatment with second-generation H1 antihistamines, omalizumab, and, in refractory cases, cyclosporine. Predictors of therapeutic response are not yet well established.

Objective  To evaluate clinical and laboratory factors associated with treatment response in patients with CU.

Methods  Cross-sectional study of 175 patients with CU followed at the Urticaria Reference Center (UCARE) of Complexo Hospitalar Universitário Professor Edgard Santos (HUPES/UFBA) between 2023 and 2024. Sociodemographic, clinical, and laboratory data were analyzed. Treatment response was assessed using the Urticaria Control Test (UCT), with responders being those with a score ≥12 or Angioedema Control Test (AECT) ≥10.

Results  Most patients were female (80.6%), with a mean age of 45.3 years. Chronic spontaneous urticaria (CSU) was predominant (86.3%). Higher body mass index (BMI), early onset, longer disease duration, and psychiatric disorders were associated with poorer response to second-generation H1 antihistamines. Responders to these drugs had shorter disease duration and a lower proportion of women compared to those requiring omalizumab. In omalizumab users, mental disorders remained associated with refractoriness. Total IgE, eosinophils, CRP, ESR, D-dimer, and anti-TPO did not correlate with therapeutic response.

Study limitations  Cross-sectional study and reliance on clinical records, information bias, and selection bias.

Conclusions  High BMI, female gender, early symptom onset, prolonged disease duration, and mental disorders were associated with poorer response to CU treatment. The evaluated laboratory tests did not demonstrate predictive value for treatment response.

Keywords
Biomarkers; Chronic urticaria; Histamine antagonists; Omalizumab