Department of Dermatology, Hospital del Mar, Parc de Salut Mar, Hospital del Mar, Parc de Salut Mar, Departament de Medicina de la UAB, Universitat Autònoma de Barcelona, ES-08003 Barcelona, Spain.
Acta Derm Venereol. 2018 Jul 11;98(7):641-647. doi: 10.2340/00015555-2941.
Chronic spontaneous urticaria (CSU) is characterized by heterogeneous activity, evolution, associated comorbidities and response to treatment. The aim of this study was to identify prognostic factors in patients with CSU that predict disease course and response to standard treatments. An observational retrospective study was conducted in a cohort of 549 patients with CSU, comparing patients with isolated CSU and those with CSU with concomitant inducible urticaria (CSU-CIndU). The factors associated with a worse prognosis in terms of duration and/or CSU activity and its episodes were: multiple episodes of CSU (19.2% had more than one lifetime episode of CSU), late-onset (63.6% of patients developed first onset of CSU after the age of 45 years), concomitant CIndU (20.2%) and functional serum autoreactivity. Patients with CSU-CIndU required more frequent therapy after 5 years and higher doses of 2nd-generation H1-antihistamines. Of patients with a baseline Urticaria Activity Score 7 (UAS7) between 16 and 42, 84.6% required cyclosporine or omalizumab to achieve symptom control, compared with 15.4% of patients with a baseline UAS7 between 0 and 15 (p?=?0.0013). Baseline CSU activity is the only factor found to be predictive for refractoriness to treatment with H1-antihistamines.
慢性自发性荨麻疹（CSU）的特点是具有异质性的活动、演变、相关合并症和对治疗的反应。本研究的目的是确定 CSU 患者的预后因素，这些因素可预测疾病过程和对标准治疗的反应。在一个由 549 例 CSU 患者组成的队列中进行了一项观察性回顾性研究，比较了单纯 CSU 患者和 CSU 伴有诱导性荨麻疹（CSU-CIndU）患者。与持续时间和/或 CSU 活动及其发作较差的预后相关的因素包括：CSU 反复发作（19.2%的患者一生中发生过不止一次 CSU 发作）、发病晚（63.6%的患者在 45 岁后首次出现 CSU）、同时伴有 CIndU（20.2%）和功能性血清自身反应性。CSU-CIndU 患者在 5 年后需要更频繁的治疗和更高剂量的第二代 H1 抗组胺药。在基线 UAS7 为 16 至 42 的患者中，84.6%需要环孢素或奥马珠单抗来控制症状，而基线 UAS7 为 0 至 15 的患者中，有 15.4%需要（p=0.0013）。基线 CSU 活动是唯一被发现对 H1 抗组胺药治疗有耐药性的预测因素。
