Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Institute of Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany.
Institute and Comprehensive Center for Inflammation Medicine, Department of Dermatology, Allergology and Venerology, University Medical Center Schleswig-Holstein, Lübeck, Germany.
J Allergy Clin Immunol Pract. 2023 Nov;11(11):3515-3525.e4. doi: 10.1016/j.jaip.2023.08.020. Epub 2023 Aug 19.
Patients with chronic spontaneous urticaria (CSU) have spontaneous wheals (W), angioedema (AE), or both, for longer than 6 weeks. Clinical differences between patients with standalone W, standalone AE, and W and AE (W+AE) remain incompletely understood.
To compare W, AE, and W+AE CSU patients regarding demographics, disease characteristics, comorbidities, disease burden, and treatment response.
Baseline data from 3,698 CSU patients in the ongoing, prospective, international, multicenter, observational Chronic Urticaria REgistry (CURE) were analyzed (data cut: September 2022).
Across all CSU patients, 59%, 36%, and 5% had W+AE, W, and AE, respectively. The W+AE patients, compared with W and AE patients, showed the lowest male-to-female ratio (0.33), higher rates of concomitant psychiatric disease (17% vs 11% vs 6%, respectively), autoimmune disease (13% vs 7% vs 9%, respectively), and nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity (9% vs 5% vs 2%, respectively) and the highest disease impact. The W patients, compared with W+AE and AE patients, showed the lowest rates of concomitant hypertension (15% vs 21% vs 40%, respectively) and obesity (11% vs 16% vs 17%, respectively), the highest rate of concomitant inducible urticaria (24% vs 22% vs 6%, respectively), and shorter W duration. The AE patients, compared with W+AE and W patients, were older at disease onset, showed longer AE duration, and the best response to increased doses of H-antihistamines (58% vs 24% vs 31%, respectively) and omalizumab (92% vs 67% vs 60%, respectively).
Our findings provide a better understanding of CSU phenotypes and may guide patient care and research efforts that aim to link them to pathogenic drivers.
患有慢性自发性荨麻疹（CSU）的患者会出现自发性风团（W）、血管性水肿（AE）或两者同时存在，持续时间超过 6 周。目前尚不完全了解 W 单独出现、AE 单独出现以及 W 和 AE 同时出现（W+AE）的患者之间的临床差异。
比较 W+AE、AE 和 W 单独出现的 CSU 患者的人口统计学、疾病特征、合并症、疾病负担和治疗反应。
对正在进行的、前瞻性的、国际性的、多中心、观察性的慢性荨麻疹登记（CURE）中 3698 例 CSU 患者的基线数据进行了分析（数据截止：2022 年 9 月）。
在所有 CSU 患者中，W+AE、W 和 AE 分别占 59%、36%和 5%。与 W 和 AE 患者相比，W+AE 患者的男女比例最低（0.33），合并精神病的比例较高（17%比 11%比 6%），自身免疫性疾病的比例较高（13%比 7%比 9%），非甾体抗炎药（NSAID）过敏的比例较高（9%比 5%比 2%），疾病的影响也最大。与 W+AE 和 AE 患者相比，W 患者的合并高血压的比例较低（15%比 21%比 40%），合并肥胖的比例较低（11%比 16%比 17%），合并诱导性荨麻疹的比例较高（24%比 22%比 6%），风团持续时间较短。与 W+AE 和 W 患者相比，AE 患者发病年龄较大，AE 持续时间较长，增加剂量的 H1 抗组胺药（58%比 24%比 31%）和奥马珠单抗（92%比 67%比 60%）治疗反应较好。
我们的研究结果更好地了解了 CSU 表型，并可能指导旨在将其与致病驱动因素联系起来的患者护理和研究工作。
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