The Predictive Value of Serum Total IgE for Antihistamine Treatment Outcomes in Chinese Patients with Chronic Spontaneous Urticaria

Li Y, Peng R, Xue J, Zhao Y. Acta Derm Venereol. 2025 Aug 3;105:adv43568. doi: 10.2340/actadv.v105.43568.

Abstract

 Comparison of clinical and laboratory characteristics
between responders and non-responders to
standard-dosed second-generation H1-antihistamines
(sgAHs) in patients with chronic spontaneous
urticaria (CSU)

Chronic spontaneous urticaria is a common skin disorder with variable treatment responses. Second-generation H1-antihistamines are the first-line treatment for chronic spontaneous urticaria, yet many patients fail to respond to licensed doses. Predictors of treatment response to second-generation H1-antihistamines could help optimize disease management and minimize unnecessary healthcare costs. In this retrospective cohort study of 99 Chinese chronic spontaneous urticaria patients, higher log-transformed serum total IgE levels were significantly associated with poor response to standard-dose antihistamines (aOR = 2.09, 95% CI: 1.29–3.38, p = 0.003). However, this association was not observed in the subgroup of patients who required dose escalation, suggesting a more complex relationship in later treatment stages. Machine learning analysis further supported total IgE as one of the top predictors of poor response to standard-dose second-generation H1-antihistamines. While serum total IgE may not serve as a diagnostic tool, it appears to be a helpful risk indicator for anticipating refractoriness to standard-dosed antihistamines in chronic spontaneous urticaria, particularly at the initial treatment stage.

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