Evaluation of the relationship between multiple inflammatory markers, disease severity and antihistamine response in chronic spontaneous urticaria

Atik Ö, Can A.  Alergologia Polska - Polish Journal of Allergology. 2025. doi:10.5114/pja.2025.156073.

Introduction

Chronic spontaneous urticaria (CSU) is a skin condition marked by excessive immune system inflammation. The C-reactive protein (CRP)/albumin ratio (CAR), neutrophil/lymphocyte ratio (NLR), eosinophil/neutrophil ratio (ENR), and eosinophil/lymphocyte ratio (ELR) are recent biomarkers that indicate systemic inflammation.

Aim

This study aims to examine the role of these inflammatory markers in assessing the severity of CSU and predicting the response to antihistamine treatment.

Material and methods

The study included 246 CSU patients from our outpatient clinic.

Patients with other conditions affecting CRP and albumin levels or using relevant medications were excluded. Blood tests, including complete blood count, erythrocyte sedimentation rate, total IgE, CRP, and albumin levels, were conducted. The relationship between these markers and disease activity, as well as their predictive value for antihistamine treatment response, was analyzed.

Results

Comparison of characteristics between responders
and non-responders to standard dose antihistamine
treatment

The cohort included 174 (70.7%) females, with a median age of 33 years. Total IgE levels in the severe group were higher than in the moderate group (181 vs. 119, p = 0.04). No significant correlation was found between UAS-7 and CAR, NLR, ENR, or ELR. In the non-responder group, total IgE levels, the presence of angioedema, and disease duration were higher compared to responders (p = 0.008, p = 0.001, p = 0.02, respectively).

Conclusions

Only total IgE was significantly linked to CSU severity. Additionally, the presence of angioedema and longer disease duration were associated with poor response to standard antihistamine treatment, helping predict treatment failure and facilitating quicker intervention.

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