Urticaria laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Laboratory evaluation can be used as a measure to determine disease severity, responsiveness to treatment and prognosis, in addition to their role as a diagnostic tool. Tests such as autologous serum skin test (ASST) and basophil activation test (BAT) are useful for detection of autoantibodies against IgE. Moreover elevated levels of c-reactive protein (CRP), erythrocyte sedimentation rate (ESR), certain interleukins and tumor necrosis factor-alpha have been reported in urticaria patients.
Laboratory Findings
- Autologous serum skin test (ASST) and basophil activation test (BAT) are two tests that are capable of detecting any autoantibodies against IgE for FcεRI.[1][2]
- Although ASST is not a specific test, positive results can determine active disease, mast cells and basophils activation and possible reduction in basophils.
- Interestingly positive autologous serum skin test (ASST) could be related to better prognosis.
- Moreover positive autologous serum skin test (ASST) seems to be related to slower response to omalizumab.
- C-reactive protein (CRP) is also related to disease activity and treatment response in urticaria.[3][4][5]
- It's elevated level is also associated with positive autologous serum skin test (ASST) and elevated levels of erythrocyte sedimentation rate (ESR), leukocytes, neutrophils and IL-6.
- Elevated CRP is related to better response to oral cyclosporine therapy and conversely poor response to antihistamines.
- In contrast to other inflammatory conditions, urticaria patients usually present with lower quantitative level of CRP.
- Complete blood count (CBC) with differential[6]
- Erythrocyte sedimentation rate (ESR): Elevated levels might be related to autoimmune disease.[6]
- Interleukins:
- Elevated level of IL-6 is related to disease activity in urticaria.[4]
- IL-18, one of the IL-1 family cytokines, has been present in serum specimens of nearly all patients with chronic spontaneous urticaria. Nevertheless more studies required to determine it's exact role in the pathogenesis of this subtype.[7][8]
- The following table is a summary of possible elevated interleukins in urticaria:[8][1][9]
| Interleukins | Explanations |
|---|---|
| Interleukin 6 | Determines disease activity |
| Interleukin 1 | Such as Interleukin 18 and Interleukin 17
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| Interleukin 23 | Interleukin 23/Interleukin 17 axis has been explained in pathogenesis of urticaria. |
| Interleukin 31 | Also elevated in other chronic skin inflammations.
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- Elevated levels of tumor necrosis factor-alpha has been detected in some patients with chronic spontaneous urticaria.
- The following table is a summary of useful markers to determine disease severity and response to treatment in urticaria:[1][10][11][12][13][14]
| Markers to determine disease severity/prognosis | |
| Markers to evaluate response to therapy |
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- High levels of vascular endothelial growth factor (VEGF) has been detected in urticaria patients, which is probably related to it's effect on vascular permeability.
- It is recommended to search for paraproteins, hepatitis B, hepatitis C, systemic lupus erythematosus and inflammatory bowel disease in patients with confirmed diagnosis of urticaria vasculitis.[15]
References
- ↑ 1.0 1.1 1.2 Puxeddu I, Petrelli F, Angelotti F, Croia C, Migliorini P (2019). "Biomarkers In Chronic Spontaneous Urticaria: Current Targets And Clinical Implications". J Asthma Allergy. 12: 285–295. doi:10.2147/JAA.S184986. PMC 6759208 Check
|pmc=value (help). PMID 31571935. - ↑ Ye YM, Park JW, Kim SH, Ban GY, Kim JH, Shin YS; et al. (2016). "Prognostic Factors for Chronic Spontaneous Urticaria: A 6-Month Prospective Observational Study". Allergy Asthma Immunol Res. 8 (2): 115–23. doi:10.4168/aair.2016.8.2.115. PMC 4713874. PMID 26739404.
- ↑ Kolkhir P, Altrichter S, Hawro T, Maurer M (2018). "C-reactive protein is linked to disease activity, impact, and response to treatment in patients with chronic spontaneous urticaria". Allergy. 73 (4): 940–948. doi:10.1111/all.13352. PMID 29130488.
- ↑ 4.0 4.1 Kasperska-Zajac A, Sztylc J, Machura E, Jop G (2011). "Plasma IL-6 concentration correlates with clinical disease activity and serum C-reactive protein concentration in chronic urticaria patients". Clin Exp Allergy. 41 (10): 1386–91. doi:10.1111/j.1365-2222.2011.03789.x. PMID 21645137.
- ↑ Ohtsuka T (2010). "Response to oral cyclosporine therapy and high sensitivity-CRP level in chronic idiopathic urticaria". Int J Dermatol. 49 (5): 579–84. doi:10.1111/j.1365-4632.2010.04384.x. PMID 20534097.
- ↑ 6.0 6.1 Kaplan AP (2017). "Chronic Spontaneous Urticaria: Pathogenesis and Treatment Considerations". Allergy Asthma Immunol Res. 9 (6): 477–482. doi:10.4168/aair.2017.9.6.477. PMC 5603475. PMID 28913986.
- ↑ Tedeschi A, Lorini M, Suli C, Asero R (2007). "Serum interleukin-18 in patients with chronic ordinary urticaria: association with disease activity". Clin Exp Dermatol. 32 (5): 568–70. doi:10.1111/j.1365-2230.2007.02450.x. PMID 17509061.
- ↑ 8.0 8.1 Puxeddu I, Italiani P, Giungato P, Pratesi F, Panza F, Bartaloni D; et al. (2013). "Free IL-18 and IL-33 cytokines in chronic spontaneous urticaria". Cytokine. 61 (3): 741–3. doi:10.1016/j.cyto.2013.01.015. PMID 23433789.
- ↑ Kolkhir P, André F, Church MK, Maurer M, Metz M (2017). "Potential blood biomarkers in chronic spontaneous urticaria". Clin Exp Allergy. 47 (1): 19–36. doi:10.1111/cea.12870. PMID 27926978.
- ↑ Grattan CE (2001). "Basophils in chronic urticaria". J Investig Dermatol Symp Proc. 6 (2): 139–40. doi:10.1046/j.0022-202x.2001.00027.x. PMID 11764301.
- ↑ Tedeschi A, Asero R, Lorini M, Marzano AV, Cugno M (2010). "Plasma levels of matrix metalloproteinase-9 in chronic urticaria patients correlate with disease severity and C-reactive protein but not with circulating histamine-releasing factors". Clin Exp Allergy. 40 (6): 875–81. doi:10.1111/j.1365-2222.2010.03473.x. PMID 20214668.
- ↑ Atwa MA, Emara AS, Youssef N, Bayoumy NM (2014). "Serum concentration of IL-17, IL-23 and TNF-α among patients with chronic spontaneous urticaria: association with disease activity and autologous serum skin test". J Eur Acad Dermatol Venereol. 28 (4): 469–74. doi:10.1111/jdv.12124. PMID 23451767.
- ↑ Sánchez-Borges M, Caballero-Fonseca F, Capriles-Hulett A, González-Aveledo L, Maurer M (2017). "Factors linked to disease severity and time to remission in patients with chronic spontaneous urticaria". J Eur Acad Dermatol Venereol. 31 (6): 964–971. doi:10.1111/jdv.14221. PMID 28299827.
- ↑ Folci M, Heffler E, Canonica GW, Furlan R, Brunetta E (2018). "Cutting Edge: Biomarkers for Chronic Spontaneous Urticaria". J Immunol Res. 2018: 5615109. doi:10.1155/2018/5615109. PMC 6280255. PMID 30584542.
- ↑ Greaves M (2000). "Chronic urticaria". J Allergy Clin Immunol. 105 (4): 664–72. doi:10.1067/mai.2000.105706. PMID 10756214.