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Introduction: The use of predictors of response to a specific treatment in patients with chronic spontaneous urticaria (CSU) can improve disease management, help prevent unnecessary healthcare costs, and save time. In this study, we aimed to identify predictors of complete response to standard-dosed and higher than standard-dosed antihistamine treatments in patients with CSU. Methods: Medical records of 475 CSU patients, 120 of them <18 years old, from 3 different centers were analyzed. We used 15 machine learning (ML) models as well as traditional statistical methods to predict complete response to standard-dosed and higher than standard-dosed antihistamine treatment based on 17 clinical parameters. Results: CSU disease activity, which was assessed by urticaria activity score (UAS), was the only clinical parameter that predicted complete response to standard-dosed and higher than standard-dosed antihistamine treatment, with ML models and traditional statistics, for all age groups. Based on ROC analyses, optimal cut-off values of disease activity to predict complete response were UAS <3 and UAS <4 for standard-dosed (area under the ROC curve [AUC] = 0.69; p = 0.001) and higher than standard-dosed (AUC = 0.79; p = 0.001) antihistamine treatments, respectively. Also, ML models identified lower total IgE (<150 IU/mL) as a predictor of complete response to a standard-dosed antihistamine and lower CRP (<3.4 mg/mL) as a predictor of complete response to higher than standard-dose antihistamine treatment. Discussion: In this study, we showed that patients with UAS <3 are highly likely to have complete response to standard-dosed AH and those with a UAS <4 are highly likely to have complete response to higher than standard-dosed AH treatment. Low CSU disease activity is the only universal predictor of complete response to AH treatment with both ML models and traditional statistics for all age groups. [ABSTRACT FROM AUTHOR]

The question how second‐generation antihistamines (sgAHs) should be used when chronic spontaneous urticaria (CSU) is under control with omalizumab is still unanswered. This study aimed to investigate the effectiveness of as‐needed sgAHs in patients with well‐controlled urticaria under omalizumab treatment. Patients from four different urticaria centers who were treated with omalizumab 300 mg/4 weeks for at least 3 months, had well‐controlled urticaria (Urticaria Control Test: 16 > UCT≥12) and were using sgAHs only if needed, were included in this study. In order to assess effectiveness of sgAHs, change in the itch, hives, and total itch‐hives scores before and after sgAHs were evaluated using modified urticaria activity score‐twice daily. Fifty‐three patients [38 female (71.7%)] with mean age 41.1 ± 11.4 years were included in this study. Median sgAH intake per patient throughout the 4 week‐intervals was 3 (2–5) tablets. sgAH intake decreased itch, hives and total itch‐hives scores 45.7% ± 52.9, 42.4% ± 39.1, and 50.2% ± 51.1, respectively (P <.001 for all). This decrease was similar in both isolated‐urticaria and urticaria‐and‐angioedema phenotypes. Baseline IgE levels were positively correlated with the decrease of three symptom scores (r = 0.31, P =.05; r = 0.375, P =.017; r = 0.31, P =.05, respectively) that showed in patients with higher baseline total IgE levels, as needed sgAH intake decreased the symptom scores less. Our study showed that sgAHs may still be an effective option for the treatment of the intermittent symptoms in patients with well‐controlled urticaria under omalizumab treatment. Baseline total IgE levels may be used as a potential biomarker for sgAH effectiveness in these patients. [ABSTRACT FROM AUTHOR]

Objective: Chronic spontaneous urticaria (CSU) is a chronic, common and debilitating disease and associated with severely impaired quality of life (QoL). The main aim of this study is to explore the presence of Chronic Widespread Pain (CWP) in patients with CSU and to reveal the possible associations between CWP and CSU on the clinical features, laboratory markers and urticaria activity scores with QoL. Methods: There were assessed the 91 patients with CSU for CWP in a tertiary outpatient clinic. CWP (pain in four or more out of five bodily regions, i.e., the four quadrants and axially at least for three months) was defined in a rheumatology outpatient clinic in patients with CSU. We also analyzed the test results of anti-nuclear antibody (ANA), blood sedimentation rate, CRP (C-reactive protein), B12, total IgE, and anti-TPO. Patients were specified for their onset and duration of disease, comorbidities, the occurrence of angioedema and history of atopy, and nocturnal pruritus with disturbed sleep. Patients disease activity were detected by the urticaria control test (UCT), urticaria activity score (UAS) and visual analog scale of physician and patient's global assessment. Furthermore, patients completed a questionnaire to assess the quality of life (QoL) for dermatologic diseases. Results: 91 patients with CSU assigned for CWP, 23 (25.3%) were positive. CWP + patients with CSU had significantly higher physician global assessment score (p=0.003), Patients global assessment score (p=0.005), UAS (p=0.046), dermatologic QoL (p<0.001) and lower UCT (p=0.005) scores. Nine of 23 CWP + patients had asthma (39.1%) as a comorbidity (p=0.008). Conclusion: The presence of CWP in patients with urticaria may have a negative impact on the quality of life of the patients and disease scores. [ABSTRACT FROM AUTHOR]

Background/aim: Spontaneous wheals and/or angioedema lasting longer than six weeks are described as chronic spontaneous urticaria (CSU). Omalizumab is used for the treatment of antihistamine-resistant CSU. The neutrophil-lymphocyte ratio (NLR), platelet- lymphocyte ratio (PLR), mean platelet volume (MPV), and platelet distribution width (PDW) are considered important indicators of inflammation and platelet activation in chronic diseases. We aimed to determine the NLR, PLR, MPV, and PDW levels in patients with CSU compared with healthy controls. We also aimed to investigate the effects of omalizumab therapy on these parameters in CSU patients. Materials and methods: This hospital-based, retrospective study included 143 patients with CSU and 132 healthy controls with a mean age of 40.0 ± 13.17 and 42.0 ± 16.34, respectively. Patients with equal or higher-than-baseline UAS scores at week 12 of omalizumab treatment were considered nonresponders, others were considered responders. We analyzed the neutrophils, lymphocytes, platelet counts, NLR, PLR, MPV, and PDW before, during, and after omalizumab treatment and compared the results with those of healthy controls. Results: CSU patients presented higher baseline MPV (P = 0.035) and lower baseline PDW values (P < 0.001) than healthy controls. There were statistically significant increases in the MPV (P < 0.001), MPV/platelet count (P = 0.005), and PDW (P = 0.003) and there was a statistically significant decrease in the NLR (P = 0.018) during omalizumab treatment. The percent increase of MPV was low in nonresponders (P = 0.009). Nonresponders had lower PDW values than responders (P = 0.040). Conclusion: The increase in the MPV and PDW may be due to platelet activation during omalizumab treatment. The decrease in the NLR may be regarded as an antiinflammatory effect of omalizumab. The effect of omalizumab on platelet and inflammatory markers may be used to discriminate the responders from nonresponders. [ABSTRACT FROM AUTHOR]