Correlations between disease activity, autoimmunity and biological parameters in patients with chronic spontaneous urticaria

BACKGROUND: Biomarkers of disease activity/severity and criteria of autoimmune chronic spontaneous urticaria (CSU) are still a matter of debate. OBJECTIVE: To investigate possible correlations between clinical and biological markers and their associations with: (i) disease activity; (ii) resistance to H1-antihistamines; (iii) autoimmunity; and (iiii) autologous serum skin test (ASST) in patients with CSU. To also analyze biological parameter modifications in patients with CSU treated with omalizumab. MATERIALS AND METHODS: Disease activity, H1-antihistamines response and presence of concomitant autoimmune disease were prospectively recorded in 95 patients with CSU. For 60 of them, ASST was performed. Broad biological analysis were performed. RESULTS: C-reactive protein (CRP) serum levels were higher in H1-antihistamines unresponders (p<0.0001) and in more active diseases (p=0.033). D-dimer plasma levels were higher in H1-antihistamines unresponders (p=0.008) and in patients with autoimmune status (concomitant autoimmune disease and/or with autoantibodies) (p=0.016). Total immunoglobuline E (IgE) serum level was lower in patients with positive ASST. Blood basophil counts were lower in patients with CSU and especially in H1-antihistamines unresponders (p=0.023), in patients with more active disease (p=0.023), with positive ASST (p=0.001), and with autoimmune status (p=0.057). Conversely, under omalizumab, a decrease of CRP (p=0.0038) and D-dimer serum/plasma levels (p=0.0002) and an increase of blood basophil counts (p=0.0023) and total IgE serum levels (p=0.0007) were observed. CONCLUSIONS: This study brings additional evidences of interest to investigate IgE, D-dimer serum/plasma levels and basophil blood counts in patients with CSU as they could be correlated to disease activity, response to treatment and/or autoimmunity

Atopic Dermatitis Score 7 (ADS7): A promising tool for daily clinical assessment of atopic dermatitis.

Atopic dermatitis (AD) is a chronic inflammatory skin disease known for its evolution with recurrent flare‐ups.1 The Harmonizing Outcome Measures for Eczema (HOME) initiative, an international working group on a core outcome set for AD, has established that the evaluation of patients with AD should explore clinical signs, patient‐reported symptoms, long‐term control, and quality of life (QoL).2, 3 Eczema Area and Severity Index (EASI)4 and Patient‐Oriented Eczema Measurement (POEM) are preferred scoring systems for, respectively, clinical signs and patient‐reported symptoms. Many other scoring systems have been developed among them SCORing Atopic Dermatitis index (SCORAD) is the most validated.5 Nevertheless, those scoring methods are time consuming, useful for clinical trials, but not for daily clinical practice. The effect of generalized AD on health‐related QoL in children is similar to that of other major chronic diseases (ie, renal disease and cystic fibrosis) and higher than asthma.6 Itch, sleep disturbance, and social embarrassment are the key items to explore QoL in patients with AD, in children and their parents and also in adults [...

JCI Insight

Loss of melanocytes is the pathological hallmark of vitiligo, a chronic inflammatory skin depigmenting disorder induced by exaggerated immune response, including autoreactive CD8 T cells producing high levels of type 1 cytokines. However, the interplay between this inflammatory response and melanocyte disappearance remains to be fully characterized. Here, we demonstrate that vitiligo skin contains a significant proportion of suprabasal melanocytes, associated with disruption of E-cadherin expression, a major protein involved in melanocyte adhesion. This phenomenon is also observed in lesional psoriatic skin. Importantly, apoptotic melanocytes were mainly observed once cells were detached from the basal layer of the epidermis, suggesting that additional mechanism(s) could be involved in melanocyte loss. The type 1 cytokines IFN-γ and TNF-α induce melanocyte detachment through E-cadherin disruption and the release of its soluble form, partly due to MMP-9. The levels of MMP-9 are increased in the skin and sera of patients with vitiligo, and MMP-9 is produced by keratinocytes in response to IFN-γ and TNF-α. Inhibition of MMP-9 or the JAK/STAT signaling pathway prevents melanocyte detachment in vitro and in vivo. Therefore, stabilization of melanocytes in the basal layer of the epidermis by preventing E-cadherin disruption appears promising for the prevention of depigmentation occurring in vitiligo and during chronic skin inflammation

Omalizumab Drug Survival in Chronic Urticaria: A Retrospective Multicentric French Study

Background: Omalizumab (OMA) dramatically improves disease control and quality of life in patients with chronic urticaria (CU).Objective: We aimed to evaluate the discontinuation patterns of OMA and their determinants in a cohort of French patients with CU.Methods: We conducted a retrospective multicenter study in 9 French tertiary referral hospitals. All patients diagnosed with either spontaneous (CSU) and/or inducible (CIndU) CU who received at least 1 injection of OMA between 2009 and 2021 were included. We analyzed OMA drug survival and investigated possible determinants using Kaplan-Meier curves and log-rank tests.Results: A total of 878 patients were included in this study; 48.8% had CSU, 10.1% CIndU, and 41.1% a combination of both. OMA was discontinued in 408 patients, but the drug was later reintroduced in 50% of them. The main reason for discontinuing treatment was the achievement of a well-controlled disease in 50% of patients. Half of the patients were still being treated with OMA 2.4 years after the initiation of treatment. Drug survival was shorter in patients with CIndU and in those with an autoimmune background. In atopic patients, OMA was discontinued earlier in patients achieving a well-controlled disease. A longer OMA drug survival was observed in patients with a longer disease duration at initiation.Conclusion: In French patients with CU, the drug survival of OMA appears to be longer than that observed in previous studies conducted elsewhere, highlighting discrepancies in prescription and reimbursement possibilities. Further studies are warranted to develop customized OMA treatment schemes based on individual patterns

Discrepancies in the Management of Acquired Cold Contact Urticaria: Results of a French-speaking Urticaria Experts Questionnaire Survey

International audienceAcquired cold contact urticaria (ACU) is a putatively serious condition, because of the risk of anaphylactic shock whenever patients are massively exposed to cold atmosphere/water, raising the question of the prescription of an "emergency kit" with oral antihistamines and epinephrine auto-injector. We performed an online survey to evaluate how French-speaking urticaria experts manage ACU. According to the 2016 consensus recommendations on chronic inducible urticarias, all the participants perform at least 1 of the available provocation tests and 84.2%, 77.8%, and 88.9% prescribe on-label use of second generation anti-H1 antihistamines (2GAH1) as a first line treatment, updosed 2GAH1 as a second line treatment, and omalizumab as a third line treatment, respectively. Interestingly, 44.4% of the practitioners always prescribe a continuous background treatment, versus 11.1% prescribing only on-demand therapy. Also, 11.7% of participants always prescribe an epinephrine auto-injector, 70.6% sometimes do, and 17.6% never do. Finally, 89.5% authorize swimming under strict conditions but 36.8% and 68.4% contra-indicate other water sports and occupational cold exposure, respectively