Allergy Asthma Immunol Res.  2016 Mar;8(2):115-123. 10.4168/aair.2016.8.2.115.

Prognostic Factors for Chronic Spontaneous Urticaria: A 6-Month Prospective Observational Study

• Ye YM
• Park JW
• Kim SH
• Ban GY
• Kim JH
• Shin YS
• Lee HY
• Park HS
• PRANA Group

• KMID: 2165927
• DOI: http://doi.org/10.4168/aair.2016.8.2.115

Abstract

PURPOSE
Chronic urticaria (CU) has a substantial impact on the quality of life. Little clinical data on the prognosis of CU has been reported. This study aimed to investigate the control status and remission rate of CU and to explore potential predictors of good responses to the treatment during a 6-month treatment period.
METHODS
A total of 75 patients with chronic spontaneous urticaria (CSU) were enrolled from 3 university hospitals in Korea. Urticaria control state was classified into 2 groups: group I (remission and well-controlled) and group II (partly and uncontrolled). CU-specific quality of life (CU-QoL) and the urticaria activity score (UAS) were measured before and after the treatment. Autologous serum skin test (ASST), and anti-nuclear and anti-thyroid antibodies were measured at the enrollment into the study. Aspirin intolerance was confirmed by an oral provocation test.
RESULTS
Of 59 patients completing the study, 21 (35.6%) arrived at well-controlled status and only 2 (3.4%) achieved remission, whereas 26 (44.1%) remained at partly controlled status and 10 (16.9%) were at uncontrolled status. Mean changes in CU-QoL (36.5+/-2.7 vs 20.6+/-4.3, P=0.017) and UAS (-7.9+/-0.8 vs -3.0+/-1.0, P=0.001) were significantly different between groups I and II. The presence of serum autoantibodies and aspirin intolerance had no influence on the control of urticaria in this study. However, ASST positivity was identified as a significant predictor of CU control in multivariate analysis (OR=6.106, P=0.017).
CONCLUSIONS
The proportion of CSU patients that achieved remission or a well-controlled state was 39% for the 6 months of stepwise treatment. Longer observations are necessary to assess the exact prognosis of CSU. ASST results may be a useful parameter for predicting a better response to treatment and both UAS and CU-QoL are helpful to monitor therapeutic response.

Keyword

Chronic urticaria; autologous serum skin test; urticaria activity score; prognosis

MeSH Terms

Antibodies
Aspirin
Autoantibodies
Hospitals, University
Humans
Korea
Multivariate Analysis
Observational Study*
Prognosis
Prospective Studies*
Quality of Life
Skin Tests
Urticaria*
Antibodies
Aspirin
Autoantibodies

Figure

• 

  Fig. 1 Proportion of CU control status during the study period.

• 

  Fig. 2 Treatment steps for controlling CU during the study period. Group I, patients with remission or well-controlled CU; Group II, patients with partly controlled or uncontrolled CU.

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  Fig. 3 Changes in UAS (A) and CU-QoL (B) according to control status. Data are presented as mean±standard error. UAS, urticaria activity score; CU-QoL, chronic urticaria-specific quality of life; group I, patients with remission or well-controlled CU; group II, patients with partly controlled or uncontrolled CU.

• 

  Fig. 4 Mean UAS (A) and CU-QoL (B) scores over the study period according to the ASST results. Data are presented as mean±standard error. *P for interaction between time and ASST results at each visit from baseline <0.05. UAS, urticaria activity score; CU-QoL, chronic urticaria-specific quality of life; ASST, autologous serum skin test.

• 

  Fig. 5 The proportion of patients who achieved well-controlled CU stratified by their treatment steps and baseline ASST results over the study period. Grey bars show the proportion of patients according to their treatment steps at each visit. Black bars represent the proportion of patients who achieved well-controlled CU with respect to their treatment step at each visit.

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