Chronic Spontaneous Urticaria

Question 1

Type I autoallergic CSU antibodies

Answer 1

• IgE-anti-TPO (expected to show a fast and good response to Omalizumab, also has been shown to be an independent predictor of antihistamine refractory CSU)
• IgE-anti-eosinophil peroxidase
  -IgE-anti-double-stranded DNA
• IgE-anti-IL-24 (serum levels correlated with CSU disease activity and basopenia as per 1 study)
  -IgE-anti-tissue factor (decrease induced by Omalizumab and paralleled to clinical response to drug)
• IgE-anti-ECP
• IgE-anti-FceRI
• IgE-anti-thyroglobulin (decrease induced by Omalizumab and paralleled to clinical response to drug)

Question 2

Diagnosis of Type I CSU

Answer 2

Requires testing for IgE autoantibodies

Question 3

Type IIb aiCSU

Answer 3

• IgG autoantibodies to IgE
• IgG autoantibodies to FceRI

Question 4

Additional markers of type IIb aiCSU

Answer 4

• Nocturnal symptoms
• Eosinopenia
• Low levels of total IgA
• Poor and/or slow response to conventional treatment with antihistamines and Omalizumab
• Symptoms more than 5 days/week
• Angioedema

Question 5

Diagnosis of type IIb aiCSU

Answer 5

• Basophil tests are considered the best single tests for dx type IIb aiCSU and showed better correlation with other markers of type IIb aiCSU and response to treatment than the ASST or immunoassays for autoantibodies

Question 6

Useful diagnostic marker for type IIb aiCSU that can be used in clinical practice

Answer 6

• The combination of high IgG-anti-TPO and low total IgE levels

(This combination has shown to be associated with positive ASST result, positive BAT result, and other markers of type IIb aiCSU)

Question 7

EAACI/GALENE/EuroGuiDerm/APAAAI urticaria guidelines recommends assessing patients with CSU for _______.

Answer 7

• For Total IgE and IgG-anti-TPO
• Importantly, total IgE levels should be assessed before starting the treatment with Omalizumab.

Question 8

Omalizumab shows 2 response patterns in the clinical setting

Answer 8

1. Early responders: often in week 1, always before week 4
2. Late responders: delayed onset of response after week 4 and up to week 24

Question 9

Best markers linked to good response to cyclosporine in CSU

Answer 9

• Low total IgE
• Positive basophil test results

Question 10

Longer remission after drug tapering/withdrawal in those with type IIb aiCSU features are seen in treatment with _______.

Answer 10

Cyclosporine, in contrast to Omalizumab