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Observational Study
. 2023 Nov;11(11):3515-3525.e4.
doi: 10.1016/j.jaip.2023.08.020. Epub 2023 Aug 19.

Patients With Chronic Spontaneous Urticaria Who Have Wheals, Angioedema, or Both, Differ Demographically, Clinically, and in Response to Treatment-Results From CURE

Thomas Buttgereit  1 , Carolina Vera  1 , Felix Aulenbacher  1 , Martin K Church  1 , Tomasz Hawro  2 , Riccardo Asero  3 , Andrea Bauer  4 , Mojca Bizjak  5 , Laurence Bouillet  6 , Joachim Dissemond  7 , Daria Fomina  8 , Ana M Giménez-Arnau  9 , Clive Grattan  10 , Stamatios Gregoriou  11 , Kanokvalai Kulthanan  12 , Alicja Kasperska-Zajac  13 , Emek Kocatürk  14 , Michael Makris  15 , Pavel Kolkhir  1 , Karsten Weller  1 , Markus Magerl  1 , Marcus Maurer  16
Affiliations
Observational Study

Patients With Chronic Spontaneous Urticaria Who Have Wheals, Angioedema, or Both, Differ Demographically, Clinically, and in Response to Treatment-Results From CURE

Thomas Buttgereit et al. J Allergy Clin Immunol Pract. 2023 Nov.

Abstract

Background: Patients with chronic spontaneous urticaria (CSU) have spontaneous wheals (W), angioedema (AE), or both, for longer than 6 weeks. Clinical differences between patients with standalone W, standalone AE, and W and AE (W+AE) remain incompletely understood.

Objective: To compare W, AE, and W+AE CSU patients regarding demographics, disease characteristics, comorbidities, disease burden, and treatment response.

Methods: Baseline data from 3,698 CSU patients in the ongoing, prospective, international, multicenter, observational Chronic Urticaria REgistry (CURE) were analyzed (data cut: September 2022).

Results: Across all CSU patients, 59%, 36%, and 5% had W+AE, W, and AE, respectively. The W+AE patients, compared with W and AE patients, showed the lowest male-to-female ratio (0.33), higher rates of concomitant psychiatric disease (17% vs 11% vs 6%, respectively), autoimmune disease (13% vs 7% vs 9%, respectively), and nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity (9% vs 5% vs 2%, respectively) and the highest disease impact. The W patients, compared with W+AE and AE patients, showed the lowest rates of concomitant hypertension (15% vs 21% vs 40%, respectively) and obesity (11% vs 16% vs 17%, respectively), the highest rate of concomitant inducible urticaria (24% vs 22% vs 6%, respectively), and shorter W duration. The AE patients, compared with W+AE and W patients, were older at disease onset, showed longer AE duration, and the best response to increased doses of H1-antihistamines (58% vs 24% vs 31%, respectively) and omalizumab (92% vs 67% vs 60%, respectively).

Conclusions: Our findings provide a better understanding of CSU phenotypes and may guide patient care and research efforts that aim to link them to pathogenic drivers.

Keywords: Angioedema; CSU; CURE registry; Chronic spontaneous urticaria; Recurrent; Without wheals.

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