Preditores da resposta ao tratamento em pacientes com urticária crônica

Abstract

PREDICTORS OF TREATMENT RESPONSE IN PATIENTS WITH CHRONIC URTICARIA. Introduction: Chronic urticaria (CU) is characterized by the recurrent appearance of wheals and/or angioedema for more than six weeks and is classified as either spontaneous or inducible, significantly impacting patients’ quality of life. Treatment begins with H1-antihistamines, in doses that may be increased up to four times the standard dosage. In refractory cases, the monoclonal anti-immunoglobulin E (IgE) antibody—IgE being the main antibody involved in allergic reactions (omalizumab)—is used, and in the absence of response, cyclosporine is indicated. This study aimed to identify clinical and laboratory predictors of treatment response in patients with CU.Methods: This was a cross-sectional study involving 175 patients with CU treated at the Urticaria Center of Reference and Excellence (UCARE) of the University Hospital Professor Edgard Santos (HUPES/UFBA). Sociodemographic, clinical, and laboratory data were collected, including age, sex, BMI, CU subtype, and presence of angioedema. Treatment response was assessed using the Urticaria Control Test (UCT) or Angioedema Control Test (AECT), with scores ≥12 and ≥10, respectively, considered satisfactory. Treatment steps were compared, and clinical-laboratory predictors of refractoriness were analyzed.Results: Most patients were female (80.6%), with a mean age of 45.3 years and an average disease duration of 11.9 years. Chronic spontaneous urticaria (CSU) was the predominant subtype (86.3%), and 30.9% had coexisting inducible forms. Higher BMI, earlier disease onset, longer disease duration, and psychiatric disorders were associated with lower response to H1-antihistamines. Responders at this stage had a shorter disease duration and a lower proportion of females compared to those requiring omalizumab. Among omalizumab users, mental disorders remained a significant predictor of refractoriness. All patients with a partial response to omalizumab had total IgE <40 IU/mL, although this was not observed in non-responders. None of the laboratory parameters evaluated (ESR, CRP, IgE, D-dimer, anti-TPO, and eosinophils) showed a significant association with treatment response. There was no statistical difference in therapeutic response between patients with CSU and those with inducible urticaria.Conclusion: Higher BMI, female sex, earlier symptom onset, prolonged disease duration, and psychiatric disorders were associated with poorer treatment response. The laboratory markers evaluated were not effective predictors of treatment response.