PREDICTION OF PROGNOSIS IN CHRONIC URTICARIA

The diagnosis and treatment of chronic spontaneous urticaria (CSU) have been well described in the literature; however, little is known about the condition’s natural history, long-term consequences, and prognostic variables. Many patients experience a relapsing–remitting disease course for years. Mul-tiple clinical and laboratory markers have been proposed to predict the course of the disease. These biomarkers can be evaluated under specific subheadings, predicting not only disease duration and se-verity but also response to various treatment approaches. Using clinical and laboratory predictors can help counsel patients on what to expect from their treatment and identify those at risk of nonresponse, allowing for early consideration of switching to potentially more effective therapies. Identifying cer-tain biomarkers, such as basophil tests and total immunoglobulin E (IgE) levels, and endotyping CSU patients to differentiate between overlapping, autoallergic, and autoimmune conditions will maximize therapeutic efficacy and enable tailored treatments in the framework of precision medicine. The age of >65 years, male gender, psychiatric comorbidities, presence of angioedema and chronic inducible urticaria were reported to be poor prognostic clinical variables influencing the remission rate. Elevated CRP, D-dimer, positive autoimmune tests (ASST, anti-TPO, ANA), eosinophil count / total IgE levels and mast cell count are among the laboratory predictors of prognosis. High total IgE and CRP level and autoimmune test positivity can also be used for predicting the treatment response. Proteomics like fi-brinogen chain proteins (FGB, FGG) and heat shock protein (HSPA8) levels can be potential biomark-ers for autoimmune subgroup. Effective and widespread use of patient-reported outcome measures is important in predicting patient satisfaction and therapeutic success. In recent years, some prognostic calculators have been developed for chronic urticaria. These studies, which use a limited number of predictors as age, angioedema, duration of the disease eg. are promising for routine use with the addi-tion of a wider range of variables.