Chronic urticaria (CU) is defined as recurrent urticaria lasting for more than 6 weeks. We aimed to characterize the phenotypes of patients with CU refractory to standard dose anti-H1 antihistamine treatment and search for clinical predictors of poor disease control. Retrospective collection of data regarding clinical characteristics, comorbidities, treatment, and disease control of all adult refractory CU patients presenting to the Allergy and Immunology Department during 1 year. Sixty-one adult patients were included, 74% females, average age 44.5 years (18 to 84 years old). Most patients (78.7%) had initiated CU less than 1 year before enrolment. Chronic spontaneous urticaria (CSU) accounted for 55.7% of the patients, CSU associated with chronic inducible urticaria (CIndU) as a comorbidity for 44.3%, and angioedema was present in 55.7%. Medically-confirmed psychiatric disorders were present in 78.7%. Complementary diagnostic tests were performed in cases with more severe presentation (UAS7 ≥ 28 and/or UCT < 12) or with longer evolution (> 1 year), corresponding to 42 tested patient. Evidence for autoimmunity (positive anti-thyroid peroxidase antibodies, anti-nuclear antibodies or autologous serum test) was found in 45.2% (n = 19/42), and high C-reactive protein was present in 14.3% (n = 6/42), half of these also had positive antinuclear antibodies. Forty-six patients (75.4%) had at least one significant exacerbation, requiring medical appointment, emergency room, hospitalization or job absenteeism. The number of exacerbations correlated with the presence of angioedema (p = 0.022), with a recent diagnosis (< 1 year), and with higher UAS7 severity (p = 0.006). Although ClndU was associated with poor symptom control (p = 0.022), it was also associated with less exacerbations requiring medical observation or hospitalization (p = 0.015). All patients were using antihistamines and 21.3% (n = 13) of them were also under treatment with omalizumab, ciclosporine or montelukast for disease control. Autoimmunity can affect about half of the patients with severe or long-term CU. UAS7 and angioedema are associated with disease exacerbations. UAS7 and UCT presented unequal accuracy, with UAS7 better associating with the occurrence of exacerbations and treatment doses. Patients with refractory CU frequently present psychiatric disorders. Accurate diagnostic tests, namely autoimmune parameters and inflammatory markers, should be recommended in some individual cases.

中文翻译：

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成人难治性慢性荨麻疹：临床特征和严重程度预测因子

慢性荨麻疹（CU）的定义是持续性荨麻疹持续超过6周。我们旨在表征标准剂量抗H1抗组胺药治疗难治性CU患者的表型，并寻找疾病控制不良的临床预测指标。回顾性收集在1年内就诊于过敏和免疫学部门的所有成人难治性CU患者的临床特征，合并症，治疗和疾病控制的数据。包括61名成年患者，女性74％，平均年龄44.5岁（18至84岁）。大多数患者（78.7％）在入组前不到一年就开始了CU。慢性自发性荨麻疹（CSU）占患者的55.7％，CSU与慢性诱导性荨麻疹（CIndU）相关，合并症占44.3％，血管性水肿占55.7％。医学确诊的精神病患者占78.7％。对于表现较严重的患者（UAS7≥28和/或UCT <12）或病程较长（> 1年）的患者，应进行辅助诊断测试，对应于42名接受测试的患者。发现自身免疫的证据（阳性抗甲状腺过氧化物酶抗体，抗核抗体或自体血清试验）占45.2％（n = 19/42），高C反应蛋白存在于14.3％（n = 6/42）。 ），其中一半还具有阳性抗核抗体。四十六名患者（75.4％）至少有一次严重加重，需要就诊，急诊室，住院或旷工。加重次数与血管性水肿的存在（p = 0.022），最近的诊断（<1年）以及较高的UAS7严重程度（p = 0.006）相关。尽管ClndU与症状控制不佳相关（p = 0.022），但与需要医学观察或住院的病情加重程度也较小（p = 0.015）。所有患者均使用抗组胺药，其中21.3％（n = 13）也接受奥马珠单抗，环孢素或孟鲁司特治疗以控制疾病。自身免疫可影响约一半患有重度或长期CU的患者。UAS7和血管性水肿与疾病加重有关。UAS7和UCT的准确性不尽相同，UAS7与病情加重和治疗剂量的关联更好。难治性CU患者经常出现精神疾病。在某些情况下，应建议进行准确的诊断测试，即自身免疫参数和炎性标志物。022），这也与需要医学观察或住院的病情加重次数减少相关（p = 0.015）。所有患者均使用抗组胺药，其中21.3％（n = 13）也接受奥马珠单抗，环孢素或孟鲁司特治疗以控制疾病。自身免疫可影响约一半患有重度或长期CU的患者。UAS7和血管性水肿与疾病加重有关。UAS7和UCT的准确性不尽相同，UAS7与病情加重和治疗剂量的关联更好。难治性CU患者经常出现精神疾病。在某些情况下，应建议进行准确的诊断测试，即自身免疫参数和炎性标志物。022），这也与需要医学观察或住院的病情加重次数减少相关（p = 0.015）。所有患者均使用抗组胺药，其中21.3％（n = 13）也接受奥马珠单抗，环孢素或孟鲁司特治疗以控制疾病。自身免疫可影响约一半患有重度或长期CU的患者。UAS7和血管性水肿与疾病加重有关。UAS7和UCT的准确性不尽相同，UAS7与病情加重和治疗剂量的关联更好。难治性CU患者经常出现精神疾病。在某些情况下，应建议进行准确的诊断测试，即自身免疫参数和炎性标志物。所有患者均使用抗组胺药，其中21.3％（n = 13）也接受奥马珠单抗，环孢素或孟鲁司特治疗以控制疾病。自身免疫可影响约一半患有重度或长期CU的患者。UAS7和血管性水肿与疾病加重有关。UAS7和UCT的准确性不尽相同，UAS7与病情加重和治疗剂量的关联更好。难治性CU患者经常出现精神疾病。在某些情况下，应建议进行准确的诊断测试，即自身免疫参数和炎性标志物。所有患者均使用抗组胺药，其中21.3％（n = 13）也接受奥马珠单抗，环孢素或孟鲁司特治疗以控制疾病。自身免疫可影响约一半患有重度或长期CU的患者。UAS7和血管性水肿与疾病加重有关。UAS7和UCT的准确性不尽相同，UAS7与病情加重和治疗剂量的关联更好。难治性CU患者经常出现精神疾病。在某些情况下，应建议进行准确的诊断测试，即自身免疫参数和炎性标志物。自身免疫可影响约一半患有重度或长期CU的患者。UAS7和血管性水肿与疾病加重有关。UAS7和UCT的准确性不尽相同，UAS7与病情加重和治疗剂量的关联更好。难治性CU患者经常出现精神疾病。在某些情况下，应建议进行准确的诊断测试，即自身免疫参数和炎性标志物。自身免疫可影响约一半患有重度或长期CU的患者。UAS7和血管性水肿与疾病加重有关。UAS7和UCT的准确性不尽相同，UAS7与病情加重和治疗剂量的关联更好。难治性CU患者经常出现精神疾病。在某些情况下，应建议进行准确的诊断测试，即自身免疫参数和炎性标志物。