Correlation between disease activity and markers of coagulation cascade in patients of chronic spontaneous urticaria: a hospital based cross-sectional study
DOI:
https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20232538Keywords:
Coagulation cascade, Extrinsic coagulation pathway, Intrinsic coagulation pathway, d-Dimer, Activated partial thromboplastin time, Prothrombin time, Urticaria activity scoreAbstract
Background: Both extrinsic as well as intrinsic coagulation cascade are involved in the pathogenesis of Chronic spontaneous urticaria. This study was done to correlate the disease activity and markers of coagulation cascade in patients of CSU.
Methods: A hospital-based, cross-sectional, descriptive study was carried out in 100 patients of chronic urticaria. Baseline D-Dimer, prothrombin time, activated partial thromboplastin time was performed. Disease activity was assessed using Urticaria activity score over 7 days.
Results: Of total 100 patients, d-dimer was raised in 72 (72%) patients. Correlation between D-dimer and UAS-7 days showed significant covariance between D-dimer and UAS-7 (p<0.001, r=0.93). Prothrombin time was raised in 55 (55%) patients. Significant correlation was found between PT and UAS-7 (p<0.001, r=0.76). Raised APTT was observed in 61(61%) patients. Correlation between APTT and UAS-7 showed that there was a significant covariance between APTT and UAS-7 (p<0.001, r=0.59).
Conclusions: A significant correlation between markers of coagulation cascade and the disease activity in patients of CSU was seen. These markers can help predict the disease severity and possibly monitor therapeutic response.
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References
Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F, et al. The diagnosis and management of acute and chronic urticaria:2014 update. J Allergy Clin Immunol. 2014;133:1270-7.
Greaves M. Chronic urticaria. J Allergy Clin Immunol. 2000;105:664-72.
Deacock SJ. An approach to the patient with urticaria. Clin Exp Immunol. 2008;153:151-61.
Cugno M, Marzano AV, Asero R, Tedeschi A. Activation of blood coagulation in chronic urticaria: pathophysiological and clinical implications. Intern Emerg Med. 2010;5:97-101.
Zuberbier T, Asero R, Bindslev-Jensen C, Walter Canonica G, Church MK, Gimenez-Arnau AM, et al. guideline: management of urticaria. Allergy. 2009; 64:1427-43.
Bracken SJ, Abraham S, MacLeod AS. Autoimmune Theories of Chronic Spontaneous Urticaria. Front Immunol. 2019;10:627.
Grattan CE, Wallington TB, Warin RP, Kennedy CT, Bradfield JW. A serological mediator in chronic idiopathic urticaria--a clinical, immunological and histological evaluation. Br J Dermatol. 1986;114:583-90.
Gruber BL, Baeza ML, Marchese MJ, Agnello V, Kaplan AP. Prevalence and functional role of anti-IgE autoantibodies in urticarial syndromes. J Invest Dermatol 1988;90:213-17.
Trinh HK, Pham DL, Ban GY, Lee HY, Park HS, Ye YM. Altered systemic adipokines in patients with chronic urticaria. Int Arch Allergy Immunol. 2016;171:102-10.
Fiebiger E, Hammerschmid F, Stingl G, Maurer D. Anti-Fc epsilon RI alpha autoantibodies in autoimmune-mediated disorders. Identification of a structure-function relationship. J Clin Invest. 1998;101:243-51.
O'Donnell BF, O'Neill CM, Francis DM, Niimi N, Barr RM, Barlow RJ, et al. Human leucocyte antigen class II associations in chronic idiopathic urticaria. Br J Dermatol. 1999;140:853-8.
Kasperska-Zajac A, Grzanka A, Damasiewicz-Bodzek A. IL-6 Transsignaling in Patients with Chronic Spontaneous Urticaria. PLoS One. 2015;10:e0145751.
Kolkhir P, Altrichter S, Hawro T, Maurer M. C-reactive protein is linked to disease activity, impact, and response to treatment in patients with chronic spontaneous urticaria. Allergy. 2018;73:940-8.
Kessel A, Bishara R, Amital A, Bamberger E, Sabo E, Grushko G, et al. Increased plasma levels of matrix metalloproteinase-9 are associated with the severity of chronic urticaria. Clin Exp Allergy. 2005;35:221-5.
Asero R, Tedeschi A, Riboldi P, Cugno M. Plasma of patients with chronic urticaria shows signs of thrombin generation, and its intradermal injection causes wheal-and-flare reactions much more frequently than autologous serum. J Allergy Clin Immunol. 2006;117: 1113-7.
Asero R, Tedeschi A, Coppola R, Griffini S, Paparella P, Riboldi P, et al. Activation of the tissue pathway of blood coagulation in patients with chronic urticaria. J Allergy Clin Immunol. 2007;119:705-10.
Cugno M, Marzano AV, Tedeschi A, Fanoni D, Venegoni L, Asero R. Expression of tissue factor by eosinophils in patients with chronic urticaria. Int Arch Allergy Immunol. 2009;148:170-4.
Asero R, Tedeschi A, Riboldi P, Griffini S, Bonanni E, Cugno M. Severe chronic urticaria is associated with elevated plasma levels of D-dimer. Allergy. 2008;63: 176-80.
Kim J-A, Kim S, Kim J-E, Gu J-Y, Yoo HJ, Kang H-R, et al. Activation of intrinsic coagulation pathway in patients with chronic urticaria. Allergy Astham Immunol Res. 2015;7:476-82.
Tedeschi A, Kolkhir P, Asero R, Pogorelov D, Olisova O, Kochergin N, et al. Chronic urticaria and coagulation: pathophysiological and clinical aspects. Allergy. 2014;69:683-91.
Asero R. D-dimer: a biomarker for antihistamine-resistant chronic urticaria. J Allergy Clin Immunol. 2013;132:983-6.
Erbagci Z. The leukotriene receptor antagonist montelukast in the treatment of chronic idiopathic urticaria: A single‑blind, placebo‑controlled, crossover clinical study. J Allergy Clin Immunol. 2002;110: 484‑8.
Puccetti A, Bason C, Simeoni S, et al. In chronic idiopathic urticaria autoantibodies against Fc epsilonRII/CD23 induce histamine release via eosinophil activation. Clin Exp Allergy. 2005;35: 1599-607.
Wang F, Tang H, Xu JH, Kang KF. Activation of the blood coagulation cascade is involved in patients with chronic urticaria. J Allergy Clin Immunol. 2009;123: 972-3.
Sere KM, Hackeng TM. Basic mechanisms of hemostasis. Semin Vasc Med. 2003;3:3-12.
Witkowski M, Landmesser U, Rauch U. Tissue factor as a link between inflammation and coagulation. Trends Cardiovasc Med. 2016;26:297-303.
Chauhan S, Mahajan VK, Mehta KS, Yadav RS, Chauhan PS, Bhushan S,et al. Clinicoepidemiologic Features of Chronic Spontaneous Urticaria in Patients with Elevated Plasma D-Dimer Levels versus those without It: A Case-Control Cross-Sectional Study of 100 Indian Patients. Indian Dermatol Online J. 2019; 10:632-8.
Schaeffer RC, Gong F, Bitrick MS, Smith TL. Thrombin and bradykinin initiate discrete endothelial solute permeability mechanisms. Am J Physiol 1993; 264:H1798-809.
Vliagoftis H. Thrombin induces mast cell adhesion to fibronectin: evidence for involvement of protease-activated receptor-1. J Immunol. 2002;169:4551-8.
Triwongwaranat D, Kulthanan K, Chularojanamontri L, Pinkaew S. Correlation between plasma D‑dimer levels and the severity of patients with chronic urticaria. Asia Pac Allergy. 2013;3:100‑5.
Asero R, Cugno M, Tedeschi A. Activation of blood coagulation in plasma from chronic urticaria patients with negative autologous plasma skin test. Eur J Dermatol Venereol. 2011;25:201-5.
Asero R, Tedeschi A, Cugno M. Heparin and tranexamic acid may be effective in treatment-resistant chronic urticaria with elevated d-dimer: a pilot study. Int Arch Allergy Immunol. 2010;152:384-9.
Farres MN, Refaat M, Melek NA, Ahmed EE, Shamseldine MG, Arafa NA. Activation of coagulation in chronic urticaria in relation to disease severity and activity. Allergol Immunopathol. 2015;43:162-7.
Bennett B, Ratnoff OD, Holt JB, Roberts HR. Hageman trait (factor XII deficiency): a probably second genotype inherited as an autosomal dominant characteristic. Blood. 1972;40:412-15.
Hentges F, Hilger C, Kohnen M, Gilson G. Angioedema and estrogen-dependent angioedema with activation of the contact system. J Allergy Clin Immunol. 2009;123:262-4.
