Evaluation of new inflammatory parameters in patients with chronic spontaneous urticaria: A new predictor of refractoriness to antihistamine treatment

Yıl 2020, , 404 - 411, 20.12.2020

Nur Cihan Coşansu

https://doi.org/10.37696/nkmj.731617

Öz

Objective: Antihistamines is used as the first-line treatment in chronic spontaneous urticaria (CSU). We investigated whether complet blood count parameters might be used as a response factor in patients under antihistamine treatment for CSU. We also compared the NLR (neutrophil lymphocyte ratio), PLR (platelet lymphocyte ratio, MPV (mean platelet volume) and RDW (erythrocyte distribution width) levels of CSU patients with healthy controls.
Material and Method: This study was conducted on a total of 150 cases, a hundred of which had CSU and fifty healthy control group.
Results: NLR and RDW were significantly higher and MPV was significantly lower in the CSU group. NLR and PLR levels were found significantly lower in patients who responded to antihistamine treatment within 4 weeks. The ROC analysis showed that NLR predicted responders with a sensitivity of 92% and with a specificity of 84%, using a cut-off value of 1,98 (p<.001). The multivariate regression analysis showed that only NLR was found as the predictor of responders.
Conclusion: NLR may be considered as a simple and cost-effective tool to determine which patients can respond to antihistamines. It may be a guide for non-responsive patients to switch to other treatment options in the early period.

Anahtar Kelimeler

Urticaria, Neutrophil to lymphocyte ratio, Antihistamines

Kronik spontan ürtikerli hastalarda yeni inflamatuar parametrelerin değerlendirilmesi: Antihistaminik tedaviye refrakterliğin yeni bir öngördürücüsü

Öz

Amaç: Antihistaminikler kronik spontan ürtikerde (KSU) ilk basamak tedavi olarak kullanılır. Çalışmada KSU için antihistaminik tedavi gören hastalarda tam kan sayımı parametrelerinin yanıt faktörü olarak kullanılıp kullanılamayacağını araştırdık. Ayrıca KSU hastalarının NLR (nötrofil lenfosit oranı), PLR (trombosit lenfosit oranı), MPV (ortalama trombosit hacmi) ve RDW (eritrosit dağılım genişliği) düzeylerini sağlıklı kontroller ile karşılaştırdık.
Materyal ve Metod: Bu çalışma, yüz KSU ve elli sağlıklı kontrol grubuna sahip toplam 150 vaka üzerinde gerçekleştirilmiştir.
Bulgular: KSU grubunda NLR ve RDW anlamlı olarak yüksek ve MPV anlamlı olarak düşüktü. Antihistaminik tedaviye 4 hafta içinde yanıt veren hastalarda NLR ve PLR düzeyleri anlamlı olarak düşük bulundu. ROC analizi NLR'nin, 1,98 kesme değeri kullanılarak, yanıt verenleri % 92 hassasiyet ve % 84 özgüllük ile tahmin ettiğini göstermiştir (p <.001). Çok değişkenli regresyon analizi, sadece NLR'nin yanıt öngördürücüsü olduğunu göstermiştir.
Sonuç: NLR hangi hastaların antihistaminiklere yanıt verebileceğini belirlemek için basit ve uygun maliyetli bir araç olarak düşünülebilir. NLR, yanıt vermeyecek hastaların erken dönemde diğer tedavi seçeneklerine geçmeleri için rehberlik edebilir.

Anahtar Kelimeler

Ürtiker, Nötrofil / lenfosit oranı, Antihistaminikler

Kaynakça

• 1. Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, et al: The EAACI/ GA (2) LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy 2014; 69:868-887.
• 2. Champion RH, Roberts SO, Carpenter RG, Roger JH. Urticaria and angio-oedema. A review of 554 patients. Br J Dermatol. 1969 Aug;81(8):588–97.
• 3. Toubi E, Kessel A, Avshovich N, Bamberger E, Sabo E, Nusem D, et al. Clinical and laboratory parameters in predicting chronic urticaria duration: a prospective study of 139 patients. Allergy. 2004 Aug;59(8):869–73.
• 4. Gaig P, Olona M, Muñoz Lejarazu D, Caballero MT, Domínguez FJ, Echechipia S, et al. Epidemiology of urticaria in Spain. J Investig Allergol Clin Immunol. 2004;14(3):214–20.
• 5. Jiamton S, Swad-Ampiraks P, Kulthanan K, Suthipinittharm P. Urticaria and angioedema in Siriraj medical students. J Med Assoc Thai. 2003 Jan;86(1):74–81.
• 6. Toubi E, Adir-Shani A, Kessel A, Shmuel Z, Sabo E, Hacham H: Immune aberrations in B and T lymphocytes derived from chronic urticaria patients. J Clin Immunol 2000; 20:371-378.
• 7. Grzanka A, Machura E, Misiolek M, Polaniak R, Kasperski J, Kasperska-Zajac A: Systemic inflammatory response and calcification markers in patients with long lasting moderate-severe chronic spontaneous urticaria. Eur J Dermatol 2015; 25:26-28.
• 8. Kasperska-Zajac A: Acute-phase response in chronic urticaria. J Eur Acad Dermatol 2012; 26:665-672.
• 9. Kasperska-Zajac A, Sztylc J, Machura E, Jop G: Plasma IL-6 concentration correlates with clinical disease activity and serum C-reactive protein concentration in chronic urticaria patients. Clin Exp Allergy 2011; 41:1386-1391.
• 10. Guillén-Aguinaga S, Jáuregui Presa I, Aguinaga-Ontoso E, Guillén-Grima F, Ferrer M. Updosing nonsedating antihistamines in patients with chronic spontaneous urticaria: a systematic review and meta-analysis. Br J Dermatol. 2016; 175(6):1.153-1.165.
• 11. Balta S, Celik T, Mikhailidis DP, Ozturk C, Demirkol S, Aparci M, et al. The relation between atherosclerosis and the neutrophil lymphocyte ratio. Clin Appl Thromb Hemost 2016 Jul;22(5):405-11.
• 12. Sen BB, Rifaioglu EN, Ekiz O, Inan MU, Sen T, Sen N. Neutrophil to lymphocyte ratio as a measure of systemic inflammation in psoriasis. Cutan Ocul Toxicol 2014;33: 223-7.
• 13. Templeton AJ, McNamara MG, Seruga B, Vera-Badillo FE, Aneja P, Ocana A, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst 2014; 106: dju124.
• 14. Torun S, Tunc BD, Suvak B, Yildiz H, Tas A, Sayilir A, et al. Assessment of neutrophil-lymphocyte ratio in ulcerative colitis: a promising marker in predicting disease severity. Clin Res Hepatol Gastroenterol 2012; 36: 491-7.
• 15. Göncü EK, Aktan Ş, Atakan N, Başkan EB, Erdem T, Koca R, et al. The Turkish guideline for the diagnosis and management of urticaria-2016. Turkderm 2016; 50.
• 16. Asero R, Tedeschi A, Marzano AV, Cugno M. Chronic urticaria: a focus on pathogenesis. F1000Res 2017; 6: 1095.
• 17. Balkarli A, Kucuk A, Babur H, Erbasan F. Neutrophil/lymphocyte ratio and mean platelet volume in Behcet’s disease. Eur Rev Med Pharmacol Sci 2016; 20:3045-50.
• 18. Ma J, Kuzman J, Ray A, Lawson BO, Khong B, Xuan S, et al. Neutrophil-to-lymphocyte Ratio (NLR) as a predictor for recurrence in patients with stage III melanoma. Sci Rep 2018; 8:4044.
• 19. Ye YM, Jin HJ, Hwang EK, Nam YH, Kim JH, Shin YS, Park HS: Co-existence of chronic urticaria and metabolic syndrome: clinical implications. Acta Derm Venereol 2013; 93:156-160.
• 20. Mathias SD, Dreskin SC, Kaplan A, Saini SS, Spector S, Rosen KE. Development of a daily diary for patients with chronic idiopathic urticaria. Ann Allergy Asthma Immunol. 2010;105(2):142–148.
• 21. Haybar H, Pezeshki SMS, Saki N. Evaluation of complete blood count parameters in cardiovascular diseases: An early indicator of prognosis? Exp Mol Pathol. 2019 Jun 11; 110:104267.
• 22. Asahina A, Kubo N, Umezawa Y, Honda H, Yanaba K, Nakagawa H. Neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and mean platelet volume in Japanese patients with psoriasis and psoriatic arthritis: Response to therapy with biologics. J Dermatol. 2017 Oct;44(10):1112-1121
• 23. Song GG, Lee YH. Red cell distribution width, platelet-to-lymphocyte ratio, and mean platelet volume in ankylosing spondylitis and their correlations with inflammation: A meta-analysis. Mod Rheumatol. 2019 Aug 1:1-6.
• 24. Karabay EA, Çerman AA, Altunay İK. Serum C-reactive protein, neutrophil-lymphocyte ratio and uric acid levels in chronic spontaneous urticaria. Turkiye Klin J Dermatology 2016; 26: 125-131.
• 25. Ertaş R, Özyurt K, Karakükçü Ç, Akkuş MR, Özlü E, Avcı A, et al. Evaluation of platelet parameters and neutrophil/lymphocyte ratio during omalizumab treatment in patients with severe chronic spontaneous urticaria. Turk J Med Sci. 2018 Dec 12;48(6):1255-1262.
• 26. Sarac G, Mantar I, Sener S, Cenk H, Kapicioglu Y. Assessment of change in neutrophil-lymphocyte ratio, platelet-lymphocyteratio in patients with acute and chronic urticaria. Annals of Medical Research. 2018;25(4)719-22.
• 27. Magen E, Mishal J, Zeldin Y, Schlesinger M. Clinical and laboratory features of antihistamine-resistant chronic idiopathic urticaria. Allergy and Asthma Proceedings. 2011;32(6):460–466.
• 28. Isiksacan N, Koser M, Cemsitoglu F, Kucuksezer UC, Gurdol F. Platelet and other hemostatic characteristics in patients with chronic urticaria. Angiology.2015 Apr;66(4):387-91.
• 29. Akelma AZ, Mete E, Cizmeci MN, Kanburoglu MK, Malli DD, Bozkaya D. The role of mean platelet volume as an inflammatory marker in children with chronic spontaneous urticaria. Allergol Immunopathol. 2015 Jan-Feb;43(1):10-3.