RESUMEN
Chronic spontaneous urticaria (CSU) should be on every dermatology practitioner's radar. CSU is a skin disorder marked by wheals, angioedema, or both for more than 6 weeks. Patients with CSU experience unexplained, itchy wheals that appear and disappear, traveling around the body and lasting less than 24 hours per area. Angioedema accompanies wheals for up to 48 hours in around half of cases. CSU is a diagnosis of exclusion, relying heavily on patient history to differentiate CSU symptoms from other causes of urticaria or angioedema. But reassuringly, CSU has a simple diagnostic algorithm and a clear initial treatment path. First-line strategies include non-pharmacologic approaches, and second-generation antihistamines (2gAH) administered up to 4 times their standard dose. Omalizumab and cyclosporine (off-label) are second- and third-line options, respectively. However, many patients will continue to have CSU symptoms despite consistent maximum-dose treatment. Novel therapies, including biologic agents and small molecule drugs targeting mast cell activation and inflammatory mediators, show promise in treating CSU refractory to standard therapy. However, further research is needed to establish their efficacy and safety in clinical practice. J Drugs Dermatol. 2024;23:9(Suppl 2):s5-14.Access the CME Activity.
Asunto(s)
Urticaria Crónica , Omalizumab , Humanos , Urticaria Crónica/tratamiento farmacológico , Urticaria Crónica/diagnóstico , Omalizumab/uso terapéutico , Omalizumab/administración & dosificación , Antagonistas de los Receptores Histamínicos/administración & dosificación , Antagonistas de los Receptores Histamínicos/uso terapéutico , Ciclosporina/uso terapéutico , Ciclosporina/administración & dosificación , Urticaria/tratamiento farmacológico , Urticaria/diagnósticoRESUMEN
Chronic spontaneous urticaria (CSU) is associated with skin mast cell activation, and its triggering mechanisms are not completely elucidated. Evidence suggests an autoimmune component of CSU. Our aim was to assess the usefulness of an autoimmune mast cell activation test (aiMAT) for diagnosing and differentiating CSU into different subtypes. We enrolled 43 patients with active, uncontrolled CSU before starting treatment with omalizumab and 15 controls. Patients were evaluated based on omalizumab response. aiMATs were performed using non-IgE-sensitized (NS) or myeloma IgE-sensitized (S) LAD2 cells, which were then stimulated with CSU/control sera (25 µL and 10 µL). The expression of CD63 was assessed with flow cytometry. CD63 response on NS-LAD2 was significantly increased in CSU patients compared to controls after the stimulation with 25 µL CSU/control sera (p = 0.0007) and with 10 µL CSU/control sera (p = 0.0001). The ROC curve analysis demonstrated an area under the curve (AUC) of 0.82. The cutoff for autoimmune-non-IgE-sensitized-MAT was 40.3% CD63+ LAD2, which resulted in 73.3% sensitivity and 81.4% specificity. CD63 response on S-LAD2 was significantly increased in CSU patients compared to controls after the stimulation with 25 µL CSU/control sera (p = 0.03). The ROC curve analysis demonstrated an AUC of 0.66. The cutoff for the autoimmune-myeloma IgE-sensitized-MAT was 58.4% CD63+ cells, which resulted in 62.8% sensitivity and 66.7% specificity. Overall, 36 out of 43 (84%) patients responded to omalizumab, and 7 (16%) were nonresponders. We found no differences between LAD2 CD63 response and response to omalizumab. In conclusion, aiMAT could represent a new diagnostic tool in CSU. Additional studies are needed to evaluate the potential benefits during omalizumab therapy.
Asunto(s)
Urticaria Crónica , Mastocitos , Tetraspanina 30 , Humanos , Urticaria Crónica/diagnóstico , Urticaria Crónica/tratamiento farmacológico , Urticaria Crónica/inmunología , Urticaria Crónica/sangre , Femenino , Mastocitos/inmunología , Mastocitos/metabolismo , Masculino , Persona de Mediana Edad , Adulto , Tetraspanina 30/metabolismo , Omalizumab/uso terapéutico , Anciano , Inmunoglobulina E/sangre , Inmunoglobulina E/inmunología , Curva ROC , Estudios de Casos y ControlesAsunto(s)
Urticaria Crónica , Disnea , Granulomatosis con Poliangitis , Humanos , Granulomatosis con Poliangitis/diagnóstico , Granulomatosis con Poliangitis/complicaciones , Granulomatosis con Poliangitis/tratamiento farmacológico , Granulomatosis con Poliangitis/patología , Disnea/etiología , Disnea/diagnóstico , Urticaria Crónica/diagnóstico , Urticaria Crónica/tratamiento farmacológico , Femenino , Masculino , Persona de Mediana Edad , Urticaria/diagnóstico , Urticaria/etiología , Urticaria/tratamiento farmacológicoRESUMEN
Urticaria is a skin rash with several etiologic factors, including infectious agents. Blastocystis hominis is an intestinal protozoan parasite that has been linked to urticaria and skin lesions. The aim of this work was to investigate the association between B. hominis infection and chronic urticaria. In a case-control study, stool samples were obtained from 94 patients with chronic urticaria as case group and 285 healthy individuals as control group. Urticaria activity score 7 (UAS7) was used to score the severity of urticaria, classified as mild, moderate and intense. All stool samples underwent routine stool examinations, as well as polymerase chain reaction (PCR) for the detection of B. hominis. Molecular detection was carried out using the small subunit ribosomal RNA (SSU-rRNA) gene and the parasite subtypes were determined by sequencing. The rate of B. hominis infection was 21.3% (20 out of 94) and 17.2% (49 out of 285) between the case and control groups, respectively (p = 0.463). Three subtypes of B. hominis, including ST-1, ST-2 and ST-3, were detected in the case and control groups (ST-1 = 30% vs. 8.3%, ST-2 = 40% vs. 25% and ST-3 = 30% vs. 66.6% in the case and control group, respectively), which was statistically significant (p = 0.00001). However, no statistical differences were found between the severity of the urticaria and the B. hominis subtypes (p = 0.533). This study revealed a higher prevalence (but not significant) of B. hominis infection among patients with urticaria than healthy individuals. However, the results did not find a significant association between the subtypes of B. hominis and the severity of urticaria.
Asunto(s)
Infecciones por Blastocystis , Blastocystis hominis , Urticaria Crónica , Heces , Humanos , Infecciones por Blastocystis/epidemiología , Infecciones por Blastocystis/complicaciones , Infecciones por Blastocystis/parasitología , Infecciones por Blastocystis/diagnóstico , Blastocystis hominis/aislamiento & purificación , Masculino , Femenino , Adulto , Estudios de Casos y Controles , Urticaria Crónica/parasitología , Urticaria Crónica/diagnóstico , Persona de Mediana Edad , Heces/parasitología , Adulto Joven , Índice de Severidad de la Enfermedad , Adolescente , Anciano , Urticaria/parasitologíaRESUMEN
Chronic inducible urticaria (CIndU) is characterized by the appearance of hives (urticaria) and/or angioedema in response to specific triggers or stimuli. For accurate diagnosis, anamnesis-driven specific, and if available, standardized trigger testings, as well as patient reported outcomes, should be applied. The currently recommended treatment algorithm is the same as for chronic spontaneous urticaria but is largely off-label for CIndU. New, and possibly more disease-specific, treatment options are needed for CIndU patients, who are often severely impacted by their disease. Several clinical trials are currently ongoing.
Asunto(s)
Urticaria Crónica , Humanos , Urticaria Crónica/diagnóstico , Urticaria Crónica/etiología , Manejo de la Enfermedad , Angioedema/diagnóstico , Angioedema/etiología , Angioedema/terapia , Urticaria/diagnóstico , Urticaria/etiología , AlgoritmosRESUMEN
This study focuses on quality of life (QoL) assessment in chronic urticaria, delving into tools, disease-specific measures, and its profound impact. With expanding therapeutic options, understanding QoL becomes crucial. QoL measures often involve comparisons of patient-reported outcomes in addition to quantitative measures of disease control. Emerging tools include the Urticaria Activity and Impact Measure, which may provide a balanced evaluation. In addition to discussions of the various QoL measures, the psychological impact of chronic urticaria are highlighted, covering emotional burden, stress, and psychiatric comorbidities. Finally, the economic impacts reveal escalating health care costs and cost-effectiveness considerations of therapies like omalizumab.
Asunto(s)
Urticaria Crónica , Calidad de Vida , Humanos , Urticaria Crónica/economía , Urticaria Crónica/psicología , Urticaria Crónica/diagnóstico , Costo de Enfermedad , Costos de la Atención en Salud , Omalizumab/uso terapéutico , Omalizumab/economía , Análisis Costo-Beneficio , Medición de Resultados Informados por el PacienteRESUMEN
Chronic urticaria is an inflammatory skin disorder defined by the presence of evanescent erythematous pruritic wheals, angioedema, or both. While treatment guidelines are continuing to become more clearly defined, there is still a gap in the medical literature surrounding chronic spontaneous urticaria (CSU) treatment in vulnerable populations such as children (aged 0-18 years), pregnant women, and the elderly (aged >65 years). The purpose of this review is to provide an update on CSU in each of these special population categories by defining prevalence, identifying diagnostic considerations, and exploring current and future management options.
Asunto(s)
Urticaria Crónica , Humanos , Embarazo , Femenino , Niño , Urticaria Crónica/diagnóstico , Urticaria Crónica/etiología , Anciano , Preescolar , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/terapia , Adolescente , Prevalencia , Recién Nacido , Manejo de la Enfermedad , Lactante , Urticaria/diagnóstico , Urticaria/etiología , Urticaria/epidemiologíaRESUMEN
Urticaria, also known as hives, is a common condition thought to affect up to 20% of individuals worldwide in their lifetime. This skin condition is characterized by the appearance of pruritic, erythematous papules or plaques with superficial swelling of the dermis. The major complaint is the symptom of pruritus. Angioedema, which involves a deeper swelling of dermal or mucosal tissues, may accompany urticaria. Urticaria can be classified by both time course of symptoms and the underlying etiology.
Asunto(s)
Urticaria Crónica , Humanos , Urticaria Crónica/diagnóstico , Urticaria Crónica/etiología , Prurito/etiología , Prurito/diagnóstico , Urticaria/etiología , Urticaria/diagnósticoRESUMEN
Chronic spontaneous urticaria (CSU) affects 0.5% to 1% of the general population and is often managed by allergy and immunology specialists. Guidelines have evolved over the past several decades with an emphasis on decreasing extensive screening laboratory testing as they are of low-yield and cost-ineffective. The utility of biomarkers remains under investigation but total immunoglobulin E may be helpful in determining specific endotypes and response to omalizumab. Antihistamines and omalizumab remain the primary therapeutic options for CSU, but an expanding body of evidence supports the use of immunosuppressants and anti-inflammatory medications in refractory cases.
Asunto(s)
Urticaria Crónica , Humanos , Urticaria Crónica/diagnóstico , Urticaria Crónica/terapia , Urticaria Crónica/tratamiento farmacológico , Manejo de la Enfermedad , Omalizumab/uso terapéutico , Biomarcadores , Antagonistas de los Receptores Histamínicos/uso terapéutico , Antialérgicos/uso terapéutico , Inmunoglobulina E/inmunología , Inmunosupresores/uso terapéuticoRESUMEN
Chronic urticaria (CU) is a common and long-lasting mast cell-mediated skin disease associated with psychiatric and autoimmune comorbidities, high economic costs, and considerable impact on quality of life. Available therapies show limited efficacy in many CU patients, which may be related to distinct underlying pathophysiology. Targeted and disease-modifying treatments with higher and broader efficacy are needed and are under development for CU. These novel drugs, small molecules, and monoclonal antibodies target mast cells and their receptors, signaling pathways, or mediators and other immune cells. In this article, the authors focus on the most promising emerging therapeutics in advanced development and discuss their potential place in future management of CU.
Asunto(s)
Urticaria Crónica , Mastocitos , Humanos , Urticaria Crónica/tratamiento farmacológico , Urticaria Crónica/terapia , Urticaria Crónica/diagnóstico , Mastocitos/inmunología , Mastocitos/metabolismo , Anticuerpos Monoclonales/uso terapéutico , Terapia Molecular Dirigida , Animales , Manejo de la Enfermedad , Calidad de VidaAsunto(s)
Antialérgicos , Urticaria Crónica , Omalizumab , Recurrencia , Humanos , Omalizumab/uso terapéutico , Urticaria Crónica/tratamiento farmacológico , Urticaria Crónica/diagnóstico , Estudios Retrospectivos , Antialérgicos/uso terapéutico , Antialérgicos/administración & dosificación , Femenino , Masculino , Adulto , Pronóstico , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Background: This study aimed to determine whether the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) at admission affect the transition of pediatric patients diagnosed with acute spontaneous urticaria to chronic urticaria. Methods: This study included 390 patients who presented to the Department of Pediatrics at Akdeniz University Hospital with acute spontaneous urticaria between January 2020 and December 2022. A statistical comparison was made between the hematological parameters of patients who developed chronic urticaria and those who did not. Neutrophil, lymphocyte, and platelet counts, as well as NLR, PLR, and SII ratios, were used for the comparison. Results: It was observed that acute urticaria progressed to chronic urticaria in 5.8% (n = 23) of the patients. No significant differences in lymphocyte, hemoglobin, and platelet counts were observed between the group progressing to chronic urticaria and the control group (P > 0.05). However, the chronic urticaria group had higher leukocyte and absolute neutrophil counts (P = 0.009 and P < 0.001, respectively). In addition, the NLR was significantly higher in the chronic urticaria group (P = 0.029), whereas no statistically significant difference was observed in the PLR (P = 0.180). The chronic urticaria group had a significantly higher SII than the control group (P = 0.011). Conclusion: Hematological parameters, particularly NLR and SII, may be useful indicators of the transition from acute to chronic urticaria in pediatric patients. The early identification of these markers could help monitor patients and guide treatment decisions. Further comprehensive studies are required to validate these findings.
Asunto(s)
Biomarcadores , Urticaria Crónica , Neutrófilos , Humanos , Femenino , Urticaria Crónica/sangre , Urticaria Crónica/diagnóstico , Biomarcadores/sangre , Masculino , Niño , Adolescente , Preescolar , Recuento de Plaquetas , Linfocitos/inmunología , Inflamación/sangre , Inflamación/diagnóstico , Plaquetas , Estudios Retrospectivos , Urticaria/sangre , Urticaria/diagnóstico , Urticaria/inmunología , Recuento de Leucocitos , Recuento de Linfocitos , Progresión de la EnfermedadAsunto(s)
Urticaria Crónica , Síndromes Periódicos Asociados a Criopirina , Errores Diagnósticos , Mosaicismo , Proteína con Dominio Pirina 3 de la Familia NLR , Humanos , Proteína con Dominio Pirina 3 de la Familia NLR/genética , Síndromes Periódicos Asociados a Criopirina/diagnóstico , Síndromes Periódicos Asociados a Criopirina/genética , Urticaria Crónica/diagnóstico , Urticaria Crónica/genética , Femenino , Adulto , Masculino , MutaciónRESUMEN
BACKGROUND: Brief erythematous-papular skin rashes suggest the diagnosis of urticaria; However, it may be another type of dermatitis, and complementary examinations must be carried out to establish its diagnosis. CASE REPORT: 53-year-old female patient, diagnosed in 2016 with diffuse large B cell lymphoma, in complete remission. Since 2010, he has had episodes of erythematous-papular lesions lasting 24-36 hours. He received antihistamines, corticosteroids and omalizumab without clinical improvement. The ANA determination was positive (1/320), nuclear mitotic pattern. The skin biopsy was compatible with dermatitis herpetiformis. The study of celiac and locus antibodies showed positivity for HLA-DQ2 and DQ2.5 in heterozygosity. The diagnosis of dermatitis herpetiformis was established. Treatment consisted of a gluten-free diet and prescription of dapsone, with satisfactory results. CONCLUSION: It is important to establish the differential diagnosis of patients with chronic urticaria who do not respond to the reference treatment, in addition to carrying out a thorough clinical examination and physical examination before starting treatment and relying on a multidisciplinary team to establish an accurate diagnosis and treatment. appropriate. Due to the side effects of dapsone, subsequent follow-up of patients is essential.
ANTECEDENTES: Los exantemas cutáneos eritemato-papulares de breve duración sugieren el diagnóstico clínico de urticaria; no obstante, puede tratarse de otro tipo de dermatitis, y para establecer el diagnóstico deben llevarse a cabo exploraciones complementarias. REPORTE DE CASO: Paciente femenina de 53 años, diagnosticada en 2016 con linfoma difuso de células B grandes, en remisión completa. Desde el 2010 manifestó episodios de lesiones eritemato-papulosas, de 24-36 horas de duración. Recibió antihistamínicos, corticoides y omalizumab sin mejoría clínica. La determinación de ANA resultó positiva (1/320), con patrón mitótico nuclear. La biopsia cutánea fue compatible con dermatitis herpetiforme. El estudio de anticuerpos de celiaquía y locus mostró positividad para HLA-DQ2 y DQ2.5 con heterocigosis. Se estableció el diagnosticó de dermatitis herpetiforme. El tratamiento consistió en dieta exenta de gluten y prescripción de dapsona, con resultados satisfactorios. CONCLUSIÓN: Es importante establecer el diagnóstico diferencial de pacientes con urticaria crónica que no responden al tratamiento de referencia, además de efectuar el examen clínico y la exploración física exhaustivos antes de iniciar el protocolo, y apoyarse de un equipo multidisciplinario para establecer el diagnóstico certero y tratamiento adecuado. Debido a los efectos secundarios de la dapsona, es imprescindible el seguimiento posterior de los pacientes.
Asunto(s)
Urticaria Crónica , Humanos , Persona de Mediana Edad , Femenino , Urticaria Crónica/etiología , Urticaria Crónica/tratamiento farmacológico , Urticaria Crónica/diagnóstico , Dermatitis Herpetiforme/diagnóstico , Dermatitis Herpetiforme/etiología , Dermatitis Herpetiforme/complicaciones , Prurito/etiología , Diagnóstico Diferencial , Dapsona/uso terapéuticoRESUMEN
BACKGROUND: Population-based studies have highlighted the link between chronic urticaria (CU) and metabolic syndrome, and metabolic alterations have been revealed in CU. However, to our knowledge, a comprehensive metabolomics study on a large cohort of patients with CU has not been reported. OBJECTIVE: We sought to explore the underlying metabolic subtypes and novel metabolite biomarkers for CU diagnosis and therapy. METHODS: Plasma samples from 80 patients with CU and 82 healthy controls were collected for metabolomics quantification and bioinformatics analysis. Another independent cohort consisting of 144 patients with CU was studied to validate the findings. Bone marrow-derived mast cells and mice with IgE-induced passive cutaneous anaphylaxis were used for in vitro and in vivo experiments, respectively. RESULTS: We observed clear metabolome differences between CU patients and healthy controls. Meanwhile, differential metabolites N6-acetyl-l-lysine, l-aspartate, maleic acid, and pyruvic acid were used to construct random forest classifiers and achieved area under receiver operating characteristic curve values greater than 0.85, suggesting their potential as diagnostic biomarkers of CU. More importantly, by exploring the underlying metabolic subtypes of CU, we found that the low abundance of pyruvic acid and maleic acid was significantly related to the activity of CU, poor efficacy of second-generation H1 antihistamines, and short relapse-free time. The results were validated in the independent cohort. Moreover, supplementation with pyruvate or maleate could significantly attenuate IgE-mediated mast cell activation in vitro and in vivo. CONCLUSIONS: Plasma pyruvic acid and maleic acid may be effective biomarkers for predicting disease activity, therapeutic efficacy, and prognosis for patients with CU.
Asunto(s)
Biomarcadores , Urticaria Crónica , Mastocitos , Ácido Pirúvico , Humanos , Biomarcadores/sangre , Urticaria Crónica/sangre , Urticaria Crónica/tratamiento farmacológico , Urticaria Crónica/diagnóstico , Masculino , Femenino , Adulto , Animales , Pronóstico , Persona de Mediana Edad , Ácido Pirúvico/sangre , Ratones , Mastocitos/inmunología , Mastocitos/metabolismo , Metabolómica , MetabolomaRESUMEN
The type II autoimmune subtype of Chronic Spontaneous Urticaria (CSU) is characterized by the presence of IgG autoantibodies targeting IgE or the IgE high-affinity receptor (FcεRI) on mast cells and basophils. In evaluation of CSU patients, indirect basophil activation testing (BAT), has been utilized, involving the mixing of patient serum with heterologous peripheral blood donors, followed by flow cytometric assessment of basophil markers. However, the reliability of the indirect BAT results hinges on the quality of the donor basophils utilized. In this study, we introduce an innovative approach where multiple potential basophil donors undergo rigorous BAT characterization alongside control samples. By selecting and pooling donors with optimal performance, we significantly enhance the inter-assay reproducibility of the indirect BAT test.
Asunto(s)
Basófilos , Urticaria Crónica , Citometría de Flujo , Humanos , Basófilos/inmunología , Urticaria Crónica/inmunología , Urticaria Crónica/diagnóstico , Urticaria Crónica/sangre , Citometría de Flujo/métodos , Reproducibilidad de los Resultados , Prueba de Desgranulación de los Basófilos/métodos , Adulto , Femenino , Inmunoglobulina E/sangre , Inmunoglobulina E/inmunología , Masculino , Autoanticuerpos/sangre , Autoanticuerpos/inmunología , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Persona de Mediana Edad , Receptores de IgE/inmunología , Donantes de SangreRESUMEN
Chronic spontaneous urticaria (CSU) is a disturbing skin condition often severely detrimental to quality of life. Haematological markers of inflammation such as neutrophil-to-lymphocyte and platelet-to-lymphocyte may be used in the assessment of inflammatory skin diseases. Their usefulness in urticaria is unknown. Neutrophil- to-lymphocyte, platelet-to-lymphocyte, and total serum IgE were investigated in urticaria patients: acute spontaneous urticaria (ASU) versus CSU, children versus adults with CSU, and patients with mild-to-moderate versus severe CSU. This retrospective cohort study included patients of all ages diagnosed with urticaria between 2005 and 2020 and blood counts within 30 days of diagnosis. Patients with comorbidities influencing blood cells (infection, surgery, malignancy) were excluded. Neutrophil-to-lymphocyte and platelet-to-lymphocyte were evaluated in patients with ASU vs CSU and mild-to-moderate CSU vs severe CSU (defined by the use of systemic medications or hospitalizations). A total of 13,541 urticaria patients were included in the study. CSU patients (n = 5,021) had higher neutrophil-to-lymphocyte and platelet-to-lymphocyte, as well as serum IgE levels compared with ASU patients (n = 8,520). Adults had higher neutrophil-to-lymphocyte and platelet-to-lymphocyte than children. Severely affected patients (n = 53) had higher neutrophil-to-lymphocyte and platelet-to-lymphocyte compared with mild-to-moderately affected patients (n = 4,968). Patients with higher neutrophil-to-lymphocyte and platelet-to-lymphocyte had higher odds of having CSU rather than ASU and severe urticaria rather mild-to-moderate. In conclusion, neutrophil-to-lymphocyte and platelet-to-lymphocyte are simple and available markers that can be used to predict and assess severe and chronic urticaria.
Asunto(s)
Urticaria Crónica , Trastornos Leucocíticos , Urticaria , Adulto , Niño , Humanos , Estudios Retrospectivos , Neutrófilos , Calidad de Vida , Enfermedad Crónica , Urticaria/tratamiento farmacológico , Urticaria Crónica/diagnóstico , Linfocitos , Inmunoglobulina ERESUMEN
BACKGROUND: Chronic spontaneous urticaria (CSU) is an inflammatory skin disease with intricate mechanisms. This study comprehensively assessed markers from diverse metabolic pathways, including novel inflammatory indicators, to evaluate their potential for diagnosing and monitoring CSU. MATERIALS AND METHODS: In the study involving 90 CSU patients and 90 healthy controls, the levels of albumin, high-density lipoprotein (HDL), fibrinogen, uric acid, D-dimer, C-reactive protein (CRP), and white blood cells (WBC) values were analyzed. The D-dimer/albumin ratio (DAR), fibrinogen/albumin ratio (FAR), and uric acid/HDL ratio (UHR), considered novel inflammatory markers, were calculated. The Urticaria Activity Score 7 (UAS7) was also calculated. Pearson chi-squared test, Mann-Whitney U test, Spearman correlation coefficient, and univariate logistic regression analysis were employed for data analysis. RESULTS: In the patient group, significant elevations were observed in DAR, FAR, fibrinogen, CRP, D-dimer, and UHR values. Additionally, albumin, HDL, and uric acid values exhibited significant decreases. HDL and albumin provided the most accurate results in the univariate logistic regression analysis. CRP had less accuracy, FAR exhibited greater accuracy than fibrinogen, and DAR demonstrated higher accuracy than D-dimer. There was no statistically significant correlation between the UAS7 and parameters. The considerable correlation of CRP with other parameters, except D-dimer, was also remarkable. CONCLUSIONS: Indicators from diverse metabolic pathways, including albumin, HDL, uric acid, fibrinogen, D-dimer, and CRP, can be valuable in assessing CSU. In particular, FAR and DAR are emerging as potential markers to consider in the assessment of CSU.