Chronic spontaneous urticaria: a low-grade disseminated intravascular coagulation only partially reversed by Omalizumab

Chronic spontaneous urticaria (CSU) is a disorder characterized by wheals and/or angioedema. The coagulation cascade and inflammation pathways are closely linked together. The aim of our study was first to investigate the dynamics of clot formation in plasma (Clot Waveform Analysis, CWA) in a group...

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Published in:Clinical and experimental medicine 2023-06, Vol.23 (2), p.495-502
Main Authors: Di Pino, Marina, Ruberto, Maria Filomena, Costanzo, Giulia, Firinu, Davide, Piras, Maria Sebastiana, Mura, Mario Nicola, Del Giacco, Stefano, Coghe, Ferdinando, Marongiu, Francesco, Barcellona, Doris
Format: Article
Language:English
Subjects:
Angioedema
Chronic Urticaria
Disseminated Intravascular Coagulation
Fibrinogen
Fibrinolysis
Hematology
Humans
Immunoglobulin E
Internal Medicine
Medicine
Medicine & Public Health
Monoclonal antibodies
Omalizumab - therapeutic use
Oncology
Original
Original Article
Platelets
Statistical analysis
Thromboplastin
Urticaria
Urticaria - drug therapy
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Summary:Chronic spontaneous urticaria (CSU) is a disorder characterized by wheals and/or angioedema. The coagulation cascade and inflammation pathways are closely linked together. The aim of our study was first to investigate the dynamics of clot formation in plasma (Clot Waveform Analysis, CWA) in a group of 47 patients with CSU along with other coagulative parameters dedicated to the study of hypercoagulability, such as D-Dimer, F 1 + 2 peptide, Fibrinogen, Platelet count and Mean Platelet Volume (MPV). Secondly, 23 out of 47 patients were treated with Omalizumab at four administration intervals from T0 to T4. A statistically significant increase in Activated Partial Thromboplastin (aPTT) ratio, D-Dimer, F1 + 2, Platelet count and MPV was found when compared with 53 healthy controls (HC). In contrast, the 2nd Derivative of aPTT showed lower values than those of the HC. No differences were found between 1st derivative of aPTT and Fibrinogen. D-Dimer only showed a significant difference between T0 and T3. An activation of both coagulation and fibrinolysis along with a weaker clot acceleration may be in agreement with a low-grade DIC. The accelerated turnover of platelets expressed by both an increase in platelet count and MPV further supports this pathway in CSU. Omalizumab does not affect the relationship between the immune and the hemostatic systems.
ISSN:1591-9528
1591-8890
1591-9528
DOI:10.1007/s10238-022-00838-9