Effective therapy for chronic spontaneous urticaria may lower mortality: Study

A new study published in the Journal of Allergy and Clinical Immunology showed that effective therapy for chronic spontaneous urticaria (CSU) may lower mortality. Between 0.5% and 1% of people have chronic spontaneous urticaria which is a prevalent immunologic condition. It is linked to several negative patient outcomes, both direct and indirect that ranged from a decline in quality of life (QoL) to a rise in allergy misdiagnosis and mislabeling.

Complete disease control is the aim of treatment for CSU, and stepwise pharmacologic therapy is advised by recommendations. Omalizumab (licensed dose 300 mg monthly) is recommended for patients with uncontrolled symptoms even after receiving maximal doses of antihistamines (approximately 20% to 50% of all patients with CSU).

This is despite the fact that the first step is the regular use of second-generation H1-antihistamines, followed by doses increasing up to 4-fold. Therefore, this study was conducted to evaluate the influence of treatment recommendations for urticaria on mortality rates, risk for comorbidities that are major causes of death, and all-cause mortality in CSU patients.

The electronic medical data of 1,27,28,913 non-urticaria controls and 2,72,190 adult CSU patients from the US Collaborative TriNetx Analytics Network are the subjects of this retrospective population-based cohort research. A total of 2,64,680 propensity score-matched people suffering from CSU and an equal number of non-urticaria controls were included in the research.

The patients with CSU had greater 3-month, 1-year, and 5-year all-cause mortality. CSU patients had greater risk and incidence of the top causes of mortality in the US, such as malignant neoplasms and suicidal thoughts and attempts, than non-CSU controls.

White and younger patients seemed to be at a higher risk of death at CSU. When compared to patients who were not treated, CSU patients treated with second-generation H1-antihistamines had significantly reduced all-cause death rates at 5 years, as were patients treated with omalizumab as opposed to those treated with antihistamines.

Overall, chronic spontaneous urticaria patients had a 1.7-fold higher risk of all-cause death than the individuals without CSU. Mortality rates were reduced by CSU therapy with omalizumab and second-generation antihistamines by indicating that these risks might be reduced with appropriate care.

Source:

Kolkhir, P., Bieber, K., Hawro, T., Kridin, K., Ludwig, M. A., Olbrich, H., Metz, M., Vorobyev, A., Ludwig, R. J., & Maurer, M. (2024). Mortality in adult patients with chronic spontaneous urticaria: A real world cohort study. In Journal of Allergy and Clinical Immunology. Elsevier BV. https://doi.org/10.1016/j.jaci.2024.11.036