title: Investigation of patient-specific characteristics associated with treatment outcomes for chronic urticaria.
abstract: BACKGROUND
  Identifying clinical characteristics of patients with chronic urticaria (CU) responsive to medication may help guide clinicians select treatment.
  
  
  OBJECTIVE
  The objective of this study was to investigate patient characteristics and medication use associated with urticaria control.
  
  
  METHODS
  A retrospective longitudinal chart review of adult patients with CU was conducted at a multisite allergy practice. Inclusion criteria required at least 4 CU office visits to allow for pre- and posttreatment assessment. Control corresponding to medication(s) used was assessed each visit. Univariate analysis followed by multiple logistic regression was performed.
  
  
  RESULTS
  A total of 221 patients with CU were included; 140 (63%) achieved complete control. The average time to control was 1.4 ± 2.7 years, which required 1-3 classes of medications. Dermatographia odds ratio (OR) = 1.85 (95% CI 1.3-2.7) or other physical urticarias, OR = 1.51 (1-2.4) and neutrophilic infiltrates on skin biopsy were markers of poor control. Thyroid autoantibodies were associated with better control using an H1-antihistamine. Whereas 22% were controlled on a second-generation H1-receptor antagonist plus a leukotriene receptor antagonist (LTRA), an additional 33% were controlled when cyclosporine was added. Use of a first or second H1-antagonist or LTRA was associated with a 3.5-16.9 times higher odds of complete CU control in those with dermatographia. The odds of achieving control for other forms of physical urticaria was greatest when colchicine was added (aOR = 32.6 [12.7-83.2]).
  
  
  CONCLUSIONS
  Patient-specific CU characteristics associated with medication-disease control may be useful for selecting treatment regimens. A subset of CU patients remains poorly controlled that indicates an unmet need for novel therapeutic agents.
authors: Division of Immunology, Allergy & Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors: Priyal
authors: P
authors: Amin
authors: Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio.
authors: Linda
authors: L
authors: Levin
authors: Division of Immunology, Allergy & Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors: Sarah J
authors: SJ
authors: Holmes
authors: Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors: Jillian
authors: J
authors: Picard
authors: Division of Immunology, Allergy & Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio. Electronic address: BERNSTJA@ucmail.uc.edu.
authors: Jonathan A
authors: JA
authors: Bernstein
mesh_terms: D000328:Adult; D018926:Anti-Allergic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001706:Biopsy; D016009:Chi-Square Distribution; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D005260:Female; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D007159:Immunologic Tests; D020024:Leukotriene Antagonists / Q000627:therapeutic use; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009820:Ohio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014581:Urticaria / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology
chemical_list: D018926:Anti-Allergic Agents; D006634:Histamine H1 Antagonists; D006635:Histamine H2 Antagonists; D020024:Leukotriene Antagonists
keywords: Chronic urticaria; Control; Dermatographism; Hives; Medications; Patient-specific clinical characteristics; Physical urticaria; Treatment selection