The effect of omalizumab treatment on hematologic and inflammatory parameters and urticaria activity score in patients with chronic spontaneous urticaria

Purpose: CSU is a common skin disease lasting 6 weeks or longer with no specific cause or trigger. Omalizumab is a monoclonal anti-IgE antibody approved for patients over 12 years of age with CSU resistant to antihistamines. There are studies suggesting that some blood parameters can be used as an indicator of CSU disease activation and in monitoring response to treatment. The aim of this study is to evaluate the relationship between disease severity (calculated by urticaria activity score) and blood cell counts, NLR, PLR, LMR, NMR, MPV, RDW, CRP, total IgE values, to investigate the change of these laboratory values with omalizumab treatment, the correlation of these laboratory values with each other, and the relationship of total IgE value with omalizumab response in patients who started omalizumab treatment with the diagnosis of CSU. Material and methods: 101 patients who were followed up in the Ankara City Hospital Dermatology outpatient clinic between February 2019 and September 2021, who did not have any dermatological comorbidity except for the diagnosis of CSU, and who received omalizumab for the first time in our clinic were included in the study. Hemogram, CRP, total IgE and UAS7 values before treatment and at the 3rd month of treatment were analyzed retrospectively. Total IgE values of 26 patients were not available in the records. Analyzes of total IgE values were performed on 75 patients. Results: 73.3% of the patients were female and 26.7% were male. The mean age was 41.6 years. The mean duration of illness was 35.5 months. 52.5% of the patients had angioedema. A significant difference was found between the mild+moderate and severe urticaria groups for the NLR and NMO variables (p:0.023, 0.019, respectively). For other variables, no significant difference was found between the mild+moderate and severe urticaria group. While a significant increase was observed in MPV (p=0.010), LMO (p=0.031) and total IgE (p<0.001) values with 3 months of omalizumab treatment; leukocyte count (p<0.001), neutrophil count (p<0.001), platelet count (p=0.018), NLR (p<0.001), TLR (p=0.013), NMO (p<0.001), CRP (p<0.001) ) ) and UAS7 (p<0.001) values significantly decreased with treatment. There was no significant difference between pre- and post-treatment values of lymphocyte, monocyte count and RDW variables. A statistically significant vi difference was found between the moderate and severe urticaria groups in the percentage of change in NLR with treatment (p=0.034). There was no statistically significant difference between the groups in the percentages of change in other laboratory values with treatment. There was no significant correlation between the laboratory values of the patients and UAS7 both before and after the treatment. According to UAS7, in the 3rd month of omalizumab treatment, 18.8% (n=19) of the patients achieved complete response (UAS7=0). Partial response was observed in 80.2% (n=81) of the patients, and non-response was observed in 0.99% (n=1). There was no statistically significant difference between patients with complete response and partial response in terms of disease duration, initial UAS7, initial total IgE value, 3rd month total IgE value, total IgE value rates, and presence of angioedema. Conclusion: This study showed that omalizumab can be an effective and rapid treatment option in patients with CSU who are resistant to high-dose antihistamine therapy, and it also inhibits inflammation and coagulation in addition to its anti-IgE effect Keywords: chronic spontaneous urticaria, C-reactive protein, lymphocyte-monocyte ratio, neutrophil-lymphocyte ratio, neutrophil-monocyte ratio, omalizumab, platelet-lymphocyte ratio, total IgE