Angioedema in patients with chronic spontaneous urticaria: assessment of disease severity and response to treatment.

RATIONALE: Angioedema (AE) and higher levels of d-dimer and C-reactive protein (CRP), in patients with chronic spontaneous urticaria (CSU), may be markers of disease severity. The aim of this study was to assess the course of AE in patients with CSU, and the link with disease severity and response to treatment.

METHODS: Retrospective study of medical records of adult patients with CSU. All patients initially had AE. The levels of D-dimer and CRP were evaluated at the time of AE, as well as the drugs used to control the disease and how long it took to improve.

RESULTS: A total of 163 patients were included, with a mean age of 49 years, most of them was female. The mean time to control urticaria was 10.4 years, and for AE, 5.1 years. One hundred and eleven patients with AE (68.1%) responded to antihistamines alone. When patients were classified according to the time to improve AE, 73 patients (44.8%) presented remission of this symptom within 1 year, 42 (25.7%) between 2 and 4 years, 37 patients (16.6%) between 5 and 9 years. Twenty-one patients (12.9%) maintained or improved AE only after ten years of treatment. High levels of D-dimer and CRP were observed at the time of AE (1032 ng/mL and 7.4 mg/L, respectively).

CONCLUSIONS: AE used to be considered a marker of disease severity in patients with CSU. In this study, d-dimer and CRP levels were elevated during the AE period; although, the majority of patients had controlled AE after antihistamines alone.