D-dimer concentrations in acute urticaria in children

Main Article Content

Janusz Zaryczański
Agnieszka Ochab
Magdalena Ochab
Anna Zaryczańska
Zenon Brzoza
Agata Chobot

Keywords

acute urticaria, children, pediatrics, D-dimers, glucocorticosteroids

Abstract

Introduction: Urticaria is a clinical entity presenting as wheals, angioedema, or both simultaneously. Elevated D-dimer levels were reported in the course of chronic spontaneous urticaria. Data regarding D-dimer levels in acute urticaria in children are limited.


Objectives: To assess potential associations between duration of glucocorticosteroid (GCS) therapy and D-dimer concentrations in children with acute urticaria.


Patients, materials, and methods: Hospital records of 106 children (59 females), aged 5.57 ± 4.91 years, hospitalized in 2014–2018 were analyzed retrospectively. The study group consisted of pediatric patients admitted to the hospital due to severe acute urticaria resistant to antihistaminic treatment that was ordered in the ambulatory care (out-patient clinic). Patients were divided into subgroups: no GCS treatment, short-duration treatment (up to 5 days) and long-duration treatment (6 and more days) GCS treatment. Simultaneously, patients received antihistaminic drugs. D-dimer level and other inflammatory factors such as white blood cell (WBC) count, platelet (PLT) count, and C-reactive protein (CRP) in each group were analyzed.


Results: The D-dimer level was elevated in 51% of cases. In the subgroup with longer GCS treatment, D-dimer concentration was significantly higher in comparison to patients with a shorter GCS course. There were no differences in the distribution of CRP, PLT, and WBC concentrations between these subgroups.


Conclusions: In the studied group of children, there was a tendency for higher D-dimer levels in patients, who required a longer GCS treatment. This finding is hypothesis-generating and requires further investigation to confirm if D-dimers can be used as a prognostic factor in acute urticaria in children.

Abstract 1004 | PDF Downloads 846 HTML Downloads 190 XML Downloads 838

References

1. Nowicki RJ, Śpiewak R. Diagnostyka pokrzywek. In: Kruszewski J, Nowicki RJ, Śpiewak R, editors. Pokrzywki. Rozpoznawanie i leczenie. Warsaw: Medycyna Praktyczna; 2011, p. 45–56.

2. Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer-Weber B, et al. The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018;73(7):1393–414. 10.1111/all.13397

3. Tsakok T, Du Toit G, Flohr C. Pediatric urticaria. Immunol Allergy Clin North Am. 2014;34:117–39. 10.1016/j.iac.2013.09.008

4. Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, et al. The EAACI/GA 2 LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014;69:868–87. 10.1111/all.12313

5. Walczak B, Demkow U, Fijałkowska A. Metody oznaczania ste¸żenia D-dimerów przydatne w diagnostyce żylnej choroby zakrzepowo-zatorowej. Pneumonol Alergol Pol. 2009;77(3):264–70.

6. Rośniak–Bąk K, Łobos M. Przydatność kliniczna i diagnostyczna oznaczeń D–dimeru w różnych stanach chorobowych. Folia Medica Lodz. 2016;43:69–91.

7. Cugno M, Borghi A, Garcovich S, Marzano AV. Coagulation and skin autoimmunity. Front Immunol. 2019;10:1407. 10.3389/fimmu.2019.01407

8. Yilmaz D, Kavakli K, Ozkayin N. The elevated markers of hypercoagulability in children with Henoch–Schönlein purpura. Pediatr Hematol Oncol. 2005;22:41–8. 10.1080/08880010590896251

9. Criado PR, Antinori LCL, Maruta CW, Reis VMS. Evaluation of D-dimer serum levels among patients with chronic urticaria, psoriasis and urticarial vasculitis. An Bras Dermatol. 2013;88(3):355–60. 10.1590/abd1806-4841.20131532

10. Hansen C. Leukocytoclastic vasculitis mistaken for chronic idiopathic urticaria. J Case Rep. 2018;6:32–5.

11. Borzova E, Grattan CEH. Urticarial vasculitis. In: Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D, editors. Rook’s textbook of dermatology. 9th ed., Jon Wiley & Sons, Ltd, Chichester 2016, p. 1–6.

12. Kasperska-Zajac A, Brzoza Z, Rogala B. D-dimer plasma concentration in chronic urticaria patients with positive autologous serum intradermal test. Adv Clin Exp Med. 2007;16(1):65–8.

13. Zhu H, Liang B, Li R, Li J, Lin L, Ma S, et al. Activation of coagulation, anti-coagulation, fibrinolysis and the complement system in patients with urticaria. Asian Pacific J Allergy Immunol. 2013;31(1):43.

14. Esmon CT. Crosstalk between inflammation and thrombosis. Maturitas. 2004;61(1–2):122–31. 10.1016/j.maturitas.2008.11.008

15. Levi M, Van Der Poll T. Two-way interactions between inflammation and coagulation. Trends Cardiovas Med. 2005;15(7):254–9. 10.1016/j.tcm.2005.07.004

16. Grzanka R, Damasiewicz-Bodzek A, Kasperska-Zajac A. Interplay between acute phase response and coagulation/fibrinolysis in chronic spontaneous urticaria. Allergy Asthma Clin Immunol. 2018;14(1):27. 10.1186/s13223-018-0255-8

17. Kasperska-Zajac A, Sztylc J, Machura E, Jop G. Plasma IL-6 concentration correlates with clinical disease activity and serum C-reactive protein concentration in chronic urticaria patients. Clin Exp Allergy. 2011;41(10):1386–91. 10.1111/j.1365-2222.2011.03789.x

18. Ghazanfar MN, Thomsen SF. D-dimer as a potential blood biomarker for disease activity and treatment response in chronic urticaria: a focused review. Eur J Dermatol. 2018;28(6):731–5.

19. Farres MN, Refaat M, Melek NA, Ahmed EE, Shamseldine MG, Arafa NA. Activation of coagulation in chronic urticaria in relation to disease severity and activity. Allergol Immunopathol (Madr). 2015;43(2):162–7. 10.1016/j.aller.2014.04.002

20. Asero R, Marzano AV, Ferrucci S, Cugno M. D-dimer plasma levels parallel the clinical response to omalizumab in patients with severe chronic spontaneous urticaria. Int Arch Allergy Immunol. 2017;172(1):40–4. 10.1159/000453453

21. Akazawa H, Ikeda U, Yamamoto K, Kuroda T, Shimada K. Hypercoagulable state in patients with Takayasu’s arteritis. Thromb Haemost. 1996;76(5):712–16. 10.1055/s-0038-1650353

22. Marzano A, Tedeschi A, Rossio R, Fanoni D, Cugno M. Prothrombotic state in churg-strauss syndrome: a case report. J Investig Allergol Clin Immunol 2010;20(7):616–19.

23. Takahashi T, Minami S, Teramura K, Tanaka T, Fujimoto N. Four cases of acute infectious urticaria showing significant elevation of plasma D-dimer level. J Dermatol. 2018;45(8):1013–16. 10.1111/1346-8138.14481

24. Baek YS, Jeon J, Kim JH, Oh CH. Severity of acute and chronic urticaria correlates with D-dimer level, but not C-reactive protein or total IgE. Clin Exp Dermatol. 2014;39(7):795–800. 10.1111/ced.12413

25. Zaryczański J. D–dimery w plamicy Schőnleina–Henocha dzieci. Pediatr Pol. 2002;9:761.

26. Zaryczański J. D-dimery u dzieci chorych na młodzieńcze przewlekłe zapalenie stawów. Reumatologia. 1999;37:376–82.

27. Zaryczański J. D–dimery w chorobach tkanki łącznej u dzieci. Pediatr Prakt. 2002;10(1):65.