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 simul-taneously. 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 anti-histaminic 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 32 | PDF Downloads 17 XML Downloads 0 HTML Downloads 0

References

1. Nowicki RJ, Śpiewak R. Diagnostyka pokrzywek. In: Kruszewski J, Nowicki RJ, Śpiewak R, editors. Pokrzywki. Rozpoznawanie i lec-zenie. 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. https://doi. org/10.1111/all.13397

3. Tsakok T, Du Toit G, Flohr C. Pediatric urticaria. Immunol Allergy Clin North Am. 2014;34:117–39. https://doi. org/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. https://doi.org/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. https://doi. org/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. https://doi. org/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. https://doi.org/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, anticoagulation, 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. https://doi.org/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. https://doi.org/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. https://doi.org/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. https://doi. org/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. https://doi.org/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. https://doi.org/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. https://doi.org/ 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. https://doi.org/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. https://doi.org/10.1111/ced.12413

25. Zaryczański J. D–dimery w plamicy Schőnleina–Henocha u 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.