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Chronic urticaria and coagulation: pathophysiological and clinical aspects.

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Coagulation factors like thrombin may play a role in chronic urticaria (CU) pathophysiology. Elevated D-dimer levels suggest coagulation activation and could indicate disease severity in CU patients.

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Area of Science:

  • Dermatology
  • Hematology
  • Immunology

Background:

  • Chronic urticaria (CU) is a skin condition marked by recurring wheals and itching lasting over six weeks.
  • While autoimmune factors are known, coagulation factors like tissue factor and thrombin may also contribute to CU's development.
  • Experimental models show eosinophil-derived tissue factor can activate coagulation, generating thrombin, which increases vascular permeability and mast cell degranulation.

Purpose of the Study:

  • To review the current understanding of coagulation's role in chronic urticaria pathophysiology.
  • To focus on clinical aspects and potential future therapeutic strategies involving anticoagulation.

Main Methods:

  • Literature review of existing studies on coagulation and chronic urticaria.
  • Analysis of data concerning tissue factor, thrombin, and D-dimer in CU.
  • Examination of evidence from case reports, series, and controlled studies on anticoagulant therapy.

Main Results:

  • D-dimer, a marker of coagulation activation, is elevated during CU flares and may correlate with severity and treatment resistance.
  • Case studies and a small controlled trial suggest potential efficacy of anticoagulant therapy in CU patients.
  • Coagulation activation can lead to increased vascular permeability and histamine release, contributing to urticarial symptoms.

Conclusions:

  • Coagulation activation is a potential contributor to chronic urticaria pathophysiology.
  • D-dimer may serve as a biomarker for disease activity and treatment response in CU.
  • Anticoagulant therapies warrant further investigation for managing chronic urticaria.