Predictors of Response to Oral Medications and Low-Histamine Diet in Patients with Chronic Urticaria
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Updated: Oct 1, 2025
Basophil Activation Test for Allergy Diagnosis
Published on: May 31, 2021
Hui-Ling Chiang1, Chen-Hung Chen2, Malcolm Koo3
1Division of Immunology, Allergy and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan.
Insights
This study identified biomarkers to predict chronic urticaria treatment response. Diamine oxidase (DAO) levels show promise for predicting efficacy of antihistamines and dietary interventions.
Area of Science:
- Immunology
- Dermatology
- Precision Medicine
Background:
- Chronic urticaria (CU) presents diverse phenotypes, necessitating personalized management strategies.
- Current treatment approaches for CU require optimization through precision medicine.
Purpose of the Study:
- To identify predictive biomarkers for various chronic urticaria treatment responses.
- To investigate the association between patient characteristics and treatment efficacy.
Main Methods:
- 78 patients with CU were analyzed.
- Serum levels of various biomarkers including diamine oxidase (DAO) were measured.
- Treatment responses to second-generation antihistamines (sgAH), corticosteroids, leukotriene receptor antagonist (LTRA), H2 blockers, and low-histamine diet were assessed.
Main Results:
- DAO levels < 10 U/mL and CU duration > 3 years predicted good sgAH response.
- Age > 50, CU duration > 3 years, and ANA titer ≥ 1:80 were inversely associated with corticosteroid response.
- DAO levels < 5.4 U/mL predicted H2 blocker response and low-histamine diet response; concomitant angioedema and multiple food triggers also predicted low-histamine diet response.
Conclusions:
- Biomarkers like DAO can predict the effectiveness of CU treatments.
- DAO may serve as a novel biomarker for dietary interventions and H1/H2 receptor antagonists in CU management.
Background:
Chronic urticaria (CU) is comprised of diverse phenotypes, and thus, a shift towards a precision medical approach is warranted in its management.
Methods:
This study enrolled 78 patients with CU. Serum erythrocyte sedimentation rate, hemoglobin, hematocrit, eosinophil count, IgE, antinuclear antibody (ANA), and serum diamine oxidase (DAO) levels of the patients were measured and were compared according to the patient's response to second-generation antihistamines (sgAH), corticosteroids, leukotriene receptor antagonist (LTRA), H2 blockers, and low-histamine diet.
Results:
Age- and sex-adjusted logistic regression analysis showed that patients with duration of CU > 3 years (adjusted odd ratio [aOR] = 4.39) and a DAO level < 10 U/mL (aOR = 3.90) were significantly associated with a good sgAH response. Age > 50 years (aOR = 0.02), duration of chronic urticaria > 3 years (aOR =0.06), and an ANA titer ≥ 1 : 80 (aOR = 0.03) were significantly and inversely associated with corticosteroid response. A low-histamine diet response was significantly associated with LTRA response (aOR = 67.29). In addition, a DAO level < 5.4 U/mL (aOR = 71.95) was significantly associated with H2 blocker response. Furthermore, concomitant angioedema (aOR = 10.56), multiple food triggers (aOR = 11.69), and a DAO level < 5.4 U/mL (aOR = 3.78) were significantly associated with a low-histamine diet response. Conversely, dermatographic urticaria and a hematocrit level < 36% were significantly and inversely associated with low-histamine diet response.
Conclusions:
Several promising biomarkers were identified in this study to predict the efficacy of chronic urticaria treatment. DAO could be a novel biomarker for predicting the efficacy not only of dietary intervention but also for antagonists of H1 and H2 receptors.
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