Etiopatogeneza i liječenje kronične spontane urtikarije

master's thesis

• Title (english): Etiopathogenesis and treatment of chronic spontaneous urticaria
• Author: Ana Barišić
• Mentor: Suzana Ljubojević Hadžavdić (mentor)
• Committee member: Zrinka Bukvić Mokos (predsjednik povjerenstva)
• Committee member: Romana Čeović (član povjerenstva)
• Committee member: Suzana Ljubojević Hadžavdić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Dermatology); Zagreb
• Defense date and country: 2022-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Dermatovenerology

Abstract

Kronična urtikarija je bolest karakterizirana pojavom urtika i angioedema u razdoblju duljem od 6 tjedana. Prevalencija kronične spontane urtikarije kreće se između 1% i 2%, s prevalencijom od oko 1,3% kod žena i oko 0,8% kod muškaraca. Kod djece je prevalencija ispod 1% i ne postoji značajna razlika u spolu.
Etiologija bolesti je nepoznata, a patogenetski mehanizam nastanka urtika i angioedema je degranulacija mastocita s otpuštanjem vazoaktivnih medijatora koji djeluju na krvne žile izazivajući vazodilataciju, kemotaksijom potiču migraciju upalnih stanica i djeluju na aferentna živčana vlakna izazivajući svrbež. U oko 50% slučajeva identificiran je i podležeći autoimunosni mehanizam aktivacije mastocita. Dva su tipa reakcija preosjetljivosti identificirana u kroničnoj autoimunoj urtikariji: u tipu I prisutna su autoantitijela IgE tipa, a u tipu II IgG-anti-IgE i IgG-anti-FcεRI protutijela.
Klinička slika urtika i angioedema često je popraćena svrbežom i boli, ali mogu biti prisutni i opći simptomi. Bolest je prosječnog trajanja od 2 do 6 godina.
U dijagnostici je prvi korak potvrda dijagnoze kroz uzimanje anamneze, fizikalni pregled i osnovne laboratorijske pretrage. Laboratorijske pretrage indicirane u dijagnostici su kompletna krvna slika, CRP, i ukupni IgE. Daljnji postupci su identifikacija komorbiditeta i faktora koji modificiraju aktivnost bolesti, te provođenje upitnika koji boduju aktivnost bolesti i utjecaj bolesti na kvalitetu života.
Terapija prvog izbora za liječenje su antagonisti H1 receptora u standardnoj dozi, te povećanje doze do 4 puta u slučaju neodgovarajućeg odgovora na jednostruke doze. Treći korak je dodavanje monoklonalnog anti-IgE protutijela omalizumaba, a četvrti korak uključivanje imunomodulatornog lijeka ciklosporina u terapiju.

Abstract (english)

Chronic urticaria is a disease that manifests with wheals and angioedema that last longer than 6 weeks. Prevalence of CSU is between 1% and 2 %, with differences between genders: it is more prevalent in females, at around 1,3%, and in males the prevalence is about 0,8%. In pediatric population the prevalence is at around 1% without differences between sexes.
Although the etiology of the disease is unknown, the main pathophysiological mechanism is degranulation of the mast cells, which release histamine and other mediators. Vasoactive mediators consequently dilate surrounding blood vessels, attract other immune cells through chemotaxis and stimulate afferent nerve fibers. In approximately 50% of cases there is an underlying autoimmune mechanism of mast cell activation. Two types of hypersensitivity reactions have been identified: type I with IgE autoantibodies and type II with IgG-anti-IgE i IgG-anti-FcεRI antibodies.
Apart from wheals and angioedema, CSU may present with itching, burning and pain, or even general symptoms. Regression of urticaria usually occurs after 2 to 6 years.
Regarding diagnostic procedures, the diagnosis is confirmed through patient's history, physical examination and the results of laboratory tests (complete blood count, serum IgE, CRP). Secondly, patient's comorbidities and disease modifying factors should be identified, as well as the disease activity and its impact on quality of life.
First-line therapy for CSU are H1-receptor antagonists. The dose of the drug can be raised up to four times if single dose is not effective. In case of an inadequate response, omalizumab should be added on to the preexisting therapeutic regimen. Ciclosporin A should be considered if the disease is resistant to omalizumab.

• Keywords: kronična spontana urtikarija; mastociti; antagonisti H1 receptora
• Keywords (english): chronic spontaneous urticaria; mast cells; H1-receptor antagonists
• Language: croatian
• URN:NBN: urn:nbn:hr:105:364232
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-01-02 11:00:03