Clinical and autoimmune characteristics associated with angioedema in patients with chronic spontaneous urticaria

Vesna, Trajkova and Natasa, Teovska Mitrevska and Emek, Kocatürk and Daria, Fomina and Hristina, Breshkovska and Daniela, Buklioska Ilievska and Irena, Dimitrovska and Ana, Ristovska Dimitrovska and Ivana, Tusheva and Sofija, Peshova and Kristina, Trpcheva Stojkov (2025) Clinical and autoimmune characteristics associated with angioedema in patients with chronic spontaneous urticaria. Exploration of Asthma & Allergy (open-access peer-reviewed journal in allergic diseases), 3. ISSN 2837-5076

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Abstract

Abstract
Aim: Angioedema is a common but often underestimated manifestation of chronic spontaneous urticaria
(CSU). Its presence may indicate higher disease severity, longer duration, and autoimmune involvement.
This study aims to assess the clinical relevance and associations of angioedema in CSU patients with disease
severity and duration, treatment response to H1-antihistamines, correlation with autoimmune status, and
autologous serum skin test (ASST) positivity.
Methods: A prospective study was conducted at the Dermatology Department, General Hospital 8th
September, Skopje, North Macedonia, from December 2021 to November 2022, including 230 CSU patients.
Disease activity was assessed using the Urticaria Activity Score over 7 days (UAS7), and severity was
categorized accordingly. Response to H1-antihistamines was defined as achieving UAS7 < 7 for several
months. Angioedema was recorded as a symptom regardless of localization. Autoimmune status was based
on autoimmune disease history and/or autoantibody (AAb) detection. The ASST was performed, classifying
patients as ASST-positive (ASST⁺) or ASST-negative (ASST⁻).Results: Angioedema was observed in 70% of CSU patients, all with accompanying wheals. It was
significantly more common in severe CSU than in moderate (82.02% vs. 65.38%, p = 0.026), mild (82.02%
vs. 65.96%, p = 0.036), and well-controlled disease (82.02% vs. 45.45%, p = 0.0004). Patients with a
positive autoimmune status more often had angioedema than those with a negative status (75.17% vs.
61.18%, p = 0.025). CSU showed longer duration in patients with angioedema (p = 0.000012), with no
association to good antihistamine response (p = 0.55).
Conclusions: Angioedema in CSU is associated with higher disease activity, autoimmune status, and
prolonged disease duration but not with differences in antihistamine response. Its presence marks a more
severe phenotype, emphasizing the need for careful monitoring and individualized management.
Keywords
chronic spontaneous urticaria, angioedema, autoimmunity, ASST

Item Type:	Article
Subjects:	Scientific Fields (Frascati) > Medical and Health Sciences > Clinical medicine
Divisions:	Higher Medical School
Depositing User:	MSc Daniela Petkovska
Date Deposited:	16 Dec 2025 10:48
Last Modified:	16 Dec 2025 10:48
URI:	https://eprints.uklo.edu.mk/id/eprint/11278

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