Do Antinuclear Antibodies Influence the Clinical Features of Chronic Spontaneous Urticaria?: A Retrospective Cohort Study

Table 3

Previous studies of chronic spontaneous urticaria with antinuclear antibodies positive results compared to our study.

Authors, year study design	Study population			ANA method	Prevalence of positive ANA	Comparing between ANA-positive CSU patients and ANA-negative CSU patients				Others
		F : M ratio	Country			Disease severity	Associated disease	Laboratory characteristics	Treatment outcome
Viswanathan et al., [22]; Retrospective study	195 CSU patients	2.8 : 1	USA	N/A	29%	N/A	N/A	N/A	Significant higher prevalence of patients refractory to antihistamines with or without the use of a LTRA; (50% vs. 30%),	Positive ANA has a significant odds ratio for identifying patients refractory to antihistamines with or without the use of a LTRA; (OR 2.3),
Calamita et al., [23]; Cross-sectional study	67 CSU patients	2.2 : 1	Brazil	IIF using HEp-2 cells	10.5%	N/A	N/A	N/A	N/A	Significant association between positive ANA and presence of anti-TPO (OR 5.94)
Magen et al., [24]; Retrospective study	-91 ANA-positive CSU patients; -478 ANA-negative CSU patients; -3131 ANA positive non-CSU patients	3.6 : 1	Israel	Fully automated Luminex-based system (BioPlex 2200 ANA screen, by Bio-Rad; Bio-Rad Laboratories, Hercules, CA)	16%	No significant difference; - initial UAS; (3.8 ), p =0.235; - prevalence of angioedema; (29.7% VS 23.8%),	Significant difference; - Sjögren’s syndrome; (3.3% vs. 0%),; - graves’ disease; (5.5% vs. 1.7%),; - Hashimoto’s thyroiditis; (23.1% vs. 14.2%),; - SLE; (4.4% vs. 0%),; - systemic sclerosis; (2.2% VS 0%), p =0.025; - overlap syndrome; (3.3% VS 0%), p =0.004; No significant difference; - rheumatoid arthritis; (2.2% VS 0.6%), p =0.182; - mixed connective tissue disease; (0% VS 0%), p = 1	Significant difference; - anti-TPO; (27.5% vs. 12.2%),; - Antithyroglobulin antibody; (20.9% vs. 10.4%),; - Basopenia; ( VS 0.15 0.11), p = <0.001; - C-reactive protein; (6.4 10.3 VS 4.1 8.8), p = 0.027; No significant difference; - IgE (U/mL); (185.5 346.6 VS 126.4 309.8), p = 0.102	Significant higher prevalence of patients resistant to four-fold standard licensed doses of antihistamines; (12.1% VS 6.1%), p =0.046
Ye et al., [25]; Prospective observational study	75 CSU patients	2.1 : 1	South Korea	IIF using HEp-2 cells	10.7%	N/A	N/A	N/A	N/A
Campos et al., [26]; Cross-sectional case-control	- 27 CSU patient; - 22 controls (other hypersensitivities without urticaria)	2.4 : 1	Brazil	Immunoassay	14.8%	N/A	N/A	N/A	N/A
Ertaş et al., 2020 [21]; Retrospective study	447 CSU patients	2.4 : 1	Turkey	IIF using HEp-2 cells	23.9%	Significant higher prevalence of angioedema; (70% vs. 53%),	Significant difference; - Sjögren’s syndrome; (4.7% vs. 0.6%),; - rheumatoid arthritis; (10.3% vs. 4.4%),; No significant difference; - thyroid disease; (24% vs. 18%),; - diabetes mellitus; (24% VS 18%), p = 0.128; - hypertension; (9% VS 11%), p = 0.651; - asthma; (20% VS 17%), p = 0.552	Significant difference; - anti-TPO; (27% VS 18%),; - Total IgE; (64 (21-160) vs. 110 (44-236)),; No significant difference; - ESR; (11 (5-18) Basopenia 8 (4-16)),; - CRP; (3.3 (3.0-7.5) vs. 3.3 (3.0-6.8)), p = 0.765	Significant higher prevalence of nonresponders (VAS improvement< 20% at week 12 of 300 mg/4weeks omalizumab treatment; (45% vs. 9%), p < 0.001
Our study; Prospective study	323 CSU patients	5.1 : 1	Thailand	IIF using HEp-20-10 cells	31%	No significant difference; - maximal UAS7; (17 (0-42) vs. 15 (0-42)),; - prevalence of angioedema groups; (21.0% vs. 18.8%),	No significant difference; - thyroid disease; (8.0% vs. 5.4%),; - diabetes mellitus; (4.0% vs. 4.0%),; - hyperlipidemia; (2.0% vs. 4.5%),; - hypertension; (7.0% vs. 5.4%), p = 0.568	Significant difference; - ESR; (18.00 (4-84) vs. 14.00 (1-60)),; No significant difference; - anti-TPO; (20.0% vs. 14.7%),	No significant difference; - cumulative medication score; (8 (2-34) vs. 8 (2-29)),; - immunosuppressive drug/omalizumab use; (32.7% vs. 24.4%),; - time to remission; (9.6 years vs. 10.3 years)

Abbreviations: ANA: antinuclear antibodies; anti-TPO, and anti-thyroid peroxidase; CSU: chronic spontaneous urticaria; F: female; LTRA: leukotriene receptor antagonist; M: male; MCTD: mixed connective tissue disease; N/A: not available; SLE: systemic lupus erythematosus.