D-dimer levels decreased in severe allergic asthma and chronic urticaria patients with the omalizumab treatment

Abstract

Background: D-dimer (DD), a fibrin degradation product formed during the lysis of a thrombus, is also detected in high levels in patients with active chronic urticaria (CU). Severe persistent allergic asthma (SPA) is associated with a procoagulant state in the bronchoalveolar space, further aggravated by impaired local activities of the anticoagulant protein C/protein S, antithrombin III system and fibrinolysis. This was demonstrated as massive fibrin depositions found in the alveoli of a SPA patient who died from a SPA attack and who did not respond to treatment.

Objectives: For this reason, we investigated the effect of omalizumab both in bronchial and systemic vascular areas and evaluated SPA (group I) and CU (group II) patients before and after therapy period.

Methods: Blood samples were taken before treatment (A), on 4th month (B), on 8th month (C) and on 12th month (D) post treatment in both groups.

Results: We compared DD levels between groups: the significant DD difference was observed between group-IA and group-IC (p = 0.031); between group-IA and group-ID (p = 0.003); between group-IB and group-ID (p = 0.049) and between group IIA-1 and group-IID (p = 0.015). In the IIA-1 group, there was a significant positive correlation between DD and age (p = 0.008, r = 0.848).

Conclusion: In conclusion, mediators and cells classically involved in procoagulant and anticoagulant pathways together play a role in SPA and CU pathophysiology, where omalizumab has its effect.

Keywords::

• anti-immunoglobulin E
• antithrombin III
• chronic urticaria
• d-dimer
• factor V Leiden and prothrombin G20210A mutation
• omalizumab
• protein C
• severe persistent allergic asthma

Acknowledgments

HC Kirmizi and A Cilli would like to thank Gizem Esra Genç for providing laboratory assistance. Authors' contributions: conceived and designed the study: AD Yalcin. Clinical follow up: AD Yalcin. Analyzed the data: S Gumuslu. Contribution of reagents/materials: AD Yalcin. Writing of the paper: AD Yalcin, B Celik.