Urticaria

Biomarkers for urticaria

Urticaria (hives) is a skin condition characterized by intensely itchy, raised wheals, sometimes accompanied by angioedema, a deeper swelling of the skin and mucosal tissues.

Chronic spontaneous urticaria (CSU) is a form of urticaria in which wheals, angioedema, or both reoccur for more than six weeks without an identifiable trigger. CSU is driven by activation of mast cells, which release inflammatory mediators such as histamine, causing itching, redness, swelling, and discomfort.

Autoimmune mechanisms can activate mast cells in CSU, leading to increased blood vessel permeability, immune cell recruitment, and persistent inflammation. CSU has also been linked to activation of coagulation and fibrinolytic pathways, with biomarkers such as D-dimer often elevated during disease flare-ups.

Despite advances in understanding CSU, reliable biomarkers are still needed to improve diagnosis, disease classification, and treatment selection. As CSU is a heterogeneous disease with distinct underlying mechanisms, biomarkers may help identify disease endotypes and predict therapeutic response.

Biomarkers associated with endotypes and treatment response in chronic spontaneous urticaria

Current biomarkers linked to coagulation and fibrinolysis have shown promise in CSU, but their clinical utility remains unclear. X-FIB is a novel assay that specifically detects fibrin degradation products generated from FXIII-crosslinked fibrin, providing greater sensitivity than conventional D-dimer assays.

In two real-world CSU cohorts, elevated X-FIB levels were consistently associated with type IIb CSU and poorer treatment outcomes. Patients with type IIb CSU showed markedly higher X-FIB levels than type I patients, both at baseline and during omalizumab treatment (Figure 1A). In a larger cohort of 336 patients, X-FIB levels were more than twofold higher in type IIb disease (Figure 1B) and in patients with poor treatment response (Figure 1C).

These findings support X-FIB as a potential biomarker for identifying severe autoimmune CSU and predicting reduced treatment response.

Figure 1. X-FIB presents higher levels in endotype IIb compared to type I and is elevated in patients responding poorly to omalizumab.

The Nordic ProteinFingerPrint Technology™ in Hidradenitis Suppurativa

Watch this video to learn how our technology can help advance Hidradenitis Suppurativa research. A simple blood sample can be quantified by the Protein Fingerprint Technology and be used as a sophisticated biomarker tool for tailoring treatment solutions, predicting and monitoring disease progression and treatment response.

About urticaria

  • Urticaria (hives) is a skin condition characterized by itchy, raised, red or skin-colored welts that appear suddenly and may disappear within hours.

  • The symptoms of urticaria include:

    – Itchy welts (hives) on the skin

    – Red or skin-colored raised patches

    – Swelling of deeper tissues (angioedema) in some cases

    • Lesions that change shape, size, and location over time

  • Nordic ProteinFingerPrint™ biomarkers can measure specific ECM remodeling fragments in blood samples, helping to characterize disease activity, identify biological pathways involved in urticaria, and potentially support patient stratification and treatment monitoring.

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