{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T16:12:13Z","timestamp":1784045533758,"version":"3.55.0"},"reference-count":28,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"},{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int Arch Allergy Immunol"],"abstract":"<jats:p>Introduction: Second-generation H1-antihistamines are the first-line therapy for chronic spontaneous urticaria (CSU); however, many patients remain symptomatic despite standard treatment. This study aims to identify the clinical and laboratory characteristics associated with high-treatment requirements in patients with CSU. Methods: This retrospective cohort study analyzed 6,033 adults with CSU who visited a tertiary hospital in Korea between 2002 and 2020. High-treatment-requirement CSU (HTR-CSU) was defined as requiring treatment with \u22654 H1-antihistamines simultaneously or at least one use of omalizumab. Results: Of 6,033 patients, 34.5% were classified as HTR-CSU. Compared with non-HTR patients, HTR-CSU patients had a higher rate of long-term follow-up (\u226560 months: 7.9% vs. 3.2%, p &lt; 0.001) and more cholinergic urticaria (2.8% vs. 2.0%, p = 0.045), while angioedema was more common in non-HTR-CSU cases (17.8% vs. 13.0%, p &lt; 0.001). The use of sedative H1-antihistamines, leukotriene receptor antagonists, corticosteroids, H2 blockers, and omalizumab was significantly higher in the HTR-CSU group. Laboratory findings showed elevated white blood cell counts (6.6 vs. 6.4 \u00d7103\/\u03bcL), neutrophil count (3.8 vs. 3.6 \u00d7103\/\u03bcL), total IgE (155.0 vs. 135.0 IU\/mL), C3 (114.3 vs. 111.0 mg\/dL), C4 (29.6 vs. 26.9 mg\/dL), and D-dimer levels (0.40 vs. 0.34 \u03bcg\/mL), along with reduced immunoglobulin G (IgG) levels (all p &lt; 0.05). Conclusion: HTR-CSU is associated with longer disease duration, heavier medication burden, and distinctive laboratory profiles characterized by elevated neutrophil, complement, D-dimer, and IgE levels, as well as decreased IgG levels, suggesting potential differences in immunological mechanisms compared to non-HTR-CSU.<\/jats:p>","DOI":"10.1159\/000552153","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T16:01:02Z","timestamp":1779120062000},"page":"1-10","source":"Crossref","is-referenced-by-count":0,"title":["Distinct Clinical and Laboratory Profiles in Chronic Spontaneous Urticaria Requiring High-Intensity Treatment"],"prefix":"10.1159","author":[{"given":"Ji-Su","family":"Shim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min-Ho","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung-Min","family":"Ahn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min-Hye","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young-Joo","family":"Cho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1111\/all.15090"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.4168\/aair.2020.12.4.563"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.waojou.2021.100533"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2019.02.064"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.15568"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.4168\/aair.2020.12.5.750"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1111\/cea.12900"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1111\/all.13209"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1186\/s13223-020-00496-0"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2019.08.025"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1177\/12034754221128819"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2222.2011.03789.x"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1186\/1476-9255-10-22"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1111\/all.13352"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines11082232"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.4168\/aair.2021.13.2.206"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.2500\/aap.2024.45.230092"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0014794"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.4168\/aair.2024.16.6.626"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacig.2023.100159"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2022.04.010"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.18502\/ijaai.v24i3.18679"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2018.00639"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1067\/mai.2002.120954"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2012-02-412080"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2013.04.037"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2014.11.016"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.23822\/EurAnnACI.1764-1489.272"}],"container-title":["International Archives of Allergy and Immunology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000552153","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T16:01:20Z","timestamp":1784044880000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000552153"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,18]]},"references-count":28,"URL":"https:\/\/doi.org\/10.1159\/000552153","archive":["Portico"],"relation":{},"ISSN":["1018-2438","1423-0097"],"issn-type":[{"value":"1018-2438","type":"print"},{"value":"1423-0097","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,18]]}}}