Abstract
Chronic spontaneous urticaria (CSU) is a mast cell-driven skin disease often associated with systemic inflammation and gut microbial dysbiosis. While probiotics show promise as an adjunct therapy, their impact on inflammatory biomarkers alongside clinical symptoms remains underexplored. To evaluate the efficacy of combined antihistamine and probiotic therapy on both clinical outcomes and systemic inflammatory markers in CSU patients over an 8-week period. In this randomized, double-blind, con-trolled trial, 42 CSU patients were assigned to either a control group (antihistamine only) or an interven-tion group (antihistamine plus a multistrain synbiotic probiotic). The Urticaria Activity Score over 7 days (UAS7) and inflammatory biomarkers (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], neutrophil counts) were assessed at baseline and week 8. After 8 weeks, the intervention group demon-strated significantly greater reductions in UAS7 scores and all measured inflammatory markers compared to the control group (CRP: 3.5 ± 1.2 vs. 5.2 ± 1.5 mg/L, p<0.01; Neutrophils: 4900 ± 500 vs. 6300 ± 550 cells/µL, p<0.01). Spearman correlation analysis revealed significant positive correlations between UAS7 scores and CRP (rho=0.56, p=0.004), ESR (rho=0.52, p=0.007), and neutrophil counts (rho=0.49, p=0.011). Adjunct probiotic therapy with antihistamines provides superior clinical and anti-inflammatory benefits in CSU compared to antihistamines alone, supporting a role for gut microbiome modulation in managing this condition.