Objective: Chronic Spontaneous Urticaria (CSU) has a complex and multifactorial pathogenesis, and a substantial proportion of pediatric patients achieve adequate disease control with second-generation antihistamines. Whereas several biomarkers, including C-C ligand 2 (CCL2), have been associated with CSU in various adult populations, their role in pediatric patients is less clear. The current study aims at investigating serum levels of CCL2 in relationship with disease severity in a population of children affected by CSU, along with other inflammatory and autoimmune markers, in order to improve understanding and management strategies of pediatric CSU.

Materials and Methods: In the pediatric immunology and allergy clinic, a prospective study was conducted on 39 pediatric CSU patients and 38 healthy controls. Disease activity was monitored by the UAS-7, and ASSTs were also performed. Serum levels of CCL2 and other biomarkers, including eosinophils, D-dimer, fibrinogen, and CRP, were measured.

Results: There were no significant differences between the serum levels of CCL2 in CSU patients and healthy controls (p = 0.601) or between mild and moderate-to-severe CSU (p = 0.83). Similarly, no significant association was observed between the levels of CCL2 and positivity to ASST (p = 0.238). On the other hand, the relationship between CCL2 and fibrinogen levels presented an inverse correlation: p = 0.012. Eosinophil counts had a significant relation to UAS-7 scores, at p = 0.044. IgE, CRP, D-dimer, and ANA did not relate to the severity of disease.

Conclusion: In this pediatric CSU cohort, CCL2 did not show a clear association with clinical or laboratory measures. As the study was exploratory and based on a limited sample, these observations should be interpreted with caution. The primary contribution of this work is the generation of preliminary pediatric data in a field where evidence is limited. Larger, well-designed studies are needed to more accurately determine the roles of CCL2 and other potential biomarkers in the assessment and management of pediatric CSU.