51
|
Örsten S, Baysal İ, Akdoğan N, İnal N, Bostan E, Çiftçi SY, Akyön Y. Possible microRNA-based mechanism underlying relationship between chronic spontaneous urticaria and Blastocystis. Exp Parasitol 2023; 245:108453. [PMID: 36584787 DOI: 10.1016/j.exppara.2022.108453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 12/08/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Blastocystis spp. has been proposed as a possible cause of extraintestinal clinical signs such as urticaria pathogenesis. OBJECTIVES The aim of this study was to investigate the differences between microRNA (miRNA) expression profiles of Chronic spontaneous urticaria (CSU) patients in the presence or absence of Blastocystis spp. as well as healthy controls. Additionally, cellular pathways which are affected in the presence of Blastocystis spp. were identified. METHODS Twenty patients diagnosed with CSU were enrolled in the study and divided into equally two groups according to the presence of Blastocystis spp. Besides, six healthy individuals were included in the study. The expression profiles of 372 human-derived miRNAs have been investigated in serum samples from CSU patients and healthy controls with miScript miRNA PCR Array Human miRBase Profiler. RESULTS Compared to Blastocystis-negative (BN)-CSU patients, expression of 3 miRNAs (hsa-miR-3183, hsa-miR-4469, hsa-miR-5191) were found to be downregulated by at least two-fold (p < 0.05) in Blastocystis-positive (BP)-CSU patients. Additionally, the miRNA expression profiles of six healthy individuals (n = 3 Blastocystis-positive, n = 3 Blastocystis-negative) were analyzed and it was determined that the expressions of 7 miRNAs (hsa-miR-4661-5p, hsa-miR-4666a-5p, hsa-miR-4803, hsa-miR-5587-5p, hsa-miR-4500, hsa-miR-5680, hsa-miR-382-3p) increased at least 3-fold in the serum of individuals with Blastocystis-positive compared to Blastocystis-negative subjects. Most down-regulated miRNAs, in BP-CSU patients, affect cell adhesion molecules (CAMs), and signaling pathways therefore, Blastocystis spp. presence may influence the clinical presentation of urticaria by leading to unbalanced immunity. In addition, Blastocystis spp. presence may be influenced TGF- β signaling pathway through altered miRNAs and may be laying the groundwork for the development of CSU in healthy individuals. CONCLUSIONS As a consequence, this is the first report to show that the miRNA expression profile is affected by the presence of Blastocystis spp. Further miRNA-based studies are needed in order to enlighten the exact underlying molecular mechanisms of the relationship between Blastocystis spp. and CSU.
Collapse
Affiliation(s)
- Serra Örsten
- Hacettepe University, Vocational School of Health Services, Ankara, Turkey.
| | - İpek Baysal
- Hacettepe University, Vocational School of Health Services, Ankara, Turkey
| | - Neslihan Akdoğan
- Hacettepe University, Faculty of Medicine Department of Dermatology and Venereology, Ankara, Turkey
| | - Neşe İnal
- Hacettepe University, Faculty of Medicine Department of Medical Microbiology, Ankara, Turkey
| | - Ecem Bostan
- Hacettepe University, Faculty of Medicine Department of Dermatology and Venereology, Ankara, Turkey
| | | | - Yakut Akyön
- Hacettepe University, Faculty of Medicine Department of Medical Microbiology, Ankara, Turkey
| |
Collapse
|
52
|
Chuamanochan M, Nochaiwong S. Clinical Outcomes, Patient-Reported Outcomes, and Economic Burden for Thai People Living with Chronic Urticaria (CORE-CU) in routine practice: A study protocol for a monocentric prospective longitudinal study. PLoS One 2023; 18:e0279566. [PMID: 36662843 PMCID: PMC9858793 DOI: 10.1371/journal.pone.0279566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/10/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Few prospective longitudinal studies have been conducted in Thailand to account for the long-term response to chronic urticaria (CU) treatment, clinical outcomes, and patient-reported outcomes (PROs) among people living with CU based on routine practice. As such, a prospective longitudinal study will be conducted to better understand the long-term responses to treatment options and the burden of disease in Thai CU patients. METHODS AND DESIGN This study is a routine clinical practice registry-based, monocentric, prospective, observational longitudinal study in the northern region of Thailand. Adult patients in an outpatient clinic diagnosed with CU, including both chronic spontaneous urticaria and chronic inducible urticaria will be recruited for this study. The cohort will be collected and registered using the joint routine clinical practice data based on multiple datasets including claims outpatient and inpatient data, routine laboratory results, medication utilization, health care costs, clinical characteristics, long-term urticaria care and monitoring, and PRO measures. The point prevalence of adverse health outcomes will be estimated and reported corresponding to 95% confidence intervals (95% CIs). The overall trend analysis will be analyzed to explore the effect of over time across the cohort time frame. CONCLUSION This prospective longitudinal study will report the clinical outcomes, PROs, and economic burden among Thai people living with CU based on routine clinical practice. Findings will provide comprehensive evidence and could facilitate best practices for CU care management for health care professionals, researchers, policymakers, and public society. TRIAL REGISTRATION Thai Clinical Trials Registry (TCTR, thaiclinicaltrials.org) registration TCTR20210706005. Registered on July 6, 2021.
Collapse
Affiliation(s)
- Mati Chuamanochan
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Surapon Nochaiwong
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
53
|
Do TT, Canty EA, Joshi SR. Current and future management of chronic spontaneous urticaria and chronic inducible urticaria. Allergy Asthma Proc 2023; 44:3-14. [PMID: 36719690 DOI: 10.2500/aap.2023.44.220093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Chronic urticaria (CU), characterized by ≥6 weeks of intense pruritus, remains a debilitating condition for patients. New and safe treatments are needed to manage CU recalcitrant to standard therapy. Objective: A review of the current literature of standard and novel therapeutics in the management of CU was conducted. Methods: A literature search via a medical literature data base and clinical trial data base was conducted to identify treatment options for CU and current clinical trials. Results: Second-generation antihistamines, omalizumab, and cyclosporine remain the most proven therapeutic options for CU. Dupilumab, mepolizumab, benralizumab, tezepelumab, and CDX-0159 are all undergoing clinical trials for CU. Although ligelizumab demonstrated initial promising results, a phase III study was discontinued due to a nonsuperior clinical impact compared with omalizumab. Conclusion: Novel therapies are needed for the treatment of recalcitrant CU. With a deeper understanding of the pathophysiology of CU, promising therapeutics are in clinical trials for CU.
Collapse
Affiliation(s)
- Toan T Do
- From the Department of Internal Medicine, Oregon Health and Science University, Portland, Oregon
| | - Ethan A Canty
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, and
| | - Shyam R Joshi
- Section of Allergy and Clinical Immunology, Oregon Health and Science University, Portland, Oregon
| |
Collapse
|
54
|
Olgaç M, Yeğit OO, Beyaz Ş, Öztop N, Tüzer C, Eyice D, Karadağ P, Coşkun R, Demir S, Çolakoğlu B, Büyüköztürk S, Gelincik A. Impact of COVID-19 pandemic on the course of refractory chronic spontaneous urticaria under omalizumab treatment. An Bras Dermatol 2023; 98:189-197. [PMID: 36609081 PMCID: PMC9747700 DOI: 10.1016/j.abd.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The course of chronic spontaneous urticaria (CSU) can be influenced by infections, depression, and stress. OBJECTIVE Our aim was to investigate the impact of the COVID-19 pandemic on the course of refractory CSU together with patient adherence to omalizumab and treatment adjustments. METHODS Urticaria Activity Score (UAS7) was used to assess disease activity. Fear of COVID-19 Scale (FC-19s), and Depression Anxiety Stress Scale (DASS-21s) were performed to assess mental health status. All scales were performed during the Quarantine Period (QP) and Return to the Normal Period (RTNP). UAS7 Before Pandemic (BP) was recorded from the patients medical records. RESULTS The authors evaluated 104 omalizumab-receiving CSU patients. UAS7 scores during QP were significantly higher than those in RTNP and BP (p < 0.01). DASS-21 and FC-19 scores were significantly higher during QP compared to RTNP (p < 0.01). Nineteen (18.2%) patients ceased omalizumab, 9 patients prolonged the intervals between subsequent doses during the pandemic. UAS7 scores in QP were significantly higher in patients who ceased omalizumab than in those who continued (p < 0.001). Among patients who continued omalizumab, 22.4% had an increase in urticaria activity and higher FC-19 scores in comparison with those with stable disease activity (p = 0.008). STUDY LIMITATIONS The small sample size of patients with prolonged intervals of omalizumab and the lack of mental health evaluation with the same tools prior to the study. CONCLUSION Fear induced by COVID-19 can determine an increase in disease activity. Therefore, patients on omalizumab should continue their treatment and prolonged interval without omalizumab can be considered in patients with good urticaria control.
Collapse
Affiliation(s)
- Müge Olgaç
- Division of Immunology and Allergic Diseases, Şişli Hamidiye Etfal Research and Education Hospital, Istanbul, Turkey.
| | - Osman Ozan Yeğit
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Şengül Beyaz
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nida Öztop
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Can Tüzer
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Deniz Eyice
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Pelin Karadağ
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Raif Coşkun
- Division of Immunology and Allergic Diseases, Okmeydanı Research and Education Hospital, Istanbul, Turkey
| | - Semra Demir
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bahaauddin Çolakoğlu
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Suna Büyüköztürk
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aslı Gelincik
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| |
Collapse
|
55
|
Zuberbier T, Altrichter S, Bauer S, Brehler R, Brockow K, Dressler C, Fluhr J, Gaskins M, Hamelmann E, Kühne K, Merk H, Mülleneisen NK, Nast A, Olze H, Ott H, Pleimes M, Ruëff F, Staubach-Renz P, Wedi B, Maurer M. S3 Guideline Urticaria. Part 1: Classification and diagnosis of urticaria - German-language adaptation of the international S3 Guideline. J Dtsch Dermatol Ges 2023; 21:81-93. [PMID: 36721941 DOI: 10.1111/ddg.14906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/11/2022] [Indexed: 02/02/2023]
Abstract
The lifetime prevalence of urticaria, a severe allergic disease, is almost 20%. It not only limits the quality of life of those affected, but also their general performance at work and in their daily activities. This publication is the first section of the Urticaria Guideline. It covers the classification and diagnosis of urticaria, taking into account the major advances in research into its causes, triggering factors and pathomechanisms. It also addresses strategies for the efficient diagnosis of the different subtypes of urticaria. This is crucial for individual, patient-oriented treatment, which is covered in the second part of the guideline, published separately. This German-language guideline was developed according to the criteria of the AWMF on the basis of the international English-language S3 guideline with special consideration of health system characteristics in the German-speaking countries. This first part of the guideline describes the classification of urticaria, distinguishing spontaneously occurring wheals (hives) and angioedema from forms of urticaria with inducible symptoms. Urticaria is defined as sudden onset of wheals, angioedema, or both, but is to be distinguished from conditions in which wheals occur as a short-term symptom, such as anaphylaxis. The diagnosis is based on (a limited number of) laboratory tests, but especially on medical history. In addition, validated instruments are available to measure the severity, activity and course of the disease.
Collapse
Affiliation(s)
- Torsten Zuberbier
- Charité - Universitätsmedizin Berlin, Institute of Allergology, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Sabine Altrichter
- University Hospital for Dermatology und Venereology, Comprehensive Allergy Center, Kepler University Hospital, Linz, Austria
| | | | - Randolf Brehler
- Center for Skin Diseases, University Hospital Münster, Department of Dermatology, Münster, Germany
| | - Knut Brockow
- Department und Clinic for Dermatology und Allergology am Biederstein, Technical University of Munich, Munich, Germany
| | - Corinna Dressler
- Division of Evidence-Based Medicine, Department for Dermatology, Venereology und Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Joachim Fluhr
- Charité - Universitätsmedizin Berlin, Institute of Allergology, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Matthew Gaskins
- Division of Evidence-Based Medicine, Department for Dermatology, Venereology und Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eckard Hamelmann
- Department for Pediatric and Adolescent Medinine, Evangelisches Klinikum Bethel, University Hospital OWL, University of Bielefeld, Bielefeld, Germany
| | | | - Hans Merk
- Department for Dermatology und Allergology, University Hospital RTWH Aachen, Aachen, Germany
| | | | - Alexander Nast
- Division of Evidence-Based Medicine, Department for Dermatology, Venereology und Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Heidi Olze
- Department of Ear, Nose and Throat Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Hagen Ott
- Hospital for Pediatric and Adolescent Medicine Auf der Bult, Hannover, Germany
| | - Marc Pleimes
- Practice for Pediatric and Adolescent Dermatology, Heidelberg, Germany
| | - Franziska Ruëff
- Department and Clinic for Dermatology und Allergology, LMU Hospital at the University of Munich, Munich, Germany
| | - Petra Staubach-Renz
- Department and Clinic for Skin Diseases, University Hospital at Johannes Gutenberg University Mainz, Mainz, Germany
| | - Bettina Wedi
- Hannover Medical School Dept. of Dermatology and Allergology, Hannover, Germany
| | - Marcus Maurer
- Charité - Universitätsmedizin Berlin, Institute of Allergology, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| |
Collapse
|
56
|
Akdaş E, Adışen E, Öztaş MO, Aksakal AB, İlter N, Gülekon A. Real-life clinical practice with omalizumab in 134 patients with refractory chronic spontaneous urticaria: a single-center experience. An Bras Dermatol 2023; 98:240-242. [PMID: 36567165 PMCID: PMC9984690 DOI: 10.1016/j.abd.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/22/2022] [Accepted: 06/11/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Elçin Akdaş
- Department of Dermatology, Gazi University Faculty of Medicine, Ankara, Turkey.
| | - Esra Adışen
- Department of Dermatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Murat Orhan Öztaş
- Department of Dermatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | - Nilsel İlter
- Department of Dermatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ayla Gülekon
- Department of Dermatology, Gazi University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
57
|
Zuberbier T, Altrichter S, Bauer S, Brehler R, Brockow K, Dressler C, Fluhr J, Gaskins M, Hamelmann E, Kühne K, Merk H, Mülleneisen NK, Nast A, Olze H, Ott H, Pleimes M, Ruëff F, Staubach-Renz P, Wedi B, Maurer M. S3-Leitlinie Urtikaria. Teil 1: Klassifikation und Diagnostik der Urtikaria - deutschsprachige Adaptation der internationalen S3-Leitlinie. J Dtsch Dermatol Ges 2023; 21:81-95. [PMID: 36721942 DOI: 10.1111/ddg.14906_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/11/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Torsten Zuberbier
- Charité - Universitätsmedizin Berlin, Institut für Allergieforschung, Berlin, Deutschland.,Fraunhofer Institut für Translationale Medizin und Pharmakologie ITMP, Allergologie und Immunologie, Berlin, Deutschland
| | - Sabine Altrichter
- Universitätsklinik für Dermatologie und Venerologie, Comprehensive Allergy Center, Kepler Universitätsklinikum, Linz, Österreich
| | | | - Randolf Brehler
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Abteilung Dermatologie, Münster, Deutschland
| | - Knut Brockow
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, München, Deutschland
| | - Corinna Dressler
- Division of Evidence-Based Medicine, Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - Joachim Fluhr
- Charité - Universitätsmedizin Berlin, Institut für Allergieforschung, Berlin, Deutschland.,Fraunhofer Institut für Translationale Medizin und Pharmakologie ITMP, Allergologie und Immunologie, Berlin, Deutschland
| | - Matthew Gaskins
- Division of Evidence-Based Medicine, Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - Eckard Hamelmann
- Klinik für Kinder- und Jugendmedizin, Evangelisches Klinikum Bethel, Universitätsklinikum OWL, Universität Bielefeld, Bielefeld, Deutschland
| | | | - Hans Merk
- Klinik für Dermatologie und Allergologie, Universitätsklinik RTWH Aachen, Aachen, Deutschland
| | | | - Alexander Nast
- Division of Evidence-Based Medicine, Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - Heidi Olze
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - Hagen Ott
- Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Deutschland
| | - Marc Pleimes
- Praxis für Kinder- und Jugenddermatologie, Heidelberg, Deutschland
| | - Franziska Ruëff
- Klinik und Poliklinik für Dermatologie und Allergologie, LMU Klinikum der Universität München, München, Deutschland
| | - Petra Staubach-Renz
- Hautklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Bettina Wedi
- de Hannover Medical School Dept. of Dermatology and Allergology, Hannover, Germany
| | - Marcus Maurer
- Charité - Universitätsmedizin Berlin, Institut für Allergieforschung, Berlin, Deutschland.,Fraunhofer Institut für Translationale Medizin und Pharmakologie ITMP, Allergologie und Immunologie, Berlin, Deutschland
| |
Collapse
|
58
|
Zysk W, Trzeciak M. Characterization of Chronic Urticaria and Associated Conditions - A Web-Based Survey. Dermatol Pract Concept 2023; 13:dpc.1301a56. [PMID: 36892341 PMCID: PMC9946080 DOI: 10.5826/dpc.1301a56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Chronic urticaria is a common disease, characterized by the development of wheals, angioedema, or both, which can be associated with several comorbidities. Most of the available studies have focused on specific common comorbidities and their association with CU, but have seldom reported the overall burden of comorbidities. OBJECTIVES This study aimed to investigate and analyze self-reported comorbidities in Polish patients with CU. METHODS An anonymous online survey consisting of 20 questions was conducted on members of an Urticaria group on the social media platform Facebook. A total of 102 people took part in this survey. The results were analyzed in Microsoft Excel 2016. RESULTS In the group, 95.1% were females and 4.9% males, with a mean age of 33.8 years. The most common diagnosed type of urticaria was spontaneous (52.9%). Angioedema accompanied urticaria in 68.6% of the respondents, mainly those with delayed pressure urticaria (86.4%). 85.3% of respondents reported comorbidities, most often atopic diseases and allergies (49%), chronic inflammation and infections (36.3%), thyroid (36.3%) and psychiatric disorders (25.5%). Moreover, in 30.4% of patients, at least one autoimmune disease was noted. As compared to the patients without autoimmune urticaria, many more with autoimmune urticaria had a coexisting autoimmune disease (50% vs. 23.7%). Family history of autoimmune diseases was positive in 42.2%, and the familial history of urticaria and atopy was positive in 7.8% and 25.5%, respectively. CONCLUSIONS The knowledge of comorbidities of chronic urticaria may support clinicians to manage and treat patients with this common condition.
Collapse
Affiliation(s)
- Weronika Zysk
- Dermatological Students Scientific Association, Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdansk, Poland
| | - Magdalena Trzeciak
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdansk, Poland
| |
Collapse
|
59
|
Shaker M, Mauger D, Fuhlbrigge AL. Value-Based, Cost-Effective Care: The Role of the Allergist-Immunologist. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:132-139. [PMID: 35944893 DOI: 10.1016/j.jaip.2022.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 01/11/2023]
Abstract
Asthma and allergic disease impact millions of patients and are associated with high costs. Up to 30% of all medical care involves wasted spending. Across the spectrum of care provided by the allergist-immunologist, there are opportunities to improve value and reduce medical waste. Several examples highlight this reality. Evidence suggests that most patients may receive cost-effective care in the management of chronic spontaneous urticaria without the need for laboratory testing. For patients with asthma, although a single maintenance and reliever therapy approach may be cost-effective, insurance-mandated therapy changes are not, and may harm patients. Biologics may be very effective in improving asthma control but are too expensive for this indication-as demonstrated by cost-effectiveness analyses and highlighted by the Institute of Clinical and Economic Review, which concluded that the value-based price for asthma biologics ranges between $6500 and 14,3000 per year. Early introduction may prevent food allergy, but screening before first introduction is neither necessary nor cost-effective, although early salvage food oral immunotherapy may result in improved quality of life and cost savings. Evidence does not support the presence of allergic disease as a risk factor for anaphylaxis to coronavirus disease 2019 vaccination, and risk-stratified vaccination approaches do not appear cost-effective. Allergen immunotherapy is a very cost-effective treatment option. The practice of allergy-immunology has continued to evolve in recent years and can provide a leading example of high-value practice.
Collapse
Affiliation(s)
- Marcus Shaker
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH.
| | - David Mauger
- Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, The Pennsylvania State University, State College, Pa
| | - Anne L Fuhlbrigge
- Pulmonary Science and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colo
| |
Collapse
|
60
|
Zhang L, Qiu L, Wu J, Qi Y, Gao X, He C, Qi R, Wang H, Yao X, Zhu H, Li Y, Hao S, Lu Q, Long H, Lian S, Zhu W, Zhang H, Lai W, Su X, Lu R, Guo Z, Li J, Li M, Liu Q, Wang H, He L, Nong X, Li F, Li Y, Yao C, Xu J, Tang H, Wang D, Li Z, Yu H, Xiao S, An J, Pu X, Yu S, Zhang J, Chen X, Wang H, Huang W, Chen H, Xiao T. GWAS of Chronic Spontaneous Urticaria Reveals Genetic Overlap with Autoimmune Diseases, Not Atopic Diseases. J Invest Dermatol 2023; 143:67-77.e15. [PMID: 35933036 DOI: 10.1016/j.jid.2022.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 07/03/2022] [Accepted: 07/09/2022] [Indexed: 02/08/2023]
Abstract
Although chronic spontaneous urticaria (CSU) is a common disease, GWASs of CSU are lacking. We aimed to identify susceptibility SNPs by performing a GWAS in Chinese Han adults with CSU. The discovery cohort included 430 CSU cases and 482 healthy controls. The GWAS findings were validated in 800 CSU cases and 900 healthy controls. Genetic, functional enrichment, and bioinformatic analyses of genome-wide significant SNPs were performed to assess the association between CSU and autoimmunity or atopy. Five genome-wide significant SNPs were identified: rs434124/LILRA3, rs61986182/IGHG1/2, rs73075571/TDGF1, rs9378141/HLA-G, and rs3789612/PTPN22. The first four SNPs were in linkage disequilibrium with autoimmune-related diseases‒associated SNPs and were cis-expression quantitative trait loci in immune cells. The five SNPs-annotated genes were significantly enriched in immune processes. Higher polygenic risk scores and allele frequencies of rs3789612∗T, rs9378141∗C, and rs73075571∗G were significantly associated with autoimmune-related CSU phenotypes, including positive antithyroglobulin IgG, positive anti-FcεRIα IgG, total IgE <40 IU/ml, and positive antithyroid peroxidase IgG but not with atopic or allergic sensitized CSU phenotypes. This GWAS of CSU identifies five risk loci and reveals that CSU shares genetic overlap with autoimmune diseases and that genetic factors predisposing to CSU mainly manifest through associations with autoimmune traits.
Collapse
Affiliation(s)
- Liming Zhang
- Department of Dermatology, The First Hospital of China Medical University, National Health Commission Key Laboratory of Immunodermatology, Key Laboratory of Immunodermatology of Ministry of Education, Shenyang, China
| | - Li Qiu
- Department of Dermatology, The First Hospital of China Medical University, National Health Commission Key Laboratory of Immunodermatology, Key Laboratory of Immunodermatology of Ministry of Education, Shenyang, China
| | - Jian Wu
- Department of Dermatology, The First Hospital of China Medical University, National Health Commission Key Laboratory of Immunodermatology, Key Laboratory of Immunodermatology of Ministry of Education, Shenyang, China
| | - Yumeng Qi
- Department of Dermatology, The First Hospital of China Medical University, National Health Commission Key Laboratory of Immunodermatology, Key Laboratory of Immunodermatology of Ministry of Education, Shenyang, China
| | - Xinghua Gao
- Department of Dermatology, The First Hospital of China Medical University, National Health Commission Key Laboratory of Immunodermatology, Key Laboratory of Immunodermatology of Ministry of Education, Shenyang, China
| | - Chundi He
- Department of Dermatology, The First Hospital of China Medical University, National Health Commission Key Laboratory of Immunodermatology, Key Laboratory of Immunodermatology of Ministry of Education, Shenyang, China
| | - Ruiqun Qi
- Department of Dermatology, The First Hospital of China Medical University, National Health Commission Key Laboratory of Immunodermatology, Key Laboratory of Immunodermatology of Ministry of Education, Shenyang, China
| | - Hexiao Wang
- Department of Dermatology, The First Hospital of China Medical University, National Health Commission Key Laboratory of Immunodermatology, Key Laboratory of Immunodermatology of Ministry of Education, Shenyang, China
| | - Xu Yao
- Department of Allergy and Rheumatology, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Hong Zhu
- Department of Allergy and Rheumatology, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Yuzhen Li
- Department of Dermatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Siyu Hao
- Department of Dermatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qianjin Lu
- Department of Dermatology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hai Long
- Department of Dermatology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shi Lian
- Department of Dermatology, Xuan Wu Hospital Capital Medical Univerisity, Beijing, China
| | - Wei Zhu
- Department of Dermatology, Xuan Wu Hospital Capital Medical Univerisity, Beijing, China
| | - Haiping Zhang
- Department of Dermatology, Xuan Wu Hospital Capital Medical Univerisity, Beijing, China
| | - Wei Lai
- Department of Dermatology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiangyang Su
- Department of Dermatology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Rongbiao Lu
- Department of Dermatology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zaipei Guo
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Jingyi Li
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Mengmeng Li
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Quanzhong Liu
- Department of Dermatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Huiping Wang
- Department of Dermatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Li He
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiang Nong
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Fuqiu Li
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, China
| | - Yang Li
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, China
| | - Chunli Yao
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, China
| | - Jinhua Xu
- Department of Dermatology, Huashan Hospital, Fudan Univeristy, Shanghai, China
| | - Hui Tang
- Department of Dermatology, Huashan Hospital, Fudan Univeristy, Shanghai, China
| | - Duoqin Wang
- Department of Dermatology, Huashan Hospital, Fudan Univeristy, Shanghai, China
| | - Zhenlu Li
- Department of Dermatology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Huiqian Yu
- Department of Dermatology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Shengxiang Xiao
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Jingang An
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Xiongming Pu
- Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Key Laboratory of Dermatology Research (XJYS1707), Xinjiang, China
| | - Shirong Yu
- Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Key Laboratory of Dermatology Research (XJYS1707), Xinjiang, China
| | - Jianzhong Zhang
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Xue Chen
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Haifeng Wang
- Department of Genetics, Shanghai-MOST Key Laboratory of Health and Disease Genomics, Chinese National Human Genome Center at Shanghai (CHGC), Shanghai Institute for Biomedical and Pharmaceutical Technologies (SIBPT), Shanghai, China
| | - Wei Huang
- Department of Genetics, Shanghai-MOST Key Laboratory of Health and Disease Genomics, Chinese National Human Genome Center at Shanghai (CHGC), Shanghai Institute for Biomedical and Pharmaceutical Technologies (SIBPT), Shanghai, China
| | - Hongduo Chen
- Department of Dermatology, The First Hospital of China Medical University, National Health Commission Key Laboratory of Immunodermatology, Key Laboratory of Immunodermatology of Ministry of Education, Shenyang, China
| | - Ting Xiao
- Department of Dermatology, The First Hospital of China Medical University, National Health Commission Key Laboratory of Immunodermatology, Key Laboratory of Immunodermatology of Ministry of Education, Shenyang, China.
| |
Collapse
|
61
|
Segú-Vergés C, Gómez J, Terradas-Montana P, Artigas L, Smeets S, Ferrer M, Savic S. Unveiling chronic spontaneous urticaria pathophysiology through systems biology. J Allergy Clin Immunol 2022; 151:1005-1014. [PMID: 36587849 DOI: 10.1016/j.jaci.2022.12.809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/06/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is a rare, heterogeneous, severely debilitating, and often poorly controlled skin disease resulting in an itchy eruption that can be persistent. Antihistamines and omalizumab, an anti-IgE mAb, are the only licensed therapies. Although CSU pathogenesis is not yet fully understood, mast cell activation through the IgE:high-affinity IgE receptor (FcεRI) axis appears central to the disease process. OBJECTIVE We sought to model CSU pathophysiology and identify in silico the mechanism of action of different CSU therapeutic strategies currently in use or under development. METHODS Therapeutic performance mapping system technology, based on systems biology and machine learning, was used to create a CSU interactome validated with gene expression data from patients with CSU and a CSU model that was used to evaluate CSU pathophysiology and the mechanism of action of different therapeutic strategies. RESULTS Our models reflect the known role of mast cell activation as a central process of CSU pathophysiology, as well as recognized roles for different therapeutic strategies in this and other innate and adaptive immune processes. They also allow determining similarities and differences between them; anti-IgE and Bruton tyrosine kinase inhibitors play a more direct role in mast cell biology through abrogation of FcεRI signaling activity, whereas anti-interleukins and anti-Siglec-8 have a role in adaptive immunity modulation. CONCLUSION In silico CSU models reproduced known CSU and therapeutic strategies features. Our results could help advance understanding of therapeutic mechanisms of action and further advance treatment research by patient profile.
Collapse
Affiliation(s)
- Cristina Segú-Vergés
- Anaxomics Biotech, Barcelona, Spain; Research Programme on Biomedical Informatics, Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | | | | | | | | | - Marta Ferrer
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra, 3Cooperative Research Network Health Oriented, Pamplona, Spain
| | - Sinisa Savic
- Department of Clinical Immunology and Allergy, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom.
| |
Collapse
|
62
|
Buttgereit T, Fijen LM, Vera C, Bergmann KC, Maurer M, Magerl M. Case report: Recurrent angioedema: Diagnosing the rare and the frequent. Front Med (Lausanne) 2022; 9:1048480. [DOI: 10.3389/fmed.2022.1048480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/21/2022] [Indexed: 12/05/2022] Open
Abstract
Hereditary angiodema with normal C1 inhibitor and unknown mutation (HAE-nC1INH-UNK), an exceedingly rare subtype of HAE, appears to be often diagnosed in patients who do not have this condition, but have mast cell-mediated angioedema. Here, we report two patients diagnosed with HAE-nC1INH-UNK by their physicians, who referred them to our center for treatment continuation with costly kallikrein-kinin-system targeted therapies. We describe how we established the correct diagnosis of recurrent mast cell-mediated angioedema after thorough investigation of both patients and initiated effective treatment with omalizumab. Also, we present and discuss the consensus criteria for diagnosing the very rare condition HAE-nC1INH in light of recent research and based on our own clinical experience. In conclusion, HAE-nC1INH-UNK should only be considered after more common differential diagnoses, i.e., mast cell-mediated angioedema, have thoroughly been investigated and ruled out. This approach reduces both the patients’ disease burden and healthcare costs and contributes to meaningful research.
Collapse
|
63
|
Pivneva I, Balp MM, Geissbühler Y, Severin T, Smeets S, Signorovitch J, Royer J, Liang Y, Cornwall T, Pan J, Danyliv A, McKenna SJ, Marsland AM, Soong W. Predicting Clinical Remission of Chronic Urticaria Using Random Survival Forests: Machine Learning Applied to Real-World Data. Dermatol Ther (Heidelb) 2022; 12:2747-2763. [PMID: 36301485 PMCID: PMC9674814 DOI: 10.1007/s13555-022-00827-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/28/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The time required to reach clinical remission varies in patients with chronic urticaria (CU). The objective of this study is to develop a predictive model using a machine learning methodology to predict time to clinical remission for patients with CU. METHODS Adults with ≥ 2 ICD-9/10 relevant CU diagnosis codes/CU-related treatment > 6 weeks apart were identified in the Optum deidentified electronic health record dataset (January 2007 to June 2019). Clinical remission was defined as ≥ 12 months without CU diagnosis/CU-related treatment. A random survival forest was used to predict time from diagnosis to clinical remission for each patient based on clinical and demographic features available at diagnosis. Model performance was assessed using concordance, which indicates the degree of agreement between observed and predicted time to remission. To characterize clinically relevant groups, features were summarized among cohorts that were defined based on quartiles of predicted time to remission. RESULTS Among 112,443 patients, 73.5% reached clinical remission, with a median of 336 days from diagnosis. From 1876 initial features, 176 were retained in the final model, which predicted a median of 318 days to remission. The model showed good performance with a concordance of 0.62. Patients with predicted longer time to remission tended to be older with delayed CU diagnosis, and have more comorbidities, more laboratory tests, higher body mass index, and polypharmacy during the 12-month period before the first CU diagnosis. CONCLUSIONS Applying machine learning to real-world data enabled accurate prediction of time to clinical remission and identified multiple relevant demographic and clinical variables with predictive value. Ongoing work aims to further validate and integrate these findings into clinical applications for CU management.
Collapse
Affiliation(s)
- Irina Pivneva
- Analysis Group, Inc., 1190 Avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montréal, QC H3B 0G7 Canada
| | | | | | | | | | | | - Jimmy Royer
- Analysis Group, Inc., 1190 Avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montréal, QC H3B 0G7 Canada
| | - Yawen Liang
- Analysis Group, Inc., 1190 Avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montréal, QC H3B 0G7 Canada
| | - Tom Cornwall
- Analysis Group, Inc., 1190 Avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montréal, QC H3B 0G7 Canada
| | - Jutong Pan
- Analysis Group, Inc., 1190 Avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montréal, QC H3B 0G7 Canada
| | | | | | | | - Weily Soong
- AllerVie Health and AllerVie Clinical Research, Birmingham, AL USA
| |
Collapse
|
64
|
Remibrutinib, a novel BTK inhibitor, demonstrates promising efficacy and safety in chronic spontaneous urticaria. J Allergy Clin Immunol 2022; 150:1498-1506.e2. [PMID: 36096203 DOI: 10.1016/j.jaci.2022.08.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is inadequately controlled in many patients and greatly affects quality of life. Remibrutinib, a highly selective, oral, novel covalent Bruton tyrosine kinase inhibitor, might be effective in CSU. OBJECTIVE This first-in-patient trial aimed to evaluate the efficacy and safety of remibrutinib in CSU treatment and characterize the dose-response. METHODS This randomized, double-blind, placebo-controlled, phase 2b dose-finding trial evaluated remibrutinib (12 weeks) in patients inadequately controlled with second-generation H1-antihistamines, with at least moderately active CSU, with or without prior anti-IgE treatment (NCT03926611). Patients received remibrutinib 10 mg once daily, 35 mg once daily, 100 mg once daily, 10 mg twice daily, 25 mg twice daily, 100 mg twice daily, or placebo (1:1:1:1:1:1:1 ratio). The main end points were weekly Urticaria Activity Score change from baseline at week 4 and safety. RESULTS Overall, 311 patients were randomized. Reduced symptom score was observed for all remibrutinib doses from week 1 until week 12, with weekly Urticaria Activity Score change from baseline at week 4: -19.1 (10 mg once daily), -19.1 (35 mg once daily), -14.7 (100 mg once daily), -16.0 (10 mg twice daily), -20.0 (25 mg twice daily), -18.1 (100 mg twice daily), and -5.4 for placebo (nominal P < .0001 for all doses vs placebo). Most adverse events were mild or moderate, with no dose-dependent pattern. CONCLUSION Remibrutinib was highly effective in the treatment of CSU over the entire dose range, with a rapid onset of action and a favorable safety profile.
Collapse
|
65
|
Novel biologics for treatment of chronic spontaneous urticaria. J Allergy Clin Immunol 2022; 150:1256-1259. [PMID: 36180286 DOI: 10.1016/j.jaci.2022.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 12/14/2022]
Abstract
Chronic idiopathic/spontaneous urticaria (CIU/CSU) causes significant impairments in quality of life and is often unresponsive to antihistamines. Although the anti-IgE mAb omalizumab has been an important addition to the therapeutic armamentarium for the management of patients with CSU, there are still a significant percentage of patients who do not respond to the combination of antihistamines and omalizumab. As a result, additional treatments are needed. With the expanding knowledge of the pathogenesis of CSU and the role of mast cells, novel therapeutic agents targeting unique pathways important in CSU are in development. This review focuses on the rationale behind, and results of, novel therapies trialed in CSU.
Collapse
|
66
|
Hung HY, Song T, Loo SKF, Chan KL, Ching JYL, Sum CH, Lo LCW, Chia SCP, Ho RTM, Cheong PK, Siu THC, Leung KC, Lin ZX. Efficacy and safety of modified Xiao-Feng Powder in the treatment of chronic urticaria: protocol of a randomized double-blind placebo-controlled study. Chin Med 2022; 17:87. [PMID: 35869554 PMCID: PMC9308295 DOI: 10.1186/s13020-022-00642-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background Chronic Urticaria (CU), a common skin disorder known as Yin Zhen in Chinese medicine, is characterized by recurrent, pruritic, pink-to-red edematous lesions and wheals on the skin. Xiao-Feng Powder (XFP, meaning Wind-Dispersing Powder), is reported to be one of the most frequently used Chinese herbal formulae for CU. In this study, we aim to investigate the effectiveness and safety of modified Xiao-Feng Powder (mXFP) for the treatment of CU. Methods In this randomised double-blind placebo-controlled clinical trial, 58 subjects identified as having mild to severe urticaria (Urticaria activity score greater than 10) will be recruited and randomised into two groups to receive antihistamine Bilastine with either mXFP or placebo for 12 weeks, followed by post treatment visits at week 16. The primary outcome measure is the change of weekly urticaria activity score (UAS7) at week 12. Secondary outcome measures include the Urticaria Control Test (UCT), Visual Analog Scale of Itch Severity (VAS), Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL), Angioedema Activity Score (AAS), immunoglobulin E (IgE) test, gut microbiota test and use of antihistamines during study period. The trial will be conducted at three Chinese medicine clinics in Hong Kong. Expected outcomes The results of this study will establish robust clinical evidence about the efficacy and safety of mXFP in the treatment of CU. A specific feature of this trial is that it is a integrative medicine trial with subjects being allowed to take the Western and Chinese medicine together for the treatment. Trial registration This is registered on ClinicalTrials.gov, ID: NCT04967092. Register date: July 19, 2021. https://clinicaltrials.gov/ct2/show/NCT04967092.
Collapse
|
67
|
Do Antinuclear Antibodies Influence the Clinical Features of Chronic Spontaneous Urticaria?: A Retrospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7468453. [PMID: 36483629 PMCID: PMC9726248 DOI: 10.1155/2022/7468453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 12/05/2022]
Abstract
Background Antinuclear antibody (ANA) is often used as a screening test for autoimmune comorbidities in patients with chronic spontaneous urticaria (CSU). However, the relationship of ANA status and the clinical course of the disease have not been fully described. Objectives To compare clinical features of CSU patients who are positive and negative for ANA. Methods This was a retrospective cohort study that enrolled CSU patients attending the Urticaria Clinic at Siriraj Hospital from 2013 to 2019. Demographics, clinical characteristics, laboratory investigations, and treatments were collected until July 2021. All patients were investigated for ANA. Clinical feature data was compared between CSU patients with positive ANA and negative ANA groups using the 2-sample t-test and the Mann-Whitney U test for quantitative variables. The chi-squared test or Fisher's exact test was conducted to explore the association of qualitative variables. Disease relapse and remission were analysed via Kaplan-Meier survival analysis. Results Of 323 CSU patients, 31% had positive ANA. There were no significant differences in disease severity or impairment in quality of life. Patients with a positive ANA test had significantly lower prevalence of allergic rhinitis (p = .048) and significantly higher level of erythrocyte sedimentation rate (p = 0.007). Kaplan-Meier survival analysis showed that 2% of ANA positive CSU patients achieved remission status after one year and 28% did so after five years. There was no statistically significant difference in time to remission and time to relapse between ANA-positive and negative groups. Conclusion Positive ANA in CSU patients could not indicate the differences in main disease characteristics from the ANA-negative CSU patients. Investigation for ANA may be useful in CSU patients who are suspected of having autoimmune diseases.
Collapse
|
68
|
Ayse Ornek S, Orcen C, Church MK, Kocaturk E. An evaluation of remission rates with first and second line treatments and indicators of antihistamine refractoriness in chronic urticaria. Int Immunopharmacol 2022; 112:109198. [PMID: 36115277 DOI: 10.1016/j.intimp.2022.109198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Guidelines recommend standard doses of antihistamines as first-line, and updosing of antihistamines as second-line treatment for the management of chronic urticaria (CU). However, remission rates with different types of first- and second-line treatments and indicators of antihistamine response are largely lacking in the literature. OBJECTIVES To examine response rates to first- and second-line treatments in CU, and to identify patient characteristics that can predict antihistamine treatment outcomes. METHODS We retrospectively analyzed treatment outcomes of 657 CU (556 chronic spontaneous urticaria (CSU), 101 chronic inducible urticaria (CIndU)) patients who had at least 3-months of follow-up data. RESULTS A standard dose of second generation antihistamines (sgAH) was effective in 43.1 % of the patients. An additional 28.8 % of patients were in remission with second-line treatments. Among patients whose disease was in remission with a standard dose of sgAHs, 14.8 % benefited from switching from their current sgAH to another sgAH. Updosing sgAHs, combination of two different sgAHs, sgAH and first generation H1-antihistamine combination, and sgAH and leukotriene receptor antagonist combination provided remission in 38.3 %, 35.8 %, 37.5 % and 25 % of patients who were given these treatments, respectively. Baseline UCT score ≤ 4, emergency referral and family history of CSU were found to be risk factors for antihistamine refractoriness in patients with CSU. CONCLUSIONS A step-wise approach to the management of CU is practical as more patients respond to treatment at each step. The presence of baseline UCT score ≤ 4, emergency referral and family history of CSU might be helpful to determine patients who require third-line treatments in advance.
Collapse
Affiliation(s)
- Sinem Ayse Ornek
- Department of Dermatology, Health Sciences University Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Cihan Orcen
- Department of Allergy Immunology, Health Science University Derince Training and Research Hospital, Kocaeli, Turkey
| | - Martin K Church
- Institute for Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Emek Kocaturk
- Institute for Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Dermatology, Koc University School of Medicine, Istanbul, Turkey; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
| |
Collapse
|
69
|
Andrades E, Clarós M, Torres JV, Nonell L, González M, Curto-Barredo L, Rozas-Muñoz E, Gimeno R, Barranco C, Pujol RM, Izquierdo I, Giménez-Arnau AM. New transcriptome and clinical findings of platelet-activating factor in chronic spontaneous urticaria: Pathogenic and treatment relevance. Biofactors 2022; 48:1284-1294. [PMID: 35927787 DOI: 10.1002/biof.1880] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/15/2022] [Indexed: 12/24/2022]
Abstract
The objective of the study was to assess the pathogenic and treatment relevance of Platelet Activating factor (PAF) in chronic spontaneous urticaria (CSU). The expression and cellular location of PAF receptor (PAFR) and serum levels of PAF and PAF acetylhydrolase (PAF-AH) in patients with moderate/severe CSU (n = 45) and healthy controls (HCs, n = 17) were studied. Skin samples from the active wheal (LS-CSU, 13 samples for qPCR and 33 for immunohistochemistry) and non-lesional skin (NLS-CSU, 13 samples) of CSU patients and HCs (13 samples and 5 for immunohistochemistry) were analyzed. Serum PAF and PAF-AH levels were measured by ELISA and compared between HC (10 samples) and CSU patients (25 samples) and, among them, between those refractory and non-refractory to second-generation H1 -antihistamines (sgAH). PAFR mRNA expression was significantly higher in LS-CSU versus HCs (p = 0.014). PAFR positive staining in immunohistochemistry was mainly found in the epidermal basal layer in HCs, whereas it was broadly present along the epidermis in LS-CSU samples. Endothelial cells showed PAFR expression exclusively in LS-CSU and NLS-CSU samples. PAFR expression was observed in the nerves of HC, LS-CSU, and NLS-CSU samples. Double PAFR/CD43 expression showed that T-lymphocytes were the main cell type from the wheal inflammatory infiltrate expressing PAFR. A significantly lower PAF-AH/PAF ratio was observed in sgAH non-responders versus responders (6.1 vs. 12.6; p = 0.049). Our study confirms that PAF is a mediator of wheal pathogenesis in CSU. The significantly lower PAF-AH/PAF ratio in sgAH non-responders vs responders suggests that PAF could be a potential biomarker of sgAH refractoriness.
Collapse
Affiliation(s)
- Evelyn Andrades
- Department of Dermatology, Hospital del Mar, Universitat Autònoma de Barcelona and Universitat Pompeu Fabra, Barcelona, Spain
- Group of Inflammatory and Neoplastic Dermatological Diseases, Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Miquel Clarós
- Microarray Analysis Service, Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | | | - Lara Nonell
- Bioinformatics Unit, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Mónica González
- Department of Pathology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laia Curto-Barredo
- Department of Dermatology, Hospital del Mar, Universitat Autònoma de Barcelona and Universitat Pompeu Fabra, Barcelona, Spain
- Group of Inflammatory and Neoplastic Dermatological Diseases, Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | | | - Ramon Gimeno
- Department of Immunology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Carlos Barranco
- Department of Pathology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ramon M Pujol
- Department of Dermatology, Hospital del Mar, Universitat Autònoma de Barcelona and Universitat Pompeu Fabra, Barcelona, Spain
- Group of Inflammatory and Neoplastic Dermatological Diseases, Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Iñaki Izquierdo
- Departament of Clinical Development & Medical Advice, Biohorm SL Palau-Solità i Plegamans, Barcelona, Spain
| | - Ana M Giménez-Arnau
- Department of Dermatology, Hospital del Mar, Universitat Autònoma de Barcelona and Universitat Pompeu Fabra, Barcelona, Spain
- Group of Inflammatory and Neoplastic Dermatological Diseases, Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| |
Collapse
|
70
|
Oztop N, Demir S, Unal D, Beyaz S, Terzioglu K, Olgac M, Gelincik A. Predictive factors of recurrence after omalizumab cessation in the elderly with urticaria: A real-life study. Allergy Asthma Proc 2022; 43:519-528. [PMID: 36335414 DOI: 10.2500/aap.2022.43.220068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: There are no well-defined data that help predict the recurrence risk of urticaria after omalizumab cessation in elderly patients with chronic spontaneous urticaria (CSU). Objective: We aimed to evaluate the effectiveness and safety of omalizumab and to determine the possible predictive factors for recurrence after omalizumab cessation in the elderly with CSU. Methods: A total of 193 patients with CSU treated with omalizumab were included and divided into two groups according to age: group 1, ages 18-64 years (n = 127), and group 2, ages ≥ 65 years (n = 66). Demographics, clinical features, immunoglobulin G (IgG) anti-thyroid peroxidase antibody (anti-TPO), serum total IgE were analyzed. The IgG anti-TPO/total IgE ratio was calculated. Pretreatment 7-day urticaria activity scores, medication scores, and urticaria control test results were compared with those after treatment periods. Adverse effects were also evaluated. Results: The most common adverse effect of omalizumab treatment was injection-site reactions (4.7%) in both groups. Omalizumab was ceased after 24 weeks in 40.9% and in 73.1% in group 1 and group 2, respectively (p < 0.001). CSU recurred after omalizumab discontinuation in 9 and 15 patients in group 1 and in group 2, respectively (p < 0.001). The median baseline IgG anti-TPO was higher in patients with recurrent CSU in group 2 than in those in group 1 (p = 0.002). In group 2, the cutoff values of IgG anti-TPO and the IgG anti-TPO/total IgE ratio were 54.83 IU/mL and 0.45 for recurrence, respectively. Conclusion: Omalizumab is effective and safe in elderly patients with CSU. The serum baseline IgG anti-TPO level and the IgG anti-TPO/total IgE ratio could serve as predictors of recurrence in CSU after omalizumab cessation in elderly patients.
Collapse
Affiliation(s)
- Nida Oztop
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Semra Demir
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Derya Unal
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sengul Beyaz
- Department of Adult Allergy and Clinical Immunology, Ankara City Hospital, Ankara, Turkey
| | - Kadriye Terzioglu
- Department of Adult Allergy and Clinical Immunology, SBÜ Kartal Education and Training Hospital, Istanbul, Turkey, and
| | - Muge Olgac
- Department of Adult Allergy and Clinical Immunology, SBU Sisli Hamidiye Etfal Education and Training Hospital, Istanbul, Turkey
| | - Aslı Gelincik
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| |
Collapse
|
71
|
Metz M, Bernstein JA, Giménez-Arnau AM, Hide M, Maurer M, Sitz K, Soong W, Sussman G, Hua E, Barve A, Barbier N, Balp MM, Severin T. Ligelizumab improves angioedema, disease severity and quality-of-life in patients with chronic spontaneous urticaria. World Allergy Organ J 2022; 15:100716. [PMID: 36440464 PMCID: PMC9672946 DOI: 10.1016/j.waojou.2022.100716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/07/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background Disease burden is particularly high in Chronic Spontaneous Urticaria (CSU) patients with angioedema, and patients whose signs and symptoms are inadequately controlled by H1-antihistamines need new treatment options. Here we report an exploratory analysis, from the ligelizumab Phase 2b study, investigating angioedema occurrence in patients with CSU and describe the changes in angioedema following treatment with ligelizumab, omalizumab, or placebo. Methods Data from the ligelizumab Phase 2b core (ligelizumab 72 mg, 240 mg, omalizumab 300 mg and placebo) and extension study (ligelizumab 240 mg) were used. Changes in Weekly Angioedema Activity Score (AAS7), the Dermatology Life Quality Index (DLQI), and Weekly Urticaria Activity Score (UAS7) among each time point were analyzed for each treatment arm. Results From a total of 297 patients analyzed, 165 (55.6%) reported angioedema occurrence at baseline, with mean AAS7 ranging 30.6—42.2 across treatment arms. At Week 12 of the core study 87.5%, 84.6%, 75.0%, and 61.0% of patients were angioedema free for ligelizumab 72 mg, 240 mg, omalizumab 300 mg, and placebo arms, respectively. In CSU patients with angioedema at baseline, the largest change from baseline in AAS7 score was observed with ligelizumab 72 mg (−31.9) at week 16 in the core study. Patients with angioedema had a higher mean DLQI at baseline (14.9—16.1) vs. patients without angioedema (10.6—12.0). In patients with angioedema, low AAS7 was significantly associated with complete response on UAS7 (UAS7 = 0) and complete normalization of DLQI (DLQI 0—1). Conclusion In the Phase 2b study, ligelizumab effectively reduced angioedema and urticaria symptoms, and improve health related quality of life in patients with moderate-to-severe CSU. Clinicaltrails.gov NCT number NCT02477332; NCT02649218.
Collapse
|
72
|
Kan AKC, Wong TTH, Chiang V, Lau CS, Li PH. Chronic Spontaneous Urticaria in Hong Kong: Clinical Characteristics, Real-World Practice and Implications for COVID-19 Vaccination. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 15:32-42. [PMID: 36693356 PMCID: PMC9880305 DOI: 10.4168/aair.2023.15.1.32] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE The real-world management and clinical characteristics of chronic spontaneous urticaria (CSU) in Hong Kong and its implications for coronavirus disease 2019 (COVID-19) vaccination are unknown. We investigated the clinical characteristics of patients with CSU and the role of an immunologist-led Urticaria Clinic as well as the impact of CSU on COVID-19 vaccine uptake in Hong Kong. METHODS Longitudinal clinical data of 257 CSU patients were collected and analyzed. Association analyses were performed to identify the relationships between variables and factors associated with COVID-19 vaccine uptake. RESULTS After the immunologist review, the Weekly Urticaria Activity Score (UAS7) was significantly lower than baseline (median: 0.00 vs. 12.0, P < 0.001). Changes in UAS7 were significantly greater among patients with baseline UAS7 ≥ 16 compared to those with UAS7 < 16 (median: -24.0 vs. -2.00, P < 0.001). CSU patients had lower COVID-19 vaccination rates than the general population with only 176 (68.5%) and 165 (65.0%) receiving at least one dose and 2 doses of vaccination, respectively. The presence of concomitant suspected drug allergy was associated with lower COVID-19 vaccine uptake (odds ratio [OR], 0.47; P = 0.010), while regular pharmacological treatment was associated with higher COVID-19 vaccine uptake among CSU patients (OR, 3.79; P = 0.010). CONCLUSIONS A dedicated immunologist-led Urticaria Clinic may effectively improve CSU management and outcomes in Hong Kong.
Collapse
Affiliation(s)
- Andy Ka Chun Kan
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Hong Kong
| | - Thomas Tsz Hang Wong
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Hong Kong
| | - Valerie Chiang
- Division of Clinical Immunology, Department of Pathology, Queen Mary Hospital, Hong Kong
| | - Chak Sing Lau
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Hong Kong
| | - Philip Hei Li
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Hong Kong
| |
Collapse
|
73
|
Evidence Gaps in Clinical Trials of Pharmacologic Treatment for H1-Antihistamine-Refractory Chronic Spontaneous Urticaria: A Systematic Review and Future Perspectives. Pharmaceuticals (Basel) 2022; 15:ph15101246. [PMID: 36297357 PMCID: PMC9607405 DOI: 10.3390/ph15101246] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 11/24/2022] Open
Abstract
No data addressing issues concerning disparities in participant and trial characteristics and trial outcome reporting have been established in clinical trials for H1-antihistamine-refractory chronic spontaneous urticaria (CSU). To better harmonize and compare the different treatment interventions, we systematically evaluated the overall landscape of pharmacological treatments for H1-antihistamine-refractory CSU clinical trials published between 2000 and 2021. This systematic review included 23 randomized clinical trials involving 2480 participants from 22 countries. We found significant increases in the number of globally published and newly tested drugs, especially biologic drugs. Regarding relatively small trials, we found that people living with H1-antihistamine-refractory CSU who were identified as members of minority groups (non-white population), populations of regions other than North America/Europe, and populations of low- to lower/upper-middle-income countries are underrepresented. Most trials were designed to evaluate treatment efficacy and safety profiles; however, less than half of the included trials reported the patient’s perspective in terms of patient-reported outcomes. Disparities in outcome reporting, including clinimetric tools for assessing treatment response and outcome sets, were observed. To close the evidence gap in H1-antihistamine-refractory CSU trials, strategies for improving trial and participant enrollment and standardizing core outcome sets for trial reporting are needed.
Collapse
|
74
|
Ryan D, Tanno LK, Angier E, Clark E, Price D, Zuberbier T, Maurer M. Clinical review: The suggested management pathway for urticaria in primary care. Clin Transl Allergy 2022; 12:e12195. [PMID: 36225262 PMCID: PMC9533216 DOI: 10.1002/clt2.12195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 11/09/2022] Open
Abstract
Background Urticaria is a common condition presenting both as acute and chronic disease within primary care. To those without specialist training it is poorly understood from the points of view of diagnosis and management. It causes a considerable disease burden to sufferers with marked impact on quality of life. Purpose of this review The recent publication of the EAACI/GA²LEN/EuroGuiDerm/APAAACI Guideline for the Definition, Classification, Diagnosis and Management of Urticaria guideline prompted us to take this excellent resource and re-configure its findings and recommendations to a non-specialist audience with particular reference to the needs of the primary care team.
Collapse
Affiliation(s)
- Dermot Ryan
- Usher InstituteUniversity of EdinburghMedical SchoolEdinburghUK
| | - Luciana K. Tanno
- Department of AllergyUniversity Hospital of MontpellierMontpellierFrance
- Institut Desbrest d’Epidémiologie et de Santé PubliqueIDESPUniversity of Montpellier – INSERMMontpellierFrance
- WHO Collaborating Centre on Scientific Classification SupportMontpellierFrance
| | - Elizabeth Angier
- Primary Care, Population Science and Medical Education, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Evangéline Clark
- Department of DermatologyMontpellier University HospitalMontpellierFrance
| | - David Price
- Observational and Pragmatic Research InstituteSingaporeSingapore
- Centre of Academic Primary Care, Division of Applied Health SciencesUniversity of AberdeenAberdeenUK
| | - Torsten Zuberbier
- Institute of AllergologyCharité – Universitätsmedizin BerlinFreie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
| | - Marcus Maurer
- Institute of AllergologyCharité – Universitätsmedizin BerlinFreie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
| |
Collapse
|
75
|
Abstract
Urticaria is an inflammatory skin disorder that affects up to 20% of the world population at some point during their life. It presents with wheals, angioedema or both due to activation and degranulation of skin mast cells and the release of histamine and other mediators. Most cases of urticaria are acute urticaria, which lasts ≤6 weeks and can be associated with infections or intake of drugs or foods. Chronic urticaria (CU) is either spontaneous or inducible, lasts >6 weeks and persists for >1 year in most patients. CU greatly affects patient quality of life, and is linked to psychiatric comorbidities and high healthcare costs. In contrast to chronic spontaneous urticaria (CSU), chronic inducible urticaria (CIndU) has definite and subtype-specific triggers that induce signs and symptoms. The pathogenesis of CSU consists of several interlinked events involving autoantibodies, complement and coagulation. The diagnosis of urticaria is clinical, but several tests can be performed to exclude differential diagnoses and identify underlying causes in CSU or triggers in CIndU. Current urticaria treatment aims at complete response, with a stepwise approach using second-generation H1 antihistamines, omalizumab and cyclosporine. Novel treatment approaches centre on targeting mediators, signalling pathways and receptors of mast cells and other immune cells. Further research should focus on defining disease endotypes and their biomarkers, identifying new treatment targets and developing improved therapies.
Collapse
Affiliation(s)
- Pavel Kolkhir
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.
| | - Ana M Giménez-Arnau
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mediques, Universitat Autònoma, Barcelona, Spain
| | - Kanokvalai Kulthanan
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jonny Peter
- Urticaria Center of Reference and Excellence (UCARE), Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Urticaria Center of Reference and Excellence (UCARE), Allergy and Immunology Unit, University of Cape Town, Lung Institute, Cape Town, South Africa
| | - Martin Metz
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.
| |
Collapse
|
76
|
Ates H, Firat S, Buhari GK, Keren M, Cifci B, Erkekol FÖ. Relationships between quality of life, sleep problems, and sleep quality in patients with chronic idiopathic urticaria. J Cosmet Dermatol 2022; 21:4072-4079. [PMID: 35166020 DOI: 10.1111/jocd.14851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 01/30/2022] [Accepted: 02/09/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND In this study, we aimed to evaluate the sleep quality among chronic urticaria patients using the Chronic Urticaria Quality-of-Life Questionnaire (CU-Q2oL), sleep quality assessment tools, and polysomnography and to investigate any relationships between the obtained results. METHODS The study included 21 patients diagnosed with chronic spontaneous urticaria and 19 healthy controls. We recorded the patients' sleep quality data, including CU-Q2 oL, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and polysomnography results. RESULT Patients in the chronic urticaria group were more likely to have an ESS score of ≥10 (52.4% vs. 5.3%, p = 0.004) and an apnea-hypopnea index of ≥5 (44.4% vs. 5.3%, p = 0.017) compared to the control group. In the patient group, the CU-Q2 oL total score was positively correlated with sleep latency (r = 0.713, p = 0.004) and PSQI-C1 score (r = 0.726, p = 0.005), while it was negatively correlated with urticaria duration (r = -0.579, p = 0.015), apnea-hypopnea index (r = -0.607, p = 0.021), longest apnea duration (r = -0.583, p = 0.029), total number of respiratory events (r = -0.618, p = 0.018), and apnea count (r = -0.686, p = 0.007). CONCLUSION We conclude that sleep-related problems exist among a considerably large proportion of patients with chronic spontaneous urticaria.
Collapse
Affiliation(s)
- Hale Ates
- Department of Allergy and Immunology, Atatürk Chest Disease and Chest Surgery Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Selma Firat
- Sleep Disorders Center, Ataturk Chest Diseases and Thoracic Surgery Education and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Gozde Koycu Buhari
- Department of Allergy and Immunology, Atatürk Chest Disease and Chest Surgery Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Metin Keren
- Department of Pulmonary Diseases, Süreyyapaşa Pulmonary Diseases Education and Research Hospital, Istanbul, Turkey
| | - Bulent Cifci
- Department of Chest Diseases, Medical School, Turkiye Yuksek Ihtisas University, Ankara, Turkey
| | - Ferda Öner Erkekol
- Department of Allergy and Immunology, Atatürk Chest Disease and Chest Surgery Training and Research Hospital, Health Sciences University, Ankara, Turkey
| |
Collapse
|
77
|
Lin WK, Lin SJ, Lee WR, Lin CC, Lin WC, Chang HC, Cheng CT, Hsu JC. Effectiveness and Safety of Immunosuppressants and Biological Therapy for Chronic Spontaneous Urticaria: A Network Meta-Analysis. Biomedicines 2022; 10:biomedicines10092152. [PMID: 36140253 PMCID: PMC9496015 DOI: 10.3390/biomedicines10092152] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/14/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022] Open
Abstract
Chronic spontaneous urticaria (CSU) is the most common phenotype of chronic urticaria. We compared treatment effects and safety profiles of the medications in patients with CSU. We searched PubMed, MEDLINE, and Web of Science for randomized control trials (RCTs), from 1 January 2000 to 31 July 2021, which evaluated omalizumab and immunosuppressants. Network meta-analyses (NMAs) were performed with a frequentist approach. Outcome assessments considered the efficacy (Dermatology Life Quality Index (DLQI) and weekly urticaria activity score (UAS7)) and tolerability profiles with evaluations of study quality, inconsistencies, and heterogeneity. We identified 14 studies which we included in our direct and indirect quantitative analyses. Omalizumab demonstrated better efficacy in DLQI and UAS7 outcomes compared to a placebo, and UAS7 assessments also demonstrated better outcomes compared to cyclosporine. Alongside this, omalizumab demonstrated relatively lower incidences of safety concerns compared to the other immunosuppressants. Cyclosporin was also associated with higher odds of adverse events than other treatment options. Our findings indicate that omalizumab resulted in greater improvements in terms of the DLQI and UAS7 with good tolerability in CSU patients compared to the other immunosuppressants.
Collapse
Affiliation(s)
- Wen-Kuang Lin
- School of Pharmacy, Taipei Medical University, Taipei 110301, Taiwan
| | - Shwu-Jiuan Lin
- School of Pharmacy, Taipei Medical University, Taipei 110301, Taiwan
| | - Woan-Ruoh Lee
- Department of Dermatology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Graduate Institute of Medical Science, School of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Chia-Chieh Lin
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Weei-Chin Lin
- Section of Hematology/Oncology, Department of Medicine and Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Hua-Ching Chang
- Department of Dermatology, Taipei Medical University Hospital, Taipei 110301, Taiwan
- Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Chi-Tsun Cheng
- Research Center of Health Care Industry Data Science, College of Management, Taipei Medical University, Taipei 110301, Taiwan
| | - Jason C. Hsu
- Research Center of Health Care Industry Data Science, College of Management, Taipei Medical University, Taipei 110301, Taiwan
- International PhD Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei 110301, Taiwan
- Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei 110301, Taiwan
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei 110301, Taiwan
- Correspondence:
| |
Collapse
|
78
|
Abstract
Annular urticarial configurations are often associated with acute and chronic urticaria. Such lesions may be short-lived, migratory, transient, pruritic, and resolving with no residual evidence, making the diagnosis of urticaria an obvious one. Annular urticarial lesions can be the presenting signs of various cutaneous and systemic diseases. The differentiation of urticarial lesions may be made by considering the duration of an individual lesion longer than 24 hours, with burning and pain sensation in the lesions or lack of pruritus; skin marks such as postinflammatory pigmentation or purpura after resolution of the lesions; associated scaling or vehiculation in the lesions; systemic symptoms such as arthralgia, fever or fatigue; and several abnormal laboratory findings. The main differential diagnoses of annular urticarial lesions include urticarial vasculitis, autoinflammatory syndromes, hypersensitivity reactions, and connective tissue diseases.
Collapse
|
79
|
Saito R, Takahagi S, Nakano F, Furutani K, Mihara S, Numata T, Kameyoshi Y, Tanaka T, Shindo H, Niimi N, Iwamoto K, Hiragun T, Hiragun M, Tanaka A, Hide M. A survey on subtypes and clinical characteristics of 1061 patients with urticaria in the primary care institutes in Japan. J Dermatol 2022; 49:1255-1262. [PMID: 36028980 DOI: 10.1111/1346-8138.16562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/01/2022] [Accepted: 08/11/2022] [Indexed: 11/26/2022]
Abstract
The prevalence of urticaria has been reported mostly in Europe and North America. However, precise information regarding its subtypes and clinical characteristics in primary care practice, especially in Asian countries, are scant. Patients with urticaria and/or angioedema who visited nine primary clinics of accredited dermatologists and allergologists in Japan were recruited from October to November 2020. The information of age, sex, disease duration, urticaria control test (UCT), and concomitant urticaria subtypes were collected. A total of 1061 patients participated. The number of patients was high in the 20 to 50 age groups with a peak in the 40s. The most frequent urticaria subtype was chronic spontaneous urticaria (CSU) followed by dermographism, acute spontaneous urticaria (ASU), angioedema, and cholinergic urticaria (CholU) (66.8%, 22.7%, 18.9%, 14.1% and 5.7% in all patients with urticaria). CSU development increased with age from the 20s to 50s, especially in females. Dermographism had a peak in the 40s. ASU had bimodal peaks in childhood and in the 30s. CholU was common in males in the 10-20s. Most angioedema patients were female with an increase in their 30s. Angioedema was solely present in 14 of 1061 participants (1.3%), while 136 (12.8%) had angioedema concomitant with urticaria. UCT showed poorly controlled urticaria with lower scores in patients with concomitant CSU and other subtypes than in those with CSU alone. Urticaria tends to develop in young to middle-aged females. The most common urticaria subtype is CSU, while the number of patients with CholU is high and that of angioedema is low in Japan.
Collapse
Affiliation(s)
- Ryo Saito
- Department of Dermatology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shunsuke Takahagi
- Department of Dermatology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Fumi Nakano
- Department of Dermatology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Shoji Mihara
- Mihara Dermatology/Allergy Clinic, Hiroshima, Japan
| | | | | | | | | | | | | | | | | | - Akio Tanaka
- Department of Dermatology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Michihiro Hide
- Department of Dermatology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
80
|
Pourali SP, Gutierrez Y, Kucharik AH, Rajkumar JR, Jones ME, Armstrong AW. Chronic spontaneous urticaria in the United States: patient characteristics and treatment patterns. Int J Dermatol 2022; 61:e308-e309. [PMID: 34370872 DOI: 10.1111/ijd.15835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/02/2021] [Accepted: 07/23/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Sarah P Pourali
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Yasmin Gutierrez
- University of California, Riverside, School of Medicine, Riverside, CA, USA
| | - Alison H Kucharik
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | | | - Madison E Jones
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - April W Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
81
|
Current and Future Approaches in Management of Chronic Spontaneous Urticaria Using Anti-IgE Antibodies. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060816. [PMID: 35744079 PMCID: PMC9227249 DOI: 10.3390/medicina58060816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/02/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022]
Abstract
Chronic spontaneous urticaria (CSU) considerably alters patients’ quality of life, often for extended periods, due to pruriginous skin lesions, impaired sleep, unexpected development of angioedema, and failure of conventional treatments in properly controlling signs and symptoms. Recent research focused on the development of new therapeutic agents with higher efficacy. Although the production of specific immunoglobulin E (IgE) antibodies against certain allergens is not a characteristic of the disease, treatment with omalizumab, a monoclonal anti-IgE antibody, proved efficient and safe in patients with moderate to severe chronic spontaneous urticaria uncontrolled by H1-antihistamines. Ligelizumab, a high-affinity monoclonal anti-IgE antibody, may also efficiently relieve symptoms of unresponsive chronic urticaria to standard therapies. This comprehensive review aims to present recently acquired knowledge on managing chronic spontaneous urticaria with new anti-IgE antibodies. We conducted extensive research on the main databases (PubMed, Google Scholar, and Web of Science) with no restrictions on the years covered, using the search terms “anti-IgE antibodies”, “omalizumab”, “ligelizumab”, and “chronic spontaneous urticaria”. The inclusion criteria were English written articles, and the exclusion criteria were animal-related studies. ClinicalTrials.gov was also reviewed for recent relevant clinical trials related to CSU treatment. CSU is a challenging disease with a significant effect on patients’ quality of life. Current therapies often fail to control signs and symptoms, and additional treatment is needed. New biologic therapies against IgE antibodies and FcεRIα receptors are currently under investigation in advanced clinical trials. We reviewed recently published data on CSU management using these novel treatments. The development of new and improved treatments for CSU will lead to a more personalized therapeutical approach for patients and provide guidance for physicians in better understanding disease mechanisms. However, some agents are still in clinical trials, and more research is needed to establish the safety and efficacy of these treatments.
Collapse
|
82
|
Kolkhir P, Muñoz M, Asero R, Ferrer M, Kocatürk E, Metz M, Xiang YK, Maurer M. Autoimmune chronic spontaneous urticaria. J Allergy Clin Immunol 2022; 149:1819-1831. [PMID: 35667749 DOI: 10.1016/j.jaci.2022.04.010] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/17/2022] [Accepted: 04/14/2022] [Indexed: 12/23/2022]
Abstract
Chronic spontaneous urticaria (CSU) is a debilitating mast cell-driven disease characterized by recurrent wheals and/or angioedema. Substantial progress has been made in dissecting the 2 main autoimmune mechanisms that drive the pathogenesis of CSU. Type I autoimmune (autoallergic) CSU is associated with IgE antibodies against autoantigens, for example, thyroid peroxidase and IL-24. Type IIb autoimmune CSU is mediated by autoantibodies that activate mast cells, for example, via IgE and FcεRI, and is present in less than 10% of patients with CSU when strict criteria are used, that is, triple positivity of autologous serum skin test, immunoassays for IgG autoantibodies, and basophil activation tests. A subpopulation of patients with CSU has both types. Type IIb autoimmune CSU is characterized by higher disease severity, concomitant autoimmune diseases, low levels of total IgE, elevated levels of IgG-anti-thyroid peroxidase, basopenia, eosinopenia, poor response to antihistamines and to omalizumab, and a good response to cyclosporine. Novel targeted therapies for CSU are under development such as ligelizumab, an anti-IgE, fenebrutinib and remibrutinib, Bruton's tyrosine kinase inhibitors, and dupilumab, an anti-IL-4Rα. Further studies should investigate the overlap between autoallergic and type IIb autoimmune CSU, optimize the diagnosis of both autoimmune endotypes using easy-to-perform, noninvasive, and inexpensive markers, and assess differences in response to therapy.
Collapse
Affiliation(s)
- Pavel Kolkhir
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany; I.M. Sechenov First Moscow State Medical University (Sechenov University), Division of Immune-Mediated Skin Diseases, Moscow, Russia
| | - Melba Muñoz
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany; Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica san Carlo, Paderno Dugnano, Italy
| | - Marta Ferrer
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra Pamplona (IDISNA), Spain, RETIC de Asma, Reacciones Adversas y Alérgicas, Madrid (ARADyAL), Spain, Madrid, Spain
| | - Emek Kocatürk
- Koç University School of Medicine, Department of Dermatology, Istanbul, Turkey
| | - Martin Metz
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Yi-Kui Xiang
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
| |
Collapse
|
83
|
Ünsel M. Therapeutic Challenges in Chronic Spontaneous Urticaria. CYPRUS JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4274/cjms.2021.2021-231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
84
|
Altrichter S, Staubach P, Pasha M, Singh B, Chang AT, Bernstein JA, Rasmussen HS, Siebenhaar F, Maurer M. An open-label, proof-of-concept study of lirentelimab for antihistamine-resistant chronic spontaneous and inducible urticaria. J Allergy Clin Immunol 2022; 149:1683-1690.e7. [PMID: 34954198 DOI: 10.1016/j.jaci.2021.12.772] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/11/2021] [Accepted: 12/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic urticaria (CU) is a debilitating mast cell-driven disease, often refractory to standard therapy (ie, antihistamines). Lirentelimab, an anti-sialic acid-binding immunoglobulin-like lectin 8 mAb, selectively inhibits mast cells and depletes eosinophils. OBJECTIVE We sought to determine safety and efficacy of lirentelimab in patients with CU. METHODS This phase 2a study enrolled patients with CU refractory to up to 4-fold H1-antihistamine doses. Patients received 6 monthly intravenous doses of lirentelimab (0.3, 1, and up to 3 mg/kg). Primary efficacy end point was change in Urticaria Control Test score at week 22. Urticaria Activity Score weekly average (UAS7) was assessed in patients with chronic spontaneous urticaria (CSU), and Cholinergic UAS7 was used for patients with cholinergic urticaria (CholU). RESULTS A total of 45 patients were enrolled in 4 cohorts (n = 13 omalizumab-naive CSU, n = 11 omalizumab-refractory CSU, n = 11 CholU, n = 10 symptomatic dermographism). Urticaria Control Test scores increased with lirentelimab across cohorts, with mean changes at week 22 of 11.1 ± 4.1, 4.8 ± 7.0, 6.5 ± 6.2, and 3.4 ± 4.1 and complete response rates (Urticaria Control Test score ≥ 12) of 92%, 36%, 82%, and 40%, respectively. In omalizumab-naive and omalizumab-refractory patients with CSU, disease activity decreased at week 22 (mean UAS7 change, -73% and -47%, respectively), with UAS7 response rates (≥50% reduction) of 77% and 45%, respectively. In patients with symptomatic dermographism, 50% (5 of 10) and 40% (4 of 10) had complete itch and hive resolution by FricTest, respectively, and 100% (7 of 7) evaluable patients with CholU had negative responses to Pulse-Controlled Ergometry exercise test. Most common adverse events included infusion-related reactions (43%; all mild/moderate and transient), nasopharyngitis (21%), and headache (19%). No treatment-related serious adverse events occurred. CONCLUSIONS Lirentelimab demonstrated activity across 3 forms of antihistamine-refractory CU.
Collapse
Affiliation(s)
- Sabine Altrichter
- Dermatologial Allergology, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany; Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Hospital Mainz, Mainz, Germany
| | | | | | | | | | | | - Frank Siebenhaar
- Dermatologial Allergology, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany; Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Marcus Maurer
- Dermatologial Allergology, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany; Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany.
| |
Collapse
|
85
|
Thomsen SF, Pritzier EC, Anderson CD, Juvik S, Baust NV, Dodge R, Dahlborn AK, Vestergaard C. Treatment Patterns and Clinical Outcomes of Chronic Urticaria: Two-year Follow-up Results from the Scandinavian AWARE Study. Acta Derm Venereol 2022; 102:adv00689. [PMID: 35166853 PMCID: PMC9558753 DOI: 10.2340/actadv.v102.1620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The AWARE (A World-wide Antihistamine-Refractory chronic urticaria patient Evaluation) study investigated outcomes in patients with chronic urticaria refractory to H1-antihistamine. The objective of the current study was to analyse the effects of treatment on patients’ symptoms and quality of life for a period of up to 2 years. Over the 2 years, there was clear improvement in the high rates of disease burden from baseline, as evidenced by lower scores for disease severity scales, better quality of life, and a decreasing rate of medical resource utilization. However, this is the result of treatment adherence to the guidelines in highly specialized Scandinavian urticaria centres, and has its basis in the relatively low treatment intensity and control at enrolment. There is a need for greater adherence to the treatment guidelines and better management of antihistamine-refractory chronic urticaria.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Christian Vestergaard
- Department of Dermatology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, DK-8200 Aarhus, Denmark.
| |
Collapse
|
86
|
Zuberbier T, Abdul Latiff AH, Abuzakouk M, Aquilina S, Asero R, Baker D, Ballmer‐Weber B, Bangert C, Ben‐Shoshan M, Bernstein JA, Bindslev‐Jensen C, Brockow K, Brzoza Z, Chong Neto HJ, Church MK, Criado PR, Danilycheva IV, Dressler C, Ensina LF, Fonacier L, Gaskins M, Gáspár K, Gelincik A, Giménez‐Arnau A, Godse K, Gonçalo M, Grattan C, Grosber M, Hamelmann E, Hébert J, Hide M, Kaplan A, Kapp A, Kessel A, Kocatürk E, Kulthanan K, Larenas‐Linnemann D, Lauerma A, Leslie TA, Magerl M, Makris M, Meshkova RY, Metz M, Micallef D, Mortz CG, Nast A, Oude‐Elberink H, Pawankar R, Pigatto PD, Ratti Sisa H, Rojo Gutiérrez MI, Saini SS, Schmid‐Grendelmeier P, Sekerel BE, Siebenhaar F, Siiskonen H, Soria A, Staubach‐Renz P, Stingeni L, Sussman G, Szegedi A, Thomsen SF, Vadasz Z, Vestergaard C, Wedi B, Zhao Z, Maurer M. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy 2022; 77:734-766. [PMID: 34536239 DOI: 10.1111/all.15090] [Citation(s) in RCA: 413] [Impact Index Per Article: 206.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 02/07/2023]
Abstract
This update and revision of the international guideline for urticaria was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the Global Allergy and Asthma European Network (GA²LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), the European Dermatology Forum (EDF; EuroGuiDerm), and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology with the participation of 64 delegates of 50 national and international societies and from 31 countries. The consensus conference was held on 3 December 2020. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease that presents with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous or inducible urticaria is disabling, impairs quality of life, and affects performance at work and school. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
Collapse
Affiliation(s)
- Torsten Zuberbier
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | | | - Mohamed Abuzakouk
- Department of Allergy and Immunology Respiratory InstituteCleveland Clinic Abu Dhabi Abu Dhabi United Arab Emirates
| | - Susan Aquilina
- Department of Dermatology Mater Dei Hospital Msida Malta
| | - Riccardo Asero
- Ambulatorio di Allergologia Clinica San Carlo Paderno Dugnano (MI) Italy
| | - Diane Baker
- Baker Allergy Asthma and Dermatology Portland Oregon USA
| | - Barbara Ballmer‐Weber
- Clinic for Dermatology and Allergology Kantonsspital St. Gallen St. Gallen Switzerland
- Department of Dermatology University Hospital Zurich Zurich Switzerland
| | - Christine Bangert
- Department of Dermatology Medical University of Vienna Vienna Austria
| | - Moshe Ben‐Shoshan
- Division of Allergy, Immunology and Dermatology Department of Pediatrics Montreal Children’s Hospital McGill University Montreal Quebec Canada
| | | | - Carsten Bindslev‐Jensen
- Department of Dermatology and Allergy Centre Odense University Hospital and University of Southern Denmark Odense Denmark
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein Faculty of Medicine Technical University Munich Munich Germany
| | - Zenon Brzoza
- Department of Internal Diseases with Division of Allergology University of Opole Opole Poland
| | - Herberto Jose Chong Neto
- Division of Allergy and Immunology Department of Pediatrics Federal University of Paraná Curitiba Brazil
| | - Martin K. Church
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- University of Southampton Southampton UK
| | - Paulo R. Criado
- Sociedade Brasileira de Dermatologia (SBD) Centro Universitário FMABCAlergoskin (UCARE) Santo André Brazil
| | - Inna V. Danilycheva
- Department of Allergology and Immunotherapy National Research Center‐Institute of Immunology Federal Medical‐Biological Agency of Russia Moscow Russia
| | - Corinna Dressler
- Division of Evidence‐Based Medicine Department of Dermatology, Venereology and Allergy Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Luis Felipe Ensina
- Division of Allergy Clinical Immunology and Rheumatology Department of Pediatrics Federal University of São Paulo São Paulo Brazil
| | - Luz Fonacier
- New York University Long Island School of Medicine New York New York USA
| | - Matthew Gaskins
- Division of Evidence‐Based Medicine Department of Dermatology, Venereology and Allergy Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Krisztian Gáspár
- Division of Dermatological Allergology Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - Aslı Gelincik
- Division of Immunology and Allergic Diseases Department of Internal Medicine Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
| | - Ana Giménez‐Arnau
- Department of Dermatology, Hospital del Mar Institut Mar d’Investigacions Mèdiques Universitat Autònoma y Universitat Pompeu Fabra Barcelona Spain
| | - Kiran Godse
- Department of Dermatology D Y Patil University School of MedicineNavi Mumbai India
| | - Margarida Gonçalo
- Department of Dermatology Coimbra University Hospital and Faculty of Medicine University of Coimbra Coimbra Portugal
| | - Clive Grattan
- Guy’s HospitalSt John’s Institute of Dermatology London UK
| | - Martine Grosber
- Department of Dermatology Universitair Ziekenhuis Brussel (UZ Brussel)Vrije Universiteit Brussel (VUB) Brussels Belgium
| | - Eckard Hamelmann
- Department of Pediatrics Children’s Center Bethel University Hospital OWLUniversity Bielefeld Bielefeld Germany
| | - Jacques Hébert
- Service d'allergie Centre Hospitalier Université Laval/Centre Hospitalier Universitaire de Québec Québec Quebec Canada
| | - Michihiro Hide
- Department of Dermatology Hiroshima University Hiroshima Japan
- Department of Dermatology Hiroshima Citizens Hospital Hiroshima Japan
| | - Allen Kaplan
- Department of Medicine Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology Medical University of South Carolina Charleston South Carolina USA
| | - Alexander Kapp
- Department of Dermatology & Allergy Hannover Medical School (MHH) Hannover Germany
| | - Aharon Kessel
- Division of Allergy and Clinical Immunology Bnai Zion Medical Center and the Bruce and Ruth Rappaport Faculty of Medicine Technion Haifa Israel
| | - Emek Kocatürk
- Department of Dermatology Koç University School of Medicine Istanbul Turkey
| | - Kanokvalai Kulthanan
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | | | - Antti Lauerma
- Department of Dermatology, Allergology and Venereology Inflammation Centre University of Helsinki and Helsinki University Hospital Helsinki Finland
| | | | - Markus Magerl
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology Berlin Germany
| | - Michael Makris
- Allergy Unit 2nd Department of Dermatology and Venereology National and Kapodistrian University of AthensUniversity General Hospital "Attikon" Athens Greece
| | - Raisa Y. Meshkova
- Department of Clinical Immunology and Allergology Smolensk State Medical University Smolensk Russia
| | - Martin Metz
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology Berlin Germany
| | | | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre Odense Research Center for Anaphylaxis (ORCA) Odense University Hospital and University of Southern Denmark Odense Denmark
| | - Alexander Nast
- Division of Evidence‐Based Medicine Department of Dermatology, Venereology and Allergy Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | | | - Ruby Pawankar
- Department of Pediatrics Nippon Medical School Tokyo Japan
| | - Paolo D. Pigatto
- Department of Biomedical Surgical and Dental Sciences University of Milan Milan Italy
| | - Hector Ratti Sisa
- Primera Cátedra de Clínica Médica Hospital de Clínicas de la Facultad de Ciencias Médicas‐Universidad Nacional de Asunción Asunción Paraguay
| | | | | | | | - Bulent E. Sekerel
- Division of Pediatric Allergy and Asthma Hacettepe University Faculty of Medicine Ankara Turkey
| | - Frank Siebenhaar
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology Berlin Germany
| | - Hanna Siiskonen
- Department of Pathology Diagnostic Imaging Centre Kuopio University Hospital Kuopio Finland
| | - Angele Soria
- Department of Dermatology and Allergology Tenon Hospital APHP Sorbonne University and Cimi‐Paris Inserm 1135 Paris France
| | | | - Luca Stingeni
- Dermatology Section Department of Medicine University of Perugia Perugia Italy
| | - Gordon Sussman
- Division of Allergy and Clinical Immunology St. Michael's Hospital and University of Toronto Toronto Canada
| | - Andrea Szegedi
- Division of Dermatological Allergology Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - Simon Francis Thomsen
- Department of Dermatology Bispebjerg Hospital University of Copenhagen Copenhagen Denmark
| | - Zahava Vadasz
- Proteomic and Clinical Flow Cytometry Unit Bnai Zion Medical Center Rappaport Faculty of Medicine Technion Haifa Israel
| | | | - Bettina Wedi
- Department of Dermatology and Allergy Comprehensive Allergy Center Hannover Medical School Hannover Germany
| | - Zuotao Zhao
- Department of Dermatology and Venereology Peking University First Hospital Beijing China
| | - Marcus Maurer
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology Berlin Germany
| |
Collapse
|
87
|
Mendes‐Bastos P, Brasileiro A, Kolkhir P, Frischbutter S, Scheffel J, Moñino‐Romero S, Maurer M. Bruton's tyrosine kinase inhibition-An emerging therapeutic strategy in immune-mediated dermatological conditions. Allergy 2022; 77:2355-2366. [PMID: 35175630 PMCID: PMC9545595 DOI: 10.1111/all.15261] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 02/06/2023]
Abstract
Bruton's tyrosine kinase (BTK), a member of the Tec kinase family, is critically involved in a range of immunological pathways. The clinical application of BTK inhibitors for B‐cell malignancies has proven successful, and there is strong rationale for the potential benefits of BTK inhibitors in some autoimmune and allergic conditions, including immune‐mediated dermatological diseases. However, the established risk‐to‐benefit profile of “first‐generation” BTK inhibitors cannot be extrapolated to these emerging, non‐oncological, indications. “Next‐generation” BTK inhibitors such as remibrutinib and fenebrutinib entered clinical development for chronic spontaneous urticaria (CSU); rilzabrutinib and tirabrutinib are being studied as potential treatments for pemphigus. Promising data from early‐phase clinical trials in CSU suggest potential for these agents to achieve strong pathway inhibition, which may translate into measurable clinical benefits, as well as other effects such as the disruption of autoantibody production. BTK inhibitors may help to overcome some of the shortcomings of monoclonal antibody treatments for immune‐mediated dermatological conditions such as CSU, pemphigus, and systemic lupus erythematosus. In addition, the use of BTK inhibitors may improve understanding of the pathophysiological roles of mast cells, basophils, and B cells in such conditions.
Collapse
Affiliation(s)
| | - Ana Brasileiro
- Department of Dermatology Hospital Santo António dos Capuchos Centro Hospitalar Universitário Lisboa Central Lisbon Portugal
- NOVA Medical School Universidade NOVA de Lisboa Lisbon Portugal
| | - Pavel Kolkhir
- Dermatological Allergology, Allergie‐Centrum‐Charité, Department of Dermatology and Allergy, Charité‐Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Division of Immune‐Mediated Skin Diseases I.M. Sechenov First Moscow State Medical University (Sechenov University) Moscow Russia
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
| | - Stefan Frischbutter
- Dermatological Allergology, Allergie‐Centrum‐Charité, Department of Dermatology and Allergy, Charité‐Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
| | - Jörg Scheffel
- Dermatological Allergology, Allergie‐Centrum‐Charité, Department of Dermatology and Allergy, Charité‐Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
| | - Sherezade Moñino‐Romero
- Dermatological Allergology, Allergie‐Centrum‐Charité, Department of Dermatology and Allergy, Charité‐Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
| | - Marcus Maurer
- Dermatological Allergology, Allergie‐Centrum‐Charité, Department of Dermatology and Allergy, Charité‐Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
| |
Collapse
|
88
|
Peng L, Wen L, Zhang J, Zhang X, Wei Q, Guo J, Zeng J. Circadian Pharmacological Effects of Paeoniflorin on Mice With Urticaria-like Lesions. Front Pharmacol 2022; 12:639580. [PMID: 35222003 PMCID: PMC8863972 DOI: 10.3389/fphar.2021.639580] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/22/2021] [Indexed: 12/29/2022] Open
Abstract
Paeoniflorin (PF) is a monoterpene glucoside with various biological properties, and it suppresses allergic and inflammatory responses in a rat model of urticaria-like lesions (UL). In the present study, we treated OVA-induced mice presenting UL with PF at four circadian time points (ZT22, ZT04, ZT10, and ZT16) to determine the optimal administration time of PF. The pharmacological effects of PF were assessed by analyzing the scratching behavior; histopathological features; allergic responses such as immunoglobulin E (IgE), leukotriene B4 (LTB4), and histamine (HIS) release; inflammatory cell infiltration [mast cell tryptase (MCT) and eosinophil protein X (EPX)]; and mRNA levels of inflammatory cytokines such as interleukin (IL)-12, IL-6, interferon-γ (IFN-γ), and IL-4. It was demonstrated that PF significantly alleviated scratching behavior and histopathological features, and ZT10 dosing was the most effective time point in remission of the condition among the four circadian time points. Moreover, PF decreased the serum levels of IgE, LTB4, and HIS, and PF administration at ZT10 produced relatively superior effectiveness. PF treatment, especially dosing at ZT10, significantly reduced the number of mast cells and granules and diminished the infiltration of MCT and EPX in the skin tissues of mice with UL. Furthermore, the oral administration of PF effectively decreased the inflammatory cytokine levels of IL-12 mRNA. In conclusion, different administration times of PF affected its efficacy in mice with UL. ZT10 administration demonstrated relatively superior effectiveness, and it might be the optimal administration time for the treatment of urticaria.
Collapse
Affiliation(s)
- Li Peng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lijuan Wen
- Clinical Skills Center, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jie Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaotong Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qin Wei
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jing Guo
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Dermatological Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Jing Guo, ; Jinhao Zeng,
| | - Jinhao Zeng
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Geriatric Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Jing Guo, ; Jinhao Zeng,
| |
Collapse
|
89
|
Zheng Q, Zheng H, Zhou S, Shi Y, Zhang L, Xiao X, Zhang W, Zhou L, Huang Y, Chen M, Zhong F, Wang C, Li Y. Efficacy of acupuncture treatment for chronic spontaneous urticaria: study protocol for a randomised controlled trial. BMJ Open 2022; 12:e045027. [PMID: 35105558 PMCID: PMC8808388 DOI: 10.1136/bmjopen-2020-045027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Chronic spontaneous urticaria (CSU) is a troublesome dermatological problem that can have a significant impact on quality of life. Previous studies have indicated that acupuncture may be beneficial for patients with CSU. However, well-designed studies determine the effects of acupuncture on CSU are rare. The aim of this study is to investigate the efficacy and safety of acupuncture treatment for patients with CSU. METHODS AND ANALYSIS This study is designed as a multicentre, parallel, three-arm, randomised, sham-controlled trial. A total of 330 patients diagnosed as CSU will be randomly allocated into three groups: the verum acupuncture group, the sham acupuncture group and the waiting-list control group in a 1:1:1 ratio. Patients in the verum and sham acupuncture groups will receive 16 treatment sessions over 4 weeks, while patients in the waiting-list control group will not receive any acupuncture treatment. The primary outcome is the changes of weekly urticaria activity scores at the end of treatment. Secondary outcomes include itching severity measurement, Dermatology Life Quality Index, Hamilton Depression Scale, Hamilton Anxiety Scale, Pittsburgh Sleep Quality Index and serum total IgE level. Adverse events will be recorded during the study observation period. All patients who are randomised in this study will be included in the intention-to-treat analysis. ETHICS AND DISSEMINATION Ethical approval of this study has been granted by the Sichuan Regional Ethics Review of Committee on Traditional Chinese Medicine (TCM) (ID: 2019 kl-006), the Medical Ethic Committee of the First Hospital of Wuhan (ID: (2019) number 7)) and the Medical Ethics Committee of the First Hospital of Hunan University of TCM (ID: HN-LLKY-2019-017-01/03) in three clinical centres in China, respectively. The results will be disseminated through peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR1900022994.
Collapse
Affiliation(s)
- Qianhua Zheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Hui Zheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Siyuan Zhou
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yunzhou Shi
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Leixiao Zhang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xianjun Xiao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Wei Zhang
- Acupuncture, Tuina and Rehabilitation Department, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Li Zhou
- Department of Acupuncture and Moxibustion, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
| | - Ying Huang
- Dermatology Department, Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, Sichuan, China
| | - Mingling Chen
- Dermatology Department, Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, Sichuan, China
| | - Feng Zhong
- Acupuncture, Tuina and Rehabilitation Department, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Chuan Wang
- Department of Acupuncture and Moxibustion, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
| | - Ying Li
- Graduate School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| |
Collapse
|
90
|
Yüksekal G, Sevimli Dikicier B, Koku Aydın B, Yılmaz K, Altındiş M, Köroğlu M. Investigation of intestinal microbiome in chronic spontaneous urticaria patients. Int J Dermatol 2022; 61:988-994. [PMID: 35100439 DOI: 10.1111/ijd.16054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 11/16/2021] [Accepted: 12/17/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Chronic urticaria is a disorder characterized by itchy erythematous plaques with edema lasting 6 weeks or more. The prevalence is 1%, and two thirds of these cases are "chronic spontaneous urticaria (CSU)." Drugs, food, infections, and systemic diseases may be etiologic factors for CSU, although it may be idiopathic. OBJECTIVES The aim of this study was to compare the diversity and distribution of the intestinal microbiome in CSU patients with that of healthy individuals. The hypothesis was to determine the probable association of intestinal microbiome with CSU. METHODS This study was conducted in Sakarya University Training and Research Hospital, Department of Dermatology. In this study, 20 CSU patients and 10 healthy volunteers were included. Stool samples were collected from all participants. 16S RNA sequencing and bioinformatic analysis were performed after isolation of DNA isolation from all samples. RESULTS Diversity in microorganisms, stool pH averages, Bristol scores, and the ratio of Firmicutes/Bacteroidetes were the significant changes between the two groups. LIMITATIONS Due to high cost involved in microbiota studies, only a limited number of patients and volunteers participated. CONCLUSION The alteration in the intestinal microbiota (dysbiosis) may be an essential factor for CSU development and may explain idiopathic cases.
Collapse
Affiliation(s)
- Gülcan Yüksekal
- Department of Dermatology, Yenikent State Hospital, Sakarya, Turkey
| | | | - Büşra Koku Aydın
- Department of Dermatology, Sakarya University Medical School, Sakarya, Turkey
| | - Kerem Yılmaz
- Department of Medical Microbiology, Sakarya University Medical School, Sakarya, Turkey
| | - Mustafa Altındiş
- Department of Medical Microbiology, Sakarya University Medical School, Sakarya, Turkey
| | - Mehmet Köroğlu
- Department of Medical Microbiology, Sakarya University Medical School, Sakarya, Turkey
| |
Collapse
|
91
|
Maouia A, Leban N, Youssef M, Helal A, Kassab A. Desloratadine efficacy in relation to GSTM1 and GSTT1 polymorphic genes in chronic spontaneous urticaria. Indian J Dermatol 2022; 67:252-257. [DOI: 10.4103/ijd.ijd_546_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
92
|
Kim H, Hyun MC, Choi BS. Natural History and Influencing Factors of Chronic Urticaria in Children. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 14:73-84. [PMID: 34983108 PMCID: PMC8724829 DOI: 10.4168/aair.2022.14.1.73] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/26/2021] [Accepted: 09/01/2021] [Indexed: 11/23/2022]
Abstract
Purpose Chronic urticaria (CU) can reduce the quality of life of children and their parents, but there are only a few studies on the course of CU in children. This study aimed to investigate the natural course of CU in children and identify the factors that influence its prognosis. Methods We evaluated 77 children diagnosed with CU, who were monitored for at least 48 months. Subjects were classified as either chronic spontaneous urticaria (CSU) or other CU, and the clinical features were compared. Remission was defined as having no symptoms without treatment for more than 1 year. The remission rate was analyzed, and the factors influencing the prognosis were investigated. Results The average age of the study population was 5.96 ± 4.06 years, and 64 (83.1%) patients had CSU. The remission rates at 6 months, 1 year, 2 years, 3 years, and 4 years after symptom onset were 22.1%, 40.3%, 52.0%, 63.7%, and 70.2%, respectively, for children with CU. For children with CSU, these values were 23.4%, 43.7%, 56.2%, 68.7%, and 75.0%, respectively. The total serum immunoglobulin E (IgE) levels were positively correlated with disease duration (r = 0.262, P = 0.021); no other factors were associated with the duration of the disease. Conclusions A high proportion of children with CU were classified as CSU. No indicators, except for total IgE were found to predict the timing of spontaneous remission. The CU remission rate identified in this study is expected to be used as one of the reference data for the progress of CU in patients.
Collapse
Affiliation(s)
- Hyeona Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Myung Chul Hyun
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Bong Seok Choi
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| |
Collapse
|
93
|
Kim SH, Moon JY, Park HS, Shin YS. The Role of Di(2-Ethylhexyl) Phthalate as an Exacerbating Factor in Chronic Spontaneous Urticaria. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 14:339-343. [PMID: 35557498 PMCID: PMC9110918 DOI: 10.4168/aair.2022.14.3.339] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/25/2022] [Accepted: 03/14/2022] [Indexed: 11/20/2022]
Abstract
Phthalates are one of the most commonly used endocrine disruptors and have been considered a risk factor for respiratory disease including asthma. However, it is not yet known how they are related to urticaria. We investigated the association between phthalate exposure and urticaria in 10 healthy controls and 20 adult patients with active urticaria. The urinary levels of mono-n-butyl phthalate (MnBP), mono-2-ethyl-5-carboxypentyl phthalate (MECPP), mono-(2-ethyl-5-oxohexyl) phthalate, and mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) were measured by using high performance liquid chromatography tandem mass spectrometry, and mast cell releasability was determined after phthalate treatment. The levels of phthalate metabolites, especially di-ethylhexyl phthalate (DEHP), are significantly increased in the urine of patients with urticaria compared to the healthy controls. The release of β-hexosaminidase in human mast cells is more significantly increased by MnBP, mono-benzyl phthalate, MEHHP, and MECPP compared to the negative controls; interestingly, the highest secretion of β-hexosaminidase is observed after the lowest stimulation of MECPP. Phthalates, including DEHP, may act as aggravating factors for chronic spontaneous urticaria and can be used as potential therapeutic targets in future studies.
Collapse
Affiliation(s)
- Seo-Hee Kim
- Department of Biomedical Science, Graduate School of Ajou University, Suwon, Korea
| | - Ji-young Moon
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Biomedical Science, Graduate School of Ajou University, Suwon, Korea
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Yoo Seob Shin
- Department of Biomedical Science, Graduate School of Ajou University, Suwon, Korea
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| |
Collapse
|
94
|
Türk M, Ertaş R, Zeydan E, Türk Y, Atasoy M, Gutsche A, Maurer M. Identification of chronic urticaria subtypes using machine learning algorithms. Allergy 2022; 77:323-326. [PMID: 34606643 DOI: 10.1111/all.15119] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/05/2021] [Accepted: 09/24/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Murat Türk
- Clinic of Immunologic and Allergic Diseases Kayseri City Education and Research Hospital Kayseri Turkey
| | - Ragıp Ertaş
- Department of Dermatology Kayseri City Education and Research Hospital Kayseri Turkey
| | - Engin Zeydan
- Communication Networks Division Centre Tecnològic de Telecomunicacions de Catalunya (CTTC) Barcelona Spain
| | | | - Mustafa Atasoy
- Department of Dermatology Kayseri City Education and Research Hospital Kayseri Turkey
| | - Annika Gutsche
- Dermatological Allergology Department of Dermatology and Allergy Berlin Institute of Health Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP) Allergology and Immunology Berlin Germany
| | - Marcus Maurer
- Dermatological Allergology Department of Dermatology and Allergy Berlin Institute of Health Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP) Allergology and Immunology Berlin Germany
| |
Collapse
|
95
|
Jamil A, Ismail R, Nor N, Bakhtiar M. A comparison of autologous serum, plasma, and whole blood for intradermal autoreactivity testing in patients with chronic spontaneous urticarial: A cross-sectional study. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2022. [DOI: 10.4103/jdds.jdds_72_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
96
|
Ferrer Puga M, Silvestre Salvador J, Bartra Tomas J, Giménez-Arnau A, Labrador-Horrillo M, Miquel-Miquel J, Ortiz de Frutos F, Sastre Dominguez J, Valero Santiago A, Terradas-Montana P, Vidal-Jorge M, Jáuregui Presa I. Daily Clinical Practice in the Management of Chronic Urticaria in Spain: Results of the UCREX Study. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:4-14. [DOI: 10.1016/j.ad.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/06/2021] [Indexed: 11/25/2022] Open
|
97
|
Ferrer Puga M, Silvestre Salvador J, Bartra Tomas J, Giménez-Arnau A, Labrador-Horrillo M, Miquel-Miquel J, Ortiz de Frutos F, Sastre Dominguez J, Valero Santiago A, Terradas-Montana P, Vidal-Jorge M, Jáuregui Presa I. [Artículo traducido] Práctica clínica diaria en el manejo de la urticaria crónica en España: resultados del estudio UCREX. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:T4-T14. [DOI: 10.1016/j.ad.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/06/2021] [Indexed: 10/20/2022] Open
|
98
|
Çildağ S, Sargın G, Şentürk T. Clinical and laboratory characteristics of chronic spontaneous urticaria with connective tissue diseases: A cross-sectional study. Arch Rheumatol 2021; 37:205-211. [PMID: 36017211 PMCID: PMC9377178 DOI: 10.46497/archrheumatol.2022.8784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 06/27/2021] [Indexed: 11/03/2022] Open
Abstract
Objectives: The aim of this study was to investigate the frequency of connective tissue diseases (CTDs) in patients with chronic spontaneous urticaria (CSU) and to evaluate clinical and laboratory characteristics of CSU accompanied by CTDs.
Patients and methods: Between January 2017 and December 2020, a total of 390 CSU patients (120 males, 270 females; mean age: 38.9±13.7 years; range, 18 to 78 years) were included in the study. Clinical and laboratory characteristics of CSU in patients with and without CTD were analyzed.
Results: A total of 6.4% patients (n=25) with CSU had CTD, and the rate was found to be 8.9% in female patients (n=24). In these patients, Sjögren syndrome (SS) was seen in 15 (5.5%), rheumatoid arthritis in five (1.85%), undifferentiated connective tissue disease in three (1.11%), and systemic lupus erythematosus in one (0.37%). Anti-thyroglobulin antibody, rheumatoid factor, anti-cyclic citrullinated peptide antibody, antinuclear antibody positivity, low complement 4 level, and erythrocyte sedimentation rate were significantly different between CSU patients with and without CTD (p=0.013, p<0.001, p<0.001, p<0.001, p=0.0182, p<0.001, respectively).
Conclusion: Our study results suggest that CSU is associated with CTDs, particularly with Sjögren syndrome. Every patient diagnosed with CSU should be questioned about rheumatic symptoms, particularly female patients and those having later-onset CSU.
Collapse
Affiliation(s)
- Songül Çildağ
- Department of Internal Medicine, Division of Immunology and Allergy Diseases, Adnan Menderes University, Faculty of Medicine, Aydın, Turkey
| | - Gökhan Sargın
- Department of Internal Medicine, Division of Rheumatology, Adnan Menderes University, Faculty of Medicine, Aydın, Turkey
| | - Taşkın Şentürk
- Department of Internal Medicine, Division of Immunology and Allergy Diseases, Adnan Menderes University, Faculty of Medicine, Aydın, Turkey
| |
Collapse
|
99
|
Di Agosta E, Salvati L, Corazza M, Baiardini I, Ambrogio F, Angileri L, Antonelli E, Belluzzo F, Bonamonte D, Bonzano L, Brancaccio R, Custurone P, De Marco A, Detoraki A, Di Guida A, Di Leo E, Fantò M, Fassio F, Ferrucci SM, Foti C, Gallo R, Gatta A, Guarneri F, Guidolin L, Hansel K, Lamacchia D, Lombardo C, Minciullo PL, Napolitano M, Pannofino A, Paravisi A, Parente R, Passante M, Patruno C, Peroni D, Quecchia C, Schettini N, Spadaro G, Stingeni L, Tarrini D, Tramontana M, Nettis E, Rossi O. Quality of life in patients with allergic and immunologic skin diseases: in the eye of the beholder. Clin Mol Allergy 2021; 19:26. [PMID: 34930291 PMCID: PMC8690422 DOI: 10.1186/s12948-021-00165-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/15/2021] [Indexed: 12/24/2022] Open
Abstract
Allergic and immunologic skin diseases negatively impact the quality of life (QoL) of affected patients with detrimental consequences. Nonetheless, in everyday clinical practice the evaluation of QoL is often overlooked. Considering the increasing prevalence of atopic dermatitis, allergic contact dermatitis, hereditary angioedema, cutaneous mastocytosis, and urticaria, it is essential to determine the effects of allergic and immunologic skin diseases on QoL. A joint meeting (GET TOGETHER 2021) of the Italian Society of Allergology, Asthma and Clinical Immunology (SIAAIC) and the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA) aimed to summarize the features of the main QoL tools used in these diseases and to describe the extent of QoL impairment as well as the impact of treatments on QoL, particularly biologic therapies. The assessment of QoL in patients with allergic and immunologic skin diseases relies on generic, organ-specific and disease-specific questionnaires. While generic and organ-specific questionnaires allow comparison between different diseases, disease-specific questionnaires are designed and validated for specific cohorts: the QoL Index for Atopic Dermatitis (QoLIAD) and the Childhood Atopic Dermatitis Impact Scale (CADIS) in atopic dermatitis, the ACD-11 in allergic contact dermatitis, the Angioedema QoL Questionnaire (AE-QoL) and the Hereditary Angioedema QoL questionnaire (HAE-QoL) in hereditary angioedema, the Mastocytosis QoL Questionnaires (MCQoL e MQLQ) in cutaneous mastocytosis, and the Chronic Urticaria QoL questionnaire (CU-Q2oL) in urticaria. Among the many factors that variably contribute to QoL impairment, pruritus can represent the leading cause of patient discomfort. Biologic therapies significantly ameliorate QoL in atopic dermatitis, hereditary angioedema, mastocytosis and chronic urticaria. In general, adequate management strategies are essential for improving QoL in patients with allergic and immunologic skin diseases.
Collapse
Affiliation(s)
- Ester Di Agosta
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Lorenzo Salvati
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Monica Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ilaria Baiardini
- Respiratory Unit for Continuity of Care, IRCCS Ospedale Policlinico San Martino, Department of Internal Medicine (DiMI), University of Genoa, Genova, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Francesca Ambrogio
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Luisa Angileri
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Elettra Antonelli
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | | | - Domenico Bonamonte
- Department of Biomedical Sciences and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Laura Bonzano
- Dermatology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Raffaele Brancaccio
- Division of Allergy and Clinical Immunology, "Santa Maria Della Speranza" Hospital, Salerno, Italy
| | - Paolo Custurone
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Aurora De Marco
- Department of Biomedical Sciences and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Aikaterini Detoraki
- Department of Internal Medicine, Clinical Immunology, Clinical Pathology and Infectious Disease, Azienda Ospedaliera Universitaria Federico II, Napoli, Italy
| | - Adriana Di Guida
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Elisabetta Di Leo
- Section of Allergy and Clinical Immunology, Unit of Internal Medicine-"F. Miulli" Hospital, Acquaviva Delle Fonti, Bari, Italy
| | - Marta Fantò
- Unit of Allergology, Department of Dermatology, Policlinico Umberto I, Hospital-University Sapienza of Rome, Roma, Italy
| | - Filippo Fassio
- Allergy and Clinical Immunology Unit, San Giovanni di Dio Hospital, Firenze, Italy
| | - Silvia Mariel Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Caterina Foti
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Rosella Gallo
- Section of Dermatology - Department of Health Sciences, University of Genoa, Ospedale Policlinico San Martino - IRCCS, Genova, Italy
| | - Alessia Gatta
- Department of Medicine and Science of Ageing, G. d'Annunzio University, Chieti, Italy
| | - Fabrizio Guarneri
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Lucia Guidolin
- Allergy Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Katharina Hansel
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Donatella Lamacchia
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Carla Lombardo
- Allergy Unit, Villa Igea Hospital. A.P.S.S. Trento, Trento, Italy
| | - Paola Lucia Minciullo
- Department of Clinical and Experimental Medicine, School and Division of Allergy and Clinical Immunology, University Hospital 'G. Martino', Messina, Italy
| | - Maddalena Napolitano
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Alessandro Pannofino
- Allergology and Immunology Clinic, Operative Unit of Medicine, Policoro Hospital, Policoro, Matera, Italy
| | - Andrea Paravisi
- Section of Dermatology, Department of Health Sciences, University of Genoa, Ospedale Policlinico San Martino - IRCCS, Genova, Italy
| | - Roberta Parente
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Maria Passante
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Diego Peroni
- Section of Pediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Cristina Quecchia
- Io e l'Asma Center, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Natale Schettini
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Napoli, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Daniele Tarrini
- Allergy and Clinical Immunology Unit, Department of Clinical Medicine, Mauriziano Umberto I Hospital, University of Turin, Torino, Italy
| | - Marta Tramontana
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy
| | - Oliviero Rossi
- Immunoallergology Unit, SOD Immunoallergologia, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
| |
Collapse
|
100
|
Foti C, Romita P, Ambrogio F, Fanelli M, Panebianco R, Vena GA, Cassano N, Ragusa M, Giuffrida R, Papaianni V, Borgia F, Cannavò SP, Guarneri F. Analysis of clinical factors as possible predictors of response to omalizumab and relapse after treatment discontinuation in chronic spontaneous urticaria. Dermatol Ther 2021; 35:e15248. [PMID: 34877757 DOI: 10.1111/dth.15248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/30/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022]
Abstract
Omalizumab is a monoclonal anti-IgE antibody which is effective in chronic spontaneous urticaria (CSU), although clinical response appears to be variable in the real-life setting. The aim of this study was to evaluate whether the response of CSU to omalizumab and disease relapse are associated with individual and/or clinical characteristics of patients. We retrospectively evaluated the clinical records of 124 patients treated with omalizumab for moderate to severe CSU refractory to antihistamines. Disease activity was assessed using the urticaria activity score over the last 7 days (UAS7). After 24 weeks of treatment, 91% of patients showed complete remission (UAS7 = 0) or good control (UAS7 < 7) of CSU. Omalizumab was re-administered in 45 patients because of recurrence of moderate to severe symptoms at week 8 after treatment discontinuation or later, and clinical results achieved with retreatment were similar to those observed in the first course. Among the parameters included in our analysis (age and sex of patients, documented history of atopy or autoimmune thyroid disease, CSU duration and baseline severity, concurrent angioedema, and association with chronic inducible urticaria), none was associated with response to omalizumab in our study population. Similarly, these parameters did not significantly differ between patients who experienced CSU relapse and those without relapse. Predictors of response to omalizumab treatment in CSU patients are still unclear, and further studies are needed to evaluate the presence of baseline factors that can influence treatment outcome.
Collapse
Affiliation(s)
- Caterina Foti
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Paolo Romita
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Francesca Ambrogio
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Margherita Fanelli
- Department of Interdisciplinary Medicine, "Aldo Moro" University of Bari, Bari, Italy
| | - Rosanna Panebianco
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | | | | | - Mariagrazia Ragusa
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine - Dermatology, University of Messina, Messina, Italy
| | - Valeria Papaianni
- Department of Clinical and Experimental Medicine - Dermatology, University of Messina, Messina, Italy
| | - Francesco Borgia
- Department of Clinical and Experimental Medicine - Dermatology, University of Messina, Messina, Italy
| | | | - Fabrizio Guarneri
- Department of Clinical and Experimental Medicine - Dermatology, University of Messina, Messina, Italy
| |
Collapse
|