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Shamblen C. What is causing this patient's urticaria? JAAPA 2024; 37:22-26. [PMID: 39051691 DOI: 10.1097/01.jaa.0000000000000021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
ABSTRACT This article describes a teenage patient who was referred to a pediatric endocrinologist after her workup for recurring urticaria revealed a suppressed thyroid-stimulating hormone level and positive microsomal thyroid peroxidase antibodies. The patient's laboratory results revealed an autoimmune cause for the urticaria as a result of new-onset autoimmune thyroid disease.
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Affiliation(s)
- Carla Shamblen
- Carla Shamblen is director of clinical education and an associate professor in the PA program at Creighton University in Phoenix, Ariz. The author has disclosed no potential conflicts of interest, financial or otherwise
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2
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Buono EV, Giannì G, Scavone S, Caffarelli C. Clinical Characteristics, Investigations and Treatment in Children with Chronic Urticaria: An Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:704. [PMID: 38792886 PMCID: PMC11122882 DOI: 10.3390/medicina60050704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/17/2024] [Accepted: 04/21/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: The guidelines for chronic urticaria in children contain recommendations that are often based on adult studies. The diagnostic pathway has not been standardized and the effectiveness of anti-H1, omalizumab, montelukast, and systemic glucocorticoids is rarely reported in the pediatric population. There is a wide variation in the rate of remission of chronic urticaria between studies. The aim of this study is to enhance our understanding of pediatric chronic urticaria. Materials and Methods: This study enrolled 37 children with chronic urticaria aged from 0 to 18 years. Demographic parameters, medical history, clinical features, laboratory data and treatment information were collected. Children were treated with the recommended dosage of second-generation H1-antihistamines, which was increased by up to twofold. Omalizumab was added for refractory anti-H1 patients. A three-day course with systemic glucocorticoids was administered for severe exacerbations. Montelukast was administered to some children. Results: Wheals without angioedema were common. Chronic urticaria was spontaneous in 32 children (86.48%), inducible in 2 (5.41%), induced by a parasite in 1 and vasculitic in 2. Treatment of the potential causes of chronic urticaria was of no benefit, except for eradication of Dientamoeba fragilis. Chronic urticaria was resolved within three years in 45.9% of cases. Allergic diseases were present in nine children (24.32%) and autoimmune diseases were present in three (8.11%). All children were treated with anti-H1 at the licensed dose or at a higher dose. A partial or complete response to anti-H1 was observed in 29 (78.38%) patients. Montelukast showed no benefit. All children treated with omalizumab responded. Systemic glucocorticoids were successfully used to treat exacerbations. Conclusions: Our findings indicate that laboratory tests should not be routinely performed in children with chronic urticaria without clinical suspicion. However, comorbidities such as thyroid autoimmune disease and coeliac disease are suggested to be monitored over the chronic urticaria course. These clinical conditions could be diagnosed from the diagnostic framework of chronic urticaria. Increasing the dosage of anti-H1 and omalizumab was effective in children resistant to standard treatment but we still need further studies to generate a standard patient-centered treatment.
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Affiliation(s)
| | | | | | - Carlo Caffarelli
- Clinica Pediatrica, Azienda Ospedaliero-Universitaria, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (E.V.B.); (G.G.); (S.S.)
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3
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Momin ZK, Chambliss JM. Chronic spontaneous urticaria preceded by localized insulin reactions: case report. SAGE Open Med Case Rep 2024; 12:2050313X241248383. [PMID: 38655126 PMCID: PMC11036908 DOI: 10.1177/2050313x241248383] [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: 08/14/2023] [Accepted: 04/02/2024] [Indexed: 04/26/2024] Open
Abstract
Chronic spontaneous urticaria presents with wheals and/or angioedema for >6 weeks without any specific triggers. The incidence of chronic spontaneous urticaria is increased in patients with comorbid autoimmune conditions. Here, we present a case of chronic spontaneous urticaria in a 9-year-old with type 1 diabetes and autoimmune thyroid disease who first presented with insulin pump site reactions concerning an insulin-related allergy. The patient was successfully treated with antihistamines and later immunosuppression with resumption of insulin pump therapy and remission of chronic spontaneous urticaria symptoms 18 months after onset.
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Affiliation(s)
- Zoha K. Momin
- Division of Allergy and Immunology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey M. Chambliss
- Division of Allergy and Immunology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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4
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Peng C, Tang L, Yu N, Ding Y, Shi Y. Global, regional and national burden of urticaria from 1990 to 2019. J Eur Acad Dermatol Venereol 2023; 37:e1330-e1332. [PMID: 37417352 DOI: 10.1111/jdv.19314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Chen Peng
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Li Tang
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Ning Yu
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Yangfeng Ding
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Yuling Shi
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
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5
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Lagacé F, D’Aguanno K, Prosty C, Laverde-Saad A, Cattelan L, Ouchene L, Oliel S, Genest G, Doiron P, Richer V, Jfri A, O’Brien E, Lefrançois P, Powell M, Moreau L, Litvinov IV, Muntyanu A, Netchiporouk E. The Role of Sex and Gender in Dermatology - From Pathogenesis to Clinical Implications. J Cutan Med Surg 2023; 27:NP1-NP36. [PMID: 37401812 PMCID: PMC10486181 DOI: 10.1177/12034754231177582] [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: 01/05/2023] [Revised: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Sex and gender have increasingly been recognized as significant risk factors for many diseases, including dermatological conditions. Historically, sex and gender have often been grouped together as a single risk factor in the scientific literature. However, both may have a distinct impact on disease incidence, prevalence, clinical presentation, severity, therapeutic response, and associated psychological distress. OBJECTIVES AND PROJECT DESCRIPTION The mechanisms that underlie differences in skin diseases between males, females, men, and women remain largely unknown. The specific objectives of this review paper are:To highlight the biological differences between males and females (sex), as well as the sociocultural differences between men and women (gender) and how they impact the integumentary system.To perform a literature review to identify important sex- and gender-related epidemiological and clinical differences for various skin conditions belonging to a range of disease categories and to discuss possible biological and sociocultural factors that could explain the observed differences.To discuss dermatological skin conditions and gender-affirming treatments within the transgender community, a population of individuals who have a gender identity which is different than the gender identity they were assigned at birth. FUTURE IMPACT With the rising number of individuals that identify as non-binary or transgender within our increasingly diverse communities, it is imperative to recognize gender identity, gender, and sex as distinct entities. By doing so, clinicians will be able to better risk-stratify their patients and select treatments that are most aligned with their values. To our knowledge, very few studies have separated sex and gender as two distinct risk factors within the dermatology literature. Our article also has the potential to help guide future prevention strategies that are patient-tailored rather than using a universal approach.
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Affiliation(s)
- François Lagacé
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | | | - Connor Prosty
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Alexandra Laverde-Saad
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Leila Cattelan
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Lydia Ouchene
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Sarah Oliel
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Genevieve Genest
- Division of Allergy and Immunology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Philip Doiron
- Division of Dermatology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Richer
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Abdulhadi Jfri
- Department of Dermatology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Elizabeth O’Brien
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Philippe Lefrançois
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Mathieu Powell
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Linda Moreau
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Ivan V. Litvinov
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Anastasiya Muntyanu
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Elena Netchiporouk
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
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6
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Staubach P, Alvaro-Lozano M, Sekerel BE, Maurer M, Ben-Shoshan M, Porter M, Hua E, Ji Y, Burciu A, Savelieva M, Severin T, Drollmann A, Bienczak A. Ligelizumab in adolescents with chronic spontaneous urticaria: Results of a dedicated phase 2b randomized clinical trial supported with pharmacometric analysis. Pediatr Allergy Immunol 2023; 34:e13982. [PMID: 37492920 DOI: 10.1111/pai.13982] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU), a long-lasting disease in children, impacts their quality of life. We report the results of a phase 2b dose-finding trial of ligelizumab (NCT03437278) and a high-affinity humanized monoclonal anti-IgE antibody, in adolescents with CSU, supported by modeling and simulation analyses, mitigating challenges in pediatric drug development. METHODS This multicenter, double-blind, placebo-controlled trial, randomized H1-antihistamine-refractory adolescent CSU patients (12-18 years) 2:1:1 to ligelizumab 24 mg, 120 mg, or placebo every 4 weeks for 24 weeks. Patients on placebo transitioned to ligelizumab 120 mg at week 12. Integrating data from the previous adult and present adolescent trial of ligelizumab, a nonlinear mixed-effects modeling described the longitudinal changes in ligelizumab pharmacokinetics, and its effect on weekly Urticaria Activity Score (UAS7). RESULTS Baseline UAS7 (mean ± SD) was 30.5 ± 7.3 (n = 24), 29.3 ± 7.7 (n = 13), and 32.5 ± 9.0 (n = 12) for patients (median age, 15 years) on ligelizumab 24 mg, 120 mg, and placebo, respectively. Change from baseline in UAS7 at week 12 with ligelizumab 24 mg, 120 mg, and placebo was -15.7 ± 10.9, -18.4 ± 12.3, and -13.0 ± 13.0, respectively. Ligelizumab was well-tolerated. The modeling analysis showed that body weight, but not age, affected ligelizumab's apparent clearance. No significant differences between adolescents and adults were detected on the model-estimated maximum effect and potency. CONCLUSIONS Ligelizumab exhibited efficacy and safety in adolescent CSU patients, consistent with that in adults. The PK and potency of ligelizumab were not impacted by age, and the same dose of ligelizumab can be used for treating adolescents and adults with CSU. Our study shows how modeling and simulation can complement pediatric drug development.
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Affiliation(s)
- Petra Staubach
- Department of Dermatology, University Medical Center, Mainz, Germany
| | - Montserrat Alvaro-Lozano
- Department of Pediatric Allergology and Clinical Immunology, Hospital Sant Joan de Déu, Esplugues (Barcelona), Institut de Recerca Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Bulent Enis Sekerel
- Faculty of Medicine, Pediatric Allergy and Asthma Unit, Hacettepe University, Ankara, Turkey
| | - 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
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Paediatrics, Montreal Children's Hospital McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Eva Hua
- Shanghai Novartis Trading Ltd., Shanghai, China
| | - Yan Ji
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
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7
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Podder I, Atanaskovic-Markovic M, Kolkhir P. Editorial comment on "Pediatric chronic urticaria: Clinical and laboratory characteristics and factors linked to remission". Pediatr Allergy Immunol 2023; 34:e13960. [PMID: 37366216 DOI: 10.1111/pai.13960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 06/28/2023]
Affiliation(s)
- Indrashis Podder
- Department of Dermatology, College of Medicine and Sagore Dutta Hospital, Kolkata, India
| | - Marina Atanaskovic-Markovic
- Faculty of Medicine, University of Belgrade, Beograd, Serbia
- University Children's Hospital of Belgrade, Beograd, Serbia
| | - Pavel Kolkhir
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
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8
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Konstantinou GN, Konstantinou GN. Psychiatric comorbidities in children and adolescents with chronic urticaria. World J Pediatr 2023; 19:315-322. [PMID: 36376557 DOI: 10.1007/s12519-022-00641-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/16/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic urticaria (CU) has been shown to impact patients' quality of life negatively and may coexist with psychiatric disorders. We systematically reviewed the published evidence of comorbid psychiatric disorders in children and adolescents with CU. METHODS A systematic review of studies published until February 2022 in PubMed, Google Scholar, and Scopus was performed. An a priori set of inclusion criteria was predefined for the studies to be included: (1) clear distinction between urticaria and other allergies; (2) precise distinction between acute and CU; (3) participants younger than 18 years old, exclusively; (4) use of appropriate standardized questionnaires, psychometric tools, and standard diagnostic nomenclature for the mental health and behavioral disorders diagnosis; and (5) manuscripts written or published in the English language. RESULTS Our search identified 582 potentially relevant papers. Only eight of them satisfied the inclusion criteria. Quantitative meta-analysis was not deemed appropriate, given the lack of relevant randomized control trials, the small number of relevant shortlisted, the small sample size of the patients included in each study, and the remarkable heterogeneity of the studies' protocols. CONCLUSIONS The included studies suggest an increased incidence of psychopathology among children and adolescents with CU as opposed to healthy age-matched individuals, but the data are scarce. Further research is required to clarify whether psychopathology is just a comorbid entity, the cause, or the consequence of CU. Meanwhile an interdisciplinary collaboration between allergists/dermatologists and psychiatrists is expected to substantially minimize CU burden and improve patients' quality of life.
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Affiliation(s)
- George N Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloníki, Greece.
| | - Gerasimos N Konstantinou
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Center for Addiction and Mental Health (CAMH), Toronto, ON, Canada
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Sandoval-Ruballos M, Domínguez O, Ortiz de Landazuri I, Gereda D, Espinoza Cisneros M, Quesada Sequeira F, Ramos Rodríguez SM, Machinena A, Piquer M, Folqué MDM, Lozano J, Jiménez-Feijoo R, Pascal M, Alvaro-Lozano M. Pediatric chronic urticaria: Clinical and laboratory characteristics and factors linked to remission. Pediatr Allergy Immunol 2023; 34:e13929. [PMID: 36974641 DOI: 10.1111/pai.13929] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/06/2023] [Accepted: 02/13/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Chronic urticaria (CU) is defined as the occurrence of wheals/angioedema for ≥6 consecutive weeks. Until now, guidelines and publications addressing CU have focused mainly on adults. As a result, evidence and guidance in the pediatric population are scarce. METHODS This study aims to describe clinical and laboratory findings in pediatric CU and to determine factors associated with remission. RESULTS 185 patients, 54% female, median age at onset of 8.8 years. Angioedema was present in almost half. The most common type of CU was chronic spontaneous urticaria (CSU) in 74%. At least one atopic comorbidity was found in almost a third (35%). In addition, 8% had an autoimmune disorder (exclusively in CSU) and 9% had a psychiatric condition. Basopenia was found in 67% and was more frequently associated with CSU. The basophil activation test (BAT) was positive in 40%. With regard to remission, being of male sex, angioedema absence, the absence of physical triggers, and eosinophil counts >0.51 × 109 /L were associated with shorter CU duration. CONCLUSION Atopy is a common condition in pediatric CU. CSU is the most common type. Autoimmune comorbidities and basopenia were significantly more common in CSU. In addition, ours is one of the few studies, assessing BAT utility in the pediatric population, being positive in a relevant percentage (40%). BAT positivity was more frequent in CSU. Our results suggest that the absence of angioedema and physical triggers, male sex, and eosinophil counts >0.51 × 109 /L appear to be associated with a better prognosis in terms of remission.
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Affiliation(s)
- Mónica Sandoval-Ruballos
- Pediatric Allergology and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Olga Domínguez
- Pediatric Allergology and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - Daniella Gereda
- Pediatric Allergology and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | | | | | | | - Adrianna Machinena
- Pediatric Allergology and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Mónica Piquer
- Pediatric Allergology and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - María Del Mar Folqué
- Pediatric Allergology and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Jaime Lozano
- Pediatric Allergology and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Rosa Jiménez-Feijoo
- Pediatric Allergology and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Mariona Pascal
- Immunology Department, CDB, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Montserrat Alvaro-Lozano
- Pediatric Allergology and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
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10
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Karim J, Gabrielli S, Mule P, Torabi B, Byrne A, De Schryver S, Gadoury-Lévesque V, Alizadehfar R, McCusker C, Zhang X, Ben-Shoshan M. Bridging knowledge gaps in paediatric chronic urticaria through a video-based educational tool. Clin Exp Dermatol 2023; 48:108-111. [PMID: 36730510 DOI: 10.1093/ced/llac054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/27/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND There is a lack of patient educational resources about chronic urticaria (CU). AIMS To develop and test the effectiveness of an education tool to help paediatric patients and their families better understand CU and its management. METHODS From July 2020 to May 2022, paediatric patients with a history of CU who presented to the allergy outpatient clinics at our institution were recruited. Consenting families and patients were asked to complete five questions related to the definition, causes and management of CU at the time of presentation to the clinic. Participants were shown a 5-min animated video addressing the main knowledge gaps about CU. At the end of the video, participants were redirected to the same five questions to respond again. The scores were recorded as a proportion of correct answers (range 0·0-1·0). RESULTS In total, 53 patients [30 girls (56·6%), 23 boys (43·4%); mean age 9·7 ± 5·1 years, range 1·4-18·5 years] were recruited. The mean baseline pre-video education questionnaire score was 0·67 ± 0·2 (range 0·2-1·0), while the mean post-video score was 0·94 ± 0·1 (range 0·4-1·0), a mean score difference of 0·27, which was statistically significant (P < 0·001). At the 1-year follow-up, 14 (26·4%) patients answered the questionnaire again to assess retention of knowledge; the mean score was 0·83 ± 0·2 (range 0·2-1·0). CONCLUSIONS Our educational video was successful in educating patients and their families to better understand urticaria. Future studies should aim to optimize patient education through nontraditional tools such as videos, and compare knowledge gain using different methods of education.
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Affiliation(s)
- Jumanah Karim
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada, UK
| | - Sofianne Gabrielli
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada, UK
| | - Pasquale Mule
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada, UK
| | - Bahar Torabi
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada, UK
| | - Adam Byrne
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada, UK
| | - Sarah De Schryver
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada, UK
| | - Vanessa Gadoury-Lévesque
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada, UK
| | - Reza Alizadehfar
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada, UK
| | - Christine McCusker
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada, UK
| | - Xun Zhang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada, UK
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada, UK
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11
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Zhu CK, Nguyen A, Prosty C, Gabrielli S, Laboccetta V, Shand G, Mulé P, Netchiporouk E, Le M, Zhang X, Ke D, Baum S, Hakroush R, Greenberger S, Ben-Shoshan M. Safety of COVID-19 mRNA vaccination in children with chronic urticaria. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1310-1313.e2. [PMID: 36621604 PMCID: PMC9812818 DOI: 10.1016/j.jaip.2022.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 12/04/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Catherine K Zhu
- Faculty of Medicine, McGill University, Montreal, QC, Canada.
| | - Alex Nguyen
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Connor Prosty
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Vera Laboccetta
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Greg Shand
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Pasquale Mulé
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, QC, Canada
| | - Elena Netchiporouk
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Michelle Le
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Xun Zhang
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Danbing Ke
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Sharon Baum
- Department of Dermatology, Chaim Sheba Medical Center, Tel-Aviv University, Sackler School of Medicine, Tel HaShomer, Israel
| | - Reman Hakroush
- Pediatric Dermatology Service, Department of Dermatology, Sheba Medical Center, Sackler School of Medicine, Ramat Gan, Israel
| | - Shoshana Greenberger
- Pediatric Dermatology Service, Department of Dermatology, Sheba Medical Center, Sackler School of Medicine, Ramat Gan, Israel
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, QC, Canada
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12
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Urticaria and Angioedema: Understanding Complex Pathomechanisms to Facilitate Patient Communication, Disease Management, and Future Treatment. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:94-106. [PMID: 36610760 DOI: 10.1016/j.jaip.2022.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 01/06/2023]
Abstract
Chronic spontaneous urticaria (CSU) is primarily a T2-dominant disease with a complex genetic background. Skin mast cell activation can be induced not only via the IgE-FcεRI axis but also from several other distinct mechanisms, molecules, and receptors involved in CSU onset, persistence, and exacerbation. These include autoallergy, autoimmunity, central or peripheral neuroimmune dysregulation, activation of both extrinsic and intrinsic coagulation pathways, and microbial infections. Besides mast cells, recent reports suggest the active and direct involvement of basophils and eosinophils. Several biological characteristics or biomarkers have been linked with CSU's known endotypes and may help forecast therapeutic responses. The introduction of biologic therapy for CSU has been a major advance in the last 10 years. The cornerstone of angioedema (AE) pathogenesis is increased vascular permeability and plasma leakage into the deeper dermis and subcutis, either mediated by histamine or bradykinin (BK). C1-inhibitor deficiency, hereditary or acquired, is the primary cause of BK-mediated AE due to increased plasma BK concentration. Other complex conditions have been identified, with some likely involving contact system dysregulation and other putative mechanisms related to vascular endothelial dysfunction. The approval of multiple hereditary-AE-specific therapies for both prevention and acute attacks has revolutionized treatment of this disease. Any new knowledge of the pathogenesis of CSU and AE offers the opportunity to improve patient information, physician-patient communication, prediction of therapeutic responses, selection of precise tailor-made treatment for each patient, and exploration of novel treatment options for those who do not achieve disease control with current medications.
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13
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Votto M, Achilli G, De Filippo M, Licari A, Marseglia A, Moiraghi A, Di Sabatino A, Marseglia GL. Pediatric chronic spontaneous urticaria: a brief clinician's guide. Expert Rev Clin Immunol 2022; 18:889-899. [PMID: 35833360 DOI: 10.1080/1744666x.2022.2101999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chronic urticaria (CU) appears with daily or intermittent/recurrent wheals with/without angioedema for more than six weeks. When no specific eliciting factors are found, chronic urticaria is defined as spontaneous (CSU). Up to 50% of patients with CSU do not respond to therapy, leading to a prolonged disease course and the need for expensive therapies, impacting the quality of life (QoL) and healthcare resources. AREAS COVERED : Diagnosis of CSU is made when other potential causes of chronic urticaria are excluded. CSU therapy aims to achieve complete control of symptoms and normalization of QoL. Current treatment options for urticaria aim to target mast cell mediators such as histamine, or activators, such as autoantibodies. Guidelines recommend starting with second generation antihistamines (sgAHs) and adding omalizumab therapy if symptoms are not controlled. This review aims to provide a practical guide for CSU in the pediatric population. EXPERT OPINION : Treatment options for pediatric CSU are primarily based on adult data that have been extrapolated for children. Current guidelines should be re-evaluated based on pediatric data, new biological treatments, and the COVID-19 pandemic. Future research is needed to investigate strategies to personalize current treatments and identify potential predictive biomarkers.
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Affiliation(s)
- Martina Votto
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
| | - Giovanna Achilli
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Maria De Filippo
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.,Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Amelia Licari
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.,Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessia Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
| | - Alice Moiraghi
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Gian Luigi Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.,Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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14
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Prosty C, Gabrielli S, Mule P, Le Gallee M, Miles LM, Le M, Zhang X, Ensina LF, Netchiporouk E, Ben-Shoshan M. Cold urticaria in a pediatric cohort: Clinical characteristics, management, and natural history. Pediatr Allergy Immunol 2022; 33:e13751. [PMID: 35338743 DOI: 10.1111/pai.13751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/04/2022] [Accepted: 02/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cold urticaria (coldU) is associated with substantial morbidity and risk of fatality. Data on coldU in children are sparse. We aimed to evaluate the clinical characteristics, management, risk of associated anaphylaxis, and resolution rate of coldU in a pediatric cohort. Additionally, we sought to compare these metrics to children with chronic spontaneous urticaria (CSU). METHODS We prospectively enrolled children with coldU from 2013-2021 in a cohort study at the Montreal Children's Hospital and an affiliated allergy clinic. Data for comparison with participants with solely CSU were extracted from a previous study. Data on demographics, comorbidities, severity of presentation, management, and laboratory values were collected at study entry. Patients were contacted yearly to assess for resolution. RESULTS Fifty-two children with cold urticaria were recruited, 51.9% were female and the median age of symptom onset was 9.5 years. Most patients were managed with second-generation H1-antihistamines (sgAHs). Well-controlled disease on sgAHs was negatively associated with concomitant CSU (adjusted odds ratio (aOR) = 0.69 [95%CI: 0.53, 0.92]). Elevated eosinophils were associated with cold-induced anaphylaxis (coldA; aOR = 1.38 [95%CI: 1.04, 1.83]), which occurred in 17.3% of patients. The resolution rate of coldU was 4.8 per 100 patient-years, which was lower than that of CSU (adjusted hazard ratio = 0.43 [95%CI: 0.21, 0.89], p < 10-2 ). CONCLUSION Pediatric coldU bears a substantial risk of anaphylaxis and a low-resolution rate. Absolute eosinophil count and co-existing CSU may be useful predictive factors.
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Affiliation(s)
- Connor Prosty
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Sofianne Gabrielli
- Faculty of Medicine, McGill University, Montreal, QC, Canada.,Division of Pediatric Allergy, Immunology, and Dermatology, Montreal Children's Hospital, Montreal, QC, Canada
| | - Pasquale Mule
- Division of Pediatric Allergy, Immunology, and Dermatology, Montreal Children's Hospital, Montreal, QC, Canada
| | | | - Laura May Miles
- Division of Pediatric Allergy, Immunology, and Dermatology, Montreal Children's Hospital, Montreal, QC, Canada
| | - Michelle Le
- Division of Dermatology, McGill University, Montreal, QC, Canada
| | - Xun Zhang
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Luis F Ensina
- Division of Allergy, Clinical Immunology, and Rheumatology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Moshe Ben-Shoshan
- Division of Pediatric Allergy, Immunology, and Dermatology, Montreal Children's Hospital, Montreal, QC, Canada
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15
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Rodríguez Del Río P, Rodríguez Fernández F, Ballester Asensio E, Tortajada-Girbés M. How bilastine is used to treat allergic rhinitis and urticaria in children. Immunotherapy 2021; 14:77-89. [PMID: 34850647 DOI: 10.2217/imt-2021-0251] [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] [Indexed: 12/28/2022] Open
Abstract
Management guidelines for allergic rhinitis and urticaria recommend oral second-generation antihistamines as first-line treatment. The efficacy and safety of bilastine, the newest nonsedating second-generation antihistamine, are well established in adolescents/adults with these allergic conditions. The bilastine development program for pediatric use (2-<12 years) followed EMA-authorized processes. Pharmacokinetic/pharmacodynamic simulation and modeling and a pharmacokinetic study were conducted to identify and confirm the pediatric dose (10 mg/day). A Phase III, multicenter, double-blind, randomized, placebo-controlled, parallel-group study was performed to confirm the safety of bilastine 10 mg/day in children. In this article, evidence is reviewed for use of bilastine in children with allergic rhinoconjunctivitis or urticaria. Several cases are presented which demonstrate its role in routine clinical practice.
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Affiliation(s)
| | | | - Esther Ballester Asensio
- Pediatric Pulmonology & Allergy Unit, Dr Peset University Hospital, Valencia, 46017, Spain.,Department of Pediatrics, Obstetrics & Gynecology, University of Valencia, Valencia, 46101, Spain
| | - Miguel Tortajada-Girbés
- Pediatric Pulmonology & Allergy Unit, Dr Peset University Hospital, Valencia, 46017, Spain.,Department of Pediatrics, Obstetrics & Gynecology, University of Valencia, Valencia, 46101, Spain.,IVI Foundation, Valencia, 46026, Spain
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16
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Sabroe RA, Lawlor F, Grattan CEH, Ardern-Jones MR, Bewley A, Campbell L, Flohr C, Leslie TA, Marsland AM, Ogg G, Sewell WAC, Hashme M, Exton LS, Mohd Mustapa MF, Ezejimofor MC. British Association of Dermatologists guidelines for the management of people with chronic urticaria 2021. Br J Dermatol 2021; 186:398-413. [PMID: 34773650 DOI: 10.1111/bjd.20892] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/30/2022]
Abstract
The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the management of urticaria. The document aims to: offer an appraisal of all relevant literature up to March 2020, focusing on any key developments address important, practical clinical questions relating to the primary guideline objective provide guideline recommendations and if appropriate research recommendations The guideline is presented as a detailed review with highlighted recommendations for practical use in primary, secondary and tertiary care, in addition to an updated Patient Information Leaflet (PIL; available on the BAD Skin Health Information website, https://www.skinhealthinfo.org.uk/a-z-conditions-treatments/).
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Affiliation(s)
- R A Sabroe
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, U.K
| | - F Lawlor
- St John's Institute of Dermatology, NHS Foundation Trust, Guy's and St Thomas, London, SE1 9RT, U.K
| | - C E H Grattan
- St John's Institute of Dermatology, NHS Foundation Trust, Guy's and St Thomas, London, SE1 9RT, U.K
| | - M R Ardern-Jones
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, U.K
| | - A Bewley
- Barts Health NHS Trust and Queen Mary University of London Medical School, London, E1 1BB, U.K
| | | | - C Flohr
- St John's Institute of Dermatology, NHS Foundation Trust, Guy's and St Thomas, London, SE1 9RT, U.K
| | - T A Leslie
- Royal Free London NHS Foundation Trust, Pond St, London, NW3 2QG, U.K
| | - A M Marsland
- University of Manchester & Salford Royal Hospital, Salford, M6 8HD, U.K
| | - G Ogg
- MRC Human Immunology Unit, The MRC Weatherall Institute of Molecular Medicine, University of Oxford, NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, OX3 9DS, U.K
| | | | - M Hashme
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
| | - L S Exton
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
| | - M C Ezejimofor
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
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17
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Immunological Targets of Biologic Drugs in Allergic Skin Diseases in Children. Biomedicines 2021; 9:biomedicines9111615. [PMID: 34829844 PMCID: PMC8616006 DOI: 10.3390/biomedicines9111615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/25/2022] Open
Abstract
Atopic dermatitis and urticaria are two invalidating skin disorders that are very common in children. Recent advances in the understanding of their specific intracellular molecular pathways have permitted the development of precise biological molecules, targeting inflammatory mediators and arresting the pathogenetic pathways of skin diseases. Many biologics with promising results have been studied, although few are currently approved in children. In this review, we aim to provide the latest evidence about the use, indications, efficacy and safety of biologic therapies to treat atopic dermatitis and chronic urticaria in children and adolescents.
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18
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Prosty C, Gabrielli S, Le M, Ensina LF, Zhang X, Netchiporouk E, Ben-Shoshan M. Prevalence, Management, and Anaphylaxis Risk of Cold Urticaria: A Systematic Review and Meta-Analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:586-596.e4. [PMID: 34673287 DOI: 10.1016/j.jaip.2021.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/08/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cold urticaria is a subtype of chronic inducible urticaria (CIndU) associated with significant morbidity and a risk for anaphylaxis. Few studies have assessed the prevalence, management, and prevalence of associated anaphylaxis of cold urticaria. OBJECTIVES To evaluate the prevalence of cold urticaria among CIndU and chronic urticaria (CU) cases, to assess the management of cold urticaria, and to determine the prevalence of associated anaphylaxis. METHODS We searched PubMed and EMBASE for studies pertaining to cold urticaria and/or CIndU published in the past 10 years. We conducted meta-analyses to evaluate the prevalence of cold urticaria among CIndU and CU cases, the management of cold urticaria with H1-antihistamines and omalizumab, and the prevalence of associated anaphylaxis. RESULTS Twenty-two studies were included in the systematic review and 14 in the meta-analysis. The pooled prevalence of cold urticaria among patients with CU and CIndU was 7.62% (95% confidence interval [CI], 3.45% to 15.99%; I2 = 98%) and 26.10% (95% CI, 14.17% to 43.05%; I2 = 97%), respectively. Cold urticaria was managed by H1-antihistamines in 95.67% (95% CI, 92.47% to 97.54%; I2 = 38%) of patients and omalizumab in 5.95% (95% CI , 2.55% to 13.27%; I2 = 83%) of patients. The pooled prevalence of anaphylaxis among patients with cold urticaria was 21.49% (95% CI, 15.79% to 28.54%; I2 = 69%). CONCLUSIONS Cold urticaria constitutes an appreciable proportion of CIndU and CU cases and is predominantly managed with H1-antihistamines; few patients receive omalizumab. Anaphylaxis is common, and an epinephrine autoinjector prescription may be considered.
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Affiliation(s)
- Connor Prosty
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Sofianne Gabrielli
- Division of Allergy, Immunology, and Dermatology, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Michelle Le
- Division of Dermatology, McGill University, Montreal, Quebec, Canada
| | - Luis F Ensina
- Department of Pediatrics, Federal University of São Paolo, São Paolo, Brazil
| | - Xun Zhang
- Centre for Outcome Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Moshe Ben-Shoshan
- Division of Allergy, Immunology, and Dermatology, Montreal Children's Hospital, Montreal, Quebec, Canada
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19
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Weller K, Maurer M, Bauer A, Wedi B, Wagner N, Schliemann S, Kramps T, Baeumer D, Multmeier J, Hillmann E, Staubach P. Epidemiology, comorbidities, and healthcare utilization of patients with chronic urticaria in Germany. J Eur Acad Dermatol Venereol 2021; 36:91-99. [PMID: 34622498 DOI: 10.1111/jdv.17724] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/02/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Comprehensive data on the epidemiology and comorbidities of chronic urticaria (CU) in Germany are either limited, or not contemporary. OBJECTIVES To investigate the epidemiology of CU, overall comorbidities and healthcare resource utilized by patients with CU in Germany, using an anonymized statutory health insurance (SHI) database. METHODS Anonymized SHI claims research database of the Institute for Applied Health Research, Berlin [InGef] (01 January 2015-30 September 2018) was used to analyse insured individuals with a confirmed diagnosis of CU (ICD-10-GM codes). Twelve-month diagnosed prevalence and incidence, comorbidities (vs. atopic dermatitis and psoriasis), and healthcare utilization by patients with CU were investigated. RESULTS Of 4 693 772 individuals of all ages listed in the database, 3 538 540 were observable during 2017. Overall, 17 524 patients (˜0.5%) were diagnosed with CU; chronic spontaneous urticaria (CSU: 71.2%), chronic inducible urticaria (CIndU: 19.7%), CSU+CIndU (9.1%). Females, vs. males, had higher diagnosed prevalence (0.62% vs. 0.37%) and diagnosed incidence (0.18% vs. 0.11%) of CU among all patients. Patients most frequently visited general practitioners (41.3% of total visits). Hypertensive diseases (43.5%), lipoprotein metabolism disorders (32.1%) and affective disorders (26.0%) were the most frequently reported comorbidities of special interest. Rates of most comorbidities of special interests were similar to atopic dermatitis and psoriasis patients, and all higher vs. overall population. More than half (54.1%) of all CU patients were not prescribed any treatment. Second-generation H1 -antihistamines were the most commonly prescribed medication for adult (17.9%) and paediatric (27.9%) patients. Patients with CIndU (paediatric, 15.5%; adult, 7.8%) were more often hospitalized versus patients with CSU (paediatric, 9.9%; adult, 4.6%). CONCLUSIONS In Germany, prevalence of CU along with multiple comorbidities may pose increased burden on the healthcare system. Awareness of adhering to treatment guidelines, and aiming for complete control of urticaria, needs to be driven and may improve outcomes.
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Affiliation(s)
- K Weller
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - M Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - A Bauer
- Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - B Wedi
- Department of Dermatology and Allergy, Comprehensive Allergy Centre, Hannover Medical School, Hannover, Germany
| | - N Wagner
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - S Schliemann
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | - T Kramps
- Novartis Pharma GmbH, Nuremberg, Germany
| | - D Baeumer
- Novartis Pharma GmbH, Nuremberg, Germany
| | | | - E Hillmann
- Novartis Pharma GmbH, Nuremberg, Germany
| | - P Staubach
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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20
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Belmesk L, Muntyanu A, Cantin E, AlHalees Z, Jack CS, Le M, Sasseville D, Iannattone L, Ben-Shoshan M, Litvinov IV, Netchiporouk E. Prominent Role of Type 2 Immunity in Skin Diseases-Beyond Atopic Dermatitis. J Cutan Med Surg 2021; 26:33-49. [PMID: 34261335 DOI: 10.1177/12034754211027858] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Type 2 immunity, illustrated by T helper 2 lymphocytes (Th2) and downstream cytokines (IL-4, IL-13, IL-31) as well as group 2 innate lymphoid cells (ILC2), is important in host defense and wound healing.1 The hallmark of type 2 inflammation is eosinophilia and/or high IgE counts and is best recognized in atopic diathesis. Persistent eosinophilia, such as seen in hypereosinophilic syndromes, leads to fibrosis and hence therapeutic Type 2 inhibition in fibrotic diseases is of high interest. Furthermore, as demonstrated in cutaneous T cell lymphoma, advanced disease is characterized by Th1 to Th2 switch allowing cancer progression and immunosuppression. Development of targeted monoclonal antibodies against IL-4Rα (eg, dupilumab) led to a paradigm shift for the treatment of atopic dermatitis (AD) and stimulated research to better understand the role of Type 2 inflammation in other skin conditions. In this review, we summarize up to date knowledge on the role of Type 2 inflammation in skin diseases other than AD and highlight whether the use of Type 2 targeted therapies has been documented or is being investigated in clinical trials. This manuscript reviews the role of Type 2 inflammation in dermatitis, neurodermatitis, IgE-mediated dermatoses (eg, bullous pemphigoid, chronic spontaneous urticaria), sclerodermoid conditions and skin neoplasms.
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Affiliation(s)
| | - Anastasiya Muntyanu
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Zeinah AlHalees
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Carolyn S Jack
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Michelle Le
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Denis Sasseville
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Lisa Iannattone
- 60301 Division of Dermatology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy Immunology and Dermatology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada
| | - Ivan V Litvinov
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Elena Netchiporouk
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
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21
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Lachover-Roth I, Rabie A, Cohen-Engler A, Rosman Y, Meir-Shafrir K, Confino-Cohen R. Chronic urticaria in children - New insights from a large cohort. Pediatr Allergy Immunol 2021; 32:999-1005. [PMID: 33502063 DOI: 10.1111/pai.13457] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/07/2021] [Accepted: 01/18/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Chronic spontaneous urticaria is well-described in adults, but less so in children. The aim of this study is to describe the demographics, clinical characteristics, comorbidities, and outcomes of children with chronic, spontaneous urticaria. METHODS This retrospective study followed children up to 18 years old, diagnosed with chronic spontaneous urticaria, between the years 2002-2018, and treated in a tertiary referral allergy and clinical immunology center. Data including demographics, clinical characteristics, comorbidities, treatments, and outcomes were extracted from electronic medical records. RESULTS Records of 380 children coded to have chronic urticaria were reviewed, of which 250 (65.8%) fulfilled the diagnostic criteria for chronic spontaneous urticaria. There were 136 females (54.4%). Mean age at diagnosis was 11.4 years, and 122 (48%) were adolescents. The average duration of chronic spontaneous urticaria was 12.25 ± 15.2 months. The urticaria in 208 children )83.2%) resolved within 24 months. Eighty-seven patients (34.8%) had at least one atopic disease. Atopic comorbidities included atopic dermatitis in 17.2%, allergic rhinitis in 16%, asthma in 13.2%, and food allergy in 3.2%. Eighteen patients (7.2%) had a concomitant autoimmune disease. Nine (3.6%) had thyroid disease. CONCLUSIONS AND CLINICAL RELEVANCE Chronic spontaneous urticaria in children is a self-limited disease with favorable prognosis. Atopic diseases are more prevalent in children with chronic spontaneous urticaria than in the general pediatric population, increasing the possibility of a special subgroup of TH2-related chronic urticaria in children.
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Affiliation(s)
- Idit Lachover-Roth
- Allergy and Clinical Immunology Unit, Meir Medical Center, Kfar-Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ahmad Rabie
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Cohen-Engler
- Allergy and Clinical Immunology Unit, Meir Medical Center, Kfar-Saba, Israel
| | - Yossi Rosman
- Allergy and Clinical Immunology Unit, Meir Medical Center, Kfar-Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Keren Meir-Shafrir
- Allergy and Clinical Immunology Unit, Meir Medical Center, Kfar-Saba, Israel
| | - Ronit Confino-Cohen
- Allergy and Clinical Immunology Unit, Meir Medical Center, Kfar-Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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22
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Sánchez-Borges M, Ansotegui IJ, Baiardini I, Bernstein J, Canonica GW, Ebisawa M, Gomez RM, González-Diaz S, Martin B, Morais de Almeida M, Ortega Martell JA. The challenges of chronic urticaria part 2: Pharmacological treatment, chronic inducible urticaria, urticaria in special situations. World Allergy Organ J 2021; 14:100546. [PMID: 34141049 PMCID: PMC8188551 DOI: 10.1016/j.waojou.2021.100546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/22/2021] [Accepted: 04/21/2021] [Indexed: 11/29/2022] Open
Abstract
This is Part 2 of an updated follow-up review of the World Allergy Organization (WAO) position paper on the diagnosis and treatment of urticaria and angioedema. Since that document was published, new advances in the understanding of the pathogenesis of chronic urticaria, and greater experience with the use of biologics in patients with severe refractory disease, mainly omalizumab, have been gained. For these reasons, WAO decided to initiate an update targeted to general practitioners around the world, incorporating the most recent information on epidemiology, immunopathogenesis, comorbidities, quality of life, clinical case presentations, and the management of chronic spontaneous and chronic inducible urticaria, and urticaria in special situations such as childhood and pregnancy. A special task force of WAO experts was invited to write the different sections of the manuscript, and the final document was approved by the WAO Board of Directors. This paper is not intended to be a substitute for current national and international guidelines on the management of urticaria and angioedema, but to provide an updated simplified guidance for physicians around the world who have to manage patients with this common ailment.
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Affiliation(s)
- Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Clínica El Avila, Caracas, Venezuela
| | - Ignacio J. Ansotegui
- Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia, Bilbao, Spain
| | - Ilaria Baiardini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Jonathan Bernstein
- Department of Internal Medicine, Division of Immunology, Allergy Section, University of Cincinnati, USA
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | | | - Sandra González-Diaz
- Regional Center for Allergy and Clinical Immunology, Faculty of Medicine and “Dr. José Eleuterio González" University Hospital, Autonomous University of Nuevo León, Monterrey, Mexico
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Chang J, Cattelan L, Ben-Shoshan M, Le M, Netchiporouk E. Management of Pediatric Chronic Spontaneous Urticaria: A Review of Current Evidence and Guidelines. J Asthma Allergy 2021; 14:187-199. [PMID: 33727832 PMCID: PMC7955742 DOI: 10.2147/jaa.s249765] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/14/2021] [Indexed: 12/27/2022] Open
Abstract
Chronic urticaria (CU) is associated with debilitating symptoms such as pruritic wheals and/or angioedema, which can significantly affect patients’ sleep, productivity and quality of life. Chronic spontaneous urticaria (CSU) is defined in cases in which no triggering factor is identified. Various guidelines directing the optimal management of CU in the adult population were published and updated over the recent years with the most accepted and widely used being the EAACI/GA2LEN/EDF/WAO 2017 guidelines. Meanwhile, guidelines specific to the pediatric population are scarce, mainly due to the fact that high quality evidence is lacking for many treatment options in this age group. The objective of this article is to review and synthesize the existing literature regarding the management of pediatric CSU. Our review highlights evidence supporting the EAACI/GA2LEN/EDF/WAO 2017 treatment guidelines with non-sedating second-generation antihistamines (sgAHs) as the mainstay of treatment for pediatric CSU, considering their demonstrated efficacy and reassuring safety profile. Additionally, the use of omalizumab in adolescents is well supported by the current literature. There is limited data available regarding the updosing of sgAHs, omalizumab in children with CSU under 12 years of age and the treatment with cyclosporine and leukotriene receptor antagonists (LTRAs) in pediatric patients of all ages. However, the results from currently available case series and case reports are promising for omalizumab and cyclosporine use in children with CSU, although large and well-designed randomized control trials (RCTs) assessing these treatment options are needed in order to formulate strong recommendations for their use. First-generation antihistamines (fgAHs) remain commonly used in pediatric CSU treatment despite a lack of studies assessing their efficacy and safety in the pediatric population and their widely known inferior safety profile compared to sgAHs.
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Affiliation(s)
- Jasmine Chang
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Leila Cattelan
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy Immunology and Dermatology, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Michelle Le
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Elena Netchiporouk
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
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Corral-Magaña O, Gil-Sánchez JA, Bover-Bauzá C, Martinez-Cepas P, Montis-Palos MC, Martín-Santiago A. Chronic urticaria in children under 15 years of age: Clinical experience beyond the clinical trials. Pediatr Dermatol 2021; 38:385-389. [PMID: 33410219 DOI: 10.1111/pde.14455] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 10/19/2020] [Accepted: 10/24/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND/OBJECTIVES The aim of the study was to describe the clinical characteristics, management, and outcome of a series of children with chronic urticaria (CU). METHODS We retrospectively studied children aged <15 years diagnosed with CU in a tertiary teaching hospital in Palma de Mallorca, Spain, between January 2014 and March 2019. CU was defined as persistence of symptoms of wheals, with or without angioedema, for >6 weeks. RESULTS Twenty-nine patients (17 girls, mean age 8 years) were included. Family history of atopy was found in 31% of the cases. In 41.3% of patients, episodes of CU were associated with angioedema. Physical triggers were found in 34.5% of the cases. Most episodes of CU were successfully managed with the recommended (60.7%) or double the recommended dose (17.2%) of H1-antihistamines. Quadruple the recommended dose of H1 antihistamines was used in six patients, five of whom were finally treated with off-label omalizumab. Treatment with anti-leukotrienes was needed in one patient. Associated thyroiditis was diagnosed in one patient, which was controlled with levothyroxine. CONCLUSIONS Pediatric CU showed features similar to CU in adulthood, including a greater predominance in females and frequent association with personal or family history of atopy. Adult guidelines for the treatment of CU are currently extrapolated to the pediatric population. Specific tools for the assessment of disease activity and impairment of quality of life in pediatric CU are needed for use in prospective studies aimed to define treatment strategies for children with CU.
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Affiliation(s)
- Oriol Corral-Magaña
- Department of Dermatology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - José Antonio Gil-Sánchez
- Department of Pediatric Allergology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Catalina Bover-Bauzá
- Department of Pediatric, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | | | - Ana Martín-Santiago
- Department of Dermatology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
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25
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Hon KL, Li JTS, Leung AKC, Lee VWY. Current and emerging pharmacotherapy for chronic spontaneous Urticaria: a focus on non-biological therapeutics. Expert Opin Pharmacother 2021; 22:497-509. [PMID: 32990110 DOI: 10.1080/14656566.2020.1829593] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Chronic spontaneous urticaria (CSU) refers to urticaria (wheals) or angioedema, which occur for a period of six weeks or longer without an apparent cause. The condition may impair the patient's quality of life. AREAS COVERED Treatment for CSU is mainly symptomatic. Both AAAAI/ACAAI practice parameters and EAACI/GA2LEN/EDF/WAO guidelines suggest CSU management in a stepwise manner. First-line therapy is with second-generation H1-antihistamines. Treatment should be stepped up along the algorithm if symptoms are not adequately controlled. Increasing the dosage of second-generation H1-antihistamines, with the addition of first-generation H1-antihistamines, H2 antagonist, omalizumab, ciclosporin A, or short-term corticosteroid may be necessary. New medications are being developed to treat refractory CSU. They include spleen tyrosine kinase inhibitor, Bruton tyrosine kinase inhibitor, prostaglandin D2 receptor inhibitor, H4-antihistamine, and other agents. The authors discuss these treatments and provide expert perspectives on the management of CSU. EXPERT OPINION Second-generation H1-antihistamines remain the first-line therapeutic options for the management of CSU. For patients not responding to higher-dose H1-antihistamines, international guidelines recommend the addition of omalizumab. Efficacy and safety data for newer agents are still pending. Large-scale, well-designed, randomized, double-blind, placebo-controlled trials will further provide evidence on the safety profile and efficacy of these agents in patients with CSU.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong & Department of Paediatrics and adolescent Medicine, the Hong Kong Children's Hospital, Shatin, Hong Kong
| | - Joyce T S Li
- Centre for Learning Enhancement and Research, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Alexander K C Leung
- Department of Pediatrics, The University of Calgary and The Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Vivian W Y Lee
- Centre for Learning Enhancement and Research, The Chinese University of Hong Kong, Shatin, Hong Kong
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26
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Cortellazzo Wiel L, Conversano E, Giangreco M, Fagotto L, Genovese MRL, Badina L, Longo G, Barbi E, Berti I. Natural history and predictors of recovery in children with chronic spontaneous urticaria. Pediatr Allergy Immunol 2021; 32:201-204. [PMID: 32460386 DOI: 10.1111/pai.13299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/26/2020] [Accepted: 05/19/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Manuela Giangreco
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | | | | | - Laura Badina
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Giorgio Longo
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Egidio Barbi
- University of Trieste, Trieste, Italy.,Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Irene Berti
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
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27
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Gonçalo M, Gimenéz‐Arnau A, Al‐Ahmad M, Ben‐Shoshan M, Bernstein J, Ensina L, Fomina D, Galvàn C, Godse K, Grattan C, Hide M, Katelaris C, Khoshkhui M, Kocatürk E, Kulthanan K, Medina I, Nasr I, Peter J, Staubach P, Wang L, Weller K, Maurer M. The global burden of chronic urticaria for the patient and society*. Br J Dermatol 2020; 184:226-236. [DOI: 10.1111/bjd.19561] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
Affiliation(s)
- M. Gonçalo
- Department of Dermatology University Hospital and Faculty of MedicineUniversity of Coimbra Coimbra Portugal
| | - A. Gimenéz‐Arnau
- Department of Dermatology Hospital del MarIMIMUniversitat Autònoma Barcelona Spain
| | - M. Al‐Ahmad
- Microbiology Department Faculty of Medicine Kuwait University Kuwait
| | - M. Ben‐Shoshan
- Division of Allergy, Immunology and Dermatology Department of Pediatrics Montreal Children’s HospitalMcGill University Montréal QC Canada
| | - J.A. Bernstein
- University of Cincinnati College of MedicineDepartment of Internal Medicine, Division of Immunology/Allergy Section, Partner Bernstein Allergy Group and Bernstein Clinical Research Center Cincinnati OH USA
| | - L.F. Ensina
- Alergoalpha/CPAlpha Allergy Clinic and Clinical Research Center and Division of Allergy, Clinical Immunology and Rheumatology Department of Pediatrics Federal University of São Paulo (UNIFESP/EPM) São Paulo SP Brazil
| | - D. Fomina
- Moscow City Center of Allergy and Immunology Clinical City Hospital #52 Department of General Therapy Pirogov Russian National Research Medical University Moscow Russian Federation
- Department of Allergology and Clinical Immunology I.M. Sechenov First Moscow State Medical University Moscow Russian Federation
| | - C.A. Galvàn
- Instituto Nacional de Salud del NiñoCentro de Referencia Nacional de Alergia Asma e Inmunología, Lima Perú
| | - K. Godse
- Department of Dermatology Dr D.Y. Patil School of Medicine Mumbai Maharashtra India
| | - C. Grattan
- St John’s Institute of DermatologyGuy’s Hospital London UK
| | - M. Hide
- Department of Dermatology Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - C.H. Katelaris
- Campbelltown Hospital and Western Sydney University Sydney NSW Australia
| | - M. Khoshkhui
- Allergy Research Center Mashhad University of Medical Sciences Mashhad Iran
| | - E. Kocatürk
- Department of Dermatology Koc University School of Medicine Istanbul Turkey
| | - K. Kulthanan
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | - I. Medina
- Centro Medico VitaeDepartment of Allergy and Clinical Immunology Buenos Aires Argentina
| | - I. Nasr
- Department of Immunology and Allergy Royal Hospital Muscat Oman
| | - J. Peter
- Division of Allergy and Clinical Immunology University of Cape Town and Allergy and Immunology UnitUniversity of Cape Town Lung Institute Cape Town South Africa
| | - P. Staubach
- Department of Dermatology University Medical Center Mainz Mainz Germany
| | - L. Wang
- Liangchun Wang – Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - K. Weller
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - M. Maurer
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
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Ouchene L, Muntyanu A, Lavoué J, Baron M, Litvinov IV, Netchiporouk E. Toward Understanding of Environmental Risk Factors in Systemic Sclerosis [Formula: see text]. J Cutan Med Surg 2020; 25:188-204. [PMID: 32988228 DOI: 10.1177/1203475420957950] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Systemic sclerosis (SSc) is a severe, chronic, and incurable autoimmune fibrotic skin disease with significant extracutaneous involvement. Low concordance rate in twin studies and unequal geographic distribution of SSc argues for importance of environment in disease initiation and progression. OBJECTIVE In this manuscript we provide a summary of all investigated potential external risk factors for SSc. DATA SOURCES A literature search in PubMed and EMBASE database was performed for studies published until January 1, 2020 by 2 reviewers (EN and LO) independently. FINDINGS Occupational and/or environmental exposures to silica and organic solvents are associated with increased incidence and severity of SSc. Exposure to epoxy resins, asbestos, and particulate air pollution favors increased risk of SSc, but data are based on limited number of observational studies. There is insufficient evidence to conclude an association between SSc development and other occupational (eg, welding fumes) or personal exposures (eg, smoking, vitamin D deficiency). Association of SSc with silicone breast implants has been disproven. Infectious pathogens (eg, Helicobacter pylori and angiotropic viruses) and dysbiosis seem to play a role in SSc development and severity, but their role remains to be clarified. CONCLUSIONS AND RELEVANCE It may be prudent to counsel our patients with SSc (or those at risk of SSc) to avoid occupations with exposure to silica, organic solvents, asbestos and epoxy resins; restraint from smoking, using cocaine or drugs with pro-fibrotic potential. While the association between low vitamin D and SSc remains to be confirmed, we believe that SSc patients should be encouraged to maintain healthy vitamin D levels as benefits outweigh the risks.
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Affiliation(s)
- Lydia Ouchene
- 12367 Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Anastasiya Muntyanu
- 54473 Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Jérôme Lavoué
- 5622 Department of Environmental and Occupational Health, School of Public Health, Université de Montreal, Montreal, Québec, Canada
| | - Murray Baron
- 5621 Division of Rheumatology, Department of Medicine, Jewish General Hospital, Montreal, QC, Canada
| | - Ivan V Litvinov
- 54473 Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Elena Netchiporouk
- 54473 Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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Stepaniuk P, Kan M, Kanani A. Natural history, prognostic factors and patient perceived response to treatment in chronic spontaneous urticaria. Allergy Asthma Clin Immunol 2020; 16:63. [PMID: 32834828 PMCID: PMC7371813 DOI: 10.1186/s13223-020-00459-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 06/26/2020] [Indexed: 11/28/2022] Open
Abstract
Background Although the diagnosis and management of chronic spontaneous urticaria (CSU) is well documented in the literature, some aspects of the disease remain unclear. We aimed to further describe the natural history, prognostic factors, humanistic burden and uptake of traditional and alternative therapies in patients with CSU. Methods This was a prospective, cross-sectional analysis at a single centre. We reviewed patient medical records and conducted a survey in patients with CSU. Results 72 patients participated in the study with a median duration of CSU of 48 months. 30% of patients had symptoms that resolved in under 2 years with these patients trending towards an older age of onset of CSU (48 ± 17 years). 16% of patients had symptoms lasting 10 years or longer with these patients trending towards a younger age of onset (22 ± 16 years). Patients with a relapsing/remitting disease course (31%) and those with co-existing angioedema (57%) trended towards a longer median duration of CSU (96 and 50 months respectively) and were observed to have a higher proportion of patients reporting CSU duration of 10 years or longer (33% and 25%, p = 0.033 and p = 0.036 respectively). Patients with co-existing autoimmune/thyroid disease (19%) trended towards a shorter median duration of CSU (37 months). 54 patients (75%) reported sleep disturbance and 29 patients (43%) required emergency room visit(s) for symptomatic control. 84% of patients who trialed second generation antihistamines reported a response to treatment, while 73% of patients who trialed omalizumab reported a response to treatment. Patients using alternative medicine such as acupuncture, traditional Chinese medicine and naturopathic medicine had lower reported response rates (20–29%) to treatment. Conclusions The natural history of CSU may be longer than previously reported with our study finding a median duration of symptoms of nearly 4 years with one-third of patients reporting a relapsing/remitting disease course. Younger age of onset, a relapsing/remitting disease course and angioedema may predict a longer duration of CSU, whereas older age of onset and co-existing autoimmune/thyroid disease may predict a shorter duration of CSU. Reported symptomatic benefit was higher from guidelines based pharmacologic therapy versus various alternative medicines.
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Affiliation(s)
- Peter Stepaniuk
- Division of Allergy and Immunology, Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Manstein Kan
- Division of Allergy and Immunology, Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Amin Kanani
- Division of Allergy and Immunology, Department of Medicine, University of British Columbia, Vancouver, BC Canada
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30
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Gabrielli S, Le M, Netchiporouk E, Miedzybrodzki B, Baum S, Greenberger S, Staubach-Renz P, Ben-Shoshan M. Reply to "Comment on: 'Children with chronic urticaria can be effectively controlled with updosing second-generation antihistamines'". J Am Acad Dermatol 2020; 83:e365-e366. [PMID: 32622144 DOI: 10.1016/j.jaad.2020.06.997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Sofianne Gabrielli
- Division of Allergy, Immunology and Dermatology, Montreal Children's Hospital, Montreal, Quebec, Canada.
| | - Michelle Le
- Division of Allergy, Immunology, and Dermatology, McGill University, Montreal, Quebec, Canada
| | | | | | - Sharon Baum
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Tel-Aviv University, Tel-Aviv, Israel
| | - Shoshana Greenberger
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Tel-Aviv University, Tel-Aviv, Israel
| | - Petra Staubach-Renz
- Department of Dermatology and Allergy, University Medical Center, Mainz, Germany
| | - Moshe Ben-Shoshan
- Division of Allergy, Immunology and Dermatology, Montreal Children's Hospital, Montreal, Quebec, Canada
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31
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Muntyanu A, Ouchene L, Ben-Shoshan M, Netchiporouk E. Ligelizumab Is Superior to Omalizumab for Chronic Spontaneous Urticaria. J Cutan Med Surg 2020; 24:201-202. [DOI: 10.1177/1203475419888873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anastasiya Muntyanu
- Division of Dermatology, McGill University Health Centre, Montreal General Hospital, QC, Canada
| | - Lydia Ouchene
- Division of Dermatology, McGill University Health Centre, Montreal General Hospital, QC, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy Clinical Immunology and Dermatology, Department of Pediatrics, Montreal Children's Hospital, McGill University, QC, Canada
| | - Elena Netchiporouk
- Division of Dermatology, McGill University Health Centre, Montreal General Hospital, QC, Canada
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32
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Gabrielli S, Le M, Netchiporouk E, Miedzybrodzki B, Baum S, Greenberger S, Staubach-Renz P, Ben-Shoshan M. Chronic urticaria in children can be controlled effectively with updosing second-generation antihistamines. J Am Acad Dermatol 2020; 82:1535-1537. [PMID: 32088268 DOI: 10.1016/j.jaad.2020.02.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 01/31/2020] [Accepted: 02/12/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Sofianne Gabrielli
- Division of Allergy, Immunology and Dermatology, Montreal Children's Hospital, Montreal, Quebec, Canada.
| | - Michelle Le
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | | | | | - Sharon Baum
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Tel-Aviv University, Tel-Aviv, Israel
| | - Shoshana Greenberger
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Tel-Aviv University, Tel-Aviv, Israel
| | - Petra Staubach-Renz
- Department of Dermatology and Allergy, University Medical Center, Mainz, Germany
| | - Moshe Ben-Shoshan
- Division of Allergy, Immunology and Dermatology, Montreal Children's Hospital, Montreal, Quebec, Canada
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Williams PV. Pharmacologic Management of Chronic Urticaria in Pediatric Patients: The Gap Between Guidelines and Practice. Paediatr Drugs 2020; 22:21-28. [PMID: 31858489 DOI: 10.1007/s40272-019-00365-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Chronic urticaria is an uncommon disorder in children but can present considerable morbidity, as well as frustration for the healthcare provider and parent. The prevalence is 0.1-0.3% but can vary considerably by country. Chronic spontaneous urticaria (no identifiable cause) is responsible for 70-80% of chronic urticaria, about half of this due to a subtype called chronic autoimmune urticaria identified by the presence of autoantibodies to IgE or the IgE receptor. Chronic urticaria that is triggered by external physical stimuli is called chronic inducible urticaria and is present in another 15-20%. Allergies, infection, and other underlying diseases such as thyroid disease, celiac disease, or Helicobacter pylori infection cause a minor proportion of cases. Chronic urticaria has considerable impact on quality of life and healthcare costs. An adverse impact on quality of life is more prevalent in older children and adolescents and can be comparable to other diseases of childhood such as diabetes and epilepsy. Healthcare costs can be 50% higher than the national estimates for healthy patients and include more hospitalizations, longer duration of hospitalizations, and more emergency department (ED) and outpatient visits. Allergic and autoimmune diseases can be comorbidities that add to healthcare utilization. Resolution can take years. Guidelines are available for diagnosis and treatment. A good history is the key to identifying the cause. Minimal laboratory tests are required and should be guided by the history. Patients with easily controlled urticaria may not need any laboratory tests. Suggested treatment emphasizes the use of non-sedating antihistamines, utilized in a step-wise fashion beginning with normal doses and advancing the dose based on the response up to four times the recommended dose for age. Other treatments are left to the urticaria specialist and are not discussed in this paper. These guidelines are not well utilized based on real-world studies; sedating antihistamines and oral steroids are overutilized. Medications should be taken daily, not as needed. Additional medications, if required, should be added to prior medications in a step-wise fashion. The gap between the guidelines for diagnosis and treatment and what is happening in the real world needs to be closed to reduce the cost and morbidity associated with this disorder.
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Affiliation(s)
- Paul V Williams
- Department of Pediatrics, Allergy Division, University of Washington School of Medicine, Seattle, WA, USA. .,Northwest Asthma & Allergy Center, 10333 19th Ave SE, Suite 105, Everett, WA, 98208, USA.
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34
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Hon KL, Leung AKC, Ng WGG, Loo SK. Chronic Urticaria: An Overview of Treatment and Recent Patents. ACTA ACUST UNITED AC 2020; 13:27-37. [PMID: 30924425 PMCID: PMC6751347 DOI: 10.2174/1872213x13666190328164931] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/19/2019] [Accepted: 03/19/2019] [Indexed: 12/21/2022]
Abstract
Background: Up to 1% of the general population in the USA and Europe suffer from chronic urticaria (CU) at some point in their lifetime. CU has an adverse effect on the quality of life. Objective: This study aims to provide an update on the epidemiology, pathogenesis, clinical manifesta-tions, diagnosis, aggravating factors, complications, treatment and prognosis of CU. Methods: The search strategy included meta-analyses, randomized controlled trials, clinical trials, reviews and pertinent references. Patents were searched using the key term “chronic urticaria” at the following links: www.google.com/patents, www.uspto.gov, and www.freepatentsonline.com. Results: CU is a clinical diagnosis, based on the episodic appearance of characteristic urticarial lesions that wax and wane rapidly, with or without angioedema, on most days of the week, for a period of six weeks or longer. Triggers such as medications, physical stimuli, and stress can be identified in 10 to 20% of cases. C-reactive protein/erythrocyte sedimentation rate, and complete blood cell count with differential are the screening tests that may be used to rule out an underlying disorder. The mainstay of therapy is reassurance, patient education, avoidance of known triggers, and pharmacotherapy. Second-generation H1 antihistamines are the drugs of choice for initial therapy because of their safety and efficacy profile. If satisfactory improvement does not occur after 2 to 4 weeks or earlier if the symptoms are intolerable, the dose of second-generation H1 antihistamines can be increased up to fourfold the manufacturer’s recom-mended dose (all be it off license). If satisfactory improvement does not occur after 2 to 4 weeks or earlier if the symptoms are intolerable after the fourfold increase in the dosage of second-generation H1 antihis-tamines, omalizumab should be added. If satisfactory improvement does not occur after 6 months or earli-er if the symptoms are intolerable after omalizumab has been added, treatment with cyclosporine and sec-ond-generation H1 antihistamines is recommended. Short-term use of systemic corticosteroids may be considered for acute exacerbation of CU and in refractory cases. Recent patents for the management of chronic urticaria are also discussed. Complications of CU may include skin excoriations, adverse effect on quality of life, anxiety, depression, and considerable humanistic and economic impacts. On average, the duration of CU is around two to five years. Disease severity has an association with disease duration. Conclusion: CU is idiopathic in the majority of cases. On average, the duration of CU is around two to five years. Treatment is primarily symptomatic with second generation antihistamines being the first line. Omalizumab has been a remarkable advancement in the management of CU and improves the quality of life beyond symptom control.
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Affiliation(s)
- Kam L Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Wing G G Ng
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Steven K Loo
- The Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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Deza G, Ricketti PA, Giménez-Arnau AM, Casale TB. Emerging Biomarkers and Therapeutic Pipelines for Chronic Spontaneous Urticaria. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 6:1108-1117. [PMID: 30033912 DOI: 10.1016/j.jaip.2018.02.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/12/2018] [Accepted: 02/16/2018] [Indexed: 01/19/2023]
Abstract
Chronic spontaneous urticaria (CSU) is defined as the appearance of evanescent wheals, angioedema, or both, for at least 6 weeks. CSU is associated with intense pruritus and poor quality of life, with higher odds of reporting depression, anxiety, and sleep difficulty. As of yet, the assessment of the activity and course of the disease along with the response to several treatments in CSU are based purely on the patient's medical history and the use of the patient-reported outcomes. Recently, several reports have suggested that certain parameters could be considered as potential disease-related biomarkers. Moreover, with the advent of such biomarkers, newer biologic agents are coming forth to revolutionize the management of potential refractory diseases such as CSU. The purpose of this article is to review the most promising biomarkers related to important aspects of CSU, such as the disease activity, the therapeutic response, and the natural history of the disease, and discuss the mechanisms of action and therapeutic effectiveness of the latest agents available or currently under investigation for the management of antihistamine-refractory CSU. The knowledge of these features could have an important impact on the management and follow-up of patients with CSU.
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Affiliation(s)
- Gustavo Deza
- Department of Dermatology, Hospital del Mar- Institut Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Peter A Ricketti
- Division of Allergy and Immunology, University of South Florida College of Medicine, Tampa, Fla
| | - Ana M Giménez-Arnau
- Department of Dermatology, Hospital del Mar- Institut Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - Thomas B Casale
- Division of Allergy and Immunology, University of South Florida College of Medicine, Tampa, Fla
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Papadopoulos NG, Zuberbier T. The safety and tolerability profile of bilastine for chronic urticaria in children. Clin Transl Allergy 2019; 9:55. [PMID: 31660121 PMCID: PMC6806519 DOI: 10.1186/s13601-019-0294-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/04/2019] [Indexed: 12/22/2022] Open
Abstract
Background Urticaria is a condition defined by the development of wheals, angioedema or both. It is classified based on its duration as acute (≤ 6 weeks) or chronic (> 6 weeks). Chronic urticaria is less frequent than acute one in children, but it represents a debilitating condition, always needing treatment. Symptoms affect child's daily activities and disturb sleeping patterns, causing emotional distress and negatively influencing learning and cognition. Therefore, the management of chronic urticaria must point to a complete control of symptoms, taking into account tolerability and the patient quality of life. Review of literature The recently revised version of EAACI/GA2LEN/EDF/WAO guideline on the management of urticaria, in addition to recommending the use of second-generation H1 antihistamines as the treatment of choice, gives particular attention to their use in the paediatric population. Bilastine has been studied in children; at the dose of 10 mg/once daily, it is licenced for the symptomatic relief of urticaria in children ≥ 6 to 11 years, in the European Union, in appropriate formulation, as oral solution or orodispersible tablet. Conclusions In line with the recent guideline recommendation for the use of second generation H1 antihistamines in children we have reviewed the safety and tolerability profile of bilastine in children with chronic urticaria.
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Affiliation(s)
| | - Torsten Zuberbier
- 2Department of Dermatology, Venerology and Allergy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Uniersität zu Berlin, Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
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Caffarelli C, Paravati F, El Hachem M, Duse M, Bergamini M, Simeone G, Barbagallo M, Bernardini R, Bottau P, Bugliaro F, Caimmi S, Chiera F, Crisafulli G, De Ranieri C, Di Mauro D, Diociaiuti A, Franceschini F, Gola M, Licari A, Liotti L, Mastrorilli C, Minasi D, Mori F, Neri I, Pantaleo A, Saretta F, Tesi CF, Corsello G, Marseglia GL, Villani A, Cardinale F. Management of chronic urticaria in children: a clinical guideline. Ital J Pediatr 2019; 45:101. [PMID: 31416456 PMCID: PMC6694633 DOI: 10.1186/s13052-019-0695-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/01/2019] [Indexed: 12/12/2022] Open
Abstract
The aim of this guidance is to provide recommendations to clinicians and other interested parties on chronic urticaria in children. The Italian Society for Pediatrics (SIP), the Italian Society for Allergy and Immunology (SIAIP), the Italian Society for Pediatric dermatology (SIDerP) convened a multidisciplinary panel that prepared clinical guidelines for diagnosis and management of chronic urticaria in childhood. Key questions on epidemiology, natural history, diagnosis, and management were developed. The literature was systematically searched and evaluated, recommendations were rated and algorithms for diagnosis and treatment were developed. The recommendations focus on identification of diseases and comorbidities, strategies to recognize triggering factors, improvement of treatment by individualized care.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Dipartimento Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Francesco Paravati
- Pediatric Unit, Maternal Infant Department, Azienda Sanitaria Provinciale Crotone, Crotone, Italy
| | - Maya El Hachem
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marzia Duse
- Department of Pediatrics, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Giovanni Simeone
- Primary care Pediatrician, Local Health Unit of Brindisi, Brindisi, Italy
| | - Massimo Barbagallo
- Pediatric Unit, Azienda di rilievo nazionale ARNAS "GARIBALDI", Catania, Italy
| | | | - Paolo Bottau
- Pediatric and Neonatology Unit, Imola Hospital, Imola, BO, Italy
| | - Filomena Bugliaro
- FEDERASMA e Allergie Onlus - Federazione Italiana Pazienti, Prato, Italy
| | - Silvia Caimmi
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Fernanda Chiera
- Pediatric Unit, Maternal Infant Department, Azienda Sanitaria Provinciale Crotone, Crotone, Italy
| | - Giuseppe Crisafulli
- UO Allergologia, Dipartimento di Pediatria, Università di Messina, Messina, Italy
| | | | - Dora Di Mauro
- Clinica Pediatrica, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andrea Diociaiuti
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Massimo Gola
- Allergological and Pediatric Dermatology Unit, AUTC and University of Florence, Florence, Italy
| | - Amelia Licari
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Lucia Liotti
- Department of Pediatrics, Senigallia Hospital, Senigallia, Italy
| | - Carla Mastrorilli
- Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - Domenico Minasi
- UOC di Pediatria Azienda Ospedaliera "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Francesca Mori
- Allergy Unit, Department of Pediatric Medicine, Anna Meyer Children's University Hospital, Florence, Italy
| | - Iria Neri
- Dermatology Unit, University of Bologna, Bologna, Italy
| | - Aurelia Pantaleo
- Clinica Pediatrica, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Francesca Saretta
- Pediatric Department, AAS2 Bassa Friulana-Isontina, Palmanova-Latisana, Italy.,Pediatric Allergy Unit, Department of Medicine, Udine, Italy
| | - Carlo Filippo Tesi
- FEDERASMA e Allergie Onlus - Federazione Italiana Pazienti, Prato, Italy
| | - Giovanni Corsello
- Clinica Pediatrica Università degli Studi di Palermo, Palermo, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alberto Villani
- UOC di Pediatria Generale e Malattie Infettive, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Fabio Cardinale
- Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy.
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Poddighe D. The prevalence of chronic spontaneous urticaria (CSU) in the pediatric population. J Am Acad Dermatol 2019; 81:e149. [PMID: 31351882 DOI: 10.1016/j.jaad.2019.07.068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 07/06/2019] [Accepted: 07/11/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Dimitri Poddighe
- Department of Medicine, Nazarbayev University School of Medicine, Nur-Sultan City, Kazakhstan.
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Filiz S, Kutluk MG, Uygun DFK. Headache deteriorates the quality of life in children with chronic spontaneous urticaria. Allergol Immunopathol (Madr) 2019; 47:254-259. [PMID: 30686612 DOI: 10.1016/j.aller.2018.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 09/18/2018] [Accepted: 09/20/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Quality of life, which is impaired in patients with chronic spontaneous urticaria (CSU), is influenced by comorbid mental disorders. Headaches could be another comorbid mental disorder that affects quality of life in children with CSU. OBJECTIVES To investigate the effect of headaches on urticaria symptoms, disease activity and quality of life in children with CSU. METHODS A total of 83 patients with CSU were enrolled in the study and were separated into two groups as those with or without headache. Demographic and clinical characteristics were studied with the Urticaria Activity Score (UAS7), Urticaria Control test (UCT) and Chronic Urticaria Quality of Life Questionnaire (CU-Q2QoL). The headache questionnaire designed according to the Department of International Classification of Headache Disorders, second edition (ICHD-II) was used and VAS (Visual Analogue Scale) and NRS (Numerical Rating Scale) were used to assess the pain measurement. In patients diagnosed with migraine, the paediatric Migraine Disability Assessment Scale (PedMIDAS) was applied. RESULTS CU-QoL total scores were significantly higher in patients with CSU with headache than in those without headache (p=0.015). In the five domains of CU-QoL, impact of daily life activities domain and sleep problems domain had higher scores in CSU with headache (p=0.008, 0.028, respectively). There was no significant relationship between UCT, UAS and CU-QoL and headache severity (p<0.05). No differences were found between the groups in respect of duration of urticaria, UAS7 and UCT. CONCLUSION Headache may be an important factor that affects and impairs quality of life in children with chronic urticaria.
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Affiliation(s)
- S Filiz
- Training and Research Hospital, Department of Pediatric Allergy and Immunology, Antalya, Turkey.
| | - M G Kutluk
- Training and Research Hospital, Department of Pediatric Neurology, Antalya, Turkey
| | - D F K Uygun
- Akdeniz University, Department of Pediatric Allergy and Immunolgy, Antalya, Turkey
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Rosman Y, Hershko AY, Meir-Shafrir K, Kedem R, Lachover-Roth I, Mekori YA, Confino-Cohen R. Characterization of chronic urticaria and associated conditions in a large population of adolescents. J Am Acad Dermatol 2019; 81:129-135. [PMID: 30797847 DOI: 10.1016/j.jaad.2019.02.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 02/12/2019] [Accepted: 02/17/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although chronic spontaneous urticaria (CSU) affects all age groups, data regarding CSU in adolescents is scarce. OBJECTIVE To characterize the epidemiology, demographics, and comorbidities associated with CSU in a large, cross-sectional nationwide population of adolescents. METHODS Medical records of 16-year-old candidate conscripts to the Israeli Defense Forces were reviewed. Data were collected on the prevalence and severity of CSU, as well as the demographics, medical comorbidities, medication use, and blood test results of affected individuals. RESULTS Medical records of 1,108,833 consecutive 16-year-old adolescents were reviewed. A total of 6617 (0.6%) adolescents received CSU diagnoses. CSU was increased in female conscripts (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.07-1.19, P < .001) and adolescents with higher socioeconomic scores (OR 1.92, 95% CI 1.56-2.32, P < .001). Individuals with CSU were significantly more likely to have allergic diseases, including food allergy (OR 7.31, 95% CI 6.13-8.72), allergic rhinitis (OR 2.9, 95% CI 2.71-3.11), atopic dermatitis (OR 2.35, 95% CI 2.03-2.72), and asthma (OR 1.46, CI 1.35-1.57). CONCLUSION Our work provides an account of CSU in a large cohort of adolescents. We found a strong link between CSU and atopic diseases. Further investigation is needed to decipher the mechanism underlying this observed association.
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Affiliation(s)
- Yossi Rosman
- Allergy and Clinical Immunology Unit, Meir General Hospital, Kfar-Saba, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Alon Y Hershko
- Allergy and Clinical Immunology Unit, Meir General Hospital, Kfar-Saba, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Keren Meir-Shafrir
- Allergy and Clinical Immunology Unit, Meir General Hospital, Kfar-Saba, Israel
| | - Ron Kedem
- Medical Corps Headquarters, Israel Defense Forces, Tel HaShomer, Israel
| | - Idit Lachover-Roth
- Allergy and Clinical Immunology Unit, Meir General Hospital, Kfar-Saba, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoseph A Mekori
- Allergy and Clinical Immunology Unit, Meir General Hospital, Kfar-Saba, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ronit Confino-Cohen
- Allergy and Clinical Immunology Unit, Meir General Hospital, Kfar-Saba, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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41
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Kudryavtseva AV, Neskorodova KA, Staubach P. Urticaria in children and adolescents: An updated review of the pathogenesis and management. Pediatr Allergy Immunol 2019; 30:17-24. [PMID: 30076637 DOI: 10.1111/pai.12967] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 12/25/2022]
Abstract
The present survey represents the latest data on diagnosis and management of childhood urticaria. It has been observed that urticaria occurs less often in children than adults, with symptoms rarely lasting for over 6 weeks. Triggers or aggravating factors can be found only in 21%-55% of cases. Finding autoantibodies in children does not impact a disease prognosis, unlike in adult patients, where the presence of autoantibodies is associated with a more prolonged run of the disease, a more severe prognosis and more intensive treatment methods. The incidence of food allergy equals to 8%-10% of cases. The incidence of Helicobacter Pylori infection in children is lower than that in adults and comes to 10%-18%. Medical experts recommend using the same treatment schemes for adults and children. This survey describes different urticaria management patterns suggested by experts from Europe, America, and Russia in their recent guidelines. It has been noted that unlike the guidelines from 2014, the 2018 clinical practice guidelines for the diagnosis and management of urticarial once again suggest a four-step treatment scheme with assigning omalizumab for Step 3 and cyclosporine A for Step 4 in the event of low therapeutic efficacy of the previous step or its impossibility. Leukotriene antagonists (LTRAs) are currently removed from basic management to alternative programs.
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Affiliation(s)
| | | | - Petra Staubach
- Department of Dermatology, University Medical Center, Mainz, Germany
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Quoi de neuf en dermatologie pédiatrique? Ann Dermatol Venereol 2018; 145 Suppl 7:VIIS32-VIIS46. [DOI: 10.1016/s0151-9638(18)31287-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
Comorbidities affecting dermatologic patients are of significant importance to providers and highly relevant for appropriate patient counseling, screening practices, prevention, and treatment. This article seeks to highlight several of the newest findings in the literature regarding comorbidities associated with dermatologic diseases including atopic dermatitis, hidradenitis suppurativa, alopecia areata, chronic urticaria, and the pemphigus family of immunobullous diseases. Further investigation is needed for associations between atopic dermatitis and pancreatic cancer and pemphigus family diseases and chronic obstructive pulmonary disease in order to better characterize the strength of these associations and clinical relevance.
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Affiliation(s)
- Azam Qureshi
- Department of Dermatology, George Washington Medical Faculty Associates, 2150 Pennsylvania Avenue Northwest, Suite 2B-427, Washington, DC 20037, USA
| | - Adam Friedman
- Department of Dermatology, George Washington Medical Faculty Associates, 2150 Pennsylvania Avenue Northwest, Suite 2B-427, Washington, DC 20037, USA; Department of Dermatology, George Washington School of Medicine and Health Sciences, 2150 Pennsylvania Avenue Northwest, Suite 2B-427, Washington, DC 20037, USA.
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Anaphylaxis in atypical cold urticaria: case report and review of literature. Ital J Pediatr 2018; 44:135. [PMID: 30424814 PMCID: PMC6234673 DOI: 10.1186/s13052-018-0578-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/31/2018] [Indexed: 12/04/2022] Open
Abstract
Background Cold-induced urticaria is a kind of physical urticaria characterized by the appearance of wheals after exposure to cold. The atypical form is a rare sub-type characterized by appearance of hives even in areas not directly exposed to the cold and by a negative cold stimulation test. Its diagnosis is often challenging because of the lack of specific tests and it is usually based on the patient’s clinical history. Hypotension due to generalized exposure to the cold is described both in the typical and the atypical forms. Case presentation We describe a 9-year-old boy who, at the beginning of the summer after the first swim in the sea, developed generalized urticaria, dyspnea, conjunctival hyperemia, blurred vision and loss of strength. The child was treated with intramuscular steroid and intravenous antihistamine, and the symptoms quickly resolved. Insect bite, contact with fish and drug ingestion were denied, and no unusual food had been eaten before the swim. A tentative diagnosis was made of either aquagenic urticaria or cold urticaria, but the specific tests were negative. Although the cause was unknown, prophylactic treatment with antihistamines was prescribed but in spite of this, wheals developed all over the body, after every swim in the sea. The child then came to our attention and relying on clinical history a diagnosis of atypical cold urticaria was made: development of hives even in areas not directly exposed to cold and a negative response to the cold stimulation test, are the characteristic features of this rare form of cold urticaria. Conclusion Atypical cold urticaria should be suspected in all cases of anaphylaxis related to cold exposure (i.e. contact with water) with a negative cold stimulation test.
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Ben-Shoshan M, Grattan C. Reply. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2018; 6:1806-1808. [PMID: 30197075 DOI: 10.1016/j.jaip.2018.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 05/01/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Moshe Ben-Shoshan
- Division of Allergy, Immunology and Dermatology, Montreal Children's Hospital, Montreal, Quebec, Canada.
| | - Clive Grattan
- Norflok and Norwich University Hospital, Norwich, United Kingdom; St John's Institute of Dermatology, London, United Kingdom
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Ben-Shoshan M, Grattan CE. Management of Pediatric Urticaria with Review of the Literature on Chronic Spontaneous Urticaria in Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1152-1161. [PMID: 29550102 DOI: 10.1016/j.jaip.2018.02.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/05/2018] [Accepted: 02/16/2018] [Indexed: 12/26/2022]
Abstract
There are substantial knowledge gaps related to diagnosis and management of pediatric cases of chronic urticaria, and in particular chronic spontaneous urticaria (CSU). In this article we aimed to review the diagnosis and management of chronic urticaria in children and CSU in particular. We conducted a systematic review of articles published in English and French on pediatric CSU management in the last 10 years. We included experimental studies (eg, randomized controlled trials), other experimental designs (eg, nonrandomized methods of assignment, controlled before-after studies, and interrupted time series), and observational studies (eg, prospective or retrospective cohort studies, cross-sectional studies, case-control studies, and case reports). Our findings highlight the efficacy of second-generation antihistamines for the treatment of CSU in children and supports the use of omalizumab for more severe cases. However, our study also reveals severe knowledge gaps related to the best management strategy in children with more severe/refractory cases of CSU. Future studies are required to establish the beneficial effect of high doses of second-generation antihistamines as well as the effectiveness and safety of omalizumab and other biologics in young children.
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Affiliation(s)
- Moshe Ben-Shoshan
- Division of Allergy Immunology and Dermatology, Montreal Children's Hospital, Montreal, Quebec, Canada.
| | - Clive E Grattan
- St John's Institute of Dermatology, Guy's Hospital, London, United Kingdom
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