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Kolkhir P, Bonnekoh H, Metz M, Maurer M. Chronic Spontaneous Urticaria: A Review. JAMA 2024:2824115. [PMID: 39325444 DOI: 10.1001/jama.2024.15568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
Importance Chronic spontaneous urticaria affects approximately 1% of the general population worldwide, including approximately 3 million people in the US, impairs patients' quality of life, and is associated with multiple comorbidities. Observations Chronic spontaneous urticaria affects patients of any age but is most common in females aged 30 to 50 years. Diagnosis is based on clinical presentation, ie, spontaneously recurring wheals, angioedema, or both. Chronic spontaneous urticaria persists for more than 1 year in most patients (1 or repeated episodes) and may present with comorbidities including chronic inducible urticaria (>10%), autoimmune thyroiditis (approximately 20%), metabolic syndrome (6%-20%), and anxiety (10%-31%) and depression (7%-29%). Known autoimmune endotypes (subtypes of urticaria defined by distinct pathogenesis) of chronic spontaneous urticaria are mediated by mast cell-activating IgE and/or IgG autoantibodies (>50%). Approximately 40% of patients with chronic spontaneous urticaria have a Dermatology Life Quality Index of more than 10, corresponding to a very large or extremely large negative effect on quality of life. Second-generation H1 antihistamines are first-line treatment; partial or complete response, defined as a reduction in urticaria symptoms of greater than 50%, is observed in approximately 40% of patients. The 2022 international urticaria guideline recommends the monoclonal anti-IgE antibody omalizumab as second-line treatment for antihistamine-refractory chronic spontaneous urticaria. However, at least 30% of patients have an insufficient response to omalizumab, especially those with IgG-mediated autoimmune urticaria. Cyclosporine, used off-label, can improve symptoms in approximately 54% to 73% of patients, especially those with autoimmune chronic spontaneous urticaria and nonresponse to omalizumab, but has adverse effects such as kidney dysfunction and hypertension. Conclusions and Relevance Chronic spontaneous urticaria is an inflammatory skin disease associated with medical and psychiatric comorbidities and impaired quality of life. Second-generation H1 antihistamines are first-line treatment, omalizumab is second-line treatment, and cyclosporine is third-line treatment for chronic spontaneous urticaria.
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Affiliation(s)
- Pavel Kolkhir
- Urticaria Center of Reference and Excellence (UCARE), 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, Immunology and Allergology, Berlin, Germany
| | - Hanna Bonnekoh
- Urticaria Center of Reference and Excellence (UCARE), 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, Immunology and Allergology, Berlin, Germany
| | - Martin Metz
- Urticaria Center of Reference and Excellence (UCARE), 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, Immunology and Allergology, Berlin, Germany
| | - Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE), 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, Immunology and Allergology, Berlin, Germany
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Conway AE, Verdi M, Kartha N, Maddukuri C, Anagnostou A, Abrams EM, Bansal P, Bukstein D, Nowak-Wegrzyn A, Oppenheimer J, Madan JC, Garnaat SL, Bernstein JA, Shaker MS. Allergic Diseases and Mental Health. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:2298-2309. [PMID: 38851487 DOI: 10.1016/j.jaip.2024.05.049] [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: 03/13/2024] [Revised: 05/21/2024] [Accepted: 05/29/2024] [Indexed: 06/10/2024]
Abstract
Neuropsychiatric symptoms have long been acknowledged as a common comorbidity for individuals with allergic diseases. The proposed mechanisms for this relationship vary by disease and patient population and may include neuroinflammation and/or the consequent social implications of disease symptoms and management. We review connections between mental health and allergic rhinitis, atopic dermatitis, asthma, vocal cord dysfunction, urticaria, and food allergy. Many uncertainties remain and warrant further research, particularly with regard to how medications interact with pathophysiologic mechanisms of allergic disease in the neuroimmune axis. Proactive screening for mental health challenges, using tools such as the Patient Health Questionnaire and Generalized Anxiety Disorder screening instruments among others, can aid clinicians in identifying patients who may need further psychiatric evaluation and support. Although convenient, symptom screening tools are limited by variable sensitivity and specificity and therefore require healthcare professionals to remain vigilant for other mental health "red flags." Ultimately, understanding the connection between allergic disease and mental health empowers clinicians to both anticipate and serve the diverse physical and mental health needs of their patient populations.
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Affiliation(s)
| | | | - Navya Kartha
- Department of Pediatrics, Akron Children's Hospital, Akron, Ohio
| | | | - Aikaterini Anagnostou
- Department of Pediatrics, Division of Allergy and Immunology, Baylor College of Medicine, Houston, Texas
| | | | - Priya Bansal
- Asthma and Allergy Wellness Center, St. Charles, Ill; Division of Allergy and Immunology, Northwestern Feinberg School of Medicine, Chicago, Ill
| | - Don Bukstein
- Allergy, Asthma, and Sinus Center, Milwaukee, Wis
| | - Anna Nowak-Wegrzyn
- Department of Population Health, NYU Grossman School of Medicine, New York, NY; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | | | - Juliette C Madan
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH; Departments of Pediatrics and Psychiatry, Division of Child Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Sarah L Garnaat
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Jonathan A Bernstein
- Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Marcus S Shaker
- Departments of Medicine and Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH; Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, NH.
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Pyatilova P, Hackler Y, Aulenbacher F, Asero R, Bauer A, Bizjak M, Day C, Dissemond J, Du-Thanh A, Fomina D, Giménez-Arnau AM, Grattan C, Gregoriou S, Hawro T, Kasperska-Zajac A, Khoshkhui M, Kocatürk E, Kovalkova E, Kulthanan K, Kuznetsova E, Makris M, Mukhina O, Pesqué D, Peter J, Salameh P, Siebenhaar F, Sikora A, Staubach P, Tuchinda P, Zamłyński M, Weller K, Maurer M, Kolkhir P. Non-Skin Related Symptoms Are Common in Chronic Spontaneous Urticaria and Linked to Active and Uncontrolled Disease: Results From the Chronic Urticaria Registry. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1890-1899.e3. [PMID: 38670260 DOI: 10.1016/j.jaip.2024.04.027] [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: 10/17/2023] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) can present with non-skin related symptoms (NSRS), including recurrent unexplained fever, joint, bone, or muscle pain (JBMP), and malaise, which also occur in other conditions that manifest with wheals (eg, urticarial vasculitis or autoinflammatory disorders) or without wheals (eg, infection). OBJECTIVE We sought to determine the rate of patients with CSU affected by fever, JBMP, and malaise, their trigger factors, links with clinical and laboratory characteristics, and their impact on everyday life and treatment responses. METHODS We analyzed baseline data from the Chronic Urticaria Registry of 2,521 patients with CSU who were aged 16 years or older. RESULTS One third of CSU patients (31.2%; 786 of 2,521) had one or more NSRS, including recurrent fever (5.3%), JBMP (19.1%), and/or malaise (18.6%). In a multivariable analysis, having one or more of these NSRS correlated with food and infection as trigger factors of urticaria (adjusted odds ratio [aOR] = 1.7 and 1.5), wheals of 24 hours or greater duration (aOR = 2.5), sleep disturbance (aOR = 2.4), anxiety (aOR = 2.8), comorbid atopic dermatitis (aOR = 2.1), gastrointestinal disease (aOR = 1.8), elevated leukocytes (aOR = 1.7) and erythrocyte sedimentation rate (aOR = 1.5). In a bivariate analysis, these NSRS were additionally associated with higher disease activity (weekly Urticaria Activity Score, median: 21 vs 14; P = .009), longer disease duration (years, median: 2 vs 1; P = .001), the presence of angioedema (74.6% vs 58.7%; P < .001), worse quality of life (Chronic Urticaria Quality of Life Questionnaire, median: 42 vs 29; P < .001) and more frequent poor control of CSU (78% vs 69%; P < .001). CONCLUSIONS The presence of NSRS in a subpopulation of patients with CSU points to the need for better control of the disease, exclusion of comorbid conditions, and/or exclusion of urticarial vasculitis and urticarial autoinflammatory diseases.
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Affiliation(s)
- Polina Pyatilova
- Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Immunology and Allergology, Berlin, Germany
| | - Yana Hackler
- Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Immunology and Allergology, Berlin, Germany
| | - Felix Aulenbacher
- Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Immunology and Allergology, Berlin, Germany
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica san Carlo, Paderno Dugnano, Italy
| | - Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Mojca Bizjak
- Division of Allergy, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Cascia Day
- Urticaria Center of Reference and Excellence, Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Urticaria Center of Reference and Excellence, Allergy and Immunology Unit, University of Cape Town, Lung Institute, Cape Town, South Africa
| | - Joachim Dissemond
- Department of Dermatology, Venerology, and Allergology, University of Essen, Essen, Germany
| | - Aurélie Du-Thanh
- University of Montpellier and University Hospital of Montpellier, Dermatology Department, Montpellier, France
| | - Daria Fomina
- Moscow City Research and Practical Center of Allergology and Immunology, Moscow Healthcare Department, City Clinical Hospital 52, Moscow, Russia; Department of Clinical Immunology and Allergology, I.M., Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Department of Pulmonology, Astana Medical University, Astana, Kazakhstan
| | - Ana M Giménez-Arnau
- Department of Dermatology, Hospital del Mar and Research Institute, Barcelona, Universitat Pompeu Fabra, Barcelona, Spain
| | - Clive Grattan
- St John's Institute of Dermatology, Guy's Hospital, London, United Kingdom
| | - Stamatis Gregoriou
- Faculty of Medicine, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Tomasz Hawro
- Department of Dermatology, Allergology, and Venereology, Institute and Comprehensive Center for Inflammation Medicine, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Alicja Kasperska-Zajac
- European Center for Diagnosis and Treatment of Urticaria/Angioedema (GA(2)LEN Urticaria Centers of Reference and Excellence Network), Medical University of Silesia in Katowice, Katowice, Poland
| | - Maryam Khoshkhui
- Allergy Research Center, Mashhad University of Medical Science, Mashhad, Iran
| | - Emek Kocatürk
- Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Immunology and Allergology, Berlin, Germany; Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey
| | - Elena Kovalkova
- Moscow City Research and Practical Center of Allergology and Immunology, Moscow Healthcare Department, City Clinical Hospital 52, Moscow, Russia
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Elizaveta Kuznetsova
- Moscow City Research and Practical Center of Allergology and Immunology, Moscow Healthcare Department, City Clinical Hospital 52, Moscow, Russia
| | - Michael Makris
- Allergy Unit, Second Department of Dermatology and Venereology, National and Kapodistrian University of Athens, University General Hospital "Attikon," Athens, Greece
| | - Olga Mukhina
- Moscow City Research and Practical Center of Allergology and Immunology, Moscow Healthcare Department, City Clinical Hospital 52, Moscow, Russia
| | - David Pesqué
- Department of Dermatology, Hospital del Mar Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jonny Peter
- Urticaria Center of Reference and Excellence, Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Urticaria Center of Reference and Excellence, Allergy and Immunology Unit, University of Cape Town, Lung Institute, Cape Town, South Africa
| | - Pascale Salameh
- Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Immunology and Allergology, Berlin, Germany; Research Department, School of Medicine, Lebanese American University, Byblos, Lebanon; Institut National de Santé Publique d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus; Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
| | - Frank Siebenhaar
- Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Immunology and Allergology, Berlin, Germany
| | - Agnieszka Sikora
- European Center for Diagnosis and Treatment of Urticaria/Angioedema (GA(2)LEN Urticaria Centers of Reference and Excellence Network), Medical University of Silesia in Katowice, Katowice, Poland
| | - Petra Staubach
- Department of Dermatology, Johannes Gutenberg University, Mainz, Germany
| | - Papapit Tuchinda
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Mateusz Zamłyński
- European Center for Diagnosis and Treatment of Urticaria/Angioedema (GA(2)LEN Urticaria Centers of Reference and Excellence Network), Medical University of Silesia in Katowice, Katowice, Poland
| | - Karsten Weller
- Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Immunology and Allergology, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Immunology and Allergology, Berlin, Germany
| | - 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; Fraunhofer Institute for Translational Medicine and Pharmacology, Immunology and Allergology, Berlin, Germany.
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Kovalkova E, Fomina D, Borzova E, Maltseva N, Chernov A, Serdoteckova S, Weller K, Maurer M. Comorbid Inducible Urticaria Is Linked to Non-Autoimmune Chronic Spontaneous Urticaria: CURE Insights. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:482-490.e1. [PMID: 38008357 DOI: 10.1016/j.jaip.2023.11.029] [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: 05/23/2023] [Revised: 10/24/2023] [Accepted: 11/16/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Patients with chronic spontaneous urticaria (CSU) can have comorbid inducible urticaria (CIndU). How comorbid CIndU affects patients and their CSU is largely unclear. OBJECTIVE To compare patients with CSU with and without comorbid CIndUs for differences in demographic features, clinical characteristics, and laboratory markers. METHODS We analyzed 708 patients with CSU of our Urticaria Center of Reference and Excellence enrolled in CURE, the chronic urticaria registry. CURE data collected until October 2022 were used to compare patients with and without comorbid CIndU for their demographic characteristics, disease onset, activity, impact, and control, as well as concomitant allergic and autoimmune diseases and laboratory parameters associated with autoimmune CSU. RESULTS Of 708 patients with CSU, 247 (35%) had comorbid CIndU. Compared with patients with standalone CSU, patients with CSU with comorbid CIndU were significantly younger, had earlier disease onset, longer disease duration, higher impact on quality of life, and a higher rate of concomitant allergic diseases. Moreover, patients with CSU with comorbid CIndU less often had features linked to autoimmune CSU such as angioedema, concomitant autoimmune diseases, eosinopenia, low levels of total IgE, and low total IgE combined with elevated anti-thyroid peroxidase IgG. CONCLUSIONS Autoimmune CSU may be less common in patients with comorbid CIndU than without, and comorbid CIndU may point to autoallergic CSU.
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Affiliation(s)
- Elena Kovalkova
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Moscow City Research and Practical Center of Allergology and Immunology, Moscow Healthcare Department, City Clinical Hospital 52, Moscow, Russia.
| | - Daria Fomina
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Moscow City Research and Practical Center of Allergology and Immunology, Moscow Healthcare Department, City Clinical Hospital 52, Moscow, Russia; Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Department of Pulmonology, Astana Medical University, Astana, Kazakhstan
| | - Elena Borzova
- Department of Dermatology and Venereology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Dermatology Division, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Natalya Maltseva
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Moscow City Research and Practical Center of Allergology and Immunology, Moscow Healthcare Department, City Clinical Hospital 52, Moscow, Russia
| | - Anton Chernov
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Moscow City Research and Practical Center of Allergology and Immunology, Moscow Healthcare Department, City Clinical Hospital 52, Moscow, Russia
| | - Sofia Serdoteckova
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Moscow City Research and Practical Center of Allergology and Immunology, Moscow Healthcare Department, City Clinical Hospital 52, Moscow, Russia
| | - Karsten Weller
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marcus Maurer
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), 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
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Zhang H, Wang M, Zhao X, Wang Y, Chen X, Su J. Role of stress in skin diseases: A neuroendocrine-immune interaction view. Brain Behav Immun 2024; 116:286-302. [PMID: 38128623 DOI: 10.1016/j.bbi.2023.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 10/16/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Psychological stress is a crucial factor in the development of many skin diseases, and the stigma caused by skin disorders may further increase the psychological burden, forming a vicious cycle of psychological stress leading to skin diseases. Therefore, understanding the relationship between stress and skin diseases is necessary. The skin, as the vital interface with the external environment, possesses its own complex immune system, and the neuroendocrine system plays a central role in the stress response of the body. Stress-induced alterations in the immune system can also disrupt the delicate balance of immune cells and inflammatory mediators in the skin, leading to immune dysregulation and increased susceptibility to various skin diseases. Stress can also affect the skin barrier function, impair wound healing, and promote the release of pro-inflammatory cytokines, thereby exacerbating existing skin diseases such as psoriasis, atopic dermatitis, acne, and urticaria. In the present review, we explored the intricate relationship between stress and skin diseases from a neuroendocrine-immune interaction perspective. We explored the occurrence and development of skin diseases in the context of stress, the stress models for skin diseases, the impact of stress on skin function and diseases, and relevant epidemiological studies and clinical trials. Understanding the relationship between stress and skin diseases from a neuroendocrine-immune interaction perspective provides a comprehensive framework for targeted interventions and new insights into the diagnosis and treatment of skin diseases.
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Affiliation(s)
- Hanyi Zhang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
| | - Mi Wang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China; Department of Mental Health Center, Xiangya Hospital, Central South University, Changsha, China
| | - Xue Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
| | - Yujie Wang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China.
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China.
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6
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Donnelly J, Ridge K, O'Donovan R, Conlon N, Dunne PJ. Psychosocial factors and chronic spontaneous urticaria: a systematic review. BMC Psychol 2023; 11:239. [PMID: 37598202 PMCID: PMC10440028 DOI: 10.1186/s40359-023-01284-2] [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: 04/30/2023] [Accepted: 08/11/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Psychosocial factors have been informally associated with Chronic Spontaneous Urticaria (CSU); however, the relationship between psychosocial factors and CSU remains relatively unexplored in the scientific literature. OBJECTIVE This review aims to provide an evaluation of peer reviewed studies exploring psychosocial factors and CSU. METHODS A systematic search was performed over four databases identifying studies exploring psychosocial factors in relation to CSU published between the years 1995 and 2022. RESULTS Eighteen studies were included for narrative analysis, and 33 psychosocial factors were identified. These were split into two subgroups: psychosocial factors that were associated with CSU symptoms aggravation/onset (n = 20), and psychosocial factors expected to be impacted by CSU symptoms (n = 13). CONCLUSION This review has highlighted a need for more research and interventions to support individuals with psychosocial factors involved in CSU.
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Affiliation(s)
- Jennifer Donnelly
- The Centre of Positive Psychology and Health, Royal College of Surgeons, Dublin, Ireland.
| | - Katie Ridge
- Clinical and Diagnostic Immunology, St. James's Hospital, Dublin, Ireland
| | - Roisin O'Donovan
- The Centre of Positive Psychology and Health, Royal College of Surgeons, Dublin, Ireland
| | - Niall Conlon
- Clinical and Diagnostic Immunology, St. James's Hospital, Dublin, Ireland
| | - Pádraic J Dunne
- The Centre of Positive Psychology and Health, Royal College of Surgeons, Dublin, Ireland
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7
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Chang HW, Lin WD, Shih PJ, Peng SL, Hsu CY, Lin CL, Liao WL, Sun MF. Acupuncture Decreases Risk of Hypertension in Patients with Chronic Spontaneous Urticaria in Taiwan: A Nationwide Study. Healthcare (Basel) 2023; 11:healthcare11101510. [PMID: 37239796 DOI: 10.3390/healthcare11101510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Patients with chronic spontaneous urticaria (CSU) have a higher risk of developing hypertension. This study aimed to determine whether acupuncture could decrease the risk of hypertension in patients with CSU. We enrolled patients newly diagnosed with CSU between 1 January 2008, and 31 December 2018, from the Taiwanese National Health Insurance Research Database. The claims data were assessed from the index date to 31 December 2019. A Cox regression model was used to compare the hazard ratios (HRs) of the two cohorts. The cumulative incidence of hypertension was estimated using the Kaplan-Meier method. After propensity score matching with a 1:1 ratio, 43,547 patients with CSU who received acupuncture were matched with 43,547 patients with CSU who did not receive acupuncture in this study. After considering potential confounding factors, patients who received acupuncture had a significantly lower risk of hypertension than those in the control group (adjusted hazard ratio = 0.56, 95% confidence interval = 0.54-0.58). Patients who received medications combined with acupuncture tended to have the lowest risk of hypertension. This study revealed that acupuncture decreases the risk of hypertension in patients with CSU in Taiwan. The detailed mechanisms can be further clarified through prospective studies.
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Affiliation(s)
- Heng-Wei Chang
- Graduate Institute of Chinese Medicine, China Medical University, Taichung 404333, Taiwan
| | - Wei-De Lin
- Department of Medical Research, China Medical University Hospital, Taichung 404327, Taiwan
| | - Pai-Jun Shih
- Erlin Four Seasons Dermatology Clinic, Erlin Township, Changhua County 526022, Taiwan
| | - Shin-Lei Peng
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung 404333, Taiwan
| | - Chung-Y Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 404333, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung 404327, Taiwan
| | - Wen-Ling Liao
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan
- Center for Personalized Medicine, China Medical University Hospital, Taichung 404327, Taiwan
| | - Mao-Feng Sun
- Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan
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8
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Tomaszewska K, Słodka A, Tarkowski B, Zalewska-Janowska A. Neuro-Immuno-Psychological Aspects of Chronic Urticaria. J Clin Med 2023; 12:jcm12093134. [PMID: 37176575 PMCID: PMC10179371 DOI: 10.3390/jcm12093134] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Urticaria is a condition characterized by the development of itchy wheals (hives), angioedema, or both. The pathophysiology of chronic spontaneous urticaria (CSU) is still poorly understood. It is suggested that there is no dominant and independent mechanism of CSU; however, there are different immunological and non-immunological abnormalities that act simultaneously or/and follow each other resulting in clinical symptoms. The latest hypothesis points out that mast cells (MCs) to be activated via autoantibodies in autoallergic or autoimmune mechanism mediators released from degranulated MCs are responsible for the vasoactive and neurospecific effect in CSU. According to many clinical observations, it is suggested that psychological stress can be both a triggering factor in the onset of CSU and a modulating one in the course of the disease and therapy effectiveness. Of importance, the mechanistic background of the psychological stress response in the skin has not yet been fully elucidated. However, of note, a variety of inflammatory mediators, neuropeptides, and neurotransmitters facilitate this phenomenon. This review presents recent findings on the neuro-immuno-psychological aspects of CSU, highlighting an emerging role of neuro-immune interactions. It also points out the usefulness of psychological tools employment for the baseline diagnosis of perceived stress level and the presence of its symptoms. Furthermore, it proposes the implementation of non-invasive interventions to reduce psychological stress and anxiety. A bio-psycho-social approach including psychological support and patient education seems to be as important as traditional pharmacotherapy for CSU. It facilitates the effective control of active disease and a prolonged remission time in this disease.
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Affiliation(s)
- Katarzyna Tomaszewska
- Psychodermatology Department, Chair of Pulmonology, Rheumatology and Clinical Immunology, Medical University of Lodz, 92-213 Lodz, Poland
| | - Aleksandra Słodka
- Psychodermatology Department, Chair of Pulmonology, Rheumatology and Clinical Immunology, Medical University of Lodz, 92-213 Lodz, Poland
| | - Bartłomiej Tarkowski
- Psychodermatology Department, Chair of Pulmonology, Rheumatology and Clinical Immunology, Medical University of Lodz, 92-213 Lodz, Poland
| | - Anna Zalewska-Janowska
- Psychodermatology Department, Chair of Pulmonology, Rheumatology and Clinical Immunology, Medical University of Lodz, 92-213 Lodz, Poland
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Xiao X, Xue P, Shi Y, Yao J, Cao W, Zhang L, Zou Z, Zhou S, Wang C, Chen M, Jin R, Li Y, Zheng Q. The efficacy and safety of high-dose nonsedating antihistamines in chronic spontaneous urticaria: a systematic review and meta-analysis of randomized clinical trials. BMC Pharmacol Toxicol 2023; 24:23. [PMID: 37024900 PMCID: PMC10080829 DOI: 10.1186/s40360-023-00665-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/20/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Standard doses of second-generation H1-antihistamines (sgAHs) as first-line treatment are not always effective in treating chronic spontaneous urticaria (CSU), and hence an increase in the dose of sgAHs is recommended. However, literature evaluating the efficacy and safety of this treatment remains inconclusive, highlighting the need for a systematic review and meta-analysis. The aim of this systematic review and meta-analysis was to evaluate the efficacy and safety of high-dose sgAHs compared with standard-dose sgAHs in treating CSU. METHODS A systematic literature search of double-blind, randomized controlled trials (RCT) utilizing multiple doses of sgAHs was performed by searching the electronic databases Medline, Embase, PsycInfo, Cochrane databases, and Web of Science. Bibliographies were also manually searched. The Cochrane Risk of Bias Tool for assessing risk of bias was used to assess the quality of randomized controlled trials (RCTs). Two reviewers screened studies, extracted data, and evaluated the risk of bias independently. The response rate, the number of adverse events, somnolence, and withdrawal due to adverse events were extracted from each article. The data were combined and analyzed to quantify the safety and efficacy of the treatment. RevMan (V5.3) software was used for data synthesis. RESULTS A total of 13 studies were identified, seven of which met the eligibility criteria for the meta-analysis. Our pooled meta-analyses showed that high-dose sgAHs was associated with a significantly higher response rate than standard-dose (RR 1.13, 95% CI 1.02 to 1.26; P = 0.02). Conversely, high doses of sgAHs were associated with significantly higher somnolence rates than standard dose (RD 0.05, 95% CI 0.01 to 0.09; P = 0.02). There was no significant difference in adverse events or withdrawal due to adverse events between standard- and high-dose treatments. CONCLUSIONS Our analyses showed that a high dose of sgAHs (up to two times the standard dose) might be more effective than a standard dose in CSU treatment. High-dose and standard-dose sgAHs showed similar adverse events, except for somnolence, where incidence was found to be dose-dependent in some studies. However, given the limited number of studies, our meta-analysis results should be interpreted with caution.
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Affiliation(s)
- Xianjun Xiao
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, Sichuan, China
| | - Peiwen Xue
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, Sichuan, China
| | - Yunzhou Shi
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Junpeng Yao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Wei Cao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Leixiao Zhang
- Department of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, Chengdu, 610000, Sichuan, China
| | - Zihao Zou
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Siyuan Zhou
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Jinniu District, Chengdu, 610075, Sichuan, China
| | - Chuan Wang
- Acupuncture department, Wuhan NO.1 Hospital, Wuhan, 430000, Hubei, China
| | - Mingling Chen
- Dermatological Department, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, Sichuan, China
| | - Rongjiang Jin
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, Sichuan, China
| | - Ying Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Jinniu District, Chengdu, 610075, Sichuan, China.
| | - Qianhua Zheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Jinniu District, Chengdu, 610075, Sichuan, China.
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10
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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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11
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Anis O, Kridin K, Cohen AD, Levmore M, Yaron S, Valdman-Grinshpoun Y, Czarnowicki T. Chronic Spontaneous Urticaria in Patients With Interstitial Cystitis/Bladder Pain Syndrome: Insights From Big Data Analyses. Urology 2023; 171:83-87. [PMID: 36343865 DOI: 10.1016/j.urology.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/07/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the association between chronic spontaneous urticaria (CSU) and interstitial cystitis/bladder pain syndrome (IC/BPS). METHODS A population-based retrospective cross-sectional study was performed using the Clalit Health Services medical database. The prevalence of CSU was compared between patients diagnosed with IC/BPS and age- and gender-matched controls. Univariate analysis was performed using Chi-square and Student t test and a multivariable analysis was performed using a logistic regression model. RESULTS The study included 681 patients with IC/BPS and 3376 demographically matched controls. The mean age of IC/BPS patients was 60 years old. The prevalence of CSU among patients with IC/BPS was higher as compared to the control group (20% vs 13.7%; P <.001). The adjusted OR for CSU in patients with IC/BPS was 1.58 (95% CI 1.28-1.97). Female gender and Jewish ethnicity were associated with the coexistence of these disorders (OR 1.7 95% CI 1.36-2.13, and 1.6 95% CI 1.28-2, respectively). CONCLUSION A significant association was found between IC/BPS and CSU. This finding may support the presence of allergic/immune components in the pathogenesis of IC/BPS.
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Affiliation(s)
- Omer Anis
- Urology department, Sheba Medical Center, Ramat Gan, Israel; The Mina & Everard Goodman Faculty of Life Sciences, Bar Ilan University, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Khalaf Kridin
- Unit of Dermatology and Skin Research Laboratory, Baruch Padeh Medical Center, Poriya, Tiberias, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel; Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Arnon Dov Cohen
- Department of Quality Measures and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel; Siaal Research Center for Family Medicine and Primary care, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Miriam Levmore
- Community Medical Services Division, Clalit Health Services, Tel Aviv, Israel
| | - Shlomit Yaron
- Community Medical Services Division, Clalit Health Services, Tel Aviv, Israel
| | | | - Tali Czarnowicki
- Shaare Zedek Medical Center, the Hebrew University of Jerusalem, Jerusalem, Israel; Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
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12
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Papapostolou N, Xepapadaki P, Katoulis A, Makris M. Comorbidities of Chronic Urticaria: A glimpse into a complex relationship. FRONTIERS IN ALLERGY 2022; 3:1008145. [PMID: 36465885 PMCID: PMC9712803 DOI: 10.3389/falgy.2022.1008145] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/17/2022] [Indexed: 08/05/2023] Open
Abstract
Chronic Urticaria (CU) is a chronic inflammatory, predominantly mast cell-driven disease, characterized by the development of wheals and/or angioedema for more than 6 weeks. It affects approximately 1%-5% of the total population worldwide and imposes a substantial burden on health-related quality of life, significantly affecting patients' daily life. The economic impact on the health system is also not negligible, with an estimated cost per patient per year of approximately 2.000 $ in the United States. Although the underlying pathophysiology is not fully explored, autoimmune mechanisms have been proposed, including type I ("autoallergy" by means of autoantibodies to self-antigens) and type IIb (autoimmunity). Atopic, autoimmune, and psychiatric disorders are prevalent comorbidities in both children and adults with Chronic Spontaneous Urticaria (CSU). Although malignancies, cardiovascular diseases and other comorbidities have also been reported as associated diseases in patients with CSU, data remain scarce. It is still unknown whether the aforementioned comorbidities share common pathophysiological mechanisms with specific endotypes of CSU. The current review aims to overview current data on comorbidities of CU, and furthermore to comment on the potential linked pathways underlying these diseases.
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Affiliation(s)
- Niki Papapostolou
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexander Katoulis
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Michael Makris
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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13
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García-Gómez E, Chapman E, García-Paba MB, Ocampo-Gómez J, Egea-Bermejo E, Garavito-De Egea G, Fang L, Sarrazola M, Sánchez-Caraballo JM, Serrano-Reyes C, Silva-Espinosa DL, Rojas-Mejía DV, Moreno SM. Multicentric and Observational Study of Omalizumab for Chronic Spontaneous Urticaria in Real-Life in Colombia. FRONTIERS IN ALLERGY 2022; 3:902344. [PMID: 35769574 PMCID: PMC9234875 DOI: 10.3389/falgy.2022.902344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background Although chronic urticaria (CU) is a common, cause of medical consulting both in general practitioners and allergist specialists worldwide, there is little information about its behavior and management in Latin America. Currently, national and international guidelines recommend using Omalizumab for cases refractory to management with antihistamines. Despite advances in the knowledge of Omalizumab for the management of CU, although there are few studies in underdeveloped countries, there are many studies evaluating the impact of Omalizumab treatment. There is not clinical information related with CSU-Omalizumab in patient settled in the Caribbean area. This research aims to evaluate the management of CU with Omalizumab in a real-life scenario in Colombia. Methodology We conducted an observational, descriptive, and retrospective study with patient recruitment between 2014 and 2017 of individuals diagnosed with Chronic Urticaria (CU) treating allergology specialists in five Colombian cities. We included patients with CU who failed to achieve disease control after treatment for 4 weeks with fourfold doses of second-generation H1-antihistamines, as recommended by the EAACI/GA2LEN/EDF/WAO guidelines and who received treatment with Omalizumab. Results We included 123 patients, 73.1% (n = 90) were women. The mean age was 47.1 years (Standard Deviation, SD: 16.2). The median of the total months of disease evolution was 30 (IQR = 13–58). 81.3 % (n = 100) of patients were diagnosed with chronic spontaneous urticarial (CSU). 4.8% (n = 6) had inducible CU (CIndU), and 13.8% (n = 17) reported mixed urticaria (spontaneous CU with at least one inducible component). Regarding emotional factors, 34.9% (n = 43) of subjects indicated anxiety symptoms, 34.1% (n = 42) had exacerbations associated with stress, and 14.6% (n = 18) manifested episodes of sadness. The percentage of patients with CSU controlled according to medical criteria at 3 months with Omalizumab were 80% (n = 80/100) and at 6 months 87% (n = 87/100). The frequency of adverse events was 29.2% (n = 36), with headache being the most frequent adverse event. Conclusions This real-life study with Omalizumab at CU describes percentages of effectiveness and safety similar to those observed in pivotal and real-life studies conducted in other regions around the world.
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Affiliation(s)
- Elizabeth García-Gómez
- Departamento de Alergología, Fundación Santa Fé de Bogotá, Bogotá, Colombia
- Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia
- Departamento de Alergología, Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ-ORL), Bogotá, Colombia
- *Correspondence: Elizabeth García-Gómez ;
| | - Edgardo Chapman
- Departamento de Alergología, Fundación Santa Fé de Bogotá, Bogotá, Colombia
- Departamento de Alergología, Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ-ORL), Bogotá, Colombia
| | - María Beatriz García-Paba
- Departamento de Alergología, Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ-ORL), Bogotá, Colombia
- Servicio de Alergología, Clínica de alergias de Colombia, Ibagué, Colombia
| | - Jaime Ocampo-Gómez
- Departamento de Alergología, Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ-ORL), Bogotá, Colombia
- Servicio de Alergología, Clínica de alergias de Colombia, Ibagué, Colombia
| | | | | | - Luis Fang
- Departamento de Medicina, Universidad del Norte, Barranquilla, Colombia
| | - Mauricio Sarrazola
- Centro de Alergia e Inmunología Sarrazola, Clínica San José de Cúcuta, Cúcuta, Colombia
| | | | - Carlos Serrano-Reyes
- Unidad de Alergia, Fundación Valle de Lili, Cali, Colombia
- Facultad Ciencias de la salud, Universidad ICESI, Cali, Colombia
| | - Diana Lucia Silva-Espinosa
- Unidad de Alergia, Fundación Valle de Lili, Cali, Colombia
- Facultad Ciencias de la salud, Universidad ICESI, Cali, Colombia
| | - Dolly Vanessa Rojas-Mejía
- Departamento de Alergología, Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ-ORL), Bogotá, Colombia
- Unidad de Alergia, Fundación Valle de Lili, Cali, Colombia
| | - Sergio M. Moreno
- Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia
- Departamento de Alergología, Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ-ORL), Bogotá, Colombia
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Tzur Bitan D, Berzin D, Kridin K, Sela Y, Cohen A. Alopecia Areata as a Proximal Risk Factor for the Development of Comorbid Depression: A Population-based Study. Acta Derm Venereol 2022; 102:adv00669. [PMID: 35146527 PMCID: PMC9558328 DOI: 10.2340/actadv.v102.1622] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Alopecia areata and depression tend to co-occur; however, their temporal association has not been comprehensively investigated. The aim of this study was to examine the temporal association between alopecia areata and depression. The study included only cases with a comorbid presentation of alopecia areata and depression (n = 1,936), extracted from the databases of the Clalit Health Services, Israel. Survival analyses were used to assess the cumulative probability of receiving alopecia areata as comorbid diagnosis in the years following depression, and vice versa, compared with the opposite trajectory. The results indicate that patients with alopecia areata had greater odds of subsequent depression within 2 years from alopecia areata diagnosis, and showed a steeper increase in cumulative probability of depression as time progressed (log-rank =336.38, p < 0.001), compared with the opposite trajectory. All patients with alopecia areata had comorbid depression within 10 years of alopecia areata, compared with 70% of depression patients receiving diagnoses of comorbid alopecia areata within the same time-frame.
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Affiliation(s)
- Dana Tzur Bitan
- Department of Behavioral Sciences, Ariel University, IL-40700 Ariel, Israel.
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15
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Ridge K, Redenbaugh V, Conlon N. Omalizumab Reduces Unplanned Healthcare Interactions in Irish Patients With Chronic Spontaneous Urticaria. FRONTIERS IN ALLERGY 2021; 2:810418. [PMID: 35387063 PMCID: PMC8974680 DOI: 10.3389/falgy.2021.810418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 11/19/2021] [Indexed: 11/16/2022] Open
Abstract
Chronic spontaneous urticaria (CSU) is a common, debilitating skin disorder associated with impaired quality of life and psychological comorbidity. Symptoms can be difficult to control and many individuals will not respond to first line treatment. Due to the chronic and unpredictable nature of the disorder, patients frequently have repeated healthcare attendances. Despite this, little is known about healthcare resource utilization internationally. Furthermore, there is no Irish data to inform fundholding decision makers. Omalizumab is an anti IgE monoclonal antibody used in refractory urticaria. It is a comparatively high cost medicine and access to this treatment can be challenging. Recent assessments of omalizumab compared with usual care suggest that omalizumab is a cost-effective treatment for refractory urticaria. We carried out a retrospective review of 47 patients commenced on omalizumab. We evaluated unplanned primary and secondary care attendances and urticaria symptomatology before and after treatment. As expected, patients with refractory disease that were commenced on omalizumab had objective improvements in urticaria symptoms. Importantly, we show that this is reflected in a dramatic reduction in unplanned healthcare interactions at primary care and emergency departments. These data suggest that omalizumab may benefit these patients by reducing disease activity and thereby reducing the need for unplanned healthcare interactions.
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Affiliation(s)
- Katie Ridge
- Clinical and Diagnostic Immunology, St. James's Hospital, Dublin, Ireland
- Department of Clinical Immunology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- *Correspondence: Katie Ridge
| | - Vyanka Redenbaugh
- Clinical and Diagnostic Immunology, St. James's Hospital, Dublin, Ireland
| | - Niall Conlon
- Clinical and Diagnostic Immunology, St. James's Hospital, Dublin, Ireland
- Department of Clinical Immunology, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Wang X, Yi W, He L, Luo S, Wang J, Jiang L, Long H, Zhao M, Lu Q. Abnormalities in Gut Microbiota and Metabolism in Patients With Chronic Spontaneous Urticaria. Front Immunol 2021; 12:691304. [PMID: 34721374 PMCID: PMC8554312 DOI: 10.3389/fimmu.2021.691304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 09/29/2021] [Indexed: 01/09/2023] Open
Abstract
Background Increasing evidence suggests that the gut microbiome plays a role in the pathogenesis of allergy and autoimmunity. The association between abnormalities in the gut microbiota and chronic spontaneous urticaria (CSU) remains largely undefined. Methods Fecal samples were obtained from 39 patients with CSU and 40 healthy controls (HCs). 16S ribosomal RNA (rRNA) gene sequencing (39 patients with CSU and 40 HCs) and untargeted metabolomics (12 patients with CSU and 12 HCs) were performed to analyze the compositional and metabolic alterations of the gut microbiome in CSU patients and HCs. Results The 16S rRNA gene sequencing results showed a significant difference in the β-diversity of the gut microbiota, presented as the Jaccard distance, between CSU patients and HCs. No significant differences were found in the α-diversity of the gut microbiota between patients and HCs. At the phylum level, the major bacteria in the gut microbiome of patients with CSU were Firmicutes, Bacteroidetes, Proteobacteria, and Actinobacteria. At the genus level, Lactobacillus, Turicibacter, and Lachnobacterium were significantly increased and Phascolarctobacterium was decreased in patients with CSU. PICRUSt and correlation analysis indicated that Lactobacillus, Turicibacter, and Phascolarctobacterium were positively related to G protein-coupled receptors. Metabolomic analysis showed that α-mangostin and glycyrrhizic acid were upregulated and that 3-indolepropionic acid, xanthine, and isobutyric acid were downregulated in patients with CSU. Correlation analysis between the intestinal microbiota and metabolites suggested that there was a positive correlation between Lachnobacterium and α-mangostin. Conclusions This study suggests that disturbances in the gut microbiome composition and metabolites and their crosstalk or interaction may participate in the pathogenesis of CSU.
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Affiliation(s)
- Xin Wang
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Wanyu Yi
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Liting He
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shuaihantian Luo
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jiaqi Wang
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Li Jiang
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hai Long
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ming Zhao
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qianjin Lu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China.,Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
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17
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Ayvaz HH, Kuyumcu A. Effect of the Mediterranean diet in patients with chronic spontaneous urticaria. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2021; 67:675-680. [PMID: 34550255 DOI: 10.1590/1806-9282.20201076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/18/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Patients with chronic spontaneous urticaria often want to be informed about dietary modifications. There have been many studies evaluating dietary approaches in chronic spontaneous urticaria. In this study, we aimed to investigate the relationship between adherence to the Mediterranean diet and chronic spontaneous urticaria. METHODS In this cross-sectional case-control observational study, 100 patients (70 males and 30 females, mean age: 38.6±13.0 years) with chronic spontaneous urticaria and age- and sex-matched 100 healthy controls 70 males and 30 females, mean age: 38.7±13.8 years) were enrolled. A validated 14-item questionnaire evaluating the Mediterranean diet score was used for the assessment of adherence to the Mediterranean diet. The severity and the control of chronic spontaneous urticaria were assessed by Urticaria Activity Score over 7 days and Urticaria Control Test, respectively. RESULTS The mean Mediterranean diet score in the patient group was 5.40±1.88, whereas in healthy controls it was 6.30±1.39 (p<0.001). The Urticaria Activity Score over 7 days score of the patients was negatively correlated with the Mediterranean diet score, whereas the Urticaria Control Test score was positively correlated. CONCLUSION We reported that adherence to the Mediterranean diet may be an independent factor that decreases the risk of chronic spontaneous urticaria. It may also reduce the severity of chronic spontaneous urticaria symptoms.
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Affiliation(s)
- Havva Hilal Ayvaz
- Suleyman Demirel University, Faculty of Medicine, Department of Dermatology - Isparta, Turkey
| | - Aliye Kuyumcu
- Suleyman Demirel University, Faculty of Health Sciences, Department of Nutrition and Dietetics - Isparta, Turkey
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18
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Sánchez-Borges M, Ansotegui IJ, Baiardini I, Bernstein J, Canonica GW, Ebisawa M, Gomez M, Gonzalez-Diaz SN, Martin B, Morais-Almeida M, Ortega Martell JA. The challenges of chronic urticaria part 1: Epidemiology, immunopathogenesis, comorbidities, quality of life, and management. World Allergy Organ J 2021; 14:100533. [PMID: 34221215 PMCID: PMC8233382 DOI: 10.1016/j.waojou.2021.100533] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/18/2021] [Accepted: 03/08/2021] [Indexed: 12/02/2022] Open
Abstract
This is Part 1 of an updated follow-up review of a World Allergy Organization (WAO) position paper published in 2012 on the diagnosis and treatment of urticaria and angioedema. Since 2012, there have been advances in the understanding of the pathogenesis of chronic urticaria, and greater experience with the use of biologics, such as omalizumab, in patients with severe refractory disease. For these reasons, the 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, including 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 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, and 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, Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Jonathan Bernstein
- Department of Internal Medicine, Division of Immunology, Allergy Section, University of Cincinnati
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 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 Nora Gonzalez-Diaz
- Regional Center for Allergy and Clinical Immunology, Faculty of Medicine and “Dr. José Eleuterio González" University Hospital, Autonomous University of Nuevo León, Monterrey, México
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