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Nickels A, Varadarajulu S, Harris P, Graden A, Richardson A, Saha T, Kharbanda EO, Zhu J, Vazquez-Benitez G. Case series of patients with acute and chronic urticaria after COVID-19 vaccination. Ann Allergy Asthma Immunol 2024; 132:395-397. [PMID: 38052374 DOI: 10.1016/j.anai.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/08/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Andrew Nickels
- Park Nicollet Health Services, St. Louis Park, Minnesota; HealthPartners Institute, Bloomington, Minnesota.
| | | | - Pamela Harris
- Park Nicollet Health Services, St. Louis Park, Minnesota
| | | | | | - Trisha Saha
- Beth Israel Deaconess, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | | | - Jingyi Zhu
- HealthPartners Institute, Bloomington, Minnesota
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Magen E, Merzon E, Green I, Magen I, Geishin A, Golan-Cohen A, Vinker S, Israel A. Chronic idiopathic eosinopenia and chronic spontaneous urticaria. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2583-2586. [PMID: 37088375 DOI: 10.1016/j.jaip.2023.03.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/10/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023]
Affiliation(s)
- Eli Magen
- Leumit Health Services, Tel Aviv-Yafo, Israel; Medicine A Department, Assuta Ashdod University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Eugene Merzon
- Leumit Health Services, Tel Aviv-Yafo, Israel; Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Ilan Green
- Leumit Health Services, Tel Aviv-Yafo, Israel; Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Israel Magen
- Medicine A Department, Assuta Ashdod University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel; Tbilisi State Medical University, Tbilisi, Georgia
| | - Akim Geishin
- Leumit Health Services, Tel Aviv-Yafo, Israel; Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Avivit Golan-Cohen
- Leumit Health Services, Tel Aviv-Yafo, Israel; Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Shlomo Vinker
- Leumit Health Services, Tel Aviv-Yafo, Israel; Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Ariel Israel
- Leumit Health Services, Tel Aviv-Yafo, Israel; Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
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Claims-based Prevalence of Disease Progression among Patients with Non-IPF Fibrosing Interstitial Lung Disease in the US. Ann Am Thorac Soc 2022; 19:1112-1121. [PMID: 35015982 PMCID: PMC9278640 DOI: 10.1513/annalsats.202102-222oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Rationale Chronic fibrosing interstitial lung disease (ILD) with a progressive phenotype is a clinical concept describing the broad group of ILDs characterized by progressive pulmonary fibrosis. The prevalence of progressive fibrotic ILDs other than idiopathic pulmonary fibrosis (IPF) is not well understood. Objectives We used a novel algorithm to estimate the prevalence range of disease progression among patients with non-IPF fibrotic ILD in a U.S. claims database. Methods This was a retrospective study including adults with commercial or Medicare Advantage with Part D (MAPD) insurance using administrative claims data from October 2015 to September 2019. Patients likely to have non-IPF fibrosing ILD with a progressive phenotype were identified via an algorithm that incorporated ILD-related diagnosis codes (excluding IPF) and claims-based proxies for fibrotic ILD progression, including pulmonary function tests, chest imaging, oral corticosteroid (OCS) medications, immunosuppressive medications, lung transplant, oxygen therapy, palliative care, and respiratory hospitalization. The prevalence range of non-IPF fibrotic ILD with progressive disease behavior was calculated using strict and lenient case definitions to account for potential imprecision in the progression proxies. Results Of nearly 9 million study-eligible patients, 17,136 were identified with non-IPF fibrosing ILD. The prevalence of disease progression per 10,000 (95% confidence interval) ranged from 12.14 (11.74–12.54) to 29.05 (28.43–29.67) over a mean observation time of 1.44 years for MAPD enrollees (n = 14,686), and from 0.89 (0.81–0.97) to 2.36 (2.24–2.48) over a mean observation time of 1.29 years for commercial enrollees (n = 2,450). Prevalence estimates increased with age for both insurance types. Among patients with progression, 4,097 met at least two progression proxies not considering OCS (strict case definition) and 9,946 met at least one progression proxy (lenient case definition). The mean (standard deviation) number of proxies met was 2.1 (1.3), and the most common individual proxies met (alone or in combination with other proxies) were OCS use (48.9%), respiratory hospitalization (44.2%), and oxygen therapy (44.1%). Conclusions This is among the first claims-based estimates of the prevalence of non-IPF chronic fibrosing ILD with a progressive phenotype. Our analysis indicates that this phenotype is rare in the overall population but increases substantially with increasing age.
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Association of herpes zoster and chronic inflammatory skin disease in US inpatients. J Am Acad Dermatol 2021; 85:1437-1445. [PMID: 31958523 PMCID: PMC10148648 DOI: 10.1016/j.jaad.2019.12.073] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/29/2019] [Accepted: 12/31/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patients with chronic inflammatory skin disease (CISD) have potential risk factors for herpes zoster (HZ). However, little is known about HZ risk in CISD. OBJECTIVE To determine whether CISD is associated with HZ. METHODS Data were analyzed from the 2002 to 2012 Nationwide Inpatient Sample, a representative cohort of US hospitalizations (N = 68,088,221 children and adults). RESULTS In multivariable logistic regression models including age, sex, race/ethnicity, insurance, household income, and long-term systemic corticosteroid use, hospitalization for HZ was associated with atopic dermatitis (adjusted odds ratio [95% confidence interval], 1.38 [1.14-1.68]), psoriasis (4.78 [2.83-8.08]), pemphigus (1.77 [1.01-3.12]), bullous pemphigoid (1.77 [1.01-3.12]), mycosis fungoides (3.79 [2.55-5.65]), dermatomyositis (7.31 [5.27-10.12]), systemic sclerosis (1.92 [1.47-2.53]), cutaneous lupus erythematosus (1.94 [1.10-3.44]), vitiligo (2.00 [1.04-3.85]), and sarcoidosis (1.52 [1.22-1.90]). Only lichen planus (crude odds ratio [95% confidence interval], 3.01 [1.36-6.67]), Sézary syndrome (12.14 [5.20-28.31]), morphea (2.74 [1.36-5.51]), and pyoderma gangrenosum (2.44 [1.16-5.13]) showed increased odds in bivariable models. Sensitivity analyses among those younger than 60 and younger than 50 years showed similar results. Predictors of HZ in CISD included female sex, fewer chronic conditions, and long-term systemic corticosteroid use. LIMITATIONS Cross-sectional study. CONCLUSIONS Many CISDs are associated with increased hospitalization for HZ, even below the ages recommended for HZ vaccination. Additional studies are needed to establish CISD-specific vaccination guidelines.
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Newcomer SR, Xu S, Kulldorff M, Daley MF, Fireman B, Glanz JM. A primer on quantitative bias analysis with positive predictive values in research using electronic health data. J Am Med Inform Assoc 2021; 26:1664-1674. [PMID: 31365086 DOI: 10.1093/jamia/ocz094] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/12/2019] [Accepted: 05/17/2019] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE In health informatics, there have been concerns with reuse of electronic health data for research, including potential bias from incorrect or incomplete outcome ascertainment. In this tutorial, we provide a concise review of predictive value-based quantitative bias analysis (QBA), which comprises epidemiologic methods that use estimates of data quality accuracy to quantify the bias caused by outcome misclassification. TARGET AUDIENCE Health informaticians and investigators reusing large, electronic health data sources for research. SCOPE When electronic health data are reused for research, validation of outcome case definitions is recommended, and positive predictive values (PPVs) are the most commonly reported measure. Typically, case definitions with high PPVs are considered to be appropriate for use in research. However, in some studies, even small amounts of misclassification can cause bias. In this tutorial, we introduce methods for quantifying this bias that use predictive values as inputs. Using epidemiologic principles and examples, we first describe how multiple factors influence misclassification bias, including outcome misclassification levels, outcome prevalence, and whether outcome misclassification levels are the same or different by exposure. We then review 2 predictive value-based QBA methods and why outcome PPVs should be stratified by exposure for bias assessment. Using simulations, we apply and evaluate the methods in hypothetical electronic health record-based immunization schedule safety studies. By providing an overview of predictive value-based QBA, we hope to bridge the disciplines of health informatics and epidemiology to inform how the impact of data quality issues can be quantified in research using electronic health data sources.
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Affiliation(s)
- Sophia R Newcomer
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA.,Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Stan Xu
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Martin Kulldorff
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA.,Department of Pediatrics, School of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Bruce Fireman
- Division of Research, Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California, USA
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA.,Department of Epidemiology, School of Public Health, University of Colorado Denver, Aurora, Colorado, USA
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Kim YH, Do Han K, Bang CH, Lee JH, Lee JY, Park YG, Park YM. High waist circumference rather than high body mass index may be a predictive risk factor for the longer disease duration of chronic spontaneous urticaria. Sci Rep 2021; 11:1875. [PMID: 33479357 PMCID: PMC7820591 DOI: 10.1038/s41598-021-81484-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/07/2021] [Indexed: 11/08/2022] Open
Abstract
In a previous study, we found that higher waist circumference (WC) and higher body mass index (BMI) both increase the risk of chronic spontaneous urticaria (CSU). The aim of this study was to determine whether WC and BMI also increase the duration of CSU. We used multivariable Cox proportional hazards models to determine the hazard ratio (HR) for longer disease duration (longer than 3 years) according to WC and BMI. A total of 52,667 subjects were enrolled and their mean age was 54.5. After adjustments for other confounding variables the high WC/high BMI group had 1.062 times higher HR (95% CI, 1.028-1.098) than the normal WC/normal BMI group. Interestingly, the high WC/normal BMI group showed a significantly higher HR (1.053; 95% CI, 1.008-1.101) than the normal WC/normal BMI group, but not the normal WC/high BMI group (0.998; 95% CI, 0.951-1.046). Taken together, our results suggest that high WC rather than high BMI is a predictive risk factor for the longer disease duration of CSU.
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Affiliation(s)
- Yeong Ho Kim
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Kyung Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Chul Hwan Bang
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jun Young Lee
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yong Gyu Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Min Park
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Chen CM, Huang WT, Chang LJ, Hsu CC, Hsu YH. Peptic Ulcer Disease is Associated with Increased Risk of Chronic Urticaria Independent of Helicobacter pylori Infection: A Population-Based Cohort Study. Am J Clin Dermatol 2021; 22:129-137. [PMID: 32915422 DOI: 10.1007/s40257-020-00561-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Some studies showed patients with chronic urticaria have a higher rate of peptic ulcer disease (PUD). Whether PUD is a risk factor for chronic urticaria is unclear. OBJECTIVE The objective of this study was to evaluate the incidence of and risk factors for chronic urticaria in patients with PUD using the Taiwan National Health Insurance Research Database. METHODS We conducted a retrospective nationwide cohort study of the period 2000-2012 and involving 11,901 patients with PUD who underwent Helicobacter pylori (HP) therapy (PUD + HP group) and an equal number of matched patients without HP infection (PUD - HP group). Furthermore, we enrolled 23,802 patients without PUD for comparison (non-PUD group). The Cox proportional hazards regression model was used to analyze chronic urticaria risk after adjusting for potential confounding factors. RESULTS The mean ages of the three groups were around 50 years. Approximately 42.6% were female. Chronic urticaria incidences in the PUD + HP and PUD - HP groups were both significantly higher than that in the non-PUD group. The hazard ratios of chronic urticaria in the PUD + HP group and the PUD - HP group were 1.34 (95% confidence interval 1.09-1.64) and 1.45 (95% confidence interval 1.19-1.79), respectively. The risk difference became significant 2 years after patients with PUD had the HP infection tests and persisted till the end of follow-up. The risk increase was significant in patients with PUD who were female or aged 40-64 years. There was no difference in the risk comparison between PUD + HP and PUD - HP groups. CONCLUSIONS Peptic ulcer disease, independent of HP infection, is associated with an increased chronic urticaria risk. Patients with PUD who were female or aged 40-64 years are more likely to have chronic urticaria.
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Wertenteil S, Strunk A, Garg A. Prevalence estimates for chronic urticaria in the United States: A sex- and age-adjusted population analysis. J Am Acad Dermatol 2019; 81:152-156. [PMID: 30872154 DOI: 10.1016/j.jaad.2019.02.064] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/22/2019] [Accepted: 02/27/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Disease burden in chronic urticaria (CU) is poorly understood. OBJECTIVE To estimate standardized overall and sex-, age-, and race-specific prevalence estimates for CU among adults in the United States. METHODS A cross-sectional analysis with electronic health records data for a demographically heterogeneous population-based sample of >55 million patients across all 4 census regions. RESULTS The overall CU prevalence was 0.23%, or 230 CU cases/100,000 adults. The adjusted prevalence in women was 310 (95% confidence interval [CI] 307-312) cases/100,000 adults, more than twice that of men (146 [95% CI 143-148] cases/100,000 adults, P < .001). CU prevalence was highest among patients aged 40-49 years (256 [95% CI 252-261] cases/100,000 adults) and 50-59 years (246 [95% CI 242-251] cases/100,000 adults) compared with all other age groups (P < .0001). Adjusted prevalences for black (292 [95% CI 285-298] cases/100,000 adults) and other (331 [95% CI 323-338] cases/100,000 adults) patients were higher than that for white patients (262 [95% CI 260-264] cases/100,000 adults; P < .001). LIMITATIONS Use of administrative data has the potential to underestimate burden. CONCLUSION There are >500,000 people estimated to have CU in the United States, most of whom are women or adults ≥40 years of age.
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Affiliation(s)
- Sara Wertenteil
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Andrew Strunk
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York.
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Seo JH, Kwon JW. Epidemiology of urticaria including physical urticaria and angioedema in Korea. Korean J Intern Med 2019; 34:418-425. [PMID: 29742892 PMCID: PMC6406086 DOI: 10.3904/kjim.2017.203] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 12/04/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND/AIMS Despite the high burden and frequency of urticaria, its epidemiology is not well known. We investigated the epidemiology of various type of urticaria in Korea and changes in its annual prevalence over 5 years. METHODS We used data from the 2010 to 2014 Health Insurance Review and Assessment database, which covers the claims of 97.0% of the South Korean population. Patients aged > 10 years old were included in this study. The presence of urticaria was identified on physician-certified diagnoses using the International Classification of Diseases 10th Revision (ICD-10) codes that include various type of urticaria (L500-L509) and angioedema (T783). Epidemiology of all type of urticaria, physical urticaria and angioedema were investigated. RESULTS The prevalence of all-type urticaria over the 5 years was 4.5% with a peak in individuals, especially females, aged 30 to 59 years. The age-specific prevalence of all-type urticaria increased with age from the 10- to 19-year age group to the 70- to 79-year age group. The prevalence of dermographism, cholinergic urticaria, and angioedema were 0.12%, 0.025%, and 0.027%, respectively. Cholinergic urticaria was most prevalent in those aged 10 to 29 years with male predominance. The annual prevalence of all-type urticaria, dermographism, and angioedema increased over the 5 years. CONCLUSION The prevalence of urticaria has increased annually in Korea. Cholinergic urticaria showed unique distribution in its age and gender, and angioedema showed remarkable increases in annual prevalence, although the prevalence estimation is still exploratory and diagnosis of urticaria based on ICD-10 codes need to be validated.
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Affiliation(s)
- Jeong-Hun Seo
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Jae-Woo Kwon
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
- Department of Allergy and Clinical Immunology, Kangwon National University School of Medicine, Chuncheon, Korea
- Correspondence to Jae-Woo Kwon, M.D. Department of Internal Medicine, Kangwon National University Hospital, 156 Baengnyeong-ro, Chuncheon 24289, Korea Tel: +82-33-258-9370 Fax: +82-33-258-2404 E-mail:
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10
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Kim YS, Han K, Lee JH, Lee JY, Park YM. Can Body Mass Index and/or Waist Circumference Be the Risk Factors of Chronic Spontaneous Urticaria?: A Nationwide Population-Based Study. Ann Dermatol 2019; 31:482-485. [PMID: 33911636 PMCID: PMC7992755 DOI: 10.5021/ad.2019.31.4.482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/15/2018] [Accepted: 01/02/2019] [Indexed: 01/10/2023] Open
Affiliation(s)
- Yoon Seob Kim
- Department of Dermatology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kyungdo Han
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jun Young Lee
- Department of Dermatology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Young Min Park
- Department of Dermatology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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He GY, Tsai TF, Lin CL, Shih HM, Hsu TY. Association between sleep disorders and subsequent chronic spontaneous urticaria development: A population-based cohort study. Medicine (Baltimore) 2018; 97:e11992. [PMID: 30142836 PMCID: PMC6112928 DOI: 10.1097/md.0000000000011992] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Patients with chronic spontaneous urticaria (CSU) often have sleep disorders (SDs) because of pruritus. However, SDs might also contribute to the development of CSU. Here, we present the first population-based cohort study on the association between SDs and subsequent CSU development.This study investigated whether SDs increase the risk of CSU by using a population-based database in Taiwan.This retrospective matched-cohort study included 105,892 patients with new-onset SDs (SD cohort) and 105,892 randomly selected controls (control cohort). Each patient was monitored for 10 years to individually identify patients who were subsequently diagnosed as having CSU during the follow-up period. A Cox proportional hazard regression analysis was conducted to determine the risk of CSU in patients with SDs compared with the controls.All relevant comorbidities were more prevalent in the SD cohort than in the control cohort (P < .001). During the follow-up period, the incidence rates of CSU among the patients with SDs and controls were 53.4 and 28.3 per 10,000 person-years, respectively. After adjustment for age, sex, and comorbidities, the adjusted hazard ratio for CSU in the SD cohort was 1.83 (95% confidence interval = 1.73-1.93, P < .001).The risk of CSU was higher in the patients with SDs than in the controls.
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Affiliation(s)
- Guan-Yi He
- Department of Dermatology, National Taiwan University Hospital Yunlin Branch, Douliou
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital
- School of Medicine, College of Medicine, China Medical University
| | - Hong-Mo Shih
- School of Medicine, College of Medicine, China Medical University
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Tai-Yi Hsu
- School of Medicine, College of Medicine, China Medical University
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
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12
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Saff RR, Li Y, Santhanakrishnan N, Camargo CA, Blumenthal KG, Zhou L, Banerji A. Identification of Inpatient Allergic Drug Reactions Using ICD-9-CM Codes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:259-264.e1. [PMID: 30075337 DOI: 10.1016/j.jaip.2018.07.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 07/04/2018] [Accepted: 07/08/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The study of allergic drug reactions has been limited because of challenges in identifying and confirming cases. OBJECTIVE To determine the utility of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for identifying inpatient allergic drug reactions and to compare findings with previous data in the emergency department. METHODS By reviewing medical records of inpatients with ICD-9-CM codes and E codes suggestive of allergic drug reactions at a large urban academic medical center, we determined codes that yielded the most drug allergy cases and identified culprit drugs. RESULTS In 2005 and 2010, 3337 and 5282 possible allergic drug reactions during hospitalization were identified and 1367 were reviewed. Allergic drug reactions were found in 409 (30.1%) of the reviewed charts, with 172 (29.7%) in 2005 and 237 (30.5%) in 2010. The codes that identified the highest percentage of true allergic drug reactions were dermatitis due to drug (693.0), allergic urticaria (708), angioneurotic edema (995.1), and anaphylaxis (995.0). Antibiotics were the most common cause (44.4%); however, multiple drug classes were often identified as likely culprit drugs. CONCLUSION Specific ICD-9-CM codes can identify patients with allergic drug reactions, with antibiotics accounting for almost half of true reactions. Most patients with codes 693.0, 995.1, 708, and 995.0 had allergic drug reactions, with 693.0 as the highest yield code. An aggregate of multiple specific codes consistently identifies a cohort of patients with confirmed allergic drug reactions.
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Affiliation(s)
- Rebecca R Saff
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Yu Li
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | | | - Carlos A Camargo
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass
| | - Kimberly G Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, Mass
| | - Li Zhou
- Harvard Medical School, Boston, Mass; Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Clinical Informatics, Partners eCare, Partners HealthCare System, Boston, Mass
| | - Aleena Banerji
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
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Eghrari-Sabet J, Sher E, Kavati A, Pilon D, Zhdanava M, Balp MM, Lefebvre P, Ortiz B, Bernstein JA. Real-world use of omalizumab in patients with chronic idiopathic/spontaneous urticaria in the United States. Allergy Asthma Proc 2018; 39:191-200. [PMID: 29458456 PMCID: PMC5911510 DOI: 10.2500/aap.2018.39.4132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Omalizumab was approved for the treatment of chronic idiopathic urticaria (CIU)/chronic spontaneous urticaria (CSU) in the United States in March 2014. OBJECTIVE This study sought to describe real-world omalizumab use, in the United States, in a large cohort of patients with CIU/CSU. METHODS Patients with CIU/CSU (ages ≥12 years) initiated on omalizumab (index date) with ≥12 months of pre- and postindex data were identified in the an insurance claims data base (January 1, 2013, to July 31, 2016). Treatment patterns, including the dosing regimen and continuous use of omalizumab (no gaps for ≥60 days), were described during the 12-month postindex follow-up period. RESULTS A total of 1546 patients (mean ± standard deviation [SD] ages, 44 ± 14.5 years; 73.1% women) were identified. Most of the patients (84.5%) were initiated on omalizumab 300-mg dose; 90% maintained the initial dose, 7.5% had a dose increase, and 4.6% had a dose decrease. The mean ± SD omalizumab treatment duration was 9.1 ± 3.8 months, the mean ± SD number of omalizumab administrations was 8.3 ± 4.8, and the mean ± SD administration frequency was 44 ± 29 days. A proportion of the patients continuously treated with omalizumab for 6, 9, and 12 months was 67.3, 54.8, and 47.4%, respectively. Among the patients who discontinued omalizumab for ≥3 months (39.8%), 21% restarted the treatment after a mean ± SD of 4.4 ± 1.3 months. The proportion of patients who used other CIU/CSU-related medications decreased pre- to postindex (94.8 to 81.1%), with the highest decrease observed in oral corticosteroids (75.7 to 49.9%). CONCLUSION In this large real-world study, the majority of the patients with CIU/CSU were initiated on a 300-mg omalizumab dose and treated without titration up or down for 9 months on average. Most of the patients were continuously treated with omalizumab for ≥6 months, and one-fourth of the patients who discontinued treatment resumed it. Moreover, compared with baseline levels, the use of other CIU/CSU-related medications was lower after omalizumab initiation, with the most prominent decrease observed in oral corticosteroids.
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Affiliation(s)
| | - Ellen Sher
- Atlantic Research Center, LLC, Ocean, New Jersey
| | - Abhishek Kavati
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | | | | | | | | - Benjamin Ortiz
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Jonathan A. Bernstein
- Bernstein Clinical Research Center, Cincinnati, Ohio and
- University of Cincinnati College of Medicine, Cincinnati, Ohio
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Kim YS, Park SH, Han K, Bang CH, Lee JH, Park YM. Prevalence and incidence of chronic spontaneous urticaria in the entire Korean adult population. Br J Dermatol 2018; 178:976-977. [PMID: 29106703 DOI: 10.1111/bjd.16105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Y S Kim
- Department of Dermatology, Seoul St Mary's Hospital
| | - S H Park
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - K Han
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - C H Bang
- Department of Dermatology, Seoul St Mary's Hospital
| | - J H Lee
- Department of Dermatology, Seoul St Mary's Hospital
| | - Y M Park
- Department of Dermatology, Seoul St Mary's Hospital
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15
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Williams PV, Kavati A, Pilon D, Xiao Y, Zhdanava M, Balp MM, Lefebvre P, Ortiz B, Hernandez-Trujillo V. Treatment Patterns, Healthcare Resource Utilization, and Spending Among Medicaid-Enrolled Children with Chronic Idiopathic/Spontaneous Urticaria in the United States. Dermatol Ther (Heidelb) 2018; 8:69-83. [PMID: 29429043 PMCID: PMC5825330 DOI: 10.1007/s13555-018-0225-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Indexed: 11/19/2022] Open
Abstract
Introduction Few studies have described chronic idiopathic/spontaneous urticaria (CIU/CSU) healthcare burden in adults, while this information remains largely unknown in children. We aimed to describe treatment patterns, healthcare resource utilization (HRU), and costs in CIU/CSU pediatric patients, as well as to compare HRU and costs in CIU/CSU and CIU/CSU-free pediatric patients. Methods Medicaid claims from four states (09/01/2013–03/31/2016) were used to identify patients less than 12 years old. The CIU/CSU cohort included patients with either at least two claims for idiopathic, other, or unspecified urticaria at least 6 weeks apart, or at least one claim for urticaria and at least one claim for angioedema at least 6 weeks apart (index date defined as the first claim). The control cohort included patients without urticaria/angioedema claims (index date randomly assigned). Patients without at least 6 months of continuous Medicaid eligibility pre- and post-index were excluded. HRU and costs were compared between propensity score-matched cohorts during the post-index follow-up. Results A total of 548 CIU/CSU patients (mean [SD] age 4.5 [3.3] years; 51.3% male) were matched 1:1 with controls. In the CIU/CSU cohort, 51.8% used non-sedating prescription H1-antihistamines, 24.3% used oral corticosteroids, and 23.5% used other prescription H1-antihistamines; 13.5% consulted allergist/immunologists and 2.4% consulted dermatologists in the first 6 months of follow-up. Compared to controls, CIU/CSU patients had significantly more per patient per year (PPPY) inpatient (incidence rate ratio [IRR] 2.05), outpatient (IRR 2.20), and emergency department (IRR 1.64) visits (all p values < 0.05). Moreover, CIU/CSU patients also had significantly higher PPPY healthcare costs (mean cost difference [MCD] $1853), driven by incremental outpatient (MCD $1286) costs (all p values < 0.01). Conclusions CIU/CSU pediatric patients had low use of non-sedating H1-antihistamines and high use of oral corticosteroids. Compared to CIU/CSU-free controls in the same age group, CIU/CSU pediatric patients had higher HRU and healthcare costs. Funding Novartis Pharmaceuticals Corporation
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Affiliation(s)
| | | | | | | | | | | | | | - Benjamin Ortiz
- Novartis Pharmaceuticals Corporation, East Hanover, NY, USA
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16
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Newcomer SR, Kulldorff M, Xu S, Daley MF, Fireman B, Lewis E, Glanz JM. Bias from outcome misclassification in immunization schedule safety research. Pharmacoepidemiol Drug Saf 2018; 27:221-228. [PMID: 29292551 DOI: 10.1002/pds.4374] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/18/2017] [Accepted: 11/20/2017] [Indexed: 11/11/2022]
Abstract
PURPOSE The Institute of Medicine recommended conducting observational studies of childhood immunization schedule safety. Such studies could be biased by outcome misclassification, leading to incorrect inferences. Using simulations, we evaluated (1) outcome positive predictive values (PPVs) as indicators of bias of an exposure-outcome association, and (2) quantitative bias analyses (QBA) for bias correction. METHODS Simulations were conducted based on proposed or ongoing Vaccine Safety Datalink studies. We simulated 4 studies of 2 exposure groups (children with no vaccines or on alternative schedules) and 2 baseline outcome levels (100 and 1000/100 000 person-years), with 3 relative risk (RR) levels (RR = 0.50, 1.00, and 2.00), across 1000 replications using probabilistic modeling. We quantified bias from non-differential and differential outcome misclassification, based on levels previously measured in database research (sensitivity > 95%; specificity > 99%). We calculated median outcome PPVs, median observed RRs, Type 1 error, and bias-corrected RRs following QBA. RESULTS We observed PPVs from 34% to 98%. With non-differential misclassification and true RR = 2.00, median bias was toward the null, with severe bias (median observed RR = 1.33) with PPV = 34% and modest bias (median observed RR = 1.83) with PPV = 83%. With differential misclassification, PPVs did not reflect median bias, and there was Type 1 error of 100% with PPV = 90%. QBA was generally effective in correcting misclassification bias. CONCLUSIONS In immunization schedule studies, outcome misclassification may be non-differential or differential to exposure. Overall outcome PPVs do not reflect the distribution of false positives by exposure and are poor indicators of bias in individual studies. Our results support QBA for immunization schedule safety research.
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Affiliation(s)
- Sophia R Newcomer
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO, USA.,Colorado School of Public Health, Anschutz Medical Campus, Department of Epidemiology, Denver, CO, USA
| | - Martin Kulldorff
- Brigham and Women's Hospital and Harvard Medical School, Division of Pharmacoepidemiology and Pharmacoeconomics, Boston, MA, USA
| | - Stan Xu
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO, USA
| | - Matthew F Daley
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO, USA.,University of Colorado Denver, School of Medicine, Department of Pediatrics, Denver, CO, USA
| | - Bruce Fireman
- Kaiser Permanente Northern California, Division of Research, Vaccine Study Center, Oakland, CA, USA
| | - Edwin Lewis
- Kaiser Permanente Northern California, Division of Research, Vaccine Study Center, Oakland, CA, USA
| | - Jason M Glanz
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO, USA.,Colorado School of Public Health, Anschutz Medical Campus, Department of Epidemiology, Denver, CO, USA
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17
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Kim YS, Park SH, Han K, Lee JH, Kim NI, Roh JY, Seo SJ, Song HJ, Lee MG, Choi JH, Park YM. Clinical Course of Chronic Spontaneous Urticaria in the Korean Adult Population. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2018; 10:83-87. [PMID: 29178681 PMCID: PMC5705488 DOI: 10.4168/aair.2018.10.1.83] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/28/2017] [Accepted: 09/11/2017] [Indexed: 01/21/2023]
Abstract
Knowledge of the clinical course of chronic spontaneous urticaria (CSU) remains unclear. The purpose of our study was to investigate the clinical course of CSU in the Korean adult population. Each patient in the CSU group who was defined by disease codes between 2003 and 2007 was tracked whether he or she went into remission or not until 2013. Kaplan-Meier survival analysis was carried out to analyze remission, and log-rank tests were performed for between-group comparisons. Demographic differences between subjects who went into remission 1 year after the initial diagnosis and those who did not were analyzed using χ2 tests. A total of 13,969 subjects were included in the CSU group. The 1-, 2-, 3-, 4-, and 5-year remission rates of CSU were 21.5%, 33.0%, 38.9%, 42.6%, and 44.6%, respectively. The proportion of subjects in the 65+ age group (P=0.050) and with male gender (P=0.002) was significantly higher among subjects who did not go into remission 1 year after the initial diagnosis. Our study indicates that CSU could have a more persistent course than previously reported.
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Affiliation(s)
- Yoon Seob Kim
- Department of Dermatology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sang Hyun Park
- Department of Medical Statistics, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kyungdo Han
- Department of Medical Statistics, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ji Hyun Lee
- Department of Dermatology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Nack In Kim
- Department of Dermatology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Joo Young Roh
- Department of Dermatology, Gachon University Gil Medical Center, Incheon, Korea
| | - Seong Jun Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hae Jun Song
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Min Geol Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Ho Choi
- Department of Dermatology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young Min Park
- Department of Dermatology, The Catholic University of Korea College of Medicine, Seoul, Korea.
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Blumenthal KG, Lai KH, Huang M, Wallace ZS, Wickner PG, Zhou L. Adverse and Hypersensitivity Reactions to Prescription Nonsteroidal Anti-Inflammatory Agents in a Large Health Care System. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:737-743.e3. [PMID: 28110055 DOI: 10.1016/j.jaip.2016.12.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 12/01/2016] [Accepted: 12/07/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most frequently used medications in the United States. NSAID use can be limited by adverse drug reactions (ADRs), including hypersensitivity reactions (HSRs). OBJECTIVE We aimed to use electronic health record data to determine the incidence and predictors of HSRs to prescription NSAIDs. METHODS We performed a retrospective cohort study of all adult outpatients in a large health care system prescribed diclofenac, indomethacin, nabumetone, or piroxicam between January 1, 2004, and September 30, 2012. The primary outcome was an ADR or HSR attributed to the prescribed NSAID within 1 year of prescription, determined from a longitudinal allergy database. We used natural language processing to classify known ADRs as either HSRs or side effects. Multivariable logistic regression models were used to identify independent risk factors for NSAID HSRs. RESULTS Of 62,719 patients prescribed NSAIDs, 1,035 (1.7%) had an ADR, of which 189 (18.3%) were HSRs. Multivariable regression analysis identified that patients with prior drug HSR history (odds ratio [OR] 1.8 [95% CI 1.3, 2.5]), female sex (OR 1.8 [95% CI 1.3, 2.4]), autoimmune disease (OR 1.7 [95% CI 1.1, 2.7]), and those prescribed the maximum standing NSAID dose (OR 1.5 [95% CI 1.1, 2.0]) had increased odds of NSAID HSR. CONCLUSIONS NSAID therapeutic use can be limited by ADRs; about 1 in 5 NSAID ADRs is an HSR. Both patient and drug factors contribute to HSR risk and are important to guide patient counseling.
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Affiliation(s)
- Kimberly G Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, Mass.
| | | | - Mingshu Huang
- Biostatistics Center, Massachusetts General Hospital, Boston, Mass
| | - Zachary S Wallace
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Paige G Wickner
- Harvard Medical School, Boston, Mass; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Li Zhou
- Harvard Medical School, Boston, Mass; Partners eCare, Partners HealthCare System, Boston, Mass; Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
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Lee N, Lee JD, Lee HY, Kang DR, Ye YM. Epidemiology of Chronic Urticaria in Korea Using the Korean Health Insurance Database, 2010-2014. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:438-445. [PMID: 28677358 PMCID: PMC5500699 DOI: 10.4168/aair.2017.9.5.438] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/27/2017] [Accepted: 04/21/2017] [Indexed: 01/27/2023]
Abstract
Purpose There are very few epidemiological studies on chronic urticaria (CU). We aimed to investigate the prevalence of CU and to depict demographics and medication patterns for the disease in a nationwide population-based study. Methods Data on urticaria (L50 of the International Classification of Diseases, 10th revision) from 2010 to 2014 were obtained from the Korean Health Insurance Review and Assessment Service. Algorithms designed to evaluate prescription drug claims for antihistamines were applied to identify CU. Results The crude prevalence of CU was 2,256.5 per 100,000 person-years and tended to increase every year. The age-standardized prevalence of CU was significantly higher in females than in males (2,466.8 vs 1,819.2 per 100,000 person-years, P<0.001). Age-specific prevalence was highest for older adults over the age of 65 years and lowest for ages 10-29 years. The median duration of CU was 591 days, and symptoms lasted for at least 1 year in 61.9% of patients. Gastrointestinal disease was the most common comorbidity in adults, whereas allergic rhinitis and common cold were more prevalent in children with CU. Around a third of CU patients were taking antihistamine treatment alone, and 70% were treated with both antihistamines and systemic corticosteroids. Cyclosporine was prescribed for 0.02% of CU patients. Conclusions The present study outlines recent longitudinal epidemiological data on the prevalence of CU in Korea. In light of limitations on the use of claims data, including no specific disease code for CU and a possible discordance between drug claims and the presence of urticaria symptoms, further investigations are necessary to describe the exact epidemiologic profile of CU patients.
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Affiliation(s)
- Nami Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine and Graduate School of Medicine, Suwon, Korea
| | - Jeong Dong Lee
- Office of Biostatistics, Ajou University School of Medicine and Graduate School of Medicine, Suwon, Korea
| | - Hyun Young Lee
- Clinical Trial Center, Ajou University Medical Center, Suwon, Korea
| | - Dae Ryong Kang
- Center of Biomedical Data Science / Institute of Genomic Cohort, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Young Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine and Graduate School of Medicine, Suwon, Korea.
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Kim YS, Han K, Lee JH, Kim NI, Roh JY, Seo SJ, Song HJ, Lee MG, Choi JH, Park YM. Increased Risk of Chronic Spontaneous Urticaria in Patients With Autoimmune Thyroid Diseases: A Nationwide, Population-based Study. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:373-377. [PMID: 28497925 PMCID: PMC5446953 DOI: 10.4168/aair.2017.9.4.373] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 02/13/2017] [Accepted: 02/20/2017] [Indexed: 01/21/2023]
Abstract
There was no previous population-based study on the comparison of the risk of chronic spontaneous urticaria (CSU) between autoimmune thyroid diseases (AITD) and age- and gender-matched controls. The primary objective of this study was to evaluate the risk of CSU after diagnosis of AITD using national registry data from Korea. The secondary objective was to evaluate other risk factors of CSU. Based on the disease code diagnoses in 2003-2005, we composed an AITD group (n=3,659) and an age- and gender-matched control group (n=18,295). Each patient was tracked for whether CSU occurs or not until 2013. After adjusting for demographic differences and comorbidities, patients with AITD had a significantly higher rate of CSU compared to the control group (hazard ratio [HR], 1.46; 95% confidence interval [CI], 1.25-1.70; P<0.001). Among the AITD patients, the adjusted HR for CSU was higher in patients with Hashimoto's thyroiditis (HR, 1.50) than in those with Grave's disease (HR, 1.33), although the difference was not statistically significant (P=0.368). Analysis of CSU patients associated with AITD showed that female patients had a significantly higher risk of CSU compared to male ones (HR, 1.34; P=0.001) and that those with allergic rhinitis (HR, 1.51; P<0.001), atopic dermatitis (HR, 2.44; P<0.001), and asthma (HR, 1.50; P<0.001) had a significantly higher risk of CSU compared to patients without respective diseases. Our results demonstrated that AITD could be significantly associated with an increased risk of CSU.
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Affiliation(s)
- Yoon Seob Kim
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyungdo Han
- Department of Medical Statistics, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nack In Kim
- Department of Dermatology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Joo Young Roh
- Department of Dermatology, Gachon University Gil Medical Center, Incheon, Korea
| | - Seong Jun Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hae Jun Song
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Min Geol Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Ho Choi
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Min Park
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Lapi F, Cassano N, Pegoraro V, Cataldo N, Heiman F, Cricelli I, Levi M, Colombo D, Zagni E, Cricelli C, Vena GA. Epidemiology of chronic spontaneous urticaria: results from a nationwide, population-based study in Italy. Br J Dermatol 2016; 174:996-1004. [PMID: 26872037 DOI: 10.1111/bjd.14470] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is a common skin disease, but there is a paucity of precise epidemiological data on this disease. OBJECTIVES To obtain information on the epidemiology of CSU in Italy. METHODS The data source was the Health Search IMS Health Longitudinal Patient Database. The study population was formed by patients aged ≥ 15 years, registered with a total of 700 general practitioners, homogeneously distributed across Italy. An algorithm based on the International Classification of Diseases, ninth revision, Clinical Modification was used for the identification of patients with CSU. The annual prevalence and incidence rates of CSU over a 12-year period (2002-2013) were estimated, along with demographic and clinical determinants. RESULTS The annual prevalence of CSU ranged from 0·02% in 2002 to 0·38% in 2013. The incidence was 0·10-1·50 per 1000 person-years. For both prevalence and incidence rates, female patients outnumbered male. The risk of CSU was statistically significantly higher in the presence of the following variables: obesity; anxiety, dissociative and somatoform disorders; malignancies; use of immunosuppressive drugs; and chronic use of systemic corticosteroids. History of autoimmune thyroiditis showed a trend towards an increased risk of CSU, though it was not statistically significant. Smoking was associated with a significantly reduced risk of CSU. CONCLUSIONS Our findings on CSU prevalence are consistent with those obtained in previous studies. Furthermore, this large population-based study provides important information regarding the association of CSU with demographic and clinical determinants, which have been examined in the primary-care setting.
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Affiliation(s)
- F Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - N Cassano
- Dermatology and Venereology Private Practice, Bari/Barletta, Italy
| | - V Pegoraro
- IMS Health Information Solutions Srl, Milan, Italy
| | - N Cataldo
- IMS Health Information Solutions Srl, Milan, Italy
| | - F Heiman
- IMS Health Information Solutions Srl, Milan, Italy
| | - I Cricelli
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - M Levi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - D Colombo
- Novartis Farma S.p.A., Origgio, Varese, Italy
| | - E Zagni
- Novartis Farma S.p.A., Origgio, Varese, Italy
| | - C Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - G A Vena
- Dermatology and Venereology Private Practice, Bari/Barletta, Italy
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Resource use and costs in an insured population of patients with chronic idiopathic/spontaneous urticaria. Am J Clin Dermatol 2015; 16:313-321. [PMID: 26055728 PMCID: PMC4529877 DOI: 10.1007/s40257-015-0134-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Chronic idiopathic or spontaneous urticaria (CIU/CSU) impairs patients’ quality of life, and updated information on disease prevalence, treatment patterns, and disease burden is lacking. Objectives We aimed to estimate these figures in a large US real-world claims database via a validated algorithm. Methods In this retrospective cross-sectional cohort study, we identified patients with CIU/CSU, estimated disease prevalence, comorbidities, and healthcare use (medications, office visits, emergency department visits, and hospitalizations) and costs (urticaria related and all cause). Results We identified 6350 CIU/CSU patients in a population of just over 5.8 million: 0.11 % prevalence. Women accounted for the majority of sufferers (68.3 %) and had a greater burden of illness than men. Patients had relatively few comorbidities (mean 3.3, standard deviation 2.2). Primary care physicians and allergists were the most common providers of CIU/CSU-related care. Oral corticosteroids were the most commonly prescribed medication, used in 54.7 % of patients. Patients accumulated a mean of 15.1 office visits per year (standard deviation 12.6). The mean all-cause healthcare cost totaled over US$9000 per year. Conclusions Although the disease affects a relatively young population, CIU/CSU carries a substantial cost. Frequent oral corticosteroid use in CIU/CSU patients is a concern because of adverse events associated with the drug. Electronic supplementary material The online version of this article (doi:10.1007/s40257-015-0134-8) contains supplementary material, which is available to authorized users.
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