1
|
Ma N, Kishimoto I, Tajima A, Kume N, Kambe N, Tanizaki H. The decrease in peripheral blood basophils in a mouse model of IgE-induced inflammation involves their migration to lymph nodes. J Dermatol Sci 2024:S0923-1811(24)00194-4. [PMID: 39366898 DOI: 10.1016/j.jdermsci.2024.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/28/2024] [Accepted: 09/18/2024] [Indexed: 10/06/2024]
Abstract
BACKGROUND During the active phase of urticaria, a decrease in peripheral blood basophils, known as basopenia, is observed. We previously reported that basopenia occurs as a result of basophils migrating to the skin in a contact dermatitis model where a Th2 response is induced with oxazolone. OBJECTIVE Although there is currently no established model for urticaria, given that urticaria is an IgE-mediated immediate-type allergic reaction, we aimed to determine whether an IgE-mediated model could reproduce the decrease in basophils in peripheral blood observed during the active phase of urticaria. METHODS Mice were pretreated with 2,4,6-trinitrophenylhaptene (TNP)-specific IgE and basophil dynamics were examined following stimulation with TNP-ovalbumin. Mast cell-deficient WBB6F1-KitW/KitW-v mice were used to investigate the role of mast cells in this IgE-mediated model. RESULTS Following stimulation, we observed immediate ear swelling and basopenia after 0.5 hours. However, the number of basophils observed in the skin lesions was low, while a higher number of basophils were observed in the antigen-draining lymph nodes (LN). In mast cell-deficient mice, no increase in basophils in the LN was observed, reflecting reduced antigen influx into the LN, but basophils remained in the skin. CONCLUSIONS In the IgE-mediated mouse model, basopenia was observed, which coincided with the induction of inflammation in the skin. The migration of basophils to the LN in this model suggests that the systemic immune system, including the LN, should be considered when exploring the pathogenesis of urticaria in humans.
Collapse
Affiliation(s)
- Ni Ma
- Department of Dermatology, Kansai Medical University, Hirakata, Japan
| | - Izumi Kishimoto
- Department of Dermatology, Kansai Medical University, Hirakata, Japan; Allergy Center, Kansai Medical University Hospital, Hiraktata, Japan
| | - Aki Tajima
- Department of Dermatology, Kansai Medical University, Hirakata, Japan
| | - Noriko Kume
- Department of Dermatology, Kansai Medical University, Hirakata, Japan
| | - Naotomo Kambe
- Department of Dermatology, Kansai Medical University, Hirakata, Japan; Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan; Center for Allergy, Kyoto University Hospital, Kyoto, Japan.
| | - Hideaki Tanizaki
- Department of Dermatology, Kansai Medical University, Hirakata, Japan
| |
Collapse
|
2
|
Do TT, Canty EA, Joshi SR. Current and future management of chronic spontaneous urticaria and chronic inducible urticaria. Allergy Asthma Proc 2023; 44:3-14. [PMID: 36719690 DOI: 10.2500/aap.2023.44.220093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Chronic urticaria (CU), characterized by ≥6 weeks of intense pruritus, remains a debilitating condition for patients. New and safe treatments are needed to manage CU recalcitrant to standard therapy. Objective: A review of the current literature of standard and novel therapeutics in the management of CU was conducted. Methods: A literature search via a medical literature data base and clinical trial data base was conducted to identify treatment options for CU and current clinical trials. Results: Second-generation antihistamines, omalizumab, and cyclosporine remain the most proven therapeutic options for CU. Dupilumab, mepolizumab, benralizumab, tezepelumab, and CDX-0159 are all undergoing clinical trials for CU. Although ligelizumab demonstrated initial promising results, a phase III study was discontinued due to a nonsuperior clinical impact compared with omalizumab. Conclusion: Novel therapies are needed for the treatment of recalcitrant CU. With a deeper understanding of the pathophysiology of CU, promising therapeutics are in clinical trials for CU.
Collapse
Affiliation(s)
- Toan T Do
- From the Department of Internal Medicine, Oregon Health and Science University, Portland, Oregon
| | - Ethan A Canty
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, and
| | - Shyam R Joshi
- Section of Allergy and Clinical Immunology, Oregon Health and Science University, Portland, Oregon
| |
Collapse
|
3
|
Poto R, Gambardella AR, Marone G, Schroeder JT, Mattei F, Schiavoni G, Varricchi G. Basophils from allergy to cancer. Front Immunol 2022; 13:1056838. [PMID: 36578500 PMCID: PMC9791102 DOI: 10.3389/fimmu.2022.1056838] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022] Open
Abstract
Human basophils, first identified over 140 years ago, account for just 0.5-1% of circulating leukocytes. While this scarcity long hampered basophil studies, innovations during the past 30 years, beginning with their isolation and more recently in the development of mouse models, have markedly advanced our understanding of these cells. Although dissimilarities between human and mouse basophils persist, the overall findings highlight the growing importance of these cells in health and disease. Indeed, studies continue to support basophils as key participants in IgE-mediated reactions, where they infiltrate inflammatory lesions, release pro-inflammatory mediators (histamine, leukotriene C4: LTC4) and regulatory cytokines (IL-4, IL-13) central to the pathogenesis of allergic diseases. Studies now report basophils infiltrating various human cancers where they play diverse roles, either promoting or hampering tumorigenesis. Likewise, this activity bears remarkable similarity to the mounting evidence that basophils facilitate wound healing. In fact, both activities appear linked to the capacity of basophils to secrete IL-4/IL-13, with these cytokines polarizing macrophages toward the M2 phenotype. Basophils also secrete several angiogenic factors (vascular endothelial growth factor: VEGF-A, amphiregulin) consistent with these activities. In this review, we feature these newfound properties with the goal of unraveling the increasing importance of basophils in these diverse pathobiological processes.
Collapse
Affiliation(s)
- Remo Poto
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy,Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy,World Allergy Organization (WAO), Center of Excellence (CoE), Naples, Italy
| | - Adriana Rosa Gambardella
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy,Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Gianni Marone
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy,World Allergy Organization (WAO), Center of Excellence (CoE), Naples, Italy,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy,Institute of Experimental Endocrinology and Oncology “G. Salvatore”, National Research Council (CNR), Naples, Italy
| | - John T. Schroeder
- Department of Medicine, Division of Allergy and Clinical Immunology, Johns Hopkins Asthma and Allergy Center, Johns Hopkins University, Baltimore, MD, United States
| | - Fabrizio Mattei
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Giovanna Schiavoni
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy,*Correspondence: Gilda Varricchi, ; Giovanna Schiavoni,
| | - Gilda Varricchi
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy,World Allergy Organization (WAO), Center of Excellence (CoE), Naples, Italy,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy,Institute of Experimental Endocrinology and Oncology “G. Salvatore”, National Research Council (CNR), Naples, Italy,*Correspondence: Gilda Varricchi, ; Giovanna Schiavoni,
| |
Collapse
|
4
|
Vurgun E, Memet B, Etikan P, Guntas G, Kocaturk E. Serum clusterin levels are not associated with chronic spontaneous urticaria regardless of serum lipids. Ital J Dermatol Venerol 2022; 157:325-329. [PMID: 35373780 DOI: 10.23736/s2784-8671.22.07222-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Clusterin is related to immunity and inflammation via regulation of complement activation and bidirectional regulation of and by major proinflammatory cytokines. Clusterin levels have been the subject of a few researches both in patients with hyperlipidemia and those with chronic spontaneous urticaria (CSU) separately. The aims of this study were evaluate the levels of clusterin levels and serum lipids and the relationships between them in patients with CSU. METHODS Fifty patients with CSU and 30 healthy controls were enrolled into the study. The activity of urticaria of the patients was determined by urticaria activity score (UAS7). Serum clusterin, total cholesterol, HDL, LDL and triglyceride levels of the participants were measured and compared. The relationships between UAS, lipids and clusterin were examined. RESULTS There was no difference in clusterin levels between CSU patients and controls. Clusterin level was not related to activity of urticaria. Clusterin levels were not correlated with any of lipid parameters neither in CSU patients nor in controls. CONCLUSIONS Findings of this study show that clusterin levels do not change due to CSU. Serum clusterin levels cannot be used as a diagnostic or a disease activity marker in CSU patients, regardless of the lipid profile.
Collapse
Affiliation(s)
- Eren Vurgun
- Department of Medical Biochemistry, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey -
| | - Bachar Memet
- Department of Dermatology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey.,Department of Dermatology, Koc University School of Medicine, Istanbul, Turkey
| | - Piril Etikan
- Department of Dermatology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey.,Department of Dermatology, Kyrenia Dr. Akcicek Government Hospital, Kyrenia, Cyprus
| | - Gulcan Guntas
- Department of Medical Biochemistry, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey.,Kirklareli University School of Health, Kirklareli, Turkey
| | - Emek Kocaturk
- Department of Dermatology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey.,Department of Dermatology, Koc University School of Medicine, Istanbul, Turkey
| |
Collapse
|
5
|
AlBalbeesi A, Alsalman H, Alotaibi H, Halawani M, Almukhadeb E, Alsaif F, Azzam N, AlKaff T, Aldosari M, Shadid A. Prevalence of Helicobacter pylori Infection Among Rosacea and Chronic Spontaneous Urticaria Patients in a Tertiary Hospital in Riyadh, Saudi Arabia. Cureus 2021; 13:e17617. [PMID: 34646668 PMCID: PMC8483814 DOI: 10.7759/cureus.17617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The multifactorial nature of rosacea and chronic spontaneous urticaria (CSU) pathogenesis complicates the achievement of satisfactory treatment outcomes. 13C urea breath test (UBT) has been identified as an accurate, non-invasive, and quick procedure to detect the presence of Helicobacter pylori (H. pylori) with high sensitivity and specificity. OBJECTIVE In this study, we aim to assess the correlation between H. pylori infection and rosacea and CSU patients. METHODS A cross-sectional, observational study was conducted on patients with rosacea and CSU in the dermatology clinic at King Khalid University Hospital in Riyadh, Saudi Arabia. History and physical examination were performed by a dermatologist. H. pylori 13C-UBT detection was performed in all subjects. RESULTS In total, 114 patients were included in this current study, with 41 rosacea and 73 urticaria patients. The vast majority of our subjects were females (96.5%). The mean (±SD) age was 42.3 (±12.7). More than half (58.8%) of the examined samples were positive for 13C-UBT; however, positive results were significantly higher in the rosacea patients (73.2%) compared to the urticaria group (50.7%), with a p-value of 0.019. CONCLUSION Our findings underline the significant association of H. pylori with rosacea and CSU regardless of the presence or absence of gastrointestinal symptoms. We thus recommend the inclusion of H. pylori testing in the routine workup of CSU and rosacea patients.
Collapse
Affiliation(s)
- Amal AlBalbeesi
- Department of Dermatology, College of Medicine King Saud University, Riyadh, SAU
| | - Hanan Alsalman
- Department of Dermatology, College of Medicine King Saud University, Riyadh, SAU
| | - Hend Alotaibi
- Department of Dermatology, College of Medicine King Saud University, Riyadh, SAU
| | - Mona Halawani
- Department of Dermatology, College of Medicine King Saud University, Riyadh, SAU
| | - Eman Almukhadeb
- Department of Dermatology, College of Medicine King Saud University, Riyadh, SAU
| | - Fahad Alsaif
- Department of Dermatology, College of Medicine King Saud University, Riyadh, SAU
| | - Nahla Azzam
- Gastroenterology, College of Medicine King Saud University, Riyadh, SAU
| | - Tuqa AlKaff
- Department of Dermatology, College of Medicine King Saud University, Riyadh, SAU
| | | | - Asem Shadid
- Dermatology, King Fahad Medical City, Riyadh, SAU
| |
Collapse
|
6
|
Khanal R, Sendil S, Oli S, Bhandari B, Atrash A. Factitious Disorder Masquerading as a Life-Threatening Anaphylaxis. J Investig Med High Impact Case Rep 2021; 9:23247096211006248. [PMID: 33787385 PMCID: PMC8020402 DOI: 10.1177/23247096211006248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Factitious disorder is a psychiatric disorder in which sufferers intentionally fabricate physical or psychological symptoms in order to assume the role of the patient, without any obvious gain. We present a case of a 23-year-old female with chronic urticaria who presented with dyspnea, dysphasia, mild generalized erythema, abdominal cramps, and headache. She was tachypneic and hypotensive. This was her third admission with similar symptoms within the last 7 months. Tryptase, complement, anti-SM/RNP, Sjogren, Scl-70, C3, and C4 were negative. Computed tomography–guided bone marrow biopsy showed no mast cells. Flow cytometry did not show any immunophenotypic reaction. Other possible differentials including pregnancy, autoimmune disorders, and infections including hepatitis, thyroid disorder, and age-related malignancies were ruled out. After a thorough review, malingering disorder was ruled out, but we noticed the patient’s intent of assuming a sick role. Later, the patient was diagnosed with major depressive disorder. Factitious anaphylaxis can present with multiple presentations including a life-threatening condition that mimics true anaphylaxis. A better approach would be thorough clinical evaluation and early multidisciplinary involvement. This case highlights the importance of further evidence-based studies in factitious disorder to decrease the disease burden and reduce the health care cost.
Collapse
Affiliation(s)
| | | | - Sharad Oli
- Maimonides Medical Center, Brooklyn, NY, USA
| | | | | |
Collapse
|
7
|
Tong H, Phan NVT, Nguyen TT, Nguyen DV, Vo NS, Le L. Review on Databases and Bioinformatic Approaches on Pharmacogenomics of Adverse Drug Reactions. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2021; 14:61-75. [PMID: 33469342 PMCID: PMC7812041 DOI: 10.2147/pgpm.s290781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/26/2020] [Indexed: 12/27/2022]
Abstract
Pharmacogenomics has been used effectively in studying adverse drug reactions by determining the person-specific genetic factors associated with individual response to a drug. Current approaches have revealed the significant importance of sequencing technologies and sequence analysis strategies for interpreting the contribution of genetic variation in developing adverse reactions. Advance in next generation sequencing and platform brings new opportunities in validating the genetic candidates in certain reactions, and could be used to develop the preemptive tests to predict the outcome of the variation in a personal response to a drug. With the highly accumulated available data recently, the in silico approach with data analysis and modeling plays as other important alternatives which significantly support the final decisions in the transformation from research to clinical applications such as diagnosis and treatments for various types of adverse responses.
Collapse
Affiliation(s)
- Hang Tong
- School of Biotechnology, International University, Ho Chi Minh City, Vietnam.,Vietnam National University, Ho Chi Minh City, Vietnam
| | - Nga V T Phan
- School of Biotechnology, International University, Ho Chi Minh City, Vietnam.,Vietnam National University, Ho Chi Minh City, Vietnam
| | - Thanh T Nguyen
- Department of Translational Biomedical Informatics, Vingroup Big Data Institute, Hanoi, Vietnam
| | - Dinh V Nguyen
- Department of Respiratory, Allergy and Clinical Immunology, Vinmec International Hospital, Hanoi, Vietnam.,College of Health Sciences, VinUniversity, Hanoi, Vietnam
| | - Nam S Vo
- Department of Translational Biomedical Informatics, Vingroup Big Data Institute, Hanoi, Vietnam
| | - Ly Le
- School of Biotechnology, International University, Ho Chi Minh City, Vietnam.,Vietnam National University, Ho Chi Minh City, Vietnam.,Department of Translational Biomedical Informatics, Vingroup Big Data Institute, Hanoi, Vietnam
| |
Collapse
|
8
|
Hamelin A, Amsler E, Mathelier-Fusade P, Pecquet C, Bayrou O, Barbaud A, Soria A. [Omalizumab for the treatment of chronic urticaria: Real-life findings]. Ann Dermatol Venereol 2019; 146:9-18. [PMID: 30638684 DOI: 10.1016/j.annder.2018.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 02/17/2018] [Accepted: 07/30/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Assessment of the efficacy and safety of omalizumab in chronic urticaria refractory to conventional treatment (H1-antihistamines at high dosage and montelukast) in real-life practice. PATIENTS AND METHODS A retrospective, descriptive, single-centre study was performed of the data for all patients presenting refractory chronic spontaneous urticaria or inducible urticaria and receiving omalizumab (300mg every four weeks) from November 2012 to June 2016. RESULTS In all, 23 patients were included. Omalizumab led to complete or significant remission in 19 patients (83%) with chronic urticaria, with remission in 9 patients (47%) occurring within 72hours of the first injection. One patient had a partial response and 3 (13%) showed no response. Only 2 patients (9%) in complete remission stopped their treatment at 1 and 3 years. 52% of patients presented non-serious adverse events, which in one case resulted in treatment withdrawal. CONCLUSION Omalizumab exhibited good real-life efficacy in a small series of chronic urticaria patients in France.
Collapse
Affiliation(s)
- A Hamelin
- Service de dermatologie et allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - E Amsler
- Service de dermatologie et allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - P Mathelier-Fusade
- Service de dermatologie et allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - C Pecquet
- Service de dermatologie et allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - O Bayrou
- Service de dermatologie et allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - A Barbaud
- Service de dermatologie et allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Faculté de médecine, Sorbonne université, 75006 Paris, France
| | - A Soria
- Service de dermatologie et allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Inserm U1135, Cimi-Paris, centre d'immunologie et de maladies infectieuses, 75013 Paris, France
| |
Collapse
|
9
|
Min TK, Saini SS. Emerging Therapies in Chronic Spontaneous Urticaria. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:470-481. [PMID: 31172716 PMCID: PMC6557779 DOI: 10.4168/aair.2019.11.4.470] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 02/06/2023]
Abstract
Chronic spontaneous urticaria (CSU) is characterized by typically short-lived and fleeting wheals, angioedema or both, which occur spontaneously and persist for longer than 6 weeks. This term is applied to the most common subtype of chronic urticaria. The underlying pathophysiology for CSU involves mast cell and basophil degranulation with release of histamine, leukotrienes, prostaglandins and other inflammatory mediators. Although a variety of treatments exist, many patients do not tolerate or benefit from the existing therapies and even require more effective treatments. Omalizumab is currently the only licensed biologic for antihistamine-refractory CSU, and novel drugs are under development. This article reviews its current status regarding pathogenesis and approach to treatment as well as therapeutic agents that are under development for the treatment of CSU.
Collapse
Affiliation(s)
- Taek Ki Min
- Pediatric Allergy and Respiratory Center, Department of Pediatrics, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Sarbjit S Saini
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
10
|
Zuberbier T, Aberer W, Asero R, Latiff AHA, Baker D, Ballmer-Weber B, Bernstein JA, Bindslev-Jensen C, Brzoza Z, Bedrikow RB, Canonica GW, Church MK, Craig T, Danilycheva IV, Dressler C, Ensina LF, Giménez-Arnau A, Godse K, Goncalo M, Grattan C, Hebert J, Hide M, Kaplan A, Kapp A, Katelaris CH, Kocatürk E, Kulthanan K, Larenas-Linnemann D, Leslie TA, Magerl M, Mathelier-Fusade P, Meshkova RY, Metz M, Nast A, Nettis E, Oude-Elberink H, Rosumeck S, Saini SS, Sánchez-Borges M, Schmid-Grendelmeier P, Staubach P, Sussman G, Toubi E, Vena GA, Vestergaard C, Wedi B, Werner RN, Zhao Z, Maurer M, Brehler R, Brockow K, Fluhr J, Grabbe J, Hamelmann E, Hartmann K, Jakob T, Merk H, Ollert M, Ott H, Reese I, Rueff F, Werfel T. EAACI/GA2LEN/EDF/WAO-Leitlinie für die Definition, Klassifikation, Diagnose und das Management der Urtikaria — konsentierte, deutschsprachige Übersetzung. ALLERGO JOURNAL 2018. [DOI: 10.1007/s15007-018-1751-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
11
|
Role of TF-Triggered Activation of the Coagulation Cascade in the Pathogenesis of Chronic Spontaneous Urticaria. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0183-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
|
12
|
Ding Y, Che D, Li C, Cao J, Wang J, Ma P, Zhao T, An H, Zhang T. Quercetin inhibits Mrgprx2-induced pseudo-allergic reaction via PLCγ-IP3R related Ca 2+ fluctuations. Int Immunopharmacol 2018; 66:185-197. [PMID: 30471617 DOI: 10.1016/j.intimp.2018.11.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 11/15/2018] [Accepted: 11/15/2018] [Indexed: 11/18/2022]
Abstract
An allergic reaction is a potentially fatal hypersensitivity response caused by mast cell activation, particularly histamine and lipid mediators. Histamine release caused by reaction to drugs is considered a pseudo-allergic reaction. Quercetin is known for its anti-allergic immune effect. However, at present, its anti-pseudo-allergic effect and its mechanism are less investigated. Therefore, the purpose of this study was to evaluate the anti-pseudo-allergic effect of Quercetin in vivo and to explore the mechanism in vitro. The anti-pseudo-allergic activity of Quercetin was evaluated in vivo using a mouse model, while Quercetin mechanism of action was examined in vitro using HEK293 cells expressing Mrgprx2, a mast cell specific receptor, and LAD2 mast cell line. Our in vivo results showed that Quercetin could attenuate Evans blue leakage in the paws and hind paw thickness in C57BL/6 mice in a dose-dependent manner, and could significantly inhibit serum histamine and chemokines release. In addition, it suppressed calcium mobilization and attenuated the release of histamine and MCP-1 in peritoneal mast cells in a dose-dependent manner. Furthermore, it inhibited the vasodilation due to histamine, the release of eosinophils, and the percentage of degranulated mast cells, indicating that Quercetin antagonized mast cell mediators in vivo, histamine-induced vasodilation and eosinophil release. In vitro results showed that Quercetin reduced pseudo-allergic induced calcium influx, suppressed degranulation and chemokines release in a similar way as dexamethasone (100 μM) (mast cell stabilizer) in LAD2 mast cell line. In addition, Quercetin inhibited Mrgprx2-induced both calcium influx and pseudo-allergic reaction in HEK293 cells expressing Mrgprx2. C48/80, a histamine promoter, and Substance P (a neuropeptide) EC50 was higher when combined with Quercetin compared to the EC50 of these compounds alone, suggesting that Quercetin could inhibit Mrgprx2-induced pseudo-allergic reaction. Furthermore, Quercetin decreased PLCγ-IP3R signaling pathway activation induced by C48/80 in LAD2 mast cell line. In Mrgprx2 knockdown LAD2 cells, the effect of Quercetin (200 μM) reduced C48/80 induced calcium flux and the release of β‑hexosaminidase, histamine, MCP-1 and IL-8 compared with non-atopic control (NC) transfected LAD2 human mast cells, suggesting that Quercetin anti-pseudo-allergic effect was related to Mrgprx2. The docking results showed that Quercetin had a good binding affinity with Mrgprx2 similar to the one of Substance P and C48/80. Therefore, Quercetin inhibited Mrgprx2-induced pseudo-allergic reaction via PLCγ-IP3R associated Ca2+ fluctuations. Our results validated Quercetin as an effective small molecule inhibiting Mrgprx2-induced pseudo-allergic reaction via PLCγ-IP3R associated Ca2+ fluctuations, thus highlighting a potential candidate to suppress Mrgprx2 induced pseudo-allergic related diseases.
Collapse
Affiliation(s)
- Yuanyuan Ding
- College of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
| | - Delu Che
- College of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
| | - Chaomei Li
- College of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
| | - Jiao Cao
- College of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
| | - Jue Wang
- College of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
| | - Pengyu Ma
- College of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
| | - Tingting Zhao
- College of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
| | - Hongli An
- Center for Translational Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
| | - Tao Zhang
- College of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China.
| |
Collapse
|
13
|
Malara G, Sciarrone C. Chronic spontaneous urticaria treated with omalizumab: report of two cases. J DERMATOL TREAT 2018; 29:3-5. [PMID: 30462560 DOI: 10.1080/09546634.2018.1551608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background: Chronic spontaneous urticaria (CSU) is a relatively common skin disease whose etiopathogenesis, as well as other factors influencing disease manifestations, are not fully understood. Mast cell function is recognised as having a central role in CSU signs and symptoms. Therapeutic options are limited; a number of drugs, recommended by international guidelines for the management of urticaria, lack regulatory approval for CSU and are prescribed off label. Omalizumab, a recombinant humanized anti IgE antibody, has recently received the approval for CSU treatment in Europe after an appropriate clinical development. Patients and results: Two case reports, that describes our encouraging experience with this therapeutic option in a real-life setting are discussed and deeply investigate the different scenario for the omalizumab use. Conclusion: In both cases, a complete remission of CSU symptoms after omalizumab treatment are demonstrated. Moreover, 6 months therapy gave the better results, whit a relapse, in one subject, 1 month after discontinuing omalizumab. Accordingly, a better understanding of long-term safety and efficacy should be needed to allow long-term administration in responding patients through a changing in prescription rules.
Collapse
Affiliation(s)
- Giovanna Malara
- a Department of Dermatology , Papardo Hospital , Messina , Italy
| | | |
Collapse
|
14
|
Leonardi L, Uva A, Duse M. Chronic urticaria in a child affected by atopic dermatitis: effective treatment with omalizumab. J DERMATOL TREAT 2018; 29:17-19. [PMID: 30388916 DOI: 10.1080/09546634.2018.1543844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This article describes a clinical experience in a 7-year-old girl with chronic spontaneous urticaria and atopic dermatitis, resistant to therapy with antihistamines and topical steroid. Omalizumab treatment not only allowed complete remission of chronic spontaneous urticaria but also significantly improved atopic dermatitis symptoms. The off-label use of omalizumab was well tolerated and no adverse events were reported.
Collapse
Affiliation(s)
- Lucia Leonardi
- a Pediatrics Department , Umberto I Hospital, Sapienza University , Roma , Italy
| | - Andrea Uva
- a Pediatrics Department , Umberto I Hospital, Sapienza University , Roma , Italy
| | - Marzia Duse
- a Pediatrics Department , Umberto I Hospital, Sapienza University , Roma , Italy
| |
Collapse
|
15
|
Urticaria, Urticarial Vasculitis, Angioedema, and Related Diseases. CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0223-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
16
|
Saini SS, Kaplan AP. Chronic Spontaneous Urticaria: The Devil's Itch. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2018; 6:1097-1106. [PMID: 30033911 PMCID: PMC6061968 DOI: 10.1016/j.jaip.2018.04.013] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/15/2018] [Accepted: 04/23/2018] [Indexed: 11/20/2022]
Abstract
Chronic urticaria is defined as the presence of urticaria for a period exceeding 6 weeks, assuming symptoms for most days of the week. It is divided into chronic inducible urticarias and chronic spontaneous urticaria, previously termed chronic idiopathic urticaria. The latter designation emphasizes that patients can experience urticaria independent of any exogenous stimulus even if one can define circumstances that may worsen symptoms. A search for such an external "cause" is fruitless because the underlying abnormality is "intrinsic," whether it is autoimmune, or some unknown process. Approximately 40% of patients with chronic spontaneous urticaria report accompanying episodes of angioedema, whereas 10% have angioedema as their primary manifestation. In most cases, it is a self-limiting disorder, persisting for 2 to 5 years in most cases, although 20% of patients suffer for more than 5 years. The treatment that has evolved is largely empiric, based on double-blind, placebo-controlled studies whenever possible, but is not yet targeted to any particular pathogenic mechanism. In this article, we review the current status regarding pathogenesis, discuss the diagnostic workup, and update the approach to treatment including consideration of published guidelines, our own experience, and guideline updates that are being prepared.
Collapse
Affiliation(s)
- Sarbjit S Saini
- Department of Medicine, Division of Allergy and Clinical Immunology, Johns Hopkins Asthma and Allergy Center, Baltimore, Md.
| | - Allen P Kaplan
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston, SC
| |
Collapse
|
17
|
Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer-Weber B, Bernstein JA, Bindslev-Jensen C, Brzoza Z, Buense Bedrikow R, Canonica GW, Church MK, Craig T, Danilycheva IV, Dressler C, Ensina LF, Giménez-Arnau A, Godse K, Gonçalo M, Grattan C, Hebert J, Hide M, Kaplan A, Kapp A, Katelaris CH, Kocatürk E, Kulthanan K, Larenas-Linnemann D, Leslie TA, Magerl M, Mathelier-Fusade P, Meshkova RY, Metz M, Nast A, Nettis E, Oude-Elberink H, Rosumeck S, Saini SS, Sánchez-Borges M, Schmid-Grendelmeier P, Staubach P, Sussman G, Toubi E, Vena GA, Vestergaard C, Wedi B, Werner RN, Zhao Z, Maurer M. The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy 2018; 73:1393-1414. [PMID: 29336054 DOI: 10.1111/all.13397] [Citation(s) in RCA: 797] [Impact Index Per Article: 132.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2017] [Indexed: 02/06/2023]
Abstract
This evidence- and consensus-based guideline was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. The conference was held on 1 December 2016. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-founded network of excellence, the Global Allergy and Asthma European Network (GA²LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO) with the participation of 48 delegates of 42 national and international societies. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria are disabling, impair quality of life and affect performance at work and school. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
Collapse
Affiliation(s)
- T. Zuberbier
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
| | - W. Aberer
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - R. Asero
- Department of Allergology; Clinica San Carlo; Paderno Dugnano MI Italy
| | - A. H. Abdul Latiff
- Allergy& Immunology Centre; Pantai Hospital Kuala Lumpur; Kuala Lumpur Malaysia
| | - D. Baker
- Baker Allergy Asthma and Dermatology Clinic; Portland OR USA
| | - B. Ballmer-Weber
- Allergy Unit; Department of Dermatology; University Hospital; Zürich Switzerland
| | - J. A. Bernstein
- University of Cincinnati Physicians Immunology Research Center; Cincinnati OH USA
| | - C. Bindslev-Jensen
- Department of Dermatology and Allergy Centre; Odense University Hospital and University of Southern Denmark; Odense Denmark
| | - Z. Brzoza
- Department of Internal Diseases, Allergology and Clinical Immunology in Katowice; Medical University of Silesia; Katowice Poland
| | | | - G. W. Canonica
- Personalized Medicine Asthma and Allergy Clinic-Humanitas University & Research Hospital; Milano Italy
| | - M. K. Church
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
| | - T. Craig
- Department of Medicine and Pediatrics; Penn State University; Hershey Medical Center; Hershey PA USA
| | - I. V. Danilycheva
- National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia; Moscow Russia
| | - C. Dressler
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Division of Evidence Based Medicine; Department of Dermatology; Berlin Germany
| | - L. F. Ensina
- Federal University of Sao Paulo; Sao Paulo Brazil
| | - A. Giménez-Arnau
- Hospital del Mar; IMIM; Universitat Autònoma Barcelona; Barcelona Spain
| | - K. Godse
- Department of Dermatology; Dr. D. Y. Patil Medical College & Hospital; Nerul Navi Mumbai India
| | - M. Gonçalo
- Clinic of Dermatology; Faculty of Medicine and University Hospital; Coimbra Portugal
| | - C. Grattan
- St John's’ Institute of Dermatology; Guy's’ and St. Thomas’ Hospital; NHS Foundation Trust; London UK
| | - J. Hebert
- Service d'allergie; Centre Hospitalier Université Laval/Centre Hospitalier Universitaire de Québec; Québec QC Canada
| | - M. Hide
- Department of Dermatology; Institute of Biomedical and Health Sciences; Hiroshima University; Hiroshima Japan
| | - A. Kaplan
- Department of Medicine; Division of Pulmonary and Critical Care Medicine; Allergy and Clinical Immunology; Medical University of South Carolina; Charleston SC USA
| | - A. Kapp
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - C. H. Katelaris
- Campbelltown Hospital and Western Sydney University; Sydney Australia
| | - E. Kocatürk
- Department of Dermatology; Okmeydani Training and Research Hospital; Istanbul Turkey
| | - K. Kulthanan
- Department of Dermatology; Faculty of Medicine Siriraj Hospital; Mahidol University; Bangkok Thailand
| | | | | | - M. Magerl
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
| | - P. Mathelier-Fusade
- Department of Dermatology and Allergy; University Hospital of Tenon; Paris France
| | - R. Y. Meshkova
- Department of Clinical Immunology and Allergy; Smolensk State Medical University; Smolensk Russia
| | - M. Metz
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
| | - A. Nast
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Division of Evidence Based Medicine; Department of Dermatology; Berlin Germany
| | - E. Nettis
- Scuola e Cattedra di Allergologia e Immunologia Clinica; Dipartimento dell'Emergenza e dei Trapianti d'Organo; Università di Bari; Bari Italy
| | | | - S. Rosumeck
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Division of Evidence Based Medicine; Department of Dermatology; Berlin Germany
| | - S. S. Saini
- Johns Hopkins Asthma and Allergy Center; Baltimore MD USA
| | - M. Sánchez-Borges
- Allergy and Clinical Immunology Department; Centro Médico-Docente La Trinidad; Caracas Venezuela
| | | | - P. Staubach
- Department of Dermatology; University Medical Center Mainz; Mainz Germany
| | - G. Sussman
- Division of Allergy and Clinical Immunology; University of Toronto; Toronto ON Canada
| | - E. Toubi
- Bnai-Zion Medical Center; Faculty of Medicine; Technion Haifa Israel
| | - G. A. Vena
- Dermatology and Venereology Private Practice; Bari and Barletta Italy
| | - C. Vestergaard
- Department of Dermatology and Venereology; Aarhus University Hospital; Aarhus Denmark
| | - B. Wedi
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - R. N. Werner
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Division of Evidence Based Medicine; Department of Dermatology; Berlin Germany
| | - Z. Zhao
- Department of Dermatology and Venereology; Peking University; First Hospital; Beijing China
| | - M. Maurer
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
| | | |
Collapse
|
18
|
Balbino B, Conde E, Marichal T, Starkl P, Reber LL. Approaches to target IgE antibodies in allergic diseases. Pharmacol Ther 2018; 191:50-64. [PMID: 29909239 DOI: 10.1016/j.pharmthera.2018.05.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 05/08/2018] [Indexed: 12/26/2022]
Abstract
IgE is the antibody isotype found at the lowest concentration in the circulation. However IgE can undeniably play an important role in mediating allergic reactions; best exemplified by the clinical benefits of anti-IgE monoclonal antibody (omalizumab) therapy for some allergic diseases. This review will describe our current understanding of the interactions between IgE and its main receptors FcεRI and CD23 (FcεRII). We will review the known and potential functions of IgE in health and disease: in particular, its detrimental roles in allergic diseases and chronic spontaneous urticaria, and its protective functions in host defense against parasites and venoms. Finally, we will present an overview of the drugs that are in clinical development or have therapeutic potential for IgE-mediated allergic diseases.
Collapse
Affiliation(s)
- Bianca Balbino
- Institut Pasteur, Department of Immunology, Unit of Antibodies in Therapy and Pathology, Paris, France; INSERM, U1222, Paris, France; Université Pierre et Marie Curie, Paris, France
| | - Eva Conde
- Institut Pasteur, Department of Immunology, Unit of Antibodies in Therapy and Pathology, Paris, France; INSERM, U1222, Paris, France; Université Pierre et Marie Curie, Paris, France; Neovacs SA, Paris, France
| | - Thomas Marichal
- GIGA-Research and Faculty of Veterinary Medicine, University of Liege, 4000, Liege, Belgium; Walloon Excellence in Life Sciences and Biotechnology, Wallonia, Belgium
| | - Philipp Starkl
- CeMM, Research Center for Molecular Medicine of the Austrian Academy of Sciences, Austria; Department of Medicine I, Research Laboratory of Infection Biology, Medical University of Vienna, Vienna, Austria
| | - Laurent L Reber
- Institut Pasteur, Department of Immunology, Unit of Antibodies in Therapy and Pathology, Paris, France; INSERM, U1222, Paris, France.
| |
Collapse
|
19
|
Yanase Y, Takahagi S, Hide M. Chronic spontaneous urticaria and the extrinsic coagulation system. Allergol Int 2018; 67:191-194. [PMID: 28993062 DOI: 10.1016/j.alit.2017.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/08/2017] [Indexed: 01/05/2023] Open
Abstract
Chronic spontaneous urticaria (CSU) is a common skin disorder characterized by daily or almost daily recurring skin edema and flare with itch. Recently, the activation of the blood coagulation cascade has been suggested to be involved in CSU, but the trigger of the coagulation cascade remains unclear. In this article, we review recent understanding of the relationship between the pathogenesis of CSU and extrinsic coagulation reactions. In CSU, vascular endothelial cells and eosinophils may play a role as TF-expressing cells for activating the extrinsic coagulation pathway. Moreover, the expression of TF on endothelial cells is synergistically enhanced by the activation of Toll-like receptors and histamine H1 receptors. The activated coagulation factors may induce plasma extravasation followed by degranulation of skin mast cells and edema formation recognized as wheal in CSU. Molecules involved in this cascade could be a target for new and more effective treatments of urticaria.
Collapse
|
20
|
Jörg L, Pecaric-Petkovic T, Reichenbach S, Coslovsky M, Stalder O, Pichler W, Hausmann O. Double-blind placebo-controlled trial of the effect of omalizumab on basophils in chronic urticaria patients. Clin Exp Allergy 2017; 48:196-204. [DOI: 10.1111/cea.13066] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/20/2017] [Accepted: 11/05/2017] [Indexed: 12/01/2022]
Affiliation(s)
- L. Jörg
- Department of Rheumatology, Immunology and Allergology, Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - T. Pecaric-Petkovic
- Adverse Drug Reactions, Analysis and Consulting; ADR-AC GmbH; Bern Switzerland
| | - S. Reichenbach
- Department of Rheumatology, Immunology and Allergology, Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
- Clinical Trial Unit; University of Bern; Bern Switzerland
| | - M. Coslovsky
- Clinical Trial Unit; University of Bern; Bern Switzerland
| | - O. Stalder
- Clinical Trial Unit; University of Bern; Bern Switzerland
| | - W. Pichler
- Adverse Drug Reactions, Analysis and Consulting; ADR-AC GmbH; Bern Switzerland
| | - O. Hausmann
- Department of Rheumatology, Immunology and Allergology, Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
- Adverse Drug Reactions, Analysis and Consulting; ADR-AC GmbH; Bern Switzerland
| |
Collapse
|
21
|
Chang HW, Cheng HM, Yen HR, Hsu CY, Lee YC, Chiang JH, Sun MF. Association between chronic idiopathic urticaria and hypertension: A population-based retrospective cohort study. Ann Allergy Asthma Immunol 2017; 116:554-8. [PMID: 27264565 DOI: 10.1016/j.anai.2016.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 03/28/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Chronic idiopathic urticaria (CIU) is defined as urticaria that is not caused by external triggers. The pathogenesis of CIU remains unknown. A previous study investigated whether hypertension is associated with extended duration of CIU. OBJECTIVE To investigate the possible association between CIU and hypertension. METHODS We performed a population-based retrospective cohort study of 2,460 patients with CIU and 9,840 age-, sex-, and index year-matched comparison patients, using the National Health Insurance of Taiwan database. The median follow-up periods were 7.13 years for the CIU cohort and 7.20 years for the non-CIU cohort. The distributions by sex and age were similar for both cohorts. RESULTS The CIU cohort had a 1.37-fold (95% CI, 1.22-1.53) greater risk of developing subsequent hypertension than the non-CIU cohort after adjusting for sex, age, comorbidities, and nonsedating antihistamine use. CONCLUSION This nationwide retrospective cohort study found that CIU is associated with a higher future risk of hypertension after adjusting for sex, age, comorbidities, and nonsedating antihistamine use. The detailed pathophysiologic mechanisms require further clarification in prospective studies.
Collapse
Affiliation(s)
- Heng-Wei Chang
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Hui-Man Cheng
- Department of Integration of Traditional Chinese and Western Medicine, China Medical University Hospital, Taichung, Taiwan; School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Hung-Rong Yen
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Chinese Medicine, China Medical University, Taichung, Taiwan; School of Chinese Medicine, China Medical University, Taichung, Taiwan; Research Center for Chinese Medicine and Acupuncture, China Medical University, Taichung, Taiwan
| | - Chung Y Hsu
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Yu-Chen Lee
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Jen-Huai Chiang
- Research Center for Chinese Medicine and Acupuncture, China Medical University, Taichung, Taiwan; Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Mao-Feng Sun
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Chinese Medicine, China Medical University, Taichung, Taiwan.
| |
Collapse
|
22
|
Emerging roles of basophils in allergic inflammation. Allergol Int 2017; 66:382-391. [PMID: 28506528 DOI: 10.1016/j.alit.2017.04.007] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 12/24/2022] Open
Abstract
Basophils have long been neglected in immunological studies because they were regarded as only minor relatives of mast cells. However, recent advances in analytical tools for basophils have clarified the non-redundant roles of basophils in allergic inflammation. Basophils play crucial roles in both IgE-dependent and -independent allergic inflammation, through their migration to the site of inflammation and secretion of various mediators, including cytokines, chemokines, and proteases. Basophils are known to produce large amounts of IL-4 in response to various stimuli. Basophil-derived IL-4 has recently been shown to play versatile roles in allergic inflammation by acting on various cell types, including macrophages, innate lymphoid cells, fibroblasts, and endothelial cells. Basophil-derived serine proteases are also crucial for the aggravation of allergic inflammation. Moreover, recent reports suggest the roles of basophils in modulating adaptive immune responses, particularly in the induction of Th2 differentiation and enhancement of humoral memory responses. In this review, we will discuss recent advances in understanding the roles of basophils in allergic inflammation.
Collapse
|
23
|
Sánchez-Borges M, Caballero-Fonseca F, Capriles-Hulett A, González-Aveledo L, Maurer M. Factors linked to disease severity and time to remission in patients with chronic spontaneous urticaria. J Eur Acad Dermatol Venereol 2017; 31:964-971. [PMID: 28299827 DOI: 10.1111/jdv.14221] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/22/2017] [Indexed: 01/19/2023]
Abstract
Biomarkers useful for the evaluation and management of patients with chronic spontaneous urticaria (CSU) are not currently available. A review of various clinical and laboratory markers that have been studied to assess their value for determining the severity or predicting the evolution of disease in adult patients with CSU was carried out. A search of the medical literature on PubMed and MEDLINE including the terms urticaria, chronic urticaria, chronic idiopathic urticaria, CSU, severity, prognosis and treatment was performed. Based on our review of the literature, among the clinical markers studied, higher age at onset, being female, long disease duration and aspirin/NSAID hypersensitivity may be linked to both severe CSU and a long time to spontaneous remission. In addition, a positive autologous serum skin test (ASST) may be associated with severe CSU, and comorbidity of inducible urticaria and concomitant recurrent angio-oedema may be linked to longer CSU duration. Potential biomarkers of CSU severity and/or duration include basophil numbers and susceptibility to activation, inflammatory markers, markers of activation of the extrinsic coagulation pathway, immunoglobulin E and vitamin D. Although the described markers are promising, further studies on representative and well-characterized patient populations are needed to determine the value of these clinical and biological markers for predicting the severity and course of disease in patients with CSU.
Collapse
Affiliation(s)
- M Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela.,Allergy Service, Clínica El Avila, Caracas, Venezuela
| | - F Caballero-Fonseca
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela.,Allergy Service, Centro Médico de Caracas, Caracas, Venezuela
| | - A Capriles-Hulett
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela.,Allergy Service, Centro Médico de Caracas, Caracas, Venezuela
| | | | - M Maurer
- Department of Dermatology and Allergy, Allergie-Centrum Charité/ECARF, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
24
|
Kaplan AP, Giménez-Arnau AM, Saini SS. Mechanisms of action that contribute to efficacy of omalizumab in chronic spontaneous urticaria. Allergy 2017; 72:519-533. [PMID: 27861988 DOI: 10.1111/all.13083] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2016] [Indexed: 12/16/2022]
Abstract
The monoclonal anti-immunoglobulin E (IgE) antibody, omalizumab, was the first drug approved for use in patients with chronic idiopathic/spontaneous urticaria (CIU/CSU) who remain symptomatic despite H1 -antihistamine treatment. Omalizumab binds to free IgE, which lowers free IgE levels and causes FcεRI receptors on basophils and mast cells to be downregulated. It has been shown to improve symptoms of CIU/CSU, but its mechanism of action is not currently understood. Potential mechanisms in CIU/CSU include reducing mast cell releasability, reversing basopenia and improving basophil IgE receptor function, reducing activity of IgG autoantibodies against FcεRI and IgE, reducing activity of IgE autoantibodies against an antigen or autoantigen that has yet to be definitively identified, reducing the activity of intrinsically 'abnormal' IgE, and decreasing in vitro coagulation abnormalities associated with disease activity. However, none of these theories alone or in combination fully account for the pattern of symptom improvement seen with omalizumab therapy, and therefore, no one mechanism is likely to be the definitive mechanism of action. Additional research is needed to further clarify the involvement of omalizumab in relieving symptoms associated with the complex, multifactorial pathogenesis of CIU/CSU.
Collapse
Affiliation(s)
- A. P. Kaplan
- Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology; Department of Medicine; Medical University of South Carolina; Charleston SC USA
| | - A. M. Giménez-Arnau
- Department of Dermatology; Hospital del Mar, Institut Mar D'Investigacions Mediques; Universitat Autònoma; Barcelona Spain
| | - S. S. Saini
- Johns Hopkins Asthma and Allergy Center; Baltimore MD USA
| |
Collapse
|
25
|
Metz M, Staubach P, Bauer A, Brehler R, Gericke J, Kangas M, Ashton-Chess J, Jarvis P, Georgiou P, Canvin J, Hillenbrand R, Erpenbeck VJ, Maurer M. Clinical efficacy of omalizumab in chronic spontaneous urticaria is associated with a reduction of FcεRI-positive cells in the skin. Am J Cancer Res 2017; 7:1266-1276. [PMID: 28435464 PMCID: PMC5399592 DOI: 10.7150/thno.18304] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 01/16/2017] [Indexed: 11/05/2022] Open
Abstract
Background. Treatment with omalizumab, a humanized recombinant monoclonal anti-IgE antibody, results in clinical efficacy in patients with Chronic Spontaneous Urticaria (CSU). The mechanism of action of omalizumab in CSU has not been elucidated in detail. Objectives. To determine the effects of omalizumab on levels of high affinity IgE receptor-positive (FcεRI+) and IgE-positive (IgE+) dermal cells and blood basophils. Treatment efficacy and safety were also assessed. Study design. In a double-blind study, CSU patients aged 18‑75 years were randomized to receive 300 mg omalizumab (n=20) or placebo (n=10) subcutaneously every 4 weeks for 12 weeks. Changes in disease activity were assessed by use of the weekly Urticaria Activity Score (UAS7). Circulating IgE levels, basophil numbers and levels of expression of FcεRI+ and IgE+ cells in the skin and in blood basophils were determined. Results. Patients receiving omalizumab showed a significantly greater decrease in UAS7 compared with patients receiving placebo. At Week 12 the mean difference in UAS7 between treatment groups was -14.82 (p=0.0027), consistent with previous studies. Total IgE levels in serum were increased after omalizumab treatment and remained elevated up to Week 12. Free IgE levels decreased after omalizumab treatment. Mean levels of FcεRI+ skin cells in patients treated with omalizumab 300 mg were decreased at Week 12 compared with baseline in the dermis of both non-lesional and lesional skin, reaching levels comparable with those seen in healthy volunteers (HVs). There were no statistically significant changes in mean FcɛRI+ cell levels in the placebo group. Similar results were seen for changes in IgE+ cells, although the changes were not statistically significant. The level of peripheral blood basophils increased immediately after treatment start and returned to Baseline values after the follow-up period. The levels of FcεRI and IgE expression on peripheral blood basophils were rapidly reduced by omalizumab treatment up to Week 12. Conclusions. Treatment with omalizumab resulted in rapid clinical benefits in patients with CSU. Treatment with omalizumab was associated with reduction in FcɛRI+ and IgE+ basophils and intradermal cells.
Collapse
|
26
|
Goyal V, Gupta A, Gupta O, Lal D, Gill M. Comparative Efficacy and Safety of Ebastine 20 mg, Ebastine 10 mg and Levocetirizine 5 mg in Acute Urticaria. J Clin Diagn Res 2017; 11:WC06-WC09. [PMID: 28511488 PMCID: PMC5427414 DOI: 10.7860/jcdr/2017/23961.9550] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/17/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Acute and chronic urticaria can result in severely impaired quality of life from pruritus and associated sleep lessness, as well as anxiety and depression. Various treatment modalities are available out of which second generation non sedating H1 antihistamines e.g., fexofenadine, loratidine, desloratadine, cetirizine, levocetirizine, ebastine etc., are used as the first line treatment. AIM To compare the safety and efficacy of ebastine 20 mg, ebastine 10 mg and levocetirizine 5 mg in the patients of urticaria. MATERIALS AND METHODS A longitudinal study was conducted in dermatology Outpatient Department (OPD) of Adesh Institute of Medical Sciences and Research, Bathinda, India. A total of 150 patients between the age group 10-70 years, both men and women having urticaria were enrolled and divided into three groups of 50 each. Group A was given ebastine 20 mg OD, Group B was given ebastine 10 mg OD and Group C was given levocetirizine 5 mg OD. The patients were asked to scale their severity of disease over a period of follow up based on Urticarial Activity Score 7 (UAS7). RESULTS The mean age of patients was 32.82 years. The mean UAS 7 score at the end of 4th week was 1.08 with ebastine 20 mg, 1.98 with levocetirizine 5 mg and 3.98 with ebastine 10 mg. In group A, 40 out of 50 patients (i.e., 80%), in Group B 25 out of 50 (i.e., 50%) get UAS7=0 and in Group C, 35 (i.e., 70%) patients who got relieved of symptoms at the end of treatment. When the scores were redefined and categorized under relieved and not relieved, and comparison done between all three groups, then there was a significant difference in the number of patients getting relieved, with p<0.001 (highly significant). Levocetirizine 5 mg had shown more side effects like dryness of mouth and sedation as compare to ebastine irrespective of dosage. The comparison made between the number of patients developing side effects among the groups was highly significant (p<0.001) for all the side effects. CONCLUSION Ebastine 20 mg is found to have superior efficacy for treatment of Urticaria as compared to ebastine 10 mg but with levocetirizine 5 mg the results were almost similar. Tolerability of ebastine 20 mg is similar to ebastine 10 mg but with levocetirizine 5 mg there were more side effects and less tolerability.
Collapse
Affiliation(s)
- Vippan Goyal
- Associate Professor and Head, Department of Dermatology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | - Anu Gupta
- Assistant Professor, Department of Dermatology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | - Onam Gupta
- Intern, Department of Dermatology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | - Dhruvendra Lal
- Post Graduate Student, Department of Community Medicine, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | - Manharan Gill
- Senior Resident, Department of Dermatology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| |
Collapse
|
27
|
Saini SS, Omachi TA, Trzaskoma B, Hulter HN, Rosén K, Sterba PM, Courneya JP, Lackey A, Chen H. Effect of Omalizumab on Blood Basophil Counts in Patients with Chronic Idiopathic/Spontaneous Urticaria. J Invest Dermatol 2016; 137:958-961. [PMID: 27939380 DOI: 10.1016/j.jid.2016.11.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 11/01/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Sarbjit S Saini
- Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland, USA
| | | | | | | | - Karin Rosén
- Genentech, Inc., South San Francisco, California, USA
| | | | | | - Alan Lackey
- LabCorp Clinical Trials, Brentwood, Tennessee, USA
| | - Hubert Chen
- Genentech, Inc., South San Francisco, California, USA.
| |
Collapse
|
28
|
Tan RJ, Sun HQ, Zhang W, Yuan HM, Li B, Yan HT, Lan CH, Yang J, Zhao Z, Wu JJ, Wu C. A 21-35 kDa Mixed Protein Component from Helicobacter pylori Activates Mast Cells Effectively in Chronic Spontaneous Urticaria. Helicobacter 2016; 21:565-574. [PMID: 27061753 DOI: 10.1111/hel.12312] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Helicobacter pylori (H. pylori) seem to involve in the etiology of chronic spontaneous urticaria (CSU). But studies of the pathogenic mechanism are very little. METHODS In this study, we detected the serum-specific anti-H. pylori IgG and IgE antibodies in 211 CSU and 137 normal subjects by enzyme-linked immunosorbent assay (ELISA), evaluated the direct activation effects of H. pylori preparations and its protein components on human LAD2 mast cell line in vitro, and analyzed the specific protein ingredients and functions of the most effective H. pylori mixed protein component using liquid chromatography-mass spectrometry and ELISA assay. RESULTS In CSU patients, the positive rate of anti-H. pylori IgG positive rate was significantly higher than that in normal controls, and the anti-H. pylori IgE levels had no statistical difference between H. pylori-infected patients with and without CSU. Further studies suggested that H. pylori preparations can directly activate human LAD2 mast cell line in a dose-dependent manner and its most powerful protein component was a mixture of 21-35 kDa proteins. Moreover, the 21-35 kDa mixed protein component mainly contained 23 kinds of proteins, which can stimulate the release of histamine, TNF-a, IL-3, IFN-γ, and LTB4 by LAD2 cells in a dose-dependent or time-dependent manner. CONCLUSIONS A 21-35 kDa mixed protein component should be regarded as the most promising pathogenic factor contributing to the CSU associated with H. pylori infection.
Collapse
Affiliation(s)
- Ran-Jing Tan
- Department of Dermatology, Daping Hospital, The Third Military Medical University, Chongqing, 400042, China.,Department of Microbiology and Biochemical Pharmacy, National Engineering Research Center of Immunological Products, College of Pharmacy, The Third Military Medical University, Chongqing, 400038, China
| | - He-Qiang Sun
- Department of Microbiology and Biochemical Pharmacy, National Engineering Research Center of Immunological Products, College of Pharmacy, The Third Military Medical University, Chongqing, 400038, China
| | - Wei Zhang
- Department of Dermatology, Daping Hospital, The Third Military Medical University, Chongqing, 400042, China
| | - Han-Mei Yuan
- Department of Microbiology and Biochemical Pharmacy, National Engineering Research Center of Immunological Products, College of Pharmacy, The Third Military Medical University, Chongqing, 400038, China
| | - Bin Li
- Department of Microbiology and Biochemical Pharmacy, National Engineering Research Center of Immunological Products, College of Pharmacy, The Third Military Medical University, Chongqing, 400038, China
| | - Hong-Tao Yan
- Department of Dermatology, Daping Hospital, The Third Military Medical University, Chongqing, 400042, China
| | - Chun-Hui Lan
- Department of Gastroenterology, Daping Hospital, The Third Military Medical University, Chongqing, 400042, China
| | - Jun Yang
- Department of Gastroenterology, Daping Hospital, The Third Military Medical University, Chongqing, 400042, China
| | - Zhuo Zhao
- Department of Microbiology and Biochemical Pharmacy, National Engineering Research Center of Immunological Products, College of Pharmacy, The Third Military Medical University, Chongqing, 400038, China
| | - Jin-Jin Wu
- Department of Dermatology, Daping Hospital, The Third Military Medical University, Chongqing, 400042, China
| | - Chao Wu
- Department of Microbiology and Biochemical Pharmacy, National Engineering Research Center of Immunological Products, College of Pharmacy, The Third Military Medical University, Chongqing, 400038, China
| |
Collapse
|
29
|
Uysal P, Avcil S, Erge D. High-dose anti-histamine use and risk factors in children with urticaria. Turk Arch Pediatr 2016; 51:198-203. [PMID: 28123332 DOI: 10.5152/turkpediatriars.2016.4202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 09/19/2016] [Indexed: 12/31/2022]
Abstract
AIM The drugs of choice in the treatment of urticaria in children are H1-antihistamines. The aim of the study was to evaluate children with urticaria and define risk factors for requirement of high-dose H1-antihistamines in children with urticaria. MATERIAL AND METHODS The medical data of children who were diagnosed as having urticaria admitted to our outpatient clinic between January 2014 and January 2016 were searched. The medical histories, concomitant atopic diseases, parental atopy histories, medications, treatment responses, blood eosinophil and basophil counts, and serum total IgE levels were recorded. In addition, the urticaria activity score for seven days, autoimmune antibody tests, and skin prick test results were evaluated in children with chronic urticaria. RESULTS The numbers of the children with acute and chronic urticaria were 138 and 92, respectively. The age of the children with chronic urticaria was higher than that of those with acute urticaria (p<0.0001). There was no difference between the two groups in terms of blood eosinophil and basophil counts, and serum total IgE levels (p>0.05). There was a negative correlation between blood eosinophil count and the UAS7 score in children with chronic urticaria (r=-0.276, p=0.011). Chronic urticaria and requirement of high dose H1-antihistamines were significant in children aged ≥10 years (p<0.001, p=0.015). High UAS7 score (OR: 1.09; CI 95%: [1.03-1.15]) and basopenia (OR: 6.77; CI 95%: [2.01-22.75]) were associated with the requirement of high-dose H1-AH in children with chronic urticaria. CONCLUSION The requirement of high-dose H1-antihistamines was higher with children's increasing age. Disease severity and basopenia were risk factors for the requirement of high-dose H1-antihistamines.
Collapse
Affiliation(s)
- Pınar Uysal
- Division of Pediatric Allergy and Clinical Immunology, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Sibelnur Avcil
- Department of Child and Adolescent Psychiatry, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Duygu Erge
- Division of Pediatric Allergy and Clinical Immunology, Adnan Menderes University School of Medicine, Aydın, Turkey
| |
Collapse
|
30
|
Azimi E, Reddy VB, Shade KTC, Anthony RM, Talbot S, Pereira PJS, Lerner EA. Dual action of neurokinin-1 antagonists on Mas-related GPCRs. JCI Insight 2016; 1:e89362. [PMID: 27734033 DOI: 10.1172/jci.insight.89362] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The challenge of translating findings from animal models to the clinic is well known. An example of this challenge is the striking effectiveness of neurokinin-1 receptor (NK-1R) antagonists in mouse models of inflammation coupled with their equally striking failure in clinical investigations in humans. Here, we provide an explanation for this dichotomy: Mas-related GPCRs (Mrgprs) mediate some aspects of inflammation that had been considered mediated by NK-1R. In support of this explanation, we show that conventional NK-1R antagonists have off-target activity on the mouse receptor MrgprB2 but not on the homologous human receptor MRGPRX2. An unrelated tripeptide NK-1R antagonist has dual activity on MRGPRX2. This tripeptide both suppresses itch in mice and inhibits degranulation from the LAD-2 human mast cell line elicited by basic secretagogue activation of MRGPRX2. Antagonists of Mrgprs may fill the void left by the failure of NK-1R antagonists.
Collapse
Affiliation(s)
- Ehsan Azimi
- Cutaneous Biology Research Center, Department of Dermatology, and
| | - Vemuri B Reddy
- Cutaneous Biology Research Center, Department of Dermatology, and
| | - Kai-Ting C Shade
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Robert M Anthony
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Sebastien Talbot
- FM Kirby Neurobiology Center, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Paula Juliana Seadi Pereira
- Cutaneous Biology Research Center, Department of Dermatology, and.,Programa de Pós-graduação em Biologia Celular e Molecular, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ethan A Lerner
- Cutaneous Biology Research Center, Department of Dermatology, and
| |
Collapse
|
31
|
Subramaniyan R, Chopra A. Treatment of Chronic Spontaneous Urticaria with a Single Dose of Omalizumab: A Study of Four Cases. Indian J Dermatol 2016; 61:467. [PMID: 27512204 PMCID: PMC4966419 DOI: 10.4103/0019-5154.185745] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Chronic spontaneous urticaria (CSU) has a detrimental effect on patients’ emotional and physical quality of life. Omalizumab, an anti-immunoglobulin E humanized monoclonal antibody, has been shown to be very effective in the treatment of refractory chronic urticaria patients but may not be an economically viable option for all CSU patients. However, we present a case series where a single dose of omalizumab gave sustained relief of symptoms in patients with CSU, which may be an economical option. Aims: The aim of this study is to assess the efficacy of a single dose of omalizumab in the treatment of CSU. Materials and Methods: Four patients of CSU whose disease was not controlled with four times the licensed dose of tablet fexofenadine 180 mg were exhibited one subcutaneous injection of omalizumab and were followed up at 4 weekly intervals for 24 weeks for Weekly Urticaria Activity Score 7 (UAS7) and Dermatology Life Quality Index (DLQI). Results: A sharp decline in UAS7 and DLQI was documented in 7–10 days. The decline was maintained up to 16 weeks in one case and 20 weeks in the other three cases. Both the scores at the end of the follow-up period of 24 weeks were better than the pre-omalizumab scores. Conclusion: The results of this case series indicate the efficacy of a single-dose omalizumab in treating moderate to severe refractory CSU. Further studies are required to identify the minimum frequency of administering omalizumab to effectively control CSU. This would greatly reduce the cost of this novel therapy.
Collapse
Affiliation(s)
| | - Ajay Chopra
- Department of Dermatology, Command Hospital Air Force, Bengaluru, Karnataka, India
| |
Collapse
|
32
|
Subramanian H, Gupta K, Ali H. Roles of Mas-related G protein-coupled receptor X2 on mast cell-mediated host defense, pseudoallergic drug reactions, and chronic inflammatory diseases. J Allergy Clin Immunol 2016; 138:700-710. [PMID: 27448446 DOI: 10.1016/j.jaci.2016.04.051] [Citation(s) in RCA: 280] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/21/2016] [Accepted: 04/06/2016] [Indexed: 12/11/2022]
Abstract
Mast cells (MCs), which are granulated tissue-resident cells of hematopoietic lineage, contribute to vascular homeostasis, innate/adaptive immunity, and wound healing. However, MCs are best known for their roles in allergic and inflammatory diseases, such as anaphylaxis, food allergy, rhinitis, itch, urticaria, atopic dermatitis, and asthma. In addition to the high-affinity IgE receptor (FcεRI), MCs express numerous G protein-coupled receptors (GPCRs), which are the largest group of membrane receptor proteins and the most common targets of drug therapy. Antimicrobial host defense peptides, neuropeptides, major basic protein, eosinophil peroxidase, and many US Food and Drug Administration-approved peptidergic drugs activate human MCs through a novel GPCR known as Mas-related G protein-coupled receptor X2 (MRGPRX2; formerly known as MrgX2). Unique features of MRGPRX2 that distinguish it from other GPCRs include their presence both on the plasma membrane and intracellular sites and their selective expression in MCs. In this article we review the possible roles of MRGPRX2 on host defense, drug-induced anaphylactoid reactions, neurogenic inflammation, pain, itch, and chronic inflammatory diseases, such as urticaria and asthma. We propose that host defense peptides that kill microbes directly and activate MCs through MRGPRX2 could serve as novel GPCR targets to modulate host defense against microbial infection. Furthermore, mAbs or small-molecule inhibitors of MRGPRX2 could be developed for the treatment of MC-dependent allergic and inflammatory disorders.
Collapse
Affiliation(s)
- Hariharan Subramanian
- Department of Pathology, University of Pennsylvania School of Dental Medicine, Philadelphia, Pa
| | - Kshitij Gupta
- Department of Pathology, University of Pennsylvania School of Dental Medicine, Philadelphia, Pa
| | - Hydar Ali
- Department of Pathology, University of Pennsylvania School of Dental Medicine, Philadelphia, Pa.
| |
Collapse
|
33
|
Acupoint stimulation for chronic urticaria: a systematic review of randomized controlled trials. Eur J Integr Med 2015. [DOI: 10.1016/j.eujim.2015.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
34
|
Bonadonna P, Bonifacio M, Lombardo C, Zanotti R. Hymenoptera Anaphylaxis and C-kit Mutations: An Unexpected Association. Curr Allergy Asthma Rep 2015; 15:49. [PMID: 26149588 DOI: 10.1007/s11882-015-0550-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Clinical manifestations of mastocytosis in adults comprise signs and symptoms linked to mast cell (MC) activation, including anaphylaxis. Depending on MC burden, adults can be diagnosed with systemic mastocytosis, when the WHO criteria are fulfilled, or with other clonal MC disorders, characterized by MC mediator symptoms and demonstration of activating KIT mutations and/or expression of CD25 on MCs. There is a specific link between mastocytosis and hymenoptera venom allergy (HVA): the reported frequency of HVA in mastocytosis is 20-50 % and raises to 60-80 % in patients affected by indolent systemic mastocytosis without skin lesions. The presentation of HVA characterized by severe hypotension in the absence of urticarial or angioedema is typical in patient with an underlying MC disorder, even in the presence of normal baseline serum tryptase levels.
Collapse
Affiliation(s)
- Patrizia Bonadonna
- Allergy Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy,
| | | | | | | |
Collapse
|
35
|
Urgert M, Elzen M, Knulst A, Fedorowicz Z, Zuuren E. Omalizumab in patients with chronic spontaneous urticaria: a systematic review and
GRADE
assessment. Br J Dermatol 2015; 173:404-15. [DOI: 10.1111/bjd.13845] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 12/01/2022]
Affiliation(s)
- M.C. Urgert
- Department of Dermatology University Medical Centre Groningen PO Box 30.001 9700 RB Groningen the Netherlands
| | - M.T. Elzen
- Department of Dermatology/Allergology University Medical Centre Utrecht PO Box 85500 3508 GA Utrecht the Netherlands
| | - A.C. Knulst
- Department of Dermatology/Allergology University Medical Centre Utrecht PO Box 85500 3508 GA Utrecht the Netherlands
| | - Z. Fedorowicz
- The Cochrane Collaboration Bahrain Branch Awali Bahrain
| | - E.J. Zuuren
- Department of Dermatology Leiden University Medical Centre PO Box 9600 2300 RC Leiden the Netherlands
| |
Collapse
|
36
|
The use of biologicals in cutaneous allergies - present and future. Curr Opin Allergy Clin Immunol 2015; 14:409-16. [PMID: 25102106 DOI: 10.1097/aci.0000000000000096] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE OF REVIEW Up-to-date biologicals in cutaneous allergies play - unfortunately - only a minor role. However, this situation might change. Recently, omalizumab was licensed for chronic urticaria; this article reviews recent advances in the use of biologicals in cutaneous allergies. RECENT FINDINGS Interestingly, the mechanism of omalizumab appears to be different in urticaria and allergic asthma for which the drug has been licensed previously. In urticaria dosage is not dependent on serum IgE-levels and response is seen very often after only 12 h. Other indications in cutaneous allergy in which biologicals have been investigated, at least in case reports or small studies, are TNF-α-antagonists and rituximab in chronic urticaria, omalizumab, rituximab and TNF-α-antagonists in atopic dermatitis as well as mepolizumab in this disease. However, all these studies appear to show a benefit for individual patients but not a clear breakthrough for the whole group of patients involved. This, however, might also be one of the future approaches that sub-groups of patients who have different responses to biologicals may be identified, as apparently different cytokine patterns are predominantly involved in the individual patient. SUMMARY In conclusion, although currently only one biological is approved in chronic urticaria, there is hope that a rapid better understanding of individual disease factors will support the development of other novel drugs in this field.
Collapse
|
37
|
Oliver ET, Sterba PM, Saini SS. Interval shifts in basophil measures correlate with disease activity in chronic spontaneous urticaria. Allergy 2015; 70:601-3. [PMID: 25631394 DOI: 10.1111/all.12578] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2015] [Indexed: 11/27/2022]
Abstract
Chronic spontaneous urticaria (CSU) significantly impacts the quality of life of those affected through symptoms of pruritus and recurrent skin lesions. In active CSU disease, reduced IgE-mediated basophil histamine release (HR) and basopenia are observed. We sought to examine the relationship between interval changes in basophil measures and shifts in patient-reported disease impairment. Simultaneous symptom and basophil evaluations were completed at two sequential study visits, and interval changes in measures were compared between visits for each subject (n = 38). These measures included Skindex-29, current itch and hives scores, total leukocyte histamine content (an indirect measure of blood basophil presence), and basophil HR in response to anti-IgE and formyl-methionine-leucine-phenylalanine. Overall, interval improvements in disease measures in CSU subjects were associated with increased basophil numbers (total leukocyte histamine content) and IgE-mediated HR. This suggests these measures are potential biomarkers for CSU disease improvement and further implicates a role for basophils in CSU.
Collapse
Affiliation(s)
- E. T. Oliver
- Division of Allergy and Clinical Immunology; Department of Medicine; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - P. M. Sterba
- Division of Allergy and Clinical Immunology; Department of Medicine; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - S. S. Saini
- Division of Allergy and Clinical Immunology; Department of Medicine; Johns Hopkins University School of Medicine; Baltimore MD USA
| |
Collapse
|
38
|
Amin P, Levin L, Holmes SJ, Picard J, Bernstein JA. Investigation of patient-specific characteristics associated with treatment outcomes for chronic urticaria. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 3:400-7. [PMID: 25680926 DOI: 10.1016/j.jaip.2014.12.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/19/2014] [Accepted: 12/23/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Identifying clinical characteristics of patients with chronic urticaria (CU) responsive to medication may help guide clinicians select treatment. OBJECTIVE The objective of this study was to investigate patient characteristics and medication use associated with urticaria control. METHODS A retrospective longitudinal chart review of adult patients with CU was conducted at a multisite allergy practice. Inclusion criteria required at least 4 CU office visits to allow for pre- and posttreatment assessment. Control corresponding to medication(s) used was assessed each visit. Univariate analysis followed by multiple logistic regression was performed. RESULTS A total of 221 patients with CU were included; 140 (63%) achieved complete control. The average time to control was 1.4 ± 2.7 years, which required 1-3 classes of medications. Dermatographia odds ratio (OR) = 1.85 (95% CI 1.3-2.7) or other physical urticarias, OR = 1.51 (1-2.4) and neutrophilic infiltrates on skin biopsy were markers of poor control. Thyroid autoantibodies were associated with better control using an H1-antihistamine. Whereas 22% were controlled on a second-generation H1-receptor antagonist plus a leukotriene receptor antagonist (LTRA), an additional 33% were controlled when cyclosporine was added. Use of a first or second H1-antagonist or LTRA was associated with a 3.5-16.9 times higher odds of complete CU control in those with dermatographia. The odds of achieving control for other forms of physical urticaria was greatest when colchicine was added (aOR = 32.6 [12.7-83.2]). CONCLUSIONS Patient-specific CU characteristics associated with medication-disease control may be useful for selecting treatment regimens. A subset of CU patients remains poorly controlled that indicates an unmet need for novel therapeutic agents.
Collapse
Affiliation(s)
- Priyal Amin
- Division of Immunology, Allergy & Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Linda Levin
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio
| | - Sarah J Holmes
- Division of Immunology, Allergy & Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jillian Picard
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jonathan A Bernstein
- Division of Immunology, Allergy & Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| |
Collapse
|
39
|
Relationship between Helicobacter pylori and idiopathic chronic urticaria: effectiveness of Helicobacter pylori eradication. Postepy Dermatol Alergol 2015; 32:15-20. [PMID: 25821422 PMCID: PMC4360011 DOI: 10.5114/pdia.2015.48729] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/14/2014] [Accepted: 07/17/2014] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Chronic urticaria (CU) is defined as the presence of urticaria on most days of the week for a period of 6 weeks or longer. Some studies have reported an association between CU and Helicobacter pylori (H. pylori) infection. AIM To determine the prevalence of H. pylori infection using the stool antigen test in patients with idiopathic CU and to investigate the infected patients with CU following eradication of H. pylori. MATERIAL AND METHODS One hundred patients with idiopathic CU and 100 healthy controls were referred to our clinic between May 2012 and June 2013 and were tested for H. pylori antigen. The patients infected with H. pylori received quadruple therapy for 2 weeks. To assess eradication efficacy, a repeated H. pylori stool antigen test was performed in each patient 6 weeks after the end of anti-H. pylori therapy. The effectiveness of eradication therapy on CU was assessed 3 months after treatment. RESULTS Thirty-six percent patients with idiopathic CU were infected with H. pylori while 23% of the controls were infected. Response to eradication therapy was evident in 33 (91.67%) patients in whom H. pylori was eradicated while 3 (8.33%) patients showed no response despite eradication of H. pylori. Clinical follow-up of 33 successfully treated patients 3 months later revealed complete remission of urticaria in 54.5%, partial remission in 18.2%, and no improvement in 27.3%. CONCLUSIONS The results of our study suggest that H. pylori infection should be included in diagnostic workup of patients with no response to habitual treatment for CU or symptomatic gastrointestinal patients. For the diagnosis of H. pylori infection, one should consider the costs and accessibility of the population to the HpSA(®) stool antigen test and Urea breath test (UBT).
Collapse
|
40
|
Saini SS, Bindslev-Jensen C, Maurer M, Grob JJ, Bülbül Baskan E, Bradley MS, Canvin J, Rahmaoui A, Georgiou P, Alpan O, Spector S, Rosén K. Efficacy and safety of omalizumab in patients with chronic idiopathic/spontaneous urticaria who remain symptomatic on H1 antihistamines: a randomized, placebo-controlled study. J Invest Dermatol 2015; 135:67-75. [PMID: 25046337 PMCID: PMC4269803 DOI: 10.1038/jid.2014.306] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/02/2014] [Accepted: 06/04/2014] [Indexed: 11/21/2022]
Abstract
ASTERIA I was a 40-week, randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of subcutaneous omalizumab as add-on therapy for 24 weeks in patients with chronic idiopathic urticaria/spontaneous urticaria (CIU/CSU) who remained symptomatic despite H1 antihistamine treatment at licensed doses. Patients aged 12-75 years with CIU/CSU who remained symptomatic despite treatment with approved doses of H1 antihistamines were randomized (1:1:1:1) in a double-blind manner to subcutaneous omalizumab 75 mg, 150 mg, or 300 mg or placebo every 4 weeks for 24 weeks followed by 16 weeks of follow-up. The primary end point was change from baseline in weekly itch severity score (ISS) at week 12. Among randomized patients (N=319: placebo n=80, omalizumab 75 mg n=78, 150 mg n=80, 300 mg n=81), 262 (82.1%) completed the study. Compared with placebo (n=80), mean weekly ISS was reduced from baseline to week 12 by an additional 2.96 points (95% confidence interval (CI): -4.71 to -1.21; P=0.0010), 2.95 points (95% CI: -4.72 to -1.18; P=0.0012), and 5.80 points (95% CI: -7.49 to -4.10; P<0.0001) in the omalizumab 75-mg (n=77), 150-mg (n=80), and 300-mg groups (n=81), respectively. The omalizumab 300-mg group met all nine secondary end points, including a significant decrease in the duration of time to reach minimally important difference response (⩾5-point decrease) in weekly ISS (P<0.0001) and higher percentages of patients with well-controlled symptoms (urticaria activity score over 7 days (UAS7) ⩽6: 51.9% vs. 11.3%; P<0.0001) and complete response (UAS7=0: 35.8% vs. 8.8%; P<0.0001) versus placebo. During the 24-week treatment period, 2 (2.9%), 3 (3.4%), 0, and 4 (5.0%) patients in the omalizumab 75-mg, 150-mg, 300-mg, and placebo groups, respectively, experienced a serious adverse event. Omalizumab 300 mg administered subcutaneously every 4 weeks reduced weekly ISS and other symptom scores versus placebo in CIU/CSU patients who remained symptomatic despite treatment with approved doses of H1 antihistamines.
Collapse
Affiliation(s)
- Sarbjit S Saini
- Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland, USA
| | | | - Marcus Maurer
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jean-Jacques Grob
- Dermatology Department, Timone Hospital and Aix-Marseille University, Marseille, France
| | - Emel Bülbül Baskan
- Dermatology Department, Uludağ University Medical Faculty, Bursa, Turkey
| | | | | | | | | | - Oral Alpan
- Section on Immunopathogenesis, O&O Alpan, Fairfax, Virginia, USA
| | - Sheldon Spector
- California Allergy and Asthma Medical Group and the University of California Medical Center, Los Angeles, California, USA
| | - Karin Rosén
- Genentech, Inc., South San Francisco, California, USA.
| |
Collapse
|
41
|
Pathogenesis of chronic urticaria: an overview. Dermatol Res Pract 2014; 2014:674709. [PMID: 25120565 PMCID: PMC4120476 DOI: 10.1155/2014/674709] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 06/15/2014] [Indexed: 12/20/2022] Open
Abstract
The pathogenesis of chronic urticaria is not well delineated and the treatment is palliative as it is not tied to the pathomechanism. The centrality of mast cells and their inappropriate activation and degranulation as the key pathophysiological event are well established. The triggering stimuli and the complexity of effector mechanisms remain speculative. Autoimmune origin of chronic urticaria, albeit controversial, is well documented. Numerical and behavioral alterations in basophils accompanied by changes in signaling molecule expression and function as well as aberrant activation of extrinsic pathway of coagulation are other alternative hypotheses. It is also probable that mast cells are involved in the pathogenesis through mechanisms that extend beyond high affinity IgE receptor stimulation. An increasing recognition of chronic urticaria as an immune mediated inflammatory disorder related to altered cytokine-chemokine network consequent to immune dysregulation resulting from disturbed innate immunity is emerging as yet another pathogenic explanation. It is likely that these different pathomechanisms are interlinked rather than independent cascades, acting either synergistically or sequentially to produce clinical expression of chronic urticaria. Insights into the complexities of pathogenesis may provide an impetus to develop safer, efficacious, and targeted immunomodulators and biological treatment for severe, refractory chronic urticaria.
Collapse
|
42
|
Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, Church MK, Ensina LF, Giménez-Arnau A, Godse K, Gonçalo M, Grattan C, Hebert J, Hide M, Kaplan A, Kapp A, Abdul Latiff AH, Mathelier-Fusade P, Metz M, Nast A, Saini SS, Sánchez-Borges M, Schmid-Grendelmeier P, Simons FER, Staubach P, Sussman G, Toubi E, Vena GA, Wedi B, Zhu XJ, Maurer M. The EAACI/GA(2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy 2014; 69:868-87. [PMID: 24785199 DOI: 10.1111/all.12313] [Citation(s) in RCA: 668] [Impact Index Per Article: 66.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2013] [Indexed: 12/13/2022]
Abstract
This guideline is the result of a systematic literature review using the 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE) methodology and a structured consensus conference held on 28 and 29 November 2012, in Berlin. It is a joint initiative of the Dermatology Section of the European Academy of Allergy and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA(2) LEN), the European Dermatology Forum (EDF), and the World Allergy Organization (WAO) with the participation of delegates of 21 national and international societies. Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The life-time prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria do not only cause a decrease in quality of life, but also affect performance at work and school and, as such, are members of the group of severe allergic diseases. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS).
Collapse
Affiliation(s)
- T. Zuberbier
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - W. Aberer
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - R. Asero
- Allergy Clinic; Clinica San Carlo; Paderno Dugnano MI Italy
| | - C. Bindslev-Jensen
- Department of Dermatology and Allergy Centre; Odense University Hospital; University of Southern Denmark; Odense Denmark
| | - Z. Brzoza
- Department of Internal Diseases, Allergology and Clinical Immunology in Katowice; Medical University of Silesia; Zabrze Poland
| | - G. W. Canonica
- Respiratory Diseases & Allergy; University of Genoa; IRCCS AOU SanMartino; Genoa Italy
| | - M. K. Church
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - L. F. Ensina
- Department of Clinical Immunology and Allergy; Federal University of Sao Paulo; Sao Paulo Brazil
| | - A. Giménez-Arnau
- Hospital del Mar. Parc de Salut Mar; Universitat Autònoma Barcelona; Barcelona Spain
| | - K. Godse
- Department of Dermatology; Dr. D. Y. Patil Medical College & Hospital; Nerul Navi Mumbai India
| | - M. Gonçalo
- Clinic of Dermatology; Faculty of Medicine and University Hospital; Coimbra Portugal
| | - C. Grattan
- St John's Institute of Dermatology; Guy's and St Thomas' Hospitals NHS Foundation Trust; London UK
| | - J. Hebert
- Center for Applied Research on Allergy Québec; Québec QC Canada
| | - M. Hide
- Department of Dermatology; Institute of Biomedical and Health Sciences; Hiroshima University; Hiroshima Japan
| | - A. Kaplan
- Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology; Department of Medicine; Medical University of South Carolina; Charleston SC USA
| | - A. Kapp
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - A. H. Abdul Latiff
- Department of Paediatrics; Pantai Hospital Kuala Lumpur; Bangsar Kuala Lumpur Malaysia
| | - P. Mathelier-Fusade
- Department of Dermatology and Allergy; University Hospital of Tenon; Paris France
| | - M. Metz
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - A. Nast
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - S. S. Saini
- Johns Hopkins Asthma and Allergy Center; Baltimore MD USA
| | - M. Sánchez-Borges
- Allergy and Clinical Immunology Department Centro Médico-Docente La Trinidad; Caracas Venezuela
| | | | - F. E. R. Simons
- Departments of Pediatrics & Child Health, Immunology; University of Manitoba; Winnipeg MB Canada
| | - P. Staubach
- Department of Dermatology; University Medical Center Mainz; Mainz Germany
| | - G. Sussman
- Division of Allergy and Clinical Immunology; University of Toronto; Toronto ON Canada
| | - E. Toubi
- Bnai-Zion Medical Center; Faculty of Medicine; Technion; Haifa Israel
| | - G. A. Vena
- Unit of Dermatology and Venereology; Department of Biomedical Sciences and Human Oncology; University of Bari; Bari Italy
| | - B. Wedi
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - X. J. Zhu
- Department of Dermatology; Peking University First Hospital; Beijing China
| | - M. Maurer
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | | | | | | | | |
Collapse
|
43
|
Fujisawa D, Kashiwakura JI, Kita H, Kikukawa Y, Fujitani Y, Sasaki-Sakamoto T, Kuroda K, Nunomura S, Hayama K, Terui T, Ra C, Okayama Y. Expression of Mas-related gene X2 on mast cells is upregulated in the skin of patients with severe chronic urticaria. J Allergy Clin Immunol 2014; 134:622-633.e9. [PMID: 24954276 DOI: 10.1016/j.jaci.2014.05.004] [Citation(s) in RCA: 255] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 02/26/2014] [Accepted: 05/01/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Wheal reactions to intradermally injected neuropeptides, such as substance P (SP) and vasoactive intestinal peptide, are significantly larger and longer lasting in patients with chronic urticaria (CU) than in nonatopic control (NC) subjects. Mas-related gene X2 (MrgX2) has been identified as a receptor for basic neuropeptides, such as SP and vasoactive intestinal peptide. Mast cell (MC) responsiveness to eosinophil mediators contributes to the late-phase reaction of allergy. OBJECTIVE We sought to compare the frequency of MrgX2 expression in skin MCs from patients with CU and NC subjects and to identify the receptor for basic eosinophil granule proteins on human skin MCs. METHODS MrgX2 expression was investigated by using immunofluorescence in skin tissues from NC subjects and patients with severe CU and on skin-derived cultured MCs. MrgX2 expression in human MCs was reduced by using a lentiviral small hairpin RNA silencing technique. Ca(2+) influx was measured in CHO cells transfected with MrgX2 in response to eosinophil granule proteins. Histamine and prostaglandin D2 levels were measured by using enzyme immunoassays. RESULTS The number of MrgX2(+) skin MCs and the percentage of MrgX2(+) MCs in all MCs in patients with CU were significantly greater than those in NC subjects. Eosinophil infiltration in urticarial lesions was observed in 7 of 9 patients with CU. SP, major basic protein, and eosinophil peroxidase, but not eosinophil-derived neurotoxin, induced histamine release from human skin MCs through MrgX2. CONCLUSION MrgX2 might be a new target molecule for the treatment of wheal reactions in patients with severe CU.
Collapse
Affiliation(s)
- Daisuke Fujisawa
- Allergy and Immunology Group, Research Institute of Medical Science, Nihon University School of Medicine, Tokyo, Japan; Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - Jun-Ichi Kashiwakura
- Laboratory for Allergic Disease, RCAI, RIKEN Center for Integrative Medical Sciences (IMS-RCAI), Yokohama, Japan
| | - Hirohito Kita
- Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn
| | - Yusuke Kikukawa
- Pharmaceutical Research Division, Takeda Pharmaceutical Company, Fujisawa, Japan
| | - Yasushi Fujitani
- Pharmaceutical Research Division, Takeda Pharmaceutical Company, Fujisawa, Japan
| | - Tomomi Sasaki-Sakamoto
- Allergy and Immunology Group, Research Institute of Medical Science, Nihon University School of Medicine, Tokyo, Japan
| | - Kazumichi Kuroda
- Department of Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Satoshi Nunomura
- Allergy and Immunology Group, Research Institute of Medical Science, Nihon University School of Medicine, Tokyo, Japan; Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - Koremasa Hayama
- Allergy and Immunology Group, Research Institute of Medical Science, Nihon University School of Medicine, Tokyo, Japan; Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - Tadashi Terui
- Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - Chisei Ra
- Department of Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshimichi Okayama
- Allergy and Immunology Group, Research Institute of Medical Science, Nihon University School of Medicine, Tokyo, Japan.
| |
Collapse
|
44
|
Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F, Sheikh J, Weldon D, Zuraw B, Bernstein DI, Blessing-Moore J, Cox L, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph CR, Schuller DE, Spector SL, Tilles SA, Wallace D. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol 2014; 133:1270-7. [DOI: 10.1016/j.jaci.2014.02.036] [Citation(s) in RCA: 320] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 02/10/2014] [Accepted: 02/12/2014] [Indexed: 12/13/2022]
|
45
|
Lang DM. A critical appraisal of omalizumab as a therapeutic option for chronic refractory urticaria/angioedema. Ann Allergy Asthma Immunol 2014; 112:276-9. [PMID: 24589165 DOI: 10.1016/j.anai.2014.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 12/30/2013] [Accepted: 01/25/2014] [Indexed: 10/25/2022]
Affiliation(s)
- David M Lang
- Department of Allergy and Clinical Immunology, Cleveland Clinic, Respiratory Institute, Cleveland, Ohio.
| |
Collapse
|
46
|
Abstract
Urticaria affects individuals of all ages and is commonplace. Nearly 1 in 5 individuals will experience an episode of urticaria in their lifetime, while the chronic form of disease has an estimated annual prevalence of approximately 1% of the population. Given the similarity of chronic urticaria symptoms to those seen in patients suffering an allergic reaction, the condition often leads to a search for an external cause. In most cases, no external trigger factor is identified. At present several theories of pathogenesis exist, none of which is firmly established.
Collapse
Affiliation(s)
- Sarbjit S Saini
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Room 2B. 71B, Baltimore, MD 21224, USA.
| |
Collapse
|
47
|
Chien PS, Tseng YF, Hsu YC, Lai YK, Weng SF. Frequency and pattern of Chinese herbal medicine prescriptions for urticaria in Taiwan during 2009: analysis of the national health insurance database. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 13:209. [PMID: 23947955 PMCID: PMC3751558 DOI: 10.1186/1472-6882-13-209] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 08/13/2013] [Indexed: 11/17/2022]
Abstract
Background Large-scale pharmaco-epidemiological studies of Chinese herbal medicine (CHM) for treatment of urticaria are few, even though clinical trials showed some CHM are effective. The purpose of this study was to explore the frequencies and patterns of CHM prescriptions for urticaria by analysing the population-based CHM database in Taiwan. Methods This study was linked to and processed through the complete traditional CHM database of the National Health Insurance Research Database in Taiwan during 2009. We calculated the frequencies and patterns of CHM prescriptions used for treatment of urticaria, of which the diagnosis was defined as the single ICD-9 Code of 708. Frequent itemset mining, as applied to data mining, was used to analyse co-prescription of CHM for patients with urticaria. Results There were 37,386 subjects who visited traditional Chinese Medicine clinics for urticaria in Taiwan during 2009 and received a total of 95,765 CHM prescriptions. Subjects between 18 and 35 years of age comprised the largest number of those treated (32.76%). In addition, women used CHM for urticaria more frequently than men (female:male = 1.94:1). There was an average of 5.54 items prescribed in the form of either individual Chinese herbs or a formula in a single CHM prescription for urticaria. Bai-Xian-Pi (Dictamnus dasycarpus Turcz) was the most commonly prescribed single Chinese herb while Xiao-Feng San was the most commonly prescribed Chinese herbal formula. The most commonly prescribed CHM drug combination was Xiao-Feng San plus Bai-Xian-Pi while the most commonly prescribed triple drug combination was Xiao-Feng San, Bai-Xian-Pi, and Di-Fu Zi (Kochia scoparia). Conclusions In view of the popularity of CHM such as Xiao-Feng San prescribed for the wind-heat pattern of urticaria in this study, a large-scale, randomized clinical trial is warranted to research their efficacy and safety.
Collapse
|
48
|
Omalizumab in patients with symptomatic chronic idiopathic/spontaneous urticaria despite standard combination therapy. J Allergy Clin Immunol 2013; 132:101-9. [DOI: 10.1016/j.jaci.2013.05.013] [Citation(s) in RCA: 362] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 05/15/2013] [Accepted: 05/20/2013] [Indexed: 11/22/2022]
|
49
|
Khafagy NH, Salem SAM, Ghaly EG. Comparative study of systemic psoralen and ultraviolet A and narrowband ultraviolet B in treatment of chronic urticaria. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2013; 29:12-7. [PMID: 23281692 DOI: 10.1111/phpp.12008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Accepted: 09/12/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous success rates of psoralen and ultraviolet A (PUVA) and narrowband UVB (NB-UVB) in the treatment of chronic urticaria are reported in few studies with no previous reports on the comparable efficacy of both modalities in the disease. AIM We aimed to compare the efficacy of PUVA versus NB-UVB in the treatment of chronic urticaria. METHODS Twenty-four patients with chronic urticaria were included and divided into two groups: 12 patients subjected to PUVA and 12 subjected to NB-UVB. They were compared according to the urticaria Total Severity Score (TSS) before and after treatment, cumulative dose, and side effects. RESULTS There was a statistically significant decrease in urticaria TSS in both the NB-UVB- and PUVA-treated groups after than before treatment (P < 0.05), with no significant difference between both groups regarding the percentage of improved patients and the mean decrease of urticaria TSS (P > 0.05). Gastrointestinal upset was reported at a significantly higher percentage in the PUVA-treated group than in the NB-UVB-treated group. CONCLUSION Both NB-UVB and PUVA show comparable efficacy in the treatment of chronic urticaria with minimal reversible side effects.
Collapse
Affiliation(s)
- Naziha Hafez Khafagy
- Department of Dermatology and Venereology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | | |
Collapse
|
50
|
Uetrecht J, Naisbitt DJ. Idiosyncratic adverse drug reactions: current concepts. Pharmacol Rev 2013; 65:779-808. [PMID: 23476052 DOI: 10.1124/pr.113.007450] [Citation(s) in RCA: 196] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Idiosyncratic drug reactions are a significant cause of morbidity and mortality for patients; they also markedly increase the uncertainty of drug development. The major targets are skin, liver, and bone marrow. Clinical characteristics suggest that IDRs are immune mediated, and there is substantive evidence that most, but not all, IDRs are caused by chemically reactive species. However, rigorous mechanistic studies are very difficult to perform, especially in the absence of valid animal models. Models to explain how drugs or reactive metabolites interact with the MHC/T-cell receptor complex include the hapten and P-I models, and most recently it was found that abacavir can interact reversibly with MHC to alter the endogenous peptides that are presented to T cells. The discovery of HLA molecules as important risk factors for some IDRs has also significantly contributed to our understanding of these adverse reactions, but it is not yet clear what fraction of IDRs have a strong HLA dependence. In addition, with the exception of abacavir, most patients who have the HLA that confers a higher IDR risk with a specific drug will not have an IDR when treated with that drug. Interindividual differences in T-cell receptors and other factors also presumably play a role in determining which patients will have an IDR. The immune response represents a delicate balance, and immune tolerance may be the dominant response to a drug that can cause IDRs.
Collapse
Affiliation(s)
- Jack Uetrecht
- Faculties of Pharmacy and Medicine, University of Toronto, Toronto, Canada M5S3M2.
| | | |
Collapse
|