Quality of life in patients with chronic idiopathic urticaria: the impact of Axis I and Axis II psychiatric disorders

Chronic Spontaneous Urticaria: Quality of Life and Economic Impacts

This study focuses on quality of life (QoL) assessment in chronic urticaria, delving into tools, disease-specific measures, and its profound impact. With expanding therapeutic options, understanding QoL becomes crucial. QoL measures often involve comparisons of patient-reported outcomes in addition to quantitative measures of disease control. Emerging tools include the Urticaria Activity and Impact Measure, which may provide a balanced evaluation. In addition to discussions of the various QoL measures, the psychological impact of chronic urticaria are highlighted, covering emotional burden, stress, and psychiatric comorbidities. Finally, the economic impacts reveal escalating health care costs and cost-effectiveness considerations of therapies like omalizumab.

Quality of life measurement in urticaria: Position statement of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient-Oriented Outcomes and Urticaria and Angioedema

The European Academy of Dermatology and Venereology (EADV) Task Forces on quality of life (QoL) and patient-oriented outcomes and on urticaria and angioedema recommendations for the assessment of Health-related (HR) QoL in all patients with urticaria in research and practice are as follows: to use the DLQI for adults and the CDLQI for children as dermatology-specific and the CU-Q2oL as a disease-specific HRQoL instruments in urticaria; to use generic instruments to provide comparison of data on urticaria with non-dermatologic diseases, or to compare with healthy volunteers or the general population; to select validated HRQoL instruments with appropriate age limits; to present exact numeric data for HRQoL results; correct title of any HRQoL instrument should be used, along with its correct abbreviation and the reference to its original publication, where possible. The EADV TFs discourage the use of non-validated HRQoL instruments and modified HRQoL instruments that have not undergone standard validation.

Efficacy of the colchicine add-on therapy in patients with autoimmune chronic urticaria

Chronic urticaria is in some cases very difficult to treat, we aimed to evaluate the effect of colchicine on chronic urticaria management. Fifty-five euthyroid patients with chronic urticaria were examined based on UQL and UAS7 questionnaires. The overall UQL-Q score after 3 months has not any statistical difference between groups. The overall UQL-Q score changes between groups was not statistically different. However, the UQL-Q score significantly reduces during study period in each group. In conclusion, colchicine can manage the sign and symptoms of chronic urticaria, which improve the patients' quality of life.

The Efficiency of Spa Rehabilitation in Chronic Ischemic Stroke Patients-Preliminary Reports

Background: Rehabilitation-oriented therapy after a stroke must continue in various forms as a life-long effort. Aim: The study investigated the impact of spa rehabilitation on the quality of life and functional efficiency in patients after an ischemic stroke at a chronic stage of recovery. Methods: The assessment was carried out in a spa resort in southeastern Poland. It involved 32 patients with strokes who participated in a three-week rehabilitation program. Three examinations were performed: upon admission, on the day of discharge and at a two-month follow-up. The quality of life and functional efficiency were assessed with the WHOQOL-BREF and Barthel Index. Results: The quality of life was significantly higher in Exam II compared with Exam I (p < 0.001), and improvement was retained at the follow-up. The Barthel scores were higher in Exam II compared with Exam I (79.84 vs. 68.59), while the differences between the scores in Exams II and III were small (p = 0.039). Conclusions: Three-week spa rehabilitation seems to favorably affect the functional efficiency and quality of life after a stroke. The effects appear to be long-term. The gender, age and time from stroke onset do not seem to impact short-term effects. However, long-term effects are related to the time from stroke onset.

Role of Adjuvant Narrow Band Ultraviolet B Phototherapy in the Treatment of Chronic Urticaria

Background:

Chronic urticaria is a common dermatological disorder that causes a great deal of distress in patients and affects daily life. Narrow band ultraviolet B (NBUVB) has been shown to be an effective treatment in chronic urticaria in few studies. However, the data regarding its role in chronic urticaria are limited.

Aims and Objectives:

The aim of this study was to determine the role of NBUVB in the treatment of chronic urticaria in combination with antihistamine.

Materials and Methods:

A total of 80 patients of chronic urticaria were recruited, out of which 40 were allocated to NBUVB-loratadine group and 40 to loratadine group. Patients were assessed using urticaria activity score (UAS) at same point of time, i.e. after 4 weeks (8 sessions), 8 weeks (16 sessions) and at follow up of 4 weeks after stopping the treatment.

Results:

On comparing the two groups, the mean UAS was significantly lower after 8 and 16 sessions in NBUVB-loratadine group (12.03 v/s 21.43 and 3.54 v/s 17.16, respectively). The difference in reduction of UAS7 in two groups was seen to be statistically significant (P value < 0.01).

Conclusion:

Thus we conclude that NBUVB may be useful in the treatment of chronic urticaria.

Burden of Illness and Quality-of-Life Measures in Angioedema Conditions

Burden of illness studies and evaluation of health-related quality of life using validated questionnaires have become an important task in the comprehensive management of angioedema conditions, mainly angioedema associated with chronic spontaneous urticaria and hereditary angioedema caused by C1-inhibitor deficiency. A review of the principal tools and studies is presented. Both diseases present a higher proportion of psychiatric disorders, impair work and studies productivity, and produce high direct and indirect costs. These assessments also have been useful to evaluate the positive impact of new drugs and interventions. More studies are desirable, especially in other types of angioedema disorders, such as hereditary angioedema with normal C1 inhibitor.

Peer-relationship-problems account for quality of life impairments in pediatric psoriasis

OBJECTIVE

Most research on HRQoL-impairments in psoriasis has been conducted in adult patients, small pediatric patient samples or samples not representative of the pediatric population at large. We thus aimed to comprehensively describe HRQoL in pediatric psoriasis compared to psoriasis-free children and adolescents, identify domains most commonly affected and analyze its impact on HRQoL while controlling for important other predictors of HRQoL in a representative pediatric sample.

METHODS

The impact of lifetime-prevalence of psoriasis on total and subscale HRQoL was analyzed by complex sample general linear models alone and adjusted for sociodemographic and clinical variables in a population-based sample (n=6518) of children and adolescents aged 11-17.

RESULTS

Total HRQoL and the physical domain were significantly affected by lifetime-psoriasis in univariate analysis. In multivariate analyses, lifetime-psoriasis significantly impacted on total HRQoL and the subscale 'quality of relationships with friends/peers'. Although substantial amounts of variance in HRQoL were explained by mental health, independent effects of lifetime-psoriasis remained after adjustment for this covariate. Total explained variance in total HRQoL was 20%.

CONCLUSION

Our findings suggest psoriasis to be a significant burden as it affects HRQoL even when controlling for mental health. Most of this effect appears to be driven by perceived impairments in the quality of relationship with friends/peers. How this exactly occurs needs to be explored in future research. Meanwhile clinicians need to be more attentive to this effect of psoriasis.

Quality of life in rheumatological patients: The impact of personality disorders

OBJECTIVE

Rheumatological diseases are associated with lower quality of life (QoL) levels. Psychiatric disturbances are frequently observed in these patients. This study examined the impact of personality disorders on the QoL of patients with rheumatological diseases.

METHOD

The study sample consisted of 142 participants including patients suffering from rheumatological disease with a personality disorder (n = 30), without any personality disorder (n = 112), and healthy control participants without physical or psychiatric disorders (n = 60). The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID-I) and the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders (SCID-II) were used to determine Axis I and Axis II psychiatric disorders, respectively. QoL levels were assessed by means of the World Health Organization QoL Assessment-Brief.

RESULTS

The subscale scores of physical health, psychological health, and social relationships were significantly lower in patients with rheumatological disease regardless of the existence of personality disorder compared with the control participants. Rheumatological patients with a personality disorder had significantly lower subscale scores of psychological health (p = 0.003) and social relationships (p < 0.003) compared with patients without any personality disorder.

CONCLUSIONS

Personality disorders seem to be a relevant factor that maybe associated with QoL in patients suffering from rheumatological disease.

Urticaria: impact on quality of life and economic cost

Patients with urticaria suffer itch, swellings, fatigue caused by sleep disturbance and the side effects of medication, and disruption of many facets of their lives. Much progress has been made in formally evaluating the degree of quality-of-life (QoL) impairment suffered by patients with urticaria. This review focuses on QoL in chronic urticaria (>6 weeks duration) and examines QoL measures, including the chronic urticaria-quality of life questionnaire (CU-Q2oL). Patients with urticaria have difficulty identifying and coping with their emotions. The psychiatric comorbidity and the financial burden on the patient and society because of chronic urticaria, is also examined.

The benefit of H2 receptors antagonist Rupatadine in treatment for urticaria

Second generation antihistamine drugs are mainly used for the therapy of patients suffering from urticaria; however, they are efficient in 45-60% of cases only. New drugs for treatment of urticaria need to be developed and implemented, and second generation antihistamine drug Rupatadine is one of them. At the same time, Rupatadine efficiently inhibits the inflammatory action of the platelet-activating factor. Due to its double action, Rupatadine used perorally in the dose of 10 mg once a day is an efficient drug for treatment of urticaria, and its safety was confirmed by clinical trials.

Is the impact of atopic disease on children and adolescents' health related quality of life modified by mental health? Results from a population-based cross-sectional study

Background

Eczema, asthma and hay fever are global health problems and their prevalence has increased considerably over the last decades. All appear to share an underlying atopic diathesis but their aetiology is considered to be multifactorial. They have been linked to decreases in health related quality of life (HRQoL) in adults, children/adolescents and/or parents of children. Research also suggests an association of the three conditions with mental health, which in turn is related to HRQoL decreases. We aimed to assess whether the impact of any of the three conditions on HRQoL is modified by presence of mental health problems.

Methods

The impact of occurrence of the three conditions within the past four weeks and 12 months on HRQoL, as measured by the ‘Quality of Life in Children – Revised’ (KINDL-R) questionnaire was analysed by use of the complex sample general linear model in a population-based sample (N = 6518) of children and adolescents aged 11 – 17. Analyses were adjusted for the other atopic conditions, sociodemographic and clinical variables and stratified for mental health as measured by the Strengths and Difficulties Questionnaire (SDQ) (normal n = 5697, borderline n = 609, abnormal n = 193).

Results

Eczema and hay fever within the past four weeks were significantly associated with decreased total or certain subscales of KINDL-R after adjusting for all other variables when no mental health abnormalities were present while asthma was associated with better HRQoL in these individuals. However, when mental health problems were present, eczema was positively associated with several subscales and the positive impact of asthma was stronger. The presence of mental health problems accentuated the negative relationship between hay fever and HRQoL (stronger negative impact). However, due to decreasing numbers in the group with mental health problems only few associations reached statistical significance.

Conclusions

While the results suggest mental health to have a modifying effect on the relationship between some atopic conditions and HRQoL caution needs to be exercised in interpreting the results: First, the groups with borderline or abnormal mental health were comparably smaller than the group with normal mental health. In the group with normal mental health small effects were more likely to become significant than in the other two groups. Secondly some problems regarding the validity of the self-report SDQ still remain.

Quality of life in postmenopausal women: the impact of depressive and anxiety disorders

OBJECTIVE

Psychiatric symptoms are frequently present in postmenopausal women. The present study aimed to investigate the impact of depressive and anxiety disorders on the quality of life (QoL) of postmenopausal women.

METHOD

The study sample consisted of 342 postmenopausal women who presented to the Gynecology Outpatient Clinic. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition was used to determine depressive and anxiety disorders. The participants' QoL level was assessed by means of the World Health Organization QoL Assessment-Brief (WHOQOL-BREF).

RESULTS

Subjects without a diagnosis of depressive or anxiety disorder had significantly higher points in all domains of WHOQOL-BREF. According to linear regression analysis, all evaluated disorders except social phobia and specific phobia were independently associated with lower scores for at least one dimension of the QoL scale. However, major depression, dysthymic disorder, and generalized anxiety disorder predicted all domains of WHOQOL-BREF.

CONCLUSION

Depressive and anxiety disorders, particularly major depression, dysthymic disorder, and generalized anxiety disorder, seem to be considerable factors affecting the QoL in postmenopausal women.

Chronic urticaria

Chronic urticaria (CU) is a disturbing allergic condition of the skin. Although frequently benign, it may sometimes be a red flag sign of a serious internal disease. A multitude of etiologies have been implicated in the causation of CU, including physical, infective, vasculitic, psychological and idiopathic. An autoimmune basis of most of the 'idiopathic' forms is now hypothesized. Histamine released from mast cells is the major effector in pathogenesis and it is clinically characterized by wheals that have a tendency to recur. Laboratory investigations aimed at a specific etiology are not always conclusive, though may be suggestive of an underlying condition. A clinical search for associated systemic disease is strongly advocated under appropriate circumstances. The mainstay of treatment remains H1 antihistaminics. These may be combined with complementary pharmacopeia in the form of H2 blockers, doxepin, nifedipine and leukotriene inhibitors. More radical therapy in the form of immunoglobulins, plasmapheresis and cyclophosphamide may be required for recalcitrant cases. Autologous transfusion and alternative remedies like acupuncture have prospects for future. A stepwise management results in favorable outcomes. An update on CU based on our experience with patients at a tertiary care centre is presented.

Recommendations for assessing patient-reported outcomes and health-related quality of life in patients with urticaria: a GA(2) LEN taskforce position paper

The aim of this Global Allergy and Asthma European Network (GA(2)LEN) consensus report is to provide recommendations and suggestions for assessing patient-reported outcomes (PROs) including health-related quality of life in patients with urticaria. We recommend that PROs should be used both in clinical trials and routine practice for the evaluation of urticaria patients. We suggest that PROs should be considered as the primary outcome of future clinical trials. Two validated and disease-specific instruments for assessing PROs are available, the urticaria activity score (for symptoms) and the chronic urticaria questionnaire on quality of life CU-Q(2)oL. This latter tool, CU-Q(2)oL, is available in many languages and should be preferred, where available, over more generic instruments for assessing urticaria-specific effects on quality of life. CU-Q(2)oL is only suited for the investigation of patients with chronic spontaneous urticaria. Similar instruments for other forms of urticaria have yet to be developed and validated. Also, tools for assessing other chronic spontaneous urticaria PROs besides quality of life and symptoms are needed.

Unmet clinical needs in chronic spontaneous urticaria. A GA²LEN task force report

Chronic spontaneous urticaria, formerly also known as chronic idiopathic urticaria and chronic urticaria (CU), is more common than previously thought. At any time, 0.5-1% of the population suffers from the disease (point prevalence). Although all age groups can be affected, the peak incidence is seen between 20 and 40 years of age. The duration of the disease is generally 1-5 years but is likely to be longer in more severe cases, cases with concurrent angioedema, in combination with physical urticaria or with a positive autologous serum skin test (autoreactivity). Chronic spontaneous urticaria has major detrimental effects on quality of life, with sleep deprivation and psychiatric comorbidity being frequent. It also has a large impact on society in terms of direct and indirect health care costs as well as reduced performance at work and in private life. In the majority of patients, an underlying cause cannot be identified making a causal and/or curative treatment difficult. Nonsedating H₁-antihistamines are the mainstay of symptomatic therapy, but treatment with licensed doses relieves symptoms effectively in < 50% of patients. Although guideline-recommended updosing up to fourfold increases symptom control in many patients, a substantial number of patients have only little benefit from H₁ -antihistamines. Consequently, there is a great need for new therapeutic strategies.

[Chronic urticaria. Prevalence, course, prognostic factors and impact]

Chronic urticaria (CU) is one of the most frequent diseases in the field of dermatology. Recent studies have shown a point prevalence between 0.5 and 1% in the total population with a predominance of females. In general, all age groups and all classes of the population can be affected. An incidence peak has been found in the third and fourth decades. According to the current guidelines, CU is characterized by the spontaneous occurrence of wheals and/or angioedema for more than 6 weeks. However, epidemiological studies have revealed that the majority of patients suffer for several months, or frequently years. Disease duration is likely to be longer in case of angioedema, a combination with physical urticaria, positivity in the autologous serum skin test (autoreactivity) and a high disease severity. Studies on the impairment of quality of life have been shown that many CU patients suffer as strong from their disease as patients with coronary artery disease. Apart from pure physical symptoms, patients experience restrictions in daily life activities and social life. In addition, sleep disturbances are common and CU patients frequently exhibit psychiatric comorbidities. To avoid frustration in care, it is important to perceive all different dimensions of CU that impact the patient's life and to take the patients and their disease seriously. The aim of therapy should be to obtain total symptom control.

Current concepts in psychodermatology

Dermatology is a discipline in which psychosomatic issues serve a key purpose in helping us understand the etiology and progression of skin diseases and determining appropriate treatment protocols. Emotional factors appear to significantly influence most skin diseases, and the correlation between stressful life events and disease flares is well recognized in dermatology. In this article, recent research is highlighted for major cutaneous disease states, as well as psychiatric disorders with symptoms that present as skin disorders. The role of the expanding field of psychoneuroimmunology as it pertains to dermatologic disorders is discussed. The author also presents recommendations for optimal evaluation and management of psychosocial concerns in the dermatology patient population.