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Magen E, Merzon E, Green I, Magen I, Golan-Cohen A, Vinker S, Israel A. Acute urticaria and cardiovascular diseases. Am J Med Sci 2024:S0002-9629(24)01397-1. [PMID: 39127421 DOI: 10.1016/j.amjms.2024.08.004] [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: 08/19/2023] [Revised: 07/28/2024] [Accepted: 08/06/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Acute urticaria (AU), characterized by sudden skin wheals, has been associated with various triggers. While chronic urticaria's cardiovascular comorbidities have been studied, AU's associations remain largely unexplored. OBJECTIVE This study aimed to identify prevalent cardiovascular comorbidities in AU patients and assess their clinical significance. METHODS A retrospective cohort study used data from Leumit Health Services, matching AU patients with controls. Demographic, clinical, and laboratory data were analyzed. Statistical analyses included Fisher's Exact Test and Mann-Whitney U test. RESULTS The AU group (72,851 individuals) showed no sex/ethnic distribution differences from controls (291,404 individuals). Systolic blood pressure, weight, BMI, glucose, hemoglobin A1c, C-reactive protein, eosinophil counts, total IgE levels were higher in AU (p < 0.001). Several cardiovascular comorbidities showed significant associations with AU, including valvular heart diseases (aortic regurgitation, mitral regurgitation, and pulmonary valve stenosis), cardiac arrhythmias (atrial fibrillation and others), deep vein thrombosis, diseases of capillaries, peripheral artery disease, cerebrovascular disease, coronary artery disease, and inflammatory heart diseases (pericarditis, heart failure, and hypertension) (p < 0.05). Medications, including antihistamines and glucocorticoids, were more prevalent in the AU group (p < 0.001). CONCLUSION This study's findings underscore the importance of recognizing cardiovascular comorbidities in AU patients and considering their implications for management. The observed associations provide insight into potential shared mechanisms between AU and cardiovascular diseases, though further research is needed to validate and expand upon these findings.
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Affiliation(s)
- Eli Magen
- Leumit Health Services, Tel Aviv-Yafo 6473817, Israel; Medicine A Department, Assuta Ashdod University Hospital Faculty of Health Sciences, Ben-Gurion University, 8410501, Beer-Sheba, Israel.
| | - Eugene Merzon
- Leumit Health Services, Tel Aviv-Yafo 6473817, Israel; Adelson School of Medicine, Ariel University, Ariel 4070000, Israel
| | - Ilan Green
- Leumit Health Services, Tel Aviv-Yafo 6473817, Israel; Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo 6997801
| | - Israel Magen
- Medicine A Department, Assuta Ashdod University Hospital Faculty of Health Sciences, Ben-Gurion University, 8410501, Beer-Sheba, Israel
| | - Avivit Golan-Cohen
- Leumit Health Services, Tel Aviv-Yafo 6473817, Israel; Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo 6997801
| | - Shlomo Vinker
- Leumit Health Services, Tel Aviv-Yafo 6473817, Israel; Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo 6997801
| | - Ariel Israel
- Leumit Health Services, Tel Aviv-Yafo 6473817, Israel; Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo 6997801
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MAGEN E, MERZON E, GREEN I, VINKER S, ISRAEL A. Dermatological Comorbidities in Patients with Acute Urticaria. Acta Derm Venereol 2024; 104:adv18399. [PMID: 38528331 PMCID: PMC10985916 DOI: 10.2340/actadv.v104.18399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/03/2023] [Indexed: 03/27/2024] Open
Abstract
Abstract is missing (Short communication)
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Affiliation(s)
- Eli MAGEN
- Leumit Health Services, Tel Aviv-Yafo
- Medicine A Department, Assuta Ashdod University Hospital Faculty of Health Sciences, Ben-Gurion University, 8410501 Beer-Sheba
| | - Eugene MERZON
- Leumit Health Services, Tel Aviv-Yafo
- Adelson School of Medicine, Ariel University, Ariel
| | - Ilan GREEN
- Leumit Health Services, Tel Aviv-Yafo
- Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel. E-mail:
| | - Shlomo VINKER
- Leumit Health Services, Tel Aviv-Yafo
- Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel. E-mail:
| | - Ariel ISRAEL
- Leumit Health Services, Tel Aviv-Yafo
- Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel. E-mail:
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Badloe FMS, Grosber M, Ring J, Kortekaas Krohn I, Gutermuth J. Treatment of acute urticaria: A systematic review. J Eur Acad Dermatol Venereol 2024. [PMID: 38420865 DOI: 10.1111/jdv.19904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/19/2024] [Indexed: 03/02/2024]
Abstract
There are only a few clinical trials which address the treatment of acute urticaria (AU). Especially, the added value of systemic corticosteroids to antihistamines is unclear in treatment of severe AU. To review the existing evidence-based approaches for AU treatment. A systematic electronic search was done in PubMed and Web of Science to retrieve all studies on the treatment of patients with AU. A descriptive synthesis was conducted based on the PRISMA statement. Quality assessment was independently performed by both reviewers ('Cochrane risk-of-bias tool' for RCTs). Ten randomized controlled trials (RCTs) (n = 857 participants) were included. Four studies assessed corticosteroid effectiveness added to antihistamines and six studies compared the efficacy of H1 and/ or H2 -antihistamines. The addition of corticosteroid (prednisone) to an antihistamine (levo)cetirizine did not improve symptoms of AU compared to antihistamine alone in two out of three RCTs. The combination of diphenhydramine (50 mg, IV) and ranitidine (50 mg, IV) or cimetidine (300 mg, IV) was most efficient for relief of urticaria in two out of five studies. Most frequent adverse effects were sedation and drowsiness. Recent guidelines on urticaria treatment mainly focus on chronic urticaria rather than on AU. Moreover, only few, small RCTs provide evidence for the management of AU. Thus, the state-of-the-art management of this frequent condition remains unclear. The addition of corticosteroids to an antihistamine as treatment for AU needs to be further investigated. Well-designed, high-quality interventional trials are needed to establish evidence-based treatment guidelines for AU.
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Affiliation(s)
- Fariza M S Badloe
- SKIN Research Group, Vrije Univeristeit Brussel (VUB), Brussels, Belgium
- Department of Dermatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Martine Grosber
- SKIN Research Group, Vrije Univeristeit Brussel (VUB), Brussels, Belgium
| | - Johannes Ring
- Department of Dermatology and Allergology Biederstein, Technical University Munich, München, Germany
| | - Inge Kortekaas Krohn
- SKIN Research Group, Vrije Univeristeit Brussel (VUB), Brussels, Belgium
- Department of Dermatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Jan Gutermuth
- SKIN Research Group, Vrije Univeristeit Brussel (VUB), Brussels, Belgium
- Department of Dermatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
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Yang M, Su Y, Xu K, Wen P, Zhang B, Guo J, Nan K, Yang P, Shao X, Liu L, Yang Z, Xu P. Common autoimmune diseases and urticaria: the causal relationship from a bidirectional two-sample mendelian randomization study. Front Immunol 2023; 14:1280135. [PMID: 38022623 PMCID: PMC10652397 DOI: 10.3389/fimmu.2023.1280135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Objective The immune response assumes a pivotal role in the underlying mechanisms of urticaria pathogenesis. The present study delves into an investigation of the genetic causal connections between urticaria and prevalent autoimmune afflictions, notably rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), ulcerative colitis (UC), and Crohn's disease (CD). Methods A bidirectional two-sample Mendelian randomization (MR) analysis was conducted to investigate the causal relationships involving four autoimmune diseases and urticaria. The genome-wide association study (GWAS) summary data of four autoimmune disease were sourced from the IEU OpenGWAS database. The GWAS summary data for urticaria were derived from the Finnish consortium dataset. The principal analytical approach employed in this study was the random-effects inverse variance weighted (IVW) method. Subsequently, a series of sensitivity analyses were performed, encompassing assessments of heterogeneity, horizontal pleiotropy, outliers, "Leave-one-out" analyses, and tests for adherence to the assumption of normal distribution. Results The random-effects IVW analysis indicate a positive genetic causal association between RA and urticaria (P < 0.001, OR 95% CI = 1.091 [1.051-1.133]). Conversely, SLE, UC, and CD do not exhibit a significant genetic causal relationship with urticaria. The reverse MR analysis reveals a positive genetic causal linkage between urticaria and SLE (P = 0.026, OR 95% CI = 1.289 [1.031-1.612]). However, the analysis demonstrates no substantial genetic causal relationship between urticaria and RA, UC, or CD. Importantly, the genetic causal assessment absence of heterogeneity, horizontal pleiotropy, and outliers. Furthermore, it remains unaffected by any individual single nucleotide polymorphism (SNP), demonstrating adherence to a normal distribution. Conclusion This investigation establishing RA as a predisposing factor for urticaria. Moreover, urticaria as a plausible risk determinant for SLE. Heightened vigilance is recommended among RA patients to monitor the manifestation of urticaria within clinical settings. Similarly, individuals afflicted by urticaria should duly acknowledge the prospective susceptibility to SLE.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Peng Xu
- Department of Joint Surgery, HongHui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
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Wang Z, Xiao Y, Wang M, Chen Q, Lin Y, Fang X, Wang W. Acupuncture as a therapeutic intervention for post-COVID-19 vaccination urticaria: a systematic review and meta-analysis protocol. BMJ Open 2023; 13:e073914. [PMID: 37802610 PMCID: PMC10565136 DOI: 10.1136/bmjopen-2023-073914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic persisted for over 3 years since its onset in December 2019, posing an ongoing global threat to human health. In the absence of specific antiviral medications for COVID-19, vaccination has emerged as a popular preventive measure adopted by the general public. However, an undesirable consequence of COVID-19 vaccination has been the frequent incidence of urticaria, a type of adverse skin manifestations. Despite the prevalence of this issue, there is currently a lack of clinical evidence exploring the potential utility of acupuncture as a therapeutic approach to managing urticaria arising after COVID-19 vaccination. To address this knowledge gap, this study aims to comprehensively evaluate the effectiveness and safety of acupuncture as a therapeutic intervention for treating urticaria in the general population following COVID-19 vaccination. METHODS AND ANALYSIS The retrieval strategies employed in this study involve obtaining all relevant articles published from December 2019 to October 2023. These articles will be obtained from databases including PubMed, EMBASE, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (SinoMed), VIP database and the WanFang database. Subsequently, the collected articles will undergo a thorough screening process based on predefined inclusion and exclusion criteria. Additionally, study quality will be evaluated using the Cochrane risk bias assessment tool. To conduct the meta-analysis, we will employ the Review Manager software (RevMan V.5.3). Finally, the study findings will be evaluated for their level of evidence. ETHICS AND DISSEMINATION As this is a secondary review of published clinical data, this study does not involve direct contact with human subjects, and therefore, ethical approval and consent are not required. The findings of the study will be disseminated through a peer-reviewed journal, ensuring that the results undergo rigorous evaluation by experts in the field. PROSPERO REGISTRATION NUMBER CRD42022377343.
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Affiliation(s)
- Zixia Wang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yao Xiao
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Muyao Wang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiqi Chen
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yueqi Lin
- The Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinyue Fang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenhui Wang
- Department of Preventive Medicine, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
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Kocatürk E, Muñoz M, Elieh-Ali-Komi D, Criado PR, Peter J, Kolkhir P, Can P, Wedi B, Rudenko M, Gotua M, Ensina LF, Grattan C, Maurer M. How Infection and Vaccination Are Linked to Acute and Chronic Urticaria: A Special Focus on COVID-19. Viruses 2023; 15:1585. [PMID: 37515272 PMCID: PMC10386070 DOI: 10.3390/v15071585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Since more than a century ago, there has been awareness of the connection between viral infections and the onset and exacerbation of urticaria. Our knowledge about the role of viral infection and vaccination in acute and chronic urticaria improved as a result of the COVID-19 pandemic but it has also highlighted knowledge gaps. Viral infections, especially respiratory tract infections like COVID-19, can trigger the onset of acute urticaria (AU) and the exacerbation of chronic urticaria (CU). Less frequently, vaccination against viruses including SARS-CoV-2 can also lead to new onset urticaria as well as worsening of CU in minority. Here, with a particular focus on COVID-19, we review what is known about the role of viral infections and vaccinations as triggers and causes of acute and chronic urticaria. We also discuss possible mechanistic pathways and outline the unmet needs in our knowledge. Although the underlying mechanisms are not clearly understood, it is believed that viral signals, medications, and stress can activate skin mast cells (MCs). Further studies are needed to fully understand the relevance of viral infections and vaccinations in acute and chronic urticaria and to better clarify causal pathways.
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Affiliation(s)
- Emek Kocatürk
- Institute of Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 12203 Berlin, Germany (D.E.-A.-K.)
- Department of Dermatology, Koç University School of Medicine, Istanbul 34010, Turkey
| | - Melba Muñoz
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 12203 Berlin, Germany (D.E.-A.-K.)
- Department of Dermatology, Koç University School of Medicine, Istanbul 34010, Turkey
| | - Daniel Elieh-Ali-Komi
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 12203 Berlin, Germany (D.E.-A.-K.)
- Department of Dermatology, Koç University School of Medicine, Istanbul 34010, Turkey
| | - Paulo Ricardo Criado
- Department of Dermatology, School of Medicine, Centro Universitário Faculdade de Medicina do ABC (CUFMABC), Santo André 09060-870, Brazil
| | - Jonny Peter
- Lung Institute, Division of Allergy and Clinical Immunology, Groote Schuur Hospital, University of Cape Town, Cape Town 7925, South Africa
| | - Pavel Kolkhir
- Institute of Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 12203 Berlin, Germany (D.E.-A.-K.)
| | - Pelin Can
- Department of Dermatology, Bahçeşehir University, Istanbul 34070, Turkey;
| | - Bettina Wedi
- Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, 30625 Hannover, Germany
| | | | - Maia Gotua
- Center of Allergy and Immunology, David Tvildiani Medical University, Tbilisi 0159, Georgia
| | - Luis Felipe Ensina
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo 01308-000, Brazil
| | - Clive Grattan
- Guy’s Hospital, St John’s Institute of Dermatology, London SE1 7EP, UK
| | - Marcus Maurer
- Institute of Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 12203 Berlin, Germany (D.E.-A.-K.)
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da Costa Farinha IF, Pereira HSPA, de Lemos SCG, de Faria EMAG, Rodrigues FMP. Hospital admissions for urticaria in a pediatric emergency department of a tertiary care hospital. Allergol Immunopathol (Madr) 2023; 51:117-123. [PMID: 37169569 DOI: 10.15586/aei.v51i3.820] [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: 01/02/2023] [Accepted: 03/02/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Urticaria is a common disorder, estimated to affect 2.1 to 6.7% of children and adolescents, and is a frequent cause of emergency department (ED) admissions. METHODS The aim of this study was to retrospectively characterize the clinical features of children and adolescents with a diagnosis of urticaria, evaluated in a tertiary care pediatric ED between 2015 and 2019. Statistical analysis was performed using IBM SPSS Statistics®, version 27.0. RESULTS A total of 2254 episodes of urticaria were counted with 98.1% corresponding to acute urticaria (AU). A suspected trigger factor was identified in 51.6% of the episodes, namely infections (27.8%), drugs (9.9%) and food (7.6%). From these episodes, excluding infections, only 59.2% were referred to an Allergy Consultation for further study, with only 18.8% (drug) and 28.3% (food) confirmed as the AU trigger. Of the 43 episodes of chronic urticaria (CU), 79% were referred to consultation, with 23 being diagnosed with chronic spontaneous urticaria, 8 with inducible urticaria and 3 with both entities. Older age (p < 0.001), personal history of atopy (p = 0.019) and angioedema (p = 0.003) were factors associated with CU, while the presence of other accompanying symptoms (p = 0.007) was associated with AU. Older age (OR = 1.2; p < 0.001) and the presence of angioedema (OR = 2.7; p = 0.007) were identified as independent factors for CU. CONCLUSION The majority of episodes corresponded to AU. Infections were the main suspected trigger, followed by drugs and food, with an overall confirmation rate ranging from 18 to 30%, highlighting the importance of an allergologic follow-up evaluation.
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Affiliation(s)
| | | | | | | | - Fernanda Maria Pereira Rodrigues
- Emergency Service and Infeciology Unit, Pediatric Hospital, Coimbra Hospital and University Center, Coimbra, Portugal
- University Clinic of Pediatrics, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
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Etiological causes in patients with acute urticaria and angioedema: A cross-sectional study. Allergol Immunopathol (Madr) 2022; 50:15-23. [PMID: 36562173 DOI: 10.15586/aei.v50isp2.784] [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: 10/05/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Acute urticaria and angioedema are emergency dermatological conditions associated with various etiologic factors. OBJECTIVE To determine the etiological causes in patients with acute urticaria and angioedema, and to investigate whether more than one etiological cause was present, along with the patients' laboratory values. METHODS The study was conducted in a tertiary hospital with one center. Etiological causes and laboratory parameters in 284 patients diagnosed with acute urticaria and angioedema were retrospectively studied. RESULTS A total of 284 patients were included in the study. The mean age of the patients was 42.7 ± 15.6 years, where 163 (57.4%) were women and 121 (42.6%) were men. Acute urticaria and angioedema occurred together in 149 (52.5%) patients. At least one precipitating factor among the predisposing risk factors was present in 220 (77.5%) patients, and more than one precipitating factor was found in 51 (18%) patients. Medication use was found in 157 (55.3%) patients and infection in 54 (19%). The development of urticaria after food consumption was noted in nine (3.2%) individuals. A history of infection and medication intake was present in 50 (17.6%) patients. A joint history of food consumption and medication intake was present in only one patient. Elevated C-reactive protein level was found in 178 (62.7%) patients and elevated anti-streptolysin O titer in 41 (14.4%) patients. Vitamin B12 deficiency was found in 116 (40.8%) patients and vitamin D deficiency in 254 (89.4%). CONCLUSION Acute urticaria and angioedema may occur as a result of multiple etiological factors, in which different triggers may be present simultaneously.
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Huong NTC, Ngan NT, Reda A, Dong V, Tam DTH, The Van T, Manh DH, Quan NH, Makram AM, Dumre SP, Hirayama K, Huy NT. Association of self-reported allergic rhinitis with dengue severity: A case-control study. Acta Trop 2022; 236:106678. [PMID: 36063904 DOI: 10.1016/j.actatropica.2022.106678] [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: 08/03/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The severity of dengue infection has been reportedly associated with patients' allergic reactions. To further elucidate the role of allergy in dengue severity, we conducted a matched case-control study to assess the association between allergic background and dengue shock syndrome. METHODS This is a matched case-control study that was carried out in the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam from January to December 2017. Dengue infection was determined by non-structure protein 1 (NS1) diagnostic quick test or anti-dengue antibodies (IgM). The total and dengue-specific IgE levels were measured using ELISA. Patients' demographics, clinical, and allergic profiles were collected using a structured questionnaire. RESULTS A total of 572 dengue patients with positive NS1 (92.7%) or IgM antibodies (7.3%) results were included in this study. Of these patients, 143 patients developed dengue shock syndrome (case group) while the other 429 patients did not (control group). None of the baseline characteristics including age, sex, or being overweight was significantly different between the two groups (p>0.05). In multivariable analysis, having a history of dengue infection (OR=3.35, 95% CI: 1.8-6.17, p<0.001) and allergic rhinitis (OR=1.95, 95% CI: 1.11-3.4, p = 0.019) were found to be associated with dengue shock syndrome. Higher levels of dengue-specific IgE were not associated with worse outcomes in patients with allergies (p = 0.204) or allergic rhinitis (p = 0.284). CONCLUSION Dengue patients presenting with a history of a previous dengue infection or allergic rhinitis should be considered high-risk patients for the development of dengue shock syndrome.
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Affiliation(s)
- Nguyen Thi Cam Huong
- Department of Infectious Diseases, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh city, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Thi Ngan
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Medicine Department, Xuyen A General Hospital, Vinh Long Province, Vietnam
| | - Abdullah Reda
- Online Research Club (http://www.onlineresearchclub.org), Nagasaki, Japan; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Vinh Dong
- Online Research Club (http://www.onlineresearchclub.org), Nagasaki, Japan; American University of the Caribbean School of Medicine, Cupecoy, Sint Maarten
| | - Dong Thi Hoai Tam
- Department of Infectious Diseases, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh city, Vietnam; Oxford University Clinical Research Unit, Wellcome Trust Asia Programme, Ho Chi Minh City, Vietnam
| | - Trung The Van
- Department of Dermatology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh city, Vietnam
| | - Dao Huy Manh
- Microbiology and Immunology Department, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Hoang Quan
- Microbiology and Immunology Department, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Abdelrahman M Makram
- Online Research Club (http://www.onlineresearchclub.org), Nagasaki, Japan; School of Public Health, Imperial College London, London, United Kingdom; Faculty of Medicine, October 6 University, Giza, Egypt
| | | | - Kenji Hirayama
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Nguyen Tien Huy
- Online Research Club (http://www.onlineresearchclub.org), Nagasaki, Japan; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, 852-8523, Japan.
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Abstract
Annular urticarial configurations are often associated with acute and chronic urticaria. Such lesions may be short-lived, migratory, transient, pruritic, and resolving with no residual evidence, making the diagnosis of urticaria an obvious one. Annular urticarial lesions can be the presenting signs of various cutaneous and systemic diseases. The differentiation of urticarial lesions may be made by considering the duration of an individual lesion longer than 24 hours, with burning and pain sensation in the lesions or lack of pruritus; skin marks such as postinflammatory pigmentation or purpura after resolution of the lesions; associated scaling or vehiculation in the lesions; systemic symptoms such as arthralgia, fever or fatigue; and several abnormal laboratory findings. The main differential diagnoses of annular urticarial lesions include urticarial vasculitis, autoinflammatory syndromes, hypersensitivity reactions, and connective tissue diseases.
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Urticaria aguda de aparición retardada tras tercera vacuna contra SARS-CoV-2. Semergen 2022; 48:437-438. [PMID: 35527184 PMCID: PMC8938178 DOI: 10.1016/j.semerg.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/14/2022] [Accepted: 03/03/2022] [Indexed: 11/23/2022]
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Techasatian L, Phungoen P, Chaiyarit J, Uppala R. Etiological and predictive factors of pediatric urticaria in an emergency context. BMC Pediatr 2021; 21:92. [PMID: 33607972 PMCID: PMC7892759 DOI: 10.1186/s12887-021-02553-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/09/2021] [Indexed: 01/03/2023] Open
Abstract
Background Urticaria is common in pediatric population and is caused by various etiologies which usually differ among different age groups. The different etiologies require different management strategies. Thus, understanding detailed of the etiologies of urticaria in children would help pediatricians to perform appropriate initial treatment. Methods A cross-sectional epidemiological study of all patients aged under 18-year-old with the diagnosis of urticaria from any causes entered in the emergency department during January 1st, 2016 to December 31st, 2019 by collecting the data from the Health Object Program®, an authorized electronic medical records program, at the Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. Results There were total of 515 urticaria patients aged under 18 years old at the emergency department. The ages of patients ranged from 8 months to 18 years with a median age of 7 years (IQR 3.17–12.08). The majority of the patients were in the preschool-aged group (40.97%), followed by the school-aged (28.16%), adolescent (22.14%), and infant (8.74%). Six major etiologic categories were identified in the present study. The most common cause of urticaria was infection (51.26%), followed by idiopathic urticaria (34.37%), inhalants (6.99%), drugs (4.08%), foods (2.52%), and insect stings (0.78%). Conclusions Having underlying allergic diseases had a strong association with all identified causes of urticaria in the study population, of which, food and inhalation etiologies had a significant difference when compared to the other identified causes. The present study has found that infection was the most common cause of acute urticaria in children. This etiology (infection-induced urticaria) usually presents concurrent with fever, however, non-febrile symptoms were also presented. Therefore, in the pediatric population, pediatricians should always look for infection as the cause of urticaria even in patients without pyrexia.
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Affiliation(s)
- Leelawadee Techasatian
- Dermatology Division, Pediatric Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Pariwat Phungoen
- Emergency Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Jitjira Chaiyarit
- Department of Statistics, Faculty of Science, Khon Kaen University, Khon Kaen, Thailand
| | - Rattapon Uppala
- Critical care and Pulmonology Division, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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Sim DW, Yu JE, Park SY, Koh YI. The first case of tegoprazan-induced urticaria. J Clin Pharm Ther 2020; 45:1187-1189. [PMID: 32598503 DOI: 10.1111/jcpt.13150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/14/2020] [Accepted: 04/06/2020] [Indexed: 11/26/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Tegoprazan induces adverse drug reactions during clinical trials; however, tegoprazan-induced urticaria has not been reported. Here, we describe the first case of this. CASE DESCRIPTION A 55-year-old woman presented with acute urticaria with pruritus after taking the gastro-oesophageal reflux disease medication, tegoprazan. Urticaria disappeared after tegoprazan discontinuation. In an oral provocation test, after taking 10% of tegoprazan, she developed pruritus, and after taking 30%, she developed urticaria on her back. WHAT IS NEW AND CONCLUSION This is the first case of urticaria induced by tegoprazan. Physicians should understand the possibility of a tegoprazan-induced hypersensitivity reactions.
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Affiliation(s)
- Da Woon Sim
- Division of Allergy, Asthma, and Clinical Immunology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Ji Eun Yu
- Division of Allergy, Asthma, and Clinical Immunology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sun-Young Park
- Division of Allergy, Asthma, and Clinical Immunology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Young-Il Koh
- Division of Allergy, Asthma, and Clinical Immunology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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14
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Palungwachira P, Vilaisri K, Musikatavorn K, Wongpiyabovorn J. A randomized controlled trial of adding intravenous corticosteroids to H1 antihistamines in patients with acute urticaria. Am J Emerg Med 2020; 42:192-197. [PMID: 32139204 DOI: 10.1016/j.ajem.2020.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/12/2020] [Accepted: 02/16/2020] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Acute urticaria is a common dermatological condition in emergency departments (EDs). The main therapy involves controlling pruritus with antihistamines. Although guidelines have promoted the use of corticosteroids in addition to H1 antihistamines, well-designed clinical trials evaluating this approach are scarce. METHODS Adult ED patients with acute urticaria and a pruritus score > 5 on a visual analog scale (VAS) were randomized into three groups: (i) IV chlorpheniramine (CPM) treatment, (ii) IV CPM and IV dexamethasone (CPM/Dex) and (iii) IV CPM and IV dexamethasone with oral prednisolone as discharge medication for 5 days (CPM/Dex/Pred). The primary outcomes were self-reported pruritus VAS scores at 60 min after treatment. We also evaluated 1-week and 1-month urticaria activity scores for 7 days and adverse events. RESULTS Seventy-five patients (25 per group) were enrolled. The VAS scores of all groups decreased, but no significant difference was found in the VAS scores at 60 min after treatment between patients in the CPM group (n = 25) and those who received both CPM and dexamethasone (n = 50). At the 1-week and 1-month follow-ups, active urticaria (indicated by the urticaria activity score at 7 days) was more prevalent in the CPM/Dex/Pred group (n = 25) than in the control group. CONCLUSIONS The present study did not find evidence that adding IV dexamethasone improves the treatment of severe pruritus from uncomplicated acute urticaria. Oral corticosteroid therapy may be associated with persistent urticaria activity. Due to the lack of clinical benefits and the potential for side effects, using corticosteroids as an adjunctive treatment is discouraged.
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Affiliation(s)
- Pakhawadee Palungwachira
- Department of Emergency Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand.
| | - Ketsara Vilaisri
- Department of Emergency Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Khrongwong Musikatavorn
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand.
| | - Jongkonnee Wongpiyabovorn
- Immunology Unit, Department of Microbiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand.
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15
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Antia C, Baquerizo K, Korman A, Alikhan A, Bernstein JA. Urticaria: A comprehensive review: Treatment of chronic urticaria, special populations, and disease outcomes. J Am Acad Dermatol 2019; 79:617-633. [PMID: 30241624 DOI: 10.1016/j.jaad.2018.01.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Second-generation antihistamines are considered first-line agents in the treatment of chronic urticaria because of their safety and efficacy profile. Some patients require higher doses of H1 antihistamines alone or in combination with other classes of medications, including H2 antihistamines, leukotriene receptor antagonists, or first-generation H1 antihistamines. One major therapeutic advance has been omalizumab, a humanized monoclonal anti-immunoglobulin E that was recently approved by the US Food and Drug Administration for the treatment of chronic urticaria that is unresponsive to H1 antagonists. In addition, the second article in this continuing medical education series outlines several evidence-based alternative treatments for urticaria and the differences in recommendations between 2 major consensus groups (the European Academy of Allergy and Clinical Immunology/World Allergy Organization and the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force).
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Affiliation(s)
- Camila Antia
- Department of Dermatology, University of Cincinnati, Cincinnati, Ohio.
| | | | - Abraham Korman
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Ali Alikhan
- Department of Dermatology, University of Cincinnati, Cincinnati, Ohio
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Barniol C, Dehours E, Mallet J, Houze-Cerfon CH, Lauque D, Charpentier S. Levocetirizine and Prednisone Are Not Superior to Levocetirizine Alone for the Treatment of Acute Urticaria: A Randomized Double-Blind Clinical Trial. Ann Emerg Med 2017; 71:125-131.e1. [PMID: 28476259 DOI: 10.1016/j.annemergmed.2017.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 02/26/2017] [Accepted: 03/01/2017] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVE We evaluate the efficacy of a 4-day course of prednisone added to antihistamine for the management of acute urticaria in an emergency department (ED). METHODS In this double-blind randomized clinical trial, patients were eligible for inclusion if aged 18 years or older and with acute urticaria of no more than 24 hours' duration. Patients with anaphylaxis or who had received antihistamines or glucocorticoids during the previous 5 days were not included. In addition to levocetirizine (5 mg orally for 5 days), patients were assigned to receive prednisone (40 mg orally for 4 days) or placebo. The primary endpoint of the study was itching relief 2 days after the ED visit, rated on a numeric scale of 0 to 10. Secondary endpoints were rash resolution, relapses, and adverse events. RESULTS A total of 100 patients were included, 50 in each group. Seven patients in the prednisone group and 8 in the placebo group discontinued treatment. At 2-day follow-up, 62% of patients in the prednisone group had an itch score of 0 versus 76% of those in the placebo group (Δ 14%; 95% confidence interval -31% to 4%). Thirty percent of patients in the prednisone group and 24% in the placebo group reported relapses (Δ 6%; 95% confidence interval -23% to 11%). Mild adverse events were reported by 12% of patients in the prednisone group and 14% in the placebo group. CONCLUSION The addition of a prednisone burst did not improve the symptomatic and clinical response of acute urticaria to levocetirizine. This study does not support the addition of corticosteroid to H1 antihistamine as first-line treatment of acute urticaria without angioedema.
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Affiliation(s)
- Caroline Barniol
- Pôle de Médecine d'Urgences, Centre Hospitalier Universitaire, Toulouse, France
| | - Emilie Dehours
- Pôle de Médecine d'Urgences, Centre Hospitalier Universitaire, Toulouse, France
| | - Jean Mallet
- Pôle de Médecine d'Urgences, Centre Hospitalier Universitaire, Toulouse, France
| | | | - Dominique Lauque
- Pôle de Médecine d'Urgences, Centre Hospitalier Universitaire, Toulouse, France; Université Paul Sabatier Toulouse III, Toulouse, France.
| | - Sandrine Charpentier
- Pôle de Médecine d'Urgences, Centre Hospitalier Universitaire, Toulouse, France; Université Paul Sabatier Toulouse III, Toulouse, France; INSERM UMR 1027 Equipe 5, Toulouse, France
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17
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Abstract
Urticaria is a common symptom seen in pediatric patients, and it has multiple allergic and nonallergic causes. Unfortunately, it is far too common that when children present acutely for urticaria, they are told that it is an "allergy." This statement often leads to increased anxiety while the patient waits to be evaluated by an allergist/immunologist. This article discusses the frequency that allergic reactions are involved in urticaria and provides examples of potential nonallergic causes. Additionally, the article discusses approaches to treatment that may be appropriate to initiate in the pediatrician's office or acute setting. This article is intended to provide a broader understanding of urticaria and its management in the outpatient or emergency setting so that we are able to tell our patients more than"you're probably just allergic to something." [Pediatr Ann. 2016;45(11):e399-e402.].
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18
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Huang H, Hohler AD. The Dermatological Manifestations of Postural Tachycardia Syndrome: A Review with Illustrated Cases. Am J Clin Dermatol 2015; 16:425-30. [PMID: 26242228 DOI: 10.1007/s40257-015-0144-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Postural tachycardia syndrome (POTS) is a syndrome of excessive tachycardia with orthostatic challenge, and relief of such symptoms with recumbence. There are several proposed subtypes of the syndrome, each with unique pathophysiology. Numerous symptoms such as excessive tachycardia, lightheadedness, blurry vision, weakness, fatigue, palpitations, chest pain, and tremulousness are associated with orthostatic intolerance. Other co-morbid conditions associated with POTS are not clearly attributable to orthostatic intolerance. These include chronic headache, fibromyalgia, functional gastrointestinal or bladder disorders, cognitive impairment, and sleep disturbances. Dermatological manifestations of POTS are also common and wide ranging, from livedo reticularis to Raynaud's phenomenon, from cutaneous flushing to erythromelalgia. Here, we provide three illustrative cases of POTS with dermatological manifestations. We discuss the potential pathophysiology underlying such dermatological manifestations, and how such mechanisms could in turn help guide development of management.
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Affiliation(s)
- Hao Huang
- Department of Neurology, Boston University Medical Campus, 72 East Concord St, A-302, Boston, MA, 02118, USA.
| | - Anna DePold Hohler
- Department of Neurology, Boston University Medical Campus, 72 East Concord St, A-302, Boston, MA, 02118, USA
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19
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Hyle EP, Alame D. Case records of the Massachusetts General Hospital. Case 13-2015. A 27-year-old woman with arthralgias and a rash. N Engl J Med 2015; 372:1657-64. [PMID: 25901430 DOI: 10.1056/nejmcpc1415172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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20
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Abstract
Anaphylaxis and urticaria are common presenting allergic complaints. Affecting up to 2% of the population, anaphylaxis is a serious, life-threatening allergic reaction. Although not life-threatening, urticaria is a rash of transient, erythematous, pruritic wheals that can be bothersome and affects up to 25% of the population. All cases of anaphylaxis warrant thorough clinical evaluation by the allergist-immunologist, although most cases of urticaria are self-limited and do not require specialist referral. This article offers an overview of our current knowledge on the epidemiology, pathogenesis, triggers, diagnosis, and treatment of anaphylaxis and urticaria.
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Affiliation(s)
- Kelli W Williams
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Hemant P Sharma
- Division of Allergy and Immunology, Children's National Medical Center, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA.
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21
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Neverman L, Weinberger M. Treatment of chronic urticaria in children with antihistamines and cyclosporine. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:434-8. [PMID: 25017532 DOI: 10.1016/j.jaip.2014.04.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 04/28/2014] [Accepted: 04/29/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Chronic idiopathic urticaria, daily hives that last >6 weeks, can be resistant to antihistamines, even when higher than conventional doses are used. Other pharmacologic agents have been associated with inconsistent benefit. OBJECTIVE We examined the relationship of clinical characteristics and the presence of autoimmune antibodies to antihistamine resistance in children. We further examined the efficacy and safety of cyclosporine in children whose urticaria was resistant to antihistamine. METHODS Patients referred to the pediatric allergy and pulmonary specialty clinic at the University of Iowa Children's Hospital and diagnosed as having chronic idiopathic urticaria were identified during the period from August 2008 to July 2013. A retrospective examination of treatment and outcome was performed. RESULTS Forty-six patients, 26 female patients and 20 male patients, with chronic idiopathic urticaria were identified. The ages of 16 patients who were antihistamine resistant ranged from 9 to 18 years (median, 12.5 years). Those patients who were antihistamine responsive had a median age of 6 years, significantly lower than those who were antihistamine resistant (P = .0001). There was no significant association between autoimmune antibodies and antihistamine resistance. All the patients who were antihistamine resistant were treated with cyclosporine; all experienced complete resolution of urticaria at times that ranged from 2 days to 3 months (median, 7 days). Relapses responsive to repeated cyclosporine occurred in 5 of the patients after 1 week to 15 months (median, 6 months). Adverse effects were not seen in these patients. CONCLUSION Our data were consistent with efficacy and safety of cyclosporine for chronic urticaria in children when even high doses of antihistamines are ineffective.
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Affiliation(s)
- Lisa Neverman
- Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa
| | - Miles Weinberger
- Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa.
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