1
|
Chae SY, Sung WS, Kim EJ, Park SS. The Effectiveness and Safety of Cupping Therapy on CV8 Shenque for Urticaria; a Protocol for Systematic Review and Meta-Analysis. J Pain Res 2023; 16:3971-3977. [PMID: 38026451 PMCID: PMC10674573 DOI: 10.2147/jpr.s435991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/17/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Urticaria is a common mast-cell-driven disease that poses a great burden on patients and society. Suggested therapeutic methods include avoidance of triggers and the use of medications, such as H1-antihistamines; however, limitations remain regarding efficacy, dealing with comorbidities, and adverse events. Cupping therapy (CT) at CV8 Shenque has been used in traditional Chinese medicine for the treatment of various dermatological diseases, including urticaria. The efficacy of the treatment has been revealed by previous clinical trials and case reports. This study was performed to provide a protocol for a systematic review and meta-analysis to analyze the effectiveness and safety of CT at CV8 Shenque for urticaria patients. Patients and Methods Searches of electronic databases using manual searches and contact with the corresponding authors will be performed using predefined criteria for all randomized controlled trials on CT at CV8 Shenque for urticaria patients. Every part of the process will be conducted by two independent researchers, with conflicts being solved by a third author. The primary outcomes will be symptom scores, quality of life, and effective rate. Secondary outcomes will be adverse events and diagnostic test results. RevMan 5.4 software will be used to perform the meta-analysis. The Cochrane Collaboration "Risk of bias" tool will be used for risk of bias judgments. Results Our study will evaluate the effectiveness and safety of CT at CV8 Shenque as a treatment option for urticaria. Conclusion This systematic review is the first to investigate the effect of CT at CV8 Shenque for urticaria patients. Our study will provide objective evidence of an alternative approach to urticaria for clinicians and patients. Study Registration PROSPERO (Registration number: CRD42023434913).
Collapse
Affiliation(s)
- Soo-Yeon Chae
- College of Korean Medicine, Dongguk University Graduate School, Seoul, Republic of Korea
| | - Won-Suk Sung
- Department of Acupuncture & Moxibustion, Dongguk University Bundang Oriental Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Eun-Jung Kim
- Department of Acupuncture & Moxibustion, Dongguk University Bundang Oriental Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Seong-Sik Park
- Department of Sasang Constitutional Medicine, Dongguk University Bundang Oriental Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| |
Collapse
|
2
|
A Meta-Analysis of Randomized Clinical Trials of Runzao Zhiyang Capsule in Chronic Urticaria. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1904598. [PMID: 36164403 PMCID: PMC9509263 DOI: 10.1155/2022/1904598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/11/2022] [Accepted: 08/26/2022] [Indexed: 11/18/2022]
Abstract
Chinese herbal medicine has many advantages in the treatment of chronic urticaria (CU). Herein, we evaluated the efficacy and safety of the Runzao Zhiyang (RZZY, Chinese patent herbal medicine capsule) capsule for CU through a meta-analysis of randomized clinical trials (RCTs). This meta-analysis included 17 RCTs involving 1,760 patients. RZZY capsule combined with conventional drugs showed a better clinical total effective rate (risk ratio (RR) = 1.20, 95% confidence interval (CI) (1.15, 1.24),
), significantly reduced the adverse reaction rate [RR = 0.68, 95% CI (0.50, 0.92),
] and recurrence rate [RR = 0.29, 95% CI (0.18, 0.46),
], and improved the life quality of patients (mean difference (MD) = −2.95, 95% CI (−4.32, −1.57),
). Meanwhile, the serum Interleukin-4 (IL-4) (MD = −13.83, 95% CI (−23.45, −4.20),
) and immunoglobulin E (IgE) (MD = −22.99, 95% CI (−31.48, −14.50),
) of patients in the intervention group decreased more significantly. In all, the RZZY capsule has potential therapeutic advantages and is relatively safe for CU. However, we are cautious about the conclusion, which needs to be further confirmed by more large samples, multicenter, and high-quality research in the later stage.
Collapse
|
3
|
Kaur S, Jabbal IS, Bhasin AK. Omalizumab as a treatment option for antihistamine-refractory aquagenic urticaria. BMJ Case Rep 2022; 15:e251057. [PMID: 35850790 PMCID: PMC9297225 DOI: 10.1136/bcr-2022-251057] [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] [Accepted: 07/05/2022] [Indexed: 11/03/2022] Open
Abstract
A teenage girl presented with symptoms of itching and hives on contact with water for 3 years. On specific provocative testing and ruling out underlying systemic conditions, she was diagnosed with aquagenic urticaria. Following failed attempts to control her symptoms with second-generation antihistamines, she was started on monthly subcutaneous injections of the monoclonal antibody, omalizumab. The patient demonstrated significant improvement, with symptoms being well-controlled for 2 years now. She enjoys a good quality of life and can take a shower without developing itching or hives.
Collapse
Affiliation(s)
- Sehajpreet Kaur
- Internal Medicine, AdventHealth, Sebring, Florida, USA
- Allergy, Mayo Clinic, Jacksonville, Florida, USA
| | | | | |
Collapse
|
4
|
Xie B, Chen Y, Hu Y, Zhao Y, Luo H, Xu J, Song X. Targets Exploration of Hydroxychloroquine for Pigmentation and Cell Protection Effect in Melanocytes: The Clue for Vitiligo Treatment. Drug Des Devel Ther 2022; 16:1011-1024. [PMID: 35411132 PMCID: PMC8994563 DOI: 10.2147/dddt.s350387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/19/2022] [Indexed: 12/13/2022] Open
Abstract
Objective The treatment of vitiligo is often challenging to dermatologists. There is ample evidence to suggest that hydroxychloroquine (HCQ) is effective for vitiligo treatment; nonetheless, the underlying mechanism remains unknown. In the present study, we sought to uncover the molecular targets of HCQ by an integrated network-based pharmacologic and transcriptomic approach. Methods The potential targets of HCQ were retrieved from databases based on the crystal structure. Targets related to vitiligo were screened and intersected with potential targets of HCQ. A protein-protein interaction network of the intersected targets was generated. Interactions between the targets were verified by molecular docking. Moreover, human vitiligo immortalized melanocytes (PIG3V) were evaluated after treatment with HCQ (1μg/mL) for 24h. The total RNA of PIG3V was extracted and determined by RNA-seq transcriptomics for differential gene expression analysis. Network pharmacology was then used to identify the relationships between putative targets of HCQ and differentially expressed genes. Results Molecular docking analysis revealed four putative key targets (ACHE, PNMT, MC1R, and VDR) of HCQ played important roles in vitiligo treatment. According to the transcriptomic results, the melanosomal biogenesis-related gene BLOC1S5 was upregulated 138005.020 fold after HCQ treatment. Genes related to protein repair (MSRB3) and anti-ultraviolet (UV) effect (UVSSA) were upregulated 4.253 and 2.603 fold, respectively, after HCQ treatment. Conclusion The expression of the BLOC1S5 gene is significantly upregulated, indicating upregulated melanosomal biogenesis after HCQ treatment. In addition, HCQ yields a protective effect on melanocytes by upregulating genes associated with damaged protein repair (MSRB3) and anti-UV effect (UVSSA). The protective effects of HCQ are mediated by binding to putative targets ACHE, PNMT, MC1R, and VDR according to network pharmacology and docking verification.
Collapse
Affiliation(s)
- Bo Xie
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
| | - Yi Chen
- Department of Dermatology, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, 310009, People's Republic of China
| | - Yebei Hu
- Department of Dermatology, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, 310009, People's Republic of China
| | - Yan Zhao
- Department of Dermatology, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, 310009, People's Republic of China
| | - Haixin Luo
- Department of Dermatology, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, 310009, People's Republic of China
| | - Jinhui Xu
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
| | - Xiuzu Song
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
| |
Collapse
|
5
|
Brock I, Eng N, Maitland A. Adult-onset mast cell activation syndrome following scombroid poisoning: a case report and review of the literature. J Med Case Rep 2021; 15:620. [PMID: 34920756 PMCID: PMC8684076 DOI: 10.1186/s13256-021-03190-w] [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] [Received: 04/11/2021] [Accepted: 11/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Mast cells are closely associated with epithelium, serving as sentinels responsible for the recognition of tissue injury and coordination of the initial inflammatory response. Upon detection of the injured cell content, mast cells then tailor the release of preformed and newly produced chemical mediators to the detected challenge, via an array of pathogen receptors. In addition to immunoglobulin E receptor-triggered mast cell activation, commonly referred to as allergic or atopic disorders, non-immunoglobulin E receptor mediated mast cell activation follows engagement of toll-like receptors, immunoglobulin G receptors, and complement receptors. Upon containment of the extrinsic challenge, acute inflammation is downregulated, and repair of the injured tissue ensues. The mast cell compartments must return to a baseline steady state to remain tolerant towards self-antigens and harmless entities, including environmental conditions, to prevent unnecessary immune activation and chronic hypersensitivity disorders. Over the past 50 years, an increasing number of patients are experiencing episodes of aberrant mast cell activation, not associated with allergen-specific mast cell disease or systemic mastocytosis. This led to proposed diagnostic criteria of mast cell activation syndrome. Mast cell activation syndrome is a heterogeneous disorder, defined by a combination of (1) recurrent symptoms typical of mast cell activation, (2) an increase of validated mast cell derived mediators, and (3) response to treatment with mast cell stabilizing or mast cell mediator-targeted therapies. Onset of mast cell activation syndrome ostensibly reflects the loss of tolerance in the mast cell compartment to nonthreatening entities and nonhazardous environmental conditions. The etiology of chronic mast cell dysregulation and associated intolerance to self-antigens or harmless entities is not well understood, but a growing number of studies point to exposure of the epithelial borders, which leads to inappropriate or excessive mast cell activation or impaired resolution of acute inflammation following neutralization of the identified pathogen. Case presentation Here we present a case of adult onset mast cell activation syndrome following scombroid poisoning. Scombroid toxicity is usually a self-limited illness, but there are individuals who have been shown to have severe symptoms or persistent illness following histamine fish poisoning. We describe a 74-year-old Caucasian woman, with a history of drug-induced urticaria, who developed a constellation of hypersensitivity illnesses consistent with the diagnosis of mast cell activation syndrome after ingestion of tainted fish. Conclusion Mast cell activation disease causes problems of increased complexity in children and adults. The increased prevalence and severity of mast cell activation disease has been attributed to dramatic changes in our lifestyles and modern living environments. These changes likely impact the integrity of the epithelial barriers, leading to loss of tolerance in the mast cell compartment. Here, we present a case of a nonatopic, 74-year-old female who developed mast cell activation disease after exposure to a potent environmental toxin. Mast cell activation disease commonly involves several organ systems, with patients often referred to a succession of different specialists. This results in delayed diagnosis and suboptimal care. Instead, early recognition of mast cell activation disease would lead to better outcomes. We review the literature, describing the diagnostic criteria for mast cell activation disorders that can improve recognition of this multiorgan system syndrome. Further research is needed into the interaction of epithelial barrier disruption and the dysregulation of the immune system.
Collapse
Affiliation(s)
- Isabelle Brock
- Comprehensive Asthma and Allergy, 200 S Broadway Suite 104, Tarrytown, NY, 10591, USA. .,Qolify, 99 Wall St Suite 1147, New York, NY, 10005, USA. .,Department of Medical and Molecular Genetics, Indiana University School of Medicine, 975 W. Walnut Street, IB 130, Indianapolis, IN, 46202, USA.
| | - Nicole Eng
- Nicole Eng, BS, Biomedical Studies, University of Pittsburgh, Pittsburgh, USA
| | - Anne Maitland
- Comprehensive Asthma and Allergy, 200 S Broadway Suite 104, Tarrytown, NY, 10591, USA.,Department of Neurology, Mount Sinai- South Nassau Hospital, The Chiari-EDS Center, 1420 Broadway, Hewlett, NY, 11557, USA
| |
Collapse
|
6
|
Brock I, Prendergast W, Maitland A. Mast cell activation disease and immunoglobulin deficiency in patients with hypermobile Ehlers-Danlos syndrome/hypermobility spectrum disorder. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2021; 187:473-481. [PMID: 34747107 DOI: 10.1002/ajmg.c.31940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/16/2021] [Indexed: 12/17/2022]
Abstract
Mast cell activation disease (MCAD) includes single organ disease such as asthma, urticaria, and gastroenteritis, as well as multiorgan system involvement such as mast cell activation syndrome and anaphylaxis. Reports link MCAD with hypermobile Ehlers-Danlos syndrome (hEDS), hypermobility spectrum disorder (HSD), and with primary immune deficiencies such as complement and immunoglobulin deficiencies (Ig Def). This study assesses the concurrence of these syndromes. We undertook a cohort analysis of patients seen in a community-based Allergy/Immunology clinic from 2015 to 2019. We searched for diagnostic codes for Ig Def disorders, hypermobility syndrome, hypermobile/Ehlers-Danlos syndrome, and MCADs. Of 974 patients with suspected MCAD, 449 (46%) had a diagnosis of MCAD; 496 (51%) of cases had a combination of at least two of hEDS/HSD, MCAD, and Ig Def. Ig Def was present in 417 (43%) of patients; 188 (19.3%) had hEDS/HSD with an Ig Def with or without MCAD and accounted for 45% of all the cases with Ig Def. Of 974 cases, 101 (10%) had hEDS/HSD and MCAD; 207 (21%) had Ig Def and MCAD; 7 (0.7%) had Ig Def and hEDS/HSD; and 181 (19%) had a combination of all three syndromes. Most patients (74%) with these comorbidities were female. The presence of MCAD and Ig Def should be explored in patients with hEDS/HSD. Identifying underlying contributors to recurrent/chronic inflammation and tissue injury is needed to tailor and personalize therapies. This, in turn, can reduce tissue damage, iatrogenic intervention, and optimize health outcomes.
Collapse
Affiliation(s)
- Isabelle Brock
- Comprehensive Asthma and Allergy, Tarrytown, New York, USA.,Qolify, New York, New York, USA.,Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Anne Maitland
- Comprehensive Asthma and Allergy, Tarrytown, New York, USA.,Department of Neurology, Mount Sinai-South Nassau, Hewlett, New York, USA
| |
Collapse
|
7
|
He L, Yi W, Huang X, Long H, Lu Q. Chronic Urticaria: Advances in Understanding of the Disease and Clinical Management. Clin Rev Allergy Immunol 2021; 61:424-448. [PMID: 34529248 DOI: 10.1007/s12016-021-08886-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 12/25/2022]
Abstract
Chronic urticaria (CU) is a common skin condition characterized by the recurrence of wheals, with or without angioedema, which lasts for at least 6 weeks. Owing to its pruritus and incurability, this disease adversely affects the patients' physical and mental health and diminishes the quality of life. CU is generally classified into two subtypes based on the relevance of eliciting factors: chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU), the latter of which is further divided into several subtypes. To improve the understanding and clinical management of this highly heterogeneous disorder, the EAACI/GA2LEN/EDF/WAO guideline was developed and published in 2018 based on evidence and expert consensus. The diagnostic and treatment algorithms proposed by the guideline have largely facilitated dermatologists in clinical practice. However, several questions remained unsolved and have been widely investigated in the recent years. First, a better understanding of the association between chronic urticaria and its potential underlying causes or eliciting factors such as autoimmunity, infections, coagulation aberrance, and vitamin D deficiency is warranted. This would lead to updates in the diagnostic and treatment procedures of different subtypes of chronic urticaria. Secondly, treatment for recalcitrant cases, especially those resistant to or intolerant of second-generation antihistamines and (or) omalizumab, calls for novel therapeutic measures or strategies. In the present review, we summarized recent advances in the understanding and management of both CSU and CIndU, with special emphasis on their underlying causes or eliciting factors, pathogenic mechanisms, potential targets for intervention, and advances in treatment strategies.
Collapse
Affiliation(s)
- Liting He
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Hunan, 410011, Changsha, China
| | - Wanyu Yi
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Hunan, 410011, Changsha, China
| | - Xin Huang
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Hunan, 410011, Changsha, China
| | - Hai Long
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Hunan, 410011, Changsha, China.
| | - Qianjin Lu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Hunan, 410011, Changsha, China.,Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, Jiangsu, China
| |
Collapse
|
8
|
What's New in the Treatment of Urticaria and Angioedema. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2170-2184. [PMID: 34112473 DOI: 10.1016/j.jaip.2021.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 12/26/2022]
Abstract
Chronic urticaria and angioedema are diseases often managed by Allergy and Immunology specialists. Recent international guidelines have outlined a stepwise approach to management of patients using dose escalation of second-generation antihistamines followed by use of omalizumab and finally cyclosporine in more refractory cases. In select patients (those with refractory chronic urticaria), nonbiologic alternative medications with anti-inflammatory or immunosuppressant activity may be considered. Angioedema without wheals may have several different pathophysiologic mechanisms. Optimal management of mast cell-mediated angioedema is less clear but is often managed similar to chronic spontaneous urticaria. Drug-induced angioedema due to angiotensin-converting enzyme inhibitors is a common cause of angioedema in the emergency department. Although bradykinin is thought to be a primary mediator for this type of angioedema, studies of targeted therapies have been generally disappointing. In contrast, several targeted therapies have been proven successful using acute and preventive approaches for management of hereditary angioedema. Further developments, including novel biologics, novel oral therapies, and gene therapy approaches, may hopefully continue to broaden therapeutic options to ensure optimal individual management of patients with hereditary angioedema.
Collapse
|
9
|
Ataseven A, Durmaz K, Temiz SA, Dursun R. Clinical and laboratory assessment for the inflammation role in chronic spontaneous urticaria: A clinical study. Dermatol Ther 2020; 33:e14125. [PMID: 32761761 DOI: 10.1111/dth.14125] [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: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 11/28/2022]
Abstract
Chronic spontaneous urticaria (CSU) is triggered by unknown causes. We would like to explore the possible effect of hemogram parameters and several biochemical markers on CSU presence and also the severity of the disease. We also aimed to discuss the relationship between CSU and inflammation associated with these values. The study was planned prospectively. We selected patients already diagnosed with CSU who applied to the dermatology outpatient clinic and healthy controls. The patients and the healthy controls were tested for complete blood count, neutrophil/lymphocytes ratio and platelets/lymphocytes ratio, erythrocyte sedimentation rate, C-reactive protein, serum albumin and total bilirubin and indirect bilirubin levels. Urticaria activity score over 7 days (UAS-7) was calculated for the CSU patients. Forty patients with CSU and 55 healthy subjects were included in the study. Mean white blood cell (WBC) count is 8.37 ± 2.14 in the patients' group and 7.41 ± 2.01 in the healthy subjects group. Mean neutrophil (NEU) count is 4.88 ± 1.65 in the patients' group and 4.19 ± 1.39 in the healthy subjects group. Mean platelets (PLT) count is 308.48 ± 88.32 in the patients' group and 268.65 ± 64.80 in the healthy subjects group. We also detected positive correlations between UAS-7 score-WBC counts and UAS-7 score-NEU counts. Future studies are needed to investigate this possible relationship and confirm these results.
Collapse
Affiliation(s)
- Arzu Ataseven
- Meram Medicine Faculty, Department of Dermatology, Necmettin Erbakan University, Konya, Turkey
| | - Koray Durmaz
- Meram Medicine Faculty, Department of Dermatology, Necmettin Erbakan University, Konya, Turkey
| | - Selami Aykut Temiz
- Meram Medicine Faculty, Department of Dermatology, Necmettin Erbakan University, Konya, Turkey
| | - Recep Dursun
- Meram Medicine Faculty, Department of Dermatology, Necmettin Erbakan University, Konya, Turkey
| |
Collapse
|
10
|
Carrillo-Martin I, Dudgeon MG, Chamorro-Pareja N, Haehn DA, Rivera-Valenzuela MG, Spaulding AC, Heckman MG, Diehl NN, Irizarry-Alvarado JM, Helmi H, Gonzalez-Estrada A. Cost-Utility of Routine Testing in Chronic Urticaria/Angioedema: A Cohort Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2823-2832. [DOI: 10.1016/j.jaip.2019.04.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/17/2019] [Accepted: 04/21/2019] [Indexed: 12/14/2022]
|
11
|
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).
Collapse
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
| | | |
Collapse
|
12
|
Abstract
Chronic idiopathic urticaria (CIU), also known as chronic spontaneous urticaria, is characterized by the presence of hives on most days of the week, for 6 weeks or longer, and without an identifiable or consistent cause. Evaluation is clinical and based on the presence of episodic urticarial lesions. Although patients are subject to overtesting during the diagnosis of CIU, guidelines suggest starting with three basic laboratory tests. Treatment is a stepwise approach, involving second-generation antihistamines, histamine2 antagonists, leukotriene receptor antagonists, first-generation antihistamines, and potent antihistamines. Refractory CIU requires adding alternative agents such as omalizumab, anti-inflammatory agents, and immunosuppressants.
Collapse
|
13
|
Shahzad Mustafa S, Sánchez-Borges M. Chronic Urticaria: Comparisons of US, European, and Asian Guidelines. Curr Allergy Asthma Rep 2018; 18:36. [PMID: 29796863 DOI: 10.1007/s11882-018-0789-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Chronic urticaria is a common dermatological condition that has significant impact on quality of life. Multiple international societies have published guidelines, and although these guidelines generally agree on the definition of urticaria, as well as approach to diagnosis and management, there have been notable differences to date. These differences have been reconciled by the recent publication of the 2017 revision and update published by the EAACI/GA2LEN/EDF/WAO. RECENT FINDINGS The 2017 revision and update to the guidelines for chronic urticaria are the most comprehensive consensus document to date, and reconcile previously existing differences between the US, European, and Asian guidelines. The purpose of our review is to present basic background on urticaria and discuss classification, diagnosis, and most importantly, management. We present differences from previous US, European, and Asian guidelines and reconcile the previous differences by summarizing the 2017 revision and update published by the EAACI/GA2LEN/EDF/WAO.
Collapse
Affiliation(s)
- S Shahzad Mustafa
- Allergy and Clinical Immunology, Rochester Regional Health, Rochester, NY, USA. .,University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela
| |
Collapse
|
14
|
Stokes J. Anti-IgE Treatment for Disorders Other Than Asthma. Front Med (Lausanne) 2017; 4:152. [PMID: 28983485 PMCID: PMC5613080 DOI: 10.3389/fmed.2017.00152] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 09/05/2017] [Indexed: 12/21/2022] Open
Abstract
Immunoglobulin E (IgE) plays a key role in the pathogenesis of many allergic diseases. Thus, IgE-mediated immunologic pathways are an attractive target for intervention in allergic diseases. Omalizumab is a recombinant humanized monoclonal antibody that binds IgE and has been used treat allergic asthma for over a decade. Currently, omalizumab is approved for the treatment of both allergic asthma and chronic spontaneous urticaria. Since IgE plays a critical role in other allergic diseases, anti-IgE therapy has been evaluated in other allergic diseases in small clinical trials and case reports. Omalizumab has demonstrated efficacy in treating allergic rhinitis, atopic dermatitis, physical urticarias, mast cell disorders, food allergy, and other allergic diseases. In addition, the use of omalizumab with conventional allergen immunotherapy improves both safety and effectiveness.
Collapse
Affiliation(s)
- Jeffrey Stokes
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| |
Collapse
|
15
|
Lima H, Gooderham M, Dutz J, Lynde C, Chapdelaine H, Ellis A, Gilbert M, Ho V, Papp K, Poulin Y, Sussman G. Management of chronic spontaneous urticaria (CSU): a treat to target approach using a patient reported outcome. Allergy Asthma Clin Immunol 2017; 13:38. [PMID: 28852410 PMCID: PMC5569543 DOI: 10.1186/s13223-017-0210-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 08/04/2017] [Indexed: 11/22/2022] Open
Abstract
Background Treat-to-target therapy approaches are established for chronic diseases such as diabetes, hypertension, and more recently rheumatoid arthritis, resulting in improved patient outcomes. These approaches do not use patient reported outcomes (PRO) as targets of therapy. Chronic spontaneous urticaria (CSU), also called chronic idiopathic urticaria (CIU), is defined as recurrent urticaria of known and unknown cause, lasting more than 6 weeks. Treatment of CSU can be challenging. However, with the advent of proven therapies and validated instruments for measuring disease activity, the concept of treat-to-target (T2T) can be successfully applied to CSU. Herein, we propose a potential PRO therapeutic target and suggest a T2T approach for the management of patients with CSU. Methods Principles and recommendations for a treat-to-target approach in CSU (T2T/CSU) were developed by a Canadian task force, consisting of dermatologists, immunologists, and allergists. The task force formulated recommendations for therapeutic targets in CSU on the basis of a systematic literature review and expert opinion. Results The key features of these T2T/CSU recommendations are the use of a PRO as the principal target, with symptom control as measured by Urticaria Activity Score 7 (UAS7 ≤ 6), targeting symptom remission (UAS7 = 0). Conclusion Treatment targets such as UAS7 ≤ 6 and UAS7 = 0 provide a benchmark for success in the care of patients with CSU, and will permit the evaluation of a PRO-based T2T approach in the care of these patients and the effect of this approach on improved patient care as seen in other chronic diseases.
Collapse
Affiliation(s)
- Hermenio Lima
- Division of Dermatology, Department of Medicine, McMaster University, HSC-3U8, 1280 Main St. West, Hamilton, ON L8S 4K1 Canada
| | - Melinda Gooderham
- SKiN Centre for Dermatology and Probity Medical Research, Peterborough, ON Canada
| | - Jan Dutz
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC Canada
| | | | - Hugo Chapdelaine
- Division of Allergy & Immunology, Department of Medicine, Université de Montréal, Montreal, QC Canada
| | - Anne Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, ON Canada
| | - Martin Gilbert
- Hôpital du Saint-Sacrement du CHU de Québec, Quebec City, QC Canada
| | - Vincent Ho
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC Canada
| | - Kim Papp
- Clinical Research and Probity Medical Research, Waterloo, ON Canada
| | - Yves Poulin
- Department of dermatology, Hôpital Hôtel-Dieu du CHU de Québec, and Centre de Recherche Dermatologique du Québec métropolitain, Quebec City, QC Canada
| | - Gordon Sussman
- Division of Allergy and Clinical Immunology, St. Michael's Hospital, Toronto, ON Canada
| |
Collapse
|
16
|
|
17
|
Kitsioulis NA, Xepapadaki P, Roussaki-Schulze AV, Papadopoulos N, Zafiriou E. Effectiveness of Autologous Whole-Blood Injections in Patients with Refractory Chronic Spontaneous Urticaria. Int Arch Allergy Immunol 2017; 172:161-166. [DOI: 10.1159/000458152] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 01/25/2017] [Indexed: 11/19/2022] Open
|
18
|
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.].
Collapse
|
19
|
Seth S, Khan DA. The Comparative Safety of Multiple Alternative Agents in Refractory Chronic Urticaria Patients. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:165-170.e2. [PMID: 27746265 DOI: 10.1016/j.jaip.2016.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 07/22/2016] [Accepted: 08/23/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients who have failed traditional treatment of chronic urticaria may require trials of alternative medications. Safety profiles, continuous laboratory monitoring, and physician comfort are often barriers to treatment. OBJECTIVES To evaluate the safety of alternative agents used in chronic urticaria. METHODS A retrospective chart review of electronic medical records from a single-center allergy and immunology clinic in a major academic hospital was conducted. One hundred twenty-six charts of patients with chronic urticaria treated with alternative agents were reviewed. RESULTS Adverse effects were reported in 39 of 73 (53%) patients on dapsone, 19 of 47 (40%) patients on sulfasalazine, 15 of 36 (42%) patients on tacrolimus, 7 of 45 (16%) patients on hydroxychloroquine, 9 of 27 (33%) patients on mycophenolate, 6 of 8 (75%) patients on cyclosporine, and 3 of 24 (4%) patients on omalizumab. Most of these adverse effects were mild, did not require discontinuation of the medication, and resolved after stopping the medication or decreasing the dose. CONCLUSIONS The use of alternative agents for the treatment of chronic urticaria angioedema is generally safe when proper laboratory and clinical monitoring is observed.
Collapse
Affiliation(s)
- Sharon Seth
- Division of Allergy and Immunology, University of Texas Southwestern Dallas, Dallas, Texas.
| | - David A Khan
- Division of Allergy and Immunology, University of Texas Southwestern Dallas, Dallas, Texas
| |
Collapse
|
20
|
Fine LM, Bernstein JA. Guideline of Chronic Urticaria Beyond. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2016; 8:396-403. [PMID: 27334777 PMCID: PMC4921693 DOI: 10.4168/aair.2016.8.5.396] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/13/2015] [Indexed: 11/20/2022]
Abstract
Urticaria is a relatively common condition that if chronic can persist for weeks, months or years and affect quality of life significantly. The etiology is often difficult to determine, especially as it becomes chronic. Many cases of chronic urticaria are thought to be autoimmune, although there is no consensus that testing for autoimmunity alters the diagnostic or management strategies or outcomes. Many times, urticaria is easily managed with antihistamines and/or short courses of oral corticosteroids, but too often control is insufficient and additional therapies must be added. For years, immune modulating medications, such as cyclosporine and Mycophenolate Mofetil, have been used in cases refractory to antihistamines and oral corticosteroids, although the evidence supporting their efficacy and safety has been limited. Omalizumab was recently approved for the treatment of chronic urticaria unresponsive to H1-antagonists. This IgG anti-IgE monoclonal antibody has been well demonstrated to safely and effectively control chronic urticaria at least partially in approximately 2/3 of cases. However, the mechanism of action and duration of treatment for omalizumab is still unclear. It is hoped that as the pathobiology of chronic urticaria becomes better defined, future therapies that target specific mechanistic pathways will be developed that continue to improve the management of these often challenging patients.
Collapse
Affiliation(s)
- Lauren M Fine
- Department of Medicine, University of Miami Miller School of Medicine, Department of Internal Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Miami, FL, USA
| | - Jonathan A Bernstein
- Department of Medicine, University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology/Allergy Section, Cincinnati, Ohio, USA.
| |
Collapse
|
21
|
Maurer M, Vena GA, Cassano N, Zuberbier T. Current and future therapies for treating chronic spontaneous urticaria. Expert Opin Pharmacother 2016; 17:1131-9. [DOI: 10.1517/14656566.2016.1159298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Marcus Maurer
- Department of Dermatology and Allergy, Allergy Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Gino A. Vena
- Dermatology and Venereology Private Practice, Bari and Barletta, Italy
| | - Nicoletta Cassano
- Dermatology and Venereology Private Practice, Bari and Barletta, Italy
| | - Torsten Zuberbier
- Department of Dermatology and Allergy, Allergy Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
22
|
Abstract
Background: Chronic spontaneous urticaria (CSU) is a skin disorder that is said to be “frustrating” and “difficult to treat.” It is characterized by recurrent hives for more than 6 weeks, and is further divided into spontaneous or inducible by physical stimuli.1 To better understand dermatologists’ perspective of this disorder, a survey was conducted with Canadian dermatologists. Methods: A detailed online practice survey was sent to all currently practicing Canadian dermatologists. Results: In all, 80 responses were received (response rate of 20%). Most respondents in Canada had treated patients with CSU (98.4%), with many of the patients having the disease last over 6 months (86.6%). A majority of the patients were female, with 84.1% of the respondents having over 50% of their patients as female. Most patients were over the age of 30 (74.2%). Of dermatologists, 85.7% felt that investigations were unhelpful in diagnosing CSU in a patient. Of respondents, 37.1% were not satisfied with current treatment methods of CSU, and 43.6% somewhat satisfied. Popular therapies included H1 and H2 antihistamines, oral corticosteroids, and montelukast. There were 16.1% of dermatologists who had over 50% of their patients refractory to treatment. Conclusions: There was a clear demographic preponderance for CSU patients with a majority as female over age 30. Investigations ordered for CSU patients do not seem to be helpful among dermatologists. Satisfaction with current therapies and investigations was quite low among Canadian dermatologists, suggesting new therapies are indicated.
Collapse
Affiliation(s)
| | - Charles W. Lynde
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
23
|
Potter P, Mitha E, Barkai L, Mezei G, Santamaría E, Izquierdo I, Maurer M. Rupatadine is effective in the treatment of chronic spontaneous urticaria in children aged 2-11 years. Pediatr Allergy Immunol 2016; 27:55-61. [PMID: 26267219 DOI: 10.1111/pai.12460] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recommendations in current guidelines for the treatment of chronic spontaneous urticaria (CSU) in infants and children are mostly based on extrapolation of data obtained in adults. This study reports the efficacy and safety of rupatadine, a modern H1 and PAF antagonist recently authorized in Europe for children with allergic rhinitis and CSU. METHODS A double-blind, randomized, parallel-group, multicentre, placebo-controlled compared study to desloratadine was carried out in children aged 2-11 years with CSU, with or without angio-oedema. Patients received either rupatadine (1 mg/ml), or desloratadine (0.5 mg/ml) or placebo once daily over 6 weeks. A modified 7-day cumulative Urticaria Activity Score (UAS7) was employed as the primary end-point. RESULTS The absolute change of UAS7 at 42 days showed statistically significant differences between active treatments vs. placebo (-5.5 ± 7.5 placebo, -11.8 ± 8.7 rupatadine and -10.6 ± 9.6 desloratadine; p < 0.001) and without differences between antihistamines compounds. There was a 55.8% decrease for rupatadine followed by desloratadine (-48.4%) and placebo (-30.3%). Rupatadine but not desloratadine was statistically superior to placebo in reduction of pruritus (-57%). Active treatments also showed a statistically better improvement in children's quality of life compared to placebo. Adverse events were uncommon and non-serious in both active groups. CONCLUSION Rupatadine is effective and well tolerated in the relief of urticaria symptoms, improving quality of life over 6 weeks in children with CSU. This is the first study using a modified UAS to assess severity and efficacy outcome in CSU in children.
Collapse
Affiliation(s)
- Paul Potter
- Allergy Diagnostic and Clinical Research Unit, Department of Medicine, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Essack Mitha
- Newtown clinical Research, Johannerburg, South Africa
| | - László Barkai
- BAZ Megyei Kórház Gyermekegészségügyi Központ, Miskolc, Hungary
| | - Györgyi Mezei
- Allergy Unit, First Department of Pediatrics, Faculty of Medicine, Semmelweis U, Budapest Hungary
| | | | | | - Marcus Maurer
- Department of Dermatology and Allergy, Allergie-Centrum Charité/ECARF, Charité-Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
24
|
Helicobacter pylori: A significant and treatable cause of chronic urticaria and angioedema. Nurse Pract 2016; 40:1-6. [PMID: 26383021 DOI: 10.1097/01.npr.0000471366.32982.f2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Two outpatient medical offices evaluated 204 patients with chronic urticaria during 2012. This article presents a retrospective study showing that 10% of patients with chronic urticaria may be infected with H. pylori. Furthermore, eradication of infection can be followed by remission of urticaria, reduced morbidity from gastric ulcers, and cancer.
Collapse
|
25
|
Criado PR, Criado RFJ, Maruta CW, Reis VMSD. Chronic urticaria in adults: state-of-the-art in the new millennium. An Bras Dermatol 2015; 90:74-89. [PMID: 25672302 PMCID: PMC4323701 DOI: 10.1590/abd1806-4841.20153509] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 06/04/2014] [Indexed: 11/21/2022] Open
Abstract
Chronic urticaria has been explored in several investigative aspects in the new
millennium, either as to its pathogenesis, its stand as an autoimmune or
auto-reactive disease, the correlation with HLA-linked genetic factors, especially
with class II or its interrelation with the coagulation and fibrinolysis systems. New
second-generation antihistamines, which act as good symptomatic drugs, emerged and
were commercialized over the last decade. Old and new drugs that may interfere with
the pathophysiology of the disease, such as cyclosporine and omalizumab have been
developed and used as treatments. The purpose of this article is to describe the
current state of knowledge on aspects of chronic urticaria such as, pathophysiology,
diagnosis and the current therapeutic approach proposed in the literature.
Collapse
|
26
|
Mehta A, Godse K, Patil S, Nadkarni N, Gautam M. Treatment of Refractory Chronic Urticaria. Indian J Dermatol 2015; 60:230-7. [PMID: 26120147 PMCID: PMC4458932 DOI: 10.4103/0019-5154.156325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Chronic spontaneous urticaria is a distressing disease encountered frequently in clinical practice. The current mainstay of therapy is the use of second-generation, non-sedating antihistamines. However, in patients who do not respond satisfactorily to these agents, a variety of other drugs are used. This article examines the available literature for frequently used agents including systemic corticosteroids, leukotriene receptor antagonists, dapsone, sulfasalazine, hydroxychloroquine, H2 antagonists, methotrexate, cyclosporine A, omalizumab, autologous serum therapy, and mycophenolate mofetil, with an additional focus on publications in Indian literature.
Collapse
Affiliation(s)
- Aayushi Mehta
- Department of Dermatology, Dr. DY Patil Medical College and Hospital, Nerul, Navi Mumbai, Maharashtra, India
| | - Kiran Godse
- Department of Dermatology, Dr. DY Patil Medical College and Hospital, Nerul, Navi Mumbai, Maharashtra, India
| | - Sharmila Patil
- Department of Dermatology, Dr. DY Patil Medical College and Hospital, Nerul, Navi Mumbai, Maharashtra, India
| | - Nitin Nadkarni
- Department of Dermatology, Dr. DY Patil Medical College and Hospital, Nerul, Navi Mumbai, Maharashtra, India
| | - Manjyot Gautam
- Department of Dermatology, Dr. DY Patil Medical College and Hospital, Nerul, Navi Mumbai, Maharashtra, India
| |
Collapse
|
27
|
Casale TB, Bernstein JA, Maurer M, Saini SS, Trzaskoma B, Chen H, Grattan CE, Gimenéz-Arnau A, Kaplan AP, Rosén K. Similar Efficacy with Omalizumab in Chronic Idiopathic/Spontaneous Urticaria Despite Different Background Therapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 3:743-50.e1. [PMID: 26054553 DOI: 10.1016/j.jaip.2015.04.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/07/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Data from the 3 omalizumab pivotal trials in patients with chronic idiopathic urticaria/chronic spontaneous urticaria (CIU/CSU) represent the largest database of patients reported to date with refractory disease (omalizumab, n = 733; placebo, n = 242). OBJECTIVE The objective of this study was to compare results from ASTERIA I and II, which included only approved doses of H1-antihistamine as background therapy based on regulatory authority requirements, to those from GLACIAL, which permitted higher doses of H1-antihistamines as well as other types of background therapy, in a post hoc analysis. METHODS Efficacy data from the placebo, omalizumab 150-mg, and omalizumab 300-mg treatment arms of ASTERIA I and II were pooled and analyzed (n = 162 and n = 160, respectively). The 300-mg treatment arm analyses were compared with the analysis of data from GLACIAL (n = 252) using analysis of covariance models. The key efficacy endpoint was change from baseline to week 12 in mean weekly itch severity score (ISS); other endpoints were also evaluated. Safety data were pooled from all 3 studies. RESULTS Mean ISS was significantly reduced from baseline at week 12 in the pooled ASTERIA I and II omalizumab 150- and 300-mg treatment arms and in the GLACIAL omalizumab 300-mg arm. The weekly ISS reduction magnitude at week 12 was similar between the omalizumab 300-mg groups in the ASTERIA I and II pooled and GLACIAL studies. Similar treatment effect sizes were observed across multiple endpoints. Omalizumab was well tolerated and the adverse-event profile was similar regardless of background therapy for CIU/CSU. The overall safety profile was generally consistent with omalizumab therapy in allergic asthma. CONCLUSION Omalizumab 300 mg was safe and effective in reducing CIU/CSU symptoms regardless of background therapy.
Collapse
Affiliation(s)
- Thomas B Casale
- Department of Medicine, Division of Allergy and Immunology, University of South Florida, Tampa, Fla
| | - Jonathan A Bernstein
- Department of Internal Medicine and Division of Immunology/Allergy Section, University of Cincinnati, Cincinnati, Ohio
| | - Marcus Maurer
- Department of Dermatology and Allergy, Charité-Universitätsmedizin, Berlin, Germany
| | - Sarbjit S Saini
- Division of Allergy and Clinical Immunology, Johns Hopkins Asthma and Allergy Center, Baltimore, Md
| | | | | | - Clive E Grattan
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Ana Gimenéz-Arnau
- Department of Dermatology, Institut Mar d'Investigacions Mediques, Universitat Autonoma, Barcelona, Spain
| | - Allen P Kaplan
- Department of Medicine, Division of Pulmonary and Critical Care and Allergy and Clinical Immunology, The Medical University of South Carolina, Charleston, SC
| | | |
Collapse
|
28
|
Rasool R, Masoodi KZ, Shera IA, Yosuf Q, Bhat IA, Qasim I, Nissar S, Shah ZA. Chronic urticaria merits serum vitamin D evaluation and supplementation; a randomized case control study. World Allergy Organ J 2015; 8:15. [PMID: 26097642 PMCID: PMC4455331 DOI: 10.1186/s40413-015-0066-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 03/23/2015] [Indexed: 01/08/2023] Open
Abstract
Background Several studies suggest that Vitamin D (Vit-D3) supplementation reduces Chronic Urticaria (CU) symptoms. Objectives Evaluation of serum 25-hydroxyvitamin-D (25 (OH)2D) level and assessment of therapeutic effect of VitD3in CU patients. Methods 192 subjects were stratified according to the baseline 25(OH)2D levels and subsequently randomized into three subgroups to receive Vit-D3 alone (VD) or antihistamine and systemic corticosteroid (H+S) or VitD3 with antihistamine and systemic corticosteroid (VD+H+S) for 6 weeks between July 2012 to Oct 2014. 130 healthy controls (HC) were followed without any intervention. The patients were evaluated for reduction in urticarial symptoms using visual analogue scale (VAS) and 5-D itch score. Results Low serum levels of 25 (OH)2D was observed in 91% of CU patients and 64% of the healthy controls (P < 0.0001). VAS and 5-D Score in subgroups VD, H + S and VD + H + S decreased significantly from 6 · 7 ± 0 · 043, 6 · 6 ± 0 · 42 and 6 · 68 ± 0 · 40 at baseline to 5 · 2 ± 0 · 70 (P = 0 · 0088), 3 · 3 ± 0 · 50 (P < 0 · 0001) and1 · 86 ± 0 · 39 (P < 0 · 0001) after treatment and from 14 · 5 ± 0 · 72, 13 · 9 ± 0 · 77 and 13 · 9 ± 0 · 221 to 12 · 06 ± 1 · 10 (P = 0 · 0072), 8 · 1 ± 1 · 13 (P < 0 · 0001) and 5 · 01 ± 0 · 94 (P < 0 · 0001) respectively. Conclusions CU patients have low serum 25(OH)2D levels and Vit-D3 supplementation in combination with antihistamine and systemic corticosteroid show elevated response in resolving the symptoms of CU. This study also warrants that each subject with CU should be screened for serum 25 (OH)2D levels before starting a treatment.
Collapse
Affiliation(s)
- Roohi Rasool
- Department of Immunology and Molecular Medicine, Sher-i- Kashmir Institute of Medical Sciences, Soura, Srinagar, J&K 190011 India
| | - Khalid Z Masoodi
- Division of Biotechnology, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir, Srinagar, J&K 190025 India
| | - Irfan A Shera
- Department of Immunology and Molecular Medicine, Sher-i- Kashmir Institute of Medical Sciences, Soura, Srinagar, J&K 190011 India
| | - Qayser Yosuf
- Department of Immunology and Molecular Medicine, Sher-i- Kashmir Institute of Medical Sciences, Soura, Srinagar, J&K 190011 India
| | - Imtiyaz A Bhat
- Department of Immunology and Molecular Medicine, Sher-i- Kashmir Institute of Medical Sciences, Soura, Srinagar, J&K 190011 India
| | - Iqbal Qasim
- Department of Immunology and Molecular Medicine, Sher-i- Kashmir Institute of Medical Sciences, Soura, Srinagar, J&K 190011 India
| | - Saniya Nissar
- Department of Immunology and Molecular Medicine, Sher-i- Kashmir Institute of Medical Sciences, Soura, Srinagar, J&K 190011 India
| | - Zafar A Shah
- Department of Immunology and Molecular Medicine, Sher-i- Kashmir Institute of Medical Sciences, Soura, Srinagar, J&K 190011 India
| |
Collapse
|
29
|
Ventura MT, Cassano N, Romita P, Vestita M, Foti C, Vena GA. Management of Chronic Spontaneous Urticaria in the Elderly. Drugs Aging 2015; 32:271-82. [DOI: 10.1007/s40266-015-0249-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
30
|
Ferrer M, Bartra J, Giménez-Arnau A, Jauregui I, Labrador-Horrillo M, Ortiz de Frutos J, Silvestre JF, Sastre J, Velasco M, Valero A. Management of urticaria: not too complicated, not too simple. Clin Exp Allergy 2015; 45:731-43. [PMID: 25429900 PMCID: PMC4403957 DOI: 10.1111/cea.12465] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2014] [Indexed: 11/27/2022]
Abstract
In spite of being an old disease and apparently easy to diagnose, chronic spontaneous urticaria (CSU) is still perceived as an uncontrollable and difficult to manage disease. The perception of the patient is that his/her condition is not well understood and that is suffering from a disorder with hidden causes that doctors are not able to tackle. Sometimes patients go through a number of clinicians until they found some CSU expert who is familiar with the disease. It is surprising that myths and believes with no scientific support still persist. Guidelines are not widely implemented, and recent tools to assess severity are infrequently used. European and American recent guidelines do not agree in several key points related to diagnosis and treatment, which further contributes to confusion. With the aim to clarify some aspects of the CSU picture, a group of allergists and dermatologists from the Spanish Dermatology and Allergy societies developed a Frequent Asked Questions leaflet that could facilitate physicians work in daily practice and contribute to a better knowledge of common clinical scenarios related to patients with CSU.
Collapse
Affiliation(s)
- M Ferrer
- Department of Allergy and Clinical Immunology, Clínica Universidad de NavarraPamplona, Spain
| | - J Bartra
- Allergy Unit, Pneumology Department, Hospital Clinic, University of BarcelonaBarcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)Barcelona, Spain
| | - A Giménez-Arnau
- Dermatology Department, Hospital del Mar, Parc de Salut Mar, Universitat Autonoma BarcelonaBarcelona, Spain
| | - I Jauregui
- Allergy Department, Hospital Universitario BasurtoBilbao, Spain
| | - M Labrador-Horrillo
- Allergy Section, Medicine Department, Hospital Vall d'Hebron, Universitat Autònoma de BarcelonaBarcelona, Spain
| | - J Ortiz de Frutos
- Dermatology Department, Hospital Universitario 12 de OctubreMadrid, Spain
| | - J F Silvestre
- Dermatology Department, Hospital General Universitario de AlicanteAlicante, Spain
| | - J Sastre
- Allergy Department, Fundación Jiménez DiazMadrid, Spain
| | - M Velasco
- Dermatology Department, Hospital Arnau de VilanovaValencia, Spain
| | - A Valero
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)Barcelona, Spain
- Allergy Unit, Pneumology and Respiratory Department, Hospital Clínic (ICT), University of BarcelonaBarcelona, Spain
| |
Collapse
|
31
|
Stokes JR, Casale TB. The Use of Anti-IgE Therapy Beyond Allergic Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 3:162-6. [DOI: 10.1016/j.jaip.2014.10.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 10/08/2014] [Accepted: 10/10/2014] [Indexed: 11/29/2022]
|
32
|
Al-Bari MAA. Chloroquine analogues in drug discovery: new directions of uses, mechanisms of actions and toxic manifestations from malaria to multifarious diseases. J Antimicrob Chemother 2015; 70:1608-21. [PMID: 25693996 PMCID: PMC7537707 DOI: 10.1093/jac/dkv018] [Citation(s) in RCA: 287] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Antimalarial drugs (e.g. chloroquine and its close structural analogues) were developed primarily to treat malaria; however, they are beneficial for many dermatological, immunological, rheumatological and severe infectious diseases, for which they are used mostly today. Chloroquine and hydroxychloroquine, two of the most fascinating drugs developed in the last 50 years, are increasingly recognized for their effectiveness in myriad non-malarial diseases. In advanced research, chloroquine and hydroxychloroquine have been shown to have various immunomodulatory and immunosuppressive effects, and currently have established roles in the management of rheumatic diseases, lupus erythematosus (different forms) and skin diseases, and in the treatment of different forms of cancer. Recently, chloroquine analogues have also been found to have metabolic, cardiovascular, antithrombotic and antineoplastic effects. This review is concerned with the lysosomotropic, anti-inflammatory and immunomodulatory mechanisms of chloroquine, hydroxychloroquine, quinacrine and related analogues, and the current evidence for both their beneficial effects and potential adverse manifestations in various diseases.
Collapse
|
33
|
Sussman G, Hébert J, Gulliver W, Lynde C, Waserman S, Kanani A, Ben-Shoshan M, Horemans S, Barron C, Betschel S, Yang WH, Dutz J, Shear N, Lacuesta G, Vadas P, Kobayashi K, Lima H, Simons FER. Insights and advances in chronic urticaria: a Canadian perspective. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2015; 11:7. [PMID: 25705232 PMCID: PMC4336710 DOI: 10.1186/s13223-015-0072-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 01/14/2015] [Indexed: 11/10/2022]
Abstract
In the past few years there have been significant advances which have changed the face of chronic urticaria. In this review, we aim to update physicians about clinically relevant advances in the classification, diagnosis and management of chronic urticaria that have occurred in recent years. These include clarification of the terminology used to describe and classify urticaria. We also detail the development and validation of instruments to assess urticaria and understand the impairment on quality-of-life and the morbidity caused by this disease. Additionally, the approach to management of chronic urticaria now focuses on evidence-based use of non-impairing, non-sedating H1-antihistamines given initially in standard doses and if this is not effective, in up to 4-fold doses. For urticaria refractory to H1-antihistamines, omalizumab treatment has emerged as an effective, safe option.
Collapse
Affiliation(s)
| | | | | | - Charles Lynde
- />University of Toronto, Medicine, Toronto, ON Canada
| | | | - Amin Kanani
- />University of British Columbia, Medicine, Kelowna, BC Canada
| | | | | | - Carly Barron
- />University of Toronto, Medicine, Toronto, ON Canada
| | | | | | - Jan Dutz
- />University of British Columbia, Medicine, Kelowna, BC Canada
| | - Neil Shear
- />University of Toronto, Medicine, Toronto, ON Canada
| | - Gina Lacuesta
- />Dalhousie University, Medicine, Halifax, NS Canada
| | - Peter Vadas
- />University of Toronto, Medicine, Toronto, ON Canada
| | | | | | | |
Collapse
|
34
|
|
35
|
Sánchez-Borges M, Ansotegui I, Jimenez JM, Rojo MI, Serrano C, Yañez A. Comparative efficacy of non-sedating antihistamine updosing in patients with chronic urticaria. World Allergy Organ J 2014; 7:33. [PMID: 25829981 PMCID: PMC4363057 DOI: 10.1186/1939-4551-7-33] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/30/2014] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico-Docente la, Trinidad and Clínica El Avila, 6a transversal Urb. Altamira, piso 8, consultorio 803, Caracas, 1060 Venezuela
| | - Ignacio Ansotegui
- Department of Allergy and Immunology, Hospital Quirón Bizkaia, Erandio, Spain
| | | | | | - Carlos Serrano
- Allergy Unit, Hospital Fundación Valle del Lili, Cali, Colombia
| | - Anahí Yañez
- Investigaciones en Alergia y Enfermedades Respiratorias, InAER, Buenos Aires, Argentina
| |
Collapse
|
36
|
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.
Collapse
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.
| |
Collapse
|
37
|
Greenberger PA. Chronic urticaria: new management options. World Allergy Organ J 2014; 7:31. [PMID: 25383135 PMCID: PMC4223736 DOI: 10.1186/1939-4551-7-31] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 09/30/2014] [Indexed: 11/16/2022] Open
Abstract
Chronic urticaria is defined as episodic or daily hives lasting for at least 6 weeks and impairs quality of life. Two main subtypes include chronic idiopathic (spontaneous) urticaria and inducible (physical) urticaria, but some patients have urticarial vasculitis. “Autoimmune chronic urticaria” implies the presence of histamine releasing or mast cell activating autoantibodies to IgE or FcϵRI, the high affinity receptor on mast cells and basophils. In patients not readily controlled with labeled dosages of second generation H1 receptor antagonists (antihistamines), there is evidence for reduction of urticaria using up to 4 fold increases in labeled dosages. The biologic modifier, omalizumab, helps to reduce lesions of chronic urticaria within 1–2 weeks.
Collapse
Affiliation(s)
- Paul A Greenberger
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, 676 N. St. Clair Street, # 14108, 60611 Chicago, IL USA
| |
Collapse
|
38
|
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.
Collapse
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.
| |
Collapse
|
39
|
Miller MM. Re: sympathomimetic drugs should be considered an alternative agent class in refractory chronic urticaria. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2014; 2:240. [PMID: 24607061 DOI: 10.1016/j.jaip.2013.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 12/28/2013] [Indexed: 06/03/2023]
Affiliation(s)
- Michael M Miller
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tenn.
| |
Collapse
|
40
|
Casale TB. Omalizumab for Chronic Urticaria. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:118-9. [DOI: 10.1016/j.jaip.2013.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 11/15/2013] [Accepted: 11/18/2013] [Indexed: 11/16/2022]
|
41
|
Khan DA. Bringing your "A" game to urticaria and angioedema. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2013; 1:425-426. [PMID: 24565611 DOI: 10.1016/j.jaip.2013.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 07/10/2013] [Indexed: 06/03/2023]
Affiliation(s)
- David A Khan
- Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Tex.
| |
Collapse
|