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Sánchez J, Caraballo D, Amaya D. Evaluation of Guideline Line-Care Approach to the Treatment of Chronic Inducible Urticaria. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:2166-2172. [PMID: 38761861 DOI: 10.1016/j.jaip.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Chronic inducible urticaria (CIndU) management often follows chronic spontaneous urticaria (CSU) guidelines, but a step-by-step evaluation of their effectiveness in CIndU is lacking. OBJECTIVE To assess the clinical impact of adapting CSU international guidelines for CIndU management. METHODS We conducted a prospective cohort study involving patients diagnosed with CIndU based on challenge tests and a Urticaria Control Test (UCT) score of ≤11 points. Following the guidelines, a stepwise approach was used: avoidance measures, antihistamines, omalizumab, and cyclosporine. Treatment steps were added based on individual response, with control defined as UCT ≥12 points. Pharmacological steps were evaluated for at least 1 month, with the next step initiated in case of a UCT score ≤11 points. RESULTS We enrolled 194 patients with CIndU. Of them, 134 patients had CIndU with concomitant CSU and 60 had CIndU only. Following the step-by-step approach outlined in the guidelines, a total of 159 (81.9%) patients reach a UCT ≥12 points, with avoidance measures 23 (11.8%) patients, antihistamines 84 (43.2%), omalizumab 35 (18%), and cyclosporine 17 (8.7%). CONCLUSIONS This study supports the use of a stepwise approach based on CSU guidelines for CIndU management. However, a significant proportion of patients, particularly those with CIndU only, did not achieve adequate control. This highlights the heterogeneity within CIndU and the need for further research to develop new therapies for patients with CIndU who remain uncontrolled.
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Affiliation(s)
- Jorge Sánchez
- Group of Experimental and Clinical Allergy, Hospital "Alma Mater de Antioquia," University of Antioquia, Medellín, Colombia.
| | - Domingo Caraballo
- Group of Experimental and Clinical Allergy, Hospital "Alma Mater de Antioquia," University of Antioquia, Medellín, Colombia
| | - Daniel Amaya
- Group of Experimental and Clinical Allergy, Hospital "Alma Mater de Antioquia," University of Antioquia, Medellín, Colombia
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Chernyshov PV, Finlay AY, Tomas-Aragones L, Zuberbier T, Kocatürk E, Manolache L, Pustisek N, Svensson A, Marron SE, Sampogna F, Bewley A, Salavastru C, Koumaki D, Augustin M, Linder D, Abeni D, Salek SS, Szepietowski J, Jemec GB. Quality of life measurement in urticaria: Position statement of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient-Oriented Outcomes and Urticaria and Angioedema. J Eur Acad Dermatol Venereol 2024. [PMID: 38855825 DOI: 10.1111/jdv.20157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/03/2024] [Indexed: 06/11/2024]
Abstract
The European Academy of Dermatology and Venereology (EADV) Task Forces on quality of life (QoL) and patient-oriented outcomes and on urticaria and angioedema recommendations for the assessment of Health-related (HR) QoL in all patients with urticaria in research and practice are as follows: to use the DLQI for adults and the CDLQI for children as dermatology-specific and the CU-Q2oL as a disease-specific HRQoL instruments in urticaria; to use generic instruments to provide comparison of data on urticaria with non-dermatologic diseases, or to compare with healthy volunteers or the general population; to select validated HRQoL instruments with appropriate age limits; to present exact numeric data for HRQoL results; correct title of any HRQoL instrument should be used, along with its correct abbreviation and the reference to its original publication, where possible. The EADV TFs discourage the use of non-validated HRQoL instruments and modified HRQoL instruments that have not undergone standard validation.
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Affiliation(s)
- P V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine
| | - A Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - L Tomas-Aragones
- Department of Psychology, University of Zaragoza, Zaragoza, Spain
| | - T Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - E Kocatürk
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey
| | - L Manolache
- Department of Dermatology, Dali Medical, Bucharest, Romania
| | - N Pustisek
- Children's Hospital Zagreb, Zagreb, Croatia
| | - A Svensson
- Department of Dermatology and Venereology, Skane University Hospital, Malmö, Sweden
| | - S E Marron
- Department of Dermatology, University Hospital Miguel Servet, Aragon Psychodermatology Research Group (GAI+PD), Zaragoza, Spain
| | - F Sampogna
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - A Bewley
- Barts Health NHS Trust, London, UK
- Queen Mary University, London, UK
| | - C Salavastru
- Department of Paediatric Dermatology, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - D Koumaki
- Department of Dermatology and Venereology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D Linder
- University Clinic for Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | - D Abeni
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - S S Salek
- School of Life & Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - J Szepietowski
- Department of Dermatology, Wroclaw Medical University, Wroclaw, Poland
| | - G B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
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3
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Sánchez J, Jaimes F, García E, Zakzuk J, Cardona R, Velasquez M. Risk calculator of the clinical response to antihistamines in chronic urticaria: Development and internal validation. PLoS One 2024; 19:e0295791. [PMID: 38394074 PMCID: PMC10889609 DOI: 10.1371/journal.pone.0295791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/28/2023] [Indexed: 02/25/2024] Open
Abstract
Early detection of CSU patients with low probability of a clinical response with antihistamines could undergo prompt initiation of therapeutic alternatives. The aim of the study was to develop and internally validate a model for predicting the clinical response to antihistamines in adult patients with chronic spontaneous urticaria (CSU), who consult allergology and dermatology care centers. A cohort of CSU patients, recruited from four participating centers, were followed up for 12 months. Fifteen candidate variables were selected to be included in the multivariate model and then internal validation was done with bootstrap analysis with 1000 simulations. The outcome variable, clinical response to antihistamines, was evaluated with the UAS (Urticaria Activity Score) scale for seven days: "No response to antihistamines" was defined as UAS7 ≥7 points after at least one month with a maximum dose of antihistamines, while "Response to antiH1" was defined as UAS7 ≤6 points for at least three months with the use of antiH1. A total of 790 patients were included. Among the different models analyzed, the model that included age, angioedema, anxiety/depression, time with the disease, NSAIDs (Non-steroidal anti-inflammatory drugs) intolerance, and UAS7 baseline was considered the one with the best performance (accuracy 0.675, HL 0.87, AUC 0.727). The internal validation analyses demonstrated good consistency of the model. In conclusion, this prediction model identifies the probability of response to antihistamines in patients with chronic spontaneous urticaria. The model could be useful for a personalized therapeutic approach according to individual patient risk.
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Affiliation(s)
- Jorge Sánchez
- Group of Clinical and Experimental Allergy, "IPS University" Clinic, University of Antioquia, Medellín, Colombia
| | - Fabian Jaimes
- Internal Medicine Department, “San Vicente” Clinic, University of Antioquia, Medellín, Colombia
| | | | - Josefina Zakzuk
- Health Economics Research Group, ALZAK Foundation, Immunological Research Institute, University of Cartagena, Cartagena, Colombia
| | - Ricardo Cardona
- Group of Clinical and Experimental Allergy, "IPS University" Clinic, University of Antioquia, Medellín, Colombia
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Rubeiz CJ, Asero R, Betschel S, Craig T, Grumach A, Hide M, Lang D, Levin M, Longhurst H, Magan E, Maurer M, Saini R, Sussman G, Toubi E, Van DN, Zuberier T, Bernstein JA. Analysis of questionnaire survey to determine worldwide trends in prescriptions of biologics for the treatment of unresponsive chronic urticaria. World Allergy Organ J 2024; 17:100858. [PMID: 38235261 PMCID: PMC10793168 DOI: 10.1016/j.waojou.2023.100858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 01/19/2024] Open
Abstract
Background Chronic spontaneous urticaria (CSU) is a common condition treated by allergist/immunologists, but the only FDA-approved biologic medication, omalizumab, may be underutilized globally. Objective This study was performed to determine the global prescription of omalizumab for treatment of CSU by allergists/immunologists. Methods Anonymous questionnaire surveys were distributed online to World Allergy Organization (WAO) members worldwide. Categorical data were analyzed for descriptive analysis using one-way frequency tabulation in SAS 9.4. Results There were 348 respondents (43 missing data); Average age 51 (range 28-90); M/F 48%/52%. 58% had > 15 years of clinical experience and 10% < 5; 42% worked in private clinics, 36% public hospitals, 24% academia, 18% private hospitals, and 4% in community practice. Eighty-two percent (82%) prescribed omalizumab for CSU patients and use of omalizumab was highest among young practitioners. The most significant barriers were cost (63%) and restricted formulary (24%). Drug safety (63%) and chances of adverse events (47%) were the most significant factors deciding treatment. Twenty-two percent (22%) reported 80-100% of CSU patients were complete responders to omalizumab; 34% preferred increasing frequency (q 2-weeks), and 18% preferred increasing dose (600 mg q 4-weeks) for partial or non-responders. UAS7, UCT, and CU-QoL were used to assess CSU by 55%, 29%, and 25% of respondents, respectively. Autoimmune thyroid disease (62%), thyroid abnormality (43%) and allergic rhinitis (35%) were the most frequent comorbidities reported. Conclusions Most clinicians favored omalizumab over other potential treatments due to safety. Although younger clinicians were more likely to prescribe omalizumab, cost and formulary access were major barriers. Only 22% of respondents reported 80% or greater of their patients had complete response to omalizumab, indicating the need for novel CSU therapies.
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Affiliation(s)
- Christine J Rubeiz
- Cincinnati Children's Hospital Medical Center, Division of Allergy and Immunology, Cincinnati, OH, USA
| | - Ricardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Pademo Dugnano, Italy
| | - Stephen Betschel
- Unity Health, St Michael's Hospital, University of Toronto, Ontario, Canada
| | - Timothy Craig
- Pediatrics and Biomedical Sciences, Penn State University, Hershey, PA, USA
| | - Anete Grumach
- Centro Universitário Faculdade de Medicina ABC, Brazil
| | - Michihiro Hide
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - David Lang
- Cleveland Clinic Lerner College of Medicine, Department of Allergy and Clinical Immunology, Cleveland, OH, USA
| | | | - Hilary Longhurst
- Department of Medicine, University of Auckland, Te Toka Tumai, New Zealand
- Department of Immunology, Auckland City Hospital, Te Toka Tumai, New Zealand
| | - Eli Magan
- Assuta Ashdod University Medical Center, Ben Gurion University of the Negev, Israel
| | | | - Romi Saini
- Johns Hopkins University School of Medicine, USA
| | | | | | - Dinh Nguyen Van
- Vinmec Health Care System, China
- College of Health Sciences, Vin University, China
- Department of Medicine, College of Medicine, Penn State University, USA
| | - Torsten Zuberier
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Institute of Allergology, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Jonathan A Bernstein
- Cincinnati Children's Hospital Medical Center, Division of Allergy and Immunology, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, Cincinnati, OH, USA
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Sánchez J, Alvarez L, López JF. Indication of Omalizumab for Chronic Urticaria Using the 'Urticaria Control Test' Instead of 'Urticaria Activity Score': Possible Impact for Health Systems. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T88-T90. [PMID: 37871896 DOI: 10.1016/j.ad.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/26/2022] [Accepted: 10/17/2022] [Indexed: 10/25/2023] Open
Affiliation(s)
- J Sánchez
- Group of Clinical and Experimental Allergy, University of Antioquia, IPSU clinic, Medellín, Colombia.
| | - L Alvarez
- Pharmacoeconomic evaluation group, SURA Company
| | - J F López
- Group of Clinical and Experimental Allergy, University of Antioquia, IPSU clinic, Medellín, Colombia
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Sánchez J, Alvarez L, López JF. Indication of Omalizumab for Chronic Urticaria Using the 'Urticaria Control Test' Instead of 'Urticaria Activity Score': Possible Impact for Health Systems. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:88-90. [PMID: 36754254 DOI: 10.1016/j.ad.2022.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/26/2022] [Accepted: 10/17/2022] [Indexed: 02/09/2023] Open
Affiliation(s)
- J Sánchez
- Group of Clinical and Experimental Allergy, University of Antioquia, IPSU Clinic, Medellín, Colombia.
| | - L Alvarez
- Pharmacoeconomic Evaluation Group, SURA Company, Colombia
| | - J F López
- Group of Clinical and Experimental Allergy, University of Antioquia, IPSU Clinic, Medellín, Colombia
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Zhang Y, Huang Y, Dang B, Hu S, Zhao C, Wang Y, Yuan Y, Liu R. Fisetin alleviates chronic urticaria by inhibiting mast cell activation via MRGPRX2. J Pharm Pharmacol 2023; 75:1310-1321. [PMID: 37410860 DOI: 10.1093/jpp/rgad056] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/01/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVES The activation of mast cell (MC) plays an important part in the pathogenesis of chronic urticaria (CU), and the expression of MRGPRX2 (Mas-related G-protein coupled receptor X2) and the circulating levels of SP (substance P) in skin MC of CU patients increased. Fisetin is a natural flavonoid with anti-inflammatory and antiallergic pharmacological effects. This study aimed to investigate the inhibitory effect of fisetin on CU via MRGPRX2 and its possible molecular mechanisms. METHODS OVA/SP co-stimulated and SP-stimulated CU like murine models were used to evaluate the effect of fisetin on CU. MRGPRX2/HEK293 cells and LAD2 cells were used to perform the antagonism effect of fisetin on MC via MRGPRX2. KEY FINDINGS The results indicated that fisetin prevented urticaria-like symptoms in murine CU models, and inhibited MCs activation by suppressing calcium mobilization and degranulation of cytokines and chemokines via binding to MRGPRX2. The bioinformatics analysis showed that fisetin might have an interaction relationship with Akt in CU. The western blotting experiments showed that fisetin downregulated the phosphorylation levels of Akt, P38, NF-κB, and PLCγ in C48/80 activated LAD2 cells. CONCLUSIONS Fisetin alleviates CU progression by inhibiting mast cell activation via MRGPRX2, which may be a novel therapeutic candidate for CU.
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Affiliation(s)
- Yonghui Zhang
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an 710061, China
| | - Yihan Huang
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an 710061, China
| | - Baowen Dang
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an 710061, China
| | - Shiting Hu
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an 710061, China
| | - Chenrui Zhao
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an 710061, China
| | - Yuejin Wang
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an 710061, China
| | - Yujuan Yuan
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an 710061, China
| | - Rui Liu
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an 710061, China
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Qian T, Jiang X, Zhang D, Song Y, Hao F. Comparative effectiveness and safety of drug therapy for chronic urticaria: a network meta-analysis and risk-benefit assessment. Expert Opin Drug Saf 2023:1-15. [PMID: 37750025 DOI: 10.1080/14740338.2023.2262377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/15/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Chronic urticaria (CU) is a prevalent chronic skin condition characterized by recurrent wheals. Clinical guidelines recommend multiple drugs for CU treatment. Our study aims to compare the effectiveness and safety of drug therapy for CU. METHODS We conducted a comprehensive search of randomized controlled trials (RCTs) and real-world studies (RWSs) in PubMed, EMBASE, and Cochrane. A network meta-analysis (NMA) was conducted to assess the response rate, decline in Urticaria Activity Score over 7 Days (UAS7), Dermatology Life Quality Index (DLQI), and adverse event rates of standard-dose and high-dose H1 antihistamine (H1AH), omalizumab (OMA) 75, 150, and 300 mg, cyclosporine and placebo. The risk-benefit assessment was conducted by probabilistic simulation and stochastic multicriteria acceptability analysis (SMAA). RESULTS A total of 39 studies were identified, including 37 RCTs and 2 RWSs. OMA 300 mg and 150 mg both had significantly higher response rate than standard-dose H1AH (p < 0.05, respectively). OMA 300 mg and 150 mg both consistently led to a huge drop in UAS7 and DLQI compared to standard-dose H1AH and high-dose H1AH (p < 0.05). CONCLUSION Regarding risk-benefit assessment, OMA 300 mg emerges as the optimal pharmacological intervention for CU, while OMA 150 mg stands as a secondary alternative compared to H1 antihistamines and cyclosporine.
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Affiliation(s)
- Tian Qian
- Dermatology and Plastic Surgery Center, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xia Jiang
- Dermatology and Plastic Surgery Center, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daojun Zhang
- Dermatology and Plastic Surgery Center, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yao Song
- Department of Pediatrics, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fei Hao
- Dermatology and Plastic Surgery Center, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Kuna M, Štefanović M, Ladika Davidović B, Mandušić N, Birkić Belanović I, Lugović-Mihić L. Chronic Urticaria Biomarkers IL-6, ESR and CRP in Correlation with Disease Severity and Patient Quality of Life-A Pilot Study. Biomedicines 2023; 11:2232. [PMID: 37626727 PMCID: PMC10452525 DOI: 10.3390/biomedicines11082232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Background: To assess the relationship between serum interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values and disease severity in patients with chronic spontaneous urticaria (CSU) and to examine which of these serum biomarkers better indicates disease severity. (2) Methods: Our pilot study included 20 patients with CSU who filled out questionnaires concerning disease severity and quality of life (the Urticaria Activity Score summed over 7 days [UAS7], the once-daily Urticaria Activity Score [UAS], the Urticaria Control Test [UCT], and the Dermatology Life Quality Index [DLQI]). Blood samples were taken to measure IL-6, ESR and CRP. (3) Results: ESR significantly correlated with the UAS7 (linear and moderate correlation; r = 0.496; p = 0.026), while CRP did not correlate with disease severity. IL-6 correlated with the once-daily UAS (r = 0.472; p = 0.036) and DLQI (r = 0.504; p = 0.023) (linear and moderate correlation) but not the UAS7 or UCT. (4) Conclusions: IL-6 was a better indicator of the once-daily UAS and DLQI, while ESR was a better indicator of the UAS7 (there was no correlation between IL-6, CRP and ESR parameters). Although our results are promising, this study should be conducted with a larger number of CSU patients.
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Affiliation(s)
- Matea Kuna
- Department of Dermatovenereology, University Hospital Center “Sestre Milosrdnice”, Vinogradska 29, 10000 Zagreb, Croatia; (N.M.); (I.B.B.); (L.L.-M.)
| | - Mario Štefanović
- Department of Clinical Chemistry, University Hospital Center “Sestre Milosrdnice”, Vinogradska 29, 10000 Zagreb, Croatia;
| | - Blaženka Ladika Davidović
- Department of Oncology and Nuclear Medicine, University Hospital Center “Sestre Milosrdnice”, Vinogradska 29, 10000 Zagreb, Croatia;
| | - Nikolina Mandušić
- Department of Dermatovenereology, University Hospital Center “Sestre Milosrdnice”, Vinogradska 29, 10000 Zagreb, Croatia; (N.M.); (I.B.B.); (L.L.-M.)
| | - Ines Birkić Belanović
- Department of Dermatovenereology, University Hospital Center “Sestre Milosrdnice”, Vinogradska 29, 10000 Zagreb, Croatia; (N.M.); (I.B.B.); (L.L.-M.)
| | - Liborija Lugović-Mihić
- Department of Dermatovenereology, University Hospital Center “Sestre Milosrdnice”, Vinogradska 29, 10000 Zagreb, Croatia; (N.M.); (I.B.B.); (L.L.-M.)
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Evidence Gaps in Clinical Trials of Pharmacologic Treatment for H1-Antihistamine-Refractory Chronic Spontaneous Urticaria: A Systematic Review and Future Perspectives. Pharmaceuticals (Basel) 2022; 15:ph15101246. [PMID: 36297357 PMCID: PMC9607405 DOI: 10.3390/ph15101246] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 11/24/2022] Open
Abstract
No data addressing issues concerning disparities in participant and trial characteristics and trial outcome reporting have been established in clinical trials for H1-antihistamine-refractory chronic spontaneous urticaria (CSU). To better harmonize and compare the different treatment interventions, we systematically evaluated the overall landscape of pharmacological treatments for H1-antihistamine-refractory CSU clinical trials published between 2000 and 2021. This systematic review included 23 randomized clinical trials involving 2480 participants from 22 countries. We found significant increases in the number of globally published and newly tested drugs, especially biologic drugs. Regarding relatively small trials, we found that people living with H1-antihistamine-refractory CSU who were identified as members of minority groups (non-white population), populations of regions other than North America/Europe, and populations of low- to lower/upper-middle-income countries are underrepresented. Most trials were designed to evaluate treatment efficacy and safety profiles; however, less than half of the included trials reported the patient’s perspective in terms of patient-reported outcomes. Disparities in outcome reporting, including clinimetric tools for assessing treatment response and outcome sets, were observed. To close the evidence gap in H1-antihistamine-refractory CSU trials, strategies for improving trial and participant enrollment and standardizing core outcome sets for trial reporting are needed.
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Abdelshafy AM, Abdallah SY, Hassan AF, Mohamed HA, Kamal NM, Ali ST, Abdelhaleem IA. The Impact of Bilastine on Symptoms of Allergic Rhinitis and Chronic Urticaria: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Rhinol Allergy 2022; 36:684-694. [PMID: 35593100 DOI: 10.1177/19458924221097449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Allergic diseases are immunological exaggerations with symptoms that may interfere with life quality. Bilastine, a novel oral second-generation H-1 antihistamine, is highly selective to H-1 receptors and has anti inflammatory properties. The present evidence regarding the drug efficacy is inconsistent. OBJECTIVES We aimed to evaluate the efficacy and safety of bilastine compared with the placebo and other active antihistamines in patients who complained either from AR or chronic urticaria. METHODS We systematically searched the Medline, Scopus, Web of Science, and Cochrane databases for randomized controlled trials (RCTs) evaluating bilastine effects on symptomatic hyper histaminic allergic conditions. We collected data on total symptoms scores (TSS), total nasal symptom scores (TNSS), discomfort associated with these allergic conditions measured by visual analog score (VAS), and quality of life (QOL) for AR and urticaria. Other outcomes such as clinical global impression and safety profiles were reported as well. We pooled the studies in a random effect model using RevMan 5.4 software. RESULTS We included 9 RCTs comprising 3801 participants. The meta-analysis revealed that bilastine was superior to placebo, improving TSS, TNSS, VAS, and QOL in AR or chronic urticaria participants. Moreover, the bilastine was comparable to active antihistamines such as cetirizine, fexofenadine, and loratadine regarding mentioned outcomes. In addition, the novel drug was safe and tolerable with no difference in the incidence of adverse events with a placebo. CONCLUSIONS Bilastine safely improved TSS in hyper histaminic allergic conditions involving nasal symptoms in AR. It decreases the discomfort associated with the disease resulting in improving the QOL of the participants.
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Affiliation(s)
- Aliaa M Abdelshafy
- 68865Faculty of Medicine, Zagazig University, Zagazig, Egypt.,68865Zagazig Medical Research Society, Zagazig, Egypt
| | - Sara Y Abdallah
- 68865Faculty of Medicine, Zagazig University, Zagazig, Egypt.,68865Zagazig Medical Research Society, Zagazig, Egypt
| | - Ahmed F Hassan
- 68865Faculty of Medicine, Zagazig University, Zagazig, Egypt.,68865Zagazig Medical Research Society, Zagazig, Egypt
| | - Hazem A Mohamed
- 68865Faculty of Medicine, Zagazig University, Zagazig, Egypt.,68865Zagazig Medical Research Society, Zagazig, Egypt
| | - Nourhan M Kamal
- 68865Faculty of Medicine, Zagazig University, Zagazig, Egypt.,68865Zagazig Medical Research Society, Zagazig, Egypt.,68103Ministry of Health and Population, Cairo, Egypt
| | - Sohila T Ali
- 68865Faculty of Medicine, Zagazig University, Zagazig, Egypt.,68865Zagazig Medical Research Society, Zagazig, Egypt
| | - Ibrahim A Abdelhaleem
- 68865Faculty of Medicine, Zagazig University, Zagazig, Egypt.,68865Zagazig Medical Research Society, Zagazig, Egypt
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12
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Liu R, Peng C, Jing D, Xiao Y, Zhu W, Zhao S, Zhang J, Chen X, Li J. Lachnospira is a signature of antihistamine efficacy in chronic spontaneous urticaria. Exp Dermatol 2021; 31:242-247. [PMID: 34558729 DOI: 10.1111/exd.14460] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/15/2021] [Accepted: 09/09/2021] [Indexed: 01/14/2023]
Abstract
Chronic spontaneous urticaria (CSU) is a mast cell-driven disease with many advances in its aetiology and pathogenesis over the past years. The main treatment of CSU is oral second-generation antihistamines. However, only an average of 50% of CSU patients responded adequately to conventional or quadruple doses of non-sedative antihistamines. Meanwhile, gut microbiota can affect the efficacy of drugs. The purpose of this study was to investigate the relationship between gut microbiota and the efficacy of antihistamines in patients with CSU. The patients with CSU were divided into responders and non-responders according to the efficacy of antihistamine monotherapy. The gut microbiota of faecal samples from 15 responders and 15 non-responders was detected by 16S rDNA sequencing, and the differential bacterial species between the two groups were verified by quantitative polymerase chain reaction (qPCR). Additional faecal samples from 30 responders and 30 non-responders were used as an extended cohort to further verify the above differential bacterial species by qPCR. Lachnospiraceae and its subordinate taxa were found to be the main differences in gut microbiota between responders and non-responders. The abundance of Lachnospira in responders was higher than that in non-responders. Lachnospira exhibits moderate diagnostic value in evaluating the efficacy of antihistamine. Lachnospira is a signature for predicting the efficacy of antihistamine in patients with CSU.
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Affiliation(s)
- Runqiu Liu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China.,The First People's Hospital of Yancheng, Yancheng, China.,The Fourth Affiliated Hospital of Nantong University, Nantong, China
| | - Cong Peng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Xiangya Clinical Research Center for Cancer Immunotherapy, Central South University, Changsha, China
| | - Danrong Jing
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Xiangya Clinical Research Center for Cancer Immunotherapy, Central South University, Changsha, China
| | - Yangjian Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Wu Zhu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Xiangya Clinical Research Center for Cancer Immunotherapy, Central South University, Changsha, China
| | - Shuang Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Xiangya Clinical Research Center for Cancer Immunotherapy, Central South University, Changsha, China
| | - Jianglin Zhang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Xiangya Clinical Research Center for Cancer Immunotherapy, Central South University, Changsha, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Xiangya Clinical Research Center for Cancer Immunotherapy, Central South University, Changsha, China
| | - Jie Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Xiangya Clinical Research Center for Cancer Immunotherapy, Central South University, Changsha, China
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13
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Sánchez J, Sánchez A, Munera M, Garcia E, Lopez JF, Velásquez-Lopera M, Cardona R. Presence of IgE Autoantibodies Against Eosinophil Peroxidase and Eosinophil Cationic Protein in Severe Chronic Spontaneous Urticaria and Atopic Dermatitis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2021; 13:746-761. [PMID: 34486259 PMCID: PMC8419645 DOI: 10.4168/aair.2021.13.5.746] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 11/20/2022]
Abstract
Purpose Eosinophils are frequently found in atopic dermatitis (AD) and chronic spontaneous urticaria (CSU) that release eosinophil peroxidase (EPX) and eosinophil cationic protein (ECP). Continuous exposure to these proteins could trigger an autoimmune response which may contribute to the pathogenesis and severity of skin inflammation. In this study, we investigate the immunoglobulin E (IgE) response against eosinophil proteins in CSU and AD. Methods We recruited patients with severe AD, severe CSU and healthy subjects to explore the presence of IgE autoantibodies and cross-reactivity against EPX, ECP and thyroid peroxidase (TPO). The potential cross-reactive epitopes among the peroxidase family were determined using in silico tools. Results The frequencies of anti-EPX IgE (28.8%) and anti-ECP IgE (26.6%) were higher in the AD group, and anti-TPO IgE was higher in the CSU group (27.2%). In the CSU group, there was a correlation between the anti-EPX IgE and anti-TPO IgE levels (r = 0.542, P < 0.001); TPO inhibited 42% of IgE binding to EPX, while EPX inhibited 59% of IgE binding to TPO, suggesting a cross-reactivity with EPX as a primary sensitizer. There was greater inhibition when we used a pool of sera CSU and AD, TPO inhibited 52% of IgE binding to EPX, while EPX inhibited 78% of IgE binding to TPO. In silico analysis showed a possible shared epitope in the peroxidase protein family. Conclusions IgE against eosinophil proteins may contribute to chronic inflammation in patients with AD and CSU. Cross-reactivity between EPX and TPO could explain thyroid problems in CSU patients.
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Affiliation(s)
- Jorge Sánchez
- Group of Clinical and Experimental Allergy, IPS Universitaria Clinic, University of Antioquia, Medellín, Colombia.
| | - Andres Sánchez
- Group of Clinical and Experimental Allergy, IPS Universitaria Clinic, University of Antioquia, Medellín, Colombia.,Medical Research Group (GINUMED), Rafael Núñez University Corporation, Department Immunology, Faculty of Medicine, Cartagena, Colombia
| | - Marlon Munera
- Medical Research Group (GINUMED), Rafael Núñez University Corporation, Department Immunology, Faculty of Medicine, Cartagena, Colombia
| | - Elizabeth Garcia
- Allergy Department, Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia.,Department Allergology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Juan-Felipe Lopez
- Group of Clinical and Experimental Allergy, IPS Universitaria Clinic, University of Antioquia, Medellín, Colombia.,Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
| | - Margarita Velásquez-Lopera
- Dermatological Research Center, Centro de Investigaciones Dermatológicas (CIDERM), University of Antioquia, Medellín, Colombia
| | - Ricardo Cardona
- Group of Clinical and Experimental Allergy, IPS Universitaria Clinic, University of Antioquia, Medellín, Colombia
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14
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Nochaiwong S, Chuamanochan M, Ruengorn C, Awiphan R, Tovanabutra N, Chiewchanvit S. Evaluation of Pharmacologic Treatments for H1 Antihistamine-Refractory Chronic Spontaneous Urticaria: A Systematic Review and Network Meta-analysis. JAMA Dermatol 2021; 157:1316-1327. [PMID: 34431983 DOI: 10.1001/jamadermatol.2021.3237] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance The comparative benefits and harms of all available treatments for H1 antihistamine-refractory chronic spontaneous urticaria (CSU) have not been established. Objective To evaluate different treatment effects of pharmacologic treatments among patients with H1 antihistamine-refractory CSU. Data Sources Searches were conducted of MEDLINE, Embase, PubMed, Cochrane Library, Web of Science, Scopus, and CINAHL from inception to April 19, 2021, with no language restrictions. Gray literature from Google Scholar, ongoing trial registers, and preprint reports was added to the searches of electronic databases. Study Selection Randomized clinical trials using validated measurement tools that investigated the benefits and harms of pharmacologic treatments among adolescent or adult patients with CSU who had an inadequate response to H1 antihistamines were screened for inclusion independently by 2 investigators. Data Extraction and Synthesis Two investigators independently extracted study data according to the predefined list of interests. A random-effects model was used to calculate the network estimates reported as standardized mean differences and odds ratios with corresponding 95% CIs. Main Outcomes and Measures The primary outcomes that reflect the patient's perspective included changes in urticaria symptoms from baseline and unacceptability of treatment (all-cause dropouts). Results Twenty-three randomized clinical trials with 2480 participants that compared 18 different interventions or dosages and placebo were included. The standardized mean differences for change in urticaria symptoms were -1.05 (95% CI, -1.37 to -0.73) for ligelizumab, 72 mg; -1.07 (95% CI, -1.39 to -0.75) for ligelizumab, 240 mg; -0.77 (95% CI, -0.91 to -0.63) for omalizumab, 300 mg; and -0.59 (95% CI, -1.10 to -0.08) for omalizumab, 600 mg. No significant differences in treatment unacceptability were observed. With respect to benefits and harms, the network estimates illustrated that the most efficacious treatments were achieved with ligelizumab, 72 or 240 mg (large beneficial effect) and omalizumab, 300 or 600 mg (moderate beneficial effect). Conclusions and Relevance The findings in this meta-analysis suggest that the biologic agents ligelizumab, 72 or 240 mg, and omalizumab, 300 or 600 mg, can be recommended as effective treatments for patients with CSU who have had an inadequate response to H1 antihistamines. Head-to-head trials with high methodologic quality and harmonized design and outcome definitions are needed to help inform subsequent international guidelines for the management of CSU.
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Affiliation(s)
- Surapon Nochaiwong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.,Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Mati Chuamanochan
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.,Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chidchanok Ruengorn
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.,Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Ratanaporn Awiphan
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.,Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Napatra Tovanabutra
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Siri Chiewchanvit
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.,Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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15
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Jorge MFS, Mourão IB, Pollo CF, Sousa TDD, Meneguin S, Miot HA. Validation of the Skindex-17 quality of life assessment instrument for a Brazilian population. An Bras Dermatol 2021; 96:51-58. [PMID: 33281012 PMCID: PMC7838104 DOI: 10.1016/j.abd.2020.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/02/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Health-related quality of life assesses how diseases affect the daily life of people; there are several generic instruments for this assessment in dermatology. Skindex was created in 1996; it is a multidimensional instrument, aiming to encompass some psychological and social aspects not yet addressed by other questionnaires. Among its versions (Skindex-29, 16, and 17), Skindex-17 had not been validated in Brazil. OBJECTIVES To validate Skindex-17 for use in Brazilians with dermatological diseases. METHODS This was a methodological, cross-sectional, and prospective study of 217 patients attended at the Dermatology Service Outpatient Clinic, Faculdade de Medicina de Botucatu - Universidade Estadual Paulista (Botucatu, SP, Brazil), from December 2017 to September 2019. The following were evaluated: content validity, filling time, internal consistency, dimensional structure, concurrent validity (DLQI), temporal stability, and responsiveness. RESULTS The sample consisted of 71% women, mean age (SD) of 45 (16) years; phototypes II-IV accounted for 95% of the cases. Cronbach's alpha coefficients were 0.82 and 0.93 for the symptoms and psychosocial conditions, respectively. A high correlation was observed with the DLQI score: symptoms (rho = 0.69) and psychosocial conditions (rho = 0.75). The instrument's two-dimensional structure was confirmed through confirmatory factor analysis. Temporal stability (ICC > 0.9) and score responsiveness (p ≤ 0.02) were verified. The instrument was shown to be feasible in clinical practice due to the content validation performed by professionals and patients, as well as the low time spent completing it (< 5 min). STUDY LIMITATIONS Single-center study, with patients exclusively from the public healthcare system. CONCLUSIONS Skindex-17 was shown to be a valid and consistent instrument for assessing quality of life among patients with dermatological diseases, in Brazil. Its two-dimensional structure was confirmed.
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Affiliation(s)
| | | | | | | | - Silmara Meneguin
- Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Hélio Amante Miot
- Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
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16
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Sánchez J, Diez S, Cardona R. Clinical Control of CSU with Antihistamines Allows for Tolerance of NSAID-Exacerbated Cutaneous Disease. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3577-3583.e1. [DOI: 10.1016/j.jaip.2020.06.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/22/2020] [Accepted: 06/26/2020] [Indexed: 11/24/2022]
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17
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Sanchez J, Velasquez M, Jaimes F. A protocol for the development and internal validation of a model to predict clinical response to antihistamines in urticaria patients. PLoS One 2020; 15:e0239962. [PMID: 33022026 PMCID: PMC7537877 DOI: 10.1371/journal.pone.0239962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/25/2020] [Indexed: 12/23/2022] Open
Abstract
Chronic urticaria causes a significant limitation to quality of life. In the literature, various studies can be found that have reviewed several clinical and laboratory markers, but none of these variables alone is sufficient to predict the patient's prognosis. In this study, we present a protocol to develop a prognostic model that can predict the clinical response of urticaria patients to antihistamines. This is a protocol for a bidirectional cohort study. Urticaria data will be routinely collected from a population of patients over 18 years old. A full multivariable logistic regression model will be fitted, following five steps: 1) Selection of predictive variables for the model; 2) Evaluation of the quality of the collected data and control of lost data; 3) Data statistical management; 4) Strategies to select the variables to include at the end of the model; 5) Evaluation of the performance of the different possible models (predictive accuracy) and selection of the best model. The performance and internal validation of the model will be assessed. Some clinical and paraclinical variables will be measured for further exploration.
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Affiliation(s)
- Jorge Sanchez
- Group of Clinical and Experimental Allergy, "IPS University" Clinic, University of Antioquia, Medellín, Colombia
| | | | - Fabian Jaimes
- Internal Medicine Department, "San Vicente" Clinic, University of Antioquia, Medellín, Colombia
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18
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Jorge MFS, Sousa TD, Pollo CF, Paiva BSR, Ianhez M, Boza JC, Meneguin S, Schmitt JV, Nunes DH, Lastoria JC, Miot HA. Dimensionality and psychometric analysis of DLQI in a Brazilian population. Health Qual Life Outcomes 2020; 18:268. [PMID: 32758227 PMCID: PMC7409396 DOI: 10.1186/s12955-020-01523-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 07/30/2020] [Indexed: 12/13/2022] Open
Abstract
Background The Dermatology Life Quality Index (DLQI) is the most commonly used instrument for clinical evaluation of the impact on health-related quality of life (HRQOL) in dermatological research protocols. The DLQI’s classical psychometric properties have been considered adequate in validation studies from several countries. However, the structure of the DLQI is a matter of discussion, especially concerning the dimensionality and informative properties of its questions according to the item response theory (IRT). Methods Pooled data from studies in Brazil that utilized the DLQI to assess HRQOL in 14 dermatoses were reanalyzed. Classical psychometrical analysis, dimensionality assessment through parallel analysis and IRT (Samejima’s ordinal model) analysis were performed. Results The sample consisted of 1286 patients with a mean age of 47 years (SD = 16), and the proportion of women was 59% (765). The DLQI scores ranged from 0 to 29, with a median (p25–p75) of 5 (2–11). All items indicated significant correlations with the total DLQI score (rho > 0.54). The Cronbach’s alpha result was 0.90 (CI 95% 0.89–0.91). Parallel analysis indicated a unidimensional factor structure. According to IRT analysis, items q6 (sports) and q7 (work/study) exhibited insufficient fit to the model (p < 0.01), while the items that indicated the best discrimination and information functions were q2 (embarrassment), q3 (shopping/gardening), q4 (clothing) and q5 (social/leisure). The ordination of the scores was confirmed for all items. Most items revealed non-uniform behavior according to sex, age and type of disease. Conclusions The DLQI exhibits adequate psychometric reliability and a unidimensional structure for assessing HRQOL in Brazilian dermatological patients. The DLQI’s performance varies in the assessment of HRQOL in heterogeneous samples.
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Affiliation(s)
- Marilia F S Jorge
- Departamento de Dermatologia da Faculdade de Medicina da Unesp, Unesp Medical School, Campus Universitário de Rubião Jr, Botucatu, SP, 18618-000, Brazil.
| | - Ticiane D Sousa
- Departamento de Enfermagem, Unesp Medical School, Botucatu, SP, Brazil, Campus Universitário de Rubião Jr, Botucatu, SP, 18618-000, Brazil
| | - Camila F Pollo
- Departamento de Enfermagem, Unesp Medical School, Botucatu, SP, Brazil, Campus Universitário de Rubião Jr, Botucatu, SP, 18618-000, Brazil
| | - Bianca S R Paiva
- Health-Related Quality of Life Research Group (GPQual), Learning and Research Institute - Barretos Cancer Hospital, Barretos, SP, 14784-40, Brazil
| | - Mayra Ianhez
- Departamento de Dermatologia, Universidade Federal de Goiás (UFGO), Av. Esperança, s/n - Chácaras de Recreio Samambaia, Goiânia, GO, 74690-900, Brazil
| | - Juliana C Boza
- Departamento de Dermatologia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Paulo Gama, 110 - Farroupilha, Porto Alegre, RS, 90040-060, Brazil
| | - Silmara Meneguin
- Departamento de Enfermagem, Unesp Medical School, Botucatu, SP, Brazil, Campus Universitário de Rubião Jr, Botucatu, SP, 18618-000, Brazil
| | - Juliano V Schmitt
- Departamento de Dermatologia da Faculdade de Medicina da Unesp, Unesp Medical School, Campus Universitário de Rubião Jr, Botucatu, SP, 18618-000, Brazil
| | - Daniel Holthausen Nunes
- Disciplina de Dermatologia, Universidade Federal de Santa Catarina (UFSC), R. Eng. Agronômico Andrei Cristian Ferreira, s/n - Trindade, Florianópolis, SC, 88040-900, Brazil
| | - Joel C Lastoria
- Departamento de Dermatologia da Faculdade de Medicina da Unesp, Unesp Medical School, Campus Universitário de Rubião Jr, Botucatu, SP, 18618-000, Brazil
| | - Hélio A Miot
- Departamento de Dermatologia da Faculdade de Medicina da Unesp, Unesp Medical School, Campus Universitário de Rubião Jr, Botucatu, SP, 18618-000, Brazil
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19
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Cyclosporine and omalizumab together: A new option for chronic refractory urticaria. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2101-2103. [DOI: 10.1016/j.jaip.2020.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 01/30/2023]
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20
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Rosenblum JD, Nassau S, Fonacier L, Mawhirt SL. Concomitant treatment with omalizumab and cyclosporine for chronic spontaneous urticaria. Ann Allergy Asthma Immunol 2020; 125:111-112. [PMID: 32360694 DOI: 10.1016/j.anai.2020.04.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 01/22/2023]
Affiliation(s)
| | - Stacy Nassau
- Division of Allergy and Immunology NYU-Winthrop Hospital Mineola, New York
| | - Luz Fonacier
- Division of Allergy and Immunology NYU-Winthrop Hospital Mineola, New York
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21
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Choi JH, Lee DH, Song WJ, Choi M, Kwon JW, Kim GW, Kim MH, Kim MA, Kim MH, Kim BK, Kim S, Kim JS, Kim JE, Kim JY, Kim JH, Kim HJ, Kim HO, Kim HB, Roh JY, Park KH, Park KY, Park HK, Park H, Bae JM, Byun JY, Song DJ, Ahn YM, Lee SE, Lee YB, Lee JS, Lee JH, Lim KH, Youn SW, Chang YS, Jeon YH, Jeon J, Jue MS, Choi SH, Hur GY, Lim DH, Ye YM, Park YM. The KAAACI/KDA Evidence-Based Practice Guidelines for Chronic Spontaneous Urticaria in Korean Adults and Children: Part 2. Management of H1-Antihistamine-Refractory Chronic Urticaria. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:750-770. [PMID: 32638557 PMCID: PMC7346997 DOI: 10.4168/aair.2020.12.5.750] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 02/25/2020] [Indexed: 01/19/2023]
Abstract
Quite a few patients with chronic spontaneous urticaria (CSU) are refractory to H₁-antihistamines, even though the dose of H₁-antihistamines is increased up to 4-fold. CSU that is not controlled with H₁-antihistamines results in increased disease burden. Several immunomodulators have been used to manage these patients. The guidelines reported herein are connected to Part 1 of the KAAACI/KDA Evidence-Based Practice Guidelines for Chronic Spontaneous Urticaria in Korean Adults and Children, and aimed to provide evidence-based recommendations for the management of H₁-antihistamine-refractory CSU. Part 2 focuses on the more commonly used additional treatment options for refractory CSU, including omalizumab, cyclosporine, leukotriene receptor antagonist, dapsone, methotrexate, and phototherapy. The evidence to support their efficacy, dosing, safety, and selection of these agents is systematically reviewed. To date, for patients with refractory CSU, the methodologically sound data to evaluate the use of omalizumab has been growing; however, the evidence of other immunomodulators and phototherapy is still insufficient. Therefore, an individualized stepwise approach with a goal of achieving complete symptom control and minimizing side effects can be recommended. Larger controlled studies are needed to elevate the level of evidence to select a rational therapeutic agent for patients with refractory CSU.
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Affiliation(s)
- Jeong Hee Choi
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Allergy and Clinical Immunology Research Center, Hallym University College of Medicine, Chuncheon, Korea
| | - Dong Hun Lee
- Department of Dermatology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Woo Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mira Choi
- Department of Dermatology, Inje University Ilsan Paik Hospital, Ilsan, Korea
| | - Jae Woo Kwon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Gun Woo Kim
- Department of Internal Medicine, St. Carollo General Hospital, Suncheon, Korea
| | - Myung Hwa Kim
- Department of Dermatology, Dankook University College of Medicine, Cheonan, Korea
| | - Mi Ae Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Min Hye Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Byung Keun Kim
- Department of Internal Medicine, Korea University Medical Center Anam Hospital, Seoul, Korea
| | - Sujeong Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Joung Soo Kim
- Department of Dermatology, Hanyang University Guri Hospital, Guri, Korea
| | - Jung Eun Kim
- Department of Dermatology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ju Young Kim
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Joo Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hyun Jung Kim
- Institute for Evidence-based Medicine, Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Hye One Kim
- Department of Dermatology, Hallym University College of Medicine, Seoul, Korea
| | - Hyo Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Joo Young Roh
- Department of Dermatology, Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
| | - Kyung Hee Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kui Young Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Han Ki Park
- Department of Allergy and Clinical Immunology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyunsun Park
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ji Yeon Byun
- Department of Dermatology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Dae Jin Song
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Young Min Ahn
- Department of Pediatrics, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Seung Eun Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Young Bok Lee
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joong Sun Lee
- Department of Dermatology, School of Medicine, Eulji University, Daejeon, Korea
| | - Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary's Hospital, Brain Korea 21 PLUS Project for Medical Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Sang Woong Youn
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yoon Seok Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - You Hoon Jeon
- Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Jiehyun Jeon
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Mihn Sook Jue
- Department of Dermatology, Veterans Health Service Medical Center, Seoul, Korea
| | - Sun Hee Choi
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Gyu Young Hur
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Dae Hyun Lim
- Department of Pediatrics, School of Medicine, Inha University, Incheon, Korea
| | - Young Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
| | - Young Min Park
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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22
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Miller RL, Shtessel M, Robinson LB, Banerji A. Advances in drug allergy, urticaria, angioedema, and anaphylaxis in 2018. J Allergy Clin Immunol 2019; 144:381-392. [PMID: 31247266 DOI: 10.1016/j.jaci.2019.06.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/22/2019] [Accepted: 06/18/2019] [Indexed: 12/11/2022]
Abstract
Many notable advances in drug allergy, urticaria, angioedema, and anaphylaxis were reported in 2018. Broad-spectrum antibiotic use and, consequently, antibiotic resistance are widespread, and algorithms to clarify β-lactam allergy and optimize antibiotic use were described. Meaningful data emerged on the pathogenesis of delayed drug hypersensitivity reactions. Progress not only in defining biomarkers but also in understanding the effect on quality of life and developing better treatments has been made for patients with chronic idiopathic urticaria. Patients with hereditary angioedema (HAE) have gained additional access to highly efficacious therapies, with associated improvements in quality of life, and some progress was made in our understanding of recurrent angioedema in patients with normal laboratory results. Guidelines have defined clear goals to help providers optimize therapies in patients with HAE. The epidemiology and triggers of anaphylaxis and the mechanisms underlying anaphylaxis were elucidated further. In summary, these disorders (and labels) cause substantial burdens for individual persons and even society. Fortunately, publications in 2018 have informed on advancements in diagnosis and management and have provided better understanding of mechanisms that potentially could yield new therapies. This progress should lead to better health outcomes and paths forward in patients with drug allergy, urticaria, HAE, and anaphylaxis.
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Affiliation(s)
- Rachel L Miller
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY; Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY.
| | - Maria Shtessel
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Lacey B Robinson
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
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23
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Yan S, Chen W, Peng C, Zhu W, Chen M, Zhang J, Su J, Li F, Liu Z, Zhang W, Li Q, Li J, Chen X. C-reactive protein (CRP) rs3093059Cpredicts poor mizolastine response in chronic spontaneous urticaria patients with elevated serum CRP level. Exp Dermatol 2019; 28:240-246. [PMID: 30632650 DOI: 10.1111/exd.13874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/18/2018] [Accepted: 01/07/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Siyu Yan
- Department of Dermatology; Xiangya Hospital; Central South University; Changsha China
- Hunan Key Laboratory of Skin Cancer and Psoriasis; Xiangya Hospital; Central South University; Changsha Hunan China
- Hunan Engineering Research Center of Skin Health and Disease; Changsha Hunan China
| | - Wangqing Chen
- Department of Dermatology; Xiangya Hospital; Central South University; Changsha China
- Hunan Key Laboratory of Skin Cancer and Psoriasis; Xiangya Hospital; Central South University; Changsha Hunan China
- Institute of Clinical Pharmacology; Xiangya Hospital; Central South University; Changsha China
| | - Cong Peng
- Department of Dermatology; Xiangya Hospital; Central South University; Changsha China
- Hunan Key Laboratory of Skin Cancer and Psoriasis; Xiangya Hospital; Central South University; Changsha Hunan China
- Hunan Engineering Research Center of Skin Health and Disease; Changsha Hunan China
| | - Wu Zhu
- Department of Dermatology; Xiangya Hospital; Central South University; Changsha China
- Hunan Key Laboratory of Skin Cancer and Psoriasis; Xiangya Hospital; Central South University; Changsha Hunan China
- Hunan Engineering Research Center of Skin Health and Disease; Changsha Hunan China
| | - Mingliang Chen
- Department of Dermatology; Xiangya Hospital; Central South University; Changsha China
- Hunan Key Laboratory of Skin Cancer and Psoriasis; Xiangya Hospital; Central South University; Changsha Hunan China
- Hunan Engineering Research Center of Skin Health and Disease; Changsha Hunan China
| | - Jianglin Zhang
- Department of Dermatology; Xiangya Hospital; Central South University; Changsha China
- Hunan Key Laboratory of Skin Cancer and Psoriasis; Xiangya Hospital; Central South University; Changsha Hunan China
- Hunan Engineering Research Center of Skin Health and Disease; Changsha Hunan China
| | - Juan Su
- Department of Dermatology; Xiangya Hospital; Central South University; Changsha China
- Hunan Key Laboratory of Skin Cancer and Psoriasis; Xiangya Hospital; Central South University; Changsha Hunan China
- Hunan Engineering Research Center of Skin Health and Disease; Changsha Hunan China
| | - Fangfang Li
- Department of Dermatology; Xiangya Hospital; Central South University; Changsha China
- Hunan Key Laboratory of Skin Cancer and Psoriasis; Xiangya Hospital; Central South University; Changsha Hunan China
- Hunan Engineering Research Center of Skin Health and Disease; Changsha Hunan China
| | - Zhaoqian Liu
- Institute of Clinical Pharmacology; Xiangya Hospital; Central South University; Changsha China
| | - Wei Zhang
- Institute of Clinical Pharmacology; Xiangya Hospital; Central South University; Changsha China
| | - Qingling Li
- Department of Pathology; Xiangya Hospital; Central South University; Changsha China
| | - Jie Li
- Department of Dermatology; Xiangya Hospital; Central South University; Changsha China
- Hunan Key Laboratory of Skin Cancer and Psoriasis; Xiangya Hospital; Central South University; Changsha Hunan China
- Hunan Engineering Research Center of Skin Health and Disease; Changsha Hunan China
| | - Xiang Chen
- Department of Dermatology; Xiangya Hospital; Central South University; Changsha China
- Hunan Key Laboratory of Skin Cancer and Psoriasis; Xiangya Hospital; Central South University; Changsha Hunan China
- Hunan Engineering Research Center of Skin Health and Disease; Changsha Hunan China
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24
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Schatz M, Sicherer SH, Khan D, Zeiger RS. The Journal of Allergy and Clinical Immunology: In Practice 2018 Highlights. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:393-411. [PMID: 30557718 DOI: 10.1016/j.jaip.2018.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 12/12/2022]
Abstract
A large number of clinically impactful studies and reviews were published in this journal in 2018. This article provides highlights of the original research published in 2018 issues of The Journal of Allergy and Clinical Immunolgy: In Practice on the subjects of anaphylaxis, asthma, dermatitis, drug allergy, eosinophilic disorders, food allergy, immune deficiency, rhinitis, and urticaria/angioedema and mast cell disorders. Within each topic, practical aspects of diagnosis and management are emphasized. Treatments discussed include lifestyle modifications, allergen avoidance therapy, positive and negative effects of pharmacologic therapy, and various forms of immunologic and desensitization management. We hope this review will help readers consolidate and use this extensive and practical knowledge for the benefit of patients.
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Affiliation(s)
- Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif.
| | - Scott H Sicherer
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David Khan
- Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
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25
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Lutfeali S, Khan DA. Review and Perspectives of the Recent International Guidelines on Treatment of Chronic Urticaria. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0184-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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26
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Larenas-Linnemann DES, Parisi CAS, Ritchie C, Cardona-Villa R, Cherrez-Ojeda I, Cherrez A, Ensina LF, Garcia E, Medina IV, Rodríguez-González M, Caraballo JMS. Update on Omalizumab for Urticaria: What's New in the Literature from Mechanisms to Clinic. Curr Allergy Asthma Rep 2018; 18:33. [PMID: 29744661 DOI: 10.1007/s11882-018-0787-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Since omalizumab has been approved for urticaria, numerous randomized and real-life observational trials have been published. We reviewed the period January 2017-February 2018. RECENT FINDINGS Omalizumab is effective for the control of urticaria recalcitrant to antihistamines in different populations globally. The ratio of total serum IgE 4-week/baseline ≥2 can predict response with a high likelihood. In observational real-life trials, doses have been adjusted on an individual basis: in some populations, up to two-thirds of the patients can be controlled with 150 mg/month; however, others are still not controlled with 300 mg/month. In these, 150 mg bimonthly could be tried, before up-dosing to 450 mg/month. On the long run (up to 3 years) omalizumab kept its efficacy. In many patients, dosing intervals could be augmented (6-8 weeks, some even more). After a 12-month treatment, about 20% showed long-term remission without relapse. Some biomarkers are being detected. Adjusting omalizumab doses in urticaria patients could enhance efficacy (shortening dosing interval and/or augmenting dose) and save costs (after 12 months: extending dosing interval and/or reducing dose).
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Affiliation(s)
- Désirée E S Larenas-Linnemann
- Research Unit, Medica Sur Hospital and Clinical Foundation, Torre 2, cons.602, Puente de Piedra 150, Col. Toriello Guerra, Del. Tlalpan, 14050, México, D.F, Mexico.
| | | | | | - Ricardo Cardona-Villa
- Grupo de Alergología Clínica y Expermiental, IPS Universitaria, Universidad de Antioquia, Medellín, Colombia
| | | | - Annia Cherrez
- Respiralab Research Group, Guayaquil, Ecuador.,Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | - Luis Felipe Ensina
- Federal University of São Paulo, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Elizabeth Garcia
- Fundación Santa Fe de Bogotá - Facultad de Medicina, Universidad de Los Andes, Bogotá, Colombia
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27
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Advances in Chronic Urticaria. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0198-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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