1
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Kolkhir P, Bonnekoh H, Metz M, Maurer M. Chronic Spontaneous Urticaria: A Review. JAMA 2024:2824115. [PMID: 39325444 DOI: 10.1001/jama.2024.15568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
Importance Chronic spontaneous urticaria affects approximately 1% of the general population worldwide, including approximately 3 million people in the US, impairs patients' quality of life, and is associated with multiple comorbidities. Observations Chronic spontaneous urticaria affects patients of any age but is most common in females aged 30 to 50 years. Diagnosis is based on clinical presentation, ie, spontaneously recurring wheals, angioedema, or both. Chronic spontaneous urticaria persists for more than 1 year in most patients (1 or repeated episodes) and may present with comorbidities including chronic inducible urticaria (>10%), autoimmune thyroiditis (approximately 20%), metabolic syndrome (6%-20%), and anxiety (10%-31%) and depression (7%-29%). Known autoimmune endotypes (subtypes of urticaria defined by distinct pathogenesis) of chronic spontaneous urticaria are mediated by mast cell-activating IgE and/or IgG autoantibodies (>50%). Approximately 40% of patients with chronic spontaneous urticaria have a Dermatology Life Quality Index of more than 10, corresponding to a very large or extremely large negative effect on quality of life. Second-generation H1 antihistamines are first-line treatment; partial or complete response, defined as a reduction in urticaria symptoms of greater than 50%, is observed in approximately 40% of patients. The 2022 international urticaria guideline recommends the monoclonal anti-IgE antibody omalizumab as second-line treatment for antihistamine-refractory chronic spontaneous urticaria. However, at least 30% of patients have an insufficient response to omalizumab, especially those with IgG-mediated autoimmune urticaria. Cyclosporine, used off-label, can improve symptoms in approximately 54% to 73% of patients, especially those with autoimmune chronic spontaneous urticaria and nonresponse to omalizumab, but has adverse effects such as kidney dysfunction and hypertension. Conclusions and Relevance Chronic spontaneous urticaria is an inflammatory skin disease associated with medical and psychiatric comorbidities and impaired quality of life. Second-generation H1 antihistamines are first-line treatment, omalizumab is second-line treatment, and cyclosporine is third-line treatment for chronic spontaneous urticaria.
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Affiliation(s)
- Pavel Kolkhir
- Urticaria Center of Reference and Excellence (UCARE), 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, Immunology and Allergology, Berlin, Germany
| | - Hanna Bonnekoh
- Urticaria Center of Reference and Excellence (UCARE), 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, Immunology and Allergology, Berlin, Germany
| | - Martin Metz
- Urticaria Center of Reference and Excellence (UCARE), 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, Immunology and Allergology, Berlin, Germany
| | - Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE), 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, Immunology and Allergology, Berlin, Germany
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2
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Kucharczyk A, Marczyk K, Kucharczyk B, Plisko R, Perkowska J, Owczarek W, Jahnz-Różyk K. Predicting relapse in chronic spontaneous urticaria: A retrospective cohort study evaluating omalizumab withdrawal regimens. Allergy 2024; 79:2554-2557. [PMID: 38922945 DOI: 10.1111/all.16194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/21/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Aleksandra Kucharczyk
- Department of Internal Diseases, Pneumonology, Allergology and Clinical Immunology, Military Institute of Medicine - National Research Institute, Warszawa, Poland
| | - Katarzyna Marczyk
- Department of Internal Diseases, Pneumonology, Allergology and Clinical Immunology, Military Institute of Medicine - National Research Institute, Warszawa, Poland
| | | | | | - Jolanta Perkowska
- Department of Infectious Diseases and Allergology, Military Institute of Medicine - National Research Institute, Warszawa, Poland
| | - Witold Owczarek
- Department of Dermatology, Military Institute of Medicine - National Research Institute, Warszawa, Poland
| | - Karina Jahnz-Różyk
- Department of Internal Diseases, Pneumonology, Allergology and Clinical Immunology, Military Institute of Medicine - National Research Institute, Warszawa, Poland
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3
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Joshi SR, Anstey KM, Khan DA. Chronic Spontaneous Urticaria: An Update on the Evaluation and Management. Immunol Allergy Clin North Am 2024; 44:503-515. [PMID: 38937012 DOI: 10.1016/j.iac.2024.03.007] [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] [Indexed: 06/29/2024]
Abstract
Chronic spontaneous urticaria (CSU) affects 0.5% to 1% of the general population and is often managed by allergy and immunology specialists. Guidelines have evolved over the past several decades with an emphasis on decreasing extensive screening laboratory testing as they are of low-yield and cost-ineffective. The utility of biomarkers remains under investigation but total immunoglobulin E may be helpful in determining specific endotypes and response to omalizumab. Antihistamines and omalizumab remain the primary therapeutic options for CSU, but an expanding body of evidence supports the use of immunosuppressants and anti-inflammatory medications in refractory cases.
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Affiliation(s)
- Shyam R Joshi
- Department of Medicine, Section of Allergy and Immunology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, PPV320, Portland, OR 97239, USA
| | - Karen M Anstey
- Department of Medicine, Section of Allergy and Immunology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, PPV320, Portland, OR 97239, USA
| | - David A Khan
- Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, 5939 Harry Hines Boulevard, HQ9.935, Dallas, TX 75390-8503, USA.
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4
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Menéndez-Sánchez M, Pérez-Fernández E, López-Estebaranz JL, Gómez-de la Fuente E. [Translated article] Use of Antihistamines During Omalizumab Therapy in Chronic Urticaria in the Routine Clinical Practice. A 48-Patient Observational Trial. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T636-T638. [PMID: 38648933 DOI: 10.1016/j.ad.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/08/2023] [Indexed: 04/25/2024] Open
Affiliation(s)
- M Menéndez-Sánchez
- Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
| | - E Pérez-Fernández
- Unidad de Investigación, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - J L López-Estebaranz
- Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - E Gómez-de la Fuente
- Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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5
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Menéndez-Sánchez M, Pérez-Fernández E, López-Estebaranz JL, Gómez-de la Fuente E. Use of Antihistamines During Omalizumab Therapy in Chronic Urticaria in the Routine Clinical Practice. A 48-Patient Observational Trial. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:636-638. [PMID: 38382744 DOI: 10.1016/j.ad.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/20/2023] [Accepted: 08/08/2023] [Indexed: 02/23/2024] Open
Affiliation(s)
- M Menéndez-Sánchez
- Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - E Pérez-Fernández
- Unidad de Investigación, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - J L López-Estebaranz
- Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - E Gómez-de la Fuente
- Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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6
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Faraz K, Seely M, Marano AL. The role of the environment in allergic skin disease. Curr Allergy Asthma Rep 2024; 24:323-330. [PMID: 38733510 DOI: 10.1007/s11882-024-01147-9] [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: 04/17/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE OF REVIEW This paper explores how environmental factors influence allergic skin diseases, including atopic dermatitis (AD), contact dermatitis (CD), urticaria, angioedema, and reactions to drugs and insect bites. RECENT FINDINGS Research indicates a significant impact of environmental elements on allergic skin diseases. High air pollution levels exacerbate symptoms, while climate change contributes to increased skin barrier dysfunction, particularly affecting AD. Allergen prevalence is influenced by climate and pollution. Irritants, like those in detergents and cosmetics, play a major role in CD. Plants also contribute, causing various skin reactions. Understanding the interplay between environmental factors and allergic skin diseases is crucial for effective management. Physicians must address these factors to support patient well-being and promote skin health amidst environmental changes.
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Affiliation(s)
- Khushnood Faraz
- Duke University School of Medicine, 1000 Trent Dr, Durham, NC, 27710, USA
| | - Mason Seely
- Duke University School of Medicine, 1000 Trent Dr, Durham, NC, 27710, USA
| | - Anne L Marano
- Department of Dermatology, Duke University Medical Center, 1000 Trent Dr, Durham, NC, 27710, USA.
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7
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García Martínez A, Lobato de la Sierra MDP, Castro Aguilar-Tablada T. Combined biologic treatment in patient with chronic spontaneous urticaria and Crohn's disease. GASTROENTEROLOGIA Y HEPATOLOGIA 2024:502213. [PMID: 38815651 DOI: 10.1016/j.gastrohep.2024.502213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/14/2024] [Indexed: 06/01/2024]
Affiliation(s)
- Alejandro García Martínez
- Unidad de Gestión Clínica de Enfermedades Digestivas, Hospital Universitario Jerez de la Frontera, Jerez de la Frontera, Cádiz, España.
| | | | - Teresa Castro Aguilar-Tablada
- Unidad de Gestión Clínica de Enfermedades Digestivas, Hospital Universitario Jerez de la Frontera, Jerez de la Frontera, Cádiz, España
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8
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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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9
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Türk M, Kocatürk E, Ertaş R, Ensina LF, Mariel Ferrucci S, Grattan C, Vestergaard C, Zuberbier T, Maurer M, Giménez‐Arnau AM. A global perspective on stepping down chronic spontaneous urticaria treatment: Results of the Urticaria Centers of Reference and Excellence SDown-CSU study. Clin Transl Allergy 2024; 14:e12343. [PMID: 38353300 PMCID: PMC10865765 DOI: 10.1002/clt2.12343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Although there have been significant advances in the treatment of chronic spontaneous urticaria (CSU) in recent years, there remains a lack of clear guidance on when and how to step down treatment in responders. This study aims to investigate stepping down approaches of different steps of CSU treatment from a global perspective. METHODS "Stepping down chronic spontaneous urticaria treatment" (SDown-CSU) is an international, multicenter, observational, cross-sectional, survey-based study of the Urticaria Centers of Reference and Excellence (UCARE) network. The questionnaire included 48 questions completed by physicians in the UCARE network. RESULTS Surveys completed by 103 physicians from 81 UCAREs and 34 countries were analyzed. Seventy-eight percent of the participants responded that they had a national urticaria management guideline written by their professional societies and 28% responded that they had to operate under a regulatory guideline proposed by central health funding organizations. Seventy-two and 58.7% of these national recommendations do not contain any detailed information on when and/or how CSU treatment should be discontinued. There was a lack of detailed information on antihistamines and cyclosporine in particular. A predefined maximum duration was generally not applicable to omalizumab and cyclosporine (81% and 82%, respectively). Nearly all UCAREs step down omalizumab within 6 months from the first controlled status and 42% discontinue cyclosporine after 6 months regardless of the control status. CONCLUSIONS The findings from the SDown-CSU study clearly highlight a global need for guidance on the process of stepping down treatment in CSU. Additionally, the study offers a step-down algorithm applicable to all stages of CSU treatment.
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Affiliation(s)
- Murat Türk
- Department of Chest DiseasesDivision of Allergy and Clinical ImmunologyErciyes University School of MedicineKayseriTurkey
- Clinic of Allergy and Clinical ImmunologyKayseri City Education and Research HospitalKayseriTurkey
| | - Emek Kocatürk
- Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
| | - Ragıp Ertaş
- Department of DermatologyChronic Skin Diseases UnitUniversity of Health SciencesKayseri City Education and Research HospitalKayseriTurkey
| | - Luis Felipe Ensina
- Division of Allergy, Immunology, RheumatologyFederal University of São PauloSao PauloBrazil
| | | | - Clive Grattan
- St John's Institute of DermatologyGuy's HospitalLondonUK
| | | | - Torsten Zuberbier
- Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
| | - Marcus Maurer
- Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
| | - Ana Maria Giménez‐Arnau
- Department of DermatologyHospital del Mar & Research InstituteBarcelonaSpain
- Universitat Pompeu FabraBarcelonaSpain
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10
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Özhan AK, Arıkoğlu T. Evaluation of Pediatric Chronic Urticaria with Emphasis on Clinical and Laboratory Characteristics and Treatment Response to Omalizumab: A Real-Life Experience from a Tertiary Allergy Center. CHILDREN (BASEL, SWITZERLAND) 2024; 11:86. [PMID: 38255399 PMCID: PMC10814258 DOI: 10.3390/children11010086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024]
Abstract
Pediatric data on the clinical and etiologic features, treatment response, and use of omalizumab for chronic urticaria (CU) are quite limited. The aim of this study was to evaluate the clinical and demographic characteristics, laboratory findings, and response to treatment of CU in children. Children with a diagnosis of CU between 2019 and 2023 were included in the study. Information on demographic characteristics, clinical features, laboratory tests, provocation tests for inducible urticaria, urticaria activity scores (UAS7), and treatment responses were obtained from patients' medical records. A total of 150 children (50.7% male) with CU were enrolled in the study. A total of 14 (9.3%) patients had autoimmune diseases of which 11 (7.3%) had autoimmune thyroiditis. Overall, 97 (64.7%) patients had chronic spontaneous urticaria (CSU) and 53 (35.3%) had chronic inducible urticaria. A total of 16 patients who remained symptomatic despite high-dose antihistamines were treated with omalizumab, with a good response in 13 (81.3%) and a partial response in 3 (18.7%) patients. CSU accounts for the majority of pediatric CU, with the etiology being in part related to an autoimmune background. This study provides an overview of CU in children and demonstrates the safety and efficacy of treatment with omalizumab.
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Affiliation(s)
- Aylin Kont Özhan
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Mersin University, Mersin 33110, Turkey;
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11
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Casale TB, Gimenez-Arnau AM, Bernstein JA, Holden M, Zuberbier T, Maurer M. Omalizumab for Patients with Chronic Spontaneous Urticaria: A Narrative Review of Current Status. Dermatol Ther (Heidelb) 2023; 13:2573-2588. [PMID: 37776480 PMCID: PMC10613187 DOI: 10.1007/s13555-023-01040-9] [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: 07/26/2023] [Accepted: 09/13/2023] [Indexed: 10/02/2023] Open
Abstract
Chronic spontaneous urticaria (CSU) is a debilitating inflammatory disorder of the skin, characterized by a fluctuating natural history, a complex mechanism of action, and a significant burden on patients, including effect on quality of life, development of psychosocial disorders, and a range of comorbidities. Recent international guidelines recommend a therapeutic approach of first-line treatment with second generation H1-antihistamines and second-line treatment with the biologic omalizumab. Here, the salient aspects of CSU and current status of data for omalizumab for patients with CSU are reviewed, with a focus on mechanism of action, efficacy and real-world effectiveness (including patient outcomes, response, relapse, and remission), and safety (including consideration of the risk of anaphylaxis). The review also considers recent data on COVID-19, CSU, and omalizumab and presents our perspective on future needs. Overall, the data suggest that omalizumab is an effective and well-tolerated treatment for patients with CSU that provides benefits for a wide range of patients.
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Affiliation(s)
- Thomas B Casale
- Internal Medicine, Division of Allergy and Immunology, Morsani College of Medicine, University of South Florida, Tampa, FL, 33620, USA.
| | | | - Jonathan A Bernstein
- Department of Medicine, Division of Immunology Allergy Section, University of Cincinnati, Cincinnati, OH, USA
| | | | - Torsten Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
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12
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Bei W, Qian J, Zilu Q, Kai C, Ruili J, Feng H, Liuqing C. Comparing four immunosuppressive agents for chronic spontaneous urticaria-A network meta-analysis. Int Immunopharmacol 2023; 123:110577. [PMID: 37567010 DOI: 10.1016/j.intimp.2023.110577] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Immunosuppression is an integral part of treating chronic spontaneous urticaria (CSU), but there is no literature to evaluate the efficacy of multiple immunosuppressive agents. OBJECTIVE The comparison of the efficacy, safety, and incidence of adverse effects of four immunosuppressive medicines (tripterygium glycosides, methotrexate, cyclosporine A, and azathioprine) in combination with antihistamines in treating CSU provides a clinical reference and evidence-based medicine for treating CSU. METHODS PUBMED, The Cochrane Library, EMBASE, WANFANG, CNKI, CBM, and clinical trial registration platform were searched to collect relevant randomized controlled trials (RCT) and cohort studies of four immunosuppressive medicines combined with antihistamines for treating CSU. The primary outcomes were the efficacy of weekly urticaria activity score 7 (UAS7) and adverse effects. RESULTS This study pooled data from seven randomized clinical trials with 410 participants. The standardized mean differences for change in UAS7 were 0.10 (95% confidence interval (CI), 0.01 to 0.68) for cyclosporine A plus antihistamine; 0.03 (95% CI, 0.00 to 0.23) for azathioprine plus antihistamine; 0.52 (95% CI, 0.32 to 0.85) for tripterygium glycosides plus antihistamine; and 1.54 (95% CI, 0.64 to 3.67) for methotrexate plus antihistamine. There were no significant differences in side effects between these medicines in the limited number of trials and clinical samples. CONCLUSION Our results indicate that cyclosporine A combined with antihistamine resulted in greater improvements regarding the UAS7 in CSU patients and that tripterygium glycosides are also effective in treating CSU.
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Affiliation(s)
- Wang Bei
- Clinical College of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430000, China; Department of Dermatology, Wuhan No. 1 Hospital, Hospital of Traditional Chinese and Western Medicine Affiliated to Hubei University of Chinese Medicine, Wuhan Hospital of Traditional Chinese and Western Medicine Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430000, China; Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, Hubei 430000, China
| | - Jiang Qian
- Department of Dermatology, Wuhan No. 1 Hospital, Hospital of Traditional Chinese and Western Medicine Affiliated to Hubei University of Chinese Medicine, Wuhan Hospital of Traditional Chinese and Western Medicine Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430000, China; Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, Hubei 430000, China
| | - Qu Zilu
- Department of Dermatology, Wuhan No. 1 Hospital, Hospital of Traditional Chinese and Western Medicine Affiliated to Hubei University of Chinese Medicine, Wuhan Hospital of Traditional Chinese and Western Medicine Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430000, China; Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, Hubei 430000, China
| | - Chen Kai
- Department of Dermatology, Wuhan No. 1 Hospital, Hospital of Traditional Chinese and Western Medicine Affiliated to Hubei University of Chinese Medicine, Wuhan Hospital of Traditional Chinese and Western Medicine Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430000, China; Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, Hubei 430000, China
| | - Jiang Ruili
- Department of Dermatology, Wuhan No. 1 Hospital, Hospital of Traditional Chinese and Western Medicine Affiliated to Hubei University of Chinese Medicine, Wuhan Hospital of Traditional Chinese and Western Medicine Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430000, China; Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, Hubei 430000, China
| | - Hu Feng
- Department of Dermatology, Wuhan No. 1 Hospital, Hospital of Traditional Chinese and Western Medicine Affiliated to Hubei University of Chinese Medicine, Wuhan Hospital of Traditional Chinese and Western Medicine Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430000, China; Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, Hubei 430000, China.
| | - Chen Liuqing
- Clinical College of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430000, China; Department of Dermatology, Wuhan No. 1 Hospital, Hospital of Traditional Chinese and Western Medicine Affiliated to Hubei University of Chinese Medicine, Wuhan Hospital of Traditional Chinese and Western Medicine Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430000, China; Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, Hubei 430000, China.
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13
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LaCava AF, Fadugba OO. Cyclosporine for omalizumab-refractory chronic urticaria: a report of five cases. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:78. [PMID: 37644553 PMCID: PMC10466821 DOI: 10.1186/s13223-023-00820-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 07/10/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND While both the AAAAI/ACAAI and the EAACI/GA2LEN/EuroGuiDerm/APAAACI guidelines recommend starting cyclosporine for patients with chronic urticaria who have had an inadequate response to omalizumab, many clinicians are hesitant to initiate cyclosporine due to paucity of clinical data. The objective of this study was to report real-life clinical outcomes in adult patients with chronic urticaria who had an inadequate response to omalizumab and were switched from omalizumab to cyclosporine. Medical records of adult patients with chronic urticaria who had an inadequate response with omalizumab and were later treated with cyclosporine were reviewed retrospectively. Data pertaining to treatment method, clinical response, and adverse effects were recorded. RESULTS/PRESENTATION OF CASES Five patients with omalizumab-refractory chronic urticaria, three of whom also had angioedema and one with an inducible urticaria, were treated with low doses of oral cyclosporine (1-3 mg/kg/d). Four of five patients in this case series had complete resolution of symptoms with oral cyclosporine, while continuing other standard therapies. Systemic side effects occurred in three patients which prompted drug discontinuation in two patients. DISCUSSION Cyclosporine alone was effective in inducing urticaria control in adult patients with chronic urticaria who had an inadequate response to omalizumab, though the impact of cyclosporine was limited by reversible adverse effects. Adverse effects were associated with pre-existing medical conditions. As novel chronic urticaria therapies are being investigated, this experience highlights the importance of uncovering chronic urticaria subtypes which tend to respond to cyclosporine, while providing alternative treatments with better tolerability.
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Affiliation(s)
- Anthony F. LaCava
- Department of Allergy and Clinical Immunology, Cleveland Clinic, 224 W. Exchange Street, Suite 380, Akron, OH 44302 USA
| | - Olajumoke O. Fadugba
- Division of Pulmonary, Allergy, & Critical Care Medicine, Section of Allergy & Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA
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14
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Terhorst-Molawi D, Fox L, Siebenhaar F, Metz M, Maurer M. Stepping Down Treatment in Chronic Spontaneous Urticaria: What We Know and What We Don't Know. Am J Clin Dermatol 2023; 24:397-404. [PMID: 36810982 DOI: 10.1007/s40257-023-00761-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/23/2023]
Abstract
In chronic spontaneous urticaria (CSU), wheals, angioedema, or both appear spontaneously for > 6 weeks. Current recommended treatment options for urticaria target mast cell mediators such as histamine, or activators, such as autoantibodies. The goal of CSU treatment is to treat the disease until it is gone as effectively and safely as possible. As no cure is available for CSU as of now, the treatment is aimed at continuously suppressing disease activity, with complete control of the disease and a normalization of quality of life. To achieve this, pharmacological treatment should be continued until no longer needed. Treatment of CSU should follow the basic principles of treating as much as needed and as little as possible taking into consideration that the activity of the disease may vary. Since CSU is a disease with spontaneous remission, it is hard to tell, in patients with complete control and no signs or symptoms, when medication is no longer needed. The current international guideline for urticaria suggests that the treatment can be stepped down once a patient is free of signs and symptoms. Other reasons for stepping down the treatment of CSU patients include safety concerns or issues, pregnancy or wanting to become pregnant, and economic factors. As of now, it is unclear over which period, with what intervals and with which dosages CSU treatment should be stepped down. Guidance on this is needed for all recommended therapies: (i) standard-dosed second-generation H1-antihistamine (sgAH), (ii) higher than standard-dosed sgAH, (iii) standard-dosed omalizumab, (iv) higher than standard-dosed omalizumab, and (v) cyclosporine. However, there is a lack of controlled trials on the step down and discontinuation of these treatments. Here, we aim to provide a summary of what is known and what needs to be investigated in further studies, based on our own experience and real-world evidence.
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Affiliation(s)
- Dorothea Terhorst-Molawi
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Paul-Ehrlich-Haus, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Lena Fox
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Paul-Ehrlich-Haus, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Frank Siebenhaar
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Paul-Ehrlich-Haus, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Martin Metz
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Paul-Ehrlich-Haus, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Paul-Ehrlich-Haus, Hindenburgdamm 27, 12203, Berlin, Germany.
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany.
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15
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Abstract
Urticaria is an inflammatory skin disorder that affects up to 20% of the world population at some point during their life. It presents with wheals, angioedema or both due to activation and degranulation of skin mast cells and the release of histamine and other mediators. Most cases of urticaria are acute urticaria, which lasts ≤6 weeks and can be associated with infections or intake of drugs or foods. Chronic urticaria (CU) is either spontaneous or inducible, lasts >6 weeks and persists for >1 year in most patients. CU greatly affects patient quality of life, and is linked to psychiatric comorbidities and high healthcare costs. In contrast to chronic spontaneous urticaria (CSU), chronic inducible urticaria (CIndU) has definite and subtype-specific triggers that induce signs and symptoms. The pathogenesis of CSU consists of several interlinked events involving autoantibodies, complement and coagulation. The diagnosis of urticaria is clinical, but several tests can be performed to exclude differential diagnoses and identify underlying causes in CSU or triggers in CIndU. Current urticaria treatment aims at complete response, with a stepwise approach using second-generation H1 antihistamines, omalizumab and cyclosporine. Novel treatment approaches centre on targeting mediators, signalling pathways and receptors of mast cells and other immune cells. Further research should focus on defining disease endotypes and their biomarkers, identifying new treatment targets and developing improved therapies.
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Affiliation(s)
- Pavel Kolkhir
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.
| | - Ana M Giménez-Arnau
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mediques, Universitat Autònoma, Barcelona, Spain
| | - Kanokvalai Kulthanan
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jonny Peter
- Urticaria Center of Reference and Excellence (UCARE), Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Urticaria Center of Reference and Excellence (UCARE), Allergy and Immunology Unit, University of Cape Town, Lung Institute, Cape Town, South Africa
| | - Martin Metz
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.
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16
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Lin WK, Lin SJ, Lee WR, Lin CC, Lin WC, Chang HC, Cheng CT, Hsu JC. Effectiveness and Safety of Immunosuppressants and Biological Therapy for Chronic Spontaneous Urticaria: A Network Meta-Analysis. Biomedicines 2022; 10:biomedicines10092152. [PMID: 36140253 PMCID: PMC9496015 DOI: 10.3390/biomedicines10092152] [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: 07/22/2022] [Revised: 08/14/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022] Open
Abstract
Chronic spontaneous urticaria (CSU) is the most common phenotype of chronic urticaria. We compared treatment effects and safety profiles of the medications in patients with CSU. We searched PubMed, MEDLINE, and Web of Science for randomized control trials (RCTs), from 1 January 2000 to 31 July 2021, which evaluated omalizumab and immunosuppressants. Network meta-analyses (NMAs) were performed with a frequentist approach. Outcome assessments considered the efficacy (Dermatology Life Quality Index (DLQI) and weekly urticaria activity score (UAS7)) and tolerability profiles with evaluations of study quality, inconsistencies, and heterogeneity. We identified 14 studies which we included in our direct and indirect quantitative analyses. Omalizumab demonstrated better efficacy in DLQI and UAS7 outcomes compared to a placebo, and UAS7 assessments also demonstrated better outcomes compared to cyclosporine. Alongside this, omalizumab demonstrated relatively lower incidences of safety concerns compared to the other immunosuppressants. Cyclosporin was also associated with higher odds of adverse events than other treatment options. Our findings indicate that omalizumab resulted in greater improvements in terms of the DLQI and UAS7 with good tolerability in CSU patients compared to the other immunosuppressants.
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Affiliation(s)
- Wen-Kuang Lin
- School of Pharmacy, Taipei Medical University, Taipei 110301, Taiwan
| | - Shwu-Jiuan Lin
- School of Pharmacy, Taipei Medical University, Taipei 110301, Taiwan
| | - Woan-Ruoh Lee
- Department of Dermatology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Graduate Institute of Medical Science, School of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Chia-Chieh Lin
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Weei-Chin Lin
- Section of Hematology/Oncology, Department of Medicine and Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Hua-Ching Chang
- Department of Dermatology, Taipei Medical University Hospital, Taipei 110301, Taiwan
- Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Chi-Tsun Cheng
- Research Center of Health Care Industry Data Science, College of Management, Taipei Medical University, Taipei 110301, Taiwan
| | - Jason C. Hsu
- Research Center of Health Care Industry Data Science, College of Management, Taipei Medical University, Taipei 110301, Taiwan
- International PhD Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei 110301, Taiwan
- Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei 110301, Taiwan
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei 110301, Taiwan
- Correspondence:
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17
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Cho YT, Chan TC, Lee CH, Chou WY, Hsiao PF, Chen YJ, Wu PY, Yang CW, Chiu TM, Chang YT, Wang WM, Hong CH, Tu WT, Huang YH, Tsai TF, Lan CC, Chu CY. Taiwanese dermatological association consensus for the definition, classification, diagnosis, and management of urticaria: A 2021 update. J Formos Med Assoc 2022; 121:1191-1203. [PMID: 35219557 DOI: 10.1016/j.jfma.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/14/2022] [Accepted: 02/07/2022] [Indexed: 12/14/2022] Open
Abstract
Urticaria is a prevalent disease with substantial physical, psychological, and economic impacts. With the advent of understandings of the disease and the emerging evidence of treatments, the international guidelines for treating urticaria have been updated in recent years. In order to update the 2014 edition of the Taiwanese Dermatological Association (TDA) consensus of urticaria, a total of 17 dermatologists with extensive experience in urticaria management were invited to and attended the TDA consensus meetings. All the specific aspects of the content were approved by at least 75% of the experts in attendance. Comparing to the former edition, several substantial modifications were made. For diagnosis, D-dimer was added as the recommended routine test in patients with chronic spontaneous urticaria. For pharmacological management, treatment suggestions were simplified. The approved-dosed, the up-dosed second-generation antihistamines, omalizumab, and cyclosporine were listed as the first-line to the fourth-line treatment, respectively. In addition, the management for patients of special considerations, such as the elderly, children, and pregnant women, were all discussed and mentioned in the consensus. We hope the updated TDA consensus can serve as a reference for all physicians and can help the physicians providing up-to-dated managements for these patients.
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Affiliation(s)
- Yung-Tsu Cho
- Chen YY's Clinic, Keelung, Taiwan; Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tom C Chan
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Cung Memorial Hospital, Kaohsiung, Taiwan
| | | | - Pa-Fan Hsiao
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan
| | - Yi-Ju Chen
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Po-Yuan Wu
- Department of Dermatology, China Medical University Hospital, Taichung, Taiwan
| | - Che-Wen Yang
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan
| | - Tsu-Man Chiu
- Department of Dermatology, Changhua Christian Hospital, Changhua, Taiwan
| | - Yun-Ting Chang
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Ming Wang
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Hui Hong
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wei-Ting Tu
- Department of Dermatology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yu-Huei Huang
- Department of Dermatology, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Che Lan
- Department of Dermatology, Kaohsiung Medical University Hospital, Taiwan
| | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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18
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Bakay OSK, Kacar N. Combined treatment with omalizumab and secukinumab in a patient with chronic spontaneous urticaria and psoriasis. Dermatol Ther 2022; 35:e15638. [PMID: 35703106 DOI: 10.1111/dth.15638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/06/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | - Nida Kacar
- Pamukkale University, Department of Dermatology, Denizli, Turkey
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19
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Kolkhir P, Muñoz M, Asero R, Ferrer M, Kocatürk E, Metz M, Xiang YK, Maurer M. Autoimmune chronic spontaneous urticaria. J Allergy Clin Immunol 2022; 149:1819-1831. [PMID: 35667749 DOI: 10.1016/j.jaci.2022.04.010] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/17/2022] [Accepted: 04/14/2022] [Indexed: 12/23/2022]
Abstract
Chronic spontaneous urticaria (CSU) is a debilitating mast cell-driven disease characterized by recurrent wheals and/or angioedema. Substantial progress has been made in dissecting the 2 main autoimmune mechanisms that drive the pathogenesis of CSU. Type I autoimmune (autoallergic) CSU is associated with IgE antibodies against autoantigens, for example, thyroid peroxidase and IL-24. Type IIb autoimmune CSU is mediated by autoantibodies that activate mast cells, for example, via IgE and FcεRI, and is present in less than 10% of patients with CSU when strict criteria are used, that is, triple positivity of autologous serum skin test, immunoassays for IgG autoantibodies, and basophil activation tests. A subpopulation of patients with CSU has both types. Type IIb autoimmune CSU is characterized by higher disease severity, concomitant autoimmune diseases, low levels of total IgE, elevated levels of IgG-anti-thyroid peroxidase, basopenia, eosinopenia, poor response to antihistamines and to omalizumab, and a good response to cyclosporine. Novel targeted therapies for CSU are under development such as ligelizumab, an anti-IgE, fenebrutinib and remibrutinib, Bruton's tyrosine kinase inhibitors, and dupilumab, an anti-IL-4Rα. Further studies should investigate the overlap between autoallergic and type IIb autoimmune CSU, optimize the diagnosis of both autoimmune endotypes using easy-to-perform, noninvasive, and inexpensive markers, and assess differences in response to therapy.
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Affiliation(s)
- Pavel Kolkhir
- 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; I.M. Sechenov First Moscow State Medical University (Sechenov University), Division of Immune-Mediated Skin Diseases, Moscow, Russia
| | - Melba Muñoz
- 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; Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica san Carlo, Paderno Dugnano, Italy
| | - Marta Ferrer
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra Pamplona (IDISNA), Spain, RETIC de Asma, Reacciones Adversas y Alérgicas, Madrid (ARADyAL), Spain, Madrid, Spain
| | - Emek Kocatürk
- Koç University School of Medicine, Department of Dermatology, Istanbul, Turkey
| | - Martin Metz
- 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
| | - Yi-Kui Xiang
- 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
| | - Marcus Maurer
- 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.
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20
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Türk M, Yılmaz İ, Şahiner ÜM, Kocatürk E, Şekerel BE, Zuberbier T, Maurer M. Experience-based advice on stepping up and stepping down the therapeutic management of chronic spontaneous urticaria: Where is the guidance? Allergy 2022; 77:1626-1630. [PMID: 35048385 DOI: 10.1111/all.15227] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/04/2022] [Accepted: 01/16/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Murat Türk
- Clinic of Immunologic and Allergic Diseases Kayseri City Education and Research Hospital Kayseri Turkey
| | - İnsu Yılmaz
- Division of Allergy and Clinical Immunology Erciyes University School of Medicine Kayseri Turkey
| | - Ümit Murat Şahiner
- Pediatric Allergy Department Hacettepe University School of Medicine Ankara Turkey
| | - Emek Kocatürk
- Department of Dermatology Koç University School of Medicine İstanbul Turkey
| | - Bülent Enis Şekerel
- Pediatric Allergy Department Hacettepe University School of Medicine Ankara Turkey
| | - Torsten Zuberbier
- Institute for 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
| | - Marcus Maurer
- Institute for 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
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21
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Abstract
INTRODUCTION Across the globe, chronic urticaria (CU), i.e. chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CINDU), is common, long-persisting and difficult to manage. Still, at least one-fifth is not sufficiently controlled by guideline-recommended treatment with H1-antihistamines and add-on therapy with the anti-IgE monoclonal antibody omalizumab. AREAS COVERED Using PubMed, ClinicalTrials.gov, Congress websites, and websites of the manufacturers, this review explored the pipeline, namely anti-IgE-, anti-cytokine-, anti-receptor biologics, and small molecules, in clinical development for CU. EXPERT OPINION The CU pipeline is promising. While three omalizumab biosimilars are investigated, the assumed early approval of ligelizumab will expand the effective and safe anti-IgE approach observed with omalizumab. For other anti-IgEs like UB-221, the development is behind. Data are too limited so far to clearly define the role of anti-cytokine and anti-cytokine receptor biologics such as dupilumab, tezepelumab, mepolizumab, benralizumab, and CDX-0159, of which only dupilumab is actually investigated in phase 3. Among three selective oral BTK inhibitors, remibrutinib, rilzabrutinib, and fenebrutinib, the development of remibrutinib is most advanced (phase 3). As the pipeline addresses different targets, study results will give deeper insights into the pathomechanisms of CU. Hopefully, in the next future additional approved and also more targeted approaches will be available.
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Affiliation(s)
- Bettina Wedi
- Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, Germany
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22
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Diluvio L, Pensa C, Piccolo A, Lanna C, Bianchi L, Campione E. Coesisting inflammatory skin diseases: Tildrakizumab to control psoriasis and Omalizumab for urticaria. Dermatol Ther 2022; 35:e15359. [PMID: 35138022 DOI: 10.1111/dth.15359] [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] [Received: 11/25/2021] [Revised: 12/24/2021] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Abstract
In Western countries the number of individuals suffering from an autoimmune condition is constantly growing and often patients suffering from autoimmune disease are susceptible to developing a second autoimmune disorder. We report a case of an adult female patient affected by psoriasis vulgaris and treated with tildrakizumab, a humanized monoclonal antibody targeting interleukin-23, who later developed chronic spontaneous urticaria and started omalizumab, a humanized antibody to IgE, showing a favorable outcome. We speculate that the two combined therapies have restored the cytokine balance bringing it towards tolerance and remission of the two pathologies. It is conceivable that tildrakizumab may have a synergic action with omalizumab in the treatment of urticaria in patients affected by both psoriasis and urticaria. Our case and the study of the mechanisms of action of the two drugs suggest how the two therapies can act with an interlocking mechanism in achieving the final therapeutic effect.
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Affiliation(s)
- Laura Diluvio
- Department of Dermatology, University of Rome Tor Vergata, Viale Oxford, Rome, Italy
| | - Chiara Pensa
- Department of Dermatology, University of Rome Tor Vergata, Viale Oxford, Rome, Italy
| | - Arianna Piccolo
- Department of Dermatology, University of Rome Tor Vergata, Viale Oxford, Rome, Italy
| | - Caterina Lanna
- Department of Dermatology, University of Rome Tor Vergata, Viale Oxford, Rome, Italy
| | - Luca Bianchi
- Department of Dermatology, University of Rome Tor Vergata, Viale Oxford, Rome, Italy
| | - Elena Campione
- Department of Dermatology, University of Rome Tor Vergata, Viale Oxford, Rome, Italy
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23
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Zhao Z, Cai T, Chen H, Chen L, Chen Y, Gao X, Gao X, Geng S, Guo Y, Hao F, Hao G, Hu Y, Jin H, Jin Z, Li C, Li H, Li J, Li Y, Liang Y, Liu G, Liu Q, Long H, Ma L, Shang Y, Song Y, Song Z, Su X, Sui H, Sun Q, Sun Y, Tang J, Tong X, Wang H, Wang G, Wang L, Wang S, Xiang L, Xiao T, Xie Z, Ye L, Yu Y, Zhang C, Zhang L, Zhang S, Zheng R, Zhi L, Zhou W, Zou Y, Maurer M. Expert consensus on the use of omalizumab in chronic urticaria in China. World Allergy Organ J 2021; 14:100610. [PMID: 34934470 PMCID: PMC8654989 DOI: 10.1016/j.waojou.2021.100610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/07/2021] [Accepted: 11/02/2021] [Indexed: 11/19/2022] Open
Abstract
Chronic urticaria (CU) is a debilitating skin disease that lasts for more than 6 weeks with wheals and/or angioedema, including chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU). In China, the prevalence of this disease is high, more than 1%, and on the rise. CU has a major impact on the quality of life (QoL) of patients who frequently experience sleep disturbance, depression, and anxiety. Nearly one-third of patients with CSU, in China, are resistant to second-generation H1-antihistamines (sgAHs), even at a fourfold dose (second line; off-label). Omalizumab is approved for the treatment of CSU treatment in Europe and shows remarkable efficacy and safety. In China, regulatory approval for the use of omalizumab is pending, and its use in clinical practice varies widely. Consensus on omalizumab CU treatment in China is urgently needed. The aim of this article is to propose a practical omalizumab treatment algorithm for the management of antihistamine-resistant CSU and CIndU in adults and special population including children and adolescents, and pregnant or breast feeding women, to guide daily clinical practice in China. In the development of this consensus, an expert group including mainly dermatologists, allergists, but also pulmonologists, ENTs, immunologists, and pediatricians in Allergic Disease Prevention and Control Committee, Chinese Preventive Medicine Association, reviewed the existing evidence and developed consensus on the use of omalizumab in CU patients from China. The goal of this consensus is to assist clinicians in making rational decisions in the management of refractory CU with omalizumab. The key clinical questions covered by the treatment algorithm are: 1) Omalizumab treatment routine strategy in both CSU and CIndU patients; 2) Recommended dose and treatment duration for different age stratification; 3) Treatment duration for CU patients with other allergic comorbidities; 4) Recommendation on omalizumab stopping strategy.
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Affiliation(s)
- Zuotao Zhao
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Corresponding author. Department of Dermatology and Venereology, Peking University First Hospital, Xishiku Avenue No. 8, Beijing, PR China.
| | - Tao Cai
- Department of Dermatology and Venerology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hong Chen
- Department of Dermatology and Venerology, Tianjin People's Hospital, Tianjin Union Medical Center, Tianjin, China
| | - Liuqing Chen
- Department of Dermatology and Venerology, Wuhan No.1 Hospital, Wuhan, China
| | - Yudi Chen
- Department of Dermatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiang Gao
- Department of Allergy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xinghua Gao
- Department of Dermatology and Venerology, The First Hospital of China Medical University, Shenyang, China
| | - Songmei Geng
- Department of Dermatology and Venerology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yinshi Guo
- Department of Allergy, Renji Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Fei Hao
- Department of Dermatology and Venerology, The Third Affiliated Hospital of Chongqing Medicine University, Chongqing, China
| | - Guodong Hao
- Department of Allergy, Tangshan Gongren Hospital, Tangshan, China
| | - Yan Hu
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Hongzhong Jin
- Department of Dermatology and Venerology, Peking Union Medical College Hospital, Chinese Academy Medical Science, Peking Union Medical College, Beijing, China
| | - Zhehu Jin
- Department of Dermatology and Venerology, Yanbian University Hospital (Yanbian Hospital), Jilin, China
| | - Chengxin Li
- Department of Dermatology and Venerology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Haili Li
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Jie Li
- Department of Dermatology and Venerology, Xiangya Hospital Central South University, Changsha, China
| | - Yanming Li
- Department of Respiratory and Critical Care Medicine, Bejing Hospital, Beijing, China
| | - Yunsheng Liang
- Department of Dermatology and Venerology, Dermatology Hospital of Southern Medical University, Guangdong Provincial Dermatology Hospital, Guangdong, China
| | - Guanghui Liu
- Department of Allergy, ZhongNan Hospital of Wuhan University, Wuhan, China
| | - Qiang Liu
- Department of Dermatology and Venerology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hai Long
- Department of Dermatology and Venerology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Lin Ma
- Department of Dermatology and Venerology, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Yuanyuan Shang
- Department of Dermatology and Venerology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yuxin Song
- Department of Allergy, Harbin Children's Hospital, Harbin, China
| | - Zhiqiang Song
- Department of Dermatology and Venerology, The First Affiliated Hospital of Third Military Medical University, Chongqing, China
| | - Xiangyang Su
- Department of Dermatology and Venerology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Haijing Sui
- Department of Otorhinolaryngology Head and Neck Surgery, Peking University First Hospital, China
| | - Qing Sun
- Department of Dermatology and Venerology, Qilu Hospital, Shandong University, Jinan, China
| | - Yuemei Sun
- Department of Allergy, Yantai Yuhuangding Hospital, Yantai, China
| | - Jianping Tang
- Department of Dermatology and Venerology, Hunan Children's Hospital, Changsha, China
| | - Xunliang Tong
- Department of Respiratory and Critical Care Medicine, Bejing Hospital, Beijing, China
| | - Huiying Wang
- Department of Allergy, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Gang Wang
- Department of Dermatology and Venerology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lianglu Wang
- Department of Allergy, Peking Union Medical College Hospital, Beijing, China
| | - Siqin Wang
- Department of Allergy, Henan Provincial Peoples Hospital, Zhengzhou, China
| | - Li Xiang
- Department of Allergy, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Ting Xiao
- Department of Dermatology and Venerology, The First Hospital of China Medical University, Shenyang, China
| | - Zhiqiang Xie
- Department of Dermatology and Venerology, Peking University Third Hospital, Beijing, China
| | - Leping Ye
- Department of Paediatrics, Peking University First Hospital, Beijing, China
| | - Yongmei Yu
- Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chunlei Zhang
- Department of Dermatology and Venerology, Peking University Third Hospital, Beijing, China
| | - Litao Zhang
- Department of Dermatology and Venerology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Shuchen Zhang
- Department of Allergy, Tongji Medical College, Huazhong University of Science&Technology, Wuhan, China
| | - Rui Zheng
- Department of Dermatology and Venerology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Lili Zhi
- Department of Allergy, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Shandong Institute of Respiratory Diseases, Jinan, China
| | - Wei Zhou
- Department of Paediatrics, Peking University Third Hospital, Beijing, China
| | - Ying Zou
- Department of Dermatology and Venerology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Marcus Maurer
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin, Berlin, Germany
- Corresponding author. Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, D-10117, Berlin, Germany.
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Abstract
Chronic spontaneous urticaria (CSU) is characterized by the presence of wheals, angioedema, or both for at least 6 weeks. It may persist for a long time-up to 50% of the patients have been reported to be symptomatic 5 years after the onset. Some patients can suffer more than one episode of CSU during their lifetime. Considering the recurrences, disabling symptoms, and significant impact on quality of life, proper and effective treatment of CSU is critical. The use of antihistamines (AHs) is still the mainstay of treatment. However, given the low rates of response to AHs (38.6% and 63.2% to standard doses and higher doses, respectively), the complete control of symptoms seems difficult to attain. The use of omalizumab for CSU has been a major breakthrough in the care of patients with CSU. However, the partial response and lack of response to omalizumab in a subgroup of patients, as high as 70% in some studies, make the development of alternative treatments desirable. Ever-increasing knowledge on the pathogenesis is making new target molecules available and enabling drug development for CSU. In addition to drug repurposing as in anti-IL-4/13, IL-5, and IL-17 antibodies, novel targeted therapy options such as ligelizumab and Bruton's tyrosine kinase inhibitors are currently undergoing clinical trials and will be available in the near future. This article reviews the current challenges in the treatment of CSU, the pathogenesis and potential target molecules, and the rationale for novel treatments and their rapidly developing status.
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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.
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26
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Salman A, Aktas M, Apti Sengun O. Remission of chronic spontaneous urticaria following omalizumab with gradually extended dosing intervals: Real-life data. Australas J Dermatol 2021; 62:398-402. [PMID: 34156714 DOI: 10.1111/ajd.13656] [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: 02/09/2021] [Accepted: 05/31/2021] [Indexed: 11/27/2022]
Abstract
Omalizumab is a well-established treatment option in chronic spontaneous urticaria unresponsive to antihistamines at standard or higher doses. However, characteristics of the remission and relapse following the withdrawal of omalizumab remain largely unknown. We aimed to define the characteristics of remission in CSU following omalizumab with gradually lengthened dosing intervals in this retrospective study of 102 patients who were treated with at least 3 doses of omalizumab between 2013 and 2020. Of 102 patients, 70 (68.6%) showed a CR to omalizumab at standard doses. Omalizumab could be discontinued in 47 of 70 patients using gradually lengthened dosing intervals. Following a mean follow-up duration of 12.2 months, 25 (58.1%) patients were still in remission while 18 (41.9%) had relapse (Follow-up data were not available in 4 patients). The relapses were unresponsive to antihistamines in 14 patients (77.7%), however, re-treatment with omalizumab led to complete control of symptoms. The patients younger than 40 were more likely to relapse. Despite the need for comparison with fixed-dosing intervals in larger, prospective studies, the results of this study imply that omalizumab with gradually extended dosing intervals might provide a long duration of remission in CSU.
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Affiliation(s)
- Andac Salman
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Meryem Aktas
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ozlem Apti Sengun
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
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27
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Maurer M, Khan DA, Elieh Ali Komi D, Kaplan AP. Biologics for the Use in Chronic Spontaneous Urticaria: When and Which. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:1067-1078. [PMID: 33685605 DOI: 10.1016/j.jaip.2020.11.043] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/11/2020] [Accepted: 11/17/2020] [Indexed: 12/20/2022]
Abstract
Guidelines for the treatment of chronic spontaneous urticaria (CSU) recommend the use of the IgE-targeted biologic omalizumab in patients with antihistamine-refractory disease. The rationale for this is supported by the key role of IgE and its high-affinity receptor, FcεRI, in the degranulation of skin mast cells that drives the development of the signs and symptoms of CSU, itchy wheals, and angioedema. Here, we review the current understanding of the pathogenesis of CSU and its autoimmune endotypes. We describe the mechanisms of action of omalizumab, the only biologic currently approved for CSU, its efficacy and ways to improve it, biomarkers for treatment response, and strategies for its discontinuation. We provide information on the effects of the off-label use, in CSU, of biologics licensed for the treatment of other diseases, including dupilumab, benralizumab, mepolizumab, reslizumab, and secukinumab. Finally, we discuss targets for novel biologics and where we stand with their clinical development. These include IgE/ligelizumab, IgE/GI-310, thymic stromal lymphopoietin/tezepelumab, C5a receptor/avdoralimab, sialic acid-binding Ig-like lectin 8/lirentelimab, CD200R/LY3454738, and KIT/CDX-0159. Our aim is to provide updated information and guidance on the use of biologics in the treatment of patients with CSU, now and in the near future.
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Affiliation(s)
- Marcus Maurer
- Department of Dermatology and Allergy, Dermatological Allergology, Allergie-Centrum-Charité, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Daniel Elieh Ali Komi
- Cellular and Molecular Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Allen P Kaplan
- Department of Medicine, Medical University of South Carolina, Charleston, SC
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28
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Bauer A, Dickel H, Jakob T, Kleinheinz A, Lippert U, Metz M, Schliemann S, Schwichtenberg U, Staubach P, Valesky E, Wagner N, Wedi B, Maurer M. Expertenkonsensus zu praxisrelevanten Aspekten bei der Behandlung der chronischen Urtikaria. ALLERGO JOURNAL 2021; 30:40-55. [PMID: 33785991 PMCID: PMC7994058 DOI: 10.1007/s15007-021-4772-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hintergrund: Die chronische Urtikaria (CU) ist eine häufige und für viele Patienten stark belastende Erkrankung. Die aktuelle Urtikaria-Leitlinie beschreibt die evidenzbasierte Diagnostik und Therapie der CU. Darüber hinaus treten jedoch oftmals Fragen im praktischen Alltag auf, die durch die Leitlinie nicht beantwortet werden. Methoden: Im Mai 2020 fand ein digitales Treffen deutscher Urtikaria-Experten statt, in dem praxisrelevante Aspekte der Behandlung der CU erörtert und unterstützende Hilfestellungen für den klinischen Behandlungsalltag formuliert wurden. Die resultierenden Hinweise dieses Dokumentes fokussieren auf praktische Fragen und der hierzu verfügbaren Literatur und Erfahrungen der Teilnehmer. Ergebnisse: Die Diagnose einer CU kann in kurzer Zeit mittels gründlicher Anamnese, einer körperlichen Untersuchung und einer laborchemischen Basisdiagnostik gestellt werden. Hierzu werden in dieser Arbeit praktische Empfehlungen für den Praxisalltag gegeben. Eine erweiterte Diagnostik ist nur in wenigen Fällen indiziert und sollte grundsätzlich parallel zu einer effektiven Therapie erfolgen. Generell gilt, dass die CU immer auf gleiche Weise zu therapieren ist, unabhängig davon, ob Quaddeln, Angioödeme oder beides auftreten. Eine symptomatische Therapie sollte nach dem von den Leitlinien empfohlenen Stufenschema erfolgen. Die vorliegende Publikation gibt hierzu praktische Hinweise für Fragen in der Praxis, wie zum Beispiel dem Vorgehen in der aktuellen COVID-19-Pandemie, dem kardialen Risiko unter höher dosierten H 1-Antihistaminika, der Selbstapplikation von Omalizumab sowie dem Impfen unter Omalizumab-Therapie. Zusätzlich zu den Behandlungsempfehlungen werden Themen wie die Dokumentation in der Praxis und Familienplanung bei Urtikaria besprochen. Diskussion: Diese unterstützenden Behandlungsempfehlungen dienen als Ergänzung zu den aktuellen Leitlinien der CU und geben beim Umgang mit Patienten mit CU eine Hilfestellung für den Praxisalltag. Ziel ist es, dass Patienten, die unter einer CU leiden, mithilfe einer optimalen Therapie eine vollständige Beschwerdefreiheit erreichen.
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Affiliation(s)
- Andrea Bauer
- Universitätsklinikum Carl Gustav Carus \/ TU Dresden, Fetscherstr. 74, 1307 Dresden, Germany
| | - Heinrich Dickel
- Klinik für Dermatologie, Venerologie und Allergologie, Gudrunstr. 56, 44791 Bochum, Germany
| | - Thilo Jakob
- Universitäts-Hautklinik Gießen, Gießen, Germany
| | | | - Undine Lippert
- Universitätsmedizin Göttingen, Klinik für Dermatologie, Venerologie und Allergologie, Göttingen, Germany
| | - Martin Metz
- Charité – Universitätsmedizin Berlin, Klinik für Dermatologie, Venerologie und Allergolo, Berlin, Germany
| | | | | | | | - Eva Valesky
- Universitätsklinikum Frankfurt, Klinik für Dermatologie, Venerologie und Allergologie, Frankfurt, Germany
| | - Nicola Wagner
- Klinikum Darmstadt, Heidelberger Landstraße 379, 64297 Darmstadt-Eberstadt, Germany
| | - Bettina Wedi
- Universitätsmedizin Göttingen, Klinik für Dermatologie, Venerologie und Allergologie, Göttingen, Germany
| | - Marcus Maurer
- Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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29
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Liao SL, Yu M, Zhao ZT, Maurer M. Case Report: Omalizumab for Chronic Spontaneous Urticaria in Pregnancy. Front Immunol 2021; 12:652973. [PMID: 33796115 PMCID: PMC8007859 DOI: 10.3389/fimmu.2021.652973] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022] Open
Abstract
Most chronic spontaneous urticaria (CSU) patients are female, and pregnancy can aggravate the disease activity of patients, but little is known about the efficacy and safety of omalizumab in pregnant CSU patients. We report two pregnant CSU patients treated with omalizumab and review the published information on omalizumab treatment during 11 pregnancies. The outcomes reported on patients with known pregnancies showed they had normal pregnancies and healthy babies as well as complete control of their CSU. The two new cases we reported support the view that omalizumab could be an effective and safe treatment option for pregnant and breastfeeding CSU patients. Further high-quality studies need to be carried out in order to obtain more information on the long-term efficacy and safety of the use of omalizumab during pregnancy in patients with chronic urticaria, including CSU.
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Affiliation(s)
- Shuang-Lu Liao
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Miao Yu
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China.,Peking University School of Nursing, Beijing, China
| | - Zuo-Tao Zhao
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Wedi B, Traidl S. Anti-IgE for the Treatment of Chronic Urticaria. Immunotargets Ther 2021; 10:27-45. [PMID: 33628747 PMCID: PMC7898214 DOI: 10.2147/itt.s261416] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/22/2021] [Indexed: 12/27/2022] Open
Abstract
Urticaria and angioedema are very common. Management of chronic urticaria subtypes, which usually persist for many years, is challenging. Recent years have demonstrated that targeting IgE with antibodies provides a safe and efficient treatment approach. Whilst several anti-IgE antibodies have been developed, omalizumab is currently the only one approved for use. International and national guidelines recommend its use after failure of antihistamines at standard and increased dose. Whilst not yet approved, many new anti-IgE approaches are currently being investigated in pre-clinical studies or clinical trials. This non-systematic focused review summarizes current knowledge of omalizumab and other anti-IgE biologics in chronic urticaria using data extracted from PubMed, Google Scholar and clinical trial databases, clinicaltrials.gov and clinicaltrials.eu. For adults, there is good evidence from randomized clinical trials and real-world data that symptomatic treatment with omalizumab is efficacious and safe in chronic spontaneous urticaria (CSU), whereas evidence in chronic inducible urticaria (CINDU) and special populations is limited. Easy-to-use tools to identify non-responders and predict the required duration of treatment have not been established yet. Phase 2 b results of ligelizumab have not only demonstrated efficacy and safety but also superiority to omalizumab. Indeed, there is preliminary evidence that omalizumab non- or partial responders benefit from ligelizumab. Whereas further development of quilizumab was discontinued, other approaches, eg UB-221 or DARPins are under investigation. Anti-IgE treatment with omalizumab represents a landmark in the treatment of chronic urticaria, with and without angioedema, and there is light on the horizon suggesting success may come with various next-generation anti-IgE approaches.
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Affiliation(s)
- Bettina Wedi
- Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, Germany
| | - Stephan Traidl
- Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, Germany
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31
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Bauer A, Dickel H, Jakob T, Kleinheinz A, Lippert U, Metz M, Schliemann S, Schwichtenberg U, Staubach P, Valesky E, Wagner N, Wedi B, Maurer M. Expert consensus on practical aspects in the treatment of chronic urticaria. ACTA ACUST UNITED AC 2021; 30:64-75. [PMID: 33643777 PMCID: PMC7903036 DOI: 10.1007/s40629-021-00162-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/30/2020] [Indexed: 12/13/2022]
Abstract
Background Chronic urticaria (CU) is a common disease which represents a considerable burden for many patients. The current urticaria guideline describes the evidence-based diagnosis and treatment of CU. In addition, however, questions often arise in everyday practice that are not addressed by the guideline. Methods In May 2020, a digital meeting with German urticaria experts was held, in which practical aspects of CU treatment were discussed and supporting aids for everyday clinical treatment formulated. The resulting advice in this document focus on practical questions and the available literature and experiences of the participants. Results The diagnosis of CU can be made in a short time by means of a thorough anamnesis, a physical examination, and a basic laboratory chemical diagnosis. For this purpose, practical recommendations for everyday practice are given in this paper. An extended diagnosis is only indicated in a few cases and should always be carried out in parallel with an effective therapy. In general, CU should always be treated in the same way, regardless of whether wheals, angioedema or both occur. Symptomatic therapy should be carried out according to the treatment steps recommended by the guidelines. This publication provides practical advice on issues in everyday practice, such as the procedure in the current coronavirus disease 2019 (COVID-19) pandemic, the cardiac risk under higher dosed H1 antihistamines, the self-administration of omalizumab as well as vaccination under omalizumab therapy. In addition to treatment recommendations, topics such as documentation in the practice and family planning with urticaria will be discussed. Discussion These supporting treatment recommendations serve as an addendum to the current CU guideline and provide support in dealing with CU patients in everyday practice. The aim is to ensure that patients suffering from CU achieve complete freedom of symptoms with the help of an optimal therapy. Supplementary Information The online version of this article (10.1007/s40629-021-00162-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Bauer
- University Hospital Carl Gustav Carus, Department of Dermatology, University Allergy Center, Urticaria Center of Reference and Excellence (UCARE), Technical University, Dresden, Germany
| | - Heinrich Dickel
- Department of Dermatology, Venereology and Allergology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Thilo Jakob
- University Medical Center Giessen (UKGM), Department of Dermatology and Allergy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Andreas Kleinheinz
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Elbe Medical Centre, Buxtehude, Germany
| | - Undine Lippert
- Department of Dermatology and Allergology, Urticaria Center of Reference and Excellence (UCARE), University Medical Center Göttingen, Göttingen, Germany
| | - Martin Metz
- Department of Dermatology and Allergy, Urticaria Center of Reference and Excellence (UCARE), Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sibylle Schliemann
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), University Hospital Jena, Jena, Germany
| | | | - Petra Staubach
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), University Medical Center Mainz, Mainz, Germany
| | - Eva Valesky
- University Hospital Frankfurt, Department of Dermatology, Venerology and Allergology, Goethe University, Frankfurt, Germany
| | - Nicola Wagner
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), University Medical Center Erlangen, Erlangen, Germany
| | - Bettina Wedi
- Department of Dermatology and Allergy, Urticaria Center of Reference and Excellence (UCARE), Comprehensive Allergy Center, Hannover Medical School, Hannover, Germany
| | - Marcus Maurer
- Department of Dermatology and Allergy, Urticaria Center of Reference and Excellence (UCARE), Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Successful treatment of intractable chronic spontaneous urticaria with omalizumab in a patient with ovarian cancer. Eur J Dermatol 2021; 31:100-101. [PMID: 33459258 PMCID: PMC8120768 DOI: 10.1684/ejd.2020.3959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Omalizumab treatment and outcomes in Chinese patients with chronic spontaneous urticaria, chronic inducible urticaria, or both. World Allergy Organ J 2021; 14:100501. [PMID: 33510832 PMCID: PMC7804987 DOI: 10.1016/j.waojou.2020.100501] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/18/2020] [Accepted: 12/03/2020] [Indexed: 11/24/2022] Open
Abstract
Background Chronic urticaria (CU) is a common skin disorder, which can be further divided into chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU). Omalizumab is effective and safe for difficult-to-treat CSU based on clinical trials. However, there are limited data comparing the therapeutic effect of omalizumab for patients with CSU, CIndU, and CSU plus CIndU. Meanwhile, there is still no reliable predictor for treatment response or relapse. Our study was conducted to collect real-world clinical data on omalizumab treatment in patients with CSU, CIndU, and both. Methods This was an observational, retrospective chart review of patients with CU initiating omalizumab treatment between February 2018 and May 2020 (maximum 28 months follow-up). Results A total of 138 patients were included, 87 with CSU alone, 33 with different forms of CIndU, and 18 with both. A total of 87.0% (n = 120/138) of the CU patients responded to omalizumab therapy, among which 65.2% (n = 90/138) of the patients showed complete response and 21.7% (n = 30/138) of the patients showed partial response. The therapeutic effect and speed of onset of effect for omalizumab were comparable among patients with CSU, CIndU, or both. Autologous serum skin test (ASST)-positive patients were more likely to show a slow response to omalizumab therapy (P = 0.043). Non-responders had lower baseline total IgE levels (35.0 vs 121.5 kU/L, P < 0.001). The proportion of patients with low total IgE levels in non-responders was significantly higher than that of responders (61.1% vs. 14.5%, P < 0.001). Also, more non-responder patients had elevated thyroid autoantibodies than responders (50.0% vs. 23.0%, P = 0.041). The median ratio of serum IgG-anti-TPO to serum total IgE in non-responders was significantly higher compared with responders (1.22 vs. 0.09, P < 0.001). Non-responders also had shorter treatment periods (4.5 vs 6.0 months, P = 0.035) compared with responders. Two of 3 patients (67.4%, n = 29/43) experienced relapse after ceasing omalizumab therapy. These patients had longer disease durations (52.0 vs. 15.0 months, P = 0.007) and higher baseline total IgE levels (179.9 vs. 72.5 kU/L, P = 0.020) than patients who did not relapse. We reinitiated omalizumab treatment for 10 relapsed patients, all of them reported a rapid response after the first injection within the first 4 weeks of retreatment. Conclusion Omalizumab is highly effective in patients with difficult-to-treat CSU, CIndU, or both. Responders tend to have unique immunological features and longer treatment periods. Patients with higher baseline total IgE levels and longer disease durations are more likely to experience rapid relapse after discontinuation of omalizumab.
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Papaioannou AI, Fouka E, Papakosta D, Papiris S, Loukides S. Switching between biologics in severe asthma patients. When the first choice is not proven to be the best. Clin Exp Allergy 2020; 51:221-227. [PMID: 33305478 DOI: 10.1111/cea.13809] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/28/2020] [Accepted: 12/06/2020] [Indexed: 12/14/2022]
Abstract
During the last decades, new treatments targeting disease mechanisms referred as biologics have been introduced in the therapy of asthma and currently, five monoclonal antibodies have been approved. Although these therapeutic agents have been formulated to target specific asthma endotypes, it is often difficult for the treating physician to identify which patient is the best candidate for each one of these specific treatments especially in the clinical scenario of a patient in whom clinical characteristics overlap between different endotypes, allowing the selection of more than one biologic agent. As no head-to-head comparisons between these biologics have been attempted, there is no evidence on the superiority of one biologic agent over the other. Furthermore, a physician's first therapeutic decision, no matter how carefully has been made, may often result in suboptimal clinical response and drug discontinuation, indicating the need for switching to a different biologic. In this short review, we discuss the available evidence regarding the switching between biologics in patients with severe asthma and we propose a simple algorithm on switching possibilities in case that the physicians' initial choice is proven not to be the best.
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Affiliation(s)
- Andriana I Papaioannou
- National and Kapodistrian University of Athens, Medical School, 2nd Respiratory medicine Dept Attikon' University Hospital, Athens, Greece
| | - Evangelia Fouka
- Respiratory Medicine Department, G Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despina Papakosta
- Respiratory Medicine Department, G Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Spyridon Papiris
- National and Kapodistrian University of Athens, Medical School, 2nd Respiratory medicine Dept Attikon' University Hospital, Athens, Greece
| | - Stelios Loukides
- National and Kapodistrian University of Athens, Medical School, 2nd Respiratory medicine Dept Attikon' University Hospital, Athens, Greece
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Türk M, Yılmaz İ. High-Dose Omalizumab versus Ligelizumab for the Treatment of Chronic Spontaneous Urticaria: Do Not We Need a Head-To-Head Comparison? Int Arch Allergy Immunol 2020; 182:461-462. [PMID: 33321510 DOI: 10.1159/000512373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Murat Türk
- Clinic of Clinical Immunology and Allergic Diseases, Kayseri Şehir Research and Training Hospital, Kayseri, Turkey,
| | - İnsu Yılmaz
- Division of Clinical Immunology and Allergy, Erciyes University, Kayseri, Turkey
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36
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Türk M, Yılmaz İ, Nazik Bahçecioğlu S, Can P, Ertaş R, Kartal D, Çınar SL, Kocatürk E. Effectiveness of as-needed antihistamines in chronic spontaneous urticaria patients under omalizumab treatment. Dermatol Ther 2020; 34:e14543. [PMID: 33190334 DOI: 10.1111/dth.14543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/30/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Abstract
The question how second-generation antihistamines (sgAHs) should be used when chronic spontaneous urticaria (CSU) is under control with omalizumab is still unanswered. This study aimed to investigate the effectiveness of as-needed sgAHs in patients with well-controlled urticaria under omalizumab treatment. Patients from four different urticaria centers who were treated with omalizumab 300 mg/4 weeks for at least 3 months, had well-controlled urticaria (Urticaria Control Test: 16 > UCT≥12) and were using sgAHs only if needed, were included in this study. In order to assess effectiveness of sgAHs, change in the itch, hives, and total itch-hives scores before and after sgAHs were evaluated using modified urticaria activity score-twice daily. Fifty-three patients [38 female (71.7%)] with mean age 41.1 ± 11.4 years were included in this study. Median sgAH intake per patient throughout the 4 week-intervals was 3 (2-5) tablets. sgAH intake decreased itch, hives and total itch-hives scores 45.7% ± 52.9, 42.4% ± 39.1, and 50.2% ± 51.1, respectively (P < .001 for all). This decrease was similar in both isolated-urticaria and urticaria-and-angioedema phenotypes. Baseline IgE levels were positively correlated with the decrease of three symptom scores (r = 0.31, P = .05; r = 0.375, P = .017; r = 0.31, P = .05, respectively) that showed in patients with higher baseline total IgE levels, as needed sgAH intake decreased the symptom scores less. Our study showed that sgAHs may still be an effective option for the treatment of the intermittent symptoms in patients with well-controlled urticaria under omalizumab treatment. Baseline total IgE levels may be used as a potential biomarker for sgAH effectiveness in these patients.
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Affiliation(s)
- Murat Türk
- Division of Allergy and Clinical Immunology, Department of Chest Diseases, Erciyes University School of Medicine, Kayseri, Turkey.,Clinic of Immunological and Allergic Diseases, Kayseri Training and Research Center, Kayseri, Turkey
| | - İnsu Yılmaz
- Division of Allergy and Clinical Immunology, Department of Chest Diseases, Erciyes University School of Medicine, Kayseri, Turkey
| | - Sakine Nazik Bahçecioğlu
- Division of Allergy and Clinical Immunology, Department of Chest Diseases, Erciyes University School of Medicine, Kayseri, Turkey
| | - Pelin Can
- Department of Dermatology, Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Ragıp Ertaş
- Clinic of Dermatology, Kayseri Training and Research Center, Kayseri, Turkey
| | - Demet Kartal
- Department of Dermatology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Salih Levent Çınar
- Department of Dermatology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Emek Kocatürk
- Department of Dermatology, Okmeydanı Training and Research Hospital, İstanbul, Turkey.,Department of Dermatology, Koç University School of Medicine, İstanbul, Turkey
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37
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Su O, Bahali AG, Onsun N. The effect of at least 1‐year use of omalizumab without interruption on relapse in patients with chronic spontaneous urticaria. Dermatol Ther 2020; 33:e14192. [DOI: 10.1111/dth.14192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/24/2020] [Accepted: 08/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Ozlem Su
- Department of Dermatoveneorology Bezmialem Vakif University Istanbul Turkey
| | - Anil Gulsel Bahali
- Department of Dermatoveneorology Bezmialem Vakif University Istanbul Turkey
| | - Nahide Onsun
- Department of Dermatoveneorology Bezmialem Vakif University Istanbul Turkey
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38
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Combination therapy with omalizumab and an immune-suppressive agent for resistant chronic spontaneous rrticaria - A real-life experience. World Allergy Organ J 2020; 13:100448. [PMID: 32774663 PMCID: PMC7403771 DOI: 10.1016/j.waojou.2020.100448] [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: 04/11/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/20/2022] Open
Abstract
Background Chronic Spontaneous Urticaria (CSU) is a relatively common immune mediated disease that can be effectively treated nowadays. Nevertheless, for some patients remission cannot be achieved following current treatment recommendations, defined as resistant CSU (r-CSU). Treating r-CSU is challenging, and, currently, there are no recommended interventions. In this real-life study we describe successful therapy of 18 r-CSU patients using an "intensified protocol" of anti-IgE-antibody (omalizumab) concomitantly with an immunosuppressant. We defined the r-CSU phenotype and compared it to omalizumab-responsive CSU (Or-CSU) phenotype. Methods Clinical and serological data of 72 CSU patients (ie, 18 r-CSU and 54 age and sex matched Or-CSU) were retrospectively collected and analyzed. All patients were diagnosed with CSU for ≥6 months and treated at the Sheba Medical Center during 2013–2018. Results Of 289 CSU patients, 18 (6%) were diagnosed with r-CSU and treated with the "intensified protocol" including omalizumab and cyclosporine-A (16p), methotrexate (1p), and azathioprine (1p). Of which, 14/18 (78%) achieved complete remission, 2/18 (11%) partial remission, and 2/18 (11%) no remission. During follow-up no serious adverse events were documented. r-CSU patients received higher doses of antihistamine (p < 0.0001) and omalizumab (425 ± 58 mg/month vs. 283 ± 86 mg/month; p < 0.0001) compared to Or-CSU. The r-CSU phenotype was linked with concomitant autoimmunity (p = 0.0005) and a lower level of IgE prior to initiation of therapy (p = 0.027). Conclusion r-CSU may be a distinct CSU phenotype characterized by severe disease, concomitant autoimmunity, and lower baseline-IgE levels (low "autoallergy"). An "intensified protocol" with omalizumab and an immunosuppressive agent was found to be efficacious and safe for r-CSU. Further larger studies are required to verify these results.
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39
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Ferastraoaru D, Bax HJ, Bergmann C, Capron M, Castells M, Dombrowicz D, Fiebiger E, Gould HJ, Hartmann K, Jappe U, Jordakieva G, Josephs DH, Levi-Schaffer F, Mahler V, Poli A, Rosenstreich D, Roth-Walter F, Shamji M, Steveling-Klein EH, Turner MC, Untersmayr E, Karagiannis SN, Jensen-Jarolim E. AllergoOncology: ultra-low IgE, a potential novel biomarker in cancer-a Position Paper of the European Academy of Allergy and Clinical Immunology (EAACI). Clin Transl Allergy 2020; 10:32. [PMID: 32695309 PMCID: PMC7366896 DOI: 10.1186/s13601-020-00335-w] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/11/2020] [Indexed: 12/13/2022] Open
Abstract
Elevated serum IgE levels are associated with allergic disorders, parasitosis and specific immunologic abnormalities. In addition, epidemiological and mechanistic evidence indicates an association between IgE-mediated immune surveillance and protection from tumour growth. Intriguingly, recent studies reveal a correlation between IgE deficiency and increased malignancy risk. This is the first review discussing IgE levels and links to pathological conditions, with special focus on the potential clinical significance of ultra-low serum IgE levels and risk of malignancy. In this Position Paper we discuss: (a) the utility of measuring total IgE levels in the management of allergies, parasitosis, and immunodeficiencies, (b) factors that may influence serum IgE levels, (c) IgE as a marker of different disorders, and d) the relationship between ultra-low IgE levels and malignancy susceptibility. While elevated serum IgE is generally associated with allergic/atopic conditions, very low or absent IgE may hamper anti-tumour surveillance, indicating the importance of a balanced IgE-mediated immune function. Ultra-low IgE may prove to be an unexpected biomarker for cancer risk. Nevertheless, given the early stage of investigations conducted mostly in patients with diseases that influence IgE levels, in-depth mechanistic studies and stratification of malignancy risk based on associated demographic, immunological and clinical co-factors are warranted.
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Affiliation(s)
- D Ferastraoaru
- Department of Internal Medicine/Allergy and Immunology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY USA
| | - H J Bax
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, 9th Floor, Guy's Tower, London, SE1 9RT UK.,School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
| | - C Bergmann
- ENT Research Institute for Clinical Studies, Essen, Germany
| | - M Capron
- LIRIC-Unite Mixte de Recherche 995 INSERM, Universite de Lille 2, CHRU de Lille, Lille, France
| | - M Castells
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - D Dombrowicz
- Recepteurs Nucleaires, Maladies Cardiovasculaires et Diabete, Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, 59000 Lille, France
| | - E Fiebiger
- Division of Gastroenterology, Hepatology and Nutrition Research, Department of Medicine Research, Children's University Hospital Boston, Boston, MA USA
| | - H J Gould
- Randall Centre for Cell and Molecular Biophysics, School of Basic & Medical Biosciences, King's College London, New Hunt's House, London, SE1 1UL UK.,Medical Research Council & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - K Hartmann
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - U Jappe
- Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University of Luebeck, Luebeck, Germany.,Division of Clinical and Molecular Allergology, Research Center Borstel, Leibniz Lung Center, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Borstel, Germany
| | - G Jordakieva
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - D H Josephs
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, 9th Floor, Guy's Tower, London, SE1 9RT UK.,School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
| | - F Levi-Schaffer
- Pharmacology and Experimental Therapeutics Unit, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - V Mahler
- Division of Allergology, Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | - A Poli
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-Sur-Alzette, Luxembourg
| | - D Rosenstreich
- Department of Internal Medicine/Allergy and Immunology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY USA
| | - F Roth-Walter
- The Interuniversity Messerli Research Inst, Univ. of Vet. Medicine Vienna, Med. Univ. Vienna, Univ. Vienna, Vienna, Austria
| | - M Shamji
- Immunomodulation and Tolerance Group, Imperial College London, and Allergy and Clinical Immunology, Imperial College London, London, UK
| | - E H Steveling-Klein
- Department of Dermatology, Allergy Division, University Hospital Basel, Basel, Switzerland
| | - M C Turner
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Canada
| | - E Untersmayr
- Institute of Pathophysiology and Allergy Research, Medical University Vienna, Vienna, Austria
| | - S N Karagiannis
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, Guy's Hospital, 9th Floor, Guy's Tower, London, SE1 9RT UK.,NIHR Biomedical Research Centre at Guy's and St. Thomas' Hospitals and King's College London, Guy's Hospital, King's College London, London, UK
| | - E Jensen-Jarolim
- The Interuniversity Messerli Research Inst, Univ. of Vet. Medicine Vienna, Med. Univ. Vienna, Univ. Vienna, Vienna, Austria.,Institute of Pathophysiology and Allergy Research, Medical University Vienna, Vienna, Austria
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Sussman G, Hébert J, Gulliver W, Lynde C, Yang WH, Papp K, Gooderham M, Chambenoit O, Khalil S, DeTakacsy F, Vieira A, Rihakova L. Omalizumab Re-Treatment and Step-Up in Patients with Chronic Spontaneous Urticaria: OPTIMA Trial. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2372-2378.e5. [DOI: 10.1016/j.jaip.2020.03.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/05/2020] [Accepted: 03/13/2020] [Indexed: 01/29/2023]
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41
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Dortas Junior S, Azizi G, Valle S. Efficacy of omalizumab in chronic spontaneous urticaria associated with chronic inducible urticaria. Ann Allergy Asthma Immunol 2020; 125:486-487. [PMID: 32544531 DOI: 10.1016/j.anai.2020.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Sérgio Dortas Junior
- Serviço de Imunologia, Hospital Universitário Clementino Fraga Filho (HUCFF-UFRJ), Rio de Janeiro, Brazil.
| | - Guilherme Azizi
- Serviço de Imunologia, Hospital Universitário Clementino Fraga Filho (HUCFF-UFRJ), Rio de Janeiro, Brazil
| | - Solange Valle
- Serviço de Imunologia, Hospital Universitário Clementino Fraga Filho (HUCFF-UFRJ), Rio de Janeiro, Brazil
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42
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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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43
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Chen YD, Maurer M, Yu M, Tu P, Zhao ZT. Addition of omalizumab to antihistamine treatment in chronic urticaria: A real-world study in China. Ann Allergy Asthma Immunol 2020; 125:217-219. [PMID: 32371240 DOI: 10.1016/j.anai.2020.04.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 04/05/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Yu-Di Chen
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy Charité-Universitatsmedizin Berlin, Berlin, Germany
| | - Miao Yu
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China; Peking University School of Nursing, Beijing, China
| | - Ping Tu
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Zuo-Tao Zhao
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China.
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44
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Saini S, Shams M, Bernstein JA, Maurer M. Urticaria and Angioedema Across the Ages. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1866-1874. [PMID: 32298850 DOI: 10.1016/j.jaip.2020.03.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/18/2020] [Accepted: 03/25/2020] [Indexed: 01/17/2023]
Abstract
Chronic urticaria (CU) and angioedema can occur at any age. Although most CU with or without angioedema occurs in adults, it can also present in children or the elderly and can complicate pregnancy and breast-feeding. The presentations of CU and angioedema are different in children, middle-aged adults, and older patients as are the differential diagnoses. Therefore, the management of CU and angioedema in these different age groups and special populations needs to take into account the age-specific features of urticaria and angioedema. Here, we describe the evaluation, diagnosis, and treatment of CU and angioedema in children, middle-aged adults, and older patients. This review focuses on CU with or without angioedema and does not discuss acute urticaria or bradykinin-mediated angioedema.
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Affiliation(s)
- Sarbjit Saini
- Department of Internal Medicine, Division of Allergy and Clinical Immunology, Johns Hopkins Asthma and Allergy Center, Baltimore, Md
| | - Marissa Shams
- Department of Internal Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Jonathan A Bernstein
- Department of Internal Medicine, Division of Immunology/Allergy Section, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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