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Keller L, Stitt J. Chronic Spontaneous Urticaria: Quality of Life and Economic Impacts. Immunol Allergy Clin North Am 2024; 44:453-467. [PMID: 38937009 DOI: 10.1016/j.iac.2024.03.004] [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
This study focuses on quality of life (QoL) assessment in chronic urticaria, delving into tools, disease-specific measures, and its profound impact. With expanding therapeutic options, understanding QoL becomes crucial. QoL measures often involve comparisons of patient-reported outcomes in addition to quantitative measures of disease control. Emerging tools include the Urticaria Activity and Impact Measure, which may provide a balanced evaluation. In addition to discussions of the various QoL measures, the psychological impact of chronic urticaria are highlighted, covering emotional burden, stress, and psychiatric comorbidities. Finally, the economic impacts reveal escalating health care costs and cost-effectiveness considerations of therapies like omalizumab.
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Affiliation(s)
- Levi Keller
- Division of Allergy and Clinical Immunology, University of Colorado School of Medicine, 12700 East 19th Avenue 10C03, Aurora, CO 80045, USA.
| | - Jenny Stitt
- Division of Allergy and Clinical Immunology, University of Colorado School of Medicine, 12700 East 19th Avenue 10C03, Aurora, CO 80045, USA
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2
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Ghazanfar MN, Sørensen JA, Zhang D, Holgersen NK, Vestergaard C, Thomsen SF. Occurrence and risk factors of mental disorders in patients with chronic urticaria. World Allergy Organ J 2023; 16:100835. [PMID: 37965094 PMCID: PMC10641245 DOI: 10.1016/j.waojou.2023.100835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/29/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023] Open
Abstract
This study aimed to evaluate the prevalence and risk factors of mental disorders in patients with chronic urticaria (CU) in a cohort of adult outpatients. Mental disorders occurred in almost one-sixth of the patients with CU, depression (9.7%), and anxiety (5.0%) being the most prevalent conditions. Furthermore, a significant difference in impairment of quality of life was seen between patients with mental disorders compared to patients without. Although, the prevalence of mental disorders in patients with CU is high, larger clinical studies are needed to investigate and understand the association and risk factors of mental disorders in patients with CU.
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Affiliation(s)
| | | | - Ditte Zhang
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | | | | | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Kulthanan K, Rujitharanawong C, Munprom K, Trakanwittayarak S, Phumariyapong P, Prasertsook S, Ungprasert P. Prevalence, Clinical Manifestations, Treatment, and Clinical Course of Chronic Urticaria in Elderly: A Systematic Review. J Asthma Allergy 2022; 15:1455-1490. [PMID: 36299736 PMCID: PMC9590340 DOI: 10.2147/jaa.s379912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose Data specific to the epidemiology, clinical features, and management of chronic urticaria (CU) in the geriatric population remain limited and not well understood. We aim to systematically review the prevalence, clinical manifestations, treatment, and clinical course of elderly patients with CU. Patients and methods Original articles that included data of elderly (aged >60 years) with CU that were published until February 2021 were searched in PubMed, Scopus, and Embase using predfefined search terms. Related articles were evaluated according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Results Among the included 85 studies and 1,112,066 elderly CU patients, most (57.4%) were women. The prevalence of elderly CU in the general population ranged from 0.2–2.8%, and from 0.7–33.3% among all CU patients. Compared to adult CU, elderly CU patients had a higher percentage of wheal alone (73.9%), and lower rate of positive autologous serum skin test and atopy. Gastrointestinal diseases were the most common comorbidity (71.9%), and there was a high rate of malignancies and autoimmune diseases. Second generation H1-antihistamines were commonly used, and achievement of complete control was most often reported. Omalizumab was prescribed in 59 refractory patients, and a significant response to treatment was reported in most patients. The treatment of comorbidities also yielded significant improvement in CU. Conclusion Elderly CU was found to be different from adult CU in both clinical and laboratory aspects. H1- antihistamines are effective as first-line therapy with minimal side-effects at licensed doses. Treatment of secondary causes is important since the elderly usually have age-related comorbidities.
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Affiliation(s)
- Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chuda Rujitharanawong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanyalak Munprom
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Phumithep Phumariyapong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suthasanee Prasertsook
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patompong Ungprasert
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA,Correspondence: Patompong Ungprasert, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA, Tel +1 216 986 4000, Fax +1 216 986 4953, Email
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Metz M, Altrichter S, Buttgereit T, Fluhr JW, Fok JS, Hawro T, Jiao Q, Kolkhir P, Krause K, Magerl M, Pyatilova P, Siebenhaar F, Su H, Terhorst-Molawi D, Weller K, Xiang YK, Maurer M. The Diagnostic Workup in Chronic Spontaneous Urticaria-What to Test and Why. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2274-2283. [PMID: 33857657 DOI: 10.1016/j.jaip.2021.03.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/17/2021] [Accepted: 03/27/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND In chronic spontaneous urticaria (CSU), the guidelines recommend very limited diagnostic procedures during the routine workup, although additional investigations might be indicated in some patients with CSU. For physicians treating patients with CSU, it is often difficult to decide which diagnostic tests are useful. OBJECTIVE To provide recommendations on what diagnostic tests should be performed on which patients with CSU. METHODS We performed an extensive literature search on the respective topics and identified relevant questions that should prompt diagnostic procedures based on the published evidence and expert consensus among all authors. RESULTS We provide questions, diagnostic testing, where appropriate, and recommendation that should be included when assessing the history of a patient with CSU, to explore and rule out differential diagnoses, to assess patients for underlying causes and modifying conditions, to explore patients for comorbid diseases and consequences of having CSU, and to assess patients for CSU components that can help to predict their disease course and response to treatment. CONCLUSIONS Here, we provide physicians treating patients with CSU with information about which clues should lead to which tests and why.
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Affiliation(s)
- Martin Metz
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sabine Altrichter
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thomas Buttgereit
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Joachim W Fluhr
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jie Shen Fok
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Respiratory Medicine, Box Hill Hospital, Melbourne, Vic, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia
| | - Tomasz Hawro
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Qingqing Jiao
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Pavel Kolkhir
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Division of Immune-mediated Skin Diseases, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Karoline Krause
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Markus Magerl
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Polina Pyatilova
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Dermatology and Venereology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Frank Siebenhaar
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Huichun Su
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Dermatology and Venereology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Dorothea Terhorst-Molawi
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Karsten Weller
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Yi-Kui Xiang
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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5
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Choi GS, Nam YH, Park CS, Kim MY, Jo EJ, Park HK, Kim HK. Anxiety, depression, and stress in Korean patients with chronic urticaria. Korean J Intern Med 2020; 35:1507-1516. [PMID: 32450676 PMCID: PMC7652653 DOI: 10.3904/kjim.2019.320] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/26/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND/AIMS Emotional distress is thought to cause or maintain chronic urticaria (CU). We aimed to investigate the presence of anxiety, depression, and stress in Korean adult CU patients and to explore their potential impact on treatment. METHODS We enrolled 79 CU patients and a disease control group comprising 39 persistent asthma patients. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate depression and anxiety. Stress and quality of life (QoL) were assessed by Stress Response Inventory and CU-QoL questionnaires. The sociodemographic and clinical data such as urticaria activity score (UAS-15, UAS-6) were obtained. RESULTS The prevalence of depression and anxiety based on the HADS were 48.1% and 38.0%. Although the prevalence of anxiety didn't differ between the CU and asthma patients, depression was significantly more prevalent in the CU patients (48.1% vs. 28.2%). Stress tended to be lower in CU patients. Anxiety, depression, and stress exhibited negative correlations with QoL. Anxiety showed significant correlation with UAS-6 and pruritus-visual analog scale (VAS; r = 0.256, r = 0.272, p < 0.05, respectively); depression correlated with sleep difficulty-VAS (r = 0.261, p < 0.05). Stress was associated with UAS-15, UAS-6, pruritus-VAS, and sleep difficulty-VAS (r = 0.251, r = 0.317, r = 0.302, r = 0.258, p < 0.05, respectively). CONCLUSION The current study first presented that Korean CU patients frequently have anxiety and depression, which affect their QoL and demonstrated that anxiety, depression, and stress had different effects on sleep difficulty, pruritus, and urticaria severity in Korean CU patients.
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Affiliation(s)
- Gil-Soon Choi
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Young-Hee Nam
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Chan-Sun Park
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Mi-Yeong Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Eun-Jung Jo
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hye-Kyung Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hee-Kyoo Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
- Correspondence to Hee-Kyoo Kim, M.D. Department of Internal Medicine, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan 49267, Korea Tel: +82-51-990-6152 Fax: +82-51-990-3145 E-mail:
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Song WJ, Choi M, Lee DH, Kwon JW, Kim GW, Kim MH, Kim MA, Kim MH, Kim BK, Kim S, Kim JS, Kim JE, Kim JY, Kim JH, Kim HJ, Kim HO, Kim HB, Roh JY, Park KH, Park KY, Park HK, Park H, Bae JM, Byun JY, Song DJ, Ahn YM, Lee SE, Lee YB, Lee JS, Lee JH, Lim KH, Ye YM, Chang YS, Jeon YH, Jeon J, Jue MS, Choi SH, Choi JH, Hur GY, Park YM, Lim DH, Youn SW. The KAAACI/KDA Evidence-Based Practice Guidelines for Chronic Spontaneous Urticaria in Korean Adults and Children: Part 1. Definition, Methodology and First-line Management. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:563-578. [PMID: 32400125 PMCID: PMC7224993 DOI: 10.4168/aair.2020.12.4.563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 02/26/2020] [Accepted: 03/01/2020] [Indexed: 12/24/2022]
Abstract
Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.
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Affiliation(s)
- Woo Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mira Choi
- Department of Dermatology, Inje University Ilsan Paik Hospital, Ilsan, Korea
| | - Dong Hun Lee
- Department of Dermatology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Woo Kwon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Gun Woo Kim
- Department of Internal Medicine, St. Carollo General Hospital, Suncheon, Korea
| | - Myung Hwa Kim
- Department of Dermatology, Dankook University College of Medicine, Cheonan, Korea
| | - Mi Ae Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Min Hye Kim
- Department of Internal Medicine, College of Medicine, Ewha Woman's University, Seoul, Korea
| | - Byung Keun Kim
- Department of Internal Medicine, Korea University Medical Center Anam Hospital, Seoul, Korea
| | - Sujeong Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Joung Soo Kim
- Department of Dermatology, Hanyang University Guri Hospital, Guri, Korea
| | - Jung Eun Kim
- Department of Dermatology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ju Young Kim
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Joo Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hyun Jung Kim
- Institute for Evidence-based Medicine, Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Hye One Kim
- Department of Dermatology, Hallym University College of Medicine, Seoul, Korea
| | - Hyo Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Joo Young Roh
- Department of Dermatology, Gachon University School of Medicine Gil Medical Center, Incheon, Korea
| | - Kyung Hee Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kui Young Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Han Ki Park
- Department of Allergy and Clinical Immunology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyunsun Park
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ji Yeon Byun
- Department of Dermatology, College of Medicine, Ewha Woman's University, Seoul, Korea
| | - Dae Jin Song
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Young Min Ahn
- Department of Pediatrics, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Seung Eun Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Young Bok Lee
- Department of Dermatology, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Joong Sun Lee
- Department of Dermatology, School of Medicine, Eulji University, Daejeon, Korea
| | - Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary's Hospital, Brain Korea 21 PLUS Project for Medical Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Young Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Yoon Seok Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - You Hoon Jeon
- Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jiehyun Jeon
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Mihn Sook Jue
- Department of Dermatology, Veterans Health Service Medical Center, Seoul, Korea
| | - Sun Hee Choi
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, School of Medicine Kyung Hee University, Seoul, Korea
| | - Jeong Hee Choi
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
- Allergy and Clinical Immunology Research Center, Hallym University College of Medicine, Chuncheon, Korea
| | - Gyu Young Hur
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Young Min Park
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dae Hyun Lim
- Department of Pediatrics, School of Medicine, Inha University, Incheon, Korea.
| | - Sang Woong Youn
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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Huang Y, Xiao Y, Zhang X, Li J, Chen X, Shen M. A Meta-Analysis of Observational Studies on the Association of Chronic Urticaria With Symptoms of Depression and Anxiety. Front Med (Lausanne) 2020; 7:39. [PMID: 32175322 PMCID: PMC7056669 DOI: 10.3389/fmed.2020.00039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/27/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Chronic urticaria (CU) is a frequently occurring skin condition associated with many psychological factors, but the effect size of associations varied in literature. Objectives: To perform a systematic review and meta-analysis on the associations of CU with the symptoms of depression and anxiety. Methods: According to a pre-specified protocol, we systematically searched articles published in PubMed, Web of Science, CNKI, and CQVIP databases between January 2000 and January 2019. Pooled estimates in terms of odds ratios (ORs) or standardized mean differences (SMDs) were calculated according to outcome measures. Subgroup analysis by disease subtypes and tool of measurement, and sensitivity analysis were performed. Risk of bias and quality of studies were evaluated. Results: Twelve studies were selected for the systematic review. The ORs were 3.99 [95% confidence interval (CI): 3.24–4.91, P < 0.001] for anxiety and 2.94 (95% CI: 2.42–3.58, P < 0.001) for depression. The SMDs of severity were 0.98 for anxiety (95% CI: 0.76–1.200, P < 0.001) and 0.84 for depression (95% CI: 0.59–1.10, P < 0.001). Subgroup analysis by disease subtypes and tool of measurement showed variations in effect size, where chronic spontaneous urticaria showed greater effects on anxiety (OR = 6.62, 95% CI: 3.67–11.95, P < 0.001) and depression (OR = 6.13, 95% CI: 2.31–16.31, P < 0.001). Sensitivity analysis demonstrated consistent results. Conclusion: CU is associated with higher risks of anxiety and depression.
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Affiliation(s)
- Yuzhou Huang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
| | - Yi Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
| | - Xingyu Zhang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jie Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
| | - Minxue Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China.,Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
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8
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Chu CY, Cho YT, Jiang JH, Chang CC, Liao SC, Tang CH. Patients with chronic urticaria have a higher risk of psychiatric disorders: a population-based study. Br J Dermatol 2019; 182:335-341. [PMID: 31220338 DOI: 10.1111/bjd.18240] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The prevalence of psychiatric comorbidities in patients with chronic urticaria (CU) in a national population is largely unknown. OBJECTIVES To investigate the prevalence of psychiatric disorders and psychiatric medication use in patients with CU in Taiwan. METHODS Data were sourced from Taiwan's National Health Insurance Research Database for 2011. Patients who had a primary/secondary International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code of 708·1, 708·8 or 708·9 during 2011 with at least two outpatient visits and an antihistamine prescription were identified as CU cases. Patients with CU were classified into three disease severity groups according to their medication types. Psychiatric disorders were identified by patients having three outpatient visits with a primary or secondary diagnosis of a given psychiatric disease. Psychiatric medication use was defined by having at least four outpatient visits with prescriptions for anxiolytics, antidepressants or sleeping pills in 2010 or 2011. RESULTS Of the 167 132 patients with CU, 82·5% had mild CU, 17·0% had moderate CU and 0·4% had severe CU. Patients with CU had a higher prevalence of psychiatric disorders and psychiatric medication prescription than control groups. The relative risk (RR) of psychiatric disorders was 1·43 for patients with mild, 1·50 for patients with moderate and 2·32 for patients with severe CU vs. the controls (P < 0·001). For psychiatric medication prescription, the RRs were 1·95, 2·70 and 2·09, respectively, vs. controls (P < 0·001). CONCLUSIONS Patients with CU had a higher prevalence and risk of psychiatric disorders and psychiatric medication prescription than control groups. What's already known about this topic? Previous studies have shown a high prevalence of psychiatric comorbidities in patients with chronic urticaria (CU), with rates ranging from 35% to 60%. Anxiety, depression and somatoform disorders have been reported as the most prevalent mental disorders in patients with CU. What does this study add? Patients with CU had a higher prevalence of psychiatric disorders and psychiatric medication use than control groups in the general population. The relative risk (RR) of psychiatric disorders was 1·43 for those with mild CU, 1·50 for those with moderate CU and 2·32 for those with severe CU vs. controls. The RR for psychiatric medication use was 1·95 for those with mild CU, 2·70 for those with moderate CU and 2·09 for those with severe CU vs. controls. Mental health evaluations and management are important elements in CU management.
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Affiliation(s)
- C Y Chu
- Departments of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, 10002, Taiwan
| | - Y T Cho
- Departments of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, 10002, Taiwan
| | - J H Jiang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - C C Chang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - S C Liao
- Departments of Psychiatry, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, 10002, Taiwan
| | - C H Tang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
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9
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The expression of serotonin transporter protein in the skin of patients with chronic spontaneous urticaria and its relation with depression and anxiety. Arch Dermatol Res 2019; 311:825-831. [DOI: 10.1007/s00403-019-01969-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 12/20/2022]
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10
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Konstantinou GN, Konstantinou GN. Psychiatric comorbidity in chronic urticaria patients: a systematic review and meta-analysis. Clin Transl Allergy 2019; 9:42. [PMID: 31462988 PMCID: PMC6706894 DOI: 10.1186/s13601-019-0278-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/29/2019] [Indexed: 01/06/2023] Open
Abstract
Background Dermatological illness can affect the quality of life and may coexist with psychiatric disorders. Objective The aim of this review was to systematically evaluate the published evidence of any psychiatric disorders that may coexist with chronic urticaria (CU) and any effect psychiatric interventions may have on CU. Methods Following the Cochrane guidance, we conducted a systematic literature search using web-based search engines provided by PubMed (for Medline database), Google Scholar and Scopus for studies that have investigated the existence of psychiatric comorbidity in patients with CU. To be included, a study had to possess features, such as: (1) distinction between chronic urticaria and allergic conditions, (2) direct collection of diagnostic psychiatric data by using clinical interview and standardized questionnaires, (3) International Classification of Disorders criteria or the Diagnostic and Statistical Manual of Mental Disorders criteria for the diagnosis of mental disorders, and (4) manuscripts written or published in the English language. Unpublished research and research in progress were not included. All the eligible studies were scrutinized for any reported psychiatric interventions that had any effect on CU. The systematic review has been registered on PROSPERO (registration number CRD42019122811) and was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Results Twenty-five studies were identified. Almost one out of three CU patients have at least one underlying psychiatric disorder. None of the studies clarified whether the psychiatric disorders pre-existed the CU onset, and no association was found between CU severity and duration, and psychological functioning. Only one case report and two case series mentioned that treatment of psychiatric disorders with either anti-depressants, anti-anxiety drugs or psychological interventions might result in improvement of urticaria. Conclusions Patients with CU frequently experience psychiatric disorders. This highlights the need for a multidisciplinary therapeutic approach involving prompt recognition and management of any potential psychiatric disorder in addition to urticaria treatment. Further studies are needed to assess whether psychiatric disorders coexist with CU independently or follow urticaria onset and whether any psychological or psychiatric intervention may help in CU control.
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Affiliation(s)
| | - George N Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, 11 Eleftheriou Benizelou Street, Kalamaria, 55 133 Thessaloniki, Greece
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11
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Shah B, Levenson JL. Use of psychotropic drugs in the dermatology patient: When to start and stop? Clin Dermatol 2018; 36:748-755. [DOI: 10.1016/j.clindermatol.2018.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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12
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Antia C, Baquerizo K, Korman A, Bernstein JA, Alikhan A. Urticaria: A comprehensive review. J Am Acad Dermatol 2018; 79:599-614. [DOI: 10.1016/j.jaad.2018.01.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Kocatürk E, Piril E, Oktay T, Nilgun A, Teoman E, Serap U, Ekin S, Emel BB, Rafet K, Sebnem A. Turkish dermatologists' approach for chronic spontaneous urticaria: A questionnaire based study. DERMATOL SIN 2018. [DOI: 10.1016/j.dsi.2017.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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14
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Soliman M, Khattab FM, Ebrahim HM, Nasr M. Serum prolactin level in chronic urticaria: Is bromocriptine inducing remission in chronic urticaria? J DERMATOL TREAT 2018; 29:826-830. [PMID: 29694255 DOI: 10.1080/09546634.2018.1468062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Chronic urticaria (CU) is a disturbing disease with a negative impact on quality of life. Despite of several clinical studies on CU patients, its pathogenesis is poorly understood. Prolactin (PRL) is peptide hormone has immunomodulatory effects in some immune inflammatory skin diseases. AIM To elucidate any possible relationship between the immunomodulatory effects of PRL and CU. Besides, the study aims to investigate the crucial role of antiprolactin drugs in the management of CU patients. PATIENTS AND METHODS The serum PRL level of 40 female patients with CU was measured using the electrochemiluminescence immunoassay. The activity of CU was assessed by European Academy of Allergology and Clinical Immunology; Global Allergy and Asthma European Network; European Dermatology Forum (EAACI/GA2LEN/EDF) activity score. Patients with high PRL level had been given anti prolactin therapy to normalize their PRL levels. Then, the disease activity was reassessed in these patients. RESULTS The serum PRL level was high in 8 of 40 (20%) patients (43.18 ± 12.81). Half of patients with high PRL level had remission after treatment of hyperprolactinemia (p = .001). CONCLUSIONS Serum PRL levels could not be considered as a marker of the disease activity in CU patients.
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Affiliation(s)
- Mohamed Soliman
- a Dermatology, Venereology and Andrology Department, Faculty of Medicine , Zagazig University , Sharkia , Egypt
| | - Fathia M Khattab
- a Dermatology, Venereology and Andrology Department, Faculty of Medicine , Zagazig University , Sharkia , Egypt
| | - Howyda Mohamed Ebrahim
- a Dermatology, Venereology and Andrology Department, Faculty of Medicine , Zagazig University , Sharkia , Egypt
| | - Mohamad Nasr
- a Dermatology, Venereology and Andrology Department, Faculty of Medicine , Zagazig University , Sharkia , Egypt
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15
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Caballero T, Prior N. Burden of Illness and Quality-of-Life Measures in Angioedema Conditions. Immunol Allergy Clin North Am 2018; 37:597-616. [PMID: 28687112 DOI: 10.1016/j.iac.2017.04.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Burden of illness studies and evaluation of health-related quality of life using validated questionnaires have become an important task in the comprehensive management of angioedema conditions, mainly angioedema associated with chronic spontaneous urticaria and hereditary angioedema caused by C1-inhibitor deficiency. A review of the principal tools and studies is presented. Both diseases present a higher proportion of psychiatric disorders, impair work and studies productivity, and produce high direct and indirect costs. These assessments also have been useful to evaluate the positive impact of new drugs and interventions. More studies are desirable, especially in other types of angioedema disorders, such as hereditary angioedema with normal C1 inhibitor.
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Affiliation(s)
- Teresa Caballero
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPaz), Paseo de la Castellana 261, Madrid 28046, Spain; CIBERER (U754), Allergy Department, Hospital La Paz Institute for Health Research (IdiPaz), Paseo de la Castellana 261, Madrid 28046, Spain.
| | - Nieves Prior
- Allergy Department, Hospital Universitario Severo Ochoa, Avenida de Orellana s/n, Leganés, Madrid 28911, Spain
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16
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Bozo Ö, Demirtepe-Saygılı D, Güneş S, Çenesiz GZ, Baysan A. Does Problem Focused Coping Buffer the Effects of Trait Anxiety on Depressive Symptoms of Chronic Urticaria Patients? The Journal of General Psychology 2018; 145:64-78. [PMID: 29345527 DOI: 10.1080/00221309.2017.1420622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The present study examined the moderating role of problem-focused coping in trait anxiety-depressive symptoms' relationship in patients with chronic urticaria (CU). Eighty-eight CU patients, who applied to an outpatient clinic of Clinical Immunology and Allergic Diseases, filled out a questionnaire set including State-Trait Anxiety Inventory, Ways of Coping Inventory, and Beck Depression Inventory. The results suggested that CU patients high on trait anxiety reported more depressive symptoms, and the ones using more problem-focused coping (PFC) strategies reported less depressive symptoms. Also, PFC strategies moderated trait anxiety-depressive symptoms relation. Accordingly, PFC strategies did not lead to any significant difference in CU patients who were low on trait anxiety in terms of the level of depressive symptoms. However, CU patients with high trait anxiety experienced significantly less depressive symptoms if they used more PFC strategies. The findings were discussed in the light of the relevant literature.
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Affiliation(s)
- Özlem Bozo
- a Orta Dogu Teknik Universitesi , Psychology , Ankara , Turkey
| | | | - Seren Güneş
- a Orta Dogu Teknik Universitesi , Psychology , Ankara , Turkey
| | - Gaye Zeynep Çenesiz
- c Yuzuncu Yil Universitesi , Department of Education Sciences , Van , Turkey
| | - Abdullah Baysan
- d Haydarpaşa Sultan Abdülhamid Han Eğitim ve Araştırma Hastanesi , Division of Immunology and Allergy , Istanbul , Turkey
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17
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Chu CY, Cho YT, Jiang JH, Lin EIC, Tang CH. Epidemiology and comorbidities of patients with chronic urticaria in Taiwan: A nationwide population-based study. J Dermatol Sci 2017; 88:192-198. [PMID: 28743610 DOI: 10.1016/j.jdermsci.2017.07.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/21/2017] [Accepted: 07/11/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Comprehensive data regarding the epidemiology of chronic urticaria (CU) in general populations are scant. OBJECTIVES To investigate the prevalence, incidence, and comorbidities of CU in general population. METHODS The data were sourced from the National Health Insurance Research Database (NHIRD) for 2009-2012. Patients who had a primary/secondary ICD-9-CM diagnosis code of 708.1, 708.8, or 708.9 during the year with at least two outpatient visits and an antihistamine prescription, were identified as the cases of CU for each year. The incidence, persistence and comorbidities of CU were examined. RESULTS The prevalence of CU ranged from 0.69% to 0.79% for each year from 2009 to 2012, and the incidence was around 0.50% per year from 2010 to 2012. Comparing to the Standard Population, the standardized prevalence ratios (SPRs) for the rheumatic diseases, thyroid disorders, inflammatory diseases, and psychiatric disorders among CU patients were 2.74, 1.81, 1.57 and 1.87, respectively. CONCLUSION The prevalence of CU in Taiwan is about 0.69-0.79%. CU is associated with a significantly increased risk of psychiatric disorders, inflammatory diseases, thyroid disorders, and rheumatic diseases. Except for thyroid disorders, the prevalence of these comorbidities tends to increase the longer CU persists.
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Affiliation(s)
- Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yung-Tsu Cho
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jhih-Hua Jiang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | | | - Chao-Hsiun Tang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan.
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18
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Ograczyk A, Miniszewska J, Pietrzak A, Zalewska-Janowska A. Sense of coherence as a protective factor in chronic urticaria. Postepy Dermatol Alergol 2017; 34:168-173. [PMID: 28507497 PMCID: PMC5420610 DOI: 10.5114/ada.2017.67084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 04/03/2016] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Chronic urticaria (CU) seems to be perceived as a psychodermatological disorder. Different psychological factors play an important role in CU triggering and course. One of them is a sense of coherence (SOC), which is believed to be a protective factor against anxiety and depression. AIM To investigate quality of life (QoL) in CU patients and to compare selected psychological parameters (anxiety, depression and sense of coherence) between CU individuals and the control group. MATERIAL AND METHODS The study comprised 46 female patients with chronic urticaria and 33 healthy females as a control group. The following methods were employed: Urticaria Activity Score (UAS), Hospital Anxiety and Depression Scale (HADS), Sense of Coherence Questionnaire (SOC-29) and Dermatology Life Quality Index (DLQI). RESULTS The CU patients presented a significantly higher anxiety level in comparison to the control group (z = 4.488; p < 0.001). There were no statistically significant differences regarding depression intensity and SOC. In both groups anxiety and depression negatively correlated with global SOC and all its components. Disease severity positively correlated with QoL (ρ = 0.46, p < 0.01) and negatively with global SOC (ρ = -0.33, p < 0.05). CONCLUSIONS Bearing in mind higher prevalence of anxiety and depressive symptoms in our CU group, it would be useful to perform screening of these aspects in all CU patients and subsequently develop respective psychological interventions, based on enhancement of personal resources.
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Affiliation(s)
- Alicja Ograczyk
- Psychodermatology Department, Medical University of Lodz, Lodz, Poland
| | - Joanna Miniszewska
- Department of Health Psychology, Institute of Psychology, University of Lodz, Lodz, Poland
| | - Anna Pietrzak
- Psychodermatology Department, Medical University of Lodz, Lodz, Poland
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19
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Maurer M, Staubach P, Raap U, Richter-Huhn G, Bauer A, Ruëff F, Jakob T, Yazdi AS, Mahler V, Wagner N, Lippert U, Hillen U, Schwinn A, Pawlak M, Behnke N, Chaouche K, Chapman-Rothe N. H1-antihistamine-refractory chronic spontaneous urticaria: it's worse than we thought - first results of the multicenter real-life AWARE study. Clin Exp Allergy 2017; 47:684-692. [PMID: 28160338 DOI: 10.1111/cea.12900] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 10/05/2016] [Accepted: 01/12/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Most data on chronic spontaneous urticaria (CSU) originate from highly selected patient populations treated at specialized centres. Little is known about CSU patient characteristics and the burden of CSU in routine clinical practice. AWARE (A World-wide Antihistamine-Refractory chronic urticaria patient Evaluation) is an ongoing global study designed to assess chronic urticaria in the real-life setting. OBJECTIVE To describe the baseline characteristics of the first 1539 German AWARE patients with H1-antihistamine-refractory CSU. METHODS This prospective non-interventional study included patients (18-75 years) with a diagnosis of H1-antihistamine-refractory CSU for > 2 months. Baseline demographic and disease characteristics, comorbidities, and pharmacological treatments were recorded. Quality of life (QoL) was assessed using the dermatology life quality index (DLQI), chronic urticaria QoL questionnaire (CU-Q2 oL), and angioedema QoL questionnaire (AE-QoL, in cases of angioedema). Previous healthcare resource utilization and sick leave data were collected retrospectively. RESULTS Between March and December 2014, 1539 patients were assessed in 256 sites across Germany. The percentage of females, mean age, and mean body mass index were 70%, 46.3 years, and 27 kg/m2 , respectively. The mean urticaria control test score was 7.9, one in two patients had angioedema, and the most frequent comorbidities were chronic inducible urticaria (CIndU; 24%), allergic rhinitis (18.2%), hypertension (18.1%), asthma (12%), and depression (9.5%). Overall, 57.6% of patients were receiving at least one pharmacological treatment including second-generation H1-antihistamines (46.3%), first-generation H1-antihistamines (9.1%), and corticosteroids (15.8%). The mean DLQI, total CU-Q2 oL, and total AE-QoL scores were 8.3, 36.2, and 46.8, respectively. CSU patients reported frequent use of healthcare resources, including emergency services (29.7%), general practitioners (71.9%), and additional allergists or dermatologists (50.7%). CONCLUSIONS AND CLINICAL RELEVANCE This study reveals that German H1-antihistamine-refractory CSU patients have high rates of uncontrolled disease, angioedema, and comorbid CIndU, are undertreated, have impaired QoL, and rely heavily on healthcare resources.
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Affiliation(s)
- M Maurer
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - P Staubach
- Department of Dermatology, University Hospital Mainz, Mainz, Germany
| | - U Raap
- Department of Dermatology and Allergy, Klinikum Oldenburg AöR, University of Oldenburg, Oldenburg, Germany
| | | | - A Bauer
- Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - F Ruëff
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - T Jakob
- Department of Dermatology and Allergology, Justus Liebig University, University Medical Center Gießen and Marburg, Gießen, Germany.,Department of Dermatology, Medical Center - University of Freiburg, Freiburg, Germany
| | - A S Yazdi
- Department of Dermatology, University of Tübingen, Tübingen, Germany
| | - V Mahler
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - N Wagner
- Department of Dermatology, Clinical Centre Darmstadt, Darmstadt, Germany
| | - U Lippert
- Department of Dermatology, Venereology and Allergology, University Medical Center, Georg-August-University, Göttingen, Germany
| | - U Hillen
- Department of Dermatology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - A Schwinn
- Praxis für Dermatologie, Memmingen, Germany
| | - M Pawlak
- Hautarztpraxis, Heilbad Heiligenstadt, Germany
| | - N Behnke
- Hautarztpraxis, Panketal, Germany
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Temperament and character profiles of patients with chronic idiopathic urticaria. Postepy Dermatol Alergol 2015; 32:167-72. [PMID: 26161056 PMCID: PMC4495117 DOI: 10.5114/pdia.2015.48063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 08/10/2014] [Accepted: 11/05/2014] [Indexed: 11/23/2022] Open
Abstract
Introduction Psychosocial factors have been implicated as being important in the onset and/or exacerbation of urticaria. Aim To examine both personality factors of patients with chronic idiopathic urticaria (CIU) and the correlations between illness duration, severity of itching, urticaria activity score (UAS) and temperament-character dimensions. Material and methods A total number of 70 CIU patients and 60 healthy individuals were included in the study. The Temperament and Character Inventory (TCI) was administered individually. The relationship between UAS, illness duration and severity of pruritus and TCI subscales were evaluated. Results The CIU group had significantly higher scores of novelty seeking and lower scores of cooperativeness, reward dependence and self-directedness than the control group. Conclusions The current study shows that CIU patients have distinctive temperament and character dimensions when compared with the control group. We suggest that evaluation and treatment of CIU should also include psychosomatic approaches in clinical practice.
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Sussman G, Hébert J, Gulliver W, Lynde C, Waserman S, Kanani A, Ben-Shoshan M, Horemans S, Barron C, Betschel S, Yang WH, Dutz J, Shear N, Lacuesta G, Vadas P, Kobayashi K, Lima H, Simons FER. Insights and advances in chronic urticaria: a Canadian perspective. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2015; 11:7. [PMID: 25705232 PMCID: PMC4336710 DOI: 10.1186/s13223-015-0072-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 01/14/2015] [Indexed: 11/10/2022]
Abstract
In the past few years there have been significant advances which have changed the face of chronic urticaria. In this review, we aim to update physicians about clinically relevant advances in the classification, diagnosis and management of chronic urticaria that have occurred in recent years. These include clarification of the terminology used to describe and classify urticaria. We also detail the development and validation of instruments to assess urticaria and understand the impairment on quality-of-life and the morbidity caused by this disease. Additionally, the approach to management of chronic urticaria now focuses on evidence-based use of non-impairing, non-sedating H1-antihistamines given initially in standard doses and if this is not effective, in up to 4-fold doses. For urticaria refractory to H1-antihistamines, omalizumab treatment has emerged as an effective, safe option.
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Affiliation(s)
| | | | | | - Charles Lynde
- />University of Toronto, Medicine, Toronto, ON Canada
| | | | - Amin Kanani
- />University of British Columbia, Medicine, Kelowna, BC Canada
| | | | | | - Carly Barron
- />University of Toronto, Medicine, Toronto, ON Canada
| | | | | | - Jan Dutz
- />University of British Columbia, Medicine, Kelowna, BC Canada
| | - Neil Shear
- />University of Toronto, Medicine, Toronto, ON Canada
| | - Gina Lacuesta
- />Dalhousie University, Medicine, Halifax, NS Canada
| | - Peter Vadas
- />University of Toronto, Medicine, Toronto, ON Canada
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Ye YM, Jang GC, Choi SH, Lee J, Yoo HS, Park KH, Shin M, Kim J, Lee SY, Choi JH, Ahn Y, Park HS, Chang YS, Jeong JW, Lee S. KAAACI Work Group report on the management of chronic urticaria. ALLERGY ASTHMA & RESPIRATORY DISEASE 2015. [DOI: 10.4168/aard.2015.3.1.3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Young-Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Gwang Cheon Jang
- Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Sun Hee Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jeongmin Lee
- Maeil Central Research Laboratory, Pyeongtaek, Korea
| | - Hye-Soo Yoo
- Suwon Center for Environmental Disease and Atopy, Suwon, Korea
| | - Kyung Hee Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Meeyong Shin
- Department of Pediatrics, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jihyun Kim
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suh-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong-Hee Choi
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Youngmin Ahn
- Department of Pediatrics, Eulji University School of Medicine, Daejeon, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Won Jeong
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Sooyoung Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
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O'Donnell BF. Urticaria: impact on quality of life and economic cost. Immunol Allergy Clin North Am 2014; 34:89-104. [PMID: 24262691 DOI: 10.1016/j.iac.2013.09.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Patients with urticaria suffer itch, swellings, fatigue caused by sleep disturbance and the side effects of medication, and disruption of many facets of their lives. Much progress has been made in formally evaluating the degree of quality-of-life (QoL) impairment suffered by patients with urticaria. This review focuses on QoL in chronic urticaria (>6 weeks duration) and examines QoL measures, including the chronic urticaria-quality of life questionnaire (CU-Q2oL). Patients with urticaria have difficulty identifying and coping with their emotions. The psychiatric comorbidity and the financial burden on the patient and society because of chronic urticaria, is also examined.
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Affiliation(s)
- Brigid F O'Donnell
- Department of Dermatology, Children's University Hospital, Temple Street, Dublin 1, Ireland; Department of Dermatology, Mater Misericordiae Hospital, Eccles Street, Dublin 7, Ireland.
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Zonneveld LNL, Sprangers MAG, Kooiman CG, van 't Spijker A, Busschbach JJV. Patients with unexplained physical symptoms have poorer quality of life and higher costs than other patient groups: a cross-sectional study on burden. BMC Health Serv Res 2013; 13:520. [PMID: 24344899 PMCID: PMC3878564 DOI: 10.1186/1472-6963-13-520] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 12/09/2013] [Indexed: 12/02/2022] Open
Abstract
Background To determine whether healthcare resources are allocated fairly, it is helpful to have information on the quality of life (QoL) of patients with Unexplained Physical Symptoms (UPS) and on the costs associated with them, and on how these relate to corresponding data in other patient groups. As studies to date have been limited to specific patient populations with UPS, the objective of this study was to assess QoL and costs in a general sample of patients with UPS using generic measures. Methods In a cross-sectional study, 162 patients with UPS reported on their QoL, use of healthcare resources and lost productivity in paid and unpaid work. To assess QoL, the generic SF-36 questionnaire was used, from which multidimensional quality-of-life scores and a one-dimensional score (utility) using the SF-6D scorings algorithm were derived. To assess costs, the TiC-P questionnaire was used. Results Patients with UPS reported a poor QoL. Their QoL was mostly decreased by limitations in functioning due to physical health, and the least by limitations in functioning due to emotional problems. The median of utilities was 0.57, and the mean was 0.58 (SD = .09). The cost for the use of healthcare services was estimated to be €3,123 (SD = €2,952) per patient per year. This cost was enlarged by work-related costs: absence from work (absenteeism), lower on-the-job productivity (presenteeism), and paid substitution of domestic tasks. The resulting mean total cost was estimated to be €6,815 per patient per year. Conclusions These findings suggest that patients with UPS have a high burden of disease and use a considerable amount of healthcare resources. In comparison with other patient groups, the QoL values of patients with UPS were among the poorest and their costs were among the highest of all patient groups. The burden for both patients and society helps to justify the allocation of sufficient resources to effective treatment for patients with UPS. Trial registration Nederlands Trial Register, NTR1609
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Affiliation(s)
- Lyonne N L Zonneveld
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus Medical Center, PO Box 2040, 3000, CA Rotterdam, The Netherlands.
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Ben-Shoshan M, Blinderman I, Raz A. Psychosocial factors and chronic spontaneous urticaria: a systematic review. Allergy 2013; 68:131-41. [PMID: 23157275 DOI: 10.1111/all.12068] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is one of the most costly allergic conditions challenging physicians as well as patients and their families. Despite evident lacunae in the understanding of the pathogenesis, at least some findings suggest that psychosocial factors likely contribute to the development and exacerbation of CSU. We aim to assess the contribution of psychological factors to CSU. METHODS Systematic search of PubMed and OVID/Medline databases was conducted from 1 January 1935 to 1 January 2012. Studies selected include original research in English, Spanish and French exploring the association between CSU and psychosocial factors. Two investigators independently reviewed all titles and abstracts to identify potentially relevant articles and resolved discrepancies by repeated review and discussion and arbitration of a third reviewer. Quality of systematic reviews and meta-analyses was assessed using a measure based on the Newcastle-Ottawa Scale and psychological conditions of CSU patients. RESULTS We identified 114 eligible studies spanning 77 years and featuring 17 reviews, 67 studies related to neither CSU nor psychosocial factors, and eight studies that provided either no prevalence estimates or insufficient sample size. Pooling effect sizes using random effects, analyses revealed that, despite large heterogeneity (I(2) of 97.60%), psychosocial factors had a prevalence of 46.09% (95% confidence interval, 44.01%, 48.08%). CONCLUSION Future research needs to better establish the contribution of psychosocial factors to the pathogenesis and exacerbation of CSU, and explore the possible benefit of behavioural interventions to the development of new management strategies.
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Affiliation(s)
- M. Ben-Shoshan
- Division of Paediatric Allergy and Clinical Immunology, Department of Paediatrics; McGill University Health Center; Montreal; Quebec; Canada
| | - I. Blinderman
- Department of Psychiatry; Lady Davis Institute for Medical Research and Jewish General Hospital, McGill University; Montreal; Quebec; Canada
| | - A. Raz
- Departments of Psychiatry, Neurology and Neurosurgery, and Psychology; Lady Davis Institute for Medical Research and Jewish General Hospital, McGill University; Montreal; Quebec; Canada
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Zonneveld LNL, van Rood YR, Timman R, Kooiman CG, Van't Spijker A, Busschbach JJV. Effective group training for patients with unexplained physical symptoms: a randomized controlled trial with a non-randomized one-year follow-up. PLoS One 2012; 7:e42629. [PMID: 22880056 PMCID: PMC3413637 DOI: 10.1371/journal.pone.0042629] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Accepted: 07/09/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although cognitive-behavioral therapy for Unexplained Physical Symptoms (UPS) is effective in secondary care, studies done in primary care produced implementation problems and conflicting results. We evaluated the effectiveness of a cognitive-behavioral group training tailored to primary care patients and provided by a secondary community mental-health service reaching out into primary care. METHODOLOGY/PRINCIPAL FINDINGS The effectiveness of this training was explored in a randomized controlled trial. In this trial, 162 patients with UPS classified as undifferentiated somatoform disorder or as chronic pain disorder were randomized either to the training or a waiting list. Both lasted 13 weeks. The preservation of the training's effect was analyzed in non-randomized follow-ups, for which the waiting group started the training after the waiting period. All patients attended the training were followed-up after three months and again after one year. The primary outcomes were the physical and the mental summary scales of the SF-36. Secondary outcomes were the other SF-36-scales and the SCL-90-R. The courses of the training's effects in the randomized controlled trial and the follow-ups were analyzed with linear mixed modeling. In the randomized controlled trial, the training had a significantly positive effect on the quality of life in the physical domain (Cohen's d = 0.38;p = .002), but this overall effect was not found in the mental domain. Regarding the secondary outcomes, the training resulted in reporting an improved physical (Cohen's d = 0.43;p = 0.01), emotional (Cohen's d = 0.44;p = 0.01), and social (Cohen's d = 0.36;p = 0.01) functioning, less pain and better functioning despite pain (Cohen's d = 0.51;p = <0.001), less physical symptoms (Cohen's d = -.23;p = 0.05) and less sleep difficulties (Cohen's d = -0.25;p = 0.04) than time in the waiting group. During the non-randomized follow-ups, there were no relapses. CONCLUSIONS/SIGNIFICANCE The cognitive-behavioral group training tailored for UPS in primary care and provided by an outreaching secondary mental-health service appears to be effective and to broaden the accessibility of treatment for UPS. TRIAL REGISTRATION TrialRegister.nl NTR1609
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Affiliation(s)
- Lyonne N L Zonneveld
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Weller K, Viehmann K, Bräutigam M, Krause K, Siebenhaar F, Zuberbier T, Maurer M. Cost-intensive, time-consuming, problematical? How physicians in private practice experience the care of urticaria patients. J Dtsch Dermatol Ges 2011; 10:341-7. [DOI: 10.1111/j.1610-0387.2011.07822.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hergüner S, Kiliç G, Karakoç S, Tamay Z, Tüzün U, Güler N. Levels of depression, anxiety and behavioural problems and frequency of psychiatric disorders in children with chronic idiopathic urticaria. Br J Dermatol 2011; 164:1342-7. [PMID: 21083542 DOI: 10.1111/j.1365-2133.2010.10138.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several studies reported that adults with chronic idiopathic urticaria (CIU) frequently exhibit psychiatric comorbidity, most commonly depression and anxiety disorders. However the literature about children is limited. OBJECTIVES To investigate the frequency of psychiatric disorders and to determine the levels of depression, anxiety and behavioural problems in a group of children with CIU. METHODS The study included 27 children with CIU and 27 age- and sex-matched healthy subjects. Psychiatric assessment was done by using the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL). The State-Trait Anxiety Inventory for Children (STAI-C), Children's Depression Inventory (CDI) and Child Behavior Checklist (CBCL) were used to examine the levels of depression, anxiety and behavioural behaviours, respectively. RESULTS The study group had more frequent psychiatric diagnoses than the control group (70% vs. 30%) and the most common psychiatric disorders were social anxiety disorder, separation anxiety disorder and specific phobia. Depression, trait anxiety, internalizing problems, somatic complaints and anxiety/depressed scores were significantly higher in children with CIU. No correlation was found between the severity and duration of illness and psychological functioning. CONCLUSION This study showed that children with CIU had high psychiatric morbidity. The results suggest that the psychological status of children with CIU should be screened by clinicians and that an interdisciplinary approach combining dermatological and psychiatric evaluations is necessary for the management of CIU.
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Affiliation(s)
- S Hergüner
- Department of Child and Adolescent Psychiatry, Division of Allergy and Chest Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Barbosa F, Freitas J, Barbosa A. Chronic idiopathic urticaria and anxiety symptoms. J Health Psychol 2011; 16:1038-47. [PMID: 21459916 DOI: 10.1177/1359105311398682] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Chronic idiopathic urticaria (CIU) is a frequently disabling disease with a negative influence on the quality of life, and can cause psychopathological symptoms, such as anxiety. Our aim is to study further anxiety symptoms on CIU patients. Both CIU patients and the control group were studied by means of validated scales for psychopathology symptoms, psychological variables and quality of life. In this study, we reported high levels of anxiety symptoms. We found statistically significant correlations between anxiety symptoms, some personality dimensions, insecure attachment styles, alexithymia and with some quality of life dimensions. CIU patients exhibit high levels of psychological distress that could potentiate difficulties at several domains, namely social, emotional, general health perception and interpersonal relationships.
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Affiliation(s)
- Filipe Barbosa
- Hospital Santa Maria, Rua Prof. Armindo Monteiro, Lisbon, Portugal.
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Maurer M, Weller K, Bindslev-Jensen C, Giménez-Arnau A, Bousquet PJ, Bousquet J, Canonica GW, Church MK, Godse KV, Grattan CEH, Greaves MW, Hide M, Kalogeromitros D, Kaplan AP, Saini SS, Zhu XJ, Zuberbier T. Unmet clinical needs in chronic spontaneous urticaria. A GA²LEN task force report. Allergy 2011; 66:317-30. [PMID: 21083565 DOI: 10.1111/j.1398-9995.2010.02496.x] [Citation(s) in RCA: 496] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Chronic spontaneous urticaria, formerly also known as chronic idiopathic urticaria and chronic urticaria (CU), is more common than previously thought. At any time, 0.5-1% of the population suffers from the disease (point prevalence). Although all age groups can be affected, the peak incidence is seen between 20 and 40 years of age. The duration of the disease is generally 1-5 years but is likely to be longer in more severe cases, cases with concurrent angioedema, in combination with physical urticaria or with a positive autologous serum skin test (autoreactivity). Chronic spontaneous urticaria has major detrimental effects on quality of life, with sleep deprivation and psychiatric comorbidity being frequent. It also has a large impact on society in terms of direct and indirect health care costs as well as reduced performance at work and in private life. In the majority of patients, an underlying cause cannot be identified making a causal and/or curative treatment difficult. Nonsedating H₁-antihistamines are the mainstay of symptomatic therapy, but treatment with licensed doses relieves symptoms effectively in < 50% of patients. Although guideline-recommended updosing up to fourfold increases symptom control in many patients, a substantial number of patients have only little benefit from H₁ -antihistamines. Consequently, there is a great need for new therapeutic strategies.
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Affiliation(s)
- M Maurer
- Department of Dermatology and Allergy, Charité- Universitätsmedizin Berlin, Berlin, Germany.
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Weller K, Altrichter S, Ardelean E, Krause K, Magerl M, Metz M, Siebenhaar F, Maurer M. [Chronic urticaria. Prevalence, course, prognostic factors and impact]. Hautarzt 2011; 61:750-7. [PMID: 20694454 DOI: 10.1007/s00105-010-1933-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Chronic urticaria (CU) is one of the most frequent diseases in the field of dermatology. Recent studies have shown a point prevalence between 0.5 and 1% in the total population with a predominance of females. In general, all age groups and all classes of the population can be affected. An incidence peak has been found in the third and fourth decades. According to the current guidelines, CU is characterized by the spontaneous occurrence of wheals and/or angioedema for more than 6 weeks. However, epidemiological studies have revealed that the majority of patients suffer for several months, or frequently years. Disease duration is likely to be longer in case of angioedema, a combination with physical urticaria, positivity in the autologous serum skin test (autoreactivity) and a high disease severity. Studies on the impairment of quality of life have been shown that many CU patients suffer as strong from their disease as patients with coronary artery disease. Apart from pure physical symptoms, patients experience restrictions in daily life activities and social life. In addition, sleep disturbances are common and CU patients frequently exhibit psychiatric comorbidities. To avoid frustration in care, it is important to perceive all different dimensions of CU that impact the patient's life and to take the patients and their disease seriously. The aim of therapy should be to obtain total symptom control.
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Affiliation(s)
- K Weller
- Klinik für Dermatologie, Venerologie und Allergologie, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin.
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Rasoulian M, Ebrahimi AA, Zare M, Taherifar Z. Psychiatric morbidity in dermatological conditions. Int J Psychiatry Clin Pract 2010; 14:18-22. [PMID: 24917228 DOI: 10.3109/13651500903262370] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract Objective. A relationship between psychological factors and skin diseases has long been hypothesized. The objective of this study is to investigate the association of dermatology conditions with depression, anxiety and personality disorders. Method. A total of 144 dermatology outpatients and 100 controls were selected and assessed by the Structured Clinical Interview for DSM III-R personality disorders and the Hospital Anxiety and Depression Scale for presence of personality disorders and anxiety and depression. Results. A total of 77 (70%) of the patients and 26 (20%) of the control group reported moderate to severe anxiety and depression. Twenty-two patients (15.27%) and five controls (5%) suffered from personality disorders. Obsessive-compulsive personality disorder was the most diagnosed personality disorder followed by avoidant, borderline and dependent personalities. Conclusion. The association between dermatological diseases and psychiatric and personality morbidity underscores the deep emotional suffering that can be associated with skin diseases and confirms the importance of psychiatric evaluation of dermatology patients. Our findings highlight the need for a biopsychosocial approach to patients with skin disease.
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Affiliation(s)
- Maryam Rasoulian
- Rasoul Akram Hospital, Psychiatry, Tehran, Islamic Republic of Iran
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Abstract
PURPOSE OF REVIEW This review discusses some of the recent advances in basic and clinical research focused on chronic urticaria. It is a concise summary of issues that occupied researchers' attention in the previous year, and it discusses a selection of novel findings that further our understanding of the pathomechanism of this disease. RECENT FINDINGS Particular consideration is given to the role of basophils, the coagulation cascade, fibrinolysis, and hormonal pathways in chronic urticaria pathogenesis. The description of clinical data is focused on prognostic issues, disease severity, and the effects of the disease on patients' quality of life. SUMMARY Mast cells are the key elements in chronic urticaria pathogenesis, whereas basophils should be regarded as bystanders and serve as biomarkers in some chronic urticaria subsets. The coagulation cascade, hormonal factors, and the psychological status of the patients seem to contribute substantially to the course and activity of the disease. Nonsedating second-generation antihistamines should be considered as first-line symptomatic treatment for chronic urticaria. Of note, the dosage should be increased up to four-fold if required before switching to second-line therapies.
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Uguz F, Engin B, Yilmaz E. Quality of life in patients with chronic idiopathic urticaria: the impact of Axis I and Axis II psychiatric disorders. Gen Hosp Psychiatry 2008; 30:453-7. [PMID: 18774429 DOI: 10.1016/j.genhosppsych.2008.06.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Revised: 05/24/2008] [Accepted: 06/13/2008] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Chronic idiopathic urticaria (CIU) associated with lower quality of life (QoL) levels. Psychiatric disturbances are frequently present in patients with CIU. This study examined the impact of Axis I and Axis II psychiatric disorders on the QoL of patients with CIU. METHOD The study sample consisted of 100 subjects including CIU patients with only Axis I psychiatric diagnoses (n=25), CIU patients with only Axis II diagnoses (n=25), CIU patients with both Axis I and Axis II diagnoses (n=25), CIU patients without any Axis I and Axis II diagnosis (n=25), and healthy control subjects with respect to urticaria and psychiatric disorders (n=25). The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (SCID-1) and the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders (SCID-II) was used to determine Axis I and Axis II psychiatric disorders, respectively. QoL levels were assessed by means of the World Health Organization QoL Assessment-Brief (WHOWOL-BREF). RESULTS There were significant differences among the groups with respect to all WHOQOL-BREF subscale scores. The QoL levels were similar among CIU patients with only Axis I psychiatric diagnoses, CIU patients with only Axis II diagnoses and CIU patients with both Axis I and Axis II diagnoses, and between CIU patients without any Axis I and Axis II diagnosis, and healthy control subjects. When compared with those of CIU patients without any Axis I and Axis II diagnosis, CIU patients without concurrent psychiatric diagnoses had significantly lower scores in most domains of the QoL scale. CONCLUSIONS Axis I and Axis II psychiatric disorders seem to be considerable factors influencing the QoL in CIU patients.
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Affiliation(s)
- Faruk Uguz
- Department of Psychiatry, Meram Faculty of Medicine, Selçuk University, Konya, Turkey.
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