1
|
Kim H, Hyun MC, Choi BS. Natural History and Influencing Factors of Chronic Urticaria in Children. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 14:73-84. [PMID: 34983108 PMCID: PMC8724829 DOI: 10.4168/aair.2022.14.1.73] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/26/2021] [Accepted: 09/01/2021] [Indexed: 11/23/2022]
Abstract
Purpose Chronic urticaria (CU) can reduce the quality of life of children and their parents, but there are only a few studies on the course of CU in children. This study aimed to investigate the natural course of CU in children and identify the factors that influence its prognosis. Methods We evaluated 77 children diagnosed with CU, who were monitored for at least 48 months. Subjects were classified as either chronic spontaneous urticaria (CSU) or other CU, and the clinical features were compared. Remission was defined as having no symptoms without treatment for more than 1 year. The remission rate was analyzed, and the factors influencing the prognosis were investigated. Results The average age of the study population was 5.96 ± 4.06 years, and 64 (83.1%) patients had CSU. The remission rates at 6 months, 1 year, 2 years, 3 years, and 4 years after symptom onset were 22.1%, 40.3%, 52.0%, 63.7%, and 70.2%, respectively, for children with CU. For children with CSU, these values were 23.4%, 43.7%, 56.2%, 68.7%, and 75.0%, respectively. The total serum immunoglobulin E (IgE) levels were positively correlated with disease duration (r = 0.262, P = 0.021); no other factors were associated with the duration of the disease. Conclusions A high proportion of children with CU were classified as CSU. No indicators, except for total IgE were found to predict the timing of spontaneous remission. The CU remission rate identified in this study is expected to be used as one of the reference data for the progress of CU in patients.
Collapse
Affiliation(s)
- Hyeona Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Myung Chul Hyun
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Bong Seok Choi
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| |
Collapse
|
2
|
Weller K, Giménez‐Arnau A, Grattan C, Asero R, Mathelier‐Fusade P, Bizjak M, Hanna M, Maurer M. The Chronic Urticaria Registry: rationale, methods and initial implementation. J Eur Acad Dermatol Venereol 2020; 35:721-729. [DOI: 10.1111/jdv.16947] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/24/2020] [Indexed: 11/26/2022]
Affiliation(s)
- K. Weller
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - A. Giménez‐Arnau
- Department of Dermatology, Hospital del Mar Autonomous University of Barcelona Barcelona Spain
| | - C. Grattan
- St John's Institute of Dermatology London UK
| | - R. Asero
- Outpatient Clinic of Allergology San Carlo Hospital Paderno Dugnano Italy
| | | | - M. Bizjak
- University Clinic of Respiratory and Allergic Diseases Golnik Golnik Slovenia
| | - M. Hanna
- Mercury Medical Research & Writing New York NY USA
| | - M. Maurer
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | | |
Collapse
|
3
|
A single reaction-diffusion equation for the multifarious eruptions of urticaria. PLoS Comput Biol 2020; 16:e1007590. [PMID: 31940345 PMCID: PMC6961880 DOI: 10.1371/journal.pcbi.1007590] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 12/08/2019] [Indexed: 12/29/2022] Open
Abstract
Urticaria is a common skin disorder characterized by the rapid appearance and disappearance of local skin edema and flares with itching. It is characterized by various macroscopic skin eruptions unique to patients and/or subtypes of urticaria with respect to shape, size, color, and/or duration of eruptions. Nevertheless, the mechanism underlying multifarious eruptions in urticaria is largely unknown. The eruptions are believed to be evoked by histamine release from mast cells in the skin. However, the majority of visible characteristics of urticaria cannot be explained by a simple injection of histamine to the skin. To explain the multifarious eruptions of urticaria, we developed a single reaction-diffusion model suggesting the self-activation and self-inhibition regulation of histamine release from mast cells. Using the model, we found that various geometrical shapes of eruptions typically observed in patients can be explained by the model parameters and randomness or strength of the initial stimuli to mast cells. Furthermore, we verified that the wheal-expanding speed of urticaria, which is shown to be much smaller than that of the intradermal injection experimental system may be explained by our model and a simple diffusion equation. Our study suggests that the simple reaction-diffusion dynamics, including the independent self-activating and -inhibitory regulation of histamine release, may account for the essential mechanism underlying the formation of multifarious eruptions in urticaria. Urticaria is a common skin disease but the mechanism underlying wheal formation is not well understood. Our mathematical model suggests that not only the self-activation of histamine production via mast cells, but also self-inhibition of histamine dynamics plays a critical role in generating the wide-spread wheal patterns observed in urticaria; this has not been previously considered in medicine. The study findings may increase the understanding of the pathogenesis of urticaria and may aid decision-making for appropriate treatments. It may also open an entirely new avenue for mathematical approaches to analyze various skin diseases with geometric eruptions and predict the effectiveness of treatments through in silico experiments.
Collapse
|
4
|
Criado PR, Maruta CW, Alchorne ADODA, Ramos AMC, Gontijo B, Santos JBD, Martins LEAM, Rivitti-Machado MC, Silvares MRC, Pires MC, Souza PKD, Orfali RL, Bonamigo RR, Bedrikow RB, Criado RFJ, Oliveira ZNPD. Consensus on the diagnostic and therapeutic management of chronic spontaneous urticaria in adults - Brazilian Society of Dermatology. An Bras Dermatol 2019; 94:56-66. [PMID: 31166404 PMCID: PMC6544033 DOI: 10.1590/abd1806-4841.2019940209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/07/2018] [Indexed: 11/22/2022] Open
Abstract
Background Urticarias are frequent diseases, with 15% to 20% of the population
presenting at least one acute episode in their lifetime. Urticaria are
classified in acute ( ≤ 6 weeks) or chronic (> 6 weeks). They may
be induced or spontaneous. Objectives To verify the diagnostic and therapeutic recommendations in chronic
spontaneous urticaria (CSU), according to the experience of Brazilian
experts, regarding the available guidelines (international and US). Methods A questionnaire was sent to Brazilian experts, with questions concerning
diagnostic and therapeutic recommendations for CSU in adults. Results Sixteen Brazilian experts answered the questionnaire related to diagnosis and
therapy of CSU in adults and data were analyzed. Final text was written,
considering the available guidelines (International and US), adapted to the
medical practices in Brazil. Diagnostic work up in CSU is rarely necessary.
Biopsy of skin lesion and histopathology may be indicated to rule out other
diseases, such as, urticarial vasculitis. Other laboratory tests, such as
complete blood count, CRP, ESR and thyroid screening. Treatment of CSU
includes second-generation anti-histamines (sgAH) at licensed doses, sgAH
two, three to fourfold doses (non-licensed) and omalizumab. Other drugs,
such as, cyclosporine, immunomodulatory drugs and immunosuppressants may be
indicated (non-licensed and with limited scientific evidence). Conclusions Most of the Brazilian experts in this study partially agreed with the
diagnostic and therapeutic recommendations of the International and US
guidelines. They agreed with the use of sgAH at licensed doses. Increase in
the dose to fourfold of sgAH may be suggested with restrictions, due to its
non-licensed dose. Sedating anti-histamines, as suggested by the US
guideline, are indicated by some of the Brazilian experts, due to its
availability. Adaptations are mandatory in the treatment of CSU, due to
scarce or lack of other therapeutic resources in the public health system in
Brazil, such as omalizumab or cyclosporine.
Collapse
Affiliation(s)
| | - Celina Wakisaka Maruta
- Department of Dermatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Andréa Machado Coelho Ramos
- Dermatology Service, Hospital das Clinicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Bernardo Gontijo
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Josemir Belo Dos Santos
- Centro de Ciências Médicas, Faculdade de Medicina, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | | | | | | | | | - Patricia Karla de Souza
- Urticaria Outpatient Clinic, Department of Dermatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Raquel Leão Orfali
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Renan Rangel Bonamigo
- Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | | |
Collapse
|
5
|
Zhang L, Xiao X, Hui R, Shi Y, Deng Y, Zheng H, Zheng Q, Zhou S, Yao J, Cao W, Liu Y, Hao P, Li Y. Autologous whole-blood or autologous serum acupoint injection therapy for chronic urticaria: A systematic review protocol. Medicine (Baltimore) 2019; 98:e16127. [PMID: 31232963 PMCID: PMC6636973 DOI: 10.1097/md.0000000000016127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Chronic urticaria (CU) is a common and easily recurring skin disease in the world. Many trials have shown that autologous whole-blood or autologous serum acupoint injection therapy is effective in treating CU. There is currently no systematic review of this therapy. The program aims to evaluate the effectiveness and safety of this therapy in patients with CU. METHODS Literature search will be conducted at Medline, PubMed, Excerpt Medica Database, Springer, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journal Database, and other databases. The search date is until May 2019. We will search for popular terms including CU and this therapy. Import the literature electronically. Duplicate documents will be deleted. The primary outcome is the urticaria activity score or other validated scales. Secondary outcomes included response rate, quality of life scale, recurrence rate, and adverse events. A systematic review and search for a randomized controlled trial of this therapy for CU. Implement the Cochrane RevMan V5.3 bias assessment tool to assess bias assessment risk, data integration risk, meta-analysis risk, and subgroup analysis risk (if conditions are met). The mean difference, standard MD, and binary data will be used to represent continuous results. RESULTS This study will provide a comprehensive review of the available evidence for the treatment of CU with this therapy. CONCLUSION This study will provide new evidence for assessing the effectiveness and side effects of this therapy for CU. Since the data is not individualized, there is no need for formal ethical approval. PROSPERO REGISTRATION NUMBER CRD42019128364.
Collapse
Affiliation(s)
- Leixiao Zhang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Xianjun Xiao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu
- The People's Hospital of Jianyang City, Jianyang
| | | | - Yunzhou Shi
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Yanli Deng
- Sichuan Second Chinese Medicine Hospital
| | - Hui Zheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Qianhua Zheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Siyuan Zhou
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Junpeng Yao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Wei Cao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Ying Liu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Pingsheng Hao
- Clinical Medical College of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ying Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu
| |
Collapse
|
6
|
Yao Q, Zhang X, Mu Y, Liu Y, An Y, Zhao B. Bloodletting therapy for treating patients with chronic urticaria: A systematic review and meta-analysis protocol. Medicine (Baltimore) 2019; 98:e14541. [PMID: 30762796 PMCID: PMC6408096 DOI: 10.1097/md.0000000000014541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronic urticaria is a common disease affecting patients' quality of life, and leading to substantial burden to both patients and society. Many trials have shown that bloodletting therapy is effective in treating chronic urticaria. There are currently no systematic reviews of bloodletting therapy for chronic urticaria. This protocol aims to present the methods used to assess the effectiveness and safety of bloodletting therapy for patients with chronic urticaria. METHODS The following databases will be searched from their inception: the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP database), and Wan-Fang Database. Clinical randomised controlled trials related to bloodletting therapy for treating chronic urticaria will be included, regardless of publication status and languages. Study selection, data collection, and quality assessment will be independently conducted by 2 researchers. For data synthesis, we will select either the fixed-effects or random-effects model according to heterogeneity assessment. Disease activity control will be assessed as the primary outcomes. Response rate, recurrence rate and adverse events will be evaluated as secondary outcomes. If it is appropriate for meta-analysis, RevMan V.5.3 statistical software will be used. Otherwise, a systematic narrative synthesis will be conducted. The results will be presented as risk ratio (RR) with 95% confidence intervals (CIs) for dichotomous data and weight mean difference (WMD) or standard mean difference (SMD) 95% CIs for continuous data. DISSEMINATION AND ETHICS The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences. It is not necessary for a formal ethical approval because the data are not individualised. TRIAL REGISTRATION NUMBER PROSPERO CRD42018111143.
Collapse
|
7
|
Dias GAC, Pires GV, Valle SORD, Dortas SD, Levy S, França AT, Baiardini I, Canonica WG. Impact of chronic urticaria on the quality of life of patients followed up at a university hospital. An Bras Dermatol 2017; 91:754-759. [PMID: 28099596 PMCID: PMC5193185 DOI: 10.1590/abd1806-4841.20165071] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 01/16/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Chronic urticaria is a debilitating disease that considerably affects
health-related quality of life, and the Chronic Urticaria Quality of Life
Questionnaire is the only questionnaire specifically designed for its
evaluation. OBJECTIVE To evaluate the quality of life of patients with chronic urticaria, using the
Brazilian Portuguese version of the Chronic Urticaria Quality of Life
Questionnaire. METHODS The Chronic Urticaria Quality of Life Questionnaire was self-administered in
112 chronic urticaria patients and disease activity was assessed through the
Urticaria Activity Score. Clinical and socio-demographic characteristics of
patients were studied, such as: age, sex, etiologic diagnosis of chronic
urticaria, duration of disease and Urticaria Activity Score. RESULTS The population studied was composed 85.72% of women with a mean age of 46
years (18-90), while the median disease duration period was 10 years (3
months-60 years). Regarding the etiologic diagnosis, 48.22% had chronic
spontaneous urticaria; 22.32% associated with inducible urticaria, 28.57%
with chronic autoimmune urticaria, and 23.21% had physical urticaria alone.
Disease activity evaluated using the Urticaria Activity Score was 1.04
± 1.61 (0-6). The total score for the Chronic Urticaria Quality of
Life Questionnaire was 36 (0-100) and dimension I (sleep/mental
status/eating) had a greater impact on quality of life. The items with the
highest mean scores were nervousness and shame over lesions, while the items
with the lowest scores were lip swelling and limitations on sporting
activities. CONCLUSIONS Chronic urticaria compromises patients' quality of life, mainly those with
more severe disease or who are diagnosed with chronic autoimmune
urticaria.
Collapse
Affiliation(s)
| | - Gisele Viana Pires
- Universidade Federal do Rio de Janeiro (UFRJ) - Rio de Janeiro (RJ), Brazil
| | | | | | - Soloni Levy
- Hospital São Zacarias - Rio de Janeiro (RJ), Brazil
| | | | | | | |
Collapse
|
8
|
Lee SJ, Ha EK, Jee HM, Lee KS, Lee SW, Kim MA, Kim DH, Jung YH, Sheen YH, Sung MS, Han MY. Prevalence and Risk Factors of Urticaria With a Focus on Chronic Urticaria in Children. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:212-219. [PMID: 28293927 PMCID: PMC5352572 DOI: 10.4168/aair.2017.9.3.212] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/14/2016] [Accepted: 08/19/2016] [Indexed: 01/26/2023]
Abstract
Purpose Limited data is available on the prevalence and risk factors of acute and chronic urticaria in children. Our purpose was to determine the prevalence and identify the risk factors of acute and chronic urticaria in Korean children. Methods This population-based study examined 4,076 children (age 4 to 13 years) who were enrolled in the 2015 prospective Seongnam Atopy Project (SAP 2015) in Korea. The parents completed an urticaria questionnaire that included questions regarding the duration, severity, and triggering factors of urticaria. Blood sampling (n=464) was performed to measure vitamin D, total eosinophil count (TEC), and total IgE levels, and skin prick tests (n=503) were done. Results The prevalences of the life-time, acute, and chronic urticaria were 22.5%, 13.9%, and 1.8% (chronic continuous urticaria, 0.7%; and chronic recurrent urticaria, 1.1%), respectively. Acute urticaria was significantly associated with allergic diseases and parental history of allergy (P<0.001), but chronic urticaria was not associated with these clinical factors. There was no significant difference in the 25-hydroxyvitamin D level between subjects with chronic urticaria and controls (P=0.124). Chronic continuous urticaria was associated with living in a new residence (aOR=2.38, 95% CI=1.02-5.54, P=0.044) and belonging to a family with a high income (aOR=4.24, 95% CI=1.24-14.56, P=0.022). Conclusions A total of 1.8% of children were found to have chronic urticaria. Living in a new residence and belonging to a family with a high income increased the risk of chronic continuous urticaria.
Collapse
Affiliation(s)
- Seung Jin Lee
- Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Eun Kyo Ha
- Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Hye Mi Jee
- Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Kyung Suk Lee
- Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea
| | | | - Mi Ae Kim
- Department of Allergy & Clinical Immunology, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Dong Hyun Kim
- Department of Dermatology, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Young Ho Jung
- Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Youn Ho Sheen
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Myong Soon Sung
- Department of Pediatrics, CHA Gumi Medical Center, CHA University School of Medicine, Gumi, Korea
| | - Man Yong Han
- Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea.
| |
Collapse
|
9
|
Yao Q, Li S, Liu X, Qin Z, Liu Z. The Effectiveness and Safety of Acupuncture for Patients with Chronic Urticaria: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2016; 2016:5191729. [PMID: 27314024 PMCID: PMC4897793 DOI: 10.1155/2016/5191729] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 04/15/2016] [Accepted: 05/03/2016] [Indexed: 01/08/2023]
Abstract
Background. Acupuncture might have effectiveness in relieving the symptoms of chronic urticaria. There are currently no systematic reviews of acupuncture for chronic urticaria published in English. Objective. We conducted a systematic review to assess the effectiveness and safety of acupuncture for chronic urticaria. Methods. A systematic review and meta-analysis of randomized, controlled trials were performed. The primary outcome was global symptom improvement. Results. We included 6 studies with 406 participants. Three trials showed significant difference between acupuncture and drugs in global symptom improvement (relative risk 1.37; 95% CI 1.11-1.70; P = 0.003). As an adjuvant to medication, acupuncture was also beneficial for global symptom improvement (relative risk 1.77; 95% CI 1.41-2.22; P < 0.01). There were no severe adverse events related to acupuncture. Limitations. Some methodological limitations were observed. The overall risk of bias in the 6 included trials was high and all included RCTs were conducted in China and published in Chinese. Besides, the lack of proper control groups and the use of different rating methods and cut-offs in the included trials also made the evidence of this review limited. Conclusions. Acupuncture might be effective and safe for chronic urticaria in relieving symptoms, based on a low level of evidence. To draw a reliable conclusion, more high quality trials are needed in the future. This trial is registered with PROSPERO CRD42015015702.
Collapse
Affiliation(s)
- Qin Yao
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
- School of Graduates, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Shanshan Li
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Xiaoxu Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
- School of Graduates, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Zongshi Qin
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
- School of Graduates, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Zhishun Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| |
Collapse
|
10
|
Abstract
INTRODUCTION This systematic review protocol aims to describe a meta-analysis to assess the effectiveness and safety of acupuncture therapy for patients with chronic urticaria. METHODS AND ANALYSIS We will electronically search the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, the Web of Science, Traditional Chinese Medicine, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP database) and Wan-Fang Database from their inception. Other sources will also be searched, including the reference lists of identified publications and conference proceedings. Any clinical randomised controlled trials related to acupuncture for treating chronic urticaria without restriction of publication status and languages will be included. Study selection, data extraction and assessment of study quality will be performed independently by 2 researchers. Data will be synthesised by either the fixed-effects or random-effects model according to a heterogeneity test. Improvement in pruritus and wheals will be assessed as the primary outcomes. Adverse events, quality of life and the recurrence rate after at least 3 months of the treatment will also be evaluated as secondary outcomes. RevMan V.5.2 statistical software will be used for meta-analysis, if possible. If it is not appropriate for a meta-analysis, then a descriptive analysis or a subgroup analysis will be conducted. The results will be expressed as a risk ratio for dichotomous data and mean difference (MD) or standardised MD for continuous data. DISSEMINATION AND ETHICS The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences. It is not necessary for a formal ethical approval because the data are not individualised. TRIAL REGISTRATION NUMBER PROSPERO CRD42015015702.
Collapse
Affiliation(s)
- Qin Yao
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- School of Graduates, Beijing University of Chinese Medicine, Beijing, China
| | - Yongming Ye
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaoxu Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- School of Graduates, Beijing University of Chinese Medicine, Beijing, China
| | - Zongshi Qin
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- School of Graduates, Beijing University of Chinese Medicine, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| |
Collapse
|
11
|
Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, Church MK, Ensina LF, Giménez-Arnau A, Godse K, Gonçalo M, Grattan C, Hebert J, Hide M, Kaplan A, Kapp A, Abdul Latiff AH, Mathelier-Fusade P, Metz M, Saini SS, Sánchez-Borges M, Schmid-Grendelmeier P, Simons FER, Staubach P, Sussman G, Toubi E, Vena GA, Wedi B, Zhu XJ, Nast A, Maurer M. Methods report on the development of the 2013 revision and update of the EAACI/GA2 LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria. Allergy 2014; 69:e1-29. [PMID: 24898678 DOI: 10.1111/all.12370] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2014] [Indexed: 10/25/2022]
Abstract
This methods report describes the process of guideline development in detail. It is the result of a systematic literature review using the 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE) methodology and a structured consensus conference held on 28 and 29 November 2012, in Berlin. It is a joint initiative of the Dermatology Section of the European Academy of Allergy and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA(2) LEN), the European Dermatology Forum (EDF), and the World Allergy Organization (WAO) with the participation of delegates of 21 national and international societies. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS) and is published in Allergy 2014; 69:868-887.
Collapse
Affiliation(s)
- T. Zuberbier
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - W. Aberer
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - R. Asero
- Allergy Clinic; Clinica San Carlo; Paderno Dugnano Italy
| | - C. Bindslev-Jensen
- Department of Dermatology and ; Allergy Centre; Odense University Hospital and University of Southern Denmark; Odense Denmark
| | - Z. Brzoza
- Department of Internal Diseases, Allergology and Clinical Immunology in Katowice; Medical University of Silesia; Katowice Poland
| | - G. W. Canonica
- Respiratory Diseases & Allergy; University of Genoa; IRCCS AOU SanMartino; Genoa Italy
| | - M. K. Church
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - L. F. Ensina
- Federal University of Sao Paulo; Sao Paulo Brazil
| | - A. Giménez-Arnau
- Hospital del Mar. Parc de Salut Mar; Universitat Autònoma; Barcelona Spain
| | - K. Godse
- Department of Dermatology; Dr. D. Y. Patil Medical College & Hospital; Nerul Navi Mumbai India
| | - M. Gonçalo
- Clinic of Dermatology; Faculty of Medicine and University Hospital; Coimbra Portugal
| | - C. Grattan
- St John's' Institute of Dermatology; Guy's' and St Thomas' Hospitals NHS Foundation Trust; London UK
| | - J. Hebert
- Center for Applied Research on Allergy Québec; Québec QC Canada
| | - M. Hide
- Department of Dermatology; Institute of Biomedical and Health Sciences; Hiroshima University; Hiroshima Japan
| | - A. Kaplan
- Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology; Department of Medicine; Medical University of South Carolina; Charleston SC USA
| | - A. Kapp
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - A. H. Abdul Latiff
- Department of Paediatrics; Pantai Hospital Kuala Lumpur; Bangsar Malaysia
| | - P. Mathelier-Fusade
- Department of Dermatology and Allergy; University Hospital of Tenon; Paris France
| | - M. Metz
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - S. S. Saini
- Johns Hopkins Asthma and Allergy Center; Baltimore MD USA
| | - M. Sánchez-Borges
- Allergy and Clinical Immunology Department; Centro Médico-Docente La Trinidad; Caracas Venezuela
| | | | - F. E. R. Simons
- Department of Pediatrics & Child Health; University of Manitoba; Winnipeg MB Canada
- Department of Immunology; University of Manitoba; Winnipeg MB Canada
| | - P. Staubach
- Department of Dermatology; University Medical Center Mainz; Mainz Germany
| | - G. Sussman
- Division of Allergy and Clinical Immunology; University of Toronto; Toronto ON Canada
| | - E. Toubi
- Bnai-Zion Medical Center; Faculty of Medicine; Technion; Haifa Israel
| | - G. A. Vena
- Unit of Dermatology and Venereology; Department of Biomedical Sciences and Human Oncology; University of Bari; Bari Italy
| | - B. Wedi
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - X. J. Zhu
- Department of Dermatology; Peking University First Hospital; Beijing China
| | - A. Nast
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - M. Maurer
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | | | | | | | | |
Collapse
|
12
|
Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, Church MK, Ensina LF, Giménez-Arnau A, Godse K, Gonçalo M, Grattan C, Hebert J, Hide M, Kaplan A, Kapp A, Abdul Latiff AH, Mathelier-Fusade P, Metz M, Nast A, Saini SS, Sánchez-Borges M, Schmid-Grendelmeier P, Simons FER, Staubach P, Sussman G, Toubi E, Vena GA, Wedi B, Zhu XJ, Maurer M. The EAACI/GA(2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy 2014; 69:868-87. [PMID: 24785199 DOI: 10.1111/all.12313] [Citation(s) in RCA: 668] [Impact Index Per Article: 66.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2013] [Indexed: 12/13/2022]
Abstract
This guideline is the result of a systematic literature review using the 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE) methodology and a structured consensus conference held on 28 and 29 November 2012, in Berlin. It is a joint initiative of the Dermatology Section of the European Academy of Allergy and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA(2) LEN), the European Dermatology Forum (EDF), and the World Allergy Organization (WAO) with the participation of delegates of 21 national and international societies. Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The life-time prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria do not only cause a decrease in quality of life, but also affect performance at work and school and, as such, are members of the group of severe allergic diseases. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS).
Collapse
Affiliation(s)
- T. Zuberbier
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - W. Aberer
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - R. Asero
- Allergy Clinic; Clinica San Carlo; Paderno Dugnano MI Italy
| | - C. Bindslev-Jensen
- Department of Dermatology and Allergy Centre; Odense University Hospital; University of Southern Denmark; Odense Denmark
| | - Z. Brzoza
- Department of Internal Diseases, Allergology and Clinical Immunology in Katowice; Medical University of Silesia; Zabrze Poland
| | - G. W. Canonica
- Respiratory Diseases & Allergy; University of Genoa; IRCCS AOU SanMartino; Genoa Italy
| | - M. K. Church
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - L. F. Ensina
- Department of Clinical Immunology and Allergy; Federal University of Sao Paulo; Sao Paulo Brazil
| | - A. Giménez-Arnau
- Hospital del Mar. Parc de Salut Mar; Universitat Autònoma Barcelona; Barcelona Spain
| | - K. Godse
- Department of Dermatology; Dr. D. Y. Patil Medical College & Hospital; Nerul Navi Mumbai India
| | - M. Gonçalo
- Clinic of Dermatology; Faculty of Medicine and University Hospital; Coimbra Portugal
| | - C. Grattan
- St John's Institute of Dermatology; Guy's and St Thomas' Hospitals NHS Foundation Trust; London UK
| | - J. Hebert
- Center for Applied Research on Allergy Québec; Québec QC Canada
| | - M. Hide
- Department of Dermatology; Institute of Biomedical and Health Sciences; Hiroshima University; Hiroshima Japan
| | - A. Kaplan
- Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology; Department of Medicine; Medical University of South Carolina; Charleston SC USA
| | - A. Kapp
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - A. H. Abdul Latiff
- Department of Paediatrics; Pantai Hospital Kuala Lumpur; Bangsar Kuala Lumpur Malaysia
| | - P. Mathelier-Fusade
- Department of Dermatology and Allergy; University Hospital of Tenon; Paris France
| | - M. Metz
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - A. Nast
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - S. S. Saini
- Johns Hopkins Asthma and Allergy Center; Baltimore MD USA
| | - M. Sánchez-Borges
- Allergy and Clinical Immunology Department Centro Médico-Docente La Trinidad; Caracas Venezuela
| | | | - F. E. R. Simons
- Departments of Pediatrics & Child Health, Immunology; University of Manitoba; Winnipeg MB Canada
| | - P. Staubach
- Department of Dermatology; University Medical Center Mainz; Mainz Germany
| | - G. Sussman
- Division of Allergy and Clinical Immunology; University of Toronto; Toronto ON Canada
| | - E. Toubi
- Bnai-Zion Medical Center; Faculty of Medicine; Technion; Haifa Israel
| | - G. A. Vena
- Unit of Dermatology and Venereology; Department of Biomedical Sciences and Human Oncology; University of Bari; Bari Italy
| | - B. Wedi
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - X. J. Zhu
- Department of Dermatology; Peking University First Hospital; Beijing China
| | - M. Maurer
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | | | | | | | | |
Collapse
|
13
|
Makris M, Maurer M, Zuberbier T. Pharmacotherapy of chronic spontaneous urticaria. Expert Opin Pharmacother 2013; 14:2511-9. [DOI: 10.1517/14656566.2013.850490] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
14
|
Persechino S, Annibale B, Caperchi C, Persechino F, Narcisi A, Tammaro A, Milione M, Corleto V. Chronic idiophatic urticaria and Helicobacter pylori: a specific pattern of gastritis and urticaria remission after Helicobacter pylori eradication. Int J Immunopathol Pharmacol 2012; 25:765-70. [PMID: 23058028 DOI: 10.1177/039463201202500324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Chronic urticaria (CU) is defined as the occurrence of spontaneous wheals for a duration of more than 6 weeks and is the most frequent skin disease, with prevalence ranging between 15 and 25%, and is a seriously disabling condition, with social isolation and mood changes causing a significant degree of dysfunction and quality of life impairment to many patients. The main clinical features of CU are the repeated occurrence of transient eruptions of pruritic wheals or patchy erythema on the skin that last less than 24 hours and disappear without sequelae. CU is often defined as chronic idiopathic urticaria (CIU) because the causes of CU remain unknown in the great majority (70-95%) of patients. Drugs, food, viruses, alimentary conservative substances or inhalant substances often seem to be involved in determining CIU skin flare. Despite a general agreement that bacteria infections and parasitic infestations can be involved in the pathogenesis of CIU, proven evidence of these relationships is lacking. The aim of the present study is to evaluate the prevalence of Helicobacter pylori (Hp) infection, and the extension and severity of gastritis in a group of CIU patients compared to controls and to evaluate the effectiveness of eradication of Hp on the CIU symptomatology, and the role of Hp infection in pathogenesis of CIU.
Collapse
Affiliation(s)
- S Persechino
- U.O.C. Dermatology, Sant' Andrea Hospital, Faculty of Psychology and Medicine of Rome "Sapienza", Italy
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Chow SKW. Management of chronic urticaria in Asia: 2010 AADV consensus guidelines. Asia Pac Allergy 2012; 2:149-60. [PMID: 22701866 PMCID: PMC3345329 DOI: 10.5415/apallergy.2012.2.2.149] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 04/04/2012] [Indexed: 12/15/2022] Open
Abstract
This guideline is a result of a consensus reached during the 19th Asian-Australasian Regional Conference of Dermatology by the Asian Academy of Dermatology and Venereology Study Group in collaboration with the League of Asian Dermatological Societies in 2010. Urticaria has a profound impact on the quality of life in Asia and the need for effective treatment is required. In line with the EAACI/GA(2)LEN/EDF/WAO guideline for the management of urticaria the recommended first-line treatment is new generation, non-sedating H1-antihistamines. If standard dosing is ineffective, increasing the dosage up to four-fold is recommended. For patients who do not respond to a four-fold increase in dosage of non-sedating H1-antihistamines, it is recommended that therapies such as H2-antihistamine, leukotriene antagonist, and cyclosporine A should be added to the antihistamine treatment. In the choice of second-line treatment, both their costs and risk/benefit profiles are the most important considerations.
Collapse
Affiliation(s)
- Steven K W Chow
- The KL Skin Centre, Pantai Hospital Kuala Lumpur, Kuala Lumpur, 59100, Malaysia
| |
Collapse
|
16
|
Zuberbier T, Balke M, Worm M, Edenharter G, Maurer M. Epidemiology of urticaria: a representative cross-sectional population survey. Clin Exp Dermatol 2011; 35:869-73. [PMID: 20456386 DOI: 10.1111/j.1365-2230.2010.03840.x] [Citation(s) in RCA: 192] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To investigate the prevalence of urticaria with a focus on chronic urticaria (CU) in a general German population. METHODS A questionnaire survey was sent to a representative cross-sectional sample of 13,300 inhabitants of Berlin, Germany, of whom 4093 responded. All respondents who stated ever having had weals or angio-oedema (n=767) were interviewed by telephone. Any interviewees with recent symptoms (within the previous 3 years) were invited for personal investigation including allergy tests; double-blind, placebo-controlled food challenge tests; and quality of life (QOL) assessment. Reported prevalence rates were weighted with regard to age, gender and education so that they were representative of the total population of Berlin. RESULTS Lifetime prevalence rate of urticaria was 8.8% (95% CI 7.9-9.7%) for all types of urticaria. Lifetime prevalence for CU was 1.8% (95% CI 1.4-2.3%), and prevalence for the 12 months before assessment was 0.8% (95% CI 0.6-1.1%), and 70.3% were female. QOL was markedly reduced for people with CU. Unlike other allergic diseases, there was no increased risk associated with higher education or social status. Prick tests found sensitization of ≥ 1 for type 1 allergens in 39.1% of patients. These were related to comorbidities such as allergic rhinitis or oral allergy syndrome, but were never the underlying cause of CU, as proven by double-blind, placebo-controlled provocation tests. CONCLUSION Urticaria is a common disease with marked effects on QOL. The lifetime prevalence of 8.8% for urticaria must be regarded as a lower limit as it is based on conservative prevalence rate calculations, and under-reporting of previous disease can be expected in a questionnaire-based study.
Collapse
Affiliation(s)
- T Zuberbier
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité-Universitätsmedizin Berlin, Germany.
| | | | | | | | | |
Collapse
|
17
|
Kasperska-Zając A, Jasinska T. No alteration of circulating testosterone concentration in patients with chronic urticaria with positive response to autologous serum skin test. Br J Dermatol 2010; 162:890-1. [DOI: 10.1111/j.1365-2133.2009.09620.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
18
|
Zuberbier T, Asero R, Bindslev‐Jensen C, Walter Canonica G, Church MK, Giménez‐Arnau A, Grattan CEH, Kapp A, Merk HF, Rogala B, Saini S, Sánchez‐Borges M, Schmid‐Grendelmeier P, Schünemann H, Staubach P, Vena GA, Wedi B, Maurer M. EAACI/GA(2)LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria. Allergy 2009; 64:1417-1426. [PMID: 19772512 DOI: 10.1111/j.1398-9995.2009.02179.x] [Citation(s) in RCA: 443] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This guideline, together with its sister guideline on the management of urticaria [Zuberbier T, Asero R, Bindslev-Jensen C, Canonica GW, Church MK, Giménez-Arnau AM et al. EAACI/GA(2)LEN/EDF/WAO Guideline: Management of urticaria. Allergy, 2009; 64:1427-1443] is the result of a consensus reached during a panel discussion at the 3rd International Consensus Meeting on Urticaria, Urticaria 2008, a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA(2)LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO). Urticaria is a frequent disease. The life-time prevalence for any subtype of urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria do not only cause a decrease in quality of life, but also affect performance at work and school and, as such, are members of the group of severe allergic diseases. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors, and pathomechanisms. In addition, it outlines evidence-based diagnostic approaches for different subtypes of urticaria. The correct management of urticaria, which is of paramount importance for patients, is very complex and is consequently covered in a separate guideline developed during the same consensus meeting. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS).
Collapse
Affiliation(s)
- T. Zuberbier
- Department of Dermatology and Allergy, Charité– Universitätsmedizin Berlin, Germany
| | - R. Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano (MI), Italy
| | - C. Bindslev‐Jensen
- Allergy Centre, Department of Dermatology, Odense University Hospital, Denmark
| | - G. Walter Canonica
- Allergy and Respiratory Diseases, DIMI – University of Genoa, Genoa, Italy
| | - M. K. Church
- Department of Dermatology and Allergy, Charité– Universitätsmedizin Berlin, Germany
| | - A. Giménez‐Arnau
- Department of Dermatology, Hospital del Mar, IMAS, Universitat Autònoma of Barcelona, Spain
| | - C. E. H. Grattan
- Dermatology Centre, Norfolk & Norwich University Hospital, Norwich, UK
| | - A. Kapp
- Department of Dermatology and Allergology, Hannover Medical University, Germany
| | - H. F. Merk
- Department of Dermatology, University Hospital RWTH Aachen, Germany
| | - B. Rogala
- Clinical Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia, Poland
| | - S. Saini
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - M. Sánchez‐Borges
- Allergy and Immunology Department, Centro Medico‐Docente La Trinidad, Caracas, Venezuela
| | | | - H. Schünemann
- Department of Clinical Epidemiology & Biostatistics, Hamilton, Canada
| | - P. Staubach
- Department of Dermatology, Johannes Gutenberg‐University, Mainz, Germany
| | - G. A. Vena
- Unit of Dermatology, University of Bari, Bari, Italy
| | - B. Wedi
- Department of Dermatology and Allergology, Hannover Medical University, Germany
| | - M. Maurer
- Department of Dermatology and Allergy, Charité– Universitätsmedizin Berlin, Germany
| | | | | | | | | |
Collapse
|
19
|
Abstract
Urticaria is defined as wheals consisting of three features: (i) central swelling of various sizes, with or without surrounding erythema; (ii) pruritus or occasional burning sensations; and (iii) the skin returning to normal appearance, usually within 1-24 hours. Angioedema is defined as: (i) abrupt swelling of the lower dermis and subcutis; (ii) occasional pain instead of pruritus; (iii) commonly involving the mucous membranes; and (iv) skin returning to normal appearance, usually within 72 hours. Acute urticaria and angioedema is defined by its duration (<6 weeks) compared with chronic urticaria and angioedema. The most common causes are infections, medications, and foods. The best tools in the evaluation of these patients are a comprehensive history and physical examination. There are a variety of skin conditions that may mimic acute urticaria and angioedema and the various reaction patterns associated with different drugs. Oral antihistamines are first-line treatment. In the event of a life-threatening reaction involving urticaria with angioedema, epinephrine may be needed to stabilize the patient. This review focuses on the value of a comprehensive clinical evaluation at the onset of symptoms. It underscores the importance of coordination of care among physicians, and the development of an action plan for evidence-based investigations, diagnosis, and therapy.
Collapse
Affiliation(s)
- Evangelo Frigas
- Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
| | | |
Collapse
|
20
|
Criado RFJ, Criado PR, Martins JEC, Valente NYS, Michalany NS, Vasconcellos C. Urticaria unresponsive to antihistaminic treatment: an open study of therapeutic options based on histopathologic features. J DERMATOL TREAT 2008; 19:92-6. [PMID: 18484427 DOI: 10.1080/09546630701499309] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The non- or low-sedating H1 receptor antagonists represent the basic therapy for urticaria. OBJECTIVE To test an alternative approach to patients unresponsive to conventional treatment. MATERIALS AND METHODS A total of 22 patients with chronic urticaria unresponsive to conventional antihistamine treatment were enrolled for this study. They had uncontrolled urticaria even using multiple combinations of antihistamines on maximum doses and corticosteroids in short cycles (prednisone 20-40 mg, per os once a day, 3-7 days per month). Cutaneous biopsies of the urticaria lesions were taken. These findings were classified as: (I) a mixture of perivascular dermal inflammatory infiltrate composed of lymphocytes, monocytes and neutrophils and/or eosinophils; (II) inflammatory infiltrate composed chiefly of neutrophils; and (III) inflammatory infiltrate composed mainly of eosinophils. According to histology, the patients were submitted to one of the following therapeutic schemes: class A - antihistamine treatment plus dapsone; class B - colchicine or dapsone; class C - montelukast. RESULTS Four patients in class A, 08 in class B and seven in class C displayed complete control of urticaria after 12 weeks of treatment; one patient in class B and two in class C did not respond to treatment. Two years after discontinuation, 16 patients are still free of urticaria. CONCLUSIONS This study suggests an alternative approach for treating unresponsive chronic urticaria.
Collapse
Affiliation(s)
- Roberta F J Criado
- Department of Dermatology, Faculdade de Medicina do ABC Santo Andre, Brazil.
| | | | | | | | | | | |
Collapse
|
21
|
Conrad R, Geiser F, Haidl G, Hutmacher M, Liedtke R, Wermter F. Relationship between anger and pruritus perception in patients with chronic idiopathic urticaria and psoriasis. J Eur Acad Dermatol Venereol 2008; 22:1062-9. [PMID: 18355189 DOI: 10.1111/j.1468-3083.2008.02714.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is evidence that chronic idiopathic urticaria (CIU) and psoriasis are associated with personality based difficulties in emotional regulation particularly with regard to the feeling of anger. This deficit in emotional awareness could lead to the phenomenon that emotions are rather experienced in bodily symptoms such as pruritus. AIM We investigated whether there is a relationship between pruritus as major symptoms in CIU and psoriasis and the experience of negative emotions. SETTING Forty-one CIU patients and 44 psoriasis patients treated at Bonn University Hospital and 49 healthy controls were included. METHOD Patients and controls were compared on questionnaires measuring alexithymia (TAS-20), emotional distress (SCL-90-R) and anger (STAXI). In skin-disordered patients, separate stepwise regressions with pruritus severity as dependent variable and questionnaires, skin status, duration, sex and age as independent variables were calculated. RESULTS CIU and psoriasis patients showed higher alexithymia, emotional distress, depression, anxiety and state anger compared with controls. State anger was the only significant predictor of pruritus severity in CIU explaining 19% of variance. Depression was the only significant predictor of pruritus severity in psoriasis explaining 12% of variance. CONCLUSIONS Our findings suggest a relationship between pruritus severity and anger in CIU. Furthermore, our results indicate a relationship between pruritus severity and depression in psoriasis.
Collapse
Affiliation(s)
- R Conrad
- Department of Psychosomatic Medicine, University of Bonn, Bonn, Germany.
| | | | | | | | | | | |
Collapse
|
22
|
Kasperska-Zajac A, Brzoza Z, Polaniak R, Rogala B, Birkner E. Markers of antioxidant defence system and lipid peroxidation in peripheral blood of female patients with chronic idiopathic urticaria. Arch Dermatol Res 2006; 298:499-503. [PMID: 17171548 DOI: 10.1007/s00403-006-0724-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2006] [Revised: 10/30/2006] [Accepted: 11/24/2006] [Indexed: 10/23/2022]
Abstract
Oxidative stress is an important event in lesional skin of patients with chronic idiopathic urticaria (CIU). In the present study, we assessed blood oxidant/antioxidant status of patients suffering from CIU with positive response to autologous serum skin test (ASST) and with negative ASST, to improve our understanding of biological processes and the part of oxidative stress in this disease. Activities of manganese superoxide dismutase (MnSOD), copper-zinc superoxide dismutase (Cu/ZnSOD), glutathione peroxidase (GSH-PX), and catalase (CAT) as indices of enzymatic antioxidant capacity, as well as malondialdehyde (MDA) level as a maker of lipid peroxidation were measured in plasma and erythrocytes from 14 CIU female patients showing positive ASST, 31 CIU female patients with negative ASST and in 19 sex- and age-matched healthy subjects. The antioxidant enzyme activity in plasma and in erythrocytes did not differ significantly among the three groups. Also, the plasma and erythrocytes MDA levels were similar in the three groups. Based on our results, it seems that systemic activity of the enzymatic antioxidants (CuZn/SOD, MnSOD, GSH-Px, and CAT) as well as level of lipid peroxidation determined by MDA may not be increased in the course of immune-inflammatory processes associated with CIU. We also suggest that the systemic oxidant/antioxidant status of CIU patients, showing positive response to ASST, may not be different from that of CIU patients with negative ASST.
Collapse
Affiliation(s)
- Alicja Kasperska-Zajac
- Clinical Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, Poland.
| | | | | | | | | |
Collapse
|
23
|
Kasperska-Zajac A, Brzoza Z, Rogala B. Blood urokinase plasminogen activator system in chronic urticaria. Arch Dermatol Res 2006; 298:409-11. [PMID: 17102952 DOI: 10.1007/s00403-006-0715-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 09/26/2006] [Accepted: 10/13/2006] [Indexed: 11/27/2022]
Abstract
The evidence gathered has pointed to the fibrinolytic system, which apart from its major role in hemostasis may also be involved in inflammatory and immune processes. To understand better the role of fibrinolysis in urticaria, we measured plasma levels of the urokinase system associated molecules such as urokinase-type plasminogen activator (uPA), its soluble receptor (suPAR; CD87) and an inhibitor, plasminogen activator inhibitor type 1 (PAI-1) activity in chronic urticaria (CU) patients. Plasma was obtained from symptomatic sixteen CU patients (12 females and 4 males) showing positive response to autologous serum skin test (ASST), 28 CU patients with negative ASST (20 females and 8 males) as well as from healthy subjects matched by sex and age. The plasma level of uPA and suPAR antigens, PAI-1 activity did not differ significantly among the three subjects groups. The data obtained suggest that CU patients showing positive response to ASST have plasma profile of the urokinase system-associated proteins, which is not markedly different as compared with CU patients with negative ASST as well as healthy subjects. Our findings have also confirmed the earlier studies, suggesting that systemic fibrinolysis may not be involved in chronic urticaria.
Collapse
Affiliation(s)
- Alicja Kasperska-Zajac
- Clinical Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia, ul. 3-go Maja 13-15, 41-800, Zabrze, Katowice, Poland.
| | | | | |
Collapse
|
24
|
Kapp A, Pichler WJ. Levocetirizine is an effective treatment in patients suffering from chronic idiopathic urticaria: a randomized, double-blind, placebo-controlled, parallel, multicenter study. Int J Dermatol 2006; 45:469-74. [PMID: 16650180 DOI: 10.1111/j.1365-4632.2005.02609.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic idiopathic urticaria (CIU) is defined by the almost daily presence of urticaria for at least 6 weeks without an identifiable cause. Symptoms include short-lived wheals, itching, and erythema. CIU impedes significantly a patient's quality of life (QoL). Levocetirizine is an antihistamine from the latest generation approved for CIU. AIM To investigate the efficacy of levocetirizine, 5 mg, and placebo for the symptoms and signs of CIU, as well as for the QoL and productivity. METHODS The primary criteria of evaluation were the pruritus severity scores over 1 week of treatment and over 4 weeks. The QoL was assessed via the Dermatology Life Quality Index (DLQI). RESULTS Baseline pruritus severity scores were comparable in the two treatment groups (2.06+/-0.58). After 1 week, levocetirizine was superior to placebo and demonstrated a considerable efficacy (difference=0.78, P<0.001). This efficacy was maintained over the entire study period (4 weeks, P<0.001). The number and size of wheals were considerably reduced compared with placebo over 1 week and over the total treatment period (P <or= 0.001). This was paralleled by an improvement in the QoL (DLQI: 7.3 units in the levocetirizine group and 2.4 units in the placebo group) and a higher productivity at work in the levocetirizine group (3.0 workdays lost per patient per month in the placebo group, 0.3 in the levocetirizine group). No unexpected adverse events occurred. CONCLUSIONS Levocetirizine, 5 mg once daily, is an effective treatment for CIU, characterized not only by a rapid and sustained response, but also by an important improvement in QoL.
Collapse
Affiliation(s)
- Alexander Kapp
- Department of Dermatology and Allergology, Hannover Medical University, Hannover, Germany.
| | | |
Collapse
|
25
|
Abstract
It is now recognized that approximately one-third of patients with chronic idiopathic urticaria (CIU) have histamine-releasing autoantibodies directed against either the high-affinity IgE receptor or, less frequently, against IgE. However, there are several unsolved problems relating to the role of such autoantibodies in the disease. Additionally, it is not clear whether CIU with autoantibodies can be classified as an autoimmune disease. The detection of patients with autoantibodies also poses challenges. Firstly, the only in vivo method, the autologous serum skin test, is at best 80% sensitive and specific using in vitro basophil histamine release assays as the verum. Secondly, in vitro tests are only done in a small number of research laboratories, and are not widely commercially available, and thirdly, there is some divergence between results obtained by different methods (functional and immunoassays) used to detect patients with autoantibodies. The presence of autoantibodies may be important clinically in a small group of severely affected, treatment-resistant patients, where immunomodulatory treatments may be helpful.
Collapse
Affiliation(s)
- R A Sabroe
- Department of Dermatology, Barnsley Hospital NHS Foundation Trust, Gawber Road, Barnsley S75 2EP, UK.
| | | |
Collapse
|
26
|
Du Toit G, Prescott R, Lawrence P, Johar A, Brown G, Weinberg EG, Motala C, Potter PC. Autoantibodies to the high-affinity IgE receptor in children with chronic urticaria. Ann Allergy Asthma Immunol 2006; 96:341-4. [PMID: 16498857 DOI: 10.1016/s1081-1206(10)61245-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chronic urticaria (CU) in childhood remains a challenge for investigation, and its etiology is largely unknown. Autoantibodies to the high-affinity IgE receptor (FcepsilonRI) are believed to play a role in the pathogenesis of this disease in adults. OBJECTIVE To determine the prevalence of autoantibodies to FcepsilonRIalpha on basophils in children with CU vs atopic eczema dermatitis syndrome (AEDS). METHODS Eighty children with CU were compared with 38 children with AEDS. In addition to complete blood cell counts and total IgE measurements, CAP-RASTs to egg, codfish, soy, milk, and peanut were performed. Stool samples were examined for parasites, and autologous serum skin testing and a functional anti-FcepsilonRIalpha assay were conducted to detect autoantibodies. RESULTS No significant differences were observed between children with CU and controls in mean basophil or eosinophil counts. Twenty (26%) of 77 children with CU and 31 (82%) of 38 with AEDS had positive CAP-RAST results (P < .001). Only 2.5% of the children with CU and 0% with AEDS had stool samples positive for parasites (P = .005). Anti-FcepsilonRIalpha autoantibodies were positive in 37 (47%) of 78 children with CU and in none of 33 with AEDS. Non-IgG histamine-releasing factors were found in 10 (13%) of 78 children with CU. CONCLUSIONS Children have a similar prevalence of autoantibodies to the FcepsilonRIalpha as has been previously published for adults. Few have type I allergies, and parasite infestation is also uncommon. Further studies are required to investigate the predictive value of the autoantibodies in these children with respect to clinical profile, requirements for medications other than antihistamines, and remission rates.
Collapse
Affiliation(s)
- George Du Toit
- Allergy and Dermatology Clinic, Red Cross Children's Hospital, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Lachapelle JM, Decroix J, Henrijean A, Roquet-Gravy PP, De Swerdt A, Boonen H, Lecuyer M, Suys E, Speelman G, Vastesaeger N. Desloratadine 5 mg once daily improves the quality of life of patients with chronic idiopathic urticaria. J Eur Acad Dermatol Venereol 2006; 20:288-92. [PMID: 16503889 DOI: 10.1111/j.1468-3083.2006.01429.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic urticaria is known to debilitate a person's quality of life via sleep disruption, itching lesions, fatigue, social isolation, energy loss and emotional/sexual difficulties. Once-daily desloratadine significantly improved the signs and symptoms of CIU. OBJECTIVE Assess the effect of desloratadine 5 mg once daily on the quality of life of patients suffering of chronic idiopathic urticaria (CIU). Study population One-hundred twenty-one consecutive patients with CIU present for at least 6 weeks prior to inclusion and with a current flare of at least 3 weeks, were included in the study in 24 Belgian centres. RESULTS The mean dermatology life quality index (DLQI) significantly decreased from baseline to day 7 and further to day 42. Sixty per cent and 77% of patients had a clinically significant change (i.e. a decrease of at least 2 points) at day 7 or day 42, respectively, as compared with that of day 0. Change in pruritus and size of the hives significantly correlated with the change in the score of the quality of life. One-third of patients experienced complete relief whereas in 1 of 10 patients no effect was experienced. CONCLUSIONS Desloratadine significantly improves the quality of life of patients with chronic idiopathic urticaria as reflected by the dermatology life quality index (DLQI).
Collapse
Affiliation(s)
- J M Lachapelle
- Department of Dermatology, Université Catholique de Louvain, Brussels, Belgium.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Zuberbier T, Bindslev-Jensen C, Canonica W, Grattan CEH, Greaves MW, Henz BM, Kapp A, Kozel MMA, Maurer M, Merk HF, Schäfer T, Simon D, Vena GA, Wedi B. EAACI/GA2LEN/EDF guideline: definition, classification and diagnosis of urticaria. Allergy 2006; 61:316-20. [PMID: 16436140 DOI: 10.1111/j.1398-9995.2005.00964.x] [Citation(s) in RCA: 191] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This guideline is the result of a consensus reached during a panel discussion at the 2nd International Consensus Meeting on Urticaria, Urticaria 2004, a joint initiative of the European Academy of Allergology and Clinical Immunology Dermatology Section and the European Union (EU)-funded network of excellence, GA2LEN. It covers the definition and classification of urticaria, taking into account the recent progress in identifying causes, eliciting factors and pathomechanisms of this disease. We have outlined useful diagnostic approaches for different subtypes of urticaria. This guideline was, in addition, accepted by the European Dermatology Forum (EDF) and was formally approved by the European Union of Medical Specialists (UEMS).
Collapse
Affiliation(s)
- T Zuberbier
- Department of Dermatology and Allergy, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
BACKGROUND Chronic idiopathic urticaria is a distressing condition that severely affects patients' quality of life. The overall costs associated with this disease, both for the healthcare payer and society, are unknown. The objective of this study was to evaluate the cost effectiveness of levocetirizine, a first-line treatment for urticaria. METHODS Data were collected from two placebo-controlled trials and from official French databases. The effectiveness of the treatment was assessed by the mean number of pruritus-free days experienced by the patient within a 30-day period (PFD30). Direct cost parameters were medications used, medical procedures and hospitalisations for urticaria or treatment of adverse events. Productivity cost parameters were the workdays lost, defined as absenteeism and/or presenteeism, resulting from urticaria. The costing was performed using a French societal perspective. Costs were reported in euro (2002 values) and were standardised to a 30-day month. Whenever possible, incremental cost-effectiveness ratios (ICERs) were derived from these data. RESULTS The pooled sample contained 294 patients. Compared with placebo, patients in the levocetirizine group experienced an additional mean 6.5 (95% CI 3.8, 9.3) pruritus-free days per month (p < 0.001). Considering only direct medical costs, the incremental cost of treatment with levocetirizine was totally offset by the reduction in other medical costs (i.e. reduced cost of additional medications, medical procedures and hospitalisations). From the perspective of society, treatment with levocetirizine was cost saving, with a net gain of Euro 91.93 per patient per month. CONCLUSION Treating chronic idiopathic urticaria with levocetirizine is a dominant strategy for society since it is more effective (in terms of pruritus-free days gained) and less costly than placebo.
Collapse
Affiliation(s)
- Alexander Kapp
- Department of Dermatology and Allergology, Hannover Medical University, Hannover, Germany.
| | | |
Collapse
|
30
|
Abstract
Urticaria has been called a vexing problem and remains so today. The most important part of the diagnostic evaluation remains a comprehensive and detailed history and physical examination, supplemented with limited laboratory testing. Although acute urticaria has been relatively well understood for some time, significant and important recent advances in under-standing the pathogenesis of chronic urticaria are beginning to provide insight in this challenging field, notably the identification of many of these patients with an autoimmune etiology. Antihistamines of various types continue to represent the keystone of symptomatic treatment, with adjunctive support from medications of other classes, such as antileukotrienes, adrenergics, and immunosuppressive and anti-inflammatory agents (including steroids and cyclosporine). Although some progress has been made at improving symptomatic control of urticaria, further research and discovery are necessary before there can yet be an effective impact on the underlying course and natural history of this condition.
Collapse
Affiliation(s)
- Donald A Dibbern
- Division of Allergy and Clinical Immunology, Oregon Health and Sciences University, Portland, OR 97239-3098, USA.
| |
Collapse
|
31
|
Kasperska-Zajac A, Rogala B, Nowakowski M. Assessment of platelet activity as expressed by plasma levels of platelet factor 4 and beta-thromboglobulin in patients with chronic idiopathic urticaria. Exp Dermatol 2005; 14:515-8. [PMID: 15946239 DOI: 10.1111/j.0906-6705.2005.00311.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Blood platelet significance in inflammation is recognized but poorly characterized in urticaria. It is known that platelets are activated during inflammatory processes and are involved in modulating inflammatory and immune response via various mediator release. The aim of our study was to investigate the functional state of platelets, expressed by release reaction of C-X-C chemokines such as platelet factor 4 (PF-4) and beta-thromboglobulin (beta-TG) in chronic idiopathic urticaria (CIU). Plasma levels of PF-4 and beta-TG, which are established markers of in vivo platelet activation and which play important role in inflammatory processes, were measured by enzyme-linked immunosorbent assay in 19 patients with CIU and in 25 healthy subjects. Mean plasma PF-4 level in CIU patients and control subjects was 5.01 +/- 1.67 and 4.13 +/- 2.05 IU/ml, respectively, whereas that for beta-TG was 29.3 +/- 14.0 and 25.2 +/- 12.6 IU/ml, respectively. In our small study, there have been no significant differences found between the members of the control and CIU group regarding plasma levels of PF-4 and beta-TG. Further studies should be performed to elucidate whether any systemic platelet activation occurs in CIU.
Collapse
Affiliation(s)
- Alicja Kasperska-Zajac
- Clinical Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia, Zabrze, Poland.
| | | | | |
Collapse
|
32
|
Puente Vázquez J, Moreno Antón F, Grande Pulido E, López Tarruella-Cobo S, Pérez Segura P, Díaz-Rubio E. Interstitial Pneumonitis and Lung Fibrosis during Adjuvant Treatment of Melanoma with Interferon Alpha according to the Kirkwood Schedule. Dermatology 2005; 210:247-9. [PMID: 15785060 DOI: 10.1159/000083796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
33
|
Kränke B, Mayr-Kanhäuser S. Urticarial Reaction to the Antihistamine Levocetirizine Dihydrochloride. Dermatology 2005; 210:246-7. [PMID: 15785059 DOI: 10.1159/000083795] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
34
|
Abstract
Antihistamines are the cornerstone of treatment for many allergic diseases, such as allergic rhinitis and chronic urticaria. Since the discovery of their beneficial effects in the 1940s, scientists have found molecules with greater selectivity to block specific histamine receptors without some of the detrimental side effects that are seen if antihistamines cross the blood-brain barrier. Levocetirizine is the active enantiomer of cetirizine and a selective H(1)-histamine blocker. It exhibits many favourable characteristics of an ideal antihistamine, both pharmacodynamically and pharmacokinetically, including high bioavailability, rapid onset of action, limited distribution and low degree of metabolism. Furthermore, clinical trials indicate that it is safe and effective for the treatment of allergic rhinitis and chronic urticaria with a minimal amount of untoward effects.
Collapse
MESH Headings
- Allergy and Immunology/trends
- Cetirizine/chemistry
- Cetirizine/pharmacology
- Cetirizine/therapeutic use
- Chronic Disease
- Clinical Trials, Phase III as Topic
- Double-Blind Method
- Histamine H1 Antagonists, Non-Sedating/chemistry
- Histamine H1 Antagonists, Non-Sedating/pharmacology
- Histamine H1 Antagonists, Non-Sedating/therapeutic use
- Humans
- Multicenter Studies as Topic
- Piperazines/chemistry
- Piperazines/pharmacology
- Piperazines/therapeutic use
- Randomized Controlled Trials as Topic
- Rhinitis, Allergic, Perennial/drug therapy
- Rhinitis, Allergic, Perennial/etiology
- Rhinitis, Allergic, Perennial/physiopathology
- Rhinitis, Allergic, Seasonal/drug therapy
- Rhinitis, Allergic, Seasonal/etiology
- Rhinitis, Allergic, Seasonal/physiopathology
- Stereoisomerism
- Urticaria/drug therapy
- Urticaria/etiology
- Urticaria/physiopathology
Collapse
Affiliation(s)
- R Matthew Bloebaum
- The University of Texas Medical Branch, Department of Internal Medicine, Allergy and Immunology Division, Medical Research Bldg. 8.104, 301 University Boulevard, Galveston, Texas 77555-1083, USA
| | | |
Collapse
|
35
|
Affiliation(s)
- Geoffrey Dover
- Department of Exercise and Sport Sciences, University of Florida, Gainesville, USA.
| | | | | |
Collapse
|
36
|
Buhner S, Reese I, Kuehl F, Lochs H, Zuberbier T. Pseudoallergic reactions in chronic urticaria are associated with altered gastroduodenal permeability. Allergy 2004; 59:1118-23. [PMID: 15355472 DOI: 10.1111/j.1398-9995.2004.00631.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND In a subgroup of patients with chronic urticaria (CU) the disease is caused by pseudoallergic reactions to food. The aim of this study was to investigate whether disturbances of the gastrointestinal barrier function play a role in the pathomechanism of the disease. METHODS In 55 patients with CU gastrointestinal permeability was measured with an in vivo triple-sugar-test before and after 24 days of a diet low in pseudoallergens. Sucrose served as marker for gastroduodenal permeability, lactulose/mannitol ratio for intestinal permeability. RESULTS Basal gastroduodenal and intestinal permeability were significantly higher in patients with urticaria as compared to controls. In 29 of the 55 patients skin symptoms decreased or completely disappeared during the diet (responders). Compared to nonresponders (n = 26), responders had a significantly higher gastroduodenal permeability before treatment (0.36 +/- 0.04 vs 0.15 +/- 0.01% sucrose; P < 0.001), which decreased after the diet (0.17 +/- 0.02; P < 0.001). The number of patients with Helicobacter pylori infections did not differ between the two groups. CONCLUSIONS The results indicate that in a subgroup of patients with CU and pseudoallergy an impaired gastroduodenal barrier function may be of pathophysiological importance. The underlying mechanisms seem to be independent of H. pylori infection.
Collapse
Affiliation(s)
- S Buhner
- Department of Gastroenterology, Hepatology, and Endocrinology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | |
Collapse
|
37
|
Abstract
PURPOSE OF REVIEW The pathogenesis of chronic urticaria is multifactorial and a specific treatment is lacking. In acute urticaria there is no doubt of a causal relationship with infections and all chronic urticaria must start as the acute form. However, in the chronic form a primary role for infection is controversial, although it is undeniable that concurrent infections exacerbate the condition. This is the first English language review based on a detailed analysis of current peer-reviewed publications dealing with infections and chronic urticaria. RECENT FINDINGS In chronic urticaria there is a lot of evidence for different infections, but randomized controlled trials are missing. The prevalence of infections is not increased but in susceptible patients the immune response may lead to the development of chronic urticaria. Interestingly, there is evidence for an infection-associated autoreactive response at least in the subgroup with a positive autologous serum skin test. A variety of mechanisms have been invoked to explain these observations, including molecular mimicry. SUMMARY Actually the arguments for an important role of underlying causal infections in chronic urticaria are weak, from an evidence-based viewpoint, but there are data suggesting a link. Moreover, an association with underlying or precipitating infectious causes is difficult to establish because there is no possibility for challenge and the number of other urticarial triggers is vast. For the future it will be necessary to reveal the link between urticaria, autoreactivity, non-immunoglobulin E-mediated hypersensitivity reactions and infections to find attractive and specific therapeutic interventions for urticarial symptomatology.
Collapse
Affiliation(s)
- Bettina Wedi
- Department of Dermatology and Allergology, Hannover Medical University, Hannover, Germany.
| | | | | |
Collapse
|
38
|
Jee YK. Etiology and Treatment of Chronic Urticaria. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2004. [DOI: 10.5124/jkma.2004.47.8.767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Young Koo Jee
- Department of Internal Medicine, Dankook University College of Medicine & Hospital, Korea.
| |
Collapse
|
39
|
Abstract
Chronic urticaria is a common condition that can be very disabling when severe. A cause for chronic idiopathic urticaria (CIU) is only infrequently identified. Potential causes include reactions to food and drugs, infections (rarely) and, apart from an increased incidence of thyroid disease, uncomplicated urticaria is not usually associated with underlying systemic disease or malignancy. About one-third of patients with CIU have circulating functional autoantibodies against the high affinity IgE receptor or against IgE, although it is not known why such antibodies are produced, or how the presence of such antibodies alters the course of the disease or response to treatment. There are only a few publications relating to childhood urticaria, but it is probably similar to the adult form, except that adult urticaria is more common. The diagnosis is based on patient history and it is vital to spend time documenting this in detail. Extensive laboratory tests are not required in the vast majority of patients. Chronic urticaria resolves spontaneously in 30-55% of patients within 5 years, but it can persist for many years. Treatment is aimed firstly at avoiding underlying causative or exacerbating factors. Histamine H1 receptor antagonists remain the mainstay of oral treatment for all forms of urticaria. The newer low-sedating antihistamines desloratadine, fexofenadine, levocetirizine and mizolastine should be tried first. Sedating antihistamines have more adverse effects but are useful if symptoms are causing sleep disturbance. Low-dose dopexin is effective and especially suitable for patients with associated depression. There is controversy as to whether the addition of an histamine H2 receptor antagonist or a leukotriene antagonist is helpful. For CIU, second-line agents include ciclosporin (cyclosporine) [which is effective in approximately 75% of patients], short courses of oral corticosteroids, intravenous immunoglobulins and plasmapheresis, although the last two were found to be beneficial in small trials only. Treatments for CIU with only limited or anecdotal supportive evidence include sulphasalazine, methotrexate, stanazol, rofecoxib and cyclophosphamide. The efficacy of photo(chemo)therapy is controversial. Physical urticarias may respond to H1 receptor antagonists, although in delayed pressure urticaria, and cold, solar and aquagenic urticaria, the response may be disappointing. Second-line agents for physical urticarias vary depending on the urticaria and most have limited supportive evidence. The potential for spontaneous resolution, the variation in the disease activity and the unpredictable nature of the disease makes the efficacy of treatments difficult to assess.
Collapse
Affiliation(s)
- Martina M A Kozel
- Department of Dermatology, Red Cross Hospital, Beverwijk, The Netherlands.
| | | |
Collapse
|
40
|
Abstract
Urticaria has been known as a disease since antiquity. However, in the last decades an increasing understanding of the mechanisms involved in its pathogenesis has shown the high heterogeneity of different urticaria subtypes. Clear distinction of the subtypes is required not only to choose the correct measures in diagnosis and management, but also to interpret the available data in research. The subtypes can be grouped into spontaneous urticaria, which includes acute urticaria and chronic urticaria, the physical urticarias, special types of urticaria including, e.g. contact urticaria, and diseases related to urticaria for historical reasons, e.g. urticaria pigmentosa. Most urticaria subtypes have a profound impact on the quality of life and effective treatment is thus required in case the diagnostic procedures do not reveal a cause which can be treated. Although, for symptomatic relief, nonsedating H1-antihistamines are the first choice in most subtypes of urticaria, double-blind controlled studies have shown that dosages required may exceed those recommended for other diseases, e.g. allergic rhinitis. Alternative treatments should be reserved for unresponsive patients.
Collapse
Affiliation(s)
- T Zuberbier
- Department of Dermatology and Allergy, University Hospital Charité, Humboldt University, Berlin, Germany
| |
Collapse
|
41
|
Boehncke WH, Ludwig RJ, Zollner TM, Ochsendorf F, Kaufmann R, Gibbs BF. The selective cyclooxygenase-2 inhibitor rofecoxib may improve the treatment of chronic idiopathic urticaria. Br J Dermatol 2003; 148:604-6. [PMID: 12653769 DOI: 10.1046/j.1365-2133.2003.05209_12.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
42
|
Kozel MMA, Bossuyt PMM, Mekkes JR, Bos JD. Laboratory tests and identified diagnoses in patients with physical and chronic urticaria and angioedema: A systematic review. J Am Acad Dermatol 2003; 48:409-16. [PMID: 12637921 DOI: 10.1067/mjd.2003.142] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The value of laboratory tests in chronic urticaria is still controversial. OBJECTIVE Our aim was to assess this value in clinical studies, and to identify factors explaining the variation in the number of identified causes. METHODS A total of 4 electronic databases were searched, and a manual literature search was performed. Only unselected patient series with more than 50 adult patients were included. From each included study predefined items were recorded to assess their quality (consecutive patients, use of standardized diagnostic criteria) and validity (follow-up, assessment of treatment effects, level of evidence). RESULTS A total of 29 studies were included, involving 6462 patients. The verification of the validity of the results and the level of evidence of the included studies were limited. CONCLUSION No relationship between the number of identified diagnoses and the number of performed laboratory tests, the different settings, the study design, or the publication period was found. On the basis of this systematic review and the relevant literature, a clinical guideline in the form of a flowchart is presented.
Collapse
Affiliation(s)
- Martina M A Kozel
- Department of Dermatology, Academic Medical Center, University of Amsterdam, The Netherlands
| | | | | | | |
Collapse
|
43
|
Abstract
In ordinary urticaria, individual lesions disappear within 24 hours. However, we sometimes encounter patients whose eruptions last longer than 24 hours, but without evidence of vasculitis or a history of exposure to pressure. In these patients, histology reveals a perivascular infiltration, predominantly of eosinophils, depending on the timing of the biopsy. Unlike urticarial vasculitis, no immunoglobulins, complement deposition, or endothelial fibrinoid degeneration is observed. The peripheral eosinophil counts and serum complement levels appear within normal range. No protein urea or joint pain is observed, and the lesions can be controlled only by systemic glucocorticoids. We recognize such a urticarial reaction as a different clinical entity than usual urticaria, which is presumably mediated by late-phase inflammatory reaction in immediate hypersensitivity.
Collapse
Affiliation(s)
- Naotomo Kambe
- Department of Dermatology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Japan.
| | | | | | | |
Collapse
|