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Maheshwari A, Garg T, Chander R, Debnath E. Chronic spontaneous urticaria: An etiopathogenic study. Indian J Dermatol 2022; 67:92. [PMID: 35656272 PMCID: PMC9154155 DOI: 10.4103/ijd.ijd_851_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Importance: Exact etiopathogenesis of chronic spontaneous urticaria (CSU) remains elusive. Infections, pseudoallergens, autoimmunity, and contact sensitization are various postulated factors. Few studies are available measuring cytokine levels in CSU. Objectives: The aim was to study various etiological factors of CSU and levels of IL-6 and IFN-ϒ in cases and controls, and correlation between various etiologies with the levels of the abovementioned interleukins in the cases. Design: Case-control study performed over 2 years with no follow-up of the participants. Setting: It was a referral-center-based study. Participants: Sixty patients of CSU and equal age and sex-matched healthy controls were recruited on the basis of convenience sampling. Exposures: Biochemical and hematological investigations with hepatitis serology, thyroid function tests, anti-thyroid antibodies, and levels IL-6 and IFN-ϒ were performed in all cases and controls. All cases were subjected to ASST. Cases with all above negative tests were patch-tested with Indian standard series. Urticaria activity score (UAS7) was calculated for all the cases and repeated in patients with positive etiological factor after 3 weeks (improvement after allergen or drug avoidance, treatment of infection). Outcomes: To study the various etiological factors (food, infection, autoimmunity, autoreactivity, and contact sensitization) and the levels of IL-6 and IFN- γ in patients of chronic spontaneous urticaria. Results: Etiology was ascertained in 75% of patients (autoimmunity: 50%, contact sensitization: 21.67%, food and drug allergy: 1.67% each). Mean values of the interleukins and anti-thyroid antibodies were significantly higher in cases versus controls. Levels of IFN-ϒ were significantly elevated in patients with higher UAS7 scores. Conclusion: Antithyroid antibodies, ASST, and patch testing are important tools and should be considered in patients of CSU after a thorough history and history-based workup. Elevated levels of IL-6 and IFN- ϒ in cases suggest that both Th1 and Th2 type of immune responses are implicated in pathogenesis of CSU.
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Persechino F, Galli G, Persechino S, Valitutti F, Zenzeri L, Mauro A, Corleto VD, Parisi P, Ziparo C, Evangelisti M, Quatrale G, Di Nardo G. Skin Manifestations and Coeliac Disease in Paediatric Population. Nutrients 2021; 13:3611. [PMID: 34684612 PMCID: PMC8537533 DOI: 10.3390/nu13103611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/16/2022] Open
Abstract
Celiac disease (CD) is an immune-mediated enteropathy caused by gluten ingestion, affecting approximately 1% of the worldwide population. Extraintestinal symptoms may be present as the first signs of CD, years before the CD diagnosis is made. A great variety of extraintestinal manifestations may be associated with CD. Cutaneous manifestations represent the main extraintestinal manifestations, with dermatitis herpetiformis being the most common in patients with CD. In adults, it has been demonstrated that the role of a gluten-free diet is crucial not only for the recovery of signs and symptoms associated with CD but also for cutaneous manifestations, which often improve after gluten avoidance. In children with CD, the association with skin disorders is well documented regarding dermatitis herpetiformis, but studies considering other dermatological conditions, such as psoriasis and atopic dermatitis, are few. The prevalence and manifestations of dermatological disorders in celiac children are often different from those in adults, explaining the gap between these populations. In addition, the therapeutic role of a gluten-free diet in the improvement in skin alterations is not fully understood in children and in adult population except for dermatitis herpetiformis. Therefore, cutaneous CD symptoms need to be known and recognized by physicians despite their specialties to improve early CD diagnosis, which is critical for a better prognosis. This review describes the current scientific evidence on skin manifestations associated with CD in the pediatric population.
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Affiliation(s)
- Flavia Persechino
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy;
| | - Gloria Galli
- Department of Medical-Surgical and Translational Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, 00185 Rome, Italy; (G.G.); (V.D.C.)
| | - Severino Persechino
- Dermatology Unit, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00185 Rome, Italy;
| | - Francesco Valitutti
- Pediatric Unit, AOU San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy and EBRIS (European Biomedical Research Institute of Salerno), 84121 Salerno, Italy;
| | - Letizia Zenzeri
- Pediatric Emergency Unit, Emergency Pediatric Department, AORN Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy; (L.Z.); (A.M.)
- Pediatric Unit, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00185 Rome, Italy; (P.P.); (C.Z.); (M.E.); (G.Q.)
| | - Angela Mauro
- Pediatric Emergency Unit, Emergency Pediatric Department, AORN Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy; (L.Z.); (A.M.)
| | - Vito Domenico Corleto
- Department of Medical-Surgical and Translational Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, 00185 Rome, Italy; (G.G.); (V.D.C.)
| | - Pasquale Parisi
- Pediatric Unit, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00185 Rome, Italy; (P.P.); (C.Z.); (M.E.); (G.Q.)
| | - Chiara Ziparo
- Pediatric Unit, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00185 Rome, Italy; (P.P.); (C.Z.); (M.E.); (G.Q.)
| | - Melania Evangelisti
- Pediatric Unit, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00185 Rome, Italy; (P.P.); (C.Z.); (M.E.); (G.Q.)
| | - Giovanna Quatrale
- Pediatric Unit, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00185 Rome, Italy; (P.P.); (C.Z.); (M.E.); (G.Q.)
| | - Giovanni Di Nardo
- Pediatric Unit, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00185 Rome, Italy; (P.P.); (C.Z.); (M.E.); (G.Q.)
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Belmesk L, Muntyanu A, Cantin E, AlHalees Z, Jack CS, Le M, Sasseville D, Iannattone L, Ben-Shoshan M, Litvinov IV, Netchiporouk E. Prominent Role of Type 2 Immunity in Skin Diseases-Beyond Atopic Dermatitis. J Cutan Med Surg 2021; 26:33-49. [PMID: 34261335 DOI: 10.1177/12034754211027858] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Type 2 immunity, illustrated by T helper 2 lymphocytes (Th2) and downstream cytokines (IL-4, IL-13, IL-31) as well as group 2 innate lymphoid cells (ILC2), is important in host defense and wound healing.1 The hallmark of type 2 inflammation is eosinophilia and/or high IgE counts and is best recognized in atopic diathesis. Persistent eosinophilia, such as seen in hypereosinophilic syndromes, leads to fibrosis and hence therapeutic Type 2 inhibition in fibrotic diseases is of high interest. Furthermore, as demonstrated in cutaneous T cell lymphoma, advanced disease is characterized by Th1 to Th2 switch allowing cancer progression and immunosuppression. Development of targeted monoclonal antibodies against IL-4Rα (eg, dupilumab) led to a paradigm shift for the treatment of atopic dermatitis (AD) and stimulated research to better understand the role of Type 2 inflammation in other skin conditions. In this review, we summarize up to date knowledge on the role of Type 2 inflammation in skin diseases other than AD and highlight whether the use of Type 2 targeted therapies has been documented or is being investigated in clinical trials. This manuscript reviews the role of Type 2 inflammation in dermatitis, neurodermatitis, IgE-mediated dermatoses (eg, bullous pemphigoid, chronic spontaneous urticaria), sclerodermoid conditions and skin neoplasms.
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Affiliation(s)
| | - Anastasiya Muntyanu
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Zeinah AlHalees
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Carolyn S Jack
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Michelle Le
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Denis Sasseville
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Lisa Iannattone
- 60301 Division of Dermatology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy Immunology and Dermatology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada
| | - Ivan V Litvinov
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Elena Netchiporouk
- 544735620507266 Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
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Khanal R, Sendil S, Oli S, Bhandari B, Atrash A. Factitious Disorder Masquerading as a Life-Threatening Anaphylaxis. J Investig Med High Impact Case Rep 2021; 9:23247096211006248. [PMID: 33787385 PMCID: PMC8020402 DOI: 10.1177/23247096211006248] [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] [Indexed: 11/17/2022] Open
Abstract
Factitious disorder is a psychiatric disorder in which sufferers intentionally fabricate physical or psychological symptoms in order to assume the role of the patient, without any obvious gain. We present a case of a 23-year-old female with chronic urticaria who presented with dyspnea, dysphasia, mild generalized erythema, abdominal cramps, and headache. She was tachypneic and hypotensive. This was her third admission with similar symptoms within the last 7 months. Tryptase, complement, anti-SM/RNP, Sjogren, Scl-70, C3, and C4 were negative. Computed tomography–guided bone marrow biopsy showed no mast cells. Flow cytometry did not show any immunophenotypic reaction. Other possible differentials including pregnancy, autoimmune disorders, and infections including hepatitis, thyroid disorder, and age-related malignancies were ruled out. After a thorough review, malingering disorder was ruled out, but we noticed the patient’s intent of assuming a sick role. Later, the patient was diagnosed with major depressive disorder. Factitious anaphylaxis can present with multiple presentations including a life-threatening condition that mimics true anaphylaxis. A better approach would be thorough clinical evaluation and early multidisciplinary involvement. This case highlights the importance of further evidence-based studies in factitious disorder to decrease the disease burden and reduce the health care cost.
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Affiliation(s)
| | | | - Sharad Oli
- Maimonides Medical Center, Brooklyn, NY, USA
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Rossi O, Piccirillo A, Iemoli E, Patrizi A, Stingeni L, Calvieri S, Gola M, Dapavo P, Cristaudo A, Zichichi L, Losappio L, Saccheri F, Pastorello EA. Socio-economic burden and resource utilisation in Italian patients with chronic urticaria: 2-year data from the AWARE study. World Allergy Organ J 2020; 13:100470. [PMID: 33343800 PMCID: PMC7726718 DOI: 10.1016/j.waojou.2020.100470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
Introduction In Italy, the real-world evidence on the extent of adherence to guidelines and the benefits of recommended therapeutic medications and their impact on the quality of life (QoL) of H1-antihistamines (H1-AH) refractory chronic urticaria (CU) patients is limited. Methods AWARE (A World-wide Antihistamine-Refractory chronic urticaria patient Evaluation) was a global prospective, non-interventional study of CU in real-world setting which included patients aged ≥18 years with a medically confirmed diagnosed of CU present for more than 2 months. In this study, the disease characteristics, pharmacological treatments and patient-reported outcomes (PROs) are reported. Results In total, 159 patients from 24 study centres in Italy completed the study. At baseline, 221 (89.5%) and 8 (3.2%) patients had chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU), respectively, while 18 (7.3%) patients had concomitant CSU and CIndU. For CSU patients, mean dermatology life quality index and CU quality of life questionnaire scores reduced to 3.0 ± 4.9 and 14.6 ± 18.6 at Month 24 from baseline scores of 7.5 ± 6.6 and 33.2 ± 19.5, respectively, indicating an improvement in QoL. This was reflected in their work-life as work productivity impairment reduced considerably after 2 years. Only 71.9% CSU patients had a prior treatment, while during the study, 96.8% of the patients were treated with a medication. At baseline, only 52.9% CSU patients reported nonsedating H1-antihistamines as first-line of treatment in prior medication, this increased to 89.6% during current medication. Conclusion This study shows that CSU has a considerable socio-economic burden and an improvement in QoL can be achieved in CSU patients if an appropriate therapeutic path is followed.
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Key Words
- AWARE study
- CIndU, chronic inducible urticaria
- CSU, chronic spontaneous urticaria
- CU, chronic urticaria
- CU-Q2oL, CU quality of life questionnaire
- Chronic spontaneous urticaria
- DLQI, dermatology life quality index
- GCP, good clinical practices
- H1-AH, H1-antihistamines
- Italy
- PRO, patient-reported outcomes
- QoL, quality of life
- Resource utilisation
- SD, standard deviation
- Socio-economic burden
- UAS7, weekly urticaria activity score
- WPAI-CU, work productivity and activity impairment questionnaire
- nsAH, non-sedating H1-AH
- sAH, sedating H1-AH
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Affiliation(s)
- Oliviero Rossi
- Azienda Ospedaliera Universitaria Careggi, SOD Immunoallergologia, Florence, Italy
| | | | | | - Annalisa Patrizi
- UOC Dermatologia Metropolitana, DIMES, University Bologna, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine, University of Perugia, Italy
| | | | - Massimo Gola
- AOU Ospedale Piero Palagi/IOT UOC Dermatologia, SAS Dermatologia Allergologica, Florence, Italy
| | - Paolo Dapavo
- A.O.U. Citta della Salute e della Scienza di Torino, Turin, Italy
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Wang H, Xu Y, Jin M, Yuan W. SELE Downregulation Suppresses Mast Cell Accumulation to Protect against Inflammatory Response in Chronic Idiopathic Urticaria. Int Arch Allergy Immunol 2020; 182:83-93. [PMID: 33285544 DOI: 10.1159/000507289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/16/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic idiopathic urticaria (CIU) represents a common skin disorder often characterized by mast cell activation and secretion of histamine and other proinflammatory factors. E-selectin (SELE) has been implicated in the pathogenesis of common inflammatory cutaneous disorders, while the role of SELE in CIU is yet to be fully understood. Thus, we aimed to investigate the mechanism by which SELE influences CIU in connection with the involvement of mast cells. METHODS SELE expression was measured in blood samples obtained from CIU patients and normal individuals. A CIU mouse model was subsequently established by intradermally injecting a normal saline solution with ovalbumin IgE antiserum into the mice. Loss- and gain-of-function investigations were conducted on the mouse models. The number of degranulated mast cells and the amount of histamine release in vitro were determined. The levels of SELE, tumor necrosis factor (TNF)-α, homologous restriction factor (HRF), and interleukin (IL)-6 levels were determined. RESULTS The CIU clinical samples exhibited upregulated SELE, while the CIU mice showed increased mast cell degranulation and an increased rate of histamine directional release, as well as an elevated expression of SELE, TNF-α, HRF, and IL-6. SELE silencing was found to decrease the number of degranulated mast cells and reduce the rate of histamine directional release, along with suppressed TNF-α, HRF, and IL-6 expression, in the serum of CIU mice. Ketotifen was observed to rescue the increased expression of TNF-α, HRF, and IL-6 caused by SELE overexpression. CONCLUSIONS This study highlights the potential of SELE downregulation to repress inflammatory factor secretion caused by the accumulation of mast cells, which ultimately inhibits the development of CIU.
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Affiliation(s)
- Hong Wang
- Department of Dermatology and Venereology, The First Hospital of Jilin University, Changchun, China,
| | - Yangchun Xu
- Department of Dermatology and Venereology, The Second Hospital of Jilin University, Changchun, China
| | - Meishan Jin
- Department of Pathology, The First Hospital of Jilin University, Changchun, China
| | - Wen Yuan
- Department of Dermatology and Venereology, The First Hospital of Jilin University, Changchun, China
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Phiri M, Li D, Li T, Ji S, Ling T, Li X, Gao H, Ding L, Shu C. Method development and validation for simultaneous determination of ebastine and its active metabolite carebastine in human plasma by liquid chromatography–tandem mass spectrometry and its application to a clinical pharmacokinetic study in healthy Chinese volunteers. Biomed Chromatogr 2020; 34:e4904. [DOI: 10.1002/bmc.4904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/07/2020] [Accepted: 05/19/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Margaret Phiri
- Department of Pharmaceutical Analysis China Pharmaceutical University 639 Longmian avenue, jiangning Nanjing jiangsu China
- Nanjing Clinical Tech Laboratories Inc. Nanjing China
| | - Duo Li
- Department of Pharmaceutical Analysis China Pharmaceutical University 639 Longmian avenue, jiangning Nanjing jiangsu China
| | - Tengfei Li
- Department of Pharmaceutical Analysis China Pharmaceutical University 639 Longmian avenue, jiangning Nanjing jiangsu China
| | - Shunli Ji
- Department of Pharmaceutical Analysis China Pharmaceutical University 639 Longmian avenue, jiangning Nanjing jiangsu China
| | - Tang Ling
- Department of Pharmaceutical Analysis China Pharmaceutical University 639 Longmian avenue, jiangning Nanjing jiangsu China
- Nanjing Clinical Tech Laboratories Inc. Nanjing China
| | - Xianjing Li
- Department of Pharmaceutical Analysis China Pharmaceutical University 639 Longmian avenue, jiangning Nanjing jiangsu China
- Nanjing Clinical Tech Laboratories Inc. Nanjing China
| | - Huaye Gao
- Department of Pharmaceutical Analysis China Pharmaceutical University 639 Longmian avenue, jiangning Nanjing jiangsu China
- Nanjing Clinical Tech Laboratories Inc. Nanjing China
| | - Li Ding
- Department of Pharmaceutical Analysis China Pharmaceutical University 639 Longmian avenue, jiangning Nanjing jiangsu China
- Nanjing Clinical Tech Laboratories Inc. Nanjing China
| | - Chang Shu
- Department of Pharmaceutical Analysis China Pharmaceutical University 639 Longmian avenue, jiangning Nanjing jiangsu China
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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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Irani C, Hallit S, Weller K, Maurer M, El Haber C, Salameh P. Chronic urticaria in most patients is poorly controlled. Results of the development, validation, and real life application of the arabic urticaria control test. Saudi Med J 2018; 38:1230-1236. [PMID: 29209673 PMCID: PMC5787635 DOI: 10.15537/smj.2017.12.21206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To translate and linguistically validate the urticaria control test (UCT) to/for Arabic speakers. No Arabic version of the UCT is available to assess disease control in patients with chronic urticaria (CU). Secondary objectives were to assess disease control in Lebanese CU patients and determine influence factors. METHODS This is a prospective observational study of 178 CU patients diagnosed during their first visit to a private Allergy/Immunology Clinic, Hotel Dieu de France Hospital, Beirut, Lebanon between January and December 2014. RESULTS Factor analysis showed that all 4 UCT items on the Arabic version converged over a solution of one factor. A high internal consistency was found with a Cronbach's alpha of 0.824. Most patients in this study had chronic spontaneous urticaria (96%), of which 19% also had inducible urticaria. The majority was less than 40 years (67.4%), with disease duration of less than 2 years (70.8%). Most patients used H1-antihistamines, but unfortunately, 34.3% used systemic glucocorticosteroids, of which 24.7% also used H1-antihistamines. The disease was poorly controlled in most patients (79.2%, UCT less than 12). Age, gender, duration, diagnosis, triggers, and/or history of atopy had no influence. CONCLUSION We developed the first linguistically validated Arabic UCT to improve CU management in Arabic speaking patients. We also found that disease control was poor in most CU patients, and is unaffected by age, disease duration, gender, subtype, triggers, history of atopy, and/or previous treatments.
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Affiliation(s)
- Carla Irani
- Hotel-Dieu de France, Faculty of Pharmacy, St Joseph University, Beirut, Lebanon. E-mail.
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Cutaneous and Mucosal Manifestations Associated with Celiac Disease. Nutrients 2018; 10:nu10070800. [PMID: 29933630 PMCID: PMC6073559 DOI: 10.3390/nu10070800] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/15/2018] [Accepted: 06/18/2018] [Indexed: 12/12/2022] Open
Abstract
Celiac disease (CD) is an immune-mediated, gluten-induced enteropathy that affects predisposed individuals of all ages. Many patients with CD do not report gastrointestinal symptoms making it difficult to reach an early diagnosis. On the other hand, CD is related to a wide spectrum of extra-intestinal manifestations, with dermatitis herpetiformis (DH) being the best characterized. These associated conditions may be the clue to reaching the diagnosis of CD. Over the last few years, there have been multiple reports of the association between CD and several cutaneous manifestations that may improve with a gluten-free diet (GFD). The presence of some of these skin diseases, even in the absence of gastrointestinal symptoms, should give rise to an appropriate screening method for CD. The aim of this paper is to describe the different cutaneous manifestations that have been associated with CD and the possible mechanisms involved.
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El-Sharkawy REED, Abd-Elmaged WM, Ahmed DA, Abdel-Wahed SAEF. Pattern of chronic urticaria and value of autologous serum skin test in Sohag Province, Upper Egypt. Electron Physician 2018; 10:6781-6788. [PMID: 29997762 PMCID: PMC6033132 DOI: 10.19082/6781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 03/28/2018] [Indexed: 01/16/2023] Open
Abstract
Background Chronic urticaria (CU) is a debilitating disorder with variable clinical course. It is characterized by hives occurring for at least 6 weeks, and is classified as spontaneous or inducible. Objective The aim of this study was to detect the pattern of CU, to study association between results of autologous serum skin test (ASST) and urticaria severity score (USS), and to detect serum levels of anti IgE receptors antibodies. Methods This study included all patients attending the Dermatology Outpatient Clinic, Sohag University Hospital, who were diagnosed as CU from April 2015 to March 2016. ASST and serum level of anti IgE receptor antibodies was assessed using ELISA. Data were analyzed by SPSS version 16, using descriptive statistics, Kruskal-Wallis and Mann-Whitney U test. Results A total of 108 patients with CU were included in the study. Females with mean age 33±12.4 years were more affected. A total of 58.3% complained of CSU, 6.5% physical urticaria and 35.2% mixed type of CU. According to USS, mild score represented 20.4%, moderate 46.3% and severe in 33.3%. ASST showed positive in 38% of patients. There was a statistically significant relation between ASST and USS and duration of CU. This indicates that more severe symptoms and prolonged duration of CU are observed in positive ASST (autoreactive type). In all, 91% of the anti IgE receptor antibodies positive patients had positive ASST. Conclusion In conclusion, chronic urticaria is not an uncommon disease in our locality which represented 1.13% of our patients. Urticaria severity score and duration of urticaria was higher in positive ASST patients and hence the autoreactive type.
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Affiliation(s)
| | - Wafaa Mohamed Abd-Elmaged
- Lecturer, Dermatology and Venereology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Doaa Anwar Ahmed
- Resident at Dermatology Department, Sohag General Hospital, Sohag, Egypt
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Maurer M, Mathias SD, Crosby RD, Rajput Y, Zazzali JL. Validity and responsiveness of the Urticaria Activity and Impact Measure: A new patient-reported tool. Ann Allergy Asthma Immunol 2018; 120:641-647. [PMID: 29567359 DOI: 10.1016/j.anai.2018.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/05/2018] [Accepted: 03/12/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU), also known as chronic idiopathic urticaria, may produce hives, itch, and angioedema. The Urticaria Activity and Impact Measure (U-AIM) is a newly developed 9-item patient-reported measure designed for use in routine clinical practice to assess CSU activity and impact during the previous 7 days. OBJECTIVE To evaluate validity, responsiveness, and clinically meaningful change of the U-AIM. METHODS Data from a 24-week, open-label, single-arm period of a randomized, placebo-controlled study of omalizumab were used to assess the psychometric properties of U-AIM items for itch, hives, and angioedema. RESULTS A total of 206 patients (75% female; mean age, 44.6 years) were enrolled. At baseline, U-AIM results included prevalent severe itch (55%) and more than 12 hives (67%), angioedema (15%), and bother by itch (84%), hives (84%), and angioedema (49%). The Urticaria Patient Daily Diary (UPDD) mean weekly scores were 15.4 (itch severity), 16.8 (number of hives), and 32.2 (Urticaria Activity Score [UAS7]). At baseline, week 12, and week 24, U-AIM itch and hives items and UAS7 proxy scores (the sum of itch severity and number of hives during 7 days) demonstrated strong correlation coefficients with their corresponding measures from the UPDD (itch severity: 0.634-0.806; hives number: 0.735-0.843; UAS7 proxy: 0.724-0.852). Changes in U-AIM scores differentiated patients by their perspective of symptom improvement. Meaningful change thresholds were established for itch severity and number of hives scores (range, 0.8-1.0 for both) and the UAS7 proxy score (range, 10.5-12.5). CONCLUSION The U-AIM is valid and responsive to change and may help clinicians monitor CSU activity and track treatment effectiveness.
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Affiliation(s)
- Marcus Maurer
- Dermatological Allergology, Department of Dermatology and Allergy, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ross D Crosby
- Health Outcomes Solutions, Winter Park, Florida; Neuropsychiatric Research Institute, Fargo, North Dakota; University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
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Choonhakarn C, Chaowattanapanit S, Julanon N. The treatment outcomes and dose de-escalation of desloratadine up-dosing in chronic spontaneous urticaria. Int J Dermatol 2018; 57:423-427. [DOI: 10.1111/ijd.13919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/13/2017] [Accepted: 01/01/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Charoen Choonhakarn
- Division of Dermatology; Department of Medicine; Faculty of Medicine; Srinagarind Hospital Medical School; Khon Kaen University; Khon Kaen Thailand
| | - Suteeraporn Chaowattanapanit
- Division of Dermatology; Department of Medicine; Faculty of Medicine; Srinagarind Hospital Medical School; Khon Kaen University; Khon Kaen Thailand
| | - Narachai Julanon
- Division of Dermatology; Department of Medicine; Faculty of Medicine; Srinagarind Hospital Medical School; Khon Kaen University; Khon Kaen Thailand
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Netchiporouk E, Sasseville D, Moreau L, Habel Y, Rahme E, Ben-Shoshan M. Evaluating Comorbidities, Natural History, and Predictors of Early Resolution in a Cohort of Children With Chronic Urticaria. JAMA Dermatol 2017; 153:1236-1242. [PMID: 28973060 DOI: 10.1001/jamadermatol.2017.3182] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Chronic urticaria (CU) affects 0.1% to 0.3% of children. Most cases have no identifiable trigger and are classified as chronic spontaneous urticaria (CSU). At least half of patients with CSU may have an autoimmune etiology that can be determined in vitro using the basophil activation test (BAT). While 30% to 55% of CU cases resolve spontaneously within 5 years in adults, the natural history and predictors of resolution in children are not known. Objective To assess the comorbidities, natural history of CU, and its subtypes in children and identify predictors of resolution. Design, Setting, and Participants We followed a pediatric cohort with chronic urticaria that presented with hives lasting at least 6 weeks between 2013 and 2015 at a single tertiary care referral center. Exposures Data were collected on disease activity, comorbidities, physical triggers, BAT results, complete blood cell count, C-reactive protein levels, thyroid-stimulating hormone levels, and thyroid peroxidase antibodies. Main Outcomes and Measures We assessed the rate of resolution (defined as absence of hives for at least 1 year with no treatment) and the association with clinical and laboratory markers. Results The cohort comprised 139 children younger than 18 years old. Thirty-one patients (20%) had inducible urticaria, most commonly cold induced. Six children had autoimmune comorbidity, such as thyroiditis and type 1 diabetes. Autoimmune disorders (24 patients [17%]) and CU (17 patients [12%]) were common in family members. Positive BAT results (CD63 levels > 1.8%) were found in 58% of patients. Patients with positive BAT results (CD63 level >1.8%) were twice as likely to resolve after 1 year compared with negative BAT results (hazard ratio [HR], 2.33; 95% CI, 1.08-5.05). In contrast, presence of basophils decreased the likelihood of resolution (HR, 0.40; 95% CI, 0.20-0.99). No correlation with age was found. Chronic urticaria resolved in 43 patients, with a rate of resolution of 10.3% per year. Levels of CD63 higher than 1.8% and absence of basophils were associated with earlier disease resolution. Conclusions and Relevance Resolution rate in children with CU is low. The presence of certain biomarkers (positive BAT result and basophil count) may help to predict the likelihood of resolution.
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Affiliation(s)
- Elena Netchiporouk
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Denis Sasseville
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Linda Moreau
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Youssef Habel
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Elham Rahme
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
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Lin CKE, Kaptein JS, Sheikh J. Differential expression of microRNAs and their possible roles in patients with chronic idiopathic urticaria and active hives. ALLERGY & RHINOLOGY 2017; 8:67-80. [PMID: 28583230 PMCID: PMC5468759 DOI: 10.2500/ar.2017.8.0199] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Chronic idiopathic urticaria (CIU) is a complicated skin disease with unknown pathophysiology. MicroRNAs (miRNA) have been shown to be active in cellular regulation. The goal of this pilot study was to examine whether miRNAs may be involved in the regulation of CIU or as biomarkers for CIU. Methods: Four groups of three patients each were selected: patients with either active hives or no hives and with positive or negative chronic urticaria (CU) index results. MiRNAs were isolated from patient plasma and analyzed by using miRNA microarray technology to determine the amount of each of the 2567 known human miRNAs. Results: A total of 16 miRNAs were found to be differentially expressed in patients with active hives. Among them, five (2355–3p, 4264, 2355–5p, 29c-5p, and 361–3p) were significantly increased in samples with positive CU index results, which could be useful biomarkers for patients with chronic autoimmune urticaria. The miRNA data bases were used to find the targets of these selected miRNA sequences. These potential targets were then compared against a list of 154 urticaria-related genes. Twenty-five genes were found to match. These included eight that were significantly downregulated and eight that were significantly upregulated; however, seven of the eight downregulated genes (FBXL20, OPHN1, YPEL2, STARD9, EZH1, KLHL24, ING4) and five of the eight upregulated genes (BYSL, PNO1, ADAMTS9, STEAP4, SRGN) have no reported roles in signaling. For the 13 genes with reported roles in signaling, the following pathways were found: transforming growth factor beta signaling pathway (NRC31, KITLG, THBS1, CCL2), glucocorticoid receptor signaling pathway (NR3C1, SELE, CCL2), p53 signaling pathway (CCNG2, THBS1, CCL2), p21-activated kinase pathway (PAK1IP1, KITLG, CCL2), phosphoinositide-3 kinase protein kinase B signaling pathway (KITLG, CHRM, THBS1), and neuroactive ligand-receptor interaction (NRC31, HRH1, CHRM), which could play important roles in CIU. Conclusion: A better understanding of those genes with undefined function and simultaneous quantitation of both miRNAs and messenger RNAs are needed to fully understand CIU disease.
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16
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Busby LD. A Comparison of Multiple Chemical Sensitivity with Other Hypersensitivity Illnesses Suggests Evidence and a Path to Answers. ECOPSYCHOLOGY 2017. [DOI: 10.1089/eco.2017.0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Thomsen SF, Pritzier EC, Anderson CD, Vaugelade-Baust N, Dodge R, Dahlborn AK, Vestergaard C. Chronic urticaria in the real-life clinical practice setting in Sweden, Norway and Denmark: baseline results from the non-interventional multicentre AWARE study. J Eur Acad Dermatol Venereol 2017; 31:1048-1055. [PMID: 28294420 DOI: 10.1111/jdv.14210] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 02/10/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chronic urticaria (CU) is characterized by the recurrence of itchy hives and/or angioedema for more than 6 weeks. AWARE (A World-wide Antihistamine-Refractory Chronic Urticaria Patient Evaluation) is a multinational study designed to document the real-life treatment situation, burden of disease and clinical resource usage of H1-antihistamine-refractory CU patients. OBJECTIVE To examine baseline data from Scandinavian AWARE patients. METHODS AWARE is a prospective, non-interventional, multinational, umbrella design study, which includes adults (≥18 years) with a confirmed CU diagnosis (>2 months) that is refractory to H1-antihistamines. Baseline patient characteristics, disease activity (urticaria control test [UCT]), pharmacological treatment, comorbidities and healthcare usage were documented by the treating physician. Quality of life (QoL; dermatology life quality index [DLQI]; chronic urticaria quality of life questionnaire [CU-Q2 oL; Danish patients only]) and work productivity and activity impairment (WPAI) scores were also assessed. RESULTS Overall, 158 CU patients from seven centres in Denmark (n = 80), Norway (n = 50) and Sweden (n = 28) were included in this baseline analysis. Mean age and BMI were 40.3 years and 26.5 kg/m2 , respectively. The majority of patients were female (69.6%), had uncontrolled CU (75.6%; UCT score <12) and had a 'spontaneous' component to their CU (61.4% CSU; 20.3% both CSU and chronic inducible urticaria). Common comorbidities included asthma (19.6%), allergic rhinitis (16.5%) and food allergies (8.2%). Overall, 60.1% of patients reported using treatments for CU including non-sedative H1-antihistamines (40.5%), corticosteroids (19%), montelukast (14.6%) and omalizumab (8.2%). Pharmacological treatment rates increased to 96.2% during the baseline visit. On average, patient QoL was moderately affected (mean DLQI score 7.7) and healthcare resource usage was high. CONCLUSION Adult Scandinavian H1-antihistamine-refractory CU patients reported high rates of healthcare usage and QoL impairment. Rates of pharmacological treatment use were low before study enrolment but increased to almost 100% during the baseline visit.
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Affiliation(s)
- S F Thomsen
- Department of Dermatology, Bispebjerg Hospital & Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - E C Pritzier
- Departement of Dermatology, Stavanger University Hospital, Stavanger, Norway
| | - C D Anderson
- Divison of dermatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | | | - R Dodge
- Novartis Pharmaceutical A/S, Copenhagen, Denmark
| | | | - C Vestergaard
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
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Analysis of the association of chronic spontaneous urticaria with interlekin-4, -10, transforming growth factor-β1, interferon-γ, interleukin-17A and -23 by autologous serum skin test. Postepy Dermatol Alergol 2017; 34:70-76. [PMID: 28261034 PMCID: PMC5329100 DOI: 10.5114/pdia.2016.57679] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 01/26/2016] [Indexed: 01/05/2023] Open
Abstract
Aim To contribute to the understanding of the pathogenesis of chronic spontaneous urticaria (CSU) by identifying its relationship with autoimmunity and cytokines using the autologous serum skin test (ASST) and peripheral blood mononuclear cell culture (PBMC) method. Material and methods Interleukins (IL)-4, IL-10, transforming growth factor (TGF-β1), interferon (IFN)-γ, IL-17A, and IL-23 levels in cell supernatants obtained by the PBMC method were measured using ELISA. Disease activity was assessed by determining the urticaria activity score (UAS). Results A total of 40 patients diagnosed with CSU participated in this study. Twenty patients had positive ASST results, and 20 had negative results. The control group included 20 healthy volunteers. We found that the IL-23 (p = 0.01), IL-10 (p = 0.04) and IL-4 (p = 0.04) levels of the patient groups were significantly lower compared with those of the control group. The IL-23 (p = 0.009), IL-10 (p = 0.009), IL-4 (p = 0.001), and IL-17 (p = 0.05) levels of the ASST(–) patient group were significantly lower compared with those of the control group. In addition, the IL-4 (p = 0.03) and IFN-γ (p = 0.05) levels of the ASST(+) patient group were significantly lower compared with those of the control group, and the ASST(+) patients had a significantly higher UAS than the ASST(–) patients (p = 0.021). Conclusions These results, when considered together with current reports in the literature, indicate that immune dysregulation occurs in the pathogenesis of CSU, causing cytokine imbalance.
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Panaszek B, Pawłowicz R, Grzegrzółka J, Obojski A. Autoreactive IgE in Chronic Spontaneous/Idiopathic Urticaria and Basophil/Mastocyte Priming Phenomenon, as a Feature of Autoimmune Nature of the Syndrome. Arch Immunol Ther Exp (Warsz) 2016; 65:137-143. [PMID: 27582030 DOI: 10.1007/s00005-016-0417-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 06/20/2016] [Indexed: 01/27/2023]
Abstract
Recent years of research have shed a new light on the role of IgE in immune reactions. It seems to be more than just a contribution to immediate type of allergic response. It appears that monomeric IgE may enhance mast cell activity without cross-linking of FcεRI by IgE specific allergen or autoreactive IgG anti-IgE antibodies. Monomeric IgE molecules are heterogeneous concerning their ability to induce survival and activation of mast cells only by binding the IgE to FcεRI, but not affecting degranulation of cells. It also turned out that IgE may react to autoantigens occurring in the blood not only in chronic spontaneous urticaria (CSU) but also in other autoimmune diseases. The aforementioned phenomena may promote the activity of mast cells/basophils in CSU that easily degranulate when influenced by various inner (autoreactive IgG against IgE and FcεRI, autoreactive IgE for self-antigens) and outer factors (cold, heat, pressure) or allergens. These findings forced the new approach to the role of autoimmunity, self-antigens and IgE autoantibodies in the pathology of CSU. CSU put in the scheme of autoreactive IgG and autoreactive IgE seems to be either a kind of an autoimmune disease or a clinical manifestation of some other defined autoimmune diseases or both.
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Affiliation(s)
- Bernard Panaszek
- Department of Internal Medicine and Allergy, Wroclaw Medical University, Curie-Skłodowskiej 66, 50-367, Wrocław, Poland.
| | - Robert Pawłowicz
- Department of Internal Medicine and Allergy, Wroclaw Medical University, Curie-Skłodowskiej 66, 50-367, Wrocław, Poland
| | - Jędrzej Grzegrzółka
- Department of Histology and Embryology, Wroclaw Medical University, Wrocław, Poland
| | - Andrzej Obojski
- Department of Internal Medicine and Allergy, Wroclaw Medical University, Curie-Skłodowskiej 66, 50-367, Wrocław, Poland
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Soltani S, Saghazadeh A, Movahedi M, Tavakol M, Sadr M, Farhadi E, Rezaei N. FLG single nucleotide polymorphisms in chronic idiopathic urticaria. Allergol Immunopathol (Madr) 2016; 44:341-5. [PMID: 26796858 DOI: 10.1016/j.aller.2015.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 08/11/2015] [Accepted: 09/30/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Filaggrin (FLG), which is formed from profilaggrin protein during epidermal terminal differentiation, is a prerequisite to squame biogenesis and thus for perfect formation of the skin barrier. Yet, the relationship between genetic polymorphisms of FLG and chronic idiopathic urticaria (CIU) has not been investigated. METHODS The study population consisted of 93 CIU patients and 93 healthy control subjects without a history of allergic, autoimmune or any other systemic disease. Five single nucleotide polymorphisms (SNPs) of FLG were investigated: rs2485518, rs3126065, rs2786680, rs3814300, and rs3814299. RESULTS For all the investigated polymorphisms, 100% of both CIU patients and control subjects exhibited one given allele and consequently one given genotype as following: A/A genotype for two SNPs, rs3126065 and rs2786680, C/C genotype for two SNPs, rs2485518 and rs3814300, and G/G genotype for one SNP rs3814299 of FLG, and hence no association was found between either allele frequencies or genotype distributions of FLG SNPs and CIU in an Iranian population. CONCLUSIONS The present study examined the possible relationship between SNPs of FLG and CIU for the first time, and demonstrated that none of five investigated SNPs (rs2485518, rs3126065, rs2786680, rs3814300, and rs3814299) are correlated with CIU in an Iranian population. Further investigations are required to address whether ethnicity/race impacts on relationship between SNPs of FLG and CIU.
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21
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Fine LM, Bernstein JA. Guideline of Chronic Urticaria Beyond. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2016; 8:396-403. [PMID: 27334777 PMCID: PMC4921693 DOI: 10.4168/aair.2016.8.5.396] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/13/2015] [Indexed: 11/20/2022]
Abstract
Urticaria is a relatively common condition that if chronic can persist for weeks, months or years and affect quality of life significantly. The etiology is often difficult to determine, especially as it becomes chronic. Many cases of chronic urticaria are thought to be autoimmune, although there is no consensus that testing for autoimmunity alters the diagnostic or management strategies or outcomes. Many times, urticaria is easily managed with antihistamines and/or short courses of oral corticosteroids, but too often control is insufficient and additional therapies must be added. For years, immune modulating medications, such as cyclosporine and Mycophenolate Mofetil, have been used in cases refractory to antihistamines and oral corticosteroids, although the evidence supporting their efficacy and safety has been limited. Omalizumab was recently approved for the treatment of chronic urticaria unresponsive to H1-antagonists. This IgG anti-IgE monoclonal antibody has been well demonstrated to safely and effectively control chronic urticaria at least partially in approximately 2/3 of cases. However, the mechanism of action and duration of treatment for omalizumab is still unclear. It is hoped that as the pathobiology of chronic urticaria becomes better defined, future therapies that target specific mechanistic pathways will be developed that continue to improve the management of these often challenging patients.
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Affiliation(s)
- Lauren M Fine
- Department of Medicine, University of Miami Miller School of Medicine, Department of Internal Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Miami, FL, USA
| | - Jonathan A Bernstein
- Department of Medicine, University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology/Allergy Section, Cincinnati, Ohio, USA.
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Potter P, Mitha E, Barkai L, Mezei G, Santamaría E, Izquierdo I, Maurer M. Rupatadine is effective in the treatment of chronic spontaneous urticaria in children aged 2-11 years. Pediatr Allergy Immunol 2016; 27:55-61. [PMID: 26267219 DOI: 10.1111/pai.12460] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recommendations in current guidelines for the treatment of chronic spontaneous urticaria (CSU) in infants and children are mostly based on extrapolation of data obtained in adults. This study reports the efficacy and safety of rupatadine, a modern H1 and PAF antagonist recently authorized in Europe for children with allergic rhinitis and CSU. METHODS A double-blind, randomized, parallel-group, multicentre, placebo-controlled compared study to desloratadine was carried out in children aged 2-11 years with CSU, with or without angio-oedema. Patients received either rupatadine (1 mg/ml), or desloratadine (0.5 mg/ml) or placebo once daily over 6 weeks. A modified 7-day cumulative Urticaria Activity Score (UAS7) was employed as the primary end-point. RESULTS The absolute change of UAS7 at 42 days showed statistically significant differences between active treatments vs. placebo (-5.5 ± 7.5 placebo, -11.8 ± 8.7 rupatadine and -10.6 ± 9.6 desloratadine; p < 0.001) and without differences between antihistamines compounds. There was a 55.8% decrease for rupatadine followed by desloratadine (-48.4%) and placebo (-30.3%). Rupatadine but not desloratadine was statistically superior to placebo in reduction of pruritus (-57%). Active treatments also showed a statistically better improvement in children's quality of life compared to placebo. Adverse events were uncommon and non-serious in both active groups. CONCLUSION Rupatadine is effective and well tolerated in the relief of urticaria symptoms, improving quality of life over 6 weeks in children with CSU. This is the first study using a modified UAS to assess severity and efficacy outcome in CSU in children.
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Affiliation(s)
- Paul Potter
- Allergy Diagnostic and Clinical Research Unit, Department of Medicine, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Essack Mitha
- Newtown clinical Research, Johannerburg, South Africa
| | - László Barkai
- BAZ Megyei Kórház Gyermekegészségügyi Központ, Miskolc, Hungary
| | - Györgyi Mezei
- Allergy Unit, First Department of Pediatrics, Faculty of Medicine, Semmelweis U, Budapest Hungary
| | | | | | - Marcus Maurer
- Department of Dermatology and Allergy, Allergie-Centrum Charité/ECARF, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Powell RJ, Leech SC, Till S, Huber PAJ, Nasser SM, Clark AT. BSACI guideline for the management of chronic urticaria and angioedema. Clin Exp Allergy 2015; 45:547-65. [PMID: 25711134 DOI: 10.1111/cea.12494] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/11/2014] [Accepted: 01/09/2015] [Indexed: 12/11/2022]
Abstract
This guidance for the management of patients with chronic urticaria and angioedema has been prepared by the Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is aimed at both adult physicians and paediatricians practising in allergy. The recommendations are evidence graded. During the development of these guidelines, all BSACI members were included in the consultation process using a Web-based system. Their comments and suggestions were carefully considered by the Standards of Care Committee. Where evidence was lacking, a consensus was reached by the experts on the committee. Included in this management guideline are clinical classification, aetiology, diagnosis, investigations, treatment guidance with special sections on children with urticaria and the use of antihistamines in women who are pregnant or breastfeeding. Finally, we have made recommendations for potential areas of future research.
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Affiliation(s)
- R J Powell
- Department of Clinical Immunology and Allergy, Nottingham University, Nottingham, UK
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Cho YT, Pao YC, Chu CY. Unmet medical needs for chronic spontaneous urticaria patients: highlighting the real-life clinical practice in Taiwan. J Eur Acad Dermatol Venereol 2015; 30:41-9. [PMID: 26428436 DOI: 10.1111/jdv.13357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 07/01/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Treatment guidelines for chronic spontaneous/idiopathic urticaria (CSU) are available; however, only 50% of patients are well controlled with approved doses of H1-antihistamines, and certain patients remain symptomatic despite receiving up to 4× the approved dose of H1-antihistamines plus H2 antihistamines and/or leucotriene-receptor antagonists. OBJECTIVES To highlight real-life clinical practice in Taiwan and to understand the unmet medical needs of CSU patients. METHODS A nationwide cross-sectional, observational survey of 50 dermatologists and 200 CSU patients was conducted between June 2013 and November 2013. Face-to-face interviews of dermatologists and online interviews of CSU patients were conducted independently. RESULTS Dermatologists reported that dermographism and blood tests were the most commonly used diagnostic methods to confirm the diagnosis. The key driving factor for most clinic-based dermatologists (70%) in choosing a treatment was 'response to my medicines', and most preferred H1-antihistamines and steroids for treating CSU patients, whereas most hospital-based dermatologists (85%) gave higher priority to 'severity and impact of the conditions'. Patients were reported to have high psychological pressures and significant impact of CSU on their daily activity. In addition, CSU patients were not satisfied with their current treatment and 69% of patients switched their first-consulted physician. Furthermore, lack of information and concerns about side-effects were major factors which held back patients from seeking Western treatment. CONCLUSIONS There is an unmet medical need of CSU patients in Taiwan highlighting gaps among guidelines, real-life clinical practice, patients' perceptions and patients' knowledge of their disease.
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Affiliation(s)
- Y-T Cho
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Y-C Pao
- Novartis Co. Ltd., Taipei, Taiwan
| | - C-Y Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Cherepanov D, Raimundo K, Chang E, Eagan M, Zazzali JL, Solari PG, DeCotiis B, Hussain I, Rehman SM, Shahab N, Tilles SA, Broder MS. Validation of an ICD-9-based claims algorithm for identifying patients with chronic idiopathic/spontaneous urticaria. Ann Allergy Asthma Immunol 2015; 114:393-8. [PMID: 25771155 DOI: 10.1016/j.anai.2015.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 01/14/2015] [Accepted: 02/04/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is no specific International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for chronic idiopathic urticaria or spontaneous urticaria (CIU/CSU), a skin condition characterized by hives and angioedema lasting at least 6 weeks with no known cause. OBJECTIVE To validate an ICD-9-CM-based algorithm for identification of patients with CIU/CSU and thus facilitate claims-based research. METHODS Patient records were reviewed at 4 US practices. Patients included in the study were from a random sample of those identified by their physician as having CIU/CSU or because they met the following diagnosis-based algorithm: (1) at least 2 outpatient ICD-9-CM diagnosis codes 708.1, 708.8, or 708.9 at least 6 weeks apart or (2) 1 outpatient diagnosis of 708.1, 708.8, or 708.9 and 1 diagnosis of 995.1 at least 6 weeks apart. Data collected included ICD-9-CM codes, diagnoses of urticaria and allergy-related conditions, and medication use. Sensitivity and positive predictive value were calculated. The study was approved by the Western Institutional Review Board. RESULTS One hundred forty-nine patient records were reviewed (mean age 41.1 years; 73.8% were women; 69.1% were white): 115 were identified with the diagnosis-based algorithm, 90 were patients with "known CIU/CSU", and 56 were in the 2 groups. The mean duration of CIU/CSU was 2.9 to 3.1 years. The 2 cohorts most frequently had diagnoses of idiopathic urticaria, unspecified urticaria, and other specified urticaria. The diagnosis-based algorithm had a positive predictive value of 90.4% and a sensitivity of 71.1%. CONCLUSION The high positive predictive value suggests that patients identified using the algorithm are highly likely to have CIU/CSU. The 71.1% sensitivity suggests that most patients with CIU/CSU will be identified. The validation statistics support the use of the diagnosis-based algorithm in claims-based research, although future studies could refine the algorithm further.
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Affiliation(s)
- Dasha Cherepanov
- Partnership for Health Analytic Research, LLC, Beverly Hills, California
| | | | - Eunice Chang
- Partnership for Health Analytic Research, LLC, Beverly Hills, California
| | - Marianne Eagan
- Partnership for Health Analytic Research, LLC, Beverly Hills, California
| | | | | | - Bruce DeCotiis
- Ocean Allergy and Respiratory Research Center, Brick, New Jersey
| | - Iftikhar Hussain
- Allergy, Asthma and Immunology Center, PC, Vital Prospects Clinical Research Institute, Tulsa, Oklahoma
| | | | | | | | - Michael S Broder
- Partnership for Health Analytic Research, LLC, Beverly Hills, California
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Samtsov AV. NEW APPROACH IN URTICARIA TREATMENT. VESTNIK DERMATOLOGII I VENEROLOGII 2014. [DOI: 10.25208/0042-4609-2014-90-6-158-162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The article presents the European Guidelines for the Diagnostics and Management of Urticaria (revised in 2013) and new data on the physiopathology of urticaria related to the role of the platelet-activating factor (PAF) activating mast cells, attracting eosinophils and neutrophils, improving vascular permeability (it is more potent than histamine by 1,000 times) and mucosal edema, and increasing the level of pro-inflammatory cytokines. The data promoted the creation of a new rupatadine molecule, which blocks histamine and PAF receptors at the same time improving the therapeutic effect during urticaria treatment as compared to other antihistamine drugs. The author presents the study results confirming the efficacy and safety of rupatadine.
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Johnson M, Kwatra G, Badyal DK, Thomas EA. Levocetirizine and rupatadine in chronic idiopathic urticaria. Int J Dermatol 2014; 54:1199-204. [DOI: 10.1111/ijd.12733] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 02/25/2014] [Accepted: 04/04/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Madhulika Johnson
- Department of Pharmacology; Christian Medical College and Hospital; Ludhiana Punjab India
| | - Gagandeep Kwatra
- Department of Pharmacology; Christian Medical College and Hospital; Ludhiana Punjab India
| | - Dinesh K. Badyal
- Department of Pharmacology; Christian Medical College and Hospital; Ludhiana Punjab India
| | - Emy A. Thomas
- Department of Dermatology; Christian Medical College and Hospital; Ludhiana Punjab India
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28
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Influence of component 5a receptor 1 (C5AR1) −1330T/G polymorphism on nonsedating H1-antihistamines therapy in Chinese patients with chronic spontaneous urticaria. J Dermatol Sci 2014; 76:240-5. [DOI: 10.1016/j.jdermsci.2014.09.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 09/22/2014] [Accepted: 09/27/2014] [Indexed: 11/22/2022]
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Alasandagutti ML, Ponnana M, Sivangala R, Thada S, Joshi L, Hussain H, Ansari SS, Valluri V, Gaddam SL. Role of IFN-γ and IL-6 Cytokines and Their Association in Determining Susceptibility to Chronic Idiopathic Urticaria. Genet Test Mol Biomarkers 2014; 18:804-9. [DOI: 10.1089/gtmb.2014.0193] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
| | - Meenakshi Ponnana
- Immunology Department, Bhagwan Mahavir Medical Research Centre, Hyderabad, Andhra Pradesh, India
| | - Ramya Sivangala
- Immunology Department, Bhagwan Mahavir Medical Research Centre, Hyderabad, Andhra Pradesh, India
| | - Shruthi Thada
- Immunology Department, Bhagwan Mahavir Medical Research Centre, Hyderabad, Andhra Pradesh, India
| | - Lavanya Joshi
- Immunology Department, Bhagwan Mahavir Medical Research Centre, Hyderabad, Andhra Pradesh, India
| | - Hidayath Hussain
- Immunology Department, Bhagwan Mahavir Medical Research Centre, Hyderabad, Andhra Pradesh, India
| | - Soheb Sadath Ansari
- Immunology Department, Bhagwan Mahavir Medical Research Centre, Hyderabad, Andhra Pradesh, India
| | - Vijayalakshmi Valluri
- LEPRA India—Blue Peter Public Health and Research Centre, Cherlapally, Hyderabad, Andhra Pradesh, India
| | - Suman Latha Gaddam
- Immunology Department, Bhagwan Mahavir Medical Research Centre, Hyderabad, Andhra Pradesh, India
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Abstract
Anaphylaxis and urticaria are common presenting allergic complaints. Affecting up to 2% of the population, anaphylaxis is a serious, life-threatening allergic reaction. Although not life-threatening, urticaria is a rash of transient, erythematous, pruritic wheals that can be bothersome and affects up to 25% of the population. All cases of anaphylaxis warrant thorough clinical evaluation by the allergist-immunologist, although most cases of urticaria are self-limited and do not require specialist referral. This article offers an overview of our current knowledge on the epidemiology, pathogenesis, triggers, diagnosis, and treatment of anaphylaxis and urticaria.
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Affiliation(s)
- Kelli W Williams
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Hemant P Sharma
- Division of Allergy and Immunology, Children's National Medical Center, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA.
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31
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Affiliation(s)
- M W Greaves
- Cutaneous Allergy Clinic, St John's Institute of Dermatology, St Thomas' Hospital, Lambeth Palace Rd, London, SE1 7EH, U.K..
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32
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Rupatadine for the treatment of allergic rhinitis and urticaria: a look at the clinical data. ACTA ACUST UNITED AC 2014. [DOI: 10.4155/cli.14.26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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33
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Li N, Cao N, Niu YD, Bai XH, Lu J, Sun Y, Yu M, Sun LX, Duan XS. Effects of the polysaccharide nucleic acid fraction of bacillus Calmette-Guérin on the production of interleukin-2 and interleukin-10 in the peripheral blood lymphocytes of patients with chronic idiopathic urticaria. Biomed Rep 2013; 1:713-718. [PMID: 24649015 DOI: 10.3892/br.2013.130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 07/03/2013] [Indexed: 11/05/2022] Open
Abstract
Urticaria is one of the most frequent dermatoses and its prevalence in the general population is estimated to be ~20%, whereas a substantial percentage of the cases may be classified as chronic idiopathic urticaria (CIU). The inflammatory response presenting with spontaneous wheals exhibits pro-inflammatory characteristics, involving a prominent role for lymphocytes with a mixed Th1/Th2 response in which interleukin (IL)-2 and IL-10 are prominently secreted by Th1 and Th2 cells, respectively. In CIU patients, it was demonstrated that IL-10 production was elevated and IL-2 reduced compared to controls. Therefore, inhibition of IL-10 and promotion of IL-2 production by the lymphocytes, indicating Th2 inhibition and Th1 promotion, may facilitate the treatment of CIU. Whether the polysaccharide nucleic acid fraction of bacillus Calmette-Guérin (BCG-PSN), which possesses multiple immunomodulatory properties, has that potential, remains to be elucidated. In this study, BCG-PSN was used on lymphocytes isolated from CIU patients, with healthy donors used as controls. Immunocytochemistry and ELISA were used to detect IL-2 and IL-10 production. It was demonstrated that the IL-2 production by the lymphocytes in the CIU group was significantly lower compared to that in the healthy control group and it increased sequentially with the increase of the concentration of BCG-PSN used. By contrast, the IL-10 production by the lymphocytes in the CIU group was significantly higher compared to that in the healthy control group and decreased sequentially with the increase of the concentration of BCG-PSN used. Thus, it may be concluded that the BCG-PSN has the potential to promote IL-2 and inhibit IL-10 production in the lymphocytes of CIU patients, facilitating the treatment of CIU.
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Affiliation(s)
- Na Li
- Central Laboratory, The Affiliated Hospital of Chengde Medical College, Chengde, Hebei 067000, P.R. China
| | - Na Cao
- Department of Dermatology, The Affiliated Hospital of Chengde Medical College, Chengde, Hebei 067000, P.R. China
| | - Yan-Dong Niu
- Department of Dermatology, The Affiliated Hospital of Chengde Medical College, Chengde, Hebei 067000, P.R. China
| | - Xiu-Hui Bai
- Department of Dermatology, The Affiliated Hospital of Chengde Medical College, Chengde, Hebei 067000, P.R. China
| | - Jie Lu
- Department of Dermatology, The Affiliated Hospital of Chengde Medical College, Chengde, Hebei 067000, P.R. China
| | - Yu Sun
- Central Laboratory, The Affiliated Hospital of Chengde Medical College, Chengde, Hebei 067000, P.R. China
| | - Min Yu
- Central Laboratory, The Affiliated Hospital of Chengde Medical College, Chengde, Hebei 067000, P.R. China
| | - Li-Xin Sun
- Central Laboratory, The Affiliated Hospital of Chengde Medical College, Chengde, Hebei 067000, P.R. China
| | - Xin-Suo Duan
- Department of Dermatology, The Affiliated Hospital of Chengde Medical College, Chengde, Hebei 067000, P.R. China
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Makino T, Takegami Y, Rehman MU, Yoshihisa Y, Ishida W, Toyomoto T, Shimizu T. Maintenance of remission with low-dose olopatadine hydrochloride for itch in well-controlled chronic urticaria. Clin Cosmet Investig Dermatol 2012; 5:141-6. [PMID: 23055763 PMCID: PMC3459547 DOI: 10.2147/ccid.s36812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Indexed: 11/24/2022]
Abstract
Background: The long-term follow-up of chronic urticaria (CU) is important to ensure the adequate treatment of patients. Olopatadine hydrochloride is one of the second-generation nonsedating antihistamines. Methods: This study was designed to assess the optimal dose of olopatadine to suppress symptoms of chronic urticarial itch in well-controlled patients. After CU patients were treated with 10 mg olopatadine, patients having a visual analog scale (VAS) itch score of less than 20 were randomly allocated into one of three groups: 10 mg/day (n = 35), 5 mg/day (n = 30), or no medication (n = 32). Results: The suppressive effects of both the 5 mg and 10 mg olopatadine treatments on the VAS itch score were more significant and longer lasting over a period of 4 weeks than the no-medication treatment. Both the 5-mg group and the 10-mg group showed improved urticarial symptoms and maintained their VAS itch score within normal limits compared to the no-medication group. The differences between the 5-mg and 10-mg groups were not significant. Conclusion: These results demonstrate that treatment with olopatadine at a dose of 5 mg once daily is effective and safe for the management and prevention of CU symptoms for itch in well-controlled patients.
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Affiliation(s)
- Teruhiko Makino
- Department of Dermatology, University of Toyama, Toyama, Japan
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Caproni M, Bonciolini V, D'Errico A, Antiga E, Fabbri P. Celiac disease and dermatologic manifestations: many skin clue to unfold gluten-sensitive enteropathy. Gastroenterol Res Pract 2012; 2012:952753. [PMID: 22693492 PMCID: PMC3369470 DOI: 10.1155/2012/952753] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 03/13/2012] [Accepted: 04/05/2012] [Indexed: 12/12/2022] Open
Abstract
Cutaneous manifestations of intestinal diseases are increasingly reported both in the adult and in the children, and this association cannot longer be considered a simple random. Besides the well-known association between celiac disease (CD) and dermatitis herpetiformis (DH), considered as the cutaneous manifestation of gluten-dependent enteropathy, is more frequently reported also the association with other mucocutaneous diseases. Among these there are both autoimmune, allergic, and inflammatory diseases, but also a more heterogeneous group called miscellaneous. The knowledge about pathogenic, epidemiological, clinical, and diagnostic aspects of CD is increasing in recent years as well as those about DH, but some aspects still remain to be defined, in particular the possible pathogenetic mechanisms involved in the association between both CD and DH and CD and other immunological skin diseases. The aim of this paper is to describe the skin diseases frequently associated with CD, distinguishing them from those which have a relationship probably just coincidental.
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Affiliation(s)
- Marzia Caproni
- Division of Dermatology, Department of Medical and Surgical Critical Care, University of Florence, 50129 Florence, Italy
| | - Veronica Bonciolini
- Division of Dermatology, Department of Medical and Surgical Critical Care, University of Florence, 50129 Florence, Italy
| | - Antonietta D'Errico
- Division of Dermatology, Department of Medical and Surgical Critical Care, University of Florence, 50129 Florence, Italy
| | - Emiliano Antiga
- Division of Dermatology, Department of Medical and Surgical Critical Care, University of Florence, 50129 Florence, Italy
- Department of Clinical Physiopathology, University of Florence, 50139 Florence, Italy
| | - Paolo Fabbri
- Division of Dermatology, Department of Medical and Surgical Critical Care, University of Florence, 50129 Florence, Italy
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Nam YH, Kim JH, Jin HJ, Hwang EK, Shin YS, Ye YM, Park HS. Effects of omalizumab treatment in patients with refractory chronic urticaria. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2012; 4:357-61. [PMID: 23115733 PMCID: PMC3479230 DOI: 10.4168/aair.2012.4.6.357] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 02/10/2012] [Indexed: 11/28/2022]
Abstract
Purpose Chronic urticaria (CU) is a common and debilitating disease, and the need for effective treatment has increased. Omalizumab may be an alternative regimen in patients with CU who do not respond to conventional treatments. The aim of this study is to investigate the efficacy and to observe the clinical results of omlizumab in patients with refractory CU. Methods We conducted a retrospective analysis of 26 patients with refractory CU who were treated with omalizumab. Omalizumab was administered every 2 or 4 weeks, depending on body weight and the total serum IgE level, for 24 weeks. Results Fourteen patients (53.8%) achieved remission after the treatment; they had a significantly higher prevalence of personal (P=0.033) and family history of allergic diseases (P=0.002) than those who did not achieve remission. During omalizumab treatment, the urticaria activity score declined significantly (12.11±1.97 to 2.7±4.23; P=0.001) and the CU-quality of life score improved significantly (34.65±13.58 to 60.88±11.11; P=0.004). There were significant decreases in the use of systemic steroids (42.3%-11.5%; P=0.027) and immunomodulators (65.4%-19.2%; P=0.002). The dose of antihistamines required to control CU also decreased significantly (215.66±70.06 to 60.85±70.53 mg/week of loratadine equivalents; P<0.001). No serious adverse event was noted. Conclusions These findings suggest that omalizumab can be an effective and safe treatment in patients with refractory CU.
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Affiliation(s)
- Young-Hee Nam
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
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Abstract
Urticaria and angioedema are common disorders that can severely impair the quality of a patient's life and can be extremely difficult to treat. Symptoms can persist for years to decades. The causes of urticaria and angioedema are varied and may be immunologic, nonimmunologic, or idiopathic. This article reviews the literature and provides primary care physicians with up-to-date information of the epidemiology, basic pathophysiology, diagnosis, and management of this common and often debilitating condition. Additionally, clinical manifestations of acute and chronic urticaria, hereditary and acquired angioedema, as well as the physical urticarias will be discussed.
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Cost, utilization, and patterns of medication use associated with chronic idiopathic urticaria. Ann Allergy Asthma Immunol 2011; 108:98-102. [PMID: 22289728 DOI: 10.1016/j.anai.2011.10.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 10/31/2011] [Accepted: 10/31/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND The literature on chronic idiopathic urticaria (CIU) lacks large-scale population-based studies. OBJECTIVE To characterize an insured population with CIU, including their demographic characteristics and comorbidities. METHODS We conducted a cross-sectional analysis using insurance claims. We included patients with 1 outpatient claim with an International Classification of Diseases, 9(th)Edition, Clinical Modification (ICD-9-CM) code for idiopathic, other specified, or unspecified urticaria (ICD-9-CM 708.1, 708.8, or 708.9) and either (1) another of these claims 6 or more weeks later; (2) a claim for angioedema (ICD-9-CM 995.1) 6 or more weeks from the urticaria diagnosis; or (3) overlapping claims for 2 prescription medications commonly used for CIU. RESULTS We identified 6,019 patients who had claims consistent with CIU. The mean age was 36 years. Fifty-six percent of patients had primary care physicians as their usual source of care, 14% had allergists, and 5% had dermatologists. Allergic rhinitis was diagnosed in 48%, asthma in 21%, other allergy in 19%, and atopic dermatitis in 8%. Sixty-seven percent of patients used prescription antihistamines, 54% used oral corticosteroids (OCSs), 24% used montelukast, and 9% used oral doxepin. Antihistamine users received a mean of 152 days of prescription antihistamines, OCS users 30 days of OCSs, montelukast users 190 days of montelukast, and oral doxepin users 94 days of doxepin. CONCLUSIONS Primary care physicians managed most patients with CIU. Antihistamines were the most common treatment for CIU, although OCSs were frequently prescribed. Thirty days of OCS supply among users may represent multiple steroid bursts each year. Given the known risks of OCSs, identifying other CIU treatments with more favorable safety profiles may be beneficial.
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Abstract
Urticaria (hives) is a common disorder that often presents with angioedema (swelling that occurs beneath the skin). It is generally classified as acute, chronic or physical. Second-generation, non-sedating H1-receptor antihistamines represent the mainstay of therapy for both acute and chronic urticaria. Angioedema can occur in the absence of urticaria, with angiotensin-converting enzyme (ACE) inhibitor-induced angioedema and idiopathic angioedema being the more common causes. Rarer causes are hereditary angioedema (HAE) or acquired angioedema (AAE). Although the angioedema associated with these disorders is often self-limited, laryngeal involvement can lead to fatal asphyxiation in some cases. The management of HAE and AAE involves both prophylactic strategies to prevent attacks of angioedema (i.e., trigger avoidance, attenuated androgens, tranexamic acid, and plasma-derived C1 inhibitor replacement therapy) as well as pharmacological interventions for the treatment of acute attacks (i.e., C1 inhibitor replacement therapy, ecallantide and icatibant). In this article, the authors review the causes, diagnosis and management of urticaria (with or without angioedema) as well as the work-up and management of isolated angioedema, which vary considerably from that of angioedema that occurs in the presence of urticaria.
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Affiliation(s)
- Amin Kanani
- Division of Allergy and Immunology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Saini S, Rosen KE, Hsieh HJ, Wong DA, Conner E, Kaplan A, Spector S, Maurer M. A randomized, placebo-controlled, dose-ranging study of single-dose omalizumab in patients with H1-antihistamine-refractory chronic idiopathic urticaria. J Allergy Clin Immunol 2011; 128:567-73.e1. [PMID: 21762974 DOI: 10.1016/j.jaci.2011.06.010] [Citation(s) in RCA: 253] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 04/27/2011] [Accepted: 06/08/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Proof-of-concept studies with omalizumab in patients with chronic idiopathic urticaria (CIU) have shown significant decreases in mean urticaria activity scores (UASs). OBJECTIVE We sought to evaluate the efficacy and safety of omalizumab in patients with CIU who remain symptomatic despite concomitant H(1)-antihistamine therapy. METHODS This phase II, prospective, double-blind, placebo-controlled, dose-ranging study investigated omalizumab in patients aged 12 to 75 years in the United States and 18 to 75 years in Germany with a UAS over 7 days (UAS7) of 12 or greater despite antihistamine therapy. Patients were randomized 1:1:1:1 to receive a single subcutaneous dose of 75, 300, or 600 mg of omalizumab or placebo added to a stable dose of H(1)-antihistamine. The primary efficacy outcome was change from baseline to week 4 in UAS7. Patients were followed for an additional 12 weeks to monitor safety. RESULTS Ninety patients from the United States or Germany were enrolled. Both the 300-mg omalizumab group (-19.9 vs -6.9, P < .001) and the 600-mg omalizumab group (-14.6 vs -6.9, P = .047) showed greater improvement versus the placebo group in UAS7. No meaningful difference was observed for the 75-mg omalizumab group. Similar results were seen for key secondary end points of weekly hive and itch scores. Onset of effect occurred after 1 to 2 weeks. Omalizumab was well tolerated, and the incidence of adverse events was similar across treatment groups. CONCLUSION This study demonstrated that a fixed dose of 300 or 600 mg of omalizumab provides rapid and effective treatment of CIU in patients who are symptomatic despite treatment with H(1)-antihistamines.
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MESH Headings
- Adolescent
- Adult
- Anti-Allergic Agents/administration & dosage
- Anti-Allergic Agents/adverse effects
- Anti-Allergic Agents/therapeutic use
- Antibodies, Anti-Idiotypic/administration & dosage
- Antibodies, Anti-Idiotypic/adverse effects
- Antibodies, Anti-Idiotypic/therapeutic use
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Child
- Chronic Disease
- Dose-Response Relationship, Drug
- Double-Blind Method
- Drug Therapy, Combination
- Female
- Germany
- Histamine H1 Antagonists/administration & dosage
- Histamine H1 Antagonists/therapeutic use
- Humans
- Male
- Middle Aged
- Omalizumab
- Prospective Studies
- Treatment Outcome
- United States
- Urticaria/drug therapy
- Urticaria/physiopathology
- Young Adult
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Affiliation(s)
- Sarbjit Saini
- Johns Hopkins Asthma and Allergy Center, Baltimore, MD 21224, USA.
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Altrichter S, Peter HJ, Pisarevskaja D, Metz M, Martus P, Maurer M. IgE mediated autoallergy against thyroid peroxidase--a novel pathomechanism of chronic spontaneous urticaria? PLoS One 2011; 6:e14794. [PMID: 21532759 PMCID: PMC3075251 DOI: 10.1371/journal.pone.0014794] [Citation(s) in RCA: 187] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 12/15/2010] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic spontaneous urticaria (csU), which is characterized by recurrent episodes of mast cell-driven wheal and flare-type skin reactions, is often associated with elevated total IgE levels and thyroid autoimmunity. We speculate that some csU patients express IgE autoantibodies against thyroid antigens such as thyroid peroxidase (TPO), which could bind to skin mast cells and induce their activation. METHODS We developed and used a site-directed human IgE capture ELISA to quantify IgE-anti-TPO. We used this assay and investigated csU patients (n = 478) and healthy control subjects (n = 127) for IgE-anti-TPO and then assessed IgE-anti-TPO-positive and -negative csU patients for clinical and serological differences. PRINCIPAL FINDINGS CsU patients were found to express more than 2fold higher IgE-anti-TPO serum levels as compared to healthy control subjects (p<0.001). 54% of csU patients had serum levels higher than the cut off ( = 5 IU/ml). By distribution analyses we identified two distinct subpopulations of csU patients: 1) IgE-anti-TPO(low) ( = 39%, IgE-anti-TPO: median 2.17 interquartile range 0.86-5.44, = comparable to healthy controls) and 2) IgE-anti-TPO(high) ( = 61%, IgE-anti-TPO: median 6.67, interquartile range 5.39-8.24). IgE-anti-TPO-positive and -negative csU patients had very similar distributions of age and gender as well as disease activity and duration. IgE-anti-TPO-positive csU patients exhibited significantly higher IgG-anti-TPO levels and lymphocyte counts as well as decreased C4 complement levels. CONCLUSION Our findings show that a sizeable subgroup of csU patients expresses IgE antibodies against thyroid peroxidase. These autoantibodies could cause "autoallergic" mast cell activation, a novel pathomechanism of chronic spontaneous urticaria.
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Affiliation(s)
- Sabine Altrichter
- Department of Dermatology and Allergy,
Allergie-Centrum-Charité/ECARF, Charité - Universitätsmedizin
Berlin, Berlin, Germany
| | - Hans-Jürgen Peter
- Department of Dermatology and Allergy,
Allergie-Centrum-Charité/ECARF, Charité - Universitätsmedizin
Berlin, Berlin, Germany
| | - Dina Pisarevskaja
- Department of Dermatology and Allergy,
Allergie-Centrum-Charité/ECARF, Charité - Universitätsmedizin
Berlin, Berlin, Germany
| | - Martin Metz
- Department of Dermatology and Allergy,
Allergie-Centrum-Charité/ECARF, Charité - Universitätsmedizin
Berlin, Berlin, Germany
| | - Peter Martus
- Department of Biometry and Clinical Epidemiology,
Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus Maurer
- Department of Dermatology and Allergy,
Allergie-Centrum-Charité/ECARF, Charité - Universitätsmedizin
Berlin, Berlin, Germany
- * E-mail:
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42
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Metz M, Maurer M. Rupatadine for the treatment of allergic rhinitis and urticaria. Expert Rev Clin Immunol 2011; 7:15-20. [PMID: 21162645 DOI: 10.1586/eci.10.85] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Allergies are a widespread group of diseases of civilization and most patients are still undertreated. Since histamine is considered to be the most important mediator in allergies such as allergic rhinitis and urticaria, the most commonly used drugs to treat these disorders are antihistamines acting on the histamine 1 (H1) receptor. The currently available antihistamines, however, have significant differences in their effects and safety profiles. Furthermore, the Allergic Rhinitis and its Impact on Asthma initiative calls for additional desirable properties of antihistamines. Here, we review the profile of rupatadine, a new dual platelet-activating factor and H1-receptor antagonist that fulfils these criteria and therefore offers an excellent option for the treatment of allergic diseases.
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Affiliation(s)
- Martin Metz
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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43
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Mathias SD, Dreskin SC, Kaplan A, Saini SS, Spector S, Rosén KE. Development of a daily diary for patients with chronic idiopathic urticaria. Ann Allergy Asthma Immunol 2010; 105:142-8. [PMID: 20674825 DOI: 10.1016/j.anai.2010.06.011] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 06/11/2010] [Accepted: 06/16/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chronic idiopathic urticaria (CIU) is a disease characterized by itching and skin hives or wheals of unknown cause that vary in size and last for at least 6 weeks. The criterion standard for measuring disease activity is the urticaria activity score (UAS). However, content validity of the UAS has not been previously reported. OBJECTIVES To identify outcomes important to patients with CIU, create an urticaria patient daily diary based on the UAS and input from patients, and assess its content validity. METHODS A qualitative research study was conducted in 2 stages using one-on-one telephone interviews of patients with CIU. In stage 1, patients were asked to discuss the impact of CIU on aspects of their life and to evaluate the content of the UAS. On the basis of this information, a patient daily diary, including UAS items, was developed. In stage 2, patients were interviewed to determine whether the urticaria patient daily diary was comprehensive and easily understood. RESULTS Stage 1 interviews showed that CIU has an extensive impact on patients, from the primary symptoms of itching, hives, and angioedema to the broader aspects of sleep and health-related quality of life. Stage 2 interviews demonstrated the content validity of the urticaria patient daily diary and resulted in minor modifications to the diary. When the urticaria patient daily diary was administered in conjunction with the Dermatology Life Quality Index and Medical Outcomes Study Sleep Scale, patients considered the assessment to be comprehensive, although some recommendations were made to include more items on emotional issues and other aspects of angioedema. CONCLUSIONS The final urticaria patient daily diary is an easy-to-administer, comprehensive assessment of symptoms for CIU patients. Future research is needed to establish its additional psychometric properties.
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Abstract
Chronic urticaria is a common skin disease. In about 45% of patients the cause is an autoantibody directed at the α-subunit of the high-affinity IgE receptor (chronic autoimmune urticaria; CAU). Omalizumab is a monoclonal anti-IgE antibody that has a proven role in the treatment of various allergic diseases. We gave omalizumab once every month for 16 weeks to three patients that were refractory to standard treatment, including high doses of antihistamines, leukotriene receptor antagonist, and corticosteroid. There was dramatic improvement in the primary efficacy variable--the change in mean urticaria activity score (UAS) from baseline (i.e., the average over the first 4-week period before omalizumab) to the final 4-week period of omalizumab treatment. There was improvement in the secondary efficacy variables, which included change from baseline in interference with sleep, interference with daily activities, daily diary record of urticaria signs and symptoms based on a scoring system, and rescue medication use. These improvements persisted for 12 weeks after discontinuation of the drug. Omalizumab may have a role in treating refractory cases of CAU.
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Affiliation(s)
- Mona Al-Ahmad
- Department of Allergy, Al-Rashed Allergy Center, Kuwait.
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Effect of high-dose intravenous immunoglobulin treatment in therapy-resistant chronic spontaneous urticaria. Ann Allergy Asthma Immunol 2010; 104:253-8. [PMID: 20377115 DOI: 10.1016/j.anai.2009.12.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) lasting more than 6 weeks is one of the most disabling types of urticaria and often results in severely impaired quality of life. Patients with CSU are often unsatisfied with the standard treatment. Another treatment option recommended for patients with so-called nonresponding CSU according to the newest guidelines is intravenous immunoglobulin (IVIG). OBJECTIVE To assess the efficacy and safety of high-dose IVIG as a treatment option in patients with therapy-resistant CSU. METHODS Six patients with severe CSU unresponsive to other treatment options according to the newest guidelines for several weeks were treated with high-dose IVIG (2 g/kg every 4-6 weeks). The response to treatment was observed on the basis of clinical signs and reduction of co-medications using a special treatment score. Patients were studied during the treatment period and were followed up for an average of 16 months. Adverse events were assessed. RESULTS Patients showed an improvement in symptoms and a reduction in co-medication use just after the first cycle. Symptoms such as itching, wheals, and edema were reduced after the first or second cycle of IVIG treatment. Four of 6 patients had complete remission after 2 to 4 cycles. One patient needed a longer continuation of treatment to reach a stable state of improvement, and another patient had a slight relapse after the seventh cycle. Adverse effects, such as headache and increased blood pressure, were observed only at the beginning of treatment. CONCLUSION High-dose IVIG represents an important therapeutic option in patients with severe CSU.
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Bachert C, Maurer M. Safety and efficacy of desloratadine in subjects with seasonal allergic rhinitis or chronic urticaria: results of four postmarketing surveillance studies. Clin Drug Investig 2010; 30:109-22. [PMID: 20067329 DOI: 10.2165/11530930-000000000-00000] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Allergic rhinitis (AR) and chronic urticaria (CU) are common diseases with symptoms that impair quality of life. Second-generation antihistamines (e.g. cetirizine, desloratadine, fexofenadine, loratadine and mizolastine) are recommended first-line treatment for both conditions; however, studies of clinically relevant differences among these agents are lacking. The aim of this investigation was to evaluate the safety, tolerability and efficacy of desloratadine 5 mg once daily in four postmarketing surveillance studies in subjects with seasonal AR (SAR) or chronic idiopathic urticaria (CIU) in real-world clinical practice settings. METHODS This programme of prospective surveillance studies was conducted in Germany between February 2001 and March 2002 in allergy; dermatology; ear, nose and throat; or general practice settings. Subjects (total number 77 880) were aged > or =12 years and met the requirements for treatment of SAR or CIU with desloratadine as outlined in the package insert. All subjects received oral desloratadine 5 mg once daily for a mean duration of up to 40.4 days. Adverse events (AEs) were reported throughout the studies; serious AEs were recorded for up to 30 days after treatment. Investigators and subjects both rated tolerability at the end of treatment. Symptom severity and sleep and daily activity impairment were evaluated at baseline and after treatment using 4-point scales (0 = none; 1 = mild; 2 = moderate; 3 = severe). A post hoc subanalysis assessed desloratadine efficacy and onset of symptom relief in subjects who had received monotherapy with another second-generation antihistamine. RESULTS A total of 386 AEs were reported by 287 subjects (0.37%) in the four studies. The most commonly reported treatment-related AEs were fatigue (0.07%), headache (0.07%), dry mouth (0.04%) and nausea (0.03%). Tolerability was rated as excellent/good by 99.1% of investigators and 98.5% of subjects. Desloratadine therapy significantly reduced nasal and ocular symptom severity, itching and wheals, and sleep and activity disruption (p < 0.0001), as indicated by a reduction in mean total and individual symptom scores, and reported impairment of sleep and daily activities. The efficacy of desloratadine was rated as significantly greater by 59.4-88.0% of subjects who had previously received monotherapy with cetirizine, fexofenadine, loratadine or mizolastine (p < 0.01 for all). The percentage of subjects who rated onset of symptom relief with desloratadine as faster than previous treatment ranged from 51.6% to 82.4%. CONCLUSION Desloratadine was safe, well tolerated and efficacious in this series of surveillance studies. A post hoc analysis of subjects who had received previous monotherapy with a second-generation antihistamine found that most subjects rated efficacy as higher than their previous treatment, with a faster onset of symptom relief.
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Affiliation(s)
- Claus Bachert
- Department of Otorhinolaryngology, University Hospital Ghent, De Pintelaan 185, BE-9000 Ghent, Belgium.
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Zuberbier T, Oanta A, Bogacka E, Medina I, Wesel F, Uhl P, Antépara I, Jáuregui I, Valiente R. Comparison of the efficacy and safety of bilastine 20 mg vs levocetirizine 5 mg for the treatment of chronic idiopathic urticaria: a multi-centre, double-blind, randomized, placebo-controlled study. Allergy 2010; 65:516-28. [PMID: 19860762 DOI: 10.1111/j.1398-9995.2009.02217.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bilastine is a novel nonsedative H(1)-receptor antagonist, which may be used for the symptomatic treatment of chronic idiopathic urticaria (CU). The aim of this study was to compare the clinical efficacy and safety of bilastine 20 mg vs levocetirizine 5 mg and placebo in CU patients with moderate-to-severe symptoms. METHODS Overall 525 male and female subjects aged 18-70 years were randomized to receive bilastine 20 mg, levocetirizine 5 mg or placebo, once daily for 28 days, in double-blind manner, in 46 centres across Europe and Argentina. Patients rated symptoms of pruritus, number of wheals, and maximum size of wheals (on predefined scales) as reflective (over past 12 h) symptoms twice daily, for assessment of change from baseline in the total symptoms scores (TSS) over 28 days as the primary efficacy measure. Changes in reflective and instantaneous symptoms scores, Dermatology Life Quality Index (DLQI), and CU-associated discomfort and sleep disturbance were assessed as secondary outcomes. Safety was assessed according to adverse events, laboratory tests and electrocardiograms. RESULTS Bilastine reduced patients' mean reflective and instantaneous TSS from baseline to a significantly greater degree than placebo (P < 0.001); from day 2 onwards of treatment. The DLQI, general discomfort, and sleep disruption were also improved significantly in bilastine-treated patients as compared with placebo-treated patients (P < 0.001 for all parameters). Comparison with levocetirizine indicated both treatments to be equally efficacious as well as equally safe and well tolerated as compared with placebo. CONCLUSIONS Bilastine 20 mg is a novel effective and safe treatment option for the management of CU.
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Affiliation(s)
- T Zuberbier
- Department of Dermatology and Allergy, Charité Universitätsmedizin Berlin, Germany
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Peroni DG, Paiola G, Tenero L, Fornaro M, Bodini A, Pollini F, Piacentini GL. Chronic urticaria and celiac disease: a case report. Pediatr Dermatol 2010; 27:108-9. [PMID: 20199432 DOI: 10.1111/j.1525-1470.2009.01066.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We describe a case of a 9-year-old girl who presented chronic urticaria associated with celiac disease. The prevalence of the manifestation of chronic urticaria in celiac disease is unknown but increase in atopic immunologic disorders has been reported in the setting of gluten enteropathy. Relationship between the clinical manifestations is not clear. The present case of subclinical celiac disease diagnosis in an otherwise asymptomatic child with chronic urticaria further reinforces the evidence that differential for celiac disease warrants to be always considered in children with refractory urticaria.
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Sudhakara Rao M, Dwarakanatha Reddy D, Murthy PSN. Rupatadine: pharmacological profile and its use in the treatment of allergic rhinitis. Indian J Otolaryngol Head Neck Surg 2009; 61:320-32. [PMID: 23120659 PMCID: PMC3450081 DOI: 10.1007/s12070-009-0091-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Rupatadine is a once-daily, non-sedating, selective and long-acting new drug with a strong antagonist activity towards both histamine H1 receptors and platelet-activating factor receptors. The use of rupatadine is indicated in adult and adolescent patients (>12 years of age) suffering from intermittent and persistent allergic rhinitis. In the treatment of these conditions, rupatadine is at least as effective as ebastine, cetirizine, loratadine and desloratadine. Avery good safety profile of rupatadine has been evidenced in various studies, including a long-term (1-year) safety study. Rupatadine does not present drug-drug interactions with azithromycin, fluoxetine and lorazepam, but should not be administered concomitantly with known CYP3A4 inhibitors.
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Giuliodori K, Ganzetti G, Campanati A, Simonetti O, Marconi B, Offidani A. A non-responsive chronic autoimmune urticaria in a 12-year-old autistic girl treated with cyclosporin. J Eur Acad Dermatol Venereol 2009; 23:619-20. [PMID: 18785892 DOI: 10.1111/j.1468-3083.2008.02987.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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