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Muñoz M, Kiefer LA, Pereira MP, Bizjak M, Maurer M. New insights into chronic inducible urticaria. Curr Allergy Asthma Rep 2024; 24:457-469. [PMID: 39028396 DOI: 10.1007/s11882-024-01160-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE OF REVIEW Chronic inducible urticaria (CIndU) is a group of long-persisting and challenging to manage diseases, characterized by recurrent wheals and angioedema induced by definite triggers. In this review, we address recent findings on CIndU pathogenesis, diagnosis as well as its treatment, and we discuss novel potential targets that may lead to the development of more effective therapies for CIndU patients. RECENT ADVANCES Meaningful advances in the understanding of its pathogenesis have been reported in the last decades. Novel CIndU-specific patient-reported outcome measures enable a closer and better evaluation of patients. CIndU is a hard-to-treat disease that highly impairs quality of life (QoL) of affected patients. Provocation tests allow to diagnose CIndU subtypes. The only licensed and recommended treatment for CIndU are second generation non-sedating H1-antihistamines, which lack efficacy in many cases. Omalizumab off-label use has been assessed in all types of CIndU with overall good outcomes. Promising emerging therapies currently assessed in chronic spontaneous urticaria are paving the path for novel treatments for CIndU.
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Affiliation(s)
- Melba Muñoz
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, 10178, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin, 12203, Berlin, Germany
| | - Lea Alice Kiefer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, 10178, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin, 12203, Berlin, Germany
| | - Manuel P Pereira
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, 10178, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin, 12203, Berlin, Germany
| | - Mojca Bizjak
- Division of Allergy, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, 10178, Berlin, Germany.
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin, 12203, Berlin, Germany.
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2
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Canonica GW, Kuna P, Maurer M, Mösges R, Novak Z, Papadopoulos N, Rodriguez del Rio P. Bilastine for the treatment of allergic rhinoconjunctivitis and urticaria: results from an international Delphi study. Drugs Context 2024; 13:2024-2-3. [PMID: 38742145 PMCID: PMC11090268 DOI: 10.7573/dic.2024-2-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/12/2024] [Indexed: 05/16/2024] Open
Abstract
Background Second-generation oral H1-antihistamines, including bilastine, represent the emerging treatments of allergic rhinitis (including rhinoconjunctivitis) and chronic urticaria in both adults and children. This study analyses available evidence supporting the use of bilastine amongst second-generation antihistamines for the symptomatic treatment of allergic rhinitis and urticaria in adults and children. Methods Consensus amongst experts from 17 countries on the ideal treatment of rhinitis and urticaria, and the specific role of bilastine was measured by means of a modified Delphi process. A total of 12 statements were voted on by the experts using a five-point Likert scale (1 = strongly disagree; 2 = disagree; 3 = undecided; 4 = agree; 5 = strongly agree). The definition of consensus was set at a minimum of 80% concordance for 4+5 scores (agree or strongly agree). Results All proposed statements reached consensus, with a concordance of ≥98% for five statements and ≥96% for seven. Conclusions The wide consensus obtained for the proposed statements suggests a prominent role for bilastine in the management of allergic rhinitis and urticaria.
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Affiliation(s)
- Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Personalized Medicine Asthma & Allergy IRCCS Humanitas Research Hospital, Milan, Italy
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - Marcus Maurer
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Freie Universität Berlin, Berlin, Germany
- Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Ralph Mösges
- IMSB, Medical Faculty, University at Cologne, Cologne, Germany
- ClinCompetence Cologne GmbH, Cologne, Germany
| | - Zoltan Novak
- Pediatric Department, University of Szeged, Szeged, Hungary
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De A, Singh S, Chakraborty D, Sarda A, Godse K. Bilastine in Refractory Chronic Spontaneous Urticaria: Disease Control and Cytokine Modulation in an Open-label Prospective Study. Indian J Dermatol 2024; 69:132-136. [PMID: 38841225 PMCID: PMC11149799 DOI: 10.4103/ijd.ijd_722_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Introduction The treatment options for chronic spontaneous urticaria (CSU) primarily include second generation non-sedative antihistamine (SGAHs). Bilastine is a newer, nonsedating SGAH approved for urticaria in February 2019 by the Drugs Controller General of India. Its major advantages are in terms of superior efficacy, lack of drug interactions and adverse effects, including sedation, compared to conventional SGAHs. The role of cytokines in the pathogenesis of CSU is well known. However, there is a shortage of data regarding the change in serum levels of proinflammatory cytokines following H1 antihistamines. We conducted this trial to evaluate the role of bilastine in cytokine modulation and autoimmunity, thereby explaining its role in modifying the disease process in CSU. Materials and Methods This prospective study was conducted in a tertiary institute in Kolkata on patients aged 12 years and above with a CSU >6 months. These patients had an unsatisfactory response, as per the Urticaria Activity Score 7 (UAS7), to previous antihistamine therapies in standard doses. Treatment effectiveness was determined by comparing the UAS7 at baseline with that at weeks 4, 8 and 12. Also, baseline serum interleukin-6 (IL-6) and IL-17 were compared with those at the end of the study, that is, 12 weeks. Results Thirty patients who matched the inclusion criteria and signed informed consent were included in the study. At the end of 12 weeks, 10% of patients (n = 3) achieved a complete treatment response (UAS = 0), whereas 43.33% of patients (n = 13) were labelled as having well-controlled urticaria (UAS <6). At 12 weeks, the mean UAS7 score (6.47 ± 4.45) was statistically significant compared to the baseline score (25.47 ± 7.74). The mean values of serum IL-6 (pg/ml) and IL-17 (pg/ml) at baseline were 5.96 ± 5.24 pg/ml and 6.96 ± 5.97 pg/ml, respectively. At the end of treatment, that is, 3 months, the mean values were reduced to 4.61 ± 4.56 pg/ml and 5.08 ± 3.87 pg/ml. The reduction was statistically significant for both serum IL-6 (P < 0.001) and IL-17 (P < 0.0001). Conclusion We conclude that bilastine at a once-daily continuous dose of 40 mg for 3 months is safe and effective in CSU patients who are refractory to treatment at the standard doses of SGAHs. Improved symptomatic control with bilastine was also associated with better control over the inflammatory process, as suggested by the lowering of mean cytokine levels in our study.
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Affiliation(s)
- Abhishek De
- From the Department of Dermatology, Calcutta National Medical College, Calcutta, India
| | - Sushil Singh
- From the Department of Dermatology, Calcutta National Medical College, Calcutta, India
| | - Disha Chakraborty
- From the Department of Dermatology, Calcutta National Medical College, Calcutta, India
| | - Aarti Sarda
- Department of Dermatology, Wizderm Specialty Skin and Hair Clinic, Calcutta, India
| | - Kiran Godse
- Department of Dermatology, D Y Patil Medical College, Navi Mumbai, India
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Bréhon A, Bensefa-Colas L, D'Andrea C, Jeziorski E, Lehucher-Michel MP, Lequipe J, Marmion N, Mathelier-Fusade P, Mercier JC, Sebatigita G, Tannous J, Vigan M, Guillot B, Du-Thanh A, Soria A. Guidelines for cold urticaria management established by the Centre of Evidence of Dermatology and the Urticaria Group of the French Society of Dermatology. Br J Dermatol 2024; 190:445-447. [PMID: 38000904 DOI: 10.1093/bjd/ljad447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/02/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
This research letter provides guidelines for cold urticaria management established by the Centre of Evidence of Dermatology and the Urticaria Group of the French Society of Dermatology.
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Affiliation(s)
- Alice Bréhon
- Sorbonne Université, Service de Dermatologie et d'Allergologie, APHP, Hopital Tenon, 75020 Paris [Department of Dermatology and Allergology, AP-HP, Tenon Hospital, 75020, Paris, France]
| | | | | | | | | | | | | | - Pascale Mathelier-Fusade
- Sorbonne Université, Service de Dermatologie et d'Allergologie, APHP, Hopital Tenon, 75020 Paris [Department of Dermatology and Allergology, AP-HP, Tenon Hospital, 75020, Paris, France]
| | | | | | | | | | | | | | - Angèle Soria
- Sorbonne Université, Service de Dermatologie et d'Allergologie, APHP, Hopital Tenon, 75020 Paris [Department of Dermatology and Allergology, AP-HP, Tenon Hospital, 75020, Paris, France]
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De A, Shah B, Banodkar PD, Dhoot D, Chitnis K, Barkate H. Real-World Indian Experience of Switchover to Bilastine 40 mg/day in CSU Patient Refractory to Other Antihistamines at Double Dose. Indian J Dermatol 2023; 68:674-677. [PMID: 38371575 PMCID: PMC10869010 DOI: 10.4103/ijd.ijd_89_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
Background Although second-generation antihistamines (SGAHs) are recommended as first-line drugs in chronic spontaneous urticaria (CSU), symptom relief has been reported in <50% of patients at licensed doses and up to fourfold dosing is recommended for these patients. Bilastine (SGAH), at licensed doses and higher doses, is efficacious in CSU. However, large-scale real-world data is scarce. Objectives To report the real-world evidence of the safety and effectiveness of bilastine at a double dose (40-mg per day) in CSU management. Materials and Methods In this retrospective questionnaire-based study carried out from February 2022 to July 2022, a pre-validated questionnaire was used to gather data on patients with CSU in dermatology practice from 62 centres across India. Adult patients of either gender diagnosed with CSU and switched over to bilastine 40 mg/day due to a non-satisfactory response (UCT score <12) to other antihistamines at double dose were considered for analysis. Based on UCT scores, patients were classified as responders (UCT ≥12) and non-responders at follow-up assessment at 2 weeks as compared to baseline. Results 177 patients with a mean disease duration of 2.11 ± 1.48 years were included in the final analysis, with 53% females and 47% males. At the end of two weeks, 74/177 (42%) patients were classified as responders, and 103/177 (58%) were non-responders to Bilastine 40 mg/day. The mean change of UCT score from 5.0 ± 2.2 at baseline to 8.08 ± 5.41 (62% improvement) was significant (P < 0.001). Sedation was reported by ten patients without any discontinuation of treatment. Conclusion Bilastine 40 mg/day was effective and well-tolerated in controlling CSU symptoms refractory to antihistamines at double doses.
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Affiliation(s)
- Abhishek De
- From the Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Bela Shah
- Department of Dermatology, Venereology and Leprology, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | | | - Dhiraj Dhoot
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd., Mumbai, Maharashtra, India
| | - Kruttika Chitnis
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd., Mumbai, Maharashtra, India
| | - Hanmant Barkate
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd., Mumbai, Maharashtra, India
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Chaichan W, Ruengorn C, Thavorn K, Hutton B, Szepietowski JC, Bernstein JA, Chuamanochan M, Nochaiwong S. Comparative Safety Profiles of Individual Second-Generation H1-Antihistamines for the Treatment of Chronic Urticaria: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2365-2381. [PMID: 37088368 DOI: 10.1016/j.jaip.2023.03.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND The comparative safety and/or dosing regimens of individual second-generation H1-antihistamines (sgAHs) in patients with chronic urticaria (CU) remain poorly elucidated. OBJECTIVE To compare the safety profiles of individual sgAHs and/or dosing regimens in adolescents or adult patients with CU using a systematic review and network meta-analysis of all available evidence. METHODS With limited English publications, electronic databases and gray literature were searched for randomized clinical trials from inception, with searches last updated on January 20, 2023. Relevant safety outcomes included treatment unacceptability (all-cause discontinuation), tolerability (discontinuation due to any adverse events), adverse events, serious adverse events, central nervous system (CNS) side effects, and anticholinergic side effects. Regarding the network estimates, the probability of being associated with the highest adverse outcome risk was estimated for each treatment comparison. RESULTS Fifty-one randomized clinical trials with 14 individual sgAHs and different dosing regimens, involving 7502 participants, were included. On the basis of the findings from network meta-analyses, variations in sgAH treatment comparisons were observed regarding the unacceptability of treatment, tolerability, adverse events, and CNS side effects. There were no statistically significant differences between the results of sgAH treatment for serious adverse events and those for anticholinergic side effects. On the basis of the ranking of safety profiles, emedastine 4 mg, mizolastine 10 mg, and cetirizine 10 mg were the top 3 ranked treatments with unfavorable safety profiles associated with CNS side effects and any adverse events. CONCLUSIONS These findings suggest evidence of variations in safety profiles among sgAHs for CU treatment, particularly in terms of adverse events and CNS side effects.
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Affiliation(s)
- Wasuchon Chaichan
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chidchanok Ruengorn
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Kednapa Thavorn
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada; Institute of Clinical and Evaluative Sciences, ICES uOttawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada; Institute of Clinical and Evaluative Sciences, ICES uOttawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Jonathan A Bernstein
- Allergy Section, Division of Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Mati Chuamanochan
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
| | - Surapon Nochaiwong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
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Bonnekoh H, Butze M, Spittler S, Staubach P, Weller K, Scheffel J, Maurer M, Krause K. Inhibition of interleukin‐1 with rilonacept is not effective in cold urticaria—Results of a randomized, placebo‐controlled study. Clin Transl Allergy 2023; 13:e12226. [PMID: 36973954 PMCID: PMC9975456 DOI: 10.1002/clt2.12226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/27/2023] [Accepted: 02/07/2023] [Indexed: 03/04/2023] Open
Abstract
Background Cold urticaria (ColdU) is characterized by pruritic wheals following exposure of the skin to cold. Many patients show insufficient response to antihistamines, the first line treatment. Based on the high efficacy of interleukin‐1(IL‐1)‐inhibition in cold‐induced urticarial autoinflammatory diseases, we assessed the effects of rilonacept, an IL‐1 inhibitor, in ColdU patients unresponsive to standard treatment. Methods In this randomized, double‐blind, placebo‐controlled two‐center study, we included 20 patients with ColdU. In the first part, patients received 320 mg rilonacept or placebo (1:1) followed by weekly doses of 160 mg rilonacept or placebo for 6 weeks. In the second part, all patients received weekly 160 mg or 320 mg rilonacept for 6 weeks, open‐label. The primary endpoint was change in critical temperature threshold (CTT). Secondary endpoints included changes in quality of life impairment (Dermatology Life Quality Index, DLQI), differences of inflammatory mediators upon cold provocation and safety assessment over the study period. Results Baseline mean CTTs were 20.2°C (placebo) and 17.3°C (rilonacept). Mean CTTs did not change significantly during the 6‐week double‐blind treatment (placebo – 0.45°C; rilonacept +0.89°C). IL‐6, IL‐18 and HSP‐70 blood levels showed interindividual variability without significant changes during hand cold water bath provocation in placebo‐ or rilonacept‐treated patients. In contrast, DLQI significantly improved in the rilonacept (mean DLQI reduction of 3.8; p = 0.002) but not in the placebo group (mean DLQI reduction of 0). Comparing baseline with the rilonacept open‐label treatment, there were no changes in CTTs or DLQI scores. Conclusion IL‐1 inhibition with rilonacept did not improve ColdU, but demonstrated a good safety profile. Clinical Trial Registration EudraCT number: 2012‐005726‐30. ClinicalTrials.gov identifier: NCT02171416.
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Affiliation(s)
- Hanna Bonnekoh
- Institute of AllergologyCharité—Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin and Berlin Institute of HealthBerlinGermany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and ImmunologyBerlinGermany,Autoinflammation Reference Center Charité (ARC2)Charité—Universitätsmedizin BerlinBerlinGermany
| | - Monique Butze
- Institute of AllergologyCharité—Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin and Berlin Institute of HealthBerlinGermany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and ImmunologyBerlinGermany,Autoinflammation Reference Center Charité (ARC2)Charité—Universitätsmedizin BerlinBerlinGermany
| | - Sebastian Spittler
- Institute of AllergologyCharité—Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin and Berlin Institute of HealthBerlinGermany,Klinik für Anästhesiologie, Intensivmedizin, Schmerztherapie und NotfallmedizinBundeswehrkrankenhausBerlinGermany
| | - Petra Staubach
- Department of DermatologyUniversity Medical Center MainzMainzGermany
| | - Karsten Weller
- Institute of AllergologyCharité—Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin and Berlin Institute of HealthBerlinGermany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and ImmunologyBerlinGermany,Autoinflammation Reference Center Charité (ARC2)Charité—Universitätsmedizin BerlinBerlinGermany
| | - Jörg Scheffel
- Institute of AllergologyCharité—Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin and Berlin Institute of HealthBerlinGermany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and ImmunologyBerlinGermany,Autoinflammation Reference Center Charité (ARC2)Charité—Universitätsmedizin BerlinBerlinGermany
| | - Marcus Maurer
- Institute of AllergologyCharité—Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin and Berlin Institute of HealthBerlinGermany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and ImmunologyBerlinGermany,Autoinflammation Reference Center Charité (ARC2)Charité—Universitätsmedizin BerlinBerlinGermany
| | - Karoline Krause
- Institute of AllergologyCharité—Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin and Berlin Institute of HealthBerlinGermany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and ImmunologyBerlinGermany,Autoinflammation Reference Center Charité (ARC2)Charité—Universitätsmedizin BerlinBerlinGermany
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Kulthanan K, Church MK, Grekowitz EM, Hawro T, Kiefer LA, Munprom K, Nanchaipruek Y, Rujitharanawong C, Terhorst-Molawi D, Maurer M. Evidence for histamine release in chronic inducible urticaria – A systematic review. Front Immunol 2022; 13:901851. [PMID: 35967442 PMCID: PMC9365951 DOI: 10.3389/fimmu.2022.901851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundChronic inducible urticaria (CIndU) constitutes a group of nine different CIndUs in which pruritic wheals and/or angioedema occur after exposure to specific and definite triggers. Histamine released from activated and degranulating skin mast cells is held to play a key role in the pathogenesis of CIndU, but evidence to support this has, as of yet, not been reviewed systematically or in detail. We aim to characterize the role and relevance of histamine in CIndU.MethodsWe systematically searched 3 electronic databases (PubMed, Scopus, and Embase) for studies that reported increased serum or skin histamine concentration (direct evidence) or in vitro or ex vivo histamine release (indirect evidence) following trigger exposure.ResultsAn initial total of 3,882 articles was narrowed down to 107 relevant studies of which 52 were in cold urticaria, 19 in cholinergic urticaria, 14 in heat urticaria, 10 in contact urticaria, 7 each in solar urticaria and vibratory angioedema, 4 each in symptomatic dermographism and aquagenic urticaria, and 3 in delayed pressure urticaria. The results of our review support that histamine has a key pathogenic role in the pathogenesis of all CIndUs, but it is not the sole mediator as evidenced by the often poor relationship between the level of histamine and severity of symptoms and the variable clinical efficacy of H1-antihistamines.ConclusionsHistamine released from skin mast cells is a key driver of the development of signs and symptoms and a promising therapeutic target in CIndU.
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Affiliation(s)
- Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Martin K. Church
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Eva Maria Grekowitz
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Tomasz Hawro
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Department of Dermatology, Allergology and Venereology, Institute and Comprehensive Center for Inflammation Medicine, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Lea Alice Kiefer
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Kanyalak Munprom
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yanisorn Nanchaipruek
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chuda Rujitharanawong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Dorothea Terhorst-Molawi
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- *Correspondence: Marcus Maurer,
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9
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Understanding human mast cells: lesson from therapies for allergic and non-allergic diseases. Nat Rev Immunol 2022; 22:294-308. [PMID: 34611316 DOI: 10.1038/s41577-021-00622-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 02/07/2023]
Abstract
Mast cells have crucial roles in allergic and other inflammatory diseases. Preclinical approaches provide circumstantial evidence for mast cell involvement in many diseases, but these studies have major limitations - for example, there is still a lack of suitable mouse models for some mast cell-driven diseases such as urticaria. Some approaches for studying mast cells are invasive or can induce severe reactions, and very few mediators or receptors are specific for mast cells. Recently, several drugs that target human mast cells have been developed. These include monoclonal antibodies and small molecules that can specifically inhibit mast cell degranulation via key receptors (such as FcεRI), that block specific signal transduction pathways involved in mast cell activation (for example, BTK), that silence mast cells via inhibitory receptors (such as Siglec-8) or that reduce mast cell numbers and prevent their differentiation by acting on the mast/stem cell growth factor receptor KIT. In this Review, we discuss the existing and emerging therapies that target mast cells, and we consider how these treatments can help us to understand mast cell functions in disease.
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Prosty C, Gabrielli S, Mule P, Le Gallee M, Miles LM, Le M, Zhang X, Ensina LF, Netchiporouk E, Ben-Shoshan M. Cold urticaria in a pediatric cohort: Clinical characteristics, management, and natural history. Pediatr Allergy Immunol 2022; 33:e13751. [PMID: 35338743 DOI: 10.1111/pai.13751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/04/2022] [Accepted: 02/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cold urticaria (coldU) is associated with substantial morbidity and risk of fatality. Data on coldU in children are sparse. We aimed to evaluate the clinical characteristics, management, risk of associated anaphylaxis, and resolution rate of coldU in a pediatric cohort. Additionally, we sought to compare these metrics to children with chronic spontaneous urticaria (CSU). METHODS We prospectively enrolled children with coldU from 2013-2021 in a cohort study at the Montreal Children's Hospital and an affiliated allergy clinic. Data for comparison with participants with solely CSU were extracted from a previous study. Data on demographics, comorbidities, severity of presentation, management, and laboratory values were collected at study entry. Patients were contacted yearly to assess for resolution. RESULTS Fifty-two children with cold urticaria were recruited, 51.9% were female and the median age of symptom onset was 9.5 years. Most patients were managed with second-generation H1-antihistamines (sgAHs). Well-controlled disease on sgAHs was negatively associated with concomitant CSU (adjusted odds ratio (aOR) = 0.69 [95%CI: 0.53, 0.92]). Elevated eosinophils were associated with cold-induced anaphylaxis (coldA; aOR = 1.38 [95%CI: 1.04, 1.83]), which occurred in 17.3% of patients. The resolution rate of coldU was 4.8 per 100 patient-years, which was lower than that of CSU (adjusted hazard ratio = 0.43 [95%CI: 0.21, 0.89], p < 10-2 ). CONCLUSION Pediatric coldU bears a substantial risk of anaphylaxis and a low-resolution rate. Absolute eosinophil count and co-existing CSU may be useful predictive factors.
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Affiliation(s)
- Connor Prosty
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Sofianne Gabrielli
- Faculty of Medicine, McGill University, Montreal, QC, Canada.,Division of Pediatric Allergy, Immunology, and Dermatology, Montreal Children's Hospital, Montreal, QC, Canada
| | - Pasquale Mule
- Division of Pediatric Allergy, Immunology, and Dermatology, Montreal Children's Hospital, Montreal, QC, Canada
| | | | - Laura May Miles
- Division of Pediatric Allergy, Immunology, and Dermatology, Montreal Children's Hospital, Montreal, QC, Canada
| | - Michelle Le
- Division of Dermatology, McGill University, Montreal, QC, Canada
| | - Xun Zhang
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Luis F Ensina
- Division of Allergy, Clinical Immunology, and Rheumatology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Moshe Ben-Shoshan
- Division of Pediatric Allergy, Immunology, and Dermatology, Montreal Children's Hospital, Montreal, QC, Canada
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Shah B, Dhoot D, Choudhary A, Jangid N, Mistry D, Shah S, Kamat S, Barkate H. A Comparative, Three-Arm, Randomized Clinical Trial to Evaluate the Effectiveness and Tolerability of Bilastine vs Fexofenadine vs Levocetirizine at the Standard Dose and Bilastine vs Fexofenadine at Higher Than the Standard Dose (Up-Dosing) vs Levocetirizine and Hydroxyzine (in Combination) in Patients with Chronic Spontaneous Urticaria. Clin Cosmet Investig Dermatol 2022; 15:261-270. [PMID: 35221703 PMCID: PMC8867222 DOI: 10.2147/ccid.s350122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/24/2021] [Indexed: 11/26/2022]
Abstract
Introduction Though second-generation antihistamines (SGAH) are first-line drugs in chronic spontaneous urticaria (CSU), 50% of patients do not respond to them. In such patients, guidelines recommend either up-dosing of SGAH or combination of different antihistamines. However, the studies comparing these treatment regimens are limited. Methods In this comparative, three-arm study, CSU patients were randomized to receive standard dose of either bilastine, fexofenadine, or levocetirizine for 2 weeks. After 2 weeks of treatment, non-responders received double dose of either bilastine or fexofenadine, while hydroxyzine 25 mg once daily was added in the levocetirizine group. Patients were primarily evaluated for improvement in CSU, quality of life, and somnolence. Results A total of 110 patients with CSU were recruited. At the end of 4 weeks, 33/39, 26/35, and 22/36 patients in the bilastine, fexofenadine, and levocetirizine groups showed improvement in urticaria symptoms. At week 2, there was no statistical difference in urticaria activity score (UAS7) improvement between any of the groups; however, at week 4, there was a statistical difference between the bilastine and levocetirizine groups (p<0.05). Somnolence was significantly lower in the bilastine group (p<0.05). Bilastine was statistically significant (p<0.05) in the improvement of quality of life as compared to both groups. No major adverse events were reported during study period; however, bilastine was associated with significantly lower levels of AEs compared to levocetirizine (p<0.05). Conclusion Two-fold up-dosing of bilastine improves CSU symptoms without compromising safety as compared to two-fold up-dosing of fexofenadine and combination of first- and second-generation antihistamines.
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Affiliation(s)
- Bela Shah
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Dhiraj Dhoot
- DGM, Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
| | - Ankita Choudhary
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Neha Jangid
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Deval Mistry
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Shikha Shah
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Shruti Kamat
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Hanmant Barkate
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
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Godse K, Rajagopalan M, Shah B, Girdhar M, Shankar K, Zawar V, De A, Sharma N, Tahiliani S, Patil A. Bilastine up-dosing in chronic urticaria: A review. INDIAN JOURNAL OF DRUGS IN DERMATOLOGY 2022. [DOI: 10.4103/ijdd.ijdd_30_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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13
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Rodríguez Del Río P, Rodríguez Fernández F, Ballester Asensio E, Tortajada-Girbés M. How bilastine is used to treat allergic rhinitis and urticaria in children. Immunotherapy 2021; 14:77-89. [PMID: 34850647 DOI: 10.2217/imt-2021-0251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Management guidelines for allergic rhinitis and urticaria recommend oral second-generation antihistamines as first-line treatment. The efficacy and safety of bilastine, the newest nonsedating second-generation antihistamine, are well established in adolescents/adults with these allergic conditions. The bilastine development program for pediatric use (2-<12 years) followed EMA-authorized processes. Pharmacokinetic/pharmacodynamic simulation and modeling and a pharmacokinetic study were conducted to identify and confirm the pediatric dose (10 mg/day). A Phase III, multicenter, double-blind, randomized, placebo-controlled, parallel-group study was performed to confirm the safety of bilastine 10 mg/day in children. In this article, evidence is reviewed for use of bilastine in children with allergic rhinoconjunctivitis or urticaria. Several cases are presented which demonstrate its role in routine clinical practice.
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Affiliation(s)
| | | | - Esther Ballester Asensio
- Pediatric Pulmonology & Allergy Unit, Dr Peset University Hospital, Valencia, 46017, Spain.,Department of Pediatrics, Obstetrics & Gynecology, University of Valencia, Valencia, 46101, Spain
| | - Miguel Tortajada-Girbés
- Pediatric Pulmonology & Allergy Unit, Dr Peset University Hospital, Valencia, 46017, Spain.,Department of Pediatrics, Obstetrics & Gynecology, University of Valencia, Valencia, 46101, Spain.,IVI Foundation, Valencia, 46026, Spain
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14
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Prosty C, Gabrielli S, Le M, Ensina LF, Zhang X, Netchiporouk E, Ben-Shoshan M. Prevalence, Management, and Anaphylaxis Risk of Cold Urticaria: A Systematic Review and Meta-Analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:586-596.e4. [PMID: 34673287 DOI: 10.1016/j.jaip.2021.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/08/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cold urticaria is a subtype of chronic inducible urticaria (CIndU) associated with significant morbidity and a risk for anaphylaxis. Few studies have assessed the prevalence, management, and prevalence of associated anaphylaxis of cold urticaria. OBJECTIVES To evaluate the prevalence of cold urticaria among CIndU and chronic urticaria (CU) cases, to assess the management of cold urticaria, and to determine the prevalence of associated anaphylaxis. METHODS We searched PubMed and EMBASE for studies pertaining to cold urticaria and/or CIndU published in the past 10 years. We conducted meta-analyses to evaluate the prevalence of cold urticaria among CIndU and CU cases, the management of cold urticaria with H1-antihistamines and omalizumab, and the prevalence of associated anaphylaxis. RESULTS Twenty-two studies were included in the systematic review and 14 in the meta-analysis. The pooled prevalence of cold urticaria among patients with CU and CIndU was 7.62% (95% confidence interval [CI], 3.45% to 15.99%; I2 = 98%) and 26.10% (95% CI, 14.17% to 43.05%; I2 = 97%), respectively. Cold urticaria was managed by H1-antihistamines in 95.67% (95% CI, 92.47% to 97.54%; I2 = 38%) of patients and omalizumab in 5.95% (95% CI , 2.55% to 13.27%; I2 = 83%) of patients. The pooled prevalence of anaphylaxis among patients with cold urticaria was 21.49% (95% CI, 15.79% to 28.54%; I2 = 69%). CONCLUSIONS Cold urticaria constitutes an appreciable proportion of CIndU and CU cases and is predominantly managed with H1-antihistamines; few patients receive omalizumab. Anaphylaxis is common, and an epinephrine autoinjector prescription may be considered.
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Affiliation(s)
- Connor Prosty
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Sofianne Gabrielli
- Division of Allergy, Immunology, and Dermatology, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Michelle Le
- Division of Dermatology, McGill University, Montreal, Quebec, Canada
| | - Luis F Ensina
- Department of Pediatrics, Federal University of São Paolo, São Paolo, Brazil
| | - Xun Zhang
- Centre for Outcome Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Moshe Ben-Shoshan
- Division of Allergy, Immunology, and Dermatology, Montreal Children's Hospital, Montreal, Quebec, Canada
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15
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Chan YH, Liew KY, Tan JW, Shaari K, Israf DA, Tham CL. Pharmacological Properties of 2,4,6-Trihydroxy-3-Geranyl Acetophenone and the Underlying Signaling Pathways: Progress and Prospects. Front Pharmacol 2021; 12:736339. [PMID: 34531753 PMCID: PMC8438195 DOI: 10.3389/fphar.2021.736339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/12/2021] [Indexed: 12/01/2022] Open
Abstract
2,4,6-Trihydroxy-3-geranyl acetophenone (tHGA) is a bioactive phloroglucinol compound found in Melicope pteleifolia (Champ. ex Benth.) T.G.Hartley, a medicinal plant vernacularly known as “tenggek burung”. A variety of phytochemicals have been isolated from different parts of the plant including leaves, stems, and roots by using several extraction methods. Specifically, tHGA, a drug-like compound containing phloroglucinol structural core with acyl and geranyl group, has been identified in the methanolic extract of the young leaves. Due to its high nutritional and medicinal values, tHGA has been extensively studied by using various experimental models. These studies have successfully discovered various interesting pharmacological activities of tHGA such as anti-inflammatory, endothelial and epithelial barrier protective, anti-asthmatic, anti-allergic, and anti-cancer. More in-depth investigations later found that these activities were attributable to the modulatory actions exerted by tHGA on specific molecular targets. Despite these findings, the association between the mechanisms and signaling pathways underlying each pharmacological activity remains largely unknown. Also, little is known about the medicinal potentials of tHGA as a drug lead in the current pharmaceutical industry. Therefore, this mini review aims to summarize and relate the pharmacological activities of tHGA in terms of their respective mechanisms of action and signaling pathways in order to present a perspective into the overall modulatory actions exerted by tHGA. Besides that, this mini review will also pinpoint the unexplored potentials of this compound and provide some valuable insights into the potential applications of tHGA which may serve as a guide for the development of modern medication in the future.
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Affiliation(s)
- Yee Han Chan
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Kong Yen Liew
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Ji Wei Tan
- School of Science, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Khozirah Shaari
- Laboratory of Natural Products, Institute of Bioscience, Universiti Putra Malaysia, Serdang, Malaysia.,Department of Chemistry, Faculty of Science, Universiti Putra Malaysia, Serdang, Malaysia
| | - Daud Ahmad Israf
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Chau Ling Tham
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Cullingham K, Kost G. A case of bleomycin-induced flagellate dermatitis: A case report. SAGE Open Med Case Rep 2021; 9:2050313X211039476. [PMID: 34484791 PMCID: PMC8411647 DOI: 10.1177/2050313x211039476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The article description and significance to dermatologists: bleomycin flagellate
dermatitis is a rare cutaneous manifestation, believed to be due to the lack of bleomycin
hydrolase enzyme in the skin, which inactivates bleomycin, resulting in its accumulation.
This is thought to be a dose-dependent reaction, and doses over 200 U and higher may
increase risk. This case describes a male developing a pruritic, erythematous linear
flagellated dermatitis to the lower back after his third cycle of bleomycin, etoposide and
cisplatin for a stage 3 seminoma. Pruritis resolved and erythema improved with the
treatment of bilastine and desoximetasone cream. It is important to recognize this
condition because untreated pruritis may lead to increased impairment of the skin barrier
in already immunocompromised patient populations. This may also give further evidence to
having ongoing and continuing collaboration between Dermatology and Medical Oncology for
any patients presenting with a new rash undergoing chemotherapy treatments.
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Affiliation(s)
- Kyle Cullingham
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Gregory Kost
- University of Saskatchewan, Saskatoon, SK, Canada
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17
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Leceta A, García A, Sologuren A, Campo C. Bilastine 10 and 20 mg in paediatric and adult patients: an updated practical approach to treatment decisions. Drugs Context 2021; 10:dic-2021-5-1. [PMID: 34457015 PMCID: PMC8366504 DOI: 10.7573/dic.2021-5-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/02/2021] [Indexed: 01/03/2023] Open
Abstract
Background Bilastine, a non-sedating H1-antihistamine, is indicated to treat the symptoms of allergic disorders (e.g. rhinoconjunctivitis and urticaria) in adults and adolescents and, more recently, in children. Following its marketing approval, many questions regarding the ideal use of bilastine in various clinical practice situations have been received by the Medical Information Department (MID) of Faes Farma Spain. This article is an update of a previous review, with a focus on recent clinical information on the use of bilastine in paediatric and other populations. Methods Results of recent clinical studies in paediatric and other populations as well as questions received and responses provided by the Faes Farma MID. Results The information regarding the use of bilastine in paediatric patients is the most relevant aspect of this updated review. The stepwise approval of the paediatric formulations in various countries started with the European Medicines Agency approval in 2017 in accordance with a 2009 Paediatric Investigation Plan, followed by approval in other countries. The queries that are most commonly received by the Faes Farma MID include the potential for drug interactions involving bilastine and other frequently used drugs, and the use of bilastine in special populations or to treat specific symptoms related to allergic conditions. As the concomitant use of many medications is not permitted during clinical trials, the advice provided regarding the concomitant use of other medications with bilastine considers the pharmacological properties of both the drug in question and bilastine, as well as expert opinion. Likewise, advice regarding the use of bilastine in special populations (e.g. patients with renal impairment, obesity, lactose intolerance, and elderly or pregnant individuals) or to treat specific symptoms (e.g. treatment-resistant urticaria, pruritus or BASCULE syndrome) considers the best evidence from a variety of sources, including clinical studies, real-world experience, guideline recommendations and expert opinion. Conclusion This updated review provides current data regarding the best use of bilastine in specific situations and patients and identifies areas in which further knowledge is required. Although decisions regarding the use of bilastine may be aided by expert opinion that relies on knowledge of the underlying science, additional research and evidence are required to answer certain queries regarding the use of bilastine.
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Affiliation(s)
- Amalia Leceta
- Medical Affairs Department, Faes Farma SA, Bizkaia, Spain
| | | | | | - Cristina Campo
- Head of Clinical Research Medical Affairs Department, Faes Farma SA, Bizkaia, Spain
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The Classification, Pathogenesis, Diagnostic Workup, and Management of Urticaria: An Update. Handb Exp Pharmacol 2021; 268:117-133. [PMID: 34247278 DOI: 10.1007/164_2021_506] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Wheals and angioedema are the signature signs of urticaria, and itch is the key symptom. Urticaria, in most patients, is acute and resolves within days (acute urticaria, AU). Chronic urticaria (CU) can be of long duration and results not only in severely impaired quality of life but also has a socioeconomic impact due to work productivity impairment. In some patients with CU, the wheals and angioedema are induced exclusively by defined and definite triggers (chronic inducible urticaria, CIndU). In most patients with CU, wheals and angioedema develop unprompted, spontaneously (chronic spontaneous urticaria, CSU). The management of CU aims for the complete control and absence of its signs and symptoms. This is achieved, in most patients, by prophylactic treatment until spontaneous remission occurs. Modern, second-generation H1-antihistamines are the first-line therapy, with the option of updosing to fourfold, and omalizumab is used when this fails.
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19
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Belluco PES, Sifuentes BG, Ferreira MD. Cold urticaria and your risk of anaphylaxis. REVISTA CIÊNCIAS EM SAÚDE 2021. [DOI: 10.21876/rcshci.v11i2.1081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Cold urticaria (CU) is characterized by the appearance of wheals or angioedema after exposure to cold. It presents with mild to severe symptoms and can even lead to anaphylaxis. The risk of systemic reactions is high. We discuss this important pathology and show its strong relationship with anaphylaxis. Cold weather is one of the most common triggers for the onset of symptoms, with variables including humidity and thermal sensation. It is divided into acquired or familial forms. The diagnosis is made in patients with a medical history suggestive of the disease and should be confirmed with a stimulation test. The central aspect of treatment is to avoid cold stimuli. The prescription of self-injectable epinephrine for groups that are at high risk of systemic reactions is ideal. In conclusion, health professionals should be aware of CU in order to recognize the risk of anaphylaxis in these patients.
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20
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Dickson MC, Walker A, Grattan C, Perry H, Williams N, Ratia N, Dewit O, Gisbert S, Metz M, Maurer M. Effects of a topical treatment with spleen tyrosine kinase inhibitor in healthy subjects and patients with cold urticaria or chronic spontaneous urticaria: Results of a phase 1a/b randomised double-blind placebo-controlled study. Br J Clin Pharmacol 2021; 87:4797-4808. [PMID: 34020509 DOI: 10.1111/bcp.14923] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/15/2021] [Accepted: 04/20/2021] [Indexed: 12/19/2022] Open
Abstract
AIMS To explore the safety, tolerability, pharmacokinetics and pharmacodynamics (PD) of GSK2646264 using skin challenge models. METHODS Healthy volunteers (HV) with a positive allergen skin prick test received GSK2646264 (0.5% or 1% ww) and placebo creams on up to 10% body surface area (BSA). Cold (ColdU) or chronic spontaneous (CSU) urticaria patients received 1% GSK2646264 or placebo on up to 10% BSA. PD assessments included weal characteristics after skin allergen challenge, critical temperature threshold (CTT) in ColdU patients and defined area urticaria activity score in CSU patients. RESULTS Thirty-four patients were randomised (17 HV, 12 ColdU, 5 CSU). Topical application of GSK2646264 and placebo was well tolerated. Systemic pharmacokinetics (AUC [0-24] h*ng/mL) was similar between HVs (Geomean 97.9 [%CV 37]) and ColdU patients (Geomean 68.2 [%CV 14; 3.5% BSA] or 167 [%CV 120; 10% BSA]). Whilst in HVs a similar reduction in skin allergen challenge weal area was observed following 3 applications of GSK2646264 and placebo, a trend towards a greater reduction was seen in ColdU with GSK2646264 compared to placebo. A clinically meaningful reduction in CTT, in ColdU patients treated with GSK2646264, was observed in 4 of 9 patients, who demonstrated either a complete inhibition of ColdU to ≤4°C (n = 2) or partial response (reduction by >4°C, n = 2). Due to the small number of CSU patients recruited, no meaningful conclusions could be drawn from the defined area urticaria activity score PD endpoint. CONCLUSION This Phase 1/1b study confirms that GSK2646264 cream applied topically penetrates the skin and some reduction in CTT was observed. (NCT02424799).
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Affiliation(s)
| | | | - Clive Grattan
- St John's Institute of Dermatology, Guy's Hospital, London, UK
| | | | | | - Nirav Ratia
- GlaxoSmithKline (GSK), Brentford, Middlesex, UK
| | - Odile Dewit
- GlaxoSmithKline (GSK), Brentford, Middlesex, UK
| | | | - Martin Metz
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Maltseva N, Borzova E, Fomina D, Bizjak M, Terhorst‐Molawi D, Košnik M, Kulthanan K, Meshkova R, Thomsen SF, Maurer M. Cold urticaria - What we know and what we do not know. Allergy 2021; 76:1077-1094. [PMID: 33249577 DOI: 10.1111/all.14674] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 12/16/2022]
Abstract
Cold urticaria (ColdU) is a common form of chronic inducible urticaria characterized by the development of wheals, angioedema or both in response to cold exposure. Recent research and guideline updates have advanced our understanding and management of ColdU. Today, its pathophysiology is thought to involve the cold-induced formation of autoallergens and IgE to these autoallergens, which provoke a release of proinflammatory mediators from skin mast cells. The classification of ColdU includes typical and atypical subtypes. We know that cold-induced wheals usually develop on rewarming and resolve within an hour and that anaphylaxis can occur. The diagnosis relies on the patient's history and cold stimulation testing. Additional diagnostic work-up, including a search for underlying infections, should only be done if indicated by the patient's history. The management of ColdU includes cold avoidance, the regular use of nonsedating antihistamines and the off-label use of omalizumab. However, many questions regarding ColdU remain unanswered. Here, we review what is known about ColdU, and we present important unanswered questions on the epidemiology, underlying pathomechanisms, clinical heterogeneity and treatment outcomes. Our aim is to guide future efforts that will close these knowledge gaps and advance the management of ColdU.
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Affiliation(s)
- Natalya Maltseva
- Center of Allergy and Immunology Clinical State Hospital 52 Moscow Ministry of Healthcare Moscow Russian Federation
| | - Elena Borzova
- Department of Dermatology and Venereology I.M. Sechenov First Moscow State Medical University Moscow Russian Federation
| | - Daria Fomina
- Center of Allergy and Immunology Clinical State Hospital 52 Moscow Ministry of Healthcare Moscow Russian Federation
- Department of Clinical Immunology and Allergology I.M.Sechenov First Moscow State Medical University Moscow Russian Federation
| | - Mojca Bizjak
- University Clinic of Respiratory and Allergic Diseases Golnik Golnik Slovenia
| | - Dorothea Terhorst‐Molawi
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - Mitja Košnik
- University Clinic of Respiratory and Allergic Diseases Golnik Golnik Slovenia
| | - Kanokvalai Kulthanan
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | - Raisa Meshkova
- Smolensk State Medical University Smolensk Russian Federation
| | - Simon Francis Thomsen
- Department of Dermatology Bispebjerg Hospital University of Copenhagen Copenhagen Denmark
| | - Marcus Maurer
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
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Pozderac I, Lugović-Mihić L, Artuković M, Stipić-Marković A, Kuna M, Ferček I. Chronic inducible urticaria: classification and prominent features of physical and non-physical types. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2020. [DOI: 10.15570/actaapa.2020.29] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gilvary C, Elkhader J, Madhukar N, Henchcliffe C, Goncalves MD, Elemento O. A machine learning and network framework to discover new indications for small molecules. PLoS Comput Biol 2020; 16:e1008098. [PMID: 32764756 PMCID: PMC7437923 DOI: 10.1371/journal.pcbi.1008098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 08/19/2020] [Accepted: 06/27/2020] [Indexed: 12/25/2022] Open
Abstract
Drug repurposing, identifying novel indications for drugs, bypasses common drug development pitfalls to ultimately deliver therapies to patients faster. However, most repurposing discoveries have been led by anecdotal observations (e.g. Viagra) or experimental-based repurposing screens, which are costly, time-consuming, and imprecise. Recently, more systematic computational approaches have been proposed, however these rely on utilizing the information from the diseases a drug is already approved to treat. This inherently limits the algorithms, making them unusable for investigational molecules. Here, we present a computational approach to drug repurposing, CATNIP, that requires only biological and chemical information of a molecule. CATNIP is trained with 2,576 diverse small molecules and uses 16 different drug similarity features, such as structural, target, or pathway based similarity. This model obtains significant predictive power (AUC = 0.841). Using our model, we created a repurposing network to identify broad scale repurposing opportunities between drug types. By exploiting this network, we identified literature-supported repurposing candidates, such as the use of systemic hormonal preparations for the treatment of respiratory illnesses. Furthermore, we demonstrated that we can use our approach to identify novel uses for defined drug classes. We found that adrenergic uptake inhibitors, specifically amitriptyline and trimipramine, could be potential therapies for Parkinson's disease. Additionally, using CATNIP, we predicted the kinase inhibitor, vandetanib, as a possible treatment for Type 2 Diabetes. Overall, this systematic approach to drug repurposing lays the groundwork to streamline future drug development efforts.
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Affiliation(s)
- Coryandar Gilvary
- HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Dept. of Physiology and Biophysics, Weill Cornell Medicine, New York, New York, United States of America
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, New York, United States of America
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, New York, United States of America
- Tri-Institutional Training Program in Computational Biology and Medicine, New York, New York, United States of America
| | - Jamal Elkhader
- HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Dept. of Physiology and Biophysics, Weill Cornell Medicine, New York, New York, United States of America
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, New York, United States of America
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, New York, United States of America
- Tri-Institutional Training Program in Computational Biology and Medicine, New York, New York, United States of America
| | - Neel Madhukar
- OneThree Biotech, New York, New York, United States of America
| | - Claire Henchcliffe
- Department of Neurology, Weill Cornell Medicine, New York, New York, United States of America
| | - Marcus D. Goncalves
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, New York, United States of America
- Division of Endocrinology, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Olivier Elemento
- HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Dept. of Physiology and Biophysics, Weill Cornell Medicine, New York, New York, United States of America
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, New York, United States of America
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, New York, United States of America
- Tri-Institutional Training Program in Computational Biology and Medicine, New York, New York, United States of America
- OneThree Biotech, New York, New York, United States of America
- WorldQuant Initiative for Quantitative Prediction, Weill Cornell Medicine, New York, New York, United States of America
- * E-mail:
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Abstract
Objective: Bilastine is a potent and highly selective H1-antihistamine approved for the treatment of allergic rhinoconjunctivitis and urticaria. This article summarizes available data on the use of bilastine in the treatment of allergic disorders in different age groups, including younger and older adults, and school-age children and adolescents.Methods: A PubMed literature search ("bilastine") was conducted on 25 February 2019. Additional literature known to the authors and identified from the reference lists of cited publications was included.Results: Bilastine is administered orally at a dose of 20 mg once daily in adults and adolescents aged ≥12 years and 10 mg once daily in children aged 6 to <12 years. Clinical trials have demonstrated its efficacy at improving nasal and ocular symptoms in patients with allergic rhinitis, and wheals and itching in patients with urticaria. It has a rapid onset of action and long duration of action. Bilastine does not undergo significant metabolism and does not interact with the CYP450 system, which limits its potential for drug-drug interactions. No dosage adjustments are required in patients with renal or hepatic impairment, or in the elderly. Bilastine is generally well tolerated, even when administered at above-standard doses. It does not exhibit anticholinergic effects or cardiotoxic effects, shows no central nervous system penetration and has minimal sedative properties. It has been shown to improve health-related quality of life.Conclusions: Bilastine is a suitable option for the treatment of patients with allergic rhinoconjunctivitis or urticaria across age groups from school-age children to elderly patients.
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Affiliation(s)
- Martin K Church
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marysia Tiongco-Recto
- Department of Paediatrics, Section of Allergy and Immunology, University of the Philippines-Philippine General Hospital, Manila, The Philippines
| | - Erminia Ridolo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Zoltán Novák
- Paediatric Department, University of Szeged, Szeged, Hungary
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Maurer M, Fluhr JW, Khan DA. How to Approach Chronic Inducible Urticaria. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 6:1119-1130. [PMID: 30033913 DOI: 10.1016/j.jaip.2018.03.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 12/22/2022]
Abstract
Chronic inducible urticaria (CIndU) is a group of chronic urticarias characterized by the appearance of recurrent wheals, recurrent angioedema or both, as a response to specific triggers. CIndU includes both physical (symptomatic dermographism, cold and heat urticaria, delayed pressure urticaria, solar urticaria, and vibratory urticaria) and nonphysical urticarias (cholinergic urticaria, contact and aquagenic urticaria). Here, we review the different forms of CIndU with an emphasis on symptomatic dermographism, cold urticaria, cholinergic urticaria, and delayed pressure urticaria. We discuss the clinical features, the diagnostic workup including provocation and threshold testing, and available treatment options.
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Affiliation(s)
- Marcus Maurer
- Department of Dermatology and Allergy, Charité - Universitätsmedizin, Berlin, Germany.
| | - Joachim W Fluhr
- Department of Dermatology and Allergy, Charité - Universitätsmedizin, Berlin, Germany
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
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26
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Cataldi M, Maurer M, Taglialatela M, Church MK. Cardiac safety of second‐generation H
1
‐antihistamines when updosed in chronic spontaneous urticaria. Clin Exp Allergy 2019; 49:1615-1623. [DOI: 10.1111/cea.13500] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/16/2019] [Accepted: 09/02/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Mauro Cataldi
- Section of Pharmacology Department of Neuroscience School of Medicine University of Naples Federico II Naples Italy
| | - Marcus Maurer
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité–Universitätsmedizin Berlin Berlin Germany
| | - Maurizio Taglialatela
- Section of Pharmacology Department of Neuroscience School of Medicine University of Naples Federico II Naples Italy
| | - Martin K. Church
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité–Universitätsmedizin Berlin Berlin Germany
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27
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Gorczyza M, Curto-Barredo L, Krause K, Church MK, Hawro T, Metz M, Giménez-Arnau A, Maurer M. H1-antihistamine inhibition of histamine- and codeine-induced wheals does not predict response in chronic cold urticaria. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2043-2044. [DOI: 10.1016/j.jaip.2019.01.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
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28
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Baumann KY, Church MK, Clough GF, Quist SR, Schmelz M, Skov PS, Anderson CD, Tannert LK, Giménez-Arnau AM, Frischbutter S, Scheffel J, Maurer M. Skin microdialysis: methods, applications and future opportunities-an EAACI position paper. Clin Transl Allergy 2019; 9:24. [PMID: 31007896 PMCID: PMC6456961 DOI: 10.1186/s13601-019-0262-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/25/2019] [Indexed: 12/20/2022] Open
Abstract
Skin microdialysis (SMD) is a versatile sampling technique that can be used to recover soluble endogenous and exogenous molecules from the extracellular compartment of human skin. Due to its minimally invasive character, SMD can be applied in both clinical and preclinical settings. Despite being available since the 1990s, the technique has still not reached its full potential use as a tool to explore pathophysiological mechanisms of allergic and inflammatory reactions in the skin. Therefore, an EAACI Task Force on SMD was formed to disseminate knowledge about the technique and its many applications. This position paper from the task force provides an overview of the current use of SMD in the investigation of the pathogenesis of chronic inflammatory skin diseases, such as atopic dermatitis, chronic urticaria, psoriasis, and in studies of cutaneous events during type 1 hypersensitivity reactions. Furthermore, this paper covers drug hypersensitivity, UVB-induced- and neurogenic inflammation, and drug penetration investigated by SMD. The aim of this paper is to encourage the use of SMD and to make the technique easily accessible by providing an overview of methodology and applications, supported by standardized operating procedures for SMD in vivo and ex vivo.
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Affiliation(s)
- Katrine Y Baumann
- RefLab ApS, Copenhagen, Denmark.,2Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Martin K Church
- 3Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | | | - Sven Roy Quist
- 5Clinic of Dermatology, Otto-von-Guericke University, Magdeburg, Germany.,Skin Center MDZ, Mainz, Germany
| | - Martin Schmelz
- 7Department of Experimental Pain Research, CBTM, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Per Stahl Skov
- RefLab ApS, Copenhagen, Denmark.,8Odense Research Center for Anaphylaxis (ORCA), Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark
| | - Chris D Anderson
- 9Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Line Kring Tannert
- 8Odense Research Center for Anaphylaxis (ORCA), Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark
| | - Ana Maria Giménez-Arnau
- 10Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mèdiques, Universitat Autònoma, Barcelona, Spain
| | - Stefan Frischbutter
- 3Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jörg Scheffel
- 3Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Marcus Maurer
- 3Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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29
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Serra E, Campo C, Novák Z, Majorek-Olechowska B, Pulka G, García-Bea A, Labeaga L. Efficacy and safety of bilastine in reducing pruritus in patients with chronic spontaneous urticaria and other skin diseases: an exploratory study. J DERMATOL TREAT 2019; 31:270-278. [PMID: 30835579 DOI: 10.1080/09546634.2019.1590522] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To evaluate the efficacy/safety of bilastine in pruritus relief in patients with chronic spontaneous urticaria (CSU) or other pruritic skin diseases.Methods: In this multicenter, open-label, exploratory study (EudraCT No.: 2016-001505-17), 115 adults with CSU (n = 34), eczema/dermatitis (n = 30), prurigo (n = 25) or cutaneous pruritus (n = 26), received bilastine 20 mg once daily for 8 weeks, or in non-responder patients (<30% improvement in pruritus score at week 2), 40 mg/day from week 2.Results: The mean change in weekly pruritus severity score from baseline to week 8 (primary endpoint) was reduced with bilastine (overall and by disease group); overall, percentage and absolute reductions were 71.16% and 1.63 points, respectively (p < .001). Updosed non-responders (n = 31) had improved weekly pruritus severity scores from baseline to week 8; percentage and absolute reductions were 49.08% and 1.13 points, respectively (p < .001). Bilastine improved the Dermatology Life Quality Index at weeks 4 and 8 (p < .001) in all disease groups, and the 7-day Urticaria Activity Score in CSU patients (p < .001). Bilastine was well tolerated.Conclusions: Bilastine relieved pruritus associated with urticaria and other skin diseases, with a very good safety profile.
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Affiliation(s)
- Esther Serra
- Dermatology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Cristina Campo
- Clinical Research Department, FAES FARMA S. A., Bizkaia, Spain
| | - Zoltan Novák
- Department of Pediatrics, University of Szeged, Szeged, Hungary
| | | | | | | | - Luis Labeaga
- Medical Department, FAES FARMA S. A., Bizkaia, Spain
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30
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Kulthanan K, Hunnangkul S, Tuchinda P, Chularojanamontri L, Weerasubpong P, Subchookul C, Maurer M. Treatments of cold urticaria: A systematic review. J Allergy Clin Immunol 2019; 143:1311-1331. [PMID: 30776418 DOI: 10.1016/j.jaci.2019.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Several treatment options for cold urticaria (ColdU) have been studied and reported, but systematic reviews and meta-analyses are limited. OBJECTIVES We sought to meta-analyze and review the efficacy and safety of ColdU treatments. METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Suitable reports were identified by searching PubMed, Scopus, and Web of Science. Our systematic review included 16 studies, 9 of which met the eligibility criteria for the meta-analysis. We analyzed the effects of treatments on critical temperature thresholds (CTTs) and critical stimulation time thresholds (CSTTs), as well as on rates of complete response and adverse events. RESULTS Our pooled meta-analyses showed that nonsedating second-generation H1-antihistamines (nsAHs) are effective in the treatment of ColdU and that updosing of nsAHs significantly reduced CTTs relative to their own standard doses and placebos. In 4 studies involving CSTTs, updosing of nsAHs also resulted in significantly better CSTTs than their own standard doses or placebos. Omalizumab resulted in a marked reduction of CTTs in H1-antihistamine-resistant patients. Of 118 adverse events in 8 studies, standard-dose nsAHs, updosed nsAHs, and omalizumab produced lower numbers of adverse events than first-generation antihistamines. CONCLUSIONS Our study showed that greater dosages of nsAHs were more effective than standard dosages in controlling ColdU symptoms. Increasing the dosages was not significantly associated with higher adverse event rates. Omalizumab at 150 and 300 mg every 4 weeks was shown to be effective for patients with ColdU refractory to antihistamines.
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Affiliation(s)
- Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Saowalak Hunnangkul
- Office of Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Papapit Tuchinda
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Puncharas Weerasubpong
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chanika Subchookul
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Marcus Maurer
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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31
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Varricchi G, Raap U, Rivellese F, Marone G, Gibbs BF. Human mast cells and basophils-How are they similar how are they different? Immunol Rev 2019; 282:8-34. [PMID: 29431214 DOI: 10.1111/imr.12627] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Mast cells and basophils are key contributors to allergies and other inflammatory diseases since they are the most prominent source of histamine as well as numerous additional inflammatory mediators which drive inflammatory responses. However, a closer understanding of their precise roles in allergies and other pathological conditions has been marred by the considerable heterogeneity that these cells display, not only between mast cells and basophils themselves but also across different tissue locations and species. While both cell types share the ability to rapidly degranulate and release histamine following high-affinity IgE receptor cross-linking, they differ markedly in their ability to either react to other stimuli, generate inflammatory eicosanoids or release immunomodulating cytokines and chemokines. Furthermore, these cells display considerable pharmacological heterogeneity which has stifled attempts to develop more effective anti-allergic therapies. Mast cell- and basophil-specific transcriptional profiling, at rest and after activation by innate and adaptive stimuli, may help to unravel the degree to which these cells differ and facilitate a clearer understanding of their biological functions and how these could be targeted by new therapies.
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Affiliation(s)
- Gilda Varricchi
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy.,WAO Center of Excellence, Naples, Italy
| | - Ulrike Raap
- Department of Dermatology and Allergology, University of Oldenburg, Oldenburg, Germany
| | - Felice Rivellese
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy.,WAO Center of Excellence, Naples, Italy.,Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Gianni Marone
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy.,WAO Center of Excellence, Naples, Italy.,Institute of Experimental Endocrinology and Oncology "Gaetano Salvatore" (IEOS), National Research Council (CNR), Naples, Italy
| | - Bernhard F Gibbs
- Department of Dermatology and Allergology, University of Oldenburg, Oldenburg, Germany
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32
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Antihistamines for Allergic Rhinitis Treatment from the Viewpoint of Nonsedative Properties. Int J Mol Sci 2019; 20:ijms20010213. [PMID: 30626077 PMCID: PMC6337346 DOI: 10.3390/ijms20010213] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 12/26/2018] [Accepted: 12/29/2018] [Indexed: 12/21/2022] Open
Abstract
Antihistamines targeting the histamine H1 receptor play an important role in improving and maintaining the quality of life of patients with allergic rhinitis. For more effective and safer use of second-generation drugs, which are recommended by various guidelines, a classification based on their detailed characteristics is necessary. Antihistamines for first-line therapy should not have central depressant/sedative activities. Sedative properties (drowsiness and impaired performance) are associated with the inhibition of central histamine neurons. Brain H1 receptor occupancy (H1RO) is a useful index shown to be correlated with indices based on clinical findings. Antihistamines are classified into non-sedating (<20%), less-sedating (20–50%), and sedating (≥50%) groups based on H1RO. Among the non-sedating group, fexofenadine and bilastine are classified into “non-brain-penetrating antihistamines” based on the H1RO. These two drugs have many common chemical properties. However, bilastine has more potent binding affinity to the H1 receptor, and its action tends to last longer. In well-controlled studies using objective indices, bilastine does not affect psychomotor or driving performance even at twice the usual dose (20 mg). Upon selecting antihistamines for allergic rhinitis, various situations should be taken into our consideration. This review summarizes that the non-brain-penetrating antihistamines should be chosen for the first-line therapy of mild allergic rhinitis.
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33
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Stepaniuk P, Vostretsova K, Kanani A. Review of cold-induced urticaria characteristics, diagnosis and management in a Western Canadian allergy practice. Allergy Asthma Clin Immunol 2018; 14:85. [PMID: 30574166 PMCID: PMC6299577 DOI: 10.1186/s13223-018-0310-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 12/11/2018] [Indexed: 01/15/2023] Open
Abstract
Background Cold-induced urticaria is a significant condition, especially among young females. Despite the morbidity of this disease, studies that fully characterize the disease are limited. Methods We analyzed the characteristics of patients diagnosed with cold-induced urticaria at a community-based allergy practice in Vancouver, BC, Canada between 2003 and 2016. Detailed patient history, diagnostic measures and treatment were evaluated. Results A total of 50 patients were found to have active cold-induced urticaria with a median age of 28.5 (range 2-67) years and 35 patients (70%) were female. 16 patients (32%) had co-occurring physical urticarias while 26 patients (52%) had secondary allergic diagnoses and 3 patients (6%) were thought to have a provoking factor. Of those with a clinical history of suspected cold-induced urticaria that were evaluated with ice cube testing, a positive test was obtained in 84.7% of patients. Treatment was largely with non-sedating antihistamines, with the majority of patients receiving this modality. Conclusions Cold-induced urticaria is a complex disease with significant overlap with other chronic inducible urticarias and other allergic diseases. Diagnostic testing shows inconsistent results and the mainstay of treatment consists of non-sedating antihistamines, with other options available for those who do not respond.
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Affiliation(s)
- Peter Stepaniuk
- 1Department of Internal Medicine, University of British Columbia, Vancouver, BC Canada.,2Division of Allergy and Immunology, University of British Columbia, Suite 207 - 3195 Granville Street, Vancouver, BC V5R 3V8 Canada
| | - Kateryna Vostretsova
- 2Division of Allergy and Immunology, University of British Columbia, Suite 207 - 3195 Granville Street, Vancouver, BC V5R 3V8 Canada
| | - Amin Kanani
- 2Division of Allergy and Immunology, University of British Columbia, Suite 207 - 3195 Granville Street, Vancouver, BC V5R 3V8 Canada
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34
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Weller K, Church MK, Hawro T, Altrichter S, Labeaga L, Magerl M, Metz M, Zuberbier T, Maurer M. Updosing of bilastine is effective in moderate to severe chronic spontaneous urticaria: A real-life study. Allergy 2018; 73:2073-2075. [PMID: 29869790 DOI: 10.1111/all.13494] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- K. Weller
- Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - M. K. Church
- Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - T. Hawro
- Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - S. Altrichter
- Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - L. Labeaga
- Medical Department FAES FARMA SA Leioa (Bizkaia) Spain
| | - M. Magerl
- Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - M. Metz
- Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - T. Zuberbier
- Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - M. Maurer
- Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
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35
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Chu JT. Histamine H1 receptor gene polymorphism acts as a biological indicator of the prediction of therapeutic efficacy in patients with allergic rhinitis in the Chinese Han population. J Cell Biochem 2018; 120:164-170. [PMID: 30168182 DOI: 10.1002/jcb.27278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 06/22/2018] [Indexed: 01/30/2023]
Abstract
H1-antihistamine has been shown to be effective in treating patients with allergic rhinitis (AR), but its mechanism is still uncertain. We investigated effects of histamine H1 receptor (HRH1) gene polymorphisms on the efficacy of oral H1-antihistamine in perennial patients with AR caused by mites in the Chinese Han population for the first time. A total of 224 Han Chinese patients with AR and 165 Han Chinese healthy volunteers were selected. Genotype and allele frequency distribution of -17C/T in HRH1 gene in patients with AR, serum levels of eosinophil cationic protein (ECP), total immunoglobulin E (IgE), and specific IgE were detected. The clinical symptoms of patients with AR were evaluated with visual analogue scale (VAS). Direct counting method was applied to calculate genotype and allele frequencies. Higher levels of serum ECP and total IgE were shown in the AR group. Moreover, patients with CT, TT, or CT+TT genotype increased the risk of AR incidence in the in the -17C/T site of HRH1, and CC genotype and CT+TT genotype were associated with gender, asthma, VAS score, total IgE level, and specific IgE level in patients with AR. In addition, oral administration of H1-antihistamines improves clinical symptoms of patients with AR. At last, patients with the CC genotype showed the increased efficacy of H1-antihistamines in patients with AR. Our study provides evidence that HRH1 gene polymorphisms may correlate with oral H1-antihistamine efficacy for the treatment of patients with AR, which can be used as a biological indicator of the prediction of therapeutic efficacy of patients with AR.
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Affiliation(s)
- Jin-Tao Chu
- Department of Ears, Nose, and Throat, Weihai Central Hospital, Weihai, China
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Church MK, Kolkhir P, Metz M, Maurer M. The role and relevance of mast cells in urticaria. Immunol Rev 2018; 282:232-247. [DOI: 10.1111/imr.12632] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Martin K. Church
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - Pavel Kolkhir
- Department of Dermatology and Venereology; Sechenov First Moscow State Medical University; Moscow Russian Federation
| | - Martin Metz
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - Marcus Maurer
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
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Dressler C, Werner RN, Eisert L, Zuberbier T, Nast A, Maurer M. Chronic inducible urticaria: A systematic review of treatment options. J Allergy Clin Immunol 2018; 141:1726-1734. [PMID: 29438771 DOI: 10.1016/j.jaci.2018.01.031] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/11/2018] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chronic inducible urticaria (CindU) is a condition characterized by the appearance of recurrent wheals, angioedema, or both as a response to specific and reproducible triggers. OBJECTIVE We sought to systematically assess evidence on the efficacy and safety of treatment options for CindU. Results were used to inform the 2017 update of "The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria." METHODS Randomized controlled trials and controlled intervention studies were searched systematically in various databases. Included studies were evaluated with the Cochrane Risk of Bias tool. Where possible, results from single studies were meta-analyzed, applying the Mantel-Haenszel approach by using a random-effects model (Der Simonian-Laird). RESULTS We identified 30 studies that included patients with cold urticaria, symptomatic dermographism, delayed-pressure urticaria, or cholinergic urticaria. No studies on other forms of CindU were eligible. Risk of bias was often rated as unclear or high. Overall, second-generation antihistamines were more effective than placebo, and available data indicate that updosing might be effective. Omalizumab proved effective in patients with symptomatic dermographism, who did not respond to antihistamines. Detailed results are given for each type of CindU. CONCLUSIONS The available evidence is limited by small samples, heterogeneous efficacy outcomes, and poor reporting quality in many of the included studies. The findings are congruent with the suggested stepwise approach to treating CindUs. However, the data do not allow for drawing specific conclusions for specific subtypes of CindU.
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Affiliation(s)
- Corinna Dressler
- Department of Dermatology, Venerology and Allergy, Division of Evidence based Medicine (dEBM), Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ricardo Niklas Werner
- Department of Dermatology, Venerology and Allergy, Division of Evidence based Medicine (dEBM), Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Lisa Eisert
- Department of Dermatology, Venerology and Allergy, Division of Evidence based Medicine (dEBM), Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Torsten Zuberbier
- Department of Dermatology, Venerology and Allergy, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alexander Nast
- Department of Dermatology, Venerology and Allergy, Division of Evidence based Medicine (dEBM), Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marcus Maurer
- Department of Dermatology, Venerology and Allergy, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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Bais S, Kumari R, Prashar Y, Gill NS. Review of various molecular targets on mast cells and its relation to obesity: A future perspective. Diabetes Metab Syndr 2017; 11 Suppl 2:S1001-S1007. [PMID: 28778429 DOI: 10.1016/j.dsx.2017.07.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 07/16/2017] [Indexed: 01/02/2023]
Abstract
Mast cells are stimulatory factors in prognosis of various immunogenic and allergic diseases in human body. These cells play an important role in various immunological and metabolic diseases. The aim of present article is to explore the molecular targets to suppress the over expression of mast cells in obesity. The last 20 years literature were searched by various bibliographic data bases like Pubmed, google Scholar, Scopus and web of Science. The data were collected by keywords like "Mast Cell" "obesity" and "role of mast cell or role in obesity". Articles and their abstract were reviewed with a counting of 827 publications, in which 87 publications were considered for study and remaining was excluded because of its specificity to the subject. This review explains the characteristics, molecular targets and role of mast cells in obesity and existing research with mast cells to the area of metabolic diseases.
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Affiliation(s)
- Souravh Bais
- Department of Pharmacology, Rayat Institute of Pharmacy, Railmajra, SBS Nagar District, Punjab 144506, India.
| | - Reena Kumari
- Department of Pharmacology, Rayat Institute of Pharmacy, Railmajra, SBS Nagar District, Punjab 144506, India
| | - Yash Prashar
- Department of Pharmacology, Rayat Institute of Pharmacy, Railmajra, SBS Nagar District, Punjab 144506, India
| | - N S Gill
- Department of Pharmaceutical Chemistry, Rayat Institute of Pharmacy, Railmajra, SBS Nagar District, Punjab 144506, India
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Sánchez-Borges M, González-Aveledo L, Caballero-Fonseca F, Capriles-Hulett A. Review of Physical Urticarias and Testing Methods. Curr Allergy Asthma Rep 2017. [PMID: 28634900 DOI: 10.1007/s11882-017-0722-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW This review aims to update the information available on the prevalence, clinical picture, diagnostic methods, and treatment of urticarias induced by external physical stimuli. RECENT FINDINGS Physical urticarias are present in up to 5% of the general population, and in 10 to 50% of patients with chronic urticaria. Recent investigations have provided evidence that the presence of physical urticaria alone or when comorbid with chronic spontaneous urticaria is associated with a worse prognosis and duration. Most frequent subtypes of physical urticaria are dermographism and delayed pressure urticaria. The diagnosis is established through specific provocation tests and the management encompasses avoidance measures, pharmacologic therapy with nonsedating antihistamines, and alternative medications in refractory cases.
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Affiliation(s)
- Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela. .,Allergy and Clinical Immunology Service, Clínica El Avila, 6a transversal Urb. Altamira, piso 8, consultorio 803, Caracas, 1060, Venezuela.
| | | | - Fernan Caballero-Fonseca
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela.,Allergy and Immunology Service, Centro Médico de Caracas, Caracas, Venezuela
| | - Arnaldo Capriles-Hulett
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela.,Allergy and Immunology Service, Centro Médico de Caracas, Caracas, Venezuela
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de Montjoye L, Herman A, Nicolas JF, Baeck M. Treatment of chronic spontaneous urticaria: Immunomodulatory approaches. Clin Immunol 2017; 190:53-63. [PMID: 29129806 DOI: 10.1016/j.clim.2017.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/12/2017] [Accepted: 11/07/2017] [Indexed: 02/01/2023]
Abstract
This paper summarizes and reviews the mechanisms of action and data concerning efficacy of recommended treatments as well as other treatments that have been tested, independently of the outcomes, in the management of chronic spontaneous urticaria. Due to the central role of mast cells, basophils and histamine in the pathophysiology of this disease, H1-antihistamines remain the first-line treatment. However, current knowledge about this complex disease, also recognizes an important role for T lymphocytes, B lymphocytes, and autoantibodies. Implications of these others mediators thus provide further targets for treatment. Indeed, agents previously used to treat other autoimmune and inflammatory diseases, have demonstrated efficacy in chronic spontaneous urticaria and are therefore potential therapeutic alternatives for antihistamine unresponsive patients.
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Affiliation(s)
- Laurence de Montjoye
- Department of Dermatology, Saint-Luc University Hospital, Université catholique de Louvain, Brussels, Belgium; Institute of Experimental and Clinical Research, Pole of Pneumology, ENT and Dermatology, Université catholique de Louvain, Brussels, Belgium.
| | - Anne Herman
- Department of Dermatology, Saint-Luc University Hospital, Université catholique de Louvain, Brussels, Belgium; Institute of Experimental and Clinical Research, Pole of Pneumology, ENT and Dermatology, Université catholique de Louvain, Brussels, Belgium
| | - Jean-François Nicolas
- Department of Allergy and Clinical Immunology, Hospital Center Lyon Sud, Lyon, France; CIRI- INSERM U1111 - CNRS UMR5308, Université Lyon 1, Université de Lyon, Lyon, France
| | - Marie Baeck
- Department of Dermatology, Saint-Luc University Hospital, Université catholique de Louvain, Brussels, Belgium; Institute of Experimental and Clinical Research, Pole of Pneumology, ENT and Dermatology, Université catholique de Louvain, Brussels, Belgium
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Tan JW, Israf DA, Md Hashim NF, Cheah YK, Harith HH, Shaari K, Tham CL. LAT is essential for the mast cell stabilising effect of tHGA in IgE-mediated mast cell activation. Biochem Pharmacol 2017; 144:132-148. [PMID: 28813645 DOI: 10.1016/j.bcp.2017.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/10/2017] [Indexed: 12/29/2022]
Abstract
Mast cells play a central role in the pathogenesis of allergic reaction. Activation of mast cells by antigens is strictly dependent on the influx of extracellular calcium that involves a complex interaction between signalling molecules located within the cells. We have previously reported that tHGA, an active compound originally isolated from a local shrub known as Melicope ptelefolia, prevented IgE-mediated mast cell activation and passive systemic anaphylaxis by suppressing the release of interleukin-4 (IL-4) and tumour necrosis factor (TNF)-α from activated rat basophilic leukaemia (RBL)-2H3 cells. However, the mechanism of action (MOA) as well as the molecular target underlying the mast cell stabilising effect of tHGA has not been previously investigated. In this study, DNP-IgE-sensitised RBL-2H3 cells were pre-treated with tHGA before challenged with DNP-BSA. To dissect the MOA of tHGA in IgE-mediated mast cell activation, the effect of tHGA on the transcription of IL-4 and TNF-α mRNA was determined using Real Time-Polymerase Chain Reaction (qPCR) followed by Calcium Influx Assay to confirm the involvement of calcium in the activation of mast cells. The protein lysates were analysed by using Western Blot to determine the effect of tHGA on various important signalling molecules in the LAT-PLCγ-MAPK and PI3K-NFκB pathways. In order to identify the molecular target of tHGA in IgE-mediated mast cell activation, the LAT and LAT2 genes in RBL-2H3 cells were knocked-down by using RNA interference to establish a LAT/LAT2 competition model. The results showed that tHGA inhibited the transcription of IL-4 and TNF-α as a result of the suppression of calcium influx in activated RBL-2H3 cells. The results from Western Blot revealed that tHGA primarily inhibited the LAT-PLCγ-MAPK pathway with partial inhibition on the PI3K-p65 pathway without affecting Syk. The results from RNAi further demonstrated that tHGA failed to inhibit the release of mediators associated with mast cell degranulation under the LAT/LAT2 competition model in the absence of LAT. Collectively, this study concluded that the molecular target of tHGA could be LAT and may provide a basis for the development of a mast cell stabiliser which targets LAT.
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Affiliation(s)
- Ji Wei Tan
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43300, Malaysia
| | - Daud Ahmad Israf
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43300, Malaysia
| | - Nur Fariesha Md Hashim
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43300, Malaysia
| | - Yoke Kqueen Cheah
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43300, Malaysia
| | - Hanis Hazeera Harith
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43300, Malaysia
| | - Khozirah Shaari
- Faculty of Science, Universiti Putra Malaysia, Serdang 43300, Malaysia
| | - Chau Ling Tham
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43300, Malaysia.
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Urticaria and Angioedema: an Update on Classification and Pathogenesis. Clin Rev Allergy Immunol 2017; 54:88-101. [DOI: 10.1007/s12016-017-8628-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Church MK, Labeaga L. Bilastine: a new H 1 -antihistamine with an optimal profile for updosing in urticaria. J Eur Acad Dermatol Venereol 2017; 31:1447-1452. [PMID: 28467671 DOI: 10.1111/jdv.14305] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/05/2017] [Indexed: 12/18/2022]
Abstract
This review set out to examine published papers detailing the efficacy of bilastine in skin models and urticaria to assess whether it meets the optimal profile for updosing in urticaria, that is, strong clinical efficacy and freedom from unwanted side effects, particularly sedation. Bilastine is a highly effective H1 -antihistamine even when used at the basic dose of 20 mg daily. Its facilitated uptake after oral dosage gives it a rapid onset and long duration of action. In both wheal and flare studies and in urticaria updosing fourfold showed increased effectiveness. With respect to somnolence, bilastine is a substrate for P-glycoprotein, a membrane pump which prevents it crossing the blood-brain barrier. Consequently, bilastine is a practically 'non-sedating' H1 -antihistamine. In conclusion, the excellent profile of bilastine in both efficacy and safety make it the ideal H1 -antihistamine for updosing the daily dose fourfold in difficult-to-treat urticaria as recommended by the EAACI/GA2 LEN/EDF/WAO guideline for the management of urticaria.
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Affiliation(s)
- M K Church
- Department of Dermatology and Allergy, Allergy Centre Charité, Charité Universitätsmedizin, Berlin, Germany
| | - L Labeaga
- Medical Department, FAES Farma, S.A., Bilbao, Spain
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Bilastine in symptomatic allergic rhinoconjunctivitis and urticaria: a guide to its use. DRUGS & THERAPY PERSPECTIVES 2017. [DOI: 10.1007/s40267-017-0381-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kocatürk E, Can PK, Akbas PE, Copur M, Degirmentepe EN, Kızıltac K, Singer R. Management of chronic inducible urticaria according to the guidelines: A prospective controlled study. J Dermatol Sci 2017; 87:60-69. [PMID: 28314658 DOI: 10.1016/j.jdermsci.2017.02.283] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 02/23/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND The recommended treatment approach in chronic inducible urticarias (CIndU) is the same as that for chronic spontaneous urticaria (CSU). But there is a lack of controlled trials assessing efficacy of available treatment options. OBJECTIVE We aimed to evaluate the efficacy of treatment algorithm recommended by the guidelines and comparison of treatment responses in CIndU vs CSU. METHODS This prospective parallel group controlled study included 70 CIndU and 66 CSU patients. The same treatment algorithm recommended by the European Academy of Allergology and Clinical Immunology/Global Allergy and Asthma European Network/European Dermatology Forum/World Allergy Organization (EAACI/GA2LEN/EDF/WAO) was implemented to both CSU and CIndU patients. Treatment responses of the groups were evaluated with urticaria control test (UCT) and dermatology life quality questionnaire (DLQI) scores at the 0, 4, 8, 12 and 24th weeks for CIndU and 0, 4, 12 and 24 weeks for CSU. RESULTS Fourteen patients (20,9%) with CIndU and 25 (37,9%) with CSU responded to standard doses of H1-AHs which was significantly higher in the CSU group (p=0,031, p<0,05). Patients with CIndU and CSU showed statistically similar responses to 2nd line treatments (combining or updosing AHs) (p=0,979; p>0,05). Twenty-seven (40,3%) of CIndU patients and 21 (31,8%) of CSU patients were diagnosed as AH-resistant urticaria. Omalizumab was administered to 15 CSU patients and 17 CIndU patients. Response rates to omalizumab were similar in both groups. Total response rates increased from 37,9% (n:25) to 68,2% (n:45) with the 2nd line treatments in CSU group while it increased from 20,9% (n:14) to 59,7% (n:40) in CIndU group. When omalizumab was introduced to AH-refractory cases as a 3rd line treatment, total response rates evaluated at the 12th week were 76,1% (n:51) in patients with CIndU and 83,3% (n:55) in CSU. Continuing omalizumab treatment for 24 weeks increased response rates in patients who were unresponsive at week 12. CONCLUSION CIndU seem to be more resistant to standard doses of AHs and higher doses of AHs are required for the control of symptoms. The same guidelines for CSU may be implemented to patients with CIndU.
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Affiliation(s)
- Emek Kocatürk
- Okmeydanı Training and Research Hospital, Department of Dermatology, Kaptanpasa Mah. Darülaceze Cad. No: 27, 34384 Okmeydanı, Şişli, Istanbul, Turkey.
| | - Pelin Kuteyla Can
- Okmeydanı Training and Research Hospital, Department of Dermatology, Kaptanpasa Mah. Darülaceze Cad. No: 27, 34384 Okmeydanı, Şişli, Istanbul, Turkey.
| | - Pırıl Etikan Akbas
- Okmeydanı Training and Research Hospital, Department of Dermatology, Kaptanpasa Mah. Darülaceze Cad. No: 27, 34384 Okmeydanı, Şişli, Istanbul, Turkey.
| | - Mehmet Copur
- Okmeydanı Training and Research Hospital, Department of Dermatology, Kaptanpasa Mah. Darülaceze Cad. No: 27, 34384 Okmeydanı, Şişli, Istanbul, Turkey.
| | - Ece Nur Degirmentepe
- Okmeydanı Training and Research Hospital, Department of Dermatology, Kaptanpasa Mah. Darülaceze Cad. No: 27, 34384 Okmeydanı, Şişli, Istanbul, Turkey.
| | - Kübra Kızıltac
- Okmeydanı Training and Research Hospital, Department of Dermatology, Kaptanpasa Mah. Darülaceze Cad. No: 27, 34384 Okmeydanı, Şişli, Istanbul, Turkey.
| | - Ralfi Singer
- Okmeydanı Training and Research Hospital, Department of Dermatology, Kaptanpasa Mah. Darülaceze Cad. No: 27, 34384 Okmeydanı, Şişli, Istanbul, Turkey.
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van den Elzen MT, van Os-Medendorp H, van den Brink I, van den Hurk K, Kouznetsova OI, Lokin ASHJ, Laheij-de Boer AM, Röckmann H, Bruijnzeel-Koomen CAFM, Knulst AC. Effectiveness and safety of antihistamines up to fourfold or higher in treatment of chronic spontaneous urticaria. Clin Transl Allergy 2017; 7:4. [PMID: 28289538 PMCID: PMC5309999 DOI: 10.1186/s13601-017-0141-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/03/2017] [Indexed: 11/13/2022] Open
Abstract
Background Treatment with second-generation antihistamines is recommended in patients with chronic spontaneous urticaria (CSU). Some patients remain unresponsive even after up-dosing up to fourfold. Many third line treatment options have limited availability and/or give rise to significant side effects. We investigated effectiveness and safety of antihistamine treatment with dosages up to fourfold and higher. Methods This retrospective analysis of patients’ records was performed in adult CSU patients suffering wheals and/or angioedema (AE). Demographic, clinical, and therapeutic data was extracted from their medical records. We recorded the type, maximum prescribed dosage, effectiveness, and reported side effects of antihistamine treatment. Results Of 200 screened patients, 178 were included. Treatment was commenced with a once daily dose of antihistamines. Persisting symptoms meant that up-dosing up to fourfold occurred in 138 (78%) of patients, yielding sufficient response in 41 (23%). Up-dosing antihistamines was necessary in 110 (80%) patient with weals alone or weals with angioedema and 28 (64%) with AE only (p = 0.039). Of the remaining 97 patients with insufficient response, 59 were treated with dosages higher than fourfold (median dosage 8, range 5–12). This was sufficient in 29 patients (49%). Side effects were reported in 36 patients (20%), whereof 30 (17%) experienced somnolence. Side effects after up-dosing higher than fourfold were reported in six out of 59 patients (10%). Conclusion Up-dosing antihistamines higher than fourfold dosage seems a feasible therapeutic option with regards to effectiveness and safety. The need for third line therapies could be decreased by 49%, with a very limited increase of reported side effects.
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Affiliation(s)
- Mignon T van den Elzen
- Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands
| | - Harmieke van Os-Medendorp
- Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands
| | - Imke van den Brink
- Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands
| | - Karin van den Hurk
- Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands
| | - Ouliana I Kouznetsova
- Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands
| | - Alexander S H J Lokin
- Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands
| | - Anna-Marijke Laheij-de Boer
- Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands
| | - Heike Röckmann
- Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands
| | - Carla A F M Bruijnzeel-Koomen
- Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands
| | - André C Knulst
- Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands
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Leceta A, Sologuren A, Valiente R, Campo C, Labeaga L. Bilastine in allergic rhinoconjunctivitis and urticaria: a practical approach to treatment decisions based on queries received by the medical information department. Drugs Context 2017; 6:212500. [PMID: 28210286 PMCID: PMC5299972 DOI: 10.7573/dic.212500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Bilastine is a safe and effective commonly prescribed non-sedating H1-antihistamine approved for symptomatic treatment in patients with allergic disorders such as rhinoconjunctivitis and urticaria. It was evaluated in many patients throughout the clinical development required for its approval, but clinical trials generally exclude many patients who will benefit in everyday clinical practice (especially those with coexisting diseases and/or being treated with concomitant drugs). Following its introduction into clinical practice, the Medical Information Specialists at Faes Farma have received many practical queries regarding the optimal use of bilastine in different circumstances. DATA SOURCES AND METHODS Queries received by the Medical Information Department and the responses provided to senders of these queries. RESULTS The most frequent questions received by the Medical Information Department included the potential for drug-drug interactions with bilastine and commonly used agents such as anticoagulants (including the novel oral anticoagulants), antiretrovirals, antituberculosis regimens, corticosteroids, digoxin, oral contraceptives, and proton pump inhibitors. Most of these medicines are not usually allowed in clinical trials, and so advice needs to be based upon the pharmacological profiles of the drugs involved and expert opinion. The pharmacokinetic profile of bilastine appears favourable since it undergoes negligible metabolism and is almost exclusively eliminated via renal excretion, and it neither induces nor inhibits the activity of several isoenzymes from the CYP 450 system. Consequently, bilastine does not interact with cytochrome metabolic pathways. Other queries involved specific patient groups such as subjects with renal impairment, women who are breastfeeding or who are trying to become pregnant, and patients with other concomitant diseases. Interestingly, several questions related to topics that are well covered in the Summary of Product Characteristics (SmPC), which suggests that this resource is not being well used. CONCLUSIONS Overall, this analysis highlights gaps in our knowledge regarding the optimal use of bilastine. Expert opinion based upon an understanding of the science can help in the decision-making, but more research is needed to provide evidence-based answers in certain circumstances.
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Affiliation(s)
- Amalia Leceta
- Medical Department, Faes Farma SA, 48940-Leioa, Bizkaia, Spain
| | - Ander Sologuren
- Clinical Research Department, Faes Farma SA, 48940-Leioa, Bizkaia, Spain
| | - Román Valiente
- Clinical Research Department, Faes Farma SA, 48940-Leioa, Bizkaia, Spain
| | - Cristina Campo
- Clinical Research Department, Faes Farma SA, 48940-Leioa, Bizkaia, Spain
| | - Luis Labeaga
- Medical Department, Faes Farma SA, 48940-Leioa, Bizkaia, Spain
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48
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Boev R, Bentz JW. Balanced discussion of second-generation antihistamines' data. Ther Clin Risk Manag 2016; 12:1777-1781. [PMID: 28008261 PMCID: PMC5167562 DOI: 10.2147/tcrm.s124148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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49
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Weller K, Maurer M. Antihistamine updosing in chronic urticaria - is there enough evidence? Br J Dermatol 2016; 175:1134-1135. [DOI: 10.1111/bjd.15104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- K. Weller
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Charitéplatz 1 10117 Berlin Germany
| | - M. Maurer
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Charitéplatz 1 10117 Berlin Germany
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Staevska MT. Comparative efficacy of bilastine, levocetirizine and desloratadine updosing in chronic urticaria. Ther Clin Risk Manag 2016; 12:1793-1796. [PMID: 27932886 PMCID: PMC5135004 DOI: 10.2147/tcrm.s120628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Maria T Staevska
- Clinical Center of Allergology, Medical University, Sofia, Bulgaria
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