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Mak HW, Wong JC, So SW, Lam DL, Weller K, Maurer M, Li PH. Validation and correlations of the Angioedema Activity Score (AAS), Angioedema Quality of Life (AE-QoL) questionnaire, and Angioedema Control Test (AECT) in Chinese patients with angioedema. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100295. [PMID: 39099700 PMCID: PMC11293506 DOI: 10.1016/j.jacig.2024.100295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/31/2024] [Accepted: 04/05/2024] [Indexed: 08/06/2024]
Abstract
Background The impact of recurrent angioedema can be severely debilitating and remains difficult to quantify. Several standardized patient-reported outcome measures (PROMs), including the Angioedema Activity Score (AAS), Angioedema Quality of Life (AE-QoL) questionnaire, and Angioedema Control Test (AECT), have been developed and translated into different languages. However, these PROMs have yet to be validated in Chinese individuals, and their correlations in the Chinese population remain unknown. Objective Our aim was to validate the Chinese versions of the AAS, AE-QoL questionnaire, and AECT and assess their intercorrelations. Methods A prospective cohort of 118 Chinese patients with recurrent angioedema at the Angioedema and Urticaria Centre of Reference and Excellence in Hong Kong completed the traditional Chinese versions of the AAS, AE-QoL questionnaire, and AECT. We analyzed the reliability and validity of these PROMs and their correlations with each other as well as with generic PROMs. Results The Chinese AAS, AE-QoL questionnaire, and AECT demonstrated excellent internal consistency (Cronbach α = 0.920, 0.976, and 0.832, respectively; McDonald ω = 0.972, 0.977, and 0.901, respectively). Confirmatory factor analysis for the AE-QoL questionnaire showed an acceptable fit with the 4-dimensional model (comparative fit index = 0.869; Tucker-Lewis index = 0.842). The AECT showed significant correlations with both the AAS and AE-QoL questionnaire (ρ = -0.750 and -0.456 respectively [both P < .05]). The AE-QoL questionnaire was moderately correlated with certain domains of generic PROMs such as the Work Productivity and Activity Impairment Questionnaire: General Health, version 2.0, and the Short Form 12-Item Health Survey, version 2 (all ρ < 0.60). Conclusion The Chinese AE-QoL questionnaire, AAS, and AECT are valid and reliable tools for use with Chinese patients. More validated tools should be made available to improve patient care and research for all patients with angioedema globally.
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Affiliation(s)
- Hugo W.F. Mak
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Jane C.Y. Wong
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Sophia W.M. So
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Dorothy L.Y. Lam
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Karsten Weller
- 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, Immunology and Allergology, 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, Immunology and Allergology, Berlin, Germany
| | - Philip H. Li
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
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Hide M, Kishimoto M, Kotera I, Oh A, Inoue Y, Yamamoto BA, Noto S. Analysis of disease burden in patients with hereditary angioedema from Japan by patient-reported outcomes. J Dermatol 2024. [PMID: 39258885 DOI: 10.1111/1346-8138.17421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/12/2024] [Accepted: 07/25/2024] [Indexed: 09/12/2024]
Abstract
Hereditary angioedema (HAE) symptoms can vary greatly. Disease burden evaluation is essential for providing adequate treatments for patients. Patient-reported outcome measures (PROMs), including the 12-Item Short Form Health Survey (SF-12), the Angioedema Quality of Life (AE-QoL), the Hospital Anxiety and Depression Scale (HADS), and the Work Productivity and Activity Impairment: Specific Health Problem (WPAI:SHP) questionnaires, were collected in 2021, before modern medications for long-term prophylaxis (LTP) of HAE were licensed in Japan. Patients also reported their HAE attack frequency as "annual" (several attacks annually), "monthly" (several attacks monthly) or "weekly" (several attacks weekly). Multiple linear regression analyses were conducted on the relationship between independent parameters (sex, age, attack frequency, HAE type, and HADS scores) and dependent parameters (AE-QoL and SF-12 scores). Fifty-four patients reported PROMs. All PROMs showed substantial health-related quality of life (HRQoL) impairment. Overall, the higher the attack frequencies, the greater the reported impairment in the PROMs tended to be. In multiple linear regression analyses, higher AE-QoL Fatigue/Mood and Fears/Shame domain scores (greater impairment) were associated with higher HADS anxiety subscale scores; higher AE-QoL total scores (greater HRQoL impairment) and lower SF-12 Physical and Mental Health Composite scores (greater general health impairment) were associated with higher HADS depression subscale scores. Patients with monthly or weekly HAE attacks reported numerically low absenteeism and numerically high presenteeism and work productivity loss as measured by the WPAI:SHP questionnaire. In this study, conducted before modern LTP options were available in Japan, patients with HAE reported notable impairment in HRQoL and work productivity. Weekly or monthly HAE attack frequencies were associated with a high disease burden. Furthermore, a substantial number of patients reported notable fatigue/mood impairment as measured by the AE-QoL and depression as measured by the HADS regardless of attack frequency. These results provide a basis for future studies evaluating the effect of LTP on the clinical manifestations and HRQoL in patients with HAE.
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Affiliation(s)
- Michihiro Hide
- Department of Dermatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
- Department of Dermatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Miwa Kishimoto
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Ippei Kotera
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Akinori Oh
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Yoichi Inoue
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Beverley Anne Yamamoto
- Hereditary Angioedema Japan (HAEJ) Registered Non-Profit Organization, Hyogo, Japan
- Graduate School of Human Sciences, Osaka University, Osaka, Japan
| | - Shinichi Noto
- Department of Rehabilitation, School of Occupational Therapy, Niigata University of Health and Welfare, Niigata, Japan
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Bernstein JA, Apfelbacher C, Chu DK, Schneider L, Saini SS, Ben Shoshan M. Patient-Reported Outcome Measures in Chronic Spontaneous Urticaria, Angioedema, and Atopic Dermatitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00840-7. [PMID: 39168302 DOI: 10.1016/j.jaip.2024.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 08/05/2024] [Accepted: 08/08/2024] [Indexed: 08/23/2024]
Abstract
Reducing the burden of disease for patients and families requires being able to measure health status changes related to disease severity, control, and response to treatment over time. Patient-reported outcomes are patient perceptions of their health status. Such perceptions are critical to decision making. Some patient-reported outcome measures (PROMs) are extensive and often intended to be used only for detailed research assessments. Many PROMs, however, form critical components of valid, reliable, and responsive assessments in clinical research and routine clinical practice. The smallest score change in a PROM that would lead to different decision making by patients is called the minimally important difference. Using PROMs may also offer advantages over general questions or unvalidated tools. With the innovation of technology, the ability to chronicle disease symptoms using communication technology (mobile phone applications) has become increasingly available. Collection of real-world data in this capacity will be very useful for identifying more precise phenotypes/endotypes necessary for investigation of tailored therapies for chronic spontaneous and inducible urticaria, angioedema, and atopic dermatitis. Here, we provide an overview of PROMs that have been developed for the assessment of disease severity, control, and quality of life and that have been validated for the use of adults and children with these skin disorders.
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Affiliation(s)
- Jonathan A Bernstein
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio.
| | - Chistian Apfelbacher
- Otto-von-Guericke-Universität Magdeburg, Institute of Social Medicine and Health Systems Research (ISMHSR), Magdeburg, Germany
| | - Derek K Chu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; The Research Institute of St. Joe's Hamilton, Hamilton, Ontario, Canada
| | - Lynda Schneider
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Sarbjit S Saini
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Moshe Ben Shoshan
- Division of Pediatric Allergy, Clinical Immunology and Dermatology, Department of Pediatrics, McGill University Health Center, Montreal Children's Hospital, Montreal, Quebec, Canada
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4
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Keller L, Stitt J. Chronic Spontaneous Urticaria: Quality of Life and Economic Impacts. Immunol Allergy Clin North Am 2024; 44:453-467. [PMID: 38937009 DOI: 10.1016/j.iac.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
This study focuses on quality of life (QoL) assessment in chronic urticaria, delving into tools, disease-specific measures, and its profound impact. With expanding therapeutic options, understanding QoL becomes crucial. QoL measures often involve comparisons of patient-reported outcomes in addition to quantitative measures of disease control. Emerging tools include the Urticaria Activity and Impact Measure, which may provide a balanced evaluation. In addition to discussions of the various QoL measures, the psychological impact of chronic urticaria are highlighted, covering emotional burden, stress, and psychiatric comorbidities. Finally, the economic impacts reveal escalating health care costs and cost-effectiveness considerations of therapies like omalizumab.
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Affiliation(s)
- Levi Keller
- Division of Allergy and Clinical Immunology, University of Colorado School of Medicine, 12700 East 19th Avenue 10C03, Aurora, CO 80045, USA.
| | - Jenny Stitt
- Division of Allergy and Clinical Immunology, University of Colorado School of Medicine, 12700 East 19th Avenue 10C03, Aurora, CO 80045, USA
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5
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Cherrez-Ojeda I, Bousquet J, Giménez-Arnau A, Godse K, Krasowska D, Bartosińska J, Szczepanik-Kułak P, Wawrzycki B, Kolkhir P, Allenova A, Allenov A, Tkachenko S, Mitrevska NT, Mijakoski D, Stoleski S, Kolacinska-Flont M, Kuprys-Lipinska I, Molinska J, Kasperska-Zając A, Zajac M, Zamłyński M, Mihaltan F, Ulmeanu R, Zalewska-Janowska A, Tomaszewska K, Al-Ahmad M, Al-Nesf MA, Ibrahim T, Aqel S, Pesqué D, Rodríguez-González M, Wakida-Kuzunoki GH, Ramon GD, Ramon GN, Neisinger S, Bonnekoh H, Rukhadze M, Khoshkhui M, Fomina D, Larenas-Linnemann D, Košnik M, Kara RO, Caballero López CG, Liu Q, Ivancevich JC, Ensina LF, Rosario N, Kvedariene V, Ben-Shoshan M, Jardim Criado RF, Bauer A, Cherrez A, Cherrez S, Chong-Neto H, Rojo-Gutierrez MI, Rudenko M, Larco Sousa JI, Lesiak A, Matos E, Tinoco I, Shijin CC, Logroño RH, Sagñay JC, Faytong-Haro M, Robles-Velasco K, Zuberbier T, Maurer M. Usage prevalence of angioedema patient-reported outcome measures: Results from the UCARE and ACARE PROMUSE study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:2211-2215.e1. [PMID: 38734372 DOI: 10.1016/j.jaip.2024.04.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024]
Affiliation(s)
- Ivan Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador; RespiraLab Research Group, Department of Allergy, Immunology & Pulmonology, Guayaquil, Ecuador.
| | - Jean Bousquet
- Charité-Universitätsmedizin Berlin, Institute of Allergology, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Ana Giménez-Arnau
- Dermatology Department, Hospital del Mar Research Institute, Universitat Pompeu Fabra, Barcelona, Spain
| | - Kiran Godse
- Department of Dermatology, D. Y. Patil University School of Medicine, Navi Mumbai, India
| | - Dorota Krasowska
- Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - Joanna Bartosińska
- Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland; Department of Cosmetology and Aesthetic Medicine, Medical University of Lublin, Lublin, Poland
| | - Paulina Szczepanik-Kułak
- Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - Bartlomiej Wawrzycki
- Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - Pavel Kolkhir
- Charité-Universitätsmedizin Berlin, Institute of Allergology, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Anastasiia Allenova
- Laboratory of Immune-Mediated Skin Diseases, Institute of Regenerative Medicine, Biomedical Science & Technology Park, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Andrey Allenov
- Institute for Leadership and Health Management, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation; State Budgetary Healthcare Institution of the City of Moscow, "City Polyclinic No. 2 10 of the Department of Health of the City of Moscow," Moscow, Russian Federation; Federal State Budgetary Scientific Institution, "N. A. Semashko National Research Institute of Public Health," Moscow, Russian Federation
| | - Sergey Tkachenko
- Russian Medical Academy of Сontinuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Natasa Teovska Mitrevska
- Dermatology Department, Remedika General Hospital, Skopje, Republic of North Macedonia; International Balkan University (IBU), Skopje, Republic of North Macedonia
| | - Dragan Mijakoski
- Institute of Occupational Health of RNM-Skopje, Skopje, Republic of North Macedonia; Faculty of Medicine, Ss. Cyril and Methodius, University of Skopje, Skopje, Republic of North Macedonia
| | - Sasho Stoleski
- Institute of Occupational Health of RNM-Skopje, Skopje, Republic of North Macedonia; Faculty of Medicine, Ss. Cyril and Methodius, University of Skopje, Skopje, Republic of North Macedonia
| | - Marta Kolacinska-Flont
- Department of Internal Medicine, Asthma and Allergy, Barlicki Memorial Hospital, Medical University of Lodz, Lodz, Poland
| | - Izabela Kuprys-Lipinska
- Department of Internal Medicine, Asthma and Allergy, Barlicki Memorial Hospital, Medical University of Lodz, Lodz, Poland
| | - Joanna Molinska
- Department of Internal Medicine, Asthma and Allergy, Barlicki Memorial Hospital, Medical University of Lodz, Lodz, Poland
| | - Alicja Kasperska-Zając
- European Center for Diagnosis and Treatment of Urticaria/Angioedema (GA2LEN UCARE/ACARE Network) & Department of Clinical Allergology and Urticaria, Medical University of Silesia, Silesia, Poland
| | - Magdalena Zajac
- European Center for Diagnosis and Treatment of Urticaria/Angioedema (GA2LEN UCARE/ACARE Network) & Department of Clinical Allergology and Urticaria, Medical University of Silesia, Silesia, Poland
| | - Mateusz Zamłyński
- European Center for Diagnosis and Treatment of Urticaria/Angioedema (GA2LEN UCARE/ACARE Network) & Department of Clinical Allergology and Urticaria, Medical University of Silesia, Silesia, Poland
| | | | | | - Anna Zalewska-Janowska
- Medical University of Lodz, Chair of Clinical Immunology and Rheumatology, Department of Psychodermatology, Lodz, Poland
| | - Katarzyna Tomaszewska
- Medical University of Lodz, Chair of Clinical Immunology and Rheumatology, Department of Psychodermatology, Lodz, Poland
| | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Maryam Ali Al-Nesf
- Allergy and Immunology Division, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Tayseer Ibrahim
- Allergy and Immunology Division, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Sami Aqel
- Allergy and Immunology Division, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - David Pesqué
- Department of Dermatology, Hospital del Mar, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | | | - German D Ramon
- Instituto de Alergia e Inmunologia del Sur, GA2LEN UCARE/ADCARE/ACARE Center, Bahia Blanca, Argentina
| | - Gonzalo N Ramon
- Instituto de Alergia e Inmunologia del Sur, GA2LEN UCARE/ADCARE/ACARE Center, Bahia Blanca, Argentina
| | - Sophia Neisinger
- Charité-Universitätsmedizin Berlin, Institute of Allergology, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Hanna Bonnekoh
- Charité-Universitätsmedizin Berlin, Institute of Allergology, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany; Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maia Rukhadze
- Center Allergy & Immunology/Geomedi Teaching University, Faculty of Medicine, Tbilisi, Georgia
| | - Maryam Khoshkhui
- Allergy Research Center, Mashhad University of Medical Science (MUMS), Mashhad, Iran
| | - Daria Fomina
- Moscow Practical and Research Center of Allergy and Immunology, Clinical City Hospital, Moscow, Russian Federation; Moscow Department of Clinical Immunology and Allergology, Sechenov First Moscow State Medical University, Astana Medical University, Moscow, Russian Federation
| | | | - Mitja Košnik
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia Medical Faculty, University of Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Slovenia
| | - Rabia Oztas Kara
- Department of Dermatology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | | | - Qiang Liu
- Second Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, China
| | | | - Lius Felipe Ensina
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo and CPAlpha Clinical Research Center, São Paulo, Brazil
| | - Nelson Rosario
- Urticaria Center of Reference and Excellence (UCARE), Federal University of Parana, Rua General Carneiro, Curitiba, Brazil
| | - Violeta Kvedariene
- Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Institute of Clinical Medicine, Clinic of Chest Diseases, Immunology and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Moshe Ben-Shoshan
- Division of Allergy, Immunology and Dermatology, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada
| | | | - Andrea Bauer
- Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany
| | - Annia Cherrez
- RespiraLab Research Group, Department of Allergy, Immunology & Pulmonology, Guayaquil, Ecuador; Department of Dermatology, Venerology, and Allergology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Sofia Cherrez
- RespiraLab Research Group, Department of Allergy, Immunology & Pulmonology, Guayaquil, Ecuador; Gemeinschaftspraxis PD, Dr. Jung & Kollegen, Krämpferstr. Erfurt, Germany
| | - Herberto Chong-Neto
- Department of Pediatrics, Hospital de Clínicas, Federal University of Paraná (UFPR), Curitiba, Brazil
| | | | - Michael Rudenko
- London Allergy and Immunology Centre, London, United Kingdom
| | | | - Aleksandra Lesiak
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Medical University of Lodz, Lodz, Poland
| | - Edgar Matos
- Instituto Nacional de Salud del Nino, Lima, Peru
| | | | - Carolina Crespo Shijin
- Universidad Espíritu Santo, Samborondón, Ecuador; RespiraLab Research Group, Department of Allergy, Immunology & Pulmonology, Guayaquil, Ecuador
| | - Romina Hinostroza Logroño
- Universidad Espíritu Santo, Samborondón, Ecuador; RespiraLab Research Group, Department of Allergy, Immunology & Pulmonology, Guayaquil, Ecuador
| | - Juan C Sagñay
- Universidad Espíritu Santo, Samborondón, Ecuador; RespiraLab Research Group, Department of Allergy, Immunology & Pulmonology, Guayaquil, Ecuador
| | - Marco Faytong-Haro
- RespiraLab Research Group, Department of Allergy, Immunology & Pulmonology, Guayaquil, Ecuador; Universidad Estatal de Milagro, Cdla. Universitaria "Dr. Romulo Minchala Murillo", Guayas, Milagro, Ecuador; Sociology and Demography Department, Pennsylvania State University, University Park, Pa; Ecuadorian Development Research Laboratory, Daule, Guayas, Ecuador
| | - Karla Robles-Velasco
- Universidad Espíritu Santo, Samborondón, Ecuador; RespiraLab Research Group, Department of Allergy, Immunology & Pulmonology, Guayaquil, Ecuador
| | - Torsten Zuberbier
- Charité-Universitätsmedizin Berlin, Institute of Allergology, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Charité-Universitätsmedizin Berlin, Institute of Allergology, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany.
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6
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Cherrez-Ojeda I, Bousquet J, Giménez-Arnau A, Godse K, Krasowska D, Bartosińska J, Szczepanik-Kułak P, Wawrzycki B, Kolkhir P, Allenova A, Allenova A, Tkachenko S, Teovska Mitrevska N, Mijakoski D, Stoleski S, Kolacinska-Flont M, Kuprys-Lipinska I, Molinska J, Kasperska-Zając A, Zajac M, Zamlynski M, Mihaltan F, Ulmeanu R, Zalewska-Janowska A, Tomaszewska K, Al-Ahmad M, Al-Nesf MA, Ibrahim T, Aqel S, Pesqué D, Rodríguez-González M, Wakida-Kuzunoki GH, Ramon G, Ramon G, Neisinger S, Bonnekoh H, Rukhadze M, Khoshkhui M, Fomina D, Larenas-Linnemann D, Košnik M, Oztas Kara R, Caballero López CG, Liu Q, Ivancevich JC, Ensina LF, Rosario N, Kvedariene V, Ben-Shoshan M, Criado RFJ, Bauer A, Cherrez A, Chong-Neto H, Rojo-Gutierrez MI, Rudenko M, Larco Sousa JI, Lesiak A, Matos E, Muñoz N, Tinoco I, Moreno J, Crespo Shijin C, Hinostroza Logroño R, Sagñay J, Faytong-Haro M, Robles-Velasco K, Zuberbier T, Maurer M. Patient-Reported Outcome Measures in Atopic Dermatitis and Chronic Urticaria Are Underused in Clinical Practice. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1575-1583.e1. [PMID: 38604531 DOI: 10.1016/j.jaip.2024.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are validated and standardized tools that complement physician evaluations and guide treatment decisions. They are crucial for monitoring atopic dermatitis (AD) and chronic urticaria (CU) in clinical practice, but there are unmet needs and knowledge gaps regarding their use in clinical practice. OBJECCTIVE We investigated the global real-world use of AD and CU PROMs in allergology and dermatology clinics as well as their associated local and regional networks. METHODS Across 72 specialized allergy and dermatology centers and their local and regional networks, 2,534 physicians in 73 countries completed a 53-item questionnaire on the use of PROMs for AD and CU. RESULTS Of 2,534 physicians, 1,308 were aware of PROMs. Of these, 14% and 15% used PROMs for AD and CU, respectively. Half of physicians who use PROMs do so only rarely or sometimes. Use of AD and CU PROM is associated with being female, younger, and a dermatologist. The Patient-Oriented Scoring Atopic Dermatitis Index and Urticaria Activity Score were the most common PROMs for AD and CU, respectively. Monitoring disease control and activity are the main drivers of the use of PROMs. Time constraints were the primary obstacle to using PROMs, followed by the impression that patients dislike PROMs. Users of AD and CU PROM would like training in selecting the proper PROM. CONCLUSIONS Although PROMs offer several benefits, their use in routine practice is suboptimal, and physicians perceive barriers to their use. It is essential to attain higher levels of PROM implementation in accordance with national and international standards.
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Affiliation(s)
- Ivan Cherrez-Ojeda
- Universidad Espiritu Santo, Samborondon, Ecuador; Respiralab Research Group, Guayaquil, Ecuador.
| | - Jean Bousquet
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Ana Giménez-Arnau
- Department of Dermatology, Hospital del Mar, IMIM, Universitat Pompeu Fabra, Barcelona, Spain
| | - Kiran Godse
- Department of Dermatology, D.Y. Patil University School of Medicine, Mumbai, India
| | - Dorota Krasowska
- Department of Dermatology, Venereology, and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - Joanna Bartosińska
- Department of Dermatology, Venereology, and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland; Department of Cosmetology and Aesthetic Medicine, Medical University of Lublin, Lublin, Poland
| | - Paulina Szczepanik-Kułak
- Department of Dermatology, Venereology, and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - Bartłomiej Wawrzycki
- Department of Dermatology, Venereology, and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - Pavel Kolkhir
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Anastasiia Allenova
- Laboratory of Immune-Mediated Skin Diseases, Institute of Regenerative Medicine, Biomedical Science and Technology Park, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Andrey Allenova
- Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation; State Budgetary Healthcare Institution of the City of Moscow "City Polyclinic No. 2 10 of the Department of Health of the City of Moscow", Moscow, Russian Federation; Federal State Budgetary Scientific Institution "N.A. Semashko National Research, Institute of Public Health", Moscow, Russian Federation
| | - Sergey Tkachenko
- Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Natasa Teovska Mitrevska
- Dermatology Department, Remedika General Hospital, Skopje, Republic of North Macedonia; Department of Dermatology, International Balkan University, Skopje, Republic of North Macedonia
| | - Dragan Mijakoski
- Institute of Occupational Health of RNM, Skopje, Republic of North Macedonia; Faculty of Medicine, SS Cyril and Methodius, University of Skopje, Skopje, Republic of North Macedonia
| | - Sasho Stoleski
- Institute of Occupational Health of RNM, Skopje, Republic of North Macedonia; Faculty of Medicine, SS Cyril and Methodius, University of Skopje, Skopje, Republic of North Macedonia
| | - Marta Kolacinska-Flont
- Department of Internal Medicine, Asthma and Allergy, Barlicki Memorial Hospital, Medical University of Lodz, Poland
| | - Izabela Kuprys-Lipinska
- Department of Internal Medicine, Asthma and Allergy, Barlicki Memorial Hospital, Medical University of Lodz, Poland
| | - Joanna Molinska
- Department of Internal Medicine, Asthma and Allergy, Barlicki Memorial Hospital, Medical University of Lodz, Poland
| | - Alicja Kasperska-Zając
- European Center for Diagnosis and Treatment of Urticaria/Angioedema (GA(2)LEN UCARE /ACARE Network) and Department of Clinical Allergology and Urticaria of Medical University of Silesia, Silesia, Poland
| | - Magdalena Zajac
- European Center for Diagnosis and Treatment of Urticaria/Angioedema (GA(2)LEN UCARE /ACARE Network) and Department of Clinical Allergology and Urticaria of Medical University of Silesia, Silesia, Poland
| | - Mateusz Zamlynski
- European Center for Diagnosis and Treatment of Urticaria/Angioedema (GA(2)LEN UCARE /ACARE Network) and Department of Clinical Allergology and Urticaria of Medical University of Silesia, Silesia, Poland
| | | | | | | | | | - Mona Al-Ahmad
- Microbiology Department, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Maryam Ali Al-Nesf
- Allergy and Immunology Division, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Tayseer Ibrahim
- Allergy and Immunology Division, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Sami Aqel
- Department of Dermatology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Pesqué
- Department of Dermatology, Hospital del Mar, IMIM, Universitat Pompeu Fabra, Barcelona, Spain; Department of Dermatology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - German Ramon
- Instituto de Alergia e Inmunologia del Sur, GA(2)LEN UCARE/Adcare/Acare Center, Bahia Blanca, Argentina
| | - Gonzalo Ramon
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Sophia Neisinger
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Hanna Bonnekoh
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Maia Rukhadze
- Allergy and Immunology Center, Tbilisi, Georgia/Geomedi Teaching University, Faculty of Medicine, Tbilisi, Georgia
| | - Maryam Khoshkhui
- Allergy Research Center, Mashhad University of Medical Science, Mashhad, Iran
| | - Daria Fomina
- Moscow Practical and Research Center of Allergy and Immunology, Clinical City Hospital, Moscow, Russian Federation; Moscow Department of Clinical Immunology and Allergology, Sechenov First Moscow State Medical University, Astana Medical University, Moscow, Russian Federation
| | | | - Mitja Košnik
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia Medical Faculty, University of Ljubljana, Slovenia
| | - Rabia Oztas Kara
- Department of Dermatology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | | | - Qiang Liu
- Second Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, China
| | | | - Luis Felipe Ensina
- Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina
| | - Nelson Rosario
- Division of Allergy, Clinical Immunology, and Rheumatology, Department of Pediatrics, Federal University of São Paulo and CPAlpha Clinical Research Center, São Paulo, Brazil, (nn)Urticaria Center of Reference and Excellence, Federal University of Parana, Rua General Carneiro, Curitiba, Brazil
| | - Violeta Kvedariene
- Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Institute of Clinical Medicine, Clinic of Chest Diseases, Immunology and Allergology, Faculty of Medicine, Vilnius, Lithuania
| | - Moshe Ben-Shoshan
- Division of Allergy, Immunology and Dermatology, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada
| | | | - Andrea Bauer
- Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany
| | - Annia Cherrez
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Herberto Chong-Neto
- Department of Pediatrics, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | | | - Michael Rudenko
- London Allergy and Immunology Centre, London, United Kingdom
| | | | - Aleksandra Lesiak
- Department of Dermatology, Pediatric Dermatology, and Dermatological Oncology, Medical University of Lodz, Lodz, Poland
| | - Edgar Matos
- Instituto Nacional de Salud del Nino, Lima, Peru
| | - Nelson Muñoz
- Specialist Centre, Muñoz Alergias y Pediatría, Riobamba, Ecuador
| | | | - Jaime Moreno
- Universidad Estatal de Milagro, Cdla. Universitaria "Dr. Romulo Minchala Murillo", Guayas, Milagro, Ecuador
| | | | | | - Juan Sagñay
- Respiralab Research Group, Guayaquil, Ecuador
| | - Marco Faytong-Haro
- Universidad Espiritu Santo, Samborondon, Ecuador; Respiralab Research Group, Guayaquil, Ecuador; Sociology and Demography Department, Pennsylvania State University, University Park, Pa; Ecuadorian Development Research Lab, Daule, Guayas, Ecuador
| | - Karla Robles-Velasco
- Universidad Espiritu Santo, Samborondon, Ecuador; Respiralab Research Group, Guayaquil, Ecuador
| | - Torsten Zuberbier
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.
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7
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Petersen RS, Fijen LM, Apfelbacher C, Magerl M, Weller K, Aberer W, Adatia A, Audhya P, Bara NA, Betschel S, Boccon-Gibod I, Bouillet L, Brodszki N, Busse PJ, Buttgereit T, Bygum A, Cancian M, Craig T, Csuka D, Farkas H, Fomina D, Gil-Serrano J, Gompels M, Guidos Fogelbach G, Guilarte M, Hide M, Kiani-Alikhan S, Kinaciyan T, Lenten A, Lleonart R, Longhurst H, Lumry WR, Malbran A, Malinauskiene L, Matta Campos JJ, Mendivil J, Nieto-Martinez SA, Peter JG, Porebski G, Reshef A, Riedl M, Valerieva A, Waserman S, Maurer M, Cohn DM. A Core Outcome Set for Efficacy of Acute Treatment of Hereditary Angioedema. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1614-1621. [PMID: 38609017 DOI: 10.1016/j.jaip.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Clinical trials investigating drugs for the acute treatment of hereditary angioedema attacks have assessed many different outcomes. This heterogeneity limits the comparability of trial results and may lead to selective outcome reporting bias and a high burden on trial participants. OBJECTIVE To achieve consensus on a core outcome set composed of key outcomes that ideally should be used in all clinical efficacy trials involving the acute treatment of hereditary angioedema attacks. METHODS We conducted a Delphi consensus study involving all relevant parties: patients with hereditary angioedema, hereditary angioedema expert clinicians and clinical researchers, pharmaceutical companies, and regulatory bodies. Two Internet-based survey rounds were conducted. In round 1, panelists indicated the importance of individual outcomes used in clinical trials on a 9-point Likert scale. Based on these results, a core outcome set was developed and voted on by panelists in round 2. RESULTS A total of 58 worldwide panelists completed both rounds. The first round demonstrated high importance scores and substantial agreement among the panelists. In the second round, a consensus of 90% or greater was achieved on a core outcome set consisting of five key outcomes: change in overall symptom severity at one predetermined time point between 15 minutes and 4 hours after treatment, time to end of progression of all symptoms, the need for rescue medication during the entire attack, impairment of daily activities, and treatment satisfaction. CONCLUSIONS This international study obtained a high level of consensus on a core outcome set for the acute treatment of hereditary angioedema attacks, consisting of five key outcomes.
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Affiliation(s)
- Remy S Petersen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Lauré M Fijen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Markus Magerl
- Angioedema Center of Reference and Excellence, Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Karsten Weller
- Angioedema Center of Reference and Excellence, Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Werner Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Adil Adatia
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Noémi-Anna Bara
- Romanian Hereditary Angioedema Expertise Centre, Mediquest Clinical Research Center, Sangeorgiu de Mures, Romania
| | - Stephen Betschel
- Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Isabelle Boccon-Gibod
- National Reference Center for Angioedema (CREAK), Angioedema Center of Reference and Excellence, CHU Grenoble Alpes, France
| | - Laurence Bouillet
- National Reference Center for Angioedema (CREAK), Angioedema Center of Reference and Excellence, CHU Grenoble Alpes, France; University of Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, Grenoble, France
| | - Nicholas Brodszki
- Department of Pediatric Immunology, Childrens Hospital, Skåne University Hospital, Lund, Sweden
| | - Paula J Busse
- Division of Allergy and Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Thomas Buttgereit
- Angioedema Center of Reference and Excellence, Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Anette Bygum
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Mauro Cancian
- Department of Systems Medicine, University Hospital of Padua, Padua, Italy
| | - Timothy Craig
- Allergy, Asthma, and Immunology Division, Department of Medicine and Pediatrics, Penn State University, Hershey, Pa
| | - Dorottya Csuka
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University, Budapest, Hungary
| | - Henriette Farkas
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University, Budapest, Hungary
| | - Daria Fomina
- Urticaria Center of Reference and Excellence, Moscow Research and Clinical Center of Allergy and Immunology, Clinical City Hospital 52, Moscow, Russia; Department of Clinical Immunology and Allergology, Sechenov University, Moscow, Russia; Department of Pulmonology, Astana Medical University, Astana, Kazakhstan
| | - Johana Gil-Serrano
- Allergy Section Department, Department of Internal Medicine, Hospital Universitari Vall d' Hebron, Barcelona, Spain; Allergy Research Unit, Allergy Department, Institut de Recerca Vall d' Hebron, Universitat Autònoma de Barcelona, Spain
| | - Mark Gompels
- Clinical Immunology, North Bristol NHS Trust, Bristol, United Kingdom
| | | | - Mar Guilarte
- Allergy Section Department, Department of Internal Medicine, Hospital Universitari Vall d' Hebron, Barcelona, Spain; Allergy Research Unit, Allergy Department, Institut de Recerca Vall d' Hebron, Universitat Autònoma de Barcelona, Spain
| | - Michihiro Hide
- Department of Dermatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | | | - Tamar Kinaciyan
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Annet Lenten
- Takeda Pharmaceuticals, Hoofddorp, the Netherlands
| | - Ramon Lleonart
- Allergology Department, Hospital Universitari de Bellvitge, Institut de Recerca IDIBELL L'Hospitalet de Llobregat, Barcelona, Spain
| | - Hilary Longhurst
- Department of Immunology, Auckland District Health Board and Department of Medicine, University of Auckland, Auckland, New Zealand
| | - William R Lumry
- Internal Medicine, Allergy Division, University of Texas Health Science Center, Dallas, Tex
| | - Alejandro Malbran
- Unidad de Alergia, Asma e Inmunologia Clinica, Buenos Aires, Argentina
| | - Laura Malinauskiene
- Medical Faculty, Clinic of Chest Diseases, Immunology and Allergology, VUH Santaros Klinikos, Department of Pulmonology and Allergology, Vilnius University, Vilnius, Lithuania
| | - Juan J Matta Campos
- Allergy and Clinical Immunology Department, UMAE Hospital Especialidades CMNSXXI, IMSS, México City, Mexico
| | - Joan Mendivil
- Head Evidence and Outcomes Research, Pharvaris GmbH, Zug, Switzerland
| | | | - Jonathan G Peter
- Division of Allergy and Clinical Immunology, Groote Schuur Hospital, University of Cape Town and Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Grzegorz Porebski
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland
| | - Avner Reshef
- Angioedema Center, Barzilai University Medical Center, Ashkelon, Israel
| | - Marc Riedl
- Division of Rheumatology, Allergy, and Immunology, University of California San Diego, La Jolla, Calif
| | - Anna Valerieva
- Department of Allergology, Medical University of Sofia and Angioedema Center of Reference and Excellence Bulgaria (University Hospital Alexandrovska), Sofia, Bulgaria
| | - Susan Waserman
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Marcus Maurer
- Angioedema Center of Reference and Excellence, Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Danny M Cohn
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
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8
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Bhowmik R, Shaharyar MA, Sarkar A, Mandal A, Anand K, Shabana H, Mitra A, Karmakar S. Immunopathogenesis of urticaria: a clinical perspective on histamine and cytokine involvement. Inflamm Res 2024; 73:877-896. [PMID: 38555555 DOI: 10.1007/s00011-024-01869-6] [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] [Received: 11/10/2023] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Urticaria is a clinical condition characterized by the appearance of wheals (hives), angioedema, or both. Over the last several decades, a better understanding of the mechanisms at play in the immunopathogenesis of urticaria has underscored the existence of numerous urticaria subtypes. Separating the different kinds of urticaria explicitly helps find the best detection method for the management of this skin disorder. Subtypes of urticaria also include both spontaneous and physical types. The conventional ones include spontaneous urticaria, constituting both acute and chronic urticaria. Therefore, a broad and effective therapy is essential for the diagnosis and treatment of urticaria. METHODS To understand the immunopathogenesis of urticaria, various databases, including PubMed, Scopus, and Web of Science, were used to retrieve original articles and reviews related to urticaria. While information on several clinical trials were obtained from clinicaltrials.gov database. RESULTS This article highlights the immunopathogenesis involved in the intricate interaction between cellular infiltration, immune reactions, coagulation cascades, and autoantibodies that underlie urticaria's pathophysiology. CONCLUSION The recent progress in understanding urticaria can help to understand the intricate characteristics in the immunopathogenesis of urticaria and could play a beneficial role in the management of urticaria.
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Affiliation(s)
- Rudranil Bhowmik
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India
| | - Md Adil Shaharyar
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India
| | - Arnab Sarkar
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India
| | - Avishek Mandal
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India
| | - Kumar Anand
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India
| | - Humira Shabana
- Chaudhary Charan Singh University, Formerly, Meerut University, Meerut, Uttar Pradesh, India
| | - Achintya Mitra
- Regional Ayurveda Research Institute (RARI) CCRAS Under Ministry of AYUSH, Thapla, Ganiyadeoli, Ranikhet Almora, Uttarakhand, India
| | - Sanmoy Karmakar
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India.
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9
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Magerl M. [What are the main symptoms of urticaria and how are they systematically recorded?]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:274-280. [PMID: 38424150 DOI: 10.1007/s00105-024-05304-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 03/02/2024]
Abstract
Wheals or angioedema or both are the main symptoms of urticaria. The small number of the symptoms usually makes diagnosis easy. What is not trivial, however, is the comprehensive systematic recording and assessment of these symptoms and, above all, their sequelae, which affect many areas of the patient's life. Disease activity, quality of life and disease control can and should be measured before and during treatment in order to optimally adapt therapeutic measures. The instruments developed for this purpose have become easier and more convenient to use in recent years thanks to user-friendly platforms such as mobile health apps.
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Affiliation(s)
- Markus Magerl
- Angioedema Center of Reference and Excellence (ACARE), Institute of Allergology, CBF, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland.
- Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Deutschland.
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10
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Demir S, Eyice‐Karabacak D, Kocatürk E, Ünal D, Toprak İD, Korkmaz P, Aslan AF, İmren IG, Dikicier B, Kahveci N, Öztop N, Kara RÖ, İşsever H, Maurer M, Weller K, Gelincik A. Monitoring recurrent angioedema: Findings from the Turkish angioedema control test validation study. Clin Transl Allergy 2024; 14:e12342. [PMID: 38415974 PMCID: PMC10900914 DOI: 10.1002/clt2.12342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Determination of control level in recurrent angioedema (RAE) is necessary to guide management. Here, we validated a Turkish version of the angioedema control test (AECT) for 4-week (AECT-4wk) and for 3-month (AECT-3mth) and assessed their utility in monitoring RAE. METHOD The recommended structured translation process for patient-reported outcome measures was completed. The final versions were administered to 51 patients with mast cell-mediated angioedema (MMAE) and 38 patients with hereditary angioedema, and the minimal clinically important difference (MCID) was determined. Additionally, anchor surveys comprising angioedema activity score for 28 days (AAS-28 day), visual analog score for angioedema control, Likert scale for the control level from the patient's perspective (LS-AEC), angioedema quality of life, short form-12 (SF-12) and patients' assessment of treatment sufficiency were applied. RESULTS The Turkish AECT versions showed good convergent validity with a substantial correlation with anchor tools and known-group validity. Excellent internal consistency and reproducibility were observed. Equal or more than 10 of 16 points scored with the AECT-4wk and AECT-3mth identified patients with well-controlled disease. The disease activity, control and burden parameters were consistent with the disease control level defined depending on the cut-off point 10 of AECT. Three-point changes in AECT-4wk and -3 mt could detect MCID in disease control in all patients. CONCLUSIONS Turkish AECT versions are valid and reliable tools for assessing and monitoring disease control in patients with RAE. The use of the Turkish versions of the AECT in routine patient care, clinical trials and angioedema research is recommended.
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Affiliation(s)
- Semra Demir
- Division of Immunology and Allergy DiseasesDepartment of Internal MedicineIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Deniz Eyice‐Karabacak
- Division of Immunology and Allergy DiseasesDepartment of Internal MedicineIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Emek Kocatürk
- Department of DermatologyKoç University Faculty of MedicineIstanbulTurkey
- Institute of AllergologyCharite‐UniversitatsmedizinCorporate Member of Freie Universitat Berlin and Humboldt‐Universitat zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and AllergologyBerlinGermany
| | - Derya Ünal
- Division of Immunology and Allergy DiseasesDepartment of Internal MedicineIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - İlkim Deniz Toprak
- Division of Immunology and Allergy DiseasesDepartment of Internal MedicineIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Pelin Korkmaz
- Division of Immunology and Allergy DiseasesDepartment of Internal MedicineIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Ayşe Feyza Aslan
- Division of Immunology and Allergy DiseasesDepartment of Internal MedicineIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Işıl Göğem İmren
- Division of Immunology and Allergy DiseasesDepartment of Internal MedicineIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Bahar Dikicier
- Faculty of MedicineDepartment of DermatologySakarya UniversitySakaryaTurkey
| | - Nevzat Kahveci
- Division of Immunology and Allergy DiseasesDepartment of Internal MedicineIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Nida Öztop
- Adult Allergy and Immunology ClinicBaşakşehir Pine and Sakura City HospitalIstanbulTurkey
| | - Rabia Öztaş Kara
- Faculty of MedicineDepartment of DermatologySakarya UniversitySakaryaTurkey
| | - Halim İşsever
- Istanbul Faculty of MedicineDepartment of Public HealthIstanbul UniversityIstanbulTurkey
| | - Marcus Maurer
- Institute of AllergologyCharite‐UniversitatsmedizinCorporate Member of Freie Universitat Berlin and Humboldt‐Universitat zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and AllergologyBerlinGermany
| | - Karsten Weller
- Institute of AllergologyCharite‐UniversitatsmedizinCorporate Member of Freie Universitat Berlin and Humboldt‐Universitat zu BerlinBerlinGermany
| | - Aslı Gelincik
- Division of Immunology and Allergy DiseasesDepartment of Internal MedicineIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
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11
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Khoury P, Makiya MA, Rahim R, Bowman A, Espinoza D, Schiffenbauer A, Koch M, Anderson C, Constantine G, Maric I, Sun X, Pittaluga S, Brown T, Ware JM, Wetzler L, Fay MP, Klion AD. Mepolizumab incompletely suppresses clinical flares in a pilot study of episodic angioedema with eosinophilia. J Allergy Clin Immunol 2024; 153:821-830.e6. [PMID: 37951310 PMCID: PMC10939939 DOI: 10.1016/j.jaci.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Episodic angioedema with eosinophilia (EAE) is a rare multilineage cyclic syndrome of unknown etiology characterized by episodes of angioedema, myalgia, fatigue, and fever that occur every 3 to 8 weeks and resolve between episodes without therapy. Cyclic elevations in serum IL-5 levels and neutrophils precede the increase in absolute eosinophil count (AEC) in most patients. OBJECTIVE We sought to assess the role of IL-5-driven eosinophilia in the clinical manifestations of EAE. METHODS An open-label pilot study of mepolizumab (700 mg intravenously monthly for 3 months followed by sequential dose reduction to the Food and Drug Administration-approved dose of 300 mg subcutaneously monthly) was conducted. The primary end point was reduction in the number and severity of clinical symptoms as assessed by patient-reported symptom questionnaires. Secondary end points were greater than or equal to 75% reduction in peak AEC after 1 dose of mepolizumab and sustained reduction in AEC after 3 doses of mepolizumab. Exploratory end points included effects of mepolizumab treatment on other cell lineages (numbers and surface marker expression), levels of plasma mediators, and biomarkers of eosinophil activation. RESULTS Four female and 1 male (median age, 45 years) participants with EAE were enrolled. None of the 5 participants experienced a reduction in the number of symptomatic flares on mepolizumab therapy, and 1 participant withdrew before study completion because of lack of improvement. Peak AEC was reduced by 75% or more in 3 participants after the first dose of mepolizumab and in 4 participants after 3 doses. CONCLUSIONS In a small cohort of participants with EAE, mepolizumab was unsuccessful in substantially reducing clinical symptoms despite reduction in AEC.
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Affiliation(s)
- Paneez Khoury
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md; Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.
| | - Michelle A Makiya
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Rodaba Rahim
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Abbie Bowman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - David Espinoza
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Adam Schiffenbauer
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Md
| | - Megan Koch
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Charles Anderson
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Gregory Constantine
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Irina Maric
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Md
| | - Xiaoping Sun
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Md
| | - Stefania Pittaluga
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Md
| | - Thomas Brown
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - JeanAnne M Ware
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Lauren Wetzler
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Michael P Fay
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Amy D Klion
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
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12
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Piotrowicz-Wójcik K, Bulanda M, Czarnobilska E, Porebski G. Clinical Characteristics and Quality of Life in a Cohort of Polish Pediatric Patients with Hereditary Angioedema. CHILDREN (BASEL, SWITZERLAND) 2024; 11:237. [PMID: 38397349 PMCID: PMC10887984 DOI: 10.3390/children11020237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/25/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024]
Abstract
Hereditary angioedema (HAE) is a rare genetic disease. It is characterized by recurrent attacks of angioedema. Evidence to what extent it affects patient functioning is limited in the pediatric population. We aimed to determine the clinical characteristics and management of Polish children with HAE and to measure the health-related quality of life (HRQoL) of these patients. This cross-sectional study was conducted among 21 pediatric patients and their caregivers, as well as 21 respective controls randomly selected from the general population. During routine follow-up visits, standardized pediatric quality of life questionnaires (PedsQLTM 4.0) were administered to all caregivers and adolescents (≥13 years). Caregivers also completed a structured medical interview regarding the clinical characteristics and treatment of children with HAE during the previous six months. During this period, 57% of patients had low (group I), 24% moderate (group II), and 19% high (group III) HAE activity, corresponding to ≥10 attacks per 6 months. None of the patients received long-term prophylaxis. The children in group III had a lower HRQoL than other groups and controls on all dimensions of the PedsQLTM 4.0. The lowest scores in all groups were observed in the emotional functioning domain. Our data demonstrate that the burden of HAE on the quality of life of pediatric patients and their families encompasses a wide range of daily functioning.
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Affiliation(s)
| | | | | | - Grzegorz Porebski
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Botaniczna 3, 31-503 Krakow, Poland; (K.P.-W.); (M.B.); (E.C.)
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13
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Neisinger S, Sousa Pinto B, Ramanauskaite A, Bousquet J, Weller K, Metz M, Magerl M, Kocatürk E, Cherrez‐Ojeda I, Gimenez‐Arnau AM, Parisi CAS, Altrichter S, Ensina LF, Bouillet L, Asero R, Gonçalo M, Guillet C, Rutkowski K, Bernstein JA, Hardin H, Godse K, Brzoza Z, Sousa JIL, Thomsen SF, van Doorn M, Hide M, Ye Y, Vanderse S, Lapiņa L, Peter J, Zhao Z, Han L, Nasr I, Rockmann‐Helmbach H, Sørensen JA, Kara RÖ, Kurjāne N, Kurchenko AI, Kaidashev I, Tsaryk V, Stepanenko R, Maurer M. CRUSE ® -An innovative mobile application for patient monitoring and management in chronic spontaneous urticaria. Clin Transl Allergy 2024; 14:e12328. [PMID: 38282190 PMCID: PMC10764293 DOI: 10.1002/clt2.12328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is unpredictable and can severely impair patients' quality of life. Patients with CSU need a convenient, user-friendly platform to complete patient-reported outcome measures (PROMs) on their mobile devices. CRUSE® , the Chronic Urticaria Self Evaluation app, aims to address this unmet need. METHODS CRUSE® was developed by an international steering committee of urticaria specialists. Priorities for the app based on recent findings in CSU were defined to allow patients to track and record their symptoms and medication use over time and send photographs. The CRUSE® app collects patient data such as age, sex, disease onset, triggers, medication, and CSU characteristics that can be sent securely to physicians, providing real-time insights. Additionally, CRUSE® contains PROMs to assess disease activity and control, which are individualised to patient profiles and clinical manifestations. RESULTS CRUSE® was launched in Germany in March 2022 and is now available for free in 17 countries. It is adapted to the local language and displays a country-specific list of available urticaria medications. English and Ukrainian versions are available worldwide. From July 2022 to June 2023, 25,710 observations were documented by 2540 users; 72.7% were females, with a mean age of 39.6 years. At baseline, 93.7% and 51.3% of users had wheals and angioedema, respectively. Second-generation antihistamines were used in 74.0% of days. CONCLUSIONS The initial data from CRUSE® show the wide use and utility of effectively tracking patients' disease activity and control, paving the way for personalised CSU management.
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14
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Buttgereit T, Salameh P, Sydorenko O, Zuberbier T, Metz M, Weller K, Maurer M. The 7-day recall period version of the Urticaria Control Test-UCT7. J Allergy Clin Immunol 2023; 152:1210-1217.e14. [PMID: 37210040 DOI: 10.1016/j.jaci.2023.03.034] [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] [Received: 12/13/2022] [Revised: 02/28/2023] [Accepted: 03/29/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND The Urticaria Control Test (UCT) is a well-established, very easy to use and calculate 4-item patient-reported outcome measure to assess chronic urticaria disease control during the previous 4 weeks. Clinical trials and practice may benefit from the use of a UCT version with a shorter recall period, but this does not exist. OBJECTIVES We sought to develop and validate a UCT version with a 7-day recall period, the UCT7. METHODS The UCT7 was developed, based on the UCT, and tested, in 152 patients with chronic urticaria (spontaneous: n = 101, inducible: n = 51) for its reliability, validity and screening accuracy, and clinimetric properties, in other words, the cutoff for well-controlled disease and the minimal clinically important difference. RESULTS The UCT7 showed excellent internal consistency reliability with a Cronbach αvalue of 0.91 and test-retest reliability with an intraclass correlation coefficient of 0.83. Convergent validity was high and strongly correlated with anchors of disease control, wheal and angioedema frequency, and urticaria-related quality of life impairment. The UCT7 showed excellent sensitivity to change; however, changes in angioedema activity and impact did not correlate well with changes in UCT7. Based on receiver-operating characteristic curve analysis, the proportion of correctly classified patients, and patients' assessment of treatment efficacy, we recommend a cutoff value of 12 points for identifying patients with well-controlled disease. The UCT7 minimal clinically important difference for improvement was estimated to be 2 points. CONCLUSIONS The UCT7 is a validated 7-day recall period version of the UCT. It is ideal for the assessment of disease control at short intervals in patients with chronic urticaria in clinical studies and practice.
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Affiliation(s)
- Thomas Buttgereit
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Berlin, Germany
| | - Pascale Salameh
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; School of Medicine, Lebanese American University, Byblos, Lebanon; University of Nicosia Medical School, Nicosia, Cyprus; Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie (INSPECT-LB), Beirut, Lebanon
| | - Olga Sydorenko
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Berlin, Germany
| | - Torsten Zuberbier
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Berlin, Germany
| | - Martin Metz
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Berlin, Germany
| | - Karsten Weller
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Berlin, Germany.
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15
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Eyice Karabacak D, Can A, Demir S, Yegit OO, Colakoglu B, Buyukozturk S, Gelincik AA. How Does Pregnancy and Type of Delivery Affect the Clinical Course of Hereditary Angioedema? Int Arch Allergy Immunol 2023; 184:1216-1224. [PMID: 37673053 DOI: 10.1159/000531074] [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] [Received: 01/16/2023] [Accepted: 04/28/2023] [Indexed: 09/08/2023] Open
Abstract
INTRODUCTION Knowledge on the clinical course of hereditary angioedema (HAE) during pregnancy, delivery, and breastfeeding is very limited. In this study, we aimed to evaluate the course of HAE during these periods. METHODS The HAE attacks C1-INH prophylaxis before and during pregnancy and during breastfeeding, and the delivery types were retrospectively determined. The severity of attacks was assessed by a 10-point Visual Analogue Scale (VAS). RESULTS We evaluated 88 pregnancies in 48 HAE patients among whom 20 were primiparous. Among those who had a HAE diagnosis during pregnancy (n = 34), the median attack numbers before pregnancy, during pregnancy, breastfeeding, and after breastfeeding were 17, 39, 24, and 14 (before pregnancy vs. pregnancy, p < 0.001; during pregnancy vs. breastfeeding, p = 0.001). The mean VASs (SD) were 6.59 (1.82), 8.33 (1.58), 7.32 (1.66), and 6.95 (1.90) (before pregnancy vs. pregnancy, p < 0.001; during pregnancy vs. breastfeeding, p = 0.016), respectively. Among those who received a HAE diagnosis after pregnancy (n = 54), the number (59.3%) and the severity (60%) of HAE attacks were high in pregnancy. 47 of the deliveries were normal vaginal delivery (NVD). Regional anesthesia was applied in 8 NVDs. 20 of caesarean deliveries were performed under general anesthesia, and 21 were under spinal anesthesia. Lowest numbers of attacks were found in patients who did not receive anesthesia during NVD (p = 0.001). CONCLUSION The course of HAE can be worse during pregnancy and breastfeeding. NVD is related to fewer HAE attacks and prophylaxis with C1-INH during NVD is not necessary to prevent a HAE attack.
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Affiliation(s)
- Deniz Eyice Karabacak
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Can
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Semra Demir
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Osman Ozan Yegit
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bahauddin Colakoglu
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Suna Buyukozturk
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aslı Akkor Gelincik
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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16
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Fijen LM, Vera C, Buttgereit T, Bonnekoh H, Maurer M, Magerl M, Weller K. Sensitivity to change and minimal clinically important difference of the angioedema control test. Clin Transl Allergy 2023; 13:e12295. [PMID: 37746798 PMCID: PMC10472988 DOI: 10.1002/clt2.12295] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/20/2023] [Accepted: 08/07/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND The Angioedema Control Test (AECT) is a patient-reported outcome measure developed and validated for the assessment of disease control in patients with recurrent angioedema. Its sensitivity to change and minimal clinically important difference (MCID) have hitherto not been established. METHODS Patients with recurrent angioedema due to chronic spontaneous urticaria, hereditary angioedema, or acquired C1-inhibitor deficiency were repeatedly asked to complete the AECT along with the Angioedema Quality of Life Questionnaire (AE-QoL), Dermatology Life Quality Index (DLQI), and anchors for disease control and whether treatment was sufficient during routine care visits. The sensitivity to the change of the AECT was determined by correlating changes in its scores over time with changes in the applied anchors. The MCID was determined using anchor-based and distributional criterion-based approaches. RESULTS Eighty-six cases were used for this analysis. Changes in AECT scores correlated well with AE-QoL changes (but less with changes in the DLQI) as well as other applied anchors, demonstrating its sensitivity to change. The MCID was found to be three points for improvement of angioedema control. The available number of cases with meaningful deterioration in our dataset was too low to reach a definite conclusion on the MCID for deterioration of angioedema control. CONCLUSION The AECT is a valuable tool to assess changes in disease control in patients with recurrent angioedema over time. The lowest AECT score change that reflects a meaningful improvement of disease control to patients (MCID) is three points.
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Affiliation(s)
- Lauré M. Fijen
- Department of Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
- Institute of AllergologyCharité ‐ Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPImmunology and AllergologyBerlinGermany
| | - Carolina Vera
- Institute of AllergologyCharité ‐ Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPImmunology and AllergologyBerlinGermany
| | - Thomas Buttgereit
- Institute of AllergologyCharité ‐ Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPImmunology and AllergologyBerlinGermany
| | - Hanna Bonnekoh
- Institute of AllergologyCharité ‐ Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPImmunology and AllergologyBerlinGermany
| | - Marcus Maurer
- Institute of AllergologyCharité ‐ Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPImmunology and AllergologyBerlinGermany
| | - Markus Magerl
- Institute of AllergologyCharité ‐ Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPImmunology and AllergologyBerlinGermany
| | - Karsten Weller
- Institute of AllergologyCharité ‐ Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPImmunology and AllergologyBerlinGermany
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17
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Grumach AS, Gadir N, Kessel A, Yegin A, Martinez-Saguer I, Bernstein JA. Current challenges and future opportunities in patient-focused management of hereditary angioedema: A narrative review. Clin Transl Allergy 2023; 13:e12243. [PMID: 37227422 DOI: 10.1002/clt2.12243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/15/2023] [Accepted: 04/04/2023] [Indexed: 05/26/2023] Open
Abstract
Patients with hereditary angioedema (HAE) experience a high burden of disease due to unpredictable, painful, disfiguring, and potentially life-threatening HAE attacks. Multiple HAE-specific medications for the on-demand treatment, short-term and long-term prophylaxis of HAE attacks have entered the market in recent years; however, the availability and access to these medications may vary between different countries. For this review, PubMed and EMBASE databases were searched for guidelines, consensus statements, and other publications on HAE management as well as publications on quality of life in patients with HAE. The current guidelines and recent literature on HAE management in specific countries are summarized with the aim to highlight the similarities and differences between guideline recommendations and the country-specific clinical practice. Improvement in quality of life, which is a key goal in HAE management, is also discussed and the country-specific trends are highlighted. Finally, the ways to achieve a more patient-centric approach to HAE management within the framework set by the clinical management guidelines are examined.
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Affiliation(s)
- Anete S Grumach
- Clinical Immunology, Faculdade de Medicina, Centro Universitario Faculdade de Medicina ABC (FMABC), Santo Andre, Brazil
| | - Noga Gadir
- Takeda Development Center Americas, Inc., Lexington, Massachusetts, USA
| | - Aharon Kessel
- Division of Allergy and Clinical Immunology, Bnai Zion Medical Centre, Technion Faculty of Medicine, Haifa, Israel
| | - Ashley Yegin
- Takeda Development Center Americas, Inc., Lexington, Massachusetts, USA
| | | | - Jonathan A Bernstein
- Division of Rheumatology, Allergy and Immunology, University of Cincinnati College of Medicine and Bernstein Clinical Research Center, Cincinnati, Ohio, USA
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18
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Vanya M, Watt M, Shahraz S, Kosmas CE, Rhoten S, Costa-Cabral S, Menauthoril J, Devercelli G, Weller K. Content validation and psychometric evaluation of the Angioedema Quality of Life Questionnaire for hereditary angioedema. J Patient Rep Outcomes 2023; 7:33. [PMID: 37012445 PMCID: PMC10070575 DOI: 10.1186/s41687-023-00576-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/14/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND There is considerable burden of illness in hereditary angioedema (HAE). However, instruments to assess health-related quality of life (HRQoL) in HAE are limited. The Angioedema Quality of Life Questionnaire (AE-QoL) was developed to measure HRQoL in patients with recurrent angioedema; the validity of the AE-QoL in patients with HAE is described. METHODS To identify disease-related experiences with a focus on the impact of HAE on HRQoL, interviews were conducted with a group of clinician experts and patients with HAE from Canada, France, Germany, Spain, the United Kingdom, and the United States, along with a targeted literature review. Concepts were mapped to the AE-QoL to assess item relevance, interpretation, and conceptual coverage. Cognitive interviews assessed item clarity and relevance. A psychometric validation was performed using data from a phase 3 trial. RESULTS Interviews were conducted with seven clinicians and 40 adult patients. Patients reported 35 unique impacts of HAE on their lives, the most frequent being on work/school, social relationships, physical activities, and emotions, particularly fear/worrying and anxiety. Saturation for these impacts was reached, and all concepts covered in the AE-QoL were reported during the interviews. Patients agreed that the questionnaire items and response options were clear and relevant, and the 4-week recall period was appropriate. The psychometric validation included data from 64 patients. For AE-QoL total scores, excellent internal consistency (Cronbach's alpha > 0.90), test-retest reliability (intraclass coefficient > 0.80), convergent validity with the Sheehan Disability Scale (r = 0.663), divergent validity with the EQ-5D-5L index (r = 0.292) and EQ-VAS (r = 0.337), and known-groups validity (p < 0.0001; ɳ2 = 0.56) were demonstrated. CONCLUSIONS Qualitative and psychometric analyses showed that the AE-QoL is a reliable and valid instrument for measuring HRQoL in adult patients with HAE from six countries.
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Affiliation(s)
- Magdalena Vanya
- ICON plc, South San Francisco, CA, USA.
- Takeda Development Center Americas, Inc, Lexington, MA, USA.
| | - Maureen Watt
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - Saeid Shahraz
- ICON plc, South San Francisco, CA, USA
- Tufts Medical Center Institute for Clinical Research and Health Policy, Boston, MA, USA
| | | | - Stephanie Rhoten
- ICON plc, South San Francisco, CA, USA
- IQVIA, San Francisco, CA, USA
| | | | | | | | - Karsten Weller
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie, Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
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19
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Ferrer M, Rodriguez-Garijo N, Sabaté-Brescó M. Medical algorithm: Diagnosis and management of histaminergic angioedema. Allergy 2023; 78:599-602. [PMID: 36478245 DOI: 10.1111/all.15618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/11/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Marta Ferrer
- Department of Allergy and Clinical Immunology, Clinica Universidad de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,RETIC de Asma, Reacciones Adversas y Alérgicas (ARADYAL), Madrid, Spain
| | | | - Marina Sabaté-Brescó
- Department of Allergy and Clinical Immunology, Clinica Universidad de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,RETIC de Asma, Reacciones Adversas y Alérgicas (ARADYAL), Madrid, Spain
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20
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Zuberbier T, Altrichter S, Bauer S, Brehler R, Brockow K, Dressler C, Fluhr J, Gaskins M, Hamelmann E, Kühne K, Merk H, Mülleneisen NK, Nast A, Olze H, Ott H, Pleimes M, Ruëff F, Staubach-Renz P, Wedi B, Maurer M. S3 Guideline Urticaria. Part 1: Classification and diagnosis of urticaria - German-language adaptation of the international S3 Guideline. J Dtsch Dermatol Ges 2023; 21:81-93. [PMID: 36721941 DOI: 10.1111/ddg.14906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/11/2022] [Indexed: 02/02/2023]
Abstract
The lifetime prevalence of urticaria, a severe allergic disease, is almost 20%. It not only limits the quality of life of those affected, but also their general performance at work and in their daily activities. This publication is the first section of the Urticaria Guideline. It covers the classification and diagnosis of urticaria, taking into account the major advances in research into its causes, triggering factors and pathomechanisms. It also addresses strategies for the efficient diagnosis of the different subtypes of urticaria. This is crucial for individual, patient-oriented treatment, which is covered in the second part of the guideline, published separately. This German-language guideline was developed according to the criteria of the AWMF on the basis of the international English-language S3 guideline with special consideration of health system characteristics in the German-speaking countries. This first part of the guideline describes the classification of urticaria, distinguishing spontaneously occurring wheals (hives) and angioedema from forms of urticaria with inducible symptoms. Urticaria is defined as sudden onset of wheals, angioedema, or both, but is to be distinguished from conditions in which wheals occur as a short-term symptom, such as anaphylaxis. The diagnosis is based on (a limited number of) laboratory tests, but especially on medical history. In addition, validated instruments are available to measure the severity, activity and course of the disease.
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Affiliation(s)
- Torsten Zuberbier
- Charité - Universitätsmedizin Berlin, Institute of Allergology, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Sabine Altrichter
- University Hospital for Dermatology und Venereology, Comprehensive Allergy Center, Kepler University Hospital, Linz, Austria
| | | | - Randolf Brehler
- Center for Skin Diseases, University Hospital Münster, Department of Dermatology, Münster, Germany
| | - Knut Brockow
- Department und Clinic for Dermatology und Allergology am Biederstein, Technical University of Munich, Munich, Germany
| | - Corinna Dressler
- Division of Evidence-Based Medicine, Department for Dermatology, Venereology und Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Joachim Fluhr
- Charité - Universitätsmedizin Berlin, Institute of Allergology, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Matthew Gaskins
- Division of Evidence-Based Medicine, Department for Dermatology, Venereology und Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eckard Hamelmann
- Department for Pediatric and Adolescent Medinine, Evangelisches Klinikum Bethel, University Hospital OWL, University of Bielefeld, Bielefeld, Germany
| | | | - Hans Merk
- Department for Dermatology und Allergology, University Hospital RTWH Aachen, Aachen, Germany
| | | | - Alexander Nast
- Division of Evidence-Based Medicine, Department for Dermatology, Venereology und Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Heidi Olze
- Department of Ear, Nose and Throat Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Hagen Ott
- Hospital for Pediatric and Adolescent Medicine Auf der Bult, Hannover, Germany
| | - Marc Pleimes
- Practice for Pediatric and Adolescent Dermatology, Heidelberg, Germany
| | - Franziska Ruëff
- Department and Clinic for Dermatology und Allergology, LMU Hospital at the University of Munich, Munich, Germany
| | - Petra Staubach-Renz
- Department and Clinic for Skin Diseases, University Hospital at Johannes Gutenberg University Mainz, Mainz, Germany
| | - Bettina Wedi
- Hannover Medical School Dept. of Dermatology and Allergology, Hannover, Germany
| | - Marcus Maurer
- Charité - Universitätsmedizin Berlin, Institute of Allergology, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
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21
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Zuberbier T, Altrichter S, Bauer S, Brehler R, Brockow K, Dressler C, Fluhr J, Gaskins M, Hamelmann E, Kühne K, Merk H, Mülleneisen NK, Nast A, Olze H, Ott H, Pleimes M, Ruëff F, Staubach-Renz P, Wedi B, Maurer M. S3-Leitlinie Urtikaria. Teil 1: Klassifikation und Diagnostik der Urtikaria - deutschsprachige Adaptation der internationalen S3-Leitlinie. J Dtsch Dermatol Ges 2023; 21:81-95. [PMID: 36721942 DOI: 10.1111/ddg.14906_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/11/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Torsten Zuberbier
- Charité - Universitätsmedizin Berlin, Institut für Allergieforschung, Berlin, Deutschland.,Fraunhofer Institut für Translationale Medizin und Pharmakologie ITMP, Allergologie und Immunologie, Berlin, Deutschland
| | - Sabine Altrichter
- Universitätsklinik für Dermatologie und Venerologie, Comprehensive Allergy Center, Kepler Universitätsklinikum, Linz, Österreich
| | | | - Randolf Brehler
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Abteilung Dermatologie, Münster, Deutschland
| | - Knut Brockow
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, München, Deutschland
| | - Corinna Dressler
- Division of Evidence-Based Medicine, Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - Joachim Fluhr
- Charité - Universitätsmedizin Berlin, Institut für Allergieforschung, Berlin, Deutschland.,Fraunhofer Institut für Translationale Medizin und Pharmakologie ITMP, Allergologie und Immunologie, Berlin, Deutschland
| | - Matthew Gaskins
- Division of Evidence-Based Medicine, Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - Eckard Hamelmann
- Klinik für Kinder- und Jugendmedizin, Evangelisches Klinikum Bethel, Universitätsklinikum OWL, Universität Bielefeld, Bielefeld, Deutschland
| | | | - Hans Merk
- Klinik für Dermatologie und Allergologie, Universitätsklinik RTWH Aachen, Aachen, Deutschland
| | | | - Alexander Nast
- Division of Evidence-Based Medicine, Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - Heidi Olze
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - Hagen Ott
- Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Deutschland
| | - Marc Pleimes
- Praxis für Kinder- und Jugenddermatologie, Heidelberg, Deutschland
| | - Franziska Ruëff
- Klinik und Poliklinik für Dermatologie und Allergologie, LMU Klinikum der Universität München, München, Deutschland
| | - Petra Staubach-Renz
- Hautklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Bettina Wedi
- de Hannover Medical School Dept. of Dermatology and Allergology, Hannover, Germany
| | - Marcus Maurer
- Charité - Universitätsmedizin Berlin, Institut für Allergieforschung, Berlin, Deutschland.,Fraunhofer Institut für Translationale Medizin und Pharmakologie ITMP, Allergologie und Immunologie, Berlin, Deutschland
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22
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Alizadeh Aghdam M, Hofman ZLM, Meertens M, Lebens A, Hack CE, Knulst AC, Maas C, Röckmann H. Recombinant human C1 esterase inhibitor as prophylactic treatment in idiopathic non-histaminergic angioedema. Allergy 2022; 77:3673-3676. [PMID: 35837765 PMCID: PMC10084080 DOI: 10.1111/all.15437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/24/2022] [Accepted: 07/11/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Mehran Alizadeh Aghdam
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Zonne L M Hofman
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,CDL Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michelle Meertens
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ans Lebens
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - C Erik Hack
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - André C Knulst
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Coen Maas
- CDL Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Heike Röckmann
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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23
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Jean-Baptiste M, Itzler R, Prusty S, Supina D, Martin ML. The symptom experience of hereditary angioedema (HAE) patients beyond HAE attacks: literature review and clinician interviews. Orphanet J Rare Dis 2022; 17:232. [PMID: 35710442 PMCID: PMC9204898 DOI: 10.1186/s13023-022-02360-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hereditary angioedema (HAE) is a genetic disorder characterized by re-occurring swelling episodes called "attacks," usually in the limbs, face, airways, and intestinal tract. New prophylactic therapies have reduced the frequency of these attacks. This study describes results from a literature review and clinician interviews assessing patient HAE symptom experiences and timing, and then evaluates whether existing patient-reported outcome (PRO) tools adequately reflect this experience. METHODS A targeted literature review as well as interviews with key opinion leaders (KOLs), were conducted to capture information about the patient experience and their symptoms. An assessment of various PROs was then conducted to determine how well they each covered HAE symptoms and impacts. RESULTS Nineteen HAE symptoms were identified. KOLs reported that patients on prophylactic therapy experienced some symptoms indicating an attack was imminent, but then never experienced an attack. The comparison of the different PROs found that the Hereditary Angioedema Patient-Reported Outcome was the instrument that most thoroughly examined the symptoms of patients with HAE. CONCLUSIONS Given the introduction of new prophylactic therapies, further research is needed to determine the effect of being attack-free for longer periods of time on health-related quality of life.
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Affiliation(s)
| | | | | | - Dylan Supina
- Jazz Pharmaceuticals (Formerly CSL Behring), King of Prussia, PA, USA
| | - Mona L Martin
- Evidera, 615 2nd Ave Ste 500, Seattle, WA, 98104, USA.
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24
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Ahsan DM, Altrichter S, Gutsche A, Bernstein JA, Altunergil T, Brockstaedt M, Maurer M, Weller K, Terhorst‐Molawi D. Development of the Cold Urticaria Activity Score. Allergy 2022; 77:2509-2519. [PMID: 35403217 DOI: 10.1111/all.15310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/11/2022] [Accepted: 03/22/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cold urticaria (ColdU) is a form of inducible urticaria where cold induces wheals and/or angioedema. The burden of disease is high and linked to trigger thresholds, exposure, and avoidance. There are presently no validated patient-reported outcome measures (PROMs) to assess and monitor disease activity. Our objective was to develop a disease-specific activity score for ColdU that is easy to administer and evaluate. METHODS A Cold Urticaria Activity Score (ColdUAS) questionnaire was developed, directed by PROM developing guidelines. After the generation of a conceptional framework, the item generation phase included the literature research on ColdU signs and symptoms and on comparable tools for similar diseases and 47 ColdU patient interviews. Subsequently, an impact analysis for content validity was performed. The final selection of items underwent expert review for face validity and cognitive debriefing. RESULTS The ColdUAS, a self-administered questionnaire for the prospective assessment of disease activity in patients with ColdU, consists of 4 items: 1. the frequency and severity of the signs (wheals and/or angioedema), 2. the frequency and severity of the symptoms (e.g., itch and burn), 3. the exposure to specific triggers, and 4. the avoidance of these triggers. The recall period for each item is the last 24 h. CONCLUSIONS The ColdUAS is the first disease-specific PROM to assess ColdU disease activity. It may help to better assess patients' disease status in routine clinical practice as well as in clinical trials. Anchor-based approaches are currently used to validate the ColdUAS.
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Affiliation(s)
- Dalia Melina Ahsan
- 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
| | - Sabine Altrichter
- 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 and Venerology Kepler University Hospital Linz Austria
| | - Annika Gutsche
- 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
| | - Jonathan A. Bernstein
- Division of Immunology and Allergy Department of Internal Medicine University of Cincinnati College of Medicine Cincinnati OH USA
| | - Tatjana Altunergil
- 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
| | - Maxi Brockstaedt
- 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
| | - Karsten Weller
- 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
| | - 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
- Institute of Clinical Physiology/Nutritional Medicine Medical Department Division of Gastroenterology, Infectiology, Rheumatology Charité ‐ Universitätsmedizin Berlin Berlin Germany
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25
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Fain O, Du-Thanh A, Gobert D, Launay D, Inhaber N, Boudjemia K, Aubineau M, Sobel A, Boccon-Gibod I, Weiss L, Bouillet L. Long-term prophylaxis with lanadelumab for HAE: authorization for temporary use in France. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2022; 18:30. [PMID: 35365234 PMCID: PMC8976389 DOI: 10.1186/s13223-022-00664-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 03/03/2022] [Indexed: 11/10/2022]
Abstract
Background Hereditary angioedema (HAE) is associated with a heavy burden of illness. Objective To evaluate use of lanadelumab in a French Authorization for Temporary Use (ATU) program. Methods ATU requests were made between October 12, 2018, and March 13, 2019; patients were followed through September 23, 2019. At entry, patients received lanadelumab 300 mg every 2 weeks. HAE attack characteristics were evaluated at day (D) 0 and months (M) 3 and 6. Patients completed the Angioedema Quality of Life (AE-QoL) questionnaire at initiation and monthly and the Angioedema Activity Score questionnaire daily in 28 day cycles (AAS28). Results In total, 77 patients received ≥ 1 lanadelumab dose; 69 had ≥ 1 quarterly follow-up visit (analyzed population). Mean (standard deviation [SD]) lanadelumab exposure was 240.4 (53.7) days. Lanadelumab dose was modified in 12 patients (mostly to every 4 weeks). For the analyzed population, compared with attacks/month (mean [SD]) within 6 months before ATU (2.68 [2.54]), fewer attacks occurred between initiation and first visit (0.16 [0.42]; P < 0.001) or last visit (0.16 [0.42]; P < 0.001); D15 and last visit (0.15 [0.41]); and D70 and last visit (0.17 [0.70]). AE-QoL total and domain scores were significantly higher at initiation versus M3 and M6; 55% and 65% of patients, respectively, achieved a minimal clinically important difference from D0 to M3 and D0 to M6. Proportion of patients with AAS28 of 0 was higher during M3 (90%) and M6 (83%) than initiation (59%). The most frequently reported adverse events included headache (7.3%) and injection site pain (6.3%). Conclusions Lanadelumab reduced attack rates, improved quality of life, and was generally well tolerated. Supplementary Information The online version contains supplementary material available at 10.1186/s13223-022-00664-4.
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Affiliation(s)
- Olivier Fain
- service de médecine interne, AP-HP, Hôpital Saint Antoine, Sorbonne Université, 75012, Paris, France.
| | - Aurelie Du-Thanh
- Dermatology Department, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Delphine Gobert
- service de médecine interne, AP-HP, Hôpital Saint Antoine, Sorbonne Université, 75012, Paris, France
| | - David Launay
- U1286-Infinite-Institute for Translational Research in Inflammation, Department of Internal Medicine and Clinical Immunology, National Reference Centre for Angioedema (CREAK), Inserm, CHU Lille, University of Lille, Lille, France
| | - Neil Inhaber
- Takeda Development Center Americas, Inc, Lexington, MA, USA
| | | | - Magali Aubineau
- Department of Internal Medicine, CHU Edouard Herriot, Lyon, France
| | - Alain Sobel
- Hotel-Dieu de Paris, Université de Paris, Paris, France
| | - Isabelle Boccon-Gibod
- Department of Internal Medicine, National Reference Centre for Angioedema (CREAK), INSERM-CNRS-CEA, CHU Grenoble, Université Grenoble Alpes, Joint Unit, 1036, Grenoble, France
| | | | - Laurence Bouillet
- Department of Internal Medicine, National Reference Centre for Angioedema (CREAK), INSERM-CNRS-CEA, CHU Grenoble, Université Grenoble Alpes, Joint Unit, 1036, Grenoble, France
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26
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Zuberbier T, Abdul Latiff AH, Abuzakouk M, Aquilina S, Asero R, Baker D, Ballmer‐Weber B, Bangert C, Ben‐Shoshan M, Bernstein JA, Bindslev‐Jensen C, Brockow K, Brzoza Z, Chong Neto HJ, Church MK, Criado PR, Danilycheva IV, Dressler C, Ensina LF, Fonacier L, Gaskins M, Gáspár K, Gelincik A, Giménez‐Arnau A, Godse K, Gonçalo M, Grattan C, Grosber M, Hamelmann E, Hébert J, Hide M, Kaplan A, Kapp A, Kessel A, Kocatürk E, Kulthanan K, Larenas‐Linnemann D, Lauerma A, Leslie TA, Magerl M, Makris M, Meshkova RY, Metz M, Micallef D, Mortz CG, Nast A, Oude‐Elberink H, Pawankar R, Pigatto PD, Ratti Sisa H, Rojo Gutiérrez MI, Saini SS, Schmid‐Grendelmeier P, Sekerel BE, Siebenhaar F, Siiskonen H, Soria A, Staubach‐Renz P, Stingeni L, Sussman G, Szegedi A, Thomsen SF, Vadasz Z, Vestergaard C, Wedi B, Zhao Z, Maurer M. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy 2022; 77:734-766. [PMID: 34536239 DOI: 10.1111/all.15090] [Citation(s) in RCA: 412] [Impact Index Per Article: 206.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 02/07/2023]
Abstract
This update and revision of the international guideline for urticaria was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the Global Allergy and Asthma European Network (GA²LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), the European Dermatology Forum (EDF; EuroGuiDerm), and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology with the participation of 64 delegates of 50 national and international societies and from 31 countries. The consensus conference was held on 3 December 2020. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease that presents with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous or inducible urticaria is disabling, impairs quality of life, and affects performance at work and school. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
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Affiliation(s)
- Torsten Zuberbier
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | | | - Mohamed Abuzakouk
- Department of Allergy and Immunology Respiratory InstituteCleveland Clinic Abu Dhabi Abu Dhabi United Arab Emirates
| | - Susan Aquilina
- Department of Dermatology Mater Dei Hospital Msida Malta
| | - Riccardo Asero
- Ambulatorio di Allergologia Clinica San Carlo Paderno Dugnano (MI) Italy
| | - Diane Baker
- Baker Allergy Asthma and Dermatology Portland Oregon USA
| | - Barbara Ballmer‐Weber
- Clinic for Dermatology and Allergology Kantonsspital St. Gallen St. Gallen Switzerland
- Department of Dermatology University Hospital Zurich Zurich Switzerland
| | - Christine Bangert
- Department of Dermatology Medical University of Vienna Vienna Austria
| | - Moshe Ben‐Shoshan
- Division of Allergy, Immunology and Dermatology Department of Pediatrics Montreal Children’s Hospital McGill University Montreal Quebec Canada
| | | | - Carsten Bindslev‐Jensen
- Department of Dermatology and Allergy Centre Odense University Hospital and University of Southern Denmark Odense Denmark
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein Faculty of Medicine Technical University Munich Munich Germany
| | - Zenon Brzoza
- Department of Internal Diseases with Division of Allergology University of Opole Opole Poland
| | - Herberto Jose Chong Neto
- Division of Allergy and Immunology Department of Pediatrics Federal University of Paraná Curitiba Brazil
| | - Martin K. Church
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- University of Southampton Southampton UK
| | - Paulo R. Criado
- Sociedade Brasileira de Dermatologia (SBD) Centro Universitário FMABCAlergoskin (UCARE) Santo André Brazil
| | - Inna V. Danilycheva
- Department of Allergology and Immunotherapy National Research Center‐Institute of Immunology Federal Medical‐Biological Agency of Russia Moscow Russia
| | - Corinna Dressler
- Division of Evidence‐Based Medicine Department of Dermatology, Venereology and Allergy Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Luis Felipe Ensina
- Division of Allergy Clinical Immunology and Rheumatology Department of Pediatrics Federal University of São Paulo São Paulo Brazil
| | - Luz Fonacier
- New York University Long Island School of Medicine New York New York USA
| | - Matthew Gaskins
- Division of Evidence‐Based Medicine Department of Dermatology, Venereology and Allergy Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Krisztian Gáspár
- Division of Dermatological Allergology Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - Aslı Gelincik
- Division of Immunology and Allergic Diseases Department of Internal Medicine Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
| | - Ana Giménez‐Arnau
- Department of Dermatology, Hospital del Mar Institut Mar d’Investigacions Mèdiques Universitat Autònoma y Universitat Pompeu Fabra Barcelona Spain
| | - Kiran Godse
- Department of Dermatology D Y Patil University School of MedicineNavi Mumbai India
| | - Margarida Gonçalo
- Department of Dermatology Coimbra University Hospital and Faculty of Medicine University of Coimbra Coimbra Portugal
| | - Clive Grattan
- Guy’s HospitalSt John’s Institute of Dermatology London UK
| | - Martine Grosber
- Department of Dermatology Universitair Ziekenhuis Brussel (UZ Brussel)Vrije Universiteit Brussel (VUB) Brussels Belgium
| | - Eckard Hamelmann
- Department of Pediatrics Children’s Center Bethel University Hospital OWLUniversity Bielefeld Bielefeld Germany
| | - Jacques Hébert
- Service d'allergie Centre Hospitalier Université Laval/Centre Hospitalier Universitaire de Québec Québec Quebec Canada
| | - Michihiro Hide
- Department of Dermatology Hiroshima University Hiroshima Japan
- Department of Dermatology Hiroshima Citizens Hospital Hiroshima Japan
| | - Allen Kaplan
- Department of Medicine Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology Medical University of South Carolina Charleston South Carolina USA
| | - Alexander Kapp
- Department of Dermatology & Allergy Hannover Medical School (MHH) Hannover Germany
| | - Aharon Kessel
- Division of Allergy and Clinical Immunology Bnai Zion Medical Center and the Bruce and Ruth Rappaport Faculty of Medicine Technion Haifa Israel
| | - Emek Kocatürk
- Department of Dermatology Koç University School of Medicine Istanbul Turkey
| | - Kanokvalai Kulthanan
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | | | - Antti Lauerma
- Department of Dermatology, Allergology and Venereology Inflammation Centre University of Helsinki and Helsinki University Hospital Helsinki Finland
| | | | - Markus Magerl
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology Berlin Germany
| | - Michael Makris
- Allergy Unit 2nd Department of Dermatology and Venereology National and Kapodistrian University of AthensUniversity General Hospital "Attikon" Athens Greece
| | - Raisa Y. Meshkova
- Department of Clinical Immunology and Allergology Smolensk State Medical University Smolensk Russia
| | - Martin Metz
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology Berlin Germany
| | | | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre Odense Research Center for Anaphylaxis (ORCA) Odense University Hospital and University of Southern Denmark Odense Denmark
| | - Alexander Nast
- Division of Evidence‐Based Medicine Department of Dermatology, Venereology and Allergy Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | | | - Ruby Pawankar
- Department of Pediatrics Nippon Medical School Tokyo Japan
| | - Paolo D. Pigatto
- Department of Biomedical Surgical and Dental Sciences University of Milan Milan Italy
| | - Hector Ratti Sisa
- Primera Cátedra de Clínica Médica Hospital de Clínicas de la Facultad de Ciencias Médicas‐Universidad Nacional de Asunción Asunción Paraguay
| | | | | | | | - Bulent E. Sekerel
- Division of Pediatric Allergy and Asthma Hacettepe University Faculty of Medicine Ankara Turkey
| | - Frank Siebenhaar
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology Berlin Germany
| | - Hanna Siiskonen
- Department of Pathology Diagnostic Imaging Centre Kuopio University Hospital Kuopio Finland
| | - Angele Soria
- Department of Dermatology and Allergology Tenon Hospital APHP Sorbonne University and Cimi‐Paris Inserm 1135 Paris France
| | | | - Luca Stingeni
- Dermatology Section Department of Medicine University of Perugia Perugia Italy
| | - Gordon Sussman
- Division of Allergy and Clinical Immunology St. Michael's Hospital and University of Toronto Toronto Canada
| | - Andrea Szegedi
- Division of Dermatological Allergology Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - Simon Francis Thomsen
- Department of Dermatology Bispebjerg Hospital University of Copenhagen Copenhagen Denmark
| | - Zahava Vadasz
- Proteomic and Clinical Flow Cytometry Unit Bnai Zion Medical Center Rappaport Faculty of Medicine Technion Haifa Israel
| | | | - Bettina Wedi
- Department of Dermatology and Allergy Comprehensive Allergy Center Hannover Medical School Hannover Germany
| | - Zuotao Zhao
- Department of Dermatology and Venereology Peking University First Hospital Beijing China
| | - Marcus Maurer
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology Berlin Germany
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Manto IA, Latysheva EA, Sorokina LE, Latysheva TV. The place of scales and questionnaires in assessing the disease’s severity and the long-term prophylaxis’s prescribing in patients with hereditary angioedema. TERAPEVT ARKH 2022; 93:1498-1509. [DOI: 10.26442/00403660.2021.12.201294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 11/22/2022]
Abstract
Hereditary angioedema is a hereditary life-threatening disease characterized by recurrent angioedema of various strength and localization. To date, definite diseases severity criteria have not been developed. There are many different factors to consider not only the frequency of episodes, but also their duration, strength, influence on the patient's appearance, the severity of the pain syndrome. Disease related quality of life, the number of work disability days, and the patient's satisfaction with the prescribed treatment are important. In addition, there are no criteria for prescribing long-term prophylaxis, and no parameters for choosing a specific drug. The introduction of specific scales and questionnaires developed to assess such characteristics as disease activity, disease control, quality of life in patients with recurrent angioedema into clinical practice seems to be the best solution for both questions. The comprehensive understanding of the diseases severity in a particular patient can be carried out with the combined use of assessment tools.
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Maurer M, Magerl M, Aygören-Pürsün E, Bork K, Farkas H, Longhurst H, Kiani-Alikhan S, Bouillet L, Boccon-Gibod I, Cancian M, Zanichelli A, Launay D. Attenuated androgen discontinuation in patients with hereditary angioedema: a commented case series. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2022; 18:4. [PMID: 35027083 PMCID: PMC8759255 DOI: 10.1186/s13223-021-00644-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/26/2021] [Indexed: 11/16/2022]
Abstract
Background Hereditary angioedema (HAE) is characterized by potentially severe and life-threatening attacks of localized swelling. Prophylactic therapies are available, including attenuated androgens. Efficacy of attenuated androgens has not been assessed in large, randomized, placebo-controlled trials and can be associated with frequent, and sometimes severe, side effects. As better tolerated targeted therapies become available, attenuated androgen withdrawal is increasingly considered by physicians and their patients with HAE. Attenuated androgens withdrawal has not been systematically studied in HAE, although examination of other disorders indicates that attenuated androgen withdrawal may result in mood disturbances and flu-like symptoms. Standardized protocols for attenuated androgen discontinuation that continue to provide control of attacks while limiting potential attenuated androgen withdrawal symptoms are not established as the outcomes of different withdrawal strategies have not been compared. We aim to describe the challenges of attenuated androgen discontinuation in patients with HAE and how these may continue into the post-androgen period. Case presentation We present a retrospective case series of 10 patients with confirmed type I HAE who have discontinued prophylactic treatment with attenuated androgens. The most common reason for attenuated androgen discontinuation was side effects. Attenuated androgens were either immediately withdrawn, tapered and/or overlapped with another treatment. The major challenge of discontinuation was the management of an increased frequency and severity of HAE attacks in some patients. Conclusions Healthcare teams need to undertake careful planning and monitoring after attenuated androgens discontinuation, and modify treatment strategies if HAE control is destabilized with an increased number of attacks. Discontinuation of attenuated androgens is definitively an option in an evolving HAE treatment landscape, and outcomes can be favourable with additional patient support and education. Supplementary Information The online version contains supplementary material available at 10.1186/s13223-021-00644-0.
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Affiliation(s)
- Marcus Maurer
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Angioedema Center of Reference and Excellence (ACARE), Dermatological Allergology, Allergie-Centrum-Charité, Berlin, Germany.
| | - Markus Magerl
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Angioedema Center of Reference and Excellence (ACARE), Dermatological Allergology, Allergie-Centrum-Charité, Berlin, Germany
| | | | - Konrad Bork
- Department of Dermatology, Johannes Gutenberg University, Mainz, Germany
| | - Henriette Farkas
- Hungarian Angioedema Center of Excellence and Reference (ACARE), Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Hilary Longhurst
- Auckland District Health Board and University of Auckland, Auckland, New Zealand
| | - Sorena Kiani-Alikhan
- Angioedema Center of Reference and Excellence (ACARE), Barts Health NHS Trust, London, UK
| | - Laurence Bouillet
- French National Center of Reference and Excellence for Angioedema, Grenoble Alpes University Hospital, Grenoble, France
| | - Isabelle Boccon-Gibod
- French National Center of Reference and Excellence for Angioedema, Grenoble Alpes University Hospital, Grenoble, France
| | - Mauro Cancian
- Italian Network for Hereditary and Acquired Angioedema (ITACA), Interregional Center of Reference for Angioedema, University of Padova, Padova, Italy
| | - Andrea Zanichelli
- Italian National Center of Reference for Angiodema, Department of Internal Medicine, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco - Università degli Studi di Milano, Milan, Italy
| | - David Launay
- University of Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, French National Center of Reference for Angioedema, 59000, Lille, France
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29
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Maurer M, Magerl M, Betschel S, Aberer W, Ansotegui IJ, Aygören‐Pürsün E, Banerji A, Bara N, Boccon‐Gibod I, Bork K, Bouillet L, Boysen HB, Brodszki N, Busse PJ, Bygum A, Caballero T, Cancian M, Castaldo A, Cohn DM, Csuka D, Farkas H, Gompels M, Gower R, Grumach AS, Guidos‐Fogelbach G, Hide M, Kang H, Kaplan AP, Katelaris C, Kiani‐Alikhan S, Lei W, Lockey R, Longhurst H, Lumry WB, MacGinnitie A, Malbran A, Martinez Saguer I, Matta JJ, Nast A, Nguyen D, Nieto‐Martinez SA, Pawankar R, Peter J, Porebski G, Prior N, Reshef A, Riedl M, Ritchie B, Rafique Sheikh F, Smith WR, Spaeth PJ, Stobiecki M, Toubi E, Varga LA, Weller K, Zanichelli A, Zhi Y, Zuraw B, Craig T. The international WAO/EAACI guideline for the management of hereditary angioedema-The 2021 revision and update. Allergy 2022; 77:1961-1990. [PMID: 35006617 DOI: 10.1111/all.15214] [Citation(s) in RCA: 154] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/22/2021] [Accepted: 12/08/2021] [Indexed: 12/11/2022]
Abstract
Hereditary angioedema (HAE) is a rare and disabling disease for which early diagnosis and effective therapy are critical. This revision and update of the global WAO/EAACI guideline on the diagnosis and management of HAE provides up-to-date guidance for the management of HAE. For this update and revision of the guideline, an international panel of experts reviewed the existing evidence, developed 28 recommendations, and established consensus by an online DELPHI process. The goal of these recommendations and guideline is to help physicians and their patients in making rational decisions in the management of HAE with deficient C1 inhibitor (type 1) and HAE with dysfunctional C1 inhibitor (type 2), by providing guidance on common and important clinical issues, such as: (1) How should HAE be diagnosed? (2) When should HAE patients receive prophylactic on top of on-demand treatment and what treatments should be used? (3) What are the goals of treatment? (4) Should HAE management be different for special HAE patient groups such as children or pregnant/breast-feeding women? and (5) How should HAE patients monitor their disease activity, impact, and control? It is also the intention of this guideline to help establish global standards for the management of HAE and to encourage and facilitate the use of recommended diagnostics and therapies for all patients.
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Affiliation(s)
- Marcus Maurer
- Institute of Allergology Charité—Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin Germany
| | - Markus Magerl
- Institute of Allergology Charité—Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin Germany
| | | | - Werner Aberer
- Department of Dermatology Medical University of Graz Graz Austria
| | | | - Emel Aygören‐Pürsün
- Center for Children and Adolescents University Hospital Frankfurt Frankfurt Germany
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology Massachusetts General Hospital Boston Massachusetts USA
| | - Noémi‐Anna Bara
- Romanian Hereditary Angioedema Expertise CentreMediquest Clinical Research Center Sangeorgiu de Mures Romania
| | - Isabelle Boccon‐Gibod
- National Reference Center for Angioedema (CREAK) Angioedema Center of Reference and Excellence (ACARE) Grenoble Alpes University Hospital Grenoble France
| | - Konrad Bork
- Department of Dermatology University Medical CenterJohannes Gutenberg University Mainz Germany
| | - Laurence Bouillet
- National Reference Center for Angioedema (CREAK) Angioedema Center of Reference and Excellence (ACARE) Grenoble Alpes University Hospital Grenoble France
| | | | - Nicholas Brodszki
- Department of Pediatric Immunology Childrens HospitalSkåne University Hospital Lund Sweden
| | | | - Anette Bygum
- Clinical Institute University of Southern Denmark Odense Denmark
- Department of Clinical Genetics Odense University Hospital Odense Denmark
| | - Teresa Caballero
- Allergy Department Hospital Universitario La PazIdiPaz, CIBERER U754 Madrid Spain
| | - Mauro Cancian
- Department of Systems Medicine University Hospital of Padua Padua Italy
| | | | - Danny M. Cohn
- Department of Vascular Medicine Amsterdam UMC/University of Amsterdam Amsterdam The Netherlands
| | - Dorottya Csuka
- Department of Internal Medicine and Haematology Hungarian Angioedema Center of Reference and Excellence Semmelweis University Budapest Hungary
| | - Henriette Farkas
- Department of Internal Medicine and Haematology Hungarian Angioedema Center of Reference and Excellence Semmelweis University Budapest Hungary
| | - Mark Gompels
- Clinical Immunology North Bristol NHS Trust Bristol UK
| | - Richard Gower
- Marycliff Clinical ResearchPrinciple Research Solutions Spokane Washington USA
| | | | | | - Michihiro Hide
- Department of Dermatology Hiroshima Citizens Hospital Hiroshima Japan
- Department of Dermatology Hiroshima University Hiroshima Japan
| | - Hye‐Ryun Kang
- Department of Internal Medicine Seoul National University College of Medicine Seoul Korea
| | - Allen Phillip Kaplan
- Division of Pulmonary, Critical Care, Allergy and Immunology Medical university of South Carolina Charleston South Carolina USA
| | - Constance Katelaris
- Department of Medicine Campbelltown Hospital and Western Sydney University Sydney NSW Australia
| | | | - Wei‐Te Lei
- Division of Allergy, Immunology, and Rheumatology Department of Pediatrics Mackay Memorial Hospital Hsinchu Taiwan
| | - Richard Lockey
- Division of Allergy and Immunology Department of Internal Medicine Morsani College of MedicineUniversity of South Florida Tampa Florida USA
| | - Hilary Longhurst
- Department of Immunology Auckland District Health Board and Department of MedicineUniversity of Auckland Auckland New Zealand
| | - William B. Lumry
- Internal Medicine Allergy Division University of Texas Health Science Center Dallas Texas USA
| | - Andrew MacGinnitie
- Division of Immunology Department of Pediatrics Boston Children's HospitalHarvard Medical School Boston Massachusetts USA
| | - Alejandro Malbran
- Unidad de Alergia, Asma e Inmunología Clínica Buenos Aires Argentina
| | | | | | - Alexander Nast
- Department of Dermatology, Venereology and Allergology Division of Evidence‐Based Medicine Charité ‐ Universitätsmedizin Berlincorporate member of Free University of BerlinHumboldt University of Berlin, and Berlin Institute of Health Berlin Germany
| | - Dinh Nguyen
- Respiratory, Allergy and Clinical Immunology Unit Internal Medicine Department Vinmec Healthcare System College of Health SciencesVinUniversity Hanoi Vietnam
| | | | - Ruby Pawankar
- Department of Pediatrics Nippon Medical School Tokyo Japan
| | - Jonathan Peter
- Division of Allergy and Clinical Immunology University of Cape Town Cape Town South Africa
- Allergy and Immunology Unit University of Cape Town Lung Institute Cape Town South Africa
| | - Grzegorz Porebski
- Department of Clinical and Environmental Allergology Jagiellonian University Medical College Krakow Poland
| | - Nieves Prior
- Allergy Hospital Universitario Severo Ochoa Madrid Spain
| | - Avner Reshef
- Angioderma CenterBarzilai University Medical Center Ashkelon Israel
| | - Marc Riedl
- Division of Rheumatology, Allergy and Immunology University of California San Diego La Jolla California USA
| | - Bruce Ritchie
- Departments of Medicine and Medical Oncology University of Alberta Edmonton AB Canada
| | - Farrukh Rafique Sheikh
- Section of Adult Allergy & Immunology Department of Medicine King Faisal Specialist Hospital & Research Centre Riyadh Saudi Arabia
| | - William R. Smith
- Clinical Immunology and Allergy Royal Adelaide Hospital Adelaide SA Australia
| | - Peter J. Spaeth
- Institute of PharmacologyUniversity of Bern Bern Switzerland
| | - Marcin Stobiecki
- Department of Clinical and Environmental Allergology Jagiellonian University Medical College Krakow Poland
| | - Elias Toubi
- Division of Allergy and Clinical Immunology Bnai Zion Medical CenterAffiliated with Rappaport Faculty of MedicineTechnion‐Israel Institute of Technology Haifa Israel
| | - Lilian Agnes Varga
- Department of Internal Medicine and Haematology Hungarian Angioedema Center of Reference and Excellence Semmelweis University Budapest Hungary
| | - Karsten Weller
- Institute of Allergology Charité—Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin Germany
| | - Andrea Zanichelli
- Department of Internal Medicine ASST Fatebenefratelli Sacco Ospedale Luigi Sacco‐University of Milan Milan Italy
| | - Yuxiang Zhi
- Department of Allergy and Clinical Immunology Bejing Union Medical College Hospital & Chinese Academy of Medical Sciences Bejing China
| | - Bruce Zuraw
- University of California, San Diego San Diego California USA
| | - Timothy Craig
- Departments of Medicine and Pediatrics Penn State University Hershey Pennsylvania USA
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30
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Zhao Z, Cai T, Chen H, Chen L, Chen Y, Gao X, Gao X, Geng S, Guo Y, Hao F, Hao G, Hu Y, Jin H, Jin Z, Li C, Li H, Li J, Li Y, Liang Y, Liu G, Liu Q, Long H, Ma L, Shang Y, Song Y, Song Z, Su X, Sui H, Sun Q, Sun Y, Tang J, Tong X, Wang H, Wang G, Wang L, Wang S, Xiang L, Xiao T, Xie Z, Ye L, Yu Y, Zhang C, Zhang L, Zhang S, Zheng R, Zhi L, Zhou W, Zou Y, Maurer M. Expert consensus on the use of omalizumab in chronic urticaria in China. World Allergy Organ J 2021; 14:100610. [PMID: 34934470 PMCID: PMC8654989 DOI: 10.1016/j.waojou.2021.100610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/07/2021] [Accepted: 11/02/2021] [Indexed: 11/19/2022] Open
Abstract
Chronic urticaria (CU) is a debilitating skin disease that lasts for more than 6 weeks with wheals and/or angioedema, including chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU). In China, the prevalence of this disease is high, more than 1%, and on the rise. CU has a major impact on the quality of life (QoL) of patients who frequently experience sleep disturbance, depression, and anxiety. Nearly one-third of patients with CSU, in China, are resistant to second-generation H1-antihistamines (sgAHs), even at a fourfold dose (second line; off-label). Omalizumab is approved for the treatment of CSU treatment in Europe and shows remarkable efficacy and safety. In China, regulatory approval for the use of omalizumab is pending, and its use in clinical practice varies widely. Consensus on omalizumab CU treatment in China is urgently needed. The aim of this article is to propose a practical omalizumab treatment algorithm for the management of antihistamine-resistant CSU and CIndU in adults and special population including children and adolescents, and pregnant or breast feeding women, to guide daily clinical practice in China. In the development of this consensus, an expert group including mainly dermatologists, allergists, but also pulmonologists, ENTs, immunologists, and pediatricians in Allergic Disease Prevention and Control Committee, Chinese Preventive Medicine Association, reviewed the existing evidence and developed consensus on the use of omalizumab in CU patients from China. The goal of this consensus is to assist clinicians in making rational decisions in the management of refractory CU with omalizumab. The key clinical questions covered by the treatment algorithm are: 1) Omalizumab treatment routine strategy in both CSU and CIndU patients; 2) Recommended dose and treatment duration for different age stratification; 3) Treatment duration for CU patients with other allergic comorbidities; 4) Recommendation on omalizumab stopping strategy.
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Affiliation(s)
- Zuotao Zhao
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Corresponding author. Department of Dermatology and Venereology, Peking University First Hospital, Xishiku Avenue No. 8, Beijing, PR China.
| | - Tao Cai
- Department of Dermatology and Venerology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hong Chen
- Department of Dermatology and Venerology, Tianjin People's Hospital, Tianjin Union Medical Center, Tianjin, China
| | - Liuqing Chen
- Department of Dermatology and Venerology, Wuhan No.1 Hospital, Wuhan, China
| | - Yudi Chen
- Department of Dermatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiang Gao
- Department of Allergy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xinghua Gao
- Department of Dermatology and Venerology, The First Hospital of China Medical University, Shenyang, China
| | - Songmei Geng
- Department of Dermatology and Venerology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yinshi Guo
- Department of Allergy, Renji Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Fei Hao
- Department of Dermatology and Venerology, The Third Affiliated Hospital of Chongqing Medicine University, Chongqing, China
| | - Guodong Hao
- Department of Allergy, Tangshan Gongren Hospital, Tangshan, China
| | - Yan Hu
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Hongzhong Jin
- Department of Dermatology and Venerology, Peking Union Medical College Hospital, Chinese Academy Medical Science, Peking Union Medical College, Beijing, China
| | - Zhehu Jin
- Department of Dermatology and Venerology, Yanbian University Hospital (Yanbian Hospital), Jilin, China
| | - Chengxin Li
- Department of Dermatology and Venerology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Haili Li
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Jie Li
- Department of Dermatology and Venerology, Xiangya Hospital Central South University, Changsha, China
| | - Yanming Li
- Department of Respiratory and Critical Care Medicine, Bejing Hospital, Beijing, China
| | - Yunsheng Liang
- Department of Dermatology and Venerology, Dermatology Hospital of Southern Medical University, Guangdong Provincial Dermatology Hospital, Guangdong, China
| | - Guanghui Liu
- Department of Allergy, ZhongNan Hospital of Wuhan University, Wuhan, China
| | - Qiang Liu
- Department of Dermatology and Venerology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hai Long
- Department of Dermatology and Venerology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Lin Ma
- Department of Dermatology and Venerology, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Yuanyuan Shang
- Department of Dermatology and Venerology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yuxin Song
- Department of Allergy, Harbin Children's Hospital, Harbin, China
| | - Zhiqiang Song
- Department of Dermatology and Venerology, The First Affiliated Hospital of Third Military Medical University, Chongqing, China
| | - Xiangyang Su
- Department of Dermatology and Venerology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Haijing Sui
- Department of Otorhinolaryngology Head and Neck Surgery, Peking University First Hospital, China
| | - Qing Sun
- Department of Dermatology and Venerology, Qilu Hospital, Shandong University, Jinan, China
| | - Yuemei Sun
- Department of Allergy, Yantai Yuhuangding Hospital, Yantai, China
| | - Jianping Tang
- Department of Dermatology and Venerology, Hunan Children's Hospital, Changsha, China
| | - Xunliang Tong
- Department of Respiratory and Critical Care Medicine, Bejing Hospital, Beijing, China
| | - Huiying Wang
- Department of Allergy, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Gang Wang
- Department of Dermatology and Venerology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lianglu Wang
- Department of Allergy, Peking Union Medical College Hospital, Beijing, China
| | - Siqin Wang
- Department of Allergy, Henan Provincial Peoples Hospital, Zhengzhou, China
| | - Li Xiang
- Department of Allergy, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Ting Xiao
- Department of Dermatology and Venerology, The First Hospital of China Medical University, Shenyang, China
| | - Zhiqiang Xie
- Department of Dermatology and Venerology, Peking University Third Hospital, Beijing, China
| | - Leping Ye
- Department of Paediatrics, Peking University First Hospital, Beijing, China
| | - Yongmei Yu
- Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chunlei Zhang
- Department of Dermatology and Venerology, Peking University Third Hospital, Beijing, China
| | - Litao Zhang
- Department of Dermatology and Venerology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Shuchen Zhang
- Department of Allergy, Tongji Medical College, Huazhong University of Science&Technology, Wuhan, China
| | - Rui Zheng
- Department of Dermatology and Venerology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Lili Zhi
- Department of Allergy, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Shandong Institute of Respiratory Diseases, Jinan, China
| | - Wei Zhou
- Department of Paediatrics, Peking University Third Hospital, Beijing, China
| | - Ying Zou
- Department of Dermatology and Venerology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Marcus Maurer
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin, Berlin, Germany
- Corresponding author. Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, D-10117, Berlin, Germany.
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31
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Di Agosta E, Salvati L, Corazza M, Baiardini I, Ambrogio F, Angileri L, Antonelli E, Belluzzo F, Bonamonte D, Bonzano L, Brancaccio R, Custurone P, De Marco A, Detoraki A, Di Guida A, Di Leo E, Fantò M, Fassio F, Ferrucci SM, Foti C, Gallo R, Gatta A, Guarneri F, Guidolin L, Hansel K, Lamacchia D, Lombardo C, Minciullo PL, Napolitano M, Pannofino A, Paravisi A, Parente R, Passante M, Patruno C, Peroni D, Quecchia C, Schettini N, Spadaro G, Stingeni L, Tarrini D, Tramontana M, Nettis E, Rossi O. Quality of life in patients with allergic and immunologic skin diseases: in the eye of the beholder. Clin Mol Allergy 2021; 19:26. [PMID: 34930291 PMCID: PMC8690422 DOI: 10.1186/s12948-021-00165-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/15/2021] [Indexed: 12/24/2022] Open
Abstract
Allergic and immunologic skin diseases negatively impact the quality of life (QoL) of affected patients with detrimental consequences. Nonetheless, in everyday clinical practice the evaluation of QoL is often overlooked. Considering the increasing prevalence of atopic dermatitis, allergic contact dermatitis, hereditary angioedema, cutaneous mastocytosis, and urticaria, it is essential to determine the effects of allergic and immunologic skin diseases on QoL. A joint meeting (GET TOGETHER 2021) of the Italian Society of Allergology, Asthma and Clinical Immunology (SIAAIC) and the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA) aimed to summarize the features of the main QoL tools used in these diseases and to describe the extent of QoL impairment as well as the impact of treatments on QoL, particularly biologic therapies. The assessment of QoL in patients with allergic and immunologic skin diseases relies on generic, organ-specific and disease-specific questionnaires. While generic and organ-specific questionnaires allow comparison between different diseases, disease-specific questionnaires are designed and validated for specific cohorts: the QoL Index for Atopic Dermatitis (QoLIAD) and the Childhood Atopic Dermatitis Impact Scale (CADIS) in atopic dermatitis, the ACD-11 in allergic contact dermatitis, the Angioedema QoL Questionnaire (AE-QoL) and the Hereditary Angioedema QoL questionnaire (HAE-QoL) in hereditary angioedema, the Mastocytosis QoL Questionnaires (MCQoL e MQLQ) in cutaneous mastocytosis, and the Chronic Urticaria QoL questionnaire (CU-Q2oL) in urticaria. Among the many factors that variably contribute to QoL impairment, pruritus can represent the leading cause of patient discomfort. Biologic therapies significantly ameliorate QoL in atopic dermatitis, hereditary angioedema, mastocytosis and chronic urticaria. In general, adequate management strategies are essential for improving QoL in patients with allergic and immunologic skin diseases.
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Affiliation(s)
- Ester Di Agosta
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Lorenzo Salvati
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Monica Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ilaria Baiardini
- Respiratory Unit for Continuity of Care, IRCCS Ospedale Policlinico San Martino, Department of Internal Medicine (DiMI), University of Genoa, Genova, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Francesca Ambrogio
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Luisa Angileri
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Elettra Antonelli
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | | | - Domenico Bonamonte
- Department of Biomedical Sciences and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Laura Bonzano
- Dermatology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Raffaele Brancaccio
- Division of Allergy and Clinical Immunology, "Santa Maria Della Speranza" Hospital, Salerno, Italy
| | - Paolo Custurone
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Aurora De Marco
- Department of Biomedical Sciences and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Aikaterini Detoraki
- Department of Internal Medicine, Clinical Immunology, Clinical Pathology and Infectious Disease, Azienda Ospedaliera Universitaria Federico II, Napoli, Italy
| | - Adriana Di Guida
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Elisabetta Di Leo
- Section of Allergy and Clinical Immunology, Unit of Internal Medicine-"F. Miulli" Hospital, Acquaviva Delle Fonti, Bari, Italy
| | - Marta Fantò
- Unit of Allergology, Department of Dermatology, Policlinico Umberto I, Hospital-University Sapienza of Rome, Roma, Italy
| | - Filippo Fassio
- Allergy and Clinical Immunology Unit, San Giovanni di Dio Hospital, Firenze, Italy
| | - Silvia Mariel Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Caterina Foti
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Rosella Gallo
- Section of Dermatology - Department of Health Sciences, University of Genoa, Ospedale Policlinico San Martino - IRCCS, Genova, Italy
| | - Alessia Gatta
- Department of Medicine and Science of Ageing, G. d'Annunzio University, Chieti, Italy
| | - Fabrizio Guarneri
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Lucia Guidolin
- Allergy Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Katharina Hansel
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Donatella Lamacchia
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Carla Lombardo
- Allergy Unit, Villa Igea Hospital. A.P.S.S. Trento, Trento, Italy
| | - Paola Lucia Minciullo
- Department of Clinical and Experimental Medicine, School and Division of Allergy and Clinical Immunology, University Hospital 'G. Martino', Messina, Italy
| | - Maddalena Napolitano
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Alessandro Pannofino
- Allergology and Immunology Clinic, Operative Unit of Medicine, Policoro Hospital, Policoro, Matera, Italy
| | - Andrea Paravisi
- Section of Dermatology, Department of Health Sciences, University of Genoa, Ospedale Policlinico San Martino - IRCCS, Genova, Italy
| | - Roberta Parente
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Maria Passante
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Diego Peroni
- Section of Pediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Cristina Quecchia
- Io e l'Asma Center, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Natale Schettini
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Napoli, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Daniele Tarrini
- Allergy and Clinical Immunology Unit, Department of Clinical Medicine, Mauriziano Umberto I Hospital, University of Turin, Torino, Italy
| | - Marta Tramontana
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy
| | - Oliviero Rossi
- Immunoallergology Unit, SOD Immunoallergologia, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
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Sabroe RA, Lawlor F, Grattan CEH, Ardern-Jones MR, Bewley A, Campbell L, Flohr C, Leslie TA, Marsland AM, Ogg G, Sewell WAC, Hashme M, Exton LS, Mohd Mustapa MF, Ezejimofor MC. British Association of Dermatologists guidelines for the management of people with chronic urticaria 2021. Br J Dermatol 2021; 186:398-413. [PMID: 34773650 DOI: 10.1111/bjd.20892] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/30/2022]
Abstract
The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the management of urticaria. The document aims to: offer an appraisal of all relevant literature up to March 2020, focusing on any key developments address important, practical clinical questions relating to the primary guideline objective provide guideline recommendations and if appropriate research recommendations The guideline is presented as a detailed review with highlighted recommendations for practical use in primary, secondary and tertiary care, in addition to an updated Patient Information Leaflet (PIL; available on the BAD Skin Health Information website, https://www.skinhealthinfo.org.uk/a-z-conditions-treatments/).
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Affiliation(s)
- R A Sabroe
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, U.K
| | - F Lawlor
- St John's Institute of Dermatology, NHS Foundation Trust, Guy's and St Thomas, London, SE1 9RT, U.K
| | - C E H Grattan
- St John's Institute of Dermatology, NHS Foundation Trust, Guy's and St Thomas, London, SE1 9RT, U.K
| | - M R Ardern-Jones
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, U.K
| | - A Bewley
- Barts Health NHS Trust and Queen Mary University of London Medical School, London, E1 1BB, U.K
| | | | - C Flohr
- St John's Institute of Dermatology, NHS Foundation Trust, Guy's and St Thomas, London, SE1 9RT, U.K
| | - T A Leslie
- Royal Free London NHS Foundation Trust, Pond St, London, NW3 2QG, U.K
| | - A M Marsland
- University of Manchester & Salford Royal Hospital, Salford, M6 8HD, U.K
| | - G Ogg
- MRC Human Immunology Unit, The MRC Weatherall Institute of Molecular Medicine, University of Oxford, NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, OX3 9DS, U.K
| | | | - M Hashme
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
| | - L S Exton
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
| | - M C Ezejimofor
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
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Maurer M, Magerl M. Differences and Similarities in the Mechanisms and Clinical Expression of Bradykinin-Mediated vs. Mast Cell-Mediated Angioedema. Clin Rev Allergy Immunol 2021; 61:40-49. [PMID: 33534062 PMCID: PMC8282544 DOI: 10.1007/s12016-021-08841-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 12/22/2022]
Abstract
Angioedema (AE), transient localized swelling due to extravasated fluid, is commonly classified as mast cell mediator-induced, bradykinin-mediated or of unknown cause. AE often occurs more than once, and it is these recurrent forms of AE that are challenging for patients and physicians, and they are the ones we focus on and refer to as AE in this review. Since effective treatment depends on the causative mediator, reliable and early diagnosis is essential. Although their clinical presentations bear similarities, many forms of angioedema exhibit specific patterns of clinical appearance or disease history that may aid in diagnosis. Here, we describe the most common differences and similarities in the mechanisms and clinical features of bradykinin-mediated and mast cell mediator-induced types of angioedema. We first provide an overview of the diseases that manifest with mast cell mediator-induced versus bradykinin-mediated angioedema as well as their respective underlying pathogenesis. We then compare these diseases for key clinical features, including angioedema location, course and duration of swelling, attack frequency, prevalence and relevance of prodromal signs and symptoms, triggers of angioedema attacks, and other signs and symptoms including wheals, age of onset, and duration. Our review and comparison of the clinical profiles of different types of angioedema incorporate our own clinical experience as well as published information. Our aim is to highlight that mast cell mediator-induced and bradykinin-mediated angioedema types share common features but are different in many aspects. Knowledge of the differences in underlying pathomechanisms and clinical profiles between different types of angioedema can help with the diagnostic approach in affected patients and facilitate targeted and effective treatment.
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Affiliation(s)
- 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.
| | - Markus Magerl
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Eyice Karabacak D, Demir S, Yeğit OO, Can A, Terzioğlu K, Ünal D, Olgaç M, Coşkun R, Çolakoğlu B, Büyüköztürk S, Gelincik A. Impact of anxiety, stress and depression related to COVID-19 pandemic on the course of hereditary angioedema with C1-inhibitor deficiency. Allergy 2021; 76:2535-2543. [PMID: 33650198 PMCID: PMC8014132 DOI: 10.1111/all.14796] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/24/2021] [Accepted: 02/05/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Hereditary angioedema (HAE) attacks can be provoked with psychological factors. The aim of this study was to assess the effects of anxiety, depression and stress related to COVID-19 pandemic on disease activity of HAE patients during the quarantine period (QP) and the return to normal period (RTNP). METHODS This study was conducted between March 2020 and September 2020 in four allergy centres. Demographic, clinical features and mental health status were evaluated in QP (from March to the beginning of June) and RTNP (from June to the beginning of September) applied by the government. The 10-point visual analogue scale (VAS10) was used to define the severity of HAE attacks. Depression, Anxiety and Stress Scales-21 (DASS-21) and Fear of COVID-19 (FC-19) scale were performed to assess mental health status. RESULTS 139 HAE patients were included in the study. In QP, median attack numbers and median VAS10 scores were 5 (min-max: 0-45) and 6 (min-max: 0-10), respectively. HAE attack numbers, DASS-21 stress, anxiety, depression and total DASS-21 scores, and FC-19 scores were higher in QP than RTNP (p = 0.001, p < 0.001, p = 0.001, p < 0.001, p < 0.001, p < 0.001, respectively). However, there was no difference in attack severity scores between the two periods (p > 0.05). CONCLUSIONS This study revealed that the restriction measures during COVID-19 outbreak cause an increase in the number of HAE attacks in relation to anxiety, depression, stress and fear of COVID-19 pandemic. Therefore, it is important to provide psychological support to HAE patients during the pandemic.
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Affiliation(s)
- Deniz Eyice Karabacak
- Department of Internal MedicineDivision of Immunology and Allergic DiseasesIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Semra Demir
- Department of Internal MedicineDivision of Immunology and Allergic DiseasesIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Osman Ozan Yeğit
- Department of Internal MedicineDivision of Immunology and Allergic DiseasesIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Ali Can
- Department of Internal MedicineDivision of Immunology and Allergic DiseasesIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Kadriye Terzioğlu
- Kartal Lütfi Kırdar Education and Research HospitalAdult Immunology and Allergy ClinicIstanbulTurkey
| | - Derya Ünal
- Department of Internal MedicineDivision of Immunology and Allergic DiseasesIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Müge Olgaç
- Şişli Hamidiye Etfal Education and Research HospitalAdult Immunology and Allergy ClinicIstanbulTurkey
| | - Raif Coşkun
- Prof Dr Cemil Taşçıoğlu City HospitalAdult Immunology and Allergy ClinicIstanbulTurkey
| | - Bahauddin Çolakoğlu
- Department of Internal MedicineDivision of Immunology and Allergic DiseasesIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Suna Büyüköztürk
- Department of Internal MedicineDivision of Immunology and Allergic DiseasesIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Aslı Gelincik
- Department of Internal MedicineDivision of Immunology and Allergic DiseasesIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
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Rönsch H, Berndt K, Bauer A. Behandlungszufriedenheit bei chronischer Urtikaria unter leitliniengerechter Therapie. J Dtsch Dermatol Ges 2021; 19:833-841. [PMID: 34139070 DOI: 10.1111/ddg.14415_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 12/26/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Henriette Rönsch
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Deutschland
| | - Katja Berndt
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Deutschland
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Deutschland
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Can PK, Degi Rmentepe EN, Etikan P, Kiziltaç K, Gelincik A, Demir S, Buyukozturk S, Haşal E, Bülbül Başkan E, Aydin Ö, Maurer M, Weller K, Kocaturk E. Assessment of disease activity and quality of life in patients with recurrent bradykinin-mediated versus mast cell-mediated angioedema. World Allergy Organ J 2021; 14:100554. [PMID: 34221217 PMCID: PMC8219995 DOI: 10.1016/j.waojou.2021.100554] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 04/30/2021] [Accepted: 05/21/2021] [Indexed: 11/08/2022] Open
Abstract
Objective Recurrent Angioedema (RAE) is characterized by sudden swelling of mucosal surfaces or deep dermis and is either mast cell-(MMAE) or bradykinin-mediated (BMAE). How patients with BMAE and MMAE differ in terms of disease activity and impact remains largely unknown. Here, we determined validity, reliability, and sensitivity to change of Turkish versions of angioedema activity score (AAS) and quality of life questionnaire (AE-QoL) and used both instruments to investigate and compare patients with BMAE and MMAE. Methods Turkish versions of AAS28 and AE-QoL were applied to 94 patients with RAE (18–72 years). Patients’ global self-assessment of QoL (PGA-QoL), disease activity (PGA-DA-VRS, PatGA-DA-VAS), and 12-Item-Short Form Survey were used at week 4 (visit 2), and week 8 (visit 3). Demographic characteristics, clinical features, and AAS28 and AE-QoL values were compared between 31 patients with BMAE and 63 patients with MMAE. Results Turkish AAS28 and AE-QoL showed excellent internal consistency, high reproducibility and known-groups validity. Compared to patients with MMAE, BMAE patients were younger (34.6 ± 10.7 vs. 40.7 ± 13.3 years), had longer disease duration (236 ± 178 vs. 51 ± 78 months), high prevalence of family history (63% vs 14%), longer duration of attacks (65 ± 20 vs. 40 ± 25 h), and they were more commonly affected by upper airway angioedema (70% vs 23%). Disease activity (AAS28) was lower (29.3 ± 24.6 vs 55.2 ± 52.9), but AE-QoL was higher (44.2 ± 16.1 vs 34.5 ± 22.5) in BMAE patients as compared to MMAE patients. Conclusions Patients with BMAE and MMAE have distinct disease characteristics. Recurrent bradykinin-mediated angioedema impacts quality of life more than mast cell-mediated angioedema. The discriminating characteristics of patients with BMAE and MMAE may help to improve the diagnosis and management of patients with RAE.
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Affiliation(s)
- Pelin Kuteyla Can
- Bahcesehir University, Faculty of Medicine, Department of Dermatology, Istanbul, Turkey
| | - Ece Nur Degi Rmentepe
- Okmeydani Training and Research Hospital, Dermatology and Venerology, Istanbul, Turkey
| | - Piril Etikan
- Okmeydani Training and Research Hospital, Dermatology and Venerology, Istanbul, Turkey
| | - Kübra Kiziltaç
- Okmeydani Training and Research Hospital, Dermatology and Venerology, Istanbul, Turkey
| | - Asli Gelincik
- Istanbul University, Istanbul Faculty of Medicine, Adult Allergy Clinic, Istanbul, Turkey
| | - Semra Demir
- Istanbul University, Istanbul Faculty of Medicine, Adult Allergy Clinic, Istanbul, Turkey
| | - Suna Buyukozturk
- Istanbul University, Istanbul Faculty of Medicine, Adult Allergy Clinic, Istanbul, Turkey
| | - Eda Haşal
- Uludağ University Faculty of Medicine Department of Dermatology, Bursa, Turkey
| | - Emel Bülbül Başkan
- Uludağ University Faculty of Medicine Department of Dermatology, Bursa, Turkey
| | - Ömür Aydin
- Ankara University Faculty of Medicine, Adult Allergy Clinic, Ankara, Turkey
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Karsten Weller
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Emek Kocaturk
- Koç University School of Medicine Department of Dermatology, Istanbul, Turkey
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Rönsch H, Berndt K, Bauer A. Treatment satisfaction in chronic urticaria during guideline-based therapy. J Dtsch Dermatol Ges 2021; 19:833-840. [PMID: 33931937 DOI: 10.1111/ddg.14415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 12/26/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Patients with chronic urticaria are often unsatisfied with their treatment. We aimed to assess patient satisfaction, chronic urticaria control, treatment goals, self-treatment competence, knowledge, and factors influencing treatment satisfaction. PATIENTS AND METHODS Eighty-seven adult patients with chronic urticaria who were previously insufficiently treated with oral antihistamines received guideline-based care for six months and completed questionnaires. RESULTS This study included patients with chronic spontaneous (80 %) and/or inducible urticaria (CIndU, 32 %). Significant median improvements were observed with the urticaria control test (UCT, from 7 to 11), the urticaria activity score for patients with chronic spontaneous urticaria (from 19 to 10), and treatment satisfaction (from 5.2 to 8.4). Six significant, independent factors of treatment satisfaction after six months of treatment were identified (negative: male sex, CIndU, sleep disturbances; positive: UCT, baseline treatment satisfaction, perceived competence of the study physician). Adequate urticaria control (UCT ≥ 12) was achieved in 19 % of patients with CIndU and 61 % of patients without CIndU. CONCLUSIONS In patients with chronic urticaria who were previously insufficiently treated with antihistamines, six months of guideline-based therapy significantly improved disease control and treatment satisfaction. Adequate control requires several consultations for many patients and is considerably more difficult to achieve for CIndU.
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Affiliation(s)
- Henriette Rönsch
- Department of Dermatology, University Hospital Carl Gustav Carus at the Technical University Dresden, Dresden, Germany
| | - Katja Berndt
- Department of Dermatology, University Hospital Carl Gustav Carus at the Technical University Dresden, Dresden, Germany
| | - Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus at the Technical University Dresden, Dresden, Germany
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Bork K, Anderson JT, Caballero T, Craig T, Johnston DT, Li HH, Longhurst HJ, Radojicic C, Riedl MA. Assessment and management of disease burden and quality of life in patients with hereditary angioedema: a consensus report. Allergy Asthma Clin Immunol 2021; 17:40. [PMID: 33875020 PMCID: PMC8056543 DOI: 10.1186/s13223-021-00537-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hereditary angioedema (HAE) is a rare disease characterized by unpredictable, potentially life-threatening attacks, resulting in significant physical and emotional burdens for patients and families. To optimize care for patients with HAE, an individualized management plan should be considered in partnership with the physician, requiring comprehensive assessment of the patient's frequency and severity of attacks, disease burden, and therapeutic control. Although several guidelines and consensus papers have been published concerning the diagnosis and treatment of HAE, there has been limited specific clinical guidance on the assessment of disease burden and quality of life (QoL) in this patient population. Practical guidance is critical in supporting effective long-term clinical management of HAE and improving patient outcomes. The objective of this review is to provide evidence-based guidelines for an individualized assessment of disease burden and QoL in patients with HAE. METHODS A consensus meeting was held on February 29, 2020, consisting of 9 HAE experts from the United States and Europe with extensive clinical experience in the treatment of HAE. Consensus statements were developed based on a preliminary literature review and discussions from the consensus meeting. RESULTS Final statements reflect the consensus of the expert panel and include the assessment of attack severity, evaluation of disease burden, and long-term clinical management of HAE caused by C1-esterase inhibitor deficiency. Patient-reported outcome measures for assessing HAE attack severity and frequency are available and valuable tools; however, attack frequency and severity are insufficient markers of disease severity unless they are evaluated in the broader context of the effect on an individual patient's QoL. QoL assessments should be individualized for each patient and minimally, they should address the interference of HAE with work, school, social, family, and physical activity, along with access to and burden of HAE treatment. Advances in HAE therapies offer the opportunity for comprehensive, individualized treatment plans, allowing patients to achieve minimal attack burden with reduced disease and treatment burden. CONCLUSION This consensus report builds on existing guidelines by expanding the assessment of disease burden and QoL measures for patients with HAE.
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Affiliation(s)
- Konrad Bork
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - John T Anderson
- Clinical Research Center of Alabama, 504 Brookwood Boulevard, Suite 250, Birmingham, AL, 35209, USA
| | - Teresa Caballero
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPaz), Biomedical Research Network on Rare Diseases (CIBERER, U754), Paseo Castellana 261, 28406, Madrid, Spain
| | - Timothy Craig
- Department of Medicine and Pediatrics, Penn State University, 200 Campus Drive, Suite 1300, Entrance 4, Hershey, University Park, PA, 17033, USA
| | - Douglas T Johnston
- Asthma and Allergy Specialists, 8405 Providence Road, Suite 300, Charlotte, NC, 28277, USA
| | - H Henry Li
- Institute for Asthma and Allergy, 2 Wisconsin Circle, Suite 250, Chevy Chase, MD, 20815, USA
| | - Hilary J Longhurst
- Addenbrookes Hospital, Cambridge Universities NHS Foundation Trust, Cambridge and University College Hospital London, Cambridge, CB2 0QQ, UK
| | - Cristine Radojicic
- Division of Allergy and Clinical Immunology, Department of Medicine, Duke University, 1821 Hillandale Rd, Durham, NC, 27705, USA
| | - Marc A Riedl
- University of California San Diego, 8899 University Center Ln, San Diego, CA, 92122, USA
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Bauer A, Dickel H, Jakob T, Kleinheinz A, Lippert U, Metz M, Schliemann S, Schwichtenberg U, Staubach P, Valesky E, Wagner N, Wedi B, Maurer M. Expertenkonsensus zu praxisrelevanten Aspekten bei der Behandlung der chronischen Urtikaria. ALLERGO JOURNAL 2021; 30:40-55. [PMID: 33785991 PMCID: PMC7994058 DOI: 10.1007/s15007-021-4772-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hintergrund: Die chronische Urtikaria (CU) ist eine häufige und für viele Patienten stark belastende Erkrankung. Die aktuelle Urtikaria-Leitlinie beschreibt die evidenzbasierte Diagnostik und Therapie der CU. Darüber hinaus treten jedoch oftmals Fragen im praktischen Alltag auf, die durch die Leitlinie nicht beantwortet werden. Methoden: Im Mai 2020 fand ein digitales Treffen deutscher Urtikaria-Experten statt, in dem praxisrelevante Aspekte der Behandlung der CU erörtert und unterstützende Hilfestellungen für den klinischen Behandlungsalltag formuliert wurden. Die resultierenden Hinweise dieses Dokumentes fokussieren auf praktische Fragen und der hierzu verfügbaren Literatur und Erfahrungen der Teilnehmer. Ergebnisse: Die Diagnose einer CU kann in kurzer Zeit mittels gründlicher Anamnese, einer körperlichen Untersuchung und einer laborchemischen Basisdiagnostik gestellt werden. Hierzu werden in dieser Arbeit praktische Empfehlungen für den Praxisalltag gegeben. Eine erweiterte Diagnostik ist nur in wenigen Fällen indiziert und sollte grundsätzlich parallel zu einer effektiven Therapie erfolgen. Generell gilt, dass die CU immer auf gleiche Weise zu therapieren ist, unabhängig davon, ob Quaddeln, Angioödeme oder beides auftreten. Eine symptomatische Therapie sollte nach dem von den Leitlinien empfohlenen Stufenschema erfolgen. Die vorliegende Publikation gibt hierzu praktische Hinweise für Fragen in der Praxis, wie zum Beispiel dem Vorgehen in der aktuellen COVID-19-Pandemie, dem kardialen Risiko unter höher dosierten H 1-Antihistaminika, der Selbstapplikation von Omalizumab sowie dem Impfen unter Omalizumab-Therapie. Zusätzlich zu den Behandlungsempfehlungen werden Themen wie die Dokumentation in der Praxis und Familienplanung bei Urtikaria besprochen. Diskussion: Diese unterstützenden Behandlungsempfehlungen dienen als Ergänzung zu den aktuellen Leitlinien der CU und geben beim Umgang mit Patienten mit CU eine Hilfestellung für den Praxisalltag. Ziel ist es, dass Patienten, die unter einer CU leiden, mithilfe einer optimalen Therapie eine vollständige Beschwerdefreiheit erreichen.
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Affiliation(s)
- Andrea Bauer
- Universitätsklinikum Carl Gustav Carus \/ TU Dresden, Fetscherstr. 74, 1307 Dresden, Germany
| | - Heinrich Dickel
- Klinik für Dermatologie, Venerologie und Allergologie, Gudrunstr. 56, 44791 Bochum, Germany
| | - Thilo Jakob
- Universitäts-Hautklinik Gießen, Gießen, Germany
| | | | - Undine Lippert
- Universitätsmedizin Göttingen, Klinik für Dermatologie, Venerologie und Allergologie, Göttingen, Germany
| | - Martin Metz
- Charité – Universitätsmedizin Berlin, Klinik für Dermatologie, Venerologie und Allergolo, Berlin, Germany
| | | | | | | | - Eva Valesky
- Universitätsklinikum Frankfurt, Klinik für Dermatologie, Venerologie und Allergologie, Frankfurt, Germany
| | - Nicola Wagner
- Klinikum Darmstadt, Heidelberger Landstraße 379, 64297 Darmstadt-Eberstadt, Germany
| | - Bettina Wedi
- Universitätsmedizin Göttingen, Klinik für Dermatologie, Venerologie und Allergologie, Göttingen, Germany
| | - Marcus Maurer
- Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Balla Z, Ignácz B, Varga L, Kőhalmi KV, Farkas H. How Angioedema Quality of Life Questionnaire Can Help Physicians in Treating C1-Inhibitor Deficiency Patients? Clin Rev Allergy Immunol 2021; 61:50-59. [PMID: 33660212 PMCID: PMC8282561 DOI: 10.1007/s12016-021-08850-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 11/29/2022]
Abstract
The Angioedema Quality of Life Questionnaire (AE-QoL) is an angioedema (AE)-specific validated questionnaire, which surveys the quality of life of diagnosed patients. The questionnaire has been used in multiple clinical trials. Our aim was to investigate how the questionnaire can assist physicians in the everyday practice of following up and managing C1-inhibitor deficiency patients. In a prospective trial conducted in our center between 2016 and 2018, 125 hereditary angioedema and 10 diagnosed with acquired angioedema completed an AE-QoL during their annual follow-up visit. Laboratory indices (i.e., complement levels) were obtained for each patient. Statistical analysis comparing clinical data with QoL parameters was performed. Results of the analysis show that AE-QoL total score and number of AE attacks per year correlated well (r = 0.47; p < 0.0001). Women reached higher AE-QoL total score values than men, over a 3-year period (p = 0.0014). The highest AE-QoL total scores were reached by the 41–60-year age group; we obtained a similar result, when analyzing the four domains. No correlation was found between the AE-QoL total score and complement parameters. Patients with a negative correlation between AE-QoL total score and number of AE attacks had a positive correlation with psychologic attributes like fatigue/mood and fears/shame domains. Patients that acquired HAE showed a significant correlation between the annual number of AE attacks and the AE-QoL total scores (r = 0.46; p < 0.0001). The study establishes the use of AE-QoL as a clinical tool for follow-up which can help in the complex assessment of both hereditary and acquired HAE patients, and help to develop better therapeutic strategies.
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Affiliation(s)
- Zsuzsanna Balla
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
- School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Bettina Ignácz
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Lilian Varga
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Kinga Viktória Kőhalmi
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
- Department of Rheumatology and Clinical Immunology, Semmelweis University, Budapest, Hungary
- Department of Rheumatology, Hospital of the Hospitaller Brothers of Saint John of God, Budapest, Hungary
| | - Henriette Farkas
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary.
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New Instrument for the Evaluation of Prodromes and Attacks of Hereditary Angioedema (HAE-EPA). Clin Rev Allergy Immunol 2021; 61:29-39. [PMID: 33538950 DOI: 10.1007/s12016-021-08843-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
A disease-specific, patient-reported outcome instrument suitable for evaluation of prodromes and attacks of hereditary angioedema (HAE) is a clinical unmet need. We constructed such instrument and examined its validity, acceptability, and discriminative ability. Sixty-six patients participated in a survey addressing their demographics, social, and medical status. Discriminant content validity involved: (1) construct definition by in-depth cognitive debriefing interviews, (2) item selection identifying relevant categories, and (3) judgment of the format whereby questionnaires were tested on experienced patients and its content/reliability was validated. Prodromes and attacks affecting certain body systems (domains) were organized in "clusters". Internal consistency, content, and convergent validities were analyzed. Analyses of variance and regression models were used to evaluate the discriminative ability of the instrument to differentiate between attacks and prodromes. The study demonstrates very high internal consistency (Cronbach's α: attacks 0.88-0.98, prodromes 0.78-0.98). Analysis of variance confirmed significant differences between all dimensions and in pre-defined clusters (F (4, 61) = 45.74, p < 0.001, Eta2 = 0.77). Significant correlations were found between dimensions of prodromes and attacks. Prodromes are associated but differentiated from attacks. Correlations in severity were high for all domains. Interactions were found between prodromes and patients' experience in illness. In conclusion, the new Prodrome-Attack Evaluation questionnaire (HAE-EPA) is capable of distinguishing attacks and prodromes of HAE, as well as determining associations between the two interrelated phenomena. The new instrument achieves the required discriminative ability, acceptability, and content validity/reliability and therefore can be used as a reliable tool for the investigation of prodromes, attacks, and their relationships.
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42
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Türk M, Yılmaz İ, Nazik Bahçecioğlu S, Can P, Ertaş R, Kartal D, Çınar SL, Kocatürk E. Effectiveness of as-needed antihistamines in chronic spontaneous urticaria patients under omalizumab treatment. Dermatol Ther 2020; 34:e14543. [PMID: 33190334 DOI: 10.1111/dth.14543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/30/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Abstract
The question how second-generation antihistamines (sgAHs) should be used when chronic spontaneous urticaria (CSU) is under control with omalizumab is still unanswered. This study aimed to investigate the effectiveness of as-needed sgAHs in patients with well-controlled urticaria under omalizumab treatment. Patients from four different urticaria centers who were treated with omalizumab 300 mg/4 weeks for at least 3 months, had well-controlled urticaria (Urticaria Control Test: 16 > UCT≥12) and were using sgAHs only if needed, were included in this study. In order to assess effectiveness of sgAHs, change in the itch, hives, and total itch-hives scores before and after sgAHs were evaluated using modified urticaria activity score-twice daily. Fifty-three patients [38 female (71.7%)] with mean age 41.1 ± 11.4 years were included in this study. Median sgAH intake per patient throughout the 4 week-intervals was 3 (2-5) tablets. sgAH intake decreased itch, hives and total itch-hives scores 45.7% ± 52.9, 42.4% ± 39.1, and 50.2% ± 51.1, respectively (P < .001 for all). This decrease was similar in both isolated-urticaria and urticaria-and-angioedema phenotypes. Baseline IgE levels were positively correlated with the decrease of three symptom scores (r = 0.31, P = .05; r = 0.375, P = .017; r = 0.31, P = .05, respectively) that showed in patients with higher baseline total IgE levels, as needed sgAH intake decreased the symptom scores less. Our study showed that sgAHs may still be an effective option for the treatment of the intermittent symptoms in patients with well-controlled urticaria under omalizumab treatment. Baseline total IgE levels may be used as a potential biomarker for sgAH effectiveness in these patients.
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Affiliation(s)
- Murat Türk
- Division of Allergy and Clinical Immunology, Department of Chest Diseases, Erciyes University School of Medicine, Kayseri, Turkey.,Clinic of Immunological and Allergic Diseases, Kayseri Training and Research Center, Kayseri, Turkey
| | - İnsu Yılmaz
- Division of Allergy and Clinical Immunology, Department of Chest Diseases, Erciyes University School of Medicine, Kayseri, Turkey
| | - Sakine Nazik Bahçecioğlu
- Division of Allergy and Clinical Immunology, Department of Chest Diseases, Erciyes University School of Medicine, Kayseri, Turkey
| | - Pelin Can
- Department of Dermatology, Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Ragıp Ertaş
- Clinic of Dermatology, Kayseri Training and Research Center, Kayseri, Turkey
| | - Demet Kartal
- Department of Dermatology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Salih Levent Çınar
- Department of Dermatology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Emek Kocatürk
- Department of Dermatology, Okmeydanı Training and Research Hospital, İstanbul, Turkey.,Department of Dermatology, Koç University School of Medicine, İstanbul, Turkey
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Maurer M, Costa C, Gimenez Arnau A, Guillet G, Labrador‐Horrillo M, Lapeere H, Meshkova R, Savic S, Chapman‐Rothe N. Antihistamine‐resistant chronic spontaneous urticaria remains undertreated: 2‐year data from the AWARE study. Clin Exp Allergy 2020; 50:1166-1175. [DOI: 10.1111/cea.13716] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Marcus Maurer
- Dermatological Allergology Department of Dermatology, Venereology, and Allergology Allergie‐Centrum‐CharitéCharité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Celia Costa
- Serviço de Imunoalergologia Hospital de Santa Maria Lisbon Portugal
| | - AnaMaria Gimenez Arnau
- Dermatology Department, Hospital del Mar Parc de Salut Mar IMIMUniversitat Autònoma de Barcelona Barcelona Spain
| | - Gerard Guillet
- Service de Dermato‐allergologie CHU Poitiers Poitiers France
| | - Moises Labrador‐Horrillo
- Allergy Section Hospital Vall d'Hebron Vall d'Hebron Research Institute (VHIR)Universitat Autònoma de Barcelona Barcelona Spain
- ARADyAL Research Network (RD16/0006/0020) Instituto de Salud Carlos III (ISCIII) Madrid Spain
| | - Hilde Lapeere
- Department of Dermatology Ghent University Hospital Ghent Belgium
| | - Raisa Meshkova
- Allergy and Clinical Immunology Smolensk State Medical University Smolensk Russia
| | - Sinisa Savic
- National Institute for Health Research‐Leeds Biomedical Research Centre Leeds Institute of Rheumatic and Musculoskeletal Medicine St James's University Hospital Leeds UK
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Tawil S, Irani C, Kfoury R, Salameh P, Baiardini I, Weller K, Maurer M, Ezzedine K. The Arabic Urticaria Activity Score and Chronic Urticaria Quality of Life Questionnaire: validation and correlations. Int J Dermatol 2020; 59:893-901. [PMID: 32638368 DOI: 10.1111/ijd.15006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/02/2020] [Accepted: 05/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The international guideline for urticaria recommends the use of the Urticaria Activity Score 7 (UAS7) and the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) to assess patients with chronic spontaneous urticaria (CSU) for their disease activity and impact on quality of life, respectively. Over the last decade, both tools have been validated in many different languages but not in Arabic. OBJECTIVE To validate the Arabic UAS7 and CU-Q2oL in patients with CSU in Lebanon. METHODS After a structured translation process of both instruments into Arabic, their construct and known-groups validity as well as internal consistency reliability were tested in a longitudinal prospective study using a cluster sample of 152 Lebanese CSU patients. The study also included a repetitive administration of both instruments in 2-week intervals in 44 patients in order to assess their test-retest reliability. RESULTS Both the Arabic UAS7 and CU-Q2oL demonstrated high internal consistency (Cronbach alpha of 0.95 and 0.82, respectively) and moderate-to-high test-retest reliability (intraclass coefficient of 0.61 and 0.91, respectively). Exploratory factor analysis of the Arabic CU-Q2oL revealed five components that explained 81.8% of the total variance. Significant correlations were found between the Arabic CU-Q2oL and the Dermatology Life Quality Index (DLQI) (r = 0.86) and mild-to-moderate correlations between the Arabic UAS7 and CU-Q2oL (r = 0.52) as well as the DLQI (r = 0.51). CONCLUSIONS Our findings demonstrate that the Arabic versions of the UAS7 and the CU-Q2oL are valid and reliable patient-reported outcome measures in patients with CSU in Lebanon.
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Affiliation(s)
- Samah Tawil
- Drug Information Center, Lebanese Order of Pharmacists, Beirut, Lebanon.,Continuing Education Department, Lebanese Order of Pharmacists, Beirut, Lebanon
| | - Carla Irani
- Internal Medicine and Clinical Immunology, Hotel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Riwa Kfoury
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Pascale Salameh
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon.,INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Beirut, Lebanon.,Faculty of Pharmacy and of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Ilaria Baiardini
- Allergy and Respiratory Diseases Clinic- DIMI - University of Genoa, RCCS AOU San Martino-IST, Genoa, Italy
| | - Karsten Weller
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Khaled Ezzedine
- Department of Dermatology, Henri-Mondor University Hospital, Creteil, France.,EA7379 Epiderm E (Epidemiology in Dermatology and Therapeutics Evaluation), UPEC-University, Creteil, France
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45
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Weller K, Donoso T, Magerl M, Aygören‐Pürsün E, Staubach P, Martinez‐Saguer I, Hawro T, Altrichter S, Krause K, Siebenhaar F, Metz M, Zuberbier T, Freier D, Maurer M. Development of the Angioedema Control Test-A patient-reported outcome measure that assesses disease control in patients with recurrent angioedema. Allergy 2020; 75:1165-1177. [PMID: 31815297 DOI: 10.1111/all.14144] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/25/2019] [Accepted: 11/18/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Recurrent angioedema (AE) is an important clinical problem in the context of chronic urticaria (mast cell mediator-induced), ACE-inhibitor intake and hereditary angioedema (both bradykinin-mediated). To help patients obtain control of their recurrent AE is a major treatment goal. However, a tool to assess control of recurrent AE is not yet available. This prompted us to develop such a tool, the Angioedema Control Test (AECT). METHODS After a conceptional framework was developed for the AECT, a list of potential AECT items was generated by a combined approach of patient interviews, literature review and expert input. Subsequent item reduction was based on impact analysis, inter-item correlation, additional predefined criteria for item performance, and a review of the item selection process for content validity. Finally, an instruction section was generated, and an US-American-English version was developed by a structured translation process. RESULTS A 4-item AECT with recall periods of 4 weeks and 3 months was developed based on 106 potential items tested in 97 patients with mast cell mediator-induced (n = 49) or bradykinin-mediated recurrent AE (n = 48). Eighty-four items were excluded based on impact analysis. The remaining 22 items could be further reduced by a method-mix of inter-item correlation, additional predefined criteria for item performance and review for content validity. CONCLUSIONS The AECT is the first tool to assess disease control in recurrent AE patients. Its retrospective approach, its brevity and its simple scoring make the AECT ideally suited for clinical practice and trials. Its validity and reliability need to be determined in future independent studies.
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Affiliation(s)
- Karsten Weller
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité – Universitätsmedizin Berlin Berlin Germany
| | - Tamara Donoso
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité – Universitätsmedizin Berlin Berlin Germany
| | - Markus Magerl
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité – Universitätsmedizin Berlin Berlin Germany
| | - Emel Aygören‐Pürsün
- Department of Children and Adolescents University Hospital Frankfurt Goethe University Frankfurt Germany
| | - Petra Staubach
- Department of Dermatology University Medical Center Mainz Mainz Germany
| | | | - Tomasz Hawro
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité – Universitätsmedizin Berlin Berlin Germany
| | - Sabine Altrichter
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité – Universitätsmedizin Berlin Berlin Germany
| | - Karoline Krause
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité – Universitätsmedizin Berlin Berlin Germany
| | - Frank Siebenhaar
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité – Universitätsmedizin Berlin Berlin Germany
| | - Martin Metz
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité – Universitätsmedizin Berlin Berlin Germany
| | - Torsten Zuberbier
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité – Universitätsmedizin Berlin Berlin Germany
| | - Denise Freier
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité – Universitätsmedizin Berlin Berlin Germany
| | - Marcus Maurer
- Department of Dermatology and Allergy Allergie‐Centrum‐Charité Charité – Universitätsmedizin Berlin Berlin Germany
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Mandel VD, Alicandro T, Pepe P, Bonzano L, Guanti MB, Andreone P, Pellacani G. Chronic Spontaneous Urticaria: A Review of Pathological Mechanisms, Diagnosis, Clinical Management, and Treatment. EUROPEAN MEDICAL JOURNAL 2020. [DOI: 10.33590/emj/19-00162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Urticaria is a poorly understood and underestimated clinical condition characterised by the sudden onset of itchy wheals and/or angioedema, which usually resolve within 24 and 72 hours, respectively. It is generally classified as being acute (lasting <6 weeks) or chronic (continuous or intermittent for ≥6 weeks). Chronic urticaria can be further classified as chronic spontaneous urticaria (CSU) and chronic inducible urticaria, appearing in response to specific eliciting factors, such as heat, cold, or sun exposure, or following the application of pressure. Scientific advances have been made in the understanding of pathological mechanisms and treatment, especially associated with CSU. The exact pathological mechanism of how urticaria develops is still not yet fully understood, but the clinical implications on the patients’ quality of life are severe and have been associated with mental disorders and metabolic diseases. The diagnosis of urticaria is based on medical history and clinical manifestations. The treatment pathway begins with the administration of second-generation, nonsedating, nonimpairing histamine 1 receptor antihistamines and, in case of nonresponse, with new-generation biological drugs. The current review presents an update of the pathological mechanisms, diagnosis, clinical management, and treatment of CSU. It also focusses on the future implications of new-generation drugs and their effects on the clinical practice.
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Affiliation(s)
- Victor Desmond Mandel
- Dermatology Unit, Surgical, Medical, and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy; Dermatology Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Tatiana Alicandro
- Allergology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Patrizia Pepe
- Dermatology Unit, Surgical, Medical, and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy; Allergology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Bonzano
- Allergology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Mario Bruno Guanti
- Allergology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Pietro Andreone
- Division of Internal Medicine, Department of Medical and Surgical Sciences, Maternal-Infantile and the Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Pellacani
- Dermatology Unit, Surgical, Medical, and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Maurer M, Eyerich K, Eyerich S, Ferrer M, Gutermuth J, Hartmann K, Jakob T, Kapp A, Kolkhir P, Larenas-Linnemann D, Park HS, Pejler G, Sánchez-Borges M, Schäkel K, Simon D, Simon HU, Weller K, Zuberbier T, Metz M. Urticaria: Collegium Internationale Allergologicum (CIA) Update 2020. Int Arch Allergy Immunol 2020; 181:321-333. [PMID: 32224621 DOI: 10.1159/000507218] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 12/13/2022] Open
Abstract
This update on chronic urticaria (CU) focuses on the prevalence and pathogenesis of chronic spontaneous urticaria (CSU), the expanding spectrum of patient-reported outcome measures (PROMs) for assessing CU disease activity, impact, and control, as well as future treatment options for CU. This update is needed, as several recently reported findings have led to significant advances in these areas. Some of these key discoveries were first presented at past meetings of the Collegium Internationale Allergologicum (CIA). New evidence shows that the prevalence of CSU is geographically heterogeneous, high in all age groups, and increasing. Several recent reports have helped to better characterize two endotypes of CSU: type I autoimmune (or autoallergic) CSU, driven by IgE to autoallergens, and type IIb autoimmune CSU, which is due to mast cell (MC)-targeted autoantibodies. The aim of treatment in CU is complete disease control with absence of signs and symptoms as well as normalization of quality of life (QoL). This is best monitored by the use of an expanding set of PROMs, to which the Angioedema Control Test, the Cholinergic Urticaria Quality of Life Questionnaire, and the Cholinergic Urticaria Activity Score have recently been added. Current treatment approaches for CU under development include drugs that inhibit the effects of signals that drive MC activation and accumulation, drugs that inhibit intracellular pathways of MC activation and degranulation, and drugs that silence MCs by binding to inhibitory receptors. The understanding, knowledge, and management of CU are rapidly increasing. The aim of this review is to provide physicians who treat CU patients with an update on where we stand and where we will go. Many questions and unmet needs remain to be addressed, such as the development of routine diagnostic tests for type I and type IIb autoimmune CSU, the global dissemination and consistent use of PROMs to assess disease activity, impact, and control, and the development of more effective and well-tolerated long-term treatments for all forms of CU.
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Affiliation(s)
- 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,
| | - Kilian Eyerich
- Division of Dermatology and Venerology, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stefanie Eyerich
- Center for Allergy and Environment, Technical University and Helmholtz Center Munich, Munich, Germany
| | - Marta Ferrer
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra Pamplona, Spain, RETIC de Asma, Reacciones Adversas y Alérgicas, Madrid, Spain
| | - Jan Gutermuth
- Department of Dermatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Karin Hartmann
- Division of Allergy, Department of Dermatology, University of Basel, Basel, Switzerland
| | - Thilo Jakob
- Department of Dermatology and Allergy, University Medical Center Giessen, Justus-Liebig University Giessen, Giessen, Germany
| | - Alexander Kapp
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Pavel Kolkhir
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Division of Immune-Mediated Skin Diseases, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Désirée Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur, Clinical Foundation and Hospital, Mexico City, Mexico
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Gunnar Pejler
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela
| | - Knut Schäkel
- Department of Dermatology, Heidelberg University, Heidelberg, Germany
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Bern, Switzerland.,Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Karsten Weller
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Torsten Zuberbier
- 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
| | - 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
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48
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Angioedema Activity Score (AAS): A Valid and Reliable Tool to Use in Asian Patients. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9157895. [PMID: 31781652 PMCID: PMC6874972 DOI: 10.1155/2019/9157895] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/14/2019] [Indexed: 11/20/2022]
Abstract
The Angioedema Activity Score (AAS) is recommended by the EAACI/GA2LEN/EDF/WAO guidelines for urticaria as the standard measure for assessing disease activity in patients with recurrent angioedema (RAE). To date, it has been translated into 80 languages for use in 52 countries, but it has not been formally validated in Asian patient populations. As RAE may be different in Asian and non-Asian patients, it is important to validate and characterize the reliability of tools to assess RAE disease activity in Asian patients. This study proposed to demonstrate the validity and reliability of the AAS in Asian patients. Accordingly, this study aimed to generate and validate the Thai version of the AAS and to characterize its reliability in Asian patients, specifically in Thailand. A structured translation was conducted with approval from the original authors. The Patient Global Assessment of Disease Activity (PGA-DA) was used as an instrument to compare with the Thai version of the AAS. In total, 86 patients with RAE participated in the study. Seventy-six (88%) patients had RAE with chronic spontaneous urticaria. The Thai AAS was found to be a valid and reliable instrument, with high convergent and known-groups validities, excellent internal consistency, and good test-retest reliability. The validity and reliability of the AAS for assessing RAE disease activity in Asian patients have been demonstrated by our study, making it the first to do so. This will help promote the use of the AAS, in clinical trials and practice, in Asia. It will also facilitate the comparison of disease activity in patients with RAE inside and outside Asia in future studies. However, a limitation of this study was its small number of patients.
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Maurer M, Zuberbier T, Siebenhaar F, Krause K. Chronic urticaria - What does the new guideline tell us? J Dtsch Dermatol Ges 2019; 16:584-593. [PMID: 29750467 DOI: 10.1111/ddg.13531] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 04/06/2018] [Indexed: 01/13/2023]
Abstract
Patients with chronic urticaria experience significant impairment, and require an effective treatment. Such treatment is preceded by a thorough diagnostic workup and measurement of disease activity, disease burden and disease control using well--established tools. Treatment is subsequently adjusted according to patient needs and therapeutic response, based on the tenet "as much as necessary, as little as possible" (in that order). Once disease control has been achieved, it is recommended that intermittent attempts at medication withdrawal be made in order to identify spontaneous disease remission. Chronic urticaria should be treated until spontaneous remission occurs.
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Affiliation(s)
- Marcus Maurer
- Department of Dermatology, Venereology, and Allergology, Charité - University Medical Center, Berlin, Germany
| | - Torsten Zuberbier
- Department of Dermatology, Venereology, and Allergology, Charité - University Medical Center, Berlin, Germany
| | - Frank Siebenhaar
- Department of Dermatology, Venereology, and Allergology, Charité - University Medical Center, Berlin, Germany
| | - Karoline Krause
- Department of Dermatology, Venereology, and Allergology, Charité - University Medical Center, Berlin, Germany
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50
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Caffarelli C, Paravati F, El Hachem M, Duse M, Bergamini M, Simeone G, Barbagallo M, Bernardini R, Bottau P, Bugliaro F, Caimmi S, Chiera F, Crisafulli G, De Ranieri C, Di Mauro D, Diociaiuti A, Franceschini F, Gola M, Licari A, Liotti L, Mastrorilli C, Minasi D, Mori F, Neri I, Pantaleo A, Saretta F, Tesi CF, Corsello G, Marseglia GL, Villani A, Cardinale F. Management of chronic urticaria in children: a clinical guideline. Ital J Pediatr 2019; 45:101. [PMID: 31416456 PMCID: PMC6694633 DOI: 10.1186/s13052-019-0695-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/01/2019] [Indexed: 12/12/2022] Open
Abstract
The aim of this guidance is to provide recommendations to clinicians and other interested parties on chronic urticaria in children. The Italian Society for Pediatrics (SIP), the Italian Society for Allergy and Immunology (SIAIP), the Italian Society for Pediatric dermatology (SIDerP) convened a multidisciplinary panel that prepared clinical guidelines for diagnosis and management of chronic urticaria in childhood. Key questions on epidemiology, natural history, diagnosis, and management were developed. The literature was systematically searched and evaluated, recommendations were rated and algorithms for diagnosis and treatment were developed. The recommendations focus on identification of diseases and comorbidities, strategies to recognize triggering factors, improvement of treatment by individualized care.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Dipartimento Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Francesco Paravati
- Pediatric Unit, Maternal Infant Department, Azienda Sanitaria Provinciale Crotone, Crotone, Italy
| | - Maya El Hachem
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marzia Duse
- Department of Pediatrics, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Giovanni Simeone
- Primary care Pediatrician, Local Health Unit of Brindisi, Brindisi, Italy
| | - Massimo Barbagallo
- Pediatric Unit, Azienda di rilievo nazionale ARNAS "GARIBALDI", Catania, Italy
| | | | - Paolo Bottau
- Pediatric and Neonatology Unit, Imola Hospital, Imola, BO, Italy
| | - Filomena Bugliaro
- FEDERASMA e Allergie Onlus - Federazione Italiana Pazienti, Prato, Italy
| | - Silvia Caimmi
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Fernanda Chiera
- Pediatric Unit, Maternal Infant Department, Azienda Sanitaria Provinciale Crotone, Crotone, Italy
| | - Giuseppe Crisafulli
- UO Allergologia, Dipartimento di Pediatria, Università di Messina, Messina, Italy
| | | | - Dora Di Mauro
- Clinica Pediatrica, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andrea Diociaiuti
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Massimo Gola
- Allergological and Pediatric Dermatology Unit, AUTC and University of Florence, Florence, Italy
| | - Amelia Licari
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Lucia Liotti
- Department of Pediatrics, Senigallia Hospital, Senigallia, Italy
| | - Carla Mastrorilli
- Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - Domenico Minasi
- UOC di Pediatria Azienda Ospedaliera "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Francesca Mori
- Allergy Unit, Department of Pediatric Medicine, Anna Meyer Children's University Hospital, Florence, Italy
| | - Iria Neri
- Dermatology Unit, University of Bologna, Bologna, Italy
| | - Aurelia Pantaleo
- Clinica Pediatrica, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Francesca Saretta
- Pediatric Department, AAS2 Bassa Friulana-Isontina, Palmanova-Latisana, Italy.,Pediatric Allergy Unit, Department of Medicine, Udine, Italy
| | - Carlo Filippo Tesi
- FEDERASMA e Allergie Onlus - Federazione Italiana Pazienti, Prato, Italy
| | - Giovanni Corsello
- Clinica Pediatrica Università degli Studi di Palermo, Palermo, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alberto Villani
- UOC di Pediatria Generale e Malattie Infettive, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Fabio Cardinale
- Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy.
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