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Chernyshov PV, Finlay AY, Tomas-Aragones L, Zuberbier T, Kocatürk E, Manolache L, Pustisek N, Svensson A, Marron SE, Sampogna F, Bewley A, Salavastru C, Koumaki D, Augustin M, Linder D, Abeni D, Salek SS, Szepietowski J, Jemec GB. Quality of life measurement in urticaria: Position statement of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient-Oriented Outcomes and Urticaria and Angioedema. J Eur Acad Dermatol Venereol 2024. [PMID: 38855825 DOI: 10.1111/jdv.20157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/03/2024] [Indexed: 06/11/2024]
Abstract
The European Academy of Dermatology and Venereology (EADV) Task Forces on quality of life (QoL) and patient-oriented outcomes and on urticaria and angioedema recommendations for the assessment of Health-related (HR) QoL in all patients with urticaria in research and practice are as follows: to use the DLQI for adults and the CDLQI for children as dermatology-specific and the CU-Q2oL as a disease-specific HRQoL instruments in urticaria; to use generic instruments to provide comparison of data on urticaria with non-dermatologic diseases, or to compare with healthy volunteers or the general population; to select validated HRQoL instruments with appropriate age limits; to present exact numeric data for HRQoL results; correct title of any HRQoL instrument should be used, along with its correct abbreviation and the reference to its original publication, where possible. The EADV TFs discourage the use of non-validated HRQoL instruments and modified HRQoL instruments that have not undergone standard validation.
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Affiliation(s)
- P V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine
| | - A Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - L Tomas-Aragones
- Department of Psychology, University of Zaragoza, Zaragoza, Spain
| | - T Zuberbier
- 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
| | - E Kocatürk
- 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, Koç University School of Medicine, Istanbul, Turkey
| | - L Manolache
- Department of Dermatology, Dali Medical, Bucharest, Romania
| | - N Pustisek
- Children's Hospital Zagreb, Zagreb, Croatia
| | - A Svensson
- Department of Dermatology and Venereology, Skane University Hospital, Malmö, Sweden
| | - S E Marron
- Department of Dermatology, University Hospital Miguel Servet, Aragon Psychodermatology Research Group (GAI+PD), Zaragoza, Spain
| | - F Sampogna
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - A Bewley
- Barts Health NHS Trust, London, UK
- Queen Mary University, London, UK
| | - C Salavastru
- Department of Paediatric Dermatology, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - D Koumaki
- Department of Dermatology and Venereology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D Linder
- University Clinic for Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | - D Abeni
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - S S Salek
- School of Life & Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - J Szepietowski
- Department of Dermatology, Wroclaw Medical University, Wroclaw, Poland
| | - G B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
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2
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Zubiaga-Fernandez L, Testera-Montes A, Rondon C, Perez-Sanchez N, Gomez-Perez F, Vega-Chicote JM, Bartra J, Ferrer M, Eguiluz-Gracia I, Torres MJ. Biomarkers predicting the controller dose of omalizumab in patients with chronic spontaneous urticaria. Clin Exp Allergy 2024; 54:402-411. [PMID: 38343206 DOI: 10.1111/cea.14462] [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: 10/02/2023] [Revised: 01/13/2024] [Accepted: 01/22/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Clinical trials showed the efficacy of 300 mg/4 weeks of omalizumab (OMA) during 6 months in patients with severe chronic spontaneous urticaria (CSU). Nevertheless, in real life, many patients require higher doses and/or longer treatment. This study assesses the real-life performance of OMA in severe CSU and identifies factors associated with the response. METHODS CSU patients eligible for OMA were recruited prospectively. Clinical data and a blood test were collected before OMA initiation. Urticaria Activity Score 7 (UAS7) was calculated at baseline and every 3 months during OMA treatment. CSU control was defined as UAS7 <7 points. This work was partially sponsored by OMA manufacturer. RESULTS Eighty-nine adults (19.1% males) with severe CSU were recruited. Median duration of CSU prior to OMA initiation was 2 years, and median severity by UAS7 at baseline was 24 points (range 10-42 points). OMA controlled 94.4% of patients, but 17.9% of responders required doses >300 mg/4 weeks. A blood basophil count >20 cells/μL (OR 13.33; 95% CI 3.32-52.63; p < .001) and the absence of hypothyroidism (OR 3.65; 95% CI 0.78-16.95; p = .099) were identified as predictive factors to achieve control with 300 mg/4 weeks. Twelve patients were able to stop OMA during the study (responders in remission, RR). RR had received OMA for a median of 29 months (12-53 months). Conversely, 32 patients had been on OMA for >29 months at the end of the study (active responders, AR). AR had received OMA for a median of 45 months (30-100 months). There were no significant differences in clinical or analytical factors between RR and AR patients. CONCLUSIONS Low blood basophil count and the presence of hypothyroidism might serve as biomarkers for the controller dose of OMA in severe CSU patients.
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Affiliation(s)
- L Zubiaga-Fernandez
- Allergy Department, Allergy Unit, Hospital Regional Universitario de Malaga and Instituto de Investigacion Biomedica de Malaga (IBIMA)-Plataforma BIONAND, Malaga, Spain
| | - A Testera-Montes
- Allergy Department, Allergy Unit, Hospital Regional Universitario de Malaga and Instituto de Investigacion Biomedica de Malaga (IBIMA)-Plataforma BIONAND, Malaga, Spain
- RICORS de Enfermedades Inflamatorias (ISCIII), Madrid, Spain
| | - C Rondon
- Allergy Department, Allergy Unit, Hospital Regional Universitario de Malaga and Instituto de Investigacion Biomedica de Malaga (IBIMA)-Plataforma BIONAND, Malaga, Spain
- RICORS de Enfermedades Inflamatorias (ISCIII), Madrid, Spain
| | - N Perez-Sanchez
- Allergy Department, Allergy Unit, Hospital Regional Universitario de Malaga and Instituto de Investigacion Biomedica de Malaga (IBIMA)-Plataforma BIONAND, Malaga, Spain
- RICORS de Enfermedades Inflamatorias (ISCIII), Madrid, Spain
| | - F Gomez-Perez
- Allergy Department, Allergy Unit, Hospital Regional Universitario de Malaga and Instituto de Investigacion Biomedica de Malaga (IBIMA)-Plataforma BIONAND, Malaga, Spain
- RICORS de Enfermedades Inflamatorias (ISCIII), Madrid, Spain
| | - J M Vega-Chicote
- Allergy Department, Allergy Unit, Hospital Regional Universitario de Malaga and Instituto de Investigacion Biomedica de Malaga (IBIMA)-Plataforma BIONAND, Malaga, Spain
| | - J Bartra
- RICORS de Enfermedades Inflamatorias (ISCIII), Madrid, Spain
- Pulmonology Department, Allergy Section, Hospital Clinic and IDIBAPS, Barcelona, Spain
| | - M Ferrer
- RICORS de Enfermedades Inflamatorias (ISCIII), Madrid, Spain
- Department of Allergy, Clinica Universidad de Navarra, Pamplona, Spain
| | - I Eguiluz-Gracia
- Allergy Department, Allergy Unit, Hospital Regional Universitario de Malaga and Instituto de Investigacion Biomedica de Malaga (IBIMA)-Plataforma BIONAND, Malaga, Spain
- RICORS de Enfermedades Inflamatorias (ISCIII), Madrid, Spain
| | - M J Torres
- Allergy Department, Allergy Unit, Hospital Regional Universitario de Malaga and Instituto de Investigacion Biomedica de Malaga (IBIMA)-Plataforma BIONAND, Malaga, Spain
- RICORS de Enfermedades Inflamatorias (ISCIII), Madrid, Spain
- Department of Medicine and Dermatology, Universidad de Malaga, Malaga, Spain
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Pesqué D, Ciudad A, Andrades E, Soto D, Gimeno R, Pujol RM, Giménez-Arnau AM. Solar Urticaria: An Ambispective Study in a Long-term Follow-up Cohort with Emphasis on Therapeutic Predictors and Outcomes. Acta Derm Venereol 2024; 104:adv25576. [PMID: 38189220 PMCID: PMC10789168 DOI: 10.2340/actadv.v104.25576] [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: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 01/09/2024] Open
Abstract
Solar urticaria is a rare photodermatosis with several unknown pathogenic, clinical and therapeutic aspects. This study analysed the clinical and therapeutic features of a long-term follow-up solar urticaria cohort, with a focus on omalizumab management and outcomes, and characterized omalizumab response with the use of the high-affinity immunoglobulin E (IgE) receptor (FcεRI) and the Urticaria Control Test. An observational, unicentric, ambispective study was conducted from 2007 to 2023. Solar urticaria was diagnosed in 41 patients with a median follow-up of 60 months. Thirteen patients were prescribed omalizumab, with a median treatment time of 48 months. A significant decrease in FcεRI baseline levels and subsequent median increase in Urticaria Control Test was evidenced after omalizumab prescription in all patients. Drug survival at 48 months was at 88.9%. Omalizumab stepping-down protocol led to sustained omalizumab discontinuation in only 1 patient. Median basal Urticaria Control Test was lower (p < 0.01) in patients who were prescribed omalizumab and in patients without remission. This study contributes to our knowledge of omalizumab outcomes in real-life clinical practice and highlights the pathogenic importance of IgE-mediated pathways in solar urticaria, where FcεRI emerges as a possible biomarker of omalizumab response.
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Affiliation(s)
- David Pesqué
- Department of Dermatology, Hospital del Mar Research Institute, Department of Medicine, Autonomous University of Barcelona/Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Andrea Ciudad
- Department of Dermatology, Hospital del Mar Research Institute, Barcelona, Spain
| | - Evelyn Andrades
- Department of Immunology, IMIM Hospital del Mar Research Institute, Barcelona, Spain
| | - Dulce Soto
- Department of Immunology, IMIM Hospital del Mar Research Institute, Barcelona, Spain
| | - Ramon Gimeno
- DDepartment of Immunology, IMIM Hospital del Mar Research Institute, Barcelona, Spain
| | - Ramon M Pujol
- Department of Dermatology, Hospital del Mar Research Institute, Barcelona, Spain
| | - Ana M Giménez-Arnau
- DDepartment of Dermatology, Hospital del Mar Research Institute. Universitat Pompeu Fabra, Barcelona, Spain.
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Yen H, Yen H, Huang CH, Huang IH, Hung WK, Su HJ, Tai CC, Haw WWY, Flohr C, Yiu ZZN, Chi CC. Systematic Review and Critical Appraisal of Urticaria Clinical Practice Guidelines: A Global Guidelines in Dermatology Mapping Project (GUIDEMAP). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3213-3220.e11. [PMID: 37451615 DOI: 10.1016/j.jaip.2023.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/12/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Management of urticaria can be optimized with clinical practice guidelines (CPGs). However, the quality of recent urticaria CPGs remains unclear. OBJECTIVE To identify and appraise urticaria CPGs worldwide published in the last 5 years. METHODS A search for relevant urticaria CPGs was conducted between January 1, 2017, and May 31, 2022, using the following databases: MEDLINE, Embase, National Institute for Health and Care Excellence (NICE) Evidence Search, Guidelines International Network, ECRI Guidelines Trust, Australian Clinical Practice Guidelines, Trip Medical Database, and DynaMed. The included CPGs were critically appraised using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, Lenzer et al's red flags, and the Institute of Medicine (IOM) criteria of trustworthiness. RESULTS We included 21 urticaria CPGs. Most guidelines reviewed treatment recommendations of chronic spontaneous urticaria. The majority of guidelines were from European and Asian countries with high and high-middle sociodemographic index, written in English, and openly accessible. Seventeen guidelines (81%) had at least 1 AGREE II domain rated poor quality. Applicability, rigor of development, and stakeholder involvement were the 3 AGREE II domains that scored the lowest across guidelines. Appraisal with Lenzer et al's red flags showed that 18 guidelines (86%) raised at least 1 red flag indicating potential bias. The top 3 domains raising red flags were: no inclusion of nonphysician experts/patient representative/community stakeholders, no or limited involvement of a methodologist in the evaluation of evidence, and lack of external review. Based on IOM's criteria of trustworthiness, 20 guidelines (95%) had 1 or more criteria that did not meet best practice standards. The 3 domains with the highest number of best practice standards not met were updating procedures, rating strength of recommendations, and external review. Guidelines scored highest for the AGREE II domains of defining scope and purpose and clarity of presentation, and had the most fully met IOM's best practice standard for articulation of recommendations. However, only 1 urticaria CPG by NICE was identified as rigorously developed across all 3 appraisal tools. CONCLUSIONS The quality of urticaria CPGs in the last 5 years varied widely. Only the NICE urticaria guideline consistently demonstrated excellent quality, high trustworthiness, and low risk of bias. Use of a rigorous framework to rate certainty of evidence and grade strength of recommendation, involvement of methodologists, stakeholder engagement with external review, and clear guidance for updating can help improve the quality of future CPGs.
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Affiliation(s)
- Hsi Yen
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Division of Pediatric Dermatology, Medical College of Wisconsin, Milwaukee, Wis
| | - Hsuan Yen
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chun-Hsien Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - I-Hsin Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Wei-Kai Hung
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Hsing-Jou Su
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Cheng-Chen Tai
- Medical Library, Department of Medical Education, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - William W Y Haw
- Northern Care Alliance NHS Foundation Trust, Manchester, UK; Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Carsten Flohr
- Unit for Paediatric and Population-Based Dermatology Research, St. John's Institute of Dermatology, King's College London and Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - Zenas Z N Yiu
- Northern Care Alliance NHS Foundation Trust, Manchester, UK; Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ching-Chi Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Kuna M, Štefanović M, Ladika Davidović B, Mandušić N, Birkić Belanović I, Lugović-Mihić L. Chronic Urticaria Biomarkers IL-6, ESR and CRP in Correlation with Disease Severity and Patient Quality of Life-A Pilot Study. Biomedicines 2023; 11:2232. [PMID: 37626727 PMCID: PMC10452525 DOI: 10.3390/biomedicines11082232] [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: 06/30/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Background: To assess the relationship between serum interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values and disease severity in patients with chronic spontaneous urticaria (CSU) and to examine which of these serum biomarkers better indicates disease severity. (2) Methods: Our pilot study included 20 patients with CSU who filled out questionnaires concerning disease severity and quality of life (the Urticaria Activity Score summed over 7 days [UAS7], the once-daily Urticaria Activity Score [UAS], the Urticaria Control Test [UCT], and the Dermatology Life Quality Index [DLQI]). Blood samples were taken to measure IL-6, ESR and CRP. (3) Results: ESR significantly correlated with the UAS7 (linear and moderate correlation; r = 0.496; p = 0.026), while CRP did not correlate with disease severity. IL-6 correlated with the once-daily UAS (r = 0.472; p = 0.036) and DLQI (r = 0.504; p = 0.023) (linear and moderate correlation) but not the UAS7 or UCT. (4) Conclusions: IL-6 was a better indicator of the once-daily UAS and DLQI, while ESR was a better indicator of the UAS7 (there was no correlation between IL-6, CRP and ESR parameters). Although our results are promising, this study should be conducted with a larger number of CSU patients.
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Affiliation(s)
- Matea Kuna
- Department of Dermatovenereology, University Hospital Center “Sestre Milosrdnice”, Vinogradska 29, 10000 Zagreb, Croatia; (N.M.); (I.B.B.); (L.L.-M.)
| | - Mario Štefanović
- Department of Clinical Chemistry, University Hospital Center “Sestre Milosrdnice”, Vinogradska 29, 10000 Zagreb, Croatia;
| | - Blaženka Ladika Davidović
- Department of Oncology and Nuclear Medicine, University Hospital Center “Sestre Milosrdnice”, Vinogradska 29, 10000 Zagreb, Croatia;
| | - Nikolina Mandušić
- Department of Dermatovenereology, University Hospital Center “Sestre Milosrdnice”, Vinogradska 29, 10000 Zagreb, Croatia; (N.M.); (I.B.B.); (L.L.-M.)
| | - Ines Birkić Belanović
- Department of Dermatovenereology, University Hospital Center “Sestre Milosrdnice”, Vinogradska 29, 10000 Zagreb, Croatia; (N.M.); (I.B.B.); (L.L.-M.)
| | - Liborija Lugović-Mihić
- Department of Dermatovenereology, University Hospital Center “Sestre Milosrdnice”, Vinogradska 29, 10000 Zagreb, Croatia; (N.M.); (I.B.B.); (L.L.-M.)
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Kim MA, Choi JH, Shin YS, Park HS, Ye YM. Efficacy of Second-Line Treatments in Chronic Urticaria Refractory to Standard Dose Antihistamines. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2023; 15:496-511. [PMID: 37153977 DOI: 10.4168/aair.2023.15.4.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/26/2022] [Accepted: 01/11/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE The prevalence of chronic urticaria (CU) is increasing worldwide, and it imposes a major burden on patients. Few studies have evaluated the efficacy of second-line treatments of CU, particularly for patients being considered for costly third-line treatments such as omalizumab. We compared the efficacy and safety of second-line treatments of CU refractory to standard doses of nonsedating H1-antihistamines (nsAHs). METHODS This 4-week, prospective, randomized, open-label trial divided patients into 4 treatment groups: 4-fold updosing of nsAHs, multiple combination of 4 nsAHs, switching to other nsAHs, and adjunctive H2-receptor antagonist. The clinical outcomes included urticaria control status, symptoms, and rescue medication use. RESULTS This study included 109 patients. After 4 weeks of second-line treatment, urticaria was well-controlled, partly controlled, and uncontrolled in 43.1%, 36.7%, and 20.2% of patients, respectively. Complete control of CU was achieved in 20.4% of patients. Among the patients with high-dose nsAHs, the proportion with well-controlled status was higher compared to the patients who received standard doses (51.9% vs. 34.5%, P = 0.031). No significant difference was observed in the proportion of well-controlled cases between the updosing and combination treatment groups (57.7% vs. 46.4%, P = 0.616). However, increasing the dose of nsAHs 4-fold was associated with a higher rate of complete symptom control compared to multiple combination treatment with 4 nsAHs (40.0% vs. 10.7%, P = 0.030). Logistic regression analysis confirmed the higher efficacy of updosing of nsAHs for complete control of CU compared to the other treatment strategies (odds ratio, 0.180; P = 0.020). CONCLUSIONS In patients with CU refractory to standard doses of nsAHs, both updosing of nsAHs 4-fold and multiple combination treatment with 4 nsAHs increased the rate of well-controlled cases without causing significant adverse effects. Updosing of nsAHs is more effective for complete CU control than combination treatment.
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Affiliation(s)
- Mi-Ae Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jeong-Hee Choi
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Yoo-Seob Shin
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Young-Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
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Olgaç M, Yeğit OO, Beyaz Ş, Öztop N, Tüzer C, Eyice D, Karadağ P, Coşkun R, Demir S, Çolakoğlu B, Büyüköztürk S, Gelincik A. Impact of COVID-19 pandemic on the course of refractory chronic spontaneous urticaria under omalizumab treatment. An Bras Dermatol 2023; 98:189-197. [PMID: 36609081 PMCID: PMC9747700 DOI: 10.1016/j.abd.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The course of chronic spontaneous urticaria (CSU) can be influenced by infections, depression, and stress. OBJECTIVE Our aim was to investigate the impact of the COVID-19 pandemic on the course of refractory CSU together with patient adherence to omalizumab and treatment adjustments. METHODS Urticaria Activity Score (UAS7) was used to assess disease activity. Fear of COVID-19 Scale (FC-19s), and Depression Anxiety Stress Scale (DASS-21s) were performed to assess mental health status. All scales were performed during the Quarantine Period (QP) and Return to the Normal Period (RTNP). UAS7 Before Pandemic (BP) was recorded from the patients medical records. RESULTS The authors evaluated 104 omalizumab-receiving CSU patients. UAS7 scores during QP were significantly higher than those in RTNP and BP (p < 0.01). DASS-21 and FC-19 scores were significantly higher during QP compared to RTNP (p < 0.01). Nineteen (18.2%) patients ceased omalizumab, 9 patients prolonged the intervals between subsequent doses during the pandemic. UAS7 scores in QP were significantly higher in patients who ceased omalizumab than in those who continued (p < 0.001). Among patients who continued omalizumab, 22.4% had an increase in urticaria activity and higher FC-19 scores in comparison with those with stable disease activity (p = 0.008). STUDY LIMITATIONS The small sample size of patients with prolonged intervals of omalizumab and the lack of mental health evaluation with the same tools prior to the study. CONCLUSION Fear induced by COVID-19 can determine an increase in disease activity. Therefore, patients on omalizumab should continue their treatment and prolonged interval without omalizumab can be considered in patients with good urticaria control.
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Affiliation(s)
- Müge Olgaç
- Division of Immunology and Allergic Diseases, Şişli Hamidiye Etfal Research and Education Hospital, Istanbul, Turkey.
| | - Osman Ozan Yeğit
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Şengül Beyaz
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nida Öztop
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Can Tüzer
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Deniz Eyice
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Pelin Karadağ
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Raif Coşkun
- Division of Immunology and Allergic Diseases, Okmeydanı Research and Education Hospital, Istanbul, Turkey
| | - Semra Demir
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bahaauddin Çolakoğlu
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Suna Büyüköztürk
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aslı Gelincik
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Ding Y, Dang B, Wang Y, Zhao C, An H. Artemisinic acid attenuated symptoms of substance P-induced chronic urticaria in a mice model and mast cell degranulation via Lyn/PLC-p38 signal pathway. Int Immunopharmacol 2022; 113:109437. [DOI: 10.1016/j.intimp.2022.109437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/21/2022] [Accepted: 11/04/2022] [Indexed: 11/18/2022]
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9
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Ye YM, Koh YI, Choi JH, Kim MA, Park JW, Kim TB, Nam YH, Chang YS, Park HS. The burden of symptomatic patients with chronic spontaneous urticaria: a real-world study in Korea. Korean J Intern Med 2022; 37:1050-1060. [PMID: 36068718 PMCID: PMC9449199 DOI: 10.3904/kjim.2022.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/15/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/AIMS Chronic spontaneous urticaria (CSU) poses a considerable burden both on the quality of life (QoL) of individual patients and on healthcare systems. Real‑world data evaluating the disease burden of CSU are limited in this country. This study evaluated the disease burden and healthcare resource utilization (HRU) among symptomatic CSU patients. METHODS This multicenter, noninterventional, retrospective, and cross-sectional study assessed CSU patients symptomatic for more than 6 months despite step-wise H1-antihistamine medications. Primary outcomes included Urticaria Activity Score over 7 days (UAS7) and Chronic Urticaria QoL scale (CU-QoL). Secondary outcomes included EuroQol 5-Dimension 5-Level (EQ-5D-5L), Dermatology Life Quality Index (DLQI), association of disease activity with QoL, medications used for the past 6 months, and HRU. RESULTS Five hundred patients with CSU were enrolled. Mean disease duration was 3.7 years. Based on UAS7, 22.2% of patients were in well-controlled status and 31.2%, 28.4%, and 18.2% of them had mild, moderate, and severe disease, respectively. Mean CU-QoL and DLQI scores were 57.5 ± 29.7 and 10.2 ± 7.6, respectively, while the EQ-5D-5L utility score was 0.8 ± 0.2. H1-antihistamines were prescribed to 95% of patients, while omalizumab was prescribed to 33% of patients. Most patients (98%) had outpatient visits in the past 6 months. Negative correlations were noted between UAS7 and CU-QoL, EQ-5D-5L, EQ-5D-5L visual analog scale scores, but a positive correlation was noted with DLQI score (p < 0.001 for all). The number of outpatient department visits increased with disease activity (p = 0.001). CONCLUSION CSU affects QoL, leading to increased HRU, particularly in patients with severe disease.
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Affiliation(s)
- Young-Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Young-Il Koh
- Department of Allergy, Asthma and Clinical Immunology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jeong-Hee Choi
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Mi-Ae Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jung-Won Park
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Hee Nam
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
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10
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Ryan D, Flokstra – de Blok BMJ, Clark E, Gaudin C, Mamodaly M, Kocks J, van der Velde JL, Angier L, Romberg K, Gawlik R, Demoly P, Tanno LK. Allergic and hypersensitivity conditions in non-specialist care: Flow diagrams to support clinical practice. Allergy 2022; 77:2618-2633. [PMID: 35266160 PMCID: PMC9543313 DOI: 10.1111/all.15273] [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: 11/03/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 01/27/2023]
Abstract
Most patients presenting with allergies are first seen by primary care health professionals. The perceived knowledge gaps and educational needs were recently assessed in response to which the LOGOGRAM Task Force was established with the remit of constructing pragmatic flow diagrams for common allergic conditions in line with an earlier EAACI proposal to develop simplified pathways for the diagnosis and management of allergic diseases in primary care. To address the lack of accessible and pragmatic guidance, we designed flow diagrams for five major clinical allergy conditions: asthma, anaphylaxis, food allergy, drug allergy, and urticaria. Existing established allergy guidelines were collected and iteratively distilled to produce five pragmatic and accessible tools to aid diagnosis and management of these common allergic problems. Ultimately, they should now be validated prospectively in primary care settings.
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Affiliation(s)
- Dermot Ryan
- Usher InstituteUniversity of EdinburghEdinburghUK
| | - Bertine M. J. Flokstra – de Blok
- General Practitioners Research Institute (GPRI)GroningenThe Netherlands,University of GroningenUniversity Medical Center GroningenGRIAC Research InstituteGroningenThe Netherlands,Department of Pediatric Pulmonology and Pediatric AllergologyUniversity of GroningenUniversity Medical Center GroningenBeatrix Children's HospitalGroningenThe Netherlands
| | | | | | | | - Janwillem Kocks
- General Practitioners Research Institute (GPRI)GroningenThe Netherlands,Observational and Pragmatic Research InstituteSingaporeSingapore,University of GroningenUniversity Medical Center GroningenGRIAC Research InstituteGroningenThe Netherlands
| | - Jantina Lucia van der Velde
- University of GroningenUniversity Medical Center GroningenGRIAC Research InstituteGroningenThe Netherlands,Department of General PracticeUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Liz Angier
- Primary Care and Population SciencesUniversity of SouthamptonSouthamptonUK
| | - Kerstin Romberg
- Health Care CentreNäsets LäkargruppHöllvikenSweden,Respiratory Medicine and AllergologyClinical Sciences LundLund UniversityLundSweden
| | - Radek Gawlik
- Department of Internal Medicine, Allergology and Clinical ImmunologySilesian University of MedicineKatowicePoland
| | - Pascal Demoly
- University Hospital of MontpellierMontpellierFrance,IDESP, INSERM – UniversityMontpellierFrance,WHO Collaborating Centre on Scientific Classification SupportMontpellierFrance
| | - Luciana Kase Tanno
- University Hospital of MontpellierMontpellierFrance,IDESP, INSERM – UniversityMontpellierFrance,WHO Collaborating Centre on Scientific Classification SupportMontpellierFrance
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11
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Che D, Zhang T, Zhang T, Zheng Y, Hou Y, Geng S, He L. Clarithromycin-treated chronic spontaneous urticaria with the negative regulation of FcεRΙ and MRGPRX2 activation via CD300f. Int Immunopharmacol 2022; 110:109063. [PMID: 35853276 DOI: 10.1016/j.intimp.2022.109063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 11/29/2022]
Abstract
Mast cells (MCs) are main effector cells in chronic spontaneous urticaria (CSU). Both Fc epsilon RI (FcεRΙ)- and MAS-related G coupled receptor-X2 (MRGPRX2)-mediated MC activations affect CSU course. Leukocyte mono-immunoglobulin-like receptor 3 (CD300f) has been shown to regulate FcεRΙ activation. However, no study has verified CD300f is a target to cure CSU. Therefore this study aimed to verify whether clarithromycin (CLA) regulates FcεRΙ- and MRGPRX2-mediated MC activations via CD300f and shows therapeutic effect on CSU. The target of CLA was verification. CLA inhibited FcεRΙ- and MRGPRX2-mediated MC activations were shown in vivo and in vitro. A single-center, self-comparison study was performed, and CLA-treated CSU was investigated in 28 patients who were not sensitive to the third-generation antihistamines. Serum inflammatory mediators in patients before and after CLA administration were analyzed. CLA effectively inhibited type Ι anaphylactic reactions and pseudo-allergic reactions in mice. Moreover, CLA inhibited FcεRΙ- and MRGPRX2-mediated MC signaling pathway activation. Regulatory effects of CLA were decreased significantly after CD300f knockdown. CLA effectively alleviated the symptoms of wheal and itch and reduced serum cytokine levels in patients. CLA negatively regulated FcεRΙ- and MRGPRX2-mediated MC activation via CD300f and showed significant therapeutic effect on CSU.
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Affiliation(s)
- Delu Che
- Department of Dermatology, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an 710061, China; School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China; Center for Dermatology Disease, Precision Medical Institute, Xi'an 710000, China
| | - Tao Zhang
- School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
| | - Tianxiao Zhang
- School of Public Health, Xi'an Jiaotong University, Xi'an 710061, China
| | - Yi Zheng
- Department of Dermatology, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an 710061, China
| | - Yajing Hou
- School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
| | - Songmei Geng
- Department of Dermatology, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an 710061, China; Center for Dermatology Disease, Precision Medical Institute, Xi'an 710000, China.
| | - Langchong He
- School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China.
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12
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Ferrer Puga M, Silvestre Salvador J, Bartra Tomas J, Giménez-Arnau A, Labrador-Horrillo M, Miquel-Miquel J, Ortiz de Frutos F, Sastre Dominguez J, Valero Santiago A, Terradas-Montana P, Vidal-Jorge M, Jáuregui Presa I. Daily Clinical Practice in the Management of Chronic Urticaria in Spain: Results of the UCREX Study. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:4-14. [DOI: 10.1016/j.ad.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/06/2021] [Indexed: 11/25/2022] Open
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13
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Ferrer Puga M, Silvestre Salvador J, Bartra Tomas J, Giménez-Arnau A, Labrador-Horrillo M, Miquel-Miquel J, Ortiz de Frutos F, Sastre Dominguez J, Valero Santiago A, Terradas-Montana P, Vidal-Jorge M, Jáuregui Presa I. [Artículo traducido] Práctica clínica diaria en el manejo de la urticaria crónica en España: resultados del estudio UCREX. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:T4-T14. [DOI: 10.1016/j.ad.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/06/2021] [Indexed: 10/20/2022] Open
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14
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Madsen H, Mortz CG, Bindslev‐Jensen C, Reilev M, Hallas J, Henriksen DP. High-dose non-sedating antihistamines are used insufficiently in chronic urticaria patients treated with omalizumab. Clin Transl Allergy 2021; 11:e12085. [PMID: 34938439 PMCID: PMC8665689 DOI: 10.1002/clt2.12085] [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: 10/20/2021] [Revised: 11/18/2021] [Accepted: 11/24/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The lifetime prevalence of chronic urticaria (CU) is 0.5%-1%. In some patients with CU, symptomatic control is not achieved with non-sedating second-generation H1 antihistamines (nsAH1) alone, even with quadrupled standard doses as recommended in international guidelines. In these cases, biological treatment with omalizumab can be added. Since omalizumab is expensive compared to antihistamines, lack of adherence to guidelines for high dose nsAH1 (up to four-fold standard dose per day) may be associated with substantial unnecessary costs. The aim was to measure the use nsAH1 before and during omalizumab use for the first time in an omalizumab treated CU population. METHODS We identified all Danish patients with CU who initiated omalizumab from March 2014 to December 2018 and evaluated new and ongoing nsAH1 treatments using the Danish nationwide registries. RESULTS A total of 955 CU patients initiated treatment with omalizumab within the study period (median age 40 years [IQR 28-50], 74.5% females). During the 12 months prior to omalizumab initiation, 95.6% of the patients filled at least one prescription with nsAH1 at some point, while 84.7% filled at least one prescription during the three months before omalizumab. From 3 months before omalizumab initiation till 3 months after, the proportions of users of high-dose nsAH1 was maximum 31.1%. CONCLUSIONS Omalizumab was usually administered before sufficient nsAH1 treatment was tried. In despite of the labelling that omalizumab should be co-administered with high dose nsAH1, this does not happen This may lead to substantial unnecessary costs.
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Affiliation(s)
- Hanne Madsen
- Department of Dermatology and Allergy CenterOdense University HospitalOdenseDenmark
- Department of Internal Medicine & Acute MedicineOdense University HospitalOdenseDenmark
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy CenterOdense University HospitalOdenseDenmark
| | | | - Mette Reilev
- Clinical Pharmacology, Pharmacy and Environmental MedicineDepartment of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - Jesper Hallas
- Clinical Pharmacology, Pharmacy and Environmental MedicineDepartment of Public HealthUniversity of Southern DenmarkOdenseDenmark
- Department of Clinical PharmacologyOdense University HospitalOdenseDenmark
| | - Daniel P. Henriksen
- Clinical Pharmacology, Pharmacy and Environmental MedicineDepartment of Public HealthUniversity of Southern DenmarkOdenseDenmark
- Department of Clinical PharmacologyOdense University HospitalOdenseDenmark
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15
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Obtulowicz A, Dubiela P, Dyga W, Migacz-Gruszka K, Mikolajczyk T, Wojas-Pelc A, Obtulowicz K. The Role of Bradykinin Receptors in the Etiopathogenesis of Chronic Spontaneous Urticaria. MEDICINA-LITHUANIA 2021; 57:medicina57101133. [PMID: 34684170 PMCID: PMC8539896 DOI: 10.3390/medicina57101133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 12/20/2022]
Abstract
Background and Objectives: Chronic spontaneous urticaria (CSU) is a distressing skin condition, which manifests as red, swollen, itchy, and sometimes painful hives or wheals appearing on skin. Recently, CSU has been associated with bradykinin release, which was previously discovered to be the main trigger of hereditary angioedema attacks. To study the role of bradykinin receptors 1 (BR1) and 2 (BR2) in the etiopathogenesis of CSU. Materials and Methods: A total of 60 individuals, 30 patients with CSU and 30 healthy subjects, were recruited to the study. CSU was diagnosed in accordance with the standardized protocol of dermatological assessment of skin symptoms. The level of bradykinin receptors was determined in populations of CD3+, CD4+, and CD8+ lymphocytes as well as in CD14++CD16−, CD14++CD16+ and CD14+CD16+ monocytes. In addition, urticaria activity score summed over 7 days (UAS-7) was assessed and correlated with BR1 and BR2 expression. Results: A statistically significant higher concentration of BR1 expression in lymphocytes was found in patients with CSU, compared to the control group (p < 0.001). Moreover, a statistically significant positive correlation was observed between UAS-7 and BR1/BR2 expression in CD14++CD16− cells (p = 0.03, R = 0.4). Conclusions: Bradykinin receptors are elevated in selected populations of lymphocytes in symptomatic CSU patients compared to healthy controls, indicating their role in the etiopathogenesis of the disease.
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Affiliation(s)
- Aleksander Obtulowicz
- Department of Dermatology, Jagiellonian University Medical College, Kopernika 50, 31-501 Krakow, Poland; (A.O.); (K.M.-G.); (A.W.-P.)
| | - Pawel Dubiela
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, 15-269 Bialystok, Poland
- Correspondence:
| | - Wojciech Dyga
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Botaniczna 3, 31-503 Krakow, Poland; (W.D.); (K.O.)
| | - Kamila Migacz-Gruszka
- Department of Dermatology, Jagiellonian University Medical College, Kopernika 50, 31-501 Krakow, Poland; (A.O.); (K.M.-G.); (A.W.-P.)
| | - Tomasz Mikolajczyk
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, Skarbowa 1, 31-121 Krakow, Poland;
| | - Anna Wojas-Pelc
- Department of Dermatology, Jagiellonian University Medical College, Kopernika 50, 31-501 Krakow, Poland; (A.O.); (K.M.-G.); (A.W.-P.)
| | - Krystyna Obtulowicz
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Botaniczna 3, 31-503 Krakow, Poland; (W.D.); (K.O.)
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16
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Weller K, Maurer M, Bauer A, Wedi B, Wagner N, Schliemann S, Kramps T, Baeumer D, Multmeier J, Hillmann E, Staubach P. Epidemiology, comorbidities, and healthcare utilization of patients with chronic urticaria in Germany. J Eur Acad Dermatol Venereol 2021; 36:91-99. [PMID: 34622498 DOI: 10.1111/jdv.17724] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/02/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Comprehensive data on the epidemiology and comorbidities of chronic urticaria (CU) in Germany are either limited, or not contemporary. OBJECTIVES To investigate the epidemiology of CU, overall comorbidities and healthcare resource utilized by patients with CU in Germany, using an anonymized statutory health insurance (SHI) database. METHODS Anonymized SHI claims research database of the Institute for Applied Health Research, Berlin [InGef] (01 January 2015-30 September 2018) was used to analyse insured individuals with a confirmed diagnosis of CU (ICD-10-GM codes). Twelve-month diagnosed prevalence and incidence, comorbidities (vs. atopic dermatitis and psoriasis), and healthcare utilization by patients with CU were investigated. RESULTS Of 4 693 772 individuals of all ages listed in the database, 3 538 540 were observable during 2017. Overall, 17 524 patients (˜0.5%) were diagnosed with CU; chronic spontaneous urticaria (CSU: 71.2%), chronic inducible urticaria (CIndU: 19.7%), CSU+CIndU (9.1%). Females, vs. males, had higher diagnosed prevalence (0.62% vs. 0.37%) and diagnosed incidence (0.18% vs. 0.11%) of CU among all patients. Patients most frequently visited general practitioners (41.3% of total visits). Hypertensive diseases (43.5%), lipoprotein metabolism disorders (32.1%) and affective disorders (26.0%) were the most frequently reported comorbidities of special interest. Rates of most comorbidities of special interests were similar to atopic dermatitis and psoriasis patients, and all higher vs. overall population. More than half (54.1%) of all CU patients were not prescribed any treatment. Second-generation H1 -antihistamines were the most commonly prescribed medication for adult (17.9%) and paediatric (27.9%) patients. Patients with CIndU (paediatric, 15.5%; adult, 7.8%) were more often hospitalized versus patients with CSU (paediatric, 9.9%; adult, 4.6%). CONCLUSIONS In Germany, prevalence of CU along with multiple comorbidities may pose increased burden on the healthcare system. Awareness of adhering to treatment guidelines, and aiming for complete control of urticaria, needs to be driven and may improve outcomes.
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Affiliation(s)
- K Weller
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - M Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - A Bauer
- Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - B Wedi
- Department of Dermatology and Allergy, Comprehensive Allergy Centre, Hannover Medical School, Hannover, Germany
| | - N Wagner
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - S Schliemann
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | - T Kramps
- Novartis Pharma GmbH, Nuremberg, Germany
| | - D Baeumer
- Novartis Pharma GmbH, Nuremberg, Germany
| | | | - E Hillmann
- Novartis Pharma GmbH, Nuremberg, Germany
| | - P Staubach
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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17
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Daily Clinical Practice in the Management of Chronic Urticaria in Spain: Results of the UCREX Study. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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18
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What's New in the Treatment of Urticaria and Angioedema. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2170-2184. [PMID: 34112473 DOI: 10.1016/j.jaip.2021.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 12/26/2022]
Abstract
Chronic urticaria and angioedema are diseases often managed by Allergy and Immunology specialists. Recent international guidelines have outlined a stepwise approach to management of patients using dose escalation of second-generation antihistamines followed by use of omalizumab and finally cyclosporine in more refractory cases. In select patients (those with refractory chronic urticaria), nonbiologic alternative medications with anti-inflammatory or immunosuppressant activity may be considered. Angioedema without wheals may have several different pathophysiologic mechanisms. Optimal management of mast cell-mediated angioedema is less clear but is often managed similar to chronic spontaneous urticaria. Drug-induced angioedema due to angiotensin-converting enzyme inhibitors is a common cause of angioedema in the emergency department. Although bradykinin is thought to be a primary mediator for this type of angioedema, studies of targeted therapies have been generally disappointing. In contrast, several targeted therapies have been proven successful using acute and preventive approaches for management of hereditary angioedema. Further developments, including novel biologics, novel oral therapies, and gene therapy approaches, may hopefully continue to broaden therapeutic options to ensure optimal individual management of patients with hereditary angioedema.
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19
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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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20
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Wagner N, Zink A, Hell K, Reinhardt M, Romer K, Hillmann E, Baeumer D, Schielein MC. Patients with Chronic Urticaria Remain Largely Undertreated: Results from the DERMLINE Online Survey. Dermatol Ther (Heidelb) 2021; 11:1027-1039. [PMID: 33945120 PMCID: PMC8163939 DOI: 10.1007/s13555-021-00537-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/16/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Chronic urticaria (CU) is an unpredictable disease, with high disease burden and a significant negative impact on quality of life, especially in patients of working age. Many patients are undertreated, and there is poor awareness of strategies to manage patients with CU in the real-world setting. The current study aimed to gain a better understanding of CU from the patients’ perspective, including the body areas most affected by wheals and angioedema, the disease burden and current use of the healthcare system. Methods A nationwide online survey was performed in Germany involving individuals who reported a diagnosis of CU and experienced symptoms within 3 months prior to inclusion. Results This self-report survey included 1037 participants (89.2% female), with a mean ± standard deviation (SD) age of 33.4 ± 11.0 years and a mean ± SD disease duration of 10.0 ± 9.4 years. On average, participants suffered from urticaria symptoms for 3.0 ± 4.3 years before diagnosis. In 73% of participants, symptoms worsened due to external factors, with the majority specifying stress in their personal life or work-related stress as eliciting factors. Within the previous 3 months, 87.4 and 44.1% of participants experienced wheals and angioedema, respectively, at multiple body areas, and most (79.6%) participants had uncontrolled symptoms as measured with the Urticaria Control Test. Despite the high burden of disease, 60.3% of participants stated that they were not currently receiving treatment. The most commonly used therapies to treat CU were oral (72.8%) and non-prescription (43.3%) and prescription (47.3%) topical drugs, with 18.0% of the participants receiving injectable/infused drugs. Conclusion The majority of the participants responding to the survey reported that CU is not sufficiently controlled, thereby severely influencing a highly productive time in their life. The body areas most affected by wheals and angioedema are specified, based on data provided by a large group of affected participants. A greater awareness of disease burden and available treatment options is needed. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00537-5.
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Affiliation(s)
- Nicola Wagner
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Alexander Zink
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Katharina Hell
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany.,Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilian University (LMU), Munich, Germany
| | | | | | | | | | - Maximilian C Schielein
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
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21
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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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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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23
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Baumann K, Marcelino J, Skov P, Santos M, Wyroslak I, Scheffel J, Altrichter S, Woetmann A, Costa C, Maurer M. Autologous serum skin test reactions in chronic spontaneous urticaria differ from heterologous cell reactions. J Eur Acad Dermatol Venereol 2021; 35:1338-1345. [DOI: 10.1111/jdv.17131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/08/2021] [Indexed: 12/25/2022]
Affiliation(s)
- K. Baumann
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
- RefLab ApS Copenhagen Denmark
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology University of Copenhagen Copenhagen Denmark
| | - J. Marcelino
- Immunoallergology Department, Hospital Santa Maria Centro Hospitalar Universitário Lisboa Norte E.P.E Lisbon Portugal
| | - P.S. Skov
- RefLab ApS Copenhagen Denmark
- Odense Research Center for Anaphylaxis (ORCA), Urticaria Center of Reference and Excellence (UCARE) Odense University Hospital Odense Denmark
| | - M.C.P. Santos
- Laboratory of Clinical Immunology Faculdade de Medicina, Instituto de Medicina Molecular Universidade de Lisboa Lisbon Portugal
| | - I. Wyroslak
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - J. Scheffel
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - S. Altrichter
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - A. Woetmann
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology University of Copenhagen Copenhagen Denmark
| | - C. Costa
- Immunoallergology Department, Hospital Santa Maria Centro Hospitalar Universitário Lisboa Norte E.P.E Lisbon Portugal
| | - M. Maurer
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
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24
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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. Expert consensus on practical aspects in the treatment of chronic urticaria. ACTA ACUST UNITED AC 2021; 30:64-75. [PMID: 33643777 PMCID: PMC7903036 DOI: 10.1007/s40629-021-00162-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/30/2020] [Indexed: 12/13/2022]
Abstract
Background Chronic urticaria (CU) is a common disease which represents a considerable burden for many patients. The current urticaria guideline describes the evidence-based diagnosis and treatment of CU. In addition, however, questions often arise in everyday practice that are not addressed by the guideline. Methods In May 2020, a digital meeting with German urticaria experts was held, in which practical aspects of CU treatment were discussed and supporting aids for everyday clinical treatment formulated. The resulting advice in this document focus on practical questions and the available literature and experiences of the participants. Results The diagnosis of CU can be made in a short time by means of a thorough anamnesis, a physical examination, and a basic laboratory chemical diagnosis. For this purpose, practical recommendations for everyday practice are given in this paper. An extended diagnosis is only indicated in a few cases and should always be carried out in parallel with an effective therapy. In general, CU should always be treated in the same way, regardless of whether wheals, angioedema or both occur. Symptomatic therapy should be carried out according to the treatment steps recommended by the guidelines. This publication provides practical advice on issues in everyday practice, such as the procedure in the current coronavirus disease 2019 (COVID-19) pandemic, the cardiac risk under higher dosed H1 antihistamines, the self-administration of omalizumab as well as vaccination under omalizumab therapy. In addition to treatment recommendations, topics such as documentation in the practice and family planning with urticaria will be discussed. Discussion These supporting treatment recommendations serve as an addendum to the current CU guideline and provide support in dealing with CU patients in everyday practice. The aim is to ensure that patients suffering from CU achieve complete freedom of symptoms with the help of an optimal therapy. Supplementary Information The online version of this article (10.1007/s40629-021-00162-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Bauer
- University Hospital Carl Gustav Carus, Department of Dermatology, University Allergy Center, Urticaria Center of Reference and Excellence (UCARE), Technical University, Dresden, Germany
| | - Heinrich Dickel
- Department of Dermatology, Venereology and Allergology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Thilo Jakob
- University Medical Center Giessen (UKGM), Department of Dermatology and Allergy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Andreas Kleinheinz
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Elbe Medical Centre, Buxtehude, Germany
| | - Undine Lippert
- Department of Dermatology and Allergology, Urticaria Center of Reference and Excellence (UCARE), University Medical Center Göttingen, Göttingen, Germany
| | - Martin Metz
- Department of Dermatology and Allergy, Urticaria Center of Reference and Excellence (UCARE), Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sibylle Schliemann
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), University Hospital Jena, Jena, Germany
| | | | - Petra Staubach
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), University Medical Center Mainz, Mainz, Germany
| | - Eva Valesky
- University Hospital Frankfurt, Department of Dermatology, Venerology and Allergology, Goethe University, Frankfurt, Germany
| | - Nicola Wagner
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), University Medical Center Erlangen, Erlangen, Germany
| | - Bettina Wedi
- Department of Dermatology and Allergy, Urticaria Center of Reference and Excellence (UCARE), Comprehensive Allergy Center, Hannover Medical School, Hannover, Germany
| | - Marcus Maurer
- Department of Dermatology and Allergy, Urticaria Center of Reference and Excellence (UCARE), Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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25
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Schielein MC, Tizek L, Baeumer D, Hillmann E, Romer K, Wagner N, Zink A. People-centered care for psoriasis and urticaria: Are we overlooking Internet addiction while only considering patients and physician settings? J Dermatol 2021; 48:825-834. [PMID: 33406282 DOI: 10.1111/1346-8138.15740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/29/2020] [Accepted: 12/06/2020] [Indexed: 11/27/2022]
Abstract
Psoriasis and chronic urticaria (CU) are chronic skin diseases with a high impact on individuals' life and mental health. Some studies indicate a high prevalence of Internet addiction and many affected individuals seem not to utilize healthcare, but rather search for health-related information online. The aims of the study were to assess Internet addiction as a potential comorbidity in both diseases as well as identify differences in healthcare utilization between individuals with psoriasis and CU. This cross-sectional study is based on self-reported data from individuals with psoriasis and CU living throughout Germany using the framework of an online survey from 12/2018 to 01/2019. Advertisements on Google and Facebook were used to address Internet users who searched online for information on psoriasis or CU. The study questionnaire comprised questions on demographics, current contact with physicians, and disease history as well as validated screening tools for well-being and Internet addiction. Overall, 1686 participants (74.0% female, 38.5% psoriasis) with a mean age of 36.9 ± 12.9 years were analyzed. Participants with CU were more likely female (89.2% vs 49.8%, P < 0.001) and not in medical care compared to participants with psoriasis (60.3% vs 45.9%, P < 0.001). Sixteen percent of the participants overall were screened positive for Internet addiction. Furthermore, not utilizing medical care showed a significant association with being screened positive for Internet addiction in participants with CU (adjusted odds ratio [aOR] = 1.49, 95% confidence interval [CI] 1.10-2.02), but not in those with psoriasis. The study revealed a high proportion of affected individuals not being in medical care and a high prevalence of Internet addiction, with individuals with CU not utilizing medical resources having a higher chance of being screened positive for Internet addiction. This underlines the approach of people-centered care and highlights its importance for further research.
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Affiliation(s)
- Maximilian Christian Schielein
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Munich, Germany.,Pettenkofer School of Public Health, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Linda Tizek
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Munich, Germany.,Pettenkofer School of Public Health, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | | | | | - Nicola Wagner
- Department of Dermatology, University Hospital Erlangen-Nürnberg, Erlangen, Germany
| | - Alexander Zink
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
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26
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A T, Lambrou GI, Kyritsi A, Geronikolou SA, Nikolaidou E, Katsarou A, Chatziioannou A, Stratigos A, Rigopoulos D. Urticaria from the Neurodermatological Perspective: A Temporal Analysis of Urticaria and Cognition. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1339:209-220. [DOI: 10.1007/978-3-030-78787-5_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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27
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Agache I, Rocha C, Pereira A, Song Y, Alonso‐Coello P, Solà I, Beltran J, Posso M, Akdis CA, Akdis M, Brockow K, Chivato T, del Giacco S, Eiwegger T, Eyerich K, Giménez‐Arnau A, Gutermuth J, Guttman‐Yassky E, Maurer M, Ogg G, Ong P, O’Mahony L, Schwarze J, Werfel T, Canelo‐Aybar C, Palomares O, Jutel M. Efficacy and safety of treatment with omalizumab for chronic spontaneous urticaria: A systematic review for the EAACI Biologicals Guidelines. Allergy 2021; 76:59-70. [PMID: 32767573 DOI: 10.1111/all.14547] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 12/20/2022]
Abstract
This systematic review evaluates the efficacy and safety of omalizumab for chronic spontaneous urticaria (CSU). PubMed, Embase, and Cochrane Library were searched for RCTs. Critical and important CSU-related outcomes were considered. The risk of bias and the certainty of the evidence were assessed using GRADE. Ten RCTs including 1620 subjects aged 12 to 75 years old treated with omalizumab for 16 to 40 weeks were evaluated. Omalizumab 150 mg does not result in clinically meaningful improvement (high certainty) of the urticaria activity score (UAS)7 (mean difference (MD) -5; 95%CI -7.75 to -2.25), and the itch severity score (ISS)7 (MD -2.15; 95% CI -3.2 to -1.1) does not increase (moderate certainty) quality of life (QoL) (Dermatology Life Quality Index (DLQI); MD -2.01; 95%CI -3.22 to -0.81) and decreases (moderate certainty) rescue medication use (MD -1.68; 95%CI -2.95 to -0.4). Omalizumab 300 mg results in clinically meaningful improvements (moderate certainty) of the UAS7 (MD -11.05; 95%CI -12.87 to -9.24), the ISS7 (MD -4.45; 95%CI -5.39 to -3.51), and QoL (high certainty) (DLQI; MD -4.03; 95% CI -5.56 to -2.5) and decreases (moderate certainty) rescue medication use (MD -2.04; 95%CI -3.19 to -0.88) and drug-related serious AEs (RR 0.77; 95%CI 0.20 to 2.91).
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine Transylvania University Brasov Romania
| | - Claudio Rocha
- Iberoamerican Cochrane Centre ‐ Department of Clinical Epidemiology and Public Health Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona Spain
| | - Ana Pereira
- Iberoamerican Cochrane Centre ‐ Department of Clinical Epidemiology and Public Health Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona Spain
| | - Yang Song
- Iberoamerican Cochrane Centre ‐ Department of Clinical Epidemiology and Public Health Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona Spain
| | - Pablo Alonso‐Coello
- Iberoamerican Cochrane Centre ‐ Department of Clinical Epidemiology and Public Health Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre ‐ Department of Clinical Epidemiology and Public Health Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona Spain
| | - Jessica Beltran
- Iberoamerican Cochrane Centre ‐ Department of Clinical Epidemiology and Public Health Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona Spain
| | - Margarita Posso
- Department of Epidemiology and Evaluation IMIM (Hospital del Mar Medical Research Institute) Barcelona Spain
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education Davos Switzerland
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education Davos Switzerland
| | - Knut Brockow
- Department of Dermatology and Allergology Biederstein Technical University of Munich Munich Germany
| | - Tomas Chivato
- School of Medicine University CEU San Pablo Madrid Spain
| | - Stefano del Giacco
- Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy
| | - Thomas Eiwegger
- Translational Medicine Program, Research Institute Hospital for Sick Children Toronto ON Canada
- Department of Immunology University of Toronto Toronto ON Canada
- Division of Immunology and Allergy Food Allergy and Anaphylaxis Program, The Hospital for Sick Children Departments of Paediatrics and Immunology University of Toronto Toronto ON Canada
| | - Kilian Eyerich
- Department of Dermatology and Allergy Biederstein Technical University of Munich Munich Germany
| | - Ana Giménez‐Arnau
- Department of Dermatology Hospital del Mar‐ Institut Mar d'Investigacions Mèdiques Universitat Autònoma de Barcelona Barcelona Spain
| | - Jan Gutermuth
- Department of Dermatology Universitair Ziekenhuis Brussel Vrije Universiteit Brussel (VUB) Brussels Belgium
| | - Emma Guttman‐Yassky
- Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Marcus Maurer
- Dermatological Allergology, Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Graham Ogg
- MRC Human Immunology Unit Department of Medicine Weatherall Institute of Molecular Medicine University of Oxford Radcliffe, Oxford UK
| | - Peck Ong
- Keck School of Medicine University of Southern California Los Angeles CA USA
| | - Liam O’Mahony
- Departments of Medicine and Microbiology APC Microbiome Ireland University College Cork Cork Ireland
| | - Jürgen Schwarze
- Centre for Inflammation Research Child Life and Health The University of Edinburgh Edinburgh UK
| | - Thomas Werfel
- Division of Immunodermatology and Allergy Research Department of Dermatology and Allergy Hannover Medical School Hannover Germany
| | - Carlos Canelo‐Aybar
- Iberoamerican Cochrane Centre ‐ Department of Clinical Epidemiology and Public Health Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology Chemistry School Complutense University of Madrid Madrid Spain
| | - Marek Jutel
- Department of Clinical Immunology Wroclaw Medical University Wroclaw Poland
- All‐MED Medical Research Institute Wroclaw Poland
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28
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Alen Coutinho I, Regateiro FS, Fernandes RA, Pita JS, Gomes R, Coelho C, Todo Bom A. Refractory chronic urticaria in adults: clinical characterization and predictors of severity. Allergy Asthma Clin Immunol 2020; 16:97. [PMID: 33292453 PMCID: PMC7661155 DOI: 10.1186/s13223-020-00496-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/28/2020] [Indexed: 12/04/2022] Open
Abstract
Background Chronic urticaria (CU) is defined as recurrent urticaria lasting for more than 6 weeks. Objectives We aimed to characterize the phenotypes of patients with CU refractory to standard dose anti-H1 antihistamine treatment and search for clinical predictors of poor disease control. Methods Retrospective collection of data regarding clinical characteristics, comorbidities, treatment, and disease control of all adult refractory CU patients presenting to the Allergy and Immunology Department during 1 year. Results Sixty-one adult patients were included, 74% females, average age 44.5 years (18 to 84 years old). Most patients (78.7%) had initiated CU less than 1 year before enrolment. Chronic spontaneous urticaria (CSU) accounted for 55.7% of the patients, CSU associated with chronic inducible urticaria (CIndU) as a comorbidity for 44.3%, and angioedema was present in 55.7%. Medically-confirmed psychiatric disorders were present in 78.7%. Complementary diagnostic tests were performed in cases with more severe presentation (UAS7 ≥ 28 and/or UCT < 12) or with longer evolution (> 1 year), corresponding to 42 tested patient. Evidence for autoimmunity (positive anti-thyroid peroxidase antibodies, anti-nuclear antibodies or autologous serum test) was found in 45.2% (n = 19/42), and high C-reactive protein was present in 14.3% (n = 6/42), half of these also had positive antinuclear antibodies. Forty-six patients (75.4%) had at least one significant exacerbation, requiring medical appointment, emergency room, hospitalization or job absenteeism. The number of exacerbations correlated with the presence of angioedema (p = 0.022), with a recent diagnosis (< 1 year), and with higher UAS7 severity (p = 0.006). Although ClndU was associated with poor symptom control (p = 0.022), it was also associated with less exacerbations requiring medical observation or hospitalization (p = 0.015). All patients were using antihistamines and 21.3% (n = 13) of them were also under treatment with omalizumab, ciclosporine or montelukast for disease control. Conclusions Autoimmunity can affect about half of the patients with severe or long-term CU. UAS7 and angioedema are associated with disease exacerbations. UAS7 and UCT presented unequal accuracy, with UAS7 better associating with the occurrence of exacerbations and treatment doses. Patients with refractory CU frequently present psychiatric disorders. Accurate diagnostic tests, namely autoimmune parameters and inflammatory markers, should be recommended in some individual cases.
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Affiliation(s)
- Iolanda Alen Coutinho
- Allergy and Clinical Immunology Departement, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal.
| | - Frederico Soares Regateiro
- Allergy and Clinical Immunology Departement, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal.,Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,ICBR - Coimbra Institute for Clinical and Biomedical Research, CIBB, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Rosa Anita Fernandes
- Allergy and Clinical Immunology Departement, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal
| | - Joana Sofia Pita
- Allergy and Clinical Immunology Departement, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal
| | - Raquel Gomes
- Allergy and Clinical Immunology Departement, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal
| | | | - Ana Todo Bom
- Allergy and Clinical Immunology Departement, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal.,ICBR - Coimbra Institute for Clinical and Biomedical Research, CIBB, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Institute of Pathophysiology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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29
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Gonçalo M, Gimenéz‐Arnau A, Al‐Ahmad M, Ben‐Shoshan M, Bernstein J, Ensina L, Fomina D, Galvàn C, Godse K, Grattan C, Hide M, Katelaris C, Khoshkhui M, Kocatürk E, Kulthanan K, Medina I, Nasr I, Peter J, Staubach P, Wang L, Weller K, Maurer M. The global burden of chronic urticaria for the patient and society*. Br J Dermatol 2020; 184:226-236. [DOI: 10.1111/bjd.19561] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
Affiliation(s)
- M. Gonçalo
- Department of Dermatology University Hospital and Faculty of MedicineUniversity of Coimbra Coimbra Portugal
| | - A. Gimenéz‐Arnau
- Department of Dermatology Hospital del MarIMIMUniversitat Autònoma Barcelona Spain
| | - M. Al‐Ahmad
- Microbiology Department Faculty of Medicine Kuwait University Kuwait
| | - M. Ben‐Shoshan
- Division of Allergy, Immunology and Dermatology Department of Pediatrics Montreal Children’s HospitalMcGill University Montréal QC Canada
| | - J.A. Bernstein
- University of Cincinnati College of MedicineDepartment of Internal Medicine, Division of Immunology/Allergy Section, Partner Bernstein Allergy Group and Bernstein Clinical Research Center Cincinnati OH USA
| | - L.F. Ensina
- Alergoalpha/CPAlpha Allergy Clinic and Clinical Research Center and Division of Allergy, Clinical Immunology and Rheumatology Department of Pediatrics Federal University of São Paulo (UNIFESP/EPM) São Paulo SP Brazil
| | - D. Fomina
- Moscow City Center of Allergy and Immunology Clinical City Hospital #52 Department of General Therapy Pirogov Russian National Research Medical University Moscow Russian Federation
- Department of Allergology and Clinical Immunology I.M. Sechenov First Moscow State Medical University Moscow Russian Federation
| | - C.A. Galvàn
- Instituto Nacional de Salud del NiñoCentro de Referencia Nacional de Alergia Asma e Inmunología, Lima Perú
| | - K. Godse
- Department of Dermatology Dr D.Y. Patil School of Medicine Mumbai Maharashtra India
| | - C. Grattan
- St John’s Institute of DermatologyGuy’s Hospital London UK
| | - M. Hide
- Department of Dermatology Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - C.H. Katelaris
- Campbelltown Hospital and Western Sydney University Sydney NSW Australia
| | - M. Khoshkhui
- Allergy Research Center Mashhad University of Medical Sciences Mashhad Iran
| | - E. Kocatürk
- Department of Dermatology Koc University School of Medicine Istanbul Turkey
| | - K. Kulthanan
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | - I. Medina
- Centro Medico VitaeDepartment of Allergy and Clinical Immunology Buenos Aires Argentina
| | - I. Nasr
- Department of Immunology and Allergy Royal Hospital Muscat Oman
| | - J. Peter
- Division of Allergy and Clinical Immunology University of Cape Town and Allergy and Immunology UnitUniversity of Cape Town Lung Institute Cape Town South Africa
| | - P. Staubach
- Department of Dermatology University Medical Center Mainz Mainz Germany
| | - L. Wang
- Liangchun Wang – Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - K. Weller
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - M. Maurer
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
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30
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Maurer M, Giménez-Arnau A, Ensina LF, Chu CY, Jaumont X, Tassinari P. Chronic urticaria treatment patterns and changes in quality of life: AWARE study 2-year results. World Allergy Organ J 2020; 13:100460. [PMID: 32983330 PMCID: PMC7493083 DOI: 10.1016/j.waojou.2020.100460] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 12/18/2022] Open
Abstract
Background A Worldwide Antihistamine-Refractory Chronic Urticaria (CU) patient Evaluation (AWARE) is a non-interventional, multicenter study including patients from Europe, Central and Latin America, Asia-Pacific, and the Middle East. AWARE describes real-world evidence for CU, including clinical characteristics, treatment patterns and the impact on quality of life. Methods Over the 2-year study, therapy changes, angioedema occurrence, and patient-reported outcomes (PROs) were recorded over 9 visits, including dermatology life quality index (DLQI) and 7-day urticaria activity score (UAS7). Data were stratified into subgroups: chronic spontaneous urticaria (CSU), chronic inducible urticaria (CIndU), or CSU + CIndU. Results Out of 4838 patients analyzed, 9.9% were receiving no treatment for their CU symptoms at baseline, and 20.4% were receiving first-line non-sedating H1-antihistamine at approved doses. The predominant baseline therapy was up-dosed non-sedating H1-antihistamines (25.5%). By Visit 2, omalizumab was the overall most commonly used therapy (29.6%), increasing to 30.1% by the end of the study. Baseline DLQI scores for patients with CSU, CIndU and CSU + CIndU were 8.3, 7.6 and 9.1, respectively; scores decreased over the study for CSU and CSU + CIndU patients, but fluctuated for CIndU patients. Baseline angioedema occurrence was higher in CSU and CSU + CIndU patients, reported in 45.4% and 45.5% of patients, respectively, compared to 17.0% in CIndU patients. By the final visit, angioedema had decreased to 11.9% and 11.2% for CSU and CSU + CIndU, respectively, and 9.6% for CIndU. Conclusion CU patients are undertreated at baseline; after entering the AWARE study, more patients received appropriate treatment. However, over two thirds are not escalated to third-line treatments.
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Key Words
- AMAC, Asia-Pacific and the Middle East
- AWARE, A Worldwide Antihistamine-Refractory Chronic Urticaria patient Evaluation
- Angioedema
- CIndU, chronic inducible urticaria
- CSU, chronic spontaneous urticaria
- CU, chronic urticaria
- DLQI, dermatology life quality index
- Dermatology
- LaCAN, Central and Latin America
- PRO, patient-reported outcome
- QoL, quality of life
- Quality-of-life
- SD, standard deviation
- UAS7, 7-day urticaria activity score
- Urticaria
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Affiliation(s)
- Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité -Universitätsmedizin Berlin, Germany
| | - Ana Giménez-Arnau
- Dermatology Department, Hospital del Mar. IMIM, Universitat Autònoma, Barcelona, Spain
| | - Luis Felipe Ensina
- CPAlpha Clinical Research Center, São Paulo, Brazil.,Hospital Sírio-Libanês, São Paulo, Brazil
| | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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31
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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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32
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Savic S, Leeman L, El-Shanawany T, Ellis R, Gach JE, Marinho S, Wahie S, Sargur R, Bewley AP, Nakonechna A, Randall R, Fragkas N, Somenzi O, Marsland A. Chronic urticaria in the real-life clinical practice setting in the UK: results from the noninterventional multicentre AWARE study. Clin Exp Dermatol 2020; 45:1003-1010. [PMID: 32246853 DOI: 10.1111/ced.14230] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Chronic urticaria (CU) is a skin condition characterized by repeated occurrence of itchy weals and/or angio-oedema for > 6 weeks. AIM To provide data demonstrating the real-life burden of CU in the UK. METHODS This UK subset of the worldwide, prospective, noninterventional AWARE study included patients aged 18-75 years diagnosed with H1-antihistamine (H1-AH)-refractory chronic spontaneous urticaria (CSU) for > 2 months. Baseline characteristics, disease activity, treatments, comorbidities and healthcare resource use were documented. Quality of life (QoL), work productivity and activity impairment were assessed. RESULTS Baseline analysis included 252 UK patients. Mean age and body mass index were 45.0 years and 29.0 kg/m2 , respectively. Most patients were female (77.8%) and had moderate/severe disease activity (mean Urticaria Activity Score over 7 days was 18.4) and a 'spontaneous' component to their CU (73.4% CSU; 24.6% CSU and chronic inducible urticaria). Common comorbidities included depression/anxiety (24.6%), asthma (23.8%) and allergic rhinitis (12.7%). A previous treatment was recorded for 57.9% of patients. Mean Dermatology Life Quality Index score was 9.5, and patients reported impairments in work productivity and activity. Healthcare resource use was high. Severity of CSU was associated with female sex, obesity, anxiety and diagnosis. Only 28.5% of patients completed all nine study visits, limiting analysis of long-term treatment patterns and disease impact. CONCLUSIONS Adult H1-AH-refractory patients with CU in the UK reported high rates of healthcare resource use and impairment in QoL, work productivity and activity at baseline. The differing structures of UK healthcare may explain the high study discontinuation rates versus other countries.
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Affiliation(s)
- S Savic
- Department of Clinical Immunology and Allergy, St James's University Hospital, Leeds, UK
| | - L Leeman
- The Eden Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - T El-Shanawany
- Department of Immunology, University Hospital of Wales, Cardiff, UK
| | - R Ellis
- Department of Dermatology, James Cook University Hospital, Middlesbrough, UK
| | - J E Gach
- Department of Dermatology, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - S Marinho
- The Allergy Centre, Wythenshawe Hospital, Manchester University Foundation Trust and University of Manchester, Manchester, UK
| | - S Wahie
- Department of Dermatology, University Hospital of North Durham, Durham, UK
| | - R Sargur
- Immunology and Allergy Unit, Sheffield Teaching Hospitals, Sheffield, UK
| | - A P Bewley
- Department of Dermatology, Whipps Cross Hospital and Royal London Hospital, Barts Health NHS Trust, London, UK
| | - A Nakonechna
- Clinical Immunology and Allergy Unit, Sheffield Teaching Hospitals, Sheffield, UK.,University of Liverpool, Liverpool, UK
| | - R Randall
- Respiratory and Inflammation, Novartis Pharmaceuticals UK Ltd, Camberley, Surrey, UK
| | - N Fragkas
- Respiratory and Inflammation, Novartis Pharmaceuticals UK Ltd, Camberley, Surrey, UK
| | - O Somenzi
- Respiratory and Inflammation, Novartis Pharmaceuticals UK Ltd, Camberley, Surrey, UK
| | - A Marsland
- Centre for Dermatology, Salford Royal Hospital, Salford, UK.,University of Manchester, Manchester, UK
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33
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Combination therapy with omalizumab and an immune-suppressive agent for resistant chronic spontaneous rrticaria - A real-life experience. World Allergy Organ J 2020; 13:100448. [PMID: 32774663 PMCID: PMC7403771 DOI: 10.1016/j.waojou.2020.100448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/20/2022] Open
Abstract
Background Chronic Spontaneous Urticaria (CSU) is a relatively common immune mediated disease that can be effectively treated nowadays. Nevertheless, for some patients remission cannot be achieved following current treatment recommendations, defined as resistant CSU (r-CSU). Treating r-CSU is challenging, and, currently, there are no recommended interventions. In this real-life study we describe successful therapy of 18 r-CSU patients using an "intensified protocol" of anti-IgE-antibody (omalizumab) concomitantly with an immunosuppressant. We defined the r-CSU phenotype and compared it to omalizumab-responsive CSU (Or-CSU) phenotype. Methods Clinical and serological data of 72 CSU patients (ie, 18 r-CSU and 54 age and sex matched Or-CSU) were retrospectively collected and analyzed. All patients were diagnosed with CSU for ≥6 months and treated at the Sheba Medical Center during 2013–2018. Results Of 289 CSU patients, 18 (6%) were diagnosed with r-CSU and treated with the "intensified protocol" including omalizumab and cyclosporine-A (16p), methotrexate (1p), and azathioprine (1p). Of which, 14/18 (78%) achieved complete remission, 2/18 (11%) partial remission, and 2/18 (11%) no remission. During follow-up no serious adverse events were documented. r-CSU patients received higher doses of antihistamine (p < 0.0001) and omalizumab (425 ± 58 mg/month vs. 283 ± 86 mg/month; p < 0.0001) compared to Or-CSU. The r-CSU phenotype was linked with concomitant autoimmunity (p = 0.0005) and a lower level of IgE prior to initiation of therapy (p = 0.027). Conclusion r-CSU may be a distinct CSU phenotype characterized by severe disease, concomitant autoimmunity, and lower baseline-IgE levels (low "autoallergy"). An "intensified protocol" with omalizumab and an immunosuppressive agent was found to be efficacious and safe for r-CSU. Further larger studies are required to verify these results.
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34
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Roberts G. The end of as required inhaled short-acting bronchodilator for asthma? Clin Exp Allergy 2020; 49:560-561. [PMID: 31034746 DOI: 10.1111/cea.13395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- G Roberts
- Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
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35
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Tamer F. Omalizumab does not lead to a distinct alteration in hematological parameters and complete blood count-derived inflammation biomarkers except for basophil count. Cutan Ocul Toxicol 2020; 39:229-232. [PMID: 32380865 DOI: 10.1080/15569527.2020.1766483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Omalizumab is a monoclonal anti-IgE antibody used to treat patients with chronic spontaneous urticaria by decreasing free IgE levels. Omalizumab may have an anti-inflammatory effect by inhibiting T-cell activation and inducing eosinophil apoptosis. In this study, we evaluated the effect of omalizumab on hematological parameters and inflammation biomarkers in patients with chronic spontaneous urticaria. METHODS Between July 2018 and November 2019, medical records of 60 patients (44 female, 16 male) with chronic spontaneous urticaria who were treated with omalizumab were reviewed retrospectively. Hematological parameters and inflammation biomarkers including the neutrophil/lymphocyte, monocyte/lymphocyte, platelet/lymphocyte and mean platelet volume/platelet count ratios were compared before and after 12 weeks of omalizumab treatment. RESULTS The absolute count of basophils and percentage of basophils increased significantly after omalizumab treatment (p = 0.04, p = 0.004). The absolute count of eosinophils, percentage of eosinophils, neutrophil/lymphocyte, monocyte/lymphocyte, and mean platelet volume/platelet ratios decreased, while platelet/lymphocyte ratio increased after omalizumab treatment. Nevertheless, these changes were not statistically significant. CONCLUSIONS Increased basophil counts suggest that omalizumab has a crucial effect through basophils in chronic spontaneous urticaria. Further studies focussing on basophils may contribute to the literature both to elucidate the etiopathogenesis of urticaria and to improve novel treatment agents for the disease. On the other hand, our study revealed that omalizumab did not have a distinct effect on complete blood count-derived inflammation biomarkers and thus inflammation.
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Affiliation(s)
- Funda Tamer
- Department of Dermatology, Gazi University School of Medicine, Ankara, Turkey
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36
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Gabrielli S, Le M, Netchiporouk E, Miedzybrodzki B, Baum S, Greenberger S, Staubach-Renz P, Ben-Shoshan M. Chronic urticaria in children can be controlled effectively with updosing second-generation antihistamines. J Am Acad Dermatol 2020; 82:1535-1537. [PMID: 32088268 DOI: 10.1016/j.jaad.2020.02.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 01/31/2020] [Accepted: 02/12/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Sofianne Gabrielli
- Division of Allergy, Immunology and Dermatology, Montreal Children's Hospital, Montreal, Quebec, Canada.
| | - Michelle Le
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | | | | | - Sharon Baum
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Tel-Aviv University, Tel-Aviv, Israel
| | - Shoshana Greenberger
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Tel-Aviv University, Tel-Aviv, Israel
| | - Petra Staubach-Renz
- Department of Dermatology and Allergy, University Medical Center, Mainz, Germany
| | - Moshe Ben-Shoshan
- Division of Allergy, Immunology and Dermatology, Montreal Children's Hospital, Montreal, Quebec, Canada
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37
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Baiardini I, Fasola S, Maurer M, Weller K, Canonica GW, Braido F. Minimal important difference of the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL). Allergy 2019; 74:2542-2544. [PMID: 31169906 DOI: 10.1111/all.13939] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Ilaria Baiardini
- Department of Biomedical Sciences Humanitas University Milan Italy
- Dipartimento di Medicina Interna (DiMI) Università di Genova Genova Italy
- IRCCS Ospedale Policlinico San Martino Genova Italy
| | - Salvatore Fasola
- National Research Council of Italy Institute of Biomedicine and Molecular Immunology Palermo Italy
| | - Marcus Maurer
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - Karsten Weller
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences Humanitas University Milan Italy
- Personalized Medicine Asthma & Allergy Humanitas University Rozzano‐Milan Italy
| | - Fulvio Braido
- Dipartimento di Medicina Interna (DiMI) Università di Genova Genova Italy
- IRCCS Ospedale Policlinico San Martino Genova Italy
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38
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Popov TA, Church MK, Christoff G, Maurer M. Angioedema and prescribing of omalizumab for chronic urticaria in countries with limited financial resources. World Allergy Organ J 2019; 12:100079. [PMID: 31687062 PMCID: PMC6820250 DOI: 10.1016/j.waojou.2019.100079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/22/2019] [Accepted: 10/02/2019] [Indexed: 01/04/2023] Open
Affiliation(s)
- Todor A Popov
- University Hospital "Sv. Ivan Rilski", Sofia, Bulgaria
| | | | - George Christoff
- Faculty of Public Health, Medical University Sofia, Sofia, Bulgaria
| | - Marcus Maurer
- Charité - University Medical Center, Berlin, Germany
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39
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Cataldi M, Maurer M, Taglialatela M, Church MK. Cardiac safety of second‐generation H
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‐antihistamines when updosed in chronic spontaneous urticaria. Clin Exp Allergy 2019; 49:1615-1623. [DOI: 10.1111/cea.13500] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/16/2019] [Accepted: 09/02/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Mauro Cataldi
- Section of Pharmacology Department of Neuroscience School of Medicine University of Naples Federico II Naples Italy
| | - Marcus Maurer
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité–Universitätsmedizin Berlin Berlin Germany
| | - Maurizio Taglialatela
- Section of Pharmacology Department of Neuroscience School of Medicine University of Naples Federico II Naples Italy
| | - Martin K. Church
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité–Universitätsmedizin Berlin Berlin Germany
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