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Menéndez-Sánchez M, Pérez-Fernández E, López-Estebaranz JL, Gómez-de la Fuente E. [Translated article] Use of Antihistamines During Omalizumab Therapy in Chronic Urticaria in the Routine Clinical Practice. A 48-Patient Observational Trial. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T636-T638. [PMID: 38648933 DOI: 10.1016/j.ad.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/08/2023] [Indexed: 04/25/2024] Open
Affiliation(s)
- M Menéndez-Sánchez
- Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
| | - E Pérez-Fernández
- Unidad de Investigación, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - J L López-Estebaranz
- Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - E Gómez-de la Fuente
- Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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Menéndez-Sánchez M, Pérez-Fernández E, López-Estebaranz JL, Gómez-de la Fuente E. Use of Antihistamines During Omalizumab Therapy in Chronic Urticaria in the Routine Clinical Practice. A 48-Patient Observational Trial. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:636-638. [PMID: 38382744 DOI: 10.1016/j.ad.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/20/2023] [Accepted: 08/08/2023] [Indexed: 02/23/2024] Open
Affiliation(s)
- M Menéndez-Sánchez
- Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - E Pérez-Fernández
- Unidad de Investigación, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - J L López-Estebaranz
- Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - E Gómez-de la Fuente
- Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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Türk M, Kocatürk E, Ertaş R, Ensina LF, Mariel Ferrucci S, Grattan C, Vestergaard C, Zuberbier T, Maurer M, Giménez‐Arnau AM. A global perspective on stepping down chronic spontaneous urticaria treatment: Results of the Urticaria Centers of Reference and Excellence SDown-CSU study. Clin Transl Allergy 2024; 14:e12343. [PMID: 38353300 PMCID: PMC10865765 DOI: 10.1002/clt2.12343] [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: 11/20/2023] [Revised: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Although there have been significant advances in the treatment of chronic spontaneous urticaria (CSU) in recent years, there remains a lack of clear guidance on when and how to step down treatment in responders. This study aims to investigate stepping down approaches of different steps of CSU treatment from a global perspective. METHODS "Stepping down chronic spontaneous urticaria treatment" (SDown-CSU) is an international, multicenter, observational, cross-sectional, survey-based study of the Urticaria Centers of Reference and Excellence (UCARE) network. The questionnaire included 48 questions completed by physicians in the UCARE network. RESULTS Surveys completed by 103 physicians from 81 UCAREs and 34 countries were analyzed. Seventy-eight percent of the participants responded that they had a national urticaria management guideline written by their professional societies and 28% responded that they had to operate under a regulatory guideline proposed by central health funding organizations. Seventy-two and 58.7% of these national recommendations do not contain any detailed information on when and/or how CSU treatment should be discontinued. There was a lack of detailed information on antihistamines and cyclosporine in particular. A predefined maximum duration was generally not applicable to omalizumab and cyclosporine (81% and 82%, respectively). Nearly all UCAREs step down omalizumab within 6 months from the first controlled status and 42% discontinue cyclosporine after 6 months regardless of the control status. CONCLUSIONS The findings from the SDown-CSU study clearly highlight a global need for guidance on the process of stepping down treatment in CSU. Additionally, the study offers a step-down algorithm applicable to all stages of CSU treatment.
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Affiliation(s)
- Murat Türk
- Department of Chest DiseasesDivision of Allergy and Clinical ImmunologyErciyes University School of MedicineKayseriTurkey
- Clinic of Allergy and Clinical ImmunologyKayseri City Education and Research HospitalKayseriTurkey
| | - Emek Kocatürk
- Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
| | - Ragıp Ertaş
- Department of DermatologyChronic Skin Diseases UnitUniversity of Health SciencesKayseri City Education and Research HospitalKayseriTurkey
| | - Luis Felipe Ensina
- Division of Allergy, Immunology, RheumatologyFederal University of São PauloSao PauloBrazil
| | | | - Clive Grattan
- St John's Institute of DermatologyGuy's HospitalLondonUK
| | | | - Torsten Zuberbier
- Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
| | - Marcus Maurer
- Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
| | - Ana Maria Giménez‐Arnau
- Department of DermatologyHospital del Mar & Research InstituteBarcelonaSpain
- Universitat Pompeu FabraBarcelonaSpain
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Terhorst-Molawi D, Fox L, Siebenhaar F, Metz M, Maurer M. Stepping Down Treatment in Chronic Spontaneous Urticaria: What We Know and What We Don't Know. Am J Clin Dermatol 2023; 24:397-404. [PMID: 36810982 DOI: 10.1007/s40257-023-00761-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/23/2023]
Abstract
In chronic spontaneous urticaria (CSU), wheals, angioedema, or both appear spontaneously for > 6 weeks. Current recommended treatment options for urticaria target mast cell mediators such as histamine, or activators, such as autoantibodies. The goal of CSU treatment is to treat the disease until it is gone as effectively and safely as possible. As no cure is available for CSU as of now, the treatment is aimed at continuously suppressing disease activity, with complete control of the disease and a normalization of quality of life. To achieve this, pharmacological treatment should be continued until no longer needed. Treatment of CSU should follow the basic principles of treating as much as needed and as little as possible taking into consideration that the activity of the disease may vary. Since CSU is a disease with spontaneous remission, it is hard to tell, in patients with complete control and no signs or symptoms, when medication is no longer needed. The current international guideline for urticaria suggests that the treatment can be stepped down once a patient is free of signs and symptoms. Other reasons for stepping down the treatment of CSU patients include safety concerns or issues, pregnancy or wanting to become pregnant, and economic factors. As of now, it is unclear over which period, with what intervals and with which dosages CSU treatment should be stepped down. Guidance on this is needed for all recommended therapies: (i) standard-dosed second-generation H1-antihistamine (sgAH), (ii) higher than standard-dosed sgAH, (iii) standard-dosed omalizumab, (iv) higher than standard-dosed omalizumab, and (v) cyclosporine. However, there is a lack of controlled trials on the step down and discontinuation of these treatments. Here, we aim to provide a summary of what is known and what needs to be investigated in further studies, based on our own experience and real-world evidence.
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Affiliation(s)
- Dorothea Terhorst-Molawi
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Paul-Ehrlich-Haus, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Lena Fox
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Paul-Ehrlich-Haus, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Frank Siebenhaar
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Paul-Ehrlich-Haus, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Martin Metz
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Paul-Ehrlich-Haus, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Paul-Ehrlich-Haus, Hindenburgdamm 27, 12203, Berlin, Germany.
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany.
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Türk M, Yılmaz İ, Şahiner ÜM, Kocatürk E, Şekerel BE, Zuberbier T, Maurer M. Experience-based advice on stepping up and stepping down the therapeutic management of chronic spontaneous urticaria: Where is the guidance? Allergy 2022; 77:1626-1630. [PMID: 35048385 DOI: 10.1111/all.15227] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/04/2022] [Accepted: 01/16/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Murat Türk
- Clinic of Immunologic and Allergic Diseases Kayseri City Education and Research Hospital Kayseri Turkey
| | - İnsu Yılmaz
- Division of Allergy and Clinical Immunology Erciyes University School of Medicine Kayseri Turkey
| | - Ümit Murat Şahiner
- Pediatric Allergy Department Hacettepe University School of Medicine Ankara Turkey
| | - Emek Kocatürk
- Department of Dermatology Koç University School of Medicine İstanbul Turkey
| | - Bülent Enis Şekerel
- Pediatric Allergy Department Hacettepe University School of Medicine Ankara Turkey
| | - Torsten Zuberbier
- Institute for Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
| | - Marcus Maurer
- Institute for 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
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