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Oliver ET, Saini SS. Chronic Spontaneous Urticaria: Etiology and Pathogenesis. Immunol Allergy Clin North Am 2024; 44:421-438. [PMID: 38937007 DOI: 10.1016/j.iac.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
Urticaria, also known as hives, is a common condition thought to affect up to 20% of individuals worldwide in their lifetime. This skin condition is characterized by the appearance of pruritic, erythematous papules or plaques with superficial swelling of the dermis. The major complaint is the symptom of pruritus. Angioedema, which involves a deeper swelling of dermal or mucosal tissues, may accompany urticaria. Urticaria can be classified by both time course of symptoms and the underlying etiology.
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Affiliation(s)
- Eric T Oliver
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle/ Room 3A. 18A, Baltimore, MD 21224, USA
| | - Sarbjit S Saini
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Room 2B. 71B, Baltimore, MD 21224, USA.
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Min TK, Saini SS. The future of targeted therapy in chronic spontaneous urticaria. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00343-0. [PMID: 38885835 DOI: 10.1016/j.anai.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/09/2024] [Accepted: 05/31/2024] [Indexed: 06/20/2024]
Abstract
Chronic urticaria can be divided into 2 subsets: chronic spontaneous urticaria (CSU) with skin lesions occurring without a specific trigger and chronic inducible urticaria, which has an identified specific stimulus. The annual prevalence of chronic urticaria is 0.5% to 2.3% globally. The CSU is a self-limited disorder in most cases, with an average duration of 2 to 5 years, but symptoms persist beyond 5 years in up to 30% of patients. The first line of treatment is a daily nonsedating, second-generation H1-antihistamine. The CSU guidelines recommend using oral nonsedating antihistamines up to 4 fold in patients with CSU unresponsive to standard doses as the next step in treatment. A meta-analysis found that the rate of response in patients with CSU who responded to updosing was 63.2%. Therefore, approximately 40% of patients continue to have persistent hives and itching requiring treatment with the biologic omalizumab, based on evidence from randomized controlled trials. Although omalizumab has been shown to markedly relieve symptoms of CSU, omalizumab is not effective in all patients and has not been shown to induce long-term disease remission. Thus, there is an unmet need for more effective treatments that can lead to cure or long-term remission. In this review, we will provide an overview of new treatment targets and biologics that are under investigation for the treatment of CSU.
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Affiliation(s)
- Taek Ki Min
- Pediatric Allergy and Respiratory Center, Department of Pediatrics, Soonchunhyang University Hospital, Seoul, Korea
| | - Sarbjit S Saini
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland.
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Habershon C, Rivlin W, Gribbin H, Morwood K. Nurse-led urticaria clinic: shortened wait times without an increase in adverse events. Intern Med J 2024; 54:1042-1043. [PMID: 38881458 DOI: 10.1111/imj.16411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/19/2024] [Indexed: 06/18/2024]
Affiliation(s)
- Courtney Habershon
- Sunshine Cost University Hospital, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Warwick Rivlin
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Hannah Gribbin
- Sunshine Cost University Hospital, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Karen Morwood
- Sunshine Cost University Hospital, Brisbane, Queensland, Australia
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Predicting Clinical Remission of Chronic Urticaria Using Random Survival Forests: Machine Learning Applied to Real-World Data. Dermatol Ther (Heidelb) 2022; 12:2747-2763. [DOI: 10.1007/s13555-022-00827-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/28/2022] [Indexed: 11/03/2022] Open
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Kulthanan K, Rujitharanawong C, Munprom K, Trakanwittayarak S, Phumariyapong P, Prasertsook S, Ungprasert P. Prevalence, Clinical Manifestations, Treatment, and Clinical Course of Chronic Urticaria in Elderly: A Systematic Review. J Asthma Allergy 2022; 15:1455-1490. [PMID: 36299736 PMCID: PMC9590340 DOI: 10.2147/jaa.s379912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose Data specific to the epidemiology, clinical features, and management of chronic urticaria (CU) in the geriatric population remain limited and not well understood. We aim to systematically review the prevalence, clinical manifestations, treatment, and clinical course of elderly patients with CU. Patients and methods Original articles that included data of elderly (aged >60 years) with CU that were published until February 2021 were searched in PubMed, Scopus, and Embase using predfefined search terms. Related articles were evaluated according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Results Among the included 85 studies and 1,112,066 elderly CU patients, most (57.4%) were women. The prevalence of elderly CU in the general population ranged from 0.2–2.8%, and from 0.7–33.3% among all CU patients. Compared to adult CU, elderly CU patients had a higher percentage of wheal alone (73.9%), and lower rate of positive autologous serum skin test and atopy. Gastrointestinal diseases were the most common comorbidity (71.9%), and there was a high rate of malignancies and autoimmune diseases. Second generation H1-antihistamines were commonly used, and achievement of complete control was most often reported. Omalizumab was prescribed in 59 refractory patients, and a significant response to treatment was reported in most patients. The treatment of comorbidities also yielded significant improvement in CU. Conclusion Elderly CU was found to be different from adult CU in both clinical and laboratory aspects. H1- antihistamines are effective as first-line therapy with minimal side-effects at licensed doses. Treatment of secondary causes is important since the elderly usually have age-related comorbidities.
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Affiliation(s)
- Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chuda Rujitharanawong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanyalak Munprom
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Phumithep Phumariyapong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suthasanee Prasertsook
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patompong Ungprasert
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA,Correspondence: Patompong Ungprasert, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA, Tel +1 216 986 4000, Fax +1 216 986 4953, Email
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Kan AKC, Wong TTH, Chiang V, Lau CS, Li PH. Chronic Spontaneous Urticaria in Hong Kong: Clinical Characteristics, Real-World Practice and Implications for COVID-19 Vaccination. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 15:32-42. [PMID: 36693356 PMCID: PMC9880305 DOI: 10.4168/aair.2023.15.1.32] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE The real-world management and clinical characteristics of chronic spontaneous urticaria (CSU) in Hong Kong and its implications for coronavirus disease 2019 (COVID-19) vaccination are unknown. We investigated the clinical characteristics of patients with CSU and the role of an immunologist-led Urticaria Clinic as well as the impact of CSU on COVID-19 vaccine uptake in Hong Kong. METHODS Longitudinal clinical data of 257 CSU patients were collected and analyzed. Association analyses were performed to identify the relationships between variables and factors associated with COVID-19 vaccine uptake. RESULTS After the immunologist review, the Weekly Urticaria Activity Score (UAS7) was significantly lower than baseline (median: 0.00 vs. 12.0, P < 0.001). Changes in UAS7 were significantly greater among patients with baseline UAS7 ≥ 16 compared to those with UAS7 < 16 (median: -24.0 vs. -2.00, P < 0.001). CSU patients had lower COVID-19 vaccination rates than the general population with only 176 (68.5%) and 165 (65.0%) receiving at least one dose and 2 doses of vaccination, respectively. The presence of concomitant suspected drug allergy was associated with lower COVID-19 vaccine uptake (odds ratio [OR], 0.47; P = 0.010), while regular pharmacological treatment was associated with higher COVID-19 vaccine uptake among CSU patients (OR, 3.79; P = 0.010). CONCLUSIONS A dedicated immunologist-led Urticaria Clinic may effectively improve CSU management and outcomes in Hong Kong.
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Affiliation(s)
- Andy Ka Chun Kan
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Hong Kong
| | - Thomas Tsz Hang Wong
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Hong Kong
| | - Valerie Chiang
- Division of Clinical Immunology, Department of Pathology, Queen Mary Hospital, Hong Kong
| | - Chak Sing Lau
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Hong Kong
| | - Philip Hei Li
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Hong Kong
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Prospective analysis of clinical evolution in chronic urticaria: Persistence, remission, recurrence, and pruritus alone. World Allergy Organ J 2022; 15:100705. [PMID: 36267098 PMCID: PMC9554810 DOI: 10.1016/j.waojou.2022.100705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/25/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Population and study's methodology heterogenicity became clinical evolution of chronic spontaneous urticaria (CSU) highly variable. Objective In a prospective cohort, we evaluated the different pathways of clinical evolution of CSU and identified possible risk factors. Methods A total of 685 CSU patients (>12 years) were prospectively followed over 5 years. Diagnosis and follow-up of urticaria were based on medical evaluation and photographic records. Remission was defined as at least 6 months without symptoms (hives, angioedema, or pruritus) and medication. The follow-up included at least 2 visits per year, with photographic registration and clinical evaluation. Predefined clinical and paraclinical variables were included in the regression analyses. Results We identified four clinical evolution pathways; The cumulative prevalence of remission at 5 years was 59.1%, recurrence was 17.1%, persistence was 11.6%, and chronic pruritus without hives or angioedema was 12.2%. The probability of persistence increased with hypothyroidism diagnosis (HR 0.425, 95% CI 0.290-0.621) and each point in the UAS7 (HR 0.931 95% CI 0.918-0.945). Conclusion Chronic urticaria has different evolutions. Disease activity and hypothyroidism predict persistence and remission. Recurrence and chronic pruritus phenotypes require further study to evaluate their causality and prognosis.
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Thiede RM, Fazel M, MacDonald KM, Abraham I. Does synthetic pharmacotherapy still have a place in treating chronic spontaneous urticaria? Expert Opin Pharmacother 2022; 23:1563-1567. [PMID: 36173375 DOI: 10.1080/14656566.2022.2128671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Rebecca M Thiede
- Division of Dermatology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Mohammad Fazel
- Division of Dermatology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | | | - Ivo Abraham
- Matrix45, Tucson, AZ, USA.,Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA.,Department of Pharmacy Practice and Science, R. Ken Coit College of Pharmacy, University of Arizona, Tucson, AZ, USA.,Department of Family and Community Medicine, R. Ken Coit College of Pharmacy, University of Arizona, Tucson, AZ, USA
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Saito R, Takahagi S, Nakano F, Furutani K, Mihara S, Numata T, Kameyoshi Y, Tanaka T, Shindo H, Niimi N, Iwamoto K, Hiragun T, Hiragun M, Tanaka A, Hide M. A survey on subtypes and clinical characteristics of 1061 patients with urticaria in the primary care institutes in Japan. J Dermatol 2022; 49:1255-1262. [PMID: 36028980 DOI: 10.1111/1346-8138.16562] [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: 04/01/2022] [Revised: 07/01/2022] [Accepted: 08/11/2022] [Indexed: 11/26/2022]
Abstract
The prevalence of urticaria has been reported mostly in Europe and North America. However, precise information regarding its subtypes and clinical characteristics in primary care practice, especially in Asian countries, are scant. Patients with urticaria and/or angioedema who visited nine primary clinics of accredited dermatologists and allergologists in Japan were recruited from October to November 2020. The information of age, sex, disease duration, urticaria control test (UCT), and concomitant urticaria subtypes were collected. A total of 1061 patients participated. The number of patients was high in the 20 to 50 age groups with a peak in the 40s. The most frequent urticaria subtype was chronic spontaneous urticaria (CSU) followed by dermographism, acute spontaneous urticaria (ASU), angioedema, and cholinergic urticaria (CholU) (66.8%, 22.7%, 18.9%, 14.1% and 5.7% in all patients with urticaria). CSU development increased with age from the 20s to 50s, especially in females. Dermographism had a peak in the 40s. ASU had bimodal peaks in childhood and in the 30s. CholU was common in males in the 10-20s. Most angioedema patients were female with an increase in their 30s. Angioedema was solely present in 14 of 1061 participants (1.3%), while 136 (12.8%) had angioedema concomitant with urticaria. UCT showed poorly controlled urticaria with lower scores in patients with concomitant CSU and other subtypes than in those with CSU alone. Urticaria tends to develop in young to middle-aged females. The most common urticaria subtype is CSU, while the number of patients with CholU is high and that of angioedema is low in Japan.
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Affiliation(s)
- Ryo Saito
- Department of Dermatology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shunsuke Takahagi
- Department of Dermatology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Fumi Nakano
- Department of Dermatology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Shoji Mihara
- Mihara Dermatology/Allergy Clinic, Hiroshima, Japan
| | | | | | | | | | | | | | | | | | - Akio Tanaka
- Department of Dermatology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Michihiro Hide
- Department of Dermatology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Tienforti D, Di Giulio F, Spagnolo L, Castellini C, Totaro M, Muselli M, Francavilla S, Baroni MG, Barbonetti A. Chronic urticaria and thyroid autoimmunity: a meta-analysis of case-control studies. J Endocrinol Invest 2022; 45:1317-1326. [PMID: 35181847 PMCID: PMC9184403 DOI: 10.1007/s40618-022-01761-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/07/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Autoimmunity has been implicated in some patients with idiopathic chronic urticaria (CU). Because of the frequency of autoimmune thyroid diseases, their association with CU deserves special attention. We tested both the existence and the extent of an association between thyroid autoimmunity and CU. METHODS A thorough search of PubMed, Scopus, Web of Science, and Cochrane databases was performed. Studies reporting the positivity rate for anti-thyroperoxidase antibodies (TPOAbs) in people with (cases) and without CU (controls) were included. Quality of the studies was assessed by the Newcastle-Ottawa Scale. Between-study heterogeneity was assessed by Cochrane Q and I2 tests, and the odds ratio (OR) for TPOAbs positivity was combined using random-effects models. RESULTS Nineteen studies provided information about TPOAbs positivity on 14,351 patients with CU and 12,404 controls. The pooled estimate indicated a more than fivefold increased risk of exhibiting TPOAbs positivity in the group with CU (pooled OR 5.18, 95% CI 3.27, 8.22; P < 0.00001). Correction for publication bias had a negligible effect on the overall estimate (pooled adjusted OR: 4.42, 95% CI 2.84, 6.87, P < 0.0001). Between‑study heterogeneity was established (I2 = 62%, Pfor heterogeneity = 0.0002) and when, according to meta‑regression models, a sensitivity analysis was restricted to the 16 studies with the highest quality scores, the OR for TPOAbs positivity rose to 6.72 (95% CI 4.56, 9.89; P < 0.00001) with no significant heterogeneity (I2 = 31%, Pfor heterogeneity = 0.11). CONCLUSIONS Patients with CU have a five-to-nearly sevenfold higher risk of displaying TPOAbs positivity. All patients with CU may well be offered a screening for thyroid autoimmunity.
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Affiliation(s)
- D Tienforti
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - F Di Giulio
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - L Spagnolo
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - C Castellini
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - M Totaro
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - M Muselli
- Epidemiology Division, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - S Francavilla
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - M G Baroni
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - A Barbonetti
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
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Wang X, Liu LJ, Li LF, Shi XD, Shen YW. Clinical Features of Urticaria: Results From a Hospital-Based Multicenter Study in China. Front Med (Lausanne) 2022; 9:899857. [PMID: 35755046 PMCID: PMC9220089 DOI: 10.3389/fmed.2022.899857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 04/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background The clinical features of urticaria have not been fully illustrated. Objectives To demonstrate clinical features of urticaria in different areas of southern and northern China. Methods In this hospital-based multicenter study, outpatients with urticaria filled in a questionnaire during the initial visit and follow-up (once per week, lasting for a month). Results Overall, 1,715 outpatients with urticaria with a mean age of 37.86 ± 16.08 years (range = 0.5–87 years) were recruited. The median disease duration was 1.94 ± 4.31 years (range = 0–58 years). More itching was observed in the northern areas higher than that in the southern areas (99.5 vs 94.1%, P < 0.001). The incidence of pain, arthralgia, and family history in southern areas was higher than that in northern areas (5.1 vs 1.1%, 9.6 vs 0, 10.6% vs 3.2%, P < 0.001). The leading subtypes of specified urticaria were chronic spontaneous urticaria (81.4%) and symptomatic dermographism (35.9%). The incidence of symptomatic dermographism and cold urticaria in the southern areas was lower than that in the northern areas (31.8 vs. 50.3%, 4 vs. 8.5%, P < 0.001). Allergic diseases were the most common concomitant disorders of urticaria. More than half of the patients had to avoid certain food, such as fish-prawn-crab (30.7%) and alcohol (20%). Ebastine (41.1%) was the most commonly prescribed drug. The disease duration negatively correlated with the severity of itching and number of wheals (>50/24H) (Spearman’s rank correlation test, p < 0.001). Conclusion This study provides a profile of clinical characteristics of urticaria in China and filled the gap in the field of regional comparative studies on urticaria.
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Affiliation(s)
- Xin Wang
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Li-Juan Liu
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lin-Feng Li
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiao-Dong Shi
- AI Research and Development Center, China Telecom Research Institute, Beijing, China
| | - Yi-Wei Shen
- Department of Dermatology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Balp MM, Halliday AC, Severin T, Leonard SA, Partha G, Kalra M, Marsland AM. Clinical Remission of Chronic Spontaneous Urticaria (CSU): A Targeted Literature Review. Dermatol Ther (Heidelb) 2022; 12:15-27. [PMID: 34807372 PMCID: PMC8776966 DOI: 10.1007/s13555-021-00641-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Indexed: 10/30/2022] Open
Abstract
INTRODUCTION Chronic spontaneous (previously known as idiopathic) urticaria (CSU) is a chronic skin disease with the potential for natural remission. The objectives of this targeted literature review were to identify evidence on the clinical course of CSU, including remission rates, and to estimate cumulative remission rates for different time points. METHODS Electronic databases (MEDLINE, MEDLINE-In Process, Embase, Web of Science, BIOSIS Previews and the Cochrane Library) and relevant conference proceedings were searched to identify studies involving patients with CSU aged ≥ 12 years that provide data on remission rates and disease duration. Observational studies with patient follow-ups of ≥ 1 year or review articles were included. Data extracted from five selected studies were used to run Kaplan-Meier (KM) analyses and best-fit distributions to calculate remission rates per 4-week period and weighted averages. RESULTS Ten publications were included in this review. The proportion of patients achieving remission within year 1 ranged from 21 to 47%, while reported remission rate estimates at year 5 were 34% and 45%. Based on calculated 4-weekly remission rates, cumulative remission estimates ranged from 9 to 38% at year 1, from 29 to 71% at year 5 and from 52 to 93% at year 20. Cumulative weighted average estimates for the proportion of patients remitting at years 1, 5 and 20 were 17%, 45% and 73%, respectively. CONCLUSIONS Published evidence suggests that CSU is a self-limiting condition with variable disease severity and duration, apparently dependent on multiple factors. However, data sources differed in terms of definitions of disease severity and remission, as well as in conclusions on influencing factors. Further studies and uniform definitions are required.
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Affiliation(s)
| | - Anna C Halliday
- Health Economics and Outcomes Research, Novartis Pharmaceuticals UK Limited, London, UK
| | | | | | | | - Manik Kalra
- Novartis Healthcare Pvt. Ltd., Hyderabad, India.
| | - Alexander M Marsland
- Department of Dermatology & University of Manchester, Salford Royal Foundation Trust, Manchester, UK
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Kim H, Hyun MC, Choi BS. Natural History and Influencing Factors of Chronic Urticaria in Children. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 14:73-84. [PMID: 34983108 PMCID: PMC8724829 DOI: 10.4168/aair.2022.14.1.73] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/26/2021] [Accepted: 09/01/2021] [Indexed: 11/23/2022]
Abstract
Purpose Chronic urticaria (CU) can reduce the quality of life of children and their parents, but there are only a few studies on the course of CU in children. This study aimed to investigate the natural course of CU in children and identify the factors that influence its prognosis. Methods We evaluated 77 children diagnosed with CU, who were monitored for at least 48 months. Subjects were classified as either chronic spontaneous urticaria (CSU) or other CU, and the clinical features were compared. Remission was defined as having no symptoms without treatment for more than 1 year. The remission rate was analyzed, and the factors influencing the prognosis were investigated. Results The average age of the study population was 5.96 ± 4.06 years, and 64 (83.1%) patients had CSU. The remission rates at 6 months, 1 year, 2 years, 3 years, and 4 years after symptom onset were 22.1%, 40.3%, 52.0%, 63.7%, and 70.2%, respectively, for children with CU. For children with CSU, these values were 23.4%, 43.7%, 56.2%, 68.7%, and 75.0%, respectively. The total serum immunoglobulin E (IgE) levels were positively correlated with disease duration (r = 0.262, P = 0.021); no other factors were associated with the duration of the disease. Conclusions A high proportion of children with CU were classified as CSU. No indicators, except for total IgE were found to predict the timing of spontaneous remission. The CU remission rate identified in this study is expected to be used as one of the reference data for the progress of CU in patients.
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Affiliation(s)
- Hyeona Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Myung Chul Hyun
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Bong Seok Choi
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
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Gold-Olufadi S, Ayanlowo O, Akinkugbe AO, Otrofanowei E. Clinical and aetiologic profile of patients with chronic urticaria at the outpatient clinic of a tertiary hospital in Lagos, Nigeria: a cross-sectional observational study. Pan Afr Med J 2021; 40:141. [PMID: 34925676 PMCID: PMC8654876 DOI: 10.11604/pamj.2021.40.141.27655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/08/2021] [Indexed: 11/11/2022] Open
Abstract
Chronic urticaria is a condition characterized by recurrent wheals associated with itching lasting longer than six weeks. The condition tends to run a chronic course with significant morbidity. Several factors have been explored in the cause, yet the aetiology is still uncertain. We documented the clinical profile and assessed the possible aetiologic factors in patients with chronic urticaria. Clinical profile of sixty consecutive patients with chronic spontaneous urticaria was assessed with possible precipitants identified using a structured questionnaire. The complete blood count with erythrocyte sedimentation rate, antithyroid peroxidase (antiTPO), hepatitis B surface antigen (HBsAg), antihepatitis C virus screening (AntiHCV), stool for ova and parasites and helicobacter pylori were carried out. Controls without a history of urticaria were recruited in a 1: 1 ratio for stool for parasites and H. pylori because of the high prevalence rates reported in this environment. Data analysis was carried out with Statistical Packages for Social Sciences (SPSS) version 22. Sixty patients with chronic urticaria and sixty age and sex matched controls were enrolled in the study. Females presented more often with urticaria with a M: F ratio of 1: 2.5. The mean age of onset of urticaria was in the third decade of life. Precipitants were identified in close to a third of patients. The investigated antigenic aetiology was not found to play a role. The presentation and clinical profile of patients in this environment is similar to previously documented studies. History still remains the cornerstone of management as precipitants and triggers may be identified. Management of patients should therefore be individualized.
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Affiliation(s)
| | - Olusola Ayanlowo
- University of Lagos, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Erere Otrofanowei
- University of Lagos, Lagos University Teaching Hospital, Lagos, Nigeria
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15
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Shamshad H, Sayqal A, Zeb J, Mirza AZ. Simultaneous Determination of Chloroquine and Pyrimethamine with Cetirizine in an Active Form and Human Serum by RP-HPLC. J Chromatogr Sci 2021; 59:923-927. [PMID: 33621328 DOI: 10.1093/chromsci/bmab018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/14/2020] [Indexed: 11/15/2022]
Abstract
A simple, accurate and precise RP-HPLC method was developed for the simultaneous determination of chloroquine, pyrimethamine and cetirizine hydrochloride concentrations in bulk drug and human serum. The assay was performed using a mobile phase of methanol: water (70:30) at pH of 2.8 ± 0.05 on the Purospher C-18 column with UV detection at 230 nm and rosuvastatin used as an internal standard. The retention times observed for chloroquine, pyrimethamine and cetirizine hydrochloride were 3.5, 2.5 and 5.5 minutes, respectively. The method was found to be specific for the assayed drugs showing a linear response in the concentration range of 1-100 μg mL-1 with coefficients of determination values of (r = 0.999). The method was developed and validated according to ICH guidelines. The method was used to monitor the serum samples and was found to be sensitive for therapeutic purposes, showing the potential to be a useful tool for routine analysis in laboratories.
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Affiliation(s)
- Hina Shamshad
- Research Institute of Pharmaceutical Sciences, Faculty of Pharmacy, University of Karachi, Karachi 75270, Pakistan
| | - Ali Sayqal
- Chemistry Department, Faculty of Applied Sciences, Umm Al-Qura University, Makkah, 21955 Saudi Arabia
| | - Jahan Zeb
- Department of Environmental and Health Research, The Custodian of the Two Holy Mosques, Institute of Hajj and Umrah Research, Umm Al-Qura University, Makkah, 21955 Saudi Arabia
| | - Agha Zeeshan Mirza
- Chemistry Department, Faculty of Applied Sciences, Umm Al-Qura University, Makkah, 21955 Saudi Arabia
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16
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Use of biologics in chronic spontaneous urticaria - beyond omalizumab therapy? Allergol Select 2021; 5:89-95. [PMID: 33615122 PMCID: PMC7890936 DOI: 10.5414/alx02204e] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/13/2021] [Indexed: 12/12/2022] Open
Abstract
In chronic spontaneous urticaria (CSU), itchy wheals, angioedema, or both occur regularly, often daily, and for years. An effective therapy for CSU aims at achieving complete symptom control. The current guideline for the management of CSU patients recommends non-sedative anthistamines in standard or up to 4-fold higher dosages as 1 and 2 line treatment. For most CSU patients this treatment is not sufficient; for them, the anti-IgE antibody omalizumab is the therapy of choice. Although good to very good symptom control can be achieved in most cases, there are many patients with insufficient response. For these patients, but also as an alternative to therapy with omalizumab, numerous other biologicals are currently under development. In this review, we provide an overview of possible future biologic therapies for chronic urticaria.
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17
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Al Rushud MA, Gaffar Mohammed M, Murshid A, Almuammar S, AlHossan AM. Graves' Disease Presenting as Urticaria. Cureus 2020; 12:e12134. [PMID: 33489546 PMCID: PMC7813521 DOI: 10.7759/cureus.12134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Graves’ disease (GD) is an autoimmune disease that is characterized by the presence of antibodies targeting the thyroid gland. Commonly, the disease presents with symptoms of thyrotoxicosis such as sweating, tremors, and weight loss; less frequently, patients with GD might also have urticaria. Urticaria is clinically defined as the presence of wheals, angioedema, or both. While its pathophysiology is not completely understood, urticaria is believed to be an immune-mediated response activating mast cells, leading to the release of histamine and cytokines. Although the association between urticaria and GD is well established, it is uncommon for GD patients to present with urticaria as their sole complaint. In this paper, we present a case of a previously healthy patient who originally presented to the dermatology clinic with urticaria alone; however, she developed thyrotoxic symptoms soon after. Furthermore, her treatment was complicated by developing an allergic reaction to carbimazole.
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Affiliation(s)
| | | | | | - Saud Almuammar
- Internal Medicine, Alfaisal University College of Medicine, Riyadh, SAU
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18
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Chen YL, Shi HY, Ma TT, Wang XY. Investigation of self-reported chronic urticaria among adults in grasslands of northern China. Medicine (Baltimore) 2020; 99:e23301. [PMID: 33217863 PMCID: PMC7676511 DOI: 10.1097/md.0000000000023301] [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] [Indexed: 11/26/2022] Open
Abstract
The clinical epidemiological characteristics of chronic urticaria (CU) in different populations were not completely consistent, and the epidemiological characteristics of CU were very complex. At present, there were some patient-based studies on CU, but few natural population-based studied in the world.This study aimed to analysis the prevalence of self-reported CU among adults in grasslands of northern China and its closely related factors.A multistage and proportionately stratified random sampling with a field interviewer-administered survey study was performed together with skin prick tests (SPT) and measurements of the daily pollen count.A total of 3406 subjects completed the study. The prevalence of self-reported CU was 5.61% (n = 191), which was higher in women than that of men (6.91% vs 4.08%, X = 12.785, P < .001). Seasonal or seasonal aggravation CU accounted for 110 (57.59%) patients. Pollen dispersal season was basically consistent with the peak season of CU, but there was no significant difference in the positive rate of pollen SPT between CU with seasonal or seasonal aggravation symptom and CU with free of symptom (X = 0.425, P = .51), as well as between CU with seasonal or seasonal aggravation symptom and perennial CU (X = 0.439, P = .51). Eczema (odds ratio [OR] = 2.807, P < .001), chronic diarrhea (OR = 2.486, P < .01), food allergy history (OR = 1.890, P < .01), history of family allergy (OR = 1.800, P < .001), and conjunctivitis (OR = 1.749, P < .01) were closely related to CU.This investigation provided the factors closely related to CU, and provided certain ideas for further research on the etiology and prevention of CU.
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19
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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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20
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Stepaniuk P, Kan M, Kanani A. Natural history, prognostic factors and patient perceived response to treatment in chronic spontaneous urticaria. Allergy Asthma Clin Immunol 2020; 16:63. [PMID: 32834828 PMCID: PMC7371813 DOI: 10.1186/s13223-020-00459-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 06/26/2020] [Indexed: 11/28/2022] Open
Abstract
Background Although the diagnosis and management of chronic spontaneous urticaria (CSU) is well documented in the literature, some aspects of the disease remain unclear. We aimed to further describe the natural history, prognostic factors, humanistic burden and uptake of traditional and alternative therapies in patients with CSU. Methods This was a prospective, cross-sectional analysis at a single centre. We reviewed patient medical records and conducted a survey in patients with CSU. Results 72 patients participated in the study with a median duration of CSU of 48 months. 30% of patients had symptoms that resolved in under 2 years with these patients trending towards an older age of onset of CSU (48 ± 17 years). 16% of patients had symptoms lasting 10 years or longer with these patients trending towards a younger age of onset (22 ± 16 years). Patients with a relapsing/remitting disease course (31%) and those with co-existing angioedema (57%) trended towards a longer median duration of CSU (96 and 50 months respectively) and were observed to have a higher proportion of patients reporting CSU duration of 10 years or longer (33% and 25%, p = 0.033 and p = 0.036 respectively). Patients with co-existing autoimmune/thyroid disease (19%) trended towards a shorter median duration of CSU (37 months). 54 patients (75%) reported sleep disturbance and 29 patients (43%) required emergency room visit(s) for symptomatic control. 84% of patients who trialed second generation antihistamines reported a response to treatment, while 73% of patients who trialed omalizumab reported a response to treatment. Patients using alternative medicine such as acupuncture, traditional Chinese medicine and naturopathic medicine had lower reported response rates (20–29%) to treatment. Conclusions The natural history of CSU may be longer than previously reported with our study finding a median duration of symptoms of nearly 4 years with one-third of patients reporting a relapsing/remitting disease course. Younger age of onset, a relapsing/remitting disease course and angioedema may predict a longer duration of CSU, whereas older age of onset and co-existing autoimmune/thyroid disease may predict a shorter duration of CSU. Reported symptomatic benefit was higher from guidelines based pharmacologic therapy versus various alternative medicines.
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Affiliation(s)
- Peter Stepaniuk
- Division of Allergy and Immunology, Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Manstein Kan
- Division of Allergy and Immunology, Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Amin Kanani
- Division of Allergy and Immunology, Department of Medicine, University of British Columbia, Vancouver, BC Canada
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21
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Tawil S, Irani C, Kfoury R, Salameh P, Baiardini I, Weller K, Maurer M, Ezzedine K. The Arabic Urticaria Activity Score and Chronic Urticaria Quality of Life Questionnaire: validation and correlations. Int J Dermatol 2020; 59:893-901. [PMID: 32638368 DOI: 10.1111/ijd.15006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/02/2020] [Accepted: 05/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The international guideline for urticaria recommends the use of the Urticaria Activity Score 7 (UAS7) and the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) to assess patients with chronic spontaneous urticaria (CSU) for their disease activity and impact on quality of life, respectively. Over the last decade, both tools have been validated in many different languages but not in Arabic. OBJECTIVE To validate the Arabic UAS7 and CU-Q2oL in patients with CSU in Lebanon. METHODS After a structured translation process of both instruments into Arabic, their construct and known-groups validity as well as internal consistency reliability were tested in a longitudinal prospective study using a cluster sample of 152 Lebanese CSU patients. The study also included a repetitive administration of both instruments in 2-week intervals in 44 patients in order to assess their test-retest reliability. RESULTS Both the Arabic UAS7 and CU-Q2oL demonstrated high internal consistency (Cronbach alpha of 0.95 and 0.82, respectively) and moderate-to-high test-retest reliability (intraclass coefficient of 0.61 and 0.91, respectively). Exploratory factor analysis of the Arabic CU-Q2oL revealed five components that explained 81.8% of the total variance. Significant correlations were found between the Arabic CU-Q2oL and the Dermatology Life Quality Index (DLQI) (r = 0.86) and mild-to-moderate correlations between the Arabic UAS7 and CU-Q2oL (r = 0.52) as well as the DLQI (r = 0.51). CONCLUSIONS Our findings demonstrate that the Arabic versions of the UAS7 and the CU-Q2oL are valid and reliable patient-reported outcome measures in patients with CSU in Lebanon.
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Affiliation(s)
- Samah Tawil
- Drug Information Center, Lebanese Order of Pharmacists, Beirut, Lebanon.,Continuing Education Department, Lebanese Order of Pharmacists, Beirut, Lebanon
| | - Carla Irani
- Internal Medicine and Clinical Immunology, Hotel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Riwa Kfoury
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Pascale Salameh
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon.,INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Beirut, Lebanon.,Faculty of Pharmacy and of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Ilaria Baiardini
- Allergy and Respiratory Diseases Clinic- DIMI - University of Genoa, RCCS AOU San Martino-IST, Genoa, Italy
| | - Karsten Weller
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Khaled Ezzedine
- Department of Dermatology, Henri-Mondor University Hospital, Creteil, France.,EA7379 Epiderm E (Epidemiology in Dermatology and Therapeutics Evaluation), UPEC-University, Creteil, France
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22
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Cholinergic Urticaria: Clinical Presentation and Natural History in a Tropical Country. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7301652. [PMID: 32596363 PMCID: PMC7273400 DOI: 10.1155/2020/7301652] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/06/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cholinergic urticaria (CholU) is a subset of chronic inducible urticaria characterized by the recurrent pinpoint-sized wheals that are induced by exercising or increasing core body temperature. Currently, the data of CholU in tropical climate is still limited. OBJECTIVE To investigate the clinical features and natural course of CholU in a tropical country. MATERIALS AND METHODS This retrospective chart review study analyzed the data of CholU patients aged over 18 years who visited Siriraj Urticaria Clinic, Siriraj Hospital, Bangkok, Thailand, between January 2007 and September 2019. Demographic data, clinical presentations, and results of provocation tests and other laboratory investigations were evaluated and compared with other studies reported in temperate zones. RESULTS Sixteen out of 2,175 chronic urticaria patients (0.7%) were diagnosed with CholU. The median age of CholU patients was 28.0 ± 11.7 years with male predominance (56.3%). Three patients (18.8%) had a history of atopy. Fifteen patients (93.8%) were positive to the exercise provocation test. Nonsedating antihistamine drugs were a main treatment (73.8%). Six patients (37.5%) were in remission at the time of the study, with a mean duration 4.3 years. The Kaplan-Meier survival analysis demonstrated that 12.5%, 35.5%, and 67.9% of patients would have disease remission within 1 year, 5 years, and 13 years, respectively. CONCLUSIONS The prevalence of CholU differs in each geographic region and is found to be low in tropical countries with a median duration 4.3 years. The prevalence of atopy and anaphylaxis with CholU is also lower in tropical countries than in temperate.
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23
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Pereyra-Rodriguez JJ, Galán Gutiérrez M, Armario-Hita JC, Ruiz-Villaverde R. Prevalence of chronic urticaria refractory to antihistamines in Andalucia, Spain. Dermatol Ther 2020; 33:e13866. [PMID: 32558086 DOI: 10.1111/dth.13866] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 11/28/2022]
Abstract
Chronic urticaria (CU) has a devastating effect on the quality of life of patients who suffer from it. The objective of this study is to determine the prevalence of severe chronic spontaneous urticaria (CSU) in adults in eight health areas in Andalucía. A retrospective observational study from January 2019 to December 2019 was conducted with the participation of seven reference hospitals that were analyzed, including a total reference population of 3 159 001 individuals ≥18 years. The analysis was carried out on the characteristics of the population and the estimated prevalence. In total, 369 patients with a diagnosis of CSU refractory to antagonist of histamine were registered. We have found a prevalence of refractory patients of 0.0012% (95% CI 0.0010%-0.0013), ranging from 0.006% to 0.02%. The present study has helped to describe the prevalence and characteristics of patients with severe urticarial. The prevalence is lower than previously reported. We have observed differences between hospital areas. There will be a new line of research at the national level to help improve the identification of patients with CSU.
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24
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Nettis E, Foti C, Ambrifi M, Baiardini I, Bianchi L, Borghi A, Caminati M, Canonica GW, Casciaro M, Colli L, Colombo G, Corazza M, Cristaudo A, De Feo G, De Pita’ O, Di Gioacchino M, Di Leo E, Fassio F, Gangemi S, Gatta A, Hansel K, Heffler E, Incorvaia C, Napolitano M, Patruno C, Peveri S, Pigatto PD, Quecchia C, Radice A, Ramirez GA, Romita P, Rongioletti F, Rossi O, Savi E, Senna G, Triggiani M, Zucca M, Maggi E, Stingeni L. Urticaria: recommendations from the Italian Society of Allergology, Asthma and Clinical Immunology and the Italian Society of Allergological, Occupational and Environmental Dermatology. Clin Mol Allergy 2020; 18:8. [PMID: 32390768 PMCID: PMC7201804 DOI: 10.1186/s12948-020-00123-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 04/25/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Urticaria is a disorder affecting skin and mucosal tissues characterized by the occurrence of wheals, angioedema or both, the latter defining the urticaria-angioedema syndrome. It is estimated that 12-22% of the general population has suffered at least one subtype of urticaria during life, but only a small percentage (estimated at 7.6-16%) has acute urticaria, because it is usually self-limited and resolves spontaneously without requiring medical attention. This makes likely that its incidence is underestimated. The epidemiological data currently available on chronic urticaria in many cases are deeply discordant and not univocal, but a recent Italian study, based on the consultation of a national registry, reports a prevalence of chronic spontaneous urticaria of 0.02% to 0.4% and an incidence of 0.1-1.5 cases/1000 inhabitants/year. METHODS We reviewed the recent international guidelines about urticaria and we described a methodologic approach based on classification, pathophysiology, impact on quality of life, diagnosis and prognosis, differential diagnosis and management of all the types of urticaria. CONCLUSIONS The aim of the present document from the Italian Society of Allergology, Asthma and Clinical Immunology (SIAAIC) and the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA) is to provide updated information to all physicians involved in diagnosis and management of urticaria and angioedema.
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Affiliation(s)
- Eustachio Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy
| | - Caterina Foti
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, Bari, Italy
| | - Marina Ambrifi
- San Gallicano Dermatological Institute -IRCCS, Rome, Italy
| | - Ilaria Baiardini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Leonardo Bianchi
- Section of Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Alessandro Borghi
- Section of Dermatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Marco Caminati
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas, Rozzano, Milan, Italy
| | - Marco Casciaro
- School and Division of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Laura Colli
- Department of Biomedical, Surgical and Dental Sciences, Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, University of Milan, Milan, Italy
| | - Giselda Colombo
- Unit of Immunology, Rheumatology Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Monica Corazza
- Section of Dermatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Giulia De Feo
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Ornella De Pita’
- Clinical Pathology and Immune Inflammatory Disease of the Skin, Cristo Re Hospital, Rome, Italy
| | - Mario Di Gioacchino
- Department of Medicine and Science on Ageing, School of Medicine, G. d’Annunzio University, Chieti-Pescara, Italy
| | - Elisabetta Di Leo
- Section of Allergy and Clinical Immunology, Unit of Internal Medicine, “F. Miulli” Hospital, Strada Provinciale per Santeramo Km 4.100, Acquaviva Delle Fonti (BA), Italy
| | - Filippo Fassio
- Allergy and Clinical Immunology Unit, Azienda USL Toscana Centro, Florence, Italy
| | - Sebastiano Gangemi
- School and Division of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alessia Gatta
- Department of Medicine and Science on Ageing, School of Medicine, G. d’Annunzio University, Chieti-Pescara, Italy
| | - Katharina Hansel
- Section of Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas, Rozzano, Milan, Italy
| | | | - Maddalena Napolitano
- Section of Dermatology, Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Silvia Peveri
- Allergy Department Unit, Piacenza Hospital, Piacenza, Italy
| | - Paolo Daniele Pigatto
- Department of Biomedical, Surgical and Dental Sciences, Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, University of Milan, Milan, Italy
| | - Cristina Quecchia
- Centro “Io e l’Asma”, Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy
| | - Anna Radice
- Immunoallergology Unit, Careggi University Hospital, Florence, Italy
| | - Giuseppe Alvise Ramirez
- Unit of Immunology, Rheumatology Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Romita
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, Bari, Italy
| | - Franco Rongioletti
- Dermatological Clinic/UC of Dermatology, Department of Medical Science and Public Health, AOU Cagliari, Cagliari, Italy
| | - Oliviero Rossi
- Immunoallergology Unit, Careggi University Hospital, Florence, Italy
| | - Eleonora Savi
- Allergy Department Unit, Piacenza Hospital, Piacenza, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Myriam Zucca
- Dermatological Clinic/UC of Dermatology, Department of Medical Science and Public Health, AOU Cagliari, Cagliari, Italy
| | - Enrico Maggi
- Department of Experimental and Clinical Medicine and Center of Excellence for Research, Transfer and High Education DENOTHE of the University of Florence, Florence, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
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Maurer M, Eyerich K, Eyerich S, Ferrer M, Gutermuth J, Hartmann K, Jakob T, Kapp A, Kolkhir P, Larenas-Linnemann D, Park HS, Pejler G, Sánchez-Borges M, Schäkel K, Simon D, Simon HU, Weller K, Zuberbier T, Metz M. Urticaria: Collegium Internationale Allergologicum (CIA) Update 2020. Int Arch Allergy Immunol 2020; 181:321-333. [PMID: 32224621 DOI: 10.1159/000507218] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 12/13/2022] Open
Abstract
This update on chronic urticaria (CU) focuses on the prevalence and pathogenesis of chronic spontaneous urticaria (CSU), the expanding spectrum of patient-reported outcome measures (PROMs) for assessing CU disease activity, impact, and control, as well as future treatment options for CU. This update is needed, as several recently reported findings have led to significant advances in these areas. Some of these key discoveries were first presented at past meetings of the Collegium Internationale Allergologicum (CIA). New evidence shows that the prevalence of CSU is geographically heterogeneous, high in all age groups, and increasing. Several recent reports have helped to better characterize two endotypes of CSU: type I autoimmune (or autoallergic) CSU, driven by IgE to autoallergens, and type IIb autoimmune CSU, which is due to mast cell (MC)-targeted autoantibodies. The aim of treatment in CU is complete disease control with absence of signs and symptoms as well as normalization of quality of life (QoL). This is best monitored by the use of an expanding set of PROMs, to which the Angioedema Control Test, the Cholinergic Urticaria Quality of Life Questionnaire, and the Cholinergic Urticaria Activity Score have recently been added. Current treatment approaches for CU under development include drugs that inhibit the effects of signals that drive MC activation and accumulation, drugs that inhibit intracellular pathways of MC activation and degranulation, and drugs that silence MCs by binding to inhibitory receptors. The understanding, knowledge, and management of CU are rapidly increasing. The aim of this review is to provide physicians who treat CU patients with an update on where we stand and where we will go. Many questions and unmet needs remain to be addressed, such as the development of routine diagnostic tests for type I and type IIb autoimmune CSU, the global dissemination and consistent use of PROMs to assess disease activity, impact, and control, and the development of more effective and well-tolerated long-term treatments for all forms of CU.
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Affiliation(s)
- Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany,
| | - Kilian Eyerich
- Division of Dermatology and Venerology, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stefanie Eyerich
- Center for Allergy and Environment, Technical University and Helmholtz Center Munich, Munich, Germany
| | - Marta Ferrer
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra Pamplona, Spain, RETIC de Asma, Reacciones Adversas y Alérgicas, Madrid, Spain
| | - Jan Gutermuth
- Department of Dermatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Karin Hartmann
- Division of Allergy, Department of Dermatology, University of Basel, Basel, Switzerland
| | - Thilo Jakob
- Department of Dermatology and Allergy, University Medical Center Giessen, Justus-Liebig University Giessen, Giessen, Germany
| | - Alexander Kapp
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Pavel Kolkhir
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Division of Immune-Mediated Skin Diseases, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Désirée Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur, Clinical Foundation and Hospital, Mexico City, Mexico
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Gunnar Pejler
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela
| | - Knut Schäkel
- Department of Dermatology, Heidelberg University, Heidelberg, Germany
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Bern, Switzerland.,Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Karsten Weller
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Torsten Zuberbier
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martin Metz
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Chung BY, Um JY, Kang SY, Kim HO, Park CW. Natural History of Chronic Urticaria in Korea. Ann Dermatol 2019; 32:38-46. [PMID: 33911707 PMCID: PMC7992631 DOI: 10.5021/ad.2020.32.1.38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 11/16/2022] Open
Abstract
Background Data on the natural history and prognostic variables of chronic urticaria (CU) are rare and information about spontaneous remission of CU is limited. Objective This study evaluated the natural history of CU and identified predictors for remission. Methods Total 329 Korean patients with CU, who had follow-ups more than 6 months after diagnosis during a 7-year period in the department of dermatology in three university hospitals were enrolled. Clinical data and laboratory findings obtained by medical records and telephone interviews were analyzed, retrospectively. Results The proportion recovered in 1, 3, and 5 years after the onset of CU was 10.8%, 18.8%, and 32.9%, respectively. The mean duration of CU was 6.3 years. There were no significant differences in median recovery time depending on sex, age group, severity of CU, and type of CU. The presence of angioedema was significantly related to CU severity. There were no differences in prognosis with respect to the presence of dermographism or angioedema. Patients with atopic dermatitis (AD) had a significantly worse prognosis than patients without a history of AD; but not in patients with the history of allergic rhinitis or asthma. Patients with abnormal laboratory findings did not differ significantly in prognosis. Conclusion CU remission rate significantly differ according to the presence of AD. This study provides information about the natural course of CU of Korean patients.
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Affiliation(s)
- Bo Young Chung
- Department of Dermatology, College of Medicine, Hallym University, Seoul, Korea
| | - Ji-Young Um
- Department of Dermatology, College of Medicine, Hallym University, Seoul, Korea
| | - Seok Young Kang
- Department of Dermatology, College of Medicine, Hallym University, Seoul, Korea
| | - Hye One Kim
- Department of Dermatology, College of Medicine, Hallym University, Seoul, Korea
| | - Chun Wook Park
- Department of Dermatology, College of Medicine, Hallym University, Seoul, Korea
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Effectiveness and safety of Omalizumab in the treatment of chronic spontaneous urticaria: Systematic review and meta-analysis. Allergol Immunopathol (Madr) 2019; 47:515-522. [PMID: 31607407 DOI: 10.1016/j.aller.2019.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/06/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Chronic spontaneous urticaria (CSU) affects approximately 1% of the population, affecting both children and adults. Omalizumab (Oma) is a therapeutic option for patients with refractory forms of CSU. OBJECTIVES To determine the effectiveness and safety of Oma in the treatment of CSU. METHODS Systematic review (Cochrane Collaboration methodology) of randomized clinical trials comparing Oma to placebo in refractory CSU treatment. The search is based on MEDLINE; EMBASE, Central Cochrane Library, and LILACS. The outcomes evaluated were: control of the illness, adverse events, and quality of life. RESULTS Of the 848 identified studies 13 were selected for further review and six were included in the meta-analysis. For all outcomes, high-quality evidence has confirmed that Oma is effective in the treatment of CSU. The dosage of 300mg/month achieved better results; namely a significant reduction in pruritus, papules, and urticaria activity, as well as an increase in the number of patients with a controlled condition, improvement in the quality of life and no differences in adverse events compared to the placebo. CONCLUSIONS High-quality evidence demonstrates that Oma is effective and safe in the treatment of CSU refractory to therapy with H1 antihistamines.
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The expression of serotonin transporter protein in the skin of patients with chronic spontaneous urticaria and its relation with depression and anxiety. Arch Dermatol Res 2019; 311:825-831. [DOI: 10.1007/s00403-019-01969-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 12/20/2022]
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Johal KJ, Saini SS. Current and emerging treatments for chronic spontaneous urticaria. Ann Allergy Asthma Immunol 2019; 125:380-387. [PMID: 31494233 DOI: 10.1016/j.anai.2019.08.465] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To review the published literature on current and new treatments for chronic spontaneous urticaria (CSU) and to provide guidance on the potential use of these therapeutics. DATA SOURCES A PubMed search was performed to include English-language articles with the keywords chronic spontaneous urticaria, pathophysiology, quality of life, and treatments, with a preference to those articles written in the last 5 years. ClinicalTrials.gov was reviewed for recent relevant clinical trials related to potential CSU therapeutics. STUDY SELECTIONS Literature was included if it provided information related to the current understanding of the pathophysiology and management of CSU as well as potential novel therapeutics currently in development. RESULTS CSU has a significant effect on patients' quality of life. Current therapies include antihistamines, leukotriene receptor antagonists, omalizumab, and immunosuppressants; however, additional treatments are needed. New therapeutics under investigation include IgG1 anti-IgE monoclonal antibodies (ligelizumab), chemoattractant rector-homologous molecule expressed on TH2 cells antagonists (AZD1981), Bruton tyrosine kinase inhibitors (fenebrutinib), anti-siglec-8 monoclonal antibody (AK002), and topical spleen tyrosine kinase inhibitors (GSK2646264). We review the mechanisms of action as well as recently published data from clinical trials regarding the efficacy and safety of these treatments. CONCLUSION The development of new treatments for CSU will lead to improved options for patients and may assist with improving our understanding of disease pathophysiology.
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Affiliation(s)
- Kirti J Johal
- Johns Hopkins Asthma and Allergy Center, Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarbjit S Saini
- Johns Hopkins Asthma and Allergy Center, Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Clinical characteristics and epidemiology of chronic urticaria: a nationwide, multicentre study on 1091 patients. Postepy Dermatol Alergol 2019; 36:184-191. [PMID: 31320852 PMCID: PMC6627267 DOI: 10.5114/ada.2019.84594] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 01/30/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction Urticaria is one of the most common skin diseases. Depending on the length of symptoms, acute (lasting less than 6 weeks) and chronic urticaria (CU) (> 6 weeks) are distinguished. According to the current European guidelines, CU is divided into inducible urticaria (IU) and chronic spontaneous urticaria (CSU). Aim To assess the epidemiology and clinical characteristics of CU in Poland. Material and methods This was a nationwide, multicentre, cross-sectional, questionnaire-based study performed under the auspices of the Polish Dermatological Society. A total of 102 physicians (dermatologists and allergists) recruited 1091 patients suffering from CU. Results Among 1091 adults with CU, IU was found in 35.1% (n = 383) of patients and CSU was responsible for 61.1% (n = 667) of CU cases. The remaining patients (n = 41, 3.8%) suffered from both, IU and CSU. Persons with CSU were twice more likely to report family history of urticaria than those with IU (12.1% vs. 6.0%, p = 0.001). Generalized eruptions of wheals predominated in CSU (generalized wheals: 57.9%, localized wheals: 42.1%), whereas wheals localized in particular body areas were found more commonly in IU (generalized wheals: 45.2%, localized wheals: 54.8%, p < 0.001). The CU was the cause of absenteeism in almost every fifth patient suffering from this disease. Conclusions The CSU is about twice as frequent cause of CU as compared to IU. The treatment of CU is a major challenge for physicians of various specialties and the treatment choice is closely associated with the specialist knowledge of current treatment guidelines.
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Min TK, Saini SS. Emerging Therapies in Chronic Spontaneous Urticaria. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:470-481. [PMID: 31172716 PMCID: PMC6557779 DOI: 10.4168/aair.2019.11.4.470] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 02/06/2023]
Abstract
Chronic spontaneous urticaria (CSU) is characterized by typically short-lived and fleeting wheals, angioedema or both, which occur spontaneously and persist for longer than 6 weeks. This term is applied to the most common subtype of chronic urticaria. The underlying pathophysiology for CSU involves mast cell and basophil degranulation with release of histamine, leukotrienes, prostaglandins and other inflammatory mediators. Although a variety of treatments exist, many patients do not tolerate or benefit from the existing therapies and even require more effective treatments. Omalizumab is currently the only licensed biologic for antihistamine-refractory CSU, and novel drugs are under development. This article reviews its current status regarding pathogenesis and approach to treatment as well as therapeutic agents that are under development for the treatment of CSU.
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Affiliation(s)
- Taek Ki Min
- Pediatric Allergy and Respiratory Center, Department of Pediatrics, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Sarbjit S Saini
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Kulthanan K, Tuchinda P, Chularojanamontri L, Kiratiwongwan R. Cold Urticaria: Clinical Features and Natural Course in a Tropical Country. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:538-547. [PMID: 31172722 PMCID: PMC6557767 DOI: 10.4168/aair.2019.11.4.538] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/07/2019] [Accepted: 03/10/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE To review the clinical features and natural courses of cold urticaria (ColdU) in a tropical country. METHODS A retrospective chart review was performed of patients who visited Siriraj Urticaria Clinic, Siriraj Hospital, Bangkok, Thailand, and were diagnosed with ColdU between 2007 and 2018. Data on provocation and threshold tests, clinical courses, and laboratory work-up were analyzed and compared with data reported by studies in temperate countries. RESULTS Of 1,063 chronic urticaria patients, 27 (2.5%) were diagnosed with ColdU, with a mean age of symptom onset of 34.8 years. Half of the patients had a history of atopy, and 1 (3.7%) had a history of anaphylaxis. All patients were positive to 1 of 3 provocation tests: an ice cube test; TempTest 4.0; or a tray filled with ice, salt and water. Thirteen patients underwent the ice cube test, and all had positive results. TempTest was performed on 15 patients, 8 of whom had positive results, with a mean critical temperature threshold (CTT) of 21.0°C. All of the 7 patients who had a negative TempTest result later produced positive results to the immersion of their hand and forearm in a tray filled with ice, salt, and water. All patients were treated with H₁-antihistamines, the vast majority (96.3%) being non-sedating H₁-antihistamines. Some (14.8%) needed to be administered oral corticosteroids, ciclosporin, or omalizumab. Six patients (22.2%) were in remission. A Kaplan-Meier survival curve demonstrated 5-year and 10-year remission rates of 13.8% and 42.6%, respectively. CONCLUSIONS The rate of anaphylaxis in patients with ColdU in a tropical country was lower than those reported by other studies conducted intemperate climates. On the other hand, the number of female patients, mean age at symptom onset, atopy rate, rate of concomitant chronic spontaneous urticaria and mean CTT were higher.
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Affiliation(s)
- Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Papapit Tuchinda
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rungsima Kiratiwongwan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Eun SJ, Lee JY, Kim DY, Yoon HS. Natural course of new-onset urticaria: Results of a 10-year follow-up, nationwide, population-based study. Allergol Int 2019; 68:52-58. [PMID: 29945815 DOI: 10.1016/j.alit.2018.05.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/06/2018] [Accepted: 05/20/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Previous epidemiologic studies of the natural course of urticaria mainly focused on chronic spontaneous urticaria and were conducted at hospitals. The natural course of new-onset urticaria in the general population is unknown. METHODS Patients with new-onset urticaria were identified from the National Health Insurance Service-National Sample Cohort data. Patients who had at least one visit for urticaria in 2002 and 2003 were excluded and the study cohort consisted of 1,027,620 subjects with no history of urticaria. We analyzed cumulative incidences of urticaria, chronic urticaria, and chronic urticaria remission using the life table estimation method from 2004 to 2013. Their association with related factors was analyzed using the Cox proportional hazards analysis. RESULTS From 2004 to 2013, a total of 49,129 patients with new-onset urticaria were identified. The 10-year cumulative incidence rate of urticaria for the general population was 4.9% and that of chronic urticaria among patients with new-onset urticaria was 7.8%. Remission rates of chronic urticaria were 52.6% at 1 year and 88.9% at 5 years. Age, sex, residential area, and autoimmune thyroid disease were significantly associated with urticaria or chronic urticaria, but not with chronic urticaria remission, after adjusting for covariates. Female individuals were more likely to have new-onset urticaria but less likely to develop chronic urticaria compared with male individuals. CONCLUSIONS During the 10-year follow-up period, only a small proportion of patients with new-onset urticaria developed chronic urticaria. Remission was achieved in the majority of patients with chronic urticaria regardless of demographic characteristics or accompanying thyroid disease.
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Affiliation(s)
- Sang Jun Eun
- Department of Preventive Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Jin Yong Lee
- Public Health Medical Service, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Do-Yeop Kim
- Department of Dermatology, Seoul National University Hospital, Seoul, South Korea
| | - Hyun-Sun Yoon
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, South Korea.
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Cutting Edge: Biomarkers for Chronic Spontaneous Urticaria. J Immunol Res 2018; 2018:5615109. [PMID: 30584542 PMCID: PMC6280255 DOI: 10.1155/2018/5615109] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/13/2018] [Indexed: 12/22/2022] Open
Abstract
Chronic spontaneous urticaria (CSU) is defined by the appearance of wheals and a variable presence of angioedema which persists for at least 6 weeks. It represents the most common subtype of chronic urticaria and is gaining importance in civil society because of its association with impaired quality of life. Moreover, CSU has a growing impact on national health systems representing a great burden due to its variable rate of response to the approved therapies. In this scenario, the identification of clinical and molecular biomarkers is of pivotal importance. Some groups are trying to detect molecules which would be able to help clinicians in reaching a proper diagnosis; additionally, the opportunity to describe disease severity which leads to cluster patients in different groups could fill the gap in the numerous unmet clinical needs. Several biomarkers are currently being studied with the purpose to predict the response to a defined therapy; unfortunately, none of them are ready to be translated from bench to bedside.
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Abstract
Chronic idiopathic urticaria (CIU), also known as chronic spontaneous urticaria, is characterized by the presence of hives on most days of the week, for 6 weeks or longer, and without an identifiable or consistent cause. Evaluation is clinical and based on the presence of episodic urticarial lesions. Although patients are subject to overtesting during the diagnosis of CIU, guidelines suggest starting with three basic laboratory tests. Treatment is a stepwise approach, involving second-generation antihistamines, histamine2 antagonists, leukotriene receptor antagonists, first-generation antihistamines, and potent antihistamines. Refractory CIU requires adding alternative agents such as omalizumab, anti-inflammatory agents, and immunosuppressants.
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Thyroid Autoimmunity and Autoimmunity in Chronic Spontaneous Urticaria Linked to Disease Severity, Therapeutic Response, and Time to Remission in Patients with Chronic Spontaneous Urticaria. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9856843. [PMID: 30515422 PMCID: PMC6236973 DOI: 10.1155/2018/9856843] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 09/28/2018] [Accepted: 10/18/2018] [Indexed: 11/17/2022]
Abstract
Background Chronic spontaneous urticaria (CSU) is autoimmune in nature and associated with thyroid autoimmunity (TA), but evidence on autoimmunity in relation to CSU progression and prognosis is limited. We evaluated whether TA and autoimmunity in CSU are correlated with disease severity, therapeutic response, and time to remission and establish an association between CSU characteristics linked to thyroid autoantibody. Methods Medical records of patients diagnosed with urticaria attending outpatient dermatology clinic at a university-based hospital from 2013 to 2017 were retrospectively reviewed. Data on the clinical characteristics, laboratory investigations particularly thyroid antibody titers, autologous serum skin test (ASST) and autologous plasma skin test (APST) results and their link to disease severity, treatments, and time to remission of CSU patients were analyzed. Results Of 1,096 patients with urticaria, 60.2% had CSU. Three-hundred patients fulfilled the inclusion criteria for CSU with complete thyroid antibody testing. Positive TA was significantly associated with female gender and age > 35 years (p = 0.008). Antithyroid peroxidase (anti-TPO)-positive patients suffered from CSU longer than 12 and 18 months compared to anti-TPO-negative patients (100.0% vs. 82.6%, p = 0.042, and 100.0% vs. 75.9% p = 0.020, respectively). The presence of urticarial attacks > 4 days/week was significantly seen in ASST and APST-positive patients compared to those without (84.6% vs. 61.3%, p = 0.011, and 85.3% vs. 61.8%, p = 0.006, respectively). Positive APST patients were more difficult to treat than those with negative results (61.2% vs. 37.8%, p = 0.017). Conclusions Antithyroid peroxidase is a predictor of time to remission, while autologous skin testing is linked to disease severity (ASST and APST) and therapeutic response (APST) in CSU patients.
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Kolkhir P, Pereverzina N, Olisova O, Maurer M. Comorbidity of viral hepatitis and chronic spontaneous urticaria: A systematic review. Allergy 2018; 73:1946-1953. [PMID: 29786879 DOI: 10.1111/all.13482] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2018] [Indexed: 12/17/2022]
Abstract
Chronic viral infections including those by hepatitis B (CHB) virus and hepatitis C (CHC) virus have been reported to be comorbidities of chronic spontaneous urticaria (CSU). Here, we performed the first comprehensive review of the peer-reviewed literature (PubMed, Web of Science and Google Scholar) on the prevalence of CHB and CHC in patients with CSU and vice versa. The prevalence of CHB and CHC in CSU does not appear to be increased. Less than 5% and 2% of patients with CSU have markers of CHB and CHC, respectively, according to most of the 32 studies reviewed. Urticarial rash including CSU occurs in ≤3% of patients with CHC as reported by most of 20 studies analysed. Very few patients have been assessed for the effects of antiviral hepatitis treatment on their CSU, and two but not all reportedly showed improvement. Hepatitis B/C infections appear unlikely to be linked to CSU. We suggest that routine screening for these infections in patients with CSU is not relevant or cost-effective and should not be performed unless liver function tests are abnormal, risk factors or symptoms of viral hepatitis are present, or urticarial vasculitis is suspected.
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Affiliation(s)
- P. Kolkhir
- Division of Immune‐mediated Skin Diseases Department of Dermatology and Venereology I.M. Sechenov First Moscow State Medical University Moscow Russian Federation
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - N. Pereverzina
- Division of Immune‐mediated Skin Diseases Department of Dermatology and Venereology I.M. Sechenov First Moscow State Medical University Moscow Russian Federation
| | - O. Olisova
- Division of Immune‐mediated Skin Diseases Department of Dermatology and Venereology I.M. Sechenov First Moscow State Medical University Moscow Russian Federation
| | - M. Maurer
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
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Critical appraisal of the unmet needs in the treatment of chronic spontaneous urticaria with omalizumab: an Italian perspective. Curr Opin Allergy Clin Immunol 2018; 17:453-459. [PMID: 28968274 DOI: 10.1097/aci.0000000000000404] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The humanized anti-IgE antibody omalizumab has been available for patients with chronic spontaneous urticaria (CSU) in Italy since 2015. This review summarizes the unresolved issues and unmet therapeutic needs associated with omalizumab and discusses practical recommendations for its use in the management of CSU. RECENT FINDINGS Although modern second-generation H1-antihistamines are the standard of care for patients with CSU, adjunctive treatments (including omalizumab) may be required for effective control of symptoms in many patients. Evidence from clinical trials and experience from daily clinical practice suggest that the use of omalizumab in patients with CSU who have inadequate response to H1-antihistamines remains challenging. SUMMARY Based on current international guidelines, omalizumab labelling information and our experience in clinical practice, we provide treatment recommendations regarding the use of omalizumab in patients with CSU. These include: optimal treatment duration, the use of concomitant antihistamine therapy, the definition and management of disease relapse after treatment, and the management of patients with late or no response to treatment.
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El-Sharkawy REED, Abd-Elmaged WM, Ahmed DA, Abdel-Wahed SAEF. Pattern of chronic urticaria and value of autologous serum skin test in Sohag Province, Upper Egypt. Electron Physician 2018; 10:6781-6788. [PMID: 29997762 PMCID: PMC6033132 DOI: 10.19082/6781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 03/28/2018] [Indexed: 01/16/2023] Open
Abstract
Background Chronic urticaria (CU) is a debilitating disorder with variable clinical course. It is characterized by hives occurring for at least 6 weeks, and is classified as spontaneous or inducible. Objective The aim of this study was to detect the pattern of CU, to study association between results of autologous serum skin test (ASST) and urticaria severity score (USS), and to detect serum levels of anti IgE receptors antibodies. Methods This study included all patients attending the Dermatology Outpatient Clinic, Sohag University Hospital, who were diagnosed as CU from April 2015 to March 2016. ASST and serum level of anti IgE receptor antibodies was assessed using ELISA. Data were analyzed by SPSS version 16, using descriptive statistics, Kruskal-Wallis and Mann-Whitney U test. Results A total of 108 patients with CU were included in the study. Females with mean age 33±12.4 years were more affected. A total of 58.3% complained of CSU, 6.5% physical urticaria and 35.2% mixed type of CU. According to USS, mild score represented 20.4%, moderate 46.3% and severe in 33.3%. ASST showed positive in 38% of patients. There was a statistically significant relation between ASST and USS and duration of CU. This indicates that more severe symptoms and prolonged duration of CU are observed in positive ASST (autoreactive type). In all, 91% of the anti IgE receptor antibodies positive patients had positive ASST. Conclusion In conclusion, chronic urticaria is not an uncommon disease in our locality which represented 1.13% of our patients. Urticaria severity score and duration of urticaria was higher in positive ASST patients and hence the autoreactive type.
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Affiliation(s)
| | - Wafaa Mohamed Abd-Elmaged
- Lecturer, Dermatology and Venereology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Doaa Anwar Ahmed
- Resident at Dermatology Department, Sohag General Hospital, Sohag, Egypt
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Ben-Shoshan M, Grattan CE. Management of Pediatric Urticaria with Review of the Literature on Chronic Spontaneous Urticaria in Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1152-1161. [PMID: 29550102 DOI: 10.1016/j.jaip.2018.02.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/05/2018] [Accepted: 02/16/2018] [Indexed: 12/26/2022]
Abstract
There are substantial knowledge gaps related to diagnosis and management of pediatric cases of chronic urticaria, and in particular chronic spontaneous urticaria (CSU). In this article we aimed to review the diagnosis and management of chronic urticaria in children and CSU in particular. We conducted a systematic review of articles published in English and French on pediatric CSU management in the last 10 years. We included experimental studies (eg, randomized controlled trials), other experimental designs (eg, nonrandomized methods of assignment, controlled before-after studies, and interrupted time series), and observational studies (eg, prospective or retrospective cohort studies, cross-sectional studies, case-control studies, and case reports). Our findings highlight the efficacy of second-generation antihistamines for the treatment of CSU in children and supports the use of omalizumab for more severe cases. However, our study also reveals severe knowledge gaps related to the best management strategy in children with more severe/refractory cases of CSU. Future studies are required to establish the beneficial effect of high doses of second-generation antihistamines as well as the effectiveness and safety of omalizumab and other biologics in young children.
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Affiliation(s)
- Moshe Ben-Shoshan
- Division of Allergy Immunology and Dermatology, Montreal Children's Hospital, Montreal, Quebec, Canada.
| | - Clive E Grattan
- St John's Institute of Dermatology, Guy's Hospital, London, United Kingdom
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Boonpiyathad T, Mitthamsiri W, Pradubpongsa P, Sangasapaviliya A. Urticaria Diagnosis. EUROPEAN MEDICAL JOURNAL 2018. [DOI: 10.33590/emj/10312091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Urticaria is a common skin condition that, though rarely fatal, can seriously impair a patient’s quality of life. Urticaria is caused by cutaneous mast cell activation and degranulation disease triggered by numerous stimuli. The condition is defined as chronic if it persists for >6 weeks. Self-remission is common in acute urticaria, but in chronic cases less than half of patients achieve remission within 1 year. Diagnosis is typically reached using the patient’s history along with a physical examination. Laboratory workup is based on clinical suspicion and is used to exclude underlying causes, although most cases constitute unknown or spontaneous causes. Extensive routine testing for an exogenous cause is not necessary and does not change the management. This review details the pathophysiology, aetiology, diagnosis, investigation, prognosis, differential diagnosis, and assessment of disease severity, highlighting the potential diagnosis of urticaria and enabling clinicians to make informed assessment decisions.
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Affiliation(s)
- Tadech Boonpiyathad
- Division of Allergy and Clinical Immunology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Wat Mitthamsiri
- Division of Allergy and Clinical Immunology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Panitan Pradubpongsa
- Division of Allergy and Clinical Immunology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Atik Sangasapaviliya
- Division of Allergy and Clinical Immunology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
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Epidemiology of urticaria in Poland - nationally representative survey results. Postepy Dermatol Alergol 2018; 35:67-73. [PMID: 29599674 PMCID: PMC5872247 DOI: 10.5114/ada.2018.73165] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 05/04/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction The prevalence of urticaria is 15–20%. Women are twice as likely to be affected. Aim To present the epidemiology of urticaria and angioedema in Poland. Material and methods A questionnaire-based survey was conducted on a representative group of 4,897 individuals, aged 15–74 years. Results A total of 11.2% of respondents reported at least one episode of urticaria symptoms in their life, and the frequency was higher in females (OR = 1.46; p < 0.001). Single episodes accounted for 34.8%, while repeated episodes accounted for 65.2%. Acute urticaria was observed in 10.6% (more frequent in females; OR = 1.41; p < 0.001), chronic in 0.6%. Median age of the first episode was 15 years. Angioedema was observed in 3.2%. The last episode of urticaria symptoms and/or angioedema occurred within the previous week in 0.7% of subjects, the last month in 1%, and the last year in 2.2%. 8.8% had experienced urticaria symptoms or angioedema over 1 year prior to the survey. The impact of urticaria symptoms on patients’ daily activities was rated with 3.8 points on a scale of 0–10. In addition, chronic urticaria was rated 6.5, and acute urticaria 3.6. Angioedema and urticaria had a negative impact of 5.7 points. Conclusions Urticaria and angioedema are serious health problems in Poland, although their prevalence is below the mean rate for the global population. Females are more likely to suffer from these diseases. People affected by urticaria most frequently report contact with plants and substances, insect bites/stings, and food as the provoking factors.
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Kim YS, Park SH, Han K, Bang CH, Lee JH, Park YM. Prevalence and incidence of chronic spontaneous urticaria in the entire Korean adult population. Br J Dermatol 2018; 178:976-977. [PMID: 29106703 DOI: 10.1111/bjd.16105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Y S Kim
- Department of Dermatology, Seoul St Mary's Hospital
| | - S H Park
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - K Han
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - C H Bang
- Department of Dermatology, Seoul St Mary's Hospital
| | - J H Lee
- Department of Dermatology, Seoul St Mary's Hospital
| | - Y M Park
- Department of Dermatology, Seoul St Mary's Hospital
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Choonhakarn C, Chaowattanapanit S, Julanon N. The treatment outcomes and dose de-escalation of desloratadine up-dosing in chronic spontaneous urticaria. Int J Dermatol 2018; 57:423-427. [DOI: 10.1111/ijd.13919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/13/2017] [Accepted: 01/01/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Charoen Choonhakarn
- Division of Dermatology; Department of Medicine; Faculty of Medicine; Srinagarind Hospital Medical School; Khon Kaen University; Khon Kaen Thailand
| | - Suteeraporn Chaowattanapanit
- Division of Dermatology; Department of Medicine; Faculty of Medicine; Srinagarind Hospital Medical School; Khon Kaen University; Khon Kaen Thailand
| | - Narachai Julanon
- Division of Dermatology; Department of Medicine; Faculty of Medicine; Srinagarind Hospital Medical School; Khon Kaen University; Khon Kaen Thailand
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Kim YS, Park SH, Han K, Lee JH, Kim NI, Roh JY, Seo SJ, Song HJ, Lee MG, Choi JH, Park YM. Clinical Course of Chronic Spontaneous Urticaria in the Korean Adult Population. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2018; 10:83-87. [PMID: 29178681 PMCID: PMC5705488 DOI: 10.4168/aair.2018.10.1.83] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/28/2017] [Accepted: 09/11/2017] [Indexed: 01/21/2023]
Abstract
Knowledge of the clinical course of chronic spontaneous urticaria (CSU) remains unclear. The purpose of our study was to investigate the clinical course of CSU in the Korean adult population. Each patient in the CSU group who was defined by disease codes between 2003 and 2007 was tracked whether he or she went into remission or not until 2013. Kaplan-Meier survival analysis was carried out to analyze remission, and log-rank tests were performed for between-group comparisons. Demographic differences between subjects who went into remission 1 year after the initial diagnosis and those who did not were analyzed using χ2 tests. A total of 13,969 subjects were included in the CSU group. The 1-, 2-, 3-, 4-, and 5-year remission rates of CSU were 21.5%, 33.0%, 38.9%, 42.6%, and 44.6%, respectively. The proportion of subjects in the 65+ age group (P=0.050) and with male gender (P=0.002) was significantly higher among subjects who did not go into remission 1 year after the initial diagnosis. Our study indicates that CSU could have a more persistent course than previously reported.
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Affiliation(s)
- Yoon Seob Kim
- Department of Dermatology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sang Hyun Park
- Department of Medical Statistics, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kyungdo Han
- Department of Medical Statistics, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ji Hyun Lee
- Department of Dermatology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Nack In Kim
- Department of Dermatology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Joo Young Roh
- Department of Dermatology, Gachon University Gil Medical Center, Incheon, Korea
| | - Seong Jun Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hae Jun Song
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Min Geol Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Ho Choi
- Department of Dermatology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young Min Park
- Department of Dermatology, The Catholic University of Korea College of Medicine, Seoul, Korea.
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Netchiporouk E, Sasseville D, Moreau L, Habel Y, Rahme E, Ben-Shoshan M. Evaluating Comorbidities, Natural History, and Predictors of Early Resolution in a Cohort of Children With Chronic Urticaria. JAMA Dermatol 2017; 153:1236-1242. [PMID: 28973060 DOI: 10.1001/jamadermatol.2017.3182] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Chronic urticaria (CU) affects 0.1% to 0.3% of children. Most cases have no identifiable trigger and are classified as chronic spontaneous urticaria (CSU). At least half of patients with CSU may have an autoimmune etiology that can be determined in vitro using the basophil activation test (BAT). While 30% to 55% of CU cases resolve spontaneously within 5 years in adults, the natural history and predictors of resolution in children are not known. Objective To assess the comorbidities, natural history of CU, and its subtypes in children and identify predictors of resolution. Design, Setting, and Participants We followed a pediatric cohort with chronic urticaria that presented with hives lasting at least 6 weeks between 2013 and 2015 at a single tertiary care referral center. Exposures Data were collected on disease activity, comorbidities, physical triggers, BAT results, complete blood cell count, C-reactive protein levels, thyroid-stimulating hormone levels, and thyroid peroxidase antibodies. Main Outcomes and Measures We assessed the rate of resolution (defined as absence of hives for at least 1 year with no treatment) and the association with clinical and laboratory markers. Results The cohort comprised 139 children younger than 18 years old. Thirty-one patients (20%) had inducible urticaria, most commonly cold induced. Six children had autoimmune comorbidity, such as thyroiditis and type 1 diabetes. Autoimmune disorders (24 patients [17%]) and CU (17 patients [12%]) were common in family members. Positive BAT results (CD63 levels > 1.8%) were found in 58% of patients. Patients with positive BAT results (CD63 level >1.8%) were twice as likely to resolve after 1 year compared with negative BAT results (hazard ratio [HR], 2.33; 95% CI, 1.08-5.05). In contrast, presence of basophils decreased the likelihood of resolution (HR, 0.40; 95% CI, 0.20-0.99). No correlation with age was found. Chronic urticaria resolved in 43 patients, with a rate of resolution of 10.3% per year. Levels of CD63 higher than 1.8% and absence of basophils were associated with earlier disease resolution. Conclusions and Relevance Resolution rate in children with CU is low. The presence of certain biomarkers (positive BAT result and basophil count) may help to predict the likelihood of resolution.
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Affiliation(s)
- Elena Netchiporouk
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Denis Sasseville
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Linda Moreau
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Youssef Habel
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Elham Rahme
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
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Maurer M, Abuzakouk M, Bérard F, Canonica W, Oude Elberink H, Giménez-Arnau A, Grattan C, Hollis K, Knulst A, Lacour JP, Lynde C, Marsland A, McBride D, Nakonechna A, Ortiz de Frutos J, Proctor C, Sussman G, Sweeney C, Tian H, Weller K, Wolin D, Balp MM. The burden of chronic spontaneous urticaria is substantial: Real-world evidence from ASSURE-CSU. Allergy 2017; 72:2005-2016. [PMID: 28543019 PMCID: PMC5724512 DOI: 10.1111/all.13209] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) can be debilitating, difficult to treat, and frustrating for patients and physicians. Real-world evidence for the burden of CSU is limited. The objective of this study was to document disease duration, treatment history, and disease activity, as well as impact on health-related quality of life (HRQoL) and work among patients with inadequately controlled CSU, and to describe its humanistic, societal, and economic burden. METHODS This international observational study assessed a cohort of 673 adult patients with CSU whose symptoms persisted for ≥12 months despite treatment. Demographics, disease characteristics, and healthcare resource use in the previous 12 months were collected from medical records. Patient-reported data on urticaria and angioedema symptoms, HRQoL, and work productivity and activity impairment were collected from a survey and a diary. RESULTS Almost 50% of patients had moderate-to-severe disease activity as reported by Urticaria Activity Score. Mean (SD) Dermatology Life Quality Index and Chronic Urticaria Quality of Life Questionnaire scores were 9.1 (6.62) and 33.6 (20.99), respectively. Chronic spontaneous urticaria markedly interfered with sleep and daily activities. Angioedema in the previous 12 months was reported by 66% of enrolled patients and significantly affected HRQoL. More than 20% of patients reported ≥1 hour per week of missed work; productivity impairment was 27%. These effects increased with increasing disease activity. Significant healthcare resources and costs were incurred to treat CSU. CONCLUSIONS Chronic spontaneous urticaria has considerable humanistic and economic impacts. Patients with greater disease activity and with angioedema experience greater HRQoL impairments.
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Affiliation(s)
- M. Maurer
- Charité - Universitätsmedizin Berlin; Berlin Germany
| | | | - F. Bérard
- Claude Bernard University Lyon; Lyon France
| | - W. Canonica
- IRCCS-Humanitas Research Hospital; Humanitas University; Rozzano-Milano Italy
| | | | | | | | - K. Hollis
- RTI Health Solutions; Research Triangle Park NC USA
| | - A. Knulst
- University Medical Center Utrecht; Utrecht The Netherlands
| | | | - C. Lynde
- Lynderm Research; Toronto ON Canada
| | - A. Marsland
- Salford Royal Hospital; University of Manchester; Salford UK
| | | | - A. Nakonechna
- Royal Liverpool and Broadgreen University Hospitals; Liverpool UK
| | | | - C. Proctor
- RTI Health Solutions; Research Triangle Park NC USA
| | - G. Sussman
- University of Toronto; Toronto ON Canada
| | - C. Sweeney
- RTI Health Solutions; Research Triangle Park NC USA
| | - H. Tian
- Novartis Pharmaceuticals Corporation; East Hanover NJ USA
| | - K. Weller
- Charité - Universitätsmedizin Berlin; Berlin Germany
| | - D. Wolin
- RTI Health Solutions; Research Triangle Park NC USA
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Kulthanan K, Tuchinda P, Likitwattananurak C, Weerasubpong P, Chularojanamontri L. Does omalizumab modify a course of recalcitrant chronic spontaneous urticaria?: A retrospective study in Asian patients. J Dermatol 2017; 45:17-23. [PMID: 29044681 DOI: 10.1111/1346-8138.14081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 09/03/2017] [Indexed: 11/28/2022]
Abstract
Omalizumab has been approved for the treatment of recalcitrant chronic spontaneous urticaria (CSU). However, it remains unanswered whether omalizumab modifies a CSU course. We aimed to study a course of CSU after omalizumab treatment in an Asian population. Medical records of recalcitrant CSU patients who attended Siriraj Hospital between 2013 and 2017 were reviewed. All patients receiving omalizumab treatment were followed after the first injection for at least 1 year. Of 15 patients receiving omalizumab treatment, 11 patients (73.3%) responded well to 150 mg while the rest required 300 mg. The median follow-up period was 18 months (range, 13.5-25.3). Three patterns of response were proposed and measured: excellent (disease remission over than 6 months) was found in 20%; good (injection interval extended longer than 6 months) was found in 27%; and modest (frequently required injections) was found in 53%. The mean duration of complete remission was 33 weeks (range, 26-38). Two-thirds of patients had disease relapse and required omalizumab injections to control symptoms. The other third did not show relapses for at least 69 weeks of the follow-up period. After 1 year of treatment, Kaplan-Meier curves estimated that a higher percentage (86.7%) of recalcitrant CSU patients receiving omalizumab treatment would be free of symptoms (weekly Urticaria Activity Score = 0) without prednisolone and/or cyclosporin as compared with 42% of patients not receiving omalizumab treatment. In conclusion, patients seem to be easily and safely manageable with omalizumab. Prednisolone and cyclosporin could be discontinued in all patients. Further studies are needed to conclude whether omalizumab can exactly modify CSU.
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Affiliation(s)
- Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Papapit Tuchinda
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Puncharas Weerasubpong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Autoimmune comorbidity in chronic spontaneous urticaria: A systematic review. Autoimmun Rev 2017; 16:1196-1208. [PMID: 29037900 DOI: 10.1016/j.autrev.2017.10.003] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 08/05/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Numerous autoimmune diseases (AIDs) have been linked to chronic spontaneous urticaria (CSU). Here, we provide the first extensive and comprehensive evaluation of the prevalence of AIDs in patients with CSU and vice versa. METHODS A Pubmed and Google Scholar search was performed to identify studies reporting the prevalence of various AIDs in CSU and vice versa published before April 2017. RESULTS The prevalence of individual AIDs in CSU is increased (≥1% in most studies vs ≤1% in the general population). AIDs with relatively high prevalence in the general population are also quite common in CSU patients, whereas those with low prevalence remain a rare finding in CSU. The rates of comorbidity in most studies were ≥1% for insulin-dependent diabetes mellitus, rheumatoid arthritis (RA), psoriasis and celiac disease (CD), ≥2% for Graves' disease, ≥3% for vitiligo, and ≥5% for pernicious anemia and Hashimoto's thyroiditis. Organ-specific AIDs are more prevalent in CSU than systemic (multiorgan or non organ-specific) AIDs. >2% of CSU patients have autoimmune polyglandular syndromes encompassing autoimmune thyroid disease (ATD) and vitiligo or pernicious anemia. Antithyroid and antinuclear antibodies are the most prevalent AID-associated autoantibodies in CSU. >15% of CSU patients have a positive family history for AIDs. The prevalence of urticarial rash in AID patients is >1% in most studies. This rash is more prevalent in eosinophilic granulomatosis with polyangiitis, ATD, systemic lupus erythematosus, RA and CD. CONCLUSIONS CSU patients have an increased risk of AIDs, especially adult female patients and those with a positive family history and a genetic predisposition for AIDs, who should be screened for signs and symptoms of AIDs.
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