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Zuberbier T, Peter J, Staubach P, Chularojanamontri L, Kulthanan K. Potential Therapeutic Approaches for Chronic Urticaria: Beyond H1-Antihistamines and Biologics. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2265-2273. [PMID: 37356753 DOI: 10.1016/j.jaip.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/31/2023] [Accepted: 06/14/2023] [Indexed: 06/27/2023]
Abstract
Chronic urticaria is a disease that can significantly impact a patient's quality of life and ability to function. There are effective treatment options, such as nonsedating antihistamines or biologics, but some patients do not respond to these therapies, or the therapies are not available or affordable to all patients. This review aims to summarize potential treatment strategies for patients (1) who do not respond to antihistamines and (2) cannot readily access or do not respond to biologics. The review emphasizes the importance of sound clinical practice, including correct diagnosis of chronic urticaria phenotypes, treatment of associated comorbidities, and consideration of add-on pharmacological and nonpharmacological approaches. Although some treatments may lack high-quality evidence, they may still be justifiable in certain cases, provided that there is shared decision-making, regular reassessment, and early recognition of adverse events.
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Affiliation(s)
- Torsten Zuberbier
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany.
| | - Jonny Peter
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Petra Staubach
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Zuberbier T, Altrichter S, Bauer S, Brehler R, Brockow K, Dressler C, Fluhr J, Gaskins M, Hamelmann E, Kühne K, Merk H, Mülleneisen NK, Nast A, Olze H, Ott H, Pleimes M, Ruëff F, Staubach-Renz P, Wedi B, Maurer M. S3 Guideline Urticaria. Part 2: Treatment of urticaria - German-language adaptation of the international S3 guideline. J Dtsch Dermatol Ges 2023; 21:202-215. [PMID: 36730626 DOI: 10.1111/ddg.14932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/12/2022] [Indexed: 02/04/2023]
Abstract
This publication is the second part of the German-language S3 guideline on urticaria. It covers the management of urticaria and should be used together with Part 1 of the guideline on classification and diagnosis. This publication was prepared according to the criteria of the AWMF on the basis of the international English-language S3 guideline with special consideration of health system conditions in German-speaking countries. Chronic urticaria has a high impact on the quality of life and daily activities of patients. Therefore, if causal factors cannot be eliminated, effective symptomatic treatment is necessary. The recommended first-line treatment is to administer new generation, non-sedating H1 antihistamines. If the standard dose is not sufficiently effective, the dose should be increased up to fourfold. For patients who do not respond to this treatment, the second-line treatment in addition to antihistamines in the treatment algorithm is omalizumab and, if this treatment fails, ciclosporin. Other low-evidence therapeutic agents should only be used if all treatments in the treatment algorithm agreed upon by the guideline group fail. Both the benefit-risk profile and cost should be considered. Corticosteroids are not recommended for long-term treatment due to their inevitable severe side effects.
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Affiliation(s)
- Torsten Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Sabine Altrichter
- University Hospital for Dermatology und Venereology, Comprehensive Allergy Center, Kepler University Hospital, Linz, Austria
| | | | - Randolf Brehler
- Center for Skin Diseases, University Hospital Münster, Department of Dermatology, Münster, Germany
| | - Knut Brockow
- Department and Clinic for Dermatology und Allergology am Biederstein, Technical University of Munich, Munich, Germany
| | - Corinna Dressler
- Division of Evidence-Based Medicine, Department for Dermatology, Venereology und Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Joachim Fluhr
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Matthew Gaskins
- Division of Evidence-Based Medicine, Department for Dermatology, Venereology und Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Eckard Hamelmann
- Department for Pediatric and Adolescent Medinine, Evangelisches Klinikum Bethel, University Hospital OWL, University of Bielefeld, Bielefeld, Germany
| | | | - Hans Merk
- Department for Dermatology und Allergology, University Hospital RTWH Aachen, Aachen, Germany
| | | | - Alexander Nast
- Division of Evidence-Based Medicine, Department for Dermatology, Venereology und Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Heidi Olze
- Department of Ear, Nose and Throat Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Hagen Ott
- Hospital for Pediatric and Adolescent Medicine Auf der Bult, Hannover, Germany
| | - Marc Pleimes
- Practice for Pediatric and Adolescent Dermatology, Heidelberg, Germany
| | - Franziska Ruëff
- Department and Clinic for Dermatology und Allergology, LMU Hospital at the University of Munich, Munich, Germany
| | - Petra Staubach-Renz
- Department and Clinic for Skin Diseases, University Hospital at Johannes Gut, enberg University Mainz, Mainz, Germany
| | - Bettina Wedi
- Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
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Zuberbier T, Altrichter S, Bauer S, Brehler R, Brockow K, Dressler C, Fluhr J, Gaskins M, Hamelmann E, Kühne K, Merk H, Mülleneisen NK, Nast A, Olze H, Ott H, Pleimes M, Ruëff F, Staubach-Renz P, Wedi B, Maurer M. S3-Leitlinie Urtikaria. Teil 2: Therapie der Urtikaria - deutschsprachige Adaption der internationalen S3-Leitlinie. J Dtsch Dermatol Ges 2023; 21:202-216. [PMID: 36808444 DOI: 10.1111/ddg.14932_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/12/2022] [Indexed: 02/22/2023]
Affiliation(s)
- Torsten Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Sabine Altrichter
- Universitätsklinik für Dermatologie und Venerologie, Comprehensive Allergy Center, Kepler Universitätsklinikum, Linz, Österreich
| | | | - Randolf Brehler
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Abteilung Dermatologie, Münster, Deutschland
| | - Knut Brockow
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, München, Deutschland
| | - Corinna Dressler
- Division of Evidence-Based Medicine, Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Deutschland
| | - Joachim Fluhr
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Matthew Gaskins
- Division of Evidence-Based Medicine, Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Deutschland
| | - Eckard Hamelmann
- Klinik für Kinder- und Jugendmedizin, Evangelisches Klinikum Bethel, Universitätsklinikum OWL, Universität Bielefeld, Bielefeld, Deutschland
| | | | - Hans Merk
- Klinik für Dermatologie und Allergologie, Universitätsklinik RTWH Aachen, Aachen, Deutschland
| | | | - Alexander Nast
- Division of Evidence-Based Medicine, Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Deutschland
| | - Heidi Olze
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Deutschland
| | - Hagen Ott
- Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Deutschland
| | - Marc Pleimes
- Praxis für Kinder- und Jugenddermatologie, Heidelberg, Deutschland
| | - Franziska Ruëff
- Klinik und Poliklinik für Dermatologie und Allergologie, LMU Klinikum der Universität München, München, Deutschland
| | - Petra Staubach-Renz
- Hautklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Bettina Wedi
- Klinik für Dermatologie, Allergologie und Venerologie, Comprehensive Allergy Center (CAC), Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
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4
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Zuberbier T, Abdul Latiff AH, Abuzakouk M, Aquilina S, Asero R, Baker D, Ballmer‐Weber B, Bangert C, Ben‐Shoshan M, Bernstein JA, Bindslev‐Jensen C, Brockow K, Brzoza Z, Chong Neto HJ, Church MK, Criado PR, Danilycheva IV, Dressler C, Ensina LF, Fonacier L, Gaskins M, Gáspár K, Gelincik A, Giménez‐Arnau A, Godse K, Gonçalo M, Grattan C, Grosber M, Hamelmann E, Hébert J, Hide M, Kaplan A, Kapp A, Kessel A, Kocatürk E, Kulthanan K, Larenas‐Linnemann D, Lauerma A, Leslie TA, Magerl M, Makris M, Meshkova RY, Metz M, Micallef D, Mortz CG, Nast A, Oude‐Elberink H, Pawankar R, Pigatto PD, Ratti Sisa H, Rojo Gutiérrez MI, Saini SS, Schmid‐Grendelmeier P, Sekerel BE, Siebenhaar F, Siiskonen H, Soria A, Staubach‐Renz P, Stingeni L, Sussman G, Szegedi A, Thomsen SF, Vadasz Z, Vestergaard C, Wedi B, Zhao Z, Maurer M. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy 2022; 77:734-766. [PMID: 34536239 DOI: 10.1111/all.15090] [Citation(s) in RCA: 409] [Impact Index Per Article: 204.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 02/07/2023]
Abstract
This update and revision of the international guideline for urticaria was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the Global Allergy and Asthma European Network (GA²LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), the European Dermatology Forum (EDF; EuroGuiDerm), and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology with the participation of 64 delegates of 50 national and international societies and from 31 countries. The consensus conference was held on 3 December 2020. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease that presents with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous or inducible urticaria is disabling, impairs quality of life, and affects performance at work and school. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
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Affiliation(s)
- Torsten Zuberbier
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | | | - Mohamed Abuzakouk
- Department of Allergy and Immunology Respiratory InstituteCleveland Clinic Abu Dhabi Abu Dhabi United Arab Emirates
| | - Susan Aquilina
- Department of Dermatology Mater Dei Hospital Msida Malta
| | - Riccardo Asero
- Ambulatorio di Allergologia Clinica San Carlo Paderno Dugnano (MI) Italy
| | - Diane Baker
- Baker Allergy Asthma and Dermatology Portland Oregon USA
| | - Barbara Ballmer‐Weber
- Clinic for Dermatology and Allergology Kantonsspital St. Gallen St. Gallen Switzerland
- Department of Dermatology University Hospital Zurich Zurich Switzerland
| | - Christine Bangert
- Department of Dermatology Medical University of Vienna Vienna Austria
| | - Moshe Ben‐Shoshan
- Division of Allergy, Immunology and Dermatology Department of Pediatrics Montreal Children’s Hospital McGill University Montreal Quebec Canada
| | | | - Carsten Bindslev‐Jensen
- Department of Dermatology and Allergy Centre Odense University Hospital and University of Southern Denmark Odense Denmark
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein Faculty of Medicine Technical University Munich Munich Germany
| | - Zenon Brzoza
- Department of Internal Diseases with Division of Allergology University of Opole Opole Poland
| | - Herberto Jose Chong Neto
- Division of Allergy and Immunology Department of Pediatrics Federal University of Paraná Curitiba Brazil
| | - Martin K. Church
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- University of Southampton Southampton UK
| | - Paulo R. Criado
- Sociedade Brasileira de Dermatologia (SBD) Centro Universitário FMABCAlergoskin (UCARE) Santo André Brazil
| | - Inna V. Danilycheva
- Department of Allergology and Immunotherapy National Research Center‐Institute of Immunology Federal Medical‐Biological Agency of Russia Moscow Russia
| | - Corinna Dressler
- Division of Evidence‐Based Medicine Department of Dermatology, Venereology and Allergy Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Luis Felipe Ensina
- Division of Allergy Clinical Immunology and Rheumatology Department of Pediatrics Federal University of São Paulo São Paulo Brazil
| | - Luz Fonacier
- New York University Long Island School of Medicine New York New York USA
| | - Matthew Gaskins
- Division of Evidence‐Based Medicine Department of Dermatology, Venereology and Allergy Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Krisztian Gáspár
- Division of Dermatological Allergology Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - Aslı Gelincik
- Division of Immunology and Allergic Diseases Department of Internal Medicine Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
| | - Ana Giménez‐Arnau
- Department of Dermatology, Hospital del Mar Institut Mar d’Investigacions Mèdiques Universitat Autònoma y Universitat Pompeu Fabra Barcelona Spain
| | - Kiran Godse
- Department of Dermatology D Y Patil University School of MedicineNavi Mumbai India
| | - Margarida Gonçalo
- Department of Dermatology Coimbra University Hospital and Faculty of Medicine University of Coimbra Coimbra Portugal
| | - Clive Grattan
- Guy’s HospitalSt John’s Institute of Dermatology London UK
| | - Martine Grosber
- Department of Dermatology Universitair Ziekenhuis Brussel (UZ Brussel)Vrije Universiteit Brussel (VUB) Brussels Belgium
| | - Eckard Hamelmann
- Department of Pediatrics Children’s Center Bethel University Hospital OWLUniversity Bielefeld Bielefeld Germany
| | - Jacques Hébert
- Service d'allergie Centre Hospitalier Université Laval/Centre Hospitalier Universitaire de Québec Québec Quebec Canada
| | - Michihiro Hide
- Department of Dermatology Hiroshima University Hiroshima Japan
- Department of Dermatology Hiroshima Citizens Hospital Hiroshima Japan
| | - Allen Kaplan
- Department of Medicine Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology Medical University of South Carolina Charleston South Carolina USA
| | - Alexander Kapp
- Department of Dermatology & Allergy Hannover Medical School (MHH) Hannover Germany
| | - Aharon Kessel
- Division of Allergy and Clinical Immunology Bnai Zion Medical Center and the Bruce and Ruth Rappaport Faculty of Medicine Technion Haifa Israel
| | - Emek Kocatürk
- Department of Dermatology Koç University School of Medicine Istanbul Turkey
| | - Kanokvalai Kulthanan
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | | | - Antti Lauerma
- Department of Dermatology, Allergology and Venereology Inflammation Centre University of Helsinki and Helsinki University Hospital Helsinki Finland
| | | | - Markus Magerl
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology Berlin Germany
| | - Michael Makris
- Allergy Unit 2nd Department of Dermatology and Venereology National and Kapodistrian University of AthensUniversity General Hospital "Attikon" Athens Greece
| | - Raisa Y. Meshkova
- Department of Clinical Immunology and Allergology Smolensk State Medical University Smolensk Russia
| | - Martin Metz
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology Berlin Germany
| | | | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre Odense Research Center for Anaphylaxis (ORCA) Odense University Hospital and University of Southern Denmark Odense Denmark
| | - Alexander Nast
- Division of Evidence‐Based Medicine Department of Dermatology, Venereology and Allergy Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | | | - Ruby Pawankar
- Department of Pediatrics Nippon Medical School Tokyo Japan
| | - Paolo D. Pigatto
- Department of Biomedical Surgical and Dental Sciences University of Milan Milan Italy
| | - Hector Ratti Sisa
- Primera Cátedra de Clínica Médica Hospital de Clínicas de la Facultad de Ciencias Médicas‐Universidad Nacional de Asunción Asunción Paraguay
| | | | | | | | - Bulent E. Sekerel
- Division of Pediatric Allergy and Asthma Hacettepe University Faculty of Medicine Ankara Turkey
| | - Frank Siebenhaar
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology Berlin Germany
| | - Hanna Siiskonen
- Department of Pathology Diagnostic Imaging Centre Kuopio University Hospital Kuopio Finland
| | - Angele Soria
- Department of Dermatology and Allergology Tenon Hospital APHP Sorbonne University and Cimi‐Paris Inserm 1135 Paris France
| | | | - Luca Stingeni
- Dermatology Section Department of Medicine University of Perugia Perugia Italy
| | - Gordon Sussman
- Division of Allergy and Clinical Immunology St. Michael's Hospital and University of Toronto Toronto Canada
| | - Andrea Szegedi
- Division of Dermatological Allergology Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - Simon Francis Thomsen
- Department of Dermatology Bispebjerg Hospital University of Copenhagen Copenhagen Denmark
| | - Zahava Vadasz
- Proteomic and Clinical Flow Cytometry Unit Bnai Zion Medical Center Rappaport Faculty of Medicine Technion Haifa Israel
| | | | - Bettina Wedi
- Department of Dermatology and Allergy Comprehensive Allergy Center Hannover Medical School Hannover Germany
| | - Zuotao Zhao
- Department of Dermatology and Venereology Peking University First Hospital Beijing China
| | - Marcus Maurer
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology Berlin Germany
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Dastoli S, Nisticò SP, Morrone P, Patruno C, Leo A, Citraro R, Gallelli L, Russo E, De Sarro G, Bennardo L. Colchicine in Managing Skin Conditions: A Systematic Review. Pharmaceutics 2022; 14:pharmaceutics14020294. [PMID: 35214027 PMCID: PMC8878049 DOI: 10.3390/pharmaceutics14020294] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 12/13/2022] Open
Abstract
(1) Background: Colchicine is a natural alkaloid with anti-inflammatory properties used to treat various disorders, including some skin diseases. This paper aims to incorporate all the available studies proposing colchicine as a treatment alternative in the management of cutaneous conditions. (2) Methods: In this systematic review, the available articles present in various databases (PubMed, Scopus-Embase, and Web of Science), proposing colchicine as a treatment for cutaneous pathological conditions, have been selected. Exclusion criteria included a non-English language and non-human studies. (3) Results: Ninety-six studies were included. Most of them were case reports and case series studies describing colchicine as single therapy, or in combination with other drugs. Hidradenitis suppurativa, pyoderma gangrenosum, erythema nodosum, erythema induratum, storage diseases, perforating dermatosis, bullous diseases, psoriasis, vasculitis, acne, urticaria, stomatitis, actinic keratosis, and pustular dermatosis were the main diseases discussed in literature. Although the therapeutic outcomes were variable, most of the studies reported, on average, good clinical results (4) Conclusions: Colchicine could be, as a single therapy or in combination with other drugs, a possible treatment to manage several skin diseases.
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Affiliation(s)
- Stefano Dastoli
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Steven Paul Nisticò
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | | | - Cataldo Patruno
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Antonio Leo
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Rita Citraro
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Luca Gallelli
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Emilio Russo
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Giovambattista De Sarro
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Luigi Bennardo
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
- Azienda Ospedaliera di Cosenza, 87100 Cosenza, Italy;
- Correspondence: ; Tel.: +39-09-613627195
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6
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Saylam Kurtipek G, Zekey E, Tuncez Akyurek F. Successful treatment of delayed pressure urticaria with 300 mg of omalizumab every 14 days. J Cosmet Dermatol 2020; 20:1897-1899. [PMID: 33103846 DOI: 10.1111/jocd.13764] [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: 08/19/2020] [Accepted: 09/25/2020] [Indexed: 11/29/2022]
Abstract
Delayed pressure urticaria is a rare form of chronic inducible urticaria characterized by erythematous-painful plaques that develop in areas of the skin exposed to prolonged pressure. Its treatment is very difficult, and its response to antihistamines is variable. Cases of delayed pressure urticaria, which have been completely controlled with the use of omalizumab in recent years, have been reported.
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Affiliation(s)
| | - Emre Zekey
- Department of Dermatoloji, Selcuk University Faculty of Medicine, Konya, Turkey
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Kulthanan K, Ungprasert P, Tuchinda P, Chularojanamontri L, Charoenpipatsin N, Maurer M. Delayed Pressure Urticaria: A Systematic Review of Treatment Options. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2035-2049.e5. [PMID: 32179196 DOI: 10.1016/j.jaip.2020.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/10/2020] [Accepted: 03/03/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Delayed pressure urticaria (DPU) is characterized by recurrent erythematous and often painful swelling after the skin is exposed to sustained pressure. Treatment is challenging. Antihistamines, the first-line and only approved treatment, are often not effective. OBJECTIVE To systematically review the treatment options for DPU. METHOD A literature search of electronic databases for all relevant articles published till April 29, 2019, was conducted using the search terms "delayed pressure urticaria" and "pressure urticaria." This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. RESULTS Twenty-one studies (8 randomized controlled trials [RCTs], 10 retrospective cohort studies, and 3 open-label prospective studies) were included. Second-generation H1 antihistamines (sgAHs) were effective in 3 RCTs. The combination of an sgAH and montelukast (2 RCTs) or an sgAH and theophylline (1 non-RCT) was more effective than the sgAH alone. The disease improved with omalizumab (4 non-RCTs), sulphones (3 non-RCTs), oral prednisolone (1 RCT and 2 non-RCTs), intravenous immunoglobulin (1 non-RCT), and gluten-free diet (1 non-RCT). There are no studies on updosing of antihistamines over standard dosage in DPU. CONCLUSIONS Overall, the quality of studies on DPU is low. Because of the lack of other evidence, antihistamines remain the first-line therapy. Updosing of sgAHs could be considered in patients with uncontrolled symptoms on the basis of the extrapolation of evidence from chronic spontaneous urticaria, even though there is no evidence of its efficacy over standard dosage. Addition of montelukast may be considered. Omalizumab or sulphones may be used in treatment-resistant patients. High-quality DPU studies should be conducted.
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Affiliation(s)
- Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patompong Ungprasert
- Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Papapit Tuchinda
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Norramon Charoenpipatsin
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Maurer M, Fluhr JW, Khan DA. How to Approach Chronic Inducible Urticaria. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 6:1119-1130. [PMID: 30033913 DOI: 10.1016/j.jaip.2018.03.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 12/22/2022]
Abstract
Chronic inducible urticaria (CIndU) is a group of chronic urticarias characterized by the appearance of recurrent wheals, recurrent angioedema or both, as a response to specific triggers. CIndU includes both physical (symptomatic dermographism, cold and heat urticaria, delayed pressure urticaria, solar urticaria, and vibratory urticaria) and nonphysical urticarias (cholinergic urticaria, contact and aquagenic urticaria). Here, we review the different forms of CIndU with an emphasis on symptomatic dermographism, cold urticaria, cholinergic urticaria, and delayed pressure urticaria. We discuss the clinical features, the diagnostic workup including provocation and threshold testing, and available treatment options.
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Affiliation(s)
- Marcus Maurer
- Department of Dermatology and Allergy, Charité - Universitätsmedizin, Berlin, Germany.
| | - Joachim W Fluhr
- Department of Dermatology and Allergy, Charité - Universitätsmedizin, Berlin, Germany
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
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Antia C, Baquerizo K, Korman A, Alikhan A, Bernstein JA. Urticaria: A comprehensive review: Treatment of chronic urticaria, special populations, and disease outcomes. J Am Acad Dermatol 2019; 79:617-633. [PMID: 30241624 DOI: 10.1016/j.jaad.2018.01.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Second-generation antihistamines are considered first-line agents in the treatment of chronic urticaria because of their safety and efficacy profile. Some patients require higher doses of H1 antihistamines alone or in combination with other classes of medications, including H2 antihistamines, leukotriene receptor antagonists, or first-generation H1 antihistamines. One major therapeutic advance has been omalizumab, a humanized monoclonal anti-immunoglobulin E that was recently approved by the US Food and Drug Administration for the treatment of chronic urticaria that is unresponsive to H1 antagonists. In addition, the second article in this continuing medical education series outlines several evidence-based alternative treatments for urticaria and the differences in recommendations between 2 major consensus groups (the European Academy of Allergy and Clinical Immunology/World Allergy Organization and the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force).
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Affiliation(s)
- Camila Antia
- Department of Dermatology, University of Cincinnati, Cincinnati, Ohio.
| | | | - Abraham Korman
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Ali Alikhan
- Department of Dermatology, University of Cincinnati, Cincinnati, Ohio
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Zuberbier T, Aberer W, Asero R, Latiff AHA, Baker D, Ballmer-Weber B, Bernstein JA, Bindslev-Jensen C, Brzoza Z, Bedrikow RB, Canonica GW, Church MK, Craig T, Danilycheva IV, Dressler C, Ensina LF, Giménez-Arnau A, Godse K, Goncalo M, Grattan C, Hebert J, Hide M, Kaplan A, Kapp A, Katelaris CH, Kocatürk E, Kulthanan K, Larenas-Linnemann D, Leslie TA, Magerl M, Mathelier-Fusade P, Meshkova RY, Metz M, Nast A, Nettis E, Oude-Elberink H, Rosumeck S, Saini SS, Sánchez-Borges M, Schmid-Grendelmeier P, Staubach P, Sussman G, Toubi E, Vena GA, Vestergaard C, Wedi B, Werner RN, Zhao Z, Maurer M, Brehler R, Brockow K, Fluhr J, Grabbe J, Hamelmann E, Hartmann K, Jakob T, Merk H, Ollert M, Ott H, Reese I, Rueff F, Werfel T. EAACI/GA2LEN/EDF/WAO-Leitlinie für die Definition, Klassifikation, Diagnose und das Management der Urtikaria — konsentierte, deutschsprachige Übersetzung. ALLERGO JOURNAL 2018. [DOI: 10.1007/s15007-018-1751-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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11
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Urticaria, Urticarial Vasculitis, Angioedema, and Related Diseases. CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0223-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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12
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Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer-Weber B, Bernstein JA, Bindslev-Jensen C, Brzoza Z, Buense Bedrikow R, Canonica GW, Church MK, Craig T, Danilycheva IV, Dressler C, Ensina LF, Giménez-Arnau A, Godse K, Gonçalo M, Grattan C, Hebert J, Hide M, Kaplan A, Kapp A, Katelaris CH, Kocatürk E, Kulthanan K, Larenas-Linnemann D, Leslie TA, Magerl M, Mathelier-Fusade P, Meshkova RY, Metz M, Nast A, Nettis E, Oude-Elberink H, Rosumeck S, Saini SS, Sánchez-Borges M, Schmid-Grendelmeier P, Staubach P, Sussman G, Toubi E, Vena GA, Vestergaard C, Wedi B, Werner RN, Zhao Z, Maurer M. The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy 2018; 73:1393-1414. [PMID: 29336054 DOI: 10.1111/all.13397] [Citation(s) in RCA: 795] [Impact Index Per Article: 132.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2017] [Indexed: 02/06/2023]
Abstract
This evidence- and consensus-based guideline was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. The conference was held on 1 December 2016. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-founded network of excellence, the Global Allergy and Asthma European Network (GA²LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO) with the participation of 48 delegates of 42 national and international societies. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria are disabling, impair quality of life and affect performance at work and school. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
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Affiliation(s)
- T. Zuberbier
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
| | - W. Aberer
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - R. Asero
- Department of Allergology; Clinica San Carlo; Paderno Dugnano MI Italy
| | - A. H. Abdul Latiff
- Allergy& Immunology Centre; Pantai Hospital Kuala Lumpur; Kuala Lumpur Malaysia
| | - D. Baker
- Baker Allergy Asthma and Dermatology Clinic; Portland OR USA
| | - B. Ballmer-Weber
- Allergy Unit; Department of Dermatology; University Hospital; Zürich Switzerland
| | - J. A. Bernstein
- University of Cincinnati Physicians Immunology Research Center; Cincinnati OH USA
| | - C. Bindslev-Jensen
- Department of Dermatology and Allergy Centre; Odense University Hospital and University of Southern Denmark; Odense Denmark
| | - Z. Brzoza
- Department of Internal Diseases, Allergology and Clinical Immunology in Katowice; Medical University of Silesia; Katowice Poland
| | | | - G. W. Canonica
- Personalized Medicine Asthma and Allergy Clinic-Humanitas University & Research Hospital; Milano Italy
| | - M. K. Church
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
| | - T. Craig
- Department of Medicine and Pediatrics; Penn State University; Hershey Medical Center; Hershey PA USA
| | - I. V. Danilycheva
- National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia; Moscow Russia
| | - C. Dressler
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Division of Evidence Based Medicine; Department of Dermatology; Berlin Germany
| | - L. F. Ensina
- Federal University of Sao Paulo; Sao Paulo Brazil
| | - A. Giménez-Arnau
- Hospital del Mar; IMIM; Universitat Autònoma Barcelona; Barcelona Spain
| | - K. Godse
- Department of Dermatology; Dr. D. Y. Patil Medical College & Hospital; Nerul Navi Mumbai India
| | - M. Gonçalo
- Clinic of Dermatology; Faculty of Medicine and University Hospital; Coimbra Portugal
| | - C. Grattan
- St John's’ Institute of Dermatology; Guy's’ and St. Thomas’ Hospital; NHS Foundation Trust; London UK
| | - J. Hebert
- Service d'allergie; Centre Hospitalier Université Laval/Centre Hospitalier Universitaire de Québec; Québec QC Canada
| | - M. Hide
- Department of Dermatology; Institute of Biomedical and Health Sciences; Hiroshima University; Hiroshima Japan
| | - A. Kaplan
- Department of Medicine; Division of Pulmonary and Critical Care Medicine; Allergy and Clinical Immunology; Medical University of South Carolina; Charleston SC USA
| | - A. Kapp
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - C. H. Katelaris
- Campbelltown Hospital and Western Sydney University; Sydney Australia
| | - E. Kocatürk
- Department of Dermatology; Okmeydani Training and Research Hospital; Istanbul Turkey
| | - K. Kulthanan
- Department of Dermatology; Faculty of Medicine Siriraj Hospital; Mahidol University; Bangkok Thailand
| | | | | | - M. Magerl
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
| | - P. Mathelier-Fusade
- Department of Dermatology and Allergy; University Hospital of Tenon; Paris France
| | - R. Y. Meshkova
- Department of Clinical Immunology and Allergy; Smolensk State Medical University; Smolensk Russia
| | - M. Metz
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
| | - A. Nast
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Division of Evidence Based Medicine; Department of Dermatology; Berlin Germany
| | - E. Nettis
- Scuola e Cattedra di Allergologia e Immunologia Clinica; Dipartimento dell'Emergenza e dei Trapianti d'Organo; Università di Bari; Bari Italy
| | | | - S. Rosumeck
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Division of Evidence Based Medicine; Department of Dermatology; Berlin Germany
| | - S. S. Saini
- Johns Hopkins Asthma and Allergy Center; Baltimore MD USA
| | - M. Sánchez-Borges
- Allergy and Clinical Immunology Department; Centro Médico-Docente La Trinidad; Caracas Venezuela
| | | | - P. Staubach
- Department of Dermatology; University Medical Center Mainz; Mainz Germany
| | - G. Sussman
- Division of Allergy and Clinical Immunology; University of Toronto; Toronto ON Canada
| | - E. Toubi
- Bnai-Zion Medical Center; Faculty of Medicine; Technion Haifa Israel
| | - G. A. Vena
- Dermatology and Venereology Private Practice; Bari and Barletta Italy
| | - C. Vestergaard
- Department of Dermatology and Venereology; Aarhus University Hospital; Aarhus Denmark
| | - B. Wedi
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - R. N. Werner
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Division of Evidence Based Medicine; Department of Dermatology; Berlin Germany
| | - Z. Zhao
- Department of Dermatology and Venereology; Peking University; First Hospital; Beijing China
| | - M. Maurer
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
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13
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Robinson KP, Chan JJ. Colchicine in dermatology: A review. Australas J Dermatol 2018; 59:278-285. [PMID: 29430631 DOI: 10.1111/ajd.12795] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/23/2017] [Indexed: 01/14/2023]
Abstract
Colchicine is an anti-inflammatory agent that has been used for decades for the treatment of various diseases including gout, familial Mediterranean fever and pericarditis and in recent years for dermatological indications including chronic urticaria, cutaneous vasculitis and psoriasis. Despite its efficacy in various cutaneous diseases, the use of colchicine may be limited by concerns over its side-effects and the potential for toxicity. This article reviews the current literature on the pharmacology of colchicine and its clinical applications in dermatology.
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Affiliation(s)
| | - Jonathan J Chan
- Department of Dermatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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Dressler C, Werner RN, Eisert L, Zuberbier T, Nast A, Maurer M. Chronic inducible urticaria: A systematic review of treatment options. J Allergy Clin Immunol 2018; 141:1726-1734. [PMID: 29438771 DOI: 10.1016/j.jaci.2018.01.031] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/11/2018] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chronic inducible urticaria (CindU) is a condition characterized by the appearance of recurrent wheals, angioedema, or both as a response to specific and reproducible triggers. OBJECTIVE We sought to systematically assess evidence on the efficacy and safety of treatment options for CindU. Results were used to inform the 2017 update of "The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria." METHODS Randomized controlled trials and controlled intervention studies were searched systematically in various databases. Included studies were evaluated with the Cochrane Risk of Bias tool. Where possible, results from single studies were meta-analyzed, applying the Mantel-Haenszel approach by using a random-effects model (Der Simonian-Laird). RESULTS We identified 30 studies that included patients with cold urticaria, symptomatic dermographism, delayed-pressure urticaria, or cholinergic urticaria. No studies on other forms of CindU were eligible. Risk of bias was often rated as unclear or high. Overall, second-generation antihistamines were more effective than placebo, and available data indicate that updosing might be effective. Omalizumab proved effective in patients with symptomatic dermographism, who did not respond to antihistamines. Detailed results are given for each type of CindU. CONCLUSIONS The available evidence is limited by small samples, heterogeneous efficacy outcomes, and poor reporting quality in many of the included studies. The findings are congruent with the suggested stepwise approach to treating CindUs. However, the data do not allow for drawing specific conclusions for specific subtypes of CindU.
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Affiliation(s)
- Corinna Dressler
- Department of Dermatology, Venerology and Allergy, Division of Evidence based Medicine (dEBM), Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ricardo Niklas Werner
- Department of Dermatology, Venerology and Allergy, Division of Evidence based Medicine (dEBM), Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Lisa Eisert
- Department of Dermatology, Venerology and Allergy, Division of Evidence based Medicine (dEBM), Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Torsten Zuberbier
- Department of Dermatology, Venerology and Allergy, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alexander Nast
- Department of Dermatology, Venerology and Allergy, Division of Evidence based Medicine (dEBM), Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marcus Maurer
- Department of Dermatology, Venerology and Allergy, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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Holm JG, Ivyanskiy I, Thomsen SF. Use of nonbiologic treatments in antihistamine-refractory chronic urticaria: a review of published evidence. J DERMATOL TREAT 2017; 29:80-97. [DOI: 10.1080/09546634.2017.1329505] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | - Ilya Ivyanskiy
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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16
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Greiwe J, Bernstein JA. Therapy of antihistamine-resistant chronic spontaneous urticaria. Expert Rev Clin Immunol 2016; 13:311-318. [PMID: 27744711 DOI: 10.1080/1744666x.2017.1249467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Chronic urticaria affects up to 1-3% of the general population and contributes to significant direct and indirect medical costs as well as decreased quality of life, which has a significant economic impact on our health care system. Areas covered: Given the prevalence of this condition on a large sector of the population, finding lasting relief for refractory cases is essential and is the focus of this review. Expert commentary: The choice of appropriate therapy in chronic refractory urticaria is not a 'one-size fits all' approach. Treatment should take multiple factors into consideration including the chronicity of hives, presence of physical urticaria, type of cellular infiltrate on skin histopathology, patient age, concomitant comorbid conditions, as well as patient preference and cost.
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Affiliation(s)
- Justin Greiwe
- a Bernstein Allergy Group , Cincinnati , OH , USA.,b Department of Internal Medicine, Division of Immunology Rheumatology and Allergy , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Jonathan A Bernstein
- a Bernstein Allergy Group , Cincinnati , OH , USA.,b Department of Internal Medicine, Division of Immunology Rheumatology and Allergy , University of Cincinnati College of Medicine , Cincinnati , OH , USA
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17
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Magerl M, Altrichter S, Borzova E, Giménez-Arnau A, Grattan CEH, Lawlor F, Mathelier-Fusade P, Meshkova RY, Zuberbier T, Metz M, Maurer M. The definition, diagnostic testing, and management of chronic inducible urticarias - The EAACI/GA(2) LEN/EDF/UNEV consensus recommendations 2016 update and revision. Allergy 2016; 71:780-802. [PMID: 26991006 DOI: 10.1111/all.12884] [Citation(s) in RCA: 207] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2016] [Indexed: 01/13/2023]
Abstract
These recommendations for the definition, diagnosis and management of chronic inducible urticaria (CIndU) extend, revise and update our previous consensus report on physical urticarias and cholinergic urticaria (Allergy, 2009). The aim of these recommendations is to improve the diagnosis and management of patients with CIndU. Our recommendations acknowledge the latest changes in our understanding of CIndU, and the available therapeutic options, as well as the development of novel diagnostic tools.
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Affiliation(s)
- M. Magerl
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - S. Altrichter
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - E. Borzova
- Department of Clinical Allergology; Russian Medical Academy of Postgraduate Education; Moscow Russia
| | - A. Giménez-Arnau
- Department of Dermatology; Hospital del Mar; Institut Mar d′Investigacions Mèdiques IMIM; Universitat Autònoma Barcelona; Barcelona Spain
| | - C. E. H. Grattan
- Cutaneous Allergy; St John's Institute of Dermatology; St Thomas' Hospital; London UK
| | - F. Lawlor
- Cutaneous Allergy; St John's Institute of Dermatology; St Thomas' Hospital; London UK
| | | | - R. Y. Meshkova
- Klinika Medicinskoy Immunologii I Allergologii; Smolensk Russia
| | - T. Zuberbier
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - M. Metz
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - M. Maurer
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
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Vestergaard C, Deleuran M. Chronic spontaneous urticaria: latest developments in aetiology, diagnosis and therapy. Ther Adv Chronic Dis 2015; 6:304-13. [PMID: 26568807 PMCID: PMC4622315 DOI: 10.1177/2040622315603951] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic urticaria is a debilitating disease characterized by itching and hives with or without angioedema lasting for more than 6 weeks. The disease carries a significant emotional and economic burden for the patient and often results in an odyssey between doctors of different specialities. Patients suffering from chronic urticaria are considered more difficult to satisfy, treat and to have a bigger emotional burden than the average patient in dermatology, paediatric and general practice settings. A joint initiative under the Dermatology section of the European Academy of Allergy and Clinical immunology (EAACI), the Global Allergy and Asthma European Network (GA(2)LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO) has resulted in recently published guidelines for the diagnosis, classification and treatment of chronic urticarial: these guidelines are clinically useful and have a high success rate when followed in daily clinical practice. The treatment of choice for chronic urticaria is still nonsedating antihistamines although other treatments are available, with omalizumab (humanized IgG anti IgE antibodies) as the newest therapy. The pathogenesis of urticaria is poorly understood but autoimmunity is considered as one of the major underlying causes for this disease, although other theories exist.
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Affiliation(s)
| | - Mette Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
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Leung YY, Yao Hui LL, Kraus VB. Colchicine--Update on mechanisms of action and therapeutic uses. Semin Arthritis Rheum 2015; 45:341-50. [PMID: 26228647 DOI: 10.1016/j.semarthrit.2015.06.013] [Citation(s) in RCA: 520] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/19/2015] [Accepted: 06/19/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To review the literature and provide an update on the mechanisms of action and therapeutic uses of oral colchicine in arthritis and inflammatory conditions. METHODS We performed PubMed database searches through June 2014 for relevant studies in the English literature published since the last update of colchicine in 2008. Searches encompassed colchicine mechanisms of action and clinical applications in medical conditions. A total of 381 articles were reviewed. RESULTS The primary mechanism of action of colchicine is tubulin disruption. This leads to subsequent down regulation of multiple inflammatory pathways and modulation of innate immunity. Newly described mechanisms include various inhibitory effects on macrophages including the inhibition of the NACHT-LRRPYD-containing protein 3 (NALP3) inflammasome, inhibition of pore formation activated by purinergic receptors P2X7 and P2X2, and stimulation of dendritic cell maturation and antigen presentation. Colchicine also has anti-fibrotic activities and various effects on endothelial function. The therapeutic use of colchicine has extended beyond gouty arthritis and familial Mediterranean fever, to osteoarthritis, pericarditis, and atherosclerosis. CONCLUSION Further understanding of the mechanisms of action underlying the therapeutic efficacy of colchicine will lead to its potential use in a variety of conditions.
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Affiliation(s)
- Ying Ying Leung
- Department of Rheumatology & Immunology, Singapore General Hospital, The Academia, Level 4, 20 College Rd, Singapore 169856; Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore.
| | - Laura Li Yao Hui
- Department of Rheumatology & Immunology, Singapore General Hospital, The Academia, Level 4, 20 College Rd, Singapore 169856
| | - Virginia B Kraus
- Duke Molecular Physiology Institute and Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC
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Amin P, Levin L, Holmes SJ, Picard J, Bernstein JA. Investigation of patient-specific characteristics associated with treatment outcomes for chronic urticaria. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 3:400-7. [PMID: 25680926 DOI: 10.1016/j.jaip.2014.12.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/19/2014] [Accepted: 12/23/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Identifying clinical characteristics of patients with chronic urticaria (CU) responsive to medication may help guide clinicians select treatment. OBJECTIVE The objective of this study was to investigate patient characteristics and medication use associated with urticaria control. METHODS A retrospective longitudinal chart review of adult patients with CU was conducted at a multisite allergy practice. Inclusion criteria required at least 4 CU office visits to allow for pre- and posttreatment assessment. Control corresponding to medication(s) used was assessed each visit. Univariate analysis followed by multiple logistic regression was performed. RESULTS A total of 221 patients with CU were included; 140 (63%) achieved complete control. The average time to control was 1.4 ± 2.7 years, which required 1-3 classes of medications. Dermatographia odds ratio (OR) = 1.85 (95% CI 1.3-2.7) or other physical urticarias, OR = 1.51 (1-2.4) and neutrophilic infiltrates on skin biopsy were markers of poor control. Thyroid autoantibodies were associated with better control using an H1-antihistamine. Whereas 22% were controlled on a second-generation H1-receptor antagonist plus a leukotriene receptor antagonist (LTRA), an additional 33% were controlled when cyclosporine was added. Use of a first or second H1-antagonist or LTRA was associated with a 3.5-16.9 times higher odds of complete CU control in those with dermatographia. The odds of achieving control for other forms of physical urticaria was greatest when colchicine was added (aOR = 32.6 [12.7-83.2]). CONCLUSIONS Patient-specific CU characteristics associated with medication-disease control may be useful for selecting treatment regimens. A subset of CU patients remains poorly controlled that indicates an unmet need for novel therapeutic agents.
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Affiliation(s)
- Priyal Amin
- Division of Immunology, Allergy & Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Linda Levin
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio
| | - Sarah J Holmes
- Division of Immunology, Allergy & Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jillian Picard
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jonathan A Bernstein
- Division of Immunology, Allergy & Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, Church MK, Ensina LF, Giménez-Arnau A, Godse K, Gonçalo M, Grattan C, Hebert J, Hide M, Kaplan A, Kapp A, Abdul Latiff AH, Mathelier-Fusade P, Metz M, Nast A, Saini SS, Sánchez-Borges M, Schmid-Grendelmeier P, Simons FER, Staubach P, Sussman G, Toubi E, Vena GA, Wedi B, Zhu XJ, Maurer M. The EAACI/GA(2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy 2014; 69:868-87. [PMID: 24785199 DOI: 10.1111/all.12313] [Citation(s) in RCA: 668] [Impact Index Per Article: 66.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2013] [Indexed: 12/13/2022]
Abstract
This guideline is the result of a systematic literature review using the 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE) methodology and a structured consensus conference held on 28 and 29 November 2012, in Berlin. It is a joint initiative of the Dermatology Section of the European Academy of Allergy and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA(2) LEN), the European Dermatology Forum (EDF), and the World Allergy Organization (WAO) with the participation of delegates of 21 national and international societies. Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The life-time prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria do not only cause a decrease in quality of life, but also affect performance at work and school and, as such, are members of the group of severe allergic diseases. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS).
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Affiliation(s)
- T. Zuberbier
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - W. Aberer
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - R. Asero
- Allergy Clinic; Clinica San Carlo; Paderno Dugnano MI Italy
| | - C. Bindslev-Jensen
- Department of Dermatology and Allergy Centre; Odense University Hospital; University of Southern Denmark; Odense Denmark
| | - Z. Brzoza
- Department of Internal Diseases, Allergology and Clinical Immunology in Katowice; Medical University of Silesia; Zabrze Poland
| | - G. W. Canonica
- Respiratory Diseases & Allergy; University of Genoa; IRCCS AOU SanMartino; Genoa Italy
| | - M. K. Church
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - L. F. Ensina
- Department of Clinical Immunology and Allergy; Federal University of Sao Paulo; Sao Paulo Brazil
| | - A. Giménez-Arnau
- Hospital del Mar. Parc de Salut Mar; Universitat Autònoma Barcelona; Barcelona Spain
| | - K. Godse
- Department of Dermatology; Dr. D. Y. Patil Medical College & Hospital; Nerul Navi Mumbai India
| | - M. Gonçalo
- Clinic of Dermatology; Faculty of Medicine and University Hospital; Coimbra Portugal
| | - C. Grattan
- St John's Institute of Dermatology; Guy's and St Thomas' Hospitals NHS Foundation Trust; London UK
| | - J. Hebert
- Center for Applied Research on Allergy Québec; Québec QC Canada
| | - M. Hide
- Department of Dermatology; Institute of Biomedical and Health Sciences; Hiroshima University; Hiroshima Japan
| | - A. Kaplan
- Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology; Department of Medicine; Medical University of South Carolina; Charleston SC USA
| | - A. Kapp
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - A. H. Abdul Latiff
- Department of Paediatrics; Pantai Hospital Kuala Lumpur; Bangsar Kuala Lumpur Malaysia
| | - P. Mathelier-Fusade
- Department of Dermatology and Allergy; University Hospital of Tenon; Paris France
| | - M. Metz
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - A. Nast
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - S. S. Saini
- Johns Hopkins Asthma and Allergy Center; Baltimore MD USA
| | - M. Sánchez-Borges
- Allergy and Clinical Immunology Department Centro Médico-Docente La Trinidad; Caracas Venezuela
| | | | - F. E. R. Simons
- Departments of Pediatrics & Child Health, Immunology; University of Manitoba; Winnipeg MB Canada
| | - P. Staubach
- Department of Dermatology; University Medical Center Mainz; Mainz Germany
| | - G. Sussman
- Division of Allergy and Clinical Immunology; University of Toronto; Toronto ON Canada
| | - E. Toubi
- Bnai-Zion Medical Center; Faculty of Medicine; Technion; Haifa Israel
| | - G. A. Vena
- Unit of Dermatology and Venereology; Department of Biomedical Sciences and Human Oncology; University of Bari; Bari Italy
| | - B. Wedi
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - X. J. Zhu
- Department of Dermatology; Peking University First Hospital; Beijing China
| | - M. Maurer
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
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Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F, Sheikh J, Weldon D, Zuraw B, Bernstein DI, Blessing-Moore J, Cox L, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph CR, Schuller DE, Spector SL, Tilles SA, Wallace D. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol 2014; 133:1270-7. [DOI: 10.1016/j.jaci.2014.02.036] [Citation(s) in RCA: 320] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 02/10/2014] [Accepted: 02/12/2014] [Indexed: 12/13/2022]
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24
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Contemporary approaches to the diagnosis and management of physical urticaria. Ann Allergy Asthma Immunol 2013; 111:235-41. [PMID: 24054356 DOI: 10.1016/j.anai.2013.07.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/08/2013] [Accepted: 07/26/2013] [Indexed: 11/22/2022]
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Khan DA. Alternative agents in refractory chronic urticaria: evidence and considerations on their selection and use. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2013; 1:433-440.e1. [PMID: 24565613 DOI: 10.1016/j.jaip.2013.06.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 06/02/2013] [Accepted: 06/19/2013] [Indexed: 10/26/2022]
Abstract
Patients with chronic urticaria (CU) who are refractory to antihistamines are frequently encountered by allergy specialists. Several alternative agents have been used to treat these patients; however, the evidence to support these agents is generally limited. This review focuses on some of the more commonly used alternative agents in refractory CU, including anti-inflammatory agents (montelukast, hydroxychloroquine, dapsone, sulfasalazine, methotrexate, colchicine), immunosuppressants (cyclosporine, tacrolimus, mycophenolate), and immunomodulatory agents (omalizumab, immune globulin). The evidence to support their use, dosing, potential toxicity, monitoring, and selection of these alternative agents is reviewed. Although numerous knowledge gaps exist for alternative agents in refractory CU, a rational, patient-based approach can be used with a goal of improving control and quality of life and minimizing adverse medication effects.
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Affiliation(s)
- David A Khan
- Division of Allergy & Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex.
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26
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Magerl M, Borzova E, Giménez-Arnau A, Grattan CEH, Lawlor F, Mathelier-Fusade P, Metz M, Młynek A, Maurer M. The definition and diagnostic testing of physical and cholinergic urticarias--EAACI/GA2LEN/EDF/UNEV consensus panel recommendations. Allergy 2009; 64:1715-21. [PMID: 19793059 DOI: 10.1111/j.1398-9995.2009.02177.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The recommendations for the definition and diagnosis presented in this position paper are the result of a panel consensus meeting held in December 2008 in Berlin. This consensus meeting was a joint initiative of EAACI (European Academy of Allergology and Clinical Immunology) Dermatology Section, the EU-funded network of excellence, GA(2)LEN (Global Allergy and Asthma European Network), the EDF (European Dermatology Forum) and UNEV (urticaria network e.V.). The aim of these recommendations is to improve the diagnosis and management of patients with physical urticaria or cholinergic urticaria and to promote research and a better understanding of these diseases. Our recommendations used the paper produced by a 1996 expert meeting (1) and they acknowledge the latest changes in our understanding of physical urticarias and cholinergic urticaria as well as the recent development of novel diagnostic tools. In addition, this consensus paper highlights areas of need for further research.
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Affiliation(s)
- M Magerl
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité- Universitätsmedizin, Berlin, Germany
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Zuberbier T, Asero R, Bindslev‐Jensen C, Walter Canonica G, Church MK, Giménez‐Arnau AM, Grattan CEH, Kapp A, Maurer M, Merk HF, Rogala B, Saini S, Sánchez‐Borges M, Schmid‐Grendelmeier P, Schünemann H, Staubach P, Vena GA, Wedi B. EAACI/GA(2)LEN/EDF/WAO guideline: management of urticaria. Allergy 2009; 64:1427-1443. [PMID: 19772513 DOI: 10.1111/j.1398-9995.2009.02178.x] [Citation(s) in RCA: 359] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This guideline, together with its sister guideline on the classification of urticaria (Zuberbier T, Asero R, Bindslev-Jensen C, Canonica GW, Church MK, Giménez-Arnau AM et al. EAACI/GA(2)LEN/EDF/WAO Guideline: definition, classification and diagnosis of urticaria. Allergy 2009;64: 1417-1426), is the result of a consensus reached during a panel discussion at the Third International Consensus Meeting on Urticaria, Urticaria 2008, a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA(2)LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO). As members of the panel, the authors had prepared their suggestions regarding management of urticaria before the meeting. The draft of the guideline took into account all available evidence in the literature (including Medline and Embase searches and hand searches of abstracts at international allergy congresses in 2004-2008) and was based on the existing consensus reports of the first and the second symposia in 2000 and 2004. These suggestions were then discussed in detail among the panel members and with the over 200 international specialists of the meeting to achieve a consensus using a simple voting system where appropriate. Urticaria has a profound impact on the quality of life and effective treatment is, therefore, required. The recommended first line treatment is new generation, nonsedating H(1)-antihistamines. If standard dosing is not effective, increasing the dosage up to four-fold is recommended. For patients who do not respond to a four-fold increase in dosage of nonsedating H(1)-antihistamines, it is recommended that second-line therapies should be added to the antihistamine treatment. In the choice of second-line treatment, both their costs and risk/benefit profiles are most important to consider. Corticosteroids are not recommended for long-term treatment due to their unavoidable severe adverse effects. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS).
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Affiliation(s)
- T. Zuberbier
- Department of Dermatology and Allergy, Charité– Universitätsmedizin Berlin, Berlin, Germany
| | - R. Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano (MI), Italy
| | - C. Bindslev‐Jensen
- Allergy Centre, Department of Dermatology, Odense University Hospital, Odense Area, Denmark
| | - G. Walter Canonica
- Allergy and Respiratory Diseases, DIMI – University of Genoa, Genoa, Italy
| | - M. K. Church
- Department of Dermatology and Allergy, Charité– Universitätsmedizin Berlin, Berlin, Germany
| | - A. M. Giménez‐Arnau
- Department of Dermatology, Hospital del Mar, IMAS, Universitat Autònoma of Barcelona, Barcelona, Spain
| | - C. E. H. Grattan
- Dermatology Centre, Norfolk & Norwich University Hospital, Norwich, UK
| | - A. Kapp
- Department of Dermatology and Allergology, Hannover Medical University, Hannover, Germany
| | - M. Maurer
- Department of Dermatology and Allergy, Charité– Universitätsmedizin Berlin, Berlin, Germany
| | - H. F. Merk
- Department of Dermatology, University Hospital RWTH Aachen, Aachen, Germany
| | - B. Rogala
- Clinical Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, Poland
| | - S. Saini
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - M. Sánchez‐Borges
- Allergy and Immunology Department, Centro Medico‐Docente La Trinidad, Caracas, Venezuela
| | | | - H. Schünemann
- Department of Clinical Epidemiology & Biostatistics, Hamilton, Canada
| | - P. Staubach
- Department of Clinical Epidemiology & Biostatistics, Hamilton, Canada
| | - G. A. Vena
- Department of Dermatology, Johannes Gutenberg‐University Mainz, Mainz, Germany
| | - B. Wedi
- Department of Dermatology and Allergology, Hannover Medical University, Hannover, Germany
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Therapeutic alternatives for chronic urticaria: an evidence-based review, part 1. Ann Allergy Asthma Immunol 2008; 100:403-11; quiz 412-4, 468. [PMID: 18517070 DOI: 10.1016/s1081-1206(10)60462-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the use of alternative therapies for chronic urticaria refractory to first-line treatments in an evidence-based manner. DATA SOURCES MEDLINE searches were performed cross-referencing urticaria with the names of multiple therapies. Articles were then reviewed for additional citations. Articles published after 1950 were considered. STUDY SELECTION All articles, including case reports, were reviewed for soundness and relevance. RESULTS Experience has been reported for a wide variety of alternative therapies in the treatment of chronic idiopathic and physical urticarias. Evidence for most agents is limited to anecdotal reports. The second-line therapies reviewed are also categorized based on criteria of safety, efficacy, convenience, and cost, in relation to the first-line antihistamines. CONCLUSIONS Alternative agents should be considered in patients with chronic urticaria who are both severely affected and unresponsive to antihistamines. Although monitoring for toxicity is important in management with many alternative agents, safety is favorable compared with corticosteroids.
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Nettis E, Colanardi MC, Soccio AL, Ferrannini A, Vacca A. Desloratadine in combination with montelukast suppresses the dermographometer challenge test papule, and is effective in the treatment of delayed pressure urticaria: a randomized, double-blind, placebo-controlled study. Br J Dermatol 2007; 155:1279-82. [PMID: 17107402 DOI: 10.1111/j.1365-2133.2006.07533.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Delayed pressure urticaria (DPU) comes under the heading of physical urticaria. Characteristically itchy, tender or painful weals occur at sites of local pressure including the waistband, soles of the feet and palms of the hands. Lesion onset is typically 3-12 h after the application of pressure, and lesions may persist for more than 24 h. The treatment of DPU is often unsatisfactory. OBJECTIVES To determine the efficacy of desloratadine and montelukast in the treatment of DPU. METHODS The study was conducted in 36 subjects affected by DPU. A challenge test with a dermographometer was administered to confirm the diagnosis. After diagnosis, patients were randomized to receive the following treatment once daily for 2 weeks: (i) oral desloratadine 5 mg plus oral placebo; (ii) oral desloratadine 5 mg plus montelukast 10 mg; and (iii) oral placebo alone. RESULTS At rechallenge, patients from the treatment groups (desloratadine plus montelukast group and desloratadine alone group) demonstrated a significant reduction in mean diameter of papules after 70 s of pressure compared with the placebo group (P < 0.05). Moreover, patients treated with desloratadine plus montelukast showed a significant reduction in mean diameter of papules at 70 s of pressure compared with those treated with desloratadine alone (P < 0.05). In addition, the combination was effective in improving clinical parameters (erythema, oedema and pruritus, and number of separate urticarial episodes). CONCLUSIONS This study has demonstrated that both desloratadine alone and desloratadine plus montelukast administered once daily yield improvements with respect to the baseline assessment, regarding the suppression of the dermographometer challenge test papule and clinical improvement of urticaria. However, the combination of desloratadine and montelukast was shown to be more efficacious and may therefore be proposed in patients with DPU, in order to avoid corticosteroid therapy.
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Affiliation(s)
- E Nettis
- Department of Medical Clinic, Immunology and Infectious Diseases, Division of Allergy and Clinical Immunology, University of Bari Medical School, Bari, Italy.
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Zuberbier T, Bindslev-Jensen C, Canonica W, Grattan CEH, Greaves MW, Henz BM, Kapp A, Kozel MMA, Maurer M, Merk HF, Schäfer T, Simon D, Vena GA, Wedi B. EAACI/GA2LEN/EDF guideline: management of urticaria. Allergy 2006; 61:321-31. [PMID: 16436141 DOI: 10.1111/j.1398-9995.2005.00962.x] [Citation(s) in RCA: 191] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This guideline is the result of a consensus reached during a panel discussion at the second International Consensus Meeting on Urticara, Urticaria 2004, a joint initiative of the EAACI Dermatology Section and GA2LEN. Urticaria has a profound impact on the quality of life, and effective treatment is therefore required. The recommended first line treatment are nonsedating H1 antihistamines. They have proven to be effective in double-blind controlled studies, but dosages increased up to fourfold over the recommended doses may be necessary. However, for different urticaria subtypes and in view of individual variation in the course of the disease and response to treatment, additional or alternative therapies may be required. Immunosuppressive drugs like cyclosporin A and corticosteroids are not recommended for long-term treatment due to unavoidable severe adverse effects. This guideline was, in addition, accepted by the European Dermatology Forum (EDF) and formally approved by the European Union of Medical Specialists (UEMS).
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Affiliation(s)
- T Zuberbier
- Department of Dermatology and Allergy, Charité- Universitätsmedizin Berlin, Berlin, Germany
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32
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Kerstan A, Rose C, Simon D, Simon HU, Bröcker EB, Trautmann A, Leverkus M. Bullous delayed pressure urticaria: pathogenic role for eosinophilic granulocytes? Br J Dermatol 2005; 153:435-9. [PMID: 16086763 DOI: 10.1111/j.1365-2133.2005.06677.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Bullous delayed pressure urticaria (DPU) is a rare variant of DPU. Treatment of DPU is difficult and the underlying pathogenic mechanism of DPU remains elusive. We report a 72-year-old man with DPU and associated chronic urticaria as well as delayed urticarial dermographism. Pressure challenge gave rise to a deep weal covered by multiple vesicles and bullae after 24 h. Histological examination of a skin biopsy specimen obtained 24 h after pressure challenge demonstrated intraepidermal bullae filled with eosinophils accompanied by a dense, predominantly eosinophilic infiltrate in the dermis. Whereas the numbers and morphology of mast cells were unaltered, the extracellular deposition of eosinophil cationic protein revealed evidence for eosinophil activation. Concomitantly, both CD4+ and CD8+ T lymphocytes were present in the infiltrate and expressed interleukin 5. As bullous DPU may represent the maximal variant of DPU, the investigation of the cellular infiltrate and the chemokines/cytokines released may reveal potential pathogenic mechanisms. A possible effector role of eosinophilic granulocytes, T-cell subsets and mast cells is discussed.
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Affiliation(s)
- A Kerstan
- Department of Dermatology Venerology and Allerology, University of Würzburg, Germany
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Abstract
Urticaria belongs to the most frequent dermatologic diseases. Although the pathogenesis of urticaria is not fully understood, systematic studies in recent years have identified the most important triggering factors of the different forms of urticaria. Based on these results, it is recommended to restrict diagnostic procedures in acute urticaria to history and physical examination, while in chronic urticaria, one should exclude drugs, infections, pseudoallergic reactions, and autoimmune processes as causes. For the diagnosis of physical urticaria, standardized provocation test are recommended.
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Affiliation(s)
- K Hartmann
- Klinik und Poliklinik für Dermatologie und Venerologie der Universität zu Köln, Köln.
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Abstract
Delayed pressure urticaria is a mechanical urticaria in which pressure causes whealing. Delayed cutaneous erythema and edema occur in association with marked subcutaneous swelling after the application of a sustained pressure stimulus to the skin. The earliest reports and theories of the pathogenesis of delayed pressure urticaria are summarized. Detailed attention is given to making the diagnosis by taking a history and provoking the lesions. The clinical features and natural history are considered. The effects of the disorder on quality of life are delineated, and management strategies are suggested.
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Affiliation(s)
- Frances Lawlor
- St John's Institute of Dermatology, St Thomas' Hospital, London, UK.
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35
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Dawn G, Urcelay M, Ah-Weng A, O'Neill SM, Douglas WS. Effect of high-dose intravenous immunoglobulin in delayed pressure urticaria. Br J Dermatol 2003; 149:836-40. [PMID: 14616377 DOI: 10.1046/j.1365-2133.2003.05486.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Delayed pressure urticaria (DPU) is difficult to treat. High-dose intravenous immunoglobulin (IVIG) has been found to be effective in treating patients with autoimmune chronic urticaria. OBJECTIVES To report the effect of IVIG on eight patients with severe unremitting DPU. METHODS IVIG was administered at a dose of 2 g kg-1 over 2-3 days on an in-patient basis. The response to treatment was assessed subjectively and recorded as remission, improved or unchanged. An autologous serum skin test (ASST) was performed in seven patients. RESULTS Three of eight patients achieved remission; two after one infusion and one after three infusions. Two patients improved. Three patients remained unchanged; of these, two declined further treatment after two infusions, and one failed to improve after six infusions at monthly intervals. Four of seven patients had positive ASST; three responded to IVIG. Two developed delayed positive ASST; both responded to IVIG. Of three patients with negative ASST, two responded. CONCLUSIONS IVIG induced remission or improved symptoms in five of eight patients with DPU with severe unremitting disease who had failed to respond to other therapies or were controlled only with systemic corticosteroids. Those who responded did so with three or fewer infusions. ASST is not a reliable predictor of response to IVIG.
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Affiliation(s)
- G Dawn
- Department of Dermatology, Monklands Hospital, Airdrie, Lanarkshire, ML6 0JS, U.K.
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36
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Wai YC, Sussman GL. Evaluating chronic urticaria patients for allergies, infections, or autoimmune disorders. Clin Rev Allergy Immunol 2002; 23:185-93. [PMID: 12221863 DOI: 10.1385/criai:23:2:185] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Urticaria is a common disorder affecting one-fifth of the world's population. The pathophysiology is characterized by an increased propensity for mast cell degranulation with the release of potent mediators into the dermal and subdermal tissues with resulting vasoactive, chemotactic, and inflammatory effects. The final clinical manifestation of the typical urticarial lesion is the effect of several diverse effects and causes. The general classification is acute, chronic, and physical urticaria. In general, allergenic triggers can be identified in between 60-80% of acute urticarias. Physical urticarias are characterized by the onset after the specific inciting stimulus, which can reproduce the characteristic lesion which is usually of shorter duration (with the exception of delayed pressure urticaria). Chronic idiopathic urticaria is associated with thyroid autoimmunity and, more recently, anti-mast cell receptor antibodies. An extensive work-up is usually not indicated or helpful in identifying a cause. Food or other allergens are rare causes of this type of presentation. The evaluation and work-up is dependent on clues identified by history. The treatment is removal of specific and non-specific triggers and the use of symptomatic medications generally attenuating the mediator effects.
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Affiliation(s)
- Y C Wai
- St. Michael's Hospital, University of Toronto, 202 St. Clair Avenue West, Toronto, Ontario, Canada M4V 1R2
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37
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Abstract
Delayed pressure urticaria is a physical urticaria where erythematous, often painful swellings occur at sites of sustained pressure on the skin, after a delay of several hours. If sought, it is present in up to 40% of patients with ordinary chronic "idiopathic urticaria" to a varying degree. Compared with other urticarias, the pressure-induced lesions impair the quality of life of patients most severely. The pathogenesis is not well characterized, but whealing is dependent on mast cell activation, with the histology of lesions also showing a deep dermal inflammatory infiltrate of neutrophils and eosinophils, without vasculitis. Treatment of delayed pressure is generally unsatisfactory, and is often resistant to antihistamine and a range of anti-inflammatory medication. Oral steroids, although the most effective therapy, are unsuitable for long-term use. Delayed pressure urticaria may persist for many years, and improved or novel methods of management are under investigation.
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Affiliation(s)
- A Kobza-Black
- St John's Institute of Dermatology, King's College London, St Thomas Hospital, UK
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Zuberbier T, Greaves MW, Juhlin L, Merk H, Stingl G, Henz BM. Management of urticaria: a consensus report. J Investig Dermatol Symp Proc 2001; 6:128-31. [PMID: 11764297 DOI: 10.1046/j.0022-202x.2001.00023.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This consensus report is the result of a panel discussion during the International Clinically Oriented ESDR Symposium Urticaria 2000. Urticaria has a profound impact on the quality of life and effective treatment is required. The most important are nonsedating H1 antihistamines. They have been proven to be effective in double-blind controlled studies, but concentrations higher than those recommended may be necessary. Due to different urticaria subtypes and the individual variation in the course of the disease and response to treatment, however, alternative therapies may be required. Immunosuppressive drugs like cyclosporine A and corticosteroids should not be used long term due to undesirable side-effects.
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Affiliation(s)
- T Zuberbier
- Department of Dermatology and Allergy, Charité, Humboldt University, Berlin, Germany.
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39
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Abstract
Urticaria is a very common and disabling disorder. Recent advances in understanding of pathomechanisms has led to important advances in diagnosis and treatment. However, the cause in many patients remains obscure and the treatment poorly effective.
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Affiliation(s)
- M Greaves
- St John's Institute of Dermatology, St Thomas' Hospital, London
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40
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Sanchez MR. Miscellaneous treatments: thalidomide, potassium iodide, levamisole, clofazimine, colchicine, and D-penicillamine. Clin Dermatol 2000; 18:131-45. [PMID: 10701095 DOI: 10.1016/s0738-081x(99)00103-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- M R Sanchez
- New York University School of Medicine, Ronald O. Perelman Department of Dermatology, NY 10016, USA
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41
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Abstract
There are many types of urticaria and the principal form of assessment is by clinical history and examination. Urticarial weal formation involves acute, reversible vasodilatation and increased vascular permeability. If the process is deeper the more diffuse swelling is termed angio-oedema. The major types of urticaria include allergic, physical and idiopathic forms. In allergic urticaria, IgE-mediated degranulation of mast cells results in weals of short duration which typically respond well to antihistamines. Physical urticarias are induced by physical insults including pressure, scratch, cold, etc. The distribution and duration of individual weals may suggest the causal factor. Chronic idiopathic urticaria can be very variable, with individual weals lasting between 90 min and 24 hours. Longer-lasting weals are less responsive to anti-histamines and clearly involve other mediators. When long-lasting weals fade leaving a bruised appearance urticarial vasculitis is present which may only respond to systemic corticosteroids. In a proportion of individuals with chronic idiopathic urticaria, auto-antibodies are present with specificity for the high affinity receptor for IgE or sometimes, for IgE itself. In general laboratory tests for allergic factors or other assessments of general health are completely unhelpful.
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Affiliation(s)
- P S Friedmann
- Department of Dermatology, University of Southampton, Southampton, UK
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42
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Affiliation(s)
- J K Sharma
- Division of Dermatology, Department of Internal Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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43
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Sabroe RA, Poon E, Orchard GE, Lane D, Francis DM, Barr RM, Black MM, Black AK, Greaves MW. Cutaneous inflammatory cell infiltrate in chronic idiopathic urticaria: comparison of patients with and without anti-FcepsilonRI or anti-IgE autoantibodies. J Allergy Clin Immunol 1999; 103:484-93. [PMID: 10069884 DOI: 10.1016/s0091-6749(99)70475-6] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Previous studies defining the histopathologic features of patients with chronic idiopathic urticaria (CIU) were performed on wheals of uncertain duration and before the identification of functional autoantibodies against FcepsilonRI and/or IgE, now known to be present in approximately 30% of patients with CIU. OBJECTIVE We sought to determine the timing of the inflammatory infiltrate in the wheals of patients with CIU and to detect differences between patients with and without autoantibodies. METHODS Immunohistochemistry was used to identify neutrophils (neutrophil elastase), T lymphocytes (CD3), and activated eosinophils (EG2) in biopsy specimens from uninvolved skin and wheals present for less than 4 hours and greater than 12 hours in 22 patients with CIU, as well as in biopsy specimens from the skin of 12 healthy control subjects. Patients were identified as having functional autoantibodies on the basis of their serum-evoked histamine release in vitro from the basophils of 2 healthy donors. RESULTS EG2(+), neutrophil elastase+, and, to a lesser extent, CD3(+) cells were found in greater numbers in wheals undergoing biopsy at less than 4 and greater than 12 hours than in uninvolved skin (P <.05). Patients without autoantibodies (n = 12) had significantly more EG2(+) cells in wheals of greater than 12 hours' duration than patients with autoantibodies (n = 10; P =.02). There was no other difference between patients with and without autoantibodies in the cutaneous cellular infiltrate. CONCLUSION Neutrophil and eosinophil accumulation occurs early in the evolution of a wheal in patients with CIU, but eosinophil activation may occur later or be more persistent in patients without autoantibodies.
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Affiliation(s)
- R A Sabroe
- Professorial Unit, St John's Institute of Dermatology, Guy's, King's College and St Thomas's Hospitals' Medical and Dental Schools, St Thomas's Hospital, London, United Kingdom
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44
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Sabroe RA, Seed PT, Francis DM, Barr RM, Black AK, Greaves MW. Chronic idiopathic urticaria: comparison of the clinical features of patients with and without anti-FcepsilonRI or anti-IgE autoantibodies. J Am Acad Dermatol 1999; 40:443-50. [PMID: 10071316 DOI: 10.1016/s0190-9622(99)70495-0] [Citation(s) in RCA: 189] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Previous studies defining the clinical features of patients with chronic idiopathic urticaria (CIU) were performed before the identification of functional autoantibodies against FcepsilonRI and/or IgE, now known to be present in approximately 30% of patients with CIU. OBJECTIVE Our purpose was to determine whether there are differences between patients with and those without autoantibodies in the clinical features or severity of CIU. METHODS The clinical features of 107 patients with CIU were evaluated prospectively. Patients were identified as having functional autoantibodies on the basis of the serum-evoked histamine release in vitro from the basophils of 2 healthy donors. RESULTS Patients with autoantibodies (31%) had more wheals (P = .005), a wider distribution of wheals (P = .009), higher itch scores for the most severe episodes of itching (P = .002), more systemic symptoms (P = .03), and lower serum IgE levels (P < .0005) than patients without autoantibodies. CONCLUSION The presence of autoantibodies indicates a subset of patients with more severe CIU.
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Affiliation(s)
- R A Sabroe
- Professorial Unit, St John's Institute of Dermatology, Guy's, King's College and St Thomas's Hospitals' Medical and Dental Schools, London, United Kingdom
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Black AK, Lawlor F, Greaves MW. Consensus meeting on the definition of physical urticarias and urticarial vasculitis. Clin Exp Dermatol 1996; 21:424-6. [PMID: 9167337 DOI: 10.1111/j.1365-2230.1996.tb00146.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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46
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Schafer CM. PHYSICAL URTICARIA. Immunol Allergy Clin North Am 1995. [DOI: 10.1016/s0889-8561(22)00812-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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47
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Affiliation(s)
- M W Greaves
- St. John's Institute of Dermatology, United Medical School, St. Thomas's Hospital, London, United Kingdom
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48
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Barlow RJ, Ross EL, MacDonald DM, Kobza Black A, Greaves MW. Mast cells and T lymphocytes in chronic urticaria. Clin Exp Allergy 1995; 25:317-22. [PMID: 7600377 DOI: 10.1111/j.1365-2222.1995.tb01049.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Mast cells are considered to be the primary effector cells in urticaria but it is possible that lymphocytes contribute to the formation of weals by secreting histamine releasing factors. The aim of this study was to examine the population of mast cells and to quantify the T cell subsets and their activation status in delayed pressure urticaria (DPU), chronic idiopathic urticaria and normal controls. Three biopsies were obtained from each of four patients with chronic idiopathic urticaria but not DPU. Three biopsies were taken from each of 13 patients with DPU, from a combination of unchallenged skin and at 0, 2, 6, 24, 48, and 120 h after weighted steel rods (diameter 1.5 cm) had been applied to the thighs. Three biopsies were similarly obtained from each of four normal controls before an identical pressure challenge and at 6, 24 and 48 h afterwards. The chloracetate esterase stain was used to demonstrate mast cells and an alkaline phosphatase anti-alkaline phosphatase immunohistochemical technique to assess the phenotypic and activation characteristics of the T cell infiltrate. The mast cell count did not differ significantly between unchallenged skin from DPU patients and normal controls. Following a pressure challenge to the DPU patients, the number of stainable mast cells decreased significantly to a level comparable with that in spontaneous weals of chronic idiopathic urticaria. Investigation of T cell subsets showed a preponderance of CD4+ cells over CD8+ cells.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R J Barlow
- St John's Institute of Dermatology, UMDS, St Thomas's Hospital, London, UK
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49
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Barlow RJ, Macdonald DM, Black AK, Greaves MW. The effects of topical corticosteroids on delayed pressure urticaria. Arch Dermatol Res 1995; 287:285-8. [PMID: 7541190 DOI: 10.1007/bf01105080] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Six patients with delayed pressure urticaria (DPU) applied clobetasol propionate (0.05%) ointment or its base to predetermined test sites on the right and left thigh as part of a randomized, double-blind study. A pressure challenge was administered to each test site at the initial visit and repeated after 3 days and 6 weeks of treatment and at between 4 and 8 weeks after treatment. The areas of pressure-induced weals were measured 6 h after each challenge. At the 6-week visit, a 4-mm punch biopsy was taken from pressure-challenged skin on each test site. Sections were stained for mast cells and immunohistochemical labelling was used to demonstrate neutrophils (neutrophil elastase), eosinophils (eosinophil cationic protein), monocytes/macrophages (EBM 11), cells expressing the beta-2 integrins (CD11/18) and the vascular adhesion molecules, E selectin and intercellular adhesion molecule-1 (ICAM-1). In the steroid-treated sites, there was a significant decrease (P < 0.05, Wilcoxon's matched-pairs test) in the size of the pressure weals compared with baseline at 3 days, 6 weeks and at follow-up. Demonstrable mast cells were significantly decreased (P = 0.059) in the pressure-challenged areas in the steroid-treated sites compared with the base-treated sites. The histological response to pressure was minimal in both sites perhaps demonstrating an active pharmacological effect of the ointment base. In conclusion, the application of potent topical steroids significantly reduced the clinical response to pressure in patients with DPU, possibly through a reduction in mast cells.
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Affiliation(s)
- R J Barlow
- St John's Institute of Dermatology, UMDS, St Thomas Hospital, London, UK
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50
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Barlow RJ, Ross EL, MacDonald D, Black AK, Greaves MW. Adhesion molecule expression and the inflammatory cell infiltrate in delayed pressure urticaria. Br J Dermatol 1994; 131:341-7. [PMID: 7522516 DOI: 10.1111/j.1365-2133.1994.tb08521.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We have investigated the kinetics of the leucocyte infiltrate in delayed pressure urticaria (DPU) in relation to the in vivo expression of the cytokine-regulated cell surface adhesion molecules, E-selectin (endothelial adhesion molecule-1, ELAM-1), intercellular adhesion molecule-1 (ICAM-1), and vascular adhesion molecule-1 (VCAM-1). Immunohistochemical analysis was performed on biopsies taken from unchallenged skin, and at 0, 2, 6, 24, 48 and 120 h after weighted rods had been applied to 13 patients with DPU. There was moderate to marked upregulation of E-selectin at 6 and 24 h after application of pressure. At 24 h, more patients showed expression of VCAM-1 on perivascular cells than before pressure. Moderate expression of ICAM-1 was present in some biopsies from both unchallenged and pressure-challenged skin, but there was no clear trend. In DPU, there was a significant increase in the neutrophil count at 2 h after a pressure challenge, with further increases at 6 and 24 h. The median cell counts per high-power field of eosinophils and monocyte/macrophages increased significantly at 24 h after pressure. Biopsies from four normal controls subjected to an identical pressure challenge showed no detectable changes in adhesion molecule expression or in the cell infiltrate. The findings in four patients with chronic idiopathic urticaria not associated with DPU were qualitatively similar to (but intermediate in severity between) the findings in DPU weals at 6 and 24 h. These results suggest that vascular endothelial activation is an early response to pressure challenge in DPU, and is also present in chronic idiopathic urticaria.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R J Barlow
- St John's Institute of Dermatology, St Thomas' Hospital, London, U.K
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