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Chronic spontaneous urticaria guidelines: What is new? J Allergy Clin Immunol 2022; 150:1249-1255. [PMID: 36481045 DOI: 10.1016/j.jaci.2022.10.004] [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: 08/08/2022] [Revised: 09/29/2022] [Accepted: 10/05/2022] [Indexed: 12/07/2022]
Abstract
Urticaria is a heterogeneous inflammatory disorder that can be acute or chronic and is defined by the appearance of wheals, angioedema, or both. Very recently, the newest update and revision of the international European Academy of Allergy and Clinical Immunology/Global Allergy and Asthma European Network/European Dermatology Forum/Asia Pacific Association of Allergy Asthma Clinical Immunology guideline for the definition, classification, diagnosis, and management of urticaria was published. It aims to help primary care physicians and specialists in the management of their patients with urticaria. The guideline applied the Grading of Recommendations Assessment Development and Evaluations approach to developing consensus recommendations. These recommendations were then discussed in a Delphi conference that included more than 250 specialists in the field, and they are endorsed by more than 50 international societies. Here, we highlight changes from previous versions of the international urticaria guideline and their impact on clinical practice.
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Shah B, Dhoot D, Choudhary A, Jangid N, Mistry D, Shah S, Kamat S, Barkate H. A Comparative, Three-Arm, Randomized Clinical Trial to Evaluate the Effectiveness and Tolerability of Bilastine vs Fexofenadine vs Levocetirizine at the Standard Dose and Bilastine vs Fexofenadine at Higher Than the Standard Dose (Up-Dosing) vs Levocetirizine and Hydroxyzine (in Combination) in Patients with Chronic Spontaneous Urticaria. Clin Cosmet Investig Dermatol 2022; 15:261-270. [PMID: 35221703 PMCID: PMC8867222 DOI: 10.2147/ccid.s350122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/24/2021] [Indexed: 11/26/2022]
Abstract
Introduction Though second-generation antihistamines (SGAH) are first-line drugs in chronic spontaneous urticaria (CSU), 50% of patients do not respond to them. In such patients, guidelines recommend either up-dosing of SGAH or combination of different antihistamines. However, the studies comparing these treatment regimens are limited. Methods In this comparative, three-arm study, CSU patients were randomized to receive standard dose of either bilastine, fexofenadine, or levocetirizine for 2 weeks. After 2 weeks of treatment, non-responders received double dose of either bilastine or fexofenadine, while hydroxyzine 25 mg once daily was added in the levocetirizine group. Patients were primarily evaluated for improvement in CSU, quality of life, and somnolence. Results A total of 110 patients with CSU were recruited. At the end of 4 weeks, 33/39, 26/35, and 22/36 patients in the bilastine, fexofenadine, and levocetirizine groups showed improvement in urticaria symptoms. At week 2, there was no statistical difference in urticaria activity score (UAS7) improvement between any of the groups; however, at week 4, there was a statistical difference between the bilastine and levocetirizine groups (p<0.05). Somnolence was significantly lower in the bilastine group (p<0.05). Bilastine was statistically significant (p<0.05) in the improvement of quality of life as compared to both groups. No major adverse events were reported during study period; however, bilastine was associated with significantly lower levels of AEs compared to levocetirizine (p<0.05). Conclusion Two-fold up-dosing of bilastine improves CSU symptoms without compromising safety as compared to two-fold up-dosing of fexofenadine and combination of first- and second-generation antihistamines.
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Affiliation(s)
- Bela Shah
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Dhiraj Dhoot
- DGM, Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
| | - Ankita Choudhary
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Neha Jangid
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Deval Mistry
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Shikha Shah
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Shruti Kamat
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Hanmant Barkate
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
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Magen E, Yakov A, Green I, Israel A, Vinker S, Merzon E. Chronic spontaneous urticaria after BNT162b2 mRNA (Pfizer-BioNTech) vaccination against SARS-CoV-2. Allergy Asthma Proc 2022; 43:30-36. [PMID: 34983707 DOI: 10.2500/aap.2022.43.210111] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: The factors that trigger and exacerbate chronic spontaneous urticaria (CSU) are well known, but it is not unclear whether messenger RNA (mRNA) vaccination against severe acute respiratory syndrome coronavirus 2 can trigger new cases of CSU or a relapse of CSU after long-term remission. Objective: To study the clinical cases of patients with new-onset CSU and CSU in remission who relapsed within 3 months after BNT162b2 mRNA vaccination. Methods: All patients with a CSU diagnosis within 12 weeks of BNT162b2 mRNA vaccination were retrospectively identified and included in the new-onset CSU and the relapsed CSU groups. The first control group (CSU control group) retrospectively consisted of patients diagnosed with CSU in complete clinical remission for ≥ 6 months, with no CSU relapse after vaccination. The second control group (healthy control group) consisted of subjects who were fully vaccinated and without CSU, matched 1:2 for age and sex with patients with CSU. Results: Twenty-seven patients were included in the relapsed CSU group, 32 patients in the new-onset CSU group, 179 patients in the CSU control group, and 476 subjects in the healthy control group. The relapsed CSU and new-onset CSU groups had more allergic comorbidities overall (19 [70.4%] and 13 [40.6%], respectively) than the CSU control group and the healthy control group (50 [27.9%] and 110 [23.1%], respectively; p < 0.001). Multiple logistic regression analysis showed that a positive autologous serum skin test result, overall allergic comorbidities, and basopenia were positively associated with the probability of CSU relapse within 3 months after BNT162b2 mRNA vaccination (odds ratio [OR] 5.54 [95% confidence interval {CI}, 2.36-13.02], p < 0.001); OR 6.13 [95% CI, 2.52-14.89], p = 0.001; and OR 2.81 [95% CI, 1.17-6.72, p = 0.020, respectively). Conclusion: It is possible that BNT162b2 mRNA vaccination serves as a provoking and/or relapsing factor of CSU in individuals with allergic diseases and/or predisposed autoimmunity.
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Affiliation(s)
- Eli Magen
- From the Leumit Research Institute and Department of Family Medicine, Leumit Health Services, Ashkelon, Israel
| | - Avi Yakov
- From the Leumit Research Institute and Department of Family Medicine, Leumit Health Services, Ashkelon, Israel
| | - Ilan Green
- From the Leumit Research Institute and Department of Family Medicine, Leumit Health Services, Ashkelon, Israel
| | - Ariel Israel
- From the Leumit Research Institute and Department of Family Medicine, Leumit Health Services, Ashkelon, Israel
| | - Shlomo Vinker
- From the Leumit Research Institute and Department of Family Medicine, Leumit Health Services, Ashkelon, Israel
| | - Eugene Merzon
- From the Leumit Research Institute and Department of Family Medicine, Leumit Health Services, Ashkelon, Israel
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McManus NM, Zehrung RJ, Armstrong TC, Offman RP. Anaphylaxis Caused by Swimming: A Case Report of Cold-induced Urticaria in the Emergency Department. Clin Pract Cases Emerg Med 2021; 5:307-311. [PMID: 34437035 PMCID: PMC8373186 DOI: 10.5811/cpcem.2021.4.51164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/06/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction Cold-induced urticaria is a subset of physical urticaria that presents as wheals or angioedema in response to cold exposure. While most cases are idiopathic, secondary associations with infections, medications, and certain cancers have been described. Case Report We discuss the case of a 50-year-old male with recent episodes of urticaria from cold air exposure following a flu-like illness six months prior, who presented with symptoms of anaphylaxis upon jumping into a lake. Conclusion While the majority of patients develop localized symptoms, understanding this disease entity is imperative as up to one-third of patients can develop severe symptoms including anaphylaxis, particularly from water submersion during activities such as swimming.
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Affiliation(s)
- Nicholas M McManus
- Mercy Health Hospital, Department of Emergency Medicine, Muskegon, Michigan
| | - Robert J Zehrung
- Mercy Health Hospital, Department of Emergency Medicine, Muskegon, Michigan
| | - Trevor C Armstrong
- Mercy Health Hospital, Department of Emergency Medicine, Muskegon, Michigan
| | - Ryan P Offman
- Mercy Health Hospital, Department of Emergency Medicine, Muskegon, Michigan
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A T, Lambrou GI, Kyritsi A, Geronikolou SA, Nikolaidou E, Katsarou A, Chatziioannou A, Stratigos A, Rigopoulos D. Urticaria from the Neurodermatological Perspective: A Temporal Analysis of Urticaria and Cognition. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1339:209-220. [DOI: 10.1007/978-3-030-78787-5_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Huang Y, Xiao Y, Jing D, Li J, Zhang J, Chen X, Shen M. Association of Chronic Spontaneous Urticaria With Anxiety and Depression in Adolescents: A Mediation Analysis. Front Psychiatry 2021; 12:655802. [PMID: 34557115 PMCID: PMC8454946 DOI: 10.3389/fpsyt.2021.655802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Chronic spontaneous urticaria (CSU) is related to psychiatric comorbidities. It is not clear whether the relationship is affected by modifiable factors. Objectives: To investigate whether the effect of CSU on anxiety and depression in adolescents is mediated by the symptoms of itching and sleep disturbance. Methods: Questionnaire survey was conducted among newly enrolled college students. Dermatologists diagnose skin diseases, including CSU, during health examination. Anxiety and depression were measured by the Generalized Anxiety Disorder Scale and Patient Health Questionnaire, respectively. Sleep quality was measured by the Pittsburgh Sleep Quality Index. The symptoms of itching were measured by the numeric rating scale. According to the hypothesis, the mediating effect model was put forward and the structural equation model is used to build the mediation effect model. The mediation effect model was proposed according to the hypothesis and established using a structural equation model. Results: A total of 2,358 students with no history of systemic disease and no pruritus disease (except CSU) were included in the analysis. A total of 393 CSU patients were included, and 1,965 healthy controls were selected based on age and sex matching. CSU was significantly associated with both anxiety and depression when the symptoms of itching and sleep quality were not modeled. A mediation model was proposed as CSU → itching → sleep disturbance → anxiety or depression. Itching and sleep quality mediated 65.4 and 77.6% of CSU's effects on anxiety and depression, respectively, and CSU had no significant direct effect on anxiety or depression in the mediation models. Conclusions: The associations of CSU with anxiety and depression were mediated by the symptoms of itching and sleep disturbance. Effectively reducing the symptoms of itching thereby could increase natural sleep, which can further treat the emotional disorders among patients with CSU.
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Affiliation(s)
- Yuzhou Huang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China
| | - Yi Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China
| | - Danrong Jing
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China
| | - Jie Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China
| | - Jianglin Zhang
- Department of Detmatology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China
| | - Minxue Shen
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
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Weller K, Giménez‐Arnau A, Grattan C, Asero R, Mathelier‐Fusade P, Bizjak M, Hanna M, Maurer M. The Chronic Urticaria Registry: rationale, methods and initial implementation. J Eur Acad Dermatol Venereol 2020; 35:721-729. [DOI: 10.1111/jdv.16947] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/24/2020] [Indexed: 11/26/2022]
Affiliation(s)
- K. Weller
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - A. Giménez‐Arnau
- Department of Dermatology, Hospital del Mar Autonomous University of Barcelona Barcelona Spain
| | - C. Grattan
- St John's Institute of Dermatology London UK
| | - R. Asero
- Outpatient Clinic of Allergology San Carlo Hospital Paderno Dugnano Italy
| | | | - M. Bizjak
- University Clinic of Respiratory and Allergic Diseases Golnik Golnik Slovenia
| | - M. Hanna
- Mercury Medical Research & Writing New York NY USA
| | - M. Maurer
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
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Chu CY, Al Hammadi A, Agmon-Levin N, Atakan N, Farag A, Arnaout RK, Kannenberg S, Kulthanan K, Mubarak A, Zaitoun F, Crowe S, Malfait S, Cooke K, Dekker EL. Clinical characteristics and management of chronic spontaneous urticaria in patients refractory to H 1-Antihistamines in Asia, Middle-East and Africa: Results from the AWARE-AMAC study. World Allergy Organ J 2020; 13:100117. [PMID: 32382379 PMCID: PMC7200453 DOI: 10.1016/j.waojou.2020.100117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/21/2020] [Accepted: 03/10/2020] [Indexed: 11/25/2022] Open
Abstract
Background Chronic urticaria (CU) is a condition characterized by recurrent itchy hives and/or angioedema for ≥6 weeks. Most of the data about CU come from western countries with very little information available about CU in Asia, Africa, and the Middle East. Methods AWARE-AMAC is a 24-month prospective, observational, real-world, non-interventional study in patients aged ≥18 years from Asia, the Middle East, and Africa (AMAC) with CU refractory to H1-antihistamines (H1-AH). The main objective was to describe the real-world experience with CU, including clinical characteristics, presence of angioedema, treatment patterns (shifts between treatment classes and changes within a treatment class), investigator-assessed disease control, and the impact on quality of life. Subgroups of interest were type of CU at Baseline and treatment class (based on 2013 urticaria guidelines). There were no mandatory visits and diagnostic/monitoring procedures additional to routine practice, except the patient diary (7-day Urticaria Activity Score) and patient reported outcome assessments. Results The focus of the current manuscript is on patients with chronic spontaneous urticaria (CSU), who formed 98% of the sample. Patients were predominantly female (69.6% female, mean age ± SD 39.8 ± 13.29 years). Time since current diagnosis (Mean ± SD) was 28.6 ± 49.06 months. Amongst patients with CSU, 31.0% had comorbid chronic inducible urticaria (CINDU) and 46.4% had a history of angioedema. 91.9% received H1-AH therapy (±other treatments). The most frequently prescribed treatment classes at Baseline were any/combination of medications, not classified under the other 7 treatment classes, named “Others” (30.5%) followed by, omalizumab (OMA; 23.6%) and second-generation H1-AH monotherapy (sgAH; 15.1%). At Month 12, the most prescribed treatment classes (>15%) for patients were OMA (23.5%) and "Other" (21.3%); 19.7% received "No drug". At Month 24, OMA (22.5%), and "Other" (17.9%) were most frequently prescribed; 28.6% received "No drug". Overall, 79.5% of patients had some type of change in treatment. Over the study period, improvement in self-reported QoL increased, which was mirrored by better disease control. Conclusion In AMAC countries, the non-recommended "Other" treatment class played a major role in the initial management of CU patients. High usage of H1-AH (±other treatments) and OMA was observed. Treatment changes were observed in a majority of patients. Treatment escalation from sgAH was mostly via OMA. Improvement of disease control and QoL was achieved during the study period. Trial registration Observational study (NA).
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Key Words
- AMAC, Asia Middle East and Africa
- CINDU, Chronic inducible urticarial
- CSU, Chronic spontaneous urticarial
- CU, Chronic urticaria
- Chronic spontaneous urticaria
- CsA, Cyclosporine A
- DLQI, Dermatology Life Quality Index
- Efficacy
- GCP, Good Clinical Practice
- H1-AH, H1-antihistamines
- HRCU, H1-antihistamines refractory chronic urticarial
- HRQoL, Health-related quality of life
- MONT, Montelukast monotherapy, or in combination with any H1-AH
- OMA, Omalizumab monotherapy, or in combination with any H1-AH, with or without steroids
- Omalizumab
- PRO, Patient-reported outcomes
- PhyGA-VAS, Physician Global Assessment of disease control-visual analog scale
- QoL, Quality of life
- Quality of life
- SD, Standard deviation
- SGC, Systemic glucocorticosteroids monotherapy, or in combination with any H1-AH
- Second-generation antihistamines
- UAS7, 7-day Urticaria Activity Score
- fgAH, First-generation antihistamines monotherapy, or in combination with sgAH
- sgAH, Second-generation antihistamines monotherapy approved dose: once daily or as needed
- sgAHUP, Updosed second-generation H1-AH
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Affiliation(s)
- Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Anwar Al Hammadi
- Dermatology Center, Dubai Health Authority, Dubai, United Arab Emirates
| | - Nancy Agmon-Levin
- Clinical Immunology, Angioedema and Allergy Department, z Center for Autoimmune Diseases, Sheba Medical Centre, Ramat Gan, Israel
| | - Nilgun Atakan
- Department of Dermatology, Hacettepe University, Ankara, Turkey
| | - Assem Farag
- Dermatology Department, Faculty of Medicine, Benha University, Cairo, Egypt
| | - Rand K Arnaout
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Suretha Kannenberg
- Division of Dermatology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Fares Zaitoun
- Allergy, Asthma & Immunology Center Specialty Clinics Center, Beirut, Lebanon
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How guideline can shape clinical practice globally: the diagnosis and rationale for action against cow's milk allergy experience. Curr Opin Allergy Clin Immunol 2020; 19:185-191. [PMID: 30632997 DOI: 10.1097/aci.0000000000000513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Allergic diseases are increasing worldwide and are considered an important public health problem causing severe and even life-threatening reactions. The creation of guidelines aims to help clinicians improving the quality of diagnosis and management of such diseases. Clinical practice guidelines alone are not sufficient and there is a need for implementation strategies for their introduction into daily practice. We report here the main international allergy guidelines with a more focused look on the Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines and their effect on clinical practice. RECENT FINDINGS DRACMA guidelines have clearly modified the approach to cow's milk allergy (CMA) from its diagnosis to treatment tailoring the choices for each patient. Although they strongly recommend oral food challenge for diagnosing CMA, they also indicate that it may not be necessary in many cases with the introduction of the pretest probability of CMA. Studies on the implementation of DRACMA guidelines show how they influenced the formula market, making appropriate treatments more affordable. SUMMARY DRACMA reconciled international differences in the diagnosis and management of CMA. They introduced the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology in the field of food allergy and highlighted the importance for meta-analyses to be able to adapt recommendations to the local context.
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The relation of chronic idiopathic urticaria with Fibromyalgia, sleep disturbance and anxiety. JOURNAL OF CONTEMPORARY MEDICINE 2019. [DOI: 10.16899/jcm.578711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kandikattu HK, Upparahalli Venkateshaiah S, Mishra A. Synergy of Interleukin (IL)-5 and IL-18 in eosinophil mediated pathogenesis of allergic diseases. Cytokine Growth Factor Rev 2019; 47:83-98. [PMID: 31126874 PMCID: PMC6781864 DOI: 10.1016/j.cytogfr.2019.05.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/28/2019] [Accepted: 05/09/2019] [Indexed: 02/07/2023]
Abstract
Eosinophils are circulating granulocytes that have pleiotropic effects in response to inflammatory signals in the body. In response to allergens or pathogens, exposure eosinophils are recruited in various organs that execute pathological immune responses. IL-5 plays a key role in the differentiation, development, and survival of eosinophils. Eosinophils are involved in a variety of allergic diseases including asthma, dermatitis and various gastrointestinal disorders (EGID). IL-5 signal transduction involves JAK-STAT-p38MAPK-NFκB activation and executes extracellular matrix remodeling, EMT transition and immune responses in allergic diseases. IL-18 is a classical cytokine also involved in immune responses and has a critical role in inflammasome pathway. We recently identified the IL-18 role in the generation, transformation, and maturation of (CD101+CD274+) pathogenic eosinophils. In, addition, several other cytokines like IL-2, IL-4, IL-13, IL-21, and IL-33 also contribute in advancing eosinophils associated immune responses in innate and adaptive immunity. This review discusses with a major focus (1) Eosinophils and its constituents, (2) Role of IL-5 and IL-18 in eosinophils development, transformation, maturation, signal transduction of IL-5 and IL-18, (3) The role of eosinophils in allergic disorders and (4) The role of several other associated cytokines in promoting eosinophils mediated allergic diseases.
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Affiliation(s)
- Hemanth Kumar Kandikattu
- Department of Medicine, Tulane Eosinophilic Disorders Centre (TEDC), Section of Pulmonary Diseases, Tulane University School of Medicine, New Orleans, LA 70112, United States
| | - Sathisha Upparahalli Venkateshaiah
- Department of Medicine, Tulane Eosinophilic Disorders Centre (TEDC), Section of Pulmonary Diseases, Tulane University School of Medicine, New Orleans, LA 70112, United States
| | - Anil Mishra
- Department of Medicine, Tulane Eosinophilic Disorders Centre (TEDC), Section of Pulmonary Diseases, Tulane University School of Medicine, New Orleans, LA 70112, United States.
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Özlü O, Yorulmaz İS, Eşbah AÜ, Er U. An unexpected challenging airway: Urticaria factitia caused difficult mask ventilation and tracheal intubation. J Clin Anesth 2019; 57:116. [PMID: 30981179 DOI: 10.1016/j.jclinane.2019.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/22/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Onur Özlü
- Duzce University Faculty of Medicine, Anesthesiology and Intensive Care Department, Duzce, Turkey
| | - İlknur Suidiye Yorulmaz
- Duzce University Faculty of Medicine, Anesthesiology and Intensive Care Department, Duzce, Turkey.
| | - Ali Ümit Eşbah
- Duzce University Faculty of Medicine, Anesthesiology and Intensive Care Department, Duzce, Turkey
| | - Uygur Er
- Duzce University Faculty of Medicine, Neurosurgery Department, Duzce, Turkey
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Niu XL, Zhu LL, Shi MH, Zhang YJ, Gao XH, Qi RQ. Association of positive and negative autologous serum skin test responses with clinical features of chronic spontaneous urticaria in Asian patients: A systematic review and meta-analysis. Exp Ther Med 2019; 17:2603-2613. [PMID: 30906452 PMCID: PMC6425266 DOI: 10.3892/etm.2019.7266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 10/03/2018] [Indexed: 01/25/2023] Open
Abstract
Previous studies on the correlation between positive autologous serum skin test (ASST) responses and the clinical features of patients with chronic spontaneous urticaria (CSU) have provided conflicting results. To evaluate the significance of ASST responses in CSU, a variety of databases were searched from inception to March 2018 to identify relevant studies on CSU. Data were analyzed with use of the Cochrane Collaboration's Review Manager 5.2. Multiple relevant factors of CSU were evaluated by calculating the weighted mean difference, odds ratio and 95% confidence interval. The results indicated that CSU cases with positive ASST responses had higher urticaria activity scores and higher levels of total serum immunoglobulin E than CSU cases with negative responses in the ASST. In addition, a positive ASST response was more likely to be accompanied with the presence of thyroid autoantibodies and angioedema. An increased prevalence of CSU was identified in females, who were more likely to have a positive response in the ASST. It was also indicated that a greater incidence of positive ASST responses was present in CSU patients as compared with that in healthy controls. No statistically significant differences were obtained between positive and negative ASST responses with regard to age and duration of disease. Based on these results, it was concluded that the ASST provides an effective means of predicting urticaria activity and recurrence in CSU patients.
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Affiliation(s)
- Xue Li Niu
- Department of Dermatology, No. 1 Hospital of China Medical University and Key Laboratory of Immunodermatology, Ministry of Health and Ministry of Education, Shenyang, Liaoning 110001, P.R. China
| | - Li Li Zhu
- Department of Dermatology, The People's Hospital of Liaoning Province, Shenyang, Liaoning 110016, P.R. China
| | - Mei Hui Shi
- Department of Dermatology, No. 1 Hospital of China Medical University and Key Laboratory of Immunodermatology, Ministry of Health and Ministry of Education, Shenyang, Liaoning 110001, P.R. China
| | - Yu Jing Zhang
- Department of Dermatology, No. 1 Hospital of China Medical University and Key Laboratory of Immunodermatology, Ministry of Health and Ministry of Education, Shenyang, Liaoning 110001, P.R. China
| | - Xing Hua Gao
- Department of Dermatology, No. 1 Hospital of China Medical University and Key Laboratory of Immunodermatology, Ministry of Health and Ministry of Education, Shenyang, Liaoning 110001, P.R. China
| | - Rui Qun Qi
- Department of Dermatology, No. 1 Hospital of China Medical University and Key Laboratory of Immunodermatology, Ministry of Health and Ministry of Education, Shenyang, Liaoning 110001, P.R. China
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Yao Q, Zhang X, Mu Y, Liu Y, An Y, Zhao B. Bloodletting therapy for treating patients with chronic urticaria: A systematic review and meta-analysis protocol. Medicine (Baltimore) 2019; 98:e14541. [PMID: 30762796 PMCID: PMC6408096 DOI: 10.1097/md.0000000000014541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronic urticaria is a common disease affecting patients' quality of life, and leading to substantial burden to both patients and society. Many trials have shown that bloodletting therapy is effective in treating chronic urticaria. There are currently no systematic reviews of bloodletting therapy for chronic urticaria. This protocol aims to present the methods used to assess the effectiveness and safety of bloodletting therapy for patients with chronic urticaria. METHODS The following databases will be searched from their inception: the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP database), and Wan-Fang Database. Clinical randomised controlled trials related to bloodletting therapy for treating chronic urticaria will be included, regardless of publication status and languages. Study selection, data collection, and quality assessment will be independently conducted by 2 researchers. For data synthesis, we will select either the fixed-effects or random-effects model according to heterogeneity assessment. Disease activity control will be assessed as the primary outcomes. Response rate, recurrence rate and adverse events will be evaluated as secondary outcomes. If it is appropriate for meta-analysis, RevMan V.5.3 statistical software will be used. Otherwise, a systematic narrative synthesis will be conducted. The results will be presented as risk ratio (RR) with 95% confidence intervals (CIs) for dichotomous data and weight mean difference (WMD) or standard mean difference (SMD) 95% CIs for continuous data. DISSEMINATION AND ETHICS The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences. It is not necessary for a formal ethical approval because the data are not individualised. TRIAL REGISTRATION NUMBER PROSPERO CRD42018111143.
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Lutfeali S, Khan DA. Review and Perspectives of the Recent International Guidelines on Treatment of Chronic Urticaria. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0184-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Zuberbier T, Bernstein JA. A Comparison of the United States and International Perspective on Chronic Urticaria Guidelines. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1144-1151. [PMID: 29779967 DOI: 10.1016/j.jaip.2018.04.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 11/30/2022]
Abstract
Urticaria is a heterogeneous skin disorder that may be acute or chronic and is defined by the appearance of wheals, angioedema, or both. The European perspective is expressed in a recent international guideline and the American perspective has been based on the US Joint Task Force chronic urticaria practice parameter published in 2014. Both the international guideline (initiated by the European societies European Academy of Allergology and Clinical Immunology [EAACI]/Global Allergy and Asthma European Network [GA2LEN]/European Dermatology Forum [EDF] in collaboration with the World Allergy Organization [WAO]) and the US (American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma and Immunology) guideline have been developed to help direct primary care physicians and specialists in the management of their patients with urticaria. The EAACI/GA2LEN/EDF/WAO guideline applied the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to developing consensus recommendations and these were then discussed in a Delphi conference including more than 250 specialists in the field and have been endorsed by more than 40 international societies. In contrast, the US Joint Task Force CU practice parameter made recommendations based on scientific evidence whenever possible; however, when there was insufficient evidence, recommendations were based on expert consensus opinion. Although both agree on most points regarding the definition, general evaluation, and treatment, there are some differences that exist between the 2 guidelines. Most of these differences pertain to recommendations based on expert opinion because of weak scientific evidence. Within this document, we compare the recommendations of these 2 groups, highlighting the key similarities and differences.
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Affiliation(s)
- Torsten Zuberbier
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Epidemiology of urticaria in Poland - nationally representative survey results. Postepy Dermatol Alergol 2018; 35:67-73. [PMID: 29599674 PMCID: PMC5872247 DOI: 10.5114/ada.2018.73165] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 05/04/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction The prevalence of urticaria is 15–20%. Women are twice as likely to be affected. Aim To present the epidemiology of urticaria and angioedema in Poland. Material and methods A questionnaire-based survey was conducted on a representative group of 4,897 individuals, aged 15–74 years. Results A total of 11.2% of respondents reported at least one episode of urticaria symptoms in their life, and the frequency was higher in females (OR = 1.46; p < 0.001). Single episodes accounted for 34.8%, while repeated episodes accounted for 65.2%. Acute urticaria was observed in 10.6% (more frequent in females; OR = 1.41; p < 0.001), chronic in 0.6%. Median age of the first episode was 15 years. Angioedema was observed in 3.2%. The last episode of urticaria symptoms and/or angioedema occurred within the previous week in 0.7% of subjects, the last month in 1%, and the last year in 2.2%. 8.8% had experienced urticaria symptoms or angioedema over 1 year prior to the survey. The impact of urticaria symptoms on patients’ daily activities was rated with 3.8 points on a scale of 0–10. In addition, chronic urticaria was rated 6.5, and acute urticaria 3.6. Angioedema and urticaria had a negative impact of 5.7 points. Conclusions Urticaria and angioedema are serious health problems in Poland, although their prevalence is below the mean rate for the global population. Females are more likely to suffer from these diseases. People affected by urticaria most frequently report contact with plants and substances, insect bites/stings, and food as the provoking factors.
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Chung MC, Symons C, Gilliam J, Kaminski ER. Posttraumatic stress disorder, emotional suppression and psychiatric co-morbidity in patients with chronic idiopathic urticaria: a moderated mediation analysis. J Ment Health 2018; 27:442-449. [PMID: 29431522 DOI: 10.1080/09638237.2018.1437601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is evidence suggesting that posttraumatic stress disorder (PTSD) symptom severity and CIU severity are linked and partially mediated by the high-anxious defense mechanism. What is unclear is whether emotional suppression, as a defense serving the opposite purpose for high-anxious defense, can also act as a mediator and whether this mediational effect is partly influenced by time since trauma and trauma type. AIMS To investigate whether emotional suppression mediated the links between PTSD and CIU symptom severities, and PTSD and psychiatric co-morbid symptom severities. It then examined whether the mediating effect would be moderated by how long ago the trauma occurred and trauma type. METHODS One hundred CIU patients were compared with 60 allergy patients. They completed questionnaires measuring PTSD, psychiatric co-morbidity and emotional suppression. RESULTS Suppressing depression mediated the relationship between PTSD and psychiatric co-morbidity. How long ago the trauma occurred and trauma type moderated the mediational effect of suppressing depression. CONCLUSIONS Following a past trauma, CIU patients may develop PTSD symptoms which influence their psychological well-being through using different levels of emotional suppression, especially suppressing depression. The levels depend on the severity of PTSD symptoms, trauma history and whether they experienced interpersonal traumas.
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Affiliation(s)
- Man Cheung Chung
- a Department of Educational Psychology, Faculty of Education , The Chinese University of Hong Kong , Shatin NT , Hong Kong , and
| | - Christine Symons
- b Department of Clinical Immunology & Allergy , Derriford Hospital , Plymouth , UK
| | - Jane Gilliam
- b Department of Clinical Immunology & Allergy , Derriford Hospital , Plymouth , UK
| | - Edward R Kaminski
- a Department of Educational Psychology, Faculty of Education , The Chinese University of Hong Kong , Shatin NT , Hong Kong , and
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Hajdu K, Irinyi B, Gyimesi E, Kapitány A, Dajnoki Z, Bata‐Csörgő Z, Kinyó Á, Kiss F, Gáspár K, Szegedi A. A simple, combined test can improve the diagnosis of autoimmune urticaria. Br J Dermatol 2017; 177:864-866. [DOI: 10.1111/bjd.15175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- K. Hajdu
- Division of Dermatological Allergology Faculty of Medicine University of Debrecen Debrecen Hungary
- Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - B. Irinyi
- Division of Dermatological Allergology Faculty of Medicine University of Debrecen Debrecen Hungary
- Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - E. Gyimesi
- Department of Laboratory Medicine Faculty of Medicine University of Debrecen Debrecen Hungary
| | - A. Kapitány
- Division of Dermatological Allergology Faculty of Medicine University of Debrecen Debrecen Hungary
- Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - Zs. Dajnoki
- Division of Dermatological Allergology Faculty of Medicine University of Debrecen Debrecen Hungary
- Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - Zs. Bata‐Csörgő
- Department of Dermatology and Allergology Albert Szent‐Györgyi Medical Center University of Szeged Szeged Hungary
| | - Á. Kinyó
- Department of Dermatology, Venereology and Oncodermatology University of Pécs Pécs Hungary
| | - F. Kiss
- Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
- Center for Medical Education Cardiff University Cardiff U.K
| | - K. Gáspár
- Division of Dermatological Allergology Faculty of Medicine University of Debrecen Debrecen Hungary
- Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - A. Szegedi
- Division of Dermatological Allergology Faculty of Medicine University of Debrecen Debrecen Hungary
- Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
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Staubach P, Zuberbier T, Vestergaard C, Siebenhaar F, Toubi E, Sussman G. Controversies and challenges in the management of chronic urticaria. J Eur Acad Dermatol Venereol 2017; 30 Suppl 5:16-24. [PMID: 27286499 DOI: 10.1111/jdv.13696] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 03/31/2016] [Indexed: 11/29/2022]
Abstract
This supplement reports proceedings of the second international Global Urticaria Forum, which was held in Berlin, Germany in November 2015. Despite the clear international guideline, there remain a number of controversies and challenges in the management of patients with chronic urticaria (CU). As a result of major advancements in urticaria over the past 4 years, the current EAACI/GA(2) LEN/EDF/WAO urticaria guideline treatment algorithm requires updating. Case studies from patients with chronic spontaneous urticaria (CSU) [also called chronic idiopathic urticaria (CIU)], chronic inducible urticaria (CIndU) or diseases and syndromes related to CU are useful in describing and exploring challenges in disease management. Case studies of specific CSU patient populations such as children with CU or patients with angio-edema but no hives also require consideration as potentially challenging groups with unmet needs. The current EAACI/GA(2) LEN/EDF/WAO urticaria guideline provides a general framework for the management of patients with CU but, as these cases highlight, a personalized approach based on the expert knowledge of the physician may be required.
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Affiliation(s)
- P Staubach
- Department of Dermatology, University Medical Center, Mainz, Germany
| | - T Zuberbier
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - C Vestergaard
- Department of Dermatology and Venereology, Aarhus University, Aarhus, Denmark
| | - F Siebenhaar
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - E Toubi
- Division of Allergy and Clinical Immunology, Bnai-Zion Medical Center, Haifa, Israel
| | - G Sussman
- Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto, ON, Canada
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Silvares MRC, Fortes MRP, Nascimento RDAML, Padovani CR, Miot HA, Nogueira CR, Mazeto GMFDS. Thyrotropin receptor gene expression in the association between chronic spontaneous urticaria and Hashimoto's thyroiditis. Int J Dermatol 2017; 56:547-552. [DOI: 10.1111/ijd.13487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 06/02/2016] [Accepted: 09/12/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Maria R. C. Silvares
- Department of Dermatology and Radiotherapy; Botucatu Medical School; Sao Paulo State University - Unesp; Botucatu Sao Paulo Brazil
| | - Maria R. P. Fortes
- Department of Dermatology and Radiotherapy; Botucatu Medical School; Sao Paulo State University - Unesp; Botucatu Sao Paulo Brazil
| | - Renata de A. M. L. Nascimento
- Department of Internal Medicine; Botucatu Medical School; Sao Paulo State University - Unesp; Botucatu Sao Paulo Brazil
| | - Carlos R. Padovani
- Department of Biostatistics; Institute of Bioscience; Sao Paulo State University - Unesp; Botucatu Sao Paulo Brazil
| | - Hélio A. Miot
- Department of Dermatology and Radiotherapy; Botucatu Medical School; Sao Paulo State University - Unesp; Botucatu Sao Paulo Brazil
| | - Célia R. Nogueira
- Department of Internal Medicine; Botucatu Medical School; Sao Paulo State University - Unesp; Botucatu Sao Paulo Brazil
| | - Gláucia M. F. da S. Mazeto
- Department of Internal Medicine; Botucatu Medical School; Sao Paulo State University - Unesp; Botucatu Sao Paulo Brazil
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Lee JB, Lee SH, Han MY, Yoon JW. Allergen sensitization and vitamin D status in young Korean children with urticaria. ALLERGY ASTHMA & RESPIRATORY DISEASE 2017. [DOI: 10.4168/aard.2017.5.3.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jeong Bong Lee
- Department of Pediatrics, Seonam University of Medicine, Myongji Hospital, Goyang, Korea
| | - Shin Hae Lee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Jung Won Yoon
- Department of Pediatrics, Seonam University of Medicine, Myongji Hospital, Goyang, Korea
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Christopher JJ, Nehemiah HK, Arputharaj K, Moses GL. Computer-assisted Medical Decision-making System for Diagnosis of Urticaria. MDM Policy Pract 2016; 1:2381468316677752. [PMID: 30288410 PMCID: PMC6125052 DOI: 10.1177/2381468316677752] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 09/24/2016] [Indexed: 11/17/2022] Open
Abstract
Background: Urticaria is a common allergic disease that affects all age groups. Allergic disorders are diagnosed at allergy testing centers using skin tests. Though skin tests are the gold standard tests for allergy diagnosis, specialists are required to interpret the observations and test results. Hence, a computer-assisted medical decision-making (CMD) system can be used as an aid for decision support, by junior clinicians, in order to diagnose the presence of urticaria. Methods: The data from intradermal skin test results of 778 patients, who exhibited allergic symptoms, are considered for this study. Based on food habits and the history of a patient, 40 relevant allergens are tested. Allergen extracts are used for skin test. Ten independent runs of 10-fold cross-validation are used to train the system. The performance of the CMD system is evaluated using a set of test samples. The test samples were also presented to the junior clinicians at the allergy testing center to diagnose the presence or absence of urticaria. Results: From a set of 91 features, a subset of 41 relevant features is chosen based on the relevance score of the feature selection algorithm. The Bayes classification approach achieves a classification accuracy of 96.92% over the test samples. The junior clinicians were able to classify the test samples with an average accuracy of 75.68%. Conclusion: A probabilistic classification approach is used for identifying the presence or absence of urticaria based on intradermal skin test results. In the absence of an allergy specialist, the CDM system assists junior clinicians in clinical decision making.
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Affiliation(s)
- Jabez J Christopher
- Ramanujan Computing Centre (JJC, HKN), Anna University, Chennai, Tamil Nadu, India.,Department of Information Science and Technology (KA), Anna University, Chennai, Tamil Nadu, India.,Good Samaritan Lab and Allergy Testing Centre, Kilpauk, Chennai, Tamil Nadu, India (GLM)
| | - Harichandran Khanna Nehemiah
- Ramanujan Computing Centre (JJC, HKN), Anna University, Chennai, Tamil Nadu, India.,Department of Information Science and Technology (KA), Anna University, Chennai, Tamil Nadu, India.,Good Samaritan Lab and Allergy Testing Centre, Kilpauk, Chennai, Tamil Nadu, India (GLM)
| | - Kannan Arputharaj
- Ramanujan Computing Centre (JJC, HKN), Anna University, Chennai, Tamil Nadu, India.,Department of Information Science and Technology (KA), Anna University, Chennai, Tamil Nadu, India.,Good Samaritan Lab and Allergy Testing Centre, Kilpauk, Chennai, Tamil Nadu, India (GLM)
| | - George L Moses
- Ramanujan Computing Centre (JJC, HKN), Anna University, Chennai, Tamil Nadu, India.,Department of Information Science and Technology (KA), Anna University, Chennai, Tamil Nadu, India.,Good Samaritan Lab and Allergy Testing Centre, Kilpauk, Chennai, Tamil Nadu, India (GLM)
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Yao Q, Li S, Liu X, Qin Z, Liu Z. The Effectiveness and Safety of Acupuncture for Patients with Chronic Urticaria: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2016; 2016:5191729. [PMID: 27314024 PMCID: PMC4897793 DOI: 10.1155/2016/5191729] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 04/15/2016] [Accepted: 05/03/2016] [Indexed: 01/08/2023]
Abstract
Background. Acupuncture might have effectiveness in relieving the symptoms of chronic urticaria. There are currently no systematic reviews of acupuncture for chronic urticaria published in English. Objective. We conducted a systematic review to assess the effectiveness and safety of acupuncture for chronic urticaria. Methods. A systematic review and meta-analysis of randomized, controlled trials were performed. The primary outcome was global symptom improvement. Results. We included 6 studies with 406 participants. Three trials showed significant difference between acupuncture and drugs in global symptom improvement (relative risk 1.37; 95% CI 1.11-1.70; P = 0.003). As an adjuvant to medication, acupuncture was also beneficial for global symptom improvement (relative risk 1.77; 95% CI 1.41-2.22; P < 0.01). There were no severe adverse events related to acupuncture. Limitations. Some methodological limitations were observed. The overall risk of bias in the 6 included trials was high and all included RCTs were conducted in China and published in Chinese. Besides, the lack of proper control groups and the use of different rating methods and cut-offs in the included trials also made the evidence of this review limited. Conclusions. Acupuncture might be effective and safe for chronic urticaria in relieving symptoms, based on a low level of evidence. To draw a reliable conclusion, more high quality trials are needed in the future. This trial is registered with PROSPERO CRD42015015702.
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Affiliation(s)
- Qin Yao
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
- School of Graduates, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Shanshan Li
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Xiaoxu Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
- School of Graduates, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Zongshi Qin
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
- School of Graduates, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Zhishun Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
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Chung SD, Wang KH, Tsai MC, Lin HC, Chen CH. Hyperlipidemia Is Associated with Chronic Urticaria: A Population-Based Study. PLoS One 2016; 11:e0150304. [PMID: 26964045 PMCID: PMC4786290 DOI: 10.1371/journal.pone.0150304] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 02/04/2016] [Indexed: 11/21/2022] Open
Abstract
The etiology of chronic urticaria (CU) is diverse, with chronic infections and inflammation being reported as considerable contributing factors. Although the prevalence of metabolic syndrome was found to be significantly elevated in patients with CU, no one has specifically estimated the effects on CU following hyperlipidemia. This study aimed to examine the association between hyperlipidemia and CU using a population-based dataset in Taiwan. This study included 9798 adults with CU as cases and 9798 sex- and age-matched controls. These patients were examined for whether they had received a prior diagnosis of hyperlipidemia. We used conditional logistic regression analyses to calculate the odds ratio (OR) and its corresponding 95% confidence interval (CI) for having been previously diagnosed with hyperlipidemia between cases and controls. In total, 7066 (36.1%) patients had received a prior diagnosis of hyperlipidemia, including 4287 (43.8%) among CU cases and 2779 (28.4%) among controls. The conditional logistic regression revealed that the OR of prior hyperlipidemia for cases was 1.97 (95% CI: 1.85~2.09) compared to the controls. Furthermore, compared to patients without CU, patients with CU independently experienced a 1.65-fold (95% CI = 1.55~1.76; p<0.001) increased risk of having a prior hyperlipidemia diagnosis, after adjustments were made. We concluded that CU was associated with having received a prior diagnosis of hyperlipidemia.
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Affiliation(s)
- Shiu-Dong Chung
- Department of Surgery, Far Eastern Memorial Hospital, Banciao, Taipei, Taiwan
- Graduate Program in Biomedical Informatics, College of Informatics, Yuan-Ze University, Chung-Li, Taiwan
- Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Kuo-Hsien Wang
- Department of Dermatology, Taipei Medical University and Hospital, Taipei, Taiwan
| | - Ming-Chieh Tsai
- School of Healthcare Administration, Taipei Medical University, Taipei, Taiwan
- Department of Internal Medicine, Cathay General Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Herng-Ching Lin
- Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- School of Healthcare Administration, Taipei Medical University, Taipei, Taiwan
- * E-mail:
| | - Chao-Hung Chen
- Department & Institute of Physiology, National Yang-Ming University, Taipei, Taiwan
- Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- Department of Thoracic Surgery, MacKay Memorial Hospital, Taipei, Taiwan
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Dakhale GN, Wankhede SS, Mahatme MS, Hiware SK, Mishra DB, Dudhgaonkar SS. Comparison of Efficacy, Safety and Cost-effectiveness of Rupatadine and Olopatadine in Patients of Chronic Spontaneous Urticaria: A Randomized, Double-blind, Comparative, Parallel Group Trial. Indian J Dermatol 2016; 61:63-9. [PMID: 26955097 PMCID: PMC4763697 DOI: 10.4103/0019-5154.159621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To compare efficacy, safety and cost-effectiveness of rupatadine and olopatadine in patients of chronic spontaneous urticaria. Materials and Methods: A 6-week, single-centered, randomized, double blind, parallel group comparative clinical study was conducted on patients with chronic spontaneous urticaria. Following inclusion and exclusion criteria, 60 patients were recruited and were randomized to two treatment groups and received the respective drugs for 6 weeks. At follow-up, parameters assessed were mean total symptom score (MTSS) calculated by adding the mean number of wheals (MNW) and the mean pruritus score (MPS), number of wheals, size of wheal, scale for interference of wheals with sleep (SIWS). Results: Both the drugs significantly reduced the MTSS, number of wheals, size of wheal, scale for interference of wheals with sleep, but olopatadine was found to be superior. In olopatadine group, there was significantly higher reduction in MTSS (p = 0.01), Number of wheals (P < 0.05), Size of wheals (p < 0.05), Scale for intensity of erythema (p < 0.05) and change in eosinopils count (p = 0.015) than that of rupatadine. Incidence of adverse effects was found to be less in olopatadine group when compared with rupatadine group. Cost effectiveness ratio was less in olopatadine group as compared to rupatadine group throughout the treatment. Conclusions: Olopatadine is a better choice in chronic spontaneous urticaria in comparison to rupatadine due to its better efficacy, safety and cost effectiveness profile.
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Affiliation(s)
- Ganesh N Dakhale
- Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India
| | - Sumit S Wankhede
- Department of Pharmacology, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Mohini S Mahatme
- Department of Pharmacology, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Sachin K Hiware
- Department of Pharmacology, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Dharmendra B Mishra
- Department of Skin and VD, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Sujata S Dudhgaonkar
- Department of Pharmacology, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India
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Varghese R, Rajappa M, Chandrashekar L, Kattimani S, Archana M, Munisamy M, Revathy G, Thappa DM. Association among stress, hypocortisolism, systemic inflammation, and disease severity in chronic urticaria. Ann Allergy Asthma Immunol 2016; 116:344-348.e1. [PMID: 26905640 DOI: 10.1016/j.anai.2016.01.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 01/06/2016] [Accepted: 01/20/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chronic urticaria (CU) is an immune-mediated disease characterized by wheals for at least 6 weeks. The role of stress and the correlation of stress, hypocortisolism, and inflammatory markers are not well understood. OBJECTIVES To estimate C-reactive protein (CRP), interleukin (IL)-18, and cortisol levels in patients with CU and to explore their association with disease severity and stress. METHODS Forty-five patients with CU and 45 age- and sex-matched healthy controls were recruited for this cross-sectional study. Disease severity was assessed by the urticaria activity score (UAS) and stress by Presumptive Stressful Life Events (PSLE) and Daily Hassles and Uplifts Scale-Revised (DHUS-R) scoring. IL-18 and high-sensitivity CRP (hs-CRP) were estimated using enzyme-linked immunosorbent assay kits and cortisol levels by chemiluminescence. RESULTS We observed significant systemic inflammation (increased hs-CRP and IL-18 levels) and stress scores, whereas there was a lowering of basal cortisol levels in patients with CU compared with controls. This finding was more pronounced with increasing disease severity and autoimmune disease, except for stress scores, which did not vary between patients with positive and negative autologous plasma skin test results. We further observed that patients with CU with hypocortisolism had higher levels of hs-CRP and IL-18 and higher PSLE and DHUS-R scores compared with those without hypocortisolism. The hs-CRP level, IL-18 level, PSLE score, DHUS-R score, and duration of the symptoms are significantly positively correlated with UAS, whereas the cortisol level is significantly negatively correlated with UAS. Cortisol has a significant negative correlation with PSLE score, DHUS-R score, and the duration of the disease. CONCLUSION CU is associated with systemic inflammation and stress, along with a significant lower basal cortisol, especially with severe disease and autoimmune urticaria. Thus, chronic stress may precipitate the vicious cycle in the pathogenesis of CU.
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Affiliation(s)
- Rosin Varghese
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Medha Rajappa
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Laxmisha Chandrashekar
- Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
| | - Shivanand Kattimani
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Mony Archana
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Malathi Munisamy
- Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Gunaseelan Revathy
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Devinder Mohan Thappa
- Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Abstract
INTRODUCTION This systematic review protocol aims to describe a meta-analysis to assess the effectiveness and safety of acupuncture therapy for patients with chronic urticaria. METHODS AND ANALYSIS We will electronically search the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, the Web of Science, Traditional Chinese Medicine, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP database) and Wan-Fang Database from their inception. Other sources will also be searched, including the reference lists of identified publications and conference proceedings. Any clinical randomised controlled trials related to acupuncture for treating chronic urticaria without restriction of publication status and languages will be included. Study selection, data extraction and assessment of study quality will be performed independently by 2 researchers. Data will be synthesised by either the fixed-effects or random-effects model according to a heterogeneity test. Improvement in pruritus and wheals will be assessed as the primary outcomes. Adverse events, quality of life and the recurrence rate after at least 3 months of the treatment will also be evaluated as secondary outcomes. RevMan V.5.2 statistical software will be used for meta-analysis, if possible. If it is not appropriate for a meta-analysis, then a descriptive analysis or a subgroup analysis will be conducted. The results will be expressed as a risk ratio for dichotomous data and mean difference (MD) or standardised MD for continuous data. DISSEMINATION AND ETHICS The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences. It is not necessary for a formal ethical approval because the data are not individualised. TRIAL REGISTRATION NUMBER PROSPERO CRD42015015702.
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Affiliation(s)
- Qin Yao
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- School of Graduates, Beijing University of Chinese Medicine, Beijing, China
| | - Yongming Ye
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaoxu Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- School of Graduates, Beijing University of Chinese Medicine, Beijing, China
| | - Zongshi Qin
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- School of Graduates, Beijing University of Chinese Medicine, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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The relation of autologous serum and plasma skin test results with urticarial activity score, sex and age in patients with chronic urticaria. Postepy Dermatol Alergol 2015; 32:173-8. [PMID: 26161057 PMCID: PMC4495116 DOI: 10.5114/pdia.2015.48057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 08/29/2014] [Accepted: 09/24/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction Some previous studies reported autoimmunity as an etiologic factor in chronic urticaria (CU), but the results of some autoimmunity tests in these studies are conflicting. Aim To concretize whether there was any relation of autologous serum skin test (ASST) and autologous plasma skin test (APST) results with sex, age and urticarial activity score (UAS) in patients with CU. Material and methods Fifty patients with CU and twenty healthy subjects admitted to our dermatology clinic were included in the present study. The ASST and APST were applied to all individuals. Results The positiveness rates of ASST and APST were significantly higher in the patient group than controls (p = 0.027, p = 0.001, respectively). Among patients, the APST positiveness rate (72%) was significantly (p < 0.05) higher than ASST (46%). It was seen that 48% of patients with negative ASST results had positive APST. However, no patient with negative APST results had positive ASST. There were significant (p < 0.05) relations of the tests’ positiveness rates with sex and old age but with UAS. The diameter of the erythematous papule was remarkably (p < 0.05) larger in APST than ASST and also significantly (p < 0.05) larger in females compared to males in both tests (p < 0.05). It was positively increased with old age (p < 0.05). Conclusions We can suggest that APST is more sensitive than ASST in the assessment of autoimmunity in CU. A high positiveness rate of APST results may be attributed to high numbers of autoantibodies and coagulation factors present in plasma that might probably play a role in etiopathogenesis of CU.
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Trevisonno J, Balram B, Netchiporouk E, Ben-Shoshan M. Physical urticaria: Review on classification, triggers and management with special focus on prevalence including a meta-analysis. Postgrad Med 2015; 127:565-70. [DOI: 10.1080/00325481.2015.1045817] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Torabi B, Ben-Shoshan M. The association of cholinergic and cold-induced urticaria: diagnosis and management. BMJ Case Rep 2015; 2015:bcr-2014-205258. [PMID: 25694628 DOI: 10.1136/bcr-2014-205258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Physical urticaria is often challenging to diagnose and manage. We present a case of both cholinergic and cold-induced urticaria and discuss the diagnosis and management strategies of these two important conditions.
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Affiliation(s)
- Bahar Torabi
- Division of Paediatric Allergy and Clinical Immunology, Department of Paediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Moshe Ben-Shoshan
- Division of Paediatric Allergy and Clinical Immunology, Department of Paediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
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Omalizumab (Xolair) in Children above 12 Years With Chronic Urticaria: A Review of Literature. JOURNAL OF PEDIATRICS REVIEW 2015. [DOI: 10.5812/jpr.152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Mitchell S, Balp MM, Samuel M, McBride D, Maurer M. Systematic review of treatments for chronic spontaneous urticaria with inadequate response to licensed first-line treatments. Int J Dermatol 2014; 54:1088-104. [DOI: 10.1111/ijd.12727] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | - Marcus Maurer
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité, Universitätsmedizin Berlin; Berlin Germany
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Does urticaria risk increase in patients with celiac disease? A large population-based cohort study. Eur J Dermatol 2014; 23:681-7. [PMID: 24135663 DOI: 10.1684/ejd.2013.2158] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Case reports and smaller case-control studies suggest an association between celiac disease (CD) and urticaria but risk estimates have varied considerably across studies and as yet there are no studies on CD and the risk of future urticaria. OBJECTIVE To examine the association between CD and urticaria. METHODS We identified 28,900 patients with biopsy-verified CD (equal to Marsh stage 3) and compared them with 143,397 age- and sex-matched controls with regards to the risk of urticaria and chronic urticaria (duration ≥6 weeks). Hazard ratios (HRs) were estimated using a Cox regression model. RESULTS During follow-up, 453 patients with CD and no previous diagnosis of urticaria developed urticaria (expected n = 300) and 79 of these 453 had chronic urticaria (expected n = 41). The corresponding HRs were 1.51 for any urticaria (95%CI = 1.36-1.68) and 1.92 for chronic urticaria (95%CI = 1.48-2.48). The absolute risk for urticaria in CD was 140/100,000 person-years (excess risk = 47/100,000 person-years). Corresponding figures for chronic urticaria were 24/100,000 person-years and 12/100,000 person-years. Patients with CD were also at increased risk of having both urticaria (odds ratio, OR = 1.31; 95%CI = 1.12-1.52) and chronic urticaria (OR = 1.54; 95%CI = 1.08-2.18) prior to the CD diagnosis. CONCLUSION This study suggests that CD is associated with urticaria, especially chronic urticaria.
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Sheeran C, Cahill J, Nixon R. Glove-related hand urticaria caused by disposable gloves in healthcare workers. Contact Dermatitis 2014; 71:115-6. [PMID: 25040713 DOI: 10.1111/cod.12201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 12/06/2013] [Accepted: 12/11/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Claire Sheeran
- Occupational Dermatology Research Education Centre, Skin Cancer Foundation, Melbourne 3053, Australia
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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, Saini SS, Sánchez-Borges M, Schmid-Grendelmeier P, Simons FER, Staubach P, Sussman G, Toubi E, Vena GA, Wedi B, Zhu XJ, Nast A, Maurer M. Methods report on the development of the 2013 revision and update of the EAACI/GA2 LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria. Allergy 2014; 69:e1-29. [PMID: 24898678 DOI: 10.1111/all.12370] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2014] [Indexed: 10/25/2022]
Abstract
This methods report describes the process of guideline development in detail. It 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. 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) and is published in Allergy 2014; 69:868-887.
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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 Italy
| | - 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
- 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
- Federal University of Sao Paulo; Sao Paulo Brazil
| | - A. Giménez-Arnau
- Hospital del Mar. Parc de Salut Mar; Universitat Autònoma; 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 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
| | - 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
- Department of Pediatrics & Child Health; University of Manitoba; Winnipeg MB Canada
- Department of 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
| | - A. Nast
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - M. Maurer
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
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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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Zhong H, Song Z, Chen W, Li H, He L, Gao T, Fang H, Guo Z, Xv J, Yu B, Gao X, Xie H, Gu H, Luo D, Chen X, Lei T, Gu J, Cheng B, Duan Y, Xv A, Zhu X, Hao F. Chronic urticaria in Chinese population: a hospital-based multicenter epidemiological study. Allergy 2014; 69:359-64. [PMID: 24354882 DOI: 10.1111/all.12338] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND The epidemiologic profiles of chronic urticaria (CU) vary considerably among regions, and few such data are available from China. METHODS We performed a multicenter open questionnaire investigation about the clinical and laboratory features of CU, defined as recurrent wheals with/without angioedema lasting for ≥6 weeks, among 3027 patients. RESULTS Female preponderance was observed (female/male ratio, 1.46 : 1). The mean age at diagnosis was 34.7 ± 13.8 years, and the mean disease duration was 18.5 ± 46.1 months (range, 1.5-127 months). Patients were classified as having chronic spontaneous urticaria (CSU, 61.0% of patients), physical urticaria (PU, 26.2%), or other urticaria types (OU, 2.3%). Nocturnal attacks were reported by 60% of cases. The Urticaria Activity Score (UAS) in patients with CSU was 3.8 ± 1.4. The mean Dermatology Life Quality Index was 7.3 ± 3.4 (range 0-30). Induction or exacerbation of wheals with alcohol drinking was reported by 55.7% of patients. Chronic hepatitis B was less prevalent in our CU patients compared with the general Chinese population (2.7% vs 7%). Positive autologous serum skin tests (ASSTs) were observed in 66.9% of patients. Patients with positive ASST had higher UAS, greater angioedema frequencies, longer disease durations, and poorer QoL compared with patients with negative ASST (P < 0.05). CONCLUSION In this Chinese population, CU usually affected youth, and CSU was the most common subtype. Autoreactivity and alcohol consumption were the top two triggers for CU, whereas latent infectious and chronic inflammatory diseases were not as common as in previous reports.
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Affiliation(s)
- H. Zhong
- Department of Dermatology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - Z. Song
- Department of Dermatology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - W. Chen
- Department of Dermatology and Allergy; Technische Universitaet Muenchen; Muenchen Germany
| | - H. Li
- Department of Dermatology; The First Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - L. He
- Department of Dermatology; The First Hospital Affiliated to Kunming Medical College; Kunming China
| | - T. Gao
- Department of Dermatology; Xijing Hospital; Fourth Military Medical University; Xi'an China
| | - H. Fang
- Department of Dermatology; The First Affiliated Hospital of Medical School of Zhejiang University; Hangzhou China
| | - Z. Guo
- Department of Dermatology; West China Hospital of Sichuan University; Chengdu China
| | - J. Xv
- Department of Dermatology; Huashan Hospital; Fudan University; Shanghai China
| | - B. Yu
- Department of Dermatology; PeKing University Shenzhen Hospital; Shenzhen China
| | - X. Gao
- Department of Dermatology; The First Affiliated Hospital of China Medical University; Shenyang China
| | - H. Xie
- Department of Dermatology; Xiangya Hospital; Central South University; Changsha China
| | - H. Gu
- Institute of Dermatology; Chinese Academy of Medical Sciences & Peking Union Medical College; Nanjing China
| | - D. Luo
- Department of Dermatology; Jiangsu Province Hospital; Nanjing China
| | - X. Chen
- Department of Dermatology; Sichuan Provincial People's Hospital; Chengdu China
| | - T. Lei
- Department of Dermatology; Shenyang No. 7 People's Hospital; Shenyang China
| | - J. Gu
- Department of Dermatology; Changhai Hospital; Second Military Medical University; Shanghai China
| | - B. Cheng
- Department of Dermatology; The First Affiliated Hospital of Fujian Medical University; Fuzhou China
| | - Y. Duan
- Department of Dermatology; Wuhan Integrated TCM & Western Medicine Hospital; Wuhan China
| | - A. Xv
- Department of Dermatology; Hangzhou Third People's Hospital; Hangzhou China
| | - X. Zhu
- Department of Dermatology; Peking University First Hospital; Beijing China
| | - F. Hao
- Department of Dermatology; Southwest Hospital; Third Military Medical University; Chongqing China
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Chandrashekar L, Rajappa M, Munisamy M, Ananthanarayanan PH, Thappa DM, Arumugam B. 25-Hydroxy vitamin D levels in chronic urticaria and its correlation with disease severity from a tertiary care centre in South India. ACTA ACUST UNITED AC 2014; 52:e115-8. [DOI: 10.1515/cclm-2013-1014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 12/12/2013] [Indexed: 11/15/2022]
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Demonstrating measurement equivalence of the electronic and paper formats of the Urticaria Patient Daily Diary in patients with chronic idiopathic urticaria. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2013; 6:225-31. [PMID: 23918000 DOI: 10.1007/s40271-013-0021-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The Urticaria Patient Daily Diary (UPDD), originally developed on paper, is a measure of key symptoms of chronic idiopathic urticaria (CIU). The development of the electronic version (eUPDD) involved moderate modifications to the appearance of the paper version. OBJECTIVE This study assessed the measurement equivalence of the electronic and paper versions of the UPDD in a sample of patients with CIU. METHODS This was a cross-over study of patients with moderate-severe CIU refractory to H1 antihistamines. Patients were randomized to either the eUPDD followed by the paper UPDD or vice versa. The UPDD includes morning and evening questions; both sets were administered together in this study. An hour-long filler task was given between paper and electronic administrations. Patients with stable symptoms between the two assessments were included in the analyses. Cohen's kappa coefficients and intraclass correlation coefficients (ICC) were computed as applicable to assess equivalence. RESULTS A total of 91 patients participated (mean age 43 years, 79.1 % female). Symptoms were stable between assessments for 67-74 (74-81 %) patients (varied by symptom). Kappa coefficients ranged from 0.82 to 1.00 for the individual UPDD items. For the Urticaria Activity Score (the sum of the 'itch severity' and 'number of hives' item scores) the ICC was 0.90 for the morning (Wilcoxon p = 0.331) and 0.95 for the evening (Wilcoxon p = 0.836). CONCLUSIONS All test-retest statistics in this study were well above the accepted threshold, indicating excellent agreement between the two administration methods. Findings support the measurement equivalence of the electronic and paper versions of the UPDD to measure CIU symptoms.
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Wan KS, Chang YS. Efficacy of leukotriene receptor antagonist with anti-H1 receptor antagonist plus anti-H2 receptor antagonist for treatment of refractory chronic idiopathic urticaria. J DERMATOL TREAT 2013; 25:459-61. [DOI: 10.3109/09546634.2013.849791] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yener M, Erturan I, Ceyhan AM, Inal EE, Kazanoglu OO. The evaluation of prevalence of fibromyalgia in patients with chronic urticaria. Med Sci Monit 2013; 19:757-61. [PMID: 24022252 PMCID: PMC3781201 DOI: 10.12659/msm.889626] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The pathophysiology of chronic idiopathic urticaria (CIU) is not fully understood; however, it has been hypothesized that a subset of people with CIU may have an autoimmune disease and that peripheral cutaneous nerve fibers may be involved in CIU. Similarly, it has been postulated that fibromyalgia syndrome (FMS) is an autoimmune disorder and may be associated with alterations of peripheral cutaneous nerve fibers. Accordingly, the present study aimed to determine whether the frequency of FMS is higher in patients with CIU. Material/Methods A total of 72 patients with CIU and 67 sex- and age-matched healthy controls were included. Urticaria activity score (UAS), fibromyalgia impact questionnaire (FIQ), tender point number, and visual analogue scale (VAS) were assessed. Results The frequency of FMS was similar between the groups (9.7% vs. 4.5%, p=0.32). However, symptom duration of FMS was significantly longer, and tender point number and FIQ were significantly higher in patients with CIU than in controls. In addition, patients with CIU had significantly higher VAS scores. UAS was significantly correlated with presence of FMS, symptom duration of FMS, tender point number, and FIQ and VAS scores. Logistic regression analysis revealed that UAS was an independent predictor of presence of FMS (β=0.34, p=0.003). Conclusions Frequency of FMS was slightly, but not significantly, higher in patients with CIU than in controls. However, symptom duration of FMS, tender point number, and FIQ and VAS scores were significantly higher in patients with CIU, and UAS reflecting severity of the disease was significantly and independently associated with presence of FMS.
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Affiliation(s)
- Mahmut Yener
- Suleyman Demirel University, Faculty of Medicine, Physical Medicine and Rehabilitation Department, Isparta, Turkey
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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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Chandrashekar L, Rajappa M, Sundar I, Munisamy M, Ananthanarayanan PH, Thappa DM, Toi PC. Vascular endothelial growth factor levels in patients with chronic urticaria. Clin Chim Acta 2013; 422:44-6. [PMID: 23570821 DOI: 10.1016/j.cca.2013.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 04/01/2013] [Accepted: 04/01/2013] [Indexed: 01/13/2023]
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Cingi C, Oghan F, Eskiizmir G, Yaz A, Ural A, Erdogmus N. Desloratadine-montelukast combination improves quality of life and decreases nasal obstruction in patients with perennial allergic rhinitis. Int Forum Allergy Rhinol 2013; 3:801-6. [DOI: 10.1002/alr.21185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 04/08/2013] [Accepted: 04/23/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Cemal Cingi
- Department of Otorhinolaryngology, Faculty of Medicine; Osmangazi University; Eskisehir Turkey
| | - Fatih Oghan
- Department of Otorhinolaryngology, Faculty of Medicine; Dumlupinar University; Kutahya Turkey
| | - Gorkem Eskiizmir
- Department of Otorhinolaryngology, Faculty of Medicine; Celal Bayar University; Manisa Turkey
| | - Aytekin Yaz
- Department of Otorhinolaryngology; Tepecik Training and Research Hospital; Izmir Turkey
| | - Ahmet Ural
- Department of Otorhinolaryngology, Faculty of Medicine; Karadeniz Technical University; Trabzon Turkey
| | - Nagehan Erdogmus
- Department of Otorhinolaryngology, Faculty of Medicine; Osmangazi University; Eskisehir Turkey
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Abstract
Classification is based on GA2LEN/EAACI/WAO/EDF guidelines (2009). These guidelines classify urticaria according to clinical manifestations. Urticaria is mediated by mast cells. According to level of mast cell degranulation clinical signs are superficial (Urticaria) or deep swelling (Angioedema).
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Song Z, Zhai Z, Zhong H, Zhou Z, Chen W, Hao F. Evaluation of autologous serum skin test and skin prick test reactivity to house dust mite in patients with chronic spontaneous urticaria. PLoS One 2013; 8:e64142. [PMID: 23741306 PMCID: PMC3669345 DOI: 10.1371/journal.pone.0064142] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 04/09/2013] [Indexed: 11/23/2022] Open
Abstract
Background Chronic spontaneous urticaria (CSU) is a common skin disorder with etiology that is not well understood. Methods In this study, we evaluated the prevalence of autologous serum skin test (ASST) and skin prick testing (SPT) to house dust mite (HDM) in 862 CSU cases in China. Clinical features, courses and treatment responses were also recorded. Results The prevalence of positive ASST was 46.3%, and patients aged 30–39 years had the highest positive rate (52.1%). Positive SPT to HDM was seen in 153 patients (17.7%) with the highest positive rate (34.2%) in patients aged 20 or less. Patients with positive ASST had higher urticaria activity scores (UAS) (4.18±0.65 vs. 3.67±0.53) but lower positive rates of HDM (24.6% vs. 37.6%), as compared with those with negative ASST (odds ratio (OR) 1.84, 95% CI 1.38–2.47). Patients could be categorized into four groups based on the results of ASST and SPT to HDM and patients with positive ASST and positive SPT to HDM had the highest disease activity scores, experienced higher frequencies of angioedema, diseases duration, and required higher dosage of loratadine every month, compared with other subgroups (P<0.0001). Conclusions Patients with CSU showed varied responses of positive ASST and varied sensitivity to HDM, Patients with positive ASST and/or positive SPT had more disease activity compared with patients with negative ASST and/or negative SPT. Further classification can be made based on the result of SPT and ASST.
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Affiliation(s)
- Zhiqiang Song
- Department of Dermatology, Southwest Hospital, The Third Military Medical University, Chongqing, China
| | - Zhifang Zhai
- Department of Dermatology, Southwest Hospital, The Third Military Medical University, Chongqing, China
| | - Hua Zhong
- Department of Dermatology, Southwest Hospital, The Third Military Medical University, Chongqing, China
| | - Ziyuan Zhou
- Department of Toxicology, Preventive College, The Third Military Medical University, Chongqing, China
| | - WenChieh Chen
- Department of Dermatology and Allergy, Technische Universitaet Muenchen, Munich, Germany
| | - Fei Hao
- Department of Dermatology, Southwest Hospital, The Third Military Medical University, Chongqing, China
- * E-mail:
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Chandrashekar L, Rajappa M, Sundar I, Munisamy M, Ananthanarayanan PH, Thappa DM, Toi PC. Platelet activation in chronic urticaria and its correlation with disease severity. Platelets 2013; 25:162-5. [PMID: 23586442 DOI: 10.3109/09537104.2013.786822] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Chronic urticaria (CU) is characterized by the occurrence of wheals lasting for more than 6 weeks. The role of platelet activation in the pathophysiology of this condition has not been clearly studied. We undertook a cross-sectional study among 45 patients with CU and 45 age- and gender-matched healthy controls. The severity of the disease was assessed using the urticaria severity score. The autologous plasma skin test (APST) was done in all cases of CU. The platelet count and indices were estimated by an automated haematological laser optical analyzer. Platelet aggregation and soluble P-selectin levels were estimated in all study participants. It was observed that there was a significantly higher mean platelet volume (MPV) and platelet distribution width (PDW) in patients with CU when compared to controls. Platelet aggregation and soluble P-selectin levels were significantly higher in patients with CU, as compared to controls. Urticaria severity score correlated positively with platelet aggregability and soluble P-selectin levels. APST-positive patients had significantly higher platelet aggregation and higher soluble P-selectin levels, when compared to the APST-negative patients, indicating more platelet activation in the autoimmune group. There is significant platelet activation in patients with CU, especially in those with autoreactivity.
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