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Friedman A, Kwatra SG, Yosipovitch G. A Practical Approach to Diagnosing and Managing Chronic Spontaneous Urticaria. Dermatol Ther (Heidelb) 2024; 14:1371-1387. [PMID: 38758422 PMCID: PMC11169305 DOI: 10.1007/s13555-024-01173-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Abstract
Chronic spontaneous urticaria (CSU) is an unpredictable inflammatory skin condition characterized by the spontaneous onset of itchy wheals, angioedema, or both, which occurs for longer than 6 weeks overall. Despite the relatively straightforward diagnostic algorithm for CSU, relying primarily on a detailed medical history and only limited laboratory tests, patients often wait years to be diagnosed, with many cycling through different healthcare practitioners before a diagnosis is made. Even then, current treatment options for CSU are limited, with approximately half of patients resistant to standard-of-care second-generation antihistamines at standard or higher doses. As such, there is an unmet need for improved, streamlined management for patients with CSU. Here, we review the evidence-based diagnostic algorithm for CSU, consider the required steps of the diagnostic workup, and provide practical, real-world advice on the management of CSU to improve the timely diagnosis and care of patients with this debilitating disease.
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Affiliation(s)
- Adam Friedman
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - Shawn G Kwatra
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, MD, USA
- Maryland Itch Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Gil Yosipovitch
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Coral Gables, FL, USA
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Predictors of Response to Oral Medications and Low-Histamine Diet in Patients with Chronic Urticaria. J Immunol Res 2022; 2022:5243825. [PMID: 35242884 PMCID: PMC8888069 DOI: 10.1155/2022/5243825] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/24/2022] [Accepted: 02/08/2022] [Indexed: 11/30/2022] Open
Abstract
Background Chronic urticaria (CU) is comprised of diverse phenotypes, and thus, a shift towards a precision medical approach is warranted in its management. Methods This study enrolled 78 patients with CU. Serum erythrocyte sedimentation rate, hemoglobin, hematocrit, eosinophil count, IgE, antinuclear antibody (ANA), and serum diamine oxidase (DAO) levels of the patients were measured and were compared according to the patient's response to second-generation antihistamines (sgAH), corticosteroids, leukotriene receptor antagonist (LTRA), H2 blockers, and low-histamine diet. Results Age- and sex-adjusted logistic regression analysis showed that patients with duration of CU > 3 years (adjusted odd ratio [aOR] = 4.39) and a DAO level < 10 U/mL (aOR = 3.90) were significantly associated with a good sgAH response. Age > 50 years (aOR = 0.02), duration of chronic urticaria > 3 years (aOR =0.06), and an ANA titer ≥ 1 : 80 (aOR = 0.03) were significantly and inversely associated with corticosteroid response. A low-histamine diet response was significantly associated with LTRA response (aOR = 67.29). In addition, a DAO level < 5.4 U/mL (aOR = 71.95) was significantly associated with H2 blocker response. Furthermore, concomitant angioedema (aOR = 10.56), multiple food triggers (aOR = 11.69), and a DAO level < 5.4 U/mL (aOR = 3.78) were significantly associated with a low-histamine diet response. Conversely, dermatographic urticaria and a hematocrit level < 36% were significantly and inversely associated with low-histamine diet response. Conclusions Several promising biomarkers were identified in this study to predict the efficacy of chronic urticaria treatment. DAO could be a novel biomarker for predicting the efficacy not only of dietary intervention but also for antagonists of H1 and H2 receptors.
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Cassano N, Genovese G, Asero R, Crimi N, Cristaudo A, Dapavo P, DE Pità O, Ferrucci SM, Fierro MT, Foti C, Girolomoni G, Nettis E, Offidani A, Patrizi A, Pepe P, Pigatto P, Stingeni L, Marzano AV, Vena GA. Chronic spontaneous urticaria in clinical practice: a pilot survey about attitudes and perceptions on assessment, diagnostic work-up and dietary management. Ital J Dermatol Venerol 2020; 156:659-664. [PMID: 33228337 DOI: 10.23736/s2784-8671.20.06760-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is a heterogeneous condition whose management can be complex and challenging. The aim of this study is to evaluate physicians' attitudes regarding practical aspects of CSU management, including adherence to international guidelines, criteria and instruments for CSU assessment, prescription of laboratory investigations and role of dietary measures. METHODS A cross-sectional survey was conducted using a study-specific questionnaire. It was administered to a group of physicians with a specialist interest in CSU from different areas of Italy definable as "CSU experts" (group A; N.=21) and subsequently to other physicians who managed CSU only occasionally in their clinical activity (group B; N.=25). RESULTS The EAACI/GA2LEN/EDF/WAO guidelines were considered very or moderately useful by the majority of participants. Significantly more physicians in group A reported that such guidelines were always followed in clinical practice (P=0.0008). Instruments for the assessment of CSU severity/activity and quality of life were used in clinical practice significantly more often by CSU experts as compared to group B. Dietary measures were frequently suggested for CSU patients by nearly three quarters of group B members and by only 5% of CSU experts (P<0.00001). When physicians were asked to indicate the type of laboratory examinations that were commonly performed in patients with longstanding and/or uncontrolled CSU, regardless of history, the investigations most frequently reported were full blood count and thyroid autoantibodies, followed by erythrocyte sedimentation rate and/or C-reactive protein and thyroid function tests. CONCLUSIONS The results of the present pilot survey seem to suggest the heterogeneity of the approaches used for CSU management in clinical practice.
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Affiliation(s)
| | - Giovanni Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Riccardo Asero
- Outpatient Service of Allergology, San Carlo Clinic, Paderno Dugnano, Milan, Italy
| | - Nunzio Crimi
- Department of Clinical and Experimental Medicine-Respiratory Medicine and Allergy, University of Catania, Catania, Italy
| | - Antonio Cristaudo
- Service of Occupational and Environmental Allergic Dermatology, San Gallicano Dermatology Institute for Research and Care, Rome, Italy
| | - Paolo Dapavo
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Ornella DE Pità
- Department of Dermatology and Allergy, Cristo Re Hospital, Rome, Italy
| | - Silvia M Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria T Fierro
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Caterina Foti
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Giampiero Girolomoni
- Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, Aldo Moro University, Bari, Italy
| | - Annamaria Offidani
- Dermatology Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Annalisa Patrizi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Patrizia Pepe
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Pigatto
- Clinical Dermatology, Department of Biomedical, Surgical and Dental Sciences, IRCCS Galeazzi Orthopedic Institute, University of Milan, Milan, Italy
| | - Luca Stingeni
- Section of Clinical, Allergological and Venereological Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy - .,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Cassano N, Genovese G, Asero R, Crimi N, Cristaudo A, Dapavo P, DE Pità O, Ferrucci S, Fierro MT, Foti C, Girolomoni G, Nettis E, Offidani A, Patrizi A, Pepe P, Pigatto P, Stingeni L, Marzano AV, Vena GA. Therapeutic management of chronic spontaneous urticaria in clinical practice: results from a pilot survey. Ital J Dermatol Venerol 2020; 157:33-38. [PMID: 33228338 DOI: 10.23736/s2784-8671.20.06761-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The therapeutic approaches to patients with chronic spontaneous urticaria (CSU) differ among health care professionals and may be influenced by many factors. This cross-sectional survey was aimed at evaluating physicians' attitudes regarding therapeutic management of CSU in clinical practice. METHODS A study-specific questionnaire was administered to a group of physicians (N.=21) with a specialist interest in CSU from different areas of Italy (group A) and also to other physicians (N.=25) who manage CSU only occasionally in their clinical activity (group B). RESULTS In case of ineffectiveness of second-generation antihistamines at standard doses, higher doses of the same drug were always or frequently prescribed by most physicians in both groups, and 64% in group B and one third in group A usually increased the dose up to twice. Old-generation antihistamines were never used in clinical practice by 14% of survey participants in group A and 24% in group B, with the remaining physicians reporting rare or occasional uses. The prescription of systemic corticosteroids appeared to be more common among physicians in group B. The question concerning the use of alternative drugs in refractory CSU produced different answers between the two groups. Costs and access to specialist reference centers were indicated as the most important barriers to the use of medications different from antihistamines. CONCLUSIONS These preliminary results suggest that therapeutic approaches to CSU seem to be heterogeneous in clinical practice and could be at least in part conditioned by the different medical settings where physicians usually work.
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Affiliation(s)
| | - Giovanni Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Riccardo Asero
- Outpatient Service of Allergology, San Carlo Clinic, Paderno Dugnano, Milan, Italy
| | - Nunzio Crimi
- Department of Clinical and Experimental Medicine-Respiratory Medicine and Allergy, University of Catania, Catania, Italy
| | - Antonio Cristaudo
- Service of Occupational and Environmental Allergic Dermatology, San Gallicano Dermatology Institute for Research and Care, Rome, Italy
| | - Paolo Dapavo
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Ornella DE Pità
- Department of Dermatology and Allergy, Cristo Re Hospital, Rome, Italy
| | - Silvia Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria T Fierro
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Caterina Foti
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Giampiero Girolomoni
- Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, Aldo Moro University, Bari, Italy
| | - Annamaria Offidani
- Dermatology Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Annalisa Patrizi
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Patrizia Pepe
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Pigatto
- Section of Clinical Dermatology, Department of Biomedical, Surgical and Dental Sciences, IRCCS Galeazzi Orthopedic Institute, University of Milan, Milan, Italy
| | - Luca Stingeni
- Section of Clinical, Allergological and Venereological Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy - .,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Firooz A, Akhlaghi A, Golbidi P, Pourjafari M, Abdollahimajd F, Azimi H, Banihashemi M, Darvish Damavandi F, Erfani AR, Farajzadeh S, Ghassemi M, Gheisari M, Hamedpour K, Handjani F, Hashemi SA, Herizchi H, Iraji F, Jalili H, Khatami A, Lajevardi V, Mansouri P, Masjedi H, Mehrian P, Mohammadi S, Mohebbi A, Namazi N, Nasiri Kashani M, Radmehr A, Safar F, Saffarian Z, Saneei S, Seirafi H, Taheri S, Yazdanpanah MJ, Zaboli Nejad N, Naseri M, Peiravi P, Teymori G. Real life management of chronic urticaria: Multicenter and cross sectional study on patients and dermatologists in Iran. Dermatol Ther 2018; 32:e12796. [PMID: 30520195 DOI: 10.1111/dth.12796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 12/03/2018] [Indexed: 12/16/2022]
Abstract
Recently, advances in understanding the etiology of urticaria and updates of diagnostic and therapeutic management guidelines have drawn attention to chronic urticaria (CU) morbidity. The present study aimed to evaluate Iranian dermatologists' practice and real life management of CU patients. A total of 35 dermatologists and 443 patients were included in the study. Number of female patients was 321 (72.5%). Mean (standard deviation) age of the study patients was 38 (13) years and the median (inter quartile range) of disease duration was 12 (6-48) months. Severity of patients' symptoms was mild for 32.1%, moderate for 38.7%, severe for 18.8%, and 10.4% of them had no evident signs or symptoms. The most common diagnostic methods were physical examination (96.6%), differential blood count (83.5%), erythrocyte sedimentation rate (77.4%), and C-reactive protein (62.8%). The number of dermatologists prescribed nonsedating antihistamines (nsAH) in regular dose and high dose mono therapy were 26 (74%) and 6 (17%), respectively. About 66% of dermatologists were familiar with British Association of Dermatologists (BAD) guideline. The most common first-line treatment for CU by Iranian dermatologists was nonsedating antihistamines in regular or high doses. The real-life management of patients with CU in Iran was in accordance with the available practice guidelines.
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Affiliation(s)
- Alireza Firooz
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - AliAsghar Akhlaghi
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | | | | | | | | | - Mahnaz Banihashemi
- Department of Dermatology, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | | | - Saeedeh Farajzadeh
- Department of Dermatology, Afzalipoor Hospital, Kerman University of Medical Science, Kerman, Iran
| | | | - Mehdi Gheisari
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Farhad Handjani
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Ali Hashemi
- Sadaf Clinic, Roudbar Building, East Roudbar Street, Mirdamad Boulevard, Shariati Street, Tehran, Iran
| | | | - Fariba Iraji
- Isfahan University of Medical Sciences, Isfahan, Iran
| | - Homa Jalili
- No 20, Parastar 1 Street, Ahmadabad, Mashad, Iran
| | - Alireza Khatami
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Parvin Mansouri
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Heidar Masjedi
- The National Research Institute of TB and Lung Diseases, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Azadeh Mohebbi
- Dermatology Ward, Kerman University of Medical Sciences, Afzalipour Hospital, Kerman, Iran
| | | | - Mansour Nasiri Kashani
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Radmehr
- Department of Dermatology, Sina Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Zahra Saffarian
- Department of Dermatology, Imam Khomeini Hospital Complex, Tehran University of Medical Science, Tehran, Iran
| | - Sara Saneei
- Department of Dermatology, Sina Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hassan Seirafi
- Department of Dermatology, Tehran University of Medical Sciences, Razi Hospital, Tehran, Iran
| | - Soheila Taheri
- Yas Dermatology and Laser Clinic, West Hashtbehesht Street, Fadak Building, Isfahan, Iran
| | - Mohammad Javad Yazdanpanah
- Department of Dermatology, Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naghmeh Zaboli Nejad
- Department of Dermatology, Cutaneous Leishmaniasis Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahsa Naseri
- Rooyan Dermatology & Hair Transplantation Clinic, Zargari Bridge, Khabarnegar Street, Shiraz, Iran
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Kolkhir P, Pogorelov D, Darlenski R, Caminati M, Tanno LK, Le Pham D, Gonzalez-Estrada A, Antolín-Amérigo D, Dimov V, Weller K, Sánchez-Borges M, Ansotegui I, Maurer M. Management of chronic spontaneous urticaria: a worldwide perspective. World Allergy Organ J 2018; 11:14. [PMID: 29988758 PMCID: PMC6030778 DOI: 10.1186/s40413-018-0193-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background The approaches to the diagnosis and treatment of chronic spontaneous urticaria (CSU) differ in various parts of the world. We sought to determine the adherence to international and national urticaria guidelines as well as the motives to deviate from the guidelines among physicians worldwide. Methods A web-based questionnaire was created and launched via e-mail by the World Allergy Organization (WAO) to representatives of all WAO Member Societies, the members of the American Academy of Allergy, Asthma & Immunology (AAAAI) and the members of the WAO Junior Members Group (JMG), regardless of the specialty, affiliation, or nationality in March 2017. Results We received 1140 completed surveys from participating physicians from 99 countries. Virtually all participants (96%) were aware of at least one urticaria guideline and reported that they follow a guideline. However, one in five physicians who follow a guideline (22%) reported to deviate from it. Reliance on own clinical experience is the most frequent reason for deviation from guidelines or not following them (44%). Young (< 40 years) and less experienced physicians more often follow a guideline and less often deviate than older and experienced ones. Physicians who follow a urticaria guideline showed higher rates of routinely ordering a complete blood count, the erythrocyte sedimentation rate, C-reactive protein, anti-thyroid antibodies, and thyroid-stimulating hormone and of performing the autologous serum skin test as compared to those who do not. Physicians who follow a urticaria guideline showed higher rates of using second generation antihistamines as their first-line treatment of CSU (p = 0.001) and more frequently observed higher efficacy of these drugs (or had more confidence that it would work, p < 0.019) as compared to those who do not follow the guidelines. Conclusions Physicians’ characteristics (e.g. age, clinical experience, and specialty) and country specifics and regional features (e.g. availability of drugs for CSU treatment) importantly influence adherence to urticaria guidelines and CSU patient care and should be addressed in more detail in future research. Electronic supplementary material The online version of this article (10.1186/s40413-018-0193-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pavel Kolkhir
- 1Division of Immune-mediated skin diseases, I.M. Sechenov First Moscow State Medical University, 119991, Trubeckaya str., 8/2, Moscow, Russian Federation
| | - Dmitry Pogorelov
- 2Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Razvigor Darlenski
- 3Department of Dermatology and Venereology, Trakia University, Stara Zagora, Bulgaria
| | - Marco Caminati
- 4Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
| | - Luciana Kase Tanno
- 5Hospital Sírio Libanês and Post-graduation Program in Health Sciences of IAMSPE São Paulo, São Paulo, Brazil.,6University Hospital of Montpellier, Montpellier and Sorbonne Universités, Paris, France
| | - Duy Le Pham
- 7Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Alexei Gonzalez-Estrada
- 8Division of Allergy, Pulmonary and Sleep Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Darío Antolín-Amérigo
- 9Servicio de Enfermedades del Sistema Inmune-Alergia, Hospital Universitario Príncipe de Asturias, Madrid, Spain.,10Departamento de Medicina y Especialidades Médicas, Facultad de Medicina, Universidad de Alcalá, Madrid, Spain
| | - Ves Dimov
- 11Department of Allergy and Immunology, Cleveland Clinic Florida, Weston, Florida, USA
| | - Karsten Weller
- 12Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mario Sánchez-Borges
- 13Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Caracas, Venezuela
| | - Ignacio Ansotegui
- Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia, Bilbao, Spain
| | - Marcus Maurer
- 12Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Kocatürk E, Piril E, Oktay T, Nilgun A, Teoman E, Serap U, Ekin S, Emel BB, Rafet K, Sebnem A. Turkish dermatologists' approach for chronic spontaneous urticaria: A questionnaire based study. DERMATOL SIN 2018. [DOI: 10.1016/j.dsi.2017.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Vena GA, Cassano N, Marzano AV, Asero R. The Role of Platelets in Chronic Urticaria. Int Arch Allergy Immunol 2016; 169:71-9. [PMID: 27035367 DOI: 10.1159/000444085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/18/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Platelets are implicated in many pathophysiological processes, including inflammation and immunity. Ever-growing evidence suggests the active involvement of platelets in the pathogenesis of various inflammatory disorders, including cutaneous inflammatory diseases. A limited number of studies have investigated the role of platelets in chronic urticaria (CU). In this review, we summarize the current knowledge regarding the role of platelets in chronic spontaneous and inducible urticarias. METHODS A literature search was performed using PubMed and Google Scholar, and the references of relevant literature were reviewed. RESULTS Overall, in CU patients, conflicting results have been obtained from the assessment of platelet indices, such as mean platelet volume, platelet count and distribution width, as well as markers of platelet aggregation and activation. Nevertheless, a few studies showed significant changes of such parameters in CU patients compared to controls, in apparent correlation with clinical severity, autoreactivity and/or inflammatory status. CONCLUSIONS In the absence of definitive conclusions, the pathogenic role of platelets in CU needs to be further explored. Platelets might represent a link between inflammation, coagulation and histamine release in the pathophysiological network of CU.
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Affiliation(s)
- Gino Antonio Vena
- Dermatology and Venereology Private Practice, Bari and Barletta, Italy
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