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Chen S, Cao W, Xiao X, Wang L, Wan R, Zou Z, Yang Q, Li Y. A systematic review and meta-analysis of efficacy and safety of compound glycyrrhizin combined with second-generation non-sedated antihistamine for the treatment of chronic urticaria. J DERMATOL TREAT 2024; 35:2299597. [PMID: 38166511 DOI: 10.1080/09546634.2023.2299597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/20/2023] [Indexed: 01/04/2024]
Abstract
BACKGROUND Chronic urticaria (CU) is a prevalent dermatologic disease that negatively affects life, current therapies remain suboptimal. Hence, there is an urgent need to identify effective and safe treatment. OBJECTIVE Assess the efficacy and safety of compound glycyrrhizin (CG) combined with second-generation nonsedated antihistamine for the treatment of CU. METHODS Nine databases were queried to screen RCTs related. Two reviewers independently assessed the risk of bias using Cochrane Collaboration. Primary objective was the total efficiency rate, while secondary was rate of recurrence, adverse events, and cure. Statistical analyses using Review Manager 5.4 and Stata17. RESULTS Twenty-four RCTs were identified. Significant differences were noted in rate of total efficiency (n = 2649, RR = 1.36, 95%CI:1.30-1.43, p < 0.00001), cure (n = 2649, RR = 1.54, 95%CI:1.42-1.66, p < 0.00001) and recurrence (n = 446, RR = 0.34, 95%CI:0.20-0.58, p < 0.00001) between the combination of CG with second-generation non-sedated antihistamine and antihistamine monotherapy. Contrastingly, adverse events rate (n = 2317, RR = 0.76, 95% CI:0.59-0.97, p = 0.03) was comparable between the two groups. Our results indicated that CG combined with second-generation non-sedated antihistamine could significantly mitigate the symptoms in CU compared with antihistamine monotherapy. No serious adverse events were reported. CONCLUSIONS CG combined with second-generation nonsedated antihistamine is effective for CU. Nevertheless, higher-quality studies are warranted to validate our results.
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Affiliation(s)
- Sijue Chen
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wei Cao
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xianjun Xiao
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lu Wang
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Renhong Wan
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zihao Zou
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qian Yang
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ying Li
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Ryan C, Li K, Bennett R, Davis MJ, Shaker M, Hsu Blatman K, Hughes S, Mann JA. Chronic urticaria after Moderna COVID-19 vaccine boosters: A case series. JAAD Case Rep 2024; 45:27-30. [PMID: 38379871 PMCID: PMC10876461 DOI: 10.1016/j.jdcr.2023.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Affiliation(s)
- Chenin Ryan
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Kevin Li
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Raven Bennett
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Matthew J. Davis
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Marcus Shaker
- Section of Allergy and Clinical Immunology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Karen Hsu Blatman
- Section of Allergy and Clinical Immunology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Sarah Hughes
- Section of Allergy and Clinical Immunology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Julianne A. Mann
- Departments of Dermatology and Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
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Sun C, Liang H, Zhao Y, Li S, Li X, Yuan X, Cheng G, Zhang Y, Liu M, Guan Y, Yao J, Zhang G. Jingfang Granules improve glucose metabolism disturbance and inflammation in mice with urticaria by up-regulating LKB1/AMPK/SIRT1 axis. JOURNAL OF ETHNOPHARMACOLOGY 2023; 302:115913. [PMID: 36347302 DOI: 10.1016/j.jep.2022.115913] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Jingfang Granule (JFG) is a Traditional Chinese Medicine prescription to empirically treat skin disease such as urticaria in clinical practice. However, the potential mechanisms of JFG on urticaria are not fully defined. AIM OF STUDY The aim of this study is to investigate the mechanisms of JFG in treating urticaria through an OVA/aluminum hydroxide induced urticaria mice model. MATERIALS AND METHODS KM mice were injected intraperitoneally (i.p.) with OVA/aluminium hydroxide to establish the model with urticaria. After the mice were administered JFG, itching degree and hematoxylin and eosin (H&E) staining were used to assess the protective effect of JFG on mice with urticaria. The regulatory networks were investigated by proteomics and central carbon metabolomics. Spleen T lymphocyte subsets were detected by flow cytometry. Peripheral blood cytokines were detected using ELISA kits or Cytometric Bead Array (CBA) kits. The protein expression of skin tissue was detected by western blot or immunohistochemical staining. RESULTS JFG significantly relived skin tissue lesions and skin pruritus in mice with urticaria. Meanwhile, JFG significantly decreased IgE, IL-1β, IL-6, IL-4, TNF-α and IL-17A levels and increased IFN-γ levels in the serum of urticaria mice by inhibiting the expression of inflammation associated proteins including TLR4 and p-NF-κB p65, p-ERK1/2, p-JNK and p-p38, NLRP3, ASC and cleaved caspase-1. The results of proteomics, central carbon metabolomics, western blot and immunohistochemical staining confirmed that JFG inhibited Glycolysis/Gluconeogenesis and Pentose phosphate pathway in the skin tissue of urticaria mice by activating the LKB1/AMPK/SIRT1 axis and then downregulating the protein expressions of Glut1, TORC2, p-CREB, PEPCK, HNF4α and G6Pase. CONCLUSION The current study demonstrates that JFG is effective in treating OVA/aluminum hydroxide-induced skin lesions and inflammation in mice, and JFG exhibits the clinical benefits via modulating LKB1/AMPK/SIRT1 axis, which in turn inhibits Glycolysis/Gluconeogenesis and Pentose phosphate pathway.
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Affiliation(s)
- Chenghong Sun
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China; State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi, 276005, China.
| | - Hongbao Liang
- State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi, 276005, China; Linyi Key Laboratory for Immunopharmacology and Immunotoxicology of Natural Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi, 273400, China.
| | - Yun Zhao
- State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi, 276005, China; Linyi Key Laboratory for Immunopharmacology and Immunotoxicology of Natural Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi, 273400, China.
| | - Shirong Li
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China.
| | - Xiangzi Li
- State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi, 276005, China; Linyi Key Laboratory for Immunopharmacology and Immunotoxicology of Natural Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi, 273400, China.
| | - Xiaomei Yuan
- State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi, 276005, China.
| | - Guoliang Cheng
- College of Traditional Chinese Medicine, Beijing University of Traditional Chinese Medicine, Beijing, 100029, China.
| | - Yongkang Zhang
- College of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China.
| | - Mingfei Liu
- Key Laboratory of Marine Drugs, Chinese Ministry of Education, School of Medicine and Pharmacy, Ocean University of China, Qingdao, 266003, China.
| | - Yongxia Guan
- State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi, 276005, China.
| | - Jingchun Yao
- State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi, 276005, China; Linyi Key Laboratory for Immunopharmacology and Immunotoxicology of Natural Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi, 273400, China.
| | - Guimin Zhang
- State Key Laboratory of Generic Manufacture Technology of Chinese Traditional Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi, 276005, China; Linyi Key Laboratory for Immunopharmacology and Immunotoxicology of Natural Medicine, Lunan Pharmaceutical Group Co. LTD., Linyi, 273400, China.
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Bruton's Kinase Inhibitors for the Treatment of Immunological Diseases: Current Status and Perspectives. J Clin Med 2022; 11:jcm11102807. [PMID: 35628931 PMCID: PMC9145705 DOI: 10.3390/jcm11102807] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 02/01/2023] Open
Abstract
The use of Bruton’s tyrosine kinase (BTK) inhibitors has changed the management of patients with B-cell lymphoid malignancies. BTK is an important molecule that interconnects B-cell antigen receptor (BCR) signaling. BTK inhibitors (BTKis) are classified into three categories, namely covalent irreversible inhibitors, covalent reversible inhibitors, and non-covalent reversible inhibitors. Ibrutinib is the first covalent, irreversible BTK inhibitor approved in 2013 as a breakthrough therapy for chronic lymphocytic leukemia patients. Subsequently, two other covalent, irreversible, second-generation BTKis, acalabrutinib and zanubrutinib, have been developed for lymphoid malignancies to reduce the ibrutinib-mediated adverse effects. More recently, irreversible and reversible BTKis have been under development for immune-mediated diseases, including autoimmune hemolytic anemia, immune thrombocytopenia, multiple sclerosis, pemphigus vulgaris, atopic dermatitis, rheumatoid arthritis, systemic lupus erythematosus, Sjögren’s disease, and chronic spontaneous urticaria, among others. This review article summarizes the preclinical and clinical evidence supporting the role of BTKis in various autoimmune, allergic, and inflammatory conditions.
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Wang S, Song P, Ma R, Wang Y, Yu B, Wang M, Wang M, Shen J, Dai Y, Wang Y, Xie W. Research on Characteristic of Chronic Spontaneous Urticaria Based on Multiscale Entropy. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:6691356. [PMID: 34122619 PMCID: PMC8172304 DOI: 10.1155/2021/6691356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/21/2021] [Accepted: 04/12/2021] [Indexed: 12/12/2022]
Abstract
Chronic spontaneous urticaria (CSU) is a common skin disease which symptom is local pruritus and pain. In medicine, researchers take a certain point that the brain is the control center of CSU, but in previous experiments, the researchers found that cerebellum also had a certain effect on CSU. In order to find out the influence of CSU in the brain and cerebellum, we collected the brain resting-state fMRI data from 40 healthy controls and 32 CSU patients and used DPABI to preprocess. We calculated the entropy values of five scales by using multiscale entropy (MSE) and the average entropy values of two groups' BOLD signals; 15 regions with significant differences were found which not only had a more detailed impact in the brain but also had an impact in the cerebellum, such as precentral gyrus, lenticular putamen, and vermis of cerebellum. In addition, we found that compared with the healthy controls, the entropy values of CSU patients showed two trends which need further study. The advantage of our experiment is that the multiscale entropy value is used to get more influence regions of CSU in the brain and cerebellum. The results of this paper may provide some help for the pathological study of CSU.
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Affiliation(s)
- Shujuan Wang
- College of Mathematical Sciences, Harbin Engineering University, Harbin 150001, China
| | - Ping Song
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Rong Ma
- College of Mathematical Sciences, Harbin Engineering University, Harbin 150001, China
| | - Yanzhong Wang
- School of Population Health & Environmental Sciences, Faculty of Life Science and Medicine, King's College London, London, UK
- Suzhou Fanhan Information Technology Co., Ltd, China
| | - Bin Yu
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Min Wang
- College of Mathematical Sciences, Harbin Engineering University, Harbin 150001, China
| | - Meiqi Wang
- College of Mathematical Sciences, Harbin Engineering University, Harbin 150001, China
| | - Jihong Shen
- College of Mathematical Sciences, Harbin Engineering University, Harbin 150001, China
| | - Yuntao Dai
- College of Mathematical Sciences, Harbin Engineering University, Harbin 150001, China
| | - Yuming Wang
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Wanqing Xie
- College of Mathematical Sciences, Harbin Engineering University, Harbin 150001, China
- Suzhou Fanhan Information Technology Co., Ltd, China
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Mobeen A, Ahmad AK. The efficacy and safety of herbal combination of Unani Medicine in chronic urticaria: A randomized, controlled study. J Tradit Complement Med 2021; 11:303-310. [PMID: 34195024 PMCID: PMC8240108 DOI: 10.1016/j.jtcme.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/26/2020] [Accepted: 12/30/2020] [Indexed: 01/01/2023] Open
Abstract
Background and Aim; Chronic urticaria (CU) is a fluctuating and pruritic erythematous papule that persists for over six weeks. It affects 0.5-1% of the population and interferes with subjective well-being and daily life. Its etiology is highly complex which makes a causal and/or curative treatment difficult. Nonsedating H1-antihistamines are given as symptomatic therapy, which reduces symptoms effectively in <50% of patients. In Unani medicine, urticaria is known as Shara and treated according to its established etiology. The present study objective was to investigate the effect of herbal combination of Unani medicine (HCUM) comprising Rosa damascena Mill, Bambusa arundinacea Linn, Cinnamomum camphora Linn, Mentha arvensis Linn, in comparison with Levocetirizine in CU. Experimental procedure; This randomized open-labeled standard control clinical trial was conducted between 42 male/female patients aged 20-50 years with moderate to severe CU who were randomly allocated in a 3:1 ratio into HCUM and Levocetirizine 5 mg groups. HCUM powder 5.125 Gm and Levocetirizine 5 mg were given for 4 weeks. Urticaria activity score (UAS7) and chronic urticaria quality of life questionnaire (CU-Q2oL) were primary and secondary outcomes and analyzed per protocol. Results: A total of 40 patients completed the study. Data analysis showed a significant decrease (P=<0.001) in the scores of UAS7 (32.43 ± 2.34-14.03 ± 2.16 and 32.10 ± 2.33-28.40 ± 3.78) and CU-Q2oL (67.57 ± 9.56-36.50 ± 3.01 and 65.20 ± 11.78-59.60 ± 11.13) in HCUM and Levocetirizine groups respectively. Conclusion: As an alternative treatment in terms of safety, efficacy, tolerability, and quality of life the HCUM treatment proved to be more effective than Levocetirizine 5 mg in moderate to severe CU.
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Affiliation(s)
- Abdul Mobeen
- Dept. of Moalajat, Ntional Institute of Unani Medicine, Bangalore, 56009, India
| | - A Khaleel Ahmad
- Dept. of Moalajat, Government Unani Medical College, Chennai, 600106, India
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Ninković-Baroš Đ, Gajanin V, Zrnić B, Gajanin Ž, Katalina G. Comparative analysis of clinical and laboratory parameters of autoimmune and idiopathic chronic urticaria patients. SCRIPTA MEDICA 2021. [DOI: 10.5937/scriptamed52-33568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: According to the cause, chronic urticaria is most frequently divided into autoimmune and idiopathic urticaria. Aim of the paper was to determine the frequency of autoimmune urticaria using autologous serum skin testing and a comparative analysis of chronic idiopathic and chronic autoimmune urticaria by disease course, severity and most common comorbidities. Methods: Analysis covered 64 adult patients of both sexes with chronic urticaria, divided into two groups according to their positivity in autologous serum skin testing (group I with positive test and group II with negative test). General haematological and biochemical parameters, antithyroid antibodies, hepatitis serum markers, Helicobacter pylori and Borrelia burgdorferi antibodies were performed for patients in both groups. First group patients were treated by autologous blood therapy (autohaemotherapy). The analytical statistical tool SPSS (Statistical Product and Service Solutions) version 20 for descriptive statistics and statistical methods was used. The significance level used was p = 0.05. Results: The frequency of positive autologous serum test in total population of patients with chronic urticaria was 43.8 %. The average duration of urticaria was 20 months in both groups. Statistically significant difference was found in weekly scores between the studied groups (p = 0.032) in favour of chronic autoimmune urticaria with a positive autologous serum test. Subjects with chronic autoimmune urticaria had a significantly higher association with autoimmune thyroid diseases. Conclusions: Direct relation was established between the use of autologous blood therapy in patients with autoimmune chronic urticaria and improvement of the clinical picture.
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Nada H, Hassan R, Ibrahim RAEH, Abdelsalam OE, Fathy A, Toraih EA, Atwa MA. Interleukin 17 receptor A haplotype analysis in chronic spontaneous urticaria: A preliminary study. J Cosmet Dermatol 2020; 20:1331-1342. [PMID: 32969586 DOI: 10.1111/jocd.13730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/24/2020] [Accepted: 09/11/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is a distressing skin disease. Family clustering and heterogeneity in the onset and progression indicate that susceptibility to CSU is a complex trait. In this study, we performed haplotype analysis for one of the key player gene, IL17RA, for CSU to test the association with disease susceptibility and severity. METHODOLOGY The study included 70 CSU patients and 30 healthy controls. The severity of the disease was evaluated by autologous serum skin test (ASST) and urticaria activity score (UAS). ASST test was done and quality of life was assessed using a questionnaire. Allelic discrimination analysis for rs4819554 and rs879577 was performed using real-time polymerase chain reaction technology. RESULTS Carriers of rs4819554*G were more prone to develop CSU than its counterpart (P = .039), while rs4819554*A allele displayed more severe phenotype in the form of more prolonged disease duration (P = .040), concurrent angioedema (P < .001), higher level of treatment (P < .001), and higher score of quality of life (P < .001). Additionally, homozygote patients with rs879577*CC were associated with angioedema (P < .001). Haplotype analysis revealed that cohorts with both rs4819554*A and rs879577*T conferred protection against developing CSU (OR = 0.07, 95% CI = 0.01-0.32, P = .001). CONCLUSION Our results showed that IL17RA gene polymorphisms might contribute to the increased susceptibility to CSU.
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Affiliation(s)
- Hesham Nada
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ranya Hassan
- Clinical Pathology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | | | | | - Amal Fathy
- Clinical Pathology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Eman Ali Toraih
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA, USA.,Genetics Unit, Histology and Cell Biology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mona A Atwa
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Tamer F. Omalizumab does not lead to a distinct alteration in hematological parameters and complete blood count-derived inflammation biomarkers except for basophil count. Cutan Ocul Toxicol 2020; 39:229-232. [PMID: 32380865 DOI: 10.1080/15569527.2020.1766483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Omalizumab is a monoclonal anti-IgE antibody used to treat patients with chronic spontaneous urticaria by decreasing free IgE levels. Omalizumab may have an anti-inflammatory effect by inhibiting T-cell activation and inducing eosinophil apoptosis. In this study, we evaluated the effect of omalizumab on hematological parameters and inflammation biomarkers in patients with chronic spontaneous urticaria. METHODS Between July 2018 and November 2019, medical records of 60 patients (44 female, 16 male) with chronic spontaneous urticaria who were treated with omalizumab were reviewed retrospectively. Hematological parameters and inflammation biomarkers including the neutrophil/lymphocyte, monocyte/lymphocyte, platelet/lymphocyte and mean platelet volume/platelet count ratios were compared before and after 12 weeks of omalizumab treatment. RESULTS The absolute count of basophils and percentage of basophils increased significantly after omalizumab treatment (p = 0.04, p = 0.004). The absolute count of eosinophils, percentage of eosinophils, neutrophil/lymphocyte, monocyte/lymphocyte, and mean platelet volume/platelet ratios decreased, while platelet/lymphocyte ratio increased after omalizumab treatment. Nevertheless, these changes were not statistically significant. CONCLUSIONS Increased basophil counts suggest that omalizumab has a crucial effect through basophils in chronic spontaneous urticaria. Further studies focussing on basophils may contribute to the literature both to elucidate the etiopathogenesis of urticaria and to improve novel treatment agents for the disease. On the other hand, our study revealed that omalizumab did not have a distinct effect on complete blood count-derived inflammation biomarkers and thus inflammation.
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Affiliation(s)
- Funda Tamer
- Department of Dermatology, Gazi University School of Medicine, Ankara, Turkey
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Urticaria and silent parasitism by Ascaridoidea: Component-resolved diagnosis reinforces the significance of this association. PLoS Negl Trop Dis 2020; 14:e0008177. [PMID: 32243436 PMCID: PMC7170265 DOI: 10.1371/journal.pntd.0008177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 04/20/2020] [Accepted: 02/27/2020] [Indexed: 12/11/2022] Open
Abstract
Urticaria remains a major problem in terms of aetiology, investigation, and management, and although parasitic diseases are considered potential causes, the absence of a consistent link between parasitic infections and skin allergy symptoms leads to the need for a deeper study of parameters that support this association. The objectives of this study were to analyse a possible relationship between parasitism by Ascarididae (Toxocara canis and Anisakis simplex) and the clinical expression of urticaria and to identify possible parasitic molecular markers for improving the diagnosis of unknown urticaria aetiology. The prevalence of Toxocara and Anisakis infestations was evaluated by measuring the levels of specific IgG (sIgG) and IgE (sIgE) antibodies against crude extracts and isolated components from whole larvae of Anisakis simplex (Ani s 1, Ani s 3 and Ani s 7) and Toxocara canis (TES-120, TES-70, TES-32 and TES-26) using immunologic and molecular diagnostic methods. A cross-sectional study was performed in a group of 400 individuals. The study group consisted of 95 patients diagnosed with urticaria (55 with chronic urticaria and 40 with acute urticaria). A control group consisted of 305 subjects without urticaria (182 diagnosed with respiratory allergy and 123 without allergy). Statistically significant differences were demonstrated in the seroprevalence of specific IgG and IgE antibodies between the urticaria patients and the healthy general population when isolated ascarid antigens were evaluated. The prevalence of IgG antibodies against Ani s 1, IgE antibodies against TES-120 and IgE antibodies against TES-70 were significantly different between the control individuals (healthy general population) and patients with urticaria. Moreover, the urticaria patient group demonstrated a higher seroprevalence of antibodies (sIgE and sIgG) against Anisakis simplex larva whole extract than the control group but just with statistically diferences when sIgE was evaluated. The presence of IgE and/or IgG antibodies against Ani s 3 (tropomyosin) can help to discriminate between patients with and without urticaria. Both ascarids seem to be associated with urticaria, although in our region, Anisakis seems to have greater involvement than Toxocara in this relationship. Molecular diagnostics can be used to associate urticaria with parasite infestations. Tropomyosin and Ani s 1 were the most relevant markers to demonstrate the association between urticaria and the most relevant Ascarididae parasites in our region.
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Exacerbating Factors in Chronic Spontaneous Urticaria. CURRENT TREATMENT OPTIONS IN ALLERGY 2020. [DOI: 10.1007/s40521-020-00254-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Bansal CJ, Bansal AS. Stress, pseudoallergens, autoimmunity, infection and inflammation in chronic spontaneous urticaria. Allergy Asthma Clin Immunol 2019; 15:56. [PMID: 31528163 PMCID: PMC6737621 DOI: 10.1186/s13223-019-0372-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/04/2019] [Indexed: 02/06/2023] Open
Abstract
Chronic spontaneous urticaria (CSU) is often associated with organ specific autoimmunity but is rarely caused by food allergy. Colourings and preservatives in pre-packaged foods, so called pseudoallergens, have also been implicated. Factors that promote inflammation or reduce anti-inflammatory mechanisms may however, predispose susceptible individuals to CSU. Chronic underlying infection and mental and emotional stress can sometimes precede the onset of CSU and once established can exacerbate the symptoms. There is early evidence of dysbiosis within the gastrointestinal tract in people with CSU and reduced levels of vitamin D are also evident. The latter may be related to the importance of vitamin D3 in increasing T regulatory function which can control a tendency to autoimmunity. It is quite possible that a state of on-going chronic inflammation with reduced anti-oxidant mechanisms may underlie the not infrequent association between CSU and metabolic syndrome. Effective treatment of CSU should involve the use of anti-histamines, intermittent steroids and anti-IgE therapy. For recalcitrant disease immune modulatory therapy has a place. However, talking therapies that reduce stress and anxiety, vitamin D3 supplementation, correction of intestinal dysbiosis and treatment of any chronic infection should also be considered.
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The effect of omalizumab treatment on severe allergic asthma and allergic comorbidities: real-life experience from the Czech Anti-IgE Registry. Postepy Dermatol Alergol 2018; 35:510-515. [PMID: 30429711 PMCID: PMC6232552 DOI: 10.5114/ada.2018.77243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/11/2018] [Indexed: 01/23/2023] Open
Abstract
Introduction Omalizumab is indicated for the treatment of severe allergic asthma (SAA) and chronic spontaneous urticaria, although a number of studies have confirmed the effectiveness of this therapy also for other IgE-mediated diseases. Aim To assess the impact of anti-IgE therapy on SAA and comorbid IgE-mediated allergic diseases in patients treated with omalizumab for SAA enrolled in the CAR (Czech Anti-IgE Registry). Material and methods Three hundred and ten patients with SAA treated with omalizumab were enrolled in the CAR. Two hundred and twenty-nine individuals were evaluated after 12 months of omalizumab treatment for asthma control test (ACT), examination of fractional exhaled nitric oxide (FENO), forced expiratory volume in 1 s (FEV1), the use of systemic corticosteroids, side effects of treatment and clinical effect of omalizumab on allergic comorbidities (allergic rhinitis, chronic urticaria, atopic dermatitis and food allergy). Results After 12 months of treatment with omalizumab, patients experienced a significant improvement of ACT and FEV1, reduction of FENO, use of systemic corticosteroids for asthma exacerbations and dose of maintenance oral corticosteroid therapy. The positive effect of treatment with omalizumab was observed in 82.2% of patients with allergic rhinitis, in 85.7% of patients with chronic urticaria, in 82.1% of patients with atopic dermatitis, and in 67.3% of patients with food allergy. Conclusions In the CAR registry, patients with SAA treated with omalizumab showed a significant positive effect of anti-IgE therapy not only on the asthma control, but also on allergic comorbidities.
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Cherrez Ojeda I, Vanegas E, Felix M, Mata V, Cherrez S, Simancas-Racines D, Greiding L, Cano J, Cherrez A, Calderon JC. Etiology of chronic urticaria: the Ecuadorian experience. World Allergy Organ J 2018; 11:1. [PMID: 29308115 PMCID: PMC5753451 DOI: 10.1186/s40413-017-0181-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 12/07/2017] [Indexed: 02/07/2023] Open
Abstract
Background The purpose of this study was to identify chronic urticaria (CU) etiologies and treatment modalities in Ecuador. We propose that the sample distribution fits the expected one, and that there is an association between the etiology and its treatment. Methods We performed a retrospective study involving 112 patients diagnosed with CU using a Checklist for a complete chronic urticaria medical history. Demographic and clinical variables were collected. The etiology of CU was classified using the EAACI/GA2LEN/EDF/WAO guideline. Descriptive analyses were performed for demographical and clinical variables. Chi square tests were applied to analyze the fit of distribution and the independence of variables. P values less than 0.05 were considered significant. Results Among all the patients, 76.8% were diagnosed with chronic spontaneous urticaria (CSU), of which 22.3% had a known etiology or possible exacerbating condition. Food allergy was identified as the most common accompanying condition in patients with CSU (10.7%) (p < 0.01).. On the other hand, 23.2% inducible urticarias (CIndU) were indentified; dermographism was the most common (10.7%) (p < 0.01). Regarding treatment regimens, sg-H1-antihistamines alone represented the highest proportion (44.6%). The combination of any H1-antihistamine plus other drug was a close second (42.0%) (p < 0.01). Almost 48% of CSUs of unknown etiology were treated with any antihistamine plus another drug. In patients with known etiology, sg-antihistamines alone (44.0%) was the most common management. In addition, 53.8% of CIndUs were treated with sg-antihistamines alone. Though, these associations were not statistically significant. Conclusion CSU is the most frequent subtype of CU. Modern non-sedating antihistamines in licensed doses are the drug of choice. Nevertheless, a great proportion of patients require the addition of another type of medication.
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Affiliation(s)
- I Cherrez Ojeda
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Código postal: 0901-952 Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - E Vanegas
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Código postal: 0901-952 Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - M Felix
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - V Mata
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - S Cherrez
- School of Medicine, University of Heidelberg, Heidelberg, Germany
| | - D Simancas-Racines
- Centro de Investigación en Salud Pública y Epidemiología Clínica. Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito, Ecuador
| | - L Greiding
- Instituto Argentino de Alergia e Inmunología, Buenos Aires, Argentina
| | - J Cano
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Código postal: 0901-952 Samborondón, Ecuador
| | - A Cherrez
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador.,University Hospital, Dermatology Department, Rostock, Germany
| | - Juan Carlos Calderon
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Código postal: 0901-952 Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
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Cherrez-Ojeda I, Robles-Velasco K, Bedoya-Riofrío P, Schmid-Grendelmeier P, Cherrez S, Colbatzky F, Cardona R, Barberan-Torres P, Calero E, Cherrez A. Checklist for a complete chronic urticaria medical history: an easy tool. World Allergy Organ J 2017; 10:34. [PMID: 29043012 PMCID: PMC5625775 DOI: 10.1186/s40413-017-0165-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/16/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Existing guidelines do not offer a quick, efficient alternative to the patient's recollection of relevant clinical features during anamnesis and physical examination for chronic urticaria (CU). This study aimed to identify specific items reflecting the main characteristics of CU that should be included in a comprehensive medical history for patients with CU. We also aimed to clarify possible eliciting factors for CU to support accurate diagnosis of the disease. METHODS A panel of postgraduate dermatologists conducted a literature search for relevant studies on CU using Medline, the Cochrane database, and PubMed. RESULTS We identified82 articles from which we drew a collection of items to inform development of an easy-to-use checklist and collection of items that should be included in a correct medical history. The final version of the checklist included42 items across two areas: essential clues for anamnesis and diagnosis of CU; and typical symptoms/parameters or characteristics according to subtype, etiology, and laboratory findings. Items included time of disease onset; duration, shape, size, color, and distribution of wheals; associated angioedema; atopy; and triggering factors. CONCLUSIONS Our guide provides an easy-to-use tool to support clinicians to focus, orient themselves, and save time in medical consultations for CU, allowing better diagnosis and management of this disease.
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Affiliation(s)
- Ivan Cherrez-Ojeda
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Código postal: 0901-952 Samborondón, Ecuador
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - Karla Robles-Velasco
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Código postal: 0901-952 Samborondón, Ecuador
| | - Pamela Bedoya-Riofrío
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Código postal: 0901-952 Samborondón, Ecuador
| | | | - Sofía Cherrez
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
- School of Medicine, University of Heidelberg, Heidelberg, Germany
| | | | - Ricardo Cardona
- Grupo de Alergología Clínica y Experimental, Universidad de Antioquia, Medellín, Colombia
| | - Pedro Barberan-Torres
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Código postal: 0901-952 Samborondón, Ecuador
| | - Erick Calero
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Código postal: 0901-952 Samborondón, Ecuador
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - Annia Cherrez
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
- School of Medicine, University of Heidelberg, Heidelberg, Germany
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Wu MA, Perego F, Zanichelli A, Cicardi M. Angioedema Phenotypes: Disease Expression and Classification. Clin Rev Allergy Immunol 2017; 51:162-9. [PMID: 27113957 DOI: 10.1007/s12016-016-8541-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Due to marked heterogeneity of clinical presentations, comprehensive knowledge of angioedema phenotypes is crucial for correct diagnosis and choosing the appropriate therapeutic approach. One of the ways to a meaningful clinical distinction can be made between forms of angioedema occurring "with or without wheals." Angioedema with wheals (rash) is a hallmark of urticaria, either acute or chronic, spontaneous or inducible. Angioedema without wheals may still be manifested in about 10 % of patients with urticaria, but it may also occur as a separate entity. Several classifications of angioedema as part of urticaria were published over time, while a latest one, released in 2014 (HAWK group consensus, see below), provided a classification of all forms of "angioedema without wheals" distinct from urticaria, which will be the focus of the present review. At this time, the HAWK consensus classification is the best in terms of covering the pathophysiology, mediators involved, angioedema triggers, and clinical expression. According to this classification, three types of hereditary angioedema (genetic C1-INH deficiency, normal C1-INH with factor XII mutations, and unknown origin) and four types of acquired angioedema (C1-INH deficiency, related to ACE inhibitors intake, idiopathic histaminergic, and idiopathic non-histaminergic) are presented. We will review the distinctive clinical features of each phenotype in details.
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Affiliation(s)
- Maddalena Alessandra Wu
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Francesca Perego
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Andrea Zanichelli
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Marco Cicardi
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Luigi Sacco Hospital, Milan, Italy.
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Dilek F, Ozceker D, Ozkaya E, Tamay Z, Yazici M, Kesgin S, Kocyigit A, Guler N. Plasma Levels of Matrix Metalloproteinase-9 in Children With Chronic Spontaneous Urticaria. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2016; 8:522-6. [PMID: 27582403 PMCID: PMC5011052 DOI: 10.4168/aair.2016.8.6.522] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/19/2016] [Accepted: 03/23/2016] [Indexed: 01/04/2023]
Abstract
Purpose Chronic spontaneous urticaria (CSU) is a disease that is primarily seen in adults and is comparatively rare in children. Consequently, only a few studies have focused on the pathogenesis of the disease in children. This study investigated the possible role of metalloproteinase-9 (MMP-9) in the pathogenesis of CSU in children. Methods The study group was composed of 54 children with CSU; 34 healthy children comprised the control group. The demographic and clinical features of the study group were extensively evaluated, and laboratory assessments were also performed. An enzyme-linked immunosorbent assay was used to evaluate levels of plasma MMP-9. Disease activity was quantified using the urticaria activity score (UAS). Results The median value of plasma MMP-9 was 108.9 ng/mL (interquartile range, 93.3-124.1) in the CSU group and 87.8 ng/mL (69.4-103.0) in the control group. The difference between the 2 groups was statistically significant (P<0.001). Also, MMP-9 levels showed a significant positive correlation with UAS (rho=0.57, P<0.001). Twenty-six percent of patients had positive autologous serum skin test (ASST) results. Neither UAS nor plasma MMP-9 levels were significantly different between ASST-positive and -negative patients (P>0.05). Conclusions Plasma MMP-9 levels were elevated in children with CSU and were positively correlated with disease activity. MMP-9 may be both a good biomarker of disease activity and a potential therapeutic target in CSU.
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Affiliation(s)
- Fatih Dilek
- Department of Pediatric Allergy and Immunology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey.
| | - Deniz Ozceker
- Department of Pediatric Allergy, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Emin Ozkaya
- Department of Pediatric Allergy and Immunology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Zeynep Tamay
- Department of Pediatric Allergy, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Mebrure Yazici
- Department of Pediatric Allergy and Immunology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Siddika Kesgin
- Department of Clinical Biochemistry, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Abdurrahim Kocyigit
- Department of Clinical Biochemistry, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Nermin Guler
- Department of Pediatrics, Istanbul Bilim University, Istanbul, Turkey
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