1
|
Liu X, Cao Y, Wang W. Burden of and Trends in Urticaria Globally, Regionally, and Nationally from 1990 to 2019: Systematic Analysis. JMIR Public Health Surveill 2023; 9:e50114. [PMID: 37883176 PMCID: PMC10636626 DOI: 10.2196/50114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/04/2023] [Accepted: 10/03/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Urticaria presents a significant global health challenge due to its sudden onset and potential for severe allergic reactions. Past data on worldwide prevalence and incidence is inconsistent due to differing study methodologies, regional differences, and evolving diagnostic criteria. Past studies have often provided broad ranges instead of specific figures, underscoring the necessity for a cohesive global perspective to inform public health strategies. OBJECTIVE We aimed to assess the global burden of urticaria using the 2019 Global Burden of Disease (GBD) study data and systematically analyze urticaria prevalence, incidence, and disability-adjusted life years (DALYs) at global, regional, and national levels, thereby informing more effective prevention and treatment strategies. METHODS We analyzed the global, regional, and national burden of urticaria from 1990 to 2019 using the 2019 GBD study coordinated by the Institute for Health Metrics and Evaluation. Estimations of urticaria prevalence, incidence, and DALYs were derived using DisMod-MR 2.1, a Bayesian meta-regression tool. The Socio-demographic Index (SDI) was used to correlate development status with health outcomes. The GBD's division of the world into 21 regions and 204 countries and territories facilitated a comprehensive assessment. Age-standardized estimated annual percentage changes were generated for urticaria metrics to quantify temporal trends, with age standardization adjusting for potential confounding from age structure. RESULTS From 1990 to 2019, the global age-standardized prevalence, incidence, and DALY rates of urticaria showed marginal changes. In 2019, 65.14 million individuals were affected, with a prevalence rate of 841.88 per 100,000 population. The DALY rate was 50.39 per 100,000 population. Compared to 1990, the global age-standardized prevalence, incidence, and DALY rates saw increases of 2.92, 4.84, and 0.31 per 100,000 population, respectively. Women persistently had higher rates than men. At a regional level in 2019, low-middle SDI regions exhibited the highest age-standardized metrics, whereas high SDI regions reported the lowest. Central Europe showed the highest rates, contrasting with Western Europe's lowest rates. Nationally, urticaria prevalence in 2019 varied dramatically, from a low of 27.1 per 100,000 population in Portugal to a high of 92.0 per 100,000 population in Nepal. India reported the most DALYs at 749,495.9, followed by China, Pakistan, and the United States. Agewise data showed higher rates in younger age groups, which diminished with age and then experienced a slight resurgence in the oldest populations. This pattern was pronounced in women and younger populations, with the largest rises seen in those aged less than 40 years and the smallest in those aged more than 70 years. CONCLUSIONS Urticaria remains a significant global health issue, with considerable variation across regions, countries, and territories. The increased burden among women, the rising burden in younger populations, and the regional differences in disease burden call for tailored interventions and policies to tackle this emerging public health issue.
Collapse
Affiliation(s)
- Xiaoli Liu
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yuan Cao
- Department of Dermatology, Peking University Third Hospital, Beijing, China
| | - Wenhui Wang
- Department of Dermatology, Peking University Third Hospital, Beijing, China
| |
Collapse
|
2
|
Yang X, Liang G, Wang H, Kong M, Song Z, Chen Q. Atopy Does Not Influence the Clinical Outcome of Acute Urticaria: A Retrospective Study. Int Arch Allergy Immunol 2023; 185:79-83. [PMID: 37844549 DOI: 10.1159/000534020] [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: 08/23/2023] [Accepted: 09/05/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Acute urticaria (AU) may be associated with atopy, but the relationship between atopic status and the clinical features of the disease has not been fully described. OBJECTIVES The aim of the study was to determine the proportion of atopy in AU patients and to see whether atopy is related to the clinical characteristics of AU and whether it has an impact on the outcome of the disease. MATERIALS AND METHOD A retrospective analysis of patients with AU was performed. Demographic data, clinical features, and laboratory results were compared and analyzed between the atopic and non-atopic AU (napAU). RESULTS In total, 139 participants were included. 54 (38.8%) patients were atopic AU (apAU) and 85 (61.2%) were napAU. Compared with napAU patients, apAU patients were more likely to have anaphylaxis, higher levels of C4, and lower levels of antistreptolysin. There were no significant differences between the two groups in terms of other clinical features, laboratory tests, the natural course of the disease, or disease outcomes. CONCLUSION Atopy does exist in some patients with AU, and AU patients with an atopic background are at higher risk for anaphylaxis. Atopy does not influence the clinical outcome of AU and is not correlated with other clinical features and laboratory results of AU.
Collapse
Affiliation(s)
- Xianjie Yang
- School of Medicine, Chongqing University, Chongqing, China,
| | - Gaopeng Liang
- Department of Dermatology, Southwest Hospital, Amy Medical University, Chongqing, China
| | - Huan Wang
- Department of Dermatology, Southwest Hospital, Amy Medical University, Chongqing, China
| | - Minmin Kong
- Department of Dermatology, Southwest Hospital, Amy Medical University, Chongqing, China
| | - Zhiqiang Song
- Department of Dermatology, Southwest Hospital, Amy Medical University, Chongqing, China
| | - Qiquan Chen
- Department of Dermatology, Southwest Hospital, Amy Medical University, Chongqing, China
| |
Collapse
|
3
|
Pezeshki PS, Nowroozi A, Razi S, Rezaei N. Asthma and Allergy. Clin Immunol 2023. [DOI: 10.1016/b978-0-12-818006-8.00002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
4
|
Etiological causes in patients with acute urticaria and angioedema: A cross-sectional study. Allergol Immunopathol (Madr) 2022; 50:15-23. [PMID: 36562173 DOI: 10.15586/aei.v50isp2.784] [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: 10/05/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Acute urticaria and angioedema are emergency dermatological conditions associated with various etiologic factors. OBJECTIVE To determine the etiological causes in patients with acute urticaria and angioedema, and to investigate whether more than one etiological cause was present, along with the patients' laboratory values. METHODS The study was conducted in a tertiary hospital with one center. Etiological causes and laboratory parameters in 284 patients diagnosed with acute urticaria and angioedema were retrospectively studied. RESULTS A total of 284 patients were included in the study. The mean age of the patients was 42.7 ± 15.6 years, where 163 (57.4%) were women and 121 (42.6%) were men. Acute urticaria and angioedema occurred together in 149 (52.5%) patients. At least one precipitating factor among the predisposing risk factors was present in 220 (77.5%) patients, and more than one precipitating factor was found in 51 (18%) patients. Medication use was found in 157 (55.3%) patients and infection in 54 (19%). The development of urticaria after food consumption was noted in nine (3.2%) individuals. A history of infection and medication intake was present in 50 (17.6%) patients. A joint history of food consumption and medication intake was present in only one patient. Elevated C-reactive protein level was found in 178 (62.7%) patients and elevated anti-streptolysin O titer in 41 (14.4%) patients. Vitamin B12 deficiency was found in 116 (40.8%) patients and vitamin D deficiency in 254 (89.4%). CONCLUSION Acute urticaria and angioedema may occur as a result of multiple etiological factors, in which different triggers may be present simultaneously.
Collapse
|
5
|
Harada F, Yamamoto K, Matsuda T, Yamamoto C, Tani Y, Ohnishi M, Takita M, Tanimoto T, Kami M, Shineha R. Allergic reaction to anisakis-contaminated fish after the first administration of BNT162b2 mRNA vaccine: a case report. Gastroenterol Rep (Oxf) 2022; 10:goac034. [PMID: 35966631 PMCID: PMC9366182 DOI: 10.1093/gastro/goac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fumiue Harada
- Department of Internal Medicine, Soma Central Hospital, Soma, Fukushima, Japan
| | - Kana Yamamoto
- Department of Radiation Health Management, Fukushima Medical University, Fukushima, Fukushima, Japan
| | - Tomoki Matsuda
- Department of Internal Medicine, Soma Central Hospital, Soma, Fukushima, Japan
| | - Chika Yamamoto
- Department of Radiation Health Management, Fukushima Medical University, Fukushima, Fukushima, Japan
| | - Yuta Tani
- Research Division, Medical Governance Research Institute, Minato, Tokyo, Japan
| | - Mutsuko Ohnishi
- Research Division, Medical Governance Research Institute, Minato, Tokyo, Japan
| | - Morihito Takita
- Department of Radiation Health Management, Fukushima Medical University, Fukushima, Fukushima, Japan
| | - Tetsuya Tanimoto
- Research Division, Medical Governance Research Institute, Minato, Tokyo, Japan
| | - Masahiro Kami
- Research Division, Medical Governance Research Institute, Minato, Tokyo, Japan
| | - Ryusaburo Shineha
- Department of Internal Medicine, Soma Central Hospital, Soma, Fukushima, Japan
| |
Collapse
|
6
|
Abstract
BACKGROUND Allergic contact dermatitis (ACD) can exist in the setting of other dermatologic conditions. It is known that the treatment of these conditions can cause ACD, increasing both diagnostic and treatment difficulty. OBJECTIVE The aim of this study was to determine the frequency of common dermatologic conditions in the setting of ACD and in specific patient populations. METHODS A retrospective database study was completed using Truven Health to collect information on patch-tested ACD patients. Demographics and diagnostic information were retrieved. Of those with ACD, the presence of 15 dermatologic diagnoses was investigated. Subanalyses were conducted for each condition, including International Classification of Diseases, 10th Revision code specificity, demographics, and diagnostic information. RESULTS A total of 6380 patients (76.83% female) were given a diagnosis of ACD via patch testing. Of those with concomitant disease, those most common include atopic dermatitis (23.98%), urticaria (16.69%), and acne (11.51%). Eight of the concomitant conditions were found to have statistical significance in comparing the average age of ACD diagnosis with the selected diagnoses (α = 0.05). CONCLUSIONS Common dermatologic diseases can exist concomitantly with ACD, many of which can be treated by compounds that precipitate or worsen preexisting ACD. The average age of the diagnosis varies from concomitant diagnoses, which can contribute to difficulty in ACD diagnosis and treatment.
Collapse
|
7
|
Palungwachira P, Vilaisri K, Musikatavorn K, Wongpiyabovorn J. A randomized controlled trial of adding intravenous corticosteroids to H1 antihistamines in patients with acute urticaria. Am J Emerg Med 2020; 42:192-197. [PMID: 32139204 DOI: 10.1016/j.ajem.2020.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/12/2020] [Accepted: 02/16/2020] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Acute urticaria is a common dermatological condition in emergency departments (EDs). The main therapy involves controlling pruritus with antihistamines. Although guidelines have promoted the use of corticosteroids in addition to H1 antihistamines, well-designed clinical trials evaluating this approach are scarce. METHODS Adult ED patients with acute urticaria and a pruritus score > 5 on a visual analog scale (VAS) were randomized into three groups: (i) IV chlorpheniramine (CPM) treatment, (ii) IV CPM and IV dexamethasone (CPM/Dex) and (iii) IV CPM and IV dexamethasone with oral prednisolone as discharge medication for 5 days (CPM/Dex/Pred). The primary outcomes were self-reported pruritus VAS scores at 60 min after treatment. We also evaluated 1-week and 1-month urticaria activity scores for 7 days and adverse events. RESULTS Seventy-five patients (25 per group) were enrolled. The VAS scores of all groups decreased, but no significant difference was found in the VAS scores at 60 min after treatment between patients in the CPM group (n = 25) and those who received both CPM and dexamethasone (n = 50). At the 1-week and 1-month follow-ups, active urticaria (indicated by the urticaria activity score at 7 days) was more prevalent in the CPM/Dex/Pred group (n = 25) than in the control group. CONCLUSIONS The present study did not find evidence that adding IV dexamethasone improves the treatment of severe pruritus from uncomplicated acute urticaria. Oral corticosteroid therapy may be associated with persistent urticaria activity. Due to the lack of clinical benefits and the potential for side effects, using corticosteroids as an adjunctive treatment is discouraged.
Collapse
Affiliation(s)
- Pakhawadee Palungwachira
- Department of Emergency Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand.
| | - Ketsara Vilaisri
- Department of Emergency Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Khrongwong Musikatavorn
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand.
| | - Jongkonnee Wongpiyabovorn
- Immunology Unit, Department of Microbiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand.
| |
Collapse
|
8
|
Eczema and Urticaria in the Adult Population in Portugal: A Prevalence Study. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
9
|
Lu W, Chen B, Wang C, Yang X, Zhou C. Serum amyloid A levels in acute and chronic urticaria. An Bras Dermatol 2019; 94:411-415. [PMID: 31644612 PMCID: PMC7007030 DOI: 10.1590/abd1806-4841.20197761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/25/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Serum amyloid A is an acute-phase protein. There is no available data regarding serum amyloid A levels in patients with acute (AU) and chronic urticaria (CU). OBJECTIVE To investigate the association between serum amyloid A and urticaria. METHODS This was a case-control study of 81 patients who visited our Hospital between June and December 2016 with a diagnosis of urticaria. Eighty healthy controls (HC) who visited for routine health examination and physical checkups were recruited. Serum amyloid A and C-reactive protein levels were measured by automated methods. RESULTS Serum amyloid A and C-reactive protein levels were significantly higher in AU (Serum amyloid A: 207.1 (6.7-439.0) mg/L; C-reactive protein: 16.0 (0.2-90.0) mg/L) and CU (Serum amyloid A: 6.5 (2.5-35.8) mg/L; C-reactive protein: 1.0 (0.1-16.0) mg/L) compared with HC (Serum amyloid A: 5.04 (2.0-9.1) mg/L; C-reactive protein: 1.2 (0.1-5.6) mg/L), and in AU compared with CU (all P<0.05). There were no differences between the CU and HC group. In CU, Serum amyloid A levels in those with moderate/severe urticaria (median, 16.4 (9.7-35.8) mg/L) were higher than in those with mild urticaria (median, 5.7 (2.5-9.5) mg/L) and HC (all P<0.05). Serum amyloid A and C-reactive protein levels exceeded the normal lab range in 90.7% and 72.1% patients with AU compared with 28.9% and 13.2% patients with CU, respectively. Significant positive correlations were found between serum amyloid A and C-reactive protein (r = 0.562, P < 0.001). STUDY LIMITATIONS There was no comparison between active disease and remission. CONCLUSION There was an association between serum amyloid A levels and urticaria. Higher serum amyloid A levels were associated with AU and more severe CU. Serum amyloid A may help to identify CU patients earlier.
Collapse
Affiliation(s)
- Wei Lu
- Medical Laboratory Center, Zhejiang Province Traditional Chinese Medical Hospital, Hangzhou, Zhejiang, China
| | - Baobing Chen
- Medical Laboratory Center, The Third People’s Hospital of Hangzhou, Hangzhou, Zhejiang, China
| | - Chunfeng Wang
- Medical Laboratory Center, Zhejiang Province Traditional Chinese Medical Hospital, Hangzhou, Zhejiang, China
| | - Xiaohong Yang
- Dermatological Department, Zhejiang Province Traditional Chinese Medical Hospital, Hangzhou, Zhejiang, China
| | - Changyu Zhou
- Radiology Department, Zhejiang Province Traditional Chinese Medical Hospital, Hangzhou, Zhejiang, China
| |
Collapse
|
10
|
Carvalho D, Aguiar P, Ferrinho P, Mendes-Bastos P, Palma-Carlos A. Eczema and Urticaria in the Adult Population in Portugal: A Prevalence Study. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:744-751. [PMID: 31153546 DOI: 10.1016/j.ad.2019.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/07/2019] [Accepted: 03/10/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND AND AIMS Eczema and urticaria are both inflammatory skin diseases. The prevalence of both diseases varies worldwide and the reasons are unknown. We aimed to investigate the eczema and urticaria prevalence in the Portuguese adult (≥16 years-old) population. MATERIALS AND METHODS A telephone interview survey was performed in the last quarter of 2017. To calculate the prevalences, subjects should have been previously diagnosed with eczema/urticaria by a health professional, be aged ≥16 years-old, and reside in Portugal. The sample had a proportion that was approximately representative by population, region, gender, and age group. Odds ratios were performed to measure associations with prevalences. SPSS statistics and values of p<0.05 with 95% confidence intervals were considered statistically significant. RESULTS 5,000 phone calls were analysed. The prevalence of eczema and urticaria in Portugal is 4.4% and 3.4%, respectively. Algarve is the region with the highest prevalence for both diseases. Being a female is the factor that most influenced these diseases with an OR=1.99 (p<0.001; CI 1.49-2.66) for eczema and 1.73 (p=0.001; CI 1.25 - 2.40) for urticaria, with also higher prevalences (5.7% and 4.2%, respectively). CONCLUSIONS The prevalences found are higher than in previous studies in Portugal and comparable to results from other countries. Comparisons among prevalence of eczema are affected by several obstacles. Regarding urticaria, our results seem to be in the same line as others. Being female with eczema and urticaria is more common and represents a higher risk factor than male subjects. According to Harrop et al., 2007, in Europe, atopic eczema is 0.14-0.60% of general eczema. In this way, we can estimate that prevalence of atopic eczema in Portugal is around 0.61-2.64%.
Collapse
Affiliation(s)
- D Carvalho
- Centro de Investigación de Salud Pública, Universidad Nova de Lisboa, Lisboa, Portugal.
| | - P Aguiar
- Centro de Investigación de Salud Pública, Universidad Nova de Lisboa, Lisboa, Portugal
| | - P Ferrinho
- GHTM, Instituto de Higiene y Medicina Tropical, Universidad Nova de Lisboa, Lisboa, Portugal
| | - P Mendes-Bastos
- Centro de Dermatología, Hospital CUF Descobertas, Lisboa, Portugal
| | - A Palma-Carlos
- Clínica de Alergia e Inmunología Clínicas (CAIC), Lisboa, Portugal
| |
Collapse
|
11
|
Chen G, Zhao J, Chen T, Zhang Z, Huang C, Xu Z, Xu H. Efficacy and safety of Xiaofeng powder (xiao feng san) in treating urticaria: A protocol for a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018; 97:e13039. [PMID: 30407300 PMCID: PMC6250537 DOI: 10.1097/md.0000000000013039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 10/09/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Urticaria is a common skin disease that has a high impact on a patient's daily life. Xiaofeng powder (XFP) is one of the most commonly used Chinese herbal formula in China for urticaria. However, due to the lack of systematic evaluations, its clinical efficacy remains controversial. This meta-analysis was performed to evaluate the effect and safety of XFP for urticaria. METHODS Seven databases, including Cochrane Central Register of Controlled Trials, PubMed, Embase, the Chinese National Knowledge Infrastructure (CNKI), the Chinese Scientific Journal Database (VIP), the Chinese Biomedical Literature Database (CBM), and the Wanfang Database. The period will be from their inception to September 2018. Randomized controlled trials of XFS used separately against conventional Western medicine therapy in patients with urticarial were included. After the methodologic quality was assessed and the valid data were extracted, RevMan 5.3 software was used for the final meta-analysis. RESULTS The results will provide evidence regarding the efficacy and safety of XFP in treating urticaria. CONCLUSION The conclusion of our systematic review will provide evidence to judge whether XFP is an effective intervention for patient with urticaria. This systematic review will be disseminated in peer-reviewed publications. The results of the study will provide evidence concerning the efficacy and safety of Xiaofeng Powder (xiao feng san) in treating urticaria. PROSPERO REGISTRATION NUMBER PROSPERO CRD 42018087260.
Collapse
Affiliation(s)
| | | | | | | | | | - Zhirui Xu
- Guangzhou University of Chinese Medicine
| | - Hua Xu
- Department of Paediatrics, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| |
Collapse
|
12
|
Goyal V, Gupta A, Gupta O, Lal D, Gill M. Comparative Efficacy and Safety of Ebastine 20 mg, Ebastine 10 mg and Levocetirizine 5 mg in Acute Urticaria. J Clin Diagn Res 2017; 11:WC06-WC09. [PMID: 28511488 PMCID: PMC5427414 DOI: 10.7860/jcdr/2017/23961.9550] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/17/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Acute and chronic urticaria can result in severely impaired quality of life from pruritus and associated sleep lessness, as well as anxiety and depression. Various treatment modalities are available out of which second generation non sedating H1 antihistamines e.g., fexofenadine, loratidine, desloratadine, cetirizine, levocetirizine, ebastine etc., are used as the first line treatment. AIM To compare the safety and efficacy of ebastine 20 mg, ebastine 10 mg and levocetirizine 5 mg in the patients of urticaria. MATERIALS AND METHODS A longitudinal study was conducted in dermatology Outpatient Department (OPD) of Adesh Institute of Medical Sciences and Research, Bathinda, India. A total of 150 patients between the age group 10-70 years, both men and women having urticaria were enrolled and divided into three groups of 50 each. Group A was given ebastine 20 mg OD, Group B was given ebastine 10 mg OD and Group C was given levocetirizine 5 mg OD. The patients were asked to scale their severity of disease over a period of follow up based on Urticarial Activity Score 7 (UAS7). RESULTS The mean age of patients was 32.82 years. The mean UAS 7 score at the end of 4th week was 1.08 with ebastine 20 mg, 1.98 with levocetirizine 5 mg and 3.98 with ebastine 10 mg. In group A, 40 out of 50 patients (i.e., 80%), in Group B 25 out of 50 (i.e., 50%) get UAS7=0 and in Group C, 35 (i.e., 70%) patients who got relieved of symptoms at the end of treatment. When the scores were redefined and categorized under relieved and not relieved, and comparison done between all three groups, then there was a significant difference in the number of patients getting relieved, with p<0.001 (highly significant). Levocetirizine 5 mg had shown more side effects like dryness of mouth and sedation as compare to ebastine irrespective of dosage. The comparison made between the number of patients developing side effects among the groups was highly significant (p<0.001) for all the side effects. CONCLUSION Ebastine 20 mg is found to have superior efficacy for treatment of Urticaria as compared to ebastine 10 mg but with levocetirizine 5 mg the results were almost similar. Tolerability of ebastine 20 mg is similar to ebastine 10 mg but with levocetirizine 5 mg there were more side effects and less tolerability.
Collapse
Affiliation(s)
- Vippan Goyal
- Associate Professor and Head, Department of Dermatology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | - Anu Gupta
- Assistant Professor, Department of Dermatology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | - Onam Gupta
- Intern, Department of Dermatology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | - Dhruvendra Lal
- Post Graduate Student, Department of Community Medicine, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | - Manharan Gill
- Senior Resident, Department of Dermatology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| |
Collapse
|
13
|
James C, Bernstein JA. Current and future therapies for the treatment of histamine-induced angioedema. Expert Opin Pharmacother 2017; 18:253-262. [PMID: 28081650 DOI: 10.1080/14656566.2017.1282461] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Angioedema, a sudden, self-limited swelling of localized areas of any part of the body that may or may not be associated with urticaria, is thought to be the result of a mast-cell mediated process versus a bradykinin etiology. Understanding the mechanism is key in determining the proper treatment. Areas Covered: Clinical presentation of varying angioedema types may be similar; however, the appropriate treatment algorithm is dependent upon clinicians' knowledge of the underlying pathophysiology and classification of angioedema. Literature review of recent guidelines, available medications, and alternative therapies was completed to provide an overview of options. CONCLUSION There are no formal guidelines for treatment of acute or chronic histamine-mediated angioedema, and therefore, algorithms for the treatment of acute and chronic urticaria should be followed until such information becomes available. Differentiating histamine-mediated versus bradykinin mediated angioedema is essential, as treatments and treatment responses are quite different. Further research is needed to better understand idiopathic angioedema that is unresponsive to H1/H2 antagonists, LTMAs, or medications designed to treat bradykinin-mediated angioedema.
Collapse
Affiliation(s)
- Christine James
- a Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy , University of Cincinnati College of Medicine , Cincinnati , Ohio , USA
| | - Jonathan A Bernstein
- a Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy , University of Cincinnati College of Medicine , Cincinnati , Ohio , USA
| |
Collapse
|
14
|
Fine LM, Bernstein JA. Guideline of Chronic Urticaria Beyond. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2016; 8:396-403. [PMID: 27334777 PMCID: PMC4921693 DOI: 10.4168/aair.2016.8.5.396] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/13/2015] [Indexed: 11/20/2022]
Abstract
Urticaria is a relatively common condition that if chronic can persist for weeks, months or years and affect quality of life significantly. The etiology is often difficult to determine, especially as it becomes chronic. Many cases of chronic urticaria are thought to be autoimmune, although there is no consensus that testing for autoimmunity alters the diagnostic or management strategies or outcomes. Many times, urticaria is easily managed with antihistamines and/or short courses of oral corticosteroids, but too often control is insufficient and additional therapies must be added. For years, immune modulating medications, such as cyclosporine and Mycophenolate Mofetil, have been used in cases refractory to antihistamines and oral corticosteroids, although the evidence supporting their efficacy and safety has been limited. Omalizumab was recently approved for the treatment of chronic urticaria unresponsive to H1-antagonists. This IgG anti-IgE monoclonal antibody has been well demonstrated to safely and effectively control chronic urticaria at least partially in approximately 2/3 of cases. However, the mechanism of action and duration of treatment for omalizumab is still unclear. It is hoped that as the pathobiology of chronic urticaria becomes better defined, future therapies that target specific mechanistic pathways will be developed that continue to improve the management of these often challenging patients.
Collapse
Affiliation(s)
- Lauren M Fine
- Department of Medicine, University of Miami Miller School of Medicine, Department of Internal Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Miami, FL, USA
| | - Jonathan A Bernstein
- Department of Medicine, University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology/Allergy Section, Cincinnati, Ohio, USA.
| |
Collapse
|
15
|
Sala-Cunill A, Guilarte M. The Role of Mast Cells Mediators in Angioedema Without Wheals. CURRENT TREATMENT OPTIONS IN ALLERGY 2015. [DOI: 10.1007/s40521-015-0067-8] [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]
|
16
|
Pedrosa M, Prieto-García A, Sala-Cunill A, Baeza ML, Cabañas R, Campos A, Cimbollek S, Gómez-Traseira C, González Quevedo T, Guilarte M, Jurado-Palomo J, Lobera T, López-Serrano MC, Marcos C, Piñero-Saavedra M, Prior N, Sáenz de San Pedro B, Ferrer M, Barceló JM, Daschner A, Echechipía M, Garcés M, Iriarte P, Jáuregui I, Lázaro M, Quiñones M, Veleiro B, Villareal O. Management of angioedema without urticaria in the emergency department. Ann Med 2014; 46:607-18. [PMID: 25580506 DOI: 10.3109/07853890.2014.949300] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Angioedema refers to a localized, transient swelling of the deep skin layers or the upper respiratory or gastrointestinal mucosa. It develops as a result of mainly two different vasoactive peptides, histamine or bradykinin. Pathophysiology, as well as treatment, is different in each case; nevertheless, the resulting signs and symptoms may be similar and difficult to distinguish. Angioedema may occur at any location. When the affected area involves the upper respiratory tract, both forms of angioedema can lead to an imminent upper airway obstruction and a life-threatening emergency. Emergency physicians must have a basic understanding of the pathophysiology underlying this process. Angioedema evaluation in the emergency department (ED) should aim to distinguish between histamine- and bradykinin-induced angioedema, in order to provide appropriate treatment to patients. However, diagnostic methods are not available at the ED setting, neither to confirm one mechanism or the other, nor to identify a cause. For this reason, the management of angioedema should rely on clinical data depending on the particular features of the episode and the patient in each case. The history-taking should be addressed to identify a possible etiology or triggering agent, recording complete information for an ulterior diagnostic study in the outpatient clinic. It is mandatory quickly to recognize and treat a potential life-threatening upper airway obstruction or anaphylaxis. This review focuses on the underlying mechanisms and management of histamine- and bradykinin-induced angioedema at the emergency department and provides an update on the currently available treatments.
Collapse
Affiliation(s)
- Maria Pedrosa
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
Urticaria affects individuals of all ages and is commonplace. Nearly 1 in 5 individuals will experience an episode of urticaria in their lifetime, while the chronic form of disease has an estimated annual prevalence of approximately 1% of the population. Given the similarity of chronic urticaria symptoms to those seen in patients suffering an allergic reaction, the condition often leads to a search for an external cause. In most cases, no external trigger factor is identified. At present several theories of pathogenesis exist, none of which is firmly established.
Collapse
Affiliation(s)
- Sarbjit S Saini
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Room 2B. 71B, Baltimore, MD 21224, USA.
| |
Collapse
|
18
|
|
19
|
Bernstein JA, Moellman J. Emerging concepts in the diagnosis and treatment of patients with undifferentiated angioedema. Int J Emerg Med 2012; 5:39. [PMID: 23131076 PMCID: PMC3518251 DOI: 10.1186/1865-1380-5-39] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 10/15/2012] [Indexed: 11/10/2022] Open
Abstract
Angioedema is a sudden, transient swelling of well-demarcated areas of the dermis, subcutaneous tissue, mucosa, and submucosal tissues that can occur with or without urticaria. Up to 25% of people in the US will experience an episode of urticaria or angioedema during their lifetime, and many will present to the emergency department with an acute attack. Most cases of angioedema are attributable to the vasoactive mediators histamine and bradykinin. Histamine-mediated (allergic) angioedema occurs through a type I hypersensitivity reaction, whereas bradykinin-mediated (non-allergic) angioedema is iatrogenic or hereditary in origin.Although their clinical presentations bear similarities, the treatment algorithm for histamine-mediated angioedema differs significantly from that for bradykinin-mediated angioedema. Corticosteroids, and epinephrine are effective in the management of histamine-mediated angioedema but are ineffective in the management of bradykinin-mediated angioedema. Recent advancements in the understanding of angioedema have yielded pharmacologic treatment options for hereditary angioedema, a rare hereditary form of bradykinin-mediated angioedema. These novel therapies include a kallikrein inhibitor (ecallantide) and a bradykinin β2 receptor antagonist (icatibant). The physician's ability to distinguish between these types of angioedema is critical in optimizing outcomes in the acute care setting with appropriate treatment. This article reviews the pathophysiologic mechanisms, clinical presentations, and diagnostic laboratory evaluation of angioedema, along with acute management strategies for attacks.
Collapse
Affiliation(s)
- Jonathan A Bernstein
- Department of Internal Medicine, Division of Immunology/Allergy, University of Cincinnati Medical Center, 231 Albert Sabin Way, PO Box 670563, Cincinnati, OH, 45267-0550, USA
| | - Joseph Moellman
- Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| |
Collapse
|
20
|
Abstract
Urticaria and angioedema are common disorders that can severely impair the quality of a patient's life and can be extremely difficult to treat. Symptoms can persist for years to decades. The causes of urticaria and angioedema are varied and may be immunologic, nonimmunologic, or idiopathic. This article reviews the literature and provides primary care physicians with up-to-date information of the epidemiology, basic pathophysiology, diagnosis, and management of this common and often debilitating condition. Additionally, clinical manifestations of acute and chronic urticaria, hereditary and acquired angioedema, as well as the physical urticarias will be discussed.
Collapse
|
21
|
Current World Literature. Curr Opin Allergy Clin Immunol 2010; 10:511-4. [DOI: 10.1097/aci.0b013e32833f1ba6] [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]
|
22
|
|