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Bhowmik R, Shaharyar MA, Sarkar A, Mandal A, Anand K, Shabana H, Mitra A, Karmakar S. Immunopathogenesis of urticaria: a clinical perspective on histamine and cytokine involvement. Inflamm Res 2024; 73:877-896. [PMID: 38555555 DOI: 10.1007/s00011-024-01869-6] [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: 11/10/2023] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Urticaria is a clinical condition characterized by the appearance of wheals (hives), angioedema, or both. Over the last several decades, a better understanding of the mechanisms at play in the immunopathogenesis of urticaria has underscored the existence of numerous urticaria subtypes. Separating the different kinds of urticaria explicitly helps find the best detection method for the management of this skin disorder. Subtypes of urticaria also include both spontaneous and physical types. The conventional ones include spontaneous urticaria, constituting both acute and chronic urticaria. Therefore, a broad and effective therapy is essential for the diagnosis and treatment of urticaria. METHODS To understand the immunopathogenesis of urticaria, various databases, including PubMed, Scopus, and Web of Science, were used to retrieve original articles and reviews related to urticaria. While information on several clinical trials were obtained from clinicaltrials.gov database. RESULTS This article highlights the immunopathogenesis involved in the intricate interaction between cellular infiltration, immune reactions, coagulation cascades, and autoantibodies that underlie urticaria's pathophysiology. CONCLUSION The recent progress in understanding urticaria can help to understand the intricate characteristics in the immunopathogenesis of urticaria and could play a beneficial role in the management of urticaria.
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Affiliation(s)
- Rudranil Bhowmik
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India
| | - Md Adil Shaharyar
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India
| | - Arnab Sarkar
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India
| | - Avishek Mandal
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India
| | - Kumar Anand
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India
| | - Humira Shabana
- Chaudhary Charan Singh University, Formerly, Meerut University, Meerut, Uttar Pradesh, India
| | - Achintya Mitra
- Regional Ayurveda Research Institute (RARI) CCRAS Under Ministry of AYUSH, Thapla, Ganiyadeoli, Ranikhet Almora, Uttarakhand, India
| | - Sanmoy Karmakar
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India.
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Soegiharto R, Westmeijer M, Boekema-Bakker N, Groenewegen IAM, Knulst AC, van den Reek JMPA, Röckmann H. Prevalence of chronic urticaria and healthcare usage of patients with the condition in primary care: a population-based study in the Netherlands. Br J Dermatol 2024; 190:287-289. [PMID: 37897501 DOI: 10.1093/bjd/ljad426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/18/2023] [Accepted: 10/29/2023] [Indexed: 10/30/2023]
Abstract
We present a large population-based study on the prevalence and healthcare usage of patients with chronic urticaria (CU) in primary care. The observed annual point prevalence of 0.48–0.30% and a median follow-up duration of 1.5 years provides new and reliable insight into the vastness, relatively modest healthcare usage and estimated disease duration of CU in the general population, which is useful knowledge when counselling new patients with CU in both primary and specialist care settings.
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Affiliation(s)
| | | | - Nicole Boekema-Bakker
- Julius Center for Health Sciences and Primary Health Care, University Medical Centre Utrecht, Utrecht
| | - Irene A M Groenewegen
- Julius Center for Health Sciences and Primary Health Care, University Medical Centre Utrecht, Utrecht
| | | | - Juul M P A van den Reek
- Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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Maurer M, Albuquerque M, Boursiquot JN, Dery E, Giménez-Arnau A, Godse K, Guitiérrez G, Kanani A, Lacuesta G, McCarthy J, Nigen S, Winders T. A Patient Charter for Chronic Urticaria. Adv Ther 2024; 41:14-33. [PMID: 37991694 PMCID: PMC10796664 DOI: 10.1007/s12325-023-02724-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023]
Abstract
Chronic urticaria (CU) is the recurring development of wheals (aka "hives" or "welts"), angioedema, or both for more than 6 weeks. Wheals and angioedema occur with no definite triggers in chronic spontaneous urticaria, and in response to known and definite physical triggers in chronic inducible urticaria. Approximately 1.4% of individuals globally will have CU during their lifetime. The itching and physical discomfort associated with CU have a profound impact on daily activities, sexual function, work or school performance, and sleep, causing significant impairment in a patient's physical and mental quality of life. CU also places a financial burden on patients and healthcare systems. Patients should feel empowered to self-advocate to receive the best care. The voice of the patient in navigating the journey of CU diagnosis and management may improve patient-provider communication, thereby improving diagnosis and outcomes. A collaboration of patients, providers, advocacy organizations, and pharmaceutical representatives have created a patient charter to define the realistic and achievable principles of care that patients with CU should expect to receive. Principle (1): I deserve an accurate and timely diagnosis of my CU; Principle (2): I deserve access to specialty care for my CU; Principle (3): I deserve access to innovative treatments that reduce the burden of CU on my daily life; Principle (4): I deserve to be free of unnecessary treatment-related side-effects during the management of my CU; and Principle (5): I expect a holistic treatment approach to address all the components of my life impacted by CU. The stated principles may serve as a guide for healthcare providers who care for patients with CU and translate into better patient-physician communication. In addition, we urge policymakers and authors of CU treatment guidelines to consider these principles in their decision-making to ensure the goals of the patient are achievable.
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Affiliation(s)
- Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | | | | | - Elaine Dery
- Canadian Chronic Urticaria Society, Quebec City, Canada
| | - Ana Giménez-Arnau
- Hospital del Mar Research Institute, Universitat Pompeu Fabra, Barcelona, Spain
| | | | | | - Amin Kanani
- University of British Columbia, Vancouver, Canada
| | | | | | - Simon Nigen
- Montreal General Hospital, McGill University, Montreal, Canada
| | - Tonya Winders
- Global Allergy & Airways Patient Platform, Vienna, Austria.
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Mostmans Y, Richert B, De Maertelaer V, Saidi I, Benslimane A, Thi Thanh TT, Corazza F, Michel O. Chronic Spontaneous Urticaria in Belgium: Deciphering the Clinical Profile and Treatment of Patients Visiting an Urban City Immunology Department. Dermatology 2023; 239:926-936. [PMID: 37634502 DOI: 10.1159/000533394] [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: 01/17/2023] [Accepted: 07/31/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Chronic urticaria (CSU) is a chronic inflammatory mast cell-driven disorder of which reliable clinical data in Belgium are lacking. This study focusses on clinical characteristics of CSU patients presenting at an urban Immunology-Allergology department. METHODS Outpatients with CSU were included from 2018 to 2021. Clinical characteristics, Dermatology Life Quality Index (DLQI) and Urticaria activity score (UAS7) were collected by thorough anamnesis and questionnaires. Furthermore, patients underwent provocational testing, an autologous serum skin test (ASST) and a blood analysis. RESULTS The study included 49 CSU patients and 20 non-CSU subjects. CSU was distributed differently with age and sex, showing higher numbers in female patients below the age of 46 years. 67% of CSU patients had accompanying angioedema of which 9% were reported genital. CSU patients scored a mean 8/30 on their DLQI questionnaire. There was no significant difference in immunoglobulin E (IgE), C-reactive protein, and tryptase levels between CSU patients and controls. Oral glucocorticosteroids were prescribed in 23% of CSU patients during their disease course though only half of these patients had a severity grade 4 CSU. In 82% of the included CSU patients, Urticaria Control Test (UCT) scores were below 12. When we hypothetically considered low IgE levels and high IgG anti-thyroid peroxidase levels as differentiation marker for autoimmune (ai)CSU and non-aiCSU, we found that 4% of all included CSU patients could be considered aiCSU. CONCLUSION Generally, the inner-city population displayed the same clinical characteristics, as previous cohorts from Northern Europe. The relatively high rate of CSU patients receiving oral glucocorticosteroid treatment for their disease though not always classified as severe, underlines the need to train doctors of various specialties in the treatment algorithms of CSU. Furthermore, by looking at potential autoimmune characteristics, our findings open perspectives on the identification of new routinely used clinical parameters for the detection of aiCSU, a relatively small immunological subtype of CSU.
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Affiliation(s)
- Yora Mostmans
- Department of Immunology-Allergology, CHU Brugmann, Université Libre de Bruxelles, Laken, Belgium
- Department of Dermatology, CHU Brugmann, Université Libre de Bruxelles, Laken, Belgium
| | - Bertrand Richert
- Department of Dermatology, CHU Brugmann, Université Libre de Bruxelles, Laken, Belgium
| | - Viviane De Maertelaer
- IRIBHM, Statistical Unit, Fac. Medicine, Université Libre de Bruxelles, Anderlecht, Belgium
| | - Ines Saidi
- Department of Dermatology, CHU Brugmann, Université Libre de Bruxelles, Laken, Belgium
| | - Asma Benslimane
- Department of Immunology, Laboratoire Hospitalier Universitaire de Bruxelles/Universitair Laboratorium Brussels (LHUB-ULB), Brussels, Belgium
| | - Thao Tran Thi Thanh
- Department of Immunology, Laboratoire Hospitalier Universitaire de Bruxelles/Universitair Laboratorium Brussels (LHUB-ULB), Brussels, Belgium
| | - Francis Corazza
- Department of Immunology, Laboratoire Hospitalier Universitaire de Bruxelles/Universitair Laboratorium Brussels (LHUB-ULB), Brussels, Belgium
| | - Olivier Michel
- Department of Immunology-Allergology, CHU Brugmann, Université Libre de Bruxelles, Laken, Belgium
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Konstantinou GN, Podder I, Karapiperis D. Omalizumab prevents respiratory illnesses in non-atopic chronic spontaneous urticaria patients: A prospective, parallel-group, pilot pragmatic trial. Clin Transl Allergy 2023; 13:e12279. [PMID: 37488725 PMCID: PMC10339798 DOI: 10.1002/clt2.12279] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/16/2023] [Accepted: 06/23/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Omalizumab is the recommended treatment for antihistamine-refractory chronic spontaneous urticaria (CSU) and severe allergic asthma. In addition, it has been shown to reduce the frequency of viral respiratory infections in allergic asthma. Respiratory illness is a known trigger for asthma and CSU. OBJECTIVES To explore whether the antiviral effect of omalizumab may be extended to CSU patients independent of their atopic status. METHODS We conducted a prospective parallel-group pilot pragmatic trial including 30 non-allergic and non-atopic CSU patients (cases) under omalizumab 300 mg Q4-weeks (due to refractory to H1-antihistamines) and 30 age-matched healthy controls. All CSU patients had to have a weekly urticaria activity score UAS7 <15 at least 4 weeks before recruitment. Using the self-filled validated Jackson scale, we evaluated all study participants for common cold symptoms. All cases and controls rated weekly their respiratory symptoms. An increase in the symptom score of at least 4 points compared to baseline (defined as the minimum weekly report of symptoms) was considered an episode suggestive of a viral infection of the upper respiratory tract (URT). The patients were follow-up every 4 weeks throughout the study period (10 months). RESULTS CSU patients under omalizumab reported fewer episodes suggestive of an URT viral infection than the healthy controls (median of reported episodes: 0 vs. 1, inter-quartile range 0-1 vs. 1-1, min-max: 0-3 vs. 0-4, respectively; p = 0.0095). The duration of each episode was the same in both cases and controls. CONCLUSIONS Omalizumab can reduce the number of common cold episodes in CSU patients and consequently may minimize viral-related CSU exacerbations. This beneficial effect is exerted independently of the atopic status, even in non-asthmatic individuals or non-allergic patients without any evidence of respiratory susceptibility. Further large-scale studies are needed to validate the current findings and elucidate the underlying relevant pathophysiology.
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Affiliation(s)
- George N Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, Greece
| | - Indrashis Podder
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, Greece
- Department of Dermatology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Dimitrios Karapiperis
- Department of Infectious Diseases, 424 General Military Training Hospital, Thessaloniki, Greece
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Wiuff AC, Knudsgaard Wiis MA, Heilskov S, Frølunde AS, Sørensen JA, Deleuran M, Thomsen SF, Vestergaard C. The impact of home treatment and self-administration of omalizumab on chronic urticaria. World Allergy Organ J 2022; 15:100725. [PMID: 36531648 PMCID: PMC9731880 DOI: 10.1016/j.waojou.2022.100725] [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: 05/15/2022] [Revised: 11/01/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
Background Patients suffering from Chronic Spontaneous Urticaria (CSU) may be recalcitrant to treatment with high dose second-generation antihistamines. These patients are, according to international guidelines, eligible to treatment with omalizumab. Treatment with omalizumab has proven to be very effective for this group of patients. Until 2018, when the self-administration of omalizumab was approved, patients have had to visit an outpatient clinic to receive the treatment. Methods In this study we performed a survey among 75 CSU patients who had changed their treatment from administration at an outpatient clinic to self-administration at home. Results None of the patients experienced decreased effect of the treatment with omalizumab, whereas 41.4% reported improved effect of the treatment during self-administration.The most common reported benefits for the patients were decreased travel time and the ability to choose dosing time at the day of treatment, whereas the most reported concern was fear of performing the injection. Conclusions Patients are very content with self-administration of omalizumab. There has been no decreased effect of the treatment, and as discussed in this paper, there might be other societal benefits from self-administration. Thus, self-administration at home of omalizumab should be standard of care when using this treatment.
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Affiliation(s)
| | | | - Sofine Heilskov
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Mette Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
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Papapostolou N, Xepapadaki P, Katoulis A, Makris M. Comorbidities of Chronic Urticaria: A glimpse into a complex relationship. FRONTIERS IN ALLERGY 2022; 3:1008145. [PMID: 36465885 PMCID: PMC9712803 DOI: 10.3389/falgy.2022.1008145] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/17/2022] [Indexed: 08/05/2023] Open
Abstract
Chronic Urticaria (CU) is a chronic inflammatory, predominantly mast cell-driven disease, characterized by the development of wheals and/or angioedema for more than 6 weeks. It affects approximately 1%-5% of the total population worldwide and imposes a substantial burden on health-related quality of life, significantly affecting patients' daily life. The economic impact on the health system is also not negligible, with an estimated cost per patient per year of approximately 2.000 $ in the United States. Although the underlying pathophysiology is not fully explored, autoimmune mechanisms have been proposed, including type I ("autoallergy" by means of autoantibodies to self-antigens) and type IIb (autoimmunity). Atopic, autoimmune, and psychiatric disorders are prevalent comorbidities in both children and adults with Chronic Spontaneous Urticaria (CSU). Although malignancies, cardiovascular diseases and other comorbidities have also been reported as associated diseases in patients with CSU, data remain scarce. It is still unknown whether the aforementioned comorbidities share common pathophysiological mechanisms with specific endotypes of CSU. The current review aims to overview current data on comorbidities of CU, and furthermore to comment on the potential linked pathways underlying these diseases.
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Affiliation(s)
- Niki Papapostolou
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexander Katoulis
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Michael Makris
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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Godse K, Patil A, De A, Sharma N, Rajagopalan M, Shah B, Tahiliani S, Girdhar M, Zawar V, Sangolli P, Shankar DSK, Dhar S. Diagnosis and Management of Urticaria in Indian Settings: Skin Allergy Research Society's Guideline-2022. Indian J Dermatol 2022; 67:732-743. [PMID: 36998850 PMCID: PMC10043650 DOI: 10.4103/ijd.ijd_307_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Urticaria is a common skin disorder. Chronic urticaria, i.e., the presence of symptoms for more than six weeks, is associated with a significant adverse impact on sleep, performance, quality of life, and financial status of the patients. Although several treatment options are available, the condition can be challenging to treat for many clinicians. Several updates have been published on the subject of urticaria and its management since the publication of an updated consensus statement in 2018 by Indian experts. The objective of this consensus statement is to summarize the updates and provide concise information, including classification, diagnosis, and management of urticaria. Understanding and elimination of the underlying eliciting trigger are essential in all possible cases. The goal of pharmacological treatment is to provide symptomatic relief. Second-generation nonsedating H1 antihistamine continue to be recommended as the first-line treatment, the dose of which can be increased up to four times in patients not responding satisfactorily, in the second step. The role of omalizumab, cyclosporine, H2 antihistamines, and other options is also discussed.
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Affiliation(s)
- Kiran Godse
- From the Department of Dermatology, D Y Patil Hospital, Navi Mumbai, Maharashtra, India
| | - Anant Patil
- Department of Pharmacology, D Y Patil Hospital, Navi Mumbai, Maharashtra, India
| | - Abhishek De
- Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Nidhi Sharma
- Department of Dermatology, The Medicity, Medanta Hospital, Gurugram, Haryana, India
| | | | - Bela Shah
- Department of Dermatology, BJ Medical College, Ahmedabad, Gujarat, India
| | - Sushil Tahiliani
- Department of Dermatology, PD Hinduja Hospital, Mumbai, Maharashtra, India
| | - Mukesh Girdhar
- Department of Dermatology, Max Super Speciality Hospital, Patparganj, Delhi, India
| | - Vijay Zawar
- Department of Dermatology, Skin Diseases Centre, Nashik, Maharashtra, India
| | - Prabhakar Sangolli
- Consultant Dermatologist, Skin Care Centre, Rajajinagar, Bengaluru, Karnataka, India
| | - DS Krupa Shankar
- Department of Dermatology, Mallige Hospital, Bengaluru, Karnataka, India
| | - Sandipan Dhar
- Department of Dermatology, Institute of Child Health, Kolkata, West Bengal, India
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9
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Abstract
Urticaria is an inflammatory skin disorder that affects up to 20% of the world population at some point during their life. It presents with wheals, angioedema or both due to activation and degranulation of skin mast cells and the release of histamine and other mediators. Most cases of urticaria are acute urticaria, which lasts ≤6 weeks and can be associated with infections or intake of drugs or foods. Chronic urticaria (CU) is either spontaneous or inducible, lasts >6 weeks and persists for >1 year in most patients. CU greatly affects patient quality of life, and is linked to psychiatric comorbidities and high healthcare costs. In contrast to chronic spontaneous urticaria (CSU), chronic inducible urticaria (CIndU) has definite and subtype-specific triggers that induce signs and symptoms. The pathogenesis of CSU consists of several interlinked events involving autoantibodies, complement and coagulation. The diagnosis of urticaria is clinical, but several tests can be performed to exclude differential diagnoses and identify underlying causes in CSU or triggers in CIndU. Current urticaria treatment aims at complete response, with a stepwise approach using second-generation H1 antihistamines, omalizumab and cyclosporine. Novel treatment approaches centre on targeting mediators, signalling pathways and receptors of mast cells and other immune cells. Further research should focus on defining disease endotypes and their biomarkers, identifying new treatment targets and developing improved therapies.
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Affiliation(s)
- Pavel Kolkhir
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.
| | - Ana M Giménez-Arnau
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mediques, Universitat Autònoma, Barcelona, Spain
| | - Kanokvalai Kulthanan
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jonny Peter
- Urticaria Center of Reference and Excellence (UCARE), Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Urticaria Center of Reference and Excellence (UCARE), Allergy and Immunology Unit, University of Cape Town, Lung Institute, Cape Town, South Africa
| | - Martin Metz
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.
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