1
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Oztas Kara R, Sevimli Dikicier B. Clinical Features and Outcomes of Acute versus Chronic Urticaria Triggered by COVID-19 Infection. Adv Skin Wound Care 2024; 37:1-5. [PMID: 38506583 DOI: 10.1097/asw.0000000000000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVE Although acute urticaria (AU) and urticaria-like rash are commonly reported with COVID-19 infection, chronic spontaneous urticaria (CSU) triggered by COVID-19 is rare. The authors compared the features of COVID-19 infection-induced chronic CSU and AU to determine which patients' COVID-19 infection leads to CSU and possible indicators of chronicity. METHODS The authors retrieved the charts of patients diagnosed with AU or CSU following COVID-19 at the Urticaria Centers of Reference and Excellence and compared patients in terms of demographic characteristics, length of time between infection and onset of urticaria, duration of urticaria, COVID-19 disease severity, laboratory test results, vaccination, and treatment status. RESULTS A total of 92 patients were included in the study: 7 with CSU following COVID-19 and 85 with AU after COVID-19. The mean duration of urticaria for CSU and AU following COVID-19 was 13.0 ± 6.0 months and 7.1 ± 3.4 days, respectively. The average time between COVID-19 and the start of urticaria was longer in the CSU group (20.7 ± 3.9 days vs 4.5 ± 2.8 days, respectively; P = .000). No between-group differences were found for any other parameters. CONCLUSIONS The onset of urticaria more than 2 weeks after COVID-19 infection may serve as an indicator for urticaria chronicity beyond 6 weeks and may help physicians predict the possible course of urticaria associated with COVID-19 infection. The relevance of basopenia and eosinopenia needs to be determined.
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Affiliation(s)
- Rabia Oztas Kara
- In the School of Medicine, Sakarya University, Sakarya, Turkey, Rabia Oztas Kara, MD, is Assistant Professor, and Bahar Sevimli Dikicier, MD, is Associate Professor
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2
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Pan X, Dong Z. Yellow urticaria following plasma transfusion. J Dermatol 2024; 51:e108-e109. [PMID: 38414184 DOI: 10.1111/1346-8138.17160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Xiaoyuan Pan
- Department of Dermatology, Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Zhengbang Dong
- Department of Dermatology, Zhongda Hospital Affiliated to Southeast University, Nanjing, China
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3
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Nakaizumi H, Kambe N, Irie H, Kaku Y, Fujimoto M, Yoshifuji H, Kazuma Y, Katagiri K, Kanekura T, Kabashima K. Neutrophilic epitheliotropism, proposed as an auto-inflammatory condition of neutrophilic urticarial dermatosis including Schnitzler syndrome, is also observed in Japanese cases. J Dermatol 2024; 51:592-596. [PMID: 38057948 DOI: 10.1111/1346-8138.17067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/01/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023]
Abstract
Schnitzler syndrome (SchS) is a rare autoinflammatory disease characterized by bone pain, recurrent fever, leukocytosis, and elevated C-reactive protein, along with an urticaria-like rash and monoclonal immunoglobulin (Ig)M or IgG gammopathy. Notably, the condition is distinguished by a relatively persistent recurrent urticarial-like rash. Histopathological features observed in the skin comprise diffuse neutrophil infiltration into the dermis, absence of dermal edema, and vascular wall degeneration, all of which classify SchS as a neutrophilic urticarial dermatosis (NUD). Accumulated histological data from skin biopsies of patients with NUD have revealed a sensitive histopathological marker for NUD, acknowledged as neutrophilic epitheliotropism, which has been proposed as reflecting an autoinflammatory condition. In this report, we present three SchS patients: two men (ages 55 and 68) and a woman (age 75), all displaying neutrophilic epitheliotropism in their skin biopsy specimens. Additionally, a review of eight previously reported SchS cases in Japan identified neutrophilic epithliotropism in five cases. These findings suggest that the inclination of neutrophils toward the epithelial tissue could aid in confirming diagnoses of NUD in most cases that need to be differentiated from conventional urticaria. Consequently, we emphasize that acknowledging neutrophilic epithelial predilection as a hallmark of NUD is critical for expediting early diagnosis and appropriate treatment for SchS.
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Affiliation(s)
- Hitomi Nakaizumi
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naotomo Kambe
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Center for Allergy, Kyoto University Hospital, Kyoto, Japan
| | - Hiroyuki Irie
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yo Kaku
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masakazu Fujimoto
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuhiro Kazuma
- Department of Hematology and Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazumoto Katagiri
- Department of Dermatology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Takuro Kanekura
- Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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4
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Sulk M, Hammers CM, Heine G. [Spontaneous remission of urticaria: does it exist and if so, when?]. Dermatologie (Heidelb) 2024; 75:303-308. [PMID: 38466406 DOI: 10.1007/s00105-024-05320-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Urticaria mostly occurs acutely with a very high probability of spontaneous remission. When it persists for more than 6 weeks a chronic urticaria is manifest, which occurs either spontaneously or inducible by specific triggers. The underlying mechanisms are not fully understood but recent research points to defined pathogenetic factors. QUESTION AND AIM Whether spontaneous remission is possible in urticaria is summarized descriptively in this review, and suggestions are given for the "step down" of urticaria treatment after remission. The mechanisms including autoallergic, immunoglobulin E (IgE)-dependent type I reactions and autoimmune, activating IgG-dependent type IIb reactions are presented. These are discussed in the context of spontaneous remission and the possibilities of induced remission.
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Affiliation(s)
- Mathias Sulk
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster, Deutschland
| | - Christoph M Hammers
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Guido Heine
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland.
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5
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Wagner N, Berking C. [Recognition and management of relevant comorbidities in chronic spontaneous urticaria]. Dermatologie (Heidelb) 2024; 75:289-294. [PMID: 38411698 DOI: 10.1007/s00105-024-05311-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 02/28/2024]
Abstract
Various mechanisms contributing to the activity of chronic spontaneous urticaria (CU) have been postulated. Associated comorbidities are increasingly leading to the discovery of further signaling pathways which may support the activity of chronic urticaria or contribute to low-grade systemic inflammation. Moreover psychoimmunological factors may also be involved. The aim of this work is to improve the clinical care of patients with CU by increasing knowledge regarding optional influencing factors due to comorbidities and to possibly influence disease activity. Chronic urticaria due to autoimmune mechanisms may dispose to other autoimmune diseases, especially autoimmune thyroiditis, which can trigger chronic disease. Association of CU with metabolic syndrome has received little attention to date. Obesity may contribute to low-grade systemic inflammation by cytokine-secreting adipose tissue and hence to mediator-release of mast cells. Furthermore, neuroimmunological pathways, especially increased release of substance P, an activating ligand of Mas-related G protein-coupled receptor X2 (MRGPX2) on mast cells, should be addressed when optimizing therapy.
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Affiliation(s)
- Nicola Wagner
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Deutschland.
| | - Carola Berking
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Deutschland
- Hautklinik, Uniklinikum Erlangen, 91054, Erlangen, Germany
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6
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Magerl M. [What are the main symptoms of urticaria and how are they systematically recorded?]. Dermatologie (Heidelb) 2024; 75:274-280. [PMID: 38424150 DOI: 10.1007/s00105-024-05304-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 03/02/2024]
Abstract
Wheals or angioedema or both are the main symptoms of urticaria. The small number of the symptoms usually makes diagnosis easy. What is not trivial, however, is the comprehensive systematic recording and assessment of these symptoms and, above all, their sequelae, which affect many areas of the patient's life. Disease activity, quality of life and disease control can and should be measured before and during treatment in order to optimally adapt therapeutic measures. The instruments developed for this purpose have become easier and more convenient to use in recent years thanks to user-friendly platforms such as mobile health apps.
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Affiliation(s)
- Markus Magerl
- Angioedema Center of Reference and Excellence (ACARE), Institute of Allergology, CBF, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland.
- Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Deutschland.
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7
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Orakwue A, Bray J, Comfere N, Sokumbi O. Neutrophilic Urticarial Dermatosis. Dermatol Clin 2024; 42:219-229. [PMID: 38423683 DOI: 10.1016/j.det.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Neutrophilic urticarial dermatosis (NUD) is a rare form of dermatosis that is poorly understood. It was first described by Kieffer and colleagues as an urticarial eruption that is histopathologically characterized by a perivascular and interstitial neutrophilic infiltrate with intense leukocytoclasia and without vasculitis or dermal edema. NUD clinically presents as a chronic or recurrent eruption that consists of nonpruritic macules, papules, or plaques that are pink to reddish and that resolve within 24 hours without residual pigmentation. NUD is often associated with systemic diseases such as Schnitzler syndrome, lupus erythematosus, adult-onset Still's disease, and cryopyrin-associated periodic syndromes.
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Affiliation(s)
- Amarachi Orakwue
- University of Minnesota Medical School, 420 Delaware Street Southeast Suite C607, Minneapolis, MN 55455, USA
| | - Jeremy Bray
- Department of Dermatology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL 32224, USA
| | - Nneka Comfere
- Department of Dermatology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Department of Laboratory Medicine & Pathology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Olayemi Sokumbi
- Department of Dermatology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL 32224, USA; Department of Laboratory Medicine & Pathology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL 32224, USA.
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8
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Baudy A, Raison-Peyron N, Serrand C, Crépy MN, Du-Thanh A. Impact of Chronic Spontaneous or Inducible Urticaria on Occupational Activity. Acta Derm Venereol 2024; 104:adv36122. [PMID: 38551378 PMCID: PMC11000653 DOI: 10.2340/actadv.v104.36122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/27/2024] [Indexed: 04/02/2024] Open
Abstract
The impact of chronic urticaria on work has been scarcely reported, whereas its peak incidence is between the ages of 20 and 40. The aim of this study was to assess the occupational impact of chronic urticaria and its treatment, by combining objective and patient-reported data. A monocentric observational study was performed using questionnaires over a 1-year period from 2021 to 2022 in chronic urticaria patients who were in a period of professional activity and agreed to participate. Of the 88 patients included, 55.7% assessed the occupational impact of their chronic urticaria as significant, and even more severe when chronic urticaria was poorly controlled. Some 86% of patients had symptoms at work, in a third of cases aggravated by work. However, occupational physical factors were not associated with an aggravation of inducible chronic urticaria. A total of 20% reported treatment-related adverse effects affecting their work. Despite low absenteeism, presenteeism and reduced productivity were important (> 20%). Six patients (6.8%) had difficulties keeping their work. For 72.7% of the patients, the occupational physician was not informed. The occupational impact of chronic urticaria should be discussed during consultations, particularly when it is insufficiently controlled. The occupational physician should be informed in order to support patients' professional project.
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Affiliation(s)
- Amandine Baudy
- Department of Dermatology, University Hospital of Montpellier, Montpellier, France; University of Montpellier, Montpellier, France
| | - Nadia Raison-Peyron
- Department of Dermatology, University Hospital of Montpellier, Montpellier, France
| | - Chris Serrand
- University of Montpellier, Montpellier, France; Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, Nîmes university hospital, Nîmes, France
| | - Marie-Noëlle Crépy
- Department of Dermatology, University Hospital of Centre of Paris, Cochin Hospital, AP-HP, Paris, France; Department of Occupational and Environmental Diseases, University Hospital of Centre of Paris, Hotel-Dieu Hospital, AP-HP, Paris, France
| | - Aurélie Du-Thanh
- Department of Dermatology, University Hospital of Montpellier, Montpellier, France; University of Montpellier, Montpellier, France.
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9
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MAGEN E, MERZON E, GREEN I, VINKER S, ISRAEL A. Dermatological Comorbidities in Patients with Acute Urticaria. Acta Derm Venereol 2024; 104:adv18399. [PMID: 38528331 PMCID: PMC10985916 DOI: 10.2340/actadv.v104.18399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/03/2023] [Indexed: 03/27/2024] Open
Abstract
Abstract is missing (Short communication)
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Affiliation(s)
- Eli MAGEN
- Leumit Health Services, Tel Aviv-Yafo
- Medicine A Department, Assuta Ashdod University Hospital Faculty of Health Sciences, Ben-Gurion University, 8410501 Beer-Sheba
| | - Eugene MERZON
- Leumit Health Services, Tel Aviv-Yafo
- Adelson School of Medicine, Ariel University, Ariel
| | - Ilan GREEN
- Leumit Health Services, Tel Aviv-Yafo
- Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel. E-mail:
| | - Shlomo VINKER
- Leumit Health Services, Tel Aviv-Yafo
- Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel. E-mail:
| | - Ariel ISRAEL
- Leumit Health Services, Tel Aviv-Yafo
- Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel. E-mail:
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10
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Alrafiaah AS, Netchiporouk E, Ben-Shoshan M. Cold-induced anaphylaxis triggered by drinking cold water. Allergol Immunopathol (Madr) 2024; 52:45-47. [PMID: 38459889 DOI: 10.15586/aei.v52i2.1041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/16/2024] [Indexed: 03/11/2024]
Abstract
Cold urticaria is an inducible urticaria in which hives and angioedema appear after exposure to cold. The symptoms of cold urticaria often are limited to hives/angioedema. However, in up to 20% of cases, cold exposure may trigger anaphylaxis. We report the case of an 11-year-old boy previously diagnosed with chronic spontaneous urticaria who developed facial swelling, itchy hives, difficulty in breathing, vomiting and abdominal pain within 5 minutes of drinking cold water. He received a standard dose of non-sedating second-generation antihistamines at home. He was observed in the emergency room for 2 hours and discharged with an epinephrin autoinjector. During the subsequent outpatient clinic visit, an ice cube test was performed which confirmed the new diagnosis of comorbid cold-induced chronic urticaria. On further questioning, the parents reported occurrence of hives following swimming in the swimming pool. Cold-induced urticaria should be suspected in cases of anaphylaxis associated with cold exposure. Patients with chronic forms of urticaria who present with new anaphylaxis should be assessed for a potential concomitant cold-induced form.
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Affiliation(s)
- Abdulaziz S Alrafiaah
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Quebec, Canada
- Division of Pediatric, College of Medicine, Majmaah University, Al Majma'ah, Saudi Arabia;
| | - Elena Netchiporouk
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Quebec, Canada
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11
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Relvas M, Silva J, Matos AL, Alves F, Gonçalo M. Concomitant evaluation of D-dimer and C-reactive protein in chronic spontaneous urticaria may show divergent values. Eur Ann Allergy Clin Immunol 2024; 56:89-92. [PMID: 35791699 DOI: 10.23822/eurannaci.1764-1489.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- M Relvas
- Department of Dermatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Silva
- Department of Occupational Health, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A L Matos
- Department of Dermatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - F Alves
- Department of Dermatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - M Gonçalo
- Department of Dermatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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12
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Heldin J, Malinovschi A, Hägg SA, Gíslason T, Benediktsdóttir B, Movérare R, Hallgren J, Molin M, Jogi R, Janson C. Urticaria and angioedema in Estonia, Iceland and Sweden. Clin Exp Allergy 2024; 54:228-230. [PMID: 38191145 DOI: 10.1111/cea.14449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/12/2023] [Accepted: 12/27/2023] [Indexed: 01/10/2024]
Affiliation(s)
- Johanna Heldin
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala Universitet, Uppsala, Sweden
| | - Shadi Amid Hägg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Thorarinn Gíslason
- The Medical Faculty, University of Iceland, Reykjavik, Iceland
- Department of Sleep, Landspitali University Hospital Reykjavik, Reykjavik, Iceland
| | - Bryndís Benediktsdóttir
- The Medical Faculty, University of Iceland, Reykjavik, Iceland
- Department of Sleep, Landspitali University Hospital Reykjavik, Reykjavik, Iceland
| | - Robert Movérare
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
- Thermo Fisher Scientific, Uppsala, Sweden
| | - Jenny Hallgren
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Magnus Molin
- Thermo Fisher Scientific, Uppsala, Sweden
- Readily Diagnostics, Uppsala, Sweden
| | - Rain Jogi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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13
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Nahm WJ, Corriveau DJ, Mathe CA, Wyant WA, Vega C, Arthur A, Min KC. Urticaria Pigmentosa Without Pruritus. J Drugs Dermatol 2024; 23:e81-e82. [PMID: 38443117 DOI: 10.36849/jdd.7558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Mastocytosis is a group of disorders characterized by the pathologic accumulation of mast cells in various tissues. One example of mastocytosis is urticaria pigmentosa, which presents with mastocytomas that can cause hives and, when irritated, pruritus. To our knowledge, we are describing the first case of urticaria pigmentosa without pruritus. The patient had a positive Darier's sign, stated that they never felt itchy, and denied ever using a topical steroid or antihistamine. Although our patient declined additional testing, patients like this may benefit from a detailed evaluation of their sensory system through both quantitative sensory testing and genetic analysis. J Drugs Dermatol. 2024;23(3): doi:10.36849/JDD.7558e.
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14
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Kim EJ, Zhang Z, Hlobik M, Ho T, Huang JT. Urticaria in infants: A single-institution retrospective study. Pediatr Dermatol 2024; 41:260-262. [PMID: 38193388 DOI: 10.1111/pde.15519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/16/2023] [Indexed: 01/10/2024]
Abstract
Urticaria in infants can cause significant anxiety in parents, especially if a trigger cannot be identified. In a retrospective study of 246 infants seen for urticaria of unknown etiology at Boston Children's Hospital, 88.2% had resolution of urticaria within 6 weeks. The etiology of urticaria was ultimately established in 62.6% (72/115) of acute urticaria and 12.5% (2/16) of chronic urticaria cases with follow-up data. Pediatric healthcare providers can counsel families that while etiology of urticaria is never determined in over 40% of infants, symptoms are most likely to resolve spontaneously.
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Affiliation(s)
- Eun Jae Kim
- Harvard Medical School, Boston, Massachusetts, USA
| | - Zinan Zhang
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Madeline Hlobik
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Tina Ho
- Harvard Medical School, Boston, Massachusetts, USA
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jennifer T Huang
- Harvard Medical School, Boston, Massachusetts, USA
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
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15
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Andrade Garbán P, Rosado A, Macías Iglesias J, Goyanes Malumbres M, Moro Moro M. Exhaustive Diagnosis of Heat Urticaria in a Regular Clinical Practice: Report of 2 Cases. J Investig Allergol Clin Immunol 2024; 34:56-57. [PMID: 37219948 DOI: 10.18176/jiaci.0915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Affiliation(s)
- P Andrade Garbán
- Allergy Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - A Rosado
- Allergy Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - J Macías Iglesias
- Allergy Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - M Moro Moro
- Allergy Unit, Hospital Virgen del Valle, Toledo, Spain
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16
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Bréhon A, Bensefa-Colas L, D'Andrea C, Jeziorski E, Lehucher-Michel MP, Lequipe J, Marmion N, Mathelier-Fusade P, Mercier JC, Sebatigita G, Tannous J, Vigan M, Guillot B, Du-Thanh A, Soria A. Guidelines for cold urticaria management established by the Centre of Evidence of Dermatology and the Urticaria Group of the French Society of Dermatology. Br J Dermatol 2024; 190:445-447. [PMID: 38000904 DOI: 10.1093/bjd/ljad447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/02/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
This research letter provides guidelines for cold urticaria management established by the Centre of Evidence of Dermatology and the Urticaria Group of the French Society of Dermatology.
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Affiliation(s)
- Alice Bréhon
- Sorbonne Université, Service de Dermatologie et d'Allergologie, APHP, Hopital Tenon, 75020 Paris [Department of Dermatology and Allergology, AP-HP, Tenon Hospital, 75020, Paris, France]
| | | | | | | | | | | | | | - Pascale Mathelier-Fusade
- Sorbonne Université, Service de Dermatologie et d'Allergologie, APHP, Hopital Tenon, 75020 Paris [Department of Dermatology and Allergology, AP-HP, Tenon Hospital, 75020, Paris, France]
| | | | | | | | | | | | | | - Angèle Soria
- Sorbonne Université, Service de Dermatologie et d'Allergologie, APHP, Hopital Tenon, 75020 Paris [Department of Dermatology and Allergology, AP-HP, Tenon Hospital, 75020, Paris, France]
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17
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Dobrican-Băruța CT, Deleanu DM, Muntean IA, Nedelea I, Bălan RG, Filip GA, Procopciuc LM. The Alarmin Triad-IL-25, IL-33, and TSLP-Serum Levels and Their Clinical Implications in Chronic Spontaneous Urticaria. Int J Mol Sci 2024; 25:2026. [PMID: 38396704 PMCID: PMC10889490 DOI: 10.3390/ijms25042026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/01/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
This study delves into the critical role of alarmins in chronic spontaneous urticaria (CSU), focusing on their impact on disease severity and the quality of life (QoL) of patients. We investigated the alterations in alarmin levels in CSU patients and their correlations with the Urticaria Activity Score (UAS7) and the Dermatology Life Quality Index (DLQI). We analyzed serum levels of interleukin-25 (IL-25), interleukin-33 (IL-33), and thymic stromal lymphopoietin (TSLP) in 50 CSU patients, comparing these to 38 healthy controls. The study examined the relationship between alarmin levels and clinical outcomes, including disease severity and QoL. Elevated levels of IL-33 and TSLP in CSU patients (p < 0.0001) highlight their potential role in CSU pathogenesis. Although IL-25 showed higher levels in CSU patients, this did not reach statistical significance (p = 0.0823). Crucially, IL-33's correlation with both UAS7 and DLQI scores underscores its potential as a biomarker for CSU diagnosis and severity assessment. Of the alarmins analyzed, IL-33 emerges as particularly significant for further exploration as a diagnostic and prognostic biomarker in CSU. Its substantial correlation with disease severity and impact on QoL makes it a compelling candidate for future research, potentially serving as a target for therapeutic interventions. Given these findings, IL-33 deserves additional investigation to confirm its role and effectiveness as a biomarker and therapeutic target in CSU.
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Affiliation(s)
- Carmen-Teodora Dobrican-Băruța
- Department of Allergology and Immunology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj Napoca, Romania; (C.-T.D.-B.)
- Allergology Department, “Octavian Fodor” Institute of Gastroenterology and Hepatology, 400162 Cluj Napoca, Romania
| | - Diana Mihaela Deleanu
- Department of Allergology and Immunology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj Napoca, Romania; (C.-T.D.-B.)
- Allergology Department, “Octavian Fodor” Institute of Gastroenterology and Hepatology, 400162 Cluj Napoca, Romania
| | - Ioana Adriana Muntean
- Department of Allergology and Immunology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj Napoca, Romania; (C.-T.D.-B.)
- Allergology Department, “Octavian Fodor” Institute of Gastroenterology and Hepatology, 400162 Cluj Napoca, Romania
| | - Irena Nedelea
- Department of Allergology and Immunology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj Napoca, Romania; (C.-T.D.-B.)
- Allergology Department, “Octavian Fodor” Institute of Gastroenterology and Hepatology, 400162 Cluj Napoca, Romania
| | - Radu-Gheorghe Bălan
- Department of Allergology and Immunology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj Napoca, Romania; (C.-T.D.-B.)
| | - Gabriela Adriana Filip
- Department of Anatomy, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Lucia Maria Procopciuc
- Department of Biochemistry, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
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18
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Good SD, Rerkpichaisuth V, Fishbein MC, Ardehali A, Kermani TA. Multivalvular Cardiac Disease in a Young Woman With Hypocomplementemic Urticarial Vasculitis. Arthritis Care Res (Hoboken) 2024; 76:155-163. [PMID: 37652750 DOI: 10.1002/acr.25225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/14/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023]
Affiliation(s)
- Samuel D Good
- Division of Rheumatology, University of California, Los Angeles, CA, United States
| | - Vilasinee Rerkpichaisuth
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Michael C Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Abbas Ardehali
- Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Tanaz A Kermani
- Division of Rheumatology, University of California, Los Angeles, CA, United States
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19
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Gimenez-Arnau AM, Salman A, Podder I. Biomarkers to predict therapeutic response in chronic spontaneous urticaria: a review. Eur J Dermatol 2024; 34:3-12. [PMID: 38557452 DOI: 10.1684/ejd.2024.4600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Chronic spontaneous urticaria (CSU) is a relatively common dermatological disorder characterized by sudden and unpredictable onset of pruritic wheals and/or angioedema, for more than six weeks. It is a mast cell-mediated histaminergic disorder, considerably worsening patients' quality of life. Current treatment options include anti-histamines, omalizumab and cyclosporine, in a step-wise algorithmic approach, aimed at complete symptom control. Patients do not respond uniformly to these therapeutic options due to phenotypic and endotypic heterogeneity, and often remain uncontrolled/poorly controlled. Recent research is focused on identifying certain biomarkers to predict therapeutic response and facilitate patient-targeted personalized treatment, for maximum benefit. The current article summarizes various biomarkers explored to date, and also elaborates their role in predicting therapeutic response to anti-histamines, omalizumab and cyclosporine, in CSU patients. High disease activity, elevated CRP/ESR and elevated D-dimer are the most important predictors of non/poor-response to antihistamines. Low and very low baseline IgE, elevated CRP/ESR, ASST+, BAT/BHRA+, basopenia, eosinopenia, and elevated D-dimer are predictors of poor and good response to omalizumab and cyclosporine, respectively. Additionally, normal or slightly elevated baseline IgE and FceR1 overexpression are predictors of a faster response with omalizumab. However, none of these predictors have so far been completely validated and are not yet recommended for routine use. Thus, large-scale prospective studies are needed to confirm these predictive biomarkers and identify new ones to achieve the goal of personalized medicine for CSU.
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Affiliation(s)
- Ana Maria Gimenez-Arnau
- Department of Dermatology, Hospital del Mar. IMIM, Universitat Pompeu Fabra, Barcelona, Spain
| | - Andaç Salman
- Department of Dermatology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Indrashis Podder
- Department of Dermatology, College of Medicine and Sagore Dutta Hospital, Kolkata, India
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20
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Pesqué D, Ciudad A, Andrades E, Soto D, Gimeno R, Pujol RM, Giménez-Arnau AM. Solar Urticaria: An Ambispective Study in a Long-term Follow-up Cohort with Emphasis on Therapeutic Predictors and Outcomes. Acta Derm Venereol 2024; 104:adv25576. [PMID: 38189220 PMCID: PMC10789168 DOI: 10.2340/actadv.v104.25576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 01/09/2024] Open
Abstract
Solar urticaria is a rare photodermatosis with several unknown pathogenic, clinical and therapeutic aspects. This study analysed the clinical and therapeutic features of a long-term follow-up solar urticaria cohort, with a focus on omalizumab management and outcomes, and characterized omalizumab response with the use of the high-affinity immunoglobulin E (IgE) receptor (FcεRI) and the Urticaria Control Test. An observational, unicentric, ambispective study was conducted from 2007 to 2023. Solar urticaria was diagnosed in 41 patients with a median follow-up of 60 months. Thirteen patients were prescribed omalizumab, with a median treatment time of 48 months. A significant decrease in FcεRI baseline levels and subsequent median increase in Urticaria Control Test was evidenced after omalizumab prescription in all patients. Drug survival at 48 months was at 88.9%. Omalizumab stepping-down protocol led to sustained omalizumab discontinuation in only 1 patient. Median basal Urticaria Control Test was lower (p < 0.01) in patients who were prescribed omalizumab and in patients without remission. This study contributes to our knowledge of omalizumab outcomes in real-life clinical practice and highlights the pathogenic importance of IgE-mediated pathways in solar urticaria, where FcεRI emerges as a possible biomarker of omalizumab response.
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Affiliation(s)
- David Pesqué
- Department of Dermatology, Hospital del Mar Research Institute, Department of Medicine, Autonomous University of Barcelona/Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Andrea Ciudad
- Department of Dermatology, Hospital del Mar Research Institute, Barcelona, Spain
| | - Evelyn Andrades
- Department of Immunology, IMIM Hospital del Mar Research Institute, Barcelona, Spain
| | - Dulce Soto
- Department of Immunology, IMIM Hospital del Mar Research Institute, Barcelona, Spain
| | - Ramon Gimeno
- DDepartment of Immunology, IMIM Hospital del Mar Research Institute, Barcelona, Spain
| | - Ramon M Pujol
- Department of Dermatology, Hospital del Mar Research Institute, Barcelona, Spain
| | - Ana M Giménez-Arnau
- DDepartment of Dermatology, Hospital del Mar Research Institute. Universitat Pompeu Fabra, Barcelona, Spain.
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21
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Carvallo A, Veleiro B, Sabaté-Brescó M, Baeza ML, Guilarte M, Herrera-Lasso V, Rodríguez-Garijo N, Diaz Donado C, Labrador-Horrillo M, Ferrer M. Serum Amyloid A as a Potential Biomarker for Disease Activity in Chronic Spontaneous Urticaria. J Allergy Clin Immunol Pract 2024; 12:195-200. [PMID: 37716523 DOI: 10.1016/j.jaip.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/16/2023] [Accepted: 09/01/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is an inflammatory skin disease with a complex physiopathology. Serum amyloid A (SAA), an acute-phase reactant, has been proposed as a potential biomarker in urticaria but has yet to be studied in a population with CSU or correlated with disease activity as indicated by the Urticaria Activity Score summed over 7 days (UAS7). OBJECTIVE We sought to determine SAA-1 levels in patients with CSU and correlate them with its activity and control, as well as with clinical features of CSU and other potential blood biomarkers. METHODS We conducted a retrospective multicenter study of 67 patients with CSU, from whom we obtained demographic and clinical data, UAS7 as an indicator of CSU activity, and blood and serum markers. RESULTS SAA-1 levels positively correlated with UAS7 (rs = 0.47, P < .001). SAA-1 levels were higher in patients with noncontrolled (UAS7 > 6) CSU than in those with controlled (UAS ≤ 6) CSU (P < .001) and were also higher in patients with concomitant angioedema (P = .003) or delayed pressure urticaria (P = .003). CONCLUSION We propose SAA-1 as a potential biomarker for activity in CSU. Further studies are required to evaluate its potential role as a biomarker for other CSU outcomes, such as response to treatment.
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Affiliation(s)
- Alvaro Carvallo
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Beatriz Veleiro
- Allergy Department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Marina Sabaté-Brescó
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Pamplona, Spain; Immune, Infectious and Inflammatory Diseases Research, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain; RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain.
| | - Maria Luisa Baeza
- Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Biomedical Research Network on Rare Diseases (CIBERER)-U761, Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Mar Guilarte
- Allergy Section, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Carmen Diaz Donado
- Allergy Section, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Moisés Labrador-Horrillo
- Allergy Section, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Marta Ferrer
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Pamplona, Spain; Immune, Infectious and Inflammatory Diseases Research, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain; RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
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22
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Sánchez J, Alvarez L, López JF. Indication of Omalizumab for Chronic Urticaria Using the 'Urticaria Control Test' Instead of 'Urticaria Activity Score': Possible Impact for Health Systems. Actas Dermosifiliogr 2024; 115:T88-T90. [PMID: 37871896 DOI: 10.1016/j.ad.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/26/2022] [Accepted: 10/17/2022] [Indexed: 10/25/2023] Open
Affiliation(s)
- J Sánchez
- Group of Clinical and Experimental Allergy, University of Antioquia, IPSU clinic, Medellín, Colombia.
| | - L Alvarez
- Pharmacoeconomic evaluation group, SURA Company
| | - J F López
- Group of Clinical and Experimental Allergy, University of Antioquia, IPSU clinic, Medellín, Colombia
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23
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Weller K, Gimenez-Arnau AM, Baron J, Brehler R, Ferrer M, Groffik A, Grundmann S, Jakob T, Labrador-Horrillo M, Müller S, Staubach P, Wurpts G, Metz M, Maurer M. Efficacy and safety of on-demand versus daily rupatadine in chronic spontaneous urticaria: A randomized trial. Allergy 2024; 79:93-103. [PMID: 37597162 DOI: 10.1111/all.15854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/25/2023] [Accepted: 06/16/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Non-sedating H1 -antihistamines (nsAH) are the most commonly used treatment for chronic spontaneous urticaria (CSU). Many patients use them as on-demand (OD) therapy rather than a maintenance treatment. Here, we compared OD versus daily maintenance treatment with the nsAH rupatadine, assessed the efficacy of rupatadine updosing, and investigated potential long-term disease-modifying effects. METHODS This multicenter, randomized study consisted of 2 weeks of screening, 8 weeks of double-blind treatment, and 6 weeks of treatment-free follow-up (OD allowed). Adult patients were randomized to 10 mg rupatadine OD or 10 mg rupatadine daily. At Week 4, if patients did not have a complete response, they switched from 10 to 20 mg rupatadine daily or underwent sham updosing (patients on 10 mg rupatadine OD). The primary aim was to compare CSU disease activity at the end of follow-up between daily versus OD. Additionally, we assessed the efficacy of rupatadine updosing. Major outcomes were disease activity, CSU-related quality of life (QoL), and disease control. RESULTS At Week 4, disease activity and QoL significantly improved in daily versus OD-treated patients. Updosing of rupatadine did not improve the mean disease activity, but the number of complete responders increased during updosing from 5% to 22%. At the end of follow-up, the disease activity of patients treated OD versus daily was not significantly different. CONCLUSIONS Daily rupatadine treatment significantly improved CSU disease activity and QoL during treatment versus OD treatment but not after discontinuation of rupatadine, indicating the benefits of a daily maintenance nsAH schedule.
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Affiliation(s)
- Karsten Weller
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ana Maria Gimenez-Arnau
- Department of Dermatology, Hospital del Mar, IMIM, Universitat Pompeu Fabra, Barcelona, Spain
| | - Jens Baron
- Department of Dermatology and Allergy, University Hospital, RWTH Aachen, Aachen, Germany
| | - Randolf Brehler
- Department of Dermatology, University Hospital Muenster, Muenster, Germany
| | - Marta Ferrer
- Department of Allergy, Clinica Universidad de Navarra, Pamplona, Spain
- RICORS Red De Enfermedades Inflamatorias (REI)-RD21/0002/0028, Madrid, Spain
| | - Adriane Groffik
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | | | - Thilo Jakob
- Department of Dermatology and Allergy, University Medical Center, Justus Liebig University Gießen, Giessen, Germany
| | - Moisés Labrador-Horrillo
- Allergy Department, Hospital Universitario Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sabine Müller
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Petra Staubach
- Department of Dermatology and Allergy, University Medical Center, Mainz, Germany
| | - Gerda Wurpts
- Clinic for Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), Uniklinik RWTH Aachen, Aachen, Germany
| | - Martin Metz
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marcus Maurer
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Chen L, Xu Q, Liu J, Li Z, Wang J. Severe acute urticaria is associated with elevated plasma levels of D-dimer. J Dermatol 2024; 51:81-87. [PMID: 37950405 DOI: 10.1111/1346-8138.17024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/23/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023]
Abstract
Evaluation of the disease severity of acute urticaria (AU) is essential for adequate treatment of patients. However, there are no reliable biomarkers for such an evaluation. In our department, we observed patients with severe AU having elevated plasma D-dimer levels. Thus, the objective of this study was to investigate the elevated D-dimer levels in patients with severe AU in more detail. One hundred and thirty-nine hospital patients diagnosed with severe AU were enrolled. Clinical laboratory data were collected from electronic medical records. One hundred and seventeen of the patients presented with elevated plasma D-dimer levels. Compared to the normal group, the elevated group had a significantly higher proportion of patients who were female, younger, febrile, and had a shorter prehospital time (P < 0.05). Univariate regression analysis showed that neutrophil percentage, C-reactive protein (CRP), and lactate dehydrogenase (LDH) levels increased as D-dimer levels increased, while prehospital time showed the opposite trend. Multiple regression analysis was used to estimate the simultaneous effects of CRP and LDH on D-dimer levels. Patients who responded to additional antibiotic treatment had higher levels of D-dimer. The group with highly elevated D-dimer levels required a higher maximum dose of daily glucocorticoids (GCs) to control the symptoms of AU. In conclusion, patients with severe AU might have elevated plasma D-dimer levels, which are positively correlated with CRP and LDH levels. Patients with severe AU with dramatically elevated D-dimer levels might need a higher dose of daily GCs and antibiotics to relieve symptoms. D-dimer may be a reasonable marker to evaluate the severity of AU and guide treatment.
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Affiliation(s)
- Lele Chen
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qiuyang Xu
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jingjing Liu
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhiming Li
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jingying Wang
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Baskurt D, Sarac E, Asero R, Kocatürk E. D-dimer levels decline after immunosuppressive treatment rather than anticoagulant treatment in severe autoimmune chronic spontaneous urticaria. Eur Ann Allergy Clin Immunol 2024; 56:42-44. [PMID: 36305339 DOI: 10.23822/eurannaci.1764-1489.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Summary Chronic spontaneous urticaria (CSU) is a common dermatological condition presenting with wheals and/or angioedema for more than 6 weeks. The role of autoimmunity and inflammation in the pathogenesis of CSU have been studied, but the precise mechanism remains unknown. Association with coagulation cascade has been suggested based on the observations of increased coagulation indicators such as serum D-dimer levels. We report an omalizumab refractory case of severe CSU with high D-Dimer levels that declined only after disease remission with cyclosporine treatment but not with anticoagulation. Activation of coagulation cascade occurs secondary to the pro-inflammatory state in CSU patients and the correlation between D-dimer levels and disease activity may indicate the need for more studies to better understand the relationship of D-dimer levels and Omalizumab resistance. Clinicians should consider this relationship in CSU patients with significant D-dimer levels before considering treatment with anticoagulants.
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Affiliation(s)
- D Baskurt
- School of Medicine, Koç University, Istanbul, Turkey
| | - E Sarac
- Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey
| | - R Asero
- Allergology Clinic, Clinica San Carlo, Paderno Dugnano, Milan, Italy
| | - E Kocatürk
- Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey
- 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
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Zhang DG, Sørensen JA, Ghazanfar MN, Thomsen SF. Clinical applicability of the urticaria control test in patients with chronic urticaria: Further evidence from 622 adult and pediatric patients with different disease subtypes. Allergy 2024; 79:263-264. [PMID: 37966905 DOI: 10.1111/all.15955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/27/2023] [Accepted: 11/08/2023] [Indexed: 11/17/2023]
Affiliation(s)
| | | | | | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Sánchez J, Alvarez L, López JF. Indication of Omalizumab for Chronic Urticaria Using the 'Urticaria Control Test' Instead of 'Urticaria Activity Score': Possible Impact for Health Systems. Actas Dermosifiliogr 2024; 115:88-90. [PMID: 36754254 DOI: 10.1016/j.ad.2022.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/26/2022] [Accepted: 10/17/2022] [Indexed: 02/09/2023] Open
Affiliation(s)
- J Sánchez
- Group of Clinical and Experimental Allergy, University of Antioquia, IPSU Clinic, Medellín, Colombia.
| | - L Alvarez
- Pharmacoeconomic Evaluation Group, SURA Company, Colombia
| | - J F López
- Group of Clinical and Experimental Allergy, University of Antioquia, IPSU Clinic, Medellín, Colombia
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Gutsche A, Salameh P, Aulenbacher F, Buttgereit T, Weller K, Siebenhaar F, Maurer M. Response to "Clinical applicability of the Urticaria control test in patients with chronic urticaria: Further evidence from 622 adult and pediatric patients with different disease subtypes". Allergy 2024; 79:265-267. [PMID: 37921400 DOI: 10.1111/all.15941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Annika Gutsche
- Urticaria Center of Reference and Excellence (UCARE), 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, Immunology and Allergology, Berlin, Germany
| | - Pascale Salameh
- Urticaria Center of Reference and Excellence (UCARE), 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, Immunology and Allergology, Berlin, Germany
- School of Medicine, Lebanese American University, Byblos, Lebanon
- Institut National de Santé Publique d'Épidémiologie Clinique et de Toxicologie-Liban (INSPECT-LB), Beirut, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Felix Aulenbacher
- Urticaria Center of Reference and Excellence (UCARE), 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, Immunology and Allergology, Berlin, Germany
| | - Thomas Buttgereit
- Urticaria Center of Reference and Excellence (UCARE), 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, Immunology and Allergology, Berlin, Germany
| | - Karsten Weller
- Urticaria Center of Reference and Excellence (UCARE), 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, Immunology and Allergology, Berlin, Germany
| | - Frank Siebenhaar
- Urticaria Center of Reference and Excellence (UCARE), 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, Immunology and Allergology, Berlin, Germany
| | - Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE), 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, Immunology and Allergology, Berlin, Germany
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Reinhart JP, Kumar AB, Casanegra AI, Rooke TW, Sartori-Valinotti JC, Tollefson MM, Klaas KM, Davis DM. Bridging the gap in BASCULE syndrome: A retrospective case series of a recently described clinical entity. Pediatr Dermatol 2024; 41:46-50. [PMID: 38014569 DOI: 10.1111/pde.15470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/24/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Bier anemic spots, cyanosis with urticaria-like eruption (BASCULE) syndrome is a recently described entity with episodic urticarial lesions and white anemic halos on a background of erythrocyanosis, commonly affecting the lower extremities. Possible association with autonomic dysfunction remains poorly understood. Existing publications are limited, but the condition is suggested as highly underrecognized. OBJECTIVE To further characterize clinical and epidemiologic data for BASCULE syndrome. METHODS We performed an IRB-approved retrospective chart review on patients with BASCULE syndrome evaluated at Mayo Clinic from April 2021 to November 2022. RESULTS A total of 17 patients were identified (13 female, 4 male). Median age of onset was 12 years (range 9-17). Lower extremities were involved in all patients (17). Most patients were symptomatic with pruritus (8) or burning pain (8); three were asymptomatic. Triggers were standing (11), hot showers or hot environments (7), or no clear trigger (4). Autonomic dysfunction was present in 10 patients. Treatment responses were observed from propranolol (3) and high-dose cetirizine (1). CONCLUSION Novel epidemiologic data from 17 pediatric and young adult patients with BASCULE syndrome further supports an association with autonomic dysfunction and suggests a higher prevalence than previously acknowledged.
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Affiliation(s)
- Jacob P Reinhart
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ana I Casanegra
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Thom W Rooke
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Megha M Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kelsey M Klaas
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Dawn M Davis
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
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31
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Salameh P, Gutsche A, Aulenbacher F, Buttgereit T, Weller K, Siebenhaar F, Maurer M. Urticaria Control Test real-world performance: A post-hoc analysis. Allergy 2024; 79:229-232. [PMID: 37439320 DOI: 10.1111/all.15813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/21/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Pascale Salameh
- Urticaria Center of Reference and Excellence (UCARE), 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
- School of Medicine, Lebanese American University, Byblos, Lebanon
- Institut National de Santé Publique d'Épidémiologie Clinique et de Toxicologie-Liban (INSPECT-LB), Beirut, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Annika Gutsche
- Urticaria Center of Reference and Excellence (UCARE), 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
| | - Felix Aulenbacher
- Urticaria Center of Reference and Excellence (UCARE), 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
| | - Thomas Buttgereit
- Urticaria Center of Reference and Excellence (UCARE), 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
| | - Karsten Weller
- Urticaria Center of Reference and Excellence (UCARE), 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
| | - Frank Siebenhaar
- Urticaria Center of Reference and Excellence (UCARE), 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
| | - Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE), 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
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32
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Ale SI. [Patch test in the diagnosis of food allergy]. Rev Alerg Mex 2023; 70:250-254. [PMID: 38506867 DOI: 10.29262/ram.v70i4.1336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/29/2023] [Indexed: 03/21/2024] Open
Abstract
Food allergens are capable of producing adverse reactions through multiple mechanisms of an allergic or non-allergic nature, and through different routes of exposure; generally by ingestion or contact, as in protein contact dermatitis or contact urticaria, including inhalation. Food allergy reactions, in turn, can be mediated by immediate hypersensitivity mechanisms, delayed hypersensitivity or mixed immediate-delayed mechanisms. The reference diagnostic method in food allergy is the double-blind placebo-controlled food challenge test (DBPCFC), but skin and serological tests are important in the clinical context. The diagnosis of immediate food allergy depends on well-standardized allergological tests, such as the skin prick test (SPT) or specific IgE dosing, which are ideally tested by food challenge testing. However, the diagnosis of delayed mechanism food allergy and mixed allergies, which combine both immune mechanisms, is more complex. Delayed hypersensitivity reactions are evaluated with the epicutaneous patch test, or patch testing, for the diagnosis of contact dermatitis. The atopy patch test is initially used for the investigation of inflammatory reactions, which may be linked to food allergens in patients with atopic dermatitis. It was later applied in other diseases, whose pathogenesis is mainly mediated by a mechanism of delayed hypersensitivity to protein allergens: eosinophilic esophagitis, enterocolitis induced by food proteins, protein contact dermatitis, contact urticaria, among other disorders.
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Affiliation(s)
- Selva Iris Ale
- Especialista en Alergia y Dermatología; Directora de la Licenciatura de Alergia, Facultad de Medicina, Montevideo,
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33
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Lou J, Zhang X. Atypical cutaneous presentation of AOSD with persistent itchy urticaria: A case report. Medicine (Baltimore) 2023; 102:e36251. [PMID: 38115334 PMCID: PMC10727623 DOI: 10.1097/md.0000000000036251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/01/2023] [Indexed: 12/21/2023] Open
Abstract
RATIONALE Adult-onset Still's disease (AOSD) is a rare multisystem disorder considered a complex autoinflammatory syndrome. The clinical and biological features of AOSD typically include a high fever with arthritic symptoms, evanescent skin rash, sore throat, striking neutrophilic leukocytosis, hyperferritinemia, and abnormal liver function. The typical rash and fever are important diagnostic clues for AOSD. Here, we report a case of atypical rash manifesting as persistent itchy urticaria. PATIENT CONCERNS A 57-year-old female presented with a 6-day history of fever. During her hospital stay, she progressively developed rashes that were not associated with fever, primarily distributed on her back and the distal extremities, and associated with pronounced itching. The rash was initially suspected to be urticaria; however, the patient exhibited a poor response to antihistamines. After malignancies and other rheumatic diseases were excluded, the diagnosis leaned towards AOSD based on diagnostic criteria. The patient's fever was well controlled with the initiation of glucocorticoids, and no further rashes were observed. DIAGNOSES Although the patient exhibited atypical rashes, after ruling out malignancies and other rheumatic diseases, she met 2 major and 3 minor criteria. Based on Yamaguchi's criteria, the patient was diagnosed with AOSD. INTERVENTIONS Initially, the patient was administered an intravenous infusion of methylprednisolone at 40 mg once daily. This was later transitioned to oral administration with gradual dose reduction. OUTCOMES Follow-up at 1 year showed no recurrence of the rash, with a stable condition and no relapse. LESSONS This case provides valuable insights for the early diagnosis of AOSD, emphasizing the importance of considering this diagnosis even when presenting with atypical skin rash.
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Affiliation(s)
- Jingfeng Lou
- Department of General Medicine, Chengdu Second People’s Hospital, Chengdu, China
| | - Xingping Zhang
- Department of General Medicine, Chengdu Second People’s Hospital, Chengdu, China
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Cakmak ME, Yegit OO, Öztop N. A Case-Control Study Comparing the General Characteristics of Patients with Symptomatic Dermographism and Chronic Spontaneous Urticaria: Is Atopy a Risk Factor for Symptomatic Dermographism? Int Arch Allergy Immunol 2023; 185:247-252. [PMID: 38086338 DOI: 10.1159/000535290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/11/2023] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Symptomatic dermographism (SDerm) is the most common chronic inducible urticaria (CIndU) subtype. There is still limited information in the literature about clinical features, triggering factors, and accompanying comorbidities of SDerm. The aim of this study was to compare the clinical features and laboratory data of patients with SDerm and chronic spontaneous urticaria (CSU). METHODS The clinical features and laboratory data of patients with SDerm and CSU were compared retrospectively. The laboratory data and general characteristic features of the patients were obtained from the medical records. RESULTS The study included a total of 361 patients (CSU: 220, SDerm: 141). The rates of asthma (odds ratio [OR]: 1.79, p = 0.036), allergic rhinitis (OR: 6.03, p < 0.001), and thyroid disease (OR: 1.78, p = 0.039) were higher in patients with SDerm. The disease duration (median 12 months, p < 0.001) and regular antihistamine use (OR: 0.31, p < 0.001) were lower in patients with SDerm. Total IgE level (median: 193, p < 0.001), thyroid antibody positivity (OR: 1.93, p = 0.039), and atopy (OR: 8.81, p < 0.001) were higher in patients with SDerm. Dermatophagoides pteronyssinus (OR: 17.72, p < 0.001), Dermatophagoides farinae (OR: 17.20, p < 0.001), grass pollen (OR: 2.50, p < 0.026), cat epithelium (OR: 3.68, p < 0.023), and cockroach (OR: 4.93, p < 0.009) allergen positivity rates were higher in patients with SDerm. CONCLUSION Atopic diseases such as asthma and allergic rhinitis and the sensitization rate to aeroallergens seem to be higher in patients with SDerm than in patients with CSU. The results of this study should be supported by multicenter studies of patients from different geographical regions.
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Affiliation(s)
- Mehmet Erdem Cakmak
- Department of Allergy and Clinical Immunology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Osman Ozan Yegit
- Department of Allergy and Clinical Immunology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Nida Öztop
- Department of Allergy and Clinical Immunology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
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35
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Mahajan S, Parrish C. Pediatric Chronic Urticaria: Clinical and Laboratory Characteristics and Factors Linked to Remission. Pediatrics 2023; 152:S31-S32. [PMID: 38038527 DOI: 10.1542/peds.2023-064344ia] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
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36
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Baumann K, Jørgensen AHR, Sørensen JA, Zhang DG, Ghazanfar MN, Skov PS, Woetmann A, Vestergaard C, Maurer M, Thomsen SF. Positive basophil histamine release assay predicts insufficient response to standard-dosed omalizumab in patients with chronic spontaneous urticaria. Clin Exp Allergy 2023; 53:1318-1321. [PMID: 37771063 DOI: 10.1111/cea.14402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023]
Affiliation(s)
- Katrine Baumann
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
- RefLab ApS, Copenhagen, Denmark
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Astrid-Helene Ravn Jørgensen
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jennifer Astrup Sørensen
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Ditte Georgina Zhang
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Misbah Noshela Ghazanfar
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Anders Woetmann
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Christian Vestergaard
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology and Venerology, Aarhus University Hospital, Aarhus, Denmark
| | - Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE), 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
| | - Simon Francis Thomsen
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Zhang L, Jiang W, Gebreab YB, Ye X. Increased D-dimer and fibrin degradation product levels as potential indicators for evaluating infection-related acute urticaria: a case-case-control study. Arch Dermatol Res 2023; 315:2871-2876. [PMID: 37650955 DOI: 10.1007/s00403-023-02706-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/21/2023] [Accepted: 08/13/2023] [Indexed: 09/01/2023]
Abstract
About 20% of world population suffer from acute urticaria at some stage in their lives. Recent studies showed coagulation dysfunction in chronic urticaria. The involvement of coagulation changes in acute urticaria remains unclear. Fifty-eight acute urticaria patients were enrolled in this study and divided into two groups (referred to throughout as infection-related and infection-unrelated acute urticaria). The routine laboratory parameters including coagulation tests between the two groups were compared. The correlation between coagulation tests and CRP at acute phase was also assessed. Dynamic change of routine coagulation test results at acute phase and resolving phase was compared. The potential performance of coagulation for infection indication was tested. We found D-dimer, fibrin degradation product (FDP), and fibrinogen (Fg) increased in the acute phase of infection-related acute urticaria patients. D-dimer, FDP, Fg, and APTT are positively correlated with CRP in the acute phase. D-dimer and FDP decreased in the resolving phase of infection-related acute urticaria patients. Higher D-dimer (> 0.48 mg/L) and FDP (> 3.84 mg/L) may indicate infection-related acute urticaria. In conclusion, in acute urticaria with low venous thromboembolism risk, D-dimer level and dynamic change can be potentially used for the infection-related clinical practice management.
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Affiliation(s)
- Lei Zhang
- Department of Dermatology, Shaanxi Provincial People's Hospital, The Third Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Weiwei Jiang
- Department of Dermatology, 72nd Group Army Hospital of PLA, Huzhou, Zhejiang, People's Republic of China
| | - Yacob Berhane Gebreab
- Department of Laboratory Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Xin Ye
- Department of Laboratory Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China.
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38
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Mervis MO, Leo HL. The Common Triggers of Urticaria in Children Admitted to The Pediatric Emergency Room. Pediatrics 2023; 152:S31. [PMID: 38038559 DOI: 10.1542/peds.2023-064344i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
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39
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Larenas-Linnemann D. Biomarkers of Autoimmune Chronic Spontaneous Urticaria. Curr Allergy Asthma Rep 2023; 23:655-664. [PMID: 38064133 DOI: 10.1007/s11882-023-01117-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/23/2023]
Abstract
PURPOSEOF REVIEW Chronic spontaneous urticaria and chronic inducible urticaria (CSU/CindU) are caused by mast cell and basophil activation leading to degranulation and the release of histamine and several other mediators. Three kinds of factors can trigger mast cells in CSU: (1) activation of stimulating receptor(s) on the mast cell membrane, (2) upregulation of certain receptor(s), and (3) intracellular dysregulation in signaling with overexpression of the spleen tyrosine kinase (SYK) or reduced activation of the inhibitory Src homology 2 (SH2)-containing inositol phosphatases (SHIP)-related pathways. In CSU, two major endotypes exist based on the primary receptor activating mechanism: type I hypersensitivity (IgE-mediated, directed against auto-allergens) and type IIb (autoimmune, via IgG autoantibodies directed against IgE or the IgE-receptor). Their treatment responses vary. We discuss in vitro and in vivo biomarkers. RECENT FINDINGS Patients with auto-allergic CSU have clinical characteristics that can distinguish them partly from those with autoimmune CSU. Most importantly, their disease generally presents a less aggressive course, a better response to second generation (up-dosed) antihistamines and a good response to omalizumab, if necessary. Meanwhile, autoimmune CSU/CindU patients fare less well and often need immunosuppressive drugs. Biomarkers that might help endotype CSU/CindU patients and select the most appropriate treatment, dose, and duration, e.g., for autoallergic CSU, high total IgE and IgE against auto-allergens; for autoimmune CSU, low IgE, basopenia, and IgG against autoantigens like thyroid peroxidase and a positive autologous serum skin test (but sometimes also positive in autoallergy). Some biomarkers are easily accessible but of low specificity; others are highly specific but more futuristic.
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Affiliation(s)
- Désirée Larenas-Linnemann
- Centro de Excelencia en Asma y Alergia, Hospital Médica Sur, Puente de Piedra 150, T2-602 Colonia Toriello-Guerra, Delegación Tlalpan, 14050, Mexico City, Mexico.
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40
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Giménez-Arnau AM, Manzanares N, Podder I. Recent updates in urticaria. Med Clin (Barc) 2023; 161:435-444. [PMID: 37537021 DOI: 10.1016/j.medcli.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 08/05/2023]
Abstract
Urticaria is a skin-condition characterized by sudden-onset pruritic wheals with/without angioedema. Urticaria can be acute or chronic. Chronic urticaria may be spontaneous or inducible, based on absence/presence of specific triggers. Chronic spontaneous urticaria is most frequent (∼80%). Urticaria is primarily a mast-cell mediated histaminergic-disorder. Recently, other inflammatory cells and pro-inflammatory cytokines have been implicated. Deeper understanding has unmasked two endotypes - IgE-mediated type I autoimmunity/autoallergy and IgG-mediated type IIb autoimmunity. Current treatment recommendation involving second-generation H1-antihistamines, omalizumab and cyclosporine is effective in 60-80% patients. So, newer treatment options are being explored based on emerging targets. Despite being non-lethal, urticaria considerably impairs patient's quality-of-life and may be associated with extra-cutaneous comorbidities. Several "patient reported outcome measures" have been proposed to evaluate disease-activity, impact and control, for effective treatment modulation till complete disease control. This review discusses the current understanding about urticaria and its future directions, to facilitate optimum evidenced-based care.
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Affiliation(s)
- Ana M Giménez-Arnau
- Department of Dermatology, Hospital del Mar-IMIM, Universitat Pompeu Fabra de Barcelona, Spain.
| | - Nerea Manzanares
- Department of Dermatology, Hospital del Mar-IMIM, Universitat Pompeu Fabra de Barcelona, Spain
| | - Indrashis Podder
- Department of Dermatology, College of Medicine and Sagore Dutta Hospital, Kolkata 700058, West Bengal, India
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41
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Can A, Tuzer OC. The evaluation of melatonin levels in chronic spontaneous urticaria: A case control study. Allergy Asthma Proc 2023; 44:e29-e35. [PMID: 37714684 DOI: 10.2500/aap.2023.44.230044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Background: Although sleep disturbance is known to be common in patients with chronic spontaneous urticaria (CSU), sleep hormone levels in the blood have never before been studied in CSU. Objective: In this study, we aimed to evaluate the serum melatonin levels in patients with CSU. Methods: For the patient group, 80 patients with recently diagnosed CSU, and, for the control group, 75 healthy controls (HC) were included. The study participants' melatonin levels were measured by using the enzyme-linked immunosorbent assay method. CSU disease activity was evaluated by using the urticaria activity score-7 (UAS-7), and the quality of life was assessed with the chronic urticaria quality of life questionnaire (CU-Q2oL). The patients with concomitant diseases likely to affect the melatonin levels or those using related medications were excluded from the study. Results: The patient group consisted of 53 female subjects (67%); the median (interquartile range) age was 34 years (27-43 years). The levels of melatonin were lower in the patients with CSU when compared with the HCs (p < 0.03). The melatonin levels had no significant relationship between UAS-7 and the total scores in CU-Q2oL (p > 0.05). However, a significant negative correlation in the melatonin levels was observed with questions 7 (overall sleep assessment) and 11 (difficulty in falling into sleep) in the CU-Q2oL (r = -0.55 [p < 0.001] and r = -0.62 [p < 0.001], respectively). Conclusion: The presence of low melatonin levels in the patients with CSU suggests that melatonin has a key regulatory role in the CSU development in addition to the deterioration in sleep quality. A new treatment strategy to increase the melatonin levels in CSU may be pursued in further studies to confirm our findings.
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Affiliation(s)
- Ali Can
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, University of Health Sciences, Van Training and Research Hospital, Van, Turkey, and
| | - Ozdemir Can Tuzer
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, University of Health Sciences, Batman Training and Research Hospital, Batman, Turkey
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Buttgereit T, Salameh P, Sydorenko O, Zuberbier T, Metz M, Weller K, Maurer M. The 7-day recall period version of the Urticaria Control Test-UCT7. J Allergy Clin Immunol 2023; 152:1210-1217.e14. [PMID: 37210040 DOI: 10.1016/j.jaci.2023.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/28/2023] [Accepted: 03/29/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND The Urticaria Control Test (UCT) is a well-established, very easy to use and calculate 4-item patient-reported outcome measure to assess chronic urticaria disease control during the previous 4 weeks. Clinical trials and practice may benefit from the use of a UCT version with a shorter recall period, but this does not exist. OBJECTIVES We sought to develop and validate a UCT version with a 7-day recall period, the UCT7. METHODS The UCT7 was developed, based on the UCT, and tested, in 152 patients with chronic urticaria (spontaneous: n = 101, inducible: n = 51) for its reliability, validity and screening accuracy, and clinimetric properties, in other words, the cutoff for well-controlled disease and the minimal clinically important difference. RESULTS The UCT7 showed excellent internal consistency reliability with a Cronbach αvalue of 0.91 and test-retest reliability with an intraclass correlation coefficient of 0.83. Convergent validity was high and strongly correlated with anchors of disease control, wheal and angioedema frequency, and urticaria-related quality of life impairment. The UCT7 showed excellent sensitivity to change; however, changes in angioedema activity and impact did not correlate well with changes in UCT7. Based on receiver-operating characteristic curve analysis, the proportion of correctly classified patients, and patients' assessment of treatment efficacy, we recommend a cutoff value of 12 points for identifying patients with well-controlled disease. The UCT7 minimal clinically important difference for improvement was estimated to be 2 points. CONCLUSIONS The UCT7 is a validated 7-day recall period version of the UCT. It is ideal for the assessment of disease control at short intervals in patients with chronic urticaria in clinical studies and practice.
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Affiliation(s)
- Thomas Buttgereit
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Berlin, Germany
| | - Pascale Salameh
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; School of Medicine, Lebanese American University, Byblos, Lebanon; University of Nicosia Medical School, Nicosia, Cyprus; Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie (INSPECT-LB), Beirut, Lebanon
| | - Olga Sydorenko
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Berlin, Germany
| | - Torsten Zuberbier
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Berlin, Germany
| | - Martin Metz
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Berlin, Germany
| | - Karsten Weller
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Berlin, Germany.
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43
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Bellanti JA, Settipane RA. Navigating the uncharted waters of chronic urticaria: A perplexing challenge for the allergist-immunologist. Allergy Asthma Proc 2023; 44:379-381. [PMID: 37919849 PMCID: PMC10629373 DOI: 10.2500/aap.2023.44.230067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
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44
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Asero R, Tedeschi A. Chronic spontaneous urticaria: from the hunt for causes and pathogenesis to the identification of different endotypes. Eur Ann Allergy Clin Immunol 2023; 55:253-260. [PMID: 37497632 DOI: 10.23822/eurannaci.1764-1489.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Summary The hunt for the causes and pathogenic mechanisms involved in chronic spontaneous urticaria (CSU) has engaged clinicians and scientists for decades. Although not all aspects of the disease are defined, our knowledge has now improved to the point that we can consider CSU as an umbrella clinical phenotype under which several different endotypes probably exist. The present article will briefly summarize the fascinating history of the progress in our knowledge of this disease.
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Affiliation(s)
- R Asero
- Allergology Clinic, Clinica San Carlo, Paderno Dugnano, Milan, Italy
| | - A Tedeschi
- Department of Immunology Outpatient, UO General Medicine, Bolognini Hospital, ASST Bergamo Est, Seriate, Bergamo, Italy
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45
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Karabag Citlak H, Azkur D, Kavas Yildiz Y, Demirel AC, Kot H, Vezir E, Kilic M, Usta Guc B, Kilic M, Yakici N, Kocabas CN, Dibek Misirlioglu E, Civelek E, Orhan F. Cold-induced urticaria in children: A multicenter, retrospective cohort study. Allergy Asthma Proc 2023; 44:e36-e43. [PMID: 37919847 DOI: 10.2500/aap.2023.44.230050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Background: Studies of cold-induced urticaria (ColdU) in pediatric patients are limited and not well characterized. Objective: The objective of the study was to investigate the characteristics of ColdU in children. Methods: A multicenter, retrospective chart review was performed in children ages ≤18 years diagnosed with ColdU at 11 pediatric allergy and immunology centers in Turkey between September 1, 2010, and August 31, 2022. Results: A total of 83 children with ColdU were included, 54.2% were girls, and the mean age of symptom onset was 8.8 years. The median duration of ColdU at the time of diagnosis was significantly higher in the girls than in the boys (1.0 years [0.0-13.8 years] versus 0.3 years [0.0-15.0 years]; p = 0.007). All the patients underwent an ice cube test, and 71.1% were found positive (typical ColdU). The mean ± standard deviation age of onset was significantly higher in the patients with typical ColdU versus atypical patients (9.4 ± 4.5 years versus 7.3 ± 4.5 years; p = 0.041). Swimming alone and in combination with the wind were significantly the most reported triggers in patients with cold-induced anaphylaxis (ColdA) when compared with patients with ColdU and with nonanaphylactic symptoms (70.0% versus 28.9% [p = 0.022], and 50.0% versus 4.1% [p < 0.001], respectively). Only patients with other chronic urticaria were found to be associated with the development of typical ColdU (p = 0.036). The median total serum immunoglobulin E (IgE) was significantly higher in typical ColdU than in atypical patients (72.5 IU/mL [3.86 - 2500 IU/mL] versus 30.0 IU/mL [0.83 - 1215 IU/mL]; p = 0.007); however, total serum IgE differences were not found to affect ColdU resolution between the two groups (p = 0.204). The resolution was documented in 30.4%. Conclusion: Those who were boys and had a positive ice cube test result could have an association with earlier onset of ColdU. Those swimming alone on a windy day were at highest risk for ColdA. It is still unclear what characteristics are associated with the resolution of ColdU, and this warrants further investigation.
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Affiliation(s)
- Hilal Karabag Citlak
- From the Department of Pediatric Immunology and Allergy, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Dilek Azkur
- Department of Pediatric Immunology and Allergy, Kirikkale University Faculty of Medicine, Kirikkale, Turkey
| | - Yuksel Kavas Yildiz
- Department of Pediatric Immunology and Allergy, Ankara Training and Research Hospital, Ankara, Turkey
| | - Ali Can Demirel
- Department of Pediatric Immunology and Allergy, Bilkent City Hospital, University of Health Sciences, Ankara, Turkey
| | - Hakan Kot
- From the Department of Pediatric Immunology and Allergy, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Emine Vezir
- Department of Pediatric Immunology and Allergy, Ankara Training and Research Hospital, Ankara, Turkey
| | - Mehmet Kilic
- Department of Pediatric Immunology and Allergy, Firat University Faculty of Medicine, Elazıg, Turkey
| | - Belgin Usta Guc
- Department of Pediatric Immunology and Allergy, Adana City Hospital, Adana, Turkey
| | - Mehtap Kilic
- Pediatric Immunology and Allergy practitioner, Samsun, Turkey
| | - Nalan Yakici
- Department of Pediatric Immunology and Allergy, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey, and
| | - Can Naci Kocabas
- Department of Pediatric Immunology and Allergy, Sıtkı Kocman University Faculty of Medicine, Mugla, Turkey
| | - Emine Dibek Misirlioglu
- Department of Pediatric Immunology and Allergy, Bilkent City Hospital, University of Health Sciences, Ankara, Turkey
| | - Ersoy Civelek
- Department of Pediatric Immunology and Allergy, Bilkent City Hospital, University of Health Sciences, Ankara, Turkey
| | - Fazil Orhan
- From the Department of Pediatric Immunology and Allergy, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
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46
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Reddy S, Yi L, Shields B, Platts-Mills T, Wilson J, Flowers RH. Alpha-gal syndrome: A review for the dermatologist. J Am Acad Dermatol 2023; 89:750-757. [PMID: 37150300 DOI: 10.1016/j.jaad.2023.04.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 05/09/2023]
Abstract
Alpha-gal syndrome (AGS) is an allergy to "red meat" and other mammalian products due to immunoglobulin E (IgE) antibodies against the sugar moiety galactose-alpha-1,3-galactose (alpha-gal), which is acquired following tick bites. Clinically, AGS presents with urticaria, abdominal pain, nausea, and occasionally anaphylaxis, and has wide inter- and intra-personal variability. Because symptom onset is generally delayed by 2 to 6 hours after meat consumption, AGS can be easily confused with other causes of urticaria and anaphylaxis, such as chronic spontaneous urticaria (CSU) and mast cell activation syndrome (MCAS). Diagnosis relies on a combination of clinical history, positive alpha-gal IgE blood testing and improvement on a mammalian-restricted diet. Management of the syndrome centers primarily on avoidance of mammalian meats (and occasionally dairy and other products) as well as acute management of allergic symptoms. Counseling about tick avoidance measures is also important as AGS will wane over time in many patients.
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Affiliation(s)
- Soumya Reddy
- Department of Dermatology, University of Virginia, Charlottesville, Virginia.
| | - Lauren Yi
- Department of Dermatology, University of Virginia, Charlottesville, Virginia
| | - Bridget Shields
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Thomas Platts-Mills
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Jeffrey Wilson
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - R Hal Flowers
- Department of Dermatology, University of Virginia, Charlottesville, Virginia
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47
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Yen H, Yen H, Huang CH, Huang IH, Hung WK, Su HJ, Tai CC, Haw WWY, Flohr C, Yiu ZZN, Chi CC. Systematic Review and Critical Appraisal of Urticaria Clinical Practice Guidelines: A Global Guidelines in Dermatology Mapping Project (GUIDEMAP). J Allergy Clin Immunol Pract 2023; 11:3213-3220.e11. [PMID: 37451615 DOI: 10.1016/j.jaip.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/12/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Management of urticaria can be optimized with clinical practice guidelines (CPGs). However, the quality of recent urticaria CPGs remains unclear. OBJECTIVE To identify and appraise urticaria CPGs worldwide published in the last 5 years. METHODS A search for relevant urticaria CPGs was conducted between January 1, 2017, and May 31, 2022, using the following databases: MEDLINE, Embase, National Institute for Health and Care Excellence (NICE) Evidence Search, Guidelines International Network, ECRI Guidelines Trust, Australian Clinical Practice Guidelines, Trip Medical Database, and DynaMed. The included CPGs were critically appraised using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, Lenzer et al's red flags, and the Institute of Medicine (IOM) criteria of trustworthiness. RESULTS We included 21 urticaria CPGs. Most guidelines reviewed treatment recommendations of chronic spontaneous urticaria. The majority of guidelines were from European and Asian countries with high and high-middle sociodemographic index, written in English, and openly accessible. Seventeen guidelines (81%) had at least 1 AGREE II domain rated poor quality. Applicability, rigor of development, and stakeholder involvement were the 3 AGREE II domains that scored the lowest across guidelines. Appraisal with Lenzer et al's red flags showed that 18 guidelines (86%) raised at least 1 red flag indicating potential bias. The top 3 domains raising red flags were: no inclusion of nonphysician experts/patient representative/community stakeholders, no or limited involvement of a methodologist in the evaluation of evidence, and lack of external review. Based on IOM's criteria of trustworthiness, 20 guidelines (95%) had 1 or more criteria that did not meet best practice standards. The 3 domains with the highest number of best practice standards not met were updating procedures, rating strength of recommendations, and external review. Guidelines scored highest for the AGREE II domains of defining scope and purpose and clarity of presentation, and had the most fully met IOM's best practice standard for articulation of recommendations. However, only 1 urticaria CPG by NICE was identified as rigorously developed across all 3 appraisal tools. CONCLUSIONS The quality of urticaria CPGs in the last 5 years varied widely. Only the NICE urticaria guideline consistently demonstrated excellent quality, high trustworthiness, and low risk of bias. Use of a rigorous framework to rate certainty of evidence and grade strength of recommendation, involvement of methodologists, stakeholder engagement with external review, and clear guidance for updating can help improve the quality of future CPGs.
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Affiliation(s)
- Hsi Yen
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Division of Pediatric Dermatology, Medical College of Wisconsin, Milwaukee, Wis
| | - Hsuan Yen
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chun-Hsien Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - I-Hsin Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Wei-Kai Hung
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Hsing-Jou Su
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Cheng-Chen Tai
- Medical Library, Department of Medical Education, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - William W Y Haw
- Northern Care Alliance NHS Foundation Trust, Manchester, UK; Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Carsten Flohr
- Unit for Paediatric and Population-Based Dermatology Research, St. John's Institute of Dermatology, King's College London and Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - Zenas Z N Yiu
- Northern Care Alliance NHS Foundation Trust, Manchester, UK; Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ching-Chi Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Sultan J, Goethals M, Jandus P, Harr T, Perone N, Braillard O. [Urticaria : updates of a chronic condition]. Rev Med Suisse 2023; 19:1730-1733. [PMID: 37753909 DOI: 10.53738/revmed.2023.19.843.1730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Urticaria is a frequent disease and exist in an acute or chronic form. The pathophysiology, focused on mast cells and histamine among other mediators, is an active research field but still poorly understood. The medical care focus on the avoidance of triggers and aggravating factors. The recommended drug therapy has not changed. The acknowledgment of chronic urticaria as a chronic disease is essential according to the last international recommendations. Acknowledging the disease morbidity and consequences, in a private, social or professional environment, allows better medical care for patients. The latter should get support on the long term, thanks to multiple diagnostic and therapeutic guidance tools.
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Affiliation(s)
- Judith Sultan
- Service de médecine de premier recours, Département de médecine de premier recours, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Maureen Goethals
- Service de médecine de premier recours, Département de médecine de premier recours, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Peter Jandus
- Service d'immunologie et allergologie, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Thomas Harr
- Service d'immunologie et allergologie, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Nicolas Perone
- Service de médecine de premier recours, Département de médecine de premier recours, Hôpitaux universitaires de Genève, 1211 Genève 14
- Institut de médecine de famille et de l'enfance, Faculté de médecine, Centre médical universitaire, 1211 Genève 4
- Centre médical de Lancy, Route de Chancy 59C, 1213 Petit-Lancy
| | - Olivia Braillard
- Service de médecine de premier recours, Département de médecine de premier recours, Hôpitaux universitaires de Genève, 1211 Genève 14
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Karavaizoglu C, Suleyman A, Yavuz Alıc R, Dolu KO, Yucel E, Demirkale ZH, Cimen SS, Ozdemir C, Tamay ZU. Drug Allergy in Children: Adverse Reactions after Skin Testing. Int Arch Allergy Immunol 2023; 185:56-62. [PMID: 37729879 DOI: 10.1159/000533641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/07/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION Skin tests are one of the most widely used diagnostic tools for suspected drug allergies in children. Studies on systemic reactions occurring during skin testing with allergens have mostly been conducted in pediatric and adult patient groups together. However, data on adverse reactions including allergic reactions after drug skin tests in children are scarce. It is aimed to determine the adverse reactions after skin test in children with suspected drug allergy. METHODS Patients who underwent a drug skin test due to the suspicion of drug allergy between May 2017 and June 2020 were evaluated, retrospectively. Data about adverse reactions seen after skin testing at the testing area in the clinic were analyzed. RESULTS The study included 1,073 children (585 [54.5%] boys and 488 [45.5%] girls) with a median age of 7.5 years. A total of 12 (1.1%) reactions were detected after skin testing, and 4 (0.4%) of them were allergic reactions. Of the allergic reactions, three were anaphylaxis and one was urticaria. Two of the reactions (1 anaphylaxis and 1 urticaria) were detected after the skin prick test and the remaining 2 were detected after intradermal test. Three of the nonallergic reactions were considered as vasovagal reactions and seven were considered as nonspecific and anxiety-related reactions. CONCLUSION Although drug skin tests were generally well-tolerated and adverse reactions were rare, severe allergic reactions including anaphylaxis may ensue. Skin tests should be necessarily performed in clinical settings in experienced centers.
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Affiliation(s)
- Cagla Karavaizoglu
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey,
| | - Ayse Suleyman
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Roza Yavuz Alıc
- Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kazım Okan Dolu
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Esra Yucel
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zeynep Hızlı Demirkale
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sevgi Sipahi Cimen
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Cevdet Ozdemir
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Institute of Child Health, Department of Pediatric Basic Sciences, Istanbul University, Istanbul, Turkey
| | - Zeynep Ulker Tamay
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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50
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Gayathri E, Sowmya P, Punnagai K, Mahalakshmi V. Comparative study on the efficacy and safety of bepotastine besilate versus levocetirizine in chronic spontaneous urticaria: A randomised, open-label, parallel study. Indian J Dermatol Venereol Leprol 2023; 89:672-679. [PMID: 37067147 DOI: 10.25259/ijdvl_333_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/01/2022] [Indexed: 01/28/2023]
Abstract
Background Urticaria is a common skin disease which often causes impairment in the quality of life. The ideal drug for chronic urticaria would have antihistaminic and anti-inflammatory actions. Bepotastine besilate is a recently approved novel anti-allergic agent with multiple mechanisms of action; levocetirizine is a potent and selective second-generation H1 receptor antagonist used in the treatment of urticaria. Aim To compare the efficacy and safety of bepotastine besilate versus levocetirizine in patients with chronic spontaneous urticaria. Methods The study design is a randomised, open-label, parallel-group, prospective interventional study. The study subjects were randomly assigned to either of the two groups a and b, each group had 50 patients with chronic urticaria. Statistical analyses were performed using (SPSS, version 18) for all the variables. Chi-square test was used for comparison between categorical variables. An unpaired student's t-test was done for quantitative variables. Results There was a significant decrease in mean urticaria activity score (P < 0.001), chronic urticaria quality of life (P < 0.001) and clinical global improvement (P < 0.001) in both the treatment groups but this improvement was higher in the bepotastine than in the levocetirizine group. There was no significant difference in the mean of absolute eosinophil count, C-reactive protein, aspartate transaminase, alanine transaminase from baseline to 4th week between the two study groups. Visual analogue scale showed statistically significant improvement from baseline to 4th week (P < 0.001) of follow-up but this increase was higher in levocetirizine group (0.64-4.24) than in bepotastine group (0.56-2.56) Limitations Blinding was not done. To assess the efficacy and safety of bepotastine, a larger study can be planned. Conclusion This study found that bepotastine is superior to levocetirizine and showed a statistically significant reduction in mean urticaria activity score 7, improved quality of life and clinical global improvement in patients with urticaria.
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Affiliation(s)
- Elango Gayathri
- Department of Pharmacology, Dhanalakshmi Srinivasan Medical College, Perambalur, Tamil Nadu, India
| | - Parvathareddy Sowmya
- Department of Pharmacology, Sri Ramachandra Medical College & Research Institute, Chennai, Tamil Nadu, India
| | - Kumaravelu Punnagai
- Department of Pharmacology, Sri Ramachandra Medical College & Research Institute, Chennai, Tamil Nadu, India
| | - Veeraraghavan Mahalakshmi
- Department of Pharmacology, Sri Ramachandra Medical College & Research Institute, Chennai, Tamil Nadu, India
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