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Pu Y, He L, Wang X, Zhang Y, Zhao S, Fan J. Global, regional, and national levels and trends in burden of urticaria: A systematic analysis for the Global Burden of Disease study 2019. J Glob Health 2024; 14:04095. [PMID: 38818613 PMCID: PMC11140429 DOI: 10.7189/jogh.14.04095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
Background Urticaria places a significant burden on individuals and society due to its widespread nature. The aim of this study was to evaluate the burden of urticaria in different regions and nations by analysing data from the Global Burden of Disease study 2019 (GBD 2019), with the goal of providing information to health care policymakers. Methods By utilising data from the GBD 2019 database, this study analysed metrics such as incidence, prevalence, disability-adjusted life years (DALYs), age-standardised rate (ASR), and estimated annual percentage changes (EAPC) globally and across 204 countries and regions. The data was further stratified by age, sex, and sociodemographic index (SDI). Results In 2019, global incidence cases, prevalence cases, and overall disease burden as measured by DALYs all increased. The distribution of the burden exhibited marked geographical heterogeneity. At the regional level, the burden is highest in Central and Eastern Europe and Central Asia, with the strongest growth in South Asia, compared with a decline in the high-income Asia Pacific. At the country level, Nepal reports the highest burden of urticaria, while Portugal has the lowest. Gender and age analyses showed that the burden of urticaria is higher in females than in males, with urticaria cases declining with age, especially in children, and picking up among the elderly. The study also finds a correlation between the burden of urticaria and the SDI, with the central part of the SDI showing a consistent increasing trend. Conclusion This study found that the global burden of urticaria has risen from 1990 to 2019. Factors like geographic location, gender, and SDI influenced the urticaria burden. Overall, these results offer a resource to guide public health strategies seeking to reduce the burden of urticaria.
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Affiliation(s)
- Yuanchun Pu
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Liyu He
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiangyu Wang
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University (Xibei Hospital), Xi'an, China
| | - Yaodong Zhang
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shidi Zhao
- Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jinhai Fan
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Bhowmik R, Shaharyar MA, Sarkar A, Mandal A, Anand K, Shabana H, Mitra A, Karmakar S. Immunopathogenesis of urticaria: a clinical perspective on histamine and cytokine involvement. Inflamm Res 2024; 73:877-896. [PMID: 38555555 DOI: 10.1007/s00011-024-01869-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Urticaria is a clinical condition characterized by the appearance of wheals (hives), angioedema, or both. Over the last several decades, a better understanding of the mechanisms at play in the immunopathogenesis of urticaria has underscored the existence of numerous urticaria subtypes. Separating the different kinds of urticaria explicitly helps find the best detection method for the management of this skin disorder. Subtypes of urticaria also include both spontaneous and physical types. The conventional ones include spontaneous urticaria, constituting both acute and chronic urticaria. Therefore, a broad and effective therapy is essential for the diagnosis and treatment of urticaria. METHODS To understand the immunopathogenesis of urticaria, various databases, including PubMed, Scopus, and Web of Science, were used to retrieve original articles and reviews related to urticaria. While information on several clinical trials were obtained from clinicaltrials.gov database. RESULTS This article highlights the immunopathogenesis involved in the intricate interaction between cellular infiltration, immune reactions, coagulation cascades, and autoantibodies that underlie urticaria's pathophysiology. CONCLUSION The recent progress in understanding urticaria can help to understand the intricate characteristics in the immunopathogenesis of urticaria and could play a beneficial role in the management of urticaria.
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Affiliation(s)
- Rudranil Bhowmik
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India
| | - Md Adil Shaharyar
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India
| | - Arnab Sarkar
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India
| | - Avishek Mandal
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India
| | - Kumar Anand
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India
| | - Humira Shabana
- Chaudhary Charan Singh University, Formerly, Meerut University, Meerut, Uttar Pradesh, India
| | - Achintya Mitra
- Regional Ayurveda Research Institute (RARI) CCRAS Under Ministry of AYUSH, Thapla, Ganiyadeoli, Ranikhet Almora, Uttarakhand, India
| | - Sanmoy Karmakar
- Bioequivalence Study Centre, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, 700032, India.
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3
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Sulk M, Hammers CM, Heine G. [Spontaneous remission of urticaria: does it exist and if so, when?]. DERMATOLOGIE (HEIDELBERG, GERMANY) 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] [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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Ornek SA, Suroji Alkilinc A, Kızıltac U, Kızıltac K, Kocaturk E. Effect of Puberty, Menstruation, Pregnancy, Lactation, and Menopause on Chronic Urticaria Activity. J Cutan Med Surg 2023; 27:466-471. [PMID: 37537974 DOI: 10.1177/12034754231191472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
BACKGROUND Chronic urticaria (CU) is a systemic disorder which is characterized by recurrent wheals and/or angioedema lasting more than 6 weeks. Sex hormones have been suggested to play a role in CU pathogenesis, however, their clinical implications have not been adequately described in the literature. OBJECTIVE To determine whether conditions that change sex hormone levels such as puberty, menstruation, pregnancy, breastfeeding, and menopause affect the course of CU. METHODS This cross-sectional questionnaire study was conducted on female CU patients at Okmeydani Training and Research Hospital UCARE Center between 2016 and 2017. The open-ended questionnaire consisted of questions evaluating the effects of hormonal changes on disease course. RESULTS A total of 111 female CU patients were included in the analysis. During the perimenstrual period, CU symptoms worsened in 29% of patients but improved in 4.8%. The disease course did not change in the majority of patients during puberty, pregnancy, lactation, or menopause (100%, 96%, 83.8%, and 95.6%, respectively). CONCLUSIONS Contrary to expectations, a change in sex hormone levels had no effect on the course of CU in the majority of cases. However, disease activity increased in one-third of CU patients during the perimenstrual period.
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Affiliation(s)
- Sinem Ayse Ornek
- Department of Dermatology, Health Sciences University Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Alisa Suroji Alkilinc
- Department of Dermatology, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Utkan Kızıltac
- Department of Dermatology, Istinye University Medical Park Gaziosmanpasa Hospital, Istanbul, Turkey
| | - Kubra Kızıltac
- Department of Dermatology, Ozel Medar Atasehir Hospital, Istanbul, Turkey
| | - Emek Kocaturk
- Department of Dermatology, Koc 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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Kim MA, Choi JH, Shin YS, Park HS, Ye YM. Efficacy of Second-Line Treatments in Chronic Urticaria Refractory to Standard Dose Antihistamines. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2023; 15:496-511. [PMID: 37153977 DOI: 10.4168/aair.2023.15.4.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/26/2022] [Accepted: 01/11/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE The prevalence of chronic urticaria (CU) is increasing worldwide, and it imposes a major burden on patients. Few studies have evaluated the efficacy of second-line treatments of CU, particularly for patients being considered for costly third-line treatments such as omalizumab. We compared the efficacy and safety of second-line treatments of CU refractory to standard doses of nonsedating H1-antihistamines (nsAHs). METHODS This 4-week, prospective, randomized, open-label trial divided patients into 4 treatment groups: 4-fold updosing of nsAHs, multiple combination of 4 nsAHs, switching to other nsAHs, and adjunctive H2-receptor antagonist. The clinical outcomes included urticaria control status, symptoms, and rescue medication use. RESULTS This study included 109 patients. After 4 weeks of second-line treatment, urticaria was well-controlled, partly controlled, and uncontrolled in 43.1%, 36.7%, and 20.2% of patients, respectively. Complete control of CU was achieved in 20.4% of patients. Among the patients with high-dose nsAHs, the proportion with well-controlled status was higher compared to the patients who received standard doses (51.9% vs. 34.5%, P = 0.031). No significant difference was observed in the proportion of well-controlled cases between the updosing and combination treatment groups (57.7% vs. 46.4%, P = 0.616). However, increasing the dose of nsAHs 4-fold was associated with a higher rate of complete symptom control compared to multiple combination treatment with 4 nsAHs (40.0% vs. 10.7%, P = 0.030). Logistic regression analysis confirmed the higher efficacy of updosing of nsAHs for complete control of CU compared to the other treatment strategies (odds ratio, 0.180; P = 0.020). CONCLUSIONS In patients with CU refractory to standard doses of nsAHs, both updosing of nsAHs 4-fold and multiple combination treatment with 4 nsAHs increased the rate of well-controlled cases without causing significant adverse effects. Updosing of nsAHs is more effective for complete CU control than combination treatment.
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Affiliation(s)
- Mi-Ae Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jeong-Hee Choi
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Yoo-Seob Shin
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Young-Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
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Armstrong AW, Soong W, Bernstein JA. Chronic Spontaneous Urticaria: How to Measure It and the Need to Define Treatment Success. Dermatol Ther (Heidelb) 2023:10.1007/s13555-023-00955-7. [PMID: 37354293 PMCID: PMC10366057 DOI: 10.1007/s13555-023-00955-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/01/2023] [Indexed: 06/26/2023] Open
Abstract
Chronic spontaneous urticaria (CSU) is a complex skin disease characterized by the spontaneous appearance of wheals, angioedema, or both, for more than 6 weeks. Many patients experience a relapsing-remitting disease course for years. Owing to the unpredictability of wheal recurrence and the severity of pruritis, patients suffer considerable impairment in their quality of life. Physicians face multiple challenges, not least of which is a lack of clear guidance on what constitutes "treatment success". There is a lack of awareness of which measures should be used to best assess the various aspects of CSU, including disease activity, disease control, and quality of life-which themselves each comprise multiple components-and how to apply the results of each score to treatment decision-making. Although the overarching aim of treatment is for patients to be completely free of signs and symptoms of CSU, a more realistic definition of "treatment success" is needed to guide ongoing, long-term disease management for each individual patient. In this review, we consider what lessons can be learned from the current evidence base to provide further direction toward a universal definition of "treatment success".
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Affiliation(s)
- April W Armstrong
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Weily Soong
- Alabama Allergy and Asthma Center and Clinical Research Center of Alabama, Birmingham, AL, USA
| | - Jonathan A Bernstein
- Division of Immunology/Allergy Section, Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Predicting Clinical Remission of Chronic Urticaria Using Random Survival Forests: Machine Learning Applied to Real-World Data. Dermatol Ther (Heidelb) 2022; 12:2747-2763. [DOI: 10.1007/s13555-022-00827-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/28/2022] [Indexed: 11/03/2022] Open
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8
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Kulthanan K, Rujitharanawong C, Munprom K, Trakanwittayarak S, Phumariyapong P, Prasertsook S, Ungprasert P. Prevalence, Clinical Manifestations, Treatment, and Clinical Course of Chronic Urticaria in Elderly: A Systematic Review. J Asthma Allergy 2022; 15:1455-1490. [PMID: 36299736 PMCID: PMC9590340 DOI: 10.2147/jaa.s379912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose Data specific to the epidemiology, clinical features, and management of chronic urticaria (CU) in the geriatric population remain limited and not well understood. We aim to systematically review the prevalence, clinical manifestations, treatment, and clinical course of elderly patients with CU. Patients and methods Original articles that included data of elderly (aged >60 years) with CU that were published until February 2021 were searched in PubMed, Scopus, and Embase using predfefined search terms. Related articles were evaluated according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Results Among the included 85 studies and 1,112,066 elderly CU patients, most (57.4%) were women. The prevalence of elderly CU in the general population ranged from 0.2–2.8%, and from 0.7–33.3% among all CU patients. Compared to adult CU, elderly CU patients had a higher percentage of wheal alone (73.9%), and lower rate of positive autologous serum skin test and atopy. Gastrointestinal diseases were the most common comorbidity (71.9%), and there was a high rate of malignancies and autoimmune diseases. Second generation H1-antihistamines were commonly used, and achievement of complete control was most often reported. Omalizumab was prescribed in 59 refractory patients, and a significant response to treatment was reported in most patients. The treatment of comorbidities also yielded significant improvement in CU. Conclusion Elderly CU was found to be different from adult CU in both clinical and laboratory aspects. H1- antihistamines are effective as first-line therapy with minimal side-effects at licensed doses. Treatment of secondary causes is important since the elderly usually have age-related comorbidities.
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Affiliation(s)
- Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chuda Rujitharanawong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanyalak Munprom
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Phumithep Phumariyapong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suthasanee Prasertsook
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patompong Ungprasert
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA,Correspondence: Patompong Ungprasert, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA, Tel +1 216 986 4000, Fax +1 216 986 4953, Email
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9
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Prospective analysis of clinical evolution in chronic urticaria: Persistence, remission, recurrence, and pruritus alone. World Allergy Organ J 2022; 15:100705. [PMID: 36267098 PMCID: PMC9554810 DOI: 10.1016/j.waojou.2022.100705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/25/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Population and study's methodology heterogenicity became clinical evolution of chronic spontaneous urticaria (CSU) highly variable. Objective In a prospective cohort, we evaluated the different pathways of clinical evolution of CSU and identified possible risk factors. Methods A total of 685 CSU patients (>12 years) were prospectively followed over 5 years. Diagnosis and follow-up of urticaria were based on medical evaluation and photographic records. Remission was defined as at least 6 months without symptoms (hives, angioedema, or pruritus) and medication. The follow-up included at least 2 visits per year, with photographic registration and clinical evaluation. Predefined clinical and paraclinical variables were included in the regression analyses. Results We identified four clinical evolution pathways; The cumulative prevalence of remission at 5 years was 59.1%, recurrence was 17.1%, persistence was 11.6%, and chronic pruritus without hives or angioedema was 12.2%. The probability of persistence increased with hypothyroidism diagnosis (HR 0.425, 95% CI 0.290-0.621) and each point in the UAS7 (HR 0.931 95% CI 0.918-0.945). Conclusion Chronic urticaria has different evolutions. Disease activity and hypothyroidism predict persistence and remission. Recurrence and chronic pruritus phenotypes require further study to evaluate their causality and prognosis.
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Abstract
Urticaria is an inflammatory skin disorder that affects up to 20% of the world population at some point during their life. It presents with wheals, angioedema or both due to activation and degranulation of skin mast cells and the release of histamine and other mediators. Most cases of urticaria are acute urticaria, which lasts ≤6 weeks and can be associated with infections or intake of drugs or foods. Chronic urticaria (CU) is either spontaneous or inducible, lasts >6 weeks and persists for >1 year in most patients. CU greatly affects patient quality of life, and is linked to psychiatric comorbidities and high healthcare costs. In contrast to chronic spontaneous urticaria (CSU), chronic inducible urticaria (CIndU) has definite and subtype-specific triggers that induce signs and symptoms. The pathogenesis of CSU consists of several interlinked events involving autoantibodies, complement and coagulation. The diagnosis of urticaria is clinical, but several tests can be performed to exclude differential diagnoses and identify underlying causes in CSU or triggers in CIndU. Current urticaria treatment aims at complete response, with a stepwise approach using second-generation H1 antihistamines, omalizumab and cyclosporine. Novel treatment approaches centre on targeting mediators, signalling pathways and receptors of mast cells and other immune cells. Further research should focus on defining disease endotypes and their biomarkers, identifying new treatment targets and developing improved therapies.
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Affiliation(s)
- Pavel Kolkhir
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.
| | - Ana M Giménez-Arnau
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mediques, Universitat Autònoma, Barcelona, Spain
| | - Kanokvalai Kulthanan
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jonny Peter
- Urticaria Center of Reference and Excellence (UCARE), Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Urticaria Center of Reference and Excellence (UCARE), Allergy and Immunology Unit, University of Cape Town, Lung Institute, Cape Town, South Africa
| | - Martin Metz
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.
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Sex, Allergic Diseases and Omalizumab. Biomedicines 2022; 10:biomedicines10020328. [PMID: 35203537 PMCID: PMC8869622 DOI: 10.3390/biomedicines10020328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
Gender differences are increasingly emerging in every area of medicine including drug therapy; however, specific gender-targeted studies are infrequent. Sex is a fundamental variable, which cannot be neglected. When optimizing therapies, gender pharmacology must always be considered in order to improve the effectiveness and safety of the use of drugs. Knowledge of gender differences promotes appropriate use of therapies and greater health protection for both genders. Further development of gender research would make it possible to report on differences in the assimilation and response of the female organism as compared to the male, in order to identify potential risks and benefits that can be found between genders. Furthermore, a better understanding of sex/gender-related influences, with regard to pharmacological activity, would allow the development of personalized “tailor-made” medicines. Here, we summarize the state of knowledge on the role of sex in several allergic diseases and their treatment with omalizumab, the first biologic drug authorized for use in the field of allergology.
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12
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He L, Yi W, Huang X, Long H, Lu Q. Chronic Urticaria: Advances in Understanding of the Disease and Clinical Management. Clin Rev Allergy Immunol 2021; 61:424-448. [PMID: 34529248 DOI: 10.1007/s12016-021-08886-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 12/25/2022]
Abstract
Chronic urticaria (CU) is a common skin condition characterized by the recurrence of wheals, with or without angioedema, which lasts for at least 6 weeks. Owing to its pruritus and incurability, this disease adversely affects the patients' physical and mental health and diminishes the quality of life. CU is generally classified into two subtypes based on the relevance of eliciting factors: chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU), the latter of which is further divided into several subtypes. To improve the understanding and clinical management of this highly heterogeneous disorder, the EAACI/GA2LEN/EDF/WAO guideline was developed and published in 2018 based on evidence and expert consensus. The diagnostic and treatment algorithms proposed by the guideline have largely facilitated dermatologists in clinical practice. However, several questions remained unsolved and have been widely investigated in the recent years. First, a better understanding of the association between chronic urticaria and its potential underlying causes or eliciting factors such as autoimmunity, infections, coagulation aberrance, and vitamin D deficiency is warranted. This would lead to updates in the diagnostic and treatment procedures of different subtypes of chronic urticaria. Secondly, treatment for recalcitrant cases, especially those resistant to or intolerant of second-generation antihistamines and (or) omalizumab, calls for novel therapeutic measures or strategies. In the present review, we summarized recent advances in the understanding and management of both CSU and CIndU, with special emphasis on their underlying causes or eliciting factors, pathogenic mechanisms, potential targets for intervention, and advances in treatment strategies.
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Affiliation(s)
- Liting He
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Hunan, 410011, Changsha, China
| | - Wanyu Yi
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Hunan, 410011, Changsha, China
| | - Xin Huang
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Hunan, 410011, Changsha, China
| | - Hai Long
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Hunan, 410011, Changsha, China.
| | - Qianjin Lu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Hunan, 410011, Changsha, China.,Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, Jiangsu, China
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13
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Criado RFJ, Criado PR, Baldavira N, Cardial D, Gimenez-Arnau AM, Machado Filho CD. What lessons can we learn? Clinical and epidemiological retrospective analysis of 267 patients with urticaria in a Brazilian tertiary center. An Bras Dermatol 2021; 96:436-441. [PMID: 34030917 PMCID: PMC8245716 DOI: 10.1016/j.abd.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 12/08/2020] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND There are few epidemiological studies of urticaria, published in the indexed literature (PubMed/Medline). OBJECTIVE The study aimed to evaluate the epidemiological and clinical data among patients with urticaria/angioedema attending a reference clinic in Brazil. METHODS Two hundred sixty-seven patients were evaluated retrospectively considering demographic data, time course of the disease, triggering symptoms, the presence of angioedema, complementary laboratory tests including total blood count, reactive-C protein, erythrocyte sedimentation rate, IgE serum levels, and other, as necessary. RESULTS The most commonly diagnosed type of urticaria was chronic spontaneous urticaria (56.93%). Angioedema was associated with chronic urticaria in 108 patients (40.08%). STUDY LIMITATIONS Unicentered and retrospective. CONCLUSION Some relevant findings in this study are the observation of a female prevalence of cases (4-females: 1-man), a result more elevated than demonstrated in previous studies in Europe and Asia, the median age was 43-years old and the delay of time between the diagnosis of urticaria and the admission for treatment in a specialized center was approximately 2-years. Other multicenter studies can better establish these differences in Brazilian patients.
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Affiliation(s)
| | - Paulo Ricardo Criado
- Department of Dermatology, Centro Universitário Saúde ABC, Santo André, SP, Brazil
| | - Nathalia Baldavira
- Department of Dermatology, Centro Universitário Saúde ABC, Santo André, SP, Brazil
| | - Debora Cardial
- Department of Dermatology, Centro Universitário Saúde ABC, Santo André, SP, Brazil
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14
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Hormonal Effects on Urticaria and Angioedema Conditions. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2209-2219. [PMID: 33895364 DOI: 10.1016/j.jaip.2021.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/02/2021] [Accepted: 04/15/2021] [Indexed: 12/18/2022]
Abstract
Women appear to be more frequently affected with urticaria and angioedema. Sex hormones are believed to have an important mechanistic role in regulating pathways involved in these conditions. This effect is likely nonspecific for chronic spontaneous urticaria (CSU) or many forms of angioedema (AE), because many other chronic diseases such as asthma are also affected by sex hormones. The role of sex hormones has been better elucidated for hereditary AE, because they have been shown to have multiple effects including upregulation of FXII, an important activator of the kallikrein pathway. However, their role in the underlying pathogenesis for CSU is less clear. Autoimmunity is clearly linked to CSU, which is more common in women. This suggests that sex hormones could act as adjuvants in activating or upregulating autoimmune pathways. The purpose of this review is to discuss in detail the role of sex hormones in CSU and AE and how a better understanding of the impact hormones has on these conditions might lead to new treatment advancements with better clinical outcomes.
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15
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Ye YM, Yoon J, Woo SD, Jang JH, Lee Y, Lee HY, Shin YS, Nahm DH, Park HS. Clustering the Clinical Course of Chronic Urticaria Using a Longitudinal Database: Effects on Urticaria Remission. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2021; 13:390-403. [PMID: 33733635 PMCID: PMC7984955 DOI: 10.4168/aair.2021.13.3.390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/07/2020] [Accepted: 10/10/2020] [Indexed: 12/16/2022]
Abstract
Purpose Little is known about the clinical course of chronic urticaria (CU) and predictors of its prognosis. We evaluated CU patient clusters based on medication scores during the initial 3 months of treatment in an attempt to investigate time to remission and relapse rates for CU and to identify predictors for CU remission. Methods In total, 4,552 patients (57.9% female; mean age of 38.6 years) with CU were included in this retrospective cohort study. The K-medoids algorithm was used for clustering CU patients. Kaplan-Meier survival analysis with Cox regression was applied to identify predictors of CU remission. Results Four distinct clusters were identified: patients with consistently low disease activity (cluster 1, n = 1,786), with medium-to-low disease activity (cluster 2, n = 1,031), with consistently medium disease activity (cluster 3, n = 1,332), or with consistently high disease activity (cluster 4, n = 403). Mean age, treatment duration, peripheral neutrophil counts, total immunoglobulin E, and complements levels were significantly higher for cluster 4 than the other 3 clusters. Median times to remission were also different among the 4 clusters (2.1 vs. 3.3 vs. 6.4 vs. 9.4 years, respectively, P < 0.001). Sensitization to house dust mites (HDMs; at least class 3) and female sex were identified as significant predictors of CU remission. Around 20% of patients who achieved CU remission experienced relapse. Conclusions In this study, we identified 4 CU patient clusters by analyzing medication scores during the first 3 months of treatment and found that sensitization to HDMs and female sex can affect CU prognosis. The use of immunomodulators was implicated in the risk for CU relapse.
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Affiliation(s)
- Young Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
| | - Jiwon Yoon
- Clinical Trial Center, Ajou University Medical Center, Suwon, Korea
| | - Seong Dae Woo
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Jae Hyuk Jang
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Youngsoo Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Young Lee
- Clinical Trial Center, Ajou University Medical Center, Suwon, Korea
| | - Yoo Seob Shin
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Dong Ho Nahm
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
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16
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Choi JH. Medication Requirements for Disease Control Predict the Prognosis of Chronic Urticaria. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2021; 13:357-359. [PMID: 33733631 PMCID: PMC7984949 DOI: 10.4168/aair.2021.13.3.357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Jeong Hee Choi
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.,Allergy and Clinical Immunology Research Center, Hallym University College of Medicine, Chuncheon, Korea.
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17
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Erdem Y, Polat Ekinci A, Altunay IK, Sivaz O, Inal S, Gokalp MO, Pehlivan G, Özkaya E. The impact of COVID-19 pandemic on the management of patients with chronic urticaria: An observational two-center study from Turkey. Dermatol Ther 2020; 34:e14652. [PMID: 33301190 PMCID: PMC7883220 DOI: 10.1111/dth.14652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/19/2020] [Accepted: 12/03/2020] [Indexed: 02/06/2023]
Abstract
The Coronavirus Disease 2019 (COVID‐19) outbreak significantly affected the clinical practice in hospitals and the management of many diseases. The aim of this study was to evaluate the effect of pandemic‐related factors on the severity and course of chronic urticaria (CU). A total of 194 CU patients who were on regular follow‐up, were enrolled in the study. The disease activity was assessed by means of the weekly urticaria activity score (UAS7) and urticaria control test (UCT). Patients were divided into two subgroups according to their disease aggravation as “aggravated” and “non‐aggravated”. Two groups were compared in terms of demographic, clinical, COVID‐19‐associated parameters, and parameters related with the effect of COVID‐19 pandemic on CU management. The omalizumab use was statistically higher (P = .017), and the systemic corticosteroid use was statistically lower (P = .025) in the “aggravated” group. Adherence to quarantine was significantly lower in the “aggravated” group (P = .027). 173 patients (89.2%) were unable to contact a dermatologist during the pandemic. Among 186 patients who received treatment for CU before the pandemic, 48 (25.8%) did not continue the existing treatment during the pandemic. CU aggravated in one patient with COVID‐19 and remained stable in the other. This study showed that CU patients, especially those on omalizumab therapy, had difficulties in attending medical care and even in the maintenance of their existing therapies during the pandemic. Creating novel follow‐up and treatment models as well as the increased use of teledermatology might be beneficial in the management of this life‐disturbing condition.
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Affiliation(s)
- Yasemin Erdem
- Sisli Hamidiye Etfal Training and Research Hospital, Department of Dermatology, Health Science University, Istanbul, Turkey
| | - Algün Polat Ekinci
- Istanbul Faculty of Medicine, Department of Dermatology and Venereology, Istanbul University, Istanbul, Turkey
| | - Ilknur Kivanc Altunay
- Sisli Hamidiye Etfal Training and Research Hospital, Department of Dermatology, Health Science University, Istanbul, Turkey
| | - Onur Sivaz
- Sisli Hamidiye Etfal Training and Research Hospital, Department of Dermatology, Health Science University, Istanbul, Turkey
| | - Sena Inal
- Sisli Hamidiye Etfal Training and Research Hospital, Department of Dermatology, Health Science University, Istanbul, Turkey
| | - Mehmet Onur Gokalp
- Istanbul Faculty of Medicine, Department of Dermatology and Venereology, Istanbul University, Istanbul, Turkey
| | - Gizem Pehlivan
- Istanbul Faculty of Medicine, Department of Dermatology and Venereology, Istanbul University, Istanbul, Turkey
| | - Esen Özkaya
- Istanbul Faculty of Medicine, Department of Dermatology and Venereology, Istanbul University, Istanbul, Turkey
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18
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Gonçalo M, Gimenéz‐Arnau A, Al‐Ahmad M, Ben‐Shoshan M, Bernstein J, Ensina L, Fomina D, Galvàn C, Godse K, Grattan C, Hide M, Katelaris C, Khoshkhui M, Kocatürk E, Kulthanan K, Medina I, Nasr I, Peter J, Staubach P, Wang L, Weller K, Maurer M. The global burden of chronic urticaria for the patient and society*. Br J Dermatol 2020; 184:226-236. [DOI: 10.1111/bjd.19561] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
Affiliation(s)
- M. Gonçalo
- Department of Dermatology University Hospital and Faculty of MedicineUniversity of Coimbra Coimbra Portugal
| | - A. Gimenéz‐Arnau
- Department of Dermatology Hospital del MarIMIMUniversitat Autònoma Barcelona Spain
| | - M. Al‐Ahmad
- Microbiology Department Faculty of Medicine Kuwait University Kuwait
| | - M. Ben‐Shoshan
- Division of Allergy, Immunology and Dermatology Department of Pediatrics Montreal Children’s HospitalMcGill University Montréal QC Canada
| | - J.A. Bernstein
- University of Cincinnati College of MedicineDepartment of Internal Medicine, Division of Immunology/Allergy Section, Partner Bernstein Allergy Group and Bernstein Clinical Research Center Cincinnati OH USA
| | - L.F. Ensina
- Alergoalpha/CPAlpha Allergy Clinic and Clinical Research Center and Division of Allergy, Clinical Immunology and Rheumatology Department of Pediatrics Federal University of São Paulo (UNIFESP/EPM) São Paulo SP Brazil
| | - D. Fomina
- Moscow City Center of Allergy and Immunology Clinical City Hospital #52 Department of General Therapy Pirogov Russian National Research Medical University Moscow Russian Federation
- Department of Allergology and Clinical Immunology I.M. Sechenov First Moscow State Medical University Moscow Russian Federation
| | - C.A. Galvàn
- Instituto Nacional de Salud del NiñoCentro de Referencia Nacional de Alergia Asma e Inmunología, Lima Perú
| | - K. Godse
- Department of Dermatology Dr D.Y. Patil School of Medicine Mumbai Maharashtra India
| | - C. Grattan
- St John’s Institute of DermatologyGuy’s Hospital London UK
| | - M. Hide
- Department of Dermatology Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - C.H. Katelaris
- Campbelltown Hospital and Western Sydney University Sydney NSW Australia
| | - M. Khoshkhui
- Allergy Research Center Mashhad University of Medical Sciences Mashhad Iran
| | - E. Kocatürk
- Department of Dermatology Koc University School of Medicine Istanbul Turkey
| | - K. Kulthanan
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | - I. Medina
- Centro Medico VitaeDepartment of Allergy and Clinical Immunology Buenos Aires Argentina
| | - I. Nasr
- Department of Immunology and Allergy Royal Hospital Muscat Oman
| | - J. Peter
- Division of Allergy and Clinical Immunology University of Cape Town and Allergy and Immunology UnitUniversity of Cape Town Lung Institute Cape Town South Africa
| | - P. Staubach
- Department of Dermatology University Medical Center Mainz Mainz Germany
| | - L. Wang
- Liangchun Wang – Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - K. Weller
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - M. Maurer
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
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Qin Y, Guo J, Song P, Hou T, He Y, Han M, Yu Q, Lin W, Chen M, Su H. Multi-center study for acupuncture combined with Chinese medicine in the treatment of chronic spontaneous urticaria based on the theory of taking shu-stream points when the disease is aggravated. Medicine (Baltimore) 2020; 99:e21266. [PMID: 32871985 PMCID: PMC7437762 DOI: 10.1097/md.0000000000021266] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Chronic spontaneous urticaria (CSU) is a common dermatologic disease that seriously affects patient quality of life. The choice of therapy to control the disease and prevent its recurrence has always presented a difficult clinical issue. Previous studies have shown that traditional Chinese medicine is a safe and effective treatment for CSU. Recently, the temporal rhythms of CSU, a disease characterized by intermittent flares of active disease and periods of little or no disease, have attracted the attention of traditional Chinese medicine researchers. We designed a multicenter, randomized, controlled study to evaluate the efficacy and safety of combining a Chinese herbal formulation with acupuncture using shu-stream acupoints applied on the corresponding time meridians during disease exacerbations. We plan to recruit 111 outpatients with CSU aged 18 to 65 years. Participants will be randomized to 1 of the 3 groups: group A, which will be given basic acupuncture and the herbal formulation dangui yinzi; group B, which will be given danggui yinzi and shu-stream acupuncture; and a control group, which will be given danggui yinzi alone. Patients will be treated for 4 weeks and followed for 8 additional weeks. Investigators will evaluate the following parameters: the symptoms and side effects of treatment, quality of life (using the chronic urticaria quality of life questionnaire), and overall patient condition. Each week, patients will also complete the measurement of 7-day urticarial activity score. This is the first use of a combination of shu-stream acupoints and Chinese herbal medicine in the treatment of CSU. If successful, it will prove to be a simple, inexpensive, treatment strategy for solving a difficult clinical problem.
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Affiliation(s)
- Yuesi Qin
- Hospital of Chengdu University of Traditional Chinese Medicine
- Chengdu Integrated TCM & Western Medicine Hospital
| | - Jing Guo
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Pan Song
- Chengdu Integrated TCM & Western Medicine Hospital
| | - Tianshu Hou
- Chengdu Integrated TCM & Western Medicine Hospital
| | - Yan He
- The First People's Hospital of Longquanyi District Chengdu
| | - Ming Han
- Xinjin County Hospital of traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qianying Yu
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Wenxia Lin
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Mingling Chen
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Hong Su
- Chengdu Integrated TCM & Western Medicine Hospital
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20
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Cao W, Xiao X, Zhang L, Liu Y, Wang L, Zou Z, Cao Y, Li C, Zheng Q, Zhou S, Li Y. Compound glycyrrhizin combined with antihistamines for chronic urticaria: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e21624. [PMID: 32872021 PMCID: PMC7437846 DOI: 10.1097/md.0000000000021624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To investigate the efficacy and safety of compound glycyrrhizin (CG) combined with antihistamines in the treatment of chronic urticaria (CU). METHODS We will use computers to search all databases including Medline, Embase, Pubmed, Web of Science and Cochrane Central Register of Controlled Trials and China's 4 databases: China National Knowledge Infrastructure Database, China Biomedical Literature Database, China Science Journal Database, and Wanfang Database. Find data from creation date to July 2020. In addition, we will manually search the list of medical journals as a supplement. The scope of the search included randomized controlled clinical studies related to CG combined with antihistamines for CU. The primary outcome is the disease activity control. Secondary outcomes include response rate, adverse events, and recurrence rates. The Cochrane RevMan V5.3 Deviation Assessment Tool will be used to assess bias assessment risk, data integration risk, meta-analysis risk, and subgroup analysis risk (if conditions are met). The average difference, standard mean difference, and binary data will be used to represent continuous results. RESULTS This study will comprehensively review the existing evidence on CG combined with antihistamines for CU. CONCLUSION This systematic review will provide a basis for judging the effectiveness and safety of CG combined with antihistamines in the treatment of CU. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42020156153.
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Affiliation(s)
- Wei Cao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Xianjun Xiao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
- Rehabilitation Department, The People's Hospital of Jianyang City
| | - Leixiao Zhang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Ying Liu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Lu Wang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Zihao Zou
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Yue Cao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Chunxiao Li
- Dermatological Department, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qianhua Zheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Siyuan Zhou
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Ying Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
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21
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Song WJ, Choi M, Lee DH, Kwon JW, Kim GW, Kim MH, Kim MA, Kim MH, Kim BK, Kim S, Kim JS, Kim JE, Kim JY, Kim JH, Kim HJ, Kim HO, Kim HB, Roh JY, Park KH, Park KY, Park HK, Park H, Bae JM, Byun JY, Song DJ, Ahn YM, Lee SE, Lee YB, Lee JS, Lee JH, Lim KH, Ye YM, Chang YS, Jeon YH, Jeon J, Jue MS, Choi SH, Choi JH, Hur GY, Park YM, Lim DH, Youn SW. The KAAACI/KDA Evidence-Based Practice Guidelines for Chronic Spontaneous Urticaria in Korean Adults and Children: Part 1. Definition, Methodology and First-line Management. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:563-578. [PMID: 32400125 PMCID: PMC7224993 DOI: 10.4168/aair.2020.12.4.563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 02/26/2020] [Accepted: 03/01/2020] [Indexed: 12/24/2022]
Abstract
Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.
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Affiliation(s)
- Woo Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mira Choi
- Department of Dermatology, Inje University Ilsan Paik Hospital, Ilsan, Korea
| | - Dong Hun Lee
- Department of Dermatology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Woo Kwon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Gun Woo Kim
- Department of Internal Medicine, St. Carollo General Hospital, Suncheon, Korea
| | - Myung Hwa Kim
- Department of Dermatology, Dankook University College of Medicine, Cheonan, Korea
| | - Mi Ae Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Min Hye Kim
- Department of Internal Medicine, College of Medicine, Ewha Woman's University, Seoul, Korea
| | - Byung Keun Kim
- Department of Internal Medicine, Korea University Medical Center Anam Hospital, Seoul, Korea
| | - Sujeong Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Joung Soo Kim
- Department of Dermatology, Hanyang University Guri Hospital, Guri, Korea
| | - Jung Eun Kim
- Department of Dermatology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ju Young Kim
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Joo Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hyun Jung Kim
- Institute for Evidence-based Medicine, Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Hye One Kim
- Department of Dermatology, Hallym University College of Medicine, Seoul, Korea
| | - Hyo Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Joo Young Roh
- Department of Dermatology, Gachon University School of Medicine Gil Medical Center, Incheon, Korea
| | - Kyung Hee Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kui Young Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Han Ki Park
- Department of Allergy and Clinical Immunology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyunsun Park
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ji Yeon Byun
- Department of Dermatology, College of Medicine, Ewha Woman's University, Seoul, Korea
| | - Dae Jin Song
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Young Min Ahn
- Department of Pediatrics, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Seung Eun Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Young Bok Lee
- Department of Dermatology, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Joong Sun Lee
- Department of Dermatology, School of Medicine, Eulji University, Daejeon, Korea
| | - Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary's Hospital, Brain Korea 21 PLUS Project for Medical Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Young Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Yoon Seok Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - You Hoon Jeon
- Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jiehyun Jeon
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Mihn Sook Jue
- Department of Dermatology, Veterans Health Service Medical Center, Seoul, Korea
| | - Sun Hee Choi
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, School of Medicine Kyung Hee University, Seoul, Korea
| | - Jeong Hee Choi
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
- Allergy and Clinical Immunology Research Center, Hallym University College of Medicine, Chuncheon, Korea
| | - Gyu Young Hur
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Young Min Park
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dae Hyun Lim
- Department of Pediatrics, School of Medicine, Inha University, Incheon, Korea.
| | - Sang Woong Youn
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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22
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Cao W, Xiao X, Zhang L, Wang L, Zheng Q, Zhou S, Liu Y, Cao Y, Chen M, Li C, Li Y. Acupoint injection of Bacillus Calmette-Guerin polysaccharide nucleic acid for patients with chronic urticaria: A protocol for systematic review. Medicine (Baltimore) 2020; 99:e19924. [PMID: 32358360 PMCID: PMC7440172 DOI: 10.1097/md.0000000000019924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To investigate the efficacy and safety of acupoint injection of Bacillus Calmette-Guerin polysaccharide nucleic acid (BCG-PSN) in the treatment of chronic urticaria (CU). METHODS The following databases will be searched from their inception: Medline, Embase, Pubmed, Web of Science, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure Database, China Biomedical Literature Database, China Science Journal Database, and Wanfang Database. All databases will be searched from the date of creation until October 2019. In addition, we will manually search the list of medical journals as a supplement. The scope of the search included randomized controlled clinical studies related to acupoint injection of BCG-PSN for CU. The primary outcome is the disease activity control. Secondary outcomes include response rate, adverse events, and recurrence rates. The Cochrane RevMan V5.3 Deviation Assessment Tool will be used to assess bias assessment risk, data integration risk, meta-analysis risk, and subgroup analysis risk (if conditions are met). The average difference, standard mean difference and binary data will be used to represent continuous results. RESULTS This study will comprehensively review the existing evidence on the treatment of CU by acupoint injection of BCG-PSN. CONCLUSION This systematic review will provide a judgment basis for the effectiveness and safety of acupoint injection of BCG-PSN in the treatment of CU. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42019139885.
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Affiliation(s)
- Wei Cao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Xianjun Xiao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
- Rehabilitation Department, The People's Hospital of Jianyang City
| | - Leixiao Zhang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Lu Wang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Qianhua Zheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Siyuan Zhou
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Ying Liu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Yue Cao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Mingling Chen
- Dermatological Department, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Chunxiao Li
- Dermatological Department, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ying Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
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23
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Gonzalez-Diaz SN, Sanchez-Borges M, Rangel-Gonzalez DM, Guzman-Avilan RI, Canseco-Villarreal JI, Arias-Cruz A. Chronic urticaria and thyroid pathology. World Allergy Organ J 2020; 13:100101. [PMID: 32180891 PMCID: PMC7063156 DOI: 10.1016/j.waojou.2020.100101] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/27/2019] [Accepted: 12/31/2019] [Indexed: 12/11/2022] Open
Abstract
Urticaria is defined as the sudden appearance of erythematous, itchy wheals of variable size, with or without angioedema (AE) (swelling of the deeper layers of the skin). Its classification depends on time course of symptoms and the presence of eliciting factors. When it lasts less than 6 weeks it is classified as acute urticaria (AU), and if the symptoms persist for more than 6 weeks, it is classified as chronic urticaria (CU). Current International Guidelines also classify CU as chronic spontaneous urticaria (CSU) and inducible urticarial, according to the absence or presence of environmental triggering factors. CSU is defined as urticaria and/or angioedema in which there is no evidence of a specific eliciting factor. CSU is associated with autoimmunity in 30-45% of the cases, sharing some immunological mechanisms with other autoimmune diseases, and is associated with autoimmune thyroid disease (ATD) in about 4.3%-57.4% patients. Several studies suggest that adequate therapy with anti-thyroid drugs or levothyroxine in early stages of ATD and CSU, may help to remit the latter; but there is still a lack of double-blind, placebo-controlled studies that support this hypothesis in patients without abnormal thyroid hormone levels. The objective of this review is to describe the pathophysiology of chronic spontaneous urticaria and its association with autoimmune thyroid disease.
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Key Words
- AAbs, autoantibodies
- AD, autoimmune diseases
- AE, angioedema
- AMA, antithyroid microsomal antibody
- ASST, autologous serum skin test
- ATAbs, anti-thyroid autoantibodies
- ATD, autoimmune thyroid disease
- Autoimmunity
- BAT, basophil activation test
- CAU, chronic autoimmune urticaria
- CSU, chronic spontaneous urticaria
- CU, chronic urticaria
- Chronic urticaria
- DAMPs, damage-associated molecular patterns
- FcεRIa, high affinity IgE receptor
- GD, Graves' disease
- HT, Hashimoto's thyroiditis/autoimmune thyroiditis
- Histamine
- ICU, inducible chronic urticaria
- IFN-γ, gamma interferon
- IL, Interleukin
- IgE, Immunoglobulin E
- IgG, Immunoglobulin G
- Levothyroxine
- NSAH, non-sedating antihistamines
- PAF, platelet activating factor
- PAMPs, pathogen-associated molecular patterns
- T4L, free thyroxine
- TG, thyroglobulin
- TGAbs, anti-thyroglobulin antibodies
- TLR, Toll-like receptors
- TNF-α, tumor necrosis factor alpha
- TPOAbs, anti-thyroid peroxidase antibodies
- TSH, thyroid stimulating hormone
- TSHR, thyroid stimulating hormone receptor
- Thyroid disease
- Treg, regulatory T cells
- UAS, urticaria activity score
- Urticaria
- VEGF, vascular endothelial growth factor
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Affiliation(s)
- Sandra Nora Gonzalez-Diaz
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
| | - Mario Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Allergy Service, Clinica El Avila, 6a. Transversal Urb. Altamira, Piso 8, Consultorio 803, Caracas, 1060, Venezuela
| | - Diana Maria Rangel-Gonzalez
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
| | - Rosa Ivett Guzman-Avilan
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
| | - Jose Ignacio Canseco-Villarreal
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
| | - Alfredo Arias-Cruz
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
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24
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Fricke J, Ávila G, Keller T, Weller K, Lau S, Maurer M, Zuberbier T, Keil T. Prevalence of chronic urticaria in children and adults across the globe: Systematic review with meta-analysis. Allergy 2020; 75:423-432. [PMID: 31494963 DOI: 10.1111/all.14037] [Citation(s) in RCA: 174] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/10/2019] [Accepted: 07/14/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Urticaria is a frequent skin condition, but reliable prevalence estimates from population studies particularly of the chronic form are scarce. The objective of this study was to systematically evaluate and summarize the prevalence of chronic urticaria by evaluating population-based studies worldwide. METHODS We performed a systematic search in PUBMED and EMBASE for population-based studies of cross-sectional or cohort design and studies based on health insurance/system databases. Risk of bias was assessed using a specific tool for prevalence studies. For meta-analysis, we used a random effects model. RESULTS Eighteen studies were included in the systematic evaluation and 11 in the meta-analysis including data from over 86 000 000 participants. Risk of bias was mainly moderate, whereas the statistical heterogeneity (I2 ) between the studies was high. Asian studies combined showed a higher point prevalence of chronic urticaria (1.4%, 95%-CI 0.5-2.9) than those from Europe (0.5%, 0.2-1.0) and Northern American (0.1%, 0.1-0.1). Women were slightly more affected than men, whereas in children < 15 years we did not find a sex-specific difference in the prevalence. The four studies that examined time trends indicated an increasing prevalence of chronic urticaria over time. CONCLUSIONS On a global level, the prevalence of chronic urticaria showed considerable regional differences. There is a need to obtain more sex-specific population-based and standardized international data particularly for children and adolescents, different chronic urticaria subtypes and potential risk and protective factors.
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Affiliation(s)
- Julia Fricke
- Institute for Social Medicine, Epidemiology and Health Economics Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Gabriela Ávila
- Institute for Social Medicine, Epidemiology and Health Economics Charité ‐ Universitätsmedizin Berlin Berlin Germany
- Institute of Medical Informatics, Biometry and Epidemiology (IBE) Ludwig‐Maximilians‐Universität Munich Munich Germany
| | - Theresa Keller
- Institute for Social Medicine, Epidemiology and Health Economics Charité ‐ Universitätsmedizin Berlin Berlin Germany
- Institute of Biometry and Clinical Epidemiology Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Karsten Weller
- Department of Dermatology and Allergy Comprehensive Allergy Centre Charité Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Susanne Lau
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Marcus Maurer
- Department of Dermatology and Allergy Comprehensive Allergy Centre Charité Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Torsten Zuberbier
- Department of Dermatology and Allergy Comprehensive Allergy Centre Charité Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Thomas Keil
- Institute for Social Medicine, Epidemiology and Health Economics Charité ‐ Universitätsmedizin Berlin Berlin Germany
- Institute of Clinical Epidemiology and Biometry University of Wuerzburg Wuerzburg Germany
- State Institute of Health Bavarian Health and Food Safety Authority Bad Kissingen Germany
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25
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Bansal CJ, Bansal AS. Stress, pseudoallergens, autoimmunity, infection and inflammation in chronic spontaneous urticaria. Allergy Asthma Clin Immunol 2019; 15:56. [PMID: 31528163 PMCID: PMC6737621 DOI: 10.1186/s13223-019-0372-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/04/2019] [Indexed: 02/06/2023] Open
Abstract
Chronic spontaneous urticaria (CSU) is often associated with organ specific autoimmunity but is rarely caused by food allergy. Colourings and preservatives in pre-packaged foods, so called pseudoallergens, have also been implicated. Factors that promote inflammation or reduce anti-inflammatory mechanisms may however, predispose susceptible individuals to CSU. Chronic underlying infection and mental and emotional stress can sometimes precede the onset of CSU and once established can exacerbate the symptoms. There is early evidence of dysbiosis within the gastrointestinal tract in people with CSU and reduced levels of vitamin D are also evident. The latter may be related to the importance of vitamin D3 in increasing T regulatory function which can control a tendency to autoimmunity. It is quite possible that a state of on-going chronic inflammation with reduced anti-oxidant mechanisms may underlie the not infrequent association between CSU and metabolic syndrome. Effective treatment of CSU should involve the use of anti-histamines, intermittent steroids and anti-IgE therapy. For recalcitrant disease immune modulatory therapy has a place. However, talking therapies that reduce stress and anxiety, vitamin D3 supplementation, correction of intestinal dysbiosis and treatment of any chronic infection should also be considered.
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26
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Xiao X, Shi Y, Zhang L, Cao W, Liu Y, Zhou S, Chen M, Zheng Q, Li Y. Cupping for patients with chronic urticaria: A systematic review protocol. Medicine (Baltimore) 2019; 98:e17115. [PMID: 31567949 PMCID: PMC6756615 DOI: 10.1097/md.0000000000017115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The program aims to evaluate the effectiveness and safety of cupping in patients with chronic urticaria (CU). METHODS We will search the databases including PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, China Science Journal Database, China National Knowledge Infrastructure, Wan-fang Database, and China Biomedical Literature Database from their inception to May 2019. In addition, we will manually search the list of medical journals as a supplement. The clinical randomized controlled trials or quasi-randomized controlled trials related to cupping for the treatment of CU will be included in the study. Data were synthesized by using a fixed-effect model or random effect model depend on the heterogeneity test. The primary outcome is the total effective rate. Secondary outcomes include skin disease quality of life index scores, adverse events, and recurrence rates. RevMan V.5.3 statistical software will be used for meta-analysis. If it is not appropriate for a meta-analysis, then a descriptive analysis will be conducted. Data synthesis will use the risk ratio and the standardized or weighted average difference of continuous data to represent the results. RESULTS This study will provide a comprehensive review of the available evidence to assess the effectiveness and safety of cupping for patients with CU. CONCLUSION This systematic review (SR) will provide evidence to judge whether cupping is an effective intervention for patients with CU. ETHICS AND DISSEMINATION The protocol of the SR does not require ethical approval because it does not involve humans. We will publish this article in peer-reviewed journals and presented at relevant conferences. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42019137451.
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Affiliation(s)
- Xianjun Xiao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
- Rehabilitation Department, The People's Hospital of Jianyang City
| | - Yunzhou Shi
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Leixiao Zhang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Wei Cao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Ying Liu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Siyuan Zhou
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Mingling Chen
- Dermatological Department, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qianhua Zheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Ying Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
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27
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Miller RL, Shtessel M, Robinson LB, Banerji A. Advances in drug allergy, urticaria, angioedema, and anaphylaxis in 2018. J Allergy Clin Immunol 2019; 144:381-392. [PMID: 31247266 DOI: 10.1016/j.jaci.2019.06.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/22/2019] [Accepted: 06/18/2019] [Indexed: 12/11/2022]
Abstract
Many notable advances in drug allergy, urticaria, angioedema, and anaphylaxis were reported in 2018. Broad-spectrum antibiotic use and, consequently, antibiotic resistance are widespread, and algorithms to clarify β-lactam allergy and optimize antibiotic use were described. Meaningful data emerged on the pathogenesis of delayed drug hypersensitivity reactions. Progress not only in defining biomarkers but also in understanding the effect on quality of life and developing better treatments has been made for patients with chronic idiopathic urticaria. Patients with hereditary angioedema (HAE) have gained additional access to highly efficacious therapies, with associated improvements in quality of life, and some progress was made in our understanding of recurrent angioedema in patients with normal laboratory results. Guidelines have defined clear goals to help providers optimize therapies in patients with HAE. The epidemiology and triggers of anaphylaxis and the mechanisms underlying anaphylaxis were elucidated further. In summary, these disorders (and labels) cause substantial burdens for individual persons and even society. Fortunately, publications in 2018 have informed on advancements in diagnosis and management and have provided better understanding of mechanisms that potentially could yield new therapies. This progress should lead to better health outcomes and paths forward in patients with drug allergy, urticaria, HAE, and anaphylaxis.
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Affiliation(s)
- Rachel L Miller
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY; Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY.
| | - Maria Shtessel
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Lacey B Robinson
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
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