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Zuberbier T, Peter J, Staubach P, Chularojanamontri L, Kulthanan K. Potential Therapeutic Approaches for Chronic Urticaria: Beyond H1-Antihistamines and Biologics. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2265-2273. [PMID: 37356753 DOI: 10.1016/j.jaip.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/31/2023] [Accepted: 06/14/2023] [Indexed: 06/27/2023]
Abstract
Chronic urticaria is a disease that can significantly impact a patient's quality of life and ability to function. There are effective treatment options, such as nonsedating antihistamines or biologics, but some patients do not respond to these therapies, or the therapies are not available or affordable to all patients. This review aims to summarize potential treatment strategies for patients (1) who do not respond to antihistamines and (2) cannot readily access or do not respond to biologics. The review emphasizes the importance of sound clinical practice, including correct diagnosis of chronic urticaria phenotypes, treatment of associated comorbidities, and consideration of add-on pharmacological and nonpharmacological approaches. Although some treatments may lack high-quality evidence, they may still be justifiable in certain cases, provided that there is shared decision-making, regular reassessment, and early recognition of adverse events.
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Affiliation(s)
- Torsten Zuberbier
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany.
| | - Jonny Peter
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Petra Staubach
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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2
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Zuberbier T, Altrichter S, Bauer S, Brehler R, Brockow K, Dressler C, Fluhr J, Gaskins M, Hamelmann E, Kühne K, Merk H, Mülleneisen NK, Nast A, Olze H, Ott H, Pleimes M, Ruëff F, Staubach-Renz P, Wedi B, Maurer M. S3 Guideline Urticaria. Part 2: Treatment of urticaria - German-language adaptation of the international S3 guideline. J Dtsch Dermatol Ges 2023; 21:202-215. [PMID: 36730626 DOI: 10.1111/ddg.14932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/12/2022] [Indexed: 02/04/2023]
Abstract
This publication is the second part of the German-language S3 guideline on urticaria. It covers the management of urticaria and should be used together with Part 1 of the guideline on classification and diagnosis. This publication was prepared according to the criteria of the AWMF on the basis of the international English-language S3 guideline with special consideration of health system conditions in German-speaking countries. Chronic urticaria has a high impact on the quality of life and daily activities of patients. Therefore, if causal factors cannot be eliminated, effective symptomatic treatment is necessary. The recommended first-line treatment is to administer new generation, non-sedating H1 antihistamines. If the standard dose is not sufficiently effective, the dose should be increased up to fourfold. For patients who do not respond to this treatment, the second-line treatment in addition to antihistamines in the treatment algorithm is omalizumab and, if this treatment fails, ciclosporin. Other low-evidence therapeutic agents should only be used if all treatments in the treatment algorithm agreed upon by the guideline group fail. Both the benefit-risk profile and cost should be considered. Corticosteroids are not recommended for long-term treatment due to their inevitable severe side effects.
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Affiliation(s)
- Torsten Zuberbier
- 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
| | - Sabine Altrichter
- University Hospital for Dermatology und Venereology, Comprehensive Allergy Center, Kepler University Hospital, Linz, Austria
| | | | - Randolf Brehler
- Center for Skin Diseases, University Hospital Münster, Department of Dermatology, Münster, Germany
| | - Knut Brockow
- Department and Clinic for Dermatology und Allergology am Biederstein, Technical University of Munich, Munich, Germany
| | - Corinna Dressler
- Division of Evidence-Based Medicine, Department for Dermatology, Venereology und Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Joachim Fluhr
- 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
| | - Matthew Gaskins
- Division of Evidence-Based Medicine, Department for Dermatology, Venereology und Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Eckard Hamelmann
- Department for Pediatric and Adolescent Medinine, Evangelisches Klinikum Bethel, University Hospital OWL, University of Bielefeld, Bielefeld, Germany
| | | | - Hans Merk
- Department for Dermatology und Allergology, University Hospital RTWH Aachen, Aachen, Germany
| | | | - Alexander Nast
- Division of Evidence-Based Medicine, Department for Dermatology, Venereology und Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Heidi Olze
- Department of Ear, Nose and Throat Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Hagen Ott
- Hospital for Pediatric and Adolescent Medicine Auf der Bult, Hannover, Germany
| | - Marc Pleimes
- Practice for Pediatric and Adolescent Dermatology, Heidelberg, Germany
| | - Franziska Ruëff
- Department and Clinic for Dermatology und Allergology, LMU Hospital at the University of Munich, Munich, Germany
| | - Petra Staubach-Renz
- Department and Clinic for Skin Diseases, University Hospital at Johannes Gut, enberg University Mainz, Mainz, Germany
| | - Bettina Wedi
- Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, Germany
| | - 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
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3
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Zuberbier T, Altrichter S, Bauer S, Brehler R, Brockow K, Dressler C, Fluhr J, Gaskins M, Hamelmann E, Kühne K, Merk H, Mülleneisen NK, Nast A, Olze H, Ott H, Pleimes M, Ruëff F, Staubach-Renz P, Wedi B, Maurer M. S3-Leitlinie Urtikaria. Teil 2: Therapie der Urtikaria - deutschsprachige Adaption der internationalen S3-Leitlinie. J Dtsch Dermatol Ges 2023; 21:202-216. [PMID: 36808444 DOI: 10.1111/ddg.14932_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/12/2022] [Indexed: 02/22/2023]
Affiliation(s)
- Torsten Zuberbier
- 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
| | - Sabine Altrichter
- Universitätsklinik für Dermatologie und Venerologie, Comprehensive Allergy Center, Kepler Universitätsklinikum, Linz, Österreich
| | | | - Randolf Brehler
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Abteilung Dermatologie, Münster, Deutschland
| | - Knut Brockow
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, München, Deutschland
| | - Corinna Dressler
- Division of Evidence-Based Medicine, Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Deutschland
| | - Joachim Fluhr
- 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
| | - Matthew Gaskins
- Division of Evidence-Based Medicine, Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Deutschland
| | - Eckard Hamelmann
- Klinik für Kinder- und Jugendmedizin, Evangelisches Klinikum Bethel, Universitätsklinikum OWL, Universität Bielefeld, Bielefeld, Deutschland
| | | | - Hans Merk
- Klinik für Dermatologie und Allergologie, Universitätsklinik RTWH Aachen, Aachen, Deutschland
| | | | - Alexander Nast
- Division of Evidence-Based Medicine, Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Deutschland
| | - Heidi Olze
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Deutschland
| | - Hagen Ott
- Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Deutschland
| | - Marc Pleimes
- Praxis für Kinder- und Jugenddermatologie, Heidelberg, Deutschland
| | - Franziska Ruëff
- Klinik und Poliklinik für Dermatologie und Allergologie, LMU Klinikum der Universität München, München, Deutschland
| | - Petra Staubach-Renz
- Hautklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Bettina Wedi
- Klinik für Dermatologie, Allergologie und Venerologie, Comprehensive Allergy Center (CAC), Medizinische Hochschule Hannover, Hannover, Deutschland
| | - 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
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4
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Do TT, Canty EA, Joshi SR. Current and future management of chronic spontaneous urticaria and chronic inducible urticaria. Allergy Asthma Proc 2023; 44:3-14. [PMID: 36719690 DOI: 10.2500/aap.2023.44.220093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Chronic urticaria (CU), characterized by ≥6 weeks of intense pruritus, remains a debilitating condition for patients. New and safe treatments are needed to manage CU recalcitrant to standard therapy. Objective: A review of the current literature of standard and novel therapeutics in the management of CU was conducted. Methods: A literature search via a medical literature data base and clinical trial data base was conducted to identify treatment options for CU and current clinical trials. Results: Second-generation antihistamines, omalizumab, and cyclosporine remain the most proven therapeutic options for CU. Dupilumab, mepolizumab, benralizumab, tezepelumab, and CDX-0159 are all undergoing clinical trials for CU. Although ligelizumab demonstrated initial promising results, a phase III study was discontinued due to a nonsuperior clinical impact compared with omalizumab. Conclusion: Novel therapies are needed for the treatment of recalcitrant CU. With a deeper understanding of the pathophysiology of CU, promising therapeutics are in clinical trials for CU.
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Affiliation(s)
- Toan T Do
- From the Department of Internal Medicine, Oregon Health and Science University, Portland, Oregon
| | - Ethan A Canty
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, and
| | - Shyam R Joshi
- Section of Allergy and Clinical Immunology, Oregon Health and Science University, Portland, Oregon
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5
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Zuberbier T, Abdul Latiff AH, Abuzakouk M, Aquilina S, Asero R, Baker D, Ballmer‐Weber B, Bangert C, Ben‐Shoshan M, Bernstein JA, Bindslev‐Jensen C, Brockow K, Brzoza Z, Chong Neto HJ, Church MK, Criado PR, Danilycheva IV, Dressler C, Ensina LF, Fonacier L, Gaskins M, Gáspár K, Gelincik A, Giménez‐Arnau A, Godse K, Gonçalo M, Grattan C, Grosber M, Hamelmann E, Hébert J, Hide M, Kaplan A, Kapp A, Kessel A, Kocatürk E, Kulthanan K, Larenas‐Linnemann D, Lauerma A, Leslie TA, Magerl M, Makris M, Meshkova RY, Metz M, Micallef D, Mortz CG, Nast A, Oude‐Elberink H, Pawankar R, Pigatto PD, Ratti Sisa H, Rojo Gutiérrez MI, Saini SS, Schmid‐Grendelmeier P, Sekerel BE, Siebenhaar F, Siiskonen H, Soria A, Staubach‐Renz P, Stingeni L, Sussman G, Szegedi A, Thomsen SF, Vadasz Z, Vestergaard C, Wedi B, Zhao Z, Maurer M. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy 2022; 77:734-766. [PMID: 34536239 DOI: 10.1111/all.15090] [Citation(s) in RCA: 342] [Impact Index Per Article: 171.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 02/07/2023]
Abstract
This update and revision of the international guideline for urticaria was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the Global Allergy and Asthma European Network (GA²LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), the European Dermatology Forum (EDF; EuroGuiDerm), and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology with the participation of 64 delegates of 50 national and international societies and from 31 countries. The consensus conference was held on 3 December 2020. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease that presents with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous or inducible urticaria is disabling, impairs quality of life, and affects performance at work and school. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
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Affiliation(s)
- Torsten Zuberbier
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | | | - Mohamed Abuzakouk
- Department of Allergy and Immunology Respiratory InstituteCleveland Clinic Abu Dhabi Abu Dhabi United Arab Emirates
| | - Susan Aquilina
- Department of Dermatology Mater Dei Hospital Msida Malta
| | - Riccardo Asero
- Ambulatorio di Allergologia Clinica San Carlo Paderno Dugnano (MI) Italy
| | - Diane Baker
- Baker Allergy Asthma and Dermatology Portland Oregon USA
| | - Barbara Ballmer‐Weber
- Clinic for Dermatology and Allergology Kantonsspital St. Gallen St. Gallen Switzerland
- Department of Dermatology University Hospital Zurich Zurich Switzerland
| | - Christine Bangert
- Department of Dermatology Medical University of Vienna Vienna Austria
| | - Moshe Ben‐Shoshan
- Division of Allergy, Immunology and Dermatology Department of Pediatrics Montreal Children’s Hospital McGill University Montreal Quebec Canada
| | | | - Carsten Bindslev‐Jensen
- Department of Dermatology and Allergy Centre Odense University Hospital and University of Southern Denmark Odense Denmark
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein Faculty of Medicine Technical University Munich Munich Germany
| | - Zenon Brzoza
- Department of Internal Diseases with Division of Allergology University of Opole Opole Poland
| | - Herberto Jose Chong Neto
- Division of Allergy and Immunology Department of Pediatrics Federal University of Paraná Curitiba Brazil
| | - Martin K. Church
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- University of Southampton Southampton UK
| | - Paulo R. Criado
- Sociedade Brasileira de Dermatologia (SBD) Centro Universitário FMABCAlergoskin (UCARE) Santo André Brazil
| | - Inna V. Danilycheva
- Department of Allergology and Immunotherapy National Research Center‐Institute of Immunology Federal Medical‐Biological Agency of Russia Moscow Russia
| | - Corinna Dressler
- Division of Evidence‐Based Medicine Department of Dermatology, Venereology and Allergy Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Luis Felipe Ensina
- Division of Allergy Clinical Immunology and Rheumatology Department of Pediatrics Federal University of São Paulo São Paulo Brazil
| | - Luz Fonacier
- New York University Long Island School of Medicine New York New York USA
| | - Matthew Gaskins
- Division of Evidence‐Based Medicine Department of Dermatology, Venereology and Allergy Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Krisztian Gáspár
- Division of Dermatological Allergology Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - Aslı Gelincik
- Division of Immunology and Allergic Diseases Department of Internal Medicine Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
| | - Ana Giménez‐Arnau
- Department of Dermatology, Hospital del Mar Institut Mar d’Investigacions Mèdiques Universitat Autònoma y Universitat Pompeu Fabra Barcelona Spain
| | - Kiran Godse
- Department of Dermatology D Y Patil University School of MedicineNavi Mumbai India
| | - Margarida Gonçalo
- Department of Dermatology Coimbra University Hospital and Faculty of Medicine University of Coimbra Coimbra Portugal
| | - Clive Grattan
- Guy’s HospitalSt John’s Institute of Dermatology London UK
| | - Martine Grosber
- Department of Dermatology Universitair Ziekenhuis Brussel (UZ Brussel)Vrije Universiteit Brussel (VUB) Brussels Belgium
| | - Eckard Hamelmann
- Department of Pediatrics Children’s Center Bethel University Hospital OWLUniversity Bielefeld Bielefeld Germany
| | - Jacques Hébert
- Service d'allergie Centre Hospitalier Université Laval/Centre Hospitalier Universitaire de Québec Québec Quebec Canada
| | - Michihiro Hide
- Department of Dermatology Hiroshima University Hiroshima Japan
- Department of Dermatology Hiroshima Citizens Hospital Hiroshima Japan
| | - Allen Kaplan
- Department of Medicine Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology Medical University of South Carolina Charleston South Carolina USA
| | - Alexander Kapp
- Department of Dermatology & Allergy Hannover Medical School (MHH) Hannover Germany
| | - Aharon Kessel
- Division of Allergy and Clinical Immunology Bnai Zion Medical Center and the Bruce and Ruth Rappaport Faculty of Medicine Technion Haifa Israel
| | - Emek Kocatürk
- Department of Dermatology Koç University School of Medicine Istanbul Turkey
| | - Kanokvalai Kulthanan
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | | | - Antti Lauerma
- Department of Dermatology, Allergology and Venereology Inflammation Centre University of Helsinki and Helsinki University Hospital Helsinki Finland
| | | | - Markus Magerl
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology Berlin Germany
| | - Michael Makris
- Allergy Unit 2nd Department of Dermatology and Venereology National and Kapodistrian University of AthensUniversity General Hospital "Attikon" Athens Greece
| | - Raisa Y. Meshkova
- Department of Clinical Immunology and Allergology Smolensk State Medical University Smolensk Russia
| | - Martin Metz
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology Berlin Germany
| | | | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre Odense Research Center for Anaphylaxis (ORCA) Odense University Hospital and University of Southern Denmark Odense Denmark
| | - Alexander Nast
- Division of Evidence‐Based Medicine Department of Dermatology, Venereology and Allergy Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | | | - Ruby Pawankar
- Department of Pediatrics Nippon Medical School Tokyo Japan
| | - Paolo D. Pigatto
- Department of Biomedical Surgical and Dental Sciences University of Milan Milan Italy
| | - Hector Ratti Sisa
- Primera Cátedra de Clínica Médica Hospital de Clínicas de la Facultad de Ciencias Médicas‐Universidad Nacional de Asunción Asunción Paraguay
| | | | | | | | - Bulent E. Sekerel
- Division of Pediatric Allergy and Asthma Hacettepe University Faculty of Medicine Ankara Turkey
| | - Frank Siebenhaar
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology Berlin Germany
| | - Hanna Siiskonen
- Department of Pathology Diagnostic Imaging Centre Kuopio University Hospital Kuopio Finland
| | - Angele Soria
- Department of Dermatology and Allergology Tenon Hospital APHP Sorbonne University and Cimi‐Paris Inserm 1135 Paris France
| | | | - Luca Stingeni
- Dermatology Section Department of Medicine University of Perugia Perugia Italy
| | - Gordon Sussman
- Division of Allergy and Clinical Immunology St. Michael's Hospital and University of Toronto Toronto Canada
| | - Andrea Szegedi
- Division of Dermatological Allergology Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - Simon Francis Thomsen
- Department of Dermatology Bispebjerg Hospital University of Copenhagen Copenhagen Denmark
| | - Zahava Vadasz
- Proteomic and Clinical Flow Cytometry Unit Bnai Zion Medical Center Rappaport Faculty of Medicine Technion Haifa Israel
| | | | - Bettina Wedi
- Department of Dermatology and Allergy Comprehensive Allergy Center Hannover Medical School Hannover Germany
| | - Zuotao Zhao
- Department of Dermatology and Venereology Peking University First Hospital Beijing China
| | - Marcus Maurer
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology Berlin Germany
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6
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Vaishampayan SS, Bhati SS, Lachhiramani RR, Shrivastava S, Jain P, Raghuwanshi AS. Intravenous Immunoglobulin: Revisited - My Experience. Indian J Dermatol 2021; 66:329. [PMID: 34446966 PMCID: PMC8375533 DOI: 10.4103/ijd.ijd_559_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: Many a times while treating dermatoses conventional therapies are either contraindicated or not effective. Intravenous immunoglobulin (IVIG) is a good alternative available to tide over crises. Method: Over the last 15 years of my practice I have used IVIg in various severe or recalcitrant diseases (including TEN, autoimmune blistering disease,connective tissue disorders , chronic urticaria etc) which were either unresponsive to conventional modality of therapy or primary therapy could not be given because of co-morbidities. Result: IVIg a sterile, highly purified preparation containing more than 95% unmodified IgG,was first approved by FDA in 1981 for 6 diseases. As mentioned above in many circumstances we reached a situation when either conventional primary therapy was contraindicated or patients were not responding. IVIg came to our rescue in large number of conditions to tide over the crisis and also created the environment leading to conventional therapy becoming effective. Very few minor side effects like low grade fever and myalgia were observed in very few cases. No serious or severe side effects were seen, however , one has to be prepared for anaphylactic reaction which is a theoretical possibility. Conclusion: It can be said that IVIg though not a magic drug, is a very effective tool available in the armamentarium of Dermatologists to treat plethora of chronic and intractable dermatoses.
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Affiliation(s)
| | | | | | - Shivank Shrivastava
- Department of Dermatology, Index Medical College, Indore, Madhya Pradesh, India
| | - Prateek Jain
- Department of Dermatology, Index Medical College, Indore, Madhya Pradesh, India
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7
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Saylam Kurtipek G, Zekey E, Tuncez Akyurek F. Successful treatment of delayed pressure urticaria with 300 mg of omalizumab every 14 days. J Cosmet Dermatol 2020; 20:1897-1899. [PMID: 33103846 DOI: 10.1111/jocd.13764] [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: 08/19/2020] [Accepted: 09/25/2020] [Indexed: 11/29/2022]
Abstract
Delayed pressure urticaria is a rare form of chronic inducible urticaria characterized by erythematous-painful plaques that develop in areas of the skin exposed to prolonged pressure. Its treatment is very difficult, and its response to antihistamines is variable. Cases of delayed pressure urticaria, which have been completely controlled with the use of omalizumab in recent years, have been reported.
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Affiliation(s)
| | - Emre Zekey
- Department of Dermatoloji, Selcuk University Faculty of Medicine, Konya, Turkey
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8
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Sánchez-Borges M, Díaz SG, Ortega-Martell JA, Rojo MI, Ansotegui IJ. Current and Potential Biologic Drugs for the Treatment of Chronic Urticaria. Immunol Allergy Clin North Am 2020; 40:609-623. [PMID: 33012323 DOI: 10.1016/j.iac.2020.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article reviews biologic treatments that are currently applied for the treatment of severe chronic urticaria. Monoclonal anti-immunoglobulin E (omalizumab) is effective and safe in many patients, but accessibility and cost constitute barriers to its wider use. Questions on the optimal duration of the treatment and possible symptom recurrences after discontinuing the drug are still raised. A discussion is presented about several other biologics currently under investigation with potential to be incorporated in the near future in patients with severe chronic urticaria.
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Affiliation(s)
- Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela; Allergy and Clinical Immunology Department, Clínica El Avila, Caracas, Venezuela.
| | - Sandra González Díaz
- Centro Regional de Excelencia CONACYT/WAO en Alergia Asma e Inmunologia Clìnica, Hospital Universitario, Facultad de Medicina, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico; San Francisco Centro de Especialistas Médicos 27196008(82)
| | - Jose Antonio Ortega-Martell
- Universidad Autónoma del Estado de Hidalgo, Artículo 27 # 102. Col. Constitución, Pachuca, Hidalgo CP 42080, Mexico
| | | | - Ignacio J Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Carretera Leioa-Unbe 33 bis, Erandio-Bilbao 48950, Spain
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9
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Kulthanan K, Ungprasert P, Tuchinda P, Chularojanamontri L, Charoenpipatsin N, Maurer M. Delayed Pressure Urticaria: A Systematic Review of Treatment Options. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2035-2049.e5. [PMID: 32179196 DOI: 10.1016/j.jaip.2020.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/10/2020] [Accepted: 03/03/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Delayed pressure urticaria (DPU) is characterized by recurrent erythematous and often painful swelling after the skin is exposed to sustained pressure. Treatment is challenging. Antihistamines, the first-line and only approved treatment, are often not effective. OBJECTIVE To systematically review the treatment options for DPU. METHOD A literature search of electronic databases for all relevant articles published till April 29, 2019, was conducted using the search terms "delayed pressure urticaria" and "pressure urticaria." This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. RESULTS Twenty-one studies (8 randomized controlled trials [RCTs], 10 retrospective cohort studies, and 3 open-label prospective studies) were included. Second-generation H1 antihistamines (sgAHs) were effective in 3 RCTs. The combination of an sgAH and montelukast (2 RCTs) or an sgAH and theophylline (1 non-RCT) was more effective than the sgAH alone. The disease improved with omalizumab (4 non-RCTs), sulphones (3 non-RCTs), oral prednisolone (1 RCT and 2 non-RCTs), intravenous immunoglobulin (1 non-RCT), and gluten-free diet (1 non-RCT). There are no studies on updosing of antihistamines over standard dosage in DPU. CONCLUSIONS Overall, the quality of studies on DPU is low. Because of the lack of other evidence, antihistamines remain the first-line therapy. Updosing of sgAHs could be considered in patients with uncontrolled symptoms on the basis of the extrapolation of evidence from chronic spontaneous urticaria, even though there is no evidence of its efficacy over standard dosage. Addition of montelukast may be considered. Omalizumab or sulphones may be used in treatment-resistant patients. High-quality DPU studies should be conducted.
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Affiliation(s)
- Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patompong Ungprasert
- Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Papapit Tuchinda
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Norramon Charoenpipatsin
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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10
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Soliman YS, Lim HW, Kerr HA. Recalcitrant, delayed pressure urticaria treated with long-term intravenous immunoglobulin. JAAD Case Rep 2020; 6:176-177. [PMID: 32099887 PMCID: PMC7029339 DOI: 10.1016/j.jdcr.2019.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Yssra S. Soliman
- Department of Internal Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, New York
| | - Henry W. Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Holly A. Kerr
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
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11
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Maurer M, Fluhr JW, Khan DA. How to Approach Chronic Inducible Urticaria. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 6:1119-1130. [PMID: 30033913 DOI: 10.1016/j.jaip.2018.03.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 12/22/2022]
Abstract
Chronic inducible urticaria (CIndU) is a group of chronic urticarias characterized by the appearance of recurrent wheals, recurrent angioedema or both, as a response to specific triggers. CIndU includes both physical (symptomatic dermographism, cold and heat urticaria, delayed pressure urticaria, solar urticaria, and vibratory urticaria) and nonphysical urticarias (cholinergic urticaria, contact and aquagenic urticaria). Here, we review the different forms of CIndU with an emphasis on symptomatic dermographism, cold urticaria, cholinergic urticaria, and delayed pressure urticaria. We discuss the clinical features, the diagnostic workup including provocation and threshold testing, and available treatment options.
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Affiliation(s)
- Marcus Maurer
- Department of Dermatology and Allergy, Charité - Universitätsmedizin, Berlin, Germany.
| | - Joachim W Fluhr
- Department of Dermatology and Allergy, Charité - Universitätsmedizin, Berlin, Germany
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
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12
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Zuberbier T, Aberer W, Asero R, Latiff AHA, Baker D, Ballmer-Weber B, Bernstein JA, Bindslev-Jensen C, Brzoza Z, Bedrikow RB, Canonica GW, Church MK, Craig T, Danilycheva IV, Dressler C, Ensina LF, Giménez-Arnau A, Godse K, Goncalo M, Grattan C, Hebert J, Hide M, Kaplan A, Kapp A, Katelaris CH, Kocatürk E, Kulthanan K, Larenas-Linnemann D, Leslie TA, Magerl M, Mathelier-Fusade P, Meshkova RY, Metz M, Nast A, Nettis E, Oude-Elberink H, Rosumeck S, Saini SS, Sánchez-Borges M, Schmid-Grendelmeier P, Staubach P, Sussman G, Toubi E, Vena GA, Vestergaard C, Wedi B, Werner RN, Zhao Z, Maurer M, Brehler R, Brockow K, Fluhr J, Grabbe J, Hamelmann E, Hartmann K, Jakob T, Merk H, Ollert M, Ott H, Reese I, Rueff F, Werfel T. EAACI/GA2LEN/EDF/WAO-Leitlinie für die Definition, Klassifikation, Diagnose und das Management der Urtikaria — konsentierte, deutschsprachige Übersetzung. ALLERGO JOURNAL 2018. [DOI: 10.1007/s15007-018-1751-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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13
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Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer-Weber B, Bernstein JA, Bindslev-Jensen C, Brzoza Z, Buense Bedrikow R, Canonica GW, Church MK, Craig T, Danilycheva IV, Dressler C, Ensina LF, Giménez-Arnau A, Godse K, Gonçalo M, Grattan C, Hebert J, Hide M, Kaplan A, Kapp A, Katelaris CH, Kocatürk E, Kulthanan K, Larenas-Linnemann D, Leslie TA, Magerl M, Mathelier-Fusade P, Meshkova RY, Metz M, Nast A, Nettis E, Oude-Elberink H, Rosumeck S, Saini SS, Sánchez-Borges M, Schmid-Grendelmeier P, Staubach P, Sussman G, Toubi E, Vena GA, Vestergaard C, Wedi B, Werner RN, Zhao Z, Maurer M. The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy 2018; 73:1393-1414. [PMID: 29336054 DOI: 10.1111/all.13397] [Citation(s) in RCA: 767] [Impact Index Per Article: 127.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2017] [Indexed: 02/06/2023]
Abstract
This evidence- and consensus-based guideline was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. The conference was held on 1 December 2016. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-founded network of excellence, the Global Allergy and Asthma European Network (GA²LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO) with the participation of 48 delegates of 42 national and international societies. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria are disabling, impair quality of life and affect performance at work and school. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
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Affiliation(s)
- T. Zuberbier
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
| | - W. Aberer
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - R. Asero
- Department of Allergology; Clinica San Carlo; Paderno Dugnano MI Italy
| | - A. H. Abdul Latiff
- Allergy& Immunology Centre; Pantai Hospital Kuala Lumpur; Kuala Lumpur Malaysia
| | - D. Baker
- Baker Allergy Asthma and Dermatology Clinic; Portland OR USA
| | - B. Ballmer-Weber
- Allergy Unit; Department of Dermatology; University Hospital; Zürich Switzerland
| | - J. A. Bernstein
- University of Cincinnati Physicians Immunology Research Center; Cincinnati OH USA
| | - C. Bindslev-Jensen
- Department of Dermatology and Allergy Centre; Odense University Hospital and University of Southern Denmark; Odense Denmark
| | - Z. Brzoza
- Department of Internal Diseases, Allergology and Clinical Immunology in Katowice; Medical University of Silesia; Katowice Poland
| | | | - G. W. Canonica
- Personalized Medicine Asthma and Allergy Clinic-Humanitas University & Research Hospital; Milano Italy
| | - M. K. Church
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
| | - T. Craig
- Department of Medicine and Pediatrics; Penn State University; Hershey Medical Center; Hershey PA USA
| | - I. V. Danilycheva
- National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia; Moscow Russia
| | - C. Dressler
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Division of Evidence Based Medicine; Department of Dermatology; Berlin Germany
| | - L. F. Ensina
- Federal University of Sao Paulo; Sao Paulo Brazil
| | - A. Giménez-Arnau
- Hospital del Mar; IMIM; Universitat Autònoma Barcelona; Barcelona Spain
| | - K. Godse
- Department of Dermatology; Dr. D. Y. Patil Medical College & Hospital; Nerul Navi Mumbai India
| | - M. Gonçalo
- Clinic of Dermatology; Faculty of Medicine and University Hospital; Coimbra Portugal
| | - C. Grattan
- St John's’ Institute of Dermatology; Guy's’ and St. Thomas’ Hospital; NHS Foundation Trust; London UK
| | - J. Hebert
- Service d'allergie; Centre Hospitalier Université Laval/Centre Hospitalier Universitaire de Québec; Québec QC Canada
| | - M. Hide
- Department of Dermatology; Institute of Biomedical and Health Sciences; Hiroshima University; Hiroshima Japan
| | - A. Kaplan
- Department of Medicine; Division of Pulmonary and Critical Care Medicine; Allergy and Clinical Immunology; Medical University of South Carolina; Charleston SC USA
| | - A. Kapp
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - C. H. Katelaris
- Campbelltown Hospital and Western Sydney University; Sydney Australia
| | - E. Kocatürk
- Department of Dermatology; Okmeydani Training and Research Hospital; Istanbul Turkey
| | - K. Kulthanan
- Department of Dermatology; Faculty of Medicine Siriraj Hospital; Mahidol University; Bangkok Thailand
| | | | | | - M. Magerl
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
| | - P. Mathelier-Fusade
- Department of Dermatology and Allergy; University Hospital of Tenon; Paris France
| | - R. Y. Meshkova
- Department of Clinical Immunology and Allergy; Smolensk State Medical University; Smolensk Russia
| | - M. Metz
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
| | - A. Nast
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Division of Evidence Based Medicine; Department of Dermatology; Berlin Germany
| | - E. Nettis
- Scuola e Cattedra di Allergologia e Immunologia Clinica; Dipartimento dell'Emergenza e dei Trapianti d'Organo; Università di Bari; Bari Italy
| | | | - S. Rosumeck
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Division of Evidence Based Medicine; Department of Dermatology; Berlin Germany
| | - S. S. Saini
- Johns Hopkins Asthma and Allergy Center; Baltimore MD USA
| | - M. Sánchez-Borges
- Allergy and Clinical Immunology Department; Centro Médico-Docente La Trinidad; Caracas Venezuela
| | | | - P. Staubach
- Department of Dermatology; University Medical Center Mainz; Mainz Germany
| | - G. Sussman
- Division of Allergy and Clinical Immunology; University of Toronto; Toronto ON Canada
| | - E. Toubi
- Bnai-Zion Medical Center; Faculty of Medicine; Technion Haifa Israel
| | - G. A. Vena
- Dermatology and Venereology Private Practice; Bari and Barletta Italy
| | - C. Vestergaard
- Department of Dermatology and Venereology; Aarhus University Hospital; Aarhus Denmark
| | - B. Wedi
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - R. N. Werner
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Division of Evidence Based Medicine; Department of Dermatology; Berlin Germany
| | - Z. Zhao
- Department of Dermatology and Venereology; Peking University; First Hospital; Beijing China
| | - M. Maurer
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
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14
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Holm JG, Ivyanskiy I, Thomsen SF. Use of nonbiologic treatments in antihistamine-refractory chronic urticaria: a review of published evidence. J DERMATOL TREAT 2017; 29:80-97. [DOI: 10.1080/09546634.2017.1329505] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | - Ilya Ivyanskiy
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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15
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Bursztejn AC, Lipsker D. Delayed effort-induced swelling with myofasciitis and systemic manifestations: A so far unrecognized type of pressure-induced urticaria. Medicine (Baltimore) 2017; 96:e6112. [PMID: 28207531 PMCID: PMC5319520 DOI: 10.1097/md.0000000000006112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Diseases characterized by recurrent symptoms with prolonged intervals without any clinical manifestations can pose diagnostic difficulties. Some diagnoses will be obvious but other situations can be very challenging.To nosologically delineate a new entity characterized by recurrent flares of induration of the forearms and legs with swelling of the extremities accompanied by intense fatigue and variable other symptoms.Retrospective observational study of patients recorded from 2000 to 2015. All patients included were seen during a consultation at the Dermatology Department of the University Hospital of Strasbourg, France. We retrieved the medical records from patients seen and recorded over the last 16 years having induration of the extremities, the forearm and the legs occurring between 4 and 12 hours after a physical effort accompanied by systemic signs that lasted for a few days. We analyzed in detail the clinical and biological features, evolution, and treatments of these patients.We included 6 males, with a mean age of 47 years; mean age at disease onset was 42. All patients were initially misdiagnosed as having rheumatic disorders. The mean delay before diagnosis was 5 years. The main complaint was painful induration or muscle soreness of the forearms and the legs associated with transient functional impairment and prolonged asthenia for a mean duration of 3.5 days. Induration of the deep soft tissues was very suggestive of myofasciitis. The delay between the triggering physical effort and the swelling was between 6 and 12 hours. Physical effort as triggering factor was never spontaneously mentioned. Two patients had partial response to high dose antihistamines and 2 other patients to the interleukin-1 inhibitor anakinra. One patient responded to hydroxychloroquine.The very stereotypical presentation in those 6 patients suggests that this is a recognizable entity characterized by effort-induced induration of forearms and/or legs, due to deep edematous myofascial involvement, occurring a few hours after a physical effort. We suggest to name this entity delayed effort-induced swelling with myofasciitis and systemic manifestations.
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16
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Perez EE, Orange JS, Bonilla F, Chinen J, Chinn IK, Dorsey M, El-Gamal Y, Harville TO, Hossny E, Mazer B, Nelson R, Secord E, Jordan SC, Stiehm ER, Vo AA, Ballow M. Update on the use of immunoglobulin in human disease: A review of evidence. J Allergy Clin Immunol 2016; 139:S1-S46. [PMID: 28041678 DOI: 10.1016/j.jaci.2016.09.023] [Citation(s) in RCA: 371] [Impact Index Per Article: 46.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 09/12/2016] [Accepted: 09/23/2016] [Indexed: 12/20/2022]
Abstract
Human immunoglobulin preparations for intravenous or subcutaneous administration are the cornerstone of treatment in patients with primary immunodeficiency diseases affecting the humoral immune system. Intravenous preparations have a number of important uses in the treatment of other diseases in humans as well, some for which acceptable treatment alternatives do not exist. We provide an update of the evidence-based guideline on immunoglobulin therapy, last published in 2006. Given the potential risks and inherent scarcity of human immunoglobulin, careful consideration of its indications and administration is warranted.
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Affiliation(s)
- Elena E Perez
- Allergy Associates of the Palm Beaches, North Palm Beach, Fla.
| | - Jordan S Orange
- Department of Pediatrics, Section of Immunology Allergy and Rheumatology, Center for Human Immunobiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Tex
| | - Francisco Bonilla
- Department of Pediatrics, Clinical Immunology Program, Children's Hospital Boston and Harvard Medical School, Boston, Mass
| | - Javier Chinen
- Department of Pediatrics, Section of Immunology Allergy and Rheumatology, Center for Human Immunobiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Tex
| | - Ivan K Chinn
- Department of Pediatrics, Section of Immunology Allergy and Rheumatology, Center for Human Immunobiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Tex
| | - Morna Dorsey
- Department of Pediatrics, Allergy, Immunology and BMT Division, Benioff Children's Hospital and University of California, San Francisco, Calif
| | - Yehia El-Gamal
- Department of Pediatrics, Pediatric Allergy and Immunology Unit, Children's Hospital and Ain Shams University, Cairo, Egypt
| | - Terry O Harville
- Departments of Pathology and Laboratory Services and Pediatrics, University of Arkansas, Little Rock, Ark
| | - Elham Hossny
- Department of Pediatrics, Pediatric Allergy and Immunology Unit, Children's Hospital and Ain Shams University, Cairo, Egypt
| | - Bruce Mazer
- Department of Pediatrics, Allergy and Immunology, Montreal Children's Hospital and McGill University, Montreal, Quebec, Canada
| | - Robert Nelson
- Department of Medicine and Pediatrics, Division of Hematology and Oncology and Stem Cell Transplantation, Riley Hospital, Indiana University School of Medicine and the IU Melvin and Bren Simon Cancer Center, Indianapolis, Ind
| | - Elizabeth Secord
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, Mich
| | - Stanley C Jordan
- Nephrology & Transplant Immunology, Kidney Transplant Program, David Geffen School of Medicine at UCLA and Cedars-Sinai Medical Center, Los Angeles, Calif
| | - E Richard Stiehm
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, Calif
| | - Ashley A Vo
- Transplant Immunotherapy Program, Comprehensive Transplant Center, Kidney Transplant Program, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Mark Ballow
- Department of Pediatrics, Division of Allergy & Immunology, University of South Florida, Morsani College of Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Fla
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17
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Abstract
Chronic urticaria (CU) is defined as wheals, angioedema, or both, that last more than 6 weeks. Second-generation antihistamines are considered the first-line therapy for CU. Unfortunately, many patients will fail antihistamines and require alternative therapy, including immune response modifiers or biologics. Multiple biological agents have been evaluated for use in antihistamine-refractory CU, including omalizumab, rituximab, and intravenous immunoglobulin; omalizumab is the most efficacious. Because of the success of omalizumab, multiple new biologics that are directed at the IgE pathway are under investigation. This review summarizes the relevant data regarding the efficacy of biologics in antihistamine-refractory CU.
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Affiliation(s)
- Adeeb Bulkhi
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Tampa, FL, USA; Department of Internal Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Andrew J Cooke
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - Thomas B Casale
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Tampa, FL, USA.
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18
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Inducible urticaria: Case series and literature review. BIOMEDICA 2016; 36:10-21. [PMID: 27622434 DOI: 10.7705/biomedica.v36i1.2678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 06/23/2015] [Indexed: 12/13/2022]
Abstract
Inducible urticaria is a heterogeneous group of skin disorders characterized by the appearance of wheals, pruritus and/or angioedema, sometimes accompanied by systemic symptoms caused by innocuous stimuli (cold, heat, pressure, etc.). This group of disorders compromises people's quality of life and most of the literature in this regard comes from case reports and case series since its epidemiology has been poorly studied and some cases are very rare. The aim of this review is to show an up-to-date overview of the available literature for various types of inducible urticarias, always beginning with an illustrative case and then describing their pathophysiological mechanisms, clinical manifestations, and treatment.
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19
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Swerlick RA, Puar N. Delayed pressure urticaria: response to treatment with sulfasalazine in a case series of seventeen patients. Dermatol Ther 2015; 28:318-22. [DOI: 10.1111/dth.12266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Robert A. Swerlick
- Department of Dermatology; Emory University School of Medicine; Tagore Nagar Civil Lines
| | - Neha Puar
- Dayanand Medical College and Hospital; Tagore Nagar Civil Lines
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20
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Maurer M, Church M, Gonçalo M, Sussman G, Sánchez-Borges M. Management and treatment of chronic urticaria (CU). J Eur Acad Dermatol Venereol 2015; 29 Suppl 3:16-32. [DOI: 10.1111/jdv.13198] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 04/14/2015] [Indexed: 12/22/2022]
Affiliation(s)
- M. Maurer
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitatsmedizin Berlin; Berlin Germany
| | - M.K. Church
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitatsmedizin Berlin; Berlin Germany
| | - M. Gonçalo
- Clinic of Dermatology; University Hospital and Faculty of Medicine; University of Coimbra; Coimbra Portugal
| | - G. Sussman
- Division of Allergy and Clinical Immunology; St. Michael's Hospital and University of Toronto; Toronto ON Canada
| | - M. Sánchez-Borges
- Allergy and Clinical Immunology Department; Centro Médico-Docente La Trinidad; Caracas Venezuela
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21
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Severe and refractory solar urticaria treated with intravenous immunoglobulins: A phase II multicenter study. J Am Acad Dermatol 2014; 71:948-953.e1. [DOI: 10.1016/j.jaad.2014.07.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/07/2014] [Accepted: 07/14/2014] [Indexed: 11/22/2022]
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22
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Soria A, Francès C. Urticaires : diagnostic, prise en charge et traitement. Rev Med Interne 2014; 35:586-94. [DOI: 10.1016/j.revmed.2014.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 12/30/2013] [Accepted: 01/27/2014] [Indexed: 01/31/2023]
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Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, Church MK, Ensina LF, Giménez-Arnau A, Godse K, Gonçalo M, Grattan C, Hebert J, Hide M, Kaplan A, Kapp A, Abdul Latiff AH, Mathelier-Fusade P, Metz M, Nast A, Saini SS, Sánchez-Borges M, Schmid-Grendelmeier P, Simons FER, Staubach P, Sussman G, Toubi E, Vena GA, Wedi B, Zhu XJ, Maurer M. The EAACI/GA(2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy 2014; 69:868-87. [PMID: 24785199 DOI: 10.1111/all.12313] [Citation(s) in RCA: 668] [Impact Index Per Article: 66.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2013] [Indexed: 12/13/2022]
Abstract
This guideline is the result of a systematic literature review using the 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE) methodology and a structured consensus conference held on 28 and 29 November 2012, in Berlin. It is a joint initiative of the Dermatology Section of the European Academy of Allergy and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA(2) LEN), the European Dermatology Forum (EDF), and the World Allergy Organization (WAO) with the participation of delegates of 21 national and international societies. Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The life-time prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria do not only cause a decrease in quality of life, but also affect performance at work and school and, as such, are members of the group of severe allergic diseases. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS).
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Affiliation(s)
- T. Zuberbier
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - W. Aberer
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - R. Asero
- Allergy Clinic; Clinica San Carlo; Paderno Dugnano MI Italy
| | - C. Bindslev-Jensen
- Department of Dermatology and Allergy Centre; Odense University Hospital; University of Southern Denmark; Odense Denmark
| | - Z. Brzoza
- Department of Internal Diseases, Allergology and Clinical Immunology in Katowice; Medical University of Silesia; Zabrze Poland
| | - G. W. Canonica
- Respiratory Diseases & Allergy; University of Genoa; IRCCS AOU SanMartino; Genoa Italy
| | - M. K. Church
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - L. F. Ensina
- Department of Clinical Immunology and Allergy; Federal University of Sao Paulo; Sao Paulo Brazil
| | - A. Giménez-Arnau
- Hospital del Mar. Parc de Salut Mar; Universitat Autònoma Barcelona; Barcelona Spain
| | - K. Godse
- Department of Dermatology; Dr. D. Y. Patil Medical College & Hospital; Nerul Navi Mumbai India
| | - M. Gonçalo
- Clinic of Dermatology; Faculty of Medicine and University Hospital; Coimbra Portugal
| | - C. Grattan
- St John's Institute of Dermatology; Guy's and St Thomas' Hospitals NHS Foundation Trust; London UK
| | - J. Hebert
- Center for Applied Research on Allergy Québec; Québec QC Canada
| | - M. Hide
- Department of Dermatology; Institute of Biomedical and Health Sciences; Hiroshima University; Hiroshima Japan
| | - A. Kaplan
- Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology; Department of Medicine; Medical University of South Carolina; Charleston SC USA
| | - A. Kapp
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - A. H. Abdul Latiff
- Department of Paediatrics; Pantai Hospital Kuala Lumpur; Bangsar Kuala Lumpur Malaysia
| | - P. Mathelier-Fusade
- Department of Dermatology and Allergy; University Hospital of Tenon; Paris France
| | - M. Metz
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - A. Nast
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - S. S. Saini
- Johns Hopkins Asthma and Allergy Center; Baltimore MD USA
| | - M. Sánchez-Borges
- Allergy and Clinical Immunology Department Centro Médico-Docente La Trinidad; Caracas Venezuela
| | | | - F. E. R. Simons
- Departments of Pediatrics & Child Health, Immunology; University of Manitoba; Winnipeg MB Canada
| | - P. Staubach
- Department of Dermatology; University Medical Center Mainz; Mainz Germany
| | - G. Sussman
- Division of Allergy and Clinical Immunology; University of Toronto; Toronto ON Canada
| | - E. Toubi
- Bnai-Zion Medical Center; Faculty of Medicine; Technion; Haifa Israel
| | - G. A. Vena
- Unit of Dermatology and Venereology; Department of Biomedical Sciences and Human Oncology; University of Bari; Bari Italy
| | - B. Wedi
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - X. J. Zhu
- Department of Dermatology; Peking University First Hospital; Beijing China
| | - M. Maurer
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
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Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F, Sheikh J, Weldon D, Zuraw B, Bernstein DI, Blessing-Moore J, Cox L, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph CR, Schuller DE, Spector SL, Tilles SA, Wallace D. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol 2014; 133:1270-7. [DOI: 10.1016/j.jaci.2014.02.036] [Citation(s) in RCA: 320] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 02/10/2014] [Accepted: 02/12/2014] [Indexed: 12/13/2022]
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Contemporary approaches to the diagnosis and management of physical urticaria. Ann Allergy Asthma Immunol 2013; 111:235-41. [PMID: 24054356 DOI: 10.1016/j.anai.2013.07.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/08/2013] [Accepted: 07/26/2013] [Indexed: 11/22/2022]
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Sánchez-Borges M, Asero R, Ansotegui IJ, Baiardini I, Bernstein JA, Canonica GW, Gower R, Kahn DA, Kaplan AP, Katelaris C, Maurer M, Park HS, Potter P, Saini S, Tassinari P, Tedeschi A, Ye YM, Zuberbier T. Diagnosis and treatment of urticaria and angioedema: a worldwide perspective. World Allergy Organ J 2012; 5:125-47. [PMID: 23282382 PMCID: PMC3651155 DOI: 10.1097/wox.0b013e3182758d6c] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
: Urticaria and angioedema are common clinical conditions representing a major concern for physicians and patients alike. The World Allergy Organization (WAO), recognizing the importance of these diseases, has contributed to previous guidelines for the diagnosis and management of urticaria. The Scientific and Clinical Issues Council of WAO proposed the development of this global Position Paper to further enhance the clinical management of these disorders through the participation of renowned experts from all WAO regions of the world. Sections on definition and classification, prevalence, etiology and pathogenesis, diagnosis, treatment, and prognosis are based on the best scientific evidence presently available. Additional sections devoted to urticaria and angioedema in children and pregnant women, quality of life and patient-reported outcomes, and physical urticarias have been incorporated into this document. It is expected that this article will supplement recent international guidelines with the contribution of an expert panel designated by the WAO, increasing awareness of the importance of urticaria and angioedema in medical practice and will become a useful source of information for optimum patient management worldwide.
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Affiliation(s)
- Mario Sánchez-Borges
- Department of Allergy and Clinical Immunology, Centro Médico-Docente La Trinidad, Caracas, Venezuela
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno-Dugnano, Milan, Italy
| | - Ignacio J Ansotegui
- Department of Allergy and Immunology, Hospital Quirón Bizkaia, Bilbao, Spain
| | - Ilaria Baiardini
- Allergy and Respiratory Disease Clinic, University of Genova, Ospedale S.Martino di Genova, Genoa, Italy
| | - Jonathan A Bernstein
- Department of Internal Medicine, Division of Immunology/Allergy Section University of Cincinnati, Cincinnati, OH
| | - G Walter Canonica
- Allergy and Respiratory Disease Clinic, University of Genova, Ospedale S.Martino di Genova, Genoa, Italy
| | - Richard Gower
- Department of Medicine, University of Washington, Spokane, WA
| | - David A Kahn
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Allen P Kaplan
- Division of Pulmonary and Critical Care Medicine and Allergy and Immunology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Connie Katelaris
- Department of Allergy and Immunology, University of Western Sydney and Campbelltown Hospital, Sydney, Australia
| | - Marcus Maurer
- Universitätsmedizin Berlin. Allergie-Centrum-Charité, Berlin, Germany
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - Paul Potter
- Allergy Diagnostic & Clinical Research Unit, University of Cape Town Lung Institute, Groote Schuur, South Africa
| | - Sarbjit Saini
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Paolo Tassinari
- Immunology Institute, Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela
| | - Alberto Tedeschi
- U.O. Allergologia e Immunologia Clinica, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Young Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - Torsten Zuberbier
- Universitätsmedizin Berlin. Allergie-Centrum-Charité, Berlin, Germany
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Adamski H, Viguier M. L’urticaire solaire. Ann Dermatol Venereol 2012; 139:324-8; quiz 323, 330. [DOI: 10.1016/j.annder.2012.01.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 01/19/2012] [Accepted: 01/31/2012] [Indexed: 11/29/2022]
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Adamski H, Bedane C, Bonnevalle A, Thomas P, Peyron JL, Rouchouse B, Cambazard F, Jeanmougin M, Viguier M. Solar urticaria treated with intravenous immunoglobulins. J Am Acad Dermatol 2011; 65:336-340. [DOI: 10.1016/j.jaad.2010.05.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 05/11/2010] [Accepted: 05/20/2010] [Indexed: 11/15/2022]
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Grundmann SA, Kiefer S, Luger TA, Brehler R. Delayed pressure urticaria - dapsone heading for first-line therapy? J Dtsch Dermatol Ges 2011; 9:908-12. [PMID: 21771275 DOI: 10.1111/j.1610-0387.2011.07749.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pressure urticaria as a subform of physical urticaria is rare and treatment is often difficult. Established therapeutic regimes include antihistamines (generally exceeding approved dosages in order to achieve a therapeutic benefit) or antihistamines combined with montelukast. Complete relief of symptoms is difficult. PATIENTS AND METHODS We used dapsone as an early therapeutic alternative in the event of treatment failure and established a standardized therapeutic regime at our clinic. We surveyed 31 patients retrospectively who had received dapsone between 2003-2009. RESULTS In 74 % of patients in whom symptoms persisted despite established therapies, the results of treatment with dapsone were good or very good. Longer-term pressure urticaria and the co-existence of a chronic spontaneous urticaria were associated with a smaller benefit (p<0.05). No significant effects were found related to age, gender, duration of therapy, side-effects, or Met-Hb elevation (a tendency toward a decreased benefit was associated with middle-age, male sex, shorter duration of therapy, observed side-effects, and Met-Hb elevation). CONCLUSIONS Therapy is well tolerated and results in a good therapeutic benefit which lasts after termination of therapy. With adequate monitoring, the use of dapsone in patients with pressure urticaria has such a good risk-benefit ratio that we support early treatment initiation.
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Kivity S, Katz U, Daniel N, Nussinovitch U, Papageorgiou N, Shoenfeld Y. Evidence for the use of intravenous immunoglobulins--a review of the literature. Clin Rev Allergy Immunol 2010; 38:201-69. [PMID: 19590986 PMCID: PMC7101816 DOI: 10.1007/s12016-009-8155-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Intravenous immunoglobulins (IVIg) were first introduced in the middle of the twentieth century for the treatment of primary immunodeficiencies. In 1981, Paul Imbach noticed an improvement of immune-mediated thrombocytopenia, in patients receiving IVIg for immunodeficiencies. This opened a new era for the treatment of autoimmune conditions with IVIg. Since then, IVIg has become an important treatment option in a wide spectrum of diseases, including autoimmune and acute inflammatory conditions, most of them off-label (not included in the US Food and Drug Administration recommendation). A panel of immunologists and internists with experience in IVIg therapy reviewed the medical literature for published data concerning treatment with IVIg. The quality of evidence was assessed, and a summary of the available relevant literature in each disease was given. To our knowledge, this is the first all-inclusive comprehensive review, developed to assist the clinician when considering the use of IVIg in autoimmune diseases, immune deficiencies, and other conditions.
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Affiliation(s)
- Shaye Kivity
- Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
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Effect of high-dose intravenous immunoglobulin treatment in therapy-resistant chronic spontaneous urticaria. Ann Allergy Asthma Immunol 2010; 104:253-8. [PMID: 20377115 DOI: 10.1016/j.anai.2009.12.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) lasting more than 6 weeks is one of the most disabling types of urticaria and often results in severely impaired quality of life. Patients with CSU are often unsatisfied with the standard treatment. Another treatment option recommended for patients with so-called nonresponding CSU according to the newest guidelines is intravenous immunoglobulin (IVIG). OBJECTIVE To assess the efficacy and safety of high-dose IVIG as a treatment option in patients with therapy-resistant CSU. METHODS Six patients with severe CSU unresponsive to other treatment options according to the newest guidelines for several weeks were treated with high-dose IVIG (2 g/kg every 4-6 weeks). The response to treatment was observed on the basis of clinical signs and reduction of co-medications using a special treatment score. Patients were studied during the treatment period and were followed up for an average of 16 months. Adverse events were assessed. RESULTS Patients showed an improvement in symptoms and a reduction in co-medication use just after the first cycle. Symptoms such as itching, wheals, and edema were reduced after the first or second cycle of IVIG treatment. Four of 6 patients had complete remission after 2 to 4 cycles. One patient needed a longer continuation of treatment to reach a stable state of improvement, and another patient had a slight relapse after the seventh cycle. Adverse effects, such as headache and increased blood pressure, were observed only at the beginning of treatment. CONCLUSION High-dose IVIG represents an important therapeutic option in patients with severe CSU.
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Dortas Jr SD, Valle SOR, Pires AHS, Guimarães PV, Jorge AS. Urticária de pressão tardia com manifestações sistêmicas: relato de caso. An Bras Dermatol 2009; 84:671-4. [PMID: 20191182 DOI: 10.1590/s0365-05962009000600016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Accepted: 07/01/2009] [Indexed: 11/21/2022] Open
Abstract
A Urticária de Pressão Tardia é considerada uma doença rara, cujo quadro clínico é diferente da urticária clássica e pode envolver manifestações sistêmicas. Sendo assim,o diagnóstico é pouco frequente, até mesmo pelos especialistas. Neste artigo, apresentamos uma paciente, com história típica de lesões desencadeadas por pressão e que, por apresentar febre e leucocitose, foi internada para investigação de quadro infeccioso.
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Zuberbier T, Asero R, Bindslev‐Jensen C, Walter Canonica G, Church MK, Giménez‐Arnau AM, Grattan CEH, Kapp A, Maurer M, Merk HF, Rogala B, Saini S, Sánchez‐Borges M, Schmid‐Grendelmeier P, Schünemann H, Staubach P, Vena GA, Wedi B. EAACI/GA(2)LEN/EDF/WAO guideline: management of urticaria. Allergy 2009; 64:1427-1443. [PMID: 19772513 DOI: 10.1111/j.1398-9995.2009.02178.x] [Citation(s) in RCA: 359] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This guideline, together with its sister guideline on the classification of urticaria (Zuberbier T, Asero R, Bindslev-Jensen C, Canonica GW, Church MK, Giménez-Arnau AM et al. EAACI/GA(2)LEN/EDF/WAO Guideline: definition, classification and diagnosis of urticaria. Allergy 2009;64: 1417-1426), is the result of a consensus reached during a panel discussion at the Third International Consensus Meeting on Urticaria, Urticaria 2008, a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA(2)LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO). As members of the panel, the authors had prepared their suggestions regarding management of urticaria before the meeting. The draft of the guideline took into account all available evidence in the literature (including Medline and Embase searches and hand searches of abstracts at international allergy congresses in 2004-2008) and was based on the existing consensus reports of the first and the second symposia in 2000 and 2004. These suggestions were then discussed in detail among the panel members and with the over 200 international specialists of the meeting to achieve a consensus using a simple voting system where appropriate. Urticaria has a profound impact on the quality of life and effective treatment is, therefore, required. The recommended first line treatment is new generation, nonsedating H(1)-antihistamines. If standard dosing is not effective, increasing the dosage up to four-fold is recommended. For patients who do not respond to a four-fold increase in dosage of nonsedating H(1)-antihistamines, it is recommended that second-line therapies should be added to the antihistamine treatment. In the choice of second-line treatment, both their costs and risk/benefit profiles are most important to consider. Corticosteroids are not recommended for long-term treatment due to their unavoidable severe adverse effects. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS).
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Affiliation(s)
- T. Zuberbier
- Department of Dermatology and Allergy, Charité– Universitätsmedizin Berlin, Berlin, Germany
| | - R. Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano (MI), Italy
| | - C. Bindslev‐Jensen
- Allergy Centre, Department of Dermatology, Odense University Hospital, Odense Area, Denmark
| | - G. Walter Canonica
- Allergy and Respiratory Diseases, DIMI – University of Genoa, Genoa, Italy
| | - M. K. Church
- Department of Dermatology and Allergy, Charité– Universitätsmedizin Berlin, Berlin, Germany
| | - A. M. Giménez‐Arnau
- Department of Dermatology, Hospital del Mar, IMAS, Universitat Autònoma of Barcelona, Barcelona, Spain
| | - C. E. H. Grattan
- Dermatology Centre, Norfolk & Norwich University Hospital, Norwich, UK
| | - A. Kapp
- Department of Dermatology and Allergology, Hannover Medical University, Hannover, Germany
| | - M. Maurer
- Department of Dermatology and Allergy, Charité– Universitätsmedizin Berlin, Berlin, Germany
| | - H. F. Merk
- Department of Dermatology, University Hospital RWTH Aachen, Aachen, Germany
| | - B. Rogala
- Clinical Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, Poland
| | - S. Saini
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - M. Sánchez‐Borges
- Allergy and Immunology Department, Centro Medico‐Docente La Trinidad, Caracas, Venezuela
| | | | - H. Schünemann
- Department of Clinical Epidemiology & Biostatistics, Hamilton, Canada
| | - P. Staubach
- Department of Clinical Epidemiology & Biostatistics, Hamilton, Canada
| | - G. A. Vena
- Department of Dermatology, Johannes Gutenberg‐University Mainz, Mainz, Germany
| | - B. Wedi
- Department of Dermatology and Allergology, Hannover Medical University, Hannover, Germany
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Zamiri M, Jury CS, Dawe RS, O'Neill S, Douglas WS. Reactivity to autologous serum skin test and relationship with complement levels in chronic idiopathic urticaria and angio-oedema. Clin Exp Dermatol 2008; 34:587-90. [PMID: 19094131 DOI: 10.1111/j.1365-2230.2008.03032.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND A role for complement in autoantibody-mediated histamine release in urticaria has been suggested but not proven in vivo. Aim. To study serum complement levels in patients with chronic idiopathic urticaria (CIU) and to determine whether there was a relationship with autologous serum skin test (ASST) reactivity. METHODS We recruited 35 patients with CIU. Complement (C3, C4) levels and ASST were measured in all patients; additional investigations were undertaken dependent on history and examination. RESULTS Complement concentrations were outside the population reference intervals in 19/35 patients, with low C3 noted in 3/35 and low C4 in 18/35. Of 12 patients with a positive ASST, 7 had low complement levels, and 12/23 with a negative ASST had low complement levels. Patients with a positive ASST had a median C3 of 1.24 g/L (range 0.35-1.51) compared with a median of 1.25 g/L in those with a negative ASST (P = 0.36), and a median C4 of 0.20 g/L (range 0.185-0.452) in those with a positive ASST compared with 0.18 g/L in those with a negative ASST (P = 0.88). CONCLUSIONS We conclude that both a reduction in C4 and positive ASST are common in CIU and although these immunological abnormalities often coexist, there is no clear relationship between them. Other components of the complement system may be worth exploring.
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Affiliation(s)
- M Zamiri
- Dermatology, Monklands Hospital, Airdrie, UK.
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Morgan M, Khan DA. Therapeutic alternatives for chronic urticaria: an evidence-based review, Part 2. Ann Allergy Asthma Immunol 2008; 100:517-26; quiz 526-8, 544. [PMID: 18592813 DOI: 10.1016/s1081-1206(10)60047-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the use of alternative therapies for chronic urticaria refractory to first-line treatments in an evidence-based manner. DATA SOURCES MEDLINE searches were performed cross-referencing urticaria with the names of multiple therapies. Articles were then reviewed for additional citations. Articles published after 1950 were considered. STUDY SELECTION All articles, including case reports, were reviewed for soundness and relevance. RESULTS Experience has been reported for a wide variety of alternative therapies in the treatment of chronic idiopathic and physical urticarias. Evidence for most agents is limited to anecdotal reports. The therapies reviewed are also categorized based on criteria of safety, efficacy, convenience, and cost. The less preferred alternative agents in the second part of this review are divided between third-line therapies and others that are unable to be firmly recommended or that seem promising but lack substantial evidence. CONCLUSIONS Third-line alternative agents should be considered in patients with chronic urticaria who are severely affected and unresponsive to antihistamines and second-line therapies. Although monitoring for toxicity is important in management with third-line agents, safety remains favorable for most agents compared with corticosteroids.
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Affiliation(s)
- Matt Morgan
- Division of Allergy and Immunology, University of Texas Southwestern, Dallas, Texas 75390-8859, USA
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Abstract
The intravenous administration of exogenous pooled human immunoglobulin (i.v. IG) was originally licensed as antibody replacement therapy in patients with primary immunodeficiencies and there are currently six FDA-approved uses for this agent. Despite a current lack of FDA approval, off-label treatment of a multitude of dermatologic disorders with i.v. IG has shown exciting potential for this unique treatment modality. The diseases successfully treated with i.v. IG include autoimmune bullous diseases, connective tissue diseases, vasculitides, toxic epidermal necrolysis, and infectious disorders (such as streptococcal toxic shock syndrome). Currently the biggest drawback in the consideration of i.v. IG therapy in dermatologic disorders is the lack of randomized controlled trials. Nevertheless, there is a significant body of evidence demonstrating the efficacy of i.v. IG in patients with dermatologic disorders that are resistant to treatment with standard agents. In summary, i.v. IG constitutes a valuable and potentially life-saving agent in managing patients with a variety of dermatologic disorders under the appropriate circumstances.
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Affiliation(s)
- Anthony P Fernandez
- Department of Dermatology and Cutaneous Surgery, Unversity of Miami Miller School of Medicine, Miami, Florida, USA
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Nettis E, Colanardi MC, Soccio AL, Ferrannini A, Vacca A. Desloratadine in combination with montelukast suppresses the dermographometer challenge test papule, and is effective in the treatment of delayed pressure urticaria: a randomized, double-blind, placebo-controlled study. Br J Dermatol 2007; 155:1279-82. [PMID: 17107402 DOI: 10.1111/j.1365-2133.2006.07533.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Delayed pressure urticaria (DPU) comes under the heading of physical urticaria. Characteristically itchy, tender or painful weals occur at sites of local pressure including the waistband, soles of the feet and palms of the hands. Lesion onset is typically 3-12 h after the application of pressure, and lesions may persist for more than 24 h. The treatment of DPU is often unsatisfactory. OBJECTIVES To determine the efficacy of desloratadine and montelukast in the treatment of DPU. METHODS The study was conducted in 36 subjects affected by DPU. A challenge test with a dermographometer was administered to confirm the diagnosis. After diagnosis, patients were randomized to receive the following treatment once daily for 2 weeks: (i) oral desloratadine 5 mg plus oral placebo; (ii) oral desloratadine 5 mg plus montelukast 10 mg; and (iii) oral placebo alone. RESULTS At rechallenge, patients from the treatment groups (desloratadine plus montelukast group and desloratadine alone group) demonstrated a significant reduction in mean diameter of papules after 70 s of pressure compared with the placebo group (P < 0.05). Moreover, patients treated with desloratadine plus montelukast showed a significant reduction in mean diameter of papules at 70 s of pressure compared with those treated with desloratadine alone (P < 0.05). In addition, the combination was effective in improving clinical parameters (erythema, oedema and pruritus, and number of separate urticarial episodes). CONCLUSIONS This study has demonstrated that both desloratadine alone and desloratadine plus montelukast administered once daily yield improvements with respect to the baseline assessment, regarding the suppression of the dermographometer challenge test papule and clinical improvement of urticaria. However, the combination of desloratadine and montelukast was shown to be more efficacious and may therefore be proposed in patients with DPU, in order to avoid corticosteroid therapy.
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Affiliation(s)
- E Nettis
- Department of Medical Clinic, Immunology and Infectious Diseases, Division of Allergy and Clinical Immunology, University of Bari Medical School, Bari, Italy.
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Mydlarski PR, Ho V, Shear NH. Canadian consensus statement on the use of intravenous immunoglobulin therapy in dermatology. J Cutan Med Surg 2007; 10:205-21. [PMID: 17234104 DOI: 10.2310/7750.2006.00048] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND As a safe, well-tolerated, and potentially beneficial therapy, intravenous immunoglobulin (IVIG) has been increasingly used by dermatologists to treat immune-mediated skin disease. However, practical and comprehensive guidelines for the use of IVIG have yet to be established. OBJECTIVE To develop the first Canadian consensus statement on the use of IVIG therapy in skin disease. METHODS A group of Canadian dermatologists convened to discuss current issues in IVIG therapy. The participants reviewed and evaluated the literature and shared clinical experience. Using a modified Delphi process, a consensus statement was developed. RESULTS Herein we provide a brief overview of pemphigus vulgaris, pemphigus foliaceus, bullous pemphigoid, mucous membrane pemphigoid, epidermolysis bullosa acquisita, Stevens-Johnson syndrome, and toxic epidermal necrolysis. Recommendations for the management of these diseases are detailed, and therapeutic algorithms for the treatment of various autoimmune mucocutaneous blistering diseases are presented. The appropriate use of IVIG therapy is placed in context for each disease. CONCLUSION Although preliminary data suggest that IVIG is a safe and effective therapy for many skin disorders, uncontrolled clinical trials, case series, and anecdotal case reports dominate the literature. Collaborative randomized controlled trials are required to firmly establish the role of IVIG in dermatology.
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Affiliation(s)
- P Régine Mydlarski
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Canada.
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Smith DI, Swamy PM, Heffernan MP. Off-label uses of biologics in dermatology: Interferon and intravenous immunoglobulin (Part 1 of 2). J Am Acad Dermatol 2007; 56:e1-54. [PMID: 17190617 DOI: 10.1016/j.jaad.2006.06.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2005] [Revised: 05/04/2006] [Accepted: 06/19/2006] [Indexed: 11/29/2022]
Abstract
The introduction of a number of biologic therapies into the market has revolutionized the practice of dermatology. These therapies include interferons, intravenous immunoglobulin, infliximab, adalimumab, etanercept, efalizumab, alefacept, and rituximab. Most dermatologists are familiar with the Food and Drug Administration-approved indications of these medications. However, numerous off-label uses have evolved. As part 1 of a 2-part series, this article will review the literature regarding the off-label uses of the interferons and intravenous immunoglobulin in dermatology.
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Kerns MJJ, Graves JE, Smith DI, Heffernan MP. Off-Label Uses of Biologic Agents in Dermatology: A 2006 Update. ACTA ACUST UNITED AC 2006; 25:226-40. [PMID: 17174843 DOI: 10.1016/j.sder.2006.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The introduction of a number of biologic therapies into the market has revolutionized the practice of dermatology. These therapies include adalimumab, alefacept, efalizumab, etanercept, infliximab, IVIg, omalizumab, and rituximab. Most dermatologists are familiar with the indications of these medications that have been approved by the Food and Drug Administration; however, numerous off-label uses have evolved. To update the reader on more recent uses of the biologics for off-label dermatologic use, this article will emphasize more recent published data from 2005 through the date of submission in May 2006.
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Jolles S, Hughes J. Use of IGIV in the treatment of atopic dermatitis, urticaria, scleromyxedema, pyoderma gangrenosum, psoriasis, and pretibial myxedema. Int Immunopharmacol 2005; 6:579-91. [PMID: 16504920 DOI: 10.1016/j.intimp.2005.11.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There has been a rapid expansion in the use of IGIV for an ever-growing number of conditions. It is a product with an excellent safety record without the side effects of steroids or other immunosuppressive agents. There have been numerous recent advances in our understanding of the mechanisms of action of IGIV in many of the conditions for which it is being used, but there is still much to be learned. IGIV has had a major impact in neurology, haematology, immunology, rheumatology and dermatology. The limitations for IGIV are cost of the preparation itself and the logistical problems associated with its administration. Here we describe the published evidence for the use of high-dose IGIV in the dermatological conditions atopic dermatitis, urticaria, scleromyxedema, pyoderma gangrenosum, psoriasis and pretibial myxedema. These conditions have an emerging evidence base for hdIGIV which is relatively small consisting mainly of case reports and small case series. The outcomes in a number of these conditions appear encouraging, but as the reports are likely to reflect a bias for positive results, one must be cautious about drawing firm conclusions.
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Affiliation(s)
- Stephen Jolles
- National Institute for Medical Research, Mill Hill, London and University Hospital of Wales, Cardiff, UK.
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Kerstan A, Rose C, Simon D, Simon HU, Bröcker EB, Trautmann A, Leverkus M. Bullous delayed pressure urticaria: pathogenic role for eosinophilic granulocytes? Br J Dermatol 2005; 153:435-9. [PMID: 16086763 DOI: 10.1111/j.1365-2133.2005.06677.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Bullous delayed pressure urticaria (DPU) is a rare variant of DPU. Treatment of DPU is difficult and the underlying pathogenic mechanism of DPU remains elusive. We report a 72-year-old man with DPU and associated chronic urticaria as well as delayed urticarial dermographism. Pressure challenge gave rise to a deep weal covered by multiple vesicles and bullae after 24 h. Histological examination of a skin biopsy specimen obtained 24 h after pressure challenge demonstrated intraepidermal bullae filled with eosinophils accompanied by a dense, predominantly eosinophilic infiltrate in the dermis. Whereas the numbers and morphology of mast cells were unaltered, the extracellular deposition of eosinophil cationic protein revealed evidence for eosinophil activation. Concomitantly, both CD4+ and CD8+ T lymphocytes were present in the infiltrate and expressed interleukin 5. As bullous DPU may represent the maximal variant of DPU, the investigation of the cellular infiltrate and the chemokines/cytokines released may reveal potential pathogenic mechanisms. A possible effector role of eosinophilic granulocytes, T-cell subsets and mast cells is discussed.
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Affiliation(s)
- A Kerstan
- Department of Dermatology Venerology and Allerology, University of Würzburg, Germany
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