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Bernstein JA, Apfelbacher C, Chu DK, Schneider L, Saini SS, Ben Shoshan M. Patient-Reported Outcome Measures in Chronic Spontaneous Urticaria, Angioedema, and Atopic Dermatitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00840-7. [PMID: 39168302 DOI: 10.1016/j.jaip.2024.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 08/05/2024] [Accepted: 08/08/2024] [Indexed: 08/23/2024]
Abstract
Reducing the burden of disease for patients and families requires being able to measure health status changes related to disease severity, control, and response to treatment over time. Patient-reported outcomes are patient perceptions of their health status. Such perceptions are critical to decision making. Some patient-reported outcome measures (PROMs) are extensive and often intended to be used only for detailed research assessments. Many PROMs, however, form critical components of valid, reliable, and responsive assessments in clinical research and routine clinical practice. The smallest score change in a PROM that would lead to different decision making by patients is called the minimally important difference. Using PROMs may also offer advantages over general questions or unvalidated tools. With the innovation of technology, the ability to chronicle disease symptoms using communication technology (mobile phone applications) has become increasingly available. Collection of real-world data in this capacity will be very useful for identifying more precise phenotypes/endotypes necessary for investigation of tailored therapies for chronic spontaneous and inducible urticaria, angioedema, and atopic dermatitis. Here, we provide an overview of PROMs that have been developed for the assessment of disease severity, control, and quality of life and that have been validated for the use of adults and children with these skin disorders.
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Affiliation(s)
- Jonathan A Bernstein
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio.
| | - Chistian Apfelbacher
- Otto-von-Guericke-Universität Magdeburg, Institute of Social Medicine and Health Systems Research (ISMHSR), Magdeburg, Germany
| | - Derek K Chu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; The Research Institute of St. Joe's Hamilton, Hamilton, Ontario, Canada
| | - Lynda Schneider
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Sarbjit S Saini
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Moshe Ben Shoshan
- Division of Pediatric Allergy, Clinical Immunology and Dermatology, Department of Pediatrics, McGill University Health Center, Montreal Children's Hospital, Montreal, Quebec, Canada
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2
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Mak HW, Lee E, Wong JC, Weller K, Maurer M, Li PH. Validity, reliability, and sensitivity to change of the traditional Chinese Urticaria Control Test (UCT) in Hong Kong. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100290. [PMID: 39040655 PMCID: PMC11261091 DOI: 10.1016/j.jacig.2024.100290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/06/2024] [Accepted: 03/05/2024] [Indexed: 07/24/2024]
Abstract
Background Uncontrolled chronic urticaria (CU) can severely affect physical and psychosocial health as well as quality of life. Patient-reported outcome measures are crucial for measuring disease control. The Urticaria Control Test (UCT) is recommended by guidelines to monitor CU and guide clinical management. However, the traditional Chinese version of the UCT has not yet been validated. Objective We sought to validate the traditional Chinese UCT among Chinese CU patients in Hong Kong. Methods Patients with CU were enrolled at a Urticaria Centre of Reference and Excellence (aka UCARE) in Hong Kong and completed the traditional Chinese UCT. The internal consistency, test-retest reliability, construct validity, convergent validity, known-group validity, and sensitivity to change of the traditional Chinese UCT were evaluated. Results We recruited 162 CU patients (80.9% female; age 50 ± 14 years) with a mean (median) ± standard deviation baseline UCT score of 8.8 (8) ± 4.7. Overall, Chinese UCT showed excellent internal consistency (Cronbach α and McDonald ω = 0.948), as well as test-retest reliability (intraclass correlation coefficient = 0.916 [95% confidence interval = 0.866-0.953]). Exploratory factor analysis revealed a unidimensional structure and confirmed its construct validity. Strong correlation between UCT and the 7-day urticaria activity score (UAS7) attested to its convergent validity (ρ = -0.699, P < .001). Its known-group validity was supported by significantly different UCT scores among patient subgroups with different disease activity. The Chinese UCT also demonstrated good sensitivity to change, as reflected by the significant correlation between changes in UCT and UAS7 scores (ρ = 0.491, P < .001). Conclusion The traditional Chinese UCT is a valid, reliable, and sensitive-to-change instrument among Hong Kong Chinese with CU.
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Affiliation(s)
- Hugo W.F. Mak
- Department of Medicine, Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Elaine Lee
- Department of Medicine, Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Jane C.Y. Wong
- Department of Medicine, Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Karsten Weller
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Philip H. Li
- Department of Medicine, Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
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Keller L, Stitt J. Chronic Spontaneous Urticaria: Quality of Life and Economic Impacts. Immunol Allergy Clin North Am 2024; 44:453-467. [PMID: 38937009 DOI: 10.1016/j.iac.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
This study focuses on quality of life (QoL) assessment in chronic urticaria, delving into tools, disease-specific measures, and its profound impact. With expanding therapeutic options, understanding QoL becomes crucial. QoL measures often involve comparisons of patient-reported outcomes in addition to quantitative measures of disease control. Emerging tools include the Urticaria Activity and Impact Measure, which may provide a balanced evaluation. In addition to discussions of the various QoL measures, the psychological impact of chronic urticaria are highlighted, covering emotional burden, stress, and psychiatric comorbidities. Finally, the economic impacts reveal escalating health care costs and cost-effectiveness considerations of therapies like omalizumab.
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Affiliation(s)
- Levi Keller
- Division of Allergy and Clinical Immunology, University of Colorado School of Medicine, 12700 East 19th Avenue 10C03, Aurora, CO 80045, USA.
| | - Jenny Stitt
- Division of Allergy and Clinical Immunology, University of Colorado School of Medicine, 12700 East 19th Avenue 10C03, Aurora, CO 80045, USA
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Bi J, Liu L, Fan Z, Qu S, Yang J, Xu C, Cui B. Efficacy and Mechanism of Acupoint Catgut Embedding in the Treatment of Chronic Spontaneous Urticaria: Protocol for a Randomized Double-Blind Placebo-Controlled Trial. JMIR Res Protoc 2024; 13:e54376. [PMID: 39083341 PMCID: PMC11325124 DOI: 10.2196/54376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/28/2024] [Accepted: 06/13/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is a common chronic inflammatory skin disease that manifests as itching and wheals, seriously affecting quality of life. Clinical observations and previous research trials have shown that acupuncture is safe and effective for the treatment of CSU. However, there are problems, such as a short duration of action and frequent treatment. Compared with traditional acupuncture, acupoint catgut embedding (ACE) has the advantages of a longer effect and higher compliance. Clinical trials are needed to prove its efficacy and mechanism of action. OBJECTIVE This trial aims to provide definitive evidence for the treatment of CSU with ACE and explore the mechanism of ACE. METHODS This is a randomized, double-blind, placebo-controlled trial. In this trial, 108 participants aged 18-60 years with a diagnosis of CSU and no history of ACE will be randomly assigned to 2 groups (1:1 ratio) using the Statistical Analysis System: treatment (ACE) and control (sham ACE). The participants and efficacy evaluators will be blinded to the grouping. Both the ACE and sham ACE groups will undergo acupuncture, but the sham ACE group will not receive catgut sutures. Treatment will be performed twice weekly for 8 weeks, with a 1-week run-in period and a 16-week follow-up period. Twenty patients will be randomly selected to undergo functional magnetic resonance imaging before and after the treatment period. The primary outcome will be the urticaria activity score over 7 days (UAS7). We will use R (version 4.0.1; R Project for Statistical Computing) to perform ANOVA and independent samples t tests to compare the differences within and between groups before and after treatment by judging the rejection range based on a significance level of .05. RESULTS The study protocol has been approved by the Ethics Committee of Guang'anmen Hospital on September 7, 2022, and has been registered on November 30, 2022. Recruitment began on March 1, 2023. A total of 4-6 participants are expected to be recruited each month. The recruitment is planned to be completed on March 1, 2025, and we expect to publish our results by the winter of 2025. As of November 1, 2023, we have enrolled 25 participants with CSU. CONCLUSIONS This randomized, double-blind, placebo-controlled trial aims to provide definitive evidence for the treatment of CSU with ACE and explore the mechanism of ACE. We hypothesize that wheals and itching will show greater improvement in participants receiving active therapy than in those receiving sham treatment. The limitations of this study include its single-center trial design, small sample size, and short treatment duration, which may have certain impacts on the research results. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2200066274; https://www.chictr.org.cn/showprojEN.html?proj=179056. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54376.
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Affiliation(s)
- Jianing Bi
- Beijing University of Chinese Medicine, Beijing, China
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Li Liu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhu Fan
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shengyuan Qu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiao Yang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chenchen Xu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Bingnan Cui
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Gultuna S, Basa Akdogan B, Gonul M, Aydin FN, Unal S, Erkek GN, Ozalp Ates FS, Yuceege MB, Ozdemir SAO. Sleep quality in patients with chronic spontaneous urticaria and relation with Orexin-A, leptin, and ghrelin. Allergy Asthma Proc 2024; 45:e38-e45. [PMID: 38982607 DOI: 10.2500/aap.2024.45.240023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Background: Sleep can be affected in patients with chronic spontaneous urticaria (CSU). The mechanisms of sleep regulation remain poorly understood. Orexin-A, a neuroexcitatory peptide, plays a role in coordinating sleep-wake states. Ghrelin and leptin are involved in sleep regulation through the orexin system. Objective: The effects of orexin-A, ghrelin, and leptin on sleep quality in patients with CSU have not been investigated. We aimed to determine the effects of CSU on sleep quality and the association between serum orexin-A, ghrelin, and leptin levels, and sleep quality in patients with CSU. Methods: Thirty-three patients with CSU and 34 sex- and age-matched controls were included in the study. Serum orexin-A, leptin, and ghrelin levels, and the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) scores were measured in patients with CSU and in the controls; also used were the chronic urticaria quality-of-life questionnaire score and the urticaria activity score used for 7 consecutive days. Results: Median (minimum-maximum) orexin-A, leptin, and ghrelin levels in patients were 385 pg/mL (90-495 pg/mL), 3.1 ng/mL (0-21.2 ng/mL), and 701.8 pg/mL (101.9-827.7 pg/mL), respectively. Median serum orexin-A and leptin levels were higher in the patients compared with the controls (p < 0.001 and p = 0.012, respectively), whereas the median serum ghrelin levels were similar to the controls (p = 0.616). The serum orexin-A level was positively correlated with ghrelin (r = 0.298, p = 0.014), PSQI sleep quality (r = 0.356, p = 0.003), and ESS (r = 0.357, p = 0.003). Conclusion: Serum orexin-A is associated with sleep quality in patients with CSU. Further studies are needed to elucidate the role of ghrelin and leptin on sleep quality in patients with CSU.
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Affiliation(s)
- Selcan Gultuna
- From the Department of Immunology and Allergy, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Buket Basa Akdogan
- From the Department of Immunology and Allergy, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Muzeyyen Gonul
- Department of Dermatology, University of Health Sciences Etlik City Hospital, Ankara, Turkey
| | - Fevzi Nuri Aydin
- Department of Biochemistry, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital
| | - Simge Unal
- Department of Dermatology, University of Health Sciences Uşak Training and Research Hospital, Uşak, Turkey
| | | | - Funda Seher Ozalp Ates
- Department of Biostatics and Medical Informatics, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Melike Bagnu Yuceege
- Department of Chest Diseases, University of Health Sciences Etlik City Hospital, Ankara, Turkey; and
| | - Sinem Ayse Ornek Ozdemir
- Department of Dermatology, University of Health Sciences Ankara Training and Research Hospital, Ankara, Turkey
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Chernyshov PV, Finlay AY, Tomas-Aragones L, Zuberbier T, Kocatürk E, Manolache L, Pustisek N, Svensson A, Marron SE, Sampogna F, Bewley A, Salavastru C, Koumaki D, Augustin M, Linder D, Abeni D, Salek SS, Szepietowski J, Jemec GB. Quality of life measurement in urticaria: Position statement of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient-Oriented Outcomes and Urticaria and Angioedema. J Eur Acad Dermatol Venereol 2024. [PMID: 38855825 DOI: 10.1111/jdv.20157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/03/2024] [Indexed: 06/11/2024]
Abstract
The European Academy of Dermatology and Venereology (EADV) Task Forces on quality of life (QoL) and patient-oriented outcomes and on urticaria and angioedema recommendations for the assessment of Health-related (HR) QoL in all patients with urticaria in research and practice are as follows: to use the DLQI for adults and the CDLQI for children as dermatology-specific and the CU-Q2oL as a disease-specific HRQoL instruments in urticaria; to use generic instruments to provide comparison of data on urticaria with non-dermatologic diseases, or to compare with healthy volunteers or the general population; to select validated HRQoL instruments with appropriate age limits; to present exact numeric data for HRQoL results; correct title of any HRQoL instrument should be used, along with its correct abbreviation and the reference to its original publication, where possible. The EADV TFs discourage the use of non-validated HRQoL instruments and modified HRQoL instruments that have not undergone standard validation.
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Affiliation(s)
- P V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine
| | - A Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - L Tomas-Aragones
- Department of Psychology, University of Zaragoza, Zaragoza, Spain
| | - T 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
| | - E Kocatürk
- 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
- Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey
| | - L Manolache
- Department of Dermatology, Dali Medical, Bucharest, Romania
| | - N Pustisek
- Children's Hospital Zagreb, Zagreb, Croatia
| | - A Svensson
- Department of Dermatology and Venereology, Skane University Hospital, Malmö, Sweden
| | - S E Marron
- Department of Dermatology, University Hospital Miguel Servet, Aragon Psychodermatology Research Group (GAI+PD), Zaragoza, Spain
| | - F Sampogna
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - A Bewley
- Barts Health NHS Trust, London, UK
- Queen Mary University, London, UK
| | - C Salavastru
- Department of Paediatric Dermatology, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - D Koumaki
- Department of Dermatology and Venereology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D Linder
- University Clinic for Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | - D Abeni
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - S S Salek
- School of Life & Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - J Szepietowski
- Department of Dermatology, Wroclaw Medical University, Wroclaw, Poland
| | - G B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
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7
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Cherrez-Ojeda I, Bousquet J, Giménez-Arnau A, Godse K, Krasowska D, Bartosińska J, Szczepanik-Kułak P, Wawrzycki B, Kolkhir P, Allenova A, Allenova A, Tkachenko S, Teovska Mitrevska N, Mijakoski D, Stoleski S, Kolacinska-Flont M, Kuprys-Lipinska I, Molinska J, Kasperska-Zając A, Zajac M, Zamlynski M, Mihaltan F, Ulmeanu R, Zalewska-Janowska A, Tomaszewska K, Al-Ahmad M, Al-Nesf MA, Ibrahim T, Aqel S, Pesqué D, Rodríguez-González M, Wakida-Kuzunoki GH, Ramon G, Ramon G, Neisinger S, Bonnekoh H, Rukhadze M, Khoshkhui M, Fomina D, Larenas-Linnemann D, Košnik M, Oztas Kara R, Caballero López CG, Liu Q, Ivancevich JC, Ensina LF, Rosario N, Kvedariene V, Ben-Shoshan M, Criado RFJ, Bauer A, Cherrez A, Chong-Neto H, Rojo-Gutierrez MI, Rudenko M, Larco Sousa JI, Lesiak A, Matos E, Muñoz N, Tinoco I, Moreno J, Crespo Shijin C, Hinostroza Logroño R, Sagñay J, Faytong-Haro M, Robles-Velasco K, Zuberbier T, Maurer M. Patient-Reported Outcome Measures in Atopic Dermatitis and Chronic Urticaria Are Underused in Clinical Practice. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1575-1583.e1. [PMID: 38604531 DOI: 10.1016/j.jaip.2024.03.050] [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: 11/20/2023] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are validated and standardized tools that complement physician evaluations and guide treatment decisions. They are crucial for monitoring atopic dermatitis (AD) and chronic urticaria (CU) in clinical practice, but there are unmet needs and knowledge gaps regarding their use in clinical practice. OBJECCTIVE We investigated the global real-world use of AD and CU PROMs in allergology and dermatology clinics as well as their associated local and regional networks. METHODS Across 72 specialized allergy and dermatology centers and their local and regional networks, 2,534 physicians in 73 countries completed a 53-item questionnaire on the use of PROMs for AD and CU. RESULTS Of 2,534 physicians, 1,308 were aware of PROMs. Of these, 14% and 15% used PROMs for AD and CU, respectively. Half of physicians who use PROMs do so only rarely or sometimes. Use of AD and CU PROM is associated with being female, younger, and a dermatologist. The Patient-Oriented Scoring Atopic Dermatitis Index and Urticaria Activity Score were the most common PROMs for AD and CU, respectively. Monitoring disease control and activity are the main drivers of the use of PROMs. Time constraints were the primary obstacle to using PROMs, followed by the impression that patients dislike PROMs. Users of AD and CU PROM would like training in selecting the proper PROM. CONCLUSIONS Although PROMs offer several benefits, their use in routine practice is suboptimal, and physicians perceive barriers to their use. It is essential to attain higher levels of PROM implementation in accordance with national and international standards.
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Affiliation(s)
- Ivan Cherrez-Ojeda
- Universidad Espiritu Santo, Samborondon, Ecuador; Respiralab Research Group, Guayaquil, Ecuador.
| | - Jean Bousquet
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Ana Giménez-Arnau
- Department of Dermatology, Hospital del Mar, IMIM, Universitat Pompeu Fabra, Barcelona, Spain
| | - Kiran Godse
- Department of Dermatology, D.Y. Patil University School of Medicine, Mumbai, India
| | - Dorota Krasowska
- Department of Dermatology, Venereology, and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - Joanna Bartosińska
- Department of Dermatology, Venereology, and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland; Department of Cosmetology and Aesthetic Medicine, Medical University of Lublin, Lublin, Poland
| | - Paulina Szczepanik-Kułak
- Department of Dermatology, Venereology, and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - Bartłomiej Wawrzycki
- Department of Dermatology, Venereology, and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - Pavel Kolkhir
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Anastasiia Allenova
- Laboratory of Immune-Mediated Skin Diseases, Institute of Regenerative Medicine, Biomedical Science and Technology Park, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Andrey Allenova
- Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation; State Budgetary Healthcare Institution of the City of Moscow "City Polyclinic No. 2 10 of the Department of Health of the City of Moscow", Moscow, Russian Federation; Federal State Budgetary Scientific Institution "N.A. Semashko National Research, Institute of Public Health", Moscow, Russian Federation
| | - Sergey Tkachenko
- Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Natasa Teovska Mitrevska
- Dermatology Department, Remedika General Hospital, Skopje, Republic of North Macedonia; Department of Dermatology, International Balkan University, Skopje, Republic of North Macedonia
| | - Dragan Mijakoski
- Institute of Occupational Health of RNM, Skopje, Republic of North Macedonia; Faculty of Medicine, SS Cyril and Methodius, University of Skopje, Skopje, Republic of North Macedonia
| | - Sasho Stoleski
- Institute of Occupational Health of RNM, Skopje, Republic of North Macedonia; Faculty of Medicine, SS Cyril and Methodius, University of Skopje, Skopje, Republic of North Macedonia
| | - Marta Kolacinska-Flont
- Department of Internal Medicine, Asthma and Allergy, Barlicki Memorial Hospital, Medical University of Lodz, Poland
| | - Izabela Kuprys-Lipinska
- Department of Internal Medicine, Asthma and Allergy, Barlicki Memorial Hospital, Medical University of Lodz, Poland
| | - Joanna Molinska
- Department of Internal Medicine, Asthma and Allergy, Barlicki Memorial Hospital, Medical University of Lodz, Poland
| | - Alicja Kasperska-Zając
- European Center for Diagnosis and Treatment of Urticaria/Angioedema (GA(2)LEN UCARE /ACARE Network) and Department of Clinical Allergology and Urticaria of Medical University of Silesia, Silesia, Poland
| | - Magdalena Zajac
- European Center for Diagnosis and Treatment of Urticaria/Angioedema (GA(2)LEN UCARE /ACARE Network) and Department of Clinical Allergology and Urticaria of Medical University of Silesia, Silesia, Poland
| | - Mateusz Zamlynski
- European Center for Diagnosis and Treatment of Urticaria/Angioedema (GA(2)LEN UCARE /ACARE Network) and Department of Clinical Allergology and Urticaria of Medical University of Silesia, Silesia, Poland
| | | | | | | | | | - Mona Al-Ahmad
- Microbiology Department, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Maryam Ali Al-Nesf
- Allergy and Immunology Division, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Tayseer Ibrahim
- Allergy and Immunology Division, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Sami Aqel
- Department of Dermatology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Pesqué
- Department of Dermatology, Hospital del Mar, IMIM, Universitat Pompeu Fabra, Barcelona, Spain; Department of Dermatology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - German Ramon
- Instituto de Alergia e Inmunologia del Sur, GA(2)LEN UCARE/Adcare/Acare Center, Bahia Blanca, Argentina
| | - Gonzalo Ramon
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Sophia Neisinger
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Hanna Bonnekoh
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Maia Rukhadze
- Allergy and Immunology Center, Tbilisi, Georgia/Geomedi Teaching University, Faculty of Medicine, Tbilisi, Georgia
| | - Maryam Khoshkhui
- Allergy Research Center, Mashhad University of Medical Science, Mashhad, Iran
| | - Daria Fomina
- Moscow Practical and Research Center of Allergy and Immunology, Clinical City Hospital, Moscow, Russian Federation; Moscow Department of Clinical Immunology and Allergology, Sechenov First Moscow State Medical University, Astana Medical University, Moscow, Russian Federation
| | | | - Mitja Košnik
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia Medical Faculty, University of Ljubljana, Slovenia
| | - Rabia Oztas Kara
- Department of Dermatology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | | | - Qiang Liu
- Second Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, China
| | | | - Luis Felipe Ensina
- Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina
| | - Nelson Rosario
- Division of Allergy, Clinical Immunology, and Rheumatology, Department of Pediatrics, Federal University of São Paulo and CPAlpha Clinical Research Center, São Paulo, Brazil, (nn)Urticaria Center of Reference and Excellence, Federal University of Parana, Rua General Carneiro, Curitiba, Brazil
| | - Violeta Kvedariene
- Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Institute of Clinical Medicine, Clinic of Chest Diseases, Immunology and Allergology, Faculty of Medicine, Vilnius, Lithuania
| | - Moshe Ben-Shoshan
- Division of Allergy, Immunology and Dermatology, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada
| | | | - Andrea Bauer
- Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany
| | - Annia Cherrez
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Herberto Chong-Neto
- Department of Pediatrics, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | | | - Michael Rudenko
- London Allergy and Immunology Centre, London, United Kingdom
| | | | - Aleksandra Lesiak
- Department of Dermatology, Pediatric Dermatology, and Dermatological Oncology, Medical University of Lodz, Lodz, Poland
| | - Edgar Matos
- Instituto Nacional de Salud del Nino, Lima, Peru
| | - Nelson Muñoz
- Specialist Centre, Muñoz Alergias y Pediatría, Riobamba, Ecuador
| | | | - Jaime Moreno
- Universidad Estatal de Milagro, Cdla. Universitaria "Dr. Romulo Minchala Murillo", Guayas, Milagro, Ecuador
| | | | | | - Juan Sagñay
- Respiralab Research Group, Guayaquil, Ecuador
| | - Marco Faytong-Haro
- Universidad Espiritu Santo, Samborondon, Ecuador; Respiralab Research Group, Guayaquil, Ecuador; Sociology and Demography Department, Pennsylvania State University, University Park, Pa; Ecuadorian Development Research Lab, Daule, Guayas, Ecuador
| | - Karla Robles-Velasco
- Universidad Espiritu Santo, Samborondon, Ecuador; Respiralab Research Group, Guayaquil, Ecuador
| | - Torsten Zuberbier
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.
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Fu T, Wu Y, Wang R, Liu R, Wen T, Long H, Yu H, Leng M. Research hotspots in urticaria: A bibliometric study of the top 100 most cited articles. Skin Res Technol 2024; 30:e13731. [PMID: 38747942 PMCID: PMC11095479 DOI: 10.1111/srt.13731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/23/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND AND PURPOSE Urticaria is a prevalent recurrent skin allergic condition. Severe itching significantly impacts patients' quality of life. This paper aims to investigate the development status of urticaria through bibliometric analysis to predict future research hotspots and trends. METHODS On October 29, 2023, a literature search was conducted in the Web of Science (WOS) database to collect urticaria-related publications. The top 100 most cited articles were charted, and VOSviewer software was utilized for the literature data analysis. A visual analysis was performed on the number of articles, journals, main researchers, keywords, and so on. RESULTS The research involved 415 authors from 28 countries, published across 25 journals, ranging from 1963 to 2023. Marcus Maurer was the leading author, with the United States being the foremost country in urticaria research. CEH Grattan received the most citations, and The Medical University of South Carolina had the highest number of publications. Key research focuses include epidemiology, pathogenesis, drug therapy, and quality of life assessments. "Anti-high affinity IgE receptor α chain (FcεRIα)," "chronic idiopathic urticaria," "autoantibodies," "histamine-release" emerged as the keywords with the highest prominence. CONCLUSION The field of urticaria research has attracted substantial attention over the past few decades, witnessing rapid development. This study highlighted the top 100 articles by citation frequency within the urticaria field. Bibliometric analysis revealed a shift in treatment methods from traditional antihistamines to biological agents, with significant emphasis on improving the quality of life in chronic urticaria management. These areas represent the current research focal points and indicate future trends in urticaria research.
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Affiliation(s)
- Tingting Fu
- Three Gorges University Hospital of Traditional Chinese Medicine & Yichang Hospital of Traditional Chinese MedicineYichangHubeiChina
| | - Yuhong Wu
- Shenyang Seventh People's Hospital (Shenyang Hospital of Integrated Traditional Chinese and Western Medicine)ShenyangLiaoningChina
| | - Ruoxin Wang
- Daqing Hospital of Traditional Chinese MedicineDaqingHeilongjiangChina
| | - Rongqi Liu
- Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical UniversityBeijingChina
| | - Tao Wen
- Three Gorges University Hospital of Traditional Chinese Medicine & Yichang Hospital of Traditional Chinese MedicineYichangHubeiChina
| | - Huaqing Long
- Three Gorges University Hospital of Traditional Chinese Medicine & Yichang Hospital of Traditional Chinese MedicineYichangHubeiChina
| | - Hongyin Yu
- Three Gorges University Hospital of Traditional Chinese Medicine & Yichang Hospital of Traditional Chinese MedicineYichangHubeiChina
| | - Mengyin Leng
- Three Gorges University Hospital of Traditional Chinese Medicine & Yichang Hospital of Traditional Chinese MedicineYichangHubeiChina
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9
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Reeshma J, Mariyath OKR, Narayan KTPD, Devi K, Ajithkumar K. Quality of Life and Perceived Stress in Chronic Spontaneous Urticaria: Counting the Burden. Indian Dermatol Online J 2024; 15:460-463. [PMID: 38845650 PMCID: PMC11152486 DOI: 10.4103/idoj.idoj_367_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 01/24/2024] [Accepted: 02/02/2024] [Indexed: 06/09/2024] Open
Abstract
Background Chronic spontaneous urticaria (CSU) is a dermatosis with a significant psychological component. Only a few studies have assessed the quality of life (QoL) and perceived stress in CSU patients. Objectives To evaluate the QoL and perceived stress in patients with CSU. Materials and Methods A cross-sectional study was done on 54 patients of CSU attending the Urticaria clinic of the Dermatology department in a tertiary care postgraduate teaching hospital in North Kerala. QoL in chronic urticaria was assessed using the Chronic Urticaria-Quality of Life (CU-QoL) questionnaire and perceived stress was assessed using the Perceived Stress Scale (PSS). Results The mean scores of CU-QoL and PSS were 55.78 and 16.31, respectively. Out of 54 patients, 26 (48.1%) had mild impairment, 26 (48.1%) had moderate impairment, and 2 (3.7%) had severe impairment of QoL. Low stress was seen in 20 (37%) patients, moderate stress in 28 (51.9%), and six (11.1%) patients had high stress. Conclusion This study shows that more than half of the patients with CSU had moderate to severe impairment of QoL and had moderate to severe stress.
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Affiliation(s)
- Jose Reeshma
- Department of Dermatology, Malabar Medical College, Modakkallur, Kozhikode, Kerala, India
| | | | - KTP Dayal Narayan
- Department of Psychiatry, Govt Medical College, Kozhikode, Kerala, India
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10
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Rutter KJ, Peake M, Hawkshaw NJ, Scholey R, Bulfone-Paus S, Friedmann PS, Farrar MD, Rhodes LE. Solar urticaria involves rapid mast cell STAT3 activation and neutrophil recruitment, with FcεRI as an upstream regulator. J Allergy Clin Immunol 2024; 153:1369-1380.e15. [PMID: 38184075 DOI: 10.1016/j.jaci.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 12/01/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Solar urticaria is a rare photodermatosis characterized by rapid-onset sunlight-induced urticaria, but its pathophysiology is not well understood. OBJECTIVE We sought to define cutaneous cellular and molecular events in the evolution of solar urticaria following its initiation by solar-simulated UV radiation (SSR) and compare with healthy controls (HC). METHODS Cutaneous biopsy specimens were taken from unexposed skin and skin exposed to a single low (physiologic) dose of SSR at 30 minutes, 3 hours, and 24 hours after exposure in 6 patients with solar urticaria and 6 HC. Biopsy specimens were assessed by immunohistochemistry and bulk RNA-sequencing analysis. RESULTS In solar urticaria specimens, there was enrichment of several innate immune pathways, with striking early involvement of neutrophils, which was not observed in HC. Multiple proinflammatory cytokine and chemokine genes were upregulated (including IL20, IL6, and CXCL8) or identified as upstream regulators (including TNF, IL-1β, and IFN-γ). IgE and FcεRI were identified as upstream regulators, and phosphorylated signal transducer and activator of transcription 3 expression in mast cells was increased in solar urticaria at 30 minutes and 3 hours after SSR exposure, suggesting a mechanism of mast cell activation. Clinical resolution of solar urticaria by 24 hours mirrored resolution of inflammatory gene signature profiles. Comparison with available datasets of chronic spontaneous urticaria showed transcriptomic similarities relating to immune activation, but several transcripts were identified solely in solar urticaria, including CXCL8 and CSF2/3. CONCLUSIONS Solar urticaria is characterized by rapid signal transducer and activator of transcription 3 activation in mast cells and involvement of multiple chemotactic and innate inflammatory pathways, with FcεRI engagement indicated as an early event.
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Affiliation(s)
- Kirsty J Rutter
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom; Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Greater Manchester, United Kingdom.
| | - Michael Peake
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Nathan J Hawkshaw
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Rachel Scholey
- Genomic Technologies Core Facility, University of Manchester, Manchester, United Kingdom
| | - Silvia Bulfone-Paus
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Peter S Friedmann
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Mark D Farrar
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom; Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Greater Manchester, United Kingdom
| | - Lesley E Rhodes
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom; Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Greater Manchester, United Kingdom
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11
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Magerl M. [What are the main symptoms of urticaria and how are they systematically recorded?]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:274-280. [PMID: 38424150 DOI: 10.1007/s00105-024-05304-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 03/02/2024]
Abstract
Wheals or angioedema or both are the main symptoms of urticaria. The small number of the symptoms usually makes diagnosis easy. What is not trivial, however, is the comprehensive systematic recording and assessment of these symptoms and, above all, their sequelae, which affect many areas of the patient's life. Disease activity, quality of life and disease control can and should be measured before and during treatment in order to optimally adapt therapeutic measures. The instruments developed for this purpose have become easier and more convenient to use in recent years thanks to user-friendly platforms such as mobile health apps.
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Affiliation(s)
- Markus Magerl
- Angioedema Center of Reference and Excellence (ACARE), Institute of Allergology, CBF, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland.
- Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Deutschland.
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12
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Kapadia S, Nageswaramma S, Shah K, Singh A, Mahajan SC, Deshpande A, Chakraborty S, Kar BR, Padmaja P, Bharija SC, Doshi M, Ghadge P, Gabhane M, Dharmadhikari S, Mane A, Mehta S. The Efficacy and Safety of High Dose (10 mg) of Desloratadine (Dazit® 10) in the Treatment of Chronic Spontaneous Urticaria in India: A Phase III, Multicentric, Open-Label, Single-Arm Study. Cureus 2024; 16:e53125. [PMID: 38420062 PMCID: PMC10899119 DOI: 10.7759/cureus.53125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is a debilitating affliction that affects diverse quality of life (QoL) parameters such as sleep, self-esteem, and daily activities. Second-generation antihistamines, such as desloratadine, are more effective and safer in managing CSU. Desloratadine is a nonsedating, potent, and highly selective H1 receptor antagonist. At its daily dose of 5 mg, almost half of CSU patients do not show symptomatic improvement. European Academy of Allergy and Clinical Immunology (EAACI)/Global Allergy and Asthma European Network (GA2LEN)/European Dermatology Forum (EDF) (EuroGuiDerm)/Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI) guidelines recommend increasing the dosage to up to four times in such nonresponsive patients. However, there is insufficient clinical evidence in Indian settings. METHOD We evaluated the efficacy and safety of 10 mg desloratadine (OD) in 256 nonresponsive patients with moderate to severe CSU. The primary outcome was the change in Urticaria Activity Score (UAS7) from baseline to four weeks. Additionally, change in Chronic Urticaria Quality of Life (CU-Q2oL) scores during the course of treatment was also evaluated. RESULT The mean UAS7 scores showed a significant reduction from 31.9 ± 4.8 at baseline to 18.2 ± 8.1 at the end of the study (p < 0.0001). The use of a higher dose of desloratadine also decreased the CU-Q2oL scores significantly from 59.8 ± 14.7 at baseline to 35.4 ± 10 at four weeks (p < 0.0001). The incidence of adverse events (AEs) possibly linked to the drug was low (1.6%), and no serious adverse events were reported. CONCLUSION Results indicated improvements in the disease severity as well as its positive impact on participants' QoL. This study confirms the efficacy and safety of daily use of a twofold dose of desloratadine in nonresponsive moderate to severe CSU patients.
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Affiliation(s)
- Saurabh Kapadia
- Department of Dermatology, Kanoria Hospital & Research Centre, Gandhinagar, IND
| | | | - Keyur Shah
- Department of Dermatology, Medilink Hospital & Research Center, Ahmedabad, IND
| | - Ajit Singh
- Department of Allergy and Pulmonary Medicine, Sawai Man Singh (SMS) Hospital, Jaipur, IND
| | - Satyaprakash C Mahajan
- Department of Dermatology, Supe Heart and Diabetes Hospital and Research Centre, Nashik, IND
| | - Ajay Deshpande
- Department of Dermatology, Oyster & Pearl Hospital, Pune, IND
| | | | - Bikash R Kar
- Department of Dermatology, Institute of Medical Sciences (IMS) and SUM Hospital, Bhubaneswar, IND
| | - Pinjala Padmaja
- Department of Dermatology, Osmania General Hospital, Hyderabad, IND
| | | | - Maulik Doshi
- Department of India Clinical Research, Sun Pharma Laboratories Limited, Mumbai, IND
| | - Pravin Ghadge
- Department of Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, IND
| | - Mukesh Gabhane
- Department of Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, IND
| | - Shruti Dharmadhikari
- Department of Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, IND
| | - Amey Mane
- Department of Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, IND
| | - Suyog Mehta
- Department of Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, IND
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Weller K, Gimenez-Arnau AM, Baron J, Brehler R, Ferrer M, Groffik A, Grundmann S, Jakob T, Labrador-Horrillo M, Müller S, Staubach P, Wurpts G, Metz M, Maurer M. Efficacy and safety of on-demand versus daily rupatadine in chronic spontaneous urticaria: A randomized trial. Allergy 2024; 79:93-103. [PMID: 37597162 DOI: 10.1111/all.15854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/25/2023] [Accepted: 06/16/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Non-sedating H1 -antihistamines (nsAH) are the most commonly used treatment for chronic spontaneous urticaria (CSU). Many patients use them as on-demand (OD) therapy rather than a maintenance treatment. Here, we compared OD versus daily maintenance treatment with the nsAH rupatadine, assessed the efficacy of rupatadine updosing, and investigated potential long-term disease-modifying effects. METHODS This multicenter, randomized study consisted of 2 weeks of screening, 8 weeks of double-blind treatment, and 6 weeks of treatment-free follow-up (OD allowed). Adult patients were randomized to 10 mg rupatadine OD or 10 mg rupatadine daily. At Week 4, if patients did not have a complete response, they switched from 10 to 20 mg rupatadine daily or underwent sham updosing (patients on 10 mg rupatadine OD). The primary aim was to compare CSU disease activity at the end of follow-up between daily versus OD. Additionally, we assessed the efficacy of rupatadine updosing. Major outcomes were disease activity, CSU-related quality of life (QoL), and disease control. RESULTS At Week 4, disease activity and QoL significantly improved in daily versus OD-treated patients. Updosing of rupatadine did not improve the mean disease activity, but the number of complete responders increased during updosing from 5% to 22%. At the end of follow-up, the disease activity of patients treated OD versus daily was not significantly different. CONCLUSIONS Daily rupatadine treatment significantly improved CSU disease activity and QoL during treatment versus OD treatment but not after discontinuation of rupatadine, indicating the benefits of a daily maintenance nsAH schedule.
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Affiliation(s)
- Karsten Weller
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ana Maria Gimenez-Arnau
- Department of Dermatology, Hospital del Mar, IMIM, Universitat Pompeu Fabra, Barcelona, Spain
| | - Jens Baron
- Department of Dermatology and Allergy, University Hospital, RWTH Aachen, Aachen, Germany
| | - Randolf Brehler
- Department of Dermatology, University Hospital Muenster, Muenster, Germany
| | - Marta Ferrer
- Department of Allergy, Clinica Universidad de Navarra, Pamplona, Spain
- RICORS Red De Enfermedades Inflamatorias (REI)-RD21/0002/0028, Madrid, Spain
| | - Adriane Groffik
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | | | - Thilo Jakob
- Department of Dermatology and Allergy, University Medical Center, Justus Liebig University Gießen, Giessen, Germany
| | - Moisés Labrador-Horrillo
- Allergy Department, Hospital Universitario Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sabine Müller
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Petra Staubach
- Department of Dermatology and Allergy, University Medical Center, Mainz, Germany
| | - Gerda Wurpts
- Clinic for Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), Uniklinik RWTH Aachen, Aachen, Germany
| | - Martin Metz
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marcus Maurer
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Can A, Tuzer OC. The evaluation of melatonin levels in chronic spontaneous urticaria: A case control study. Allergy Asthma Proc 2023; 44:e29-e35. [PMID: 37714684 DOI: 10.2500/aap.2023.44.230044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Background: Although sleep disturbance is known to be common in patients with chronic spontaneous urticaria (CSU), sleep hormone levels in the blood have never before been studied in CSU. Objective: In this study, we aimed to evaluate the serum melatonin levels in patients with CSU. Methods: For the patient group, 80 patients with recently diagnosed CSU, and, for the control group, 75 healthy controls (HC) were included. The study participants' melatonin levels were measured by using the enzyme-linked immunosorbent assay method. CSU disease activity was evaluated by using the urticaria activity score-7 (UAS-7), and the quality of life was assessed with the chronic urticaria quality of life questionnaire (CU-Q2oL). The patients with concomitant diseases likely to affect the melatonin levels or those using related medications were excluded from the study. Results: The patient group consisted of 53 female subjects (67%); the median (interquartile range) age was 34 years (27-43 years). The levels of melatonin were lower in the patients with CSU when compared with the HCs (p < 0.03). The melatonin levels had no significant relationship between UAS-7 and the total scores in CU-Q2oL (p > 0.05). However, a significant negative correlation in the melatonin levels was observed with questions 7 (overall sleep assessment) and 11 (difficulty in falling into sleep) in the CU-Q2oL (r = -0.55 [p < 0.001] and r = -0.62 [p < 0.001], respectively). Conclusion: The presence of low melatonin levels in the patients with CSU suggests that melatonin has a key regulatory role in the CSU development in addition to the deterioration in sleep quality. A new treatment strategy to increase the melatonin levels in CSU may be pursued in further studies to confirm our findings.
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Affiliation(s)
- Ali Can
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, University of Health Sciences, Van Training and Research Hospital, Van, Turkey, and
| | - Ozdemir Can Tuzer
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, University of Health Sciences, Batman Training and Research Hospital, Batman, Turkey
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Gómez de la Fuente E, Alobid I, Ojanguren I, Rodríguez-Vázquez V, Pais B, Reyes V, Espinosa M, Luca de Tena Á, Muerza I, Vidal-Barraquer E. Addressing the unmet needs in patients with type 2 inflammatory diseases: when quality of life can make a difference. FRONTIERS IN ALLERGY 2023; 4:1296894. [PMID: 38026127 PMCID: PMC10680168 DOI: 10.3389/falgy.2023.1296894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Patients with asthma (AS), atopic dermatitis (AD), allergic rhinitis (AR), eosinophilic esophagitis (EoE), chronic rhinosinusitis with nasal polyps (CRSwNP), chronic urticaria (CU), non-steroidal anti-inflammatory drugs-exacerbated respiratory disease (N-ERD), and certain phenotypes of chronic obstructive pulmonary disease (COPD), among others, have a common underlying pathogenesis known as Type 2 inflammation (T2i). These diseases often coexist with other T2i conditions and have a substantial impact on the quality of life (QoL) of patients. However, limited data on patients' experiences, perspectives, and current management of T2i diseases have been published thus far. Aims This survey, promoted by the patient-driven T2i Network Project, aimed at identifying the common drivers and challenges related to the QoL of patients with T2i diseases by putting the patient's perspective at the force and including it in the design of new care strategies. Methodology An anonymous online survey was carried out through convenience sampling between May and June 2023. The survey was codesigned by members of different patient associations, healthcare professionals and healthcare quality experts, and implemented using EUSurvey and distributed through eight patient associations from Spain. The survey consisted of 29 questions related to the participant's sociodemographic features, a series of self-reported multiple choice or rating scale questions, including diagnosis, QoL measures, disease severity, healthcare resource utilization, and quality of care. Results The survey included 404 participants, members from eight patient associations, the majority of whom had moderate-to-severe self-reported disease severity (93%) and one or more coexisting pathologies related to T2i (59%). Patients with more than one pathology had a significantly greater impact on QoL than those with only one pathology (p < .001). Participants with self-reported severe symptoms reported significantly worse QoL than those with mild-to-moderate severity (p < .001). More than half of the patients (56%) felt constantly bothered by the unpredictability of their illness caused by potential exposure to known or unknown disease triggers. The lack of coordination between specialists and primary care was also expressed as an area of dissatisfaction by participants, with 52% indicating a complete lack of coordination and 21% indicating an average coordination. Conclusion This article reports the initial findings of a patient-led initiative, which highlights the common QoL challenges faced by individuals with type 2 inflammation-related diseases and emphasizes the importance of further clinical research to improve the management of this patient group. Considering the significant impact on QoL, a multidisciplinary approach integrated into new healthcare protocols has the potential to improve patient management and QoL, shorten the time to diagnosis and reduce healthcare resource utilization.
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Affiliation(s)
| | - Isam Alobid
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clínic, IDIBAPS, CPERES, Barcelona University, Barcelona, Spain
| | - Iñigo Ojanguren
- Pneumology Service, University Hospital Vall d’Hebron, VHIR, CIBERES, Autonomous University of Barcelona, Barcelona, Spain
| | - Virginia Rodríguez-Vázquez
- Allergology Service, University Hospital Complex of Santiago, University of Santiago Compostela, A Coruña, Spain
| | - Beatriz Pais
- Quality and Patient Safety Unit, Quality Subdirectorate, Healthcare Area of Santiago de Compostela y Barbanza, Servizo Galego de Saúde, Santiago de Compostela, Spain
| | - Víctor Reyes
- Regional Ministry of Health of Andalusia (CSJA), Adviser, Sevilla, Spain
| | - Miriam Espinosa
- Asociación Española de Esofagitis Eosinofílica (AEDESEO), Madrid, Spain
| | | | - Irantzu Muerza
- Asociación de Apoyo a Personas Afectadas por el Asma de Bizkaia (ASMABI), Bilbao, Spain
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Buttgereit T, Salameh P, Sydorenko O, Zuberbier T, Metz M, Weller K, Maurer M. The 7-day recall period version of the Urticaria Control Test-UCT7. J Allergy Clin Immunol 2023; 152:1210-1217.e14. [PMID: 37210040 DOI: 10.1016/j.jaci.2023.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/28/2023] [Accepted: 03/29/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND The Urticaria Control Test (UCT) is a well-established, very easy to use and calculate 4-item patient-reported outcome measure to assess chronic urticaria disease control during the previous 4 weeks. Clinical trials and practice may benefit from the use of a UCT version with a shorter recall period, but this does not exist. OBJECTIVES We sought to develop and validate a UCT version with a 7-day recall period, the UCT7. METHODS The UCT7 was developed, based on the UCT, and tested, in 152 patients with chronic urticaria (spontaneous: n = 101, inducible: n = 51) for its reliability, validity and screening accuracy, and clinimetric properties, in other words, the cutoff for well-controlled disease and the minimal clinically important difference. RESULTS The UCT7 showed excellent internal consistency reliability with a Cronbach αvalue of 0.91 and test-retest reliability with an intraclass correlation coefficient of 0.83. Convergent validity was high and strongly correlated with anchors of disease control, wheal and angioedema frequency, and urticaria-related quality of life impairment. The UCT7 showed excellent sensitivity to change; however, changes in angioedema activity and impact did not correlate well with changes in UCT7. Based on receiver-operating characteristic curve analysis, the proportion of correctly classified patients, and patients' assessment of treatment efficacy, we recommend a cutoff value of 12 points for identifying patients with well-controlled disease. The UCT7 minimal clinically important difference for improvement was estimated to be 2 points. CONCLUSIONS The UCT7 is a validated 7-day recall period version of the UCT. It is ideal for the assessment of disease control at short intervals in patients with chronic urticaria in clinical studies and practice.
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Affiliation(s)
- Thomas Buttgereit
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Berlin, Germany
| | - Pascale Salameh
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; School of Medicine, Lebanese American University, Byblos, Lebanon; University of Nicosia Medical School, Nicosia, Cyprus; Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie (INSPECT-LB), Beirut, Lebanon
| | - Olga Sydorenko
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Berlin, Germany
| | - Torsten Zuberbier
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Berlin, Germany
| | - Martin Metz
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Berlin, Germany
| | - Karsten Weller
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Berlin, Germany.
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Avila PC. Patient-reported outcome measures for urticaria and angioedema. J Allergy Clin Immunol 2023; 152:1090-1091. [PMID: 37660988 DOI: 10.1016/j.jaci.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
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Buttgereit T, Vera C, Aulenbacher F, Church MK, Hawro T, Asero R, Bauer A, Bizjak M, Bouillet L, Dissemond J, Fomina D, Giménez-Arnau AM, Grattan C, Gregoriou S, Kulthanan K, Kasperska-Zajac A, Kocatürk E, Makris M, Kolkhir P, Weller K, Magerl M, Maurer M. Patients With Chronic Spontaneous Urticaria Who Have Wheals, Angioedema, or Both, Differ Demographically, Clinically, and in Response to Treatment-Results From CURE. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3515-3525.e4. [PMID: 37604426 DOI: 10.1016/j.jaip.2023.08.020] [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: 04/06/2023] [Revised: 07/19/2023] [Accepted: 08/05/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Patients with chronic spontaneous urticaria (CSU) have spontaneous wheals (W), angioedema (AE), or both, for longer than 6 weeks. Clinical differences between patients with standalone W, standalone AE, and W and AE (W+AE) remain incompletely understood. OBJECTIVE To compare W, AE, and W+AE CSU patients regarding demographics, disease characteristics, comorbidities, disease burden, and treatment response. METHODS Baseline data from 3,698 CSU patients in the ongoing, prospective, international, multicenter, observational Chronic Urticaria REgistry (CURE) were analyzed (data cut: September 2022). RESULTS Across all CSU patients, 59%, 36%, and 5% had W+AE, W, and AE, respectively. The W+AE patients, compared with W and AE patients, showed the lowest male-to-female ratio (0.33), higher rates of concomitant psychiatric disease (17% vs 11% vs 6%, respectively), autoimmune disease (13% vs 7% vs 9%, respectively), and nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity (9% vs 5% vs 2%, respectively) and the highest disease impact. The W patients, compared with W+AE and AE patients, showed the lowest rates of concomitant hypertension (15% vs 21% vs 40%, respectively) and obesity (11% vs 16% vs 17%, respectively), the highest rate of concomitant inducible urticaria (24% vs 22% vs 6%, respectively), and shorter W duration. The AE patients, compared with W+AE and W patients, were older at disease onset, showed longer AE duration, and the best response to increased doses of H1-antihistamines (58% vs 24% vs 31%, respectively) and omalizumab (92% vs 67% vs 60%, respectively). CONCLUSIONS Our findings provide a better understanding of CSU phenotypes and may guide patient care and research efforts that aim to link them to pathogenic drivers.
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Affiliation(s)
- Thomas Buttgereit
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Institute of Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Carolina Vera
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Institute of Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Felix Aulenbacher
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Institute of Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Martin K Church
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Institute of Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Tomasz Hawro
- Institute and Comprehensive Center for Inflammation Medicine, Department of Dermatology, Allergology and Venerology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Riccardo Asero
- Department of Allergology, Clinica San Carlo, Paderno Dugnano, Milan, Italy
| | - Andrea Bauer
- Department of Dermatology, University Hospital, Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Mojca Bizjak
- Division of Allergy, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Laurence Bouillet
- CREAK (Centre national de référence des angioedèmes), Internal Medicine, CHU Grenobles Alpes, Grenoble, France
| | - Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University of Essen, Essen, Germany
| | - Daria Fomina
- Center of Allergy and Immunology, Clinical State Hospital 52, Moscow Healthcare Ministry, Moscow, Russian Federation; I. M. Sechenov First Moscow State Medical University (Sechenov University), Department of Clinical Immunology and Allergology, Moscow, Russian Federation
| | - Ana M Giménez-Arnau
- Department of Dermatology, Institut Mar de Investigacions Mèdiques, Universitat Pompeu Fabra, Barcelona, Spain
| | - Clive Grattan
- Guy's Hospital, St. John's Institute of Dermatology, London, UK
| | - Stamatios Gregoriou
- National and Kapodistrian University of Athens, 1st Department of Dermatology-Venereology, Andreas Sygros Hospital. Athens, Greece
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Alicja Kasperska-Zajac
- European Center for Diagnosis and Treatment of Urticaria/Angioedema (GA(2)LEN UCARE Network), Medical University of Silesia in Katowice, Katowice, Poland
| | - Emek Kocatürk
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Institute of Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany; Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey
| | - Michael Makris
- Allergy Unit "D. Kalogeromitros", 2nd Department, Dermatology and Venereology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Pavel Kolkhir
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Institute of Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Karsten Weller
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Institute of Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Markus Magerl
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Institute of Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Institute of Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany.
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Can Bostan O, Damadoglu E, Sarac BE, Kilic B, Sahiner UM, Karaaslan C, Karakaya G, Kalyoncu AF. Cytokine Profiles of Chronic Urticaria Patients and The Effect of Omalizumab Treatment. Dermatol Pract Concept 2023; 13:dpc.1304a272. [PMID: 37992372 PMCID: PMC10656130 DOI: 10.5826/dpc.1304a272] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Cytokines are key mediators in immunological and inflammatory conditions, including chronic spontaneous urticaria (CSU). OBJECTIVES To investigate Th1, Th2, and Th17 cytokine profiles in CSU and to evaluate the possible effect of omalizumab treatment. METHODS Patients who were followed up for CSU, as well as healthy volunteers, were included in the study. To assess urticaria activity, the 7-day-Urticaria Activity Score (UAS-7), the Urticaria Control Test (UCT), and the Chronic Urticaria Quality of Life Questionnaire (CU-QoL) were filled. Serum levels of IL-6, IL-17, IL-31, eotaxin, RANTES, TNF-α, and TSLP were analyzed by ELISA and compared in CSU and control groups. The patients were analyzed in two groups as the omalizumab group and the non-omalizumab group based on their treatment status. RESULTS Total IgE, ESR, CRP, RANTES, and TNF-a were significantly different in the overall comparison of the three groups: CSU-receiving omalizumab, CSU-not receiving omalizumab, and control groups (P <0.01, 0.015, <0.01, <0.01 and <0.01 respectively). Total IgE, CRP, RANTES, and TNF-α values were similar in those who received and did not receive omalizumab, yet these biomarkers were significantly higher in both groups than in the control group (P < 0.05). Statistical significance in ESR was observed only between the CSU-receiving omalizumab group and the control group (P = 0.01). Within the CSU patients, there was a slight but significant correlation between UCT and TNF-α (P = 0.008, r = 0.32) and IL-17 (P = 0.06, r = 0.33) levels. CONCLUSIONS The investigated cytokine profile in CSU patients may differ from healthy controls, particularly with the higher levels of RANTES and TNF-α, and omalizumab treatment does not seem to affect that profile in CSU patients.
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Affiliation(s)
- Ozge Can Bostan
- Hacettepe University Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Ankara, Turkey
| | - Ebru Damadoglu
- Hacettepe University Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Ankara, Turkey
| | - Basak Ezgi Sarac
- Hacettepe University Faculty of Science, Department of Biology, Molecular Biology Section, Ankara, Turkey
| | - Busra Kilic
- Hacettepe University Faculty of Science, Department of Biology, Molecular Biology Section, Ankara, Turkey
| | - Umit Murat Sahiner
- Hacettepe University Faculty of Medicine, Department of Pediatric Allergy and Asthma, Ankara, Turkey
| | - Cagatay Karaaslan
- Hacettepe University Faculty of Science, Department of Biology, Molecular Biology Section, Ankara, Turkey
| | - Gul Karakaya
- Hacettepe University Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Ankara, Turkey
| | - Ali Fuat Kalyoncu
- Hacettepe University Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Ankara, Turkey
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Gayathri E, Sowmya P, Punnagai K, Mahalakshmi V. Comparative study on the efficacy and safety of bepotastine besilate versus levocetirizine in chronic spontaneous urticaria: A randomised, open-label, parallel study. Indian J Dermatol Venereol Leprol 2023; 89:672-679. [PMID: 37067147 DOI: 10.25259/ijdvl_333_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/01/2022] [Indexed: 01/28/2023]
Abstract
Background Urticaria is a common skin disease which often causes impairment in the quality of life. The ideal drug for chronic urticaria would have antihistaminic and anti-inflammatory actions. Bepotastine besilate is a recently approved novel anti-allergic agent with multiple mechanisms of action; levocetirizine is a potent and selective second-generation H1 receptor antagonist used in the treatment of urticaria. Aim To compare the efficacy and safety of bepotastine besilate versus levocetirizine in patients with chronic spontaneous urticaria. Methods The study design is a randomised, open-label, parallel-group, prospective interventional study. The study subjects were randomly assigned to either of the two groups a and b, each group had 50 patients with chronic urticaria. Statistical analyses were performed using (SPSS, version 18) for all the variables. Chi-square test was used for comparison between categorical variables. An unpaired student's t-test was done for quantitative variables. Results There was a significant decrease in mean urticaria activity score (P < 0.001), chronic urticaria quality of life (P < 0.001) and clinical global improvement (P < 0.001) in both the treatment groups but this improvement was higher in the bepotastine than in the levocetirizine group. There was no significant difference in the mean of absolute eosinophil count, C-reactive protein, aspartate transaminase, alanine transaminase from baseline to 4th week between the two study groups. Visual analogue scale showed statistically significant improvement from baseline to 4th week (P < 0.001) of follow-up but this increase was higher in levocetirizine group (0.64-4.24) than in bepotastine group (0.56-2.56) Limitations Blinding was not done. To assess the efficacy and safety of bepotastine, a larger study can be planned. Conclusion This study found that bepotastine is superior to levocetirizine and showed a statistically significant reduction in mean urticaria activity score 7, improved quality of life and clinical global improvement in patients with urticaria.
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Affiliation(s)
- Elango Gayathri
- Department of Pharmacology, Dhanalakshmi Srinivasan Medical College, Perambalur, Tamil Nadu, India
| | - Parvathareddy Sowmya
- Department of Pharmacology, Sri Ramachandra Medical College & Research Institute, Chennai, Tamil Nadu, India
| | - Kumaravelu Punnagai
- Department of Pharmacology, Sri Ramachandra Medical College & Research Institute, Chennai, Tamil Nadu, India
| | - Veeraraghavan Mahalakshmi
- Department of Pharmacology, Sri Ramachandra Medical College & Research Institute, Chennai, Tamil Nadu, India
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Armstrong AW, Soong W, Bernstein JA. Chronic Spontaneous Urticaria: How to Measure It and the Need to Define Treatment Success. Dermatol Ther (Heidelb) 2023:10.1007/s13555-023-00955-7. [PMID: 37354293 PMCID: PMC10366057 DOI: 10.1007/s13555-023-00955-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/01/2023] [Indexed: 06/26/2023] Open
Abstract
Chronic spontaneous urticaria (CSU) is a complex skin disease characterized by the spontaneous appearance of wheals, angioedema, or both, for more than 6 weeks. Many patients experience a relapsing-remitting disease course for years. Owing to the unpredictability of wheal recurrence and the severity of pruritis, patients suffer considerable impairment in their quality of life. Physicians face multiple challenges, not least of which is a lack of clear guidance on what constitutes "treatment success". There is a lack of awareness of which measures should be used to best assess the various aspects of CSU, including disease activity, disease control, and quality of life-which themselves each comprise multiple components-and how to apply the results of each score to treatment decision-making. Although the overarching aim of treatment is for patients to be completely free of signs and symptoms of CSU, a more realistic definition of "treatment success" is needed to guide ongoing, long-term disease management for each individual patient. In this review, we consider what lessons can be learned from the current evidence base to provide further direction toward a universal definition of "treatment success".
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Affiliation(s)
- April W Armstrong
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Weily Soong
- Alabama Allergy and Asthma Center and Clinical Research Center of Alabama, Birmingham, AL, USA
| | - Jonathan A Bernstein
- Division of Immunology/Allergy Section, Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Dhabal A, Mondal H, Mondal S, Baiardini I, Chakraborty SS, Chakraborty T, Podder I. Adaptation and validation of the Bengali version of the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL). Indian J Dermatol Venereol Leprol 2023; 89:385-392. [PMID: 36331856 DOI: 10.25259/ijdvl_1059_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 09/01/2022] [Indexed: 11/04/2022]
Abstract
Background Chronic urticaria exerts a profound impact on quality of life. Recent guidelines recommend its evaluation in all chronic urticaria patients. Currently, the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) is the only validated tool to assess chronic urticaria-specific quality of life. Objective To validate and adapt the CU-Q2oL to the Bengali language for its widespread use. Methods The CU-Q2oL questionnaire was translated into Bengali. Its internal consistency and reliability were tested by asking 42 chronic urticaria patients to complete this version. They completed the validated Bengali Dermatology Life Quality Index and Urticaria Control test questionnaires, and their scores were correlated with CU-Q2oL score to assess the validity of our Bengali version. Results The mean CU-Q2oL score of our patients (mean age 38.41 ± 13.4 years, male: female 29:13) was 48.8 ± 16.5. Domain 4 (sleep problems) was worst affected, followed by domain 1 (pruritus), while domain 2 (swelling) was least affected. We detected an excellent overall internal consistency (Cronbach's alpha = 0.93) of our version and nearly complete agreement (intra-class correlation coefficient = 0.91) between the test-retest scores. We found a significant positive correlation between the overall CU-Q2oL and Dermatology Life Quality Index scores (rs = 0.53, P = 0.0002), thus implying the validity of our version. Additionally, we noted a significant negative correlation between the overall CU-Q2oL and Urticaria Control test scores (rs = -0.48, P = 0.0007), suggestive of a more severe impairment of quality of life with poorer disease control. Limitations Small sample size, observational design and bias in test-retest reliability analysis due to the use of rescue therapy in-between assessment sessions were important limitations of our study. Conclusion The Bengali version of CU-Q2oL questionnaire is a valid and reliable tool suitable for both clinical and research use in Bengali speaking chronic urticaria patients.
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Affiliation(s)
- Arunima Dhabal
- Department of Dermatology, College of Medicine & Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Himel Mondal
- Department of Physiology, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - Shaikat Mondal
- Department of Physiology, Raiganj Government Medical College, Uttar Dinajpur, West Bengal, India
| | - Ilaria Baiardini
- Personalized Medicine Clinic Asthma & Allergy, Humanitas University & Research Hospital-IRCCS, Rozzano, Milan, Italy
| | - Sankha Subhra Chakraborty
- Department of Pharmacology, College of Medicine & Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Tamali Chakraborty
- Clinical Psychologist, Department of Psychology, Asutosh College, Kolkata, West Bengal, India
| | - Indrashis Podder
- Department of Dermatology, College of Medicine & Sagore Dutta Hospital, Kolkata, West Bengal, India
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Can A, Coskun R, Karabacak DE, Tuzer OC, Yegit OO, Karadag P, Oztop N, Beyaz S, Okumus G, Demir S, Gelincik A. Common but neglected problem in chronic spontaneous urticaria: Sleep disturbance. Allergy Asthma Proc 2023; 44:179-185. [PMID: 37160750 DOI: 10.2500/aap.2023.44.230011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background: Association of chronic spontaneous urticaria (CSU) with sleep disturbance has not been evaluated in studies that involve a large number of patients. Objective: In this study, we aimed to evaluate the sleep attitude and circadian rhythm in patients with CSU. Methods: As the patient group, recently diagnosed 100 patients with CSU, 100 patients with allergic rhinitis (AR) as the patient control group, and 100 healthy controls (HCs) were included. The Pittsburgh Sleep Quality Index (PSQI) questionnaire, sleep hygiene index (SHI), Epworth Sleepiness Scale (ESS) questionnaire, and the morningness-eveningness questionnaire (MEQ) were filled to assess sleep quality and circadian rhythm. CSU disease activity was evaluated by urticaria activity score-7 (UAS-7). Patients with concomitant diseases, e.g., psychiatric illnesses, that possibly affect sleep status or those who use related medications and at moderate or high risk of obstructive sleep apnea according to the STOP-Bang questionnaire were excluded from the study. Results: PSQI, SHI, and ESS scores were higher, and the MEQ score was lower in patients with CSU and patients with AR than those in the HCs (p < 0.001, for each score). However, the scores were not different among the patients with CSU and the patients with AR. UAS-7 was only correlated with PSQI scores (r = 0.402, p < 0.001). In addition, blood eosinophil counts and the serum C Reactive Protein (CRP) level were correlated with sleep quality (p = 0.02). Conclusion: The poor sleep quality, impaired sleep hygiene, increased daytime sleepiness, and intermediate type of circadian rhythm were observed in the patients with CSU and the patients with AR. Physicians should be aware of sleep problems in patients with CSU that might affect their quality of life and the success of their treatment.
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Affiliation(s)
- Ali Can
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Raif Coskun
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Cemil Tascioglu City Hospital, Istanbul, Turkey, and
| | - Deniz Eyice Karabacak
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozdemir Can Tuzer
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Osman Ozan Yegit
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Pelin Karadag
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nida Oztop
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sengul Beyaz
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gulfer Okumus
- Department of Chest Disease, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Semra Demir
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aslı Gelincik
- From the Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Terhorst-Molawi D, Fox L, Siebenhaar F, Metz M, Maurer M. Stepping Down Treatment in Chronic Spontaneous Urticaria: What We Know and What We Don't Know. Am J Clin Dermatol 2023; 24:397-404. [PMID: 36810982 DOI: 10.1007/s40257-023-00761-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/23/2023]
Abstract
In chronic spontaneous urticaria (CSU), wheals, angioedema, or both appear spontaneously for > 6 weeks. Current recommended treatment options for urticaria target mast cell mediators such as histamine, or activators, such as autoantibodies. The goal of CSU treatment is to treat the disease until it is gone as effectively and safely as possible. As no cure is available for CSU as of now, the treatment is aimed at continuously suppressing disease activity, with complete control of the disease and a normalization of quality of life. To achieve this, pharmacological treatment should be continued until no longer needed. Treatment of CSU should follow the basic principles of treating as much as needed and as little as possible taking into consideration that the activity of the disease may vary. Since CSU is a disease with spontaneous remission, it is hard to tell, in patients with complete control and no signs or symptoms, when medication is no longer needed. The current international guideline for urticaria suggests that the treatment can be stepped down once a patient is free of signs and symptoms. Other reasons for stepping down the treatment of CSU patients include safety concerns or issues, pregnancy or wanting to become pregnant, and economic factors. As of now, it is unclear over which period, with what intervals and with which dosages CSU treatment should be stepped down. Guidance on this is needed for all recommended therapies: (i) standard-dosed second-generation H1-antihistamine (sgAH), (ii) higher than standard-dosed sgAH, (iii) standard-dosed omalizumab, (iv) higher than standard-dosed omalizumab, and (v) cyclosporine. However, there is a lack of controlled trials on the step down and discontinuation of these treatments. Here, we aim to provide a summary of what is known and what needs to be investigated in further studies, based on our own experience and real-world evidence.
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Affiliation(s)
- Dorothea Terhorst-Molawi
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Paul-Ehrlich-Haus, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Lena Fox
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Paul-Ehrlich-Haus, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Frank Siebenhaar
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Paul-Ehrlich-Haus, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Martin Metz
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Paul-Ehrlich-Haus, Hindenburgdamm 27, 12203, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Paul-Ehrlich-Haus, Hindenburgdamm 27, 12203, Berlin, Germany.
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany.
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Tawil S, Irani C, Kfoury R, Abramian S, Salameh P, Weller K, Maurer M, Ezzedine K. Association of Chronic Urticaria with Psychological Distress: A Multicentre Cross-sectional Study. Acta Derm Venereol 2023; 103:adv00865. [PMID: 36129251 PMCID: PMC9940724 DOI: 10.2340/actadv.v102.2939] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic urticaria is a debilitating disease that affects health-related quality of life, but few studies have evaluated its impact on psychological wellbeing. The aim of this study was to evaluate the quality of life of patients with chronic urticaria and determine its impact on their emotional and psychological wellbeing. A cross-sectional multicentre study of a cluster of 264 Lebanese patients visiting dermatology/immunology clinics was conducted between July 2018 and June 2020. The impact of chronic urticaria on quality of life was assessed using the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) and Dermatology Life Quality Index (DLQI), as well as its consequences on mood changes using the Patient Health Questionnaire-9 (PHQ-9) and Beirut Distress Score 22 (BDS-22) scores. A multivariable analysis of covariates was performed to determine the effect of the triggering factors of urticaria on both CU-Q2oL and PHQ-9. A moderate negative correlation was found between Urticaria Control Test and quality of life scores as well as PHQ-9 and BDS-22 (p < 0.001). Patients with the lowest Urticaria Control Test score had the highest impairment in quality of life and depression scores. In conclusion, chronic urticaria compromises patients' quality of life and emotional wellbeing. This distress is more pronounced when the disease is more severe.
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Affiliation(s)
- Samah Tawil
- INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Beirut, Lebanon; Lebanese American University, School of medicine, Byblos, Lebanon, Beirut.
| | - Carla Irani
- Internal Medicine and Clinical Immunology, Hotel-Dieu de France Hospital, Saint Joseph University, Beirut
| | - Riwa Kfoury
- Faculty of Pharmacy and of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Soula Abramian
- Drug Information Center, Lebanese Order of Pharmacists, Beirut, Lebanon
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Beirut, Lebanon; Faculty of Pharmacy and of Medical Sciences, Lebanese University, Hadath, Lebanon; Faculty of Medical School, University of Nicosia, Nicosia, Cyprus
| | - Karsten Weller
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin, Berlin, Germany
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin, Berlin, Germany
| | - Khaled Ezzedine
- EA7379 Epiderm E (Epidemiology in Dermatology and Therapeutics Evaluation), UPEC-University, Paris-Est, Creteil, Creteil, France
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Kolkhir P, Laires PA, Salameh P, Asero R, Bizjak M, Košnik M, Dissemond J, van Doorn M, Hawro T, Kasperska-Zajac A, Zajac M, Kocatürk E, Peter J, Parisi CAS, Ritchie CA, Kulthanan K, Tuchinda P, Fomina D, Kovalkova E, Khoshkhui M, Kouzegaran S, Papapostolou N, Du-Thanh A, Kamegashira A, Meshkova R, Vitchuk A, Bauer A, Grattan C, Staubach P, Bouillet L, Giménez-Arnau AM, Maurer M, Weller K. The Benefit of Complete Response to Treatment in Patients With Chronic Spontaneous Urticaria-CURE Results. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:610-620.e5. [PMID: 36481420 DOI: 10.1016/j.jaip.2022.11.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/06/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Chronic spontaneous urticaria (CSU) is a distressing disease. We report real-world data from the global Chronic Urticaria Registry (CURE) about associations between various CSU states and sleep impairment, plus important health-related quality-of-life (HRQoL) outcomes and compared different methods to assess CSU states. METHODS CURE data were collected at baseline and 6-monthly follow-ups (FU). Assessments included CSU states using the Urticaria Control Test (UCT), weekly Urticaria Activity Score (UAS7), and Physician Global Assessment (PhyGA) of treatment response. Complete response to treatment (CR, UAS7 = 0), complete control of disease (CC, UCT = 16), and PhyGA = CR were assessed, plus the Dermatology Life Quality Index and the Chronic Urticaria Quality-of-Life Questionnaire (CU-Q2oL) sleep domain. RESULTS Overall, 2078 patients were included. At baseline, 9.8%, 17.9%, and 42.3% of patients had UCT = 16, UAS7 = 0, or PhyGA = CR, respectively, which increased at FU1 and FU2. Patients with higher UCT scores had better sleep and HRQoL. The presence of angioedema without wheals, episodic disease, omalizumab treatment, and male sex were associated with CC (P < .05). Among 469 patients who achieved CC or CR, 16.4% (n = 77) showed CC or CR with all 3 instruments. Agreement between UCT = 16 and UAS7 = 0 measurements was moderate (κ = 0.581), but poor between UCT = 16 and PhyGA = CR (κ = 0.208). CONCLUSIONS Few patients had CR/CC of their CSU at baseline entry. Disease control strongly related to good sleep and better HRQoL; therefore, it is important to aim for CR in CSU treatment. Patient-reported UCT and UAS7 assessments demonstrated a more accurate measurement of CSU state versus physician assessments.
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Affiliation(s)
- Pavel Kolkhir
- 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
| | - Pedro A Laires
- Novartis Pharma AG, Basel, Switzerland; NOVA National School of Public Health, Public Health Research Center, NOVA University Lisbon, Lisbon, Portugal; Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
| | - Pascale Salameh
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus; School of Medicine, Lebanese American University, Lebanon; Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie (INSPECT-LB), Lebanon
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica san Carlo, Paderno Dugnano, Italy
| | - Mojca Bizjak
- Division of Allergy, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Mitja Košnik
- Division of Allergy, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University of Essen, Essen, Germany
| | - Martijn van Doorn
- Department of Dermatology, Erasmus MC, Rotterdam, the Netherlands; Centre for Human Drug Research, Leiden, the Netherlands
| | - Tomasz Hawro
- Department of Dermatology, Allergology and Venereology, Institute and Comprehensive Center for Inflammation Medicine, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Alicja Kasperska-Zajac
- European Center for Diagnosis and Treatment of Urticaria/Angioedema (GA2LEN UCARE Network), Zabrze, Poland; Department of Clinical Allergology, Urticaria Center of Medical University of Silesia, Zabrze, Poland
| | - Magdalena Zajac
- European Center for Diagnosis and Treatment of Urticaria/Angioedema (GA2LEN UCARE Network), Zabrze, Poland; Department of Clinical Allergology, Urticaria Center of Medical University of Silesia, Zabrze, Poland
| | - Emek Kocatürk
- 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; Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey
| | - 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
| | - Claudio A S Parisi
- Allergy Section, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Carla A Ritchie
- Allergy Section, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Papapit Tuchinda
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Daria Fomina
- Center of Allergy and Immunology, Clinical State Hospital 52, Moscow Healthcare Ministry, Moscow, Russian Federation; Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Elena Kovalkova
- Center of Allergy and Immunology, Clinical State Hospital 52, Moscow Healthcare Ministry, Moscow, Russian Federation
| | - Maryam Khoshkhui
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samaneh Kouzegaran
- Department of Allergy and Clinical Immunology, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Niki Papapostolou
- Allergy Unit "D. Kalogeromitros", 2nd Dpt. Dermatology and Venereology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Aurélie Du-Thanh
- Dermatology Department, University of Montpellier, Montpellier, France
| | - Akiko Kamegashira
- Department of Dermatology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Raisa Meshkova
- Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk, Russian Federation
| | - Alexander Vitchuk
- Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk, Russian Federation
| | - Andrea Bauer
- Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany
| | - Clive Grattan
- St John's Institute of Dermatology, Guy's Hospital, London, United Kingdom
| | - Petra Staubach
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Laurence Bouillet
- CREAK, Internal Medicine, Centre Hospitalier Universitaire Grenobles Alpes, La Tronche, France
| | - Ana M Giménez-Arnau
- Department of Dermatology, Hospital Del Mar, IMIM, Universitat Pompeu Fabra, Barcelona, Spain
| | - 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
| | - Karsten Weller
- 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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27
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Chuamanochan M, Nochaiwong S. Clinical Outcomes, Patient-Reported Outcomes, and Economic Burden for Thai People Living with Chronic Urticaria (CORE-CU) in routine practice: A study protocol for a monocentric prospective longitudinal study. PLoS One 2023; 18:e0279566. [PMID: 36662843 PMCID: PMC9858793 DOI: 10.1371/journal.pone.0279566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/10/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Few prospective longitudinal studies have been conducted in Thailand to account for the long-term response to chronic urticaria (CU) treatment, clinical outcomes, and patient-reported outcomes (PROs) among people living with CU based on routine practice. As such, a prospective longitudinal study will be conducted to better understand the long-term responses to treatment options and the burden of disease in Thai CU patients. METHODS AND DESIGN This study is a routine clinical practice registry-based, monocentric, prospective, observational longitudinal study in the northern region of Thailand. Adult patients in an outpatient clinic diagnosed with CU, including both chronic spontaneous urticaria and chronic inducible urticaria will be recruited for this study. The cohort will be collected and registered using the joint routine clinical practice data based on multiple datasets including claims outpatient and inpatient data, routine laboratory results, medication utilization, health care costs, clinical characteristics, long-term urticaria care and monitoring, and PRO measures. The point prevalence of adverse health outcomes will be estimated and reported corresponding to 95% confidence intervals (95% CIs). The overall trend analysis will be analyzed to explore the effect of over time across the cohort time frame. CONCLUSION This prospective longitudinal study will report the clinical outcomes, PROs, and economic burden among Thai people living with CU based on routine clinical practice. Findings will provide comprehensive evidence and could facilitate best practices for CU care management for health care professionals, researchers, policymakers, and public society. TRIAL REGISTRATION Thai Clinical Trials Registry (TCTR, thaiclinicaltrials.org) registration TCTR20210706005. Registered on July 6, 2021.
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Affiliation(s)
- Mati Chuamanochan
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Surapon Nochaiwong
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
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Zhao Z, Zhang C, Jiang Y, Peng C, Zhu W, Zhao S, Chen X, Li J. Chinese version of the chronic urticaria quality of life questionnaire: cultural adaptation, factor analysis, assessment of reliability and validity. Arch Dermatol Res 2022; 314:847-855. [PMID: 34739561 DOI: 10.1007/s00403-021-02300-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 12/01/2022]
Abstract
Chronic urticaria is a common skin disorder that contributes profound impact on patients' quality of life (QoL). However, the cause of the disease is not clear, and the treatment still faces challenges. To better evaluate the effectiveness of treatment, an effective questionnaire survey on quality of life is needed. For the first time in Italy, a new questionnaire for chronic spontaneous urticaria, the chronic urticaria quality of life questionnaire (CU-Q2oL), has been developed. The purpose of this study was to develop and verify the Chinese version of the chronic urticaria quality of life questionnaire (CU-Q2oL). Three hundred and twenty-eight chronic urticaria patients were prospectively recruited and evaluated by the translated Chinese version of CU-Q2oL along with the Dermatology Life Quality Index (DLQI). Factor analysis, internal consistency, convergent validity, sensitivity to change and known-group validity were determined. Multiple linear regressions were used to determine the predicting factors of CU-Q2oL results. Factor analysis revealed a six-dimensional structure, and five of the six scales showed good internal consistency. Convergent validity and know-group validity showed good correlations. It was found to distinguish well between patients with different levels of urticaria activity and those to be sensitive to change in the Chinese CU-Q2oL. Disease severity was highly significantly predictive of the CU-Q2oL score on all scales. The CU-Q2oL Chinese version is a valid, reliable and sensitive instrument. It can be widely adopted to evaluate treatment outcomes and be applied in clinical research in Chinese patients.
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Affiliation(s)
- Zuotao Zhao
- Department of Dermatology, Peking University First Hospital, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, National Clinical Research Center for Skin and Immune Diseases, Beijing, 100034, China
| | - Chong Zhang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Yu Jiang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Cong Peng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Wu Zhu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Shuang Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Jie Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, 410008, China.
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Abstract
Urticaria is an inflammatory skin disorder that affects up to 20% of the world population at some point during their life. It presents with wheals, angioedema or both due to activation and degranulation of skin mast cells and the release of histamine and other mediators. Most cases of urticaria are acute urticaria, which lasts ≤6 weeks and can be associated with infections or intake of drugs or foods. Chronic urticaria (CU) is either spontaneous or inducible, lasts >6 weeks and persists for >1 year in most patients. CU greatly affects patient quality of life, and is linked to psychiatric comorbidities and high healthcare costs. In contrast to chronic spontaneous urticaria (CSU), chronic inducible urticaria (CIndU) has definite and subtype-specific triggers that induce signs and symptoms. The pathogenesis of CSU consists of several interlinked events involving autoantibodies, complement and coagulation. The diagnosis of urticaria is clinical, but several tests can be performed to exclude differential diagnoses and identify underlying causes in CSU or triggers in CIndU. Current urticaria treatment aims at complete response, with a stepwise approach using second-generation H1 antihistamines, omalizumab and cyclosporine. Novel treatment approaches centre on targeting mediators, signalling pathways and receptors of mast cells and other immune cells. Further research should focus on defining disease endotypes and their biomarkers, identifying new treatment targets and developing improved therapies.
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Affiliation(s)
- Pavel Kolkhir
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.
| | - Ana M Giménez-Arnau
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mediques, Universitat Autònoma, Barcelona, Spain
| | - Kanokvalai Kulthanan
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jonny Peter
- Urticaria Center of Reference and Excellence (UCARE), Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Urticaria Center of Reference and Excellence (UCARE), Allergy and Immunology Unit, University of Cape Town, Lung Institute, Cape Town, South Africa
| | - Martin Metz
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.
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30
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Ates H, Firat S, Buhari GK, Keren M, Cifci B, Erkekol FÖ. Relationships between quality of life, sleep problems, and sleep quality in patients with chronic idiopathic urticaria. J Cosmet Dermatol 2022; 21:4072-4079. [PMID: 35166020 DOI: 10.1111/jocd.14851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 01/30/2022] [Accepted: 02/09/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND In this study, we aimed to evaluate the sleep quality among chronic urticaria patients using the Chronic Urticaria Quality-of-Life Questionnaire (CU-Q2oL), sleep quality assessment tools, and polysomnography and to investigate any relationships between the obtained results. METHODS The study included 21 patients diagnosed with chronic spontaneous urticaria and 19 healthy controls. We recorded the patients' sleep quality data, including CU-Q2 oL, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and polysomnography results. RESULT Patients in the chronic urticaria group were more likely to have an ESS score of ≥10 (52.4% vs. 5.3%, p = 0.004) and an apnea-hypopnea index of ≥5 (44.4% vs. 5.3%, p = 0.017) compared to the control group. In the patient group, the CU-Q2 oL total score was positively correlated with sleep latency (r = 0.713, p = 0.004) and PSQI-C1 score (r = 0.726, p = 0.005), while it was negatively correlated with urticaria duration (r = -0.579, p = 0.015), apnea-hypopnea index (r = -0.607, p = 0.021), longest apnea duration (r = -0.583, p = 0.029), total number of respiratory events (r = -0.618, p = 0.018), and apnea count (r = -0.686, p = 0.007). CONCLUSION We conclude that sleep-related problems exist among a considerably large proportion of patients with chronic spontaneous urticaria.
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Affiliation(s)
- Hale Ates
- Department of Allergy and Immunology, Atatürk Chest Disease and Chest Surgery Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Selma Firat
- Sleep Disorders Center, Ataturk Chest Diseases and Thoracic Surgery Education and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Gozde Koycu Buhari
- Department of Allergy and Immunology, Atatürk Chest Disease and Chest Surgery Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Metin Keren
- Department of Pulmonary Diseases, Süreyyapaşa Pulmonary Diseases Education and Research Hospital, Istanbul, Turkey
| | - Bulent Cifci
- Department of Chest Diseases, Medical School, Turkiye Yuksek Ihtisas University, Ankara, Turkey
| | - Ferda Öner Erkekol
- Department of Allergy and Immunology, Atatürk Chest Disease and Chest Surgery Training and Research Hospital, Health Sciences University, Ankara, Turkey
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Cho YT, Chan TC, Lee CH, Chou WY, Hsiao PF, Chen YJ, Wu PY, Yang CW, Chiu TM, Chang YT, Wang WM, Hong CH, Tu WT, Huang YH, Tsai TF, Lan CC, Chu CY. Taiwanese dermatological association consensus for the definition, classification, diagnosis, and management of urticaria: A 2021 update. J Formos Med Assoc 2022; 121:1191-1203. [PMID: 35219557 DOI: 10.1016/j.jfma.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/14/2022] [Accepted: 02/07/2022] [Indexed: 12/14/2022] Open
Abstract
Urticaria is a prevalent disease with substantial physical, psychological, and economic impacts. With the advent of understandings of the disease and the emerging evidence of treatments, the international guidelines for treating urticaria have been updated in recent years. In order to update the 2014 edition of the Taiwanese Dermatological Association (TDA) consensus of urticaria, a total of 17 dermatologists with extensive experience in urticaria management were invited to and attended the TDA consensus meetings. All the specific aspects of the content were approved by at least 75% of the experts in attendance. Comparing to the former edition, several substantial modifications were made. For diagnosis, D-dimer was added as the recommended routine test in patients with chronic spontaneous urticaria. For pharmacological management, treatment suggestions were simplified. The approved-dosed, the up-dosed second-generation antihistamines, omalizumab, and cyclosporine were listed as the first-line to the fourth-line treatment, respectively. In addition, the management for patients of special considerations, such as the elderly, children, and pregnant women, were all discussed and mentioned in the consensus. We hope the updated TDA consensus can serve as a reference for all physicians and can help the physicians providing up-to-dated managements for these patients.
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Affiliation(s)
- Yung-Tsu Cho
- Chen YY's Clinic, Keelung, Taiwan; Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tom C Chan
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Cung Memorial Hospital, Kaohsiung, Taiwan
| | | | - Pa-Fan Hsiao
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan
| | - Yi-Ju Chen
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Po-Yuan Wu
- Department of Dermatology, China Medical University Hospital, Taichung, Taiwan
| | - Che-Wen Yang
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan
| | - Tsu-Man Chiu
- Department of Dermatology, Changhua Christian Hospital, Changhua, Taiwan
| | - Yun-Ting Chang
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Ming Wang
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Hui Hong
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wei-Ting Tu
- Department of Dermatology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yu-Huei Huang
- Department of Dermatology, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Che Lan
- Department of Dermatology, Kaohsiung Medical University Hospital, Taiwan
| | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Chong AC, Chwa WJ, Ong PY. Aeroallergens in Atopic Dermatitis and Chronic Urticaria. Curr Allergy Asthma Rep 2022; 22:67-75. [PMID: 35362938 DOI: 10.1007/s11882-022-01033-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW While aeroallergens are a well-established trigger of asthma and allergic rhinitis, their role in allergic skin diseases such as atopic dermatitis and chronic urticaria remains controversial. This paper reviews the pathophysiology and clinical evidence for aeroallergens in these allergic skin diseases and summarizes current strategies for evaluation and management. RECENT FINDINGS Current evidence implicates aeroallergens as triggers of cutaneous reactions in atopic dermatitis. Direct skin contact is the likely route of trigger. Aeroallergens may also trigger chronic urticaria, though mechanistic studies are limited. These allergens may cross the skin barrier and directly trigger neurons to release substance P, resulting in mast cell degranulation and dumping of histamine and prostaglandin D2. Many studies link aeroallergen sensitization to chronic urticaria, and case reports suggest the utility of avoidance strategies. The role of aeroallergens as a trigger is clear in atopic dermatitis and becoming emergent in chronic urticaria. Skin prick testing or serum-specific immunoglobulin E testing may be used to determine sensitivities. Management at this time centers on avoidance, and further studies are necessary to evaluate the efficacy of aeroallergen immunotherapy for both conditions.
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Affiliation(s)
- Albert C Chong
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Won Jong Chwa
- Saint Louis University School of Medicine, Saint Louis University, Saint Louis, MO, USA
| | - Peck Y Ong
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. .,Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Brzoza Z, Badura-Brzoza K, Maurer M, Hawro T, Weller K. Chronic spontaneous urticaria activity, impact and control as well as their changes are strongly linked, and these links are not affected by angioedema or comorbid inducible urticaria – Results from the validation of the Polish Urticaria Control Test. World Allergy Organ J 2022; 15:100635. [PMID: 35399816 PMCID: PMC8938623 DOI: 10.1016/j.waojou.2022.100635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/31/2021] [Accepted: 02/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background Monitoring the effects of treatment on disease activity, impact, and control in patients with chronic spontaneous urticaria (CSU) is essential. We do not have enough information on how these features of CSU and its response to treatment are linked. Also, there is no information on how recurrent angioedema or coexisting chronic inducible urticaria (CIndU) affect their relation. The aim of this study was to analyse the link between disease activity, impact, and control in CSU patients and possible effects of recurrent angioedema and comorbid CIndU. Methods To perform these analyses, we validated the Polish version of the Urticaria Control Test (UCT) in 106 chronic urticaria patients. The relationship between CSU activity, impact, and control was assessed in regard to recurrent angioedema and coexisting CIndU. Results The Polish UCT showed high levels of validity, reliability, and sensitivity to change. Disease activity, impact, and control as well as their changes, assessed by the UAS, the CU-Q2oL, and the UCT, respectively, were strongly correlated. Recurrent angioedema or comorbid CIndU did not significantly affect the link of CSU activity, impact, and control or the relation of their changes. Conclusions In CSU, there is a strong, albeit not perfect correlation of disease activity, impact, and control, which underlines the need to assess all 3 features of the disease in routine clinical practice. Recurrent angioedema and comorbid CIndU, which are both common and relevant in CSU, do not affect how disease activity, impact and control in patients with CSU are related to each other.
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Affiliation(s)
- Zenon Brzoza
- Department of Internal Diseases with the Division of Allergology, Institute of Medical Sciences, University of Opole, Poland
- Corresponding author. Department of Internal Diseases with the Division of Allergology, Institute of Medical Sciences, University of Opole, Al. W. Witosa 26, 45-401 Opole, Poland
| | - Karina Badura-Brzoza
- Department of Psychiatry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité – Universitätsmedizin Berlin, Germany
| | - Tomasz Hawro
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité – Universitätsmedizin Berlin, Germany
| | - Karsten Weller
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité – Universitätsmedizin Berlin, Germany
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Shah B, Dhoot D, Choudhary A, Jangid N, Mistry D, Shah S, Kamat S, Barkate H. A Comparative, Three-Arm, Randomized Clinical Trial to Evaluate the Effectiveness and Tolerability of Bilastine vs Fexofenadine vs Levocetirizine at the Standard Dose and Bilastine vs Fexofenadine at Higher Than the Standard Dose (Up-Dosing) vs Levocetirizine and Hydroxyzine (in Combination) in Patients with Chronic Spontaneous Urticaria. Clin Cosmet Investig Dermatol 2022; 15:261-270. [PMID: 35221703 PMCID: PMC8867222 DOI: 10.2147/ccid.s350122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/24/2021] [Indexed: 11/26/2022]
Abstract
Introduction Though second-generation antihistamines (SGAH) are first-line drugs in chronic spontaneous urticaria (CSU), 50% of patients do not respond to them. In such patients, guidelines recommend either up-dosing of SGAH or combination of different antihistamines. However, the studies comparing these treatment regimens are limited. Methods In this comparative, three-arm study, CSU patients were randomized to receive standard dose of either bilastine, fexofenadine, or levocetirizine for 2 weeks. After 2 weeks of treatment, non-responders received double dose of either bilastine or fexofenadine, while hydroxyzine 25 mg once daily was added in the levocetirizine group. Patients were primarily evaluated for improvement in CSU, quality of life, and somnolence. Results A total of 110 patients with CSU were recruited. At the end of 4 weeks, 33/39, 26/35, and 22/36 patients in the bilastine, fexofenadine, and levocetirizine groups showed improvement in urticaria symptoms. At week 2, there was no statistical difference in urticaria activity score (UAS7) improvement between any of the groups; however, at week 4, there was a statistical difference between the bilastine and levocetirizine groups (p<0.05). Somnolence was significantly lower in the bilastine group (p<0.05). Bilastine was statistically significant (p<0.05) in the improvement of quality of life as compared to both groups. No major adverse events were reported during study period; however, bilastine was associated with significantly lower levels of AEs compared to levocetirizine (p<0.05). Conclusion Two-fold up-dosing of bilastine improves CSU symptoms without compromising safety as compared to two-fold up-dosing of fexofenadine and combination of first- and second-generation antihistamines.
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Affiliation(s)
- Bela Shah
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Dhiraj Dhoot
- DGM, Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
| | - Ankita Choudhary
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Neha Jangid
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Deval Mistry
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Shikha Shah
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Shruti Kamat
- Department of Dermatology, Venereology and Leprosy, B.J.Medical College, Civil Hospital, Ahmedabad, India
| | - Hanmant Barkate
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, India
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Ferrer Puga M, Silvestre Salvador J, Bartra Tomas J, Giménez-Arnau A, Labrador-Horrillo M, Miquel-Miquel J, Ortiz de Frutos F, Sastre Dominguez J, Valero Santiago A, Terradas-Montana P, Vidal-Jorge M, Jáuregui Presa I. Daily Clinical Practice in the Management of Chronic Urticaria in Spain: Results of the UCREX Study. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:4-14. [DOI: 10.1016/j.ad.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/06/2021] [Indexed: 11/25/2022] Open
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Ferrer Puga M, Silvestre Salvador J, Bartra Tomas J, Giménez-Arnau A, Labrador-Horrillo M, Miquel-Miquel J, Ortiz de Frutos F, Sastre Dominguez J, Valero Santiago A, Terradas-Montana P, Vidal-Jorge M, Jáuregui Presa I. [Artículo traducido] Práctica clínica diaria en el manejo de la urticaria crónica en España: resultados del estudio UCREX. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:T4-T14. [DOI: 10.1016/j.ad.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/06/2021] [Indexed: 10/20/2022] Open
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Nochaiwong S, Chuamanochan M, Ruengorn C, Awiphan R, Tovanabutra N, Chiewchanvit S, Hutton B, Thavorn K. Impact of Pharmacological Treatments for Chronic Spontaneous Urticaria with an Inadequate Response to H1-Antihistamines on Health-Related Quality of Life: A Systematic Review and Network Meta-Analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:297-308. [PMID: 34695599 DOI: 10.1016/j.jaip.2021.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Recently, pharmacological treatment options for H1-antihistamine-refractory chronic spontaneous urticaria have increased dramatically; however, their effects on patient-reported outcomes, including health-related quality of life (HRQOL), remain unclear. OBJECTIVE To compare the impact of these treatments on HRQOL among H1-antihistamine-refractory patients with chronic spontaneous urticaria. METHODS We completed a comprehensive search of the available literature in the electronic databases, gray literature, and preprint reports up to April 19, 2021, with no language restrictions. The primary outcome for evaluation was a change in HRQOL from the baseline, and secondary outcomes included patient unacceptability and other patient-reported outcomes. We used a random-effects network meta-analysis and estimated differences in standardized mean differences (SMDs) and odds ratios with 95% CIs. Evidence-based synthesis was based on magnitudes of effect size, evidence certainty, ranking of treatment effects, and clinically meaningful improvement. RESULTS Twelve randomized controlled trials encompassing 1866 adolescent and adult patients were included. Our evidence synthesis analyses revealed that hydroxychloroquine (SMD, -1.00 [-1.61 to -0.39]), 72 mg ligelizumab (SMD, -0.66 [-0.96 to -0.35]), 240 mg ligelizumab (SMD, -0.67 [-0.98 to -0.37]), and 300 mg omalizumab (SMD, -0.53 [-0.67 to -0.39]) significantly improved HRQOL with a moderate beneficial effect. However, the use of hydroxychloroquine seems to be limited by a higher risk of patient unacceptability of treatment. Other secondary outcomes remain inconclusive based on the available evidence. CONCLUSIONS Both ligelizumab (72 or 240 mg) and 300 mg omalizumab appeared to be effective treatments for H1-antihistamine-refractory chronic spontaneous urticaria, because they were closely associated with improved HRQOL.
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Affiliation(s)
- Surapon Nochaiwong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
| | - Mati Chuamanochan
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Chidchanok Ruengorn
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Ratanaporn Awiphan
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Napatra Tovanabutra
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Siri Chiewchanvit
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, ON, Canada; Institute of Clinical and Evaluative Sciences, ICES uOttawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kednapa Thavorn
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, ON, Canada; Institute of Clinical and Evaluative Sciences, ICES uOttawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Daily Clinical Practice in the Management of Chronic Urticaria in Spain: Results of the UCREX Study. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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The Classification, Pathogenesis, Diagnostic Workup, and Management of Urticaria: An Update. Handb Exp Pharmacol 2021; 268:117-133. [PMID: 34247278 DOI: 10.1007/164_2021_506] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Wheals and angioedema are the signature signs of urticaria, and itch is the key symptom. Urticaria, in most patients, is acute and resolves within days (acute urticaria, AU). Chronic urticaria (CU) can be of long duration and results not only in severely impaired quality of life but also has a socioeconomic impact due to work productivity impairment. In some patients with CU, the wheals and angioedema are induced exclusively by defined and definite triggers (chronic inducible urticaria, CIndU). In most patients with CU, wheals and angioedema develop unprompted, spontaneously (chronic spontaneous urticaria, CSU). The management of CU aims for the complete control and absence of its signs and symptoms. This is achieved, in most patients, by prophylactic treatment until spontaneous remission occurs. Modern, second-generation H1-antihistamines are the first-line therapy, with the option of updosing to fourfold, and omalizumab is used when this fails.
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Katelaris CH, Lima H, Marsland A, Weller K, Shah A, Waserman S. How to Measure Disease Activity, Impact, and Control in Patients with Recurrent Wheals, Angioedema, or Both. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2151-2157. [PMID: 34112471 DOI: 10.1016/j.jaip.2021.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/22/2021] [Accepted: 02/08/2021] [Indexed: 01/02/2023]
Abstract
Chronic spontaneous urticaria and chronic inducible urticaria are characterized by wheals, angioedema, or both, whereas other conditions such as hereditary angioedema present only with angioedema. The unpredictability of outbreaks, disfigurement, pruritus, and associated sleep and work disturbance can cause a significant impact on quality of life (QoL). Significant breakthroughs in the understanding of these conditions in recent years have led to the development of novel therapies. Assessment of patients with these conditions not only focuses on the clinical activity of the condition, but also on the impact on QoL and disease control with treatment. Patient-reported outcome measures, especially if sufficiently validated, give due prominence to the patient's perspective regarding disease impact and treatment outcomes. This article will review the tools readily available to assess activity, impact, and control in patients with recurrent wheals, angioedema, or both.
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Affiliation(s)
- Constance Helen Katelaris
- Western Sydney University, Faculty of Medicine, Sydney, NSW, Australia; Immunology & Allergy Unit, Campbelltown Hospital, Sydney, NSW, Australia.
| | - Hermenio Lima
- Division of Dermatology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Alexander Marsland
- The Dermatology Centre Salford Royal Hospital, Salford Royal Foundation Trust, Salford, United Kingdom; Honorary Senior Lecturer, University of Manchester, Manchester, United Kingdom
| | - Karsten Weller
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anita Shah
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Susan Waserman
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada
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Rönsch H, Berndt K, Bauer A. Behandlungszufriedenheit bei chronischer Urtikaria unter leitliniengerechter Therapie. J Dtsch Dermatol Ges 2021; 19:833-841. [PMID: 34139070 DOI: 10.1111/ddg.14415_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 12/26/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Henriette Rönsch
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Deutschland
| | - Katja Berndt
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Deutschland
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Deutschland
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Sánchez-Borges M, Ansotegui IJ, Baiardini I, Bernstein J, Canonica GW, Ebisawa M, Gomez M, Gonzalez-Diaz SN, Martin B, Morais-Almeida M, Ortega Martell JA. The challenges of chronic urticaria part 1: Epidemiology, immunopathogenesis, comorbidities, quality of life, and management. World Allergy Organ J 2021; 14:100533. [PMID: 34221215 PMCID: PMC8233382 DOI: 10.1016/j.waojou.2021.100533] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/18/2021] [Accepted: 03/08/2021] [Indexed: 12/02/2022] Open
Abstract
This is Part 1 of an updated follow-up review of a World Allergy Organization (WAO) position paper published in 2012 on the diagnosis and treatment of urticaria and angioedema. Since 2012, there have been advances in the understanding of the pathogenesis of chronic urticaria, and greater experience with the use of biologics, such as omalizumab, in patients with severe refractory disease. For these reasons, the WAO decided to initiate an update targeted to general practitioners around the world, incorporating the most recent information on epidemiology, immunopathogenesis, comorbidities, quality of life, clinical case presentations, and the management of chronic spontaneous and chronic inducible urticaria, including urticaria in special situations such as childhood and pregnancy. A special task force of WAO experts was invited to write the different sections of the manuscript, and the final document was approved by the WAO Board of Directors. This paper is not intended to be a substitute for current national and international guidelines on the management of urticaria and angioedema but to provide an updated, simplified guidance for physicians around the world who manage patients with this common ailment.
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Affiliation(s)
- Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, and Clínica El Avila, Caracas, Venezuela
| | - Ignacio J. Ansotegui
- Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia, Bilbao, Spain
| | - Ilaria Baiardini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Jonathan Bernstein
- Department of Internal Medicine, Division of Immunology, Allergy Section, University of Cincinnati
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | | | - Sandra Nora Gonzalez-Diaz
- Regional Center for Allergy and Clinical Immunology, Faculty of Medicine and “Dr. José Eleuterio González" University Hospital, Autonomous University of Nuevo León, Monterrey, México
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Rönsch H, Berndt K, Bauer A. Treatment satisfaction in chronic urticaria during guideline-based therapy. J Dtsch Dermatol Ges 2021; 19:833-840. [PMID: 33931937 DOI: 10.1111/ddg.14415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 12/26/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Patients with chronic urticaria are often unsatisfied with their treatment. We aimed to assess patient satisfaction, chronic urticaria control, treatment goals, self-treatment competence, knowledge, and factors influencing treatment satisfaction. PATIENTS AND METHODS Eighty-seven adult patients with chronic urticaria who were previously insufficiently treated with oral antihistamines received guideline-based care for six months and completed questionnaires. RESULTS This study included patients with chronic spontaneous (80 %) and/or inducible urticaria (CIndU, 32 %). Significant median improvements were observed with the urticaria control test (UCT, from 7 to 11), the urticaria activity score for patients with chronic spontaneous urticaria (from 19 to 10), and treatment satisfaction (from 5.2 to 8.4). Six significant, independent factors of treatment satisfaction after six months of treatment were identified (negative: male sex, CIndU, sleep disturbances; positive: UCT, baseline treatment satisfaction, perceived competence of the study physician). Adequate urticaria control (UCT ≥ 12) was achieved in 19 % of patients with CIndU and 61 % of patients without CIndU. CONCLUSIONS In patients with chronic urticaria who were previously insufficiently treated with antihistamines, six months of guideline-based therapy significantly improved disease control and treatment satisfaction. Adequate control requires several consultations for many patients and is considerably more difficult to achieve for CIndU.
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Affiliation(s)
- Henriette Rönsch
- Department of Dermatology, University Hospital Carl Gustav Carus at the Technical University Dresden, Dresden, Germany
| | - Katja Berndt
- Department of Dermatology, University Hospital Carl Gustav Carus at the Technical University Dresden, Dresden, Germany
| | - Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus at the Technical University Dresden, Dresden, Germany
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Womack N, Jude E. Urticaria as a manifestation of hyperthyroidism. Clin Case Rep 2021; 9:e03620. [PMID: 34084471 PMCID: PMC8142299 DOI: 10.1002/ccr3.3620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/08/2020] [Accepted: 09/19/2020] [Indexed: 11/12/2022] Open
Abstract
In clinically euthyroid patients presenting with urticaria, a trial period of withholding antithyroid medications can be exercised. In clinically hyperthyroid patients, antithyroid medications may be stopped with close observation of response.
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Affiliation(s)
- Nicholas Womack
- Tameside and Glossop Integrated Care NHS Foundation TrustAshton‐Under‐LyneUK
| | - Edward Jude
- Tameside and Glossop Integrated Care NHS Foundation TrustAshton‐Under‐LyneUK
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45
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Mobeen A, Ahmad AK. The efficacy and safety of herbal combination of Unani Medicine in chronic urticaria: A randomized, controlled study. J Tradit Complement Med 2021; 11:303-310. [PMID: 34195024 PMCID: PMC8240108 DOI: 10.1016/j.jtcme.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/26/2020] [Accepted: 12/30/2020] [Indexed: 01/01/2023] Open
Abstract
Background and Aim; Chronic urticaria (CU) is a fluctuating and pruritic erythematous papule that persists for over six weeks. It affects 0.5-1% of the population and interferes with subjective well-being and daily life. Its etiology is highly complex which makes a causal and/or curative treatment difficult. Nonsedating H1-antihistamines are given as symptomatic therapy, which reduces symptoms effectively in <50% of patients. In Unani medicine, urticaria is known as Shara and treated according to its established etiology. The present study objective was to investigate the effect of herbal combination of Unani medicine (HCUM) comprising Rosa damascena Mill, Bambusa arundinacea Linn, Cinnamomum camphora Linn, Mentha arvensis Linn, in comparison with Levocetirizine in CU. Experimental procedure; This randomized open-labeled standard control clinical trial was conducted between 42 male/female patients aged 20-50 years with moderate to severe CU who were randomly allocated in a 3:1 ratio into HCUM and Levocetirizine 5 mg groups. HCUM powder 5.125 Gm and Levocetirizine 5 mg were given for 4 weeks. Urticaria activity score (UAS7) and chronic urticaria quality of life questionnaire (CU-Q2oL) were primary and secondary outcomes and analyzed per protocol. Results: A total of 40 patients completed the study. Data analysis showed a significant decrease (P=<0.001) in the scores of UAS7 (32.43 ± 2.34-14.03 ± 2.16 and 32.10 ± 2.33-28.40 ± 3.78) and CU-Q2oL (67.57 ± 9.56-36.50 ± 3.01 and 65.20 ± 11.78-59.60 ± 11.13) in HCUM and Levocetirizine groups respectively. Conclusion: As an alternative treatment in terms of safety, efficacy, tolerability, and quality of life the HCUM treatment proved to be more effective than Levocetirizine 5 mg in moderate to severe CU.
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Affiliation(s)
- Abdul Mobeen
- Dept. of Moalajat, Ntional Institute of Unani Medicine, Bangalore, 56009, India
| | - A Khaleel Ahmad
- Dept. of Moalajat, Government Unani Medical College, Chennai, 600106, India
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Rossi O, Piccirillo A, Iemoli E, Patrizi A, Stingeni L, Calvieri S, Gola M, Dapavo P, Cristaudo A, Zichichi L, Losappio L, Saccheri F, Pastorello EA. Socio-economic burden and resource utilisation in Italian patients with chronic urticaria: 2-year data from the AWARE study. World Allergy Organ J 2020; 13:100470. [PMID: 33343800 PMCID: PMC7726718 DOI: 10.1016/j.waojou.2020.100470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
Introduction In Italy, the real-world evidence on the extent of adherence to guidelines and the benefits of recommended therapeutic medications and their impact on the quality of life (QoL) of H1-antihistamines (H1-AH) refractory chronic urticaria (CU) patients is limited. Methods AWARE (A World-wide Antihistamine-Refractory chronic urticaria patient Evaluation) was a global prospective, non-interventional study of CU in real-world setting which included patients aged ≥18 years with a medically confirmed diagnosed of CU present for more than 2 months. In this study, the disease characteristics, pharmacological treatments and patient-reported outcomes (PROs) are reported. Results In total, 159 patients from 24 study centres in Italy completed the study. At baseline, 221 (89.5%) and 8 (3.2%) patients had chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU), respectively, while 18 (7.3%) patients had concomitant CSU and CIndU. For CSU patients, mean dermatology life quality index and CU quality of life questionnaire scores reduced to 3.0 ± 4.9 and 14.6 ± 18.6 at Month 24 from baseline scores of 7.5 ± 6.6 and 33.2 ± 19.5, respectively, indicating an improvement in QoL. This was reflected in their work-life as work productivity impairment reduced considerably after 2 years. Only 71.9% CSU patients had a prior treatment, while during the study, 96.8% of the patients were treated with a medication. At baseline, only 52.9% CSU patients reported nonsedating H1-antihistamines as first-line of treatment in prior medication, this increased to 89.6% during current medication. Conclusion This study shows that CSU has a considerable socio-economic burden and an improvement in QoL can be achieved in CSU patients if an appropriate therapeutic path is followed.
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Key Words
- AWARE study
- CIndU, chronic inducible urticaria
- CSU, chronic spontaneous urticaria
- CU, chronic urticaria
- CU-Q2oL, CU quality of life questionnaire
- Chronic spontaneous urticaria
- DLQI, dermatology life quality index
- GCP, good clinical practices
- H1-AH, H1-antihistamines
- Italy
- PRO, patient-reported outcomes
- QoL, quality of life
- Resource utilisation
- SD, standard deviation
- Socio-economic burden
- UAS7, weekly urticaria activity score
- WPAI-CU, work productivity and activity impairment questionnaire
- nsAH, non-sedating H1-AH
- sAH, sedating H1-AH
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Affiliation(s)
- Oliviero Rossi
- Azienda Ospedaliera Universitaria Careggi, SOD Immunoallergologia, Florence, Italy
| | | | | | - Annalisa Patrizi
- UOC Dermatologia Metropolitana, DIMES, University Bologna, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine, University of Perugia, Italy
| | | | - Massimo Gola
- AOU Ospedale Piero Palagi/IOT UOC Dermatologia, SAS Dermatologia Allergologica, Florence, Italy
| | - Paolo Dapavo
- A.O.U. Citta della Salute e della Scienza di Torino, Turin, Italy
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Gonçalo M, Gimenéz‐Arnau A, Al‐Ahmad M, Ben‐Shoshan M, Bernstein J, Ensina L, Fomina D, Galvàn C, Godse K, Grattan C, Hide M, Katelaris C, Khoshkhui M, Kocatürk E, Kulthanan K, Medina I, Nasr I, Peter J, Staubach P, Wang L, Weller K, Maurer M. The global burden of chronic urticaria for the patient and society*. Br J Dermatol 2020; 184:226-236. [DOI: 10.1111/bjd.19561] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
Affiliation(s)
- M. Gonçalo
- Department of Dermatology University Hospital and Faculty of MedicineUniversity of Coimbra Coimbra Portugal
| | - A. Gimenéz‐Arnau
- Department of Dermatology Hospital del MarIMIMUniversitat Autònoma Barcelona Spain
| | - M. Al‐Ahmad
- Microbiology Department Faculty of Medicine Kuwait University Kuwait
| | - M. Ben‐Shoshan
- Division of Allergy, Immunology and Dermatology Department of Pediatrics Montreal Children’s HospitalMcGill University Montréal QC Canada
| | - J.A. Bernstein
- University of Cincinnati College of MedicineDepartment of Internal Medicine, Division of Immunology/Allergy Section, Partner Bernstein Allergy Group and Bernstein Clinical Research Center Cincinnati OH USA
| | - L.F. Ensina
- Alergoalpha/CPAlpha Allergy Clinic and Clinical Research Center and Division of Allergy, Clinical Immunology and Rheumatology Department of Pediatrics Federal University of São Paulo (UNIFESP/EPM) São Paulo SP Brazil
| | - D. Fomina
- Moscow City Center of Allergy and Immunology Clinical City Hospital #52 Department of General Therapy Pirogov Russian National Research Medical University Moscow Russian Federation
- Department of Allergology and Clinical Immunology I.M. Sechenov First Moscow State Medical University Moscow Russian Federation
| | - C.A. Galvàn
- Instituto Nacional de Salud del NiñoCentro de Referencia Nacional de Alergia Asma e Inmunología, Lima Perú
| | - K. Godse
- Department of Dermatology Dr D.Y. Patil School of Medicine Mumbai Maharashtra India
| | - C. Grattan
- St John’s Institute of DermatologyGuy’s Hospital London UK
| | - M. Hide
- Department of Dermatology Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - C.H. Katelaris
- Campbelltown Hospital and Western Sydney University Sydney NSW Australia
| | - M. Khoshkhui
- Allergy Research Center Mashhad University of Medical Sciences Mashhad Iran
| | - E. Kocatürk
- Department of Dermatology Koc University School of Medicine Istanbul Turkey
| | - K. Kulthanan
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | - I. Medina
- Centro Medico VitaeDepartment of Allergy and Clinical Immunology Buenos Aires Argentina
| | - I. Nasr
- Department of Immunology and Allergy Royal Hospital Muscat Oman
| | - J. Peter
- Division of Allergy and Clinical Immunology University of Cape Town and Allergy and Immunology UnitUniversity of Cape Town Lung Institute Cape Town South Africa
| | - P. Staubach
- Department of Dermatology University Medical Center Mainz Mainz Germany
| | - L. Wang
- Liangchun Wang – Sun Yat‐sen Memorial Hospital Sun Yat‐sen University Guangzhou China
| | - K. Weller
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - M. Maurer
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
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Robles‐Tenorio A, Tarango‐Martinez VM, Sierra‐Silva G. Aquagenic urticaria: Water, friend, or foe? Clin Case Rep 2020; 8:2121-2124. [PMID: 33235740 PMCID: PMC7669369 DOI: 10.1002/ccr3.2880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/24/2020] [Accepted: 03/20/2020] [Indexed: 11/07/2022] Open
Abstract
There are <100 reported cases of aquagenic urticaria. Although most are sporadic, several diseases have been associated. Diagnosis is based on provocation tests. Second-generation antihistamines are the first-line treatment.
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Affiliation(s)
- Arturo Robles‐Tenorio
- CUCS Universidad de GuadalajaraGuadalajaraMéxico
- Instituto Dermatologico de Jalisco “Dr. José Barba Rubio” (IDJ)ZapopanMéxico
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Weller K, Giménez‐Arnau A, Grattan C, Asero R, Mathelier‐Fusade P, Bizjak M, Hanna M, Maurer M. The Chronic Urticaria Registry: rationale, methods and initial implementation. J Eur Acad Dermatol Venereol 2020; 35:721-729. [DOI: 10.1111/jdv.16947] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/24/2020] [Indexed: 11/26/2022]
Affiliation(s)
- K. Weller
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - A. Giménez‐Arnau
- Department of Dermatology, Hospital del Mar Autonomous University of Barcelona Barcelona Spain
| | - C. Grattan
- St John's Institute of Dermatology London UK
| | - R. Asero
- Outpatient Clinic of Allergology San Carlo Hospital Paderno Dugnano Italy
| | | | - M. Bizjak
- University Clinic of Respiratory and Allergic Diseases Golnik Golnik Slovenia
| | - M. Hanna
- Mercury Medical Research & Writing New York NY USA
| | - M. Maurer
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
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Qin Y, Guo J, Song P, Hou T, He Y, Han M, Yu Q, Lin W, Chen M, Su H. Multi-center study for acupuncture combined with Chinese medicine in the treatment of chronic spontaneous urticaria based on the theory of taking shu-stream points when the disease is aggravated. Medicine (Baltimore) 2020; 99:e21266. [PMID: 32871985 PMCID: PMC7437762 DOI: 10.1097/md.0000000000021266] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Chronic spontaneous urticaria (CSU) is a common dermatologic disease that seriously affects patient quality of life. The choice of therapy to control the disease and prevent its recurrence has always presented a difficult clinical issue. Previous studies have shown that traditional Chinese medicine is a safe and effective treatment for CSU. Recently, the temporal rhythms of CSU, a disease characterized by intermittent flares of active disease and periods of little or no disease, have attracted the attention of traditional Chinese medicine researchers. We designed a multicenter, randomized, controlled study to evaluate the efficacy and safety of combining a Chinese herbal formulation with acupuncture using shu-stream acupoints applied on the corresponding time meridians during disease exacerbations. We plan to recruit 111 outpatients with CSU aged 18 to 65 years. Participants will be randomized to 1 of the 3 groups: group A, which will be given basic acupuncture and the herbal formulation dangui yinzi; group B, which will be given danggui yinzi and shu-stream acupuncture; and a control group, which will be given danggui yinzi alone. Patients will be treated for 4 weeks and followed for 8 additional weeks. Investigators will evaluate the following parameters: the symptoms and side effects of treatment, quality of life (using the chronic urticaria quality of life questionnaire), and overall patient condition. Each week, patients will also complete the measurement of 7-day urticarial activity score. This is the first use of a combination of shu-stream acupoints and Chinese herbal medicine in the treatment of CSU. If successful, it will prove to be a simple, inexpensive, treatment strategy for solving a difficult clinical problem.
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Affiliation(s)
- Yuesi Qin
- Hospital of Chengdu University of Traditional Chinese Medicine
- Chengdu Integrated TCM & Western Medicine Hospital
| | - Jing Guo
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Pan Song
- Chengdu Integrated TCM & Western Medicine Hospital
| | - Tianshu Hou
- Chengdu Integrated TCM & Western Medicine Hospital
| | - Yan He
- The First People's Hospital of Longquanyi District Chengdu
| | - Ming Han
- Xinjin County Hospital of traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qianying Yu
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Wenxia Lin
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Mingling Chen
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Hong Su
- Chengdu Integrated TCM & Western Medicine Hospital
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