1
|
Maoz-Segal R, Levenberg G, Levy T, Haj-Yahia S, Shavit R, Machnes-Maayan D, Lifshitz -Tunitsky Y, Niznik S, Offengenden I, Iancovich-Kidon M, Agmon-Levin N. Omalizumab withdrawal outcomes in chronic spontaneous urticaria are linked with baseline IgE and eosinophil levels. World Allergy Organ J 2024; 17:100905. [PMID: 38742157 PMCID: PMC11089392 DOI: 10.1016/j.waojou.2024.100905] [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: 12/25/2023] [Revised: 04/01/2024] [Accepted: 04/09/2024] [Indexed: 05/16/2024] Open
Abstract
Background Chronic Spontaneous Urticaria (CSU) is an immune-mediated skin disease that may require prolonged treatments. Currently, there are no recommendations for treatment discontinuation once CSU symptoms are controlled, particularly among patients primarily diagnosed with severe CSU. Objective In this real-life study we aimed to describe our experience of omalizumab (Oma) treatment withdrawal in CSU and define biomarkers related to these outcomes. Methods CSU patients followed at our allergy clinic from January 2016 to December 2022 were included. Response to Oma therapy, and Oma-withdrawal outcomes among patients who reached complete remission for >6 months were analyzed. Results During the study period 192/335(%) CSU patients were categorized as severe-CSU and entitled to receive Oma according to our country's regulations. Of them, 131/192(68%) were considered "Oma-responders", and 95/131(72.5%) patients underwent gradual treatment withdrawal. Successful Oma-withdrawal was documented in 47/95(49.5%) whereas 48/95(50.5%) patients experienced flare and were defined as unsuccessful OMA-withdrawal. The first was associated with shorter disease duration 7.1 ± 7.4 years vs. 10.7 ± 9.4 (P = 0.042), lower baseline-IgE 81.6 ± 84.1IU/ml vs. 324.7 ± 555.9 (P = 0.005), and lower baseline-eosinophils count 131.4 ± 110.5 vs. 195.6 ± 98.4 (P = 0.043) in comparison to failure of Oma-withdrawal group. Conclusion OMA may be successfully withdrawn in up to 50% of severe CSU patients following complete remission of disease symptoms, utilizing a gradual withdrawal protocol. Oma-withdrawal failure was linked with longer duration of disease as well as high IgE and eosinophil counts prior to initiation of Oma therapy. These parameters may enable the design of a treatment withdrawal algorithm.
Collapse
Affiliation(s)
- Ramit Maoz-Segal
- The Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| | - Guy Levenberg
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
| | - Tanya Levy
- The Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| | - Soad Haj-Yahia
- The Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| | - Ronen Shavit
- The Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| | - Diti Machnes-Maayan
- The Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
| | - Yulia Lifshitz -Tunitsky
- The Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
| | - Stanely Niznik
- The Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| | - Irena Offengenden
- The Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| | - Mona Iancovich-Kidon
- The Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
| | - Nancy Agmon-Levin
- The Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
| |
Collapse
|
2
|
Pesqué D, Ciudad A, Andrades E, Soto D, Gimeno R, Pujol RM, Giménez-Arnau AM. Solar Urticaria: An Ambispective Study in a Long-term Follow-up Cohort with Emphasis on Therapeutic Predictors and Outcomes. Acta Derm Venereol 2024; 104:adv25576. [PMID: 38189220 PMCID: PMC10789168 DOI: 10.2340/actadv.v104.25576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 01/09/2024] Open
Abstract
Solar urticaria is a rare photodermatosis with several unknown pathogenic, clinical and therapeutic aspects. This study analysed the clinical and therapeutic features of a long-term follow-up solar urticaria cohort, with a focus on omalizumab management and outcomes, and characterized omalizumab response with the use of the high-affinity immunoglobulin E (IgE) receptor (FcεRI) and the Urticaria Control Test. An observational, unicentric, ambispective study was conducted from 2007 to 2023. Solar urticaria was diagnosed in 41 patients with a median follow-up of 60 months. Thirteen patients were prescribed omalizumab, with a median treatment time of 48 months. A significant decrease in FcεRI baseline levels and subsequent median increase in Urticaria Control Test was evidenced after omalizumab prescription in all patients. Drug survival at 48 months was at 88.9%. Omalizumab stepping-down protocol led to sustained omalizumab discontinuation in only 1 patient. Median basal Urticaria Control Test was lower (p < 0.01) in patients who were prescribed omalizumab and in patients without remission. This study contributes to our knowledge of omalizumab outcomes in real-life clinical practice and highlights the pathogenic importance of IgE-mediated pathways in solar urticaria, where FcεRI emerges as a possible biomarker of omalizumab response.
Collapse
Affiliation(s)
- David Pesqué
- Department of Dermatology, Hospital del Mar Research Institute, Department of Medicine, Autonomous University of Barcelona/Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Andrea Ciudad
- Department of Dermatology, Hospital del Mar Research Institute, Barcelona, Spain
| | - Evelyn Andrades
- Department of Immunology, IMIM Hospital del Mar Research Institute, Barcelona, Spain
| | - Dulce Soto
- Department of Immunology, IMIM Hospital del Mar Research Institute, Barcelona, Spain
| | - Ramon Gimeno
- DDepartment of Immunology, IMIM Hospital del Mar Research Institute, Barcelona, Spain
| | - Ramon M Pujol
- Department of Dermatology, Hospital del Mar Research Institute, Barcelona, Spain
| | - Ana M Giménez-Arnau
- DDepartment of Dermatology, Hospital del Mar Research Institute. Universitat Pompeu Fabra, Barcelona, Spain.
| |
Collapse
|
3
|
Staubach P, Alvaro-Lozano M, Sekerel BE, Maurer M, Ben-Shoshan M, Porter M, Hua E, Ji Y, Burciu A, Savelieva M, Severin T, Drollmann A, Bienczak A. Ligelizumab in adolescents with chronic spontaneous urticaria: Results of a dedicated phase 2b randomized clinical trial supported with pharmacometric analysis. Pediatr Allergy Immunol 2023; 34:e13982. [PMID: 37492920 DOI: 10.1111/pai.13982] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU), a long-lasting disease in children, impacts their quality of life. We report the results of a phase 2b dose-finding trial of ligelizumab (NCT03437278) and a high-affinity humanized monoclonal anti-IgE antibody, in adolescents with CSU, supported by modeling and simulation analyses, mitigating challenges in pediatric drug development. METHODS This multicenter, double-blind, placebo-controlled trial, randomized H1-antihistamine-refractory adolescent CSU patients (12-18 years) 2:1:1 to ligelizumab 24 mg, 120 mg, or placebo every 4 weeks for 24 weeks. Patients on placebo transitioned to ligelizumab 120 mg at week 12. Integrating data from the previous adult and present adolescent trial of ligelizumab, a nonlinear mixed-effects modeling described the longitudinal changes in ligelizumab pharmacokinetics, and its effect on weekly Urticaria Activity Score (UAS7). RESULTS Baseline UAS7 (mean ± SD) was 30.5 ± 7.3 (n = 24), 29.3 ± 7.7 (n = 13), and 32.5 ± 9.0 (n = 12) for patients (median age, 15 years) on ligelizumab 24 mg, 120 mg, and placebo, respectively. Change from baseline in UAS7 at week 12 with ligelizumab 24 mg, 120 mg, and placebo was -15.7 ± 10.9, -18.4 ± 12.3, and -13.0 ± 13.0, respectively. Ligelizumab was well-tolerated. The modeling analysis showed that body weight, but not age, affected ligelizumab's apparent clearance. No significant differences between adolescents and adults were detected on the model-estimated maximum effect and potency. CONCLUSIONS Ligelizumab exhibited efficacy and safety in adolescent CSU patients, consistent with that in adults. The PK and potency of ligelizumab were not impacted by age, and the same dose of ligelizumab can be used for treating adolescents and adults with CSU. Our study shows how modeling and simulation can complement pediatric drug development.
Collapse
Affiliation(s)
- Petra Staubach
- Department of Dermatology, University Medical Center, Mainz, Germany
| | - Montserrat Alvaro-Lozano
- Department of Pediatric Allergology and Clinical Immunology, Hospital Sant Joan de Déu, Esplugues (Barcelona), Institut de Recerca Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Bulent Enis Sekerel
- Faculty of Medicine, Pediatric Allergy and Asthma Unit, Hacettepe University, Ankara, Turkey
| | - 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
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Paediatrics, Montreal Children's Hospital McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Eva Hua
- Shanghai Novartis Trading Ltd., Shanghai, China
| | - Yan Ji
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | | | | | | | | |
Collapse
|
4
|
Do TT, Canty EA, Joshi SR. Current and future management of chronic spontaneous urticaria and chronic inducible urticaria. Allergy Asthma Proc 2023; 44:3-14. [PMID: 36719690 DOI: 10.2500/aap.2023.44.220093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Chronic urticaria (CU), characterized by ≥6 weeks of intense pruritus, remains a debilitating condition for patients. New and safe treatments are needed to manage CU recalcitrant to standard therapy. Objective: A review of the current literature of standard and novel therapeutics in the management of CU was conducted. Methods: A literature search via a medical literature data base and clinical trial data base was conducted to identify treatment options for CU and current clinical trials. Results: Second-generation antihistamines, omalizumab, and cyclosporine remain the most proven therapeutic options for CU. Dupilumab, mepolizumab, benralizumab, tezepelumab, and CDX-0159 are all undergoing clinical trials for CU. Although ligelizumab demonstrated initial promising results, a phase III study was discontinued due to a nonsuperior clinical impact compared with omalizumab. Conclusion: Novel therapies are needed for the treatment of recalcitrant CU. With a deeper understanding of the pathophysiology of CU, promising therapeutics are in clinical trials for CU.
Collapse
Affiliation(s)
- Toan T Do
- From the Department of Internal Medicine, Oregon Health and Science University, Portland, Oregon
| | - Ethan A Canty
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, and
| | - Shyam R Joshi
- Section of Allergy and Clinical Immunology, Oregon Health and Science University, Portland, Oregon
| |
Collapse
|
5
|
Manti S, Giallongo A, Papale M, Parisi GF, Leonardi S. Monoclonal Antibodies in Treating Chronic Spontaneous Urticaria: New Drugs for an Old Disease. J Clin Med 2022; 11:jcm11154453. [PMID: 35956071 PMCID: PMC9369449 DOI: 10.3390/jcm11154453] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 02/04/2023] Open
Abstract
Background: H1-antihistamines (H1AH) represent the current mainstay of treatment for chronic spontaneous urticaria (CSU). However, the response to H1AH is often unsatisfactory, even with increased doses. Therefore, guidelines recommend the use of omalizumab as an add-on treatment in refractory CSU. This paved the way for the investigation of targeted therapies, such as monoclonal antibodies (mAbs), in CSU. Methods: A literature review was conducted including papers published between 2009 and 2022 and ongoing trials about the efficacy and safety of mAbs as treatment for CSU. Results: Twenty-nine articles, a trial with preliminary results, and seventeen ongoing or completed clinical trials on the use of mAbs in CSU were included. Randomized controlled trials (RCTs), meta-analysis, and real-life studies have proven the effectiveness and safety of omalizumab as a third-line treatment in refractory CSU. However, a percentage of patients remain unresponsive to omalizumab. Therefore, other mAbs, targeting different pathways, have been used off-label in case series and others are under investigation in RCTs. Most of them have showed promising results. Conclusions: Omalizumab remains the best choice to treat refractory CSU. Although results from other mAbs seem to be encouraging to achieve symptom control in refractory CSU, thus improving patients’ QoL, RCTs are needed to confirm their effectiveness and safety.
Collapse
Affiliation(s)
- Sara Manti
- Pediatric Respiratory Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (M.P.); (G.F.P.); (S.L.)
- Pediatric Unit, Department of Human and Pediatric Pathology “Gaetano Barresi”, AOUP G. Martino, University of Messina, Via Consolare Valeria, 1, 98124 Messina, Italy
- Correspondence:
| | | | - Maria Papale
- Pediatric Respiratory Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (M.P.); (G.F.P.); (S.L.)
| | - Giuseppe Fabio Parisi
- Pediatric Respiratory Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (M.P.); (G.F.P.); (S.L.)
| | - Salvatore Leonardi
- Pediatric Respiratory Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (M.P.); (G.F.P.); (S.L.)
| |
Collapse
|
6
|
Tsabouri S, Arasi S, Beken B, Church MK, Alvaro-Lozano M, Caffarelli C, Flohr C, Janmohamed SR, Konstantinou GN, Lau S, Lefevre S, Mortz CG, Pajno G, Pite H, Rutkowski K, Staubach P, Van der Poel LA, Zuberbier T, Leslie TA. A European survey of management approaches in chronic urticaria in children: EAACI pediatric urticaria taskforce. Pediatr Allergy Immunol 2022; 33:e13674. [PMID: 34601755 DOI: 10.1111/pai.13674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although well described in adults, there are scarce and heterogeneous data on the diagnosis and management of chronic urticaria (CU) in children (0-18 years) throughout Europe. Our aim was to explore country differences and identify the extent to which the EAACI/GA²LEN/EDF/WAO guideline recommendations for pediatric urticaria are implemented. METHODS The EAACI Task Force for pediatric CU disseminated an online clinical survey among EAACI pediatric section members. Members were asked to answer 35 multiple choice questions on current practices in their respective centers. RESULTS The survey was sent to 2,773 physicians of whom 358 (13.8%) responded, mainly pediatric allergists (80%) and pediatricians (49.7%), working in 69 countries. For diagnosis, Southern European countries used significantly more routine tests (eg, autoimmune testing, allergological tests, and parasitic investigation) than Northern European countries. Most respondents (60.3%) used a 2nd -generation antihistamine as first-line treatment of whom 64.8% updosed as a second line. Omalizumab was used as a second-line treatment by 1.7% and third line by 20.7% of respondents. Most clinicians (65%) follow EAACI/WAO/GA2LEN/EDF guidelines when diagnosing CU, and only 7.3% follow no specific guidelines. Some clinicians prefer to follow national guidelines (18.4%, mainly Northern European) or the AAAAI practice parameter (1.7%). CONCLUSIONS Even though most members of the Pediatric Section of EAACI are familiar with the EAACI/WAO/GA2LEN/EDF guidelines, a significant number do not follow them. Also, the large variation in diagnosis and treatment strengthens the need to re-evaluate, update, and standardize guidelines on the diagnosis and management of CU in children.
Collapse
Affiliation(s)
- Sophia Tsabouri
- Child Health Department, Medical School, University of Ioannina, Ioannina, Greece
| | - Stefania Arasi
- Translational Research in Pediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Burcin Beken
- Department of Pediatric Allergy and Immunology, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Martin K Church
- Charite-Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin, Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Department of Dermatology and Allergy, Allergy-Centre-Charite, Berlin, Germany
| | - Montserrat Alvaro-Lozano
- Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain.,Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Universitat de Barcelona, Barcelona, Spain
| | - Carlo Caffarelli
- Clinica Pediatrica, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Carsten Flohr
- Department of Pediatric Dermatology, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Sherief R Janmohamed
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - George N Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, Greece
| | - Susanne Lau
- Department for Pediatric Pneumology and Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastien Lefevre
- Regional Institute for Allergic Diseases, Metz Regional Hospital, Metz, France
| | - Charlotte G Mortz
- Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - Giovanni Pajno
- Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy
| | - Helena Pite
- Allergy Center, CUF Descobertas Hospital and CUF Tejo Hospital, Lisbon, Portugal
| | - Krzysztof Rutkowski
- Department of Pediatric Allergy, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Petra Staubach
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany.,CEDOC, Chronic Diseases Research Center, NOVA Medical School/Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Torsten Zuberbier
- Charite-Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin, Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Department of Dermatology and Allergy, Allergy-Centre-Charite, Berlin, Germany
| | - Tabi A Leslie
- Department of Dermatology, Royal Free Hospital, London, UK
| |
Collapse
|
7
|
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
|
8
|
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
|
9
|
Sabroe RA, Lawlor F, Grattan CEH, Ardern-Jones MR, Bewley A, Campbell L, Flohr C, Leslie TA, Marsland AM, Ogg G, Sewell WAC, Hashme M, Exton LS, Mohd Mustapa MF, Ezejimofor MC. British Association of Dermatologists guidelines for the management of people with chronic urticaria 2021. Br J Dermatol 2021; 186:398-413. [PMID: 34773650 DOI: 10.1111/bjd.20892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/30/2022]
Abstract
The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the management of urticaria. The document aims to: offer an appraisal of all relevant literature up to March 2020, focusing on any key developments address important, practical clinical questions relating to the primary guideline objective provide guideline recommendations and if appropriate research recommendations The guideline is presented as a detailed review with highlighted recommendations for practical use in primary, secondary and tertiary care, in addition to an updated Patient Information Leaflet (PIL; available on the BAD Skin Health Information website, https://www.skinhealthinfo.org.uk/a-z-conditions-treatments/).
Collapse
Affiliation(s)
- R A Sabroe
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, U.K
| | - F Lawlor
- St John's Institute of Dermatology, NHS Foundation Trust, Guy's and St Thomas, London, SE1 9RT, U.K
| | - C E H Grattan
- St John's Institute of Dermatology, NHS Foundation Trust, Guy's and St Thomas, London, SE1 9RT, U.K
| | - M R Ardern-Jones
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, U.K
| | - A Bewley
- Barts Health NHS Trust and Queen Mary University of London Medical School, London, E1 1BB, U.K
| | | | - C Flohr
- St John's Institute of Dermatology, NHS Foundation Trust, Guy's and St Thomas, London, SE1 9RT, U.K
| | - T A Leslie
- Royal Free London NHS Foundation Trust, Pond St, London, NW3 2QG, U.K
| | - A M Marsland
- University of Manchester & Salford Royal Hospital, Salford, M6 8HD, U.K
| | - G Ogg
- MRC Human Immunology Unit, The MRC Weatherall Institute of Molecular Medicine, University of Oxford, NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, OX3 9DS, U.K
| | | | - M Hashme
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
| | - L S Exton
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
| | - M C Ezejimofor
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
| | | |
Collapse
|
10
|
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
|
11
|
Ninković-Baroš Đ, Gajanin V, Zrnić B, Gajanin Ž, Katalina G. Comparative analysis of clinical and laboratory parameters of autoimmune and idiopathic chronic urticaria patients. SCRIPTA MEDICA 2021. [DOI: 10.5937/scriptamed52-33568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: According to the cause, chronic urticaria is most frequently divided into autoimmune and idiopathic urticaria. Aim of the paper was to determine the frequency of autoimmune urticaria using autologous serum skin testing and a comparative analysis of chronic idiopathic and chronic autoimmune urticaria by disease course, severity and most common comorbidities. Methods: Analysis covered 64 adult patients of both sexes with chronic urticaria, divided into two groups according to their positivity in autologous serum skin testing (group I with positive test and group II with negative test). General haematological and biochemical parameters, antithyroid antibodies, hepatitis serum markers, Helicobacter pylori and Borrelia burgdorferi antibodies were performed for patients in both groups. First group patients were treated by autologous blood therapy (autohaemotherapy). The analytical statistical tool SPSS (Statistical Product and Service Solutions) version 20 for descriptive statistics and statistical methods was used. The significance level used was p = 0.05. Results: The frequency of positive autologous serum test in total population of patients with chronic urticaria was 43.8 %. The average duration of urticaria was 20 months in both groups. Statistically significant difference was found in weekly scores between the studied groups (p = 0.032) in favour of chronic autoimmune urticaria with a positive autologous serum test. Subjects with chronic autoimmune urticaria had a significantly higher association with autoimmune thyroid diseases. Conclusions: Direct relation was established between the use of autologous blood therapy in patients with autoimmune chronic urticaria and improvement of the clinical picture.
Collapse
|
12
|
Altrichter S, Frischbutter S, Fok JS, Kolkhir P, Jiao Q, Skov PS, Metz M, Church MK, Maurer M. The role of eosinophils in chronic spontaneous urticaria. J Allergy Clin Immunol 2020; 145:1510-1516. [DOI: 10.1016/j.jaci.2020.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 12/21/2022]
|
13
|
Bae Y, Kang SH, Park JO, Park GH, Choi JH. Serum transglutaminase 2 activity as a potential biomarker of disease severity and response to omalizumab in chronic spontaneous urticaria. Allergol Int 2020; 69:304-306. [PMID: 31767272 DOI: 10.1016/j.alit.2019.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Youin Bae
- Department of Dermatology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea; Allergy and Clinical Immunology Research Center, Hallym University College of Medicine, Chuncheon, South Korea
| | - Sung Hun Kang
- Allergy and Clinical Immunology Research Center, Hallym University College of Medicine, Chuncheon, South Korea; Hallym University College of Medicine, Graduate School, Chuncheon, South Korea
| | - Ju Ok Park
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Gyeong-Hun Park
- Department of Dermatology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea; Allergy and Clinical Immunology Research Center, Hallym University College of Medicine, Chuncheon, South Korea
| | - Jeong-Hee Choi
- Allergy and Clinical Immunology Research Center, Hallym University College of Medicine, Chuncheon, South Korea; Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea.
| |
Collapse
|
14
|
Gonzalez-Diaz SN, Sanchez-Borges M, Rangel-Gonzalez DM, Guzman-Avilan RI, Canseco-Villarreal JI, Arias-Cruz A. Chronic urticaria and thyroid pathology. World Allergy Organ J 2020; 13:100101. [PMID: 32180891 PMCID: PMC7063156 DOI: 10.1016/j.waojou.2020.100101] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/27/2019] [Accepted: 12/31/2019] [Indexed: 12/11/2022] Open
Abstract
Urticaria is defined as the sudden appearance of erythematous, itchy wheals of variable size, with or without angioedema (AE) (swelling of the deeper layers of the skin). Its classification depends on time course of symptoms and the presence of eliciting factors. When it lasts less than 6 weeks it is classified as acute urticaria (AU), and if the symptoms persist for more than 6 weeks, it is classified as chronic urticaria (CU). Current International Guidelines also classify CU as chronic spontaneous urticaria (CSU) and inducible urticarial, according to the absence or presence of environmental triggering factors. CSU is defined as urticaria and/or angioedema in which there is no evidence of a specific eliciting factor. CSU is associated with autoimmunity in 30-45% of the cases, sharing some immunological mechanisms with other autoimmune diseases, and is associated with autoimmune thyroid disease (ATD) in about 4.3%-57.4% patients. Several studies suggest that adequate therapy with anti-thyroid drugs or levothyroxine in early stages of ATD and CSU, may help to remit the latter; but there is still a lack of double-blind, placebo-controlled studies that support this hypothesis in patients without abnormal thyroid hormone levels. The objective of this review is to describe the pathophysiology of chronic spontaneous urticaria and its association with autoimmune thyroid disease.
Collapse
Key Words
- AAbs, autoantibodies
- AD, autoimmune diseases
- AE, angioedema
- AMA, antithyroid microsomal antibody
- ASST, autologous serum skin test
- ATAbs, anti-thyroid autoantibodies
- ATD, autoimmune thyroid disease
- Autoimmunity
- BAT, basophil activation test
- CAU, chronic autoimmune urticaria
- CSU, chronic spontaneous urticaria
- CU, chronic urticaria
- Chronic urticaria
- DAMPs, damage-associated molecular patterns
- FcεRIa, high affinity IgE receptor
- GD, Graves' disease
- HT, Hashimoto's thyroiditis/autoimmune thyroiditis
- Histamine
- ICU, inducible chronic urticaria
- IFN-γ, gamma interferon
- IL, Interleukin
- IgE, Immunoglobulin E
- IgG, Immunoglobulin G
- Levothyroxine
- NSAH, non-sedating antihistamines
- PAF, platelet activating factor
- PAMPs, pathogen-associated molecular patterns
- T4L, free thyroxine
- TG, thyroglobulin
- TGAbs, anti-thyroglobulin antibodies
- TLR, Toll-like receptors
- TNF-α, tumor necrosis factor alpha
- TPOAbs, anti-thyroid peroxidase antibodies
- TSH, thyroid stimulating hormone
- TSHR, thyroid stimulating hormone receptor
- Thyroid disease
- Treg, regulatory T cells
- UAS, urticaria activity score
- Urticaria
- VEGF, vascular endothelial growth factor
Collapse
Affiliation(s)
- Sandra Nora Gonzalez-Diaz
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
| | - Mario Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Allergy Service, Clinica El Avila, 6a. Transversal Urb. Altamira, Piso 8, Consultorio 803, Caracas, 1060, Venezuela
| | - Diana Maria Rangel-Gonzalez
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
| | - Rosa Ivett Guzman-Avilan
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
| | - Jose Ignacio Canseco-Villarreal
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
| | - Alfredo Arias-Cruz
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
| |
Collapse
|
15
|
Mellerowicz E, Weller K, Zuberbier T, Maurer M, Altrichter S. Real-life treatment of patients with cholinergic urticaria in German-speaking countries. J Dtsch Dermatol Ges 2019; 17:1141-1147. [PMID: 31765087 DOI: 10.1111/ddg.13979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/04/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cholinergic urticaria (CholU) is a frequent type of chronic inducible urticaria. Symptomatic treatment with second-generation antihistamines (sgAH) is recommended by current guidelines as first-line therapy, but little is known about how patients with CholU are treated in real life and how they respond to treatment. AIM To assess real-life treatment of CholU in German-speaking countries. METHODS Patients with CholU (n = 111) took part in an online survey study that assessed their treatments and their treatment responses. RESULTS Virtually all patients (97 %) had used antihistamines, 87 % of them sgAH; 23 % had also taken first-generation antihistamines (fgAH). The proportion of patients who benefited from standard-dosed antihistamine treatment was low (sgAH: 32 % vs. fgAH: 16 %), and side effects of sgAH and fgAH were comparable. Updosing of antihistamines had been tried by 66 patients (59 %) (most commonly [98 %, n = 65] with sgAH) and resulted in marginally better responses (sgAH: 38 % vs. fgAH: 32 %). Only very few patients had used other treatments, mostly corticosteroids (30 %) and omalizumab (5 %). CONCLUSIONS SgAH were commonly used, but insufficient in about two thirds of CholU patients. Accordingly, improved use of third-line and fourth-line treatment options and development of better therapies for patients with CholU are needed.
Collapse
Affiliation(s)
- Emilia Mellerowicz
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Karsten Weller
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Torsten Zuberbier
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus Maurer
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sabine Altrichter
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
16
|
Mellerowicz E, Weller K, Zuberbier T, Maurer M, Altrichter S. Therapie von Patienten mit cholinergischer Urtikaria im Alltag in deutschsprachigen Ländern. J Dtsch Dermatol Ges 2019; 17:1141-1149. [PMID: 31765100 DOI: 10.1111/ddg.13979_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/04/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Emilia Mellerowicz
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Berlin
| | - Karsten Weller
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Berlin
| | - Torsten Zuberbier
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Berlin
| | - Marcus Maurer
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Berlin
| | - Sabine Altrichter
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Berlin
| |
Collapse
|
17
|
Yu L, Buttgereit T, Stahl Skov P, Schmetzer O, Scheffel J, Kocatürk E, Zawar V, Magerl M, Maurer M. Immunological effects and potential mechanisms of action of autologous serum therapy in chronic spontaneous urticaria. J Eur Acad Dermatol Venereol 2019; 33:1747-1754. [DOI: 10.1111/jdv.15640] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/01/2019] [Indexed: 12/18/2022]
Affiliation(s)
- L. Yu
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - T. Buttgereit
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - P. Stahl Skov
- Odense Research Center of Anaphylaxis Odense Denmark
| | - O. Schmetzer
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - J. Scheffel
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - E. Kocatürk
- Department of Dermatology Okmeydani Training and Research Hospital Istanbul Turkey
| | - V. Zawar
- Department of Dermatology Godavari Foundation Medical College and Research Center Nashik India
| | - M. Magerl
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - M. Maurer
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| |
Collapse
|
18
|
Monfort JB, Moguelet P, Amsler E, Francès C, Barbaud A, Soria A. [What is neutrophilic urticaria?]. Ann Dermatol Venereol 2019; 146:346-353. [PMID: 30910338 DOI: 10.1016/j.annder.2019.01.019] [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: 06/27/2018] [Revised: 10/24/2018] [Accepted: 01/30/2019] [Indexed: 11/17/2022]
Abstract
Some debate continues to surround the existence of neutrophilic urticaria (NU) as a nosological entity. Certain authors consider NU as a banal form of urticaria since an infiltrate predominantly made up of polynuclear neutrophils (PNN) is seen in certain cases of chronic and acute urticaria. Moreover, it has been stated that the histological appearance of chronic urticaria varies according to the time between appearance of the plaque and the performance of biopsy: the presence of PNN may occur later. According to the literature, there appear to be no specific clinical characteristics associated with the presence of PNN at histology. Most cases exhibit moderate laboratory inflammatory syndrome. Data concerning therapeutic response are contradictory: some studies have shown no significant difference in terms of therapeutic response in relation to banal urticaria, while only one study has demonstrated superior response to dapsone in the case of histologically demonstrated neutrophilic infiltrate. There does not appear to be any disease more frequently associated in the event of NU. In conclusion, the available data concerning NU are insufficient to confirm the existence of this condition. A prospective study comparing routine acute and chronic urticaria biopsies would be extremely useful to better characterise the relationships between cellular infiltrate and therapeutic response.
Collapse
Affiliation(s)
- J-B Monfort
- Service de dermatologie et d'allergologie, HUEP, Sorbonne Universités, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - P Moguelet
- Service d'anatomo-pathologie, hôpital Tenon, 4 rue de la Chine, 75020 Paris, France
| | - E Amsler
- Service de dermatologie et d'allergologie, HUEP, Sorbonne Universités, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - C Francès
- Service de dermatologie et d'allergologie, HUEP, Sorbonne Universités, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - A Barbaud
- Service de dermatologie et d'allergologie, HUEP, Sorbonne Universités, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - A Soria
- Service de dermatologie et d'allergologie, HUEP, Sorbonne Universités, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Inserm U1135, centre d'immunologie et des maladies infectieuses - Paris (Cimi-Paris), 75013 Paris, France
| |
Collapse
|
19
|
Yan S, Chen W, Peng C, Zhu W, Chen M, Zhang J, Su J, Li F, Liu Z, Zhang W, Li Q, Li J, Chen X. C-reactive protein (CRP) rs3093059Cpredicts poor mizolastine response in chronic spontaneous urticaria patients with elevated serum CRP level. Exp Dermatol 2019; 28:240-246. [PMID: 30632650 DOI: 10.1111/exd.13874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/18/2018] [Accepted: 01/07/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Siyu Yan
- Department of Dermatology; Xiangya Hospital; Central South University; Changsha China
- Hunan Key Laboratory of Skin Cancer and Psoriasis; Xiangya Hospital; Central South University; Changsha Hunan China
- Hunan Engineering Research Center of Skin Health and Disease; Changsha Hunan China
| | - Wangqing Chen
- Department of Dermatology; Xiangya Hospital; Central South University; Changsha China
- Hunan Key Laboratory of Skin Cancer and Psoriasis; Xiangya Hospital; Central South University; Changsha Hunan China
- Institute of Clinical Pharmacology; Xiangya Hospital; Central South University; Changsha China
| | - Cong Peng
- Department of Dermatology; Xiangya Hospital; Central South University; Changsha China
- Hunan Key Laboratory of Skin Cancer and Psoriasis; Xiangya Hospital; Central South University; Changsha Hunan China
- Hunan Engineering Research Center of Skin Health and Disease; Changsha Hunan China
| | - Wu Zhu
- Department of Dermatology; Xiangya Hospital; Central South University; Changsha China
- Hunan Key Laboratory of Skin Cancer and Psoriasis; Xiangya Hospital; Central South University; Changsha Hunan China
- Hunan Engineering Research Center of Skin Health and Disease; Changsha Hunan China
| | - Mingliang Chen
- Department of Dermatology; Xiangya Hospital; Central South University; Changsha China
- Hunan Key Laboratory of Skin Cancer and Psoriasis; Xiangya Hospital; Central South University; Changsha Hunan China
- Hunan Engineering Research Center of Skin Health and Disease; Changsha Hunan China
| | - Jianglin Zhang
- Department of Dermatology; Xiangya Hospital; Central South University; Changsha China
- Hunan Key Laboratory of Skin Cancer and Psoriasis; Xiangya Hospital; Central South University; Changsha Hunan China
- Hunan Engineering Research Center of Skin Health and Disease; Changsha Hunan China
| | - Juan Su
- Department of Dermatology; Xiangya Hospital; Central South University; Changsha China
- Hunan Key Laboratory of Skin Cancer and Psoriasis; Xiangya Hospital; Central South University; Changsha Hunan China
- Hunan Engineering Research Center of Skin Health and Disease; Changsha Hunan China
| | - Fangfang Li
- Department of Dermatology; Xiangya Hospital; Central South University; Changsha China
- Hunan Key Laboratory of Skin Cancer and Psoriasis; Xiangya Hospital; Central South University; Changsha Hunan China
- Hunan Engineering Research Center of Skin Health and Disease; Changsha Hunan China
| | - Zhaoqian Liu
- Institute of Clinical Pharmacology; Xiangya Hospital; Central South University; Changsha China
| | - Wei Zhang
- Institute of Clinical Pharmacology; Xiangya Hospital; Central South University; Changsha China
| | - Qingling Li
- Department of Pathology; Xiangya Hospital; Central South University; Changsha China
| | - Jie Li
- Department of Dermatology; Xiangya Hospital; Central South University; Changsha China
- Hunan Key Laboratory of Skin Cancer and Psoriasis; Xiangya Hospital; Central South University; Changsha Hunan China
- Hunan Engineering Research Center of Skin Health and Disease; Changsha Hunan China
| | - Xiang Chen
- Department of Dermatology; Xiangya Hospital; Central South University; Changsha China
- Hunan Key Laboratory of Skin Cancer and Psoriasis; Xiangya Hospital; Central South University; Changsha Hunan China
- Hunan Engineering Research Center of Skin Health and Disease; Changsha Hunan China
| |
Collapse
|
20
|
Kudryavtseva AV, Neskorodova KA, Staubach P. Urticaria in children and adolescents: An updated review of the pathogenesis and management. Pediatr Allergy Immunol 2019; 30:17-24. [PMID: 30076637 DOI: 10.1111/pai.12967] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 12/25/2022]
Abstract
The present survey represents the latest data on diagnosis and management of childhood urticaria. It has been observed that urticaria occurs less often in children than adults, with symptoms rarely lasting for over 6 weeks. Triggers or aggravating factors can be found only in 21%-55% of cases. Finding autoantibodies in children does not impact a disease prognosis, unlike in adult patients, where the presence of autoantibodies is associated with a more prolonged run of the disease, a more severe prognosis and more intensive treatment methods. The incidence of food allergy equals to 8%-10% of cases. The incidence of Helicobacter Pylori infection in children is lower than that in adults and comes to 10%-18%. Medical experts recommend using the same treatment schemes for adults and children. This survey describes different urticaria management patterns suggested by experts from Europe, America, and Russia in their recent guidelines. It has been noted that unlike the guidelines from 2014, the 2018 clinical practice guidelines for the diagnosis and management of urticarial once again suggest a four-step treatment scheme with assigning omalizumab for Step 3 and cyclosporine A for Step 4 in the event of low therapeutic efficacy of the previous step or its impossibility. Leukotriene antagonists (LTRAs) are currently removed from basic management to alternative programs.
Collapse
Affiliation(s)
| | | | - Petra Staubach
- Department of Dermatology, University Medical Center, Mainz, Germany
| |
Collapse
|
21
|
Role of TF-Triggered Activation of the Coagulation Cascade in the Pathogenesis of Chronic Spontaneous Urticaria. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0183-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
|
22
|
Can P, Etikan P, Kızıltaç U, Kızıltaç K, Singer R, Kocaturk E. Fric Test Revisited: A Suggestion for a New Scoring System and Its Correlation with Urticaria Control Test and Dermatology Life Quality Index. Int Arch Allergy Immunol 2018; 178:76-82. [DOI: 10.1159/000492970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/16/2018] [Indexed: 11/19/2022] Open
|
23
|
Ensina LF, Bastos PGA, de Lacerda AE, de Araujo CA, Camelo-Nunes I, Solé D. Comments on Balp et al. Pediatr Allergy Immunol 2018; 29:669-670. [PMID: 29974980 DOI: 10.1111/pai.12950] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Luis Felipe Ensina
- Department of Pediatrics, Division of Allergy, Clinical Immunology and Rheumatology, Federal University of São Paulo, São Paulo, Brazil
| | - Patricia Guerzet Ayres Bastos
- Department of Pediatrics, Division of Allergy, Clinical Immunology and Rheumatology, Federal University of São Paulo, São Paulo, Brazil
| | - Alex Eustaquio de Lacerda
- Department of Pediatrics, Division of Allergy, Clinical Immunology and Rheumatology, Federal University of São Paulo, São Paulo, Brazil
| | - Chayanne Andrade de Araujo
- Department of Pediatrics, Division of Allergy, Clinical Immunology and Rheumatology, Federal University of São Paulo, São Paulo, Brazil
| | - Inês Camelo-Nunes
- Department of Pediatrics, Division of Allergy, Clinical Immunology and Rheumatology, Federal University of São Paulo, São Paulo, Brazil
| | - Dirceu Solé
- Department of Pediatrics, Division of Allergy, Clinical Immunology and Rheumatology, Federal University of São Paulo, São Paulo, Brazil
| |
Collapse
|
24
|
Balp MM, Weller K, Carboni V, Chirilov A, Papavassilis C, Severin T, Tian H, Zuberbier T, Maurer M. Prevalence and clinical characteristics of chronic spontaneous urticaria in pediatric patients. Pediatr Allergy Immunol 2018; 29:630-636. [PMID: 29679413 DOI: 10.1111/pai.12910] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Data on the prevalence and disease management of chronic urticaria (CU) and chronic spontaneous urticaria (CSU) in the pediatric population are scarce. This study assessed the prevalence of CU and CSU, and disease management among pediatric patients (0-17 years). METHODS A physician-based online survey was conducted in 5 European countries (United Kingdom, Germany, Italy, France, and Spain) assessing the annual diagnosed prevalence, disease characteristics, and treatment patterns in the target population. Results are based on physician responses and analyzed using descriptive statistics. Prevalence estimates were calculated based on the number of CU/CSU pediatric patients diagnosed, seen, and treated by the respondents and extrapolated to the total pediatric population from each country. RESULTS Across 5 European countries, the one-year diagnosed prevalence of CU and CSU in pediatric patients was 1.38% (95% CI, 0.94-1.86) and 0.75% (95% CI, 0.44-1.08), respectively. Angioedema was reported in 6%-14% of patients. A large proportion of CSU pediatric patients (40%-60%) were treated with H1-antihistamines at approved dose and 16%-51% received H1-antihistamines at higher doses. Approximately 1/3 of pediatric CSU patients remained uncontrolled with H1-antihistamines at approved/higher doses. Other prescribed treatments were oral corticosteroids (10%-28%) and topical creams (15%-26%). CONCLUSIONS This study revealed a prevalence of CSU among pediatric population comparable to adults and also suggested an unmet need for approved treatments for inadequately controlled pediatric CSU patients. It is truly of concern that harmful (oral steroids) or insufficient (topical creams) treatments were frequently used despite better and guideline-recommended alternatives.
Collapse
Affiliation(s)
| | - Karsten Weller
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | - Haijun Tian
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Torsten Zuberbier
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus Maurer
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
25
|
Yanase Y, Takahagi S, Hide M. Chronic spontaneous urticaria and the extrinsic coagulation system. Allergol Int 2018; 67:191-194. [PMID: 28993062 DOI: 10.1016/j.alit.2017.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/08/2017] [Indexed: 01/05/2023] Open
Abstract
Chronic spontaneous urticaria (CSU) is a common skin disorder characterized by daily or almost daily recurring skin edema and flare with itch. Recently, the activation of the blood coagulation cascade has been suggested to be involved in CSU, but the trigger of the coagulation cascade remains unclear. In this article, we review recent understanding of the relationship between the pathogenesis of CSU and extrinsic coagulation reactions. In CSU, vascular endothelial cells and eosinophils may play a role as TF-expressing cells for activating the extrinsic coagulation pathway. Moreover, the expression of TF on endothelial cells is synergistically enhanced by the activation of Toll-like receptors and histamine H1 receptors. The activated coagulation factors may induce plasma extravasation followed by degranulation of skin mast cells and edema formation recognized as wheal in CSU. Molecules involved in this cascade could be a target for new and more effective treatments of urticaria.
Collapse
|
26
|
Church MK, Kolkhir P, Metz M, Maurer M. The role and relevance of mast cells in urticaria. Immunol Rev 2018; 282:232-247. [DOI: 10.1111/imr.12632] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Martin K. Church
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - Pavel Kolkhir
- Department of Dermatology and Venereology; Sechenov First Moscow State Medical University; Moscow Russian Federation
| | - Martin Metz
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - Marcus Maurer
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| |
Collapse
|
27
|
Cherrez Ojeda I, Vanegas E, Felix M, Mata V, Cherrez S, Simancas-Racines D, Greiding L, Cano J, Cherrez A, Calderon JC. Etiology of chronic urticaria: the Ecuadorian experience. World Allergy Organ J 2018; 11:1. [PMID: 29308115 PMCID: PMC5753451 DOI: 10.1186/s40413-017-0181-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 12/07/2017] [Indexed: 02/07/2023] Open
Abstract
Background The purpose of this study was to identify chronic urticaria (CU) etiologies and treatment modalities in Ecuador. We propose that the sample distribution fits the expected one, and that there is an association between the etiology and its treatment. Methods We performed a retrospective study involving 112 patients diagnosed with CU using a Checklist for a complete chronic urticaria medical history. Demographic and clinical variables were collected. The etiology of CU was classified using the EAACI/GA2LEN/EDF/WAO guideline. Descriptive analyses were performed for demographical and clinical variables. Chi square tests were applied to analyze the fit of distribution and the independence of variables. P values less than 0.05 were considered significant. Results Among all the patients, 76.8% were diagnosed with chronic spontaneous urticaria (CSU), of which 22.3% had a known etiology or possible exacerbating condition. Food allergy was identified as the most common accompanying condition in patients with CSU (10.7%) (p < 0.01).. On the other hand, 23.2% inducible urticarias (CIndU) were indentified; dermographism was the most common (10.7%) (p < 0.01). Regarding treatment regimens, sg-H1-antihistamines alone represented the highest proportion (44.6%). The combination of any H1-antihistamine plus other drug was a close second (42.0%) (p < 0.01). Almost 48% of CSUs of unknown etiology were treated with any antihistamine plus another drug. In patients with known etiology, sg-antihistamines alone (44.0%) was the most common management. In addition, 53.8% of CIndUs were treated with sg-antihistamines alone. Though, these associations were not statistically significant. Conclusion CSU is the most frequent subtype of CU. Modern non-sedating antihistamines in licensed doses are the drug of choice. Nevertheless, a great proportion of patients require the addition of another type of medication.
Collapse
Affiliation(s)
- I Cherrez Ojeda
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Código postal: 0901-952 Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - E Vanegas
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Código postal: 0901-952 Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - M Felix
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - V Mata
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - S Cherrez
- School of Medicine, University of Heidelberg, Heidelberg, Germany
| | - D Simancas-Racines
- Centro de Investigación en Salud Pública y Epidemiología Clínica. Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito, Ecuador
| | - L Greiding
- Instituto Argentino de Alergia e Inmunología, Buenos Aires, Argentina
| | - J Cano
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Código postal: 0901-952 Samborondón, Ecuador
| | - A Cherrez
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador.,University Hospital, Dermatology Department, Rostock, Germany
| | - Juan Carlos Calderon
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Código postal: 0901-952 Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| |
Collapse
|
28
|
de Montjoye L, Herman A, Nicolas JF, Baeck M. Treatment of chronic spontaneous urticaria: Immunomodulatory approaches. Clin Immunol 2017; 190:53-63. [PMID: 29129806 DOI: 10.1016/j.clim.2017.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/12/2017] [Accepted: 11/07/2017] [Indexed: 02/01/2023]
Abstract
This paper summarizes and reviews the mechanisms of action and data concerning efficacy of recommended treatments as well as other treatments that have been tested, independently of the outcomes, in the management of chronic spontaneous urticaria. Due to the central role of mast cells, basophils and histamine in the pathophysiology of this disease, H1-antihistamines remain the first-line treatment. However, current knowledge about this complex disease, also recognizes an important role for T lymphocytes, B lymphocytes, and autoantibodies. Implications of these others mediators thus provide further targets for treatment. Indeed, agents previously used to treat other autoimmune and inflammatory diseases, have demonstrated efficacy in chronic spontaneous urticaria and are therefore potential therapeutic alternatives for antihistamine unresponsive patients.
Collapse
Affiliation(s)
- Laurence de Montjoye
- Department of Dermatology, Saint-Luc University Hospital, Université catholique de Louvain, Brussels, Belgium; Institute of Experimental and Clinical Research, Pole of Pneumology, ENT and Dermatology, Université catholique de Louvain, Brussels, Belgium.
| | - Anne Herman
- Department of Dermatology, Saint-Luc University Hospital, Université catholique de Louvain, Brussels, Belgium; Institute of Experimental and Clinical Research, Pole of Pneumology, ENT and Dermatology, Université catholique de Louvain, Brussels, Belgium
| | - Jean-François Nicolas
- Department of Allergy and Clinical Immunology, Hospital Center Lyon Sud, Lyon, France; CIRI- INSERM U1111 - CNRS UMR5308, Université Lyon 1, Université de Lyon, Lyon, France
| | - Marie Baeck
- Department of Dermatology, Saint-Luc University Hospital, Université catholique de Louvain, Brussels, Belgium; Institute of Experimental and Clinical Research, Pole of Pneumology, ENT and Dermatology, Université catholique de Louvain, Brussels, Belgium
| |
Collapse
|
29
|
Abstract
This chapter concentrates on the role in allergic disease of histamine acting on H1-receptors. It is clear that allergy has its roots in the primary parasite rejection response in which mast cell-derived histamine creates an immediate hostile environment and eosinophils are recruited for killing. This pattern is seen in allergic rhinitis where the early events of mucus production and nasal itching are primarily histamine mediated whereas nasal blockage is secondary to eosinophil infiltration and activation. In asthma, the role of histamine is less clear. Urticaria is characterized by mast cell driven pruritic wheal and flare-type skin reactions that usually persist for less than 24 h. Although the events leading to mast cell degranulation have been unclear for many years, it is now becoming evident that urticaria has an autoimmune basis. Finally, the properties of first- and second-generation H1-antihistamines and their role in allergic is discussed.
Collapse
Affiliation(s)
- Martin K Church
- Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, D-10117, Berlin, Germany.
| |
Collapse
|
30
|
Kudryavceva AV, Neskorodova KA. Urticaria in children: pathogenetic mechanisms and the possibilities of modern therapy. VESTNIK DERMATOLOGII I VENEROLOGII 2017. [DOI: 10.25208/0042-4609-2017-93-2-73-82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The review collected the latest literature data on urticaria - one of the most frequent skin diseases in children, accompanied by the appearance of blisters. It is notorious that histamine-liberation lies in the basis of the disease pathogenesis, regardless of the cause provoking an exacerbation. Precisely this explains the unified principle of therapy for all variants of urticaria -the administration of non-sedating antihistamines in the first line. Urticaria is classified for acute and chronic based on the duration of the course (up to 6 weeks or more). Experts do not recommend that physicians carry out any special diagnostic measures in the acute form of the disease, paying the utmost attention to the administration of effective treatment. the review describes the causes of disease exacerbation, the pathogenesis and the clinic of urticaria. Attention is paid to various options for managing patients with urticaria, published in the latest expert recommendations in Europe, America and Russia.
Collapse
|
31
|
Kitsioulis NA, Xepapadaki P, Roussaki-Schulze AV, Papadopoulos N, Zafiriou E. Effectiveness of Autologous Whole-Blood Injections in Patients with Refractory Chronic Spontaneous Urticaria. Int Arch Allergy Immunol 2017; 172:161-166. [DOI: 10.1159/000458152] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 01/25/2017] [Indexed: 11/19/2022] Open
|
32
|
Thomsen SF, Pritzier EC, Anderson CD, Vaugelade-Baust N, Dodge R, Dahlborn AK, Vestergaard C. Chronic urticaria in the real-life clinical practice setting in Sweden, Norway and Denmark: baseline results from the non-interventional multicentre AWARE study. J Eur Acad Dermatol Venereol 2017; 31:1048-1055. [PMID: 28294420 DOI: 10.1111/jdv.14210] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 02/10/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chronic urticaria (CU) is characterized by the recurrence of itchy hives and/or angioedema for more than 6 weeks. AWARE (A World-wide Antihistamine-Refractory Chronic Urticaria Patient Evaluation) is a multinational study designed to document the real-life treatment situation, burden of disease and clinical resource usage of H1-antihistamine-refractory CU patients. OBJECTIVE To examine baseline data from Scandinavian AWARE patients. METHODS AWARE is a prospective, non-interventional, multinational, umbrella design study, which includes adults (≥18 years) with a confirmed CU diagnosis (>2 months) that is refractory to H1-antihistamines. Baseline patient characteristics, disease activity (urticaria control test [UCT]), pharmacological treatment, comorbidities and healthcare usage were documented by the treating physician. Quality of life (QoL; dermatology life quality index [DLQI]; chronic urticaria quality of life questionnaire [CU-Q2 oL; Danish patients only]) and work productivity and activity impairment (WPAI) scores were also assessed. RESULTS Overall, 158 CU patients from seven centres in Denmark (n = 80), Norway (n = 50) and Sweden (n = 28) were included in this baseline analysis. Mean age and BMI were 40.3 years and 26.5 kg/m2 , respectively. The majority of patients were female (69.6%), had uncontrolled CU (75.6%; UCT score <12) and had a 'spontaneous' component to their CU (61.4% CSU; 20.3% both CSU and chronic inducible urticaria). Common comorbidities included asthma (19.6%), allergic rhinitis (16.5%) and food allergies (8.2%). Overall, 60.1% of patients reported using treatments for CU including non-sedative H1-antihistamines (40.5%), corticosteroids (19%), montelukast (14.6%) and omalizumab (8.2%). Pharmacological treatment rates increased to 96.2% during the baseline visit. On average, patient QoL was moderately affected (mean DLQI score 7.7) and healthcare resource usage was high. CONCLUSION Adult Scandinavian H1-antihistamine-refractory CU patients reported high rates of healthcare usage and QoL impairment. Rates of pharmacological treatment use were low before study enrolment but increased to almost 100% during the baseline visit.
Collapse
Affiliation(s)
- S F Thomsen
- Department of Dermatology, Bispebjerg Hospital & Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - E C Pritzier
- Departement of Dermatology, Stavanger University Hospital, Stavanger, Norway
| | - C D Anderson
- Divison of dermatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | | | - R Dodge
- Novartis Pharmaceutical A/S, Copenhagen, Denmark
| | | | - C Vestergaard
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
33
|
Maurer M, Staubach P, Raap U, Richter-Huhn G, Bauer A, Ruëff F, Jakob T, Yazdi AS, Mahler V, Wagner N, Lippert U, Hillen U, Schwinn A, Pawlak M, Behnke N, Chaouche K, Chapman-Rothe N. H1-antihistamine-refractory chronic spontaneous urticaria: it's worse than we thought - first results of the multicenter real-life AWARE study. Clin Exp Allergy 2017; 47:684-692. [PMID: 28160338 DOI: 10.1111/cea.12900] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 10/05/2016] [Accepted: 01/12/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Most data on chronic spontaneous urticaria (CSU) originate from highly selected patient populations treated at specialized centres. Little is known about CSU patient characteristics and the burden of CSU in routine clinical practice. AWARE (A World-wide Antihistamine-Refractory chronic urticaria patient Evaluation) is an ongoing global study designed to assess chronic urticaria in the real-life setting. OBJECTIVE To describe the baseline characteristics of the first 1539 German AWARE patients with H1-antihistamine-refractory CSU. METHODS This prospective non-interventional study included patients (18-75 years) with a diagnosis of H1-antihistamine-refractory CSU for > 2 months. Baseline demographic and disease characteristics, comorbidities, and pharmacological treatments were recorded. Quality of life (QoL) was assessed using the dermatology life quality index (DLQI), chronic urticaria QoL questionnaire (CU-Q2 oL), and angioedema QoL questionnaire (AE-QoL, in cases of angioedema). Previous healthcare resource utilization and sick leave data were collected retrospectively. RESULTS Between March and December 2014, 1539 patients were assessed in 256 sites across Germany. The percentage of females, mean age, and mean body mass index were 70%, 46.3 years, and 27 kg/m2 , respectively. The mean urticaria control test score was 7.9, one in two patients had angioedema, and the most frequent comorbidities were chronic inducible urticaria (CIndU; 24%), allergic rhinitis (18.2%), hypertension (18.1%), asthma (12%), and depression (9.5%). Overall, 57.6% of patients were receiving at least one pharmacological treatment including second-generation H1-antihistamines (46.3%), first-generation H1-antihistamines (9.1%), and corticosteroids (15.8%). The mean DLQI, total CU-Q2 oL, and total AE-QoL scores were 8.3, 36.2, and 46.8, respectively. CSU patients reported frequent use of healthcare resources, including emergency services (29.7%), general practitioners (71.9%), and additional allergists or dermatologists (50.7%). CONCLUSIONS AND CLINICAL RELEVANCE This study reveals that German H1-antihistamine-refractory CSU patients have high rates of uncontrolled disease, angioedema, and comorbid CIndU, are undertreated, have impaired QoL, and rely heavily on healthcare resources.
Collapse
Affiliation(s)
- M Maurer
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - P Staubach
- Department of Dermatology, University Hospital Mainz, Mainz, Germany
| | - U Raap
- Department of Dermatology and Allergy, Klinikum Oldenburg AöR, University of Oldenburg, Oldenburg, Germany
| | | | - A Bauer
- Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - F Ruëff
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - T Jakob
- Department of Dermatology and Allergology, Justus Liebig University, University Medical Center Gießen and Marburg, Gießen, Germany.,Department of Dermatology, Medical Center - University of Freiburg, Freiburg, Germany
| | - A S Yazdi
- Department of Dermatology, University of Tübingen, Tübingen, Germany
| | - V Mahler
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - N Wagner
- Department of Dermatology, Clinical Centre Darmstadt, Darmstadt, Germany
| | - U Lippert
- Department of Dermatology, Venereology and Allergology, University Medical Center, Georg-August-University, Göttingen, Germany
| | - U Hillen
- Department of Dermatology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - A Schwinn
- Praxis für Dermatologie, Memmingen, Germany
| | - M Pawlak
- Hautarztpraxis, Heilbad Heiligenstadt, Germany
| | - N Behnke
- Hautarztpraxis, Panketal, Germany
| | | | | |
Collapse
|
34
|
Kim YS, Han K, Lee JH, Kim NI, Roh JY, Seo SJ, Song HJ, Lee MG, Choi JH, Park YM. Increased Risk of Chronic Spontaneous Urticaria in Patients With Autoimmune Thyroid Diseases: A Nationwide, Population-based Study. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:373-377. [PMID: 28497925 PMCID: PMC5446953 DOI: 10.4168/aair.2017.9.4.373] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 02/13/2017] [Accepted: 02/20/2017] [Indexed: 01/21/2023]
Abstract
There was no previous population-based study on the comparison of the risk of chronic spontaneous urticaria (CSU) between autoimmune thyroid diseases (AITD) and age- and gender-matched controls. The primary objective of this study was to evaluate the risk of CSU after diagnosis of AITD using national registry data from Korea. The secondary objective was to evaluate other risk factors of CSU. Based on the disease code diagnoses in 2003-2005, we composed an AITD group (n=3,659) and an age- and gender-matched control group (n=18,295). Each patient was tracked for whether CSU occurs or not until 2013. After adjusting for demographic differences and comorbidities, patients with AITD had a significantly higher rate of CSU compared to the control group (hazard ratio [HR], 1.46; 95% confidence interval [CI], 1.25-1.70; P<0.001). Among the AITD patients, the adjusted HR for CSU was higher in patients with Hashimoto's thyroiditis (HR, 1.50) than in those with Grave's disease (HR, 1.33), although the difference was not statistically significant (P=0.368). Analysis of CSU patients associated with AITD showed that female patients had a significantly higher risk of CSU compared to male ones (HR, 1.34; P=0.001) and that those with allergic rhinitis (HR, 1.51; P<0.001), atopic dermatitis (HR, 2.44; P<0.001), and asthma (HR, 1.50; P<0.001) had a significantly higher risk of CSU compared to patients without respective diseases. Our results demonstrated that AITD could be significantly associated with an increased risk of CSU.
Collapse
Affiliation(s)
- Yoon Seob Kim
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyungdo Han
- Department of Medical Statistics, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nack In Kim
- Department of Dermatology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Joo Young Roh
- Department of Dermatology, Gachon University Gil Medical Center, Incheon, Korea
| | - Seong Jun Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hae Jun Song
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Min Geol Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Ho Choi
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Min Park
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| |
Collapse
|
35
|
Church MK. Does Antihistamine Up-dosing Solve Chronic Spontaneous Urticaria? CURRENT TREATMENT OPTIONS IN ALLERGY 2016. [DOI: 10.1007/s40521-016-0098-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
36
|
Siebenhaar F, Melde A, Magerl M, Zuberbier T, Church M, Maurer M. Histamine intolerance in patients with chronic spontaneous urticaria. J Eur Acad Dermatol Venereol 2016; 30:1774-1777. [DOI: 10.1111/jdv.13778] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/11/2016] [Indexed: 11/28/2022]
Affiliation(s)
- F. Siebenhaar
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - A. Melde
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - M. Magerl
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - T. Zuberbier
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - M.K. Church
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - M. Maurer
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| |
Collapse
|
37
|
Omalizumab for the treatment of chronic spontaneous urticaria: A meta-analysis of randomized clinical trials. J Allergy Clin Immunol 2016; 137:1742-1750.e4. [PMID: 27040372 DOI: 10.1016/j.jaci.2015.12.1342] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/16/2015] [Accepted: 12/29/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is defined by itchy hives, angioedema, or both for at least 6 weeks. Omalizumab, an anti-IgE antibody that affects mast cell and basophil function, is a promising new treatment option. As of now, however, the efficacy and safety of different doses of omalizumab used in clinical trials for CSU have not been systematically analyzed and summarized. OBJECTIVE We sought to assess the efficacy and safety of different doses of omalizumab for the treatment of CSU in a meta-analysis of clinical trial results. METHODS Suitable trials were identified by searching PubMed, Medline, Embase, and Web of Science databases and with the help of omalizumab's manufacturers. Only double-blind, randomized, placebo-controlled studies with omalizumab-treated versus placebo-treated patients with CSU were included in this analysis. RESULTS We identified 7 randomized, placebo-controlled studies with 1312 patients with CSU. Patients treated with omalizumab (75-600 mg every 4 weeks) had significantly reduced weekly itch and weekly wheal scores compared with the placebo group. Omalizumab's effects were dose dependent, with the strongest reduction in weekly itch and weekly wheal scores observed with 300 mg. Rates of complete response were significantly higher in the omalizumab group (relative risk, 4.55; P < .00001) and dose dependent, with the highest rates in the 300-mg group. Rates of patients with adverse events were similar in the omalizumab and placebo groups. CONCLUSION This meta-analysis provides high-quality evidence for the efficacy and safety of omalizumab in patients with CSU and for treating these patients with 300 mg of omalizumab every 4 weeks.
Collapse
|
38
|
Abstract
There have been recent advances in the classification and management of chronic urticaria. The new term chronic spontaneous urticaria (CSU) has replaced chronic idiopathic urticaria and chronic autoimmune urticaria. In addition, chronic inducible urticaria (CINDU) has replaced physical urticaria and includes other forms of inducible urticaria, such as cholinergic and aquagenic urticaria. Furthermore, novel research has resulted in a new understanding with guidelines being revised in the past year by both the American Academy of Allergy, Asthma, and Immunology (AAAAI) and the European Academy of Allergy and Clinical Immunology (EAACI)/Global Allergy and Asthma European Network (GA
2LEN)/European Dermatology Forum (EDF)/World Allergy Organization (WAO). There are some differences in the recommendations, which will be discussed, but the core updates are common to both groups. The basic treatment for chronic urticaria involves second-generation non-sedating non-impairing H
1 antihistamines as first-line treatment. This is followed by up to a 4-fold increase in the licensed dose of these H
1 antihistamines. The major therapeutic advance in recent years has been in third-line treatment with omalizumab, a humanized monoclonal anti-immunoglobulin E (anti-IgE) antibody that prevents binding of IgE to the high-affinity IgE receptor. Several multicenter randomized controlled trials have shown safety and efficacy of omalizumab for CSU. There are also some small studies showing efficacy of omalizumab in CINDU. While there were previously many treatment options which were lacking in strong evidence, we are moving into an era where the treatment algorithm for chronic urticaria is simplified and contains more evidence-based, effective, and less toxic treatment options.
Collapse
Affiliation(s)
- Yasmin Moolani
- Division of Clinical Immunology and Allergy, University of Toronto, Toronto, OH, Canada
| | - Charles Lynde
- Division of Dermatology, University of Toronto, Toronto, ON, Canada; Lynderm Research, Lynde Institute for Dermatology, Markham, ON, Canada
| | - Gordon Sussman
- Division of Clinical Immunology and Allergy, University of Toronto, Toronto, OH, Canada; Gordon Sussman Clinical Research Inc, GSCR, Toronto, ON, Canada
| |
Collapse
|
39
|
Abstract
Background: Chronic spontaneous urticaria (CSU) is a skin disorder that is said to be “frustrating” and “difficult to treat.” It is characterized by recurrent hives for more than 6 weeks, and is further divided into spontaneous or inducible by physical stimuli.1 To better understand dermatologists’ perspective of this disorder, a survey was conducted with Canadian dermatologists. Methods: A detailed online practice survey was sent to all currently practicing Canadian dermatologists. Results: In all, 80 responses were received (response rate of 20%). Most respondents in Canada had treated patients with CSU (98.4%), with many of the patients having the disease last over 6 months (86.6%). A majority of the patients were female, with 84.1% of the respondents having over 50% of their patients as female. Most patients were over the age of 30 (74.2%). Of dermatologists, 85.7% felt that investigations were unhelpful in diagnosing CSU in a patient. Of respondents, 37.1% were not satisfied with current treatment methods of CSU, and 43.6% somewhat satisfied. Popular therapies included H1 and H2 antihistamines, oral corticosteroids, and montelukast. There were 16.1% of dermatologists who had over 50% of their patients refractory to treatment. Conclusions: There was a clear demographic preponderance for CSU patients with a majority as female over age 30. Investigations ordered for CSU patients do not seem to be helpful among dermatologists. Satisfaction with current therapies and investigations was quite low among Canadian dermatologists, suggesting new therapies are indicated.
Collapse
Affiliation(s)
| | - Charles W. Lynde
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
40
|
Erworbenes Angioödem mit C1-INH-Defizienz und begleitender chronisch spontaner Urtikaria bei chronisch lymphatischer B-Zell-Leukämie. Hautarzt 2015; 66:723-5. [DOI: 10.1007/s00105-015-3679-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|