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Buono EV, Giannì G, Scavone S, Caffarelli C. Clinical Characteristics, Investigations and Treatment in Children with Chronic Urticaria: An Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:704. [PMID: 38792886 PMCID: PMC11122882 DOI: 10.3390/medicina60050704] [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: 03/20/2024] [Revised: 04/17/2024] [Accepted: 04/21/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: The guidelines for chronic urticaria in children contain recommendations that are often based on adult studies. The diagnostic pathway has not been standardized and the effectiveness of anti-H1, omalizumab, montelukast, and systemic glucocorticoids is rarely reported in the pediatric population. There is a wide variation in the rate of remission of chronic urticaria between studies. The aim of this study is to enhance our understanding of pediatric chronic urticaria. Materials and Methods: This study enrolled 37 children with chronic urticaria aged from 0 to 18 years. Demographic parameters, medical history, clinical features, laboratory data and treatment information were collected. Children were treated with the recommended dosage of second-generation H1-antihistamines, which was increased by up to twofold. Omalizumab was added for refractory anti-H1 patients. A three-day course with systemic glucocorticoids was administered for severe exacerbations. Montelukast was administered to some children. Results: Wheals without angioedema were common. Chronic urticaria was spontaneous in 32 children (86.48%), inducible in 2 (5.41%), induced by a parasite in 1 and vasculitic in 2. Treatment of the potential causes of chronic urticaria was of no benefit, except for eradication of Dientamoeba fragilis. Chronic urticaria was resolved within three years in 45.9% of cases. Allergic diseases were present in nine children (24.32%) and autoimmune diseases were present in three (8.11%). All children were treated with anti-H1 at the licensed dose or at a higher dose. A partial or complete response to anti-H1 was observed in 29 (78.38%) patients. Montelukast showed no benefit. All children treated with omalizumab responded. Systemic glucocorticoids were successfully used to treat exacerbations. Conclusions: Our findings indicate that laboratory tests should not be routinely performed in children with chronic urticaria without clinical suspicion. However, comorbidities such as thyroid autoimmune disease and coeliac disease are suggested to be monitored over the chronic urticaria course. These clinical conditions could be diagnosed from the diagnostic framework of chronic urticaria. Increasing the dosage of anti-H1 and omalizumab was effective in children resistant to standard treatment but we still need further studies to generate a standard patient-centered treatment.
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Affiliation(s)
| | | | | | - Carlo Caffarelli
- Clinica Pediatrica, Azienda Ospedaliero-Universitaria, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (E.V.B.); (G.G.); (S.S.)
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D’Auria E, Minutoli M, Colombo A, Sartorio MUA, Zunica F, Zuccotti G, Lougaris V. Allergy and autoimmunity in children: non-mutually exclusive diseases. A narrative review. Front Pediatr 2023; 11:1239365. [PMID: 38027278 PMCID: PMC10652575 DOI: 10.3389/fped.2023.1239365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/04/2023] [Indexed: 12/01/2023] Open
Abstract
In last decades a simultaneous increase in the prevalence of atopic and autoimmune disorders in pediatric population has been observed. Despite the Th1-Th2 paradigm, supporting the polarization of the immune system with Th1 response involved in autoimmune diseases and Th2 response leading to hypersensitivity reactions, recent evidence suggests a possible coexistence of common pathogenic pathways as result of shared immune dysregulation. Similar genes and other mechanisms such as epithelial barrier damage, gut microbiota dysbiosis and reduced number of T regs and IL-10 contribute to the onset of allergy and autoimmunity. IgA deficiency is also hypothesized to be the crosslink between celiac disease and allergy by lowering gut mucous membrane protection from antigens and allergens. The present narrative review aims to give an overview of the co-occurrence of allergic and autoimmune disorders (celiac disease, inflammatory bowel diseases, type 1 diabetes mellitus, thyroid disease, juvenile idiopathic arthritis) in pediatric population, based on the available evidence. We also highlighted the common pathogenic pathways that may underpin both. Our findings confirm that allergic and autoimmune diseases are commonly associated, and clinicians should therefore be aware of the possible coexistence of these conditions in order to ameliorate disease management and patient care. Particular attention should be paid to the association between atopic dermatitis or asthma and celiac disease or type 1 diabetes and vice versa, for therapeutic interventions. Further studies are needed to better clarify mechanisms involved in the pathogenesis and eventually identify new therapeutic strategies.
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Affiliation(s)
- Enza D’Auria
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Martina Minutoli
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Alessandra Colombo
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | | | - Fiammetta Zunica
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Vassilios Lougaris
- Department of Clinical and Experimental Sciences, ASST – Spedali Civili di Brescia, Paediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, University of Brescia, Brescia, Italy
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Debbaut A, Gilliaux O. Clinical features of patients with chronic spontaneous urticaria associated with autoimmune thyroiditis. Arch Pediatr 2023; 30:131-135. [PMID: 36804356 DOI: 10.1016/j.arcped.2023.01.010] [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: 04/13/2022] [Revised: 08/30/2022] [Accepted: 01/15/2023] [Indexed: 02/19/2023]
Abstract
The aim of the study was to focus on children with both chronic spontaneous urticaria (CSU) and autoimmune thyroiditis (AT) as this topic is rarely studied in children although some publications show a higher proportion of antithyroid antibodies in children with CSU. We highlight two cases of children with both CSU and AT and compare their data with reports from the literature. Since only case reports or case series were available, we performed a descriptive analysis of 15 patients. There were 7 (46.7%) cases of hypothyroidism and the rest were euthyroid. Hypothyroidism appears before, during, and after the diagnostic of CSU. One patient with hypothyroidism and one with euthyroidism receiving l-thyroxine experienced remission of urticaria. Three patients over 12 years of age (20%) received omalizumab. Three patients (20%) had another autoimmune disease and seven (58.3%) had a family history of thyroid disease or autoimmune disease. CONCLUSION: Children with CSU need repeated testing for antithyroid antibodies. Children with both CSU and AT require close medical supervision focused on the development of other autoimmune diseases. l-thyroxine may improve urticaria in patients with hypothyroidism, but there is not enough evidence for patients with euthyroidism. Omalizumab may be of benefit in this population but well-controlled studies in children with AT and CSU are needed.
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Affiliation(s)
- A Debbaut
- Department of Pediatrics, Hôpital Civil Marie Curie, CHU of Charleroi, 140 Chaussée de Bruxelles, 6042 Charleroi, Lodelinsart, Belgium.
| | - O Gilliaux
- Department of Pediatrics, Hôpital Civil Marie Curie, CHU of Charleroi, 140 Chaussée de Bruxelles, 6042 Charleroi, Lodelinsart, Belgium; Laboratory of Experimental Medicine (ULB222), Faculty of Medicine, Université libre de Bruxelles, Belgium.
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4
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Koç Yıldırım S, Erbağcı E, Hapa A. Omalizumab treatment in combination with any other biologics: Is it really a safe duo? Australas J Dermatol 2023; 64:229-233. [PMID: 36866918 DOI: 10.1111/ajd.14019] [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: 01/28/2023] [Revised: 02/13/2023] [Accepted: 02/19/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is a mast cell-mediated disease, which is sometimes associated with various inflammatory disorders. Omalizumab is a commonly used biological agent, which is a recombinant, humanized, monoclonal antibody against human immunoglobulin E. However, there are only few reports about the combination of omalizumab for CSU with any other biologics for accompanying inflammatory diseases in the literature. The aim of this study was to evaluate the patients whose treatment of omalizumab for CSU were combined with any other biologics for associated inflammatory disorders and to describe whether these combinations might have any safety concerns. METHODS We conducted a retrospective cohort study of adult patients with CSU treated with omalizumab concurrently using another biological agent for their other dermatological conditions. RESULTS Thirty-one patients, 19 women and 12 men, were evaluated. The mean age was 45.13 years. The median duration of omalizumab was 11 months. Biological agents which patients were treated other than omalizumab were as follows: adalimumab biosimilar (n = 3), ustekinumab (n = 4), secukinumab (n = 17) and ixekizumab (n = 7). The median duration of concurrent use of omalizumab and other biologics was 8 months. None of the drug combinations was stopped because of side effects. CONCLUSION This observational study demonstrated that omalizumab treatment for CSU in combination with any other biological agents for dermatological disorders appeared to be well tolerated without any major safety concerns.
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Affiliation(s)
- Sema Koç Yıldırım
- Department of Dermatology and Venereology, Uşak University Faculty of Medicine, Uşak, Turkey
| | - Ece Erbağcı
- Department of Dermatology and Venereology, Uşak University Faculty of Medicine, Uşak, Turkey
| | - Aslı Hapa
- Department of Dermatology and Venereology, Buca Seyfi Demirsoy Training and Research Hospital, İzmir, Turkey
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Stamati L, Bountouvi E, Douros K, Skarakis N, Papadimitriou A, Papaevangelou V, Karachaliou FE. Comorbidity of chronic urticarial and Graves' disease. Minerva Pediatr (Torino) 2022; 74:804-806. [PMID: 32960003 DOI: 10.23736/s2724-5276.20.05891-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Lamprini Stamati
- School of Medicine, Third Department of Pediatrics, "Attikon" University Hospital, University of Athens, Athens, Greece
| | - Evangelia Bountouvi
- School of Medicine, Third Department of Pediatrics, "Attikon" University Hospital, University of Athens, Athens, Greece
| | - Konstantinos Douros
- School of Medicine, Third Department of Pediatrics, "Attikon" University Hospital, University of Athens, Athens, Greece
| | - Nikitas Skarakis
- School of Medicine, Third Department of Pediatrics, "Attikon" University Hospital, University of Athens, Athens, Greece
| | - Anastasios Papadimitriou
- School of Medicine, Third Department of Pediatrics, "Attikon" University Hospital, University of Athens, Athens, Greece
| | - Vasiliki Papaevangelou
- School of Medicine, Third Department of Pediatrics, "Attikon" University Hospital, University of Athens, Athens, Greece
| | - Fotini-Eleni Karachaliou
- School of Medicine, Third Department of Pediatrics, "Attikon" University Hospital, University of Athens, Athens, Greece -
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Kim H, Hyun MC, Choi BS. Natural History and Influencing Factors of Chronic Urticaria in Children. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 14:73-84. [PMID: 34983108 PMCID: PMC8724829 DOI: 10.4168/aair.2022.14.1.73] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/26/2021] [Accepted: 09/01/2021] [Indexed: 11/23/2022]
Abstract
Purpose Chronic urticaria (CU) can reduce the quality of life of children and their parents, but there are only a few studies on the course of CU in children. This study aimed to investigate the natural course of CU in children and identify the factors that influence its prognosis. Methods We evaluated 77 children diagnosed with CU, who were monitored for at least 48 months. Subjects were classified as either chronic spontaneous urticaria (CSU) or other CU, and the clinical features were compared. Remission was defined as having no symptoms without treatment for more than 1 year. The remission rate was analyzed, and the factors influencing the prognosis were investigated. Results The average age of the study population was 5.96 ± 4.06 years, and 64 (83.1%) patients had CSU. The remission rates at 6 months, 1 year, 2 years, 3 years, and 4 years after symptom onset were 22.1%, 40.3%, 52.0%, 63.7%, and 70.2%, respectively, for children with CU. For children with CSU, these values were 23.4%, 43.7%, 56.2%, 68.7%, and 75.0%, respectively. The total serum immunoglobulin E (IgE) levels were positively correlated with disease duration (r = 0.262, P = 0.021); no other factors were associated with the duration of the disease. Conclusions A high proportion of children with CU were classified as CSU. No indicators, except for total IgE were found to predict the timing of spontaneous remission. The CU remission rate identified in this study is expected to be used as one of the reference data for the progress of CU in patients.
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Affiliation(s)
- Hyeona Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Myung Chul Hyun
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Bong Seok Choi
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
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Özen B, Sancakli O, Duman Senol H, Ozdogru EE, Tuncel T. An evaluation of the factors affecting the clinical and laboratory findings, prognosis, and treatment response in children with chronic urticaria. Dermatol Ther 2021; 35:e15261. [PMID: 34907626 DOI: 10.1111/dth.15261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/23/2021] [Accepted: 12/10/2021] [Indexed: 11/28/2022]
Abstract
Chronic urticaria (CU) is a rare disease in childhood, and studies in children are limited. In this study, the aim was to investigate the clinical and laboratory findings and demographic characteristics of children with CU and to determine the factors affecting prognosis. The study included 141 patients aged 0-18 years who were diagnosed with CU in the pediatric allergy outpatient clinic between January 1, 2013, and December 31, 2018. Risk factors related to prognosis were investigated by comparing the duration of CU and treatment response with clinical and etiological features. IBM SPSS version 24 was used for statistical analyses. In the study group, the female/male ratio was 69/55, and the median age at first visit was 9.5 years (min:1, max:17). Among patients, 63 (44.5%) had an accompanying atopic disease, and 23 (16.3%) had chronic disease. Of the patients, 124 (88%) had chronic spontaneous urticaria, and 17 patients (12%) had chronic inducible urticaria (CIU). Of those with CIU, 72.2% had symptomatic dermographism, 16.7% had cholinergic urticaria, and 11.1% had cold urticaria. After the evaluations, the most common pathological findings in our patients were intestinal parasitosis (n = 14), anemia (n = 10), and urinary tract infection (n = 8). The median total duration of urticaria was 47 weeks (min:8, max:284). The duration of urticaria was longer in patients with atopy (p < 0.05), and the group that went into remission with standard-dose antihistamine was the group with highest eosinophil count (p = 0.022). In most children with CU, the underlying cause/disease cannot be determined. In our study, treatable triggers were found in some of the patients. Therefore, it is appropriate for each patient to be evaluated with selected laboratory tests after detailed history and physical examination.
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Affiliation(s)
- Burçin Özen
- Department of Pediatrics, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ozlem Sancakli
- Department of Pediatric Allergy Immunology, Baskent University Faculty of Medicine, Izmir, Turkey
| | - Handan Duman Senol
- Department of Pediatric Allergy and Immunology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Emine Ece Ozdogru
- Department of Pediatric Allergy and Immunology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Tuba Tuncel
- Department of Pediatrics, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey.,Division of Pediatric Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
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8
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Lachover-Roth I, Rabie A, Cohen-Engler A, Rosman Y, Meir-Shafrir K, Confino-Cohen R. Chronic urticaria in children - New insights from a large cohort. Pediatr Allergy Immunol 2021; 32:999-1005. [PMID: 33502063 DOI: 10.1111/pai.13457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/07/2021] [Accepted: 01/18/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Chronic spontaneous urticaria is well-described in adults, but less so in children. The aim of this study is to describe the demographics, clinical characteristics, comorbidities, and outcomes of children with chronic, spontaneous urticaria. METHODS This retrospective study followed children up to 18 years old, diagnosed with chronic spontaneous urticaria, between the years 2002-2018, and treated in a tertiary referral allergy and clinical immunology center. Data including demographics, clinical characteristics, comorbidities, treatments, and outcomes were extracted from electronic medical records. RESULTS Records of 380 children coded to have chronic urticaria were reviewed, of which 250 (65.8%) fulfilled the diagnostic criteria for chronic spontaneous urticaria. There were 136 females (54.4%). Mean age at diagnosis was 11.4 years, and 122 (48%) were adolescents. The average duration of chronic spontaneous urticaria was 12.25 ± 15.2 months. The urticaria in 208 children )83.2%) resolved within 24 months. Eighty-seven patients (34.8%) had at least one atopic disease. Atopic comorbidities included atopic dermatitis in 17.2%, allergic rhinitis in 16%, asthma in 13.2%, and food allergy in 3.2%. Eighteen patients (7.2%) had a concomitant autoimmune disease. Nine (3.6%) had thyroid disease. CONCLUSIONS AND CLINICAL RELEVANCE Chronic spontaneous urticaria in children is a self-limited disease with favorable prognosis. Atopic diseases are more prevalent in children with chronic spontaneous urticaria than in the general pediatric population, increasing the possibility of a special subgroup of TH2-related chronic urticaria in children.
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Affiliation(s)
- Idit Lachover-Roth
- Allergy and Clinical Immunology Unit, Meir Medical Center, Kfar-Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ahmad Rabie
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Cohen-Engler
- Allergy and Clinical Immunology Unit, Meir Medical Center, Kfar-Saba, Israel
| | - Yossi Rosman
- Allergy and Clinical Immunology Unit, Meir Medical Center, Kfar-Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Keren Meir-Shafrir
- Allergy and Clinical Immunology Unit, Meir Medical Center, Kfar-Saba, Israel
| | - Ronit Confino-Cohen
- Allergy and Clinical Immunology Unit, Meir Medical Center, Kfar-Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Corral-Magaña O, Gil-Sánchez JA, Bover-Bauzá C, Martinez-Cepas P, Montis-Palos MC, Martín-Santiago A. Chronic urticaria in children under 15 years of age: Clinical experience beyond the clinical trials. Pediatr Dermatol 2021; 38:385-389. [PMID: 33410219 DOI: 10.1111/pde.14455] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 10/19/2020] [Accepted: 10/24/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND/OBJECTIVES The aim of the study was to describe the clinical characteristics, management, and outcome of a series of children with chronic urticaria (CU). METHODS We retrospectively studied children aged <15 years diagnosed with CU in a tertiary teaching hospital in Palma de Mallorca, Spain, between January 2014 and March 2019. CU was defined as persistence of symptoms of wheals, with or without angioedema, for >6 weeks. RESULTS Twenty-nine patients (17 girls, mean age 8 years) were included. Family history of atopy was found in 31% of the cases. In 41.3% of patients, episodes of CU were associated with angioedema. Physical triggers were found in 34.5% of the cases. Most episodes of CU were successfully managed with the recommended (60.7%) or double the recommended dose (17.2%) of H1-antihistamines. Quadruple the recommended dose of H1 antihistamines was used in six patients, five of whom were finally treated with off-label omalizumab. Treatment with anti-leukotrienes was needed in one patient. Associated thyroiditis was diagnosed in one patient, which was controlled with levothyroxine. CONCLUSIONS Pediatric CU showed features similar to CU in adulthood, including a greater predominance in females and frequent association with personal or family history of atopy. Adult guidelines for the treatment of CU are currently extrapolated to the pediatric population. Specific tools for the assessment of disease activity and impairment of quality of life in pediatric CU are needed for use in prospective studies aimed to define treatment strategies for children with CU.
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Affiliation(s)
- Oriol Corral-Magaña
- Department of Dermatology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - José Antonio Gil-Sánchez
- Department of Pediatric Allergology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Catalina Bover-Bauzá
- Department of Pediatric, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | | | - Ana Martín-Santiago
- Department of Dermatology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
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Çildağ S, Yenisey Ç, Ünübol M, Şentürk T. Comparison of immunoglobulin E anti-thyroid peroxidase antibodies in patients with Hashimoto thyroiditis and chronic spontaneous urticaria. Med Pharm Rep 2021; 94:53-57. [PMID: 33629049 PMCID: PMC7880074 DOI: 10.15386/mpr-1598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/27/2020] [Accepted: 09/30/2020] [Indexed: 12/04/2022] Open
Abstract
Background and aim Chronic spontaneous urticaria (CSU) is a disease of unknown etiology and autoimmunity has been thought to be an etiological factor. Immunoglobulin E (IgE)-anti-thyroid peroxidase antibodies (anti-TPO) may play a role in the pathogenesis of certain cases of urticaria. The aim of this study is to investigate IgE-anti-TPO in patients with chronic spontaneous urticaria and in patients with Hashimoto’s thyroiditis. Methods A total of 175 subjects were included in this study. 59 patients had chronic spontaneous urticaria without history of Hashimoto’s thyroiditis, while 58 patients had Hashimoto’s thyroiditis without history of urticaria. The control group consisted of 58 participants without history of Hashimoto’s thyroiditis and urticaria. Serum IgE-anti-TPO levels were analyzed by site-directed IgE capture Enzyme-Linked Immunosorbent Assay technique. We used this technique by modifying it. Results IgE-anti-TPO antibodies were detected in all three groups and in all subjects. There was no significant difference between the three groups in terms of IgE-anti-TPO levels. Although total IgE and IgE-anti-TPO levels were higher in the IgG-anti-TPO positive chronic spontaneous urticaria, there was no significant difference. Conclusions IgE-anti-TPO antibodies do not play a pathogenic role in the majority of patients with chronic spontaneous urticaria.
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Affiliation(s)
- Songül Çildağ
- Department of Immunology and Allergy, Adnan Menderes University, Turkey
| | - Çiğdem Yenisey
- Department of Biochemistry, Adnan Menderes University, Turkey
| | - Mustafa Ünübol
- Department of Endocrinology and Metabolism, Adnan Menderes University, Turkey
| | - Taşkın Şentürk
- Department of Immunology and Allergy, Adnan Menderes University, Turkey
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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.
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Gonzalez-Diaz SN, Sanchez-Borges M, Rangel-Gonzalez DM, Guzman-Avilan RI, Canseco-Villarreal JI, Arias-Cruz A. Chronic urticaria and thyroid pathology. World Allergy Organ J 2020; 13:100101. [PMID: 32180891 PMCID: PMC7063156 DOI: 10.1016/j.waojou.2020.100101] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/27/2019] [Accepted: 12/31/2019] [Indexed: 12/11/2022] Open
Abstract
Urticaria is defined as the sudden appearance of erythematous, itchy wheals of variable size, with or without angioedema (AE) (swelling of the deeper layers of the skin). Its classification depends on time course of symptoms and the presence of eliciting factors. When it lasts less than 6 weeks it is classified as acute urticaria (AU), and if the symptoms persist for more than 6 weeks, it is classified as chronic urticaria (CU). Current International Guidelines also classify CU as chronic spontaneous urticaria (CSU) and inducible urticarial, according to the absence or presence of environmental triggering factors. CSU is defined as urticaria and/or angioedema in which there is no evidence of a specific eliciting factor. CSU is associated with autoimmunity in 30-45% of the cases, sharing some immunological mechanisms with other autoimmune diseases, and is associated with autoimmune thyroid disease (ATD) in about 4.3%-57.4% patients. Several studies suggest that adequate therapy with anti-thyroid drugs or levothyroxine in early stages of ATD and CSU, may help to remit the latter; but there is still a lack of double-blind, placebo-controlled studies that support this hypothesis in patients without abnormal thyroid hormone levels. The objective of this review is to describe the pathophysiology of chronic spontaneous urticaria and its association with autoimmune thyroid disease.
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Key Words
- AAbs, autoantibodies
- AD, autoimmune diseases
- AE, angioedema
- AMA, antithyroid microsomal antibody
- ASST, autologous serum skin test
- ATAbs, anti-thyroid autoantibodies
- ATD, autoimmune thyroid disease
- Autoimmunity
- BAT, basophil activation test
- CAU, chronic autoimmune urticaria
- CSU, chronic spontaneous urticaria
- CU, chronic urticaria
- Chronic urticaria
- DAMPs, damage-associated molecular patterns
- FcεRIa, high affinity IgE receptor
- GD, Graves' disease
- HT, Hashimoto's thyroiditis/autoimmune thyroiditis
- Histamine
- ICU, inducible chronic urticaria
- IFN-γ, gamma interferon
- IL, Interleukin
- IgE, Immunoglobulin E
- IgG, Immunoglobulin G
- Levothyroxine
- NSAH, non-sedating antihistamines
- PAF, platelet activating factor
- PAMPs, pathogen-associated molecular patterns
- T4L, free thyroxine
- TG, thyroglobulin
- TGAbs, anti-thyroglobulin antibodies
- TLR, Toll-like receptors
- TNF-α, tumor necrosis factor alpha
- TPOAbs, anti-thyroid peroxidase antibodies
- TSH, thyroid stimulating hormone
- TSHR, thyroid stimulating hormone receptor
- Thyroid disease
- Treg, regulatory T cells
- UAS, urticaria activity score
- Urticaria
- VEGF, vascular endothelial growth factor
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Affiliation(s)
- Sandra Nora Gonzalez-Diaz
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
| | - Mario Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Allergy Service, Clinica El Avila, 6a. Transversal Urb. Altamira, Piso 8, Consultorio 803, Caracas, 1060, Venezuela
| | - Diana Maria Rangel-Gonzalez
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
| | - Rosa Ivett Guzman-Avilan
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
| | - Jose Ignacio Canseco-Villarreal
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
| | - Alfredo Arias-Cruz
- Centro Regional de Alergia e Inmunología Clinica, Hospital Universitario “Dr. José Eleuterio González”, Ave. Gonzalitos y Madero, s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo Leon, Mexico
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Greiner B, Pelton J, Baker D. Hypothyroidism-associated angioedema. Proc (Bayl Univ Med Cent) 2020; 33:254-255. [PMID: 32313478 DOI: 10.1080/08998280.2020.1724847] [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: 01/02/2020] [Revised: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 10/25/2022] Open
Abstract
We present a 41-year-old woman with hypothyroidism who presented to the emergency department with acute onset of angioedema and profound hypothyroidism. She required complex airway management and medical treatment before being discharged home 10 days later. This may be the first case of hypothyroidism-induced angioedema that was not associated with chronic urticaria or hives.
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Affiliation(s)
- Benjamin Greiner
- College of Osteopathic Medicine, Oklahoma State University Center for Health SciencesTulsaOklahoma
| | - Jameson Pelton
- Department of Internal Medicine, Oklahoma State University Center for Health SciencesTulsaOklahoma
| | - Damon Baker
- Department of Internal Medicine, Oklahoma State University Center for Health SciencesTulsaOklahoma
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14
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Caffarelli C, Paravati F, El Hachem M, Duse M, Bergamini M, Simeone G, Barbagallo M, Bernardini R, Bottau P, Bugliaro F, Caimmi S, Chiera F, Crisafulli G, De Ranieri C, Di Mauro D, Diociaiuti A, Franceschini F, Gola M, Licari A, Liotti L, Mastrorilli C, Minasi D, Mori F, Neri I, Pantaleo A, Saretta F, Tesi CF, Corsello G, Marseglia GL, Villani A, Cardinale F. Management of chronic urticaria in children: a clinical guideline. Ital J Pediatr 2019; 45:101. [PMID: 31416456 PMCID: PMC6694633 DOI: 10.1186/s13052-019-0695-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/01/2019] [Indexed: 12/12/2022] Open
Abstract
The aim of this guidance is to provide recommendations to clinicians and other interested parties on chronic urticaria in children. The Italian Society for Pediatrics (SIP), the Italian Society for Allergy and Immunology (SIAIP), the Italian Society for Pediatric dermatology (SIDerP) convened a multidisciplinary panel that prepared clinical guidelines for diagnosis and management of chronic urticaria in childhood. Key questions on epidemiology, natural history, diagnosis, and management were developed. The literature was systematically searched and evaluated, recommendations were rated and algorithms for diagnosis and treatment were developed. The recommendations focus on identification of diseases and comorbidities, strategies to recognize triggering factors, improvement of treatment by individualized care.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Dipartimento Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Francesco Paravati
- Pediatric Unit, Maternal Infant Department, Azienda Sanitaria Provinciale Crotone, Crotone, Italy
| | - Maya El Hachem
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marzia Duse
- Department of Pediatrics, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Giovanni Simeone
- Primary care Pediatrician, Local Health Unit of Brindisi, Brindisi, Italy
| | - Massimo Barbagallo
- Pediatric Unit, Azienda di rilievo nazionale ARNAS "GARIBALDI", Catania, Italy
| | | | - Paolo Bottau
- Pediatric and Neonatology Unit, Imola Hospital, Imola, BO, Italy
| | - Filomena Bugliaro
- FEDERASMA e Allergie Onlus - Federazione Italiana Pazienti, Prato, Italy
| | - Silvia Caimmi
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Fernanda Chiera
- Pediatric Unit, Maternal Infant Department, Azienda Sanitaria Provinciale Crotone, Crotone, Italy
| | - Giuseppe Crisafulli
- UO Allergologia, Dipartimento di Pediatria, Università di Messina, Messina, Italy
| | | | - Dora Di Mauro
- Clinica Pediatrica, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andrea Diociaiuti
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Massimo Gola
- Allergological and Pediatric Dermatology Unit, AUTC and University of Florence, Florence, Italy
| | - Amelia Licari
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Lucia Liotti
- Department of Pediatrics, Senigallia Hospital, Senigallia, Italy
| | - Carla Mastrorilli
- Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - Domenico Minasi
- UOC di Pediatria Azienda Ospedaliera "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Francesca Mori
- Allergy Unit, Department of Pediatric Medicine, Anna Meyer Children's University Hospital, Florence, Italy
| | - Iria Neri
- Dermatology Unit, University of Bologna, Bologna, Italy
| | - Aurelia Pantaleo
- Clinica Pediatrica, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Francesca Saretta
- Pediatric Department, AAS2 Bassa Friulana-Isontina, Palmanova-Latisana, Italy.,Pediatric Allergy Unit, Department of Medicine, Udine, Italy
| | - Carlo Filippo Tesi
- FEDERASMA e Allergie Onlus - Federazione Italiana Pazienti, Prato, Italy
| | - Giovanni Corsello
- Clinica Pediatrica Università degli Studi di Palermo, Palermo, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alberto Villani
- UOC di Pediatria Generale e Malattie Infettive, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Fabio Cardinale
- Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy.
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Hemmings O, Kwok M, McKendry R, Santos AF. Basophil Activation Test: Old and New Applications in Allergy. Curr Allergy Asthma Rep 2018; 18:77. [PMID: 30430289 PMCID: PMC6244909 DOI: 10.1007/s11882-018-0831-5] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW The basophil activation test (BAT) using flow cytometry has supplanted traditional methods of measuring basophil degranulation using histamine and other mediator release, and can be used for clinical applications as well as to explore the immune mechanisms of effector cell response to allergen. This review discusses the advancements made in clinical, diagnostic and laboratory research of allergy utilizing an ever-evolving BAT. RECENT FINDINGS Being an in vitro surrogate of the allergic reaction that happens in vivo in the sick patient, the BAT can be used to support the diagnosis of various allergic conditions, such as food, drug, respiratory and insect venom allergies, and the assessment of clinical response to allergen-specific immunotherapy and other immunomodulatory treatments. The BAT can also be used for research purposes to explore the mechanisms of allergy and tolerance at the level of the basophil, for instance by manipulating IgE and IgG and their receptors and by studying intracellular signalling cascade in response to allergen. This review covers the applications of the BAT to the clinical management of allergic patients and the increased understanding of the mechanisms of immune response to allergens as well as technological advancements made in recent years.
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Affiliation(s)
- Oliver Hemmings
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Matthew Kwok
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Richard McKendry
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Alexandra F Santos
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK. .,Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK. .,MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK. .,Children's Allergies Department, Guy's and St. Thomas' NHS Foundation Trust, St. Thomas' Hospital, Westminster Bridge Road, London, UK.
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Thyroid Autoimmunity and Autoimmunity in Chronic Spontaneous Urticaria Linked to Disease Severity, Therapeutic Response, and Time to Remission in Patients with Chronic Spontaneous Urticaria. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9856843. [PMID: 30515422 PMCID: PMC6236973 DOI: 10.1155/2018/9856843] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 09/28/2018] [Accepted: 10/18/2018] [Indexed: 11/17/2022]
Abstract
Background Chronic spontaneous urticaria (CSU) is autoimmune in nature and associated with thyroid autoimmunity (TA), but evidence on autoimmunity in relation to CSU progression and prognosis is limited. We evaluated whether TA and autoimmunity in CSU are correlated with disease severity, therapeutic response, and time to remission and establish an association between CSU characteristics linked to thyroid autoantibody. Methods Medical records of patients diagnosed with urticaria attending outpatient dermatology clinic at a university-based hospital from 2013 to 2017 were retrospectively reviewed. Data on the clinical characteristics, laboratory investigations particularly thyroid antibody titers, autologous serum skin test (ASST) and autologous plasma skin test (APST) results and their link to disease severity, treatments, and time to remission of CSU patients were analyzed. Results Of 1,096 patients with urticaria, 60.2% had CSU. Three-hundred patients fulfilled the inclusion criteria for CSU with complete thyroid antibody testing. Positive TA was significantly associated with female gender and age > 35 years (p = 0.008). Antithyroid peroxidase (anti-TPO)-positive patients suffered from CSU longer than 12 and 18 months compared to anti-TPO-negative patients (100.0% vs. 82.6%, p = 0.042, and 100.0% vs. 75.9% p = 0.020, respectively). The presence of urticarial attacks > 4 days/week was significantly seen in ASST and APST-positive patients compared to those without (84.6% vs. 61.3%, p = 0.011, and 85.3% vs. 61.8%, p = 0.006, respectively). Positive APST patients were more difficult to treat than those with negative results (61.2% vs. 37.8%, p = 0.017). Conclusions Antithyroid peroxidase is a predictor of time to remission, while autologous skin testing is linked to disease severity (ASST and APST) and therapeutic response (APST) in CSU patients.
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Kumaran MS, Mahajan R, Goyal N, Parsad D. Clinico-epidemiological features of chronic urticaria in children: A retrospective analysis of 296 children from a tertiary care institute in Northern India. Indian J Dermatol Venereol Leprol 2018; 86:50-54. [PMID: 30264742 DOI: 10.4103/ijdvl.ijdvl_573_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Urticaria is a common dermatosis affecting approximately 25% of the population. Childhood chronic urticaria is frequently encountered, however, epidemiologic data on pediatric urticaria are limited. Aim The objective of this study was to study the clinico-epidemiological profile of children with chronic urticaria. Methods A retrospective study including children less than 14 years with chronic urticaria was conducted from January 2010 to December 2015. Detailed history, clinical examination, investigation results, treatment taken, and follow-up details were recorded on a prefixed proforma. As per the practice of the urticaria clinic, the children were investigated only in case of inadequate therapeutic response or had features of atopy/autoimmune disorders. Results Two hundred and ninety-six children (166 boys, 130 girls; mean age, 11.3 years) with chronic urticaria were included in the study. Urticaria was spontaneous in onset in 57.1% (169) children; precipitating factors were reported in 42.9% children, most common being physical factors, food allergy, drug intake and infections. Investigations were done in 48 (16.2%) patients; Antinuclear antibody was negative in all patients, raised serum IgE in 20/48 (41.6%), positive autologous serum skin test in 32/48 (66.6%) and raised anti-TPO titre in 10/48 (20.8%) children. A diagnosis of chronic spontaneous urticaria was made in 245 (82.77%) children, chronic dermographic urticaria in 35 (11.82%), cholinergic urticaria and drug-induced urticaria in 5 (1.69%) each, aquagenic urticaria in 4 (1.35%) and cold-induced urticaria in 2 (0.68%) children. Two hundred and fifteen (72.6%) children responded to nonsedating antihistamines alone, 61 (20.6%) required addition of a sedating antihistamine, 7 (0.02%) required addition of montelukast, 3 (0.01%) ranitidine and 10 (20.8%) required a short course of oral corticosteroids to control acute flare. None of the patients required any long-term immunomodulatory or immunosuppressive agent. The mean duration of treatment required was 3 to 12 months. Limitations The main limitation is the study being retrospective in nature with associated drawbacks of data loss. In addition, we did not use objective scoring system such as urticaria severity score and not all children were extensively investigated. Conclusions Chronic spontaneous urticaria is the most common type of chronic urticaria in children. Majority of these children can be managed conservatively with long-term antihistamines.
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Affiliation(s)
- Muthu Sendhil Kumaran
- Department of Dermatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Mahajan
- Department of Dermatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nupur Goyal
- Department of Dermatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Davinder Parsad
- Department of Dermatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Autoimmune comorbidity in chronic spontaneous urticaria: A systematic review. Autoimmun Rev 2017; 16:1196-1208. [PMID: 29037900 DOI: 10.1016/j.autrev.2017.10.003] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 08/05/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Numerous autoimmune diseases (AIDs) have been linked to chronic spontaneous urticaria (CSU). Here, we provide the first extensive and comprehensive evaluation of the prevalence of AIDs in patients with CSU and vice versa. METHODS A Pubmed and Google Scholar search was performed to identify studies reporting the prevalence of various AIDs in CSU and vice versa published before April 2017. RESULTS The prevalence of individual AIDs in CSU is increased (≥1% in most studies vs ≤1% in the general population). AIDs with relatively high prevalence in the general population are also quite common in CSU patients, whereas those with low prevalence remain a rare finding in CSU. The rates of comorbidity in most studies were ≥1% for insulin-dependent diabetes mellitus, rheumatoid arthritis (RA), psoriasis and celiac disease (CD), ≥2% for Graves' disease, ≥3% for vitiligo, and ≥5% for pernicious anemia and Hashimoto's thyroiditis. Organ-specific AIDs are more prevalent in CSU than systemic (multiorgan or non organ-specific) AIDs. >2% of CSU patients have autoimmune polyglandular syndromes encompassing autoimmune thyroid disease (ATD) and vitiligo or pernicious anemia. Antithyroid and antinuclear antibodies are the most prevalent AID-associated autoantibodies in CSU. >15% of CSU patients have a positive family history for AIDs. The prevalence of urticarial rash in AID patients is >1% in most studies. This rash is more prevalent in eosinophilic granulomatosis with polyangiitis, ATD, systemic lupus erythematosus, RA and CD. CONCLUSIONS CSU patients have an increased risk of AIDs, especially adult female patients and those with a positive family history and a genetic predisposition for AIDs, who should be screened for signs and symptoms of AIDs.
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Kolkhir P, Metz M, Altrichter S, Maurer M. Comorbidity of chronic spontaneous urticaria and autoimmune thyroid diseases: A systematic review. Allergy 2017; 72:1440-1460. [PMID: 28407273 DOI: 10.1111/all.13182] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 02/01/2023]
Abstract
Patients with chronic spontaneous urticaria (CSU) are widely held to often have other autoimmune disorders, including autoimmune thyroid disease. Here, we systematically evaluated the literature on the prevalence of thyroid autoimmunity in CSU and vice versa. There is a strong link between CSU and elevated levels of IgG antithyroid autoantibodies (AAbs), with most of a large number of studies reporting rates of ≥10%. Levels of IgG against thyroid peroxidase (TPO) are more often elevated in CSU than those of other IgG antithyroid AAbs (strong evidence). Levels of IgG antithyroid AAbs are more often elevated in adult patients with CSU than in children (strong evidence). Patients with CSU exhibit significantly higher levels of IgG antithyroid AAbs (strong evidence) and IgE-anti-TPO (weak evidence) than controls. Elevated IgG antithyroid AAbs in CSU are linked to the use of glucocorticoids (weak evidence) but not to disease duration or severity/activity, gender, age, or ASST response (inconsistent evidence). Thyroid dysfunction rates are increased in patients with CSU (strong evidence). Hypothyroidism and Hashimoto's thyroiditis are more common than hyperthyroidism and Graves' disease (strong evidence). Thyroid dysfunction is more common in adult patients with CSU than in children (strong evidence) and in female than in male patients with CSU (weak evidence). Urticaria including CSU is more prevalent in patients with thyroid autoimmunity than in controls (weak evidence). CSU can improve in response to treatment with levothyroxine or other thyroid drugs (strong evidence). Pathogenic mechanisms in CSU patients with thyroid autoimmunity may include IgE against autoantigens, immune complexes, and complement.
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Affiliation(s)
- P. Kolkhir
- Department of Dermatology and Venereology; I.M. Sechenov First Moscow State Medical University; Moscow Russia
| | - M. Metz
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - S. Altrichter
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - M. Maurer
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
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Abstract
INTRODUCTION chronic urticaria (CU) is a skin disorder characterized by transient, pruritic wheals persisting for longer than 6 weeks. The etiopathogenesis of the disease is still unclear, but there is evidence that autoimmunity and endocrine dysfunction may be involved. AIM the aim of this study was to determine whether chronic urticaria is statistically associated with thyroid autoimmunity. PATIENTS AND METHODS in a prospective case-control study, we compared the frequency of thyroid auto-antibodies (thyroglobulin antibody, anti-Tg and thyroid peroxidase antibody, anti-TPO) in 70 patients with chronic urticaria and in 70 healthy volunteers. Thyroid auto-antibodies and thyroid hormones (thyroxine (T4), triiodthyronine (T3) and thyroid stimulating hormone (TSH) were measured in all subjects. RESULTS thyroid functional abnormalities were found in 8 (11.43%) patients. Anti-Tg and anti-TPO were positive in 16 (23%) and 21 (30%) patients, respectively. In control group, only one subject (1.42%) had abnormalities in thyroid hormonal status, and two subjects (2.86%) had positive thyroid auto-antibodies. Compared with the control group, the frequency of both anti-Tg and anti-TPO was significantly higher in those with chronic urticaria (P < 0.05). CONCLUSION this study shows a significant association between chronic urticaria and thyroid autoimmunity, and that tests to detect thyroid auto-antibodies are relevant in patients with chronic urticaria.
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Affiliation(s)
- Emina Kasumagic-Halilovic
- Department of Dermatology and Venereology, University Clinical Center Sarajevo, Bosnia and Herzegovina
| | - Nermina Beslic
- Department of Nuclear Medicine and Endocrinology, University Clinical Center Sarajevo, Bosnia and Herzegovina
| | - Nermina Ovcina-Kurtovic
- Department of Dermatology and Venereology, University Clinical Center Sarajevo, Bosnia and Herzegovina
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Cho SY, Choi YC, Kim BG, Jung JA. Factors associated with the treatment of chronic spontaneous urticaria in children. ALLERGY ASTHMA & RESPIRATORY DISEASE 2017. [DOI: 10.4168/aard.2017.5.4.211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Sun-Young Cho
- Department of Pediatrics, Dong-A University College of Medicine, Busan, Korea
| | - Yun-Chang Choi
- Department of Pediatrics, Dong-A University College of Medicine, Busan, Korea
| | - Byoung-Gwon Kim
- Department of Preventive Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jin-A Jung
- Department of Pediatrics, Dong-A University College of Medicine, Busan, Korea
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Kumaran MS, Mangal S, Narang T, Parsad D. Autologous Serum and Plasma Skin Tests in Chronic Spontaneous Urticaria: A Reappraisal. Indian Dermatol Online J 2017; 8:94-99. [PMID: 28405547 PMCID: PMC5372454 DOI: 10.4103/2229-5178.202266] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM The objective of this study was to assess autologous serum skin test (ASST) vs autologous plasma skin test (APST) response in chronic spontaneous urticaria (CSU) patients and study the significance of intensity of positive responses in relation to clinicoepidemiological parameters. MATERIALS AND METHODS One hundred CSU patients and 100 age and sex-matched controls were recruited. The demographic and clinical features were recorded in all patients and routine investigations were performed. ASST and APST tests were performed as per the standard guidelines. RESULTS The mean duration of illness was 4.85 ± 5.07 years, 90% patients were APST (+), 68% ASST (+), and 22 patients were only APST (+). Positive predictive value (PPV) of ASST and APST was 90.7% and 95.7%, respectively. A significant inverse association was seen between thyroid status and serum IgE levels with APST and ASST positivity. CONCLUSION APST appears to have better PPV and high intensity of positive response on autologous tests, and correlates with ANA positivity and angioedema.
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Affiliation(s)
- Muthu Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sonia Mangal
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarun Narang
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Davinder Parsad
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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D'Angelo G, Marseglia L, Manti S, Colavita L, Cuppari C, Impellizzeri P, Arena S, Arrigo T, Salpietro C, Gitto E. Atopy and autoimmune thyroid diseases: melatonin can be useful? Ital J Pediatr 2016; 42:95. [PMID: 27814774 PMCID: PMC5096296 DOI: 10.1186/s13052-016-0305-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/18/2016] [Indexed: 11/25/2022] Open
Abstract
Recently, there has been growing interest in the relationship between allergic and autoimmune diseases. Allergy and autoimmunity can be considered two potential outcomes of dysregulated immunity and analysis of literature data shows a strong positive association between a history of Th2-mediated allergic disorders and Th1-mediated autoimmune disorders. Autoimmune thyroid diseases are the most common of all autoimmune pathological conditions. Currently, the mechanisms explaining an association among atopy, autoimmunity, and thyroid diseases are not fully understood. There are data in literature pointing to the relationship between melatonin and thyroid activity. Several studies have suggested a paracrine role for this molecule in the regulation of thyroid activity, documenting that administration, as an antioxidant, in thyroid tissues under conditions of increased oxidative stress, could be helpful to reduce the oxidative processes involved in autoimmune thyroid diseases. Although thyroid autoimmunity has been regularly associated with atopic conditions in children, the possible protective role of melatonin has not yet been investigated. This review summarizes what is known regarding the connection between atopy and autoimmune thyroid diseases, and analyses the probable beneficial action of melatonin.
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Affiliation(s)
- Gabriella D'Angelo
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy.
| | - Lucia Marseglia
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Sara Manti
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Laura Colavita
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Caterina Cuppari
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Pietro Impellizzeri
- Unit of Paediatric Surgery, Department of Paediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Salvatore Arena
- Unit of Paediatric Surgery, Department of Paediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Teresa Arrigo
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Carmelo Salpietro
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Eloisa Gitto
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
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Eser I, Yologlu N, Baydemir C, Aydogan M. The predictive factors for remission of chronic spontaneous urticaria in childhood: Outcome from a prospective study. Allergol Immunopathol (Madr) 2016; 44:537-541. [PMID: 27477033 DOI: 10.1016/j.aller.2016.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/07/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND There are few studies in children on the natural course of chronic spontaneous urticaria (CSU) because of its relative infrequency in childhood. OBJECTIVE To estimate the rate of remission and evaluate the prognostic factors in children with CSU. METHOD A total of 52 children with CSU were prospectively followed over a period of three years. RESULTS The remission rates at 12 months and 36 months were 32.7% and 48.1%. The mean duration of disease at the first visit in the non-remission group was higher than in the remission group at the end of the study (P=0.016). The remission rate of the patients who had been treated by standard dose antihistamine was higher than that of the patients who had been treated with the high-dose antihistamine and combination medications (P=0.004, P<0.001). The treatment steps were independent prognostic factors for remission by logistic regression analysis. CONCLUSION Our study indicates that urticaria controlled by a standard dose of antihistamine can predict a good prognosis independently from disease duration at first visit.
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Jáuregui Presa I, Navajas Rodríguez B, Ramos Bareño B, Gamboa Setién PM, Urrutia Etxebarria I, Antépara Ercoreca I. Chronic Urticaria in Special Populations: Children, Pregnancy, Lactation and Elderly People. CURRENT TREATMENT OPTIONS IN ALLERGY 2016. [DOI: 10.1007/s40521-016-0097-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mast cell activation disease and the modern epidemic of chronic inflammatory disease. Transl Res 2016; 174:33-59. [PMID: 26850903 DOI: 10.1016/j.trsl.2016.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 01/07/2016] [Accepted: 01/08/2016] [Indexed: 12/18/2022]
Abstract
A large and growing portion of the human population, especially in developed countries, suffers 1 or more chronic, often quite burdensome ailments which either are overtly inflammatory in nature or are suspected to be of inflammatory origin, but for which investigations to date have failed to identify specific causes, let alone unifying mechanisms underlying the multiple such ailments that often afflict such patients. Relatively recently described as a non-neoplastic cousin of the rare hematologic disease mastocytosis, mast cell (MC) activation syndrome-suspected to be of greatly heterogeneous, complex acquired clonality in many cases-is a potential underlying/unifying explanation for a diverse assortment of inflammatory ailments. A brief review of MC biology and how aberrant primary MC activation might lead to such a vast range of illness is presented.
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Kim DH, Sung NH, Lee AY. Effect of Levothyroxine Treatment on Clinical Symptoms in Hypothyroid Patients with Chronic Urticaria and Thyroid Autoimmunity. Ann Dermatol 2016; 28:199-204. [PMID: 27081267 PMCID: PMC4828383 DOI: 10.5021/ad.2016.28.2.199] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 07/04/2015] [Accepted: 07/13/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Thyroid autoimmunity has been increasingly reported to be associated with chronic urticaria (CU), and the possible clinical benefit of thyroid hormone or anti-thyroid drugs in some CU patients with autoimmune thyroid disease has been studied. However, the effect of thyroid hormone or anti-thyroid drugs on clinical symptoms of CU remains unclear. OBJECTIVE We investigated the clinical response of urticaria to the treatment of thyroid dysfunction. METHODS Medical records of patients with CU evaluated for thyroid autoimmunity and thyroid function were collected and reviewed. RESULTS Of 184 patients with CU, 43 patients (23.4%) had thyroid autoantibodies and 26 patients (14.1%) had thyroid dysfunction. While none of the five patients with Graves' disease showed any improvement of urticaria after treatment with anti-thyroid drugs, two of the 10 patients with Hashimoto's thyroiditis showed improved urticaria after being treated with levothyroxine. CONCLUSION Although levothyroxine treatment was effective in a minority of patients with CU, there may be a causal relationship between CU and thyroid autoimmunity.
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Affiliation(s)
- Do Hun Kim
- Department of Dermatology, Donnguk University Ilsan Hospital, Goyang, Korea
| | - Nam Hee Sung
- Department of Dermatology, Donnguk University Ilsan Hospital, Goyang, Korea
| | - Ai Young Lee
- Department of Dermatology, Donnguk University Ilsan Hospital, Goyang, Korea
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Lee XHM, Ong LX, Cheong JYV, Sultana R, Rao R, Lim HH, Ding XM, Loh WY, Punan M, Chiang WC. A stepwise approach in the management of chronic spontaneous urticaria in children. Asia Pac Allergy 2016; 6:16-28. [PMID: 26844216 PMCID: PMC4731476 DOI: 10.5415/apallergy.2016.6.1.16] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/19/2016] [Indexed: 12/03/2022] Open
Abstract
Background There is limited literature in the management of chronic urticaria in children. Treatment algorithms are generally extrapolated from adult studies. Objective Utility of a weight and age-based algorithm for antihistamines in management of chronic spontaneous urticaria (CSU) in childhood. To document associated factors that predict for step of control of CSU and time taken to attain control of symptoms in children. Methods A workgroup comprising of allergists, nurses, and pharmacists convened to develop a stepwise treatment algorithm in management of children with CSU. Sequential patients presenting to the paediatric allergy service with CSU were included in this observational, prospective study. Results Ninety-eight patients were recruited from September 2012 to September 2013. Majority were male, Chinese with median age 4 years 7 months. A third of patients with CSU had a family history of acute urticaria. Ten point two percent had previously resolved CSU, 25.5% had associated angioedema, and 53.1% had a history of atopy. A total of 96.9% of patients achieved control of symptoms, of which 91.8% achieved control with cetirizine. Fifty percent of all the patients were controlled on step 2 or higher. Forty-seven point eight percent of those on step 2 or higher were between 2 to 6 years of age compared to 32.6% and 19.6% who were 6 years and older and lesser than 2 years of age respectively. Eighty percent of those with previously resolved CSU required an increase to step 2 and above to achieve chronic urticaria control. Conclusion We propose a weight- and age-based titration algorithm for different antihistamines for CSU in children using a stepwise approach to achieve control. This algorithm may improve the management and safety profile for paediatric CSU patients and allow for review in a more systematic manner for physicians dealing with CSU in children.
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Affiliation(s)
- Xin Hui Magdeline Lee
- Pharmacy Department, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore
| | - Lin Xin Ong
- Allergy Service, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore
| | - Jing Yi Vanessa Cheong
- Pharmacy Department, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore
| | - Rehena Sultana
- Duke-NUS Graduate Medical School Singapore, Singapore 169857, Singapore
| | - Rajeshwar Rao
- Allergy Service, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore
| | - Hwee Hoon Lim
- Allergy Service, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore
| | - Xiao Mei Ding
- Allergy Service, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore
| | - Wen Yin Loh
- Allergy Service, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore
| | - Monika Punan
- Pharmacy Department, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore
| | - Wen Chin Chiang
- Allergy Service, Kandang Kerbau Women's and Children's Hospital, Singapore 229899, Singapore
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Powell RJ, Leech SC, Till S, Huber PAJ, Nasser SM, Clark AT. BSACI guideline for the management of chronic urticaria and angioedema. Clin Exp Allergy 2015; 45:547-65. [PMID: 25711134 DOI: 10.1111/cea.12494] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/11/2014] [Accepted: 01/09/2015] [Indexed: 12/11/2022]
Abstract
This guidance for the management of patients with chronic urticaria and angioedema has been prepared by the Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is aimed at both adult physicians and paediatricians practising in allergy. The recommendations are evidence graded. During the development of these guidelines, all BSACI members were included in the consultation process using a Web-based system. Their comments and suggestions were carefully considered by the Standards of Care Committee. Where evidence was lacking, a consensus was reached by the experts on the committee. Included in this management guideline are clinical classification, aetiology, diagnosis, investigations, treatment guidance with special sections on children with urticaria and the use of antihistamines in women who are pregnant or breastfeeding. Finally, we have made recommendations for potential areas of future research.
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Affiliation(s)
- R J Powell
- Department of Clinical Immunology and Allergy, Nottingham University, Nottingham, UK
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Choi SH, Baek HS. Approaches to the diagnosis and management of chronic urticaria in children. KOREAN JOURNAL OF PEDIATRICS 2015; 58:159-64. [PMID: 26124845 PMCID: PMC4481035 DOI: 10.3345/kjp.2015.58.5.159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/17/2015] [Indexed: 01/02/2023]
Abstract
Most guidelines for chronic urticaria (CU) in infants and children are based on limited pediatric evidence. Current evidence used to guide treatment in children is extrapolated from data focusing on older age groups. CU in children is a different and complex condition than that in adults. Furthermore, there is little published information regarding urticaria in Korean children. The aim of the present article is to review recent research on chronic childhood urticaria and improve the current understanding of its pathogenesis and management. The classification and definition of urticaria in adults also applies to children. CU is defined as a daily occurrence of spontaneous wheals, angioedema, or both for >6 weeks. The precise pathophysiology of CU is unknown and the rates of successful identification of a cause in children with CU vary from 20%-50%. There is no established laboratory test to evaluate the presence of urticaria. The natural course of childhood CU is undetermined, with limited reports discussing long-term outcomes. Second-generation H1 antihistamines are the cornerstone of management, while limited therapeutic drugs are available for adults.
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Affiliation(s)
- Sun Hee Choi
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hey Sung Baek
- Department of Pediatrics, Gangdong Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea
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Chansakulporn S, Pongpreuksa S, Sangacharoenkit P, Pacharn P, Visitsunthorn N, Vichyanond P, Jirapongsananuruk O. The natural history of chronic urticaria in childhood: A prospective study. J Am Acad Dermatol 2014; 71:663-8. [DOI: 10.1016/j.jaad.2014.05.069] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 05/29/2014] [Accepted: 05/29/2014] [Indexed: 10/25/2022]
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Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F, Sheikh J, Weldon D, Zuraw B, Bernstein DI, Blessing-Moore J, Cox L, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph CR, Schuller DE, Spector SL, Tilles SA, Wallace D. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol 2014; 133:1270-7. [DOI: 10.1016/j.jaci.2014.02.036] [Citation(s) in RCA: 320] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 02/10/2014] [Accepted: 02/12/2014] [Indexed: 12/13/2022]
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Affiliation(s)
- Jinho Yu
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Pedullá M, Fierro V, Papacciuolo V, Alfano R, Ruocco E. Atopy as a risk factor for thyroid autoimmunity in children affected with atopic dermatitis. J Eur Acad Dermatol Venereol 2013; 28:1057-60. [PMID: 24118567 DOI: 10.1111/jdv.12281] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 06/07/2013] [Accepted: 08/20/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND As a result of several clinical reports addressing coincidence or coprevalence of atopy and autoimmune disease such as multiple sclerosis and type I diabetes mellitus, there has been considerable interest in defining the relationship between the expression of allergic and autoimmune disease in populations of patients. Although thyroid autoimmunity has been regularly associated with chronic urticaria in children, the cofrequency of thyroid autoimmunity and atopic dermatitis has not yet been investigated. The aim of the study was to describe our experience with children affected by atopic dermatitis and associated thyroid autoimmunity. METHODS From January 2010 to December 2012, 147 children affected by atopic dermatitis were consecutively referred to the Pediatric Clinic of the Pediatric Department at the Second University of Naples. Seventy healthy children of comparable ages, unaffected by atopic dermatitis, atopy or thyroid disease, served as a control group. RESULTS On the basis of skin prick test results we selected 54 IgE-mediated (36.7%) and 93 non-IgE-mediated AD (63.3%) children. Fourteen of 147 patients (9.52%) showed increased levels of antithyroid antibodies. CONCLUSIONS Our results therefore suggest that atopy, especially food allergy, and autoimmunity are two potential outcomes of dysregulated immunity.
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Affiliation(s)
- M Pedullá
- Department of Pediatrics, Second University of Naples, Naples, Italy
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Corvaglia L, Monari C, Martini S, Aceti A, Faldella G. Pharmacological therapy of gastroesophageal reflux in preterm infants. Gastroenterol Res Pract 2013; 2013:714564. [PMID: 23878533 PMCID: PMC3710644 DOI: 10.1155/2013/714564] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 05/22/2013] [Accepted: 06/12/2013] [Indexed: 02/07/2023] Open
Abstract
Although gastroesophageal reflux (GER) is a very common phenomenon among preterm infants, its therapeutic management is still an issue of debate among neonatologists. A step-wise approach should be advisable, firstly promoting nonpharmacological interventions and limiting drugs to selected infants unresponsive to the conservative measures or who are suffering from severe GER with clinical complications. Despite of this, a concerning pharmacological overtreatment has been increasingly reported. Most of the antireflux drugs, however, have not been specifically assessed in preterm infants; moreover, serious adverse effects have been noticed in association to their administration. This review mainly aims to draw the state of the art regarding the pharmacological management of GER in preterm infants, analyzing the best piecies of evidence currently available on the most prescribed anti-reflux drugs. Although further trials are required, sodium alginate-based formulations might be considered promising; however, data regarding their safety are still limited. Few piecies of evidence on the efficacy of histamine-2 receptor blockers and proton pump inhibitors in preterm infants with GER are currently available. Nevertheless, a significantly increased risk of necrotizing enterocolitis and infections has been largely reported in association with their use, thereby leading to an unfavorable risk-benefit ratio. The efficacy of metoclopramide in GER's improvement still needs to be clarified. Other prokinetic agents, such as domperidone and erythromycin, have been reported to be ineffective, whereas cisapride has been withdrawn due to its remarkable cardiac adverse effects.
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Affiliation(s)
- Luigi Corvaglia
- Neonatology and Neonatal Intensive Care Unit, S. Orsola-Malpighi Hospital, via Massarenti 11, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy
| | - Caterina Monari
- Neonatology and Neonatal Intensive Care Unit, S. Orsola-Malpighi Hospital, via Massarenti 11, 40138 Bologna, Italy
| | - Silvia Martini
- Neonatology and Neonatal Intensive Care Unit, S. Orsola-Malpighi Hospital, via Massarenti 11, 40138 Bologna, Italy
| | - Arianna Aceti
- Neonatology and Neonatal Intensive Care Unit, S. Orsola-Malpighi Hospital, via Massarenti 11, 40138 Bologna, Italy
| | - Giacomo Faldella
- Neonatology and Neonatal Intensive Care Unit, S. Orsola-Malpighi Hospital, via Massarenti 11, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy
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Lee SY, Song WJ, Jung JW, Park HW, Cho SH, Min KU, Kang HR. Thyroid autoantibodies and the prognosis of chronic idiopathic urticaria. ALLERGY ASTHMA & RESPIRATORY DISEASE 2013. [DOI: 10.4168/aard.2013.1.2.151] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Suh-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - Woo-Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - Jae-Woo Jung
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Heung-Woo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - Sang-Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - Kyung-Up Min
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - Hye-Ryun Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
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Abstract
BACKGROUND An autoimmune etiology has been suggested in up to one-third of cases of chronic idiopathic urticaria (CIU), in which it has been proposed that a subset of cases are associated with thyroid autoimmunity. The objective of our present study was to verify the prevalence of thyroid antibodies in the patients with CIU. METHODS Sixty patients aged 12-51 years, who met criteria for CIU, and 40 aged-matched healthy controls (18 males and 22 females) were participated in this study. Serum anti-thyroid antibodies (ATAs), thyroid hormones, total immunoglobulin E (IgE), and food allergen-specific IgE antibodies were measured. The CIU group was treated with anti-H1 and anti-H2 histamines for 3 weeks. RESULTS The total ATA positive rate was 27.3% (33% males and 25% females) in the CIU group. The prevalence of anti-thyroglobulin antibodies, anti-TSH-receptor antibodies, and anti-thyroid peroxidase antibodies were 16.6%, 83.3%, and 8.3%, respectively. The thyroid hormones, T3, and T4, and the TSH were within the normal limits. The radioallergosorbent test was negative for food allergens, and only 18% of the patients had a total IgE concentration >200 IU/mL. CONCLUSION ATAs were found in 27% of the patients with CIU, but these antibodies did not dysregulate thyroid hormone secretion nor did they mediate any clinical manifestations.
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Affiliation(s)
- Kong-Sang Wan
- Department of Pediatrics, Taipei City Hospital-Renai Branch, Taipei, Taiwan.
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Sánchez-Borges M, Asero R, Ansotegui IJ, Baiardini I, Bernstein JA, Canonica GW, Gower R, Kahn DA, Kaplan AP, Katelaris C, Maurer M, Park HS, Potter P, Saini S, Tassinari P, Tedeschi A, Ye YM, Zuberbier T. Diagnosis and treatment of urticaria and angioedema: a worldwide perspective. World Allergy Organ J 2012; 5:125-47. [PMID: 23282382 PMCID: PMC3651155 DOI: 10.1097/wox.0b013e3182758d6c] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
: Urticaria and angioedema are common clinical conditions representing a major concern for physicians and patients alike. The World Allergy Organization (WAO), recognizing the importance of these diseases, has contributed to previous guidelines for the diagnosis and management of urticaria. The Scientific and Clinical Issues Council of WAO proposed the development of this global Position Paper to further enhance the clinical management of these disorders through the participation of renowned experts from all WAO regions of the world. Sections on definition and classification, prevalence, etiology and pathogenesis, diagnosis, treatment, and prognosis are based on the best scientific evidence presently available. Additional sections devoted to urticaria and angioedema in children and pregnant women, quality of life and patient-reported outcomes, and physical urticarias have been incorporated into this document. It is expected that this article will supplement recent international guidelines with the contribution of an expert panel designated by the WAO, increasing awareness of the importance of urticaria and angioedema in medical practice and will become a useful source of information for optimum patient management worldwide.
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Affiliation(s)
- Mario Sánchez-Borges
- Department of Allergy and Clinical Immunology, Centro Médico-Docente La Trinidad, Caracas, Venezuela
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno-Dugnano, Milan, Italy
| | - Ignacio J Ansotegui
- Department of Allergy and Immunology, Hospital Quirón Bizkaia, Bilbao, Spain
| | - Ilaria Baiardini
- Allergy and Respiratory Disease Clinic, University of Genova, Ospedale S.Martino di Genova, Genoa, Italy
| | - Jonathan A Bernstein
- Department of Internal Medicine, Division of Immunology/Allergy Section University of Cincinnati, Cincinnati, OH
| | - G Walter Canonica
- Allergy and Respiratory Disease Clinic, University of Genova, Ospedale S.Martino di Genova, Genoa, Italy
| | - Richard Gower
- Department of Medicine, University of Washington, Spokane, WA
| | - David A Kahn
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Allen P Kaplan
- Division of Pulmonary and Critical Care Medicine and Allergy and Immunology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Connie Katelaris
- Department of Allergy and Immunology, University of Western Sydney and Campbelltown Hospital, Sydney, Australia
| | - Marcus Maurer
- Universitätsmedizin Berlin. Allergie-Centrum-Charité, Berlin, Germany
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - Paul Potter
- Allergy Diagnostic & Clinical Research Unit, University of Cape Town Lung Institute, Groote Schuur, South Africa
| | - Sarbjit Saini
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Paolo Tassinari
- Immunology Institute, Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela
| | - Alberto Tedeschi
- U.O. Allergologia e Immunologia Clinica, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Young Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - Torsten Zuberbier
- Universitätsmedizin Berlin. Allergie-Centrum-Charité, Berlin, Germany
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Brzoza Z, Grzeszczak W, Rogala B, Trautsolt W, Moczulski D. PTPN22 polymorphism presumably plays a role in the genetic background of chronic spontaneous autoreactive urticaria. Dermatology 2012; 224:340-5. [PMID: 22722472 DOI: 10.1159/000339332] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 05/04/2012] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The association of chronic urticaria (CU) with autoimmune disorders is relatively well proved. Protein tyrosine phosphatase-22 (PTPN22) is considered to be one of the strongest genetic factors for human autoimmunity. We decided to evaluate whether additional, non 1858C>T, PTPN22 variants are independent contributors to the risk of CU occurrence in the Polish population. METHODS A total of 91 CU patients with a positive result of autologous serum skin test and 100 healthy volunteers were enrolled in the study. The Urticaria Activity Score was used in disease intensity assessment. In all subjects rs3811021, rs1310182 and rs2488457 polymorphisms were genotyped. RESULTS We found a higher prevalence of -1123 C allele among CU patients. No differences in the allele and genotype distribution were found in the other analyzed polymorphisms. Haplotype construction of the three SNPs revealed statistically significant CU association of rs2488457C, rs1310182T and rs3811021T. CONCLUSIONS Contrary to previous findings, the contribution of PTPN22 to disease susceptibility is suggested. We can speculate that CU is a genetically complex disease and that its occurrence needs multiple genetic and environmental risk factors.
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Affiliation(s)
- Z Brzoza
- Chair and Clinical Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia, ul. Ceglana 35, Katowice, Poland.
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Abstract
Urticaria affects nearly 25% of the population at some time in their lives. In a subset of children, urticaria will develop into a chronic condition that can greatly affect quality of life. Although numerous causes and triggers are proposed for chronic urticaria (CU) in children, ranging from infections, allergens, and medications to physical factors and autoimmune disease, the exact etiology is not always identifiable. Accordingly, a large subset of cases are designated "chronic idiopathic urticaria." Because of the clinical complexities of CU, as well as the confusing literature on this topic, we have developed a conceptual framework based on the cumulative evidence to assist with the categorization, clinical evaluation, and treatment of CU in children.
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Affiliation(s)
| | - Kelly M Cordoro
- Departments of Dermatology.,Pediatrics, University of California at San Francisco, San Francisco, California
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Ramos-Prol A, Rubio-Almanza M, Campos-Alborg V, Febrer-Bosch I, Merino-Torres JF. Urticaria crónica autoinmune como posible manifestación no endocrina de un síndrome poliglandular autoinmune tipo 2. ACTA ACUST UNITED AC 2011; 58:503-5. [DOI: 10.1016/j.endonu.2011.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 04/03/2011] [Accepted: 04/04/2011] [Indexed: 11/25/2022]
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Nuzzo V, Tauchmanova L, Colasanti P, Zuccoli A, Colao A. Idiopathic chronic urticaria and thyroid autoimmunity: Experience of a single center. DERMATO-ENDOCRINOLOGY 2011; 3:255-8. [PMID: 22259654 DOI: 10.4161/derm.3.4.17066] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 10/29/2011] [Indexed: 11/19/2022]
Abstract
Urticaria is one of the most frequent dermatosis, being its prevalence in general population estimated about 20%. This prospective case-control study was aimed at determining the prevalence of thyroid autoimmune disorders in a cohort of patients with chronic urticaria (CU), all living within an area with mild-to-moderate iodine deficiency. Fifty four consecutive patients affected by CU were recruited and compared to 108 healthy controls. Assessment of the thyroid function included measurement of serum concentrations of TSH, FT3, FT4, anti-thyreoglobulin (anti-TG) and anti-peroxidase (anti-TPO) antibodies. Ultrasound scan of the thyroid gland was performed in all subjects using a 7.5 MHz linear transducer. All subjects were followed up for 6 months. The prevalence of thyroid antibodies was significantly higher in our cohort of patients with CU than in controls (22% vs. 6.5 %). Hashimoto's thyroiditis was also more frequent in patients than controls (18.5% vs. 1.8%). These frequencies do not differ from those previously reported by some other authors and confirm the association between CU and thyroid autoimmunity also in the area of iodine deficiency. However, presence of antibodies or thyroiditis does not seem to influence clinical course of CU. These results suggest that screening for thyroid function may be useful in all the patients with CU.
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Affiliation(s)
- Vincenzo Nuzzo
- Internal Medicine Unit; "S. Gennaro" Hospital; Naples, Italy
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Al-Balbeesi AO. Significance of antithyroid antibodies and other auto-antibodies in Saudi patients with chronic urticaria. Possible parameters in predicting chronic over three years disease. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.jssdds.2011.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sahiner UM, Civelek E, Tuncer A, Yavuz ST, Karabulut E, Sackesen C, Sekerel BE. Chronic urticaria: etiology and natural course in children. Int Arch Allergy Immunol 2011; 156:224-30. [PMID: 21597304 DOI: 10.1159/000322349] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 10/25/2010] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) in childhood is infrequent, and information about the disease in children is limited. We attempted to investigate its etiologic factors, natural course, and predictors of prognosis. METHODS All children aged ≤ 18 years followed for CSU during an 8-year period were analyzed retrospectively, and the final outcomes were queried via a telephone interview. RESULTS One hundred patients (male/female ratio 1.27) with a median age of 9.2 years (range 0.7-17.2) at symptoms onset were evaluated. The median follow-up was 2.5 years (range 0.2-18.1). An autologous serum skin test was positive in 46.7% of the subjects (n = 45), with a female predominance (71.4%) (p = 0.023). In 13.8% of the children, ANA titers were over 1/100. Food allergy (n = 1), thyroid autoantibodies (n = 3), possible collagen disease (n = 1), and drug usage (deferoxamine) (n = 1) were found to be associated factors. Infections could not be confirmed as the cause of CSU. Recovery was seen in 16.5, 38.8, and 50.0% of the children after 12, 36, and 60 months, respectively. Though in multivariate analysis none of the factors, including age, gender, autologous serum skin test positivity, the presence of angioedema, or other allergic diseases, appeared to predict the prognosis, in univariate analysis being female and being older than 10 years of age predicted an unfavorable prognosis. CONCLUSION The etiology of CSU in children is mainly related to an autoreactive background, as in adults. CSU has a favorable prognosis, and resolution is seen in half of the children within 5 years. Girls older than 10 years may have an unfavorable prognosis.
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Affiliation(s)
- Umit M Sahiner
- Department of Pediatric Allergy and Asthma, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Altrichter S, Peter HJ, Pisarevskaja D, Metz M, Martus P, Maurer M. IgE mediated autoallergy against thyroid peroxidase--a novel pathomechanism of chronic spontaneous urticaria? PLoS One 2011; 6:e14794. [PMID: 21532759 PMCID: PMC3075251 DOI: 10.1371/journal.pone.0014794] [Citation(s) in RCA: 184] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 12/15/2010] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic spontaneous urticaria (csU), which is characterized by recurrent episodes of mast cell-driven wheal and flare-type skin reactions, is often associated with elevated total IgE levels and thyroid autoimmunity. We speculate that some csU patients express IgE autoantibodies against thyroid antigens such as thyroid peroxidase (TPO), which could bind to skin mast cells and induce their activation. METHODS We developed and used a site-directed human IgE capture ELISA to quantify IgE-anti-TPO. We used this assay and investigated csU patients (n = 478) and healthy control subjects (n = 127) for IgE-anti-TPO and then assessed IgE-anti-TPO-positive and -negative csU patients for clinical and serological differences. PRINCIPAL FINDINGS CsU patients were found to express more than 2fold higher IgE-anti-TPO serum levels as compared to healthy control subjects (p<0.001). 54% of csU patients had serum levels higher than the cut off ( = 5 IU/ml). By distribution analyses we identified two distinct subpopulations of csU patients: 1) IgE-anti-TPO(low) ( = 39%, IgE-anti-TPO: median 2.17 interquartile range 0.86-5.44, = comparable to healthy controls) and 2) IgE-anti-TPO(high) ( = 61%, IgE-anti-TPO: median 6.67, interquartile range 5.39-8.24). IgE-anti-TPO-positive and -negative csU patients had very similar distributions of age and gender as well as disease activity and duration. IgE-anti-TPO-positive csU patients exhibited significantly higher IgG-anti-TPO levels and lymphocyte counts as well as decreased C4 complement levels. CONCLUSION Our findings show that a sizeable subgroup of csU patients expresses IgE antibodies against thyroid peroxidase. These autoantibodies could cause "autoallergic" mast cell activation, a novel pathomechanism of chronic spontaneous urticaria.
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Affiliation(s)
- Sabine Altrichter
- Department of Dermatology and Allergy,
Allergie-Centrum-Charité/ECARF, Charité - Universitätsmedizin
Berlin, Berlin, Germany
| | - Hans-Jürgen Peter
- Department of Dermatology and Allergy,
Allergie-Centrum-Charité/ECARF, Charité - Universitätsmedizin
Berlin, Berlin, Germany
| | - Dina Pisarevskaja
- Department of Dermatology and Allergy,
Allergie-Centrum-Charité/ECARF, Charité - Universitätsmedizin
Berlin, Berlin, Germany
| | - Martin Metz
- Department of Dermatology and Allergy,
Allergie-Centrum-Charité/ECARF, Charité - Universitätsmedizin
Berlin, Berlin, Germany
| | - Peter Martus
- Department of Biometry and Clinical Epidemiology,
Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus Maurer
- Department of Dermatology and Allergy,
Allergie-Centrum-Charité/ECARF, Charité - Universitätsmedizin
Berlin, Berlin, Germany
- * E-mail:
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Abstract
BACKGROUND Chronic urticaria is a common clinical condition whose etiology, in about 75% of cases, is unknown and is therefore called chronic idiopathic urticaria (CIU). A link between CIU and autoimmune thyroid diseases was proposed several decades ago. Here we review this topic. SUMMARY Several studies have been performed to determine if and to what degree there is an association between CIU and autoimmune thyroid diseases, particularly autoimmune thyroiditis. Many of these studies were not well controlled, however. Approximately one-fourth of CIU patients have serological evidence of thyroid autoimmunity, suggesting that these two disorders are associated. The mechanisms for the apparent association between CIU and serological evidence of thyroid autoimmunity are not clear. There are no data regarding the correlations between CIU and histological features of autoimmune thyroiditis or hypothyroidism. Despite this, there are anecdotal reports regarding L-thyroxine administration in patients with CIU. CONCLUSIONS Screening for thyroid autoimmunity is probably useful in patients with CIU. More solid evidence, based on still lacking well-conducted controlled studies, is desirable to determine if there is a therapeutic role for L-thyroxine treatment in ameliorating the skin manifestations of urticaria.
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Affiliation(s)
- Marcello Bagnasco
- Terapia Medica e Radiometabolica, Dipartimento di Patologie Immunoendocrinologiche, Azienda Ospedaliera Universitaria San Martino, Genoa, Italy.
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Church MK, Weller K, Stock P, Maurer M. Chronic spontaneous urticaria in children: itching for insight. Pediatr Allergy Immunol 2011; 22:1-8. [PMID: 21261741 DOI: 10.1111/j.1399-3038.2010.01120.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
While there is increasing information about the pathogenesis and treatment of chronic spontaneous urticaria (csU) in adults, there is little published information about csU in children. Consequently, most of the recommendations contained in current guidelines for the prevention and treatment of csU in infants and children is based on extrapolation of data obtained in adults. To rectify this, this review points out critical gaps in our knowledge and suggests strategies which may help us to improve our understanding of this condition. How common is csU in children? What do we know about its clinical presentation and the presence of useful biomarkers? What are its common underlying causes? What is the course of csU in children? How does csU affect the everyday life of children? What treatment options are available for children? To answer these questions, two separate types of information are required. The first is information about the prevalence of the condition in the community at large and how csU affects the everyday life of both the child-patient and the parent or carer. Because most csU cases in infants and children do not come to specialists but are treated by general practitioners or by parents using over-the-counter medications, these questions may be answered only by general population surveys or schools programmes. The second is clinical information including family history and disease presentation, the presence of biomarkers and comorbidities, objective measures of severity, frequency and duration of exacerbations, the response to therapy and the time to remission. Targeted questionnaires need to be developed and validated for these investigations. This has already begun in Germany with the establishment of the CU-KID Netzwerk (Email address: cu-kid@charite.de), the aim of which is to identify clinical centres and colleagues who treat children with urticaria and to initiate the information gathering described above.
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Affiliation(s)
- Martin K Church
- Department of Dermatology and Allergy, Charité, Universitätsmedizin Berlin, Charitéplatz 1, Germany.
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Affiliation(s)
- Gurkan Kilic
- Division of Allergy and Chest Diseases, Department of Pediatrics, Istanbul Medical Faculty, Istanbul University, Turkey
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Abstract
Chronic urticaria is heterogenous, long-persisting and has a severe impact on quality of life and daily work. Effective treatment is essential but remains a confounding problem. This review summarizes available treatment strategies for chronic urticaria and their strength of evidence. Besides treatment of identified triggering factors such as chronic persistent bacterial infections (e.g., with Helicobacter pylori, streptococci, staphylococci or yersinia), standard treatment consists of nonsedating H1-antihistamines. Most patients require increasing (off-label) dosages that should be taken daily and regularly, however, this still fails in a third of cases. Reliable alternatives in the world literature are rare and the level of evidence is low. Certain subgroups may display benefit from additional treatment with cyclosporine A, cysteinyl leukotriene receptor antagonists, chloroquine, dapsone or other alternatives. A practicable step-wise treatment approach is given to optimize and individualize the treatment of patients with chronic urticaria.
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Affiliation(s)
- Bettina Wedi
- Department of Dermatology and Allergology, Hannover Medical University, Ricklinger Str. 5, D-30449 Hannover, Germany.
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