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Mobeen A, Ahmad AK. The efficacy and safety of herbal combination of Unani Medicine in chronic urticaria: A randomized, controlled study. J Tradit Complement Med 2021; 11:303-310. [PMID: 34195024 PMCID: PMC8240108 DOI: 10.1016/j.jtcme.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/26/2020] [Accepted: 12/30/2020] [Indexed: 01/01/2023] Open
Abstract
Background and Aim; Chronic urticaria (CU) is a fluctuating and pruritic erythematous papule that persists for over six weeks. It affects 0.5-1% of the population and interferes with subjective well-being and daily life. Its etiology is highly complex which makes a causal and/or curative treatment difficult. Nonsedating H1-antihistamines are given as symptomatic therapy, which reduces symptoms effectively in <50% of patients. In Unani medicine, urticaria is known as Shara and treated according to its established etiology. The present study objective was to investigate the effect of herbal combination of Unani medicine (HCUM) comprising Rosa damascena Mill, Bambusa arundinacea Linn, Cinnamomum camphora Linn, Mentha arvensis Linn, in comparison with Levocetirizine in CU. Experimental procedure; This randomized open-labeled standard control clinical trial was conducted between 42 male/female patients aged 20-50 years with moderate to severe CU who were randomly allocated in a 3:1 ratio into HCUM and Levocetirizine 5 mg groups. HCUM powder 5.125 Gm and Levocetirizine 5 mg were given for 4 weeks. Urticaria activity score (UAS7) and chronic urticaria quality of life questionnaire (CU-Q2oL) were primary and secondary outcomes and analyzed per protocol. Results: A total of 40 patients completed the study. Data analysis showed a significant decrease (P=<0.001) in the scores of UAS7 (32.43 ± 2.34-14.03 ± 2.16 and 32.10 ± 2.33-28.40 ± 3.78) and CU-Q2oL (67.57 ± 9.56-36.50 ± 3.01 and 65.20 ± 11.78-59.60 ± 11.13) in HCUM and Levocetirizine groups respectively. Conclusion: As an alternative treatment in terms of safety, efficacy, tolerability, and quality of life the HCUM treatment proved to be more effective than Levocetirizine 5 mg in moderate to severe CU.
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Affiliation(s)
- Abdul Mobeen
- Dept. of Moalajat, Ntional Institute of Unani Medicine, Bangalore, 56009, India
| | - A Khaleel Ahmad
- Dept. of Moalajat, Government Unani Medical College, Chennai, 600106, India
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Cassano N, Genovese G, Asero R, Crimi N, Cristaudo A, Dapavo P, DE Pità O, Ferrucci S, Fierro MT, Foti C, Girolomoni G, Nettis E, Offidani A, Patrizi A, Pepe P, Pigatto P, Stingeni L, Marzano AV, Vena GA. Therapeutic management of chronic spontaneous urticaria in clinical practice: results from a pilot survey. Ital J Dermatol Venerol 2020; 157:33-38. [PMID: 33228338 DOI: 10.23736/s2784-8671.20.06761-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The therapeutic approaches to patients with chronic spontaneous urticaria (CSU) differ among health care professionals and may be influenced by many factors. This cross-sectional survey was aimed at evaluating physicians' attitudes regarding therapeutic management of CSU in clinical practice. METHODS A study-specific questionnaire was administered to a group of physicians (N.=21) with a specialist interest in CSU from different areas of Italy (group A) and also to other physicians (N.=25) who manage CSU only occasionally in their clinical activity (group B). RESULTS In case of ineffectiveness of second-generation antihistamines at standard doses, higher doses of the same drug were always or frequently prescribed by most physicians in both groups, and 64% in group B and one third in group A usually increased the dose up to twice. Old-generation antihistamines were never used in clinical practice by 14% of survey participants in group A and 24% in group B, with the remaining physicians reporting rare or occasional uses. The prescription of systemic corticosteroids appeared to be more common among physicians in group B. The question concerning the use of alternative drugs in refractory CSU produced different answers between the two groups. Costs and access to specialist reference centers were indicated as the most important barriers to the use of medications different from antihistamines. CONCLUSIONS These preliminary results suggest that therapeutic approaches to CSU seem to be heterogeneous in clinical practice and could be at least in part conditioned by the different medical settings where physicians usually work.
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Affiliation(s)
| | - Giovanni Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Riccardo Asero
- Outpatient Service of Allergology, San Carlo Clinic, Paderno Dugnano, Milan, Italy
| | - Nunzio Crimi
- Department of Clinical and Experimental Medicine-Respiratory Medicine and Allergy, University of Catania, Catania, Italy
| | - Antonio Cristaudo
- Service of Occupational and Environmental Allergic Dermatology, San Gallicano Dermatology Institute for Research and Care, Rome, Italy
| | - Paolo Dapavo
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Ornella DE Pità
- Department of Dermatology and Allergy, Cristo Re Hospital, Rome, Italy
| | - Silvia Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria T Fierro
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Caterina Foti
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Giampiero Girolomoni
- Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, Aldo Moro University, Bari, Italy
| | - Annamaria Offidani
- Dermatology Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Annalisa Patrizi
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Patrizia Pepe
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Pigatto
- Section of Clinical Dermatology, Department of Biomedical, Surgical and Dental Sciences, IRCCS Galeazzi Orthopedic Institute, University of Milan, Milan, Italy
| | - Luca Stingeni
- Section of Clinical, Allergological and Venereological Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy - .,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Chu CY, Al Hammadi A, Agmon-Levin N, Atakan N, Farag A, Arnaout RK, Kannenberg S, Kulthanan K, Mubarak A, Zaitoun F, Crowe S, Malfait S, Cooke K, Dekker EL. Clinical characteristics and management of chronic spontaneous urticaria in patients refractory to H 1-Antihistamines in Asia, Middle-East and Africa: Results from the AWARE-AMAC study. World Allergy Organ J 2020; 13:100117. [PMID: 32382379 PMCID: PMC7200453 DOI: 10.1016/j.waojou.2020.100117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/21/2020] [Accepted: 03/10/2020] [Indexed: 11/25/2022] Open
Abstract
Background Chronic urticaria (CU) is a condition characterized by recurrent itchy hives and/or angioedema for ≥6 weeks. Most of the data about CU come from western countries with very little information available about CU in Asia, Africa, and the Middle East. Methods AWARE-AMAC is a 24-month prospective, observational, real-world, non-interventional study in patients aged ≥18 years from Asia, the Middle East, and Africa (AMAC) with CU refractory to H1-antihistamines (H1-AH). The main objective was to describe the real-world experience with CU, including clinical characteristics, presence of angioedema, treatment patterns (shifts between treatment classes and changes within a treatment class), investigator-assessed disease control, and the impact on quality of life. Subgroups of interest were type of CU at Baseline and treatment class (based on 2013 urticaria guidelines). There were no mandatory visits and diagnostic/monitoring procedures additional to routine practice, except the patient diary (7-day Urticaria Activity Score) and patient reported outcome assessments. Results The focus of the current manuscript is on patients with chronic spontaneous urticaria (CSU), who formed 98% of the sample. Patients were predominantly female (69.6% female, mean age ± SD 39.8 ± 13.29 years). Time since current diagnosis (Mean ± SD) was 28.6 ± 49.06 months. Amongst patients with CSU, 31.0% had comorbid chronic inducible urticaria (CINDU) and 46.4% had a history of angioedema. 91.9% received H1-AH therapy (±other treatments). The most frequently prescribed treatment classes at Baseline were any/combination of medications, not classified under the other 7 treatment classes, named “Others” (30.5%) followed by, omalizumab (OMA; 23.6%) and second-generation H1-AH monotherapy (sgAH; 15.1%). At Month 12, the most prescribed treatment classes (>15%) for patients were OMA (23.5%) and "Other" (21.3%); 19.7% received "No drug". At Month 24, OMA (22.5%), and "Other" (17.9%) were most frequently prescribed; 28.6% received "No drug". Overall, 79.5% of patients had some type of change in treatment. Over the study period, improvement in self-reported QoL increased, which was mirrored by better disease control. Conclusion In AMAC countries, the non-recommended "Other" treatment class played a major role in the initial management of CU patients. High usage of H1-AH (±other treatments) and OMA was observed. Treatment changes were observed in a majority of patients. Treatment escalation from sgAH was mostly via OMA. Improvement of disease control and QoL was achieved during the study period. Trial registration Observational study (NA).
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Key Words
- AMAC, Asia Middle East and Africa
- CINDU, Chronic inducible urticarial
- CSU, Chronic spontaneous urticarial
- CU, Chronic urticaria
- Chronic spontaneous urticaria
- CsA, Cyclosporine A
- DLQI, Dermatology Life Quality Index
- Efficacy
- GCP, Good Clinical Practice
- H1-AH, H1-antihistamines
- HRCU, H1-antihistamines refractory chronic urticarial
- HRQoL, Health-related quality of life
- MONT, Montelukast monotherapy, or in combination with any H1-AH
- OMA, Omalizumab monotherapy, or in combination with any H1-AH, with or without steroids
- Omalizumab
- PRO, Patient-reported outcomes
- PhyGA-VAS, Physician Global Assessment of disease control-visual analog scale
- QoL, Quality of life
- Quality of life
- SD, Standard deviation
- SGC, Systemic glucocorticosteroids monotherapy, or in combination with any H1-AH
- Second-generation antihistamines
- UAS7, 7-day Urticaria Activity Score
- fgAH, First-generation antihistamines monotherapy, or in combination with sgAH
- sgAH, Second-generation antihistamines monotherapy approved dose: once daily or as needed
- sgAHUP, Updosed second-generation H1-AH
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Affiliation(s)
- Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Anwar Al Hammadi
- Dermatology Center, Dubai Health Authority, Dubai, United Arab Emirates
| | - Nancy Agmon-Levin
- Clinical Immunology, Angioedema and Allergy Department, z Center for Autoimmune Diseases, Sheba Medical Centre, Ramat Gan, Israel
| | - Nilgun Atakan
- Department of Dermatology, Hacettepe University, Ankara, Turkey
| | - Assem Farag
- Dermatology Department, Faculty of Medicine, Benha University, Cairo, Egypt
| | - Rand K Arnaout
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Suretha Kannenberg
- Division of Dermatology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Fares Zaitoun
- Allergy, Asthma & Immunology Center Specialty Clinics Center, Beirut, Lebanon
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Clinical characteristics and epidemiology of chronic urticaria: a nationwide, multicentre study on 1091 patients. Postepy Dermatol Alergol 2019; 36:184-191. [PMID: 31320852 PMCID: PMC6627267 DOI: 10.5114/ada.2019.84594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 01/30/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction Urticaria is one of the most common skin diseases. Depending on the length of symptoms, acute (lasting less than 6 weeks) and chronic urticaria (CU) (> 6 weeks) are distinguished. According to the current European guidelines, CU is divided into inducible urticaria (IU) and chronic spontaneous urticaria (CSU). Aim To assess the epidemiology and clinical characteristics of CU in Poland. Material and methods This was a nationwide, multicentre, cross-sectional, questionnaire-based study performed under the auspices of the Polish Dermatological Society. A total of 102 physicians (dermatologists and allergists) recruited 1091 patients suffering from CU. Results Among 1091 adults with CU, IU was found in 35.1% (n = 383) of patients and CSU was responsible for 61.1% (n = 667) of CU cases. The remaining patients (n = 41, 3.8%) suffered from both, IU and CSU. Persons with CSU were twice more likely to report family history of urticaria than those with IU (12.1% vs. 6.0%, p = 0.001). Generalized eruptions of wheals predominated in CSU (generalized wheals: 57.9%, localized wheals: 42.1%), whereas wheals localized in particular body areas were found more commonly in IU (generalized wheals: 45.2%, localized wheals: 54.8%, p < 0.001). The CU was the cause of absenteeism in almost every fifth patient suffering from this disease. Conclusions The CSU is about twice as frequent cause of CU as compared to IU. The treatment of CU is a major challenge for physicians of various specialties and the treatment choice is closely associated with the specialist knowledge of current treatment guidelines.
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Yang SH, Lin YH, Lin JR, Chen HY, Hu S, Yang YH, Yang YH, Yang YS, Fang YF. The Efficacy and Safety of a Fixed Combination of Chinese Herbal Medicine in Chronic Urticaria: A Randomized, Double-Blind, Placebo-Controlled Pilot Study. Front Pharmacol 2018; 9:1474. [PMID: 30618764 PMCID: PMC6305335 DOI: 10.3389/fphar.2018.01474] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 11/30/2018] [Indexed: 01/22/2023] Open
Abstract
Background: Chronic urticaria is a bothersome skin disease, and Chinese herbal medicine (CHM) is commonly used as adjuvant therapy. This study aimed to evaluate the effectiveness and safety of the mixture of two CHM formula, Xiao-Feng-San (XFS) and Qing-Shang-Fang-Feng-Tang (QSFFT), in treating urticaria through a randomized, double-blind, placebo-controlled clinical trial. Methods: 78 participants entered the screening phase between November 2012 and August 2015. Participants were randomly and equally allocated in either CHM group (2 gm XFS and 2 gm QSFFT four times a day and 5 mg levocetirizine once daily for 28 days followed by 5 mg levocetirizine once daily alone for 28 days) or control group (placebo and 5 mg levocetirizine daily followed by 5 mg levocetirizine once daily for 28 days alone). Symptom improvement was set as the primary outcome, and the influence on sleep quality and changes in serum markers were used as secondary outcomes. Per protocol design was applied to the final analysis. Results: A total of 56 participants entered the final analysis stage. Participants in the CHM group had more prominent symptom relief on day 56 (the weekly urticaria activity score, UAS7, as 9.9 ± 9.2 vs. 15.6 ± 10.8, p = 0.038). In the CHM group, participants' symptom severity reduced progressively (trend analysis, p < 0.001) while the decreasing trend was less favored in the control group (trend analysis, p = 0.056). The life quality improved gradually in both groups, while the differences between CHM and control groups were statistically insignificant. For urticaria-related cytokines, interferon-γ seemed to decrease positively in the CHM group (about 30.8% reduction from baseline, trend analysis p = 0.013). For safety issue, the CHM prescription was well-tolerated with no noticeable long-term side effects when compared to the control group. At 6-month follow-up of symptom changes after the end of the trial, the CHM group participants reported positive results in no recurrence or ≥50% improvement (36.3% in CHM group vs. 20% in Control group, p = 0.103). Conclusions: The combination of XFS and QSFFT tended to be feasible and tolerable adjuvant therapy for urticaria in addition to standard therapy. However, larger study population with longer follow-up duration may be still needed. Trial registration: NCT01715740 (ClinicalTrials.gov).
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Affiliation(s)
- Sien-Hung Yang
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Chang Gung Immunology Consortium, Chang Gung Memorial Hospital and Chang Gung University, Gueishan, Taiwan
| | - Yi-Hsuan Lin
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jr-Rung Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Clinical Informatics and Medical Statistics Research Center and Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsing-Yu Chen
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Sindy Hu
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Cosmetic Science, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Yi-Han Yang
- Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Yi-Hsun Yang
- School of Dentistry, Matsumoto Dental University, Shiojiri, Japan
| | - Yin-Shuo Yang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yao-Fan Fang
- Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Kolkhir P, Pogorelov D, Darlenski R, Caminati M, Tanno LK, Le Pham D, Gonzalez-Estrada A, Antolín-Amérigo D, Dimov V, Weller K, Sánchez-Borges M, Ansotegui I, Maurer M. Management of chronic spontaneous urticaria: a worldwide perspective. World Allergy Organ J 2018; 11:14. [PMID: 29988758 PMCID: PMC6030778 DOI: 10.1186/s40413-018-0193-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background The approaches to the diagnosis and treatment of chronic spontaneous urticaria (CSU) differ in various parts of the world. We sought to determine the adherence to international and national urticaria guidelines as well as the motives to deviate from the guidelines among physicians worldwide. Methods A web-based questionnaire was created and launched via e-mail by the World Allergy Organization (WAO) to representatives of all WAO Member Societies, the members of the American Academy of Allergy, Asthma & Immunology (AAAAI) and the members of the WAO Junior Members Group (JMG), regardless of the specialty, affiliation, or nationality in March 2017. Results We received 1140 completed surveys from participating physicians from 99 countries. Virtually all participants (96%) were aware of at least one urticaria guideline and reported that they follow a guideline. However, one in five physicians who follow a guideline (22%) reported to deviate from it. Reliance on own clinical experience is the most frequent reason for deviation from guidelines or not following them (44%). Young (< 40 years) and less experienced physicians more often follow a guideline and less often deviate than older and experienced ones. Physicians who follow a urticaria guideline showed higher rates of routinely ordering a complete blood count, the erythrocyte sedimentation rate, C-reactive protein, anti-thyroid antibodies, and thyroid-stimulating hormone and of performing the autologous serum skin test as compared to those who do not. Physicians who follow a urticaria guideline showed higher rates of using second generation antihistamines as their first-line treatment of CSU (p = 0.001) and more frequently observed higher efficacy of these drugs (or had more confidence that it would work, p < 0.019) as compared to those who do not follow the guidelines. Conclusions Physicians’ characteristics (e.g. age, clinical experience, and specialty) and country specifics and regional features (e.g. availability of drugs for CSU treatment) importantly influence adherence to urticaria guidelines and CSU patient care and should be addressed in more detail in future research. Electronic supplementary material The online version of this article (10.1186/s40413-018-0193-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pavel Kolkhir
- 1Division of Immune-mediated skin diseases, I.M. Sechenov First Moscow State Medical University, 119991, Trubeckaya str., 8/2, Moscow, Russian Federation
| | - Dmitry Pogorelov
- 2Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Razvigor Darlenski
- 3Department of Dermatology and Venereology, Trakia University, Stara Zagora, Bulgaria
| | - Marco Caminati
- 4Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
| | - Luciana Kase Tanno
- 5Hospital Sírio Libanês and Post-graduation Program in Health Sciences of IAMSPE São Paulo, São Paulo, Brazil.,6University Hospital of Montpellier, Montpellier and Sorbonne Universités, Paris, France
| | - Duy Le Pham
- 7Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Alexei Gonzalez-Estrada
- 8Division of Allergy, Pulmonary and Sleep Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Darío Antolín-Amérigo
- 9Servicio de Enfermedades del Sistema Inmune-Alergia, Hospital Universitario Príncipe de Asturias, Madrid, Spain.,10Departamento de Medicina y Especialidades Médicas, Facultad de Medicina, Universidad de Alcalá, Madrid, Spain
| | - Ves Dimov
- 11Department of Allergy and Immunology, Cleveland Clinic Florida, Weston, Florida, USA
| | - Karsten Weller
- 12Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mario Sánchez-Borges
- 13Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Caracas, Venezuela
| | - Ignacio Ansotegui
- Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia, Bilbao, Spain
| | - Marcus Maurer
- 12Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Akdogan N, Incel-Uysal P, Oktem A, Hayran Y, Yalcin B. Educational level and job status are the most important factors affecting compliance with oral antihistamine therapy for patients with chronic urticaria. J DERMATOL TREAT 2018; 30:183-188. [PMID: 29757034 DOI: 10.1080/09546634.2018.1476651] [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: 10/16/2022]
Abstract
BACKGROUND Management of chronic urticaria (CU) is often difficult with oral antihistamines (OAs) despite long-term use. OBJECTIVE The aim of this study was to determine the extent of medication compliance (MC) and to assess the factors affecting the MC of patients with CU toward OA therapy. METHODS A 43-item questionnaire was administered to 201 adult patients. A compliance score (CS) of 6 points was chosen as a cutoff point. A CS of 0-6 corresponds to poor compliance and score of 6-9, to good compliance. Subsequently, associations with compliant and poorly compliant groups were made by univariate and multivariate analyses. RESULTS The median age and disease duration of all patients were 47 years (range: 18-88) and 15 months (range: 1.5-480), respectively. Overall, the rate of compliant and poorly compliant patients was 53.2% and 46.8%, respectively. Educational level and job status were significantly associated with MC. To have graduated from university and high school increased MC by 9.1-fold (p = .002, 95% confidence interval (CI): 2.26-36.37) and 3.6-fold (p = .019, 95% CI: 1.26-13.47), respectively, compared with illiterates. Patients who had worked previously and were currently looking for work were 4.8-fold (p = .032, 95% CI: 1.14-19.97) more compliant than patients who had never worked. CONCLUSION Most patients with CU had good compliance with OAs. Educational level and job status were significant predictors of MC to OAs in CU. The impact and long-term effects of education and job status should be evaluated in different patient groups.
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Affiliation(s)
- Neslihan Akdogan
- a Department of Dermatology and Venereology , Ankara Numune Training and Research Hospital , Ankara , Turkey
| | - Pinar Incel-Uysal
- a Department of Dermatology and Venereology , Ankara Numune Training and Research Hospital , Ankara , Turkey
| | - Ayşe Oktem
- a Department of Dermatology and Venereology , Ankara Numune Training and Research Hospital , Ankara , Turkey
| | - Yildiz Hayran
- a Department of Dermatology and Venereology , Ankara Numune Training and Research Hospital , Ankara , Turkey
| | - Basak Yalcin
- a Department of Dermatology and Venereology , Ankara Numune Training and Research Hospital , Ankara , Turkey
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8
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Rutkowski K, Grattan CEH. How to manage chronic urticaria 'beyond' guidelines: a practical algorithm. Clin Exp Allergy 2018; 47:710-718. [PMID: 28452145 DOI: 10.1111/cea.12944] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Chronic urticaria (CU) is a disease characterized by pruritic weals, angio-oedema or both occurring for at least 6 weeks. It encompasses spontaneous and inducible urticarias. The national and international guidelines outline the principles of treatment. Omalizumab, an anti-immunoglobulin E monoclonal antibody, has transformed the management of many severe and treatment-refractory patients. However, current UK guidance on its use does not address the needs of those with less severe disease, inducible urticarias, idiopathic histaminergic angio-oedema without weals as a presentation of CU and omalizumab non-responders. Our algorithm and a summary of the evidence to support its principles offers guidance and a more systematic targeted approach to using a range of 'off-label' agents for specific phenotypes of CU. It will be of use when guideline-recommended mast cell mediator antagonists fail to control symptoms and/or using omalizumab is ineffective, not practical or unfunded.
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Affiliation(s)
- K Rutkowski
- Urticaria Clinic, St John's Institute of Dermatology, London, UK.,Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - C E H Grattan
- Urticaria Clinic, St John's Institute of Dermatology, London, UK
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