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Izquierdo I, Casas L, Cabrera S, Fernandez A. How to handle off-label prescriptions of rupatadine, a second-generation antihistamine and PAF antagonist: a review. Drugs Context 2024; 13:2023-9-5. [PMID: 38264404 PMCID: PMC10803124 DOI: 10.7573/dic.2023-9-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/04/2023] [Indexed: 01/25/2024] Open
Abstract
The off-label use of second-generation antihistamines, used outside of the formal indications authorized by regulatory authorities, in different age groups, doses or in special populations, is very common for many allergic, autoimmune and dermatological diseases. The off-label use of rupatadine (a second-generation antihistamine with PAF antagonist activity) in these conditions is reviewed here, including in combination with immunotherapy in the treatment of food allergy or allergic rhinitis, at high doses in chronic urticaria, and with prescriptions of less common but challenging conditions such as skin pruritus or mast cell activation disorders like mastocytosis. Rupatadine use is reviewed herein to confirm if its off-label management is supported by well-designed clinical trials or by published real-world cases. This review will contribute to increasing compliance and achieving better results in clinical practice. Off-label use of rupatadine should be left to the discretion of the prescribing healthcare professional after careful clinical evaluation.
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Affiliation(s)
- Iñaki Izquierdo
- Medical Advice Department, BIOHORM S.L., Palau-Solità i Plegamans, Barcelona, Spain
| | - Laia Casas
- Clinical & Preclinical Development, Strategy and Innovation Department, BIOHORM S.L., Palau-Solità i Plegamans, Barcelona, Spain
| | - Susana Cabrera
- Pharmacovigilance Department, NOUCOR HEALTH, S.A., Palau-Solità i Plegamans, Barcelona, Spain
| | - Alberto Fernandez
- Pharmacovigilance Department, NOUCOR HEALTH, S.A., Palau-Solità i Plegamans, Barcelona, Spain
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2
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Giménez‐Arnau AM, Ribas‐Llauradó C, Mohammad‐Porras N, Deza G, Pujol RM, Gimeno R. IgE and high-affinity IgE receptor in chronic inducible urticaria, pathogenic, and management relevance. Clin Transl Allergy 2022; 12:e12117. [PMID: 35126995 PMCID: PMC8805593 DOI: 10.1002/clt2.12117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/04/2022] [Accepted: 01/09/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND IgE and high-affinity IgE receptor (FcεRI) expression on basophils have been scarcely explored in patients with chronic inducible urticaria (CIndU). OBJECTIVES To investigate baseline serum IgE and FcεRI expression on blood basophils in a large cohort of CIndU patients and its relationship to treatment response. METHODS Baseline total serum IgE and basophil FcεRI expression measured by flow cytometry in 165 patients with CIndU was studied. The relationship of both parameters with the response to antihistamine and anti-IgE (omalizumab) treatment was considered in a subsample of CIndU patients. FcεRI expression in basophils was assessed by mean fluorescence intensity (MFI) and basophil FcεRI standardized density (receptors/cell). RESULTS The median FcεRI expression standardized per density in blood basophils was found significantly higher in patients with CIndU compared to HCs. A positive correlation was found between IgE serum levels and basophil FcεRI expression. Basal FcεRI expression was not related to antihistamine treatment response. However, it was related to omalizumab, and patients responding to omalizumab showed higher basal basophil expression of FcεRI levels. Non-responders to the antihistamine showed significantly higher IgE serum levels. CONCLUSIONS FcεRI receptor overexpression in patients with CIndU shows almost the same pattern than chronic spontaneous urticaria. It seems to be independent of CIndU subtypes. Although additional studies would be welcome, our work highlights the relevance of FcεRI receptor regulation in CIndU supporting autoimmune basophil and mast cell activation and may be a biomarker for response to anti-IgE therapy.
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Affiliation(s)
- Ana M. Giménez‐Arnau
- Department of DermatologyHospital del Mar‐Institut d’Investigacions Mèdiques (IMIM)Universitat Pompeu Fabra de BarcelonaBarcelonaSpain
| | - Clara Ribas‐Llauradó
- Department of DermatologyHospital del Mar‐Institut d’Investigacions Mèdiques (IMIM)Universitat Pompeu Fabra de BarcelonaBarcelonaSpain
- Department of ImmunologyHospital del Mar‐Institut Mar d’Investigacions MèdiquesBarcelonaSpain
| | - Nasser Mohammad‐Porras
- Department of DermatologyHospital del Mar‐Institut d’Investigacions Mèdiques (IMIM)Universitat Pompeu Fabra de BarcelonaBarcelonaSpain
| | - Gustavo Deza
- Department of DermatologyHospital del Mar‐Institut d’Investigacions Mèdiques (IMIM)Universitat Pompeu Fabra de BarcelonaBarcelonaSpain
| | - Ramón M. Pujol
- Department of DermatologyHospital del Mar‐Institut d’Investigacions Mèdiques (IMIM)Universitat Pompeu Fabra de BarcelonaBarcelonaSpain
| | - Ramón Gimeno
- Department of ImmunologyHospital del Mar‐Institut Mar d’Investigacions MèdiquesBarcelonaSpain
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3
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Maltseva N, Borzova E, Fomina D, Bizjak M, Terhorst‐Molawi D, Košnik M, Kulthanan K, Meshkova R, Thomsen SF, Maurer M. Cold urticaria - What we know and what we do not know. Allergy 2021; 76:1077-1094. [PMID: 33249577 DOI: 10.1111/all.14674] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 12/16/2022]
Abstract
Cold urticaria (ColdU) is a common form of chronic inducible urticaria characterized by the development of wheals, angioedema or both in response to cold exposure. Recent research and guideline updates have advanced our understanding and management of ColdU. Today, its pathophysiology is thought to involve the cold-induced formation of autoallergens and IgE to these autoallergens, which provoke a release of proinflammatory mediators from skin mast cells. The classification of ColdU includes typical and atypical subtypes. We know that cold-induced wheals usually develop on rewarming and resolve within an hour and that anaphylaxis can occur. The diagnosis relies on the patient's history and cold stimulation testing. Additional diagnostic work-up, including a search for underlying infections, should only be done if indicated by the patient's history. The management of ColdU includes cold avoidance, the regular use of nonsedating antihistamines and the off-label use of omalizumab. However, many questions regarding ColdU remain unanswered. Here, we review what is known about ColdU, and we present important unanswered questions on the epidemiology, underlying pathomechanisms, clinical heterogeneity and treatment outcomes. Our aim is to guide future efforts that will close these knowledge gaps and advance the management of ColdU.
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Affiliation(s)
- Natalya Maltseva
- Center of Allergy and Immunology Clinical State Hospital 52 Moscow Ministry of Healthcare Moscow Russian Federation
| | - Elena Borzova
- Department of Dermatology and Venereology I.M. Sechenov First Moscow State Medical University Moscow Russian Federation
| | - Daria Fomina
- Center of Allergy and Immunology Clinical State Hospital 52 Moscow Ministry of Healthcare Moscow Russian Federation
- Department of Clinical Immunology and Allergology I.M.Sechenov First Moscow State Medical University Moscow Russian Federation
| | - Mojca Bizjak
- University Clinic of Respiratory and Allergic Diseases Golnik Golnik Slovenia
| | - Dorothea Terhorst‐Molawi
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - Mitja Košnik
- University Clinic of Respiratory and Allergic Diseases Golnik Golnik Slovenia
| | - Kanokvalai Kulthanan
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | - Raisa Meshkova
- Smolensk State Medical University Smolensk Russian Federation
| | - Simon Francis Thomsen
- Department of Dermatology Bispebjerg Hospital University of Copenhagen Copenhagen Denmark
| | - Marcus Maurer
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
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4
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Pozderac I, Lugović-Mihić L, Artuković M, Stipić-Marković A, Kuna M, Ferček I. Chronic inducible urticaria: classification and prominent features of physical and non-physical types. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2020. [DOI: 10.15570/actaapa.2020.29] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Maurer M, Fluhr JW, Khan DA. How to Approach Chronic Inducible Urticaria. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 6:1119-1130. [PMID: 30033913 DOI: 10.1016/j.jaip.2018.03.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 12/22/2022]
Abstract
Chronic inducible urticaria (CIndU) is a group of chronic urticarias characterized by the appearance of recurrent wheals, recurrent angioedema or both, as a response to specific triggers. CIndU includes both physical (symptomatic dermographism, cold and heat urticaria, delayed pressure urticaria, solar urticaria, and vibratory urticaria) and nonphysical urticarias (cholinergic urticaria, contact and aquagenic urticaria). Here, we review the different forms of CIndU with an emphasis on symptomatic dermographism, cold urticaria, cholinergic urticaria, and delayed pressure urticaria. We discuss the clinical features, the diagnostic workup including provocation and threshold testing, and available treatment options.
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Affiliation(s)
- Marcus Maurer
- Department of Dermatology and Allergy, Charité - Universitätsmedizin, Berlin, Germany.
| | - Joachim W Fluhr
- Department of Dermatology and Allergy, Charité - Universitätsmedizin, Berlin, Germany
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
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6
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Deza G, March-Rodríguez A, Sánchez S, Ribas-Llauradó C, Soto D, Pujol RM, Gimeno R, Giménez-Arnau AM. Relevance of the Basophil High-Affinity IgE Receptor in Chronic Urticaria: Clinical Experience from a Tertiary Care Institution. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1619-1626.e1. [PMID: 30685572 DOI: 10.1016/j.jaip.2019.01.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/21/2018] [Accepted: 01/11/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The high-affinity IgE receptor (FcεRI) expression on effector cells has been poorly characterized in patients with chronic urticaria (CU) to date. OBJECTIVES To investigate the FcεRI expression on blood basophils in a large cohort of patients with CU and its potential relationship with relevant features of the disease. METHODS Basophil FcεRI expression was measured by flow cytometry in 287 patients with CU (192 with chronic spontaneous urticaria and 95 with chronic inducible urticaria) at their initial evaluation in our department. A control group of healthy nonatopic individuals was included to provide reference data, and the effect of antihistamine and anti-IgE therapy on the basophil FcεRI expression was also evaluated in a cohort of patients with CU. RESULTS The median FcεRI expression was found significantly higher in patients with CU compared with healthy controls (P < .0001). A positive correlation was found between serum IgE levels and basophil FcεRI expression (R = 0.422; P < .001). Significantly higher FcεRI levels on basophils were detected in patients with CU who presented with concomitant atopic features (P = .003), negative autologous serum skin test (P = .002), negative autologous plasma skin test (P = .009), or undetected levels of antithyroid antibodies (P = 0.01). Baseline FcεRI expression was not related to the activity and duration of the disease, and was not significantly modified during antihistamine therapy; however, it correlated with the clinical response to omalizumab (P = .003). CONCLUSIONS Although further multicenter studies are needed to corroborate these findings, the assessment of basophil FcεRI levels might be relevant in daily clinical practice supporting an autoimmune pathogenesis and predicting response to anti-IgE treatment.
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Affiliation(s)
- Gustavo Deza
- Department of Dermatology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Alvaro March-Rodríguez
- Department of Dermatology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Silvia Sánchez
- Department of Dermatology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Clara Ribas-Llauradó
- Department of Dermatology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Department of Immunology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Dulce Soto
- Department of Immunology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Ramon M Pujol
- Department of Dermatology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Ramon Gimeno
- Department of Immunology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Ana M Giménez-Arnau
- Department of Dermatology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
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Zuberbier T, Aberer W, Asero R, Latiff AHA, Baker D, Ballmer-Weber B, Bernstein JA, Bindslev-Jensen C, Brzoza Z, Bedrikow RB, Canonica GW, Church MK, Craig T, Danilycheva IV, Dressler C, Ensina LF, Giménez-Arnau A, Godse K, Goncalo M, Grattan C, Hebert J, Hide M, Kaplan A, Kapp A, Katelaris CH, Kocatürk E, Kulthanan K, Larenas-Linnemann D, Leslie TA, Magerl M, Mathelier-Fusade P, Meshkova RY, Metz M, Nast A, Nettis E, Oude-Elberink H, Rosumeck S, Saini SS, Sánchez-Borges M, Schmid-Grendelmeier P, Staubach P, Sussman G, Toubi E, Vena GA, Vestergaard C, Wedi B, Werner RN, Zhao Z, Maurer M, Brehler R, Brockow K, Fluhr J, Grabbe J, Hamelmann E, Hartmann K, Jakob T, Merk H, Ollert M, Ott H, Reese I, Rueff F, Werfel T. EAACI/GA2LEN/EDF/WAO-Leitlinie für die Definition, Klassifikation, Diagnose und das Management der Urtikaria — konsentierte, deutschsprachige Übersetzung. ALLERGO JOURNAL 2018. [DOI: 10.1007/s15007-018-1751-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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8
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Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer-Weber B, Bernstein JA, Bindslev-Jensen C, Brzoza Z, Buense Bedrikow R, Canonica GW, Church MK, Craig T, Danilycheva IV, Dressler C, Ensina LF, Giménez-Arnau A, Godse K, Gonçalo M, Grattan C, Hebert J, Hide M, Kaplan A, Kapp A, Katelaris CH, Kocatürk E, Kulthanan K, Larenas-Linnemann D, Leslie TA, Magerl M, Mathelier-Fusade P, Meshkova RY, Metz M, Nast A, Nettis E, Oude-Elberink H, Rosumeck S, Saini SS, Sánchez-Borges M, Schmid-Grendelmeier P, Staubach P, Sussman G, Toubi E, Vena GA, Vestergaard C, Wedi B, Werner RN, Zhao Z, Maurer M. The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy 2018; 73:1393-1414. [PMID: 29336054 DOI: 10.1111/all.13397] [Citation(s) in RCA: 767] [Impact Index Per Article: 127.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2017] [Indexed: 02/06/2023]
Abstract
This evidence- and consensus-based guideline was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. The conference was held on 1 December 2016. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-founded network of excellence, the Global Allergy and Asthma European Network (GA²LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO) with the participation of 48 delegates of 42 national and international societies. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria are disabling, impair quality of life and affect performance at work and school. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
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Affiliation(s)
- T. Zuberbier
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
| | - W. Aberer
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - R. Asero
- Department of Allergology; Clinica San Carlo; Paderno Dugnano MI Italy
| | - A. H. Abdul Latiff
- Allergy& Immunology Centre; Pantai Hospital Kuala Lumpur; Kuala Lumpur Malaysia
| | - D. Baker
- Baker Allergy Asthma and Dermatology Clinic; Portland OR USA
| | - B. Ballmer-Weber
- Allergy Unit; Department of Dermatology; University Hospital; Zürich Switzerland
| | - J. A. Bernstein
- University of Cincinnati Physicians Immunology Research Center; Cincinnati OH USA
| | - C. Bindslev-Jensen
- Department of Dermatology and Allergy Centre; Odense University Hospital and University of Southern Denmark; Odense Denmark
| | - Z. Brzoza
- Department of Internal Diseases, Allergology and Clinical Immunology in Katowice; Medical University of Silesia; Katowice Poland
| | | | - G. W. Canonica
- Personalized Medicine Asthma and Allergy Clinic-Humanitas University & Research Hospital; Milano Italy
| | - M. K. Church
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
| | - T. Craig
- Department of Medicine and Pediatrics; Penn State University; Hershey Medical Center; Hershey PA USA
| | - I. V. Danilycheva
- National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia; Moscow Russia
| | - C. Dressler
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Division of Evidence Based Medicine; Department of Dermatology; Berlin Germany
| | - L. F. Ensina
- Federal University of Sao Paulo; Sao Paulo Brazil
| | - A. Giménez-Arnau
- Hospital del Mar; IMIM; Universitat Autònoma Barcelona; Barcelona Spain
| | - K. Godse
- Department of Dermatology; Dr. D. Y. Patil Medical College & Hospital; Nerul Navi Mumbai India
| | - M. Gonçalo
- Clinic of Dermatology; Faculty of Medicine and University Hospital; Coimbra Portugal
| | - C. Grattan
- St John's’ Institute of Dermatology; Guy's’ and St. Thomas’ Hospital; NHS Foundation Trust; London UK
| | - J. Hebert
- Service d'allergie; Centre Hospitalier Université Laval/Centre Hospitalier Universitaire de Québec; Québec QC Canada
| | - M. Hide
- Department of Dermatology; Institute of Biomedical and Health Sciences; Hiroshima University; Hiroshima Japan
| | - A. Kaplan
- Department of Medicine; Division of Pulmonary and Critical Care Medicine; Allergy and Clinical Immunology; Medical University of South Carolina; Charleston SC USA
| | - A. Kapp
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - C. H. Katelaris
- Campbelltown Hospital and Western Sydney University; Sydney Australia
| | - E. Kocatürk
- Department of Dermatology; Okmeydani Training and Research Hospital; Istanbul Turkey
| | - K. Kulthanan
- Department of Dermatology; Faculty of Medicine Siriraj Hospital; Mahidol University; Bangkok Thailand
| | | | | | - M. Magerl
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
| | - P. Mathelier-Fusade
- Department of Dermatology and Allergy; University Hospital of Tenon; Paris France
| | - R. Y. Meshkova
- Department of Clinical Immunology and Allergy; Smolensk State Medical University; Smolensk Russia
| | - M. Metz
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
| | - A. Nast
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Division of Evidence Based Medicine; Department of Dermatology; Berlin Germany
| | - E. Nettis
- Scuola e Cattedra di Allergologia e Immunologia Clinica; Dipartimento dell'Emergenza e dei Trapianti d'Organo; Università di Bari; Bari Italy
| | | | - S. Rosumeck
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Division of Evidence Based Medicine; Department of Dermatology; Berlin Germany
| | - S. S. Saini
- Johns Hopkins Asthma and Allergy Center; Baltimore MD USA
| | - M. Sánchez-Borges
- Allergy and Clinical Immunology Department; Centro Médico-Docente La Trinidad; Caracas Venezuela
| | | | - P. Staubach
- Department of Dermatology; University Medical Center Mainz; Mainz Germany
| | - G. Sussman
- Division of Allergy and Clinical Immunology; University of Toronto; Toronto ON Canada
| | - E. Toubi
- Bnai-Zion Medical Center; Faculty of Medicine; Technion Haifa Israel
| | - G. A. Vena
- Dermatology and Venereology Private Practice; Bari and Barletta Italy
| | - C. Vestergaard
- Department of Dermatology and Venereology; Aarhus University Hospital; Aarhus Denmark
| | - B. Wedi
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - R. N. Werner
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Division of Evidence Based Medicine; Department of Dermatology; Berlin Germany
| | - Z. Zhao
- Department of Dermatology and Venereology; Peking University; First Hospital; Beijing China
| | - M. Maurer
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Dermatology and Allergy; Allergy-Centre-Charité; Berlin Germany
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9
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Management of Inducible Urticarias. CURRENT TREATMENT OPTIONS IN ALLERGY 2017. [DOI: 10.1007/s40521-017-0149-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Sánchez-Borges M, González-Aveledo L, Caballero-Fonseca F, Capriles-Hulett A. Review of Physical Urticarias and Testing Methods. Curr Allergy Asthma Rep 2017. [PMID: 28634900 DOI: 10.1007/s11882-017-0722-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW This review aims to update the information available on the prevalence, clinical picture, diagnostic methods, and treatment of urticarias induced by external physical stimuli. RECENT FINDINGS Physical urticarias are present in up to 5% of the general population, and in 10 to 50% of patients with chronic urticaria. Recent investigations have provided evidence that the presence of physical urticaria alone or when comorbid with chronic spontaneous urticaria is associated with a worse prognosis and duration. Most frequent subtypes of physical urticaria are dermographism and delayed pressure urticaria. The diagnosis is established through specific provocation tests and the management encompasses avoidance measures, pharmacologic therapy with nonsedating antihistamines, and alternative medications in refractory cases.
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Affiliation(s)
- Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela. .,Allergy and Clinical Immunology Service, Clínica El Avila, 6a transversal Urb. Altamira, piso 8, consultorio 803, Caracas, 1060, Venezuela.
| | | | - Fernan Caballero-Fonseca
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela.,Allergy and Immunology Service, Centro Médico de Caracas, Caracas, Venezuela
| | - Arnaldo Capriles-Hulett
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela.,Allergy and Immunology Service, Centro Médico de Caracas, Caracas, Venezuela
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11
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Urticaria and Angioedema: an Update on Classification and Pathogenesis. Clin Rev Allergy Immunol 2017; 54:88-101. [DOI: 10.1007/s12016-017-8628-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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12
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Acquired cold urticaria: Clinical features, particular phenotypes, and disease course in a tertiary care center cohort. J Am Acad Dermatol 2016; 75:918-924.e2. [PMID: 27485164 DOI: 10.1016/j.jaad.2016.06.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/07/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Data about special phenotypes, natural course, and prognostic variables of patients with acquired cold urticaria (ACU) are scarce. OBJECTIVES We sought to describe the clinical features and disease course of patients with ACU, with special attention paid to particular phenotypes, and to examine possible parameters that could predict the evolution of the disease. METHODS This study was a retrospective chart review of 74 patients with ACU who visited a tertiary referral center of urticaria between 2005 and 2015. RESULTS Fourteen patients (18.9%) presented with life-threatening reactions after cold exposure, and 21 (28.4%) showed negative results after cold stimulation tests (classified as atypical ACU). Nineteen patients (25.7%) achieved complete symptoms resolution at the end of the surveillance period and had no subsequent recurrences. Higher rates of atypical ACU along with a lower likelihood of achieving complete symptom resolution was observed in patients who had an onset of symptoms during childhood (P < .05). In patients with atypical ACU, shorter disease duration and lower doses of antihistamines required for achieving disease control were detected (P < .05). Age at disease onset, symptom severity, and cold urticaria threshold values were found to be related to disease evolution (P < .05). LIMITATIONS This study was limited by its retrospective nature. CONCLUSIONS The knowledge of the clinical predictors of the disease evolution along with the clinical features of ACU phenotypes would allow for the establishment of an early and proper therapeutic strategy.
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Magerl M, Altrichter S, Borzova E, Giménez-Arnau A, Grattan CEH, Lawlor F, Mathelier-Fusade P, Meshkova RY, Zuberbier T, Metz M, Maurer M. The definition, diagnostic testing, and management of chronic inducible urticarias - The EAACI/GA(2) LEN/EDF/UNEV consensus recommendations 2016 update and revision. Allergy 2016; 71:780-802. [PMID: 26991006 DOI: 10.1111/all.12884] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2016] [Indexed: 01/13/2023]
Abstract
These recommendations for the definition, diagnosis and management of chronic inducible urticaria (CIndU) extend, revise and update our previous consensus report on physical urticarias and cholinergic urticaria (Allergy, 2009). The aim of these recommendations is to improve the diagnosis and management of patients with CIndU. Our recommendations acknowledge the latest changes in our understanding of CIndU, and the available therapeutic options, as well as the development of novel diagnostic tools.
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Affiliation(s)
- M. Magerl
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - S. Altrichter
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - E. Borzova
- Department of Clinical Allergology; Russian Medical Academy of Postgraduate Education; Moscow Russia
| | - A. Giménez-Arnau
- Department of Dermatology; Hospital del Mar; Institut Mar d′Investigacions Mèdiques IMIM; Universitat Autònoma Barcelona; Barcelona Spain
| | - C. E. H. Grattan
- Cutaneous Allergy; St John's Institute of Dermatology; St Thomas' Hospital; London UK
| | - F. Lawlor
- Cutaneous Allergy; St John's Institute of Dermatology; St Thomas' Hospital; London UK
| | | | - R. Y. Meshkova
- Klinika Medicinskoy Immunologii I Allergologii; Smolensk Russia
| | - T. Zuberbier
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - M. Metz
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - M. Maurer
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
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Metz M, Weller K, Neumeister C, Izquierdo I, Bödeker RH, Schwantes U, Maurer M. Rupatadine in Established Treatment Schemes Improves Chronic Spontaneous Urticaria Symptoms and Patients' Quality of Life: a Prospective, Non-interventional Trial. Dermatol Ther (Heidelb) 2015; 5:217-230. [PMID: 26591001 PMCID: PMC4674450 DOI: 10.1007/s13555-015-0089-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Indexed: 11/10/2022] Open
Abstract
Introduction Chronic spontaneous urticaria (CSU) is a common and hard to treat condition associated with a substantial negative impact on patients’ quality of life (QoL). Clinical studies have shown that rupatadine is effective and safe in the treatment of CSU, but data from routine clinical care are scarce. Therefore, we assessed the effectiveness and tolerability of rupatadine in established dosages on CSU activity and patients’ QoL in a routine daily practice setting. Methods This was an open, prospective, non-interventional study performed in 146 dermatological practices in Germany. CSU patients for whom treatment with rupatadine was indicated were eligible to participate. Key symptoms of urticaria activity and their impact on patients’ QoL were assessed at the beginning and the end of treatment. Adverse events (AEs) and withdrawals, as well as the dosage regimens chosen, were documented. Patients and physicians were requested to rate effectiveness and tolerability of therapy at the final visit. All statistical analyses were descriptive. Results The majority of the 660 patients screened to be treated (median age 44 years, IQR = 31–59 years, n = 654) received rupatadine 10 mg tablets once (477 patients) or twice (105 patients) daily for a median time of 28 days. After treatment, 93.2% of the patients (606/650) reported a clear overall improvement of symptoms. Rupatadine significantly reduced the urticaria activity score (UAS7) as well as the frequency and severity of existing angioedema episodes. Similarly all domains of the urticaria-specific QoL questionnaire (CU-Q2oL) were markedly improved. The majority of physicians and patients rated rupatadine treatment as effective and well tolerated. There were 39 (5.9%) early treatment withdrawals, and 21 patients (3.2%) experienced AEs. Conclusion Rupatadine when given according to the routine treating schemes improves symptoms and CU-Q2oL of CSU patients; the drug is also safe and well tolerated. Funding Dr. R. Pfleger GmbH. Electronic supplementary material The online version of this article (doi:10.1007/s13555-015-0089-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Martin Metz
- Department of Dermatology and Allergy, Allergy-Centre-Charité, Charité-University Hospital Berlin, Berlin, Germany
| | - Karsten Weller
- Department of Dermatology and Allergy, Allergy-Centre-Charité, Charité-University Hospital Berlin, Berlin, Germany
| | - Claudia Neumeister
- Department of Medical Science/Clinical Research, Dr. R. Pfleger GmbH, Bamberg, Germany
| | - Iñaki Izquierdo
- Department of Clinical Research, Uriach Group, Barcelona, Spain
| | - Rolf-Hasso Bödeker
- Department of Statistics, Institute for Medical Informatics, University Clinic Giessen, Giessen, Germany
| | - Ulrich Schwantes
- Department of Medical Science/Clinical Research, Dr. R. Pfleger GmbH, Bamberg, Germany.
| | - Marcus Maurer
- Department of Dermatology and Allergy, Allergy-Centre-Charité, Charité-University Hospital Berlin, Berlin, Germany
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Diagnostic and Therapeutic Management of Chronic Urticaria by Dermatologists and the Role of Dermatology Departments. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2015.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Manejo diagnóstico y terapéutico de la urticaria crónica por el dermatólogo y papel del servicio de dermatología. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:528-32. [DOI: 10.1016/j.ad.2015.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 02/08/2015] [Accepted: 02/15/2015] [Indexed: 11/19/2022] Open
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