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Keller L, Stitt J. Chronic Spontaneous Urticaria: Quality of Life and Economic Impacts. Immunol Allergy Clin North Am 2024; 44:453-467. [PMID: 38937009 DOI: 10.1016/j.iac.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
This study focuses on quality of life (QoL) assessment in chronic urticaria, delving into tools, disease-specific measures, and its profound impact. With expanding therapeutic options, understanding QoL becomes crucial. QoL measures often involve comparisons of patient-reported outcomes in addition to quantitative measures of disease control. Emerging tools include the Urticaria Activity and Impact Measure, which may provide a balanced evaluation. In addition to discussions of the various QoL measures, the psychological impact of chronic urticaria are highlighted, covering emotional burden, stress, and psychiatric comorbidities. Finally, the economic impacts reveal escalating health care costs and cost-effectiveness considerations of therapies like omalizumab.
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Affiliation(s)
- Levi Keller
- Division of Allergy and Clinical Immunology, University of Colorado School of Medicine, 12700 East 19th Avenue 10C03, Aurora, CO 80045, USA.
| | - Jenny Stitt
- Division of Allergy and Clinical Immunology, University of Colorado School of Medicine, 12700 East 19th Avenue 10C03, Aurora, CO 80045, USA
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2
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Dobrican-Băruța CT, Deleanu DM, Muntean IA, Nedelea I, Bălan RG, Filip GA, Procopciuc LM. The Alarmin Triad-IL-25, IL-33, and TSLP-Serum Levels and Their Clinical Implications in Chronic Spontaneous Urticaria. Int J Mol Sci 2024; 25:2026. [PMID: 38396704 PMCID: PMC10889490 DOI: 10.3390/ijms25042026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/01/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
This study delves into the critical role of alarmins in chronic spontaneous urticaria (CSU), focusing on their impact on disease severity and the quality of life (QoL) of patients. We investigated the alterations in alarmin levels in CSU patients and their correlations with the Urticaria Activity Score (UAS7) and the Dermatology Life Quality Index (DLQI). We analyzed serum levels of interleukin-25 (IL-25), interleukin-33 (IL-33), and thymic stromal lymphopoietin (TSLP) in 50 CSU patients, comparing these to 38 healthy controls. The study examined the relationship between alarmin levels and clinical outcomes, including disease severity and QoL. Elevated levels of IL-33 and TSLP in CSU patients (p < 0.0001) highlight their potential role in CSU pathogenesis. Although IL-25 showed higher levels in CSU patients, this did not reach statistical significance (p = 0.0823). Crucially, IL-33's correlation with both UAS7 and DLQI scores underscores its potential as a biomarker for CSU diagnosis and severity assessment. Of the alarmins analyzed, IL-33 emerges as particularly significant for further exploration as a diagnostic and prognostic biomarker in CSU. Its substantial correlation with disease severity and impact on QoL makes it a compelling candidate for future research, potentially serving as a target for therapeutic interventions. Given these findings, IL-33 deserves additional investigation to confirm its role and effectiveness as a biomarker and therapeutic target in CSU.
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Affiliation(s)
- Carmen-Teodora Dobrican-Băruța
- Department of Allergology and Immunology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj Napoca, Romania; (C.-T.D.-B.)
- Allergology Department, “Octavian Fodor” Institute of Gastroenterology and Hepatology, 400162 Cluj Napoca, Romania
| | - Diana Mihaela Deleanu
- Department of Allergology and Immunology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj Napoca, Romania; (C.-T.D.-B.)
- Allergology Department, “Octavian Fodor” Institute of Gastroenterology and Hepatology, 400162 Cluj Napoca, Romania
| | - Ioana Adriana Muntean
- Department of Allergology and Immunology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj Napoca, Romania; (C.-T.D.-B.)
- Allergology Department, “Octavian Fodor” Institute of Gastroenterology and Hepatology, 400162 Cluj Napoca, Romania
| | - Irena Nedelea
- Department of Allergology and Immunology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj Napoca, Romania; (C.-T.D.-B.)
- Allergology Department, “Octavian Fodor” Institute of Gastroenterology and Hepatology, 400162 Cluj Napoca, Romania
| | - Radu-Gheorghe Bălan
- Department of Allergology and Immunology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj Napoca, Romania; (C.-T.D.-B.)
| | - Gabriela Adriana Filip
- Department of Anatomy, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Lucia Maria Procopciuc
- Department of Biochemistry, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
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Maurer M, Albuquerque M, Boursiquot JN, Dery E, Giménez-Arnau A, Godse K, Guitiérrez G, Kanani A, Lacuesta G, McCarthy J, Nigen S, Winders T. A Patient Charter for Chronic Urticaria. Adv Ther 2024; 41:14-33. [PMID: 37991694 PMCID: PMC10796664 DOI: 10.1007/s12325-023-02724-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023]
Abstract
Chronic urticaria (CU) is the recurring development of wheals (aka "hives" or "welts"), angioedema, or both for more than 6 weeks. Wheals and angioedema occur with no definite triggers in chronic spontaneous urticaria, and in response to known and definite physical triggers in chronic inducible urticaria. Approximately 1.4% of individuals globally will have CU during their lifetime. The itching and physical discomfort associated with CU have a profound impact on daily activities, sexual function, work or school performance, and sleep, causing significant impairment in a patient's physical and mental quality of life. CU also places a financial burden on patients and healthcare systems. Patients should feel empowered to self-advocate to receive the best care. The voice of the patient in navigating the journey of CU diagnosis and management may improve patient-provider communication, thereby improving diagnosis and outcomes. A collaboration of patients, providers, advocacy organizations, and pharmaceutical representatives have created a patient charter to define the realistic and achievable principles of care that patients with CU should expect to receive. Principle (1): I deserve an accurate and timely diagnosis of my CU; Principle (2): I deserve access to specialty care for my CU; Principle (3): I deserve access to innovative treatments that reduce the burden of CU on my daily life; Principle (4): I deserve to be free of unnecessary treatment-related side-effects during the management of my CU; and Principle (5): I expect a holistic treatment approach to address all the components of my life impacted by CU. The stated principles may serve as a guide for healthcare providers who care for patients with CU and translate into better patient-physician communication. In addition, we urge policymakers and authors of CU treatment guidelines to consider these principles in their decision-making to ensure the goals of the patient are achievable.
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Affiliation(s)
- Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | | | | | - Elaine Dery
- Canadian Chronic Urticaria Society, Quebec City, Canada
| | - Ana Giménez-Arnau
- Hospital del Mar Research Institute, Universitat Pompeu Fabra, Barcelona, Spain
| | | | | | - Amin Kanani
- University of British Columbia, Vancouver, Canada
| | | | | | - Simon Nigen
- Montreal General Hospital, McGill University, Montreal, Canada
| | - Tonya Winders
- Global Allergy & Airways Patient Platform, Vienna, Austria.
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4
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Dobrican-Băruța CT, Deleanu DM, Muntean IA, Pintea I, Florea CM, Filip GA. IL-31-Pruritus Interleukin: Serum Values and Clinical Impact in Chronic Spontaneous Urticaria-A Romanian Retrospective Study. J Clin Med 2023; 12:5957. [PMID: 37762898 PMCID: PMC10532079 DOI: 10.3390/jcm12185957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/08/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: This study aimed to evaluate the implications of interleukin-31 (IL-31) in the pathogenesis of chronic spontaneous urticaria (CSU) and to assess the differences that occur between its serum values compared to controls. Additionally, the serum IL-31 levels were measured alongside other clinical and paraclinical parameters that were identified in the patients to understand its immunological importance in this skin disease and to determine if it could potentially serve as a therapeutic target in CSU in the future. (2) Methods: The serum levels of IL-31 were estimated in 50 patients diagnosed with CSU according to the accepted international guidelines. Additionally, 38 controls who had not experienced any episodes of urticaria during their lifetime were included. (3) Results: Significantly elevated serum IL-31 levels were observed in CSU patients compared to the controls (p < 0.0001). Although no direct correlations were found between IL-31 and inflammatory markers (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)), eosinophils, or total immunoglobulins E (IgE), significant differences in IL-31 levels were identified based on CSU severity, quality of life impact, itch intensity, and response to histamine H1 receptor antagonists (H1 antihistamines) (p < 0.05 for all). (4) Conclusions: Our findings underscore that IL-31 is not directly associated with general inflammation, eosinophilic response, or atopy in CSU. Nevertheless, its expression is influenced by key disease characteristics: severity, pruritus, and H1 antihistamine response. This investigation provides essential insights into CSU pathogenesis, potentially leading to novel therapeutic interventions. An enhanced understanding of these mechanisms is crucial due to the limitations of current treatment modalities in terms of fully managing CSU symptoms.
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Affiliation(s)
- Carmen-Teodora Dobrican-Băruța
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Allergology and Clinical Immunology, 400012 Cluj-Napoca, Romania; (C.-T.D.-B.); (D.M.D.)
| | - Diana Mihaela Deleanu
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Allergology and Clinical Immunology, 400012 Cluj-Napoca, Romania; (C.-T.D.-B.); (D.M.D.)
| | - Ioana Adriana Muntean
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Allergology and Clinical Immunology, 400012 Cluj-Napoca, Romania; (C.-T.D.-B.); (D.M.D.)
| | - Irena Pintea
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Allergology and Clinical Immunology, 400012 Cluj-Napoca, Romania; (C.-T.D.-B.); (D.M.D.)
| | - Cristian Marius Florea
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Cardiology, 400012 Cluj-Napoca, Romania;
| | - Gabriela Adriana Filip
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Physiology, 400012 Cluj-Napoca, Romania;
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Wang CW, Chen CB, Lu CW, Chen WT, Hui RCY, Chiu TM, Chi MH, Lin JC, Huang YH, Chang YC, Wu J, Chen KY, Lin YYW, Ger TY, Lin JY, Tsai WT, Pan YJ, Chung WH. Characteristics of immune response profile in patients with immediate allergic and autoimmune urticarial reactions induced by SARS-CoV-2 vaccines. J Autoimmun 2023; 138:103054. [PMID: 37245259 DOI: 10.1016/j.jaut.2023.103054] [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: 09/28/2022] [Revised: 12/30/2022] [Accepted: 05/03/2023] [Indexed: 05/30/2023]
Abstract
Severe allergic reactions following SARS-COV-2 vaccination are generally rare, but the reactions are increasingly reported. Some patients may develop prolonged urticarial reactions following SARS-COV-2 vaccination. Herein, we investigated the risk factors and immune mechanisms for patients with SARS-COV-2 vaccines-induced immediate allergy and chronic urticaria (CU). We prospectively recruited and analyzed 129 patients with SARS-COV-2 vaccine-induced immediate allergic and urticarial reactions as well as 115 SARS-COV-2 vaccines-tolerant individuals from multiple medical centers during 2021-2022. The clinical manifestations included acute urticaria, anaphylaxis, and delayed to chronic urticaria developed after SARS-COV-2 vaccinations. The serum levels of histamine, IL-2, IL-4, IL-6, IL-8, IL-17 A, TARC, and PARC were significantly elevated in allergic patients comparing to tolerant subjects (P-values = 4.5 × 10-5-0.039). Ex vivo basophil revealed that basophils from allergic patients could be significantly activated by SARS-COV-2 vaccine excipients (polyethylene glycol 2000 and polysorbate 80) or spike protein (P-values from 3.5 × 10-4 to 0.043). Further BAT study stimulated by patients' autoserum showed positive in 81.3% of patients with CU induced by SARS-COV-2 vaccination (P = 4.2 × 10-13), and the reactions could be attenuated by anti-IgE antibody. Autoantibodies screening also identified the significantly increased of IgE-anti-IL-24, IgG-anti-FcεRI, IgG-anti-thyroid peroxidase (TPO), and IgG-anti-thyroid-related proteins in SARS-COV-2 vaccines-induced CU patients comparing to SARS-COV-2 vaccines-tolerant controls (P-values = 4.6 × 10-10-0.048). Some patients with SARS-COV-2 vaccines-induced recalcitrant CU patients could be successfully treated with anti-IgE therapy. In conclusion, our results revealed that multiple vaccine components, inflammatory cytokines, and autoreactive IgG/IgE antibodies contribute to SARS-COV-2 vaccine-induced immediate allergic and autoimmune urticarial reactions.
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Affiliation(s)
- Chuang-Wei Wang
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan; Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung Immunology Consortium, Chang Gung Memorial Hospital and Chang Gung University, Taiwan; Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Bing Chen
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan; Chang Gung Immunology Consortium, Chang Gung Memorial Hospital and Chang Gung University, Taiwan; Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, School of Medicine, National Tsing Hua University, Hsinchu, Taiwan; Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chun-Wei Lu
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan; Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Wei-Ti Chen
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan; Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Rosaline Chung-Yee Hui
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsu-Man Chiu
- Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan; Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Min-Hui Chi
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Institute of Molecular Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jing-Chi Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Allergy Immunology and Rheumatology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Huei Huang
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Ching Chang
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jennifer Wu
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kuan-Yu Chen
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yang Yu-Wei Lin
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan
| | - Tzong-Yun Ger
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jing Yi Lin
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wan-Ting Tsai
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan
| | - Yen-Ju Pan
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan; Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung Immunology Consortium, Chang Gung Memorial Hospital and Chang Gung University, Taiwan; Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan; Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan; Department of Dermatology, Beijing Tsinghua Chang Gung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan.
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Zuberbier T, Altrichter S, Bauer S, Brehler R, Brockow K, Dressler C, Fluhr J, Gaskins M, Hamelmann E, Kühne K, Merk H, Mülleneisen NK, Nast A, Olze H, Ott H, Pleimes M, Ruëff F, Staubach-Renz P, Wedi B, Maurer M. S3 Guideline Urticaria. Part 1: Classification and diagnosis of urticaria - German-language adaptation of the international S3 Guideline. J Dtsch Dermatol Ges 2023; 21:81-93. [PMID: 36721941 DOI: 10.1111/ddg.14906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/11/2022] [Indexed: 02/02/2023]
Abstract
The lifetime prevalence of urticaria, a severe allergic disease, is almost 20%. It not only limits the quality of life of those affected, but also their general performance at work and in their daily activities. This publication is the first section of the Urticaria Guideline. It covers the classification and diagnosis of urticaria, taking into account the major advances in research into its causes, triggering factors and pathomechanisms. It also addresses strategies for the efficient diagnosis of the different subtypes of urticaria. This is crucial for individual, patient-oriented treatment, which is covered in the second part of the guideline, published separately. This German-language guideline was developed according to the criteria of the AWMF on the basis of the international English-language S3 guideline with special consideration of health system characteristics in the German-speaking countries. This first part of the guideline describes the classification of urticaria, distinguishing spontaneously occurring wheals (hives) and angioedema from forms of urticaria with inducible symptoms. Urticaria is defined as sudden onset of wheals, angioedema, or both, but is to be distinguished from conditions in which wheals occur as a short-term symptom, such as anaphylaxis. The diagnosis is based on (a limited number of) laboratory tests, but especially on medical history. In addition, validated instruments are available to measure the severity, activity and course of the disease.
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Affiliation(s)
- Torsten Zuberbier
- Charité - Universitätsmedizin Berlin, Institute of Allergology, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Sabine Altrichter
- University Hospital for Dermatology und Venereology, Comprehensive Allergy Center, Kepler University Hospital, Linz, Austria
| | | | - Randolf Brehler
- Center for Skin Diseases, University Hospital Münster, Department of Dermatology, Münster, Germany
| | - Knut Brockow
- Department und Clinic for Dermatology und Allergology am Biederstein, Technical University of Munich, Munich, Germany
| | - Corinna Dressler
- Division of Evidence-Based Medicine, Department for Dermatology, Venereology und Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Joachim Fluhr
- Charité - Universitätsmedizin Berlin, Institute of Allergology, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Matthew Gaskins
- Division of Evidence-Based Medicine, Department for Dermatology, Venereology und Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eckard Hamelmann
- Department for Pediatric and Adolescent Medinine, Evangelisches Klinikum Bethel, University Hospital OWL, University of Bielefeld, Bielefeld, Germany
| | | | - Hans Merk
- Department for Dermatology und Allergology, University Hospital RTWH Aachen, Aachen, Germany
| | | | - Alexander Nast
- Division of Evidence-Based Medicine, Department for Dermatology, Venereology und Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Heidi Olze
- Department of Ear, Nose and Throat Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Hagen Ott
- Hospital for Pediatric and Adolescent Medicine Auf der Bult, Hannover, Germany
| | - Marc Pleimes
- Practice for Pediatric and Adolescent Dermatology, Heidelberg, Germany
| | - Franziska Ruëff
- Department and Clinic for Dermatology und Allergology, LMU Hospital at the University of Munich, Munich, Germany
| | - Petra Staubach-Renz
- Department and Clinic for Skin Diseases, University Hospital at Johannes Gutenberg University Mainz, Mainz, Germany
| | - Bettina Wedi
- Hannover Medical School Dept. of Dermatology and Allergology, Hannover, Germany
| | - Marcus Maurer
- Charité - Universitätsmedizin Berlin, Institute of Allergology, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
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7
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Zuberbier T, Altrichter S, Bauer S, Brehler R, Brockow K, Dressler C, Fluhr J, Gaskins M, Hamelmann E, Kühne K, Merk H, Mülleneisen NK, Nast A, Olze H, Ott H, Pleimes M, Ruëff F, Staubach-Renz P, Wedi B, Maurer M. S3-Leitlinie Urtikaria. Teil 1: Klassifikation und Diagnostik der Urtikaria - deutschsprachige Adaptation der internationalen S3-Leitlinie. J Dtsch Dermatol Ges 2023; 21:81-95. [PMID: 36721942 DOI: 10.1111/ddg.14906_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/11/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Torsten Zuberbier
- Charité - Universitätsmedizin Berlin, Institut für Allergieforschung, Berlin, Deutschland.,Fraunhofer Institut für Translationale Medizin und Pharmakologie ITMP, Allergologie und Immunologie, Berlin, Deutschland
| | - Sabine Altrichter
- Universitätsklinik für Dermatologie und Venerologie, Comprehensive Allergy Center, Kepler Universitätsklinikum, Linz, Österreich
| | | | - Randolf Brehler
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Abteilung Dermatologie, Münster, Deutschland
| | - Knut Brockow
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, München, Deutschland
| | - Corinna Dressler
- Division of Evidence-Based Medicine, Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - Joachim Fluhr
- Charité - Universitätsmedizin Berlin, Institut für Allergieforschung, Berlin, Deutschland.,Fraunhofer Institut für Translationale Medizin und Pharmakologie ITMP, Allergologie und Immunologie, Berlin, Deutschland
| | - Matthew Gaskins
- Division of Evidence-Based Medicine, Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - Eckard Hamelmann
- Klinik für Kinder- und Jugendmedizin, Evangelisches Klinikum Bethel, Universitätsklinikum OWL, Universität Bielefeld, Bielefeld, Deutschland
| | | | - Hans Merk
- Klinik für Dermatologie und Allergologie, Universitätsklinik RTWH Aachen, Aachen, Deutschland
| | | | - Alexander Nast
- Division of Evidence-Based Medicine, Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - Heidi Olze
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - Hagen Ott
- Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Deutschland
| | - Marc Pleimes
- Praxis für Kinder- und Jugenddermatologie, Heidelberg, Deutschland
| | - Franziska Ruëff
- Klinik und Poliklinik für Dermatologie und Allergologie, LMU Klinikum der Universität München, München, Deutschland
| | - Petra Staubach-Renz
- Hautklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Bettina Wedi
- de Hannover Medical School Dept. of Dermatology and Allergology, Hannover, Germany
| | - Marcus Maurer
- Charité - Universitätsmedizin Berlin, Institut für Allergieforschung, Berlin, Deutschland.,Fraunhofer Institut für Translationale Medizin und Pharmakologie ITMP, Allergologie und Immunologie, Berlin, Deutschland
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8
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Dobrican CT, Muntean I, Pintea I, Petricău C, Deleanu DM, Filip G. Immunological signature of chronic spontaneous urticaria (Review). Exp Ther Med 2022; 23:381. [PMID: 35495604 PMCID: PMC9019689 DOI: 10.3892/etm.2022.11309] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/15/2021] [Indexed: 11/05/2022] Open
Abstract
Chronic urticaria (CU) is a condition characterized by intensely pruritic, edematous, erythematous papules lasting for more than 6 weeks. Over half of the cases have concomitant swelling of deeper tissues, known as angioedema. The socio-economic burden of the disease is significant. Unfortunately, patients with severe CU, refractory to conventional treatment, have limited and expensive therapeutic options. The pathogenesis of CU is not yet completely understood. Therefore, elucidating the pathophysiological mechanisms involved would potentially identify new therapeutic targets. It has been accepted in recent years that mast cells and their activation, followed by excessive degranulation represent the key pathophysiological events in chronic spontaneous urticaria (CSU). The triggering events and the complexity of the effector mechanisms, however, remain intensely debated topics with conflicting studies. One pathogenetic mechanism incriminated in chronic spontaneous urticaria is the response mediated by the high-affinity receptor for IgE (FcεRI) expressed on mast cells. Increasing recognition of chronic spontaneous urticaria as an autoimmune disease linked to the cytokine-chemokine network imbalance resulting from alteration of innate immune response is another pathogenetic explanation. It is likely that these different pathological mechanisms are more interconnected, both acting synergistically, rather than separately, to produce the clinical expression of CU. The discovery and understanding of pathogenic mechanisms represent the premise for the development of safe and effective immunomodulators and targeted biological treatment for severe, refractory CU.
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Affiliation(s)
- Carmen-Teodora Dobrican
- Discipline of Allergology and Immunology, Department of Functional Sciences, Iuliu Hatieganu University of Medicine and Pharmacy, 400162 Cluj‑Napoca, Romania
| | - Ioana Muntean
- Discipline of Allergology and Immunology, Department of Functional Sciences, Iuliu Hatieganu University of Medicine and Pharmacy, 400162 Cluj‑Napoca, Romania
| | - Irena Pintea
- Discipline of Allergology and Immunology, Department of Functional Sciences, Iuliu Hatieganu University of Medicine and Pharmacy, 400162 Cluj‑Napoca, Romania
| | - Carina Petricău
- Discipline of Allergology and Immunology, Department of Functional Sciences, Iuliu Hatieganu University of Medicine and Pharmacy, 400162 Cluj‑Napoca, Romania
| | - Diana-Mihaela Deleanu
- Discipline of Allergology and Immunology, Department of Functional Sciences, Iuliu Hatieganu University of Medicine and Pharmacy, 400162 Cluj‑Napoca, Romania
| | - Gabriela Filip
- Discipline of Physiology, Department of Functional Sciences, Iuliu Hatieganu University of Medicine and Pharmacy, 400162 Cluj‑Napoca, Romania
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9
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Zuberbier T, Abdul Latiff AH, Abuzakouk M, Aquilina S, Asero R, Baker D, Ballmer‐Weber B, Bangert C, Ben‐Shoshan M, Bernstein JA, Bindslev‐Jensen C, Brockow K, Brzoza Z, Chong Neto HJ, Church MK, Criado PR, Danilycheva IV, Dressler C, Ensina LF, Fonacier L, Gaskins M, Gáspár K, Gelincik A, Giménez‐Arnau A, Godse K, Gonçalo M, Grattan C, Grosber M, Hamelmann E, Hébert J, Hide M, Kaplan A, Kapp A, Kessel A, Kocatürk E, Kulthanan K, Larenas‐Linnemann D, Lauerma A, Leslie TA, Magerl M, Makris M, Meshkova RY, Metz M, Micallef D, Mortz CG, Nast A, Oude‐Elberink H, Pawankar R, Pigatto PD, Ratti Sisa H, Rojo Gutiérrez MI, Saini SS, Schmid‐Grendelmeier P, Sekerel BE, Siebenhaar F, Siiskonen H, Soria A, Staubach‐Renz P, Stingeni L, Sussman G, Szegedi A, Thomsen SF, Vadasz Z, Vestergaard C, Wedi B, Zhao Z, Maurer M. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy 2022; 77:734-766. [PMID: 34536239 DOI: 10.1111/all.15090] [Citation(s) in RCA: 413] [Impact Index Per Article: 206.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 02/07/2023]
Abstract
This update and revision of the international guideline for urticaria was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the Global Allergy and Asthma European Network (GA²LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), the European Dermatology Forum (EDF; EuroGuiDerm), and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology with the participation of 64 delegates of 50 national and international societies and from 31 countries. The consensus conference was held on 3 December 2020. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease that presents with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous or inducible urticaria is disabling, impairs quality of life, and affects performance at work and school. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
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Affiliation(s)
- Torsten Zuberbier
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | | | - Mohamed Abuzakouk
- Department of Allergy and Immunology Respiratory InstituteCleveland Clinic Abu Dhabi Abu Dhabi United Arab Emirates
| | - Susan Aquilina
- Department of Dermatology Mater Dei Hospital Msida Malta
| | - Riccardo Asero
- Ambulatorio di Allergologia Clinica San Carlo Paderno Dugnano (MI) Italy
| | - Diane Baker
- Baker Allergy Asthma and Dermatology Portland Oregon USA
| | - Barbara Ballmer‐Weber
- Clinic for Dermatology and Allergology Kantonsspital St. Gallen St. Gallen Switzerland
- Department of Dermatology University Hospital Zurich Zurich Switzerland
| | - Christine Bangert
- Department of Dermatology Medical University of Vienna Vienna Austria
| | - Moshe Ben‐Shoshan
- Division of Allergy, Immunology and Dermatology Department of Pediatrics Montreal Children’s Hospital McGill University Montreal Quebec Canada
| | | | - Carsten Bindslev‐Jensen
- Department of Dermatology and Allergy Centre Odense University Hospital and University of Southern Denmark Odense Denmark
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein Faculty of Medicine Technical University Munich Munich Germany
| | - Zenon Brzoza
- Department of Internal Diseases with Division of Allergology University of Opole Opole Poland
| | - Herberto Jose Chong Neto
- Division of Allergy and Immunology Department of Pediatrics Federal University of Paraná Curitiba Brazil
| | - Martin K. Church
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- University of Southampton Southampton UK
| | - Paulo R. Criado
- Sociedade Brasileira de Dermatologia (SBD) Centro Universitário FMABCAlergoskin (UCARE) Santo André Brazil
| | - Inna V. Danilycheva
- Department of Allergology and Immunotherapy National Research Center‐Institute of Immunology Federal Medical‐Biological Agency of Russia Moscow Russia
| | - Corinna Dressler
- Division of Evidence‐Based Medicine Department of Dermatology, Venereology and Allergy Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Luis Felipe Ensina
- Division of Allergy Clinical Immunology and Rheumatology Department of Pediatrics Federal University of São Paulo São Paulo Brazil
| | - Luz Fonacier
- New York University Long Island School of Medicine New York New York USA
| | - Matthew Gaskins
- Division of Evidence‐Based Medicine Department of Dermatology, Venereology and Allergy Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Krisztian Gáspár
- Division of Dermatological Allergology Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - Aslı Gelincik
- Division of Immunology and Allergic Diseases Department of Internal Medicine Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
| | - Ana Giménez‐Arnau
- Department of Dermatology, Hospital del Mar Institut Mar d’Investigacions Mèdiques Universitat Autònoma y Universitat Pompeu Fabra Barcelona Spain
| | - Kiran Godse
- Department of Dermatology D Y Patil University School of MedicineNavi Mumbai India
| | - Margarida Gonçalo
- Department of Dermatology Coimbra University Hospital and Faculty of Medicine University of Coimbra Coimbra Portugal
| | - Clive Grattan
- Guy’s HospitalSt John’s Institute of Dermatology London UK
| | - Martine Grosber
- Department of Dermatology Universitair Ziekenhuis Brussel (UZ Brussel)Vrije Universiteit Brussel (VUB) Brussels Belgium
| | - Eckard Hamelmann
- Department of Pediatrics Children’s Center Bethel University Hospital OWLUniversity Bielefeld Bielefeld Germany
| | - Jacques Hébert
- Service d'allergie Centre Hospitalier Université Laval/Centre Hospitalier Universitaire de Québec Québec Quebec Canada
| | - Michihiro Hide
- Department of Dermatology Hiroshima University Hiroshima Japan
- Department of Dermatology Hiroshima Citizens Hospital Hiroshima Japan
| | - Allen Kaplan
- Department of Medicine Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology Medical University of South Carolina Charleston South Carolina USA
| | - Alexander Kapp
- Department of Dermatology & Allergy Hannover Medical School (MHH) Hannover Germany
| | - Aharon Kessel
- Division of Allergy and Clinical Immunology Bnai Zion Medical Center and the Bruce and Ruth Rappaport Faculty of Medicine Technion Haifa Israel
| | - Emek Kocatürk
- Department of Dermatology Koç University School of Medicine Istanbul Turkey
| | - Kanokvalai Kulthanan
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | | | - Antti Lauerma
- Department of Dermatology, Allergology and Venereology Inflammation Centre University of Helsinki and Helsinki University Hospital Helsinki Finland
| | | | - Markus Magerl
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology Berlin Germany
| | - Michael Makris
- Allergy Unit 2nd Department of Dermatology and Venereology National and Kapodistrian University of AthensUniversity General Hospital "Attikon" Athens Greece
| | - Raisa Y. Meshkova
- Department of Clinical Immunology and Allergology Smolensk State Medical University Smolensk Russia
| | - Martin Metz
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology Berlin Germany
| | | | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre Odense Research Center for Anaphylaxis (ORCA) Odense University Hospital and University of Southern Denmark Odense Denmark
| | - Alexander Nast
- Division of Evidence‐Based Medicine Department of Dermatology, Venereology and Allergy Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | | | - Ruby Pawankar
- Department of Pediatrics Nippon Medical School Tokyo Japan
| | - Paolo D. Pigatto
- Department of Biomedical Surgical and Dental Sciences University of Milan Milan Italy
| | - Hector Ratti Sisa
- Primera Cátedra de Clínica Médica Hospital de Clínicas de la Facultad de Ciencias Médicas‐Universidad Nacional de Asunción Asunción Paraguay
| | | | | | | | - Bulent E. Sekerel
- Division of Pediatric Allergy and Asthma Hacettepe University Faculty of Medicine Ankara Turkey
| | - Frank Siebenhaar
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology Berlin Germany
| | - Hanna Siiskonen
- Department of Pathology Diagnostic Imaging Centre Kuopio University Hospital Kuopio Finland
| | - Angele Soria
- Department of Dermatology and Allergology Tenon Hospital APHP Sorbonne University and Cimi‐Paris Inserm 1135 Paris France
| | | | - Luca Stingeni
- Dermatology Section Department of Medicine University of Perugia Perugia Italy
| | - Gordon Sussman
- Division of Allergy and Clinical Immunology St. Michael's Hospital and University of Toronto Toronto Canada
| | - Andrea Szegedi
- Division of Dermatological Allergology Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - Simon Francis Thomsen
- Department of Dermatology Bispebjerg Hospital University of Copenhagen Copenhagen Denmark
| | - Zahava Vadasz
- Proteomic and Clinical Flow Cytometry Unit Bnai Zion Medical Center Rappaport Faculty of Medicine Technion Haifa Israel
| | | | - Bettina Wedi
- Department of Dermatology and Allergy Comprehensive Allergy Center Hannover Medical School Hannover Germany
| | - Zuotao Zhao
- Department of Dermatology and Venereology Peking University First Hospital Beijing China
| | - Marcus Maurer
- Comprehensive Allergy Centre Charité Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology Berlin Germany
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10
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Nagayama K, Watai K, Sekiya K, Iwata M, Hashimoto Y, Nakamura Y, Miyake A, Ryu K, Hayashi H, Ohmatsu H, Kamide Y, Fukutomi Y, Taniguchi M. Association between the severity of chronic spontaneous urticaria and sleep-disordered breathing. Allergol Int 2022; 71:103-108. [PMID: 34511312 DOI: 10.1016/j.alit.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/25/2021] [Accepted: 07/11/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is a common mast cell-driven disease, presenting with wheals, angioedema, or both. Sleep-disordered breathing (SDB) is also a common condition and contributes to various diseases by causing chronic inflammation. Recent studies have suggested an association between CSU and SDB. METHODS To determine the association between the severity of SDB and that of CSU, we studied consecutive patients with CSU who visited the Sagamihara National Hospital allergy department or dermatology department between April 1 and October 31, 2018. The severity of CSU and SDB was evaluated based on the urticaria activity score 7 (UAS7) and peripheral arterial tone apnea-hypopnea index (pAHI) derived from out-of-center sleep testing (OCST) findings, respectively; their correlation was examined. RESULTS Of the 37 patients studied, 19 had symptom-free-to-mild CSU (UAS7 ≤15) and 18 had moderate-to-severe CSU (UAS7 ≥16). The pAHI in the latter group was significantly higher than that in the former group (18 vs. 4.2, p = 0.001). In multivariate logistic analysis, moderate-to-severe SDB (pAHI ≥15) was significantly associated with moderate-to-severe CSU even after adjusting for the BMI (adjusted odds ratio 22 [95% confidence interval, 1.7-285]). CONCLUSIONS The severity of SDB is correlated with that of CSU independently of the BMI. Physicians should consider comorbid SDB when treating patients with CSU.
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Affiliation(s)
- Kisako Nagayama
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan; Course of Allergy and Clinical Immunology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kentaro Watai
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.
| | - Kiyoshi Sekiya
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Maki Iwata
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan; Course of Allergy and Clinical Immunology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuki Hashimoto
- Department of Dermatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Yuto Nakamura
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan; Course of Allergy and Clinical Immunology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Miyake
- Department of Dermatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Kai Ryu
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Hiroaki Hayashi
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Hanako Ohmatsu
- Department of Dermatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Yosuke Kamide
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Yuma Fukutomi
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan; Course of Allergy and Clinical Immunology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masami Taniguchi
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan; Course of Allergy and Clinical Immunology, Juntendo University Graduate School of Medicine, Tokyo, Japan; Center for Immunology and Allergology, Shonan Kamakura General Hospital, Kanagawa, Japan
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11
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Di Agosta E, Salvati L, Corazza M, Baiardini I, Ambrogio F, Angileri L, Antonelli E, Belluzzo F, Bonamonte D, Bonzano L, Brancaccio R, Custurone P, De Marco A, Detoraki A, Di Guida A, Di Leo E, Fantò M, Fassio F, Ferrucci SM, Foti C, Gallo R, Gatta A, Guarneri F, Guidolin L, Hansel K, Lamacchia D, Lombardo C, Minciullo PL, Napolitano M, Pannofino A, Paravisi A, Parente R, Passante M, Patruno C, Peroni D, Quecchia C, Schettini N, Spadaro G, Stingeni L, Tarrini D, Tramontana M, Nettis E, Rossi O. Quality of life in patients with allergic and immunologic skin diseases: in the eye of the beholder. Clin Mol Allergy 2021; 19:26. [PMID: 34930291 PMCID: PMC8690422 DOI: 10.1186/s12948-021-00165-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/15/2021] [Indexed: 12/24/2022] Open
Abstract
Allergic and immunologic skin diseases negatively impact the quality of life (QoL) of affected patients with detrimental consequences. Nonetheless, in everyday clinical practice the evaluation of QoL is often overlooked. Considering the increasing prevalence of atopic dermatitis, allergic contact dermatitis, hereditary angioedema, cutaneous mastocytosis, and urticaria, it is essential to determine the effects of allergic and immunologic skin diseases on QoL. A joint meeting (GET TOGETHER 2021) of the Italian Society of Allergology, Asthma and Clinical Immunology (SIAAIC) and the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA) aimed to summarize the features of the main QoL tools used in these diseases and to describe the extent of QoL impairment as well as the impact of treatments on QoL, particularly biologic therapies. The assessment of QoL in patients with allergic and immunologic skin diseases relies on generic, organ-specific and disease-specific questionnaires. While generic and organ-specific questionnaires allow comparison between different diseases, disease-specific questionnaires are designed and validated for specific cohorts: the QoL Index for Atopic Dermatitis (QoLIAD) and the Childhood Atopic Dermatitis Impact Scale (CADIS) in atopic dermatitis, the ACD-11 in allergic contact dermatitis, the Angioedema QoL Questionnaire (AE-QoL) and the Hereditary Angioedema QoL questionnaire (HAE-QoL) in hereditary angioedema, the Mastocytosis QoL Questionnaires (MCQoL e MQLQ) in cutaneous mastocytosis, and the Chronic Urticaria QoL questionnaire (CU-Q2oL) in urticaria. Among the many factors that variably contribute to QoL impairment, pruritus can represent the leading cause of patient discomfort. Biologic therapies significantly ameliorate QoL in atopic dermatitis, hereditary angioedema, mastocytosis and chronic urticaria. In general, adequate management strategies are essential for improving QoL in patients with allergic and immunologic skin diseases.
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Affiliation(s)
- Ester Di Agosta
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Lorenzo Salvati
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Monica Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ilaria Baiardini
- Respiratory Unit for Continuity of Care, IRCCS Ospedale Policlinico San Martino, Department of Internal Medicine (DiMI), University of Genoa, Genova, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Francesca Ambrogio
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Luisa Angileri
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Elettra Antonelli
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | | | - Domenico Bonamonte
- Department of Biomedical Sciences and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Laura Bonzano
- Dermatology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Raffaele Brancaccio
- Division of Allergy and Clinical Immunology, "Santa Maria Della Speranza" Hospital, Salerno, Italy
| | - Paolo Custurone
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Aurora De Marco
- Department of Biomedical Sciences and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Aikaterini Detoraki
- Department of Internal Medicine, Clinical Immunology, Clinical Pathology and Infectious Disease, Azienda Ospedaliera Universitaria Federico II, Napoli, Italy
| | - Adriana Di Guida
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Elisabetta Di Leo
- Section of Allergy and Clinical Immunology, Unit of Internal Medicine-"F. Miulli" Hospital, Acquaviva Delle Fonti, Bari, Italy
| | - Marta Fantò
- Unit of Allergology, Department of Dermatology, Policlinico Umberto I, Hospital-University Sapienza of Rome, Roma, Italy
| | - Filippo Fassio
- Allergy and Clinical Immunology Unit, San Giovanni di Dio Hospital, Firenze, Italy
| | - Silvia Mariel Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Caterina Foti
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Rosella Gallo
- Section of Dermatology - Department of Health Sciences, University of Genoa, Ospedale Policlinico San Martino - IRCCS, Genova, Italy
| | - Alessia Gatta
- Department of Medicine and Science of Ageing, G. d'Annunzio University, Chieti, Italy
| | - Fabrizio Guarneri
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Lucia Guidolin
- Allergy Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Katharina Hansel
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Donatella Lamacchia
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Carla Lombardo
- Allergy Unit, Villa Igea Hospital. A.P.S.S. Trento, Trento, Italy
| | - Paola Lucia Minciullo
- Department of Clinical and Experimental Medicine, School and Division of Allergy and Clinical Immunology, University Hospital 'G. Martino', Messina, Italy
| | - Maddalena Napolitano
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Alessandro Pannofino
- Allergology and Immunology Clinic, Operative Unit of Medicine, Policoro Hospital, Policoro, Matera, Italy
| | - Andrea Paravisi
- Section of Dermatology, Department of Health Sciences, University of Genoa, Ospedale Policlinico San Martino - IRCCS, Genova, Italy
| | - Roberta Parente
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Maria Passante
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Diego Peroni
- Section of Pediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Cristina Quecchia
- Io e l'Asma Center, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Natale Schettini
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Napoli, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Daniele Tarrini
- Allergy and Clinical Immunology Unit, Department of Clinical Medicine, Mauriziano Umberto I Hospital, University of Turin, Torino, Italy
| | - Marta Tramontana
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy
| | - Oliviero Rossi
- Immunoallergology Unit, SOD Immunoallergologia, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
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12
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Sánchez-Borges M, Ansotegui IJ, Baiardini I, Bernstein J, Canonica GW, Ebisawa M, Gomez M, Gonzalez-Diaz SN, Martin B, Morais-Almeida M, Ortega Martell JA. The challenges of chronic urticaria part 1: Epidemiology, immunopathogenesis, comorbidities, quality of life, and management. World Allergy Organ J 2021; 14:100533. [PMID: 34221215 PMCID: PMC8233382 DOI: 10.1016/j.waojou.2021.100533] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/18/2021] [Accepted: 03/08/2021] [Indexed: 12/02/2022] Open
Abstract
This is Part 1 of an updated follow-up review of a World Allergy Organization (WAO) position paper published in 2012 on the diagnosis and treatment of urticaria and angioedema. Since 2012, there have been advances in the understanding of the pathogenesis of chronic urticaria, and greater experience with the use of biologics, such as omalizumab, in patients with severe refractory disease. For these reasons, the WAO decided to initiate an update targeted to general practitioners around the world, incorporating the most recent information on epidemiology, immunopathogenesis, comorbidities, quality of life, clinical case presentations, and the management of chronic spontaneous and chronic inducible urticaria, including urticaria in special situations such as childhood and pregnancy. A special task force of WAO experts was invited to write the different sections of the manuscript, and the final document was approved by the WAO Board of Directors. This paper is not intended to be a substitute for current national and international guidelines on the management of urticaria and angioedema but to provide an updated, simplified guidance for physicians around the world who manage patients with this common ailment.
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Affiliation(s)
- Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, and Clínica El Avila, Caracas, Venezuela
| | - Ignacio J. Ansotegui
- Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia, Bilbao, Spain
| | - Ilaria Baiardini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Jonathan Bernstein
- Department of Internal Medicine, Division of Immunology, Allergy Section, University of Cincinnati
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | | | - Sandra Nora Gonzalez-Diaz
- Regional Center for Allergy and Clinical Immunology, Faculty of Medicine and “Dr. José Eleuterio González" University Hospital, Autonomous University of Nuevo León, Monterrey, México
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Effects of Serum Vitamin D Levels and Vitamin D Supplementation on Urticaria: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094911. [PMID: 34062998 PMCID: PMC8125545 DOI: 10.3390/ijerph18094911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 01/06/2023]
Abstract
(1) Backgrounds: Several studies have shown that the level of 25-hydroxyvitamin D (25(OH)D) could affect urticaria. The association of Vitamin D (VitD) with urticaria has not been well established. (2) Methods: The up-to-date meta-analysis was performed to synthesize the new findings. We performed a systematic search in PubMed, EMBASE, Web of Science, and Cochrane Database. We included the observational studies with the comparisons of 25(OH)D between urticarial populations and controls and clinical studies with the clinical severity of urticaria records. (3) Results: A meta-analysis of seventeen studies of urticaria group vs. controls revealed a mean difference of −9.35 ng/mL (95% CI −12.27 to −6.44). There was also an association of urticaria with VitD deficiency. In the subgroup analysis of age and disease type, significant effects of 25(OH)D were found among adult and chronic urticarial populations. Six VitD supplementation trials showed a significant reduction in clinical urticarial score on intervention with VitD with the standard mean difference of −3.63 and −1.54 among randomized control studies and repeated measure trials, respectively. (4) Conclusions: The urticarial population, especially the adult chronic urticarial patients, may be associated with a high risk for lower serum 25(OH)D. VitD supplementations could result in a reduction of urticarial clinical symptoms.
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New Instrument for the Evaluation of Prodromes and Attacks of Hereditary Angioedema (HAE-EPA). Clin Rev Allergy Immunol 2021; 61:29-39. [PMID: 33538950 DOI: 10.1007/s12016-021-08843-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
A disease-specific, patient-reported outcome instrument suitable for evaluation of prodromes and attacks of hereditary angioedema (HAE) is a clinical unmet need. We constructed such instrument and examined its validity, acceptability, and discriminative ability. Sixty-six patients participated in a survey addressing their demographics, social, and medical status. Discriminant content validity involved: (1) construct definition by in-depth cognitive debriefing interviews, (2) item selection identifying relevant categories, and (3) judgment of the format whereby questionnaires were tested on experienced patients and its content/reliability was validated. Prodromes and attacks affecting certain body systems (domains) were organized in "clusters". Internal consistency, content, and convergent validities were analyzed. Analyses of variance and regression models were used to evaluate the discriminative ability of the instrument to differentiate between attacks and prodromes. The study demonstrates very high internal consistency (Cronbach's α: attacks 0.88-0.98, prodromes 0.78-0.98). Analysis of variance confirmed significant differences between all dimensions and in pre-defined clusters (F (4, 61) = 45.74, p < 0.001, Eta2 = 0.77). Significant correlations were found between dimensions of prodromes and attacks. Prodromes are associated but differentiated from attacks. Correlations in severity were high for all domains. Interactions were found between prodromes and patients' experience in illness. In conclusion, the new Prodrome-Attack Evaluation questionnaire (HAE-EPA) is capable of distinguishing attacks and prodromes of HAE, as well as determining associations between the two interrelated phenomena. The new instrument achieves the required discriminative ability, acceptability, and content validity/reliability and therefore can be used as a reliable tool for the investigation of prodromes, attacks, and their relationships.
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Leibovich-Nassi I, Reshef A. The Enigma of Prodromes in Hereditary Angioedema (HAE). Clin Rev Allergy Immunol 2021; 61:15-28. [PMID: 33534063 DOI: 10.1007/s12016-021-08839-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2021] [Indexed: 11/30/2022]
Abstract
A prodrome is a premonitory set of signs and symptoms indicating the onset of a disease. Prodromes are frequently reported by hereditary angioedema (HAE) patients, antedating attacks by a few hours or even longer. In some studies, high incidence of prodromes was reported by patients, with considerable number being able to predict oncoming attacks. Regrettably, prodromes have never received a consensual definition and have not been properly investigated in a systematic fashion. Therefore, their nature remains elusive and their contribution to the diagnosis and treatment of disorders is uncertain. The term "prodrome," as used in various pathologies, denotes different meanings, timing, and duration, so it may not be equally suitable for all clinical situations. Perception of a prodrome is unique for each individual patient depending on self-experience. As modern drugs delegate the administration decision to the patients, early detection of a developing attack may help mitigate its severity and allow deployment of appropriate therapy. New diagnostic instruments were recently developed that can assist in defining the attributes of prodromes and their association with attacks. We will review the prodrome phenomenon as exhibited in certain clinical situations, with an emphasis on prodromes of HAE.
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Affiliation(s)
- Iris Leibovich-Nassi
- Barzilai University Medical Center, Ashkelon, Israel
- Department of Nursing, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avner Reshef
- Barzilai University Medical Center, Ashkelon, Israel.
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Clinically significant differences in patient-reported outcomes evaluations in chronic spontaneous urticaria. Curr Opin Allergy Clin Immunol 2020; 20:261-267. [PMID: 32073436 DOI: 10.1097/aci.0000000000000636] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to highlight the conceptual and practical knowledge for interpreting score changes in patient-reported outcomes (PROs) that have been validated for chronic spontaneous urticaria (CSU). RECENT FINDINGS The urticaria guidelines recommends to assess PROs as Health-Related Quality of Life, disease activity and disease control, to detect the CSU impact and the overall treatment effect. To this aim it is crucial to determine the minimal important difference (MID) to assess if changes in questionnaire scores represent either perceived improvement or deterioration for patients. Methods for establishing the MID are well defined and are clustered into two broad categories: distribution-based and anchor-based. SUMMARY For the majority of the available questionnaires for CSU, an MID has been defined, according to the results of various approaches. In most of the studies in our review, anchor-based methods, either alone or in combination with distribution ones, were used. The available information regarding MIDs across validated tools for CSU patients helps to interpret measurement scores and allows the implementation of PROs in routine practices.
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Cupping therapy for patients with chronic urticaria: A systematic review and meta-analysis. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2020; 18:303-312. [PMID: 32534938 DOI: 10.1016/j.joim.2020.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 04/09/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Chronic urticaria (CU) is a common skin disease, which has a negative effect on quality of life. Current treatments do not fully control the symptoms of urticaria for many CU patients, thus effective and safe treatments for CU are still needed. OBJECTIVE This review aims to evaluate the effectiveness and safety of cupping therapy in patients with CU. SEARCH STRATEGY The search strategy looked for the presence of related keywords, such as "chronic urticaria" and "cupping therapy," in the title and abstract of research articles indexed in major databases. Randomized controlled trials (RCTs) were selected after querying nine electronic databases from their inception to May 2019 with the above search terms. INCLUSION CRITERIA RCTs were included if they recruited patients with CU who were intervened with dry or wet cupping. Publications could be written in Chinese or English. DATA EXTRACTION AND ANALYSIS Data were extracted, and the studies were assessed for the quality of their methodological design and risk of bias. Meta-analyses of the RCT data were conducted to assess the total effective rate of the treatment as the primary outcome. Skin disease quality of life index score, recurrence rate, and adverse events were assessed as secondary outcomes. Subgroup analyses were conducted based on different interventions. RESULTS Thirteen comparisons from 12 RCTs involving 842 participants were included. There were no significant differences between wet cupping and medications in total effective rate (n = 372; risk ratio [RR] = 1.10, 95% confidence interval [CI] 0.97 to 1.25; P = 0.14) or recurrence rate (n = 240; RR = 0.56, 95% CI 0.23 to 1.36; P = 0.20). Cupping therapy, in combination with antihistamine treatment was more efficacious than antihistamines alone, with a greater total effective rate (n = 342; RR = 1.18, 95% CI 1.01 to 1.39; P = 0.03) and lower recurrence rate (n = 342; RR = 0.52, 95% CI 0.32 to 0.84; P = 0.007). Cupping therapy combined with acupuncture was more effective than acupuncture alone (n = 156; RR = 1.25, 95% CI 1.07 to 1.46; P = 0.006). No serious adverse events were reported. CONCLUSION Wet cupping may be as effective as treatment with antihistamines. When cupping therapy is used as an adjuvant therapy to antihistamines or acupuncture, it may enhance the efficacy. Results drawn from these studies should be interpreted with caution and applied with care to clinical practice, because of the poor quality among the studies that were reviewed. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42019137451.
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Maurer M, Eyerich K, Eyerich S, Ferrer M, Gutermuth J, Hartmann K, Jakob T, Kapp A, Kolkhir P, Larenas-Linnemann D, Park HS, Pejler G, Sánchez-Borges M, Schäkel K, Simon D, Simon HU, Weller K, Zuberbier T, Metz M. Urticaria: Collegium Internationale Allergologicum (CIA) Update 2020. Int Arch Allergy Immunol 2020; 181:321-333. [PMID: 32224621 DOI: 10.1159/000507218] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 12/13/2022] Open
Abstract
This update on chronic urticaria (CU) focuses on the prevalence and pathogenesis of chronic spontaneous urticaria (CSU), the expanding spectrum of patient-reported outcome measures (PROMs) for assessing CU disease activity, impact, and control, as well as future treatment options for CU. This update is needed, as several recently reported findings have led to significant advances in these areas. Some of these key discoveries were first presented at past meetings of the Collegium Internationale Allergologicum (CIA). New evidence shows that the prevalence of CSU is geographically heterogeneous, high in all age groups, and increasing. Several recent reports have helped to better characterize two endotypes of CSU: type I autoimmune (or autoallergic) CSU, driven by IgE to autoallergens, and type IIb autoimmune CSU, which is due to mast cell (MC)-targeted autoantibodies. The aim of treatment in CU is complete disease control with absence of signs and symptoms as well as normalization of quality of life (QoL). This is best monitored by the use of an expanding set of PROMs, to which the Angioedema Control Test, the Cholinergic Urticaria Quality of Life Questionnaire, and the Cholinergic Urticaria Activity Score have recently been added. Current treatment approaches for CU under development include drugs that inhibit the effects of signals that drive MC activation and accumulation, drugs that inhibit intracellular pathways of MC activation and degranulation, and drugs that silence MCs by binding to inhibitory receptors. The understanding, knowledge, and management of CU are rapidly increasing. The aim of this review is to provide physicians who treat CU patients with an update on where we stand and where we will go. Many questions and unmet needs remain to be addressed, such as the development of routine diagnostic tests for type I and type IIb autoimmune CSU, the global dissemination and consistent use of PROMs to assess disease activity, impact, and control, and the development of more effective and well-tolerated long-term treatments for all forms of CU.
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Affiliation(s)
- Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany,
| | - Kilian Eyerich
- Division of Dermatology and Venerology, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stefanie Eyerich
- Center for Allergy and Environment, Technical University and Helmholtz Center Munich, Munich, Germany
| | - Marta Ferrer
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra Pamplona, Spain, RETIC de Asma, Reacciones Adversas y Alérgicas, Madrid, Spain
| | - Jan Gutermuth
- Department of Dermatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Karin Hartmann
- Division of Allergy, Department of Dermatology, University of Basel, Basel, Switzerland
| | - Thilo Jakob
- Department of Dermatology and Allergy, University Medical Center Giessen, Justus-Liebig University Giessen, Giessen, Germany
| | - Alexander Kapp
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Pavel Kolkhir
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Division of Immune-Mediated Skin Diseases, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Désirée Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur, Clinical Foundation and Hospital, Mexico City, Mexico
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Gunnar Pejler
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela
| | - Knut Schäkel
- Department of Dermatology, Heidelberg University, Heidelberg, Germany
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Bern, Switzerland.,Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Karsten Weller
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Torsten Zuberbier
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martin Metz
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Lee JH. Impact of Chronic Urticaria on the Self-Assessed Health Status. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:557-559. [PMID: 32400123 PMCID: PMC7224995 DOI: 10.4168/aair.2020.12.4.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 12/03/2022]
Affiliation(s)
- Jae Hyun Lee
- Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea.
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20
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Schoepke N, Asero R, Ellrich A, Ferrer M, Gimenez‐Arnau A, E. H. Grattan C, Jakob T, Konstantinou GN, Raap U, Skov PS, Staubach P, Kromminga A, Zhang K, Bindslev‐Jensen C, Daschner A, Kinaciyan T, Knol EF, Makris M, Marrouche N, Schmid‐Grendelmeier P, Sussman G, Toubi E, Church MK, Maurer M. Biomarkers and clinical characteristics of autoimmune chronic spontaneous urticaria: Results of the PURIST Study. Allergy 2019; 74:2427-2436. [PMID: 31228881 DOI: 10.1111/all.13949] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/23/2019] [Accepted: 04/30/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Autoimmune chronic spontaneous urticaria (aiCSU) is an important subtype of chronic spontaneous urticaria (CSU) in which functional IgG autoantibodies to IgE or its high-affinity receptor (FcεRI) induces mast cell degranulation and subsequent symptom development. However, it has not been tightly characterized. This study aimed to better define the clinical and immunological features and to explore potential biomarkers of aiCSU. METHODS This was a multinational, multicenter study of 182 CSU patients. The clinical features studied included: urticaria activity and impact (UAS7 and quality of life); autologous serum skin test (ASST); IgG anti-FcεRI and IgG anti-IgE; IgG-anti-thyroperoxidase (IgG anti-TPO); total serum IgE; and basophil reactivity (BASO) using the basophil activation test (BAT) and basophil histamine release assay (BHRA). RESULTS Of the 182 patients, 107 (59%) were ASST+, 46 (25%) were BASO+, and 105 (58%) were IgG anti-FcεRI+/IgE+. Fifteen patients (8%) fulfilled all three criteria of aiCSU. aiCSU patients appeared more severe (UAS7 21 vs 9 P < 0.016) but showed no other clinical or demographic differences from non-aiCSU patients. aiCSU patients also had markedly lower total IgE levels (P < 0.0001) and higher IgG anti-TPO levels (P < 0.001). Of biomarkers, positive BAT and BHRA tests were 69% and 88% predictive of aiCSU, respectively. CONCLUSIONS aiCSU is a relatively small but immunologically distinct subtype of CSU that cannot be identified by routine clinical parameters. Inclusion of BHRA or BAT in the diagnostic workup of CSU patients may aid identification of aiCSU patients, who may have a different prognosis and benefit from specific management.
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Affiliation(s)
- Nicole Schoepke
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - Riccardo Asero
- Department of Allergology Clinica San Carlo Paderno Dugnano (MI) Italy
| | - André Ellrich
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - Marta Ferrer
- Department of Allergy and Clinical Immunology, Clinica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), RETIC de Asma Reacciones adversas y Alérgicas (ARADYAL) Pamplona Spain
| | - Ana Gimenez‐Arnau
- Department of Dermatology Hospital del Mar, IMIM, Universitat Autònoma Barcelona Barcelona Spain
| | | | - Thilo Jakob
- Department of Dermatology and Allergology, University Medical Center Giessen and Marburg Justus‐Liebig University Gießen Gießen Germany
- Allergy Research Group, Medical Center University of Freiburg Freiburg Germany
| | - George N. Konstantinou
- Department of Allergy and Clinical Immunology 424 General Military Training Hospital Thessaloniki Greece
| | - Ulrike Raap
- Department of Human Medicine and Health Sciences, University Clinic of Dermatology and Allergy University of Oldenburg Oldenburg Germany
| | - Per Stahl Skov
- RefLab ApS Copenhagen Denmark
- Odense Research Center of Anaphylaxis, ORCA Odense Denmark
| | - Petra Staubach
- Department of Dermatology University Medical Center Mainz Mainz Germany
| | - Arno Kromminga
- Bioagilytix Europe GmbH Hamburg Germany
- Institute of Immunology University of Kiel Kiel Germany
| | - Ke Zhang
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics David Geffen School of Medicine at UCLA Los Angeles California USA
| | - Carsten Bindslev‐Jensen
- Department of Dermatology and Allergy Centre Odense University Hospital, University of Southern Denmark Odense Denmark
| | - Alvaro Daschner
- Servicio de Alergia Instituto de Investigación Sanitaria (IIS)‐ Hospital Universitario de la Princesa Madrid Spain
| | - Tamar Kinaciyan
- Department of Dermatology Medical University of Vienna Vienna Austria
| | - Edward F. Knol
- Departments of Immunology and Dermatology/Allergology University Medical Center Utrecht Utrecht The Netherlands
| | - Michael Makris
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School National and Kapodistrian University of AthensAttikon” University Hospital Athens Greece
| | - Nadine Marrouche
- Department of Dermatology Norfolk and Norwich University Hospital Norwich UK
| | - Peter Schmid‐Grendelmeier
- Allergy Unit, Department of Dermatology University Hospital Zürich Switzerland
- Christine Kühne Center for Allergy Research and Education CK‐CARE Davos Switzerland
| | - Gordon Sussman
- Division of Allergy and Clinical Immunology University of Toronto Toronto Ontario Canada
| | - Elias Toubi
- Faculty of Medicine, Bnai‐Zion Medical Center Technion Haifa Israel
| | - Martin K. Church
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - Marcus Maurer
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
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Baiardini I, Fasola S, Maurer M, Weller K, Canonica GW, Braido F. Minimal important difference of the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL). Allergy 2019; 74:2542-2544. [PMID: 31169906 DOI: 10.1111/all.13939] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Ilaria Baiardini
- Department of Biomedical Sciences Humanitas University Milan Italy
- Dipartimento di Medicina Interna (DiMI) Università di Genova Genova Italy
- IRCCS Ospedale Policlinico San Martino Genova Italy
| | - Salvatore Fasola
- National Research Council of Italy Institute of Biomedicine and Molecular Immunology Palermo Italy
| | - Marcus Maurer
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - Karsten Weller
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences Humanitas University Milan Italy
- Personalized Medicine Asthma & Allergy Humanitas University Rozzano‐Milan Italy
| | - Fulvio Braido
- Dipartimento di Medicina Interna (DiMI) Università di Genova Genova Italy
- IRCCS Ospedale Policlinico San Martino Genova Italy
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Bloodletting Therapy for Patients with Chronic Urticaria: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8650398. [PMID: 31139656 PMCID: PMC6500668 DOI: 10.1155/2019/8650398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 04/04/2019] [Indexed: 12/28/2022]
Abstract
Background Many trials have reported that bloodletting therapy is effective when treating chronic urticaria. There are currently no systematic reviews of bloodletting therapy for chronic urticaria. Objective The aim of this review is to assess the effectiveness and safety of bloodletting therapy for chronic urticaria. Methods A systematic review and meta-analysis of randomized controlled trials were performed. Disease activity control was assessed as the primary outcome. Response rate, recurrence rate, and adverse events were assessed as secondary outcomes. Results Seven studies with 512 participants were included. One trial showed a significant difference between bloodletting therapy plus medicine and medicine alone in disease activity control (MD 0.67; 95% CI 0.03 to 1.31; p=0.04). Six trials (372 participants) showed a significant difference between bloodletting therapy and pharmacological medication in response rate (RR 1.10; 95% CI 0.97-1.26; P =0.15). Two studies (170 participants) showed a significant difference between bloodletting therapy plus pharmacological medication and pharmacological medication in response rate (RR 1.34; 95% CI 1.10-1.63; p=0.003). Two studies (126 participants) reported a statistically significant difference between bloodletting therapy and pharmacological medication in recurrence rate. No serious adverse events related to bloodletting therapy were reported. Conclusions Bloodletting therapy might be an effective and safe treatment for chronic urticaria, but the evidence is scarce. More high quality trials are needed in the future.
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Calderón MA, Casale TB, Demoly P. Validation of Patient-Reported Outcomes for Clinical Trials in Allergic Rhinitis: A Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1450-1461.e6. [PMID: 30797777 DOI: 10.1016/j.jaip.2019.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 01/05/2019] [Accepted: 01/07/2019] [Indexed: 01/07/2023]
Abstract
Although regulatory authorities have recently recommended the use of a combined symptom-medication score as a primary efficacy end point, none has been psychometrically validated. Here, we sought to determine to what extent allergic rhinitis (AR)-related patient-reported outcomes (symptom scores, medication scores, disease control scores, and satisfaction or quality-of-life scales) have been assessed for construct, content, and/or criterion validity, reliability, responsiveness, and the minimal clinically important difference. We searched the PubMed database from January 1997 to June 2018 with logical combinations of key words related to validation, AR, and patient-rated outcomes and scales. From a total of 1705 potentially relevant publications, 55 were reviewed. Despite the current emphasis on a combined symptom-medication score for evaluating the efficacy of allergen immunotherapy in AR, symptom scores have not been extensively validated, and we did not find any publications describing the validation of a medication score. Disease control scales (mainly the Rhinitis Control Assessment Test, the Control of Allergic Rhinitis and Asthma Test, and the Allergic Rhinitis Control Test) and health-related quality-of-life scales (mainly the Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ] and the mini-RQLQ) have been extensively validated in AR but have some practical disadvantages as primary efficacy criteria in clinical trials.
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Affiliation(s)
- Moises A Calderón
- National Heart & Lung Institute, Imperial College London, Royal Brompton Hospital NHS, London, United Kingdom
| | - Thomas B Casale
- Division of Allergy and Immunology, University of South Florida, Tampa, Fla
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France; Sorbonne Universités, UMR-S 1136, IPLESP, Equipe EPAR, Paris, France.
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Antia C, Baquerizo K, Korman A, Alikhan A, Bernstein JA. Urticaria: A comprehensive review: Treatment of chronic urticaria, special populations, and disease outcomes. J Am Acad Dermatol 2019; 79:617-633. [PMID: 30241624 DOI: 10.1016/j.jaad.2018.01.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Second-generation antihistamines are considered first-line agents in the treatment of chronic urticaria because of their safety and efficacy profile. Some patients require higher doses of H1 antihistamines alone or in combination with other classes of medications, including H2 antihistamines, leukotriene receptor antagonists, or first-generation H1 antihistamines. One major therapeutic advance has been omalizumab, a humanized monoclonal anti-immunoglobulin E that was recently approved by the US Food and Drug Administration for the treatment of chronic urticaria that is unresponsive to H1 antagonists. In addition, the second article in this continuing medical education series outlines several evidence-based alternative treatments for urticaria and the differences in recommendations between 2 major consensus groups (the European Academy of Allergy and Clinical Immunology/World Allergy Organization and the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force).
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Affiliation(s)
- Camila Antia
- Department of Dermatology, University of Cincinnati, Cincinnati, Ohio.
| | | | - Abraham Korman
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Ali Alikhan
- Department of Dermatology, University of Cincinnati, Cincinnati, Ohio
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Lee JH, Bae YJ, Lee SH, Kim SC, Lee HY, Ban GY, Shin YS, Park HS, Kratzsch J, Ye YM. Adaptation and Validation of the Korean Version of the Urticaria Control Test and Its Correlation With Salivary Cortisone. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:55-67. [PMID: 30479077 PMCID: PMC6267182 DOI: 10.4168/aair.2019.11.1.55] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/25/2018] [Accepted: 08/07/2018] [Indexed: 12/15/2022]
Abstract
Purpose Frequent changes in chronic urticaria (CU) activity over time can cause psychological stress, which also serves as a trigger of CU. To measure the control status of CU, the Urticaria Control Test (UCT) was developed in Germany. This study aimed to investigate the validity, reliability and responsiveness to changes in CU for the Korean version of the UCT (K-UCT) and its relation with salivary cortisol and cortisone levels. Methods Linguistic adaptation of the UCT into Korean was conducted. A total of 96 CU patients were enrolled, and 80 of them completed the study. The K-UCT and other outcome scores for CU were measured and repeated after 4 weeks of treatment. Control status was classified by physicians into well-controlled, partly-controlled, and uncontrolled CU. Salivary cortisol and cortisone were measured by liquid chromatography-tandem mass spectrometry. Results Excellent internal consistency and intra-class reliability were obtained. Strong correlations between the K-UCT and disease severity, reflected in the Urticaria Activity Score (UAS)/global assessment of urticaria control by physicians/patient assessment of symptom severity/CU-specific quality of life were noted. K-UCT scores ≥12 were found to be optimal for determining well-controlled CU (sensitivity, 75.0%; specificity, 758%; area under the curve, 0.824). Perceived stress scale scores were significantly correlated with the UAS and the K-UCT. Salivary cortisone levels were significantly correlated with K-UCT (r = 0.308, P = 0.009) and differed significantly according to control status determined by a K-UCT ≥12. Conclusions This study demonstrated that the K-UCT can be a valid instrument with which to gauge CU control status in Korean patients. Further studies are needed to validate salivary cortisone as a biomarker for CU control.
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Affiliation(s)
- Ji Ho Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yoon Ju Bae
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - So Hee Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Su Chin Kim
- Clinical Trial Center, Ajou University Medical Center, Suwon, Korea
| | - Hyun Young Lee
- Clinical Trial Center, Ajou University Medical Center, Suwon, Korea
| | - Ga Young Ban
- Department of Pulmonary, Allergy and Critical Care Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yoo Seob Shin
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Juergen Kratzsch
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Young Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
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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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Irani C, Hallit S, Weller K, Maurer M, El Haber C, Salameh P. Chronic urticaria in most patients is poorly controlled. Results of the development, validation, and real life application of the arabic urticaria control test. Saudi Med J 2018; 38:1230-1236. [PMID: 29209673 PMCID: PMC5787635 DOI: 10.15537/smj.2017.12.21206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To translate and linguistically validate the urticaria control test (UCT) to/for Arabic speakers. No Arabic version of the UCT is available to assess disease control in patients with chronic urticaria (CU). Secondary objectives were to assess disease control in Lebanese CU patients and determine influence factors. METHODS This is a prospective observational study of 178 CU patients diagnosed during their first visit to a private Allergy/Immunology Clinic, Hotel Dieu de France Hospital, Beirut, Lebanon between January and December 2014. RESULTS Factor analysis showed that all 4 UCT items on the Arabic version converged over a solution of one factor. A high internal consistency was found with a Cronbach's alpha of 0.824. Most patients in this study had chronic spontaneous urticaria (96%), of which 19% also had inducible urticaria. The majority was less than 40 years (67.4%), with disease duration of less than 2 years (70.8%). Most patients used H1-antihistamines, but unfortunately, 34.3% used systemic glucocorticosteroids, of which 24.7% also used H1-antihistamines. The disease was poorly controlled in most patients (79.2%, UCT less than 12). Age, gender, duration, diagnosis, triggers, and/or history of atopy had no influence. CONCLUSION We developed the first linguistically validated Arabic UCT to improve CU management in Arabic speaking patients. We also found that disease control was poor in most CU patients, and is unaffected by age, disease duration, gender, subtype, triggers, history of atopy, and/or previous treatments.
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Affiliation(s)
- Carla Irani
- Hotel-Dieu de France, Faculty of Pharmacy, St Joseph University, Beirut, Lebanon. E-mail.
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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: 795] [Impact Index Per Article: 132.5] [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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Ruft J, Asady A, Staubach P, Casale T, Sussmann G, Zuberbier T, Maurer M, Weller K, Altrichter S. Development and validation of the Cholinergic Urticaria Quality-of-Life Questionnaire (CholU-QoL). Clin Exp Allergy 2018; 48:433-444. [DOI: 10.1111/cea.13102] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/05/2018] [Accepted: 01/20/2018] [Indexed: 02/02/2023]
Affiliation(s)
- J. Ruft
- Department of Dermatology and Allergy; Urticaria Center of Reference and Excellence (UCARE); Charité-Universitätsmedizin Berlin; Berlin Germany
| | - A. Asady
- Department of Dermatology and Allergy; Urticaria Center of Reference and Excellence (UCARE); Charité-Universitätsmedizin Berlin; Berlin Germany
| | - P. Staubach
- Department of Dermatology; Urticaria Center of Reference and Excellence (UCARE); University Medical Center Mainz; Mainz RP Germany
| | - T. Casale
- Division of Allergy and Immunology; University of South Florida; Tampa FL USA
| | - G. Sussmann
- Division of Clinical Immunology and Allergy; Urticaria Center of Reference and Excellence (UCARE); University of Toronto; Toronto ON Canada
| | - T. Zuberbier
- Department of Dermatology and Allergy; Urticaria Center of Reference and Excellence (UCARE); Charité-Universitätsmedizin Berlin; Berlin Germany
| | - M. Maurer
- Department of Dermatology and Allergy; Urticaria Center of Reference and Excellence (UCARE); Charité-Universitätsmedizin Berlin; Berlin Germany
| | - K. Weller
- Department of Dermatology and Allergy; Urticaria Center of Reference and Excellence (UCARE); Charité-Universitätsmedizin Berlin; Berlin Germany
| | - S. Altrichter
- Department of Dermatology and Allergy; Urticaria Center of Reference and Excellence (UCARE); Charité-Universitätsmedizin Berlin; Berlin Germany
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Giménez‐Arnau A, Curto‐Barredo L, Nonell L, Puigdecanet E, Yelamos J, Gimeno R, Rüberg S, Santamaria‐Babi L, Pujol R. Transcriptome analysis of severely active chronic spontaneous urticaria shows an overall immunological skin involvement. Allergy 2017; 72:1778-1790. [PMID: 28407332 DOI: 10.1111/all.13183] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The knowledge about chronic spontaneous urticaria (CSU) phenotypes is based on its clinical characteristics, associated comorbidities, course of the disease, and its response to the available effective drugs. Genotype expression and its further correlation with CSU phenotypes are still unknown. We describe the cutaneous transcriptome of patients suffering a severely active CSU refractory to antihistamine treatment. METHODS Through the bioinformatic analysis of the whole Human Genome with Oligo Microarrays and quantitative real-time polymerase chain reaction (qPCR), relevant genes expressed in nonlesional (NLS-CSU) and lesional skin (LS-CSU) and peripheral blood were identified in 20 patients suffering from severely active CSU and 10 healthy controls (HCs). RESULTS From 39 genes differentially expressed in NLS-CSU when compared with HCs, 31 (79.48%) were confirmed by qPCR corresponding to genes involved in epidermal homeostasis and dermal repair. From the analysis comparing LS-CSU with NLS-CSU, a selection of 142 genes was studied with qPCR, and 103 (72.53%) were confirmed. Differentially expressed genes in the phenomenon of wheal development are involved in a variety of biological functions as, epidermal differentiation, intracellular signal function, transcriptional factors cell cycle differentiation, inflammation, or coagulation. Differentially expressed genes that uniformly increase or decrease along the skin worsening until the wheal appearance is shown. CONCLUSION The skin of CSU patients with a severely active disease shows an overall immunological skin involvement showing a peculiar gene profile.
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Affiliation(s)
- A. Giménez‐Arnau
- Department of Dermatology Hospital del Mar IMIM Universitat Autònoma de Barcelona Barcelona Spain
| | - L. Curto‐Barredo
- Department of Dermatology Hospital del Mar IMIM Universitat Autònoma de Barcelona Barcelona Spain
| | - L. Nonell
- Microarray Analysis Service Institut Hospital del Mar d'Investigacions Mèdiques (IMIM) Barcelona Spain
| | - E. Puigdecanet
- Microarray Analysis Service Institut Hospital del Mar d'Investigacions Mèdiques (IMIM) Barcelona Spain
| | - J. Yelamos
- Immunology Department Institut Hospital del Mar d'Investigacions Mèdiques (IMIM) Barcelona Spain
| | - R. Gimeno
- Immunology Department Institut Hospital del Mar d'Investigacions Mèdiques (IMIM) Barcelona Spain
| | - S. Rüberg
- Microarray Analysis Service Milteny Biotec GmbH Teterow Germany
| | - L. Santamaria‐Babi
- Translational Immunology, Department of Physiology and Immunology Universitat de Barcelona Barcelona Spain
| | - R.M. Pujol
- Department of Dermatology Hospital del Mar IMIM Universitat Autònoma de Barcelona Barcelona Spain
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Stull D, McBride D, Tian H, Gimenez Arnau A, Maurer M, Marsland A, Balp MM, Khalil S, Grattan C. Analysis of disease activity categories in chronic spontaneous/idiopathic urticaria. Br J Dermatol 2017; 177:1093-1101. [DOI: 10.1111/bjd.15454] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2017] [Indexed: 11/30/2022]
Affiliation(s)
- D. Stull
- RTI Health Solutions; 200 Park Offices Drive, PO Box 12194 Research Triangle Park NC 27709-2194 U.S.A
| | - D. McBride
- RTI Health Solutions; The Pavilion, Towers Business Park, Wilmslow Road, Didsbury Manchester M20 2LS U.K
| | - H. Tian
- Novartis Pharmaceuticals Corporation; East Hanover NJ U.S.A
| | - A. Gimenez Arnau
- Department of Dermatology; Hospital del Mar and Universitat Autònoma; Barcelona Spain
| | - M. Maurer
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - A. Marsland
- Dermatology Department; Salford Royal Hospital and University of Manchester; Manchester U.K
| | - M.-M. Balp
- Novartis Pharma AG; GMA & HEOR; Novartis Campus Basel 4056 Switzerland
| | - S. Khalil
- Novartis Pharma AG; GMA & HEOR; Novartis Campus Basel 4056 Switzerland
| | - C. Grattan
- Cutaneous Allergy; Guy's Hospital; London U.K
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Lima H, Gooderham M, Dutz J, Lynde C, Chapdelaine H, Ellis A, Gilbert M, Ho V, Papp K, Poulin Y, Sussman G. Management of chronic spontaneous urticaria (CSU): a treat to target approach using a patient reported outcome. Allergy Asthma Clin Immunol 2017; 13:38. [PMID: 28852410 PMCID: PMC5569543 DOI: 10.1186/s13223-017-0210-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 08/04/2017] [Indexed: 11/22/2022] Open
Abstract
Background Treat-to-target therapy approaches are established for chronic diseases such as diabetes, hypertension, and more recently rheumatoid arthritis, resulting in improved patient outcomes. These approaches do not use patient reported outcomes (PRO) as targets of therapy. Chronic spontaneous urticaria (CSU), also called chronic idiopathic urticaria (CIU), is defined as recurrent urticaria of known and unknown cause, lasting more than 6 weeks. Treatment of CSU can be challenging. However, with the advent of proven therapies and validated instruments for measuring disease activity, the concept of treat-to-target (T2T) can be successfully applied to CSU. Herein, we propose a potential PRO therapeutic target and suggest a T2T approach for the management of patients with CSU. Methods Principles and recommendations for a treat-to-target approach in CSU (T2T/CSU) were developed by a Canadian task force, consisting of dermatologists, immunologists, and allergists. The task force formulated recommendations for therapeutic targets in CSU on the basis of a systematic literature review and expert opinion. Results The key features of these T2T/CSU recommendations are the use of a PRO as the principal target, with symptom control as measured by Urticaria Activity Score 7 (UAS7 ≤ 6), targeting symptom remission (UAS7 = 0). Conclusion Treatment targets such as UAS7 ≤ 6 and UAS7 = 0 provide a benchmark for success in the care of patients with CSU, and will permit the evaluation of a PRO-based T2T approach in the care of these patients and the effect of this approach on improved patient care as seen in other chronic diseases.
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Affiliation(s)
- Hermenio Lima
- Division of Dermatology, Department of Medicine, McMaster University, HSC-3U8, 1280 Main St. West, Hamilton, ON L8S 4K1 Canada
| | - Melinda Gooderham
- SKiN Centre for Dermatology and Probity Medical Research, Peterborough, ON Canada
| | - Jan Dutz
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC Canada
| | | | - Hugo Chapdelaine
- Division of Allergy & Immunology, Department of Medicine, Université de Montréal, Montreal, QC Canada
| | - Anne Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, ON Canada
| | - Martin Gilbert
- Hôpital du Saint-Sacrement du CHU de Québec, Quebec City, QC Canada
| | - Vincent Ho
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC Canada
| | - Kim Papp
- Clinical Research and Probity Medical Research, Waterloo, ON Canada
| | - Yves Poulin
- Department of dermatology, Hôpital Hôtel-Dieu du CHU de Québec, and Centre de Recherche Dermatologique du Québec métropolitain, Quebec City, QC Canada
| | - Gordon Sussman
- Division of Allergy and Clinical Immunology, St. Michael's Hospital, Toronto, ON Canada
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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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Weller K, Siebenhaar F, Hawro T, Altrichter S, Schoepke N, Maurer M. Clinical Measures of Chronic Urticaria. Immunol Allergy Clin North Am 2016; 37:35-49. [PMID: 27886909 DOI: 10.1016/j.iac.2016.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The use of standardized, valid, and reliable clinical measures is an important element in modern patient management, particularly in diseases that are not objectively assessable and are associated with a high disease burden. Chronic urticaria is such a disorder for which several new and well-developed clinical measures became available. These measures comprise tools to assess disease activity, disease control, and health-related quality-of-life impairment. This review provides an overview of the currently available clinical measures for chronic urticaria. In addition, it provides information on their strengths and limitations and how to best use them and evaluate their results.
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Affiliation(s)
- Karsten Weller
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, Chariteplatz 1, 10117 Berlin, Germany.
| | - Frank Siebenhaar
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Tomasz Hawro
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Sabine Altrichter
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Nicole Schoepke
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Marcus Maurer
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, Chariteplatz 1, 10117 Berlin, Germany
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Tanno LK, Calderon MA, Smith HE, Sanchez-Borges M, Sheikh A, Demoly P. Dissemination of definitions and concepts of allergic and hypersensitivity conditions. World Allergy Organ J 2016; 9:24. [PMID: 27551327 PMCID: PMC4977713 DOI: 10.1186/s40413-016-0115-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 07/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Allergy and hypersensitivity can affect people of any age and manifest with problems in a range of organ systems. Moreover, they can have a significant impact on the quality of life of patients and their families. Although once rare, there is presently an epidemic of allergic disorders with associated considerable societal consequences. Our understanding of the pathophysiology of these disorders has changed substantially over the last 20 years. In the light of these developments, the Joint Allergy Academies have made concerted efforts to ensure that these are reflected in the current definitions and concepts used in clinical allergy and to ensure these are reflected in the forthcoming International Classification of Diseases-11 (ICD-11). OBJECTIVE In this review, we seek to provide an update on the current definitions and concepts in relation to allergic disorders. RESULTS Once the new section has been built in the ICD-11 to address allergic and hypersensitivity conditions, we have been moving actions to try to support awareness by disseminating updated concepts in the field. Aligned with the ICD and the WAO philosophy of being global, this document presents fundamental and broad allergy concepts to strengthen the understanding by different health professionals worldwide, besides to support the formation of in training students. CONCLUSION This current review intends to be accepted and used universally by all health professionals involved in diseases' classification and coding and, therefore, contribute to improve care and outcomes in this increasing sub-section of the world's population.
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Affiliation(s)
- Luciana Kase Tanno
- Hospital Sírio Libanês, São Paulo, Brazil
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
- Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France
| | - Moises A. Calderon
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, UK
| | - Helen E. Smith
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Mario Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Caracas, Venezuela
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
- Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France
| | - on behalf of Joint Allergy Academies
- Hospital Sírio Libanês, São Paulo, Brazil
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
- Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, UK
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
- Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Caracas, Venezuela
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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Staubach P, Metz M, Chapman-Rothe N, Sieder C, Bräutigam M, Canvin J, Maurer M. Effect of omalizumab on angioedema in H1 -antihistamine-resistant chronic spontaneous urticaria patients: results from X-ACT, a randomized controlled trial. Allergy 2016; 71:1135-44. [PMID: 27010957 DOI: 10.1111/all.12870] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) severely impacts quality of life (QoL), especially in patients with wheals and angioedema. Omalizumab is approved as add-on therapy for CSU patients; however, its effect on patients who are double-positive for wheals and angioedema has not been systematically studied. OBJECTIVE The primary objective was to evaluate the efficacy of omalizumab vs placebo at week 28 using the Chronic Urticaria Quality of Life (CU-Q2oL) questionnaire. Number of angioedema-burdened days, time interval between successive angioedema episodes, disease activity, angioedema-specific and overall QoL impairment were secondary objectives. METHODS X-ACT was a phase III, randomized, double-blind study conducted in 24 centres (Germany), which selectively included CSU patients with angioedema and wheals. Patients were randomized (1 : 1) to omalizumab 300 mg or placebo (every 4 weeks up to week 24) (ClinicalTrials.gov number: NCT01723072). RESULTS Of the 91 patients randomized to omalizumab (n = 44) or placebo (n = 47) at baseline, 68 completed the 28-week treatment phase (omalizumab, 35; placebo, 33). Omalizumab was superior to placebo in improving CU-Q2oL scores at week 28 (P < 0.001). There was a threefold improvement in angioedema-burdened days/week with omalizumab (0.3) vs placebo (1.1). The median time to first recurrence of angioedema was 57-63 days with omalizumab and <5 days with placebo. Omalizumab significantly improved angioedema-specific QoL (P < 0.001). The adverse events reported are in line with the established safety profile of omalizumab. CONCLUSION Omalizumab was an effective treatment option for patients with moderate-to-severe CSU symptoms and angioedema unresponsive to high doses of antihistamine treatment.
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Affiliation(s)
- P. Staubach
- Hautklinik und Poliklinik; Universitätsmedizin der Johannes Gutenberg-Universität Mainz; Mainz Germany
| | - M. Metz
- Allergie-Centrum-Charité; Klinik für Dermatologie, Venerologie und Allergologie; Charité - Universitätsmedizin Berlin; Berlin Germany
| | | | - C. Sieder
- Novartis Pharma GmbH; Nürnberg Germany
| | | | - J. Canvin
- Novartis Pharma AG; Basel Switzerland
| | - M. Maurer
- Allergie-Centrum-Charité; Klinik für Dermatologie, Venerologie und Allergologie; Charité - Universitätsmedizin Berlin; Berlin Germany
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Altrichter S, Koch K, Church MK, Maurer M. Atopic predisposition in cholinergic urticaria patients and its implications. J Eur Acad Dermatol Venereol 2016; 30:2060-2065. [PMID: 27324252 DOI: 10.1111/jdv.13765] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/31/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cholinergic urticaria (CholU) is a frequent chronic urticaria disorder with itchy weal and flare-type skin reactions in response to physical exercise or passive warming. A higher frequency of atopy among CholU patients has been reported, but the significance of this observation is unclear. OBJECTIVE To assess the prevalence and relevance of atopy in CholU patients. MATERIALS AND METHODS Thirty CholU patients were assessed for atopic skin diathesis (atopic predisposition) by use of the Erlangen Atopy Score and divided into atopic and non-atopic predisposed CholU individuals. Both groups were assessed for disease severity (CholUSI) and activity (CholUAS7), quality of life impairment [Dermatology Life Quality Index (DLQI) and CU-Q2 OL], seasonal exacerbation, total and specific serum IgE and comorbidities. RESULTS CholU patients were found to exhibit high rates of atopic predisposition (57%), with higher prevalence and scores in female than in male patients. High Erlangen Atopy Scores were linked to high CholU severity, activity and impact on QoL. Atopic predisposed CholU patients show different seasonal exacerbation patterns, IgE specificity and comorbidity profiles as compared to non-atopic CholU patients. CONCLUSION Atopic predisposition and cholinergic urticaria appear to be linked more closely than previously thought, which suggests shared pathogenetic mechanisms. Atopic patients with cholinergic urticaria have more severe disease and poorer quality of life than those who do not. Thus, all cholinergic urticaria patients should be assessed for atopic predisposition.
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Affiliation(s)
- S Altrichter
- Department of Dermatology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - K Koch
- Department of Dermatology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M K Church
- Department of Dermatology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Maurer
- Department of Dermatology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Clinically relevant outcome measures for assessing disease activity, disease control and quality of life impairment in patients with chronic spontaneous urticaria and recurrent angioedema. Curr Opin Allergy Clin Immunol 2016; 15:220-6. [PMID: 25899695 DOI: 10.1097/aci.0000000000000163] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to highlight the most important, clinically relevant patient-reported outcome (PRO) measures for chronic spontaneous urticaria and recurrent angioedema. RECENT FINDINGS The use of PROs becomes increasingly important in modern patient-centred medicine. In the past years, several new, validated and reliable tools for the assessment of disease activity, disease control and health-related quality of life impairment of chronic spontaneous urticaria and recurrent angioedema patients have become available. These are required to optimize and standardize clinical trials. In addition, they are of increasing relevance in routine management. The major advantage of their application is that they do not only improve and standardize medical record keeping and care but also release valuable time for the actual physician-patient consultation. A prerequisite for this to work out is, however, that the PROs are well embedded into patient management. SUMMARY The currently available PRO measures can help to better determine the patient's disease status, to aid, document and back treatment decisions as well as to improve the assessment of treatment effects. Linguistically validated versions of the PROs are available for many but not all languages yet. Here, further research is needed to close these gaps.
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Termeer C, Staubach P, Kurzen H, Strömer K, Ostendorf R, Maurer M. Chronic spontaneous urticaria - a management pathway for patients with chronic spontaneous urticaria. J Dtsch Dermatol Ges 2016; 13:419-28. [PMID: 25918085 DOI: 10.1111/ddg.12633] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Chronic spontaneous urticaria (CSU) is a common and challenging disease, especially with respect to healthcare provision in the context of the German statutory health insurance system. If treatment with second-generation antihistamines is unsuccessful, current guidelines recommend further therapeutic options. However, most of these are off-label. This discrepancy between treatment according to guidelines and the ability to prescribe drugs at the expense of the statutory health insurance (reimbursability) often leads to uncertainties in everyday clinical practice. In addition, physicians prescribing certain drugs are faced with the difficulty of measuring and documenting therapeutic success/outcome. Respective outcome measurement methods have not yet been established in daily practice. Using a consensus process, a working group composed of dermatologists in private practice and specialized urticaria centers has defined a practical pathway for the implementation of current treatment recommendations based on the 2013 S3 guidelines for urticaria. Here, we present a diagnostic and therapeutic management pathway for CSU. Further, we discuss prescription issues in daily practice, including updosing of antihistamines, with regard to cost-effectiveness and drug approval on the basis of published studies and current legislation. Constituting the highest treatment level, the use of cyclosporine A, montelukast, and omalizumab, which has recently become available as therapeutic option, is reviewed. The urticaria control test (UCT) is presented as a valid outcome measure in routine practice. Our objective was to provide physicians in private practice with a practical guideline-based therapeutic decision tool, taking into account the requirements imposed by the statutory health insurance system. It is not meant to replace individualized history taking or treatment of this heterogeneous disease. Rather, we would like to suggest reference points for clinical diagnosis and treatment of CSU.
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Affiliation(s)
- Christian Termeer
- Private Practice Stuttgart, Department of Dermatology, University of Freiburg
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Weller K, Zuberbier T, Maurer M. Chronic urticaria: tools to aid the diagnosis and assessment of disease status in daily practice. J Eur Acad Dermatol Venereol 2016; 29 Suppl 3:38-44. [PMID: 26053294 DOI: 10.1111/jdv.13200] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 04/14/2015] [Indexed: 11/27/2022]
Abstract
This article focuses on practical considerations for the optimal management of chronic urticaria (CU) with regard to the tools and instruments that are currently available to assist in the diagnosis and assessment of this condition before and during treatment.
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Affiliation(s)
- K Weller
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T Zuberbier
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Maurer
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Stull DE, McBride D, Houghton K, Finlay AY, Gnanasakthy A, Balp MM. Assessing Changes in Chronic Spontaneous/Idiopathic Urticaria: Comparisons of Patient-Reported Outcomes Using Latent Growth Modeling. Adv Ther 2016; 33:214-24. [PMID: 26833304 PMCID: PMC4769726 DOI: 10.1007/s12325-016-0282-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Assessing the consequences of chronic spontaneous/idiopathic urticaria (CSU) requires the evaluation of health-related quality of life (HRQoL) associated with the severity of CSU signs and symptoms. It is important to understand how signs, symptoms, and HRQoL change over time in CSU. Evidence is lacking on how closely changes in signs and symptoms of CSU are related to changes in HRQoL. The objective of this study was to assess the correlation between changes in patient-reported outcome measures (PROMs) of signs and symptoms, dermatologic quality of life (QoL), and urticaria-specific QoL. METHODS Latent growth models (LGMs) were applied to longitudinal data from three randomized, Phase 3 clinical trials investigating the efficacy and safety of omalizumab in CSU. RESULTS A near-perfect association between changes in signs and symptoms and changes in dermatologic and urticaria-specific QoLs was identified in each clinical trial when using LGMs (correlation coefficient range 0.88-0.92). CONCLUSION Evidence showed that changes in signs and symptoms are closely related to changes in HRQoL. However, analyses were performed on clinical trial results of an extremely effective treatment; a less effective treatment with much smaller changes over time may not show such close correlations. Results suggest that any of these PROMs may be used to understand changes in CSU.
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Mösges R, Lee DLY, Abong J, Siasoco B, Chow SK, Leong JL, Singh H, Kuljit S, Campomanes B. Role of bilastine in the management of allergic rhinitis and urticaria: an Asia-Pacific consensus statement. Asia Pac Allergy 2016; 6:56-66. [PMID: 26844221 PMCID: PMC4731482 DOI: 10.5415/apallergy.2016.6.1.56] [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: 09/16/2015] [Accepted: 12/31/2015] [Indexed: 01/14/2023] Open
Abstract
The prevalence of allergic diseases is increasing globally, most particularly in middle- to low-income countries. This article examines the burden of allergic rhinitis and chronic urticaria in the Asia-Pacific region, unmet clinical needs, and the potential role of bilastine in the management of these conditions. An International Advisory Group meeting was convened in association with the Asian Pacific Society of Respirology Annual Congress in November 2014, followed by a literature review, and consensus-based outcomes from the meeting and literature review are described. Regional estimates of the prevalence of allergic rhinitis range from 10% to 50%, while little is known regarding the burden of urticaria in the Asia-Pacific region. A survey of allergy patients in the region identified fast, complete, and long-lasting symptom relief as the medication attributes most important to patients. International treatment guidelines for allergic rhinitis and urticaria advocate the first-line use of second-generation, no-sedating H1-antihistamines, such as bilastine, over their first-generation counterparts and a range of these agents are available to Asia-Pacific patients. The newer agents possess many of the properties of an "ideal" antihistamine (once daily administration, rapid and complete symptom relief, limited potential for drug-drug interactions, minimal side effects). The burgeoning prevalence of allergic diseases in the Asia-Pacific region and the uncontrolled symptoms that these patients experience demand a new antihistamine that offers the highest number of positive features according to the international guidelines.
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Affiliation(s)
- Ralph Mösges
- Institute of Medical Statistics, Informatics and Epidemiology, University Hospital of Cologne, 50931 Cologne, Germany
| | - Dennis Lip Yen Lee
- Department of Ear, Nose, and Throat, United Christian Hospital and Department of Otorhinolaryngology, Head and Neck Surgery, Chinese University of Hong Kong, Hong Kong, China
| | - Jovilia Abong
- University of the Philippines College of Medicine and Philippine General Hospital, 1000 Manila, Philippines
| | - Bella Siasoco
- University of the Philippines College of Medicine and Philippine General Hospital, 1000 Manila, Philippines
| | - Steven Kw Chow
- The KL Skin Centre, Pantai Hospital, 59100 Kuala Lumpur, Malaysia
| | - Jern-Lin Leong
- Ascent Ear Nose Throat Specialist Group, Mount Elizabeth Medical Centre, Singapore 228510, Singapore
| | - Harvinder Singh
- Hospital Raja Permaisuri Bainun (Ipoh General Hospital), 30990 Ipoh, Malaysia
| | - S Kuljit
- Department of Otorhinolaryngology, Prince Court Medical Centre, 50450 Kuala Lumpur, Malaysia
| | - Benjamin Campomanes
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Santo Tomas, 1008 Manila, Philippines
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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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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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Bonner N, Abetz-Webb L, Renault L, Caballero T, Longhurst H, Maurer M, Christiansen S, Zuraw B. Development and content validity testing of a patient-reported outcomes questionnaire for the assessment of hereditary angioedema in observational studies. Health Qual Life Outcomes 2015; 13:92. [PMID: 26129930 PMCID: PMC4487558 DOI: 10.1186/s12955-015-0292-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 06/22/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hereditary Angioedema (HAE), a rare genetic disease, manifests as intermittent, painful attacks of angioedema. Attacks vary in frequency and severity and include skin, abdominal and life-threatening laryngeal swellings. This study aimed to develop a patient reported outcome (PRO) tool for the assessment of HAE attacks, including their management and impact on patients' lives, for use in clinical studies, or by physicians in general practice. METHODS The results of open-ended face to face concept elicitation interviews with HAE patients in Argentina (n = 10) and the US (n = 33) were used to develop the first draft questionnaire of the HAE patient reported outcomes questionnaire (HAE PRO). Subsequently, in-depth cognitive debriefing interviews were performed with HAE patients in the UK (n = 10), Brazil (n = 10), Germany (n = 11) and France (n = 12). Following input from eight multinational clinical experts further cognitive interviews were conducted in the US (n = 12) and Germany (n = 12). Patients who experienced abdominal, cutaneous or laryngeal attacks of varying severity levels were included in all rounds of interviews. Across the rounds of interviews patients discussed their HAE attack symptoms, impacts and treatments. Cognitive debriefing interviews explored patient understanding and relevance of questionnaire items. All interviews were conducted face to face following a pre-defined semi-structured interview guide in the patient's native language. RESULTS Patients reported a variety of HAE symptoms, attack triggers, warning signs, attack impacts and treatment options which were used to develop the HAE PRO. The HAE PRO was revised and refined following input from patients and clinical experts. The final 18-item HAE PRO provides an assessment of the HAE attack experience including symptoms, impacts, treatment requirements, healthcare resource use and loss of productivity caused by HAE attacks. CONCLUSIONS Patient and expert input has contributed to the development of a content valid questionnaire that assesses concepts important to HAE patients globally. HAE patients across cultures consider the HAE PRO a relevant and appropriate assessment of HAE attacks and treatment.
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Affiliation(s)
- Nicola Bonner
- Adelphi Values, Adelphi Mill, Bollington, Cheshire, UK.
| | | | | | - Teresa Caballero
- University Hospital, La Paz, Hospital La Paz Institute for Health Research (IdiPaz), Biomedical Research Network on Rare Diseases-U754 (CIBERER), Madrid, Spain.
| | | | - Marcus Maurer
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Sandra Christiansen
- Medicine Division Allergy/ Immunology and US HAEA Angioedema Center, University of California, San Diego, CA, USA.
| | - Bruce Zuraw
- Department of Medicine, Division of Rheumatology, Allergy and Immunology, UC San Diego School of Medicine, San Diego, CA, USA.
- San Diego Veterans Hospital, San Diego, CA, USA.
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Termeer C, Staubach P, Kurzen H, Strömer K, Ostendorf R, Maurer M. Chronische spontane Urtikaria - Ein Behandlungspfad für die Diagnosestellung und Therapie in der Praxis. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.12633_suppl] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | - Marcus Maurer
- Charité - Universitätsmedizin Berlin, Klinik für Dermatologie, Venerologie und Allergologie
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48
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Stitt JM, Dreskin SC. The potential role of omalizumab in the treatment of chronic urticaria. Immunotherapy 2015; 6:691-7. [PMID: 25186602 DOI: 10.2217/imt.14.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Treatment of chronic urticaria refractory to antihistamines presents a challenge to both people affected with the disease as well as the physicians who treat them. Omalizumab, a monoclonal antibody against IgE, has emerged as one potential solution to this challenge. In several clinical trials published between 2011 and 2013, omalizumab significantly reduced or eliminated symptoms of chronic urticaria. The optimal dose for chronic urticaria is 300 mg administered every 4 weeks, a dose that differs from those used in asthma, which are based on the patient's weight and IgE level. Omalizumab does not appear to cause lasting symptom remission, and the ideal duration of treatment for chronic urticaria has not been defined.
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Affiliation(s)
- Jenny M Stitt
- University of Colorado Denver, Division of Allergy & Clinical Immunology, Campus Box B164, Research Complex 2, Room 10002, 2700 E 19th Ave, Aurora, CO 80045, USA
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49
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O'Donnell BF. Urticaria: impact on quality of life and economic cost. Immunol Allergy Clin North Am 2014; 34:89-104. [PMID: 24262691 DOI: 10.1016/j.iac.2013.09.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Patients with urticaria suffer itch, swellings, fatigue caused by sleep disturbance and the side effects of medication, and disruption of many facets of their lives. Much progress has been made in formally evaluating the degree of quality-of-life (QoL) impairment suffered by patients with urticaria. This review focuses on QoL in chronic urticaria (>6 weeks duration) and examines QoL measures, including the chronic urticaria-quality of life questionnaire (CU-Q2oL). Patients with urticaria have difficulty identifying and coping with their emotions. The psychiatric comorbidity and the financial burden on the patient and society because of chronic urticaria, is also examined.
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Affiliation(s)
- Brigid F O'Donnell
- Department of Dermatology, Children's University Hospital, Temple Street, Dublin 1, Ireland; Department of Dermatology, Mater Misericordiae Hospital, Eccles Street, Dublin 7, Ireland.
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50
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Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, Church MK, Ensina LF, Giménez-Arnau A, Godse K, Gonçalo M, Grattan C, Hebert J, Hide M, Kaplan A, Kapp A, Abdul Latiff AH, Mathelier-Fusade P, Metz M, Saini SS, Sánchez-Borges M, Schmid-Grendelmeier P, Simons FER, Staubach P, Sussman G, Toubi E, Vena GA, Wedi B, Zhu XJ, Nast A, Maurer M. Methods report on the development of the 2013 revision and update of the EAACI/GA2 LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria. Allergy 2014; 69:e1-29. [PMID: 24898678 DOI: 10.1111/all.12370] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2014] [Indexed: 10/25/2022]
Abstract
This methods report describes the process of guideline development in detail. It is the result of a systematic literature review using the 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE) methodology and a structured consensus conference held on 28 and 29 November 2012, in Berlin. It is a joint initiative of the Dermatology Section of the European Academy of Allergy and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA(2) LEN), the European Dermatology Forum (EDF), and the World Allergy Organization (WAO) with the participation of delegates of 21 national and international societies. 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. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS) and is published in Allergy 2014; 69:868-887.
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Affiliation(s)
- T. Zuberbier
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - W. Aberer
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - R. Asero
- Allergy Clinic; Clinica San Carlo; Paderno Dugnano Italy
| | - 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
- Respiratory Diseases & Allergy; University of Genoa; IRCCS AOU SanMartino; Genoa Italy
| | - M. K. Church
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - L. F. Ensina
- Federal University of Sao Paulo; Sao Paulo Brazil
| | - A. Giménez-Arnau
- Hospital del Mar. Parc de Salut Mar; Universitat Autònoma; 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' Hospitals NHS Foundation Trust; London UK
| | - J. Hebert
- Center for Applied Research on Allergy Québec; Québec QC Canada
| | - M. Hide
- Department of Dermatology; Institute of Biomedical and Health Sciences; Hiroshima University; Hiroshima Japan
| | - A. Kaplan
- Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology; Department of Medicine; Medical University of South Carolina; Charleston SC USA
| | - A. Kapp
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - A. H. Abdul Latiff
- Department of Paediatrics; Pantai Hospital Kuala Lumpur; Bangsar Malaysia
| | - P. Mathelier-Fusade
- Department of Dermatology and Allergy; University Hospital of Tenon; Paris France
| | - M. Metz
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; 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
| | | | - F. E. R. Simons
- Department of Pediatrics & Child Health; University of Manitoba; Winnipeg MB Canada
- Department of Immunology; University of Manitoba; Winnipeg MB Canada
| | - 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
- Unit of Dermatology and Venereology; Department of Biomedical Sciences and Human Oncology; University of Bari; Bari Italy
| | - B. Wedi
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - X. J. Zhu
- Department of Dermatology; Peking University First Hospital; Beijing China
| | - A. Nast
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
| | - M. Maurer
- Department of Dermatology and Allergy; Allergy-Centre-Charité; Charité - University Hospital Berlin; Berlin Germany
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