Patient-Reported Outcome Measures in Atopic Dermatitis and Chronic Urticaria are Underused in Clinical Practice

BACKGROUND

Patient-reported outcome measures (PROMs) are validated and standardized tools that complement physician evaluations and guide treatment decisions. PROMs are crucial for monitoring atopic dermatitis (AD) and chronic urticaria (CU) in clinical practice, but there are unmet needs and knowledge gaps regarding their use in clinical practice.

OBJECTIVE

We investigated the global real-world use of AD and CU PROMs in allergology and dermatology clinics as well as their associated local and regional networks.

METHODS

Across 72 specialized allergy and dermatology centers and their local and regional networks, 2,534 physicians in 73 countries completed a 53-item questionnaire on the use of PROMs for AD and CU.

RESULTS

Of 2,534 physicians, 1,308 were aware of PROMs. Of these, 14% and 15% used PROMs for AD and CU, respectively. Half of physicians who use PROMs do so only "rarely" or "sometimes". AD and CU PROM usage is associated with being female, younger, and a dermatologist. POSCORAD and UAS were the most utilized PROMs for AD and CU, respectively. Monitoring disease control and activity are the main drivers of the use of PROMs. Time constraints were the primary obstacle to using PROMs, followed by the impression that patients dislike PROMs. AD and CU PROM users would like training in selecting the proper PROM.

CONCLUSION

Even though PROMs offer several benefits, their use in routine practice is suboptimal, and physicians perceive barriers to their use. It is essential to attain higher levels of PROM implementation in accordance with national and international standards.

Urticaria exacerbations and adverse reactions in patients with chronic urticaria receiving COVID-19 vaccination: Results of the UCARE COVAC-CU study

BACKGROUND

Concern about disease exacerbations and fear of reactions after coronavirus disease 2019 (COVID-19) vaccinations are common in chronic urticaria (CU) patients and may lead to vaccine hesitancy.

OBJECTIVE

We assessed the frequency and risk factors of CU exacerbation and adverse reactions in CU patients after COVID-19 vaccination.

METHODS

COVAC-CU is an international multicenter study of Urticaria Centers of Reference and Excellence (UCAREs) that retrospectively evaluated the effects of COVID-19 vaccination in CU patients aged ≥18 years and vaccinated with ≥1 dose of any COVID-19 vaccine. We evaluated CU exacerbations and severe allergic reactions as well as other adverse events associated with COVID-19 vaccinations and their association with various CU parameters.

RESULTS

Across 2769 COVID-19-vaccinated CU patients, most (90%) received at least 2 COVID-19 vaccine doses, and most patients received CU treatment and had well-controlled disease. The rate of COVID-19 vaccination-induced CU exacerbation was 9%. Of 223 patients with CU exacerbation after the first dose, 53.4% experienced recurrence of CU exacerbation after the second dose. CU exacerbation most often started <48 hours after vaccination (59.2%), lasted for a few weeks or less (70%), and was treated mainly with antihistamines (70.3%). Factors that increased the risk for COVID-19 vaccination-induced CU exacerbation included female sex, disease duration shorter than 24 months, having chronic spontaneous versus inducible urticaria, receipt of adenovirus viral vector vaccine, having nonsteroidal anti-inflammatory drug/aspirin intolerance, and having concerns about getting vaccinated; receiving omalizumab treatment and Latino/Hispanic ethnicity lowered the risk. First-dose vaccine-related adverse effects, most commonly local reactions, fever, fatigue, and muscle pain, were reported by 43.5% of CU patients. Seven patients reported severe allergic reactions.

CONCLUSIONS

COVID-19 vaccination leads to disease exacerbation in only a small number of CU patients and is generally well tolerated.

Circulating soluble LIGHT/TNFSF14 is increased and associated with IL-8 concentration in chronic spontaneous urticaria

LIGHT (homologous to lymphotoxins, exhibiting inducible expression, and competing with herpes simplex virus (HSV) glycoprotein D for herpes virus entry mediator (HVEM), a receptor expressed by T lymphocytes) has been involved in various autoimmune and inflammatory disorders. LIGHT induces the expression of interleukin-8 (IL-8), which is up-regulated in chronic spontaneous urticaria (CSU). To determine circulating soluble LIGHT concentration and its relationship with IL-8 concentration in patients with CSU. Concentrations of LIGHT, IL-8, and C-reactive protein (CRP) were determined in plasma or serum of CSU patients by an enzyme-linked immunosorbent assay. LIGHT plasma concentration was significantly higher in moderate–severe CSU patients as compared with the healthy subjects, but not with mild CSU patients. There were significant correlations between increased LIGHT and IL-8 concentrations, but not with increased CRP in CSU patients. Enhanced plasma concentrations of soluble LIGHT and its association with IL-8 concentration suggest the role of LIGHT in systemic inflammatory activation in CSU patients. We hypothesize that LIGHT-mediated immune–inflammatory response plays a role in severe phenotypes of the disease.

Elevated circulating heat shock protein 70 and its antibody concentrations in chronic spontaneous urticaria

Heat shock proteins (Hsp) play a complex role in cytoprotection, inflammation, and function of the immune system. They may be involved in pathogenesis of various diseases. Our aim was to determine circulating Hsp70 and anti-Hsp70 antibodies concentrations in patients with chronic spontaneous urticaria (CSU). Concentrations of Hsp70 in plasma and anti-Hsp70 antibodies in serum as well as serum C-reactive protein (CRP) were measured in CSU patients and in the controls. Plasma Hsp70 concentrations were significantly higher in CSU (all) and mild CSU patients as compared with the controls. Moderate–severe CSU patients tended to show higher Hsp70 concentration as compared with the controls, but not with mild activity of the disease. There were no significant differences in Hsp70 concentration between moderate–severe and mild CSU patients. Serum anti-Hsp70 antibodies concentrations were significantly higher in CSU (all) and mild CSU in comparison to the controls. Association was observed between anti-Hsp70 antibodies and increased CRP concentration; however, no correlation between anti-Hsp70 and Hsp70 concentrations was seen in the patients. It seems that up-regulation of Hsp70 in CSU may induce marked increase in anti-Hsp70 antibodies production, which are accompanied by parallel changes in CRP concentration. We suggest that Hsp may be released in CSU in response to stressful stimuli, such as inflammation.

[The role of vascular endothelial growth factor in inflammatory processes]

The vascular endothelial growth factor (VEGF) is produced by different types of cells and has a major role in both, physiological and pathological angiogenesis. On the one hand VEGF is a strong mitotic and chemotactic factor for the endothelial cells, stimulating thus formation of new vessels, while on the other, it enhances the vascular endothelium permeability of the existing blood vessels which contributes to development and persistence of the inflammatory conditions. In the latter its activity is by 50 000 times higher than that of histamine. VEGF facilitates formation of oedema and leukocyte migration from the circulation to the site of inflammation. VEGF is also important in remodeling of the extracellular matrix. Moreover, it has an important significance in regulation of the immunological response, therefore plays a role in autoaggressive phenomena as well as immediate- and delayed-type hypersensitivity. Its role in the pathogenesis of immunological and inflammatory diseases, including allergy, asthma and different skin disorders has been indicated.

The influence of selected preoperative factors on the course of endoscopic surgery in patients with chronic rhinosinusitis

BACKGROUND

Epidemiological data shows the increasing prevalence of chronic rhinosinusitis which poses significant health, social and economic problems in today's world. Endoscopic paranasal sinus surgery is currently the method of choice in the treatment of chronic rhinosinusitis when conservative treatment methods fail. Therefore, maintaining a high percentage of therapeutic success with a constantly growing number of surgical procedures poses the major challenge to otolaryngologists. Appropriate surgical conditions have a great influence on the course of surgical procedure, the risk of complications and postoperative outcomes.

OBJECTIVES

The aim of this study was to analyse the influence of selected perioperative factors on the course of endoscopic surgery in patients with chronic rhinosinusitis.

MATERIAL AND METHODS

A group of 212 patients (105 women and 107 men) aged 19 to 74 (mean age 46.5) diagnosed with chronic rhinosinusitis were enrolled in the retrospective study. All patients underwent endoscopic sinus surgery. The analysis was concerned with the impact of such factors and clinical parameters as gender and age of patients, disease progression, previous (conservative and surgical) treatment, comorbidities, detrimental external factors, the scope of surgical treatment influencing the duration of surgery, bleeding in the surgical field and the total blood loss during surgery.

CONCLUSIONS

It was found that the mean duration of surgery in the study group was 40.2 min, the mean blood loss was 312.17 mL and the mean degree of intraoperative bleeding scale reached 2.15. The intraoperative conditions deteriorate together with the increasing age of patients. Selected factors and clinical parameters, such as impaired nasal patency, olfactory disorders, the occurrence of nasal polyps, prior surgical treatment, the presence of aspirin-induced asthma and cardiovascular diseases, intranasal glucocorticoid therapy, a high degree of inflammatory changes in the sinuses and a large extent of surgery substantially influence the deterioration in intraoperative conditions. Knowledge of these factors and their impact on surgery enables more thorough, multidisciplinary preparation of patients for surgery, and thus enables the optimisation of surgical conditions.

[Etiology and clinical course of urticaria in hospitalized children]

INTRODUCTION

Data concerning the epidemiology, etiology and clinical course of childhood urticaria are still under discussion.

AIM

To investigate the clinical presentation of urticaria in hospitalized children and to define its possible etiologies.

MATERIAL AND METHODS

Ninety eight children (male/female 42/57) aged 0.2-17.6 years, (mean age 8.22±0.55) hospitalized due to urticaria were included in the study. The nature and localization of skin lesions, accompanying diseases and diagnostic test results were analyzed.

RESULTS

Sixty nine children (70.4%) were diagnosed as having acute, 22 (22.5%) acute recurrent and 7 (7.1%) chronic urticaria. Allergic diseases, family history of atopy and adenoid hypertrophy and/or chronic tonsillitis were present respectively in 10 (10.2%), 28 (28.6%), 21 (21.4%) children. In 32 children (46.3%) with acute urticaria, in 8 (36.3%) with recurrent and in 2 (28.5%) with chronic urticaria skin lesions covered the whole body. Serum C-reactive protein and leukocyte levels in children with acute urticaria were significantly higher compared to children with chronic urticaria (p<0.05). The serum IgE levels, the percentage and absolute count of eosinophils were similar in different forms of urticaria. Probable etiology in 62/69 children with acute urticaria (respiratory tract infections - 43, drugs - 8, lambliosis - 6, food allergy - 2, antiallergy shots - 2, urinary tract infection - 1 child), in 9/22 children with recurrent urticaria (respiratory tract infection - 7, lambliosis - 2 children) and in 3/7 children with chronic urticaria (physical urticaria - 2, urinary tract infection - 1 child) was determined.

CONCLUSIONS

Among children with urticaria, the most frequent cause for hospitalization is acute urticaria. The outbreak of hives wheels is usually triggered by upper respiratory tract infection. IgE-related allergy is a rare reason of childhood urticaria. In more than 50% of cases of recurrent and chronic urticaria the etiology was not determined.

Acute phase inflammatory markers in patients with non-steroidal anti-inflammatory drugs (NSAIDs)-induced acute urticaria/angioedema and after aspirin challenge

BACKGROUND

Active chronic urticaria, identified as a mast cell- and basophil-dependent inflammatory disorder of the skin is able to elicit acute phase response (APR). However, systemic inflammatory response in different types of urticaria is poorly characterized.

AIM

To determine APR pattern in a clearly defined group of patients with acute urticaria and/or angioedema - induced by NSAIDs.

METHODS

Plasma IL-6 and serum C-reactive protein (CRP) concentrations were studied in 17 patients with NSAIDs-induced acute urticaria/angioedema (NSAIDsAU) and in 20 healthy controls. Eleven patients who used NSAIDs were presented at the emergency room with acute urticaria/angioedema while the remaining six manifested the symptoms during the aspirin challenge test. Patients were examined in a dynamic manner: during the acute phase, and next, after subsidence of the symptoms.

RESULTS

CRP and IL-6 concentrations increased significantly in patients with NSAIDsAU as compared with their asymptomatic period and the healthy subjects. In addition, NSAIDsAU patients showed elevated concentration of the biomarkers following aspirin provocation with the baseline values recovered in the asymptomatic period.

CONCLUSION

These results indicate that an acute systemic inflammatory response is activated in patients with NSAIDs-induced urticaria and/or angioedema. The study supports the evidence proving that up-regulation of CRP and IL-6 in urticaria/angioedema does not necessarily reflect any concomitant infection or other inflammatory processes, but may be due to the disease itself.

Serum visfatin levels are decreased in schoolchildren with atopic asthma

OBJECTIVES

Very little is known about the role of adipokines in atopic asthma in children. Studies about the potential role of novel proinflammatory adiopcytokine - visfatin are lacking.

DESIGN AND SETTING

In this cross-sectional study serum visfatin (VISF) levels were measured in 89 asthmatic out-patients (61 boys and 28 girls aged 7.0-17.0 years) and in 33 healthy children.

MATERIAL AND METHODS

Among examined asthmatics 59 (19 girls and 40 boys) had normal weight and 30 (9 girls and 21 boys) were obese. Serum VISF was evaluated using standard ELISA tests and the results were analysed in relation to body weight, asthma severity, and gender were analysed.

RESULTS

The mean serum levels of visfatin were significantly (p<0.001) lower both in obese (2.13±0.07npg/ml) and non-obese asthmatic children (2.05±0.06 npg/ml) than in healthy children (2.57±0.07 pg/ml) regardless of gender. After stratifying by gender, there was a significant decrease (p<0.001) in visfatin levels in obese asthmatic girls (2.30±0.08 ng/ml) and asthmatic girls with normal weight girls (2.21±0,09 ng/ml) compared with girls from control group (2.69 ±0.06 ng/ml). In obese asthmatic boys and non-obese asthmatic boys also significantly lower (p<0.01) mean values of visfatin (2.03±0.06 ng/ml and 1.9±0.06 pg/ml respectively) were observed than in control boys (2.391±0.09 ng/ml). No relationships between examined adipokine levels and asthma severity, spirometric parameters, degree of allergic sensitization, BMI, were observed.

CONCLUSION

Visfatin is not potential biomarker in atopic asthma in children and further studies evaluating the possible role of this proinflammatory adipokine in childhood atopic asthma pathogenesis are needed.

Chronic urticaria and irregular menstrual cycle: a case report of effective therapy with oral contraception

It has been reported that urticaria may be associated with some conditions characterized by sex hormone changes. The case presented concerns a 19-year-old patient who had severe symptoms of chronic urticaria for 3 years, concomitant with an irregular menstrual cycle and functional ovarian cysts. After a laparoscopic ovarian cystectomy the patient was treated with hormonal contraceptives. After 3 weeks the symptoms of urticaria withdrew. The patient continues to receive oral contraceptive treatment, has regular menstruation and shows no symptoms of urticaria. A diagnosis with an urticaria origin should take into consideration any changes in hormone balance as one of the possible reasons for the disease. In such cases, treatment with sex hormones may positively influence the course of the illness.