1
|
Grekowitz E, Metz M, Altrichter S, Bauer A, Brockow K, Heine G, Lionnet L, Saday KK, Hultsch T, Søerensen OE, Maurer M. Targeting histamine receptor 4 in cholinergic urticaria with izuforant (LEO 152020): results from a phase IIa randomized double-blind placebo-controlled multicentre crossover trial. Br J Dermatol 2024; 190:825-835. [PMID: 38308655 DOI: 10.1093/bjd/ljae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Cholinergic urticaria (CholU) is a common subtype of chronic inducible urticaria, where signs and symptoms (e.g. pruritic wheals and angioedema) are triggered by sweating due to physical exercise, passive warming and by other sweat-inducing situations. While guidelines recommend treatment with second-generation H1 antihistamines, approximately 90% of patients report uncontrolled disease. Targeting the histamine 4 receptor (H4R) has shown promise in preclinical/clinical studies of allergic/inflammatory diseases. Izuforant (LEO 152020) is a selective oral H4R antagonist with expected dual antipruritic and anti-inflammatory effects. OBJECTIVES To assess the effects of izuforant in adults with CholU, a common type of chronic urticaria driven by histamine and characterized by high skin levels of H4R expression. METHODS This was a phase IIa randomized double-blind placebo-controlled multicentre crossover trial where patients with CholU with an inadequate response to ≥ 1 standard dose of H1 antihistamine received izuforant 100 mg twice daily or placebo (EUCTR2020-004961-38-DE; NCT04853992). The primary endpoint was change from baseline in Urticaria Activity Score. Exploratory endpoints included CholU activity score over 7 days, urticaria control test, Physician Global Assessment, patient global assessment of severity (PGA-S), provocation tests, Dermatology Life Quality Index and CholU quality of life (CholU-QoL). Pharmacokinetic and pharmacodynamic parameters, and serum biomarkers were assessed, as well as safety and tolerability. RESULTS Nineteen patients were randomized and included in the full analysis set; 18 completed treatment [mean (SD) age 29.5 (9.8) years; mean (SD) CholU duration 8.0 (6.3) years]. The primary and most of prespecified exploratory endpoints were not met; there were significant improvements in PGA-S for izuforant vs. placebo (P = 0.02), and nonsignificant improvements for other endpoints in quality of life and histamine skin prick test. All adverse events (AEs) experienced with izuforant were considered mild. The most frequently reported (> 1 patient) were nausea (three patients) and upper abdominal pain (two patients), occurring more frequently with izuforant vs. placebo (one patient each). There were no treatment-related serious AEs and no patient receiving izuforant discontinued the study. Treatment with izuforant did not cause downregulation of H4R. CONCLUSIONS This is the first study to explore the role of H4R as a therapeutic target in urticaria. Targeting H4R with izuforant was well tolerated but did not demonstrate significant improvements vs. placebo in the primary endpoint and all but one prespecified exploratory endpoint in CholU.
Collapse
Affiliation(s)
- Eva Grekowitz
- Charité - Universitätsmedizin Berlin, Institute of Allergology, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Martin Metz
- Charité - Universitätsmedizin Berlin, Institute of Allergology, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - Sabine Altrichter
- Charité - Universitätsmedizin Berlin, Institute of Allergology, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
- Department of Dermatology and Venerology, Kepler University Hospital, Linz, Austria
| | - Andrea Bauer
- Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Germany
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Faculty of Medicine, Munich, Germany
| | - Guido Heine
- Department of Dermatology, Venereology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Leonard Lionnet
- GA2LEN Network of Urticaria Centers of Reference and Excellence (UCARE), Berlin, Germany
| | | | | | | | - Marcus Maurer
- Charité - Universitätsmedizin Berlin, Institute of Allergology, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| |
Collapse
|
2
|
Daci D, Altrichter S, Grillet FM, Dib S, Mouna A, Suresh Kumar S, Terhorst-Molawi D, Maurer M, Günzel D, Scheffel J. Altered Sweat Composition Due to Changes in Tight Junction Expression of Sweat Glands in Cholinergic Urticaria Patients. Int J Mol Sci 2024; 25:4658. [PMID: 38731882 PMCID: PMC11083780 DOI: 10.3390/ijms25094658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
In cholinergic urticaria (CholU), small, itchy wheals are induced by exercise or passive warming and reduced sweating has been reported. Despite the described reduced muscarinic receptor expression, sweat duct obstruction, or sweat allergy, the underlying pathomechanisms are not well understood. To gain further insights, we collected skin biopsies before and after pulse-controlled ergometry and sweat after sauna provocation from CholU patients as well as healthy controls. CholU patients displayed partially severely reduced local sweating, yet total sweat volume was unaltered. However, sweat electrolyte composition was altered, with increased K+ concentration in CholU patients. Formalin-fixed, paraffin-embedded biopsies were stained to explore sweat leakage and tight junction protein expression. Dermcidin staining was not found outside the sweat glands. In the secretory coils of sweat glands, the distribution of claudin-3 and -10b as well as occludin was altered, but the zonula occludens-1 location was unchanged. In all, dermcidin and tight junction protein staining suggests an intact barrier with reduced sweat production capability in CholU patients. For future studies, an ex vivo skin model for quantification of sweat secretion was established, in which sweat secretion could be pharmacologically stimulated or blocked. This ex vivo model will be used to further investigate sweat gland function in CholU patients and decipher the underlying pathomechanism(s).
Collapse
Affiliation(s)
- Denisa Daci
- Clinical Physiology/Nutritional Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany; (D.D.); (S.D.); (A.M.); (S.S.K.); (D.G.)
| | - Sabine Altrichter
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, 12203 Berlin, Germany (D.T.-M.); (M.M.)
- Institute of Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
- Departement of Dermatology and Venerology, Kepler University Hospital, 4020 Linz, Austria
- Center for Medical Research, Johannes Kepler University, 4021 Linz, Austria
| | - François Marie Grillet
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, 12203 Berlin, Germany (D.T.-M.); (M.M.)
- Institute of Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
| | - Selma Dib
- Clinical Physiology/Nutritional Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany; (D.D.); (S.D.); (A.M.); (S.S.K.); (D.G.)
| | - Ahmad Mouna
- Clinical Physiology/Nutritional Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany; (D.D.); (S.D.); (A.M.); (S.S.K.); (D.G.)
| | - Sukashree Suresh Kumar
- Clinical Physiology/Nutritional Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany; (D.D.); (S.D.); (A.M.); (S.S.K.); (D.G.)
| | - Dorothea Terhorst-Molawi
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, 12203 Berlin, Germany (D.T.-M.); (M.M.)
- Institute of Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
| | - Marcus Maurer
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, 12203 Berlin, Germany (D.T.-M.); (M.M.)
- Institute of Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
| | - Dorothee Günzel
- Clinical Physiology/Nutritional Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany; (D.D.); (S.D.); (A.M.); (S.S.K.); (D.G.)
| | - Jörg Scheffel
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, 12203 Berlin, Germany (D.T.-M.); (M.M.)
- Institute of Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
| |
Collapse
|
3
|
Reshef A, Buttgereit T, Betschel SD, Caballero T, Farkas H, Grumach AS, Hide M, Jindal AK, Longhurst H, Peter J, Riedl MA, Zhi Y, Aberer W, Abuzakouk M, Al Farsi T, Al Sukaiti N, Al-Ahmad M, Altrichter S, Aygören-Pürsün E, Baeza ML, Bara NA, Bauer A, Bernstein JA, Boccon-Gibod I, Bonnekoh H, Bouillet L, Brzoza Z, Bygum A, Calderon O, de Albuquerque Campos R, Campos Romero FH, Cancian M, Chong-Neto HJ, Christoff G, Cimbollek S, Cohn DM, Craig T, Danilycheva I, Darlenski R, Du-Thanh A, Ensina LF, Fomina D, Fonacier L, Fukunaga A, Gelincik A, Giavina-Bianchi P, Godse K, Gompels M, Goncalo M, Gotua M, Guidos-Fogelbach G, Guilarte M, Kasperska-Zajac A, Katelaris CH, Kinaciyan T, Kolkhir P, Kulthanan K, Kurowski M, Latysheva E, Lauerma A, Launay D, Lleonart R, Lumry W, Malbran A, Ali RM, Nasr I, Nieto-Martinez S, Parisi C, Pawankar R, Piñero-Saavedra M, Popov TA, Porebski G, Prieto Garcia A, Pyatilova P, Rudenko M, Sekerel BE, Serpa FS, Sheikh F, Siebenhaar F, Soria A, Staevska M, Staubach P, Stobiecki M, Thomsen SF, Triggiani M, Valerieva A, Valle S, Van Dinh N, Vera Ayala CE, Zalewska-Janowska A, Zanichelli A, Magerl M, Maurer M. Definition, acronyms, nomenclature, and classification of angioedema (DANCE): AAAAI, ACAAI, ACARE, and APAAACI DANCE consensus. J Allergy Clin Immunol 2024:S0091-6749(24)00407-X. [PMID: 38670233 DOI: 10.1016/j.jaci.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/24/2024] [Accepted: 03/04/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Angioedema (AE) manifests with intermittent, localized, self-limiting swelling of the subcutaneous and/or submucosal tissue. AE is heterogeneous, can be hereditary or acquired, may occur only once or be recurrent, may exhibit wheals or not, and may be due to mast cell mediators, bradykinin, or other mechanisms. Several different taxonomic systems are currently used, making it difficult to compare the results of studies, develop multicenter collaboration, and harmonize AE treatment. OBJECTIVE We developed a consensus on the definition, acronyms, nomenclature, and classification of AE (DANCE). METHODS The initiative involved 91 experts from 35 countries and was endorsed by 53 scientific and medical societies, and patient organizations. A consensus was reached by online discussion and voting using the Delphi process over a period of 16 months (June 2021 to November 2022). RESULTS The DANCE initiative resulted in an international consensus on the definition, classification, and terminology of AE. The new consensus classification features 5 types and endotypes of AE and a harmonized vocabulary of abbreviations/acronyms. CONCLUSION The DANCE classification complements current clinical guidelines and expert consensus recommendations on the diagnostic assessment and treatment of AE. DANCE does not replace current clinical guidelines, and expert consensus algorithms and should not be misconstrued in a way that affects reimbursement of medicines prescribed by physicians using sound clinical judgment. We anticipate that this new AE taxonomy and nomenclature will harmonize and facilitate AE research and clinical studies, thereby improving patient care.
Collapse
Affiliation(s)
- Avner Reshef
- Angioedema Research Center, Barzilai University Medical Center, Ashkelon, Israel.
| | - Thomas Buttgereit
- Angioedema Center of Reference and Excellence (ACARE), 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, Immunology and Allergology, Berlin, Germany
| | - Stephen D Betschel
- Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Teresa Caballero
- Department of Allergy, La Paz University Hospital, Hospital La Paz Institute for Health Research (IdiPAZ-Group 44), Biomedical Research Network on Rare Diseases (CIBERER U754), Madrid, Spain; NRC Institute of Immunology FMBA of Russia, Moscow, Russia
| | - Henriette Farkas
- Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Anete S Grumach
- Department of Clinical Immunology, University Center Faculdade de Medicina do ABC, Santo André, Brazil
| | - Michihiro Hide
- Department of Dermatology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ankur K Jindal
- Department of Pediatrics, Allergy Immunology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hilary Longhurst
- Department of Medicine, University of Auckland and Department of Immunology, Auckland City Hospital, Auckland, New Zealand
| | - Jonathan Peter
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Cape Town, and the Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Marc A Riedl
- Division of Rheumatology, Allergy, and Immunology, University of California San Diego, La Jolla, Calif
| | - Yuxiang Zhi
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Werner Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Mohamed Abuzakouk
- Allergy and Immunology, Respiratory Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Tariq Al Farsi
- Department of Pediatric Allergy and Clinical Immunology, The Royal Hospital, Muscat, Oman
| | - Nashat Al Sukaiti
- Department of Pediatric Allergy and Clinical Immunology, The Royal Hospital, Muscat, Oman
| | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Sabine Altrichter
- Klinik für Dermatologie und Venerologie, Kepler Uniklinikum, Linz, Austria
| | - Emel Aygören-Pürsün
- Department of Pediatrics, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Maria Luisa Baeza
- Allergy Department, Hospital General Universitario Gregorio Marañón, Biomedical Research Network on Rare Diseases-U761, Gregorio Marañón Health Research Institute (IiSGM), Gregorio Marañón, Madrid, Spain
| | - Noemi Anna Bara
- Romanian Hereditary Angioedema Expertise Centre, Centrul Clinic Mediquest, Sângeorgiu de Mure, Romania
| | - Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Jonathan A Bernstein
- University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, Cincinnati, Ohio
| | | | - Hanna Bonnekoh
- Angioedema Center of Reference and Excellence (ACARE), 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, Immunology and Allergology, Berlin, Germany
| | - Laurence Bouillet
- National Reference Center of Angioedema CREAK, Grenoble, France; Internal medicine department, Grenoble University Hospital, Grenoble, France
| | - Zenon Brzoza
- Department of Internal Diseases with Division of Allergology, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Anette Bygum
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark; Clinical Institute, University of Southern Denmark, Odense, Denmark
| | | | | | - Freya Helena Campos Romero
- Department of Allergy and Clinical Immunology, Hospital Central Sur Alta Especialidad, Mexico City, Mexico City, Mexico
| | - Mauro Cancian
- Departmental Unit of Allergology, University Hospital of Padua, Padua, Italy
| | - Herberto Jose Chong-Neto
- Serviço de Alergia e Imunologia, Complexo Hospital de Clinicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - George Christoff
- Excelsior Medical Centre, Sofia, Bulgaria; Medical University-Sofia, Sofia, Bulgaria
| | | | - Danny M Cohn
- Department of Vascular Medicine, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Timothy Craig
- Department of Pediatrics, Pennsylvania State University, Hershey, Pa
| | | | - Razvigor Darlenski
- Department of Dermatovenereology, Trakia University, Stara Zagora, Bulgaria
| | - Aurélie Du-Thanh
- Département de dermatologie, ACARE, Centre Hospitalier Universitaire de Montpellier Montpellier, France
| | | | - Daria Fomina
- Moscow City Research and Practical Center of Allergoloy and Immunology, Clinical Hospital No. 52, Moscow Healthcare Department, Moscow, Russia
| | - Luz Fonacier
- New York University-Long Island School of Medicine, Mineola, NY
| | - Atsushi Fukunaga
- Department of Dermatology, Division of Medicine for Function and Morphology of Sensory Organs, Faculty of Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Asli Gelincik
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Pedro Giavina-Bianchi
- Division of Clinical lmmunology and Allergy, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Kiran Godse
- Dr D. Y. Patil Medical College and Hospital, Navi Mumbai, Maharashtra, India
| | - Mark Gompels
- Department of Immunology, ACARE, North Bristol NHS Trust, Bristol, United Kingdom
| | - Margarida Goncalo
- Department of Dermatology, Coimbra Hospital and University Center, and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maia Gotua
- Center of Allergy and Immunology and David Tvildiani Medical University, Tbilisi, Georgia
| | | | - Mar Guilarte
- Allergy Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Alicja Kasperska-Zajac
- European Center for Diagnosis and Treatment of Urticaria and Angioedema and Department of Clinical Allergology and Urticaria, Medical University of Silesia in Katowice, Katowice, Poland
| | | | - Tamar Kinaciyan
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Pavel Kolkhir
- Angioedema Center of Reference and Excellence (ACARE), 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, Immunology and Allergology, Berlin, Germany
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Marcin Kurowski
- Department of Immunology and Allergy, Medical University of Lodz, Lodz, Poland
| | - Elena Latysheva
- NRC Institute of Immunology FMBA of Russia, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - Antti Lauerma
- Department of Dermatology, Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - David Launay
- University Lille, Inserm, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Angioedemes à Kinine (CREAK), U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
| | - Ramon Lleonart
- Allergology Department, Hospital Universitari Bellvitge, IDIBILL Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Alejandro Malbran
- Unidad de Alergia, Asma e Inmunología Clínica, Buenos Aires, Argentina
| | - Ramzy Mohammed Ali
- Department of Medicine, Allergy and Immunology Division, Hamad Medical Corporation, Doha, Qatar
| | - Iman Nasr
- Immunology and Allergy Department, The Royal Hospital, Muscat, Oman
| | - Sandra Nieto-Martinez
- Unidad de Genética de la Nutrición, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - Claudio Parisi
- Pediatric and Adult Allergy sections of the Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | | | | | | | - Grzegorz Porebski
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland
| | - Alicia Prieto Garcia
- Department of Allergy, Gregorio Marañón Health Research Institute (IiSGM), Gregorio Marañón University Hospital, Madrid, Spain
| | - Polina Pyatilova
- Angioedema Center of Reference and Excellence (ACARE), 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, Immunology and Allergology, Berlin, Germany
| | - Michael Rudenko
- The London Allergy and Immunology Centre, London, United Kingdom
| | | | - Faradiba Sarquis Serpa
- Angioedema and Urticaria Reference Center, Hospital Santa Casa de Misericórdia de Vitória, Vitória, Espirito Santo, Brazil
| | | | - Frank Siebenhaar
- Angioedema Center of Reference and Excellence (ACARE), 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, Immunology and Allergology, Berlin, Germany
| | - Angèle Soria
- Médecine Sorbonne Université, Service de Dermatologie et Allergologie, hôpital Tenon, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Maria Staevska
- Department of Allergology, Medical University of Sofia, Clinic of Allergology, University Hospital "Alexandrovska" Sofia, Bulgaria
| | - Petra Staubach
- Department of Dermatology, ACARE, University Medical Center Mainz, Mainz, Germany
| | - Marcin Stobiecki
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Anna Valerieva
- Department of Allergology, Medical University of Sofia, Clinic of Allergology, University Hospital "Alexandrovska" Sofia, Bulgaria
| | - Solange Valle
- Department of Internal Medicine, Immunology Service, Hospital Universitario Clementino Fraga Filho, Rio De Janiero, Brazil
| | - Nguyen Van Dinh
- Department of General Internal Medicine, Respiratory-Allergy and Clinical Immunology Unit, Vinmec Healthcare System, Hanoi, Vietnam
| | - Carolina Elisa Vera Ayala
- Angioedema Center of Reference and Excellence (ACARE), 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, Immunology and Allergology, Berlin, Germany
| | | | - Andrea Zanichelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Operative Unit of Medicine, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Markus Magerl
- Angioedema Center of Reference and Excellence (ACARE), 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, Immunology and Allergology, Berlin, Germany
| | - Marcus Maurer
- Angioedema Center of Reference and Excellence (ACARE), 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, Immunology and Allergology, Berlin, Germany
| |
Collapse
|
4
|
Kolkhir P, Altrichter S, Badloe FMS, Belasri H, Charles N, De Vriese S, Gutermuth J, Huygen L, Kocatürk E, Kortekaas Krohn I, Muñoz M, Moñino-Romero S, Reber LL, Scheffel J, Steinert C, Xiang YK, Maurer M. The European Network for IgE-Mediated Autoimmunity and Autoallergy (ENIGMA) initiative. Nat Med 2024; 30:920-922. [PMID: 38429523 DOI: 10.1038/s41591-024-02819-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Affiliation(s)
- Pavel Kolkhir
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Immunology and Allergology, Berlin, Germany.
| | - Sabine Altrichter
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Immunology and Allergology, Berlin, Germany
- Department of Dermatology and Venerology, Kepler University Hospital, Linz, Austria
- Center for Medical Research, Johannes Kepler University, Linz, Austria
| | - Fariza Mishaal Saiema Badloe
- Vrije Universiteit Brussel (VUB), Skin Immunology and Immune Tolerance (SKIN) Research Group, Brussels, Belgium
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Dermatology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Hafsa Belasri
- Vrije Universiteit Brussel (VUB), Skin Immunology and Immune Tolerance (SKIN) Research Group, Brussels, Belgium
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Dermatology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Nicolas Charles
- Université Paris Cité, Centre de Recherche sur l'Inflammation, INSERM UMR1149, CNRS EMR8252, Faculté de Médecine Site Bichat, Paris, France
- Université Paris Cité, Laboratoire d'Excellence Inflamex, Paris, France
| | - Shauni De Vriese
- Vrije Universiteit Brussel (VUB), Skin Immunology and Immune Tolerance (SKIN) Research Group, Brussels, Belgium
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Dermatology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jan Gutermuth
- Vrije Universiteit Brussel (VUB), Skin Immunology and Immune Tolerance (SKIN) Research Group, Brussels, Belgium
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Dermatology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Lisa Huygen
- Vrije Universiteit Brussel (VUB), Skin Immunology and Immune Tolerance (SKIN) Research Group, Brussels, Belgium
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Dermatology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Emek Kocatürk
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Immunology and Allergology, Berlin, Germany
- Koç University School of Medicine, Department of Dermatology, Istanbul, Turkey
| | - Inge Kortekaas Krohn
- Vrije Universiteit Brussel (VUB), Skin Immunology and Immune Tolerance (SKIN) Research Group, Brussels, Belgium
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Dermatology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Melba Muñoz
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Immunology and Allergology, Berlin, Germany
| | - Sherezade Moñino-Romero
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Immunology and Allergology, Berlin, Germany
| | - Laurent L Reber
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), UMR 1291, University of Toulouse, INSERM, CNRS, Toulouse, France
| | - Jörg Scheffel
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Immunology and Allergology, Berlin, Germany
| | - Carolin Steinert
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Immunology and Allergology, Berlin, Germany
- Freie Universität Berlin, Department of Biology, Chemistry and Pharmacy, Berlin, Germany
| | - Yi-Kui Xiang
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Immunology and Allergology, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Immunology and Allergology, Berlin, Germany.
| |
Collapse
|
5
|
Altrichter S, Giménez-Arnau AM, Bernstein JA, Metz M, Bahadori L, Bergquist M, Brooks L, Ho CN, Jain P, Lukka PB, Rodriguez-Suárez E, Walton C, Datto CJ. Benralizumab does not elicit therapeutic effect in patients with chronic spontaneous urticaria: results from the phase 2b multinational, randomised, double-blind, placebo-controlled ARROYO trial. Br J Dermatol 2024:ljae067. [PMID: 38367194 DOI: 10.1093/bjd/ljae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/02/2024] [Accepted: 02/15/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is a relatively common skin disease associated with hives and angio-oedema. Eosinophils play a role in CSU pathogenesis. Benralizumab, an anti-interleukin-5 receptor alpha monoclonal antibody, has been shown to induce nearly complete depletion of eosinophils. OBJECTIVES To determine the clinical efficacy and safety of benralizumab in patients with CSU who were symptomatic despite H1 antihistamine treatment. METHODS The 24-week, randomised, double-blind, placebo-controlled, phase 2b portion of the ARROYO trial enrolled adult patients with CSU who were currently on H1 antihistamine treatment. Patients were randomised to one of five treatment groups according to benralizumab dose and regimen for a 24-week treatment period. The primary endpoint was change from baseline in ISS7 at Week 12. The key secondary endpoint was change from baseline in UAS7 at Week 12. Additional secondary endpoints included other metrics to assess CSU at Week 24; blood eosinophil levels; and pharmacokinetics and immunogenicity assessments. Exploratory subgroup analyses were conducted to explore responses according to demographics, clinical features and biomarkers. Safety was assessed in all treatment groups. RESULTS Of 155 patients, 59 were randomised to benralizumab 30 mg, 56 to benralizumab 60 mg and 40 to placebo. Baseline and disease characteristics were consistent with what was expected for patients with CSU. There were no significant differences in change from baseline in ISS7 score at Week 12 between benralizumab and placebo (benralizumab 30 mg vs. placebo, least-squares mean difference -1.01, 95% confidence interval -3.28 to 1.26; benralizumab 60 mg vs. placebo, least-squares mean difference -1.79, 95% confidence interval -4.09 to 0.50) nor in change from baseline in UAS7 score at Week 12 between benralizumab and placebo (benralizumab 30 mg vs. placebo, P = 0.4016; benralizumab 60 mg vs. placebo, P = 0.0819). Depletion of blood eosinophil levels was observed at Week 24 in patients treated with benralizumab. All other secondary endpoints and exploratory/subgroup analyses indicated no significant differences between benralizumab and placebo. Safety results were consistent with the known profile of benralizumab. CONCLUSIONS Although benralizumab resulted in near-complete depletion of blood eosinophils, there was no clinical benefit over placebo.
Collapse
Affiliation(s)
- Sabine Altrichter
- Department of Dermatology and Venerology, Johannes Kepler University Hospital, Linz, Austria
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany
- Johannes Kepler University Linz, Center for Medical Research, Linz, Austria
| | | | - Jonathan A Bernstein
- University of Cincinnati College of Medicine and Bernstein Clinical Research Center, LLC, Cincinnati, OH, USA
| | - Martin Metz
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany
| | - Lila Bahadori
- Late-stage Development, Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gaithersburg, MD, USA
| | - Maria Bergquist
- Late-stage Clinical Development, Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
| | - Laura Brooks
- Late-stage Development, Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Cambridge, UK
| | - Calvin N Ho
- Patient Centered Science, BioPharmaceuticals Medical Evidence, AstraZeneca, Gaithersburg, MD, USA
| | - Priya Jain
- Late-stage Development, Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Cambridge, UK
| | - Pradeep B Lukka
- Clinical and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, Research and Development, AstraZeneca, Gaithersburg, MD, USA
| | - Eva Rodriguez-Suárez
- Translational Science and Experimental Medicine, Early Respiratory and Immunology, AstraZeneca, Cambridge, UK
| | - Claire Walton
- Late-stage Development, Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Cambridge, UK
| | - Catherine J Datto
- Late-stage Development, Respiratory and Immunology, BioPharmaceuticals Research and Development, AstraZeneca, Gaithersburg, MD, USA
| |
Collapse
|
6
|
Moñino-Romero S, Kolkhir P, Ohanyan T, Szépfalusi Z, Weller K, Metz M, Scheffel J, Maurer M, Altrichter S. Elevated baseline soluble FcεRI may be linked to early response to omalizumab treatment in chronic spontaneous urticaria. J Eur Acad Dermatol Venereol 2024; 38:167-174. [PMID: 37641982 DOI: 10.1111/jdv.19485] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/03/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Omalizumab, an anti-IgE monoclonal antibody, is an effective treatment in chronic spontaneous urticaria (CSU). Predictors of fast and good response for omalizumab treatment have not yet been identified and characterized. OBJECTIVE To evaluate whether soluble FcεRI (sFcεRI), a marker of IgE-mediated mast cell activation, predicts the time of response to omalizumab in CSU. METHODS Sera of 67 CSU patients were obtained before omalizumab treatment and analysed for sFcεRI levels by ELISA (2 ng/mL was used as cut-off for elevated sFcɛRI). Treatment response during the first 4 weeks was assessed with the urticaria activity score (UAS7), urticaria control test (UCT) and the rolling UAS7 (rUAS7). RESULTS Elevated pre-treatment sFcɛRI levels were detected in more than 70% of patients with completely controlled disease (UCT = 16) and well-controlled disease (UCT = 12-15) and were significantly associated with disease control (χ2 = 4.94, p < 0.05). More than half of the patients (14/25) with low levels had poor disease control (UCT < 12). Of the patients who achieved complete and marked UAS7 response, respectively, 75% and 63% had elevated baseline sFcɛRI levels. Post-treatment UAS7 scores were lower in patients with elevated sFcɛRI levels reaching statistical significance at Week 3 (p < 0.05). Patients with elevated baseline sFcɛRI levels achieved rUAS7 ≤ 6 and = 0 earlier than those with lower levels (Days 9 vs. 13 and Days 12 vs. 14, respectively). CONCLUSION Elevated sFcεRI serum levels predict early and good response to treatment with omalizumab, which may help to better design treatment options for CSU patients.
Collapse
Affiliation(s)
- S Moñino-Romero
- 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
- Division of Pediatric Pulmonology, Allergy and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - P Kolkhir
- 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
| | - T Ohanyan
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Z Szépfalusi
- Division of Pediatric Pulmonology, Allergy and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - K Weller
- 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
| | - M Metz
- 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
| | - J Scheffel
- 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
| | - M 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
| | - S Altrichter
- 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
- Department of Dermatology and Venereology, Kepler University Hospital, Linz, Austria
| |
Collapse
|
7
|
Neisinger S, Sousa Pinto B, Ramanauskaite A, Bousquet J, Weller K, Metz M, Magerl M, Kocatürk E, Cherrez‐Ojeda I, Gimenez‐Arnau AM, Parisi CAS, Altrichter S, Ensina LF, Bouillet L, Asero R, Gonçalo M, Guillet C, Rutkowski K, Bernstein JA, Hardin H, Godse K, Brzoza Z, Sousa JIL, Thomsen SF, van Doorn M, Hide M, Ye Y, Vanderse S, Lapiņa L, Peter J, Zhao Z, Han L, Nasr I, Rockmann‐Helmbach H, Sørensen JA, Kara RÖ, Kurjāne N, Kurchenko AI, Kaidashev I, Tsaryk V, Stepanenko R, Maurer M. CRUSE ® -An innovative mobile application for patient monitoring and management in chronic spontaneous urticaria. Clin Transl Allergy 2024; 14:e12328. [PMID: 38282190 PMCID: PMC10764293 DOI: 10.1002/clt2.12328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is unpredictable and can severely impair patients' quality of life. Patients with CSU need a convenient, user-friendly platform to complete patient-reported outcome measures (PROMs) on their mobile devices. CRUSE® , the Chronic Urticaria Self Evaluation app, aims to address this unmet need. METHODS CRUSE® was developed by an international steering committee of urticaria specialists. Priorities for the app based on recent findings in CSU were defined to allow patients to track and record their symptoms and medication use over time and send photographs. The CRUSE® app collects patient data such as age, sex, disease onset, triggers, medication, and CSU characteristics that can be sent securely to physicians, providing real-time insights. Additionally, CRUSE® contains PROMs to assess disease activity and control, which are individualised to patient profiles and clinical manifestations. RESULTS CRUSE® was launched in Germany in March 2022 and is now available for free in 17 countries. It is adapted to the local language and displays a country-specific list of available urticaria medications. English and Ukrainian versions are available worldwide. From July 2022 to June 2023, 25,710 observations were documented by 2540 users; 72.7% were females, with a mean age of 39.6 years. At baseline, 93.7% and 51.3% of users had wheals and angioedema, respectively. Second-generation antihistamines were used in 74.0% of days. CONCLUSIONS The initial data from CRUSE® show the wide use and utility of effectively tracking patients' disease activity and control, paving the way for personalised CSU management.
Collapse
|
8
|
Metz M, Kolkhir P, Altrichter S, Siebenhaar F, Levi-Schaffer F, Youngblood BA, Church MK, Maurer M. Mast cell silencing: A novel therapeutic approach for urticaria and other mast cell-mediated diseases. Allergy 2024; 79:37-51. [PMID: 37605867 DOI: 10.1111/all.15850] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/21/2023] [Accepted: 07/29/2023] [Indexed: 08/23/2023]
Abstract
Chronic urticaria (CU) is a mast cell (MC)-dependent disease with limited therapeutic options. Current management strategies are directed at inhibiting IgE-mediated activation of MCs and antagonizing effects of released mediators. Due to the complexity and heterogeneity of CU and other MC diseases and mechanisms of MC activation-including multiple activating receptors and ligands, diverse signaling pathways, and a menagerie of mediators-strategies of MC depletion or MC silencing (i.e., inhibition of MC activation via binding of inhibitory receptors) have been developed to overcome limitations of singularly targeted agents. MC silencers, such as agonist monoclonal antibodies that engage inhibitory receptors (e.g., sialic acid-binding immunoglobulin-like lectin8 -[Siglec-8] [lirentelimab/AK002], Siglec-6 [AK006], and CD200R [LY3454738]), have reached preclinical and clinical stages of development. In this review, we (1) describe the role of MCs in the pathogenesis of CU, highlighting similarities with other MC diseases in disease mechanisms and response to treatment; (2) explore current therapeutic strategies, categorized by nonspecific immunosuppression, targeted inhibition of MC activation or mediators, and targeted modulation of MC activity; and (3) introduce the concept of MC silencing as an emerging strategy that could selectively block activation of MCs without eliciting or exacerbating on- or off-target, immunosuppressive adverse effects.
Collapse
Affiliation(s)
- Martin Metz
- Institute of Allergology, Charité-Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin), Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology IA, Berlin, Germany
| | - Pavel Kolkhir
- Institute of Allergology, Charité-Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin), Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology IA, Berlin, Germany
| | - Sabine Altrichter
- Institute of Allergology, Charité-Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin), Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology IA, Berlin, Germany
- Department of Dermatology and Venerology, Kepler University Hospital, Linz, Austria
| | - Frank Siebenhaar
- Institute of Allergology, Charité-Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin), Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology IA, Berlin, Germany
| | - Francesca Levi-Schaffer
- Pharmacology and Experimental Therapeutics Unit, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Martin K Church
- Institute of Allergology, Charité-Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin), Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology IA, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité-Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin), Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology IA, Berlin, Germany
| |
Collapse
|
9
|
Charles N, Kortekaas-Krohn I, Kocaturk E, Scheffel J, Altrichter S, Steinert C, Xiang YK, Gutermuth J, Reber LL, Maurer M. Autoreactive IgE: Pathogenic role and therapeutic target in autoimmune diseases. Allergy 2023; 78:3118-3135. [PMID: 37555488 DOI: 10.1111/all.15843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/08/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023]
Abstract
Autoimmunity is the break of tolerance to self-antigens that leads to organ-specific or systemic diseases often characterized by the presence of pathogenic autoreactive antibodies (AAb) produced by plasmablast and/or plasma cells. AAb are prevalent in the general population and not systematically associated with clinical symptoms. In contrast, in some individuals, these AAb are pathogenic and drive the development of signs and symptoms of antibody-mediated autoimmune diseases (AbAID). AAb production, isotype profiles, and glycosylations are promoted by pro-inflammatory triggers linked to genetic, environmental, and hormonal parameters. Recent evidence supports a role for pathogenic AAb of the IgE isotype in a number of AbAID. Autoreactive IgE can drive the activation of mast cells, basophils, and other types of FcεRI-bearing cells and may play a role in promoting autoantibody production and other pro-inflammatory pathways. In this review, we discuss the current knowledge on the pathogenicity of autoreactive IgE in AbAID and their status as therapeutic targets. We also highlight unresolved issues including the need for assays that reproducibly quantify IgE AAbs, to validate their diagnostic and prognostic value, and to further study their pathophysiological contributions to AbAID.
Collapse
Affiliation(s)
- Nicolas Charles
- Faculté de Médecine site Bichat, Centre de Recherche sur l'Inflammation, INSERM UMR1149, CNRS EMR8252, Université Paris Cité, Paris, France
- Laboratoire d'Excellence Inflamex, Université Paris Cité, Paris, France
| | - Inge Kortekaas-Krohn
- Vrije Universiteit Brussel (VUB), Skin Immunology & Immune Tolerance (SKIN) Research Group, Brussels, Belgium
- Department of Dermatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Emek Kocaturk
- Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey
- 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
| | - Jörg Scheffel
- 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
| | - Sabine Altrichter
- 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
- Departement of Dermatology and Venerology, Kepler University Hospital, Linz, Austria
| | - Carolin Steinert
- 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
- Freie Universität Berlin, Department of Biology, Chemistry and Pharmacy, Berlin, Germany
| | - Yi-Kui Xiang
- 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
| | - Jan Gutermuth
- Vrije Universiteit Brussel (VUB), Skin Immunology & Immune Tolerance (SKIN) Research Group, Brussels, Belgium
- Department of Dermatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Laurent L Reber
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), UMR 1291, University of Toulouse, INSERM, CNRS, Toulouse, France
| | - 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
| |
Collapse
|
10
|
Ettinger M, Burner T, Sharma A, Chang YT, Lackner A, Prompsy P, Deli IM, Traxler J, Wahl G, Altrichter S, Langer R, Tsai YC, Varkhande SR, Schoeftner LC, Iselin C, Gratz IK, Kimeswenger S, Guenova E, Hoetzenecker W. Th17-associated cytokines IL-17 and IL-23 in inflamed skin of Darier disease patients as potential therapeutic targets. Nat Commun 2023; 14:7470. [PMID: 37978298 PMCID: PMC10656568 DOI: 10.1038/s41467-023-43210-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023] Open
Abstract
Darier disease (DD) is a rare, inherited multi-organ disorder associated with mutations in the ATP2A2 gene. DD patients often have skin involvement characterized by malodorous, inflamed skin and recurrent, severe infections. Therapeutic options are limited and inadequate for the long-term management of this chronic disease. The aim of this study was to characterize the cutaneous immune infiltrate in DD skin lesions in detail and to identify new therapeutic targets. Using gene and protein expression profiling assays including scRNA sequencing, we demonstrate enhanced expression of Th17-related genes and cytokines and increased numbers of Th17 cells in six DD patients. We provide evidence that targeting the IL-17/IL-23 axis in a case series of three DD patients with monoclonal antibodies is efficacious with significant clinical improvement. As DD is a chronic, relapsing disease, our findings might pave the way toward additional options for the long-term management of skin inflammation in patients with DD.
Collapse
Affiliation(s)
- Monika Ettinger
- Department of Dermatology and Venereology, Kepler University Hospital Linz, Linz, Austria
- Department of Dermatology and Venereology, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Teresa Burner
- Department of Dermatology and Venereology, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Anshu Sharma
- Department of Biosciences and Molecular Biology, University of Salzburg, Salzburg, Austria
| | - Yun-Tsan Chang
- Department of Dermatology, University of Lausanne and Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Angelika Lackner
- Department of Dermatology and Venereology, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Pacôme Prompsy
- Department of Dermatology, University of Lausanne and Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Isabella M Deli
- Department of Dermatology and Venereology, Kepler University Hospital Linz, Linz, Austria
| | - Judith Traxler
- Department of Dermatology and Venereology, Kepler University Hospital Linz, Linz, Austria
| | - Gerald Wahl
- Department of Dermatology and Venereology, Kepler University Hospital Linz, Linz, Austria
| | - Sabine Altrichter
- Department of Dermatology and Venereology, Kepler University Hospital Linz, Linz, Austria
- Department of Dermatology and Venereology, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Rupert Langer
- Institute of Pathology and Molecular Pathology, Kepler University Hospital Linz, Linz, Austria
- Institute of Pathology and Molecular Pathology, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Yi-Chien Tsai
- Department of Dermatology, University of Lausanne and Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Suraj R Varkhande
- Department of Biosciences and Molecular Biology, University of Salzburg, Salzburg, Austria
| | - Leonie C Schoeftner
- Department of Biosciences and Molecular Biology, University of Salzburg, Salzburg, Austria
| | - Christoph Iselin
- Department of Dermatology, University of Lausanne and Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Iris K Gratz
- Department of Biosciences and Molecular Biology, University of Salzburg, Salzburg, Austria
| | - Susanne Kimeswenger
- Department of Dermatology and Venereology, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Emmanuella Guenova
- Department of Dermatology, University of Lausanne and Faculty of Biology and Medicine, Lausanne, Switzerland
- Department of Dermatology, Hospital 12 de octubre, Medical school, University Complutense, Madrid, Spain
| | - Wolfram Hoetzenecker
- Department of Dermatology and Venereology, Kepler University Hospital Linz, Linz, Austria.
- Department of Dermatology and Venereology, Medical Faculty, Johannes Kepler University Linz, Linz, Austria.
| |
Collapse
|
11
|
Aberer W, Altrichter S, Cerpes U, Hawranek T, Schöffl C, Kinaciyan T. [Hereditary angioedema due to C1-inhibitor deficiency, a national disease management programme]. Wien Klin Wochenschr 2023; 135:785-798. [PMID: 38063938 PMCID: PMC10709250 DOI: 10.1007/s00508-023-02298-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 12/18/2023]
Abstract
Hereditary angioedema (HAE) is a rare, painful, disabling and potentially fatal disease, where early diagnosis and effective treatment are critical. These Austrian guidelines for the diagnosis and management of HAE provide instructions and advice on the state of the art management of HAE in Austria in contrast to global guidelines, where the situation of all countries worldwide must be taken into account. Our goal is to help Austrian physicians to consider HAE as a differential diagnosis with corresponding symptoms, to make rational decisions for the diagnosis and management of HAE with C1-inhibitor deficiency (type 1 or type 2). The guidelines provide information on common and important clinical symptoms, diagnostic methods, treatment modalities, available HAE-specific medications in Austria and last but not least to motivate physicians to refer patients to HAE centers for confirmation of the diagnosis and adequate treatment decisions.
Collapse
Affiliation(s)
- Werner Aberer
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, 8036, Auenbruggerplatz 8, Graz, Österreich.
| | - Sabine Altrichter
- Universitätsklinik für Dermatologie und Venerologie, Kepler Uniklinikum, Linz, Österreich
| | - Urban Cerpes
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, 8036, Auenbruggerplatz 8, Graz, Österreich
| | - Thomas Hawranek
- Universitätsklinik für Dermatologie und Allergologie, Uniklinikum Salzburg, Salzburg, Österreich
| | - Clemens Schöffl
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, 8036, Auenbruggerplatz 8, Graz, Österreich
| | - Tamar Kinaciyan
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| |
Collapse
|
12
|
Kocatürk E, Salameh P, Sarac E, Vera Ayala CE, Thomsen SF, Zuberbier T, Ensina LF, Popov TA, van Doorn MBA, Giménez-Arnau AM, Asero R, Criado PR, Aarestrup FM, AbdulHameed Ansari Z, Al Abri S, Al-Ahmad M, Al Hinai B, Allenova A, Al-Nesf M, Altrichter S, Arnaout R, Bartosińska J, Bauer A, Bernstein JA, Bizjak M, Bonnekoh H, Bouillet L, Brzoza Z, Calvalcanti Dela Bianca Melo AC, Campinhos FL, Carne E, Purayil SC, Cherrez-Ojeda I, Chong-Neto HJ, Christoff G, Conlon N, Jardim Criado RF, Cvenkel K, Damadoglu E, Danilycheva I, Day C, de Montjoye L, Demir S, Ferucci SM, Fomina D, Fukunaga A, Garcia E, Gelincik A, Göbel JH, Godse K, Gonçalo M, Gotua M, Grattan C, Gugala A, Guillet C, Kalyoncu AF, Karakaya G, Kasperska-Zając A, Katelaris CH, Khoshkhui M, Kleinheinz A, Kolacinska-Flont M, Kolkhir P, Košnik M, Krasowska D, Kumaran MS, Kuprys-Lipinska I, Kurowski M, Kuznetsova EV, Larenas-Linnemann D, Lebedkina MS, Lee Y, Makris M, Gómez RM, Nasr I, Neisinger S, Oda Y, Kara RÖ, Palitot EB, Papapostolou N, Salvador Parisi CA, Pesque D, Peter J, Petkova E, Ridge K, Rudenko M, Rutkowski K, Saini SS, Salman A, Sanchez J, Şekerel B, Serdotetskova SA, Serpa FS, Dikicier BS, Sidiropoulos N, Sikora A, Sørensen JA, Soria A, Kucuk OS, Thalappil SR, Tomaszewska K, Tuncay G, Unal D, Valle S, van Lindonk E, Vestergaard C, Meshkova RY, Vitchuk A, Xepapadaki P, Ye YM, Zalewska-Janowska A, Zamlynski M, Maurer M. Urticaria exacerbations and adverse reactions in patients with chronic urticaria receiving COVID-19 vaccination: Results of the UCARE COVAC-CU study. J Allergy Clin Immunol 2023; 152:1095-1106. [PMID: 37574079 DOI: 10.1016/j.jaci.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 08/15/2023]
Abstract
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.
Collapse
Affiliation(s)
- Emek Kocatürk
- Department of Dermatology, Koc University School of Medicine, Istanbul, Turkey; Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.
| | - Pascale Salameh
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany; Department of Clinical Epidemiology, Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie-Liban (INSPECT-LB), Beirut, Lebanon; Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus; School of Medicine, Lebanese American University, Beirut, Germany; Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
| | - Esra Sarac
- Department of Dermatology, Koc University School of Medicine, Istanbul, Turkey
| | - Carolina E Vera Ayala
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Simon Francis Thomsen
- Department of Dermatology, Department of Biomedical Sciences, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Torsten Zuberbier
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Luis Felipe Ensina
- Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil
| | - Todor A Popov
- Department of Allergology, University Hospital Sv Ivan Rilski, Sofia, Bulgaria
| | - Martijn B A van Doorn
- Department of Dermatology, Erasmus MC Rotterdam, Rotterdam, The Netherlands; Centre for Human Drug Research, Leiden, The Netherlands
| | - Ana Maria Giménez-Arnau
- Department of Dermatology, Hospital del Mar Research Institute, Universitat Pompeu Fabra, Barcelona, Spain
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| | - Paulo Ricardo Criado
- Alergoskin Alergia e Dermatologia, Centro Universitário Faculdade de Medicina do ABC, Santo André, Brazil
| | - Fernando M Aarestrup
- Department of Allergy and Immunology, Faculdade de Ciências, Médicas e da Saúde de Juiz de Fora (SUPREMA), Hospital Maternidade Therezinha de Jesus, Minas Gerais, Brazil
| | | | - Salma Al Abri
- Clinical Immunology and Allergy Unit, Royal Hospital, Muscat, Oman
| | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Bushra Al Hinai
- Clinical Immunology and Allergy Unit, Royal Hospital, Muscat, Oman
| | - Anastasiia Allenova
- Laboratory of Immune-Mediated Skin Diseases, Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Medical Research and Education Center, M. V. Lomonosov Moscow State University, Moscow, Russia
| | - Maryam Al-Nesf
- Department of Medicine, Allergy and Immunology Division, Hamad Medical Corporation, Doha, Qatar
| | - Sabine Altrichter
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany; Department of Dermatology and Venereology, Kepler University Hospital, Linz, Austria
| | - Rand Arnaout
- Department of Dermatology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Joanna Bartosińska
- Department of Dermatology, Venereology, and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - Andrea Bauer
- Department of Dermatology, Technical University Dresden, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jonathan A Bernstein
- Department of Internal Medicine, Division of Rheumatology, Allergy, and Immunology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mojca Bizjak
- Division of Allergy, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Hanna Bonnekoh
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Laurence Bouillet
- National Reference Center for Angioedema, Grenoble University Hospital, Grenoble, France
| | - Zenon Brzoza
- Department of Internal Diseases with the Division of Allergology, Institute of Medical Sciences, University of Opole, Opole, Poland
| | | | - Fernanda L Campinhos
- Asthma Reference Center, UCARE Hospital Santa Casa de Misericórdia de Vitória, Esperito Santo, Brazil
| | - Emily Carne
- Department of Dermatology, University Hospital of Wales, Cardiff, United Kingdom
| | | | - Ivan Cherrez-Ojeda
- Research Department, Universidad Espiritu Santo, Samborondon, Ecuador; Department Allergy and Pulmonology, Respiralab Research Group, Guayaquil, Ecuador
| | - Herberto Jose Chong-Neto
- Departamento de Pediatria, Serviço de Alergia e Imunologia, Complexo Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - George Christoff
- Faculty of Public Health, Medical University Sofia, Sofia, Bulgaria
| | - Niall Conlon
- School of Medicine, Trinity College Dublin, St James's Hospital Dublin, Dublin, Ireland
| | | | - Klara Cvenkel
- Department of Dermatovenereology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ebru Damadoglu
- Department of Chest Diseases, Division of Allergy and Immunology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Inna Danilycheva
- Department of Allergology, NRC Institute of Immunology FMBA of Russia, Moscow, Russia
| | - Cascia Day
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Laurence de Montjoye
- Department of Dermatology, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Semra Demir
- Department of Internal Medicine, Division of Immunology and Allergy Diseases, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Silvia Mariel Ferucci
- Department of Dermatology, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Daria Fomina
- Moscow Healthcare Department, Moscow City Research and Practical Center of Allergoloy and Immunology, Moscow, Russia; Department of Clinical Immunology and Allergy, Sechenow First Moscow State Medical University, Moscow, Russia; Department of Pulmonology, Astana Medical University, Kazakhstan, Russia
| | - Atsushi Fukunaga
- Department of Dermatology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Elizabeth Garcia
- Faculty of Medicine, Universidad de los Andes-UNIMEQ ORL, Bogota, Colombia
| | - Asli Gelincik
- Department of Internal Medicine, Division of Immunology and Allergy Diseases, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Joe Hannah Göbel
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Kiran Godse
- Department of Dermatology, Dr D. Y. Patil Medical College & Hospital, Navi Mumbai, India
| | - Margarida Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maia Gotua
- Center of Allergy and Immunology, David Tvildiani Medical University, Tbilisi, Georgia
| | - Clive Grattan
- Department of Dermatology, St Thomas Hospital London, London, United Kingdom
| | - Agata Gugala
- Department of Immunology and Allergy, Medical University of Lodz, Lodz, Poland
| | - Carole Guillet
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Ali Fuat Kalyoncu
- Department of Chest Diseases, Division of Allergy and Immunology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Gul Karakaya
- Department of Chest Diseases, Division of Allergy and Immunology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Alicja Kasperska-Zając
- Department of Clinical Allergology and Urticaria, Medical University of Silesia, Silesia, Poland
| | | | - Maryam Khoshkhui
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Marta Kolacinska-Flont
- Department of Internal Medicine, Asthma, and Allergy, Barlicki Memorial Hospital, Medical University of Lodz, Lodz, Poland
| | - Pavel Kolkhir
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Mitja Košnik
- Division of Allergy, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Dorota Krasowska
- Department of Dermatology, Venereology, and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Izabela Kuprys-Lipinska
- Department of Internal Medicine, Asthma, and Allergy, Barlicki Memorial Hospital, Medical University of Lodz, Lodz, Poland
| | - Marcin Kurowski
- Department of Immunology and Allergy, Medical University of Lodz, Lodz, Poland
| | - Elizaveta V Kuznetsova
- Department of Clinical Immunology and Allergy, Sechenow First Moscow State Medical University, Moscow, Russia
| | | | - Marina S Lebedkina
- Moscow Healthcare Department, Moscow City Research and Practical Center of Allergoloy and Immunology, Moscow, Russia
| | - Youngsoo Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Michael Makris
- Allergy Unit, 2nd Department of Dermatology and Venereology, University Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece
| | | | - Iman Nasr
- Clinical Immunology and Allergy Unit, Royal Hospital, Muscat, Oman
| | - Sophia Neisinger
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Yoshiko Oda
- Department of Dermatology, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Rabia Öztaş Kara
- Department of Dermatology, University of Sakarya School of Medicine, Sakarya, Turkey
| | - Esther Bastos Palitot
- Federal University of Paraiba, Department of Infectious, Parasitic and Inflammatory Diseases, João Pessoa, Paraiba, Brazil; Lauro Wanderley University Hospital - Ebserh Network, João Pessoa, Brazil
| | - Niki Papapostolou
- Allergy Unit, 2nd Department of Dermatology and Venereology, University Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece
| | | | - David Pesque
- Department of Dermatology, Hospital del Mar Research Institute, Universitat Pompeu Fabra, Barcelona, Spain
| | - Jonathan Peter
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Elena Petkova
- University Hospital "Alexandrovska", Clinic of Allergology, Sofia, Bulgaria
| | - Katie Ridge
- School of Medicine, Trinity College Dublin, St James's Hospital Dublin, Dublin, Ireland
| | - Michael Rudenko
- London Allergy & Immunology Centre, Department of Allergy and Immunology, London, United Kingdom
| | - Krzysztof Rutkowski
- Urticaria Clinic, St John's Institute of Dermatology, London, United Kingdom
| | - Sarbjit S Saini
- Department of Medicine, Division of Allergy and Clinical Immunology, Johns Hopkins Asthma and Allergy Center, Baltimore, Md
| | - Andac Salman
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey; Department of Dermatology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Jorge Sanchez
- Group of Clinical and Experimental Allergy, Hospital "Alma Mater de Antioquia", University of Antioquia, Antioquia, Colombia
| | - Bülent Şekerel
- Pediatric Allergy Asthma Division, Hacettepe University, Ankara, Turkey
| | - Sofia A Serdotetskova
- Moscow Healthcare Department, Moscow City Research and Practical Center of Allergoloy and Immunology, Moscow, Russia
| | - Faradiba S Serpa
- Asthma Reference Center, UCARE Hospital Santa Casa de Misericórdia de Vitória, Esperito Santo, Brazil
| | | | - Nikitas Sidiropoulos
- Allergy Unit, 2nd Department of Dermatology and Venereology, University Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece
| | - Agnieszka Sikora
- Department of Clinical Allergology and Urticaria, Medical University of Silesia, Silesia, Poland
| | - Jennifer Astrup Sørensen
- Department of Dermatology, Department of Biomedical Sciences, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Angele Soria
- Department of Dermatology and Allergy, Tenon Hospital APHP, Sorbonne Université Paris, Paris, France
| | - Ozlem Su Kucuk
- Department of Dermatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Sherin Rahim Thalappil
- Department of Medicine, Allergy and Immunology Division, Hamad Medical Corporation, Doha, Qatar
| | | | - Gulseren Tuncay
- Department of Chest Diseases, Division of Allergy and Immunology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Derya Unal
- Department of Internal Medicine, Division of Immunology and Allergy Diseases, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Solange Valle
- Medicine Department, Immunology Service, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Esmee van Lindonk
- Department of Dermatology, Erasmus MC Rotterdam, Rotterdam, The Netherlands
| | | | - Raisa Y Meshkova
- Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk
| | - Aleksandr Vitchuk
- Department of Dermatology, Smolensk State Medical University, Smolensk, Russia
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Young-Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | | | - Mateusz Zamlynski
- Department of Clinical Allergology and Urticaria, Medical University of Silesia, Silesia, Poland
| | - Marcus Maurer
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.
| |
Collapse
|
13
|
Hu M, Pyatilova P, Altrichter S, Sheng C, Liu N, Terhorst-Molawi D, Lohse K, Ginter K, Puhl V, Maurer M, Metz M, Kolkhir P. In the skin lesions of patients with mycosis fungoides, the number of MRGPRX2-expressing cells is increased and correlates with mast cell numbers. Front Immunol 2023; 14:1197821. [PMID: 38022672 PMCID: PMC10646224 DOI: 10.3389/fimmu.2023.1197821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/28/2023] [Indexed: 12/01/2023] Open
Abstract
Background Mycosis fungoides (MF) is an indolent T-cell lymphoma that mainly affects the skin and presents with itch in more than half of the patients. Recently, the expression of Mas-related G protein-coupled receptor X2 (MRGPRX2), a receptor of mast cell (MC) responsible for the IgE-independent non-histaminergic itch, has been shown in lesional skin of patients with pruritic skin diseases, including chronic urticaria, prurigo, and mastocytosis. As of yet, limited knowledge exists regarding the MRGPRX2 expression in the skin of patients with MF. Objectives To investigate the number of MRGPRX2-expressing (MRGPRX2+) cells in the skin of patients with MF and its correlation with clinical and laboratory characteristics of the disease. Methods MRGPRX2 was analyzed in lesional and non-lesional skin of MF patients and healthy skin tissues by immunohistochemistry. Co-localization of MRGPRX2 with the MC marker tryptase was assessed by immunofluorescence. Public single-cell RNAseq data was reanalyzed to identify the MRGPRX2 expression on the distinct cell types. Results In lesional skin of MF patients, MRGPRX2+ cell number was higher than in non-lesional skin and healthy control skin (mean:15.12 vs. 6.84 vs. 5.51 cells/mm2, p=0.04), and correlated with MC numbers (r=0.73, p=0.02). MC was the primary cell type expressing MRGPRX2 in MF patients. The ratio of MRGPRX2+ MCs to MRGPRX2+ cells in lesional and non-lesional skin correlated with the severity of disease (r=0.71, p=0.02 and r=0.67, p=0.03, respectively). Conclusions Our findings point to the role of MRGPRX2 and MC in the pathogenesis of MF that should be investigated in further studies.
Collapse
Affiliation(s)
- Man Hu
- 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), Immunology and Allergology, Berlin, Germany
| | - Polina Pyatilova
- 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), Immunology and Allergology, Berlin, Germany
| | - Sabine Altrichter
- 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), Immunology and Allergology, Berlin, Germany
- Departement for Dermatology and Venerology, Kepler University Hospital, Linz, Austria
| | | | - Nian Liu
- 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), Immunology and Allergology, Berlin, Germany
| | - Dorothea Terhorst-Molawi
- 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), Immunology and Allergology, Berlin, Germany
| | - Katharina Lohse
- 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), Immunology and Allergology, Berlin, Germany
| | - Katharina Ginter
- 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), Immunology and Allergology, Berlin, Germany
- Department of Dermatology, Heidelberg University, Heidelberg, Germany
| | - Viktoria Puhl
- 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), Immunology and Allergology, Berlin, Germany
| | - 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), Immunology and Allergology, Berlin, Germany
| | - Martin Metz
- 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), Immunology and Allergology, Berlin, Germany
| | - Pavel Kolkhir
- 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), Immunology and Allergology, Berlin, Germany
| |
Collapse
|
14
|
Siebenhaar F, Altrichter S, Bonnekoh H, Hawro T, Hawro M, Michaelis EG, Kantor AM, Chang AT, Youngblood BA, Singh B, Rasmussen HS, Maurer M. Safety and efficacy of lirentelimab in patients with refractory indolent systemic mastocytosis: a first-in-human clinical trial. Br J Dermatol 2023; 189:511-519. [PMID: 37290787 DOI: 10.1093/bjd/ljad191] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/12/2023] [Accepted: 06/02/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Indolent systemic mastocytosis (ISM) is characterized by excessive mast cell (MC) accumulation and MC-driven signs and symptoms. Currently used therapies are not approved and have limited efficacy. Lirentelimab (AK002) is a monoclonal antibody against sialic acid-binding immunoglobulin-like lectin (Siglec)-8 that inhibits MC activation. OBJECTIVES To determine the safety, tolerability and efficacy of lirentelimab in reducing the symptoms of ISM. METHODS At a specialty centre for mastocytosis in Germany, we conducted a phase I first-in-human single-ascending and multidose clinical trial of lirentelimab in patients with ISM. Eligible adults had World Health Organization-confirmed ISM and an unsatisfactory response to available treatment. In part A, patients received a single dose of lirentelimab 0.0003, 0.001, 0.003, 0.01 or 0.03 mg kg-1; in part B, patients received one lirentelimab dose of 0.3 mg kg-1 or 1.0 mg kg-1; and in part C, patients received either 1.0 mg kg-1 lirentelimab every 4 weeks for 6 months or ascending doses of lirentelimab (one dose of 1 mg kg-1 followed by five doses of 3-10 mg kg-1 every 4 weeks). The primary endpoint was safety/tolerability. Secondary endpoints included changes from baseline in Mastocytosis Symptom Questionnaire (MSQ), Mastocytosis Activity Score (MAS) and Mastocytosis Quality of Life Questionnaire (MC-QoL) scores at 2 weeks after the final dose. RESULTS In 25 patients with ISM (13 in parts A + B and 12 in part C; median age 51 years, 76% female, median 4.6 years from diagnosis), the most common treatment-related adverse events (AEs) were feeling hot (76%) and experiencing a headache (48%). No serious AEs occurred. Median MSQ and MAS symptom severity scores in part C improved (vs. baseline) across all symptoms [MSQ: skin (38-56%), gastrointestinal (49-60%), neurological (47-59%), musculoskeletal (26-27%); MAS: skin (53-59%), gastrointestinal (72-85%), neurological (20-57%), musculoskeletal (25%)]. Median MC-QoL scores improved across all domains: symptoms (39%), social life/functioning (42%), emotions (57%) and skin (44%). CONCLUSIONS Lirentelimab was generally well tolerated and improved symptoms and quality of life in patients with ISM. The therapeutic potential of lirentelimab should be considered for ISM.
Collapse
Affiliation(s)
- Frank Siebenhaar
- Institute of Allergology
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology IA, Berlin, Germany
| | - Sabine Altrichter
- Institute of Allergology
- Department of Dermatology and Venerology, Kepler University Hospital, Linz, Austria
| | - Hanna Bonnekoh
- Institute of Allergology
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology IA, Berlin, Germany
| | | | | | - Edward G Michaelis
- Institute of Allergology
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin, Germany (corporate member or Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany, and Berlin Institute of Health, Berlin, Germany)
| | | | | | | | | | | | - Marcus Maurer
- Institute of Allergology
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology IA, Berlin, Germany
| |
Collapse
|
15
|
Bonnekoh H, Jelden-Thurm J, Allenova A, Chen Y, Cherrez-Ojeda I, Danilycheva I, Dorofeeva I, Jardim Criado RF, Criado PR, Gelincik Akkor A, Hawro T, Kocatürk E, Khoshkhui M, Metz M, Nasr I, Steć M, Zhao Z, Aulenbacher F, Salameh P, Altrichter S, Gonçalo M, Gimenez-Arnau A, Maurer M, Krause K, Kolkhir P. Urticarial Vasculitis Differs From Chronic Spontaneous Urticaria in Time to Diagnosis, Clinical Presentation, and Need for Anti-Inflammatory Treatment: An International Prospective UCARE Study. J Allergy Clin Immunol Pract 2023; 11:2900-2910.e21. [PMID: 37364667 DOI: 10.1016/j.jaip.2023.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) and urticarial vasculitis (UV) share several clinical features including the occurrence of wheals. As of yet, the criteria for differentiating the 2 disorders are not clearly defined. OBJECTIVE Here, we aimed to identify differences, similarities, and the likelihood for specific clinical features in patients with UV versus those with CSU. METHODS Across 10 Urticaria Centers of Reference and Excellence, 106 patients with skin biopsy-confirmed UV and 126 patients with CSU were prospectively recruited to complete a questionnaire on the clinical features, course, and response to treatment of their disease. RESULTS As compared with CSU, patients with UV more often experienced postinflammatory skin hyperpigmentation, wheals of ≥24-hour duration, eye inflammation, and fever (6.9, 4.0, 3.6, and 2.4 times, respectively). Clinical features that increased the risk for UV diagnosis when present at the onset of disease included wheals of ≥24-hour duration (7.3-fold), pain of the skin (7.0-fold), postinflammatory hyperpigmentation (4.1-fold), and fatigue (3.1-fold). The diagnostic delay was markedly longer for normocomplementemic UV as compared with hypocomplementemic UV and CSU (21 vs 5 vs 6 months, respectively). Oral corticosteroids and omalizumab were the most effective treatments in patients with UV and CSU, respectively. Patients with UV showed a higher need for immunosuppressive and anti-inflammatory therapies than patients with CSU. CONCLUSIONS Long wheal duration, skin pain and hyperpigmentation, and systemic symptoms point to UV rather than CSU as the underlying disease and should prompt further diagnostic workup including a skin biopsy.
Collapse
Affiliation(s)
- Hanna Bonnekoh
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Jannis Jelden-Thurm
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Anastasiia Allenova
- Laboratory of Immune-Mediated Skin Diseases, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Medical Scientific and Educational Center of Lomonosov Moscow State University, Moscow, Russia
| | - Yudi Chen
- Department of Dermatology and Venerology, GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), National Research Center for Skin and Immune Diseases, Peking University First Hospital, Beijing, China
| | - Ivan Cherrez-Ojeda
- Department of Allergy, Universidad Espíritu Santo, Samborondon, Ecuador; Department of Allergy and Pulmonology, Respiralab Research Group, Guayaquil, Ecuador
| | - Inna Danilycheva
- National Research Center-Institute of Immunology, Federal Medical-Biological Agency of Russia, Moscow, Russia
| | - Irina Dorofeeva
- National Research Center-Institute of Immunology, Federal Medical-Biological Agency of Russia, Moscow, Russia
| | - Roberta Fachini Jardim Criado
- Alergoskin Allergy and Dermatology, Sao Paulo, Brazil; Department of Dermatology, Centro Universitário Faculdade de Medicina do ABC, Sao Paulo, Brazil
| | - Paulo Ricardo Criado
- Alergoskin Allergy and Dermatology, Sao Paulo, Brazil; Department of Dermatology, Centro Universitário Faculdade de Medicina do ABC, Sao Paulo, Brazil
| | - Asli Gelincik Akkor
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Tomasz Hawro
- Institute and Comprehensive Center for Inflammation Medicine, Department of Dermatology, Allergology and Venereology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Emek Kocatürk
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany; Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey
| | - Maryam Khoshkhui
- Allergy Research Center, Mashhad University of Medical Science (MUMS), Mashhad, Iran
| | - Martin Metz
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Iman Nasr
- Adult Immunology and Allergy Unit, Department of Medicine, Royal Hospital, Muscat, Oman
| | - Michał Steć
- Department of Computer Science, Chair of Embedded Systems Architectures for Signal Processing, University of Potsdam, Potsdam, Germany
| | - Zuotao Zhao
- Department of Dermatology and Venerology, GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), National Research Center for Skin and Immune Diseases, Peking University First Hospital, Beijing, China
| | - Felix Aulenbacher
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Pascale Salameh
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; School of Medicine, Lebanese American University, Byblos, Lebanon; Institut National de Santé Publique d'Épidémiologie Clinique et de Toxicologie-Liban (INSPECT-LB), Beirut, Lebanon; Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Sabine Altrichter
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany; GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology and Venerology, Kepler Universitätsklinik, Linz, Austria
| | - Margarida Gonçalo
- Department of Dermatology, Centro Hospitalar e Universitário de Coimbra e Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | - Ana Gimenez-Arnau
- Hospital del Mar, Institut Mar d'Investigacions Mèdiques, Universitat Pompeu Fabra, Barcelona, Spain
| | - Marcus Maurer
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Karoline Krause
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Pavel Kolkhir
- GA(2)LEN Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
| |
Collapse
|
16
|
Schmidle P, Blank S, Altrichter S, Hoetzenecker W, Brockow K, Darsow U, Biedermann T, Eberlein B. Basophil Activation Test in Double-Sensitized Patients With Hymenoptera Venom Allergy: Additional Benefit of Component-Resolved Diagnostics. J Allergy Clin Immunol Pract 2023; 11:2890-2899.e2. [PMID: 37302791 DOI: 10.1016/j.jaip.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/10/2023] [Accepted: 06/01/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND In Hymenoptera venom allergy serologically double-sensitized patients, it is often difficult to identify the culprit insect for venom immunotherapy (VIT). OBJECTIVES To evaluate if basophil activation tests (BATs) performed not only with venom extracts but additionally with single component-resolved diagnostics could differentiate between sensitized and allergic individuals and how the test results influenced the physicians' decision regarding VIT. METHODS BATs were performed with bee and wasp venom extracts and with single components (Api m 1, Api m 10, Ves v 1, and Ves v 5) in 31 serologically double-sensitized patients. RESULTS In 28 finally included individuals, 9 BATs were positive and 4 negative for both venoms. Fourteen of 28 BATs showed positive results for wasp venom alone. Two of 10 BATs positive for bee venom were only positive to Api m 1 and 1 of 28 BATs only to Api m 10, but not for whole bee venom extract. Five of 23 BATs positive for wasp venom were only positive for Ves v 5 but negative for wasp venom extract and Ves v 1. Finally, VIT with both insect venoms was recommended in 4 of 28 individuals, with wasp venom alone in 21 of 28 patients and with bee venom alone in 1 of 28. In 2 cases no VIT was recommended. CONCLUSIONS BATs with Ves v 5, followed by Api m 1 and Api m 10, were helpful for the decision for VIT with the clinically relevant insect in 8 of 28 (28.6%) patients. A BAT with components should therefore be additionally carried out in cases with equivocal results.
Collapse
Affiliation(s)
- Paul Schmidle
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - Simon Blank
- Center of Allergy and Environment (ZAUM), Technical University of Munich, School of Medicine and Helmholtz Center Munich, German Research Center for Environmental Health, Munich, Germany
| | - Sabine Altrichter
- Department of Dermatology and Venerology, Kepler University Hospital, Linz, Austria
| | - Wolfram Hoetzenecker
- Department of Dermatology and Venerology, Kepler University Hospital, Linz, Austria
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - Ulf Darsow
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernadette Eberlein
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany.
| |
Collapse
|
17
|
Su H, Kolkhir P, Scheffel J, Xiang YK, Yao X, Maurer M, Altrichter S. One in five patients with chronic spontaneous urticaria has IgE to tissue transglutaminase 2. Allergy 2023; 78:2537-2539. [PMID: 37017141 DOI: 10.1111/all.15734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/20/2023] [Accepted: 03/31/2023] [Indexed: 04/06/2023]
Affiliation(s)
- Huichun Su
- 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
- Department of Dermatology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Pavel Kolkhir
- 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
| | - Jörg Scheffel
- 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
| | - Yi-Kui Xiang
- 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
| | - Xu Yao
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - 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
| | - Sabine Altrichter
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Dermatology and Venerology, Kepler University Hospital, Linz, Austria
| |
Collapse
|
18
|
Xiang YK, Kolkhir P, Scheffel J, Sauer M, Vera C, Frischbutter S, Krause K, Siebenhaar F, Metz M, Maurer M, Altrichter S. Most Patients With Autoimmune Chronic Spontaneous Urticaria Also Have Autoallergic Urticaria, but Not ViceVersa. J Allergy Clin Immunol Pract 2023; 11:2417-2425.e1. [PMID: 36805105 DOI: 10.1016/j.jaip.2023.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/20/2023] [Accepted: 02/03/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Two endotypes of chronic spontaneous urticaria (CSU) associated with mast cell-activating autoantibodies are described, namely autoallergic chronic spontaneous urticaria (aaCSU; with immunoglobulin E [IgE]-anti-autoallergens) and autoimmune chronic spontaneous urticaria (aiCSU; with IgG-anti-high-affinity receptor for the Fc region of immunoglobulin E [FcεRI]/IgE). OBJECTIVE To investigate the rates of CSU patients with aaCSU and aiCSU. METHODS We analyzed 111 CSU patients for aaCSU (ie, IgE to thyroid peroxidase, interleukin 24) and for aiCSU (ie, a positive autologous serum skin and Basophil Activation Test plus immunoglobulin G [IgG]-anti-FcεRI/IgE). Clinical and laboratory parameters were compared in patients with aaCSU, aiCSU, and both. RESULTS Across 111 patients with CSU, 64 (58%) had aaCSU and 9 (8%) had aiCSU. Eight of the 9 aiCSU patients had aaCSU, but only 8 of 64 patients with aaCSU had aiCSU. In total, 7% (8 of 111) of patients had both aiCSU and aaCSU, 41% (46 of 111) had neither, and 16% (18 of 111) tested negative for all markers of aaCSU and aiCSU assessed. Patients with aaCSU or aiCSU are different from those without: patients with stand-alone aaCSU tend to be younger than non-aaCSU patients, aiCSU, and aaCSU/aiCSU overlapping subpopulations. In contrast, patients with aiCSU, with or without aaCSU coexistence, are more often female, have higher levels of thyroid peroxidase autoantibodies (both IgG and IgE), and show more severe quality of life impairment. CONCLUSIONS Our novel finding that aiCSU coexisting with aaCSU needs to be confirmed in bigger cohorts and multicenter studies. Autoimmunity driven by autoreactive IgE and/or IgG in CSU needs further investigation for better understanding of the pathophysiology.
Collapse
Affiliation(s)
- Yi-Kui Xiang
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Pavel Kolkhir
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Jörg Scheffel
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Merle Sauer
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Carolina Vera
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Stefan Frischbutter
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Karoline Krause
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Frank Siebenhaar
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Martin Metz
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany.
| | - Sabine Altrichter
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany; Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology and Venereology, Comprehensive Allergy Center, Kepler Universitätsklinikum Linz, Austria
| |
Collapse
|
19
|
Puxkandl V, Currie A, Hoetzenecker W, Altrichter S. Therapy resistant urticaria as a long-term symptom of an incomplete Schnitzler syndrome. Allergy Asthma Clin Immunol 2023; 19:64. [PMID: 37496089 PMCID: PMC10373319 DOI: 10.1186/s13223-023-00819-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 07/03/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Recurring therapy resistant hives, accompanied by IgM-gammopathy, fever and joint pain can indicate Schnitzler syndrome, a rare autoimmune disorder. There is currently no approved treatment, but complete remission of symptoms can be induced with IL-1 antagonists. CASE PRESENTATION A patient with a history of chronic urticaria presented frequently at the outpatient clinic with severe hives and was treated unsuccessfully with antihistamines and omalizumab. After several years, additional symptoms such as joint pain, recurrent fever, and IgM-gammopathy developed. After the diagnostic criteria for Schnitzler syndrome were met, treatment with anakinra was initiated and resulted in an improvement of the symptoms. Shortly after the first injection, the patient developed large and painful erythematous lesions at the injection sites, leading to discontinuation of treatment and a rapid recurrence of symptoms. Subsequently, treatment with a longer-acting IL-1 antagonist (canakinumab) was initiated, resulting in a complete remission of symptoms. CONCLUSION This case report demonstrates that patients with urticarial symptoms that are not relieved by typical treatments should prompt repeated reassessments of the diagnosis, even years later, because gammopathy and other diagnostic criteria for Schnitzler syndrome can occur with a delay.
Collapse
Affiliation(s)
- Viktoria Puxkandl
- Department of Dermatology, Comprehensive Allergy Center, Kepler University Hospital Linz & Johannes Kepler University, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Antonia Currie
- Department of Dermatology, Comprehensive Allergy Center, Kepler University Hospital Linz & Johannes Kepler University, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Wolfram Hoetzenecker
- Department of Dermatology, Comprehensive Allergy Center, Kepler University Hospital Linz & Johannes Kepler University, Krankenhausstrasse 9, 4020, Linz, Austria.
| | - Sabine Altrichter
- Department of Dermatology, Comprehensive Allergy Center, Kepler University Hospital Linz & Johannes Kepler University, Krankenhausstrasse 9, 4020, Linz, Austria
- Departement of Dermatology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| |
Collapse
|
20
|
Moñino-Romero S, Kolkhir P, Szépfalusi Z, Schoepke N, Metz M, Asero R, Ferrer M, Gimenez-Arnau A, Grattan CEH, Jakob T, Konstantinou GN, Raap U, Staubach P, Zhang K, Bindslev-Jensen C, Daschner A, Kinaciyan T, Makris M, Marrouche N, Schmid-Grendelmeier P, Sussman G, Toubi E, Maurer M, Altrichter S. In chronic spontaneous urticaria soluble FcεRI is elevated and linked to atopy and chronic inducible urticaria. Clin Transl Allergy 2023; 13:e12272. [PMID: 37488737 PMCID: PMC10314276 DOI: 10.1002/clt2.12272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Affiliation(s)
- Sherezade Moñino-Romero
- Urticaria Center of Reference and Excellence (UCARE), 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
- Division of Pediatric Pulmonology, Allergy and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Pavel Kolkhir
- Urticaria Center of Reference and Excellence (UCARE), 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
| | - Zsolt Szépfalusi
- Division of Pediatric Pulmonology, Allergy and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Nicole Schoepke
- Urticaria Center of Reference and Excellence (UCARE), 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
| | - Martin Metz
- Urticaria Center of Reference and Excellence (UCARE), 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
| | - Riccardo Asero
- Department of Allergology, Clinica San Carlo, Paderno Dugnano, Milan, Italy
| | - 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 y Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Thilo Jakob
- Department of Dermatology and Allergology, University Medical Center Giessen and Marburg, Justus-Liebig University Gießen, Gießen, 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
| | - Petra Staubach
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Ke Zhang
- Allerdia Inc, 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
| | - Michael Makris
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, "Attikon" 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, Haifa, Israel
| | - Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE), 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
| | - Sabine Altrichter
- Department of Dermatology and Venerology, Kepler University Hospital, Linz, Austria
| |
Collapse
|
21
|
Steinert C, Moñino‐Romero S, Butze M, Scheffel J, Dölle‐Bierke S, Dobbertin‐Welsch J, Beyer K, Maurer M, Altrichter S. Soluble IgE-binding factors in the serum of food-allergic patients: Possible pathophysiological role of soluble FcεRI as protective factor. Clin Transl Allergy 2023; 13:e12222. [PMID: 36825516 PMCID: PMC9904993 DOI: 10.1002/clt2.12222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/16/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND IgE-mediated food allergy is the result of an aberrant immune response involving the interaction of a food allergen with its specific IgE bound to FcɛRI, the high affinity IgE receptor, on mast cells. Allergen-specific IgE also binds to soluble binding factors, but, their expression and role in food allergy is not well characterized. Here, we assess the prevalence and relevance of soluble IgE binding factors in food allergy and tolerance. METHODS We measured serum levels of four IgE binding factors, that is, galectin-3, galectin-9, soluble FcɛRI (sFcεRI) and soluble CD23 (sCD23) in 67 adults sensitized to peanut or hazelnut and sFcɛRI in 29 children sensitized to hen's egg. Adults without food allergen sensitization (n = 17) served as healthy controls. We compared serum levels of patients and controls and assessed them, in the former, for links to clinical features including allergy and tolerance. RESULTS Serum levels of sFcɛRI and sCD23, but not galectin-3 and galectin-9, significantly differ in food-sensitized patients as compared to healthy controls. A subgroup (28%) of peanut and hazelnut allergic patients had elevated sFcεRI levels, that were associated with higher total and specific IgE levels. Furthermore, sFcεRI levels were significantly higher in tolerant subjects compared to allergics. Among hazelnut allergic patients, those with high sFcεRI levels tolerated the highest protein amounts in the oral food challenge. CONCLUSION sFcɛRI but not sCD23, galectin-3 and galectin-9 might play a role in the pathophysiology of food allergy. Its functional role or use as biomarker should be assessed in further studies.
Collapse
Affiliation(s)
- Carolin Steinert
- Institute of AllergologyCharité – Universitätsmedizin BerlinFreie Universität Berlin und Humboldt‐Universität zu BerlinBerlinGermany,Allergology and ImmunologyFraunhofer Institute for Translational Medicine and Pharmacology ITMPBerlinGermany,Department of Biology, Chemistry and PharmacyFreie Universität BerlinBerlinGermany
| | - Sherezade Moñino‐Romero
- Institute of AllergologyCharité – Universitätsmedizin BerlinFreie Universität Berlin und Humboldt‐Universität zu BerlinBerlinGermany,Allergology and ImmunologyFraunhofer Institute for Translational Medicine and Pharmacology ITMPBerlinGermany
| | - Monique Butze
- Institute of AllergologyCharité – Universitätsmedizin BerlinFreie Universität Berlin und Humboldt‐Universität zu BerlinBerlinGermany,Allergology and ImmunologyFraunhofer Institute for Translational Medicine and Pharmacology ITMPBerlinGermany,University of PotsdamPotsdamGermany
| | - Jörg Scheffel
- Institute of AllergologyCharité – Universitätsmedizin BerlinFreie Universität Berlin und Humboldt‐Universität zu BerlinBerlinGermany,Allergology and ImmunologyFraunhofer Institute for Translational Medicine and Pharmacology ITMPBerlinGermany
| | - Sabine Dölle‐Bierke
- Division of Allergy and Immunology, Venerology and AllergyDepartment of DermatologyCharité – Universitätsmedizin BerlinFreie Universität Berlin und Humboldt‐Universität zu BerlinBerlinGermany
| | - Josefine Dobbertin‐Welsch
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care MedicineCharité – Universitätsmedizin BerlinFreie Universität Berlin und Humboldt‐Universität zu BerlinBerlinGermany
| | - Kirsten Beyer
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care MedicineCharité – Universitätsmedizin BerlinFreie Universität Berlin und Humboldt‐Universität zu BerlinBerlinGermany
| | - Marcus Maurer
- Institute of AllergologyCharité – Universitätsmedizin BerlinFreie Universität Berlin und Humboldt‐Universität zu BerlinBerlinGermany,Allergology and ImmunologyFraunhofer Institute for Translational Medicine and Pharmacology ITMPBerlinGermany
| | - Sabine Altrichter
- Institute of AllergologyCharité – Universitätsmedizin BerlinFreie Universität Berlin und Humboldt‐Universität zu BerlinBerlinGermany,Allergology and ImmunologyFraunhofer Institute for Translational Medicine and Pharmacology ITMPBerlinGermany,Department for Dermatology and VenerologyKepler University HospitalLinzAustria
| |
Collapse
|
22
|
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 2: Treatment of urticaria - German-language adaptation of the international S3 guideline. J Dtsch Dermatol Ges 2023; 21:202-215. [PMID: 36730626 DOI: 10.1111/ddg.14932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/12/2022] [Indexed: 02/04/2023]
Abstract
This publication is the second part of the German-language S3 guideline on urticaria. It covers the management of urticaria and should be used together with Part 1 of the guideline on classification and diagnosis. This publication was prepared according to the criteria of the AWMF on the basis of the international English-language S3 guideline with special consideration of health system conditions in German-speaking countries. Chronic urticaria has a high impact on the quality of life and daily activities of patients. Therefore, if causal factors cannot be eliminated, effective symptomatic treatment is necessary. The recommended first-line treatment is to administer new generation, non-sedating H1 antihistamines. If the standard dose is not sufficiently effective, the dose should be increased up to fourfold. For patients who do not respond to this treatment, the second-line treatment in addition to antihistamines in the treatment algorithm is omalizumab and, if this treatment fails, ciclosporin. Other low-evidence therapeutic agents should only be used if all treatments in the treatment algorithm agreed upon by the guideline group fail. Both the benefit-risk profile and cost should be considered. Corticosteroids are not recommended for long-term treatment due to their inevitable severe side effects.
Collapse
Affiliation(s)
- Torsten Zuberbier
- 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
| | - 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 and 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
- 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
| | - 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 Gut, enberg University Mainz, Mainz, Germany
| | - Bettina Wedi
- Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, Germany
| | - 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
| |
Collapse
|
23
|
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 2: Therapie der Urtikaria - deutschsprachige Adaption der internationalen S3-Leitlinie. J Dtsch Dermatol Ges 2023; 21:202-216. [PMID: 36808444 DOI: 10.1111/ddg.14932_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/12/2022] [Indexed: 02/22/2023]
Affiliation(s)
- Torsten Zuberbier
- 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
| | - 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
- 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
| | - 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
- Klinik für Dermatologie, Allergologie und Venerologie, Comprehensive Allergy Center (CAC), Medizinische Hochschule Hannover, Hannover, Deutschland
| | - 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
| |
Collapse
|
24
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
25
|
Makris M, Altrichter S, Ensina LF, Kocatürk E, Rudenko M. Editorial: The complexity of urticaria. Front Allergy 2023; 4:1149540. [PMID: 36873049 PMCID: PMC9982085 DOI: 10.3389/falgy.2023.1149540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 02/19/2023] Open
Affiliation(s)
- Michael Makris
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.,Institute for Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universitätzu Berlin, Berlin, Germany
| | - Sabine Altrichter
- Institute for Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universitätzu Berlin, Berlin, Germany.,Department of Dermatology and Venerology, Kepler University Hospital, Linz, Austria
| | - Luis Felipe Ensina
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - Emek Kocatürk
- Institute for Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universitätzu Berlin, Berlin, Germany.,Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey
| | - Michael Rudenko
- London Allergy and Immunology Centre, London, United Kingdom
| |
Collapse
|
26
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
| |
Collapse
|
27
|
Worm M, Alexiou A, Höfer V, Birkner T, Jeanrenaud ACSN, Fauchère F, Pazur K, Steinert C, Arnau‐Soler A, Banerjee P, Diefenbach A, Dobbertin‐Welsch J, Dölle‐Bierke S, Francuzik W, Ghauri A, Heller S, Kalb B, Löber U, Marenholz I, Markó L, Scheffel J, Potapenko O, Roll S, Lau S, Lee Y, Braun J, Thiel A, Babina M, Altrichter S, Forslund SK, Beyer K. An interdisciplinary approach to characterize peanut-allergic patients-First data from the FOOD@ consortium. Clin Transl Allergy 2022; 12:e12197. [PMID: 36225266 PMCID: PMC9533219 DOI: 10.1002/clt2.12197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/29/2022] [Accepted: 09/05/2022] [Indexed: 12/01/2022] Open
Abstract
Background Peanut allergy is a frequent cause of food allergy and potentially life‐threatening. Within this interdisciplinary research approach, we aim to unravel the complex mechanisms of peanut allergy. As a first step were applied in an exploratory manner the analysis of peanut allergic versus non‐allergic controls. Methods Biosamples were studied regarding DNA methylation signatures, gut microbiome, adaptive and innate immune cell populations, soluble signaling molecules and allergen‐reactive antibody specificities. We applied a scalable systems medicine computational workflow to the assembled data. Results We identified combined cellular and soluble biomarker signatures that stratify donors into peanut‐allergic and non‐allergic with high specificity. DNA methylation profiling revealed various genes of interest and stool microbiota differences in bacteria abundances. Conclusion By extending our findings to a larger set of patients (e.g., children vs. adults), we will establish predictors for food allergy and tolerance and translate these as for example, indicators for interventional studies.
Collapse
Affiliation(s)
- Margitta Worm
- Division of Allergy and ImmunologyDepartment of Dermatology, Venerology and AllergyCharité – Universitätsmedizin BerlinFreie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Aikaterina Alexiou
- Division of Allergy and ImmunologyDepartment of Dermatology, Venerology and AllergyCharité – Universitätsmedizin BerlinFreie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Veronika Höfer
- Division of Allergy and ImmunologyDepartment of Dermatology, Venerology and AllergyCharité – Universitätsmedizin BerlinFreie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Till Birkner
- Experimental and Clinical Research CenterA Cooperation of Charité‐Universitätsmedizin BerlinMax Delbrück Center for Molecular MedicineBerlinGermany,Charité‐Universitätsmedizin BerlinFreie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of HealthBerlinGermany,Max Delbrück Center for Molecular MedicineHelmholtz AssociationBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Alexander C. S. N. Jeanrenaud
- Max Delbrück Center for Molecular MedicineHelmholtz AssociationBerlinGermany,Clinic for Pediatric Allergy, Experimental and Clinical Research CenterCharité – Universitätsmedizin BerlinFreie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Florent Fauchère
- Si‐M/“Der Simulierte Mensch” a Science Framework of Technische Universität Berlin and Charité – Universitätsmedizin BerlinBerlinGermany,Regenerative Immunology and AgingBIH Center for Regenerative TherapiesCharité ‐ Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Kristijan Pazur
- Division of Allergy and ImmunologyDepartment of Dermatology, Venerology and AllergyCharité – Universitätsmedizin BerlinFreie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Carolin Steinert
- Institute of Allergology IFACharité‐Universitätsmedizin BerlinFreie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of HealthBerlinGermany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and Immunology AIBerlinGermany,Department of Biology, Chemistry and PharmacyFreie Universität BerlinBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Aleix Arnau‐Soler
- Max Delbrück Center for Molecular MedicineHelmholtz AssociationBerlinGermany,Clinic for Pediatric Allergy, Experimental and Clinical Research CenterCharité – Universitätsmedizin BerlinFreie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Priyanka Banerjee
- Institute of PhysiologyCharité – Universitätsmedizin BerlinFreie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of HealthBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Andreas Diefenbach
- Mucosal and Developmental ImmunologyGerman Rheuma Research Center Berlin (DRFZ)BerlinGermany,Department of Microbiology, Infectious Diseases, and ImmunologyLaboratory of Innate ImmunityCharité – Universitätsmedizin BerlinCampus Benjamin FranklinBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Josefine Dobbertin‐Welsch
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care MedicineCharité – Universitätsmedizin BerlinFreie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Sabine Dölle‐Bierke
- Division of Allergy and ImmunologyDepartment of Dermatology, Venerology and AllergyCharité – Universitätsmedizin BerlinFreie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Wojciech Francuzik
- Division of Allergy and ImmunologyDepartment of Dermatology, Venerology and AllergyCharité – Universitätsmedizin BerlinFreie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Ahla Ghauri
- Max Delbrück Center for Molecular MedicineHelmholtz AssociationBerlinGermany,Clinic for Pediatric Allergy, Experimental and Clinical Research CenterCharité – Universitätsmedizin BerlinFreie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Stephanie Heller
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care MedicineCharité – Universitätsmedizin BerlinFreie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Birgit Kalb
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care MedicineCharité – Universitätsmedizin BerlinFreie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Ulrike Löber
- Experimental and Clinical Research CenterA Cooperation of Charité‐Universitätsmedizin BerlinMax Delbrück Center for Molecular MedicineBerlinGermany,Charité‐Universitätsmedizin BerlinFreie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of HealthBerlinGermany,Max Delbrück Center for Molecular MedicineHelmholtz AssociationBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Ingo Marenholz
- Max Delbrück Center for Molecular MedicineHelmholtz AssociationBerlinGermany,Clinic for Pediatric Allergy, Experimental and Clinical Research CenterCharité – Universitätsmedizin BerlinFreie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Lajos Markó
- Experimental and Clinical Research CenterA Cooperation of Charité‐Universitätsmedizin BerlinMax Delbrück Center for Molecular MedicineBerlinGermany,Charité‐Universitätsmedizin BerlinFreie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of HealthBerlinGermany,Max Delbrück Center for Molecular MedicineHelmholtz AssociationBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Jörg Scheffel
- Institute of Allergology IFACharité‐Universitätsmedizin BerlinFreie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of HealthBerlinGermany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and Immunology AIBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Olena Potapenko
- Experimental and Clinical Research CenterA Cooperation of Charité‐Universitätsmedizin BerlinMax Delbrück Center for Molecular MedicineBerlinGermany,Charité‐Universitätsmedizin BerlinFreie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of HealthBerlinGermany,Max Delbrück Center for Molecular MedicineHelmholtz AssociationBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Stephanie Roll
- Institute of Social Medicine, Epidemiology and Health EconomicsCharité—Universitätsmedizin BerlinFreie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Susanne Lau
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care MedicineCharité – Universitätsmedizin BerlinFreie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Young‐Ae Lee
- Max Delbrück Center for Molecular MedicineHelmholtz AssociationBerlinGermany,Clinic for Pediatric Allergy, Experimental and Clinical Research CenterCharité – Universitätsmedizin BerlinFreie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Julian Braun
- Si‐M/“Der Simulierte Mensch” a Science Framework of Technische Universität Berlin and Charité – Universitätsmedizin BerlinBerlinGermany,Regenerative Immunology and AgingBIH Center for Regenerative TherapiesCharité ‐ Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Andreas Thiel
- Si‐M/“Der Simulierte Mensch” a Science Framework of Technische Universität Berlin and Charité – Universitätsmedizin BerlinBerlinGermany,Regenerative Immunology and AgingBIH Center for Regenerative TherapiesCharité ‐ Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Magda Babina
- Institute of Allergology IFACharité‐Universitätsmedizin BerlinFreie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of HealthBerlinGermany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and Immunology AIBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Sabine Altrichter
- Institute of Allergology IFACharité‐Universitätsmedizin BerlinFreie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of HealthBerlinGermany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and Immunology AIBerlinGermany,Department of Dermatology and VenerologyKepler University HospitalLinzAustria,KFO339, FOOD@BerlinGermany
| | - Sofia Kirke Forslund
- Experimental and Clinical Research CenterA Cooperation of Charité‐Universitätsmedizin BerlinMax Delbrück Center for Molecular MedicineBerlinGermany,Charité‐Universitätsmedizin BerlinFreie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of HealthBerlinGermany,Max Delbrück Center for Molecular MedicineHelmholtz AssociationBerlinGermany,KFO339, FOOD@BerlinGermany
| | - Kirsten Beyer
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care MedicineCharité – Universitätsmedizin BerlinFreie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,KFO339, FOOD@BerlinGermany
| |
Collapse
|
28
|
Terhorst-Molawi D, Lohse K, Ginter K, Puhl V, Metz M, Hu M, Maurer M, Altrichter S. Mast cells and tryptase are linked to itch and disease severity in mycosis fungoides: Results of a pilot study. Front Immunol 2022; 13:930979. [PMID: 36032167 PMCID: PMC9400509 DOI: 10.3389/fimmu.2022.930979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionIn mycosis fungoides (MF), the most common cutaneous T-cell lymphoma, itch is a frequent clinical symptom. Whether mast cells (MCs), eosinophils (Eos) or their mediators play a role in MF-associated itch or disease severity is controversially discussed. Here, we explored the role of MC and Eo numbers in the skin as well as blood levels of their mediators in disease severity and itch.MethodsIn 10 patients with MF and 10 matched control subjects we assessed disease severity, itch, and quality of life impairment using dedicated tools such as the mSWAT, ItchyQoL and DLQI. We analyzed skin biopsies and measured serum levels of tryptase, a mast cell mediator, as well as of the eosinophil products eosinophil cationic protein (ECP) and major basic protein (MBP).ResultsThe presence of chronic itch, in four of 10 patients, was associated with significantly higher disease severity (mSwat), larger body surface area affected, and stronger QoL impairment (Itchy-Qol, DLQI). Serum levels of tryptase, but not ECP and MBP, were linked with patient-reported disease severity, body surface area affected, and the presence of itch. Three of the four patients with chronic itch, but none of the six patients without, had tryptase levels above >6µg/l. Numbers of MCs in the papillary dermis were higher in MF skin lesions then in non-lesional skin of MF patients and skin of healthy controls.DiscussionThe MC-mediator tryptase, in MF, is linked to disease activity and impact, most prominently to itch. Our findings call for larger studies that explore the role of MCs, tryptase and other MC mediators as drivers of itch and their role in MF pathogenesis.
Collapse
Affiliation(s)
- Dorothea Terhorst-Molawi
- 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
- Institute of Clinical Physiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katharina Lohse
- 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
| | - Katharina Ginter
- 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
| | - Viktoria Puhl
- 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
| | - Martin Metz
- 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
| | - Man Hu
- 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
| | - 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
- *Correspondence: Marcus Maurer,
| | - Sabine Altrichter
- 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
- Department of Dermatology and Venerology, Kepler University Hospital, Linz, Austria
| |
Collapse
|
29
|
Wang Y, Scheffel J, Vera CA, Liu W, Günzel D, Terhorst-Molawi D, Maurer M, Altrichter S. Impaired sweating in patients with cholinergic urticaria is linked to low expression of acetylcholine receptor CHRM3 and acetylcholine esterase in sweat glands. Front Immunol 2022; 13:955161. [PMID: 35967390 PMCID: PMC9373796 DOI: 10.3389/fimmu.2022.955161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/29/2022] [Indexed: 11/15/2022] Open
Abstract
Background Cholinergic urticaria (CholU), a frequent form of chronic inducible urticaria, is characterized by itchy wheals and angioedema in response to sweating. As of now, the rate and pathophysiological relevance of impaired sweating in patients with CholU are ill-defined. Aim To assess in CholU patients the rate and extent of impaired sweating and its links to clinical and pathophysiological features of CholU. Patients and methods We assessed sweating in patients with CholU (n = 13) subjected to pulse-controlled ergometry (PCE) provocation testing. Pre- and post-PCE biopsies of lesional (L) and non-lesional (NL) skin were analyzed for the expression of acetylcholine receptor M3 (CHRM3) and acetylcholine esterase (ACh-E) by quantitative histomorphometry and compared to those of healthy control subjects (HCs). CholU patients were assessed for disease duration and severity as well as other clinical features. Results Of the 13 patients with CholU, 10 showed reduced sweating in response to PCE provocation, and 3 had severely reduced sweating. Reduced sweating was linked to long disease duration and high disease severity. CholU patients with impaired sweating responses showed reduced sweat gland epithelial expression of CHRM3 and ACh-E. Conclusion Reduced sweating is common in CholU patients, especially in those with long-standing and severe disease, and it can be severe. Reduced expression of CHRM3 and ACh-E may be the cause or consequence of CholU in patients with impaired sweating, and this should be explored by further studies.
Collapse
Affiliation(s)
- Yiyu Wang
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Dermatology, Air Force Medical Center, Beijing, China
| | - Jörg Scheffel
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine und Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Carolina Ayala Vera
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine und Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Wei Liu
- Department of Dermatology, Air Force Medical Center, Beijing, China
| | - Dorothee Günzel
- Clinical Physiology/Nutritional Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dorothea Terhorst-Molawi
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine und Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
- Clinical Physiology/Nutritional Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - 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 und Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
- *Correspondence: Marcus Maurer,
| | - Sabine Altrichter
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine und Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
- Comprehensive Allergy Center, Department of Dermatology and Venerology, Kepler University Hospital, Linz, Austria
| |
Collapse
|
30
|
Albrecht M, Schaub B, Gilles S, Köhl J, Altrichter S, Voehringer D, Spillner E, Ehlers M, Jönsson F, Loser K, Mayer JU, Rösner LM, Möbs C, Heine G, Pfützner W. Current research and unmet needs in allergy and immunology in Germany: report presented by the DGfI and DGAKI task force Allergy & Immunology. Eur J Immunol 2022; 52:851-855. [PMID: 35654759 DOI: 10.1002/eji.202270065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Melanie Albrecht
- Molecular Allergology/Vice president´s research group, Paul-Ehrlich-Institut, Langen, Germany
| | - Bianca Schaub
- University Children's Hospital, Dr. von Haunersches Kinderspital, Department of Allergy/Immunology, Lindwurmstr. 4, Germany, LMU Klinikum, Munich, 80337, Germany
| | - Stefanie Gilles
- Chair of Environmental Medicine, Faculty of Medicine, University of Augsburg, Neusäßer Str. 47, Augsburg, 86156, Germany
| | - Jörg Köhl
- Institute for Systemic Inflammation Research, University of Lübeck, Ratzeburger Allee 160, Lübeck, 23562, Germany.,Division of Immunobiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.,Airway Research Center North, German Center for Lung Research (DZL), University of Lübeck, Lübeck, Germany
| | - Sabine Altrichter
- Immunological Biotechnology, Department of Biological and Chemical Engineering, Aarhus University, Aarhus, 8000, Denmark.,Institute for Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - David Voehringer
- Department of Infection Biology, University Hospital Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, 91054
| | - Edzard Spillner
- Immunological Biotechnology, Department of Biological and Chemical Engineering, Aarhus University, Aarhus, 8000, Denmark
| | - Marc Ehlers
- Laboratories of Immunology and Antibody Glycan Analysis, Institute of Nutritional Medicine, University of Lübeck and University Medical Center of Schleswig-Holstein, Lübeck, Germany.,Airway Research Center North, German Center for Lung Research (DZL), University of Lübeck, Lübeck, Germany
| | - Friederike Jönsson
- Institut Pasteur, Université de Paris, Unit of Antibodies in Therapy and Pathology, Inserm UMR1222, Paris, F-75015.,CNRS, Paris, F-75016
| | - Karin Loser
- Institute for Immunology, Carl von Ossietzky Universität, Oldenburg, Germany
| | - Johannes U Mayer
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Lennart M Rösner
- Dpt. of Dermatology and Allergy, Div. of Immunodermatology and Allergy Research, Hannover Medical School (MHH), Hannover, Germany
| | - Christian Möbs
- Clinical & Experimental Allergy, Department of Dermatology and Allergology, Allergy Center Hessen, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Guido Heine
- Division of Allergy, Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Wolfgang Pfützner
- Clinical & Experimental Allergy, Department of Dermatology and Allergology, Allergy Center Hessen, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| |
Collapse
|
31
|
Altrichter S, Mellerowicz E, Terhorst-Molawi D, Grekowitz E, Weller K, Maurer M. Disease Impact, Diagnostic Delay, and Unmet Medical Needs of Patients With Cholinergic Urticaria in German-Speaking Countries. Front Allergy 2022; 3:867227. [PMID: 35769577 PMCID: PMC9234879 DOI: 10.3389/falgy.2022.867227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background Cholinergic urticaria (CholU) is a common type of chronic inducible urticaria. Little is known about the burden of the disease and its unmet medical needs. Aim To characterize the unmet medical needs of patients with CholU. Methods Patients with CholU (n = 111) took part in a German online survey that assessed their symptoms, diagnostic delay, impact on daily life, quality of life (QoL), and their experience with physician care. Results Virtually all patients reported typical signs and symptoms of CholU, i.e., whealing (93.7%) and itching (91.9%), in response to typical trigger situations, such as physical activity, passive warming, or stress. Despite this, patients reported a marked diagnostic delay of 30.2 months (range from 0 to 279 months). Only 38% of the patients received a blood examination, and only 16% underwent provocation testing for diagnosing CholU, as recommended by the international guidelines. Physician contacts were common, but patient satisfaction with their disease management was low. In total, 90.1% of the patients stated to have an uncontrolled disease, resulting in a strong impact on their everyday activities, sleep, and QoL. Conclusion Patients with CholU exhibit many important unmet needs, and improvement in the diagnostic workup and patient care is needed, as are better treatment options.
Collapse
Affiliation(s)
- Sabine Altrichter
- Institute for Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universitätzu Berlin, Berlin, Germany
- Department of Dermatology and Venerology, Kepler University Hospital, Linz, Austria
| | - Emilia Mellerowicz
- Institute for Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universitätzu Berlin, Berlin, Germany
| | - Dorothea Terhorst-Molawi
- Institute for Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universitätzu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine und Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Clinical Physiology/Nutritional Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Eva Grekowitz
- Institute for Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universitätzu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine und Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Karsten Weller
- Institute for Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universitätzu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine und Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute for Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universitätzu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine und Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- *Correspondence: Marcus Maurer
| |
Collapse
|
32
|
Altrichter S, Staubach P, Pasha M, Singh B, Chang AT, Bernstein JA, Rasmussen HS, Siebenhaar F, Maurer M. An open-label, proof-of-concept study of lirentelimab for antihistamine-resistant chronic spontaneous and inducible urticaria. J Allergy Clin Immunol 2022; 149:1683-1690.e7. [PMID: 34954198 DOI: 10.1016/j.jaci.2021.12.772] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/11/2021] [Accepted: 12/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic urticaria (CU) is a debilitating mast cell-driven disease, often refractory to standard therapy (ie, antihistamines). Lirentelimab, an anti-sialic acid-binding immunoglobulin-like lectin 8 mAb, selectively inhibits mast cells and depletes eosinophils. OBJECTIVE We sought to determine safety and efficacy of lirentelimab in patients with CU. METHODS This phase 2a study enrolled patients with CU refractory to up to 4-fold H1-antihistamine doses. Patients received 6 monthly intravenous doses of lirentelimab (0.3, 1, and up to 3 mg/kg). Primary efficacy end point was change in Urticaria Control Test score at week 22. Urticaria Activity Score weekly average (UAS7) was assessed in patients with chronic spontaneous urticaria (CSU), and Cholinergic UAS7 was used for patients with cholinergic urticaria (CholU). RESULTS A total of 45 patients were enrolled in 4 cohorts (n = 13 omalizumab-naive CSU, n = 11 omalizumab-refractory CSU, n = 11 CholU, n = 10 symptomatic dermographism). Urticaria Control Test scores increased with lirentelimab across cohorts, with mean changes at week 22 of 11.1 ± 4.1, 4.8 ± 7.0, 6.5 ± 6.2, and 3.4 ± 4.1 and complete response rates (Urticaria Control Test score ≥ 12) of 92%, 36%, 82%, and 40%, respectively. In omalizumab-naive and omalizumab-refractory patients with CSU, disease activity decreased at week 22 (mean UAS7 change, -73% and -47%, respectively), with UAS7 response rates (≥50% reduction) of 77% and 45%, respectively. In patients with symptomatic dermographism, 50% (5 of 10) and 40% (4 of 10) had complete itch and hive resolution by FricTest, respectively, and 100% (7 of 7) evaluable patients with CholU had negative responses to Pulse-Controlled Ergometry exercise test. Most common adverse events included infusion-related reactions (43%; all mild/moderate and transient), nasopharyngitis (21%), and headache (19%). No treatment-related serious adverse events occurred. CONCLUSIONS Lirentelimab demonstrated activity across 3 forms of antihistamine-refractory CU.
Collapse
Affiliation(s)
- Sabine Altrichter
- Dermatologial Allergology, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany; Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Hospital Mainz, Mainz, Germany
| | | | | | | | | | | | - Frank Siebenhaar
- Dermatologial Allergology, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany; Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Marcus Maurer
- Dermatologial Allergology, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany; Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany.
| |
Collapse
|
33
|
Puxkandl V, Bangerl T, Hanfstingl K, Guenova E, Hoetzenecker W, Altrichter S. Second-dose COVID-19 vaccines are well tolerated in patients with allergic reactions to the first dose – a single center experience. World Allergy Organ J 2022; 15:100654. [PMID: 35611049 PMCID: PMC9120131 DOI: 10.1016/j.waojou.2022.100654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 11/17/2022] Open
Abstract
COVID-19 vaccines contain additives such as Polyethylenglycol-2000 (PEG2000; mRNA vaccines) or Polysorbat 80 (vector vaccines), which have been described previously as culprits for anaphylactic events. This retrospective study included 46 individuals, who were referred to Comprehensive Allergy Center at the Department Dermatology and Venereology, Kepler University Hospital, Linz, Austria, with suspected allergic reactions to the first COVID-19 vaccine dose with either mRNA or vector-based vaccines. Patients underwent detailed anamnesis, clinical examination, and in most cases, skin prick testing using pure additive substances (PEG – different molecular weights, Polysorbate 80). Out of 46, 7 patients’ reactions were classified as possibly anaphylactic and graded according to Ring & Messmer. Forty patients out of 46 were assessed with skin prick tests for potential allergens in COVID-19 vaccines. Only 1 patient showed an immediate positive prick test to PEG2000. Second-dose vaccination with mRNA or vector-based vaccines were tolerated well in all patients, including the individual with a positive skin prick test against PEG2000. The currently available COVID-19 vaccines have an overall low allergic potential and may be administered safely in patients with suspected allergic reactions to the first dose.
Collapse
Affiliation(s)
- Viktoria Puxkandl
- Department of Dermatology, Comprehensive Allergy Center, Kepler University Hospital Linz & Johannes Kepler University, Linz, Austria
| | - Theresa Bangerl
- Department of Dermatology, Comprehensive Allergy Center, Kepler University Hospital Linz & Johannes Kepler University, Linz, Austria
| | - Kathrin Hanfstingl
- Department of Dermatology, Comprehensive Allergy Center, Kepler University Hospital Linz & Johannes Kepler University, Linz, Austria
| | - Emmanuella Guenova
- Department of Dermatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Wolfram Hoetzenecker
- Department of Dermatology, Comprehensive Allergy Center, Kepler University Hospital Linz & Johannes Kepler University, Linz, Austria
| | - Sabine Altrichter
- Department of Dermatology, Comprehensive Allergy Center, Kepler University Hospital Linz & Johannes Kepler University, Linz, Austria
- Institute for Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
34
|
Bizjak M, Košnik M, Dinevski D, Francis Thomsen S, Fomina D, Borzova E, Kulthanan K, Meshkova R, Aarestrup F, Melina Ahsan D, Al-Ahmad M, Altrichter S, Bauer A, Brockstädt M, Costa C, Demir S, Fachini Criado R, Felipe Ensina L, Gelincik A, Giménez-Arnau AM, Gonçalo M, Gotua M, Grønlund Holm J, Inomata N, Kasperska-Zajac A, Khoshkhui M, Klyucharova A, Kocatürk E, Lu R, Makris M, Maltseva N, Pasali M, Paulino M, Pesqué D, Peter J, Dario Ramón G, Ritchie C, Oliveira Rodrigues Valle S, Rudenko M, Sikora A, Wagner N, Xepapadaki P, Xue X, Zhao Z, Terhorst-Molawi D, Maurer M. Adrenaline autoinjector is under-prescribed in typical cold urticaria patients living in tropical climate countries. Qatar Med J 2022; 2022:19. [PMID: 35909392 PMCID: PMC9284591 DOI: 10.5339/qmj.2022.fqac.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: The diagnosis of typical cold urticaria (ColdU) relies on whealing in response to local cold stimulation testing (CST). It can also manifest with cold-induced anaphylaxis (ColdA). Till date, it is largely unclear how often patients with ColdU receive adrenaline treatment and are provided with an adrenaline autoinjector (AAI). Methods: An international, cross-sectional study, COLD-CE (i.e., comprehensive evaluation of ColdU and other cold-induced reactions), was carried out at 32 UCAREs. Detailed histories were taken and CST with an ice cube and/or TempTest® performed. ColdA was defined as an acute cold-induced (i.e., by cold water, air, or surfaces) involvement of the skin and/or visible mucosal tissue and at least one of the symptoms (cardiovascular manifestations, difficulty breathing, or gastrointestinal symptoms). Results: Of the 551 ColdU patients, 75% (n = 412) had a positive CST. Of them, concomitant chronic spontaneous urticaria was diagnosed in 10%. Of 372 patients with stand-alone ColdU, 69% were women and 91% adults. Their median age was 36 (IQR 26 − 48) years. Patients were also categorized into residents of countries with a tropical (n = 33), temperate (n = 264), or cold (n = 75) climate (Table 1: R13C1, R17C1, R21C1). AAI was more often prescribed to residents of temperate than tropical countries (30% vs. 12%, p = .038; Table 1: R31C1), although the frequency of ColdA did not significantly differ between these countries (44% vs. 42%, p = 1.000; R29C2). Residents of tropical countries had a higher frequency of ColdA induced by cold air than residents of temperate (36% vs. 12%, p = .001; R29C4) or cold (36% vs. 12%, p = .007; R25C4) countries. Cardiovascular manifestations induced by cold air were diagnosed in 33% (n = 11) of residents of tropical countries, but only 18% (n = 2) and 36% (n = 4) of them had received adrenaline and AAI, respectively (R13 − 15C7). Furthermore, hypotension and/or loss of consciousness induced by cold air occurred in 18% (n = 6) of patients, but only 17% (n = 1) received adrenaline (R13 − 14C10). ColdA was induced by complete cold water immersion in 9% (n = 3) of patients, and none of them received adrenaline treatment nor AAI (R13 − 15C3). Conclusion: Our findings suggest that ColdA is undertreated and call for changes in ColdU management.
Collapse
Affiliation(s)
- Mojca Bizjak
- COLD-CE steering committee member, *both authors have contributed equally E-mail:
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
- Division of Allergy, Urticaria Center of Reference and Excellence (UCARE), University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Mitja Košnik
- COLD-CE steering committee member, *both authors have contributed equally E-mail:
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Division of Allergy, Urticaria Center of Reference and Excellence (UCARE), University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Dejan Dinevski
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Simon Francis Thomsen
- COLD-CE steering committee member, *both authors have contributed equally E-mail:
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Daria Fomina
- Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
- Center of Allergy and Immunology, Urticaria Center of Reference and Excellence (UCARE), Clinical State Hospital 52, Moscow Ministry of Healthcare, Moscow, Russian Federation
| | - Elena Borzova
- Department of Clinical Genetics, Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University, Moscow, Russian Federation
- Department of Dermatology and Venereology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Kanokvalai Kulthanan
- COLD-CE steering committee member, *both authors have contributed equally E-mail:
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Raisa Meshkova
- COLD-CE steering committee member, *both authors have contributed equally E-mail:
- Department of Clinical Immunology and Allergology, Urticaria Center of Reference and Excellence (UCARE), Smolensk State Medical University, Smolensk, Russian Federation
| | - FernandoM Aarestrup
- Faculdade de Ciências, Médicas e da Saúde de Juiz de Fora (SUPREMA), Urticaria Center of Reference and Excellence (UCARE), Hospital Maternidade Therezinha de Jesus, Minas Gerais, Brazil
| | - Dalia Melina Ahsan
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mona Al-Ahmad
- Microbiology Department, Faculty of Medicine, Urticaria Center of Reference and Excellence (UCARE), Kuwait University, Safat, Kuwait
| | - Sabine Altrichter
- Department of Dermatology and Venerology, Urticaria Center of Reference and Excellence (UCARE), Comprehensive Allergy Center, Kepler University Hospital, Linz, Austria
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andrea Bauer
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), University Allergy Center, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany
| | - Maxi Brockstädt
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Célia Costa
- Immunoallergology Department, Urticaria Center of Reference and Excellence (UCARE), Hospital de Santa Maria, CHULN, Lisbon, Portugal
| | - Semra Demir
- Division of Allergy, Department of Internal Medicine, Istanbul Faculty of Medicine, Urticaria Center of Reference and Excellence (UCARE), Istanbul University, Istanbul, Turkey
| | - Roberta Fachini Criado
- Faculdade de Medicina do ABC (FMABC), Urticaria Center of Reference and Excellence (UCARE), Santo André, Brazil
| | - Luis Felipe Ensina
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Urticaria Center of Reference and Excellence (UCARE), Federal University of São Paulo, São Paulo, Brazil
| | - Asli Gelincik
- Division of Allergy, Department of Internal Medicine, Istanbul Faculty of Medicine, Urticaria Center of Reference and Excellence (UCARE), Istanbul University, Istanbul, Turkey
| | - Ana Maria Giménez-Arnau
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Hospital del Mar, IMIM, Universitat Autònoma, Barcelona, Spain
| | - Margarida Gonçalo
- Clinic of Dermatology, Urticaria Center of Reference and Excellence (UCARE), University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maia Gotua
- Center of Allergy and Immunology, Urticaria Center of Reference and Excellence (UCARE), Tbilsi, Georgia
| | - Jesper Grønlund Holm
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Naoko Inomata
- Department of Environmental Immuno-Dermatology, Urticaria Center of Reference and Excellence (UCARE), Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Alicja Kasperska-Zajac
- European Center for Diagnosis and Treatment of Urticaria/Angioedema (GA2LEN UCARE /ACARE Network) & Department of Clinical Allergology and Urticaria of Medical University of Silesia, Poland
| | - Maryam Khoshkhui
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Aliya Klyucharova
- Department of Internal Diseases, Institute of Fundamental Medicine and Biology (IFMB) of Kazan Federal University, Kazan, Russian Federation
- Department of Clinical Immunology and Allergology, Republican Center of Clinical Immunology and Allergology, Urticaria Center of Reference and Excellence (UCARE), Republican Clinical Hospital, Kazan State Medical University, Kazan, Russian Federation
| | - Emek Kocatürk
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Koç University School of Medicine, Istanbul, Turkey
| | - Rongbiao Lu
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Michael Makris
- Allergy Unit, Second Department of Dermatology and Venereology, Urticaria Center of Reference and Excellence (UCARE), National and Kapodistrian University of Athens, University General Hospital “Attikon”, Athens, Greece
| | - Natalya Maltseva
- Center of Allergy and Immunology, Urticaria Center of Reference and Excellence (UCARE), Clinical State Hospital 52, Moscow Ministry of Healthcare, Moscow, Russian Federation
| | - Maria Pasali
- Allergy Unit, Second Department of Dermatology and Venereology, Urticaria Center of Reference and Excellence (UCARE), National and Kapodistrian University of Athens, University General Hospital “Attikon”, Athens, Greece
| | - Marisa Paulino
- Immunoallergology Department, Urticaria Center of Reference and Excellence (UCARE), Hospital de Santa Maria, CHULN, Lisbon, Portugal
| | - David Pesqué
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Hospital del Mar, IMIM, Universitat Autònoma, Barcelona, Spain
| | - Jonny Peter
- Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
- Division of Allergy and Clinical Immunology, Department of Medicine, Urticaria Center of Reference and Excellence (UCARE), University of Cape Town, Cape Town, South Africa
| | - German Dario Ramón
- Instituto de Alergia e Inmunologia del Sur, Urticaria Center of Reference and Excellence (UCARE), Buenos Aires, Argentina
| | - Carla Ritchie
- Adults and Pediatrics Allergy Unit, Urticaria Center of Reference and Excellence (UCARE), Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Solange Oliveira Rodrigues Valle
- Department of Internal Medicine, Immunology Service, Urticaria Center of Reference and Excellence (UCARE), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Michael Rudenko
- London Allergy and Immunology Centre, Urticaria Center of Reference and Excellence (UCARE), London, UK
| | - Agnieszka Sikora
- European Center for Diagnosis and Treatment of Urticaria/Angioedema (GA2LEN UCARE /ACARE Network) & Department of Clinical Allergology and Urticaria of Medical University of Silesia, Poland
| | - Nicola Wagner
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), University Hospital of Erlangen, University of Erlangen-Nuremberg (FAU), Germany
| | - Paraskevi Xepapadaki
- Allergy Unit, 2nd Pediatric Clinic, Urticaria Center of Reference and Excellence (UCARE), National and Kapodistrian University of Athens, Greece
| | - Xiaoyang Xue
- Department of General Practice, Urticaria Center of Reference and Excellence (UCARE), Community Health Service Center, Guangzhou City, China
| | - Zuotao Zhao
- Department of Dermatology and Venerology, Urticaria Center of Reference and Excellence (UCARE), Beijing Key Laboratory of Molecular Diagnosis on Dermatoses and National Clinical Research Center for Skin and Immune Diseases, Peking University First Hospital, Beijing, China
| | - Dorothea Terhorst-Molawi
- COLD-CE steering committee member, *both authors have contributed equally E-mail:
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marcus Maurer
- COLD-CE steering committee member, *both authors have contributed equally E-mail:
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
35
|
Ahsan DM, Altrichter S, Gutsche A, Bernstein JA, Altunergil T, Brockstaedt M, Maurer M, Weller K, Terhorst‐Molawi D. Development of the Cold Urticaria Activity Score. Allergy 2022; 77:2509-2519. [PMID: 35403217 DOI: 10.1111/all.15310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/11/2022] [Accepted: 03/22/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cold urticaria (ColdU) is a form of inducible urticaria where cold induces wheals and/or angioedema. The burden of disease is high and linked to trigger thresholds, exposure, and avoidance. There are presently no validated patient-reported outcome measures (PROMs) to assess and monitor disease activity. Our objective was to develop a disease-specific activity score for ColdU that is easy to administer and evaluate. METHODS A Cold Urticaria Activity Score (ColdUAS) questionnaire was developed, directed by PROM developing guidelines. After the generation of a conceptional framework, the item generation phase included the literature research on ColdU signs and symptoms and on comparable tools for similar diseases and 47 ColdU patient interviews. Subsequently, an impact analysis for content validity was performed. The final selection of items underwent expert review for face validity and cognitive debriefing. RESULTS The ColdUAS, a self-administered questionnaire for the prospective assessment of disease activity in patients with ColdU, consists of 4 items: 1. the frequency and severity of the signs (wheals and/or angioedema), 2. the frequency and severity of the symptoms (e.g., itch and burn), 3. the exposure to specific triggers, and 4. the avoidance of these triggers. The recall period for each item is the last 24 h. CONCLUSIONS The ColdUAS is the first disease-specific PROM to assess ColdU disease activity. It may help to better assess patients' disease status in routine clinical practice as well as in clinical trials. Anchor-based approaches are currently used to validate the ColdUAS.
Collapse
Affiliation(s)
- Dalia Melina Ahsan
- 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
| | - Sabine Altrichter
- 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
- Department of Dermatology and Venerology Kepler University Hospital Linz Austria
| | - Annika Gutsche
- 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
| | - Jonathan A. Bernstein
- Division of Immunology and Allergy Department of Internal Medicine University of Cincinnati College of Medicine Cincinnati OH USA
| | - Tatjana Altunergil
- 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
| | - Maxi Brockstaedt
- 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
| | - 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
| | - Karsten Weller
- 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
| | - Dorothea Terhorst‐Molawi
- 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
- Institute of Clinical Physiology/Nutritional Medicine Medical Department Division of Gastroenterology, Infectiology, Rheumatology Charité ‐ Universitätsmedizin Berlin Berlin Germany
| |
Collapse
|
36
|
Trendelenburg V, Dölle-Bierke S, Unterleider N, Alexiou A, Kalb B, Meixner L, Heller S, Lau S, Lee YA, Fauchère F, Braun J, Babina M, Altrichter S, Birkner T, Roll S, Dobbertin-Welsch J, Worm M, Beyer K. Tolerance induction through non-avoidance to prevent persistent food allergy (TINA) in children and adults with peanut or tree nut allergy: rationale, study design and methods of a randomized controlled trial and observational cohort study. Trials 2022; 23:236. [PMID: 35346330 PMCID: PMC8962184 DOI: 10.1186/s13063-022-06149-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Peanuts (PN) and tree nuts (TN) are among the most frequent elicitors of food allergy and can lead to life-threatening reactions. The current advice for allergic patients is to strictly avoid the offending food independently of their individual threshold level, whereas sensitized patients without allergic symptoms should frequently consume the food to avoid (re-)development of food allergy. The aim of this trial is to investigate (I) whether the consumption of low allergen amounts below the individual threshold may support natural tolerance development and (II) to what extent regular allergen consumption in sensitized but tolerant subjects prevents the (re-)development of PN or TN allergy. METHODS The TINA trial consisting of (part I) a randomized, controlled, open, parallel group, single-center, superiority trial (RCT), and (part II) a prospective observational exploratory cohort study. Children and adults (age 1-67 years) with suspected or known primary PN and/or TN allergy will undergo an oral food challenge (OFC) to determine their clinical reactivity and individual threshold. In the RCT, 120 PN or TN allergic patients who tolerate ≥100 mg of food protein will be randomized (1:1 ratio) to consumption of products with low amounts of PN or TN on a regular basis or strict avoidance for 1 year. The consumption group will start with 1/100 of their individual threshold, increasing the protein amount to 1/50 and 1/10 after 4 and 8 months, respectively. The primary endpoint is the clinical tolerance to PN or TN after 1 year assessed by OFC. In the cohort study, 120 subjects sensitized to PN and/or TN but tolerant are advised to regularly consume the food and observed for 1 year. The primary endpoint is the maintenance of clinical tolerance to PN and/or TN after 1 year assessed by challenging with the former tolerated cumulative dose. DISCUSSION This clinical trial will help to determine the impact of allergen consumption versus avoidance on natural tolerance development and whether the current dietary advice for PN or TN allergic patients with higher threshold levels is still valid. TRIAL REGISTRATION German Clinical Trials Register; ID: DRKS00016764 (RCT), DRKS00020467 (cohort study). Registered on 15 January 2020, http://www.drks.de .
Collapse
Affiliation(s)
- Valérie Trendelenburg
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburgplatz 1, 13353, Berlin, Germany
| | - Sabine Dölle-Bierke
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu, Berlin, Germany
| | - Nathalie Unterleider
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburgplatz 1, 13353, Berlin, Germany
| | - Aikaterina Alexiou
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu, Berlin, Germany
| | - Birgit Kalb
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburgplatz 1, 13353, Berlin, Germany
| | - Lara Meixner
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburgplatz 1, 13353, Berlin, Germany
| | - Stephanie Heller
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburgplatz 1, 13353, Berlin, Germany
| | - Susanne Lau
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburgplatz 1, 13353, Berlin, Germany
| | - Young- Ae Lee
- Max Delbrück Center For Molecular Medicine in the Helmholtz Association, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Florent Fauchère
- Si-M / "Der Simulierte Mensch" a science framework of Technische Universität Berlin and Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies, Berlin, (BCRT), Germany
| | - Julian Braun
- Si-M / "Der Simulierte Mensch" a science framework of Technische Universität Berlin and Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies, Berlin, (BCRT), Germany
| | - Magda Babina
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu, Berlin, Germany
| | - Sabine Altrichter
- Division of Dermatological Allergy, Department of Dermatology, Venerology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Universitätsklinikum für Dermatologie und Venerologie, Kepler Uniklinikum, Linz, Austria
| | - Till Birkner
- Experimental and Clinical Research Center, a cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
| | - Stephanie Roll
- Institute for Epidemiology, Social Medicine and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Josefine Dobbertin-Welsch
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburgplatz 1, 13353, Berlin, Germany
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu, Berlin, Germany
| | - Kirsten Beyer
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburgplatz 1, 13353, Berlin, Germany.
| |
Collapse
|
37
|
Kalb B, Meixner L, Trendelenburg V, Unterleider N, Dobbertin-Welsch J, Heller S, Dölle-Bierke S, Roll S, Lau S, Lee YA, Fauchère F, Braun J, Babina M, Altrichter S, Birkner T, Worm M, Beyer K. Tolerance induction through early feeding to prevent food allergy in infants with eczema (TEFFA): rationale, study design, and methods of a randomized controlled trial. Trials 2022; 23:210. [PMID: 35279213 PMCID: PMC8917713 DOI: 10.1186/s13063-022-06126-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background Up to 8% of all children in industrialized countries suffer from food allergies, whereas children with atopic eczema are affected considerably more frequently. In addition, the type and starting time of weaning foods seem to influence the development of food allergies. However, data from interventional studies on weaning are controversial. The aim of this randomized-controlled clinical trial is to investigate, whether an early introduction of hen's egg (HE), cow’s milk (CM), peanut (PN), and hazelnut (HN) in children with atopic eczema can reduce the risk for developing food allergies in the first year of life. Methods This is a protocol for a randomized, placebo controlled, double blind, single-center clinical trial. One hundred fifty infants with atopic eczema at 4–8 months of age will be randomized in a 2:1 manner into an active group that will receive rusk-like biscuit powder with HE, CM, PN, and HN (initially approximately 2 mg of each food protein) for 6–8 months or a placebo group, whose participants will receive the same rusk-like biscuit powder without HE, CM, PN, and HN on a daily basis. During the interventional period, the amount of allergens in the study product will be increased three times, each after 6 weeks. All study participants who are sensitized to HE, CM, PN, or HN at the end of the interventional period will undergo an oral food challenge to the respective food in a further visit. Primary endpoint is IgE-mediated food allergy to at least one of the four foods (HE, CM, PN or HN) after 6–8 months of intervention (i.e., at around 1 year of age). Secondary endpoints include multiple food allergies, severity of eczema, wheezing, and sensitization levels against food allergens. Discussion This clinical trial will assess whether an early introduction of allergenic foods into the diet of children with atopic eczema can prevent the development of food allergies. This trial will contribute to update food allergy prevention guidelines. Trial registration German Clinical Trials Register DRKS00016770. Registered on 09 January 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06126-x.
Collapse
|
38
|
Bizjak M, Košnik M, Dinevski D, Thomsen SF, Fomina D, Borzova E, Kulthanan K, Meshkova R, Aarestrup FM, Ahsan DM, Al‐Ahmad M, Altrichter S, Bauer A, Brockstädt M, Costa C, Demir S, Criado RF, Ensina LF, Gelincik A, Giménez‐Arnau AM, Gonçalo M, Gotua M, Holm JG, Inomata N, Kasperska‐Zajac A, Khoshkhui M, Klyucharova A, Kocatürk E, Lu R, Makris M, Maltseva N, Pasali M, Paulino M, Pesqué D, Peter J, Ramón GD, Ritchie C, Rodrigues Valle SO, Rudenko M, Sikora A, Wagner N, Xepapadaki P, Xue X, Zhao Z, Terhorst‐Molawi D, Maurer M. Adrenaline autoinjector is underprescribed in typical cold urticaria patients. Allergy 2022; 77:2224-2229. [PMID: 35258111 DOI: 10.1111/all.15274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022]
|
39
|
Kolkhir P, Pyatilova P, Ashry T, Jiao Q, Abad-Perez AT, Altrichter S, Vera Ayala CE, Church MK, He J, Lohse K, Metz M, Scheffel J, Türk M, Frischbutter S, Maurer M. Mast cells, cortistatin, and its receptor, MRGPRX2, are linked to the pathogenesis of chronic prurigo. J Allergy Clin Immunol 2022; 149:1998-2009.e5. [DOI: 10.1016/j.jaci.2022.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/03/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
|
40
|
Bizjak M, Košnik M, Dinevski D, Thomsen SF, Fomina D, Borzova E, Kulthanan K, Meshkova R, Ahsan DM, Al‐Ahmad M, Altrichter S, Bauer A, Brockstädt M, Costa C, Demir S, Fachini Criado R, Ensina LF, Gelincik A, Giménez‐Arnau AM, Gonçalo M, Gotua M, Holm JG, Inomata N, Kasperska‐Zajac A, Khoshkhui M, Klyucharova A, Kocatürk E, Lu R, Makris M, Maltseva N, Miljković J, Pasali M, Paulino M, Pesqué D, Peter J, Ramón GD, Ritchie C, Rodrigues Valle SO, Rudenko M, Sikora A, Souza Lima EM, Wagner N, Xepapadaki P, Xue X, Zhao Z, Terhorst‐Molawi D, Maurer M. Risk factors for systemic reactions in typical cold urticaria: Results from the COLD-CE study. Allergy 2021; 77:2185-2199. [PMID: 34862605 DOI: 10.1111/all.15194] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/11/2021] [Accepted: 11/20/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cold urticaria (ColdU), that is, the occurrence of wheals or angioedema in response to cold exposure, is classified into typical and atypical forms. The diagnosis of typical ColdU relies on whealing in response to local cold stimulation testing (CST). It can also manifest with cold-induced anaphylaxis (ColdA). We aimed to determine risk factors for ColdA in typical ColdU. METHODS An international, cross-sectional study COLD-CE was carried out at 32 urticaria centers of reference and excellence (UCAREs). Detailed history was taken and CST with an ice cube and/or TempTest® performed. ColdA was defined as an acute cold-induced involvement of the skin and/or visible mucosal tissue and at least one of: cardiovascular manifestations, difficulty breathing, or gastrointestinal symptoms. RESULTS Of 551 ColdU patients, 75% (n = 412) had a positive CST and ColdA occurred in 37% (n = 151) of the latter. Cold-induced generalized wheals, angioedema, acral swelling, oropharyngeal/laryngeal symptoms, and itch of earlobes were identified as signs/symptoms of severe disease. ColdA was most commonly provoked by complete cold water immersion and ColdA caused by cold air was more common in countries with a warmer climate. Ten percent (n = 40) of typical ColdU patients had a concomitant chronic spontaneous urticaria (CSU). They had a lower frequency of ColdA than those without CSU (4% vs. 39%, p = .003). We identified the following risk factors for cardiovascular manifestations: previous systemic reaction to a Hymenoptera sting, angioedema, oropharyngeal/laryngeal symptoms, and itchy earlobes. CONCLUSION ColdA is common in typical ColdU. High-risk patients require education about their condition and how to use an adrenaline autoinjector.
Collapse
Affiliation(s)
- Mojca Bizjak
- Division of Allergy Urticaria Center of Reference and Excellence (UCARE)University Clinic of Respiratory and Allergic Diseases Golnik Golnik Slovenia
- Faculty of Medicine University of Maribor Maribor Slovenia
| | - Mitja Košnik
- Division of Allergy Urticaria Center of Reference and Excellence (UCARE)University Clinic of Respiratory and Allergic Diseases Golnik Golnik Slovenia
- Faculty of Medicine University of Ljubljana Ljubljana Slovenia
| | - Dejan Dinevski
- Faculty of Medicine University of Maribor Maribor Slovenia
| | - Simon Francis Thomsen
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)Bispebjerg HospitalUniversity of Copenhagen Copenhagen Denmark
| | - Daria Fomina
- Urticaria Center of Reference and Excellence (UCARE)Center of Allergy and ImmunologyClinical State Hospital 52Moscow Ministry of Healthcare Moscow Russian Federation
- Department of Clinical Immunology and Allergology I.M. Sechenov First Moscow State Medical University Moscow Russian Federation
| | - Elena Borzova
- Department of Dermatology and Venereology I.M. Sechenov First Moscow State Medical University Moscow Russian Federation
- Department of Clinical Genetics Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University Moscow Russian Federation
| | - Kanokvalai Kulthanan
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)Faculty of Medicine Siriraj HospitalMahidol University Bangkok Thailand
| | - Raisa Meshkova
- Department of Clinical Immunology and Allergology Urticaria Center of Reference and Excellence (UCARE)Smolensk State Medical University Smolensk Russian Federation
| | - Dalia Melina Ahsan
- Urticaria Center of Reference and Excellence (UCARE) Institute for Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
| | - Mona Al‐Ahmad
- Microbiology Department Faculty of Medicine Urticaria Center of Reference and Excellence (UCARE)Kuwait University Safat Kuwait
| | - Sabine Altrichter
- Urticaria Center of Reference and Excellence (UCARE) Institute for Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
- Department of Dermatology and Venerology Urticaria Center of Reference and Excellence (UCARE)Comprehensive Allergy CenterKepler University Hospital Linz Austria
| | - Andrea Bauer
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)University Allergy CenterUniversity Hospital Carl Gustav CarusTechnical University Dresden Germany
| | - Maxi Brockstädt
- Urticaria Center of Reference and Excellence (UCARE) Institute for Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
| | - Célia Costa
- Immunoallergology Department Urticaria Center of Reference and Excellence (UCARE)Hospital de Santa MariaCHULN Lisbon Portugal
| | - Semra Demir
- Division of Allergy Department of Internal Medicine Istanbul Faculty of Medicine Urticaria Center of Reference and Excellence (UCARE)Istanbul University Istanbul Turkey
| | - Roberta Fachini Criado
- Faculdade de Medicina do ABC (FMABC)Urticaria Center of Reference and Excellence (UCARE) Santo André Brazil
| | - Luis Felipe Ensina
- Division of Allergy, Clinical Immunology and Rheumatology Department of Pediatrics Urticaria Center of Reference and Excellence (UCARE)Federal University of São Paulo São Paulo Brazil
| | - Asli Gelincik
- Division of Allergy Department of Internal Medicine Istanbul Faculty of Medicine Urticaria Center of Reference and Excellence (UCARE)Istanbul University Istanbul Turkey
| | - Ana Maria Giménez‐Arnau
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)Hospital del MarIMIMUniversitat Autònoma Barcelona Spain
| | - Margarida Gonçalo
- Clinic of Dermatology Urticaria Center of Reference and Excellence (UCARE)University Hospital and Faculty of MedicineUniversity of Coimbra Coimbra Portugal
| | - Maia Gotua
- Center of Allergy and ImmunologyUrticaria Center of Reference and Excellence (UCARE) Tbilsi Georgia
| | - Jesper Grønlund Holm
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)Bispebjerg HospitalUniversity of Copenhagen Copenhagen Denmark
| | - Naoko Inomata
- Department of Environmental Immuno‐Dermatology Urticaria Center of Reference and Excellence (UCARE)Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Alicja Kasperska‐Zajac
- Clinical Department of Internal Diseases European Center for Diagnosis and Treatment of UrticariaUrticaria Center of Reference and Excellence (UCARE)Dermatology and Allergology of Medical University of Silesia Zabrze Poland
| | - Maryam Khoshkhui
- Allergy Research CenterMashhad University of Medical Sciences Mashhad Iran
| | - Aliya Klyucharova
- Department of Clinical Immunology and Allergology Republican Center of Clinical Immunology and AllergologyUrticaria Center of Reference and Excellence (UCARE)Republican Clinical HospitalKazan State Medical University Kazan Russian Federation
- Department of Fundamental Principles of Clinical Medicine Institute of Fundamental Medicine and Biology (IFMB) of Kazan Federal University Kazan Russian Federation
| | - Emek Kocatürk
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)Koç University School of Medicine Istanbul Turkey
| | - Rongbiao Lu
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)The Third Affiliated Hospital of Sun Yat‐sen University Guangzhou China
| | - Michael Makris
- Allergy Unit Second Department of Dermatology and Venereology Urticaria Center of Reference and Excellence (UCARE)National and Kapodistrian University of AthensUniversity General Hospital “Attikon” Athens Greece
| | - Natalya Maltseva
- Urticaria Center of Reference and Excellence (UCARE)Center of Allergy and ImmunologyClinical State Hospital 52Moscow Ministry of Healthcare Moscow Russian Federation
| | | | - Maria Pasali
- Allergy Unit Second Department of Dermatology and Venereology Urticaria Center of Reference and Excellence (UCARE)National and Kapodistrian University of AthensUniversity General Hospital “Attikon” Athens Greece
| | - Marisa Paulino
- Immunoallergology Department Urticaria Center of Reference and Excellence (UCARE)Hospital de Santa MariaCHULN Lisbon Portugal
| | - David Pesqué
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)Hospital del MarIMIMUniversitat Autònoma Barcelona Spain
| | - Jonny Peter
- Division of Allergy and Clinical Immunology Department of Medicine Urticaria Center of Reference and Excellence (UCARE)University of Cape Town Cape Town South Africa
- Allergy and Immunology Unit University of Cape Town Lung Institute Cape Town South Africa
| | - German Dario Ramón
- Urticaria Center of Reference and Excellence (UCARE)Instituto de Alergia e Inmunologia del Sur Buenos Aires Argentina
| | - Carla Ritchie
- Adults and Pediatrics Allergy Unit Urticaria Center of Reference and Excellence (UCARE)Hospital Italiano de Buenos Aires Buenos Aires Argentina
| | - Solange Oliveira Rodrigues Valle
- Department of Internal Medicine, Immunology Service Urticaria Center of Reference and Excellence (UCARE)Federal University of Rio de Janeiro Rio de Janeiro Brazil
| | - Michael Rudenko
- Urticaria Center of Reference and Excellence (UCARE)London Allergy and Immunology Centre London UK
| | - Agnieszka Sikora
- Clinical Department of Internal Diseases European Center for Diagnosis and Treatment of UrticariaUrticaria Center of Reference and Excellence (UCARE)Dermatology and Allergology of Medical University of Silesia Zabrze Poland
| | - Eduardo M. Souza Lima
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA)Urticaria Center of Reference and Excellence (UCARE)Hospital Maternidade Therezinha de Jesus Minas Gerais Brazil
| | - Nicola Wagner
- Department of Dermatology Urticaria Center of Reference and Excellence (UCARE)University Hospital of ErlangenUniversity of Erlangen‐Nuremberg (FAU) Germany
| | - Paraskevi Xepapadaki
- Allergy Unit 2nd Pediatric Clinic Urticaria Center of Reference and Excellence (UCARE)National and Kapodistrian University of Athens Greece
| | - Xiaoyang Xue
- Department of General Practice Urticaria Center of Reference and Excellence (UCARE)Community Health Service Center Guangzhou City China
| | - Zuotao Zhao
- Department of Dermatology and Venerology Urticaria Center of Reference and Excellence (UCARE)Beijing Key Laboratory of Molecular Diagnosis on Dermatoses and National Clinical Research Center for Skin and Immune DiseasesPeking University First Hospital Beijing China
| | - Dorothea Terhorst‐Molawi
- Urticaria Center of Reference and Excellence (UCARE) Institute for Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
| | - Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE) Institute for Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
| |
Collapse
|
41
|
Marcelino J, Baumann K, Skov PS, Pereira Santos MC, Wyroslak I, Scheffel J, Altrichter S, Woetmann A, Pereira-Barbosa M, Costa C, Maurer M. What Basophil Testing Tells Us About CSU Patients - Results of the CORSA Study. Front Immunol 2021; 12:742470. [PMID: 34650565 PMCID: PMC8507496 DOI: 10.3389/fimmu.2021.742470] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
Basophil testing is the most effective single approach for diagnosing type-IIb autoimmune chronic spontaneous urticaria (TIIbaiCSU). A positive basophil test has been linked to long disease duration, higher disease activity, a poor response to antihistamines and omalizumab, and a better response to cyclosporine and fenebrutinib. As of now it is unclear what other features are connected to a positive basophil test in chronic spontaneous urticaria (CSU). We aimed to identify features of basophil test-positive CSU patients. We performed a cross-sectional study of 85 CSU patients. Basophil testing was done with the basophil activation test (BAT) and the basophil histamine release assay (BHRA). Data were analysed using SPSS: Student's t-test, Chi-square test, Odds Ratio, Spearman's correlation test. Of 85 CSU patients, 44% and 28% tested positive with the BAT and BHRA, respectively. These patients showed higher disease activity and impact, lower levels of disease control and total serum IgE, as well as higher rates of having a positive autologous serum skin test (ASST), angioedema, nocturnal symptoms, symptoms for >5 days/week, and thyroid autoantibodies. The ASST, by itself, was not a good predictor of basophil test results, but it predicted a positive basophil test in up to 100% of cases when combined with angioedema, thyroid autoantibodies or low IgE. In conclusion, a positive basophil test is linked to known features of TIIbaiCSU and novel characteristics including nocturnal symptoms. Further studies on basophil test-positive and -negative CSU patients can help to better understand CSU endotypes and to develop better management approaches.
Collapse
Affiliation(s)
- João Marcelino
- Immunoallergology Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte E.P.E., Lisbon, Portugal
| | - Katrine Baumann
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.,Contract Research Dprt., RefLab ApS, Copenhagen, Denmark
| | - Per Stahl Skov
- Contract Research Dprt., RefLab ApS, Copenhagen, Denmark.,Odense Research Center for Anaphylaxis (ORCA), Urticaria Center of Reference and Excellence (UCARE), Odense University Hospital, Odense, Denmark
| | - Maria Conceição Pereira Santos
- Laboratory of Clinical Immunology, Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
| | - Inga Wyroslak
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jörg Scheffel
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Sabine Altrichter
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Anders Woetmann
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Manuel Pereira-Barbosa
- Immunoallergology Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte E.P.E., Lisbon, Portugal
| | - Célia Costa
- Immunoallergology Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte E.P.E., Lisbon, Portugal
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| |
Collapse
|
42
|
Altrichter S, Wöhrl S, Horak F, Idzko M, Jordakieva G, Untersmayr E, Szepfalusi Z, Zieglmayer P, Jensen-Jarolim E, Wiedermann U, Rosenkranz A, Hötzenecker W. Answers to burning questions for clinical allergologists related to the new COVID-19 vaccines. ACTA ACUST UNITED AC 2021; 30:169-175. [PMID: 34277326 PMCID: PMC8278365 DOI: 10.1007/s40629-021-00177-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/16/2021] [Indexed: 11/28/2022]
Abstract
Background Along with the newly approved vaccines against coronavirus disease 2019 (COVID-19), first reports of allergic or intolerance reactions were published. Subsequently, questions arose whether these vaccines pose an increased risk for intolerance reactions and whether allergic patients may be at higher risk for this. Results Allergic reactions following COVID-19 vaccinations have been reported, but mostly of mild severity and at normal (Moderna®) or only slightly increased frequency (BioNTech/Pfizer®) compared to established conventional vaccines. The risk of allergic reaction to the newly licensed vector vaccines (AstraZeneca®, Johnson&Johnson®) cannot be conclusively assessed yet, but also appears to be low. There is currently no evidence that patients with allergic diseases (atopic patients) react more frequently or more severely to these vaccines. It is currently assumed that intolerance reactions of the immediate-type are either type I allergic (IgE-mediated) reactions or occur via complement activation (CARPA, “complement activation-related pseudoallergy”). Polyethylene glycol (PEG) or polysorbate, which are present as stabilizers in the vaccines, are suspected as triggers for this. Conclusion The data available so far do not show a significantly increased risk of immediate-type allergic reactions in atopic persons. In almost all cases, atopic patients can be vaccinated without problems. Standardized follow-up tests after suspected allergic reactions or CARPA-mediated reactions are currently limited.
Collapse
Affiliation(s)
- Sabine Altrichter
- Department of Dermatology und Venerology, Comprehensive Allergy Center, Kepler University Hospital, Krankenhausstraße 9, 4020 Linz, Austria.,Department of Dermatology und Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Wöhrl
- Floridsdorfer Allergiezentrum (FAZ), Vienna, Austria
| | | | - Marco Idzko
- Department for Medicine II, Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Galateja Jordakieva
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Eva Untersmayr
- Department of Pathophysiology und Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Zsolt Szepfalusi
- Department of Pediatrics and Adolescent Medicine, Division for Pediatric Pulmonology, Allergology and Endokrinology, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Petra Zieglmayer
- Competence Center for Allergology and Immunology, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Krems, Austria
| | - Erika Jensen-Jarolim
- Department of Pathophysiology und Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.,Department of Interdisciplinary Life Sciences, Messerli Research Institute, University of Veterinary Medicine, Vienna, Austria
| | - Ursula Wiedermann
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Alexander Rosenkranz
- Division of Nephrology, Department for Medicine, Medical University Graz, Graz, Austria
| | - Wolfram Hötzenecker
- Department of Dermatology und Venerology, Comprehensive Allergy Center, Kepler University Hospital, Krankenhausstraße 9, 4020 Linz, Austria
| |
Collapse
|
43
|
Ginter K, Ahsan DM, Bizjak M, Krause K, Maurer M, Altrichter S, Terhorst-Molawi D. Cryoglobulins, Cryofibrinogens, and Cold Agglutinins in Cold Urticaria: Literature Review, Retrospective Patient Analysis, and Observational Study in 49 Patients. Front Immunol 2021; 12:675451. [PMID: 34113348 PMCID: PMC8186313 DOI: 10.3389/fimmu.2021.675451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/29/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Cryoproteins, such as cryoglobulins, cryofibrinogens and cold agglutinins, precipitate at low temperatures or agglutinate erythrocytes and dissolve again when warmed. Their pathogenetic and diagnostic importance in cold urticaria (ColdU) is unclear. In this study, we aimed to characterize the prevalence of cryoproteins in patients with ColdU. Methods We conducted 3 analyses: i) a systematic review and meta-analysis of published data using an adapted version of the Joanna Briggs Institute's critical appraisal tool for case series, ii) a retrospective analysis of 293 ColdU patients treated at our Urticaria Center of Reference and Excellence (UCARE) from 2014 to 2019, and iii) a prospective observational study, from July 2019 to July 2020, with 49 ColdU patients as defined by the EAACI/GA2LEN/EDF/UNEV consensus recommendations. Results Our systematic review identified 14 relevant studies with a total of 1151 ColdU patients. The meta-analyses showed that 3.0% (19/628), 1.1% (4/357) and 0.7% (2/283) of patients had elevated levels of cryoglobulins, cryofibrinogens and cold agglutinins, respectively. Our retrospective analyses showed that cryoproteins were assessed in 4.1% (12/293) of ColdU patients. None of 9 ColdU patients had cryoglobulins, and one of 5 had cold agglutinins. In our prospective study, none of our patients had detectable cryoglobulins (0/48) or cryofibrinogens (0/48), but 4.3% (2/46) of patients had cold agglutinins (without any known underlying autoimmune or hematological disorder). Conclusion Our investigation suggests that only very few ColdU patients exhibit cryoproteins and that the pathogenesis of ColdU is driven by other mechanisms, which remain to be identified and characterized in detail.
Collapse
Affiliation(s)
- Katharina Ginter
- Department of Dermatology and Allergy, Dermatological Allergology, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dalia Melina Ahsan
- Department of Dermatology and Allergy, Dermatological Allergology, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Mojca Bizjak
- Division of Allergy, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Karoline Krause
- Department of Dermatology and Allergy, Dermatological Allergology, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marcus Maurer
- Department of Dermatology and Allergy, Dermatological Allergology, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sabine Altrichter
- Department of Dermatology and Allergy, Dermatological Allergology, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Dermatology and Venerology, Kepler University Hospital, Linz, Austria
| | - Dorothea Terhorst-Molawi
- Department of Dermatology and Allergy, Dermatological Allergology, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| |
Collapse
|
44
|
Altrichter S, Wang Y, Schumacher P, Alraboni O, Church MK, Maurer M. Acetylcholine-induced whealing in cholinergic urticaria - What does it tell us? J Dermatol Sci 2021; 103:10-15. [PMID: 34049770 DOI: 10.1016/j.jdermsci.2021.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/18/2021] [Accepted: 05/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cholinergic urticaria (CholU) is characterized by the occurrence of itchy wheals induced by sweating. Intradermal injections of acetylcholine (ACh) have been proposed to help with diagnosing CholU and subgrouping of patients, but controlled studies are largely missing. OBJECTIVE To compare the rates of positive ACh test results in well characterized CholU patients and controls and to identify clinical features of CholU linked to ACh reactivity. METHODS Acetylcholine was injected intradermally into 38 CholU patients and 73 matched healthy controls. Wheal and flare skin responses were assessed after 15 and 30 min and correlated with clinical features of CholU. RESULTS At 15 min after intradermal injections of ACh, wheal and flare responses were significantly more frequent in CholU patients than healthy controls, wheals: 34 % vs.15% (P = 0.028); flares: 50 % vs.18 % (P <0.001). Also, wheals were 37 % and flares 172 % larger and of longer duration in CholU patients than in healthy controls (both P < 0.01). CholU patients with ACh-induced wheals (ACh+) had larger flare but not wheal responses in response to histamine than those without (ACh-; P = 0.011). Also, ACh-induced wheal responses were significantly correlated with sweating (r = 0.54, P = 0.046) in CholU patients. Finally, wheal responses lasted longer in ACh+ than in ACh- patients (P = 0.03). CONCLUSION Intradermal ACh testing does not allow for the identification of CholU patients due to its low sensitivity. ACh-induced wheals, in patients with CholU, is linked to sweating and longer lasting symptoms. Intradermal ACh testing is an interesting tool for mechanistic studies in CholU.
Collapse
Affiliation(s)
- Sabine Altrichter
- Dermatological Allergology, Allergie-Centrum-Charité, Dpt. of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Germany; Department of Dermatology and Venerology, Kepler University Hospital, Linz, Austria
| | - Yiyu Wang
- Dermatological Allergology, Allergie-Centrum-Charité, Dpt. of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Germany; Department of Dermatology, The General Hospital of Air Force, Haidian District, Beijing, China
| | - Pia Schumacher
- Dermatological Allergology, Allergie-Centrum-Charité, Dpt. of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Germany
| | - Ola Alraboni
- Dermatological Allergology, Allergie-Centrum-Charité, Dpt. of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Germany
| | - Martin K Church
- Dermatological Allergology, Allergie-Centrum-Charité, Dpt. of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Germany
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Dpt. of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Germany.
| |
Collapse
|
45
|
Sauer M, Scheffel J, Frischbutter S, Kolkhir P, Xiang YK, Siebenhaar F, Altrichter S, Maurer M, Metz M, Krause K. Lower IgA Levels in Chronic Spontaneous Urticaria Are Associated With Lower IgE Levels and Autoimmunity. Front Immunol 2021; 12:657211. [PMID: 34012441 PMCID: PMC8128143 DOI: 10.3389/fimmu.2021.657211] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/19/2021] [Indexed: 12/12/2022] Open
Abstract
Background The pathogenesis of chronic spontaneous urticaria (CSU) is still insufficiently understood. Recent findings suggest that immunoglobulins, in particular IgE but also IgA, play a role in the development of CSU. Objective Our aim was to assess differences in clinical and laboratory markers between CSU patients with and without lower levels of serum IgA and IgE. Methods We analyzed the data of 606 patients with CSU by dividing them into four groups based on their IgA and IgE levels. The groups were compared for their spectrum of symptoms, disease activity, concomitant autoimmunity and routine laboratory markers. Autoreactivity was assessed by basophil activation test (BAT). Moreover, IgE-anti-thyroid peroxidase (TPO) was measured. Results Of the patients with lower IgE levels, 66.5% also had lower IgA levels (r=0.316, p<0.001). Patients with lower IgA and lower IgE levels showed a higher prevalence of recurrent angioedema (p=0.03, p=0.04) and concomitant autoimmunity (p=0.006, p<0.001). Autoreactivity was also found more frequently in patients with lower IgA and lower IgE levels (p=0.003, p<0.001). Reduced basophil counts were linked to both, lower IgA and lower IgE levels (p<0.001), whereas low eosinophil counts were primarily present in patients with lower IgE levels (p=0.04, p<0.001). Patients with elevated IgE-anti-TPO levels had lower IgA (p=0.007) and IgE levels (p=0.001). Conclusion Lower IgA levels in CSU are linked to lower IgE levels and features of autoimmune urticaria. Our findings encourage to screen CSU patients for serum IgA and IgE levels and to further assess their role as disease biomarkers.
Collapse
Affiliation(s)
- Merle Sauer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jörg Scheffel
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Frischbutter
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Pavel Kolkhir
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Division of Immune-Mediated Skin Diseases, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Yi-Kui Xiang
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Frank Siebenhaar
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sabine Altrichter
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Metz
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Karoline Krause
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
46
|
Metz M, Altrichter S, Buttgereit T, Fluhr JW, Fok JS, Hawro T, Jiao Q, Kolkhir P, Krause K, Magerl M, Pyatilova P, Siebenhaar F, Su H, Terhorst-Molawi D, Weller K, Xiang YK, Maurer M. The Diagnostic Workup in Chronic Spontaneous Urticaria-What to Test and Why. J Allergy Clin Immunol Pract 2021; 9:2274-2283. [PMID: 33857657 DOI: 10.1016/j.jaip.2021.03.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/17/2021] [Accepted: 03/27/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND In chronic spontaneous urticaria (CSU), the guidelines recommend very limited diagnostic procedures during the routine workup, although additional investigations might be indicated in some patients with CSU. For physicians treating patients with CSU, it is often difficult to decide which diagnostic tests are useful. OBJECTIVE To provide recommendations on what diagnostic tests should be performed on which patients with CSU. METHODS We performed an extensive literature search on the respective topics and identified relevant questions that should prompt diagnostic procedures based on the published evidence and expert consensus among all authors. RESULTS We provide questions, diagnostic testing, where appropriate, and recommendation that should be included when assessing the history of a patient with CSU, to explore and rule out differential diagnoses, to assess patients for underlying causes and modifying conditions, to explore patients for comorbid diseases and consequences of having CSU, and to assess patients for CSU components that can help to predict their disease course and response to treatment. CONCLUSIONS Here, we provide physicians treating patients with CSU with information about which clues should lead to which tests and why.
Collapse
Affiliation(s)
- 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
| | - Sabine Altrichter
- 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
| | - Thomas Buttgereit
- 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
| | - Joachim W Fluhr
- 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
| | - Jie Shen Fok
- 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; Department of Respiratory Medicine, Box Hill Hospital, Melbourne, Vic, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia
| | - Tomasz Hawro
- 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
| | - Qingqing Jiao
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - 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 (Sechenov University), Moscow, Russia
| | - Karoline Krause
- 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
| | - Markus Magerl
- 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
| | - Polina Pyatilova
- 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; Department of Dermatology and Venereology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Frank Siebenhaar
- 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
| | - Huichun Su
- 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; Department of Dermatology and Venereology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Dorothea Terhorst-Molawi
- 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
| | - 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
| | - Yi-Kui Xiang
- 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
| | - 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.
| |
Collapse
|
47
|
Baumann K, Marcelino J, Skov P, Santos M, Wyroslak I, Scheffel J, Altrichter S, Woetmann A, Costa C, Maurer M. Autologous serum skin test reactions in chronic spontaneous urticaria differ from heterologous cell reactions. J Eur Acad Dermatol Venereol 2021; 35:1338-1345. [DOI: 10.1111/jdv.17131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/08/2021] [Indexed: 12/25/2022]
Affiliation(s)
- K. Baumann
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
- RefLab ApS Copenhagen Denmark
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology University of Copenhagen Copenhagen Denmark
| | - J. Marcelino
- Immunoallergology Department, Hospital Santa Maria Centro Hospitalar Universitário Lisboa Norte E.P.E Lisbon Portugal
| | - P.S. Skov
- RefLab ApS Copenhagen Denmark
- Odense Research Center for Anaphylaxis (ORCA), Urticaria Center of Reference and Excellence (UCARE) Odense University Hospital Odense Denmark
| | - M.C.P. Santos
- Laboratory of Clinical Immunology Faculdade de Medicina, Instituto de Medicina Molecular Universidade de Lisboa Lisbon Portugal
| | - I. Wyroslak
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - J. Scheffel
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - S. Altrichter
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - A. Woetmann
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology University of Copenhagen Copenhagen Denmark
| | - C. Costa
- Immunoallergology Department, Hospital Santa Maria Centro Hospitalar Universitário Lisboa Norte E.P.E Lisbon Portugal
| | - M. Maurer
- Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| |
Collapse
|
48
|
Kocatürk E, Salman A, Cherrez‐Ojeda I, Criado PR, Peter J, Comert‐Ozer E, Abuzakouk M, Agondi RC, Al‐Ahmad M, Altrichter S, Arnaout R, Arruda LK, Asero R, Bauer A, Ben‐Shoshan M, Bernstein JA, Bizjak M, Boccon‐Gibod I, Bonnekoh H, Bouillet L, Brzoza Z, Busse P, Campos RA, Carne E, Conlon N, Criado RF, Souza Lima EM, Demir S, Dissemond J, Doğan Günaydın S, Dorofeeva I, Ensina LF, Ertaş R, Ferrucci SM, Figueras‐Nart I, Fomina D, Franken SM, Fukunaga A, Giménez‐Arnau AM, Godse K, Gonçalo M, Gotua M, Grattan C, Guillet C, Inomata N, Jakob T, Karakaya G, Kasperska‐Zając A, Katelaris CH, Košnik M, Krasowska D, Kulthanan K, Kumaran MS, Lang C, Larco‐Sousa JI, Lazaridou E, Leslie TA, Lippert U, llosa OC, Makris M, Marsland A, Medina IV, Meshkova R, Palitot EB, Parisi CA, Pickert J, Ramon GD, Rodríguez‐Gonzalez M, Rosario N, Rudenko M, Rutkowski K, Sánchez J, Schliemann S, Sekerel BE, Serpa FS, Serra‐Baldrich E, Song Z, Soria A, Staevska M, Staubach P, Tagka A, Takahagi S, Thomsen SF, Treudler R, Vadasz Z, Valle SOR, Van Doorn MB, Vestergaard C, Wagner N, Wang D, Wang L, Wedi B, Xepapadaki P, Yücel E, Zalewska‐Janowska A, Zhao Z, Zuberbier T, Maurer M. The global impact of the COVID-19 pandemic on the management and course of chronic urticaria. Allergy 2021; 76:816-830. [PMID: 33284457 DOI: 10.1111/all.14687] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The COVID-19 pandemic dramatically disrupts health care around the globe. The impact of the pandemic on chronic urticaria (CU) and its management are largely unknown. AIM To understand how CU patients are affected by the COVID-19 pandemic; how specialists alter CU patient management; and the course of CU in patients with COVID-19. MATERIALS AND METHODS Our cross-sectional, international, questionnaire-based, multicenter UCARE COVID-CU study assessed the impact of the pandemic on patient consultations, remote treatment, changes in medications, and clinical consequences. RESULTS The COVID-19 pandemic severely impairs CU patient care, with less than 50% of the weekly numbers of patients treated as compared to before the pandemic. Reduced patient referrals and clinic hours were the major reasons. Almost half of responding UCARE physicians were involved in COVID-19 patient care, which negatively impacted on the care of urticaria patients. The rate of face-to-face consultations decreased by 62%, from 90% to less than half, whereas the rate of remote consultations increased by more than 600%, from one in 10 to more than two thirds. Cyclosporine and systemic corticosteroids, but not antihistamines or omalizumab, are used less during the pandemic. CU does not affect the course of COVID-19, but COVID-19 results in CU exacerbation in one of three patients, with higher rates in patients with severe COVID-19. CONCLUSIONS The COVID-19 pandemic brings major changes and challenges for CU patients and their physicians. The long-term consequences of these changes, especially the increased use of remote consultations, require careful evaluation.
Collapse
Affiliation(s)
- Emek Kocatürk
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology Koç University School of Medicine Istanbul Turkey
| | - Andaç Salman
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology Marmara University School of Medicine Istanbul Turkey
| | - Ivan Cherrez‐Ojeda
- Urticaria Center of Reference and Excellence (UCARE) School of Medicine Universidad de Especialidades Espíritu Santo, Samborondón, Ecuador and RespiraLab Research, Guayaquil Ecuador
| | - Paulo Ricardo Criado
- Urticaria Center of Reference and Excellence (UCARE)Faculdade de Medicina do ABC Santo André Brazil
- Alergoskin Alergia e Dermatologia SS ltda Santo André Brazil
- UCARE Center São Paulo Brazil
| | - Jonny Peter
- Urticaria Center of Reference and Excellence (UCARE) Division of Allergy and Clinical Immunology Department of Medicine University of Cape Town Cape Town7925South Africa
| | - Elif Comert‐Ozer
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology Marmara University School of Medicine Istanbul Turkey
| | - Mohamed Abuzakouk
- Urticaria Center of Reference and Excellence (UCARE) Cleveland Clinic Abu Dhabi UAE
| | - Rosana Câmara Agondi
- Urticaria Center of Reference and Excellence (UCARE) University of São Paulo São Paulo Brazil
| | - Mona Al‐Ahmad
- Urticaria Center of Reference and Excellence (UCARE) Microbiology Department Faculty of Medicine Kuwait University Safat Kuwait
| | - Sabine Altrichter
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Rand Arnaout
- Urticaria Center of Reference and Excellence (UCARE) King Faisal Specialist Hospital & Research Center Al Faisal University Riyadh Saudi Arabia
| | - Luisa Karla Arruda
- Urticaria Center of Reference and Excellence (UCARE) Preto Medical School University of São Paulo São Paulo Brazil
| | - Riccardo Asero
- Urticaria Center of Reference and Excellence (UCARE) Ambulatorio di AllergologiaClinica San Carlo Paderno Dugnano Italy
| | - Andrea Bauer
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology University Allergy CenterUniversity Hospital Carl Gustav CarusTechnical University Dresden Germany
| | - Moshe Ben‐Shoshan
- Urticaria Center of Reference and Excellence (UCARE) Division of Allergy, Immunology and Dermatology Department of Pediatrics McGill University Health Center Montreal QC Canada
| | - Jonathan A. Bernstein
- Urticaria Center of Reference and Excellence (UCARE) University of Cincinnati College of MedicineDivision of Immunology, Rheumatology and Allergy Cincinnati USA
| | - Mojca Bizjak
- Urticaria Center of Reference and Excellence (UCARE) Division of Allergy University Clinic of Respiratory and Allergic Diseases Golnik Golnik Slovenia
| | - Isabelle Boccon‐Gibod
- Urticaria Center of Reference and Excellence (UCARE) Clinical Immunology/Internal Medicine Department National Reference Center for AngioedemaGrenoble University Hospital Grenoble France
| | - Hanna Bonnekoh
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology and Allergy Allergie‐Centrum‐CharitéCharité ‐ Universitätsmedizin Berlin Berlin Germany
- Autoinflammation Reference Center Charité (ARC2) Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Laurence Bouillet
- Urticaria Center of Reference and Excellence (UCARE) Clinical Immunology/Internal Medicine Department National Reference Center for AngioedemaGrenoble University Hospital Grenoble France
| | - Zenon Brzoza
- Urticaria Center of Reference and Excellence (UCARE) Department of Internal Medicine with Division of Allergology Institute of Medical Sciences University of Opole Opole Poland
| | - Paula Busse
- Urticaria Center of Reference and Excellence (UCARE) Division of Clinical Immunology and Allergy Icahn School at Mount Sinai New York NY USA
| | - Regis A Campos
- Urticaria Center of Reference and Excellence (UCARE) Universidade Federal da Bahia Salvador Brazil
- Serviço de Imunologia Hospital das Clínicas Professor Edgard Santos Salvador Brazil
| | - Emily Carne
- Urticaria Center of Reference and Excellence (UCARE) University Hospital of Wales Cardiff UK
| | - Niall Conlon
- Urticaria Center of Reference and Excellence (UCARE) Department of Immunology St James’s Hospital and Trinity College Dublin Ireland
| | - Roberta F. Criado
- Urticaria Center of Reference and Excellence (UCARE)Faculdade de Medicina do ABC (FMABC) Santo André Brazil
| | - Eduardo M. Souza Lima
- Urticaria Center of Reference and Excellence, (UCARE) Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA) Hospital Maternidade Therezinha de Jesus Minas Gerais Brazil
| | - Semra Demir
- Urticaria Center of Reference and Excellence (UCARE) Division of Allergy Department of Internal Medicine Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
| | - Joachim Dissemond
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology, Venereology and Allergology University of Essen Essen Germany
| | - Sibel Doğan Günaydın
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology and Venereology Faculty of Medicine Hacettepe University Ankara Turkey
| | - Irina Dorofeeva
- Urticaria Center of Reference and Excellence (UCARE) Department of Allergy and Immunotherapy Institute of Immunology FMBA of Russia Moscow Russia
| | - Luis Felipe Ensina
- Urticaria Center of Reference and Excellence (UCARE) Division of Allergy Clinical Immunology and Rheumatology Department of Pediatrics Federal University of São Paulo São Paulo Brazil
| | - Ragıp Ertaş
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology Kayseri City Education and Research Hospital Kayseri Turkey
| | - Silvia Mariel Ferrucci
- Urticaria Center of Reference and Excellence (UCARE) Ambulatorio di Dermatologia Allergologica e Professionale Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano Italy
| | - Ignasi Figueras‐Nart
- Urticaria Center of Reference and Excellence (UCARE) The Dermatology Department of the Hospital de Bellvitge Universitat de Barcelona Barcelona Spain
| | - Daria Fomina
- Urticaria Center of Reference and Excellence (UCARE) Center of Allergy and Immunology Moscow Ministry of Healthcare Moscow Russia
- Department of Allergology and Clinical Immunology I.M. Sechenov First Moscow State Medical University Moscow Russia
| | - Sylvie M Franken
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology Amsterdam UMC Amsterdam The Netherlands
| | - Atsushi Fukunaga
- Urticaria Center of Reference and Excellence (UCARE) Division of Dermatology Kobe UniversityGraduate School of Medicine Kobe Japan
| | - Ana M. Giménez‐Arnau
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology Hospital del MarIMIMUniversitat Autònoma Barcelona Spain
| | - Kiran Godse
- Urticaria Center of Reference and Excellence (UCARE)Department of DermatologyD Y. Patil University School of Medicine Mumbai India
| | - Margarida Gonçalo
- Urticaria Center of Reference and Excellence (UCARE) Centro Hospitalar Universitário Coimbra and Faculty of MedicineUniversity of Coimbra Clinica de Dermatologia Coimbra Portugal
| | - Maia Gotua
- Urticaria Center of Reference and Excellence (UCARECenter of Allergy and Immunology Tbilsi Georgia
| | - Clive Grattan
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology Guys & St Thomas' Hospital London UK
| | - Carole Guillet
- Urticaria Center of Reference and Excellence (UCARE) Allergy Unit Department of Dermatology University Hospital of Zurich Zurich Switzerland
| | - Naoko Inomata
- Urticaria Center of Reference and Excellence (UCARE) Department of Environmental Immuno‐Dermatology Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Thilo Jakob
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology and Allergy University Medical Center Giessen (UKGMJustus‐Liebig‐University Giessen Giessen Germany
| | - Gul Karakaya
- Urticaria Center of Reference and Excellence (UCARE) School of Medicine Department of Chest Diseases Adult Allergy Unit Hacettepe University Sihhiye Ankara Turkey
| | - Alicja Kasperska‐Zając
- Urticaria Center of Reference and Excellence (UCARE) European Center for Diagnosis and Treatment of Urticaria Medical University of Silesia Zabrze Poland
| | - Constance H Katelaris
- Urticaria Center of Reference and Excellence (UCARE) Immunology & Allergy Unit Department of Medicine Campbelltown Hospital Campbelltown NSW Australia
| | - Mitja Košnik
- Urticaria Center of Reference and Excellence (UCARE) Division of Allergy University Clinic of Respiratory and Allergic Diseases Golnik Golnik Slovenia
| | - Dorota Krasowska
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology, Venereology and Pediatric Dermatology Medical University of Lublin Lublin Poland
| | - Kanokvalai Kulthanan
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | - M. Sendhil Kumaran
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Claudia Lang
- Urticaria Center of Reference and Excellence (UCARE) Allergy Unit Department of Dermatology University Hospital of Zurich Zurich Switzerland
| | | | - Elisavet Lazaridou
- Urticaria Center of Reference and Excellence (UCARE) Second department of Dermatology and Venereology Aristotle University of ThessalonikiGeneral Hospital Papageorgiou Thessaloniki Greece
| | - Tabi Anika Leslie
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology Royal Free Hospital London UK
| | - Undine Lippert
- Urticaria Center of Reference and Excellence (UCAREDepartment of DermatologyMedical Center of University Goettingen Venerology und Allergology Goettingen Germany
| | - Oscar Calderón llosa
- Urticaria Center of Reference and Excellence (UCARE) Department of Allergy SANNA el Golf San Isidro, Lima
| | - Michael Makris
- Urticaria Center of Reference and Excellence (UCARE) Second Department of Dermatology and Venereology National and Kapodistrian University of AthensUniversity General Hospital “Attikon” Athens Greece
| | - Alexander Marsland
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology The Urticaria ClinicSalford Royal Foundation TrustUniversity of Manchester Manchester UK
| | - Iris V. Medina
- Urticaria Center of Reference and Excellence (UCARE) Allergy and Clinical Immunology Department Centro Médico Vitae, de Julio Argentina
| | - Raisa Meshkova
- Urticaria Center of Reference and Excellence (UCARE) Department of Clinical Immunology and Allergology Smolensk State Medical University Smolensk Russia
| | - Esther Bastos Palitot
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology Hospital Universitário Lauro Wanderley João Pessoa PB Brazil
| | - Claudio A.S. Parisi
- Urticaria Center of Reference and Excellence (UCARE) Adults and Pediatrics Allergy Unit Hospital Italiano de Buenos Aires Buenos Aires Argentina
| | - Julia Pickert
- Urticaria Center of Reference and Excellence (UCARE) Clinical & Experimental Allergology Department of Dermatology and Allergology Philipps University Marburg Marburg Germany
| | - German D. Ramon
- Urticaria Center of Reference and Excellence (UCARE) Instituto de Alergia e Inmunologia del Sur Buenos Aires Argentina
| | - Mónica Rodríguez‐Gonzalez
- Urticaria Center of Reference and Excellence (UCARE) Department of Allergy Hospital Español de México Mexico City Mexico
| | - Nelson Rosario
- Urticaria Center of Reference and Excellence (UCARE) Federal University of ParanaRua General Carneiro Curitiba Brazil
| | - Michael Rudenko
- Urticaria Center of Reference and Excellence (UCARE) London Allergy and Immunology Centre London UK
| | - Krzysztof Rutkowski
- Urticaria Center of Reference and Excellence (UCARE) Department of Allergy Guy's and St Thomas’ Hospital NHS Foundation Trust London UK
| | - Jorge Sánchez
- Urticaria Center of Reference and Excellence (UCARE) Department of Pediatrics Graduate Program on Allergology University of Antioquia Medellín Colombia
| | - Sibylle Schliemann
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology University Hospital Jena Germany
| | - Bulent Enis Sekerel
- Urticaria Center of Reference and Excellence (UCARE) Department of Pediatric Allergy Hacettepe University Faculty of Medicine Ankara Turkey
| | - Faradiba S. Serpa
- Urticaria Center of Reference and Excellence (UCARE) Hospital Santa Casa de Misericórdia de Vitória Espírito Santo Brazil
| | - Esther Serra‐Baldrich
- Urticaria Center of Reference and Excellence (UCARE) Dermatology Department Hospital Sant Pau Barcelona Spain
| | - Zhiqiang Song
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology Southwest HospitalArmy Medical University Chongqing China
| | - Angèle Soria
- Urticaria Center of Reference and Excellence (UCARE) Service de Dermatologie et Allergologie Hopital TenonAPHPUniversité Paris Sorbonne France
| | - Maria Staevska
- Urticaria Center of Reference and Excellence (UCARE) Department of Allergy Sofia Medical University Sofia Bulgaria
| | - Petra Staubach
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology University Medical Center Mainz Germany
| | - Anna Tagka
- Urticaria Center of Reference and Excellence (UCARE) First Department of Dermatology and Venereology National and Kapodistrian University of Athens, "A. Syggros" HospitalReferral Center of Occupational Dermatological Diseases Athens Greece
| | - Shunsuke Takahagi
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan
| | - Simon Francis Thomsen
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology Bispebjerg Hospital Copenhagen Denmark
| | - Regina Treudler
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology, Venerology and Allergology and Leipzig Interdisciplinary Center of Allergology Comprehensive Allergy Center UMC Leipzig Leipzig Germany
| | - Zahava Vadasz
- Urticaria Center of Reference and Excellence (UCARE) Division of Allergy and Clinical Immunology Bnai‐Zion Medical CenterTechnion Faculty of Medicine Haifa Israel
| | - Solange Oliveira Rodrigues Valle
- Urticaria Center of Reference and Excellence (UCARE) Federal University of Rio de JaneiroDepartment of Internal Medicine, Immunology Service Rio de Janeiro Brazil
| | - Martijn B.A. Van Doorn
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology Erasmus MC Rotterdam The Netherlands
| | - Christian Vestergaard
- Urticaria Center of Reference and Excellence (UCARE) Aarhus University Hospital Aarhus Denmark
| | - Nicola Wagner
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology University of Erlangen Erlangen Germany
| | - Dahu Wang
- Urticaria Center of Reference and Excellence (UCARE) Dermatovenerological Department The Second Hospital of HeBei Medical University Shijiazhuang, HeBei Province China
| | - Liangchun Wang
- Urticaria Center of Reference and Excellence (UCAREDermatology Department of Sun Yat‐sen Memorial Hospital Guangzhou China
| | - Bettina Wedi
- Urticaria Center of Reference and Excellence (UCAREDepartment of Dermatology and AllergologyHannover Medical School Allergology Division Hannover Germany
| | - Paraskevi Xepapadaki
- Urticaria Center of Reference and Excellence (UCARE) Department of Allergy 2nd Pediatric Clinic, National and Kapodistrian University of Athens Athens Greece
| | - Esra Yücel
- Urticaria Center of Reference and Excellence (UCARE) Department of Pediatric Allergy and Immunology Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
| | - Anna Zalewska‐Janowska
- Urticaria Center of Reference and Excellence (UCARE) Chair of Clinical Immunology and Rheumatology Department of Psychodermatology Medical University of Lodz Lodz Poland
| | - Zuotao Zhao
- Urticaria Center of Reference and Excellence (UCARE) Department of Dermatology and Venerology Peking University First HospitalBeijing Key Laboratory of molecular Diagnosis on Dermatoses and National Clinical Research Center for Skin and Immune Diseases Beijing China
| | - Torsten Zuberbier
- Autoinflammation Reference Center Charité (ARC2) Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE) Dermatological Allergology Allergie‐Centrum‐CharitéDepartment of Dermatology and AllergyCharité – Universitätsmedizin Berlin Germany
| |
Collapse
|
49
|
Yu M, Terhorst-Molawi D, Altrichter S, Hawro T, Chen YD, Liu B, Song XT, Zhao ZT, Maurer M. Omalizumab in chronic inducible urticaria: A real-life study of efficacy, safety, predictors of treatment outcome and time to response. Clin Exp Allergy 2021; 51:730-734. [PMID: 33522024 DOI: 10.1111/cea.13838] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/23/2021] [Accepted: 01/27/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Miao Yu
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China.,Peking University School of Nursing, Beijing, China
| | - Dorothea Terhorst-Molawi
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sabine Altrichter
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tomasz Hawro
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Yu-Di Chen
- Department of Dermatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Bo Liu
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Xiao-Ting Song
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Zuo-Tao Zhao
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
50
|
Altrichter S, Fok JS, Jiao Q, Kolkhir P, Pyatilova P, Romero SM, Scheffel J, Siebenhaar F, Steinert C, Terhorst-Molawi D, Xiang YK, Church MK, Maurer M. Total IgE as a Marker for Chronic Spontaneous Urticaria. Allergy Asthma Immunol Res 2021; 13:206-218. [PMID: 33474856 PMCID: PMC7840871 DOI: 10.4168/aair.2021.13.2.206] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Immunoglobulin E (IgE) and its receptor, FcɛRI, importantly contribute to the pathophysiology of chronic spontaneous urticaria (CSU). Recent findings point to a possible role of total IgE as a marker of CSU disease activity, endotypes, and responses to treatment. The evidence in support of total IgE included in the diagnostic workup of patients with CSU has not yet been reviewed. METHODS Publications were searched via PubMed. The search terms used were "chronic urticaria" and "total IgE." Studies were screened by titles and abstracts, and 141 were used in the review. RESULTS CSU patients frequently had elevated total IgE serum levels (up to 50%), but normal or very low total IgE levels also occurred. High total IgE may represent high disease activity, longer disease duration, high chance of responding to omalizumab treatment, quick relapse after stopping omalizumab, and lower chance of responding to cyclosporine. Low IgE, in contrast, may suggest Type IIb autoimmune CSU, poor response to treatment with omalizumab and a better chance to benefits from cyclosporine treatment. Furthermore, IgE in different CSU cohorts may have different physicochemical properties that could explain differences in treatment responses to IgE-directed therapies. CONCLUSION The results of our review suggest that total IgE is a valuable marker for CSU, and we recommend its assessment in the routine diagnostic workup of CSU patients.
Collapse
Affiliation(s)
- Sabine Altrichter
- 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
| | - Jie Shen Fok
- 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.,Department of Respiratory Medicine, Box Hill Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Qingqing Jiao
- 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.,Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - 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 (Sechenov University), Moscow, Russian Federation
| | - Polina Pyatilova
- 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.,Department of Dermatology and Venereology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Sherezade Moñino Romero
- 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
| | - Jörg Scheffel
- 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
| | - Frank Siebenhaar
- 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
| | - Carolin Steinert
- 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.,Freie Universität Berlin, Berlin, Germany
| | - Dorothea Terhorst-Molawi
- 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
| | - Yi Kui Xiang
- 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 K Church
- 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
| | - 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.
| |
Collapse
|