A Study To Enlighten The Efficacy Of Different Homeopathic Remedies In The Management Of Urticaria In Five Patients - Case Series

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Decoding the Enigma of Urticaria and Angioedema

Urticaria (hives) is an inflammatory skin condition with transient, pruritic wheals and sometimes angioedema, due to mast cell and basophil degranulation releasing histamine into the dermis. It affects 15-20% of people and may be acute, chronic spontaneous, or chronic inducible, impacting quality of life. Management involves identifying triggers, nonsedating H1-antihistamines, and in refractory cases, immunomodulatory agents like omalizumab. Many seek complementary approaches due to persistent symptoms or drug effects. Homoeopathy, based on individualization and “like cures like,” uses remedies such as Apis mellifica, Urtica urens, Natrum muriaticum, Rhus toxicodendron, selected by symptoms and modalities. Case series and studies suggest individualized homoeopathic treatment may reduce urticaria scores and improve quality of life, though larger trials are needed. This article reviews urticaria's etiology, classification, clinical features, conventional treatment, and homoeopathic approach, including repertorial rubrics and key remedies in homoeopathic literature.

Background and Objectives: Chronic urticarial (CU) is a condition with itching and wheals due to known or unknown causes that lasts more than 6 weeks. The idiopathic nature of the disease and the adverse effects of conventional medicine, which interfere with the patient’s daily quality of life, prefer homeopathic treatment is increasingly present. The present review focuses on homeopathic management in treating CU. Methods: A literature search for all available literature published in online databases such as PubMed, Google Scholar, Wiley Online Library, Springer, Scopus, CCRH Library, and AYUSH Portal was done using the keywords “chronic urticaria,” “homeopathy,” and “homoeopathy” until March 2022. The search results were categorized by study type, and the outcomes were assessed. Results: This review selected and compared six potentially relevant articles after considering the inclusion and exclusion criteria. Two prospective observational studies, one case series, and three case reports were analyzed, and all showed the effectiveness of homeopathic treatment in treating CU cases by individualization and specific methods. Rhus toxicodendron, Natrum muriaticum, Apis, Sulphur, etc., are prescribed in constitutional method, and medicines like Histamine and Rumex used considering a single symptom, all found useful. Conclusion: Individualistic and specific homeopathic medicines will effectively treat CU. This review might help future researchers find the gaps in existing studies and direct further pragmatic research.

Anti-CD20 or anti-IgE therapy for severe chronic autoimmune urticaria

Introduction: Urticaria is a kind of skin complaint with red, raised and itchy bumps. Urticaria frequently occurs after an infection or as a result of an allergic response to some medication, insect bites or food. Psychological stress, exposure to cold or vibration may also trigger urticaria. Urticaria occurs with a lifetime prevalence of around 20%. In around 30% patients of urticaria, attacks often recur for months or years. Cases summary: This is a case series of five patients suffering from chronic urticaria having erythematous lesions, intense itching, redness and swelling treated at the Dermatology outpatient department of Dr D. P. Rastogi Central Research Institute for Homoeopathy, Noida, Uttar Pradesh, India. The patients were prescribed indicated constitutional Homoeopathic medicines. Changes in haematological and serological tests, Measure Yourself Medical Outcome Profile 2 and Urticaria Activity Score summed over 7 days at baseline and at the end of treatment showed reasonable improvement in disease as well as in the quality of life. Homoeopathic medicines such as Apis mellifica, Calcarea carbonica, Rumex crispus, Pulsatilla and Histamine were found useful.

Chronic spontaneous urticaria (CSU) in children is mostly spontaneous in onset (57%). Treatment comprises long-term antihistaminic therapy without need for elaborate investigations. A subset of such patients don't respond to conventional treatment and novel therapies to help reduce pill burden is the need of the hour. To determine the efficacy and safety of autologous serum therapy (AST) in pediatric patients with chronic spontaneous urticaria. All pediatric patients, aged between 6-16 years, attended to our OPD from March 2019 to March 2020 were recruited. Clinico-demographic data and baseline investigations of all patients were performed. Two-weekly AST therapy was given for 8 visits with levocetrizine tablet 5mg on an on-demand basis. Urticaria activity score (UAS) sheet was provided to record and return every 2 weeks. Statistical analysis was done using the IBM SPSS 26 software package. Autologous serum skin test (ASST) was positive in 63% patients. Both the ASST positive and ASST negative group showed significant reduction in UAS7 score at week 14 compared to baseline. The reduction in mean UAS7 score was associated with a decreased pill burden and positive response in the patient and physician global assessment scale. No statistically significant difference between the two groups in terms of mean UAS7 reduction was found. This study has explored the efficacy and safety of autologous serum therapy in the pediatric CSU patients. Both ASST positive and ASST negative group respond to AST therapy.

Urticaria and angioedema lasting more than 6 weeks have been designated as chronic urticaria (CU). It encompasses two major subtypes: chronic spontaneous urticaria (CSU) (previously known as chronic idiopathic urticaria) (CIU) and chronic inducible urticaria. CSU has been defined as wheals and/or angioedema that are endogenous and independent of any external physical stimulus. It affects 0.5 to 1% of the population [1]. In 40 to 45% of patients with CSU autoantibodies to the high affinity IgE receptor (FcϵRI) or to IgE itself are thought to play a psathogenic role, whereas 55 to 60% of cases are considered idiopathic [2]. Inducible urticarias include all forms of physical urticarias (cold-induced, heat-induced, solar, and pressure urticaria). According to the International Guidelines for the management of urticaria and angioedema non-sedating, second generation antihistamines (NSAHs) are recommended for the treatment of CU [3]. Nevertheless, a considerable proportion of patients do not respond sufficiently to NSAHs. According to Humphreys and Hunter up to 40% of patients with CU may not achieve good control with antihistaminic therapy [4]. They reported that out of 390 CU patients who were treated with antihistamines 44% responded well, 29% became asymptomatic, and 15% showed partial improvement. In a recent paper from Japan it was observed that the improvement rates (defined as a urticaria symptom score UAS ≤ 3) in 117 CU patients who received standard doses of AHs were 36.6% at 12 months, 51.2% at 24 months, and 66.1% at 60 months, while the remission rates were 11.5%, 13.9%, and 27.7%, respectively [5]. In patients that do not respond to standard doses, the next step in guideline-based therapy is to increase AH doses up to 4 times [3]. Investigations assessing the response to various NSAHs have demonstrated that up-dosing is significantly more effective in reducing symptoms of CU than standard-dose treatment [6]. According to Kaplan, high-dose antihistamines are effective in 45-60% of patients with CSU [7], while about one third are antihistamine resistant regardless of which dose is used [8, 9]. The present article is a review of the literature on the treatment of CU with increased doses of NSAHs in order to investigate if there are differences in efficacy between the various second generation AHs that have been studied in controlled protocols. It must be noticed, however, that it is difficult to find clinical investigations that strictly follow the criteria recommended by the guidelines on the management of urticaria, and therefore studies included in this review were those in which higher doses of NSAHs were used regardless of the clinical response to conventional doses. AHs included in this review are desloratadine, levocetirizine, fexofenadine, and the recently introduced NSAHs rupatadine and bilastine. Bilastine belongs to the piperidine class of antihistamines as do loratadine, desloratadine, and fexofenadine. Like other antihistamines bilastine is an H1 receptor inverse agonist. In vitro studies have shown that bilastine has a high specific affinity for the H1-receptor but it has no or very low affinity for 30 other tested receptors. The affinity for the H1 receptor is 3 and 6 times higher than for cetirizine and fexofenadine, respectively [10, 11]. Rupatadine fumarate is a new potent, long acting, orally active dual antagonist of both histamine H1 and Platelet-Activating Factor (PAF) receptors. In in vivo and in vitro studies rupatadine was as potent or even more potent than other second generation antihistamines (loratadine, terfenadine and cetirizine) or selective PAF antagonists [12].

Urticaria is a disabling condition, resulting in an impaired quality of life and sleep disruption, and can have an adverse impact on work-related or school-related performance and attendance. It is defined according to the presence of unknown (chronic spontaneous urticaria) or known (inducible urticaria) eliciting factors. Guidelines recommend second-generation H1-antihistamines for the first-line treatment of urticaria. Bilastine is indicated in adults, adolescents (aged ≥12 years) and children (aged ≥2 years (Mexico and some African countries), ≥4 years (Canada) or ≥6 years (Europe)) with a body weight of at least 20 kg for the symptomatic treatment of urticaria and allergic rhino-conjunctivitis. The aim of the Original Real-world cases of Bilastine In Treatment (ORBIT) study was to review real-world cases from across the Asia-Pacific region supported by evidence-based literature. Eight diverse, real-world, difficult-to-treat cases with urticaria in people aged 10–75 years are presented. Once-daily bilastine (20 mg (adults/adolescents) or 10 mg (children)) was found to be well tolerated and effective in the long-term management of chronic spontaneous urticaria and inducible urticaria.

Objective — to study and analyze thematic publications on aspects of etiopathogenesis and modern approaches to the treatment of chronic spontaneous urticaria in adult patients.Materials and methods. A study and analysis of current domestic and foreign publications was conducted on aspects of the etiopathogenesis and treatment of chronic urticaria, including the recommendations of the National Health Service of the United Kingdom (NHS, 2020) for the treatment of chronic spontaneous urticaria in adult patients, based on principles of evidence­based medicine.Results and discussion. According to domestic and foreign publications, urticaria affects about 15—20 % of the population, while in recent years the number of chronic forms of dermatosis resistant to treatment (registered in about 2 % of the population) is increasing, which reduces the capability for work and quality of life of patients. In more than half of the patients the probable cause of chronic urticaria cannot be determined, which indicates the development of a spontaneous (idiopathic) form of dermatosis. First­line drugs for the treatment of chronic urticaria are non­sedative H1­antihistamines of the second generation, which, however, in many patients do not provide a positive clinical effect in standard doses. In the European recommendations, to increase the effectiveness of treatment of patients with torpid forms of chronic urticaria, it is proposed to increase the daily dose of antihistamines by 4 times. According to NHS recommendations (2020), created on evidence­based medicine, adult patients with chronic spontaneous urticaria are recommended to use a cost­ and clinically effective second­generation antihistamine cetirizine as first­line therapy which is prescribed step by step with increasing daily dose by 2—4 times.Conclusions. Chronic urticaria is a serious medical and social problem today. More than half of patients with chronic urticaria are those having spontaneous (idiopathic) form of dermatosis. H1­antihistamines of the second generation are the first­line therapy for chronic urticaria, but due to the lack of a positive effect in some patients when using their standard doses, it is recommended to increase their daily doses by 4 times. According to NHS recommendations (2020), adult patients with chronic spontaneous urticaria are recommended an efficient and cost­effective second­generation antihistamine cetirizine as first­line (dose­increasing) therapy.

The challenges of chronic urticaria part 1: Epidemiology, immunopathogenesis, comorbidities, quality of life, and management

The challenges of chronic urticaria part 2: Pharmacological treatment, chronic inducible urticaria, urticaria in special situations

Urticaria is a common skin disease characterised by recurrent pinkish or red, raised wheals or hives with itching that usually last less than 24 h. However, in some patients lesions persist intermittently or continuously for more than six weeks and are classified as chronic urticaria (CU). CU may be further subdivided into CU with potential provoking factors; Autoimmune urticaria and Chronic idiopathic urticaria (CIU) depending upon aggravating factors and the presence of circulating auto antibodies. Homoeopathy has emerged as a treatment of choice for chronic skin diseases. Cohort surveys using validated Quality of Life questionnaires; economic surveys as well as patient-reported and clinically observed effects of Homoeopathy point towards its efficacy in chronic skin diseases and skin allergies. Treatment in Homoeopathy is individualized. In the case report presented here, Homoeopathic medicine Arnica montana was prescribed on the basis of aetiology in management of chronic urticaria. The Urticaria activity score (UAS) done at the start of treatment was 42. The weekly one dose of Arnica Montana 1M followed by Rubrum metallicum 30 ( placebo) /1 drachms four pills three times in a day for a period of three months achieved complete resolution of CU; with UAS score 0 at the end of 12 weeks. Further three month follow up with placebo was done with no appearance of symptoms in the patient. Keywords: Arnica montana, chronic urticaria (CU), aetiological prescription, homoeopathy Cite this Article Thakur T. Aetiological Prescription in Homeopathy that Cured a Case of Chronic Urticaria. Research & Reviews: A Journal of Unani, Siddha and Homeopathy . 2018; 5(2): 37–41p

Purpose of reviewUrticaria is a frequent disorder that can present with erythema, edema, and pruritus involving the skin and mucous membranes. Early diagnosis and proper management of the urticaria according to the type (i.e., acute vs chronic) is of utmost importance to reduce the burden of the disease and prevent psychosocial comorbidities. In this review, we aim to summarize the diagnosis and management of acute and chronic urticaria with emphasis on the differences.Recent findingsAutoimmune mechanisms (type I or type IIb autoimmunity) have been recently defined in the pathogenesis of chronic spontaneous urticaria. Despite the high rates of symptom control in both acute and chronic urticaria with the existing treatment options, new treatments are still needed in a subset of patients. Promising treatment targets in CSU include Bruton’s tyrosine kinase, Siglec-8, or IL-4/13.SummaryTherapeutic management of acute and chronic urticaria is still challenging despite the highly effective treatments. In addition to symptomatic treatment, elicitation of the pathogenesis of both forms of urticaria and clear understanding of the nature of the disease by the patient are essential. Urticaria has still a high impact on the patients’ quality of life warranting the studies on the pathogenesis, novel treatment options, and the factors determining which patients with acute urticaria will likely develop chronic urticaria.

Plausibility of the implausible: is it possible that ultra-high dilutions ‘without biological activity’ cause adverse effects?