Study on the incidence of blastocystosis among hospitalized patients with acute and chronic spontaneous urticaria

BACKGROUND: Chronic urticaria is a skin disease characterized by the appearance of itchy weals and/or angioedema for 6 or more weeks. Chronic urticaria is subdivided into chronic spontaneous urticaria, which occurs due to an unknown cause, and chronic inducible urticaria, which occurs as a result of exposure to various physical factors (water, cold, heat, pressure, mechanical irritation), can occur simultaneously or independently of each other. Omalizumab, anti-IgE monoclonal antibody, is approved for the treatment of patients with chronic spontaneous urticaria and is the second choice in cases of resistance to antihistamine treatment. In patients with a combination of chronic spontaneous urticaria and chronic inducible urticaria, the effectiveness of treatment with omalizumab has been little studied.
 AIM: compare the effectiveness of omalizumab treatment in patients with chronic spontaneous urticaria and patients with a combination of chronic spontaneous and chronic induced urticaria.
 MATERIALS AND METHODS: Under supervision there were 30 patients with chronic spontaneous urticaria and combined chronic spontaneous and inducible urticaria (15 patients in each group). Evaluation of the effectiveness of treatment was carried out according to the results of the questionnaires DLQI (dermatological index of quality of life), CU-Q2oL (questionnaire for quality of life in chronic urticaria), UCT (urticaria control test), UAS (urticaria activity scale), HADS (Hospital Anxiety and Depression Scale) and provocation tests in dynamics before and during treatment.
 RESULTS: All patients received omalizumab 300 mg subcutaneously once a month for 6 to 12 months. After the first injection of omalizumab, we noted a decrease in the severity of urticaria, an increase in the level of disease control and quality of life when comparing parameters before and during treatment in more than 90% of patients. Improved performance remained at this level throughout all subsequent months of treatment.
 CONCLUSION: Omalizumab is equally effective in patients with an isolated form of chronic spontaneous urticaria and in patients with a combined form of chronic spontaneous and inducible urticaria. The use of omalizumab allows you to control the symptoms of chronic spontaneous and inducible urticaria, even with prolonged use.

Decoding the Enigma of Urticaria and Angioedema

We have analysed the relationship of blood eosinophil count and serum eosinophil cationic protein (ECP) levels in patients with acute and chronic idiopathic urticaria. The ECP levels and eosinophil counts were measured in the peripheral blood of 15 patients with acute urticaria, 25 with chronic idiopathic urticaria and 10 normal healthy subjects. Blood eosinophil counts and serum ECP levels increased in all patients with acute urticaria. Concerning patients affected by chronic urticaria, taking into account the recrudescence of the disease at the moment of taking the blood sample, only symptomatic patients showed increased eosinophil blood values whereas serum ECP levels were increased both in symptomatic and asymptomatic patients. Furthermore, serum ECP levels in chronic urticaria did not correlate with the peripheral eosinophil counts, as they did in acute urticaria. The results of the present study indicate that eosinophils may play a role in the inflammatory mechanisms in patients with acute and chronic urticaria showing a positive correlation between serum ECP levels and disease activity.

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.

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Clinical utility of the Chronic Urticaria Index

Sex differences in the pathogenesis of chronic urticaria

Chronic urticaria: Expanding the autoimmune kaleidoscope

Sun-Woo Jeon·Kyu-Seok Kim·Woo-Geon Lee·Bong-Hyun Kim·Hae-Jeong Nam·Yoon-Bum Kim Objective : The aim of this study is to investigate the characteristics of Ryodoraku in the patients with acute and chronic urticaria, and to compare the acute and chronic urt icaria. Methods : Subjects were 124 patients with urticaria, acute(<8 weeks) p atients were thirty eight and chronic(≥8 weeks) patients were sixty four. We calculated the average Ryodoraku score(RS, ㎂) and each variation from physiologic range of 12 Ryodoraku points, and compared the acute and chronic urticaria Ryodoraku points pattern. Results : 1. The mean value of F3 and F5 were under 40㎂ in acute urticaria group. 2. The mean value of H1, H2, H4, H5, H6, F1 and F4 were over 60㎂ in chronic urticaria group. 3. There were significant difference between acute and chronic urticaria group at H2, H3, H4, F1, F2, F3, F4, F5 and total Ave. Conclusion : These findings suggest that there are significant difference s of Ryodoraku pattern between acute and chronic urticaria group, and Ryodoraku reflect the characteristic of urticaria.Key words : Urticaria, Ryodoraku, Autonomic nerve system

There is little information on urticaria occurring in children, especially in limited resource countries. To determine the demographic and clinical features of urticaria in children living in a developing country. A prospective study was done in children from two allergy outpatient clinics were prospectively studied. Clinical data was obtained from the medical history and physical examination. Laboratory evaluations and immediate-type skin tests with food and aeroallergen extracts were done in selected cases. Urticaria subtypes were defined according to current EAACI/GA²LEN/WAO guidelines. One hundred and twenty-three subjects were studied, 71 with acute urticaria and 52 with chronic urticaria. In patients with chronic urticaria, but not in those with acute urticaria, there was a significant predominance of girls. Triggers of urticaria were more common in acute than in chronic urticaria. Insects, foods, and drugs were the most common inducers of symptoms in acute urticaria, while urticaria induced by skin pressure was referred more often in chronic urticaria. In patients with acute or chronic urticaria there was a higher involvement of the head, upper and lower limbs. In patients with chronic urticaria, generalized urticaria, angioedema, and wheals on pressure sites were more frequent than in patients with acute urticaria. Spontaneous, papular, drug-induced, and dermographic urticaria were the most common subtypes in both groups of children. In children attending allergy services, acute urticaria was more frequent than the chronic type. Symptom triggers were different in acute than in chronic urticaria. Most common subtypes were spontaneous, papular, drug-induced, and dermographic urticaria.

Background:Urticaria is a vascular reaction of the skin marked by the transient appearance of smooth, slightly elevated papules or plaques (wheals) that are erythematous and that are often attended by severe pruritus. Chronic idiopathic urticaria (CIU)is  the common type of chronic urticaria with no obvious causes, at least some findings suggest that psychosocial factors likely contribute to the development and exacerbation of CIU. The purpose of this study was to investigate the clinical features of CIU and role of psychological stress, C-reactive protein and peripheral blood countsMethods: The research was designed as a case-control study. The case group was chronic idiopathic urticaria and control group was acute urticaria. The study subject was patients in the outpatient clinic of Dermatology Department, Sanglah Hospital’s, and aged 14 – 60 years old. Urticaria was diagnosed based on distinctive clinical features. To measure the psychological stress level, a structured interview based on Holmes-Rahe stress scale test was applied. The number of basophil, eosinophil, and neutrophil were also counted.Results: 52 research subjects were recruited which consisted of 25 patients (48.1%) with CIUin the case group and 27 patients (51.9%) with acute urticaria as control group. Family and atopic history did not correlate significantly as the triggering factor, where as environment orinhalant allergens correlated significantly. Stress was found as a significant risk factor, 17 cases (32.6%) of the 52 subjects had psychological stress, the odds ratio was 5.04 (CI 95%; 1.5 – 16.4). There was positive correlation between stress index and total lesion of CIU, R2 = 0.086. Similarly, C-RP level was also positively correlated with the stress index and total lesion of CIU. Conclusion:  32.6% of CIU was influenced by psychological stress with odds ratio = 5.04. Basophil was lower in chronic urticaria than in acute urticaria

IntroductionUrticaria is one of the most common skin diseases. Depending on the length of symptoms, acute (lasting less than 6 weeks) and chronic urticaria (CU) (> 6 weeks) are distinguished. According to the current European guidelines, CU is divided into inducible urticaria (IU) and chronic spontaneous urticaria (CSU).AimTo assess the epidemiology and clinical characteristics of CU in Poland.Material and methodsThis was a nationwide, multicentre, cross-sectional, questionnaire-based study performed under the auspices of the Polish Dermatological Society. A total of 102 physicians (dermatologists and allergists) recruited 1091 patients suffering from CU.ResultsAmong 1091 adults with CU, IU was found in 35.1% (n = 383) of patients and CSU was responsible for 61.1% (n = 667) of CU cases. The remaining patients (n = 41, 3.8%) suffered from both, IU and CSU. Persons with CSU were twice more likely to report family history of urticaria than those with IU (12.1% vs. 6.0%, p = 0.001). Generalized eruptions of wheals predominated in CSU (generalized wheals: 57.9%, localized wheals: 42.1%), whereas wheals localized in particular body areas were found more commonly in IU (generalized wheals: 45.2%, localized wheals: 54.8%, p < 0.001). The CU was the cause of absenteeism in almost every fifth patient suffering from this disease.ConclusionsThe CSU is about twice as frequent cause of CU as compared to IU. The treatment of CU is a major challenge for physicians of various specialties and the treatment choice is closely associated with the specialist knowledge of current treatment guidelines.

The natural history of the progression from acute spontaneous urticaria (ASU) to chronic spontaneous urticaria (CSU), CSU remains poorly understood. To identify clinical and laboratory patient attributes that may be predictive of ASU progression to CSU. We prospectively studied consecutive adult patients (age ≥ 18 years) with a diagnosis of urticaria of <6 weeks' duration. Healthy age- and sex-matched subjects served as controls. At study entry, autologous serum skin test (ASST), complete blood cell count, erythrocyte sedimentation rate, thyroid function tests, antinuclear antibodies, antithyroglobulin and antiperoxidase antibodies, and immunoglobulin E level were assessed in all the subjects. ASST and urticaria activity score assessment were performed in all the patients at baseline and then at weeks 7, 12, 24, and 48. Of 114 patients with acute urticaria and without identifiable causes, 73 patients (64%) were included in the ASU group, 41 patients in the CSU group (36%), and 44 healthy subjects in the control group. At baseline, 26 patients in the CSU group (63.4%) had a positive ASST result, whereas only 17 patients with a positive ASST result (23.3%) were revealed in the ASU group (p < 0.001). Patients with baseline ASST positive results were characterized by more profound basopenia (mean [standard deviation], 0.05 ± 0.08 cell/mm(3)) and more anti-thyroid peroxidase antibodies (18 [41.8%]) than those with the negative baseline ASST result (mean [standard deviation], 0.13 ± 0.09 cell/mm(3), p < 0.001 more profound basopenia; and 13 (18.1%), p = 0.009 more thyroid peroxidase antibodies). We observed the disappearance of ASST positive result in some patients with CSU with baseline positive ASST results, whereas, in some subjects with CSU, baseline negative ASST results came to be positive results throughout the study period. A baseline positive ASST result of patients with ASU was a significant determinant (odds ratio 5.91 [95% confidence interval, 2.57-13.62]; p < 0.001) for a CSU diagnosis at week 7. The patients with ASU who progressed toward CSU were characterized by a positive ASST result, thyroid autoimmunity, and profound basopenia at baseline.

PurposeLimited data is available on the prevalence and risk factors of acute and chronic urticaria in children. Our purpose was to determine the prevalence and identify the risk factors of acute and chronic urticaria in Korean children.MethodsThis population-based study examined 4,076 children (age 4 to 13 years) who were enrolled in the 2015 prospective Seongnam Atopy Project (SAP 2015) in Korea. The parents completed an urticaria questionnaire that included questions regarding the duration, severity, and triggering factors of urticaria. Blood sampling (n=464) was performed to measure vitamin D, total eosinophil count (TEC), and total IgE levels, and skin prick tests (n=503) were done.ResultsThe prevalences of the life-time, acute, and chronic urticaria were 22.5%, 13.9%, and 1.8% (chronic continuous urticaria, 0.7%; and chronic recurrent urticaria, 1.1%), respectively. Acute urticaria was significantly associated with allergic diseases and parental history of allergy (P<0.001), but chronic urticaria was not associated with these clinical factors. There was no significant difference in the 25-hydroxyvitamin D level between subjects with chronic urticaria and controls (P=0.124). Chronic continuous urticaria was associated with living in a new residence (aOR=2.38, 95% CI=1.02-5.54, P=0.044) and belonging to a family with a high income (aOR=4.24, 95% CI=1.24-14.56, P=0.022).ConclusionsA total of 1.8% of children were found to have chronic urticaria. Living in a new residence and belonging to a family with a high income increased the risk of chronic continuous urticaria.

Objective To study the relationship of serum levels of interleukin(IL)-15,IL-21 and IgE to the pathogenesis of urticaria.MethodsSerum levels of IL-15,IL-21 and IgE were detected with ELISA in 30 patients with chronic urticaria.30 patients with acute urticria and 30 sex-and age-matched normal human controls.Moreover,symptom scores and clinical course of patients were assessed.Results The serum levels of IL-15 and IL-21 were 1.59±0.73 pg/mL and 38.30±24.59 pg/mL respectively in patients with acute urticaria.2.35±0.87pg/mL and 47.67±29.57pg/mL respectively in those with chronic urticaria,4.98±4.46pg/mL and 64.94±25.37pg/mL respectively in the normal controls;the differenee was significant between these patients and controls.A significant increase was noted in the level of IgE in patients with acute urticaria and those with chronic urticaria compared with the controls(91.28±41.00 IU/mL vs 58.68±18.29IU/mL.76.65±38.49IU/mL vs 58.68±18.29IU/mL,P＜0.01,0.05respectively).No significant difierence was observed in the levels of IL-15,IL-21 or lgE between patients with acute urticaria and those with chronic urticaria(all P＞0.05).In patients with acute urticaria,the level Of IL-15 positively correlated with that of IL-21,but negatively correlated with clinical course of urticaria,while a negative correlation was observed between the levels of IL-15,IL-21 and the level of IgE,as well as between IL-21 level and symptom scores in patients with chronic urticaria.Conclusions The decrease in serum level of IL-15 and IL-2l may weaken the inhibition of IgE secretion,which seems to be associated with the pathogenesis of urticaria. Key words: Urticaria ; Interleukin-15 ; Interleukin-21 ; Inmmnoglobulin E ;