Urticaria Research Articles

Increased prevalence of urticarial diseases and antihistamine/corticosteroid consumption in patients with attention-deficit/hyperactivity disorder

ObjectivesThis nationwide cohort study investigated the association between attention-deficit/hyperactivity disorder (ADHD) and various types of urticarial diseases.MethodsWe conducted a population-based cohort study using data from Leumit Health Services (LHS), a...

Quality of life, sleep, and psychological well-being in chronic spontaneous urticaria patients receiving omalizumab: a case-control study.

Chronic spontaneous urticaria (CSU) impacts both physical and mental well-being, causing distress and sleep disturbances. While omalizumab reduces disease activity, its effects on mental health and quality of life remain unclear. This study assesses the psychosocial burden and sleep disturbances in CSU patients receiving omalizumab compared to healthy controls and explores their relationship with disease parameters. This case--control study included 210 CSU patients receiving omalizumab for at least three months and 210 age- and sex-matched healthy controls. Disease severity was assessed using the Urticaria Activity Score over 7 Days (UAS7) and Urticaria Control Test (UCT), while quality of life was evaluated with the Chronic Urticaria Quality of Life Questionnaire (CU-Q₂oL). Psychological distress and sleep disturbances were measured using validated scales, including the Perceived Stress Scale (PSS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS). CSU patients had significantly higher scores for perceived stress, depression, anxiety, and daytime sleepiness compared to controls (p < 0.001). Patients with a good response to omalizumab also showed significantly higher psychological distress and poorer sleep quality than controls (p < 0.001). Omalizumab response was good in 29.5%, moderate in 38.6%, and limited in 31.9% of patients. Despite treatment, 32.9% reported no change in quality of life, while 35.7% had mild and 31.4% had moderate improvement. A history of atopic disease was present in 55.7% of patients, who had significantly higher daytime sleepiness scores than those without (p = 0.045). In CSU patients, while omalizumab improves symptoms and quality of life, psychological distress persists in substantial subsets, highlighting the need to address mental health and lifestyle factors.

Incidence and Prevalence of Chronic Spontaneous Urticaria Among Adult and Pediatric Populations in the United States.

Published evidence on the epidemiology of chronic spontaneous urticaria (CSU) in the USA is limited. This study aimed to estimate the age- and/or sex-standardized incidence and prevalence of diagnosed CSU in the US population. The target population was identified using three anonymized databases: Optum Electronic Health Record (EHR), Optum Clinformatics Data Mart (CDM), and Truven Health MarketScan. The study population consisted of adult (aged ≥ 18years) and pediatric (aged < 18years) patients with diagnosed CSU based on ≥ 2 relevant International Classification of Diseases version 9 and/or 10 (ICD-9 and/or ICD-10) codes recorded ≥ 6weeks apart. The data identification period for Optum EHR and Optum CDM was from January1, 2012 to December31, 2018, and for MarketScan it was January1, 2012 to December31, 2017. In Optum EHR the incidence rate and prevalence were standardized by age and sex as compound strata and by age (adult and pediatric populations separately), and in both Optum CDM and MarketScan, data was standardized by sex as a single stratum of adult and pediatric populations. The age- and sex-standardized incidence rate and prevalence were calculated and reported per 100person-years and per 100 persons (%), respectively. A total of 108,384 patients (adults, 72.1%; pediatric patients, 27.9%) from Optum EHR, 107,682 (adults, 78.5%; pediatric patients, 21.5%) from Optum CDM, and 278,311 (adults, 63.5%; pediatric patients, 36.5%) from MarketScan were identified with CSU diagnosis during the identification period. The age- and sex-standardized incidence rate of diagnosed CSU among adult and pediatric populations in Optum EHR during the identification period (2012-2018) was 0.039 and 0.066 per 100 person-years, respectively, while the prevalence was 0.120% and 0.193%, respectively. The age-standardized incidence rate of diagnosed CSU among adult and pediatric populations in Optum CDM (2012-2018) was 0.094 and 0.109 per 100 person-years, respectively, while the prevalence was 0.277% and 0.304%, respectively. The sex-standardized combined (adult and pediatric) incidence rate and prevalence were 0.096 per 100person-years and 0.283%, respectively. The age-standardized incidence rate of diagnosed CSU among adult and pediatric populations in MarketScan (2012-2017) was 0.102 and 0.097 per 100 person-years, respectively, while the prevalence was 0.256% and 0.264%, respectively. The sex-standardized combined (adult and pediatric) incidence rate and prevalence were 0.088 per 100person-years and 0.244%, respectively. The findings of this study highlight a general increasing trend in the incidence and prevalence of diagnosed CSU over time among the US population. Comparatively, the incidence and prevalence were higher among pediatric patients than adults.

Genomic structural equation modeling elucidates the shared genetic architecture of allergic disorders

BackgroundThe intricate shared genetic architecture underlying allergic disorders—including allergic asthma, atopic dermatitis, contact dermatitis, allergic rhinitis, allergic conjunctivitis, allergic urticaria, anaphylaxis, and eosinophilic esophagitis—remains incompletely characterized.MethodsOur study employed genomic structural equation modeling (Genomic SEM) to define the common factor representing the shared genetic architecture of allergic disorders. Coupled with diverse post-GWAS analytical methods, we aimed to discover susceptible loci and investigate genetic associations with external traits. Furthermore, we explored enriched genetic pathways, cellular layers, and genomic elements, and investigated putative plasma protein biomarkers. Polygenic risk score (PRS) analyses, leveraging our integrated GWAS data, were conducted to assess chromosomal-level risk associations for allergic disorders.ResultsA well-fitted genomic SEM integrated GWAS data, revealing the shared genetic architecture of allergic disorders. We identified a total of 2038 genome-wide significant SNP loci (p < 5e-8), including 31 previously unreported loci. Fine-mapping of variants and gene sets pinpointed 2 causal variants and 31 candidate susceptible genes. Genetic correlation analyses further illuminated the shared genetic architecture underlying multiple traits, notably psychiatric disorders. Preliminary findings identified four putative causal plasma protein biomarkers.ConclusionNotably, this study presents the first comprehensive genetic characterization of allergic disorders through a GWAS analysis of an unmeasured composite phenotype, providing novel insights into shared etiological pathways across these conditions.

Concerns Regarding Use of High-Dose Cyclosporine in the Management of Refractory Chronic Spontaneous Urticaria

Concerns Regarding Use of High-Dose Cyclosporine in the Management of Refractory Chronic Spontaneous Urticaria

Endotypes of Chronic Spontaneous Urticaria and Angioedema.

Endotypes of Chronic Spontaneous Urticaria and Angioedema.

Dual biological treatments in immune-mediated disorders: a single center experience

BackgroundPhysicians may encounter situations where they need to co-administer omalizumab with non–IgE-targeting monoclonal antibodies. In this study, we share our experience with these dual biologic treatments.ObjectiveTo evaluate the efficacy and safety of dual biological therapy using omalizumab and non-IgE-targeting monoclonal antibodies at a single center.MethodsWe retrospectively reviewed the medical records of adults treated with a dual biological therapy regimen consisting of omalizumab and another biologic between 2020 and 2022.ResultsOur review identified nine patients (age range: 51–75 years, 7 women and 2 men) who were treated with omalizumab for high Th2 disorders, including chronic spontaneous urticaria (n = 7) and asthma (n = 2). Seven patients received a second biologic for co-existing non-Th2 disorders, while two received an additional biologic to better control their Th2-mediated disorders. The patients were treated with the following biologics: anti-IL-5 agents (mepolizumab [n = 1] and benralizumab [n = 1]), the IL-4/13 inhibitor dupilumab (n = 1), the anti-IL-17 biologic secukinumab (n = 1), the IL-1 inhibitor anakinra (n = 1), the anti-calcitonin gene–related peptide agent fremanezumab (n = 1), and anti-TNF-α agents (etanercept [n = 1], golimumab [n = 1], and adalimumab [n = 1]). Dual biotherapy was administered for 3–34 months with observed clinical improvement. No adverse events or infections were reported.ConclusionsDual biological treatment with omalizumab and another biologic appears to be safe, with no need to discontinue non–IgE-targeting agents during omalizumab therapy.

Managing Chronic Urticaria in Children: An Update.

To provide an update and new insights into the management of pediatric patients with chronic urticaria. Chronic urticaria in children may be more prevalent than previously thought, with a high resolution rate within two years. Patient-reported outcome measures (PROMs) are effective tools for assessing disease severity and control in pediatric populations. Children with chronic urticaria generally respond better to H1-antihistamines compared to adults. For patients refractory to antihistamines, omalizumab has shown excellent efficacy. Additionally, dupilumab has emerged as a potential treatment option, as it has been approved for chronic spontaneous urticaria in some countries. Managing chronic urticaria in children remains a diagnostic and therapeutic challenge. However, advancements in understanding disease mechanisms, the validation of tools to assess disease activity and control, the development of reliable biomarkers, and the availability of novel therapies offer significant promise. These developments will enable more effective treatment and improved outcomes for pediatric patients.

Efficacy and Safety of Ligelizumab in Chronic Spontaneous Urticaria: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Efficacy and Safety of Ligelizumab in Chronic Spontaneous Urticaria: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Patient-reported outcome measures for chronic spontaneous urticaria: a strategy centred on optimising patient management.

Chronic spontaneous urticaria (CSU) is a persistent skin condition characterised by itchy wheals, angioedema, or both, significantly impacting patients' quality of life. The absence of identifiable triggers makes diagnosis, monitoring, and management particularly challenging. Patient-reported outcomes (PROs) are direct reports from patients that offer valuable insights into their health and well-being, enhancing communication between patients and clinicians and enabling more personalised care and informed decision-making. This review provides an overview of twelve patient-reported outcome measures (PROMs) used in CSU, which assist in monitoring disease activity, symptom control, and quality of life. It also explores the potential of mobile health (mHealth) apps as a modern solution for real-time disease monitoring, addressing some of the current challenges in CSU management.

Omalizumab for the treatment of food allergies in adults

The growing prevalence of food allergies has social and economic impact. Therapeutic options are limited, with food avoidance remaining the main approach. Omalizumab, an anti-IgE monoclonal antibody approved for asthma, nasal polyposis, and chronic spontaneous urticaria, shows promise in treating food allergies. However, this costly treatment requires ongoing administration with an undefined duration and does not allow for the cessation of food avoidance. Further research is needed to define its indications and assess its long-term impact.

Recurrent Chronic Idiopathic Urticaria Post-hysterectomy and Loss of Xolair Effectiveness: A Case Report

Recurrent Chronic Idiopathic Urticaria Post-hysterectomy and Loss of Xolair Effectiveness: A Case Report

Is a Life Without Water Possible? Aquagenic Urticaria: Report of a Case and Review of the Literature.

Background: Aquagenic urticaria (AU) is a rare form of physical urticaria, characterized by pruritic skin eruptions triggered by water exposure, irrespective of the water's temperature. Fewer than 100 cases have been documented. The wet towel provocation test is the diagnostic standard for AU. Case Presentation: A 12-year-old female patient presented with urticarial eruptions induced by water exposure and was diagnosed with AU following the wet towel provocation test. Initially, she tolerated brief water exposure; however, over time, eruptions occurred even with exposure to her sweat. Partial symptom control was achieved through preventive measures and antihistamine therapy. Conclusions: AU is a rare chronic condition that necessitates prompt diagnosis and tailored management strategies to improve the patient's quality of life.

Efficacy of remibrutinib on patients with chronic spontaneous urticaria with or without prior exposure to biologics in the phase 3 REMIX-1 and REMIX-2 studies

Efficacy of remibrutinib on patients with chronic spontaneous urticaria with or without prior exposure to biologics in the phase 3 REMIX-1 and REMIX-2 studies

Early and long-term efficacy and safety of remibrutinib in patients with chronic spontaneous urticaria: 52-week data from the Phase 3 REMIX-1 and REMIX-2 studies

Early and long-term efficacy and safety of remibrutinib in patients with chronic spontaneous urticaria: 52-week data from the Phase 3 REMIX-1 and REMIX-2 studies

Impact of remibrutinib on dermatology-related quality of life in patients with chronic spontaneous urticaria in the Phase 3 REMIX-1 and REMIX-2 studies

Impact of remibrutinib on dermatology-related quality of life in patients with chronic spontaneous urticaria in the Phase 3 REMIX-1 and REMIX-2 studies

Comparing novel treatments in chronic spontaneous urticaria: A critical appraisal of Bruton's tyrosine kinase inhibitors versus anti-cytokine biologics in clinical trials.

Comparing novel treatments in chronic spontaneous urticaria: A critical appraisal of Bruton's tyrosine kinase inhibitors versus anti-cytokine biologics in clinical trials.

No clinically meaningful impact of remibrutinib on mean immunoglobulin levels or infections in chronic spontaneous urticaria

No clinically meaningful impact of remibrutinib on mean immunoglobulin levels or infections in chronic spontaneous urticaria

Inequalities in Access to Specialist Allergy Services in the United Kingdom: A Report From the BSACI Registry for Immunotherapy (BRIT).

There is an unmet need for specialist allergy treatment in the United Kingdom. Allergen immunotherapy and treatment with omalizumab for chronic spontaneous urticaria (CSU) are key markers for these services. The British Society for Allergy and Clinical Immunology (BSACI) Registry for Immunotherapy (BRIT) is a national project to record the real-world effectiveness, safety and access to treatment for aero-allergen, venom and peanut immunotherapy as well as omalizumab for CSU. We described participant demographics, the index of multiple deprivation (IMD) and access to treatment from the registry launch. Data for 1835 participants were available for analysis from 63 centres enrolled between 1st October 2018 and 24th August 2023. 96.5% (1771/1835) were living in England, with only 3.5% (64) being from the devolved nations. 14.4% (251/1748) were in the most affluent IMD decile compared to 4.5% (78/1748) in the most deprived IMD decile. White participants were 1.74 times more likely to be referred directly from primary care compared to people of Asian, black, mixed or other minority ethnic groups. Instead, these groups were referred more frequently from secondary or tertiary hospital services. The median distance travelled from home to the treatment centre was 15.2 miles, with evidence of clustering around specialist centres. We have described disparities and unwarranted variation in the provision of treatment around the UK. The data suggest that there is limited access to immunotherapy in the devolved nations. Access is also reduced by socioeconomic deprivation. White participants were more likely to receive a direct referral from primary care than those from other ethnic groups whose referral pathways were more complex. Registry data are limited by participant enrolment and may have selection bias. Nevertheless, BRIT has highlighted inequity in access to specialist allergy services in the UK.

Causal Relationship Between Common Allergic Diseases and Keratoconus: A Two-Sample Mendelian Randomization Study.

To investigate the impact of several allergic diseases on the development of keratoconus (KC) from a genetic perspective. Data from multiple genome-wide association studies involving European ancestry individuals were used. Ultimately, 613 allergic conjunctivitis (AC) cases and 474,657 controls, 4387 allergic rhinitis (AR) cases and 471,273 controls, 4859 allergic asthma cases and 135,449 controls, 1169 allergic urticaria cases and 212,464 controls, 22,474 atopic dermatitis cases and 774,187 controls, and 311 KC cases and 209,287 controls were included. Then inverse-variance weighted (IVW) method, potential pleiotropy, heterogeneity, and leave-one-out analyses were assessed to investigate the causal effects of those allergic diseases on KC. IVW estimates indicated that allergic asthma promoted the development of KC (IVW odds ratio [OR] = 2.18; 95% confidence interval [CI], 1.007-4.707; P = 0.048). However, the IVW estimates show that AC (IVW OR = 1.02; 95% CI, 0.960-1.086; P = 0.513), AR (OR = 0.26; 95% CI, 0.037-1.754; P = 0.165), atopic dermatitis (IVW OR = 1.50; 95% CI, 0.942-2.395; P = 0.088), allergic urticaria (IVW OR = 1.11; 95% CI, 0.822-1.511; P = 0.485) are not significantly causally associated with KC. Allergic asthma may promote KC by increasing allergy-related ocular inflammation. The possibility of increased KC in patients with allergic asthma should be considered.