Diagnosis Of Chronic Idiopathic Urticaria Research Articles

Food allergy test in chronic urticaria adult patients: A cross sectional study

Food allergy test in chronic urticaria adult patients: A cross sectional study - IJCED- Print ISSN No: - 2581-4710 Online ISSN No:- 2581-4729 Article DOI No:- 10.18231/j.ijced.2019.027, IP Indian Journal of Clinical and Experimental Dermatology-IP Indian J Clin Exp Dermatol

Disease burden in patients with asthma before initiating biologics: A retrospective cohort database study.

Background: Real-world data on the characteristics and burden of disease among patients with asthma before receiving asthma-specific biologics would improve the understanding of the use of these therapies in a clinical setting. Currently, limited data are available on the use of mepolizumab and omalizumab for the treatment of asthma. Objective: To determine the characteristics and disease burden among patients with asthma before initiating treatment with mepolizumab or omalizumab. Methods: This was a retrospective cohort analysis of commercial and Medicare Advantage Plan members from a medical claims database with a new claim for mepolizumab or omalizumab between January 1, 2015, and March 31, 2017 (GSK ID: HO-17-18283). Eligible patients had a diagnosis of asthma and continuous enrollment in the health plan, with clinical and pharmacy benefits for 12 months before initiating asthma-specific biologic treatment (baseline period), and no diagnosis of chronic idiopathic urticaria during the baseline period. Patient characteristics, exacerbations, and asthma-related health care resource utilization and costs were assessed during the baseline period. Results: Overall, 188 and 901 patients prescribed mepolizumab and omalizumab, respectively, were included. In the 12 months before initiating asthma-specific biologic therapy, the patients prescribed mepolizumab were older, had higher blood eosinophil counts, more-frequent exacerbations (2.9 versus 2.0 exacerbations/year; p < 0.001), and more inhaled corticosteroid and systemic corticosteroid use compared with those prescribed omalizumab. Overall, asthma-related health-care resource utilization and costs were similar across both treatment cohorts, although patients prescribed mepolizumab had more pharmacy fills, higher pharmacy costs, and lower clinic costs compared with patients prescribed omalizumab (20.8 versus 16.9 fills, $4504 versus $3102, and $1816 versus $2709, respectively; all p < 0.001). Conclusion: In the 12 months before initiating asthma-specific biologic therapy, the patients prescribed mepolizumab may have a greater disease burden than those prescribed omalizumab. Overall, health-care resource utilization and costs were broadly similar across both treatment cohorts.

Evaluating and managing chronic idiopathic urticaria in adults.

Chronic idiopathic urticaria (CIU), also known as chronic spontaneous urticaria, is characterized by the presence of hives on most days of the week, for 6 weeks or longer, and without an identifiable or consistent cause. Evaluation is clinical and based on the presence of episodic urticarial lesions. Although patients are subject to overtesting during the diagnosis of CIU, guidelines suggest starting with three basic laboratory tests. Treatment is a stepwise approach, involving second-generation antihistamines, histamine2 antagonists, leukotriene receptor antagonists, first-generation antihistamines, and potent antihistamines. Refractory CIU requires adding alternative agents such as omalizumab, anti-inflammatory agents, and immunosuppressants.

Recurrent Idiopathic Anaphylaxis in a Woman After Suspected Food Poisoning

Rationale Recurrent idiopathic anaphylaxis represents a vexing clinical problem associated with stress for patients and allergists. The cause is often not identified despite exhaustive testing. Methods The history of a 54-year old woman with repeated bouts of unexplained anaphylaxis is reviewed. The relationship between preceding or active infection (emphasis on gastrointestinal infections) and chronic idiopathic urticaria and anaphylaxis was explored by electronic media search (PubMed, Google) and review of reference lists of published articles. The literature on the relationship of Campylobacter jejuni infection and urticaria is reviewed. Gastrointestinal infections (Giardia, Anisakis) have been better documented in such patients. Results The patient had persistent flatulence, and looser and more frequent bowel movements for months after recovery from a bout of food poisoning. A diagnosis of “postinfectious irritable bowel syndrome” was made by a gastroenterologist. These symptoms were not related to her simultaneous diagnosis of chronic idiopathic urticaria and idiopathic anaphylaxis. After treatment with azithromycin (positive stool culture for C. jejuni), she had a systemic allergic reaction. Subsequently, the diarrhea and urticaria/anaphylaxis cleared. C. jejuni has been reported to cause chronic urticaria, but predominantly in children. A related organism, Helicobacter pylori, has been associated with chronic idiopathic urticaria. Anaphylaxis has not been related to Campylobacter infection in the past. Conclusions Urticaria and recurrent bouts of mild unexplained anaphylaxis were triggered by C. jejuni infection. The allergic and gastrointestinal symptoms resolved after antibiotic treatment. Gastrointestinal (and other) infections should be looked for in patients with urticaria or anaphylaxis

Skin prick test in patients with chronic allergic skin disorders.

Background:Chronic allergic skin disorders are the inflammatory and proliferative conditions in which both genetic and environmental factors play important roles. Chronic idiopathic urticaria (CIU) and atopic dermatitis (AD) are among the most common chronic allergic skin disorders. These can be provoked by various food and aeroallergens. Skin prick tests (SPTs) represent the cheapest and most effective method to diagnose type I hypersensitivity. Positive skin tests with a history suggestive of clinical sensitivity strongly incriminate the allergen as a contributor to the disease process.Aims and Objectives:To determine the incidence of positive SPT in patients with chronic allergic skin disorders and to identify the various allergens implicated in positive SPT.Methods:Fifty patients of chronic allergic disorders were recruited in this study. They were evaluated by SPT with both food and aeroallergens.Results:In our study, SPT positivity in patients of CIU was 63.41% and in AD was 77.78%. Out of the 41 patients of CIU, the most common allergen groups showing SPT positivity were dust and pollen, each comprising 26.83% patients. SPT reaction was positive with food items (21.6%), insects (17.07%), fungus (12.20%), and Dermatophagoides farinae, that is, house dust mite (HDM) (7.32%). The allergen which showed maximum positivity was grain dust wheat (19.51%). Among nine patients of AD, maximum SPT positivity was seen with Dermatophagoides farinae, pollen Amaranthus spinosus, grain dust wheat, and cotton mill dust; each comprising 22.22% of patients.Conclusion:Our study showed that a significant number of patients of CIU and AD showed sensitivity to dust, pollen, insects, Dermatophagoides farinae, and fungi on SPT. Thus, it is an important tool in the diagnosis of CIU and AD.

Usefulness of the autologous serum test for the diagnosis of chronic idiopathic urticaria.

BackgroundThe majority of chronic urticaria cases are chronic idiopathic urticaria (CIU) with no specific identifiable etiology. The role of autoantibodies in such cases remains controversial.ObjectiveThis study determined the positivity rate of autologous serum tests in CIU patients.MethodsThis study was performed on 30 patients with CIU and 30 individuals without any systemic or dermatologic disease. After the volar parts of right and left forearms were cleansed, 0.05 ml serum physiologic and 0.05 ml autologous serum were injected intradermally on the right forearm 5 cm apart from each other, resulting in the formation of small papules; meanwhile, 0.05 ml histamine alone was injected to the left forearm. The test results were evaluated after 30 minutes as positive in positive cases.ResultsThe autologous serum test produced significant and non-significant results in patients with CIU and controls, respectively. The positivity rates of the autologous serum test in the CIU and control groups were 53.3% and 26.6%, respectively. There was no relationship between autologous serum test positivity and sex in either group. In male patients with CIU, positive results ranged widely with age, while in female patients, positive results were mainly observed at younger ages with a narrow age range.ConclusionThe autologous serum test is a useful test in the diagnosis and treatment of CIU as well as the selection of immunotherapy, especially in patients refractory to classic therapy.

Chronic idiopathic urticaria: autologous skin tests and treatment

BackgroundChronic urticaria is defined as urticaria persisting daily or almost daily for more than 6 weeks. It affects 0.1% of the population. Intradermal injection of autologous serum and plasma elicits a cutaneous reactivity in almost 45-60% of patients with chronic idiopathic urticaria (CIU). Activation of coagulation process seems to play an important role in the pathogenesis of CIU. Oral anticoagulant therapy has been shown to be effective in the treatment of CIU.ObjectiveThe aim of this study was to evaluate and compare autologous serum skin test (ASST) and autologous plasma skin test (APST) in the diagnosis of CIU and to determine the effect of treatment with antihistamine (loratadine) and anticoagulant (dipyridamole).Patients and methodsThis study included 30 patients suffering from CIU. All patients were subjected to intradermal testing with their serum (ASST) and their plasma (APST). The patients were classified into three equal groups, according to treatment: 10 patients were treated with loratidine, 10 patients were treated with dipyridamole, and 10 patients were treated with combination of loratidine and dipyridamole for 1 month. Follow-up for the three groups was carried out at the first, second, and fourth week of treatment evaluating the effectiveness and adverse effects of drugs. Assessment of the symptom score reduce index (SSRI) in positive and negative ASST and APST patients was evaluated.ResultsThe ASST was positive in 40% of patients, whereas APST was positive in 90% of patients. Loratadine, dipyridamole, and combination of both were effective in the management of patients with CIU. However, best results occurred with combination of both. No serious side effects of treatment were encountered.ConclusionBoth ASST and APST can be used for diagnostic purposes in patients with CIU. APST is superior to ASST in diagnosis of CIU. Combined treatment with antihistamines and anticoagulants provides an effective management of chronic urticaria in positive autologous serum and plasma skin tests patients.

585 Chronic Idiopathic Urticaria and Neglected Toxocara Infection

BackgroundThe diagnosis of chronic idiopathic urticaria is stated when all possible causes of urticaria are excluded. Toxocariasis is a parasitic infection induced by a nematode belonging to the family of Ascaridae with generally affects cats and dogs. Human infestation is caused by the accidental ingestion of embryonated eggs of Toxocara; the larvae do not develop into adult worms but may migrate to several organs, giving rise to a number of clinical expressions, including chronic urticaria.MethodsFrom 2005 to 2011 in our Allergy Unit were selected 336 patients with a positive result for IgG antibodies to Toxocara canis as assessed by ELISA or Western blotting (WB). Of them, 52 patients (33 F, 19 M, age ranging from 19 to 76 years old), suffered from chronic urticaria that lasted from 3 to 10 years and was poorly responsive to antihistamines. In all these patients anthelmintic therapy was prescribed using mebendazole (one 100 mg tablet b.i.d. for 3 days), repeated after 20 days up to 3 times. In case of insufficient improvement, albendazole (one 400 mg b.i.d. for 5 days) was used, repeated after 2 months.ResultsAll patients showed a complete remission of urticaria and a decrease in serum IgG levels to Toxocara canis. In 29 patients (60%) a negative result to ELISA and WB was observed.ConclusionThese findings suggest taking into account the role of Toxocara canis in patients with apparent chronic idiopathic urticaria. In patients with positive IgG to Toxocara anthelmintic therapy achieves remission of urticaria.

Clinical utility of the Chronic Urticaria Index

Clinical utility of the Chronic Urticaria Index

Correlation Between Clinical Findings and Results of Autologous Serum Skin Test in Patients with Chronic Idiopathic Urticaria

To investigate the correlation between the clinical characteristics of chronic idiopathic urticaria (CIU) and the results of autologous serum skin test (ASST). This prospective observational study was performed in the Motahari Allergy Clinic and included 69 patients referred to the clinic with a diagnosis of CIU. ASSTs were performed on all patients. We compared the disease characteristics, including duration severity, number of urticaria, and size of urticaria between those with positive and negative results of ASST. Of 69 patients with CIU, 39 (56.5%) were female and 30 (43.5%) were male with a mean age of 32.5±12.3 (range 6-62) years. Patients with a positive ASST had a significantly higher number of wheals (P=0.043) with larger sizes (P=0.031). They also had higher frequencies of wheals (63.8% vs. 46.4% daily; P=0.039) and higher disease activity scores (1.57±0.9 vs. 2.01±1.6; P=0.044). The disease activity score was positively correlated with the size of the wheals, duration of the wheals, duration of the disease, and total number of wheals. Patients with positive ASST results had significantly higher frequencies of arthritis (P=0.027). Positive ASST results are associated with more severe disease determined by the larger wheals' size, longer duration of the disease, and higher frequencies of the disease. As ASST reveals the autoimmune basis of the CIU, it can be concluded that CIU patients with autoimmune basis will suffer from more severe disease.

Clinical Evaluation and Treatment of Chronic Urticaria

Chronic urticaria is a common disease characterized by recurrent pruritic wheals with surrounding erythema for > 6 weeks. It is associated with a significant health care burden and affects patient quality of life. The etiology of chronic urticaria is often difficult to elucidate; however, known etiologies include autoimmune urticaria, physical urticarias (eg, cold, cholinergic, and delayed pressure urticaria), and idiopathic urticaria. The etiology is unknown in many patients, leading to a diagnosis of chronic idiopathic urticaria. The diagnosis of chronic idiopathic urticaria can be challenging for the primary care physician because of the disease's chronic symptoms. Diagnosis requires a detailed patient history and comprehensive physical examination, with additional testing tailored to the patient's history. Effective treatments include antihistamines, leukotriene receptor antagonists in combination with antihistamines, and oral immunomodulatory drugs, including corticosteroids, cyclosporine, dapsone, hydroxychloroquine, and sulfasalazine. Newer experimental therapies include intravenous immunoglobulin and omalizumab. This article reviews the pathophysiology, diagnosis, and treatment of chronic urticaria.

Levocetirizine in the treatment of chronic idiopathic urticaria: a randomized, double-blind, placebo-controlled study

Chronic urticaria is a common skin condition. It is frequently a disabling disease because of the persistence of clinical symptoms, the unpredictable course and its negative influence on the quality of life. To determine whether levocetirizine is efficacious in the treatment of chronic idiopathic urticaria. A randomized, double-blind, placebo-controlled study was conducted in 106 patients with a diagnosis of chronic idiopathic urticaria. A 1-week single blind placebo run-in period (baseline) was followed by a 6-week double blind active treatment period. The patients were randomized to receive one of the following treatments once daily: (a) oral levocetirizine 5 mg, or (b) oral placebo. The study ended after another 1-week single blind placebo washout period. The evaluable population consisted of 100 patients. Levocetirizine administered once daily is effective and well tolerated in the treatment of the symptoms of chronic idiopathic urticaria and in improving the patient's quality of life. Levocetirizine was superior to placebo in reducing the mean total symptoms score as well as individual symptoms, the number of daily episodes and the number of weals, the overall severity of symptoms and the quality of life. The significant beneficial effects of levocetirizine lasted only during the active trial, while at follow-up there was a significant worsening of all the variables evaluated in this study, after the end of the active trial (week 7). A global assessment indicates that levocetirizine 5 mg once daily is an effective agent in patients with chronic idiopathic urticaria, as its action provides a rapid and satisfactory control of the symptoms and measures of subjective disease, although this is limited to the duration of treatment.

Bilan étiologique et traitement d’une urticaire chronique

Purpose. – Urticaria is a muco-cutaneous illness which is characterized by a dermal or hypodermal oedema due to a vasodilatation attributed to the release of histamine by mast cells and basophils. Urticaria is a very common complaint, since among 20% of the population will experience at least one episode of urticaria during their life. Chronic urticaria by definition is daily and has persisted for at least six weeks. By contrast with acute urticaria, its etiological and therapeutic approaches can present a significant challenge, leadind to repeated examinations. Current knowledge and key points. – Questioning and clinical examination are essential for the etiological diagnosis of chronic urticaria, because they are able to lead rapidly to the suspicion of several causes which can be eradicated to treat the symptoms. If no cause is found, further investigations may be required. Recent studies have shown the lack of profitability of exhaustive laboratory investigations. Thus, many authors at present time advise minimal and non expensive investigations which are determinated by anamnestic data. But most often, the etiology of urticaria remains unknown and this situation leads to the diagnosis of chronic idiopathic urticaria. The treatment of chronic urticaria is above all based on the elimination of the symptoms, either on a specific fashion if the etiological diagnosis is already known, or in a non specific way. The anti-H1 agents are the medications of choice for first line treatment. Future prospects and projects. – Pathophysiology of chronic urticaria is to date well established. As the mechanisms responsible for chronic urticaria are better defined, more therapeutic agents, which are effective on other targets than histamine, should become available. Moreover, recent advances have supported the notion that an underlying autoimmune process could account for many cases of chronic “idiopathic” urticaria. In such severe and refractory urticaria, immunomodulation therapy may bring about clinical improvement.

Desloratadine in the treatment of chronic idiopathic urticaria.

Chronic idiopathic urticaria (CIU) is a common dermatologic disorder that may severely impair quality of life. Patients may suffer symptoms such as pruritus and disfigurement due to wheals for years or decades. Advances have been made in the last 10 years with the identification of an autoimmune pathogenesis in a significant proportion of patients. Despite this, treatment remains symptomatic, and antihistamines are the first choice of therapy once the diagnosis of CIU has been established. The goal of treatment is rapid, long-lasting symptom relief, and currently available antihistamines fail to provide this in many cases. Desloratadine is a novel, potent H1-receptor antagonist with additional inhibitory effects on inflammatory mediators such as cytokines and adhesion molecules. Newly published data on the efficacy and safety of desloratadine in CIU is highly encouraging, suggesting that the drug may improve symptom control above that currently available.