Duration Of Chronic Urticaria Research Articles

Prevalence of chronic urticaria and healthcare usage of patients with the condition in primary care: a population-based study in theNetherlands.

We present a large population-based study on the prevalence and healthcare usage of patients with chronic urticaria (CU) in primary care. The observed annual point prevalence of 0.48–0.30% and a median follow-up duration of 1.5 years provides new and reliable insight into the vastness, relatively modest healthcare usage and estimated disease duration of CU in the general population, which is useful knowledge when counselling new patients with CU in both primary and specialist care settings.

Pediatric chronic urticaria: Clinical and laboratory characteristics and factors linked to remission.

Chronic urticaria (CU) is defined as the occurrence of wheals/angioedema for ≥6 consecutive weeks. Until now, guidelines and publications addressing CU have focused mainly on adults. As a result, evidence and guidance in the pediatric population are scarce. This study aims to describe clinical and laboratory findings in pediatric CU and to determine factors associated with remission. 185 patients, 54% female, median age at onset of 8.8 years. Angioedema was present in almost half. The most common type of CU was chronic spontaneous urticaria (CSU) in 74%. At least one atopic comorbidity was found in almost a third (35%). In addition, 8% had an autoimmune disorder (exclusively in CSU) and 9% had a psychiatric condition. Basopenia was found in 67% and was more frequently associated with CSU. The basophil activation test (BAT) was positive in 40%. With regard to remission, being of male sex, angioedema absence, the absence of physical triggers, and eosinophil counts >0.51 × 109 /L were associated with shorter CU duration. Atopy is a common condition in pediatric CU. CSU is the most common type. Autoimmune comorbidities and basopenia were significantly more common in CSU. In addition, ours is one of the few studies, assessing BAT utility in the pediatric population, being positive in a relevant percentage (40%). BAT positivity was more frequent in CSU. Our results suggest that the absence of angioedema and physical triggers, male sex, and eosinophil counts >0.51 × 109 /L appear to be associated with a better prognosis in terms of remission.

Clinicoepidemiological Profile of Patients with Chronic Urticaria and its Association with D-dimer Levels at a Tertiary Care Centre: A Prospective Cohort Study

Introduction: Chronic urticaria is a commonly encountered, long-standing skin condition that typically lasts for more than six weeks and has various underlying aetiologies, including chronic infections, infestations, immunological and non immunological causes, and physical factors. In some cases, it may be idiopathic. Recent studies have shown that the activation of the coagulation cascade is involved in the development of chronic urticaria. This involvement is reflected in plasma D-dimer levels, which are explored in the current study. Aim: To assess the epidemiological and clinical characteristics of urticaria and their association with D-dimer levels in a tertiary care centre. Materials and Methods: This prospective cohort study was conducted at Department of Dermatology, Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh, India, from August 2022 to July 2023. The study included 100 chronic urticaria patients attending the dermatology Outpatient Department (OPD) to investigate various clinical types and their epidemiological factors. D-dimer levels were estimated using the latex-enhanced immunoturbidimetry assay method. The mean and range were calculated, and statistical analysis of various clinic-epidemiological characteristics was performed using Pearson’s Chi-square test. A p-value <0.05 was considered statistically significant. Results: Among the 100 patients with chronic urticaria, 40 (40%) were males and 60 (60%) were females. The mean age of presentation was 30 years, and the mean duration was 20.5 months. Elevated plasma D-dimer levels were noted in 40 (40%) of the study population. Chronic Spontaneous Urticaria (CSU) constituted 92 (92%) of the cases, followed by Chronic Inducible Urticaria (CIU) with 4 (4%) cases and 4 (4%) cases with CSU+CIU. Angioedema was noted in 20 (20%) of the cases in the present study. Thyroid disorder was seen in 12 (12%) of the study population. The majority of patients (44%) had mild urticaria. The mean Urticaria Activity Score (UAS) score before treatment was 21.08. A statistically significant association was found between elevated plasma D-dimer levels and age range, duration of chronic urticaria, disease severity, angioedema, and response to antihistamines. The response to antihistamines was graded based on the UAS7 score calculated before and after treatment. Conclusion: The present study provides additional evidence to the existing literature by establishing an association between D-dimer levels and factors such as severity and angioedema. It also provides important insights into the relationship between age range, duration of chronic urticaria, and elevated plasma D-dimer levels by establishing statistical significance between these factors.

Unmet Needs of Patients With Chronic Urticaria: A Survey in Korea.

Chronic urticaria (CU) is a common problem with a high disease burden that has a significant negative impact on quality of life. Many patients are undertreated, and awareness of management strategies is low among clinicians. The present study aimed to improve understanding of CU from the patients' perspective, including the disease burden and current healthcare system use. Adult patients who presented to our referral hospital for CU treatment completed self-report questionnaires about demographics, clinical characteristics of CU, the impact of CU on daily life, unmet needs, and the history of medical service usage. This self-report survey included 127 participants (females, 57.0%; mean age, 42.0 ± 13.6 years; mean CU duration, 1.8 ± 3.4 years); 51.6% reported frequent discomfort with CU in daily life, including 44.1% of those who reported a good response to medication. More than half of the respondents reported a depressed mood and anxiety. Although 46.4% of the respondents reported that urticaria completely disappeared while on medication, only 10% were satisfied with the CU management provided by primary care hospitals. The principal cause of dissatisfaction was that they did not know the cause of CU (68.4% of patients). In total, 55% of the patients visited 2 or more hospitals before presenting to our referral hospital and 6.3% had tried folk remedies. In conclusion, most patients report that CU is not adequately controlled. Therefore, in addition to appropriate medication, information on the cause of CU, long-term treatment plan, medication safety, and expected prognosis is required to meet patients' needs.

Predictors of Response to Oral Medications and Low-Histamine Diet in Patients with Chronic Urticaria.

Background Chronic urticaria (CU) is comprised of diverse phenotypes, and thus, a shift towards a precision medical approach is warranted in its management. Methods This study enrolled 78 patients with CU. Serum erythrocyte sedimentation rate, hemoglobin, hematocrit, eosinophil count, IgE, antinuclear antibody (ANA), and serum diamine oxidase (DAO) levels of the patients were measured and were compared according to the patient's response to second-generation antihistamines (sgAH), corticosteroids, leukotriene receptor antagonist (LTRA), H2 blockers, and low-histamine diet. Results Age- and sex-adjusted logistic regression analysis showed that patients with duration of CU > 3 years (adjusted odd ratio [aOR] = 4.39) and a DAO level < 10 U/mL (aOR = 3.90) were significantly associated with a good sgAH response. Age > 50 years (aOR = 0.02), duration of chronic urticaria > 3 years (aOR =0.06), and an ANA titer ≥ 1 : 80 (aOR = 0.03) were significantly and inversely associated with corticosteroid response. A low-histamine diet response was significantly associated with LTRA response (aOR = 67.29). In addition, a DAO level < 5.4 U/mL (aOR = 71.95) was significantly associated with H2 blocker response. Furthermore, concomitant angioedema (aOR = 10.56), multiple food triggers (aOR = 11.69), and a DAO level < 5.4 U/mL (aOR = 3.78) were significantly associated with a low-histamine diet response. Conversely, dermatographic urticaria and a hematocrit level < 36% were significantly and inversely associated with low-histamine diet response. Conclusions Several promising biomarkers were identified in this study to predict the efficacy of chronic urticaria treatment. DAO could be a novel biomarker for predicting the efficacy not only of dietary intervention but also for antagonists of H1 and H2 receptors.

Omalizumab on Chronic Spontaneous Urticaria and Chronic Inducible Urticaria: A Real-World Study of Efficacy and Predictors of Treatment Outcome.

BackgroundOmalizumab is a very important drug for the treatment of chronic urticaria. Although omalizumab’s therapeutic efficacy has been demonstrated, data on real-world experiences in Korea, especially regarding chronic inducible urticaria (CIndU), are limited. This study attempted to compare the efficacy of omalizumab in Korean chronic spontaneous urticaria (CSU) and CIndU patients.MethodsFifty-two CSU and 29 CIndU patients were included and Urticaria Activity Score 7 (UAS7) at baseline, week 4, and week 12 was assessed retrospectively.ResultsOmalizumab 150 mg significantly decreased UAS7 in both patients with CSU and CIndU with only one dose (P < 0.001). The significant decrease in the UAS7 scores of both groups of patients continued from weeks 4 to 12. Although there was no significant difference in treatment efficacy between the two groups, the symptoms of patients with CSU tended to improve faster; furthermore, the number of antihistamines administered daily reduced more significantly in this patient group (P = 0.047). Additionally, the decrease in the UAS7 score between baseline and week 12 and the response rate were higher in patients with CSU.ConclusionOmalizumab may be slightly more effective against CSU than against CIndU. Regarding the CIndU subtypes, dermatographic urticaria was associated with the greatest reduction in the UAS7 score, and patients with this condition showed the highest response rate, indicating the best effect of omalizumab. The duration of chronic urticaria was greater in non-responders than in responders (P = 0.025). Conversely, baseline immunoglobulin E levels were significantly higher in responders (P = 0.039).

An evaluation of the factors affecting the clinical and laboratory findings, prognosis, and treatment response in children with chronic urticaria.

Chronic urticaria (CU) is a rare disease in childhood, and studies in children are limited. In this study, the aim was to investigate the clinical and laboratory findings and demographic characteristics of children with CU and to determine the factors affecting prognosis. The study included 141 patients aged 0-18 years who were diagnosed with CU in the pediatric allergy outpatient clinic between January 1, 2013, and December 31, 2018. Risk factors related to prognosis were investigated by comparing the duration of CU and treatment response with clinical and etiological features. IBM SPSS version 24 was used for statistical analyses. In the study group, the female/male ratio was 69/55, and the median age at first visit was 9.5 years (min:1, max:17). Among patients, 63 (44.5%) had an accompanying atopic disease, and 23 (16.3%) had chronic disease. Of the patients, 124 (88%) had chronic spontaneous urticaria, and 17 patients (12%) had chronic inducible urticaria (CIU). Of those with CIU, 72.2% had symptomatic dermographism, 16.7% had cholinergic urticaria, and 11.1% had cold urticaria. After the evaluations, the most common pathological findings in our patients were intestinal parasitosis (n=14), anemia (n=10), and urinary tract infection (n=8). The median total duration of urticaria was 47 weeks (min:8, max:284). The duration of urticaria was longer in patients with atopy (p < 0.05), and the group that went into remission with standard-dose antihistamine was the group with highest eosinophil count (p=0.022). In most children with CU, the underlying cause/disease cannot be determined. In our study, treatable triggers were found in some of the patients. Therefore, it is appropriate for each patient to be evaluated with selected laboratory tests after detailed history and physical examination.

Effects of pregnancy on chronic urticaria: Results of the PREG-CU UCARE study.

Chronic urticaria (CU) predominantly affects women, and sex hormones can modulate disease activity in female CU patients. As of now, the impact of pregnancy on CU is largely unknown. To analyze the course and features of CU during and after pregnancy. PREG-CU is an international, multicenter study of the Urticaria Centers of Reference and Excellence (UCARE) network. Data were collected via a 47-item questionnaire completed by CU patients, who became pregnant within the last 3years. A total of 288 pregnancies of 288 CU patients from 13 countries were analyzed (mean age at pregnancy: 32.1±6.1years, duration of CU: 84.9±74.5months; CSU 66.9%, CSU+CIndU 20.3%, CIndU 12.8%).During pregnancy, 51.1% of patients rated their CU as improved, 28.9% as worse, and 20.0% as unchanged.CU exacerbations most commonly occurred exclusively during the third trimester (in 34 of 124 patients; 27.6%) or the first (28 of 124; 22.8%). The risk factors for worsening of CU during pregnancy were having mild disease and no angioedema before pregnancy, not taking treatment before pregnancy, CIndU, CU worsening during a previous pregnancy, treatment during pregnancy, and stress as a driver of exacerbations. After giving birth, urticaria disease activity remained unchanged in 43.8% of CU patients, whereas 37.4% and 18.1% experienced worsening and improvement, respectively. These results demonstrate the complex impact of pregnancy on the course of CU and help to better counsel patients who want to become pregnant and to manage CU during pregnancy.

Natural History of Chronic Urticaria in Korea

BackgroundData on the natural history and prognostic variables of chronic urticaria (CU) are rare and information about spontaneous remission of CU is limited.ObjectiveThis study evaluated the natural history of CU and identified predictors for remission.MethodsTotal 329 Korean patients with CU, who had follow-ups more than 6 months after diagnosis during a 7-year period in the department of dermatology in three university hospitals were enrolled. Clinical data and laboratory findings obtained by medical records and telephone interviews were analyzed, retrospectively.ResultsThe proportion recovered in 1, 3, and 5 years after the onset of CU was 10.8%, 18.8%, and 32.9%, respectively. The mean duration of CU was 6.3 years. There were no significant differences in median recovery time depending on sex, age group, severity of CU, and type of CU. The presence of angioedema was significantly related to CU severity. There were no differences in prognosis with respect to the presence of dermographism or angioedema. Patients with atopic dermatitis (AD) had a significantly worse prognosis than patients without a history of AD; but not in patients with the history of allergic rhinitis or asthma. Patients with abnormal laboratory findings did not differ significantly in prognosis.ConclusionCU remission rate significantly differ according to the presence of AD. This study provides information about the natural course of CU of Korean patients.

Clinical Features of Patients with Chronic Urticaria and the Results of the Skin Prick Tests

Objective: Chronic urticaria (CU), which is mostly idiopathic, may also be a sign of an allergic or systemic disease. A variety of diseases and allergens that accompany CU have been reported in various studies. The aim of this study was to investigate the factors that play a role in the etiology of CU.Materials and Methods: The demographic and clinical data from 302 patients – aged over 18 years - who were being monitored for CU were recorded. Several tests were performed to analyze comorbidities such as infection, malignancy, and autoimmune and rheumatic diseases. Skin Prick Test (SPT) results and questionnaires were reviewed.Results: Two hundred and thirteen out of the 302 patients with a mean age of 40.26±14.3 years were females. The duration of CU was 43.30±62.60 months and 42.9% of the patients had comorbidities. The most common disease was autoimmune thyroiditis (13.9%). Fifty-five percent of the patients were sensitive to inhalant allergens, and 5% exhibited allergen positivity for food. The most common allergens were house (43.7%) dust mites. Allergen positivity was 37.2% in those with comorbidities, while it was 62.8% in those without any comorbidities and this relationship was statistically significant (p<0.05).Conclusion: This study showed that there was an association between house dust mite and CU dust sensitivity. House dust mite sensitivity may trigger CU.

Pattern of chronic urticaria and value of autologous serum skin test in Sohag Province, Upper Egypt.

BackgroundChronic urticaria (CU) is a debilitating disorder with variable clinical course. It is characterized by hives occurring for at least 6 weeks, and is classified as spontaneous or inducible.ObjectiveThe aim of this study was to detect the pattern of CU, to study association between results of autologous serum skin test (ASST) and urticaria severity score (USS), and to detect serum levels of anti IgE receptors antibodies.MethodsThis study included all patients attending the Dermatology Outpatient Clinic, Sohag University Hospital, who were diagnosed as CU from April 2015 to March 2016. ASST and serum level of anti IgE receptor antibodies was assessed using ELISA. Data were analyzed by SPSS version 16, using descriptive statistics, Kruskal-Wallis and Mann-Whitney U test.ResultsA total of 108 patients with CU were included in the study. Females with mean age 33±12.4 years were more affected. A total of 58.3% complained of CSU, 6.5% physical urticaria and 35.2% mixed type of CU. According to USS, mild score represented 20.4%, moderate 46.3% and severe in 33.3%. ASST showed positive in 38% of patients. There was a statistically significant relation between ASST and USS and duration of CU. This indicates that more severe symptoms and prolonged duration of CU are observed in positive ASST (autoreactive type). In all, 91% of the anti IgE receptor antibodies positive patients had positive ASST.ConclusionIn conclusion, chronic urticaria is not an uncommon disease in our locality which represented 1.13% of our patients. Urticaria severity score and duration of urticaria was higher in positive ASST patients and hence the autoreactive type.

The Autologous Serum Skin Test as a Prognostic Factor for the Severity and Duration of Chronic Urticaria after five years of Follow-up

The Autologous Serum Skin Test as a Prognostic Factor for the Severity and Duration of Chronic Urticaria after five years of Follow-up

Epidemiology of Chronic Urticaria in Korea Using the Korean Health Insurance Database, 2010-2014.

PurposeThere are very few epidemiological studies on chronic urticaria (CU). We aimed to investigate the prevalence of CU and to depict demographics and medication patterns for the disease in a nationwide population-based study.MethodsData on urticaria (L50 of the International Classification of Diseases, 10th revision) from 2010 to 2014 were obtained from the Korean Health Insurance Review and Assessment Service. Algorithms designed to evaluate prescription drug claims for antihistamines were applied to identify CU.ResultsThe crude prevalence of CU was 2,256.5 per 100,000 person-years and tended to increase every year. The age-standardized prevalence of CU was significantly higher in females than in males (2,466.8 vs 1,819.2 per 100,000 person-years, P<0.001). Age-specific prevalence was highest for older adults over the age of 65 years and lowest for ages 10-29 years. The median duration of CU was 591 days, and symptoms lasted for at least 1 year in 61.9% of patients. Gastrointestinal disease was the most common comorbidity in adults, whereas allergic rhinitis and common cold were more prevalent in children with CU. Around a third of CU patients were taking antihistamine treatment alone, and 70% were treated with both antihistamines and systemic corticosteroids. Cyclosporine was prescribed for 0.02% of CU patients.ConclusionsThe present study outlines recent longitudinal epidemiological data on the prevalence of CU in Korea. In light of limitations on the use of claims data, including no specific disease code for CU and a possible discordance between drug claims and the presence of urticaria symptoms, further investigations are necessary to describe the exact epidemiologic profile of CU patients.

Urinary N-methyl histamine levels relate to the presence of angioedema and decrease with the duration of chronic urticaria

Chronic urticaria (CU) defined as hives lasting more than 6 weeks1 is a challenging disease to treat due to its unpredictable nature, the lack of prognostic predictors, and minimal data on predictors of treatment response. CU affects between 0.5% and 5% of the population with the estimated incidence rate of 1.4% per year.1 Quality of life of patients with CU is significantly poor2 with associated angioedema (in approximately 40% of cases3) perceived as a particularly alarming symptom. Hives commonly last 3-5 years with 85% of patients reporting resolution of urticaria within 5 years.

ASSESSMENT OF QOL BY URTICARIA ACTIVITY SCORE IN PEDIATRIC PATIENTS WITH CHRONIC URTICARIA

There is no standard for assessing pediatric chronic urticaria in Japan. UAS7, weekly total values of the Urticaria Activity Score (UAS), has correlation with Dermatology Life Quality Index (DLQI) which assesses Quality of Life (QOL). The current European Academy of Allergy and Clinical Immunology (EAACI) guidelines recommend assessing disease activity in chronic urticaria by using UAS. We translated UAS into Japanese version, and evaluated usefulness of UAS by comparing with QOL score. Subjects were 42 patients who had received treatments in our clinic from February to September in 2014. They wrote UAS at home. They wrote Children's Dermatology Life Quality Index (CDLQI) when they visited hospital. We assessed correlation UAS7 with CDLQI. Male/Female ratio was 1:1. Median age was 7.5 years old. Duration of chronic urticaria was 5.5 months. Anti-histamine was used in 75%. UAS7 values reflected chronic urticaria patients' quality of life impairment. Change in UAS7 values reflected change in chronic urticaria patients' quality of life impairment. UAS may be a useful tool for assessing QOL in pediatric patients with chronic urticaria.

Immune correlations in chronic child urticaria

Introduction: The growing prevalence of urticaria in children over the last decade and the importance of determining the involved pathogenic mechanisms as well as of detecting the etiologic factors are some of the aspects that led to the choice of research topic. Materials and Methods: The early diagnosis and the establishment of the therapeutic and prophylactic conduct in the urticaria are a necessity. There have been evaluated through a retrospective questionnaire, anamnesis and biochemical evaluation a number of 246 children diagnosed with chronic IgE and non IgE mediated urticaria, and prick tested for a wide range of food allergens. The assessment of the intensity of the eruption was done by calculating the urticaria activity score (UAS), both at diagnosis and at subsequent evaluations to assess the response to the treatment. The immunological investigations which were carried out included the determination of the IgA, IgG, IgM, total IgE and specific IgE to food allergens and airborne allergens, as well as the determination of the IgG4-type antibodies to 20 food allergens by means of enzyme immunoassay. The ELISA method was used for dosing the total IgE, while the CLA System Quanti Scan method (Innogenetics, Heiden, Germany) was used for determining the serum-specific IgE for 20 of the most common food allergens and airborne allergens (Innogenetics, Heiden, Germany). Results: Positive statistical correlations have been made with IgE and non IgE mediated reactions, also with IgG4 antibodies. The result of the multivariate analysis shows that the existence of the atopy represents a risk factor which significantly influences the allergic sensitisation (HR = 3.186→95% CI: 2.57-5.96), followed in the order of importance by food diversification before the age of 6.months (HR = 2.157→95% CI: 1.86-5.35), natural feeding before 3.months of age (HR = 1.78→95% CI: 1003-4581) and artificial or mixed feeding (HR = 1.56→95% CI: 1056-3861). Conclusion: There have been reported different correlations between specific IgE and IgG4 with different food allergens and the period of time between the onset and the duration of chronic urticaria. The regression of specific IgE has a predictive value upon the remission of urticaria (AUC=0.557, p=0.447, 95%CI: AUC→0.398–0.717). The logistic regression for analysis of the predictives factors for the regresson of urticaria showed several factors involved:.Speciphic IgE values, compliance for the eliminating diet and treatment, allergic antecedents and the eventual polisensitivisation.

Omalizumab for chronic urticaria in Latin America

Background Chronic urticaria (CU) is defined as the spontaneous appearance of wheals, with or without angioedema, persisting for ≥6 weeks. Chronic Spontaneous Urticaria (CSU) is a type of CU which affects 0.5–1 % of the global population, but it represents a high burden to patients. In recent years, omalizumab is available as treatment of disease. Our aim is to extend previous findings, analyzing effects of omalizumab on symptoms in Latin American patients with CSU.Methods Retrospective analysis of patients treated with omalizumab in Cuenca-Ecuador. 150 mg omalizumab was administered every 4 weeks, and its effects were measured by Urticaria Activity Score (UAS) at baseline and each month in follow up. Complete response was defined as a UAS of 0 or 1, and partial response was classified as a UAS of 2 or more. Also, demographic and clinical variables were collected. Descriptive analyses were employed. Response rates were summarized as counts and percentages after 3 and 5 months. Related Samples Wilcoxon signed rank tests were used to compare UAS at baseline and after 3 months. P values <0.05 indicated statistical significance.Results 26 subjects were enrolled, almost half were female individuals (57.7 %), with mean age 47.8 years (range, 18–81 years). Mean duration of CU after diagnosis was 23.3 months (range, 2–180 months). Mean UAS at baseline was 5.7 points (range, 4–6 points). Nine patients (34.6 %) completed 3 months of treatment (33 % reported a complete response), with a mean difference in UAS of 3.33 (p = 0.01). Four patients completed 5 months of treatment (75.0 % showed a complete response). All patients previously treated with first-generation antihistamines plus corticosteroids showed no responses at neither 3 nor 5 months of treatment.Conclusion Omalizumab is an effective treatment for patients with CU. It is necessary to conduct some future investigations where we can establish if 150 mg could be an option in developing countries.

Urticaires inductibles et urticaires chroniques spontanées

In the recently published 2013 revision of the guidelines of urticaria, chronic urticaria (CU) gathers chronic spontaneous urticaria (CSU) and inducible urticaria (IU), and excludes pseudourticarial rashes with more than 24h-lasting rash or more than 72h-lasting angiœdema. Activity and psychosocial impact of the disease must be measured with validated scores such as Urticaria and Angioedema Activity Scores, Urticaria Control Test, CU-Q2OL, AE-QOL. Although an allergic cause is generaly absent in CU, pathomecanisms remain elusive even since the well-known role of mast cell degranulation and the presence of autoantibodies anti-FcRεI or anti-IgE. Coagulation pathways may be involved, at least as an amplifying phenomenon. Mean duration of CU is 1 to 4 years, but many patients still have symptoms after 10 years, some predictive factors being known as severity, angioedema, a positive autologous serum test, inducible urticaria. Recommended routine diagnosic tests are validated provocation tests for IU (and cryoproteins for cold urticaria), blood cell count and CRP for CSU, since a thorough history and a normal detailed physical examination should avoid unnecessary tests. Management of CU has been improved by the off-label use of increased dosages of second generation anti- H1 antihistamines, but a subsequent therapeutic intensification may be necessary in some cases. Educational program may prevent this intensification. Independent studies evaluating available molecules are needed, along with more fundamental research studies.

The Management and Treatment of Chronic Urticaria

Chronic urticaria (CU) is a challenging and frequently encountered diagnosis characterized by the presence of evanescent wheals that persist for greater than 6 weeks. It is estimated that 15% to 25% of the US population are affected at some time in their lives with urticaria and that 33% of all urticaria cases are considered to be chronic. Although acute urticaria is generally benign and self-limiting, serious medical illness may occur with CU. The incidence of CU is estimated to be as high as 5% in the general population and greater than 10% when surveying allergy and dermatology patients. CU is an episodic, pruritic disorder in which 45% to 90% of patients will not have an identifiable cause and occurs 4 times more often in females than males. The average disease duration of CU is between 2 and 5 years, and its typical onset is in the third to fourth decade of life. CU is thought to have the most impact on quality of life than any other allergic disease. This article will provide a clinical update and review on the management and treatment of CU.

Évaluation de l’utilité du test au sérum autologue dans l’urticaire chronique idiopathique : étude rétrospective chez 74 patients

Chronic urticaria (CU) is a debilitating disease, and patients and their physicians often seek an aetiological explanation. Studies have suggested that idiopathic CU is associated with the presence of serum auto-antibodies that may be detected by autologous serum skin test (ASST). To confirm the frequency of positivity of ASST and to evaluate its usefulness and possible correlation with the severity of urticaria (greater resistance to AH1, greater activity score or longer duration). Patients referred for CU between 1 October 2001 and 31 March 2005 were submitted to standardized explorations including clinical examination, physical tests, CBC, ESR, CRP and anti-thyroperoxidase antibodies, and an ASST was ordered. Inclusion criteria included no discernible cause of CU, acceptance of the protocol, including blood sampling and injection of ASST 3 weeks later, serological tests for HBV, HCV and HIV, and discontinuation of anti-H1 agents and corticosteroids. Exclusion criteria comprised the presence of dermographism, physical urticaria, urticarial vasculitis, and failure to discontinue anti-H1 drugs or corticosteroids. In April 2006, we contacted patients by mail to assess their current treatment, their CU activity score or its resolution. Seventy-four patients (67 women, seven men) of mean age 43 years were included. ASST was positive in 43 patients (58 %) and negative in 31 (42 %). The only noticeable difference, although not statistically significant (p=0.23), was a positive anti-thyroperoxidase antibody result in 12 % of patients with negative ASST versus 24 % of patients with positive ASST. The occurrence of angioedema, the duration of CU, the severity score, the relative inefficiency of AH1 and the use of corticosteroids or cyclosporine were similar between the two groups. ASST was positive in more than half of the patients with idiopathic CU both in our study and in the literature, with sensitivity of around 70 % and specificity approaching 80 %. However, while this test can help patients understand their disease better and avoid both a fruitless search for other causes and unnecessary proscription of food allergens, our study shows that positive or negative ASST results have no bearing on treatment and are not associated with greater severity of urticaria or greater resistance to treatment. Consequently, we do not recommend routine use of ASST in patients presenting idiopathic CU.