Mean UAS7 Research Articles

Long-term management of chronic spontaneous urticaria with omalizumab.

Clinical trials have shown the efficacy of omalizumabs efficacy in refractory chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU), but real-life management strategies are lacking. To assess the long-term efficacy and safety of omalizumab, and to identify predictive factors and optimum dosage regimens. This was a prospective study of 13 patients (11 women, 2 men) with severe CSU [weekly urticaria activity score (UAS7) >28] resistant to anti-H1 antihistamines. Patients were started on omalizumab 150mg subcutaneously every 4weeks. Dose and interval between administrations were adjusted according to clinical response (189 administrations; treatment duration range 2-38months). Mean UAS7 was 36.3±5.4. Of the 13 patients, all had experienced angio-oedema, while in addition, 7 had delayed pressure urticaria (DPU) and 1 had solar urticaria (SU). After omalizumab treatment, 4 (30.8%) of the 13 patients had complete response (CR), and the remaining 8 (61.5%) had partial response. CR was achieved with a dose of 150mg every 4 (n=2 patients) or 5 (n=2)weeks. One of these patients remained disease-free after stopping treatment. Partial responses were achieved with 150mg every 4weeks (n=4) and with 300mg (n=4) at intervals of 5weeks (n=1), 4weeks (n=2) or 3weeks (n=1). Only one patient (7.7%) did not show significant improvement, despite a dose of 300mg every 4weeks. There were no significant differences in epidemiological, clinical and laboratory data between the different response groups. Only two adverse events were observed: one was mild headache and the other was severe angio-oedema and aggravation of urticaria within 6h of omalizumab administration. Omalizumab dose and interval between administrations could be individualized for long-term management of CSU.

Histamine intolerance in patients with chronic spontaneous urticaria.

Histamine intolerance and pseudoallergy to foods have been suggested to be causes of chronic spontaneous urticaria (CSU) with some patients reporting exacerbation with histamine-rich foods. The study aim was to identify the rate of histamine-intolerant CSU patients and to characterize the relevance of histamine intolerance as an underlying cause of CSU. A cohort of 157 of moderate to severe CSU patients (UAS7 ≥ 10) was asked to provide a detailed clinical history, particularly in relation to symptom development after eating histamine-rich foods. They subsequently undertook a histamine-free pseudoallergen-low diet followed by a double-blind, placebo-controlled oral histamine provocation (75 mg). One third of patients (34%) had a positive history of histamine intolerance. There was no statistical difference between the mean UAS7 scores of patients with positive and negative histories (22.4 ± 1.0 vs. 22.7 ± 0.8). When kept on diet, 46% of patients responded with reduced CSU activity (UAS7 reduction of ≥7). Following double-blind, placebo-controlled oral histamine provocation, 17% of patients gave a positive weal response. There appeared to be little relationship between patient history, response to diet and the weal response to oral histamine provocation. First, the history-positive and -negative groups contained similar proportions of diet and histamine provocation weal-positive patients. Second, the diet-positive and -negative groups contained similar proportions of history-positive and histamine provocation weal-positive patients. Third, the histamine provocation weal-positive and -negative groups had similar rates of history- and diet-positive patients. Finally, only 2 of the 157 patients were positive in all three domains. CSU due to histamine intolerance appears to be rare and cannot be diagnosed based on the history. The study confirms that avoidance diets low in pseudoallergens can improve urticaria symptoms, this is probably not due to the absence of dietary histamine.

Real-life experiences with omalizumab for the treatment of chronic urticaria

Real-life experiences with omalizumab for the treatment of chronic urticaria