Symptoms Of Chronic Urticaria Research Articles

Multi-component forms of the 2nd generation H1 receptor antagonist drug, Bilastine and its enhanced physicochemical characteristics

Bilastine (BIL) is a novel 2nd generation antihistamine medication is used to treat symptoms of chronic urticaria and allergic rhinitis. However, its poor solubility limits its therapeutic efficacy. In order to enhance the physicochemical characteristics of BIL, various molecular adducts of BIL (Salt, hydrate and co-crystal) were discovered in this study using two distinct salt-formers: Terephthalic acid (TA), 2,4-Dihydroxybenzoic acid (2,4-DHBA), and three nutraceuticals (Vanillic Acid (VA), Hydroquinone (HQN) and Hippuric acid (HA)). Various analytical methods were used to examine the synthesised adducts, including Powder X-Ray Diffraction (PXRD), Single Crystal X-ray Diffraction (SCXRD), and thermal analysis (Thermogravimetric analysis (TGA) and Differential Scanning Calorimetry (DSC)). Single-crystal X-ray diffraction (SCXRD) studies avowed that the architectures of the molecular adducts are maintained in the solid state by an array of strong (N+H⋯O−, NH⋯O, OH⋯O) and weak (CH⋯O) hydrogen bonds. Additionally, a solubility test was performed to establish the in vitro release characteristics of newly synthesised BIL adducts and it observed that most of the molecular adducts exhibit higher rates of dissolution in comparison to pure BIL; in particular, BIL.TA.HYD showed the highest solubility and the fastest rate of dissolution. Moreover, experiments on flux permeability and diffusion demonstrated that the BIL.TA.HYD and BIL.VA salts had strong permeability and a high diffusion rate. In addition, the synthesized adduct’s stability was assessed at 25 °C and 90 % ± 5 % relative humidity, and it was found that all the molecular salts were stable and did not undergo any phase changes or dissociation. The foregoing result leads us to believe that the newly synthesized molecular adducts’ increased permeability and solubility will be advantageous for the creation of novel BIL formulations.

Antihistamine: New Advancement in H1&H2 Receptor used for Pregnancy

Abstract: The function of histamine in allergic inflammation, neurotransmission, and immunological regulation has since been better known one of the most typical skin conditions is urticaria. It may be sudden, recurring, caused by physical stimulation, or brought on by contact with an urticant. A small vessel vasculitis may be the cause of certain instances. As knowledge about this disorder grows, autoimmune pathways are now understood to contribute to chronic urticaria. This study shows that H antihistamine therapy alone is not statistically better to combined H2 and H antihistamine therapy for the treatment of chronic urticaria symptoms. Histamine has been one of the biological amines most extensively studied in medicine. It encourages the contraction of smooth muscles and the release of stomach acid, enhances vascular permeability, functions as a neurotransmitter, and has a range of actions in the control of the immune system, allergies, inflammation, haematopoiesis, and cell division. Histamine works by attaching to the H1, H2, H3, and H4 receptors. H3 and H4 receptors are predominantly presynaptic and haematopoietic, respectively, whereas H1 and H2 receptors are widely dispersed. Human H1- and H2-histamine receptors were cloned and described in the early 1990s, followed a few years later by human H3- and H4-histamine receptors. The main treatment for chronic urticaria is second-generation non-sedating non-impairing H antihistamines. Then, the H antihistamines permitted dosage is raised by a factor of up to four

Efficacy of autologous serum therapy in positive and negative autologous serum skin test patients in chronic urticaria in a tertiary care centre.

Autologous serum therapy (AST) has been a recent therapeutic choice for a variety of chronic diseases such as allergic, inflammatory, infectious, and autoimmune disorders. However, evidence were not convincing of the beneficial effects of autologous serum therapy in treatment of Chronic urticaria (CU). CU is a common dermatological condition that is very disturbing to the patient as well as to the physician. A new observation was made about the abnormal type 1 reactions to intradermal autologous serum injections in some CU patients. This has led to the new subgroup of autoimmune chronic urticaria. The autologous serum skin test (ASST) is an intradermal test result in immediate hypersensitivity-type skin reactions in a subpopulation of CU patients and it's giving promising evidence of therapeutic and diagnostic benefit. Autologous whole blood injection has already been used as one of the old treatment modalities for chronic urticaria. The objectives of this study/reasearch are to analyse the efficacy of autologous serum therapy in patients with chronic urticaria and compare its results in ASST(+) and ASST(-) chronic urticaria patients. Approximately 5 mL of patients' blood was drawn in a plain vacutainer and centrifuged at 3000 r.p.m. for 10 min, separated 2.5 mL serum injected deep intramuscularly into gluteus muscle. Injections were repeated every week for about 9 weeks and a repeat follow up at 20 weeks was done. Out of a total of 20 patients, excellent improvement in terms of decrease in Urticaria assessment severity score was seen in 6 patients; whereas, 10 patients showed partial response, 2 patients showed no response and 2 patients lost the follow up. 10 patients with ASST(+) and 6 patients of ASST(-) showed little improvement in urticaria severity score. AST therapy is a cost-effective adjuvant modality to reduce the severity of symptoms of chronic urticaria. In some patients it's giving long term remission period and it decreases the updosing of antihistamines.

Efficacy of the colchicine add-on therapy in patients with autoimmune chronic urticaria.

Chronic urticaria is in some cases very difficult to treat, we aimed to evaluate the effect of colchicine on chronic urticaria management. Fifty-five euthyroid patients with chronic urticaria were examined based on UQL and UAS7 questionnaires. The overall UQL-Q score after 3 months has not any statistical difference between groups. The overall UQL-Q score changes between groups was not statistically different. However, the UQL-Q score significantly reduces during study period in each group. In conclusion, colchicine can manage the sign and symptoms of chronic urticaria, which improve the patients' quality of life.

УРТИКАРНИЙ ВАСКУЛІТ У ДІТЕЙ

URTICARIAL VASCULITIS IN CHILDREN O. M. Оkhotnikova, O. A. Oshlyanskaya Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine Abstract. Different autoimmune diseases can present with organs malfunctioning and chronic urticaria symptoms in particular such urticarial vasculitis. This variant of vasculitis can be a separate nosological form, which includes a rare disease as hypocomplementemic urticarial vasculitis syndrome. In addition to chronic urticaria symptoms, hypocomplementemic urticarial vasculitis syndrome is characterized by severe systemic manifestations in different organs, decreased serum level of complement components, and appearance of specific markers, such as anti-C1q-antibodies. The diagnosis is confirmed by the results of skin biopsy, which is the «gold standard» of diagnosis. The condition often requires combined treatment with two immunosuppressive drugs. Hypocomplementemic urticarial vasculitis syndrome is a very rare disease, but, because of the multisystem manifestations, it can be encountered by any specialist (pediatrician, general practitioner, allergist, rheumatologist, ophthalmologist, dermatologist, nephrologist, etc.), therefore doctors should consider this condition when dealing with such patients in order to reduce the risk of hypocomplementemic urticarial vasculitis syndrome misdiagnosis as the variants of chronic urticaria or another immunopathogenetic disease. That is why doctors should be well aware of the features of the course of this disease, not only to reduce the likelihood of erroneous diagnosis of urticarial vasculitis as chronic urticaria or another disease of immunopathological genesis, but also because modern therapy of these conditions is radically different from each other: сhronic idiopathic urticaria requires adherence to a modern patient management algorithm with the initial use of H1-antihistamines with a possible increase in the dose (up to a 4-fold increase), and with their low efficiency — the transition to the use of cytostatics, monoclonal antibodies against immunoglobulin E –omalizumab, and is extremely limited and only for short-term use of glucocorticosteroids. Key words: urticarial vasculitis, its forms, hypocomplementemia, chronic urticaria, children. Olena Okhotnikova MD, PhD, professor, Head Department of Pediatrics #1, Shupyk National Healthcare University of Ukraine, 9, Dorogozhytska str., 04112, Kyiv, Ukraine e-mail: kafedra.ped1@gmail.com Аsthma and Allergy, 2021, 3, P. 16–29.

Medication used to control symptoms of chronic urticaria in children.

A number of guidelines for management of CU were established based on evidences in adults. In children, the response to CU treatment was not widely studied. To investigate the medications used to control symptoms of CU in children and to identify factors associated with time to control CU. Medical records of children with controlled CU visiting Allergy clinic, Siriraj hospital were examined. Controlled CU was defined as no urticarial lesion while the patients used the same daily medications over 8-12 weeks. Demographic data, clinical progression of CU and medications used in each visit were recorded. The steps of CU management were categorized into groups according to the Joint Task Force Practice Parameter (JTFPP) in CU 2014 guideline. One hundred children (48 males) with 'controlled CU' were recruited. The median age at first visit was 8 (5.4010.60) years. Thirty-two percent of the patients had associated angioedema. The median time to control CU was 9 (6.9011.10) months. Forty-four percent of the patients control CU with standard dose of second generation antihistamine (step 1) and the rest of the patients used the medications in step 2 to control CU. None of the patients needed systemic corticosteroid or immunomodulatory agent. The steps of treatment, angioedema and associated conditions related to CU did not affect time to control. Only up to a half of pediatric patients with CU had a favorable response to standard dose of second generation antihistamine. The rest required step 2 treatment of JTFPP to control their symptoms.

The relationship between the severity of clinical symptoms of chronic urticaria and serum D-dimer levels.

IntroductionUrticaria and angioedema belong to a heterogeneous group of diseases and it is often very difficult to determine the specific cause of clinical symptoms. Coagulation factors play an important role, and patients with chronic urticaria have elevated plasma concentrations of coagulation factor VII, prothrombin fragment 1 + 2 and D-dimers.AimTo assess the relationship between the severity of clinical symptoms of chronic urticaria and serum D-dimer levels.Material and methodsSixty patients with a diagnosis of chronic spontaneous urticaria, diagnosed and treated in the Dermatology Department of the Poznan University of Medical Sciences were qualified for the tests. The control group consisted of 35 healthy volunteers. All patients with chronic spontaneous urticaria were previously subjected to individual stages of the diagnostic process, in accordance with the guidelines of EAACI and the Polish team of specialists in the field of dermatology and venereology, and allergology. The dermatological condition was assessed using the UAS scale. The serum D-dimer concentration was determined by immunoturbidimetry.ResultsIn the basic group, statistically significant, positive and high correlations between the serum D-dimer concentration and the severity of urticaria symptoms were shown, as well as between the severity of pruritus and the value of the disease activity index were shown.ConclusionsElevated levels of D-imers are significantly correlated with the severity of urticaria.

Cardiac safety of second-generation H1 -antihistamines when updosed in chronic spontaneous urticaria.

The symptoms of chronic urticaria, be it chronic spontaneous urticaria (CSU) or chronic inducible urticaria (CindU), are mediated primarily by the actions of histamine on H1 receptors located on endothelial cells (the weal) and on sensory nerves (neurogenic flare and pruritus). Thus, second-generation H1 antihistamines (sgAHs) are the primary treatment of these conditions. However, many patients are poorly responsive to licensed doses of antihistamines. In these patients, the current EAACI/GA2 LEN/EDF/WAO guideline for urticaria suggests updosing of sgAHs up to fourfold. However, such updosing is off-label and the responsibility resides with the prescribing physician. Therefore, the safety of the drug when used above its licensed dose is of paramount importance. An important aspect of safety is potential cardiotoxicity. This problem was initially identified some 20years ago with cardiotoxic deaths occurring with astemizole and terfenadine, two early sgAHs. In this review, we discuss the mechanisms and assessments of potential cardiotoxicity of H1 antihistamines when updosed to four times their licensed dose. In particular, we have focused on the potential of H1 antihistamines to block hERG (human Ether-a-go-go-Related Gene) voltage-gated K+ channels, also known as Kv11.1 channels according to the IUPHAR classification. Blockade of these channels causes QT prolongation leading to torsade de pointes that may possibly degenerate into ventricular fibrillation and sudden death. We considered in detail bilastine, cetirizine, levocetirizine, ebastine, fexofenadine, loratadine, desloratadine, mizolastine and rupatadine and concluded that all these drugs have an excellent safety profile with no evidence of cardiotoxicity even when updosed up to four times their standard licensed dose, provided that the prescribers carefully consider and rule out potential risk factors for cardiotoxicity, such as the presence of inherited long QT syndrome, older age, cardiovascular disorders, hypokalemia and hypomagnesemia, or the use of drugs that either have direct QT prolonging effects or inhibit sgAH metabolism.

The Efficacy of a Two-Fold Increase of H1-Antihistamine in the Treatment of Chronic Urticaria - the Vietnamese Experience.

BACKGROUND:Chronic urticaria, a mast cell-driven condition, is common, debilitating and hard to treat. H1-antihistamines are the first line treatment of chronic urticaria, but often patients do not get satisfactory relief with the recommended dose. European guidelines recommend increased antihistamine doses up to four-fold.AIM:We conducted this study to evaluate the efficacy of increased H1-antihistamine doses up to two-fold in Vietnamese chronic urticaria patients.METHODS:One hundred and two patients with chronic urticaria were recruited for treatment with levocetirizine (n = 52) or fexofenadine (n = 50). Treatment started at the conventional daily dose of 5 mg levocetirizine or 180 mg fexofenadine for 2 weeks and then increased to 10 mg levocetirizine or 360 mg fexofenadine for 2 weeks if patients did not have an improvement in symptoms. At week 0, week 2 and week 4 wheal, pruritus, size of the wheal, total symptom scores, and associated side-effects were assessed.RESULTS:With the conventional dose, the total symptom scores after week 2 decreased significantly in both groups compared to baseline figures, i.e. 7.4 vs 2.3 for levocetirizine group and 8.0 vs 2.6 for fexofenadine group (p < 0.05). However, there were still 26 patients in each group who did not have improvements. Of these 26 patients, after having a two-fold increase of the conventional dose, 11.5% and 38.5% became symptom-free at week 4 in levocetirizine group and fexofenadine group, respectively. At week 4 in both groups, the total symptom scores had significantly decreased when compared with those at week 2 (2.8 ± 1.5 versus 4.7 ± 1.6 in levocetirizine group; 2.1 ± 1.9 versus 5.1 ± 1.4 in fexofenadine group). In both groups, there was no difference in the rate of negative side effects between the conventional dose and the double dose.CONCLUSION:This study showed that increasing the dosages of levocetirizine and fexofenadine by two-fold improved chronic urticaria symptoms without increasing the rate of negative side effects.

Gydymo omalizumabu veiksmingumas tarp pacientų, sergančių lėtine spontanine dilgėline

Įvadas. Lėtinė spontaninė dilgėlinė yra daugiau nei šešias savaites trunkanti liga, pasireiškianti išbėrimais pūkšlėmis ir (arba) angioedema. Daliai sergančiųjų standartinis gydymas antihistaminiais vaistais yra neveiksmingas net skiriant keturis kartus didesnę nei vaisto apraše rekomenduojama dozę. Omalizumabas – monokloninis antikūnas prieš imunoglobuliną E (anti-IgE), pastarųjų metų klinikinių tyrimų duomenimis, yra veiksmingiausias III pakopos vaistas, skirtas atsparios antihistaminiams vaistams lėtinės spontaninės dilgėlinės gydymui. Tikslas – įvertinti omalizumabo veiksmingumą malšinant lėtinės spontaninės dilgėlinės simptomus. Metodika. Atlikta 22 asmenų, sergančių antihistamininiams vaistams atsparia aktyvia lėtine spontanine dilgėline, kurie buvo tirti ir gydyti Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikų Imunologijos ir alergologijos klinikoje, retrospektyvioji duomenų analizė. Ligos aktyvumas ir gydymo omalizumabu poveikis vertinti pagal dilgėlinės aktyvumo balą (UAS7). Rezultatai. Teigiamas gydymo poveikis pasiektas (dilgėlinės aktyvumo balas sumažėjo &gt;50 proc.) 18 pacientų (81,8 proc.), septyniems pacientams (31,8 proc.) simptomų sumažėjimas stebėtas jau po pirmos vaisto injekcijos, aštuoniems asmenims (47,1 proc.) iš visų baigusiųjų 6 mėn. gydymo kursą dėl pasikartojančių intensyvių dilgėlinės simptomų vaisto vartojimas buvo atnaujintas. Išvados. Gydymas omalizumabu žymiai sumažino ligos aktyvumą. Atsinaujinus lėtinės spontaninės dilgėlinės simptomams po sėkmingo gydymo omalizumabu, vėl pratęstas gydymas šiuo vaistu buvo veiksmingas ir saugus.

Urticaria crónica espontánea: revisión de la literatura

La urticaria crónica espontánea es una enfermedad que produce gran compromiso en la calidad de vida del paciente y de la que aún se desconocen, en gran parte, los mecanismos fisiopatológicos asociados, ya que no son generalizables en todos los individuos. Existen factores intrínsecos y extrínsecos implicados en el desarrollo y persistencia de la enfermedad, los cuales pueden actuar de forma individual o coexistente. En esta revisión se proponen algunos cambios en la clasificación actual de la enfermedad, donde se incluye una subdivisión dentro de la urticaria crónica denominada urticaria crónica mixta, la cual hace referencia a los casos donde coexisten factores intrínsecos y extrínsecos para la aparición de la enfermedad en el mismo individuo. Algunos procesos infecciosos virales, bacterianos y parasitarios se han asociado en el desarrollo o severidad de los síntomas de la urticaria crónica en un subgrupo de pacientes, por lo tanto, son incluidos como factores extrínsecos del individuo dentro de las urticarias crónicas inducibles no físicas. Estas modificaciones son propuestas con el fin de optimizar el diagnóstico y manejo de los pacientes con urticaria crónica mixta.

Association between chronic urticaria and self-reported penicillin allergy

BackgroundPenicillin allergy is the most commonly reported drug allergy and often presents with cutaneous symptoms. Other common diagnoses, such as chronic urticaria, may be falsely attributed to penicillin allergy. Because chronic urticaria is fairly common in the general population, evaluation of its prevalence in patients with self-reported penicillin allergy was of interest. Similarly, the prevalence of self-reported penicillin allergy in patients with chronic urticaria is not well known and also becomes interesting in light of the high prevalence of self-reported penicillin allergy in the general population. ObjectivesTo determine the prevalence of self-reported penicillin allergy in patients with chronic urticaria and the prevalence of chronic urticaria in patients with self-reported penicillin allergy. MethodsThis was a retrospective medical record review of 11,143 patients completed using the electronic health record of the University of Pennsylvania Allergy and Immunology clinic. ResultsThe prevalence of self-reported penicillin allergy in patients with chronic urticaria was found to be approximately 3 times greater than in the general population. The prevalence of chronic urticaria in patients with self-reported penicillin allergy was also found to be approximately 3 times greater than in the population. ConclusionThis link between chronic urticaria and self-reported penicillin allergy highlights the need for clinicians to inquire about self-reported penicillin allergy in patients with chronic urticaria and to consider penicillin skin testing. Furthermore, patients who report penicillin allergy might actually have chronic urticaria, indicating the importance of inquiring about chronic urticaria symptoms in patients with self-reported penicillin allergy.

ANTIHISTAMINES IN TREATMENT OF CHRONIC URTICARIA. REVIEW OF MODERN RECOMMENDATIONS

The article provides current scientific data on the pathogenesis and symptoms of chronic urticaria; international recommendations for treatment and place of antihistamine drugs; clinical pharmacology of the new antihistamines of the 2nd and 3rd generation; results of clinical trials and meta-analyses on comparative effectiveness of antihistamines in treatment of chronic urticaria.

The Effectiveness and Safety of Acupuncture for Patients with Chronic Urticaria: A Systematic Review.

Background. Acupuncture might have effectiveness in relieving the symptoms of chronic urticaria. There are currently no systematic reviews of acupuncture for chronic urticaria published in English. Objective. We conducted a systematic review to assess the effectiveness and safety of acupuncture for chronic urticaria. Methods. A systematic review and meta-analysis of randomized, controlled trials were performed. The primary outcome was global symptom improvement. Results. We included 6 studies with 406 participants. Three trials showed significant difference between acupuncture and drugs in global symptom improvement (relative risk 1.37; 95% CI 1.11–1.70; P = 0.003). As an adjuvant to medication, acupuncture was also beneficial for global symptom improvement (relative risk 1.77; 95% CI 1.41–2.22; P < 0.01). There were no severe adverse events related to acupuncture. Limitations. Some methodological limitations were observed. The overall risk of bias in the 6 included trials was high and all included RCTs were conducted in China and published in Chinese. Besides, the lack of proper control groups and the use of different rating methods and cut-offs in the included trials also made the evidence of this review limited. Conclusions. Acupuncture might be effective and safe for chronic urticaria in relieving symptoms, based on a low level of evidence. To draw a reliable conclusion, more high quality trials are needed in the future. This trial is registered with PROSPERO CRD42015015702.

CHRONIC IDIOPATHIC URTICARIA

Objectives: Urticaria is a condition in which itchy red bumps or wheals appearon the skin unexpectedly. There are two main types ,acute condition which last for up to sixweeks while chronic idiopathic urticaria (CIU) last for more than six weeks. There are multiplefactors in causation of chronic idiopathic urticaria (CIU) and therefore association with elevatedthyroid stimulating hormone (TSH) was evaluated in this study. Study Design: Prospectivecase control. Setting: Department of Physiology Dow University of Health Sciences Karachi.Period: December 2004 to January 2006. Subjects / Patients and Methods: A total number ofninety subjects/patients were enrolled. They were divided in three groups having 30 subjects/patients in each group. Group A consist of diagnosed cases of chronic urticaria. Group Bconsist of diagnosed cases of hypothyroidism and group C consist of age and sex matchedhealthy subjects. In all selected patients/subjects, serum antithyroid autoantibodies and thyroidprofile (serum TSH, T3 and T4), complete blood count, IgE levels, ESR were done. All patientswere selected from dermatology and medical units of civil hospital, Agha Khan Hospital, JPMCand community health clinics in Karachi. Results: Out of 90 patients, 47(78%) were found tohave chronic urticaria compared to control. Out of 47 patients , serum TSH (thyroid stimulatinghormone) was found to be elevated in 20(42.6%) patients with or without hypothyroidismcompared to control group.(P &lt;0.001) Conclusion: Statistically significant association wasfound between elevated serum TSH and chronic urticaria symptoms.

Semisolid formulations containing cetirizine: human skin permeation and topical antihistaminic evaluation in a rabbit model.

Cetirizine dihydrochloride (CTZ) is a second-generation histamine H1 antagonist, effective for the treatment of a wide range of allergic diseases. It has been utilized for managing the symptoms of chronic urticaria and atopic skin conditions. Thus, two novel semisolid formulations, nanoemulsion (NE) and hydrogel (HG) were developed to study their potential utility as vehicles including cetirizine (CTZ) and evaluate the potential use as topical H1-antihistamines agents. The physicochemical and stability properties of both vehicles were tested. Drug release kinetics and human skin permeation studies were performed using Franz cells. The antihistaminic activity was assayed in New Zealand rabbits and compared with two commercial first generation antihistamines. Both formulations were stable and provided a sustained drug release. Amounts of CTZ remaining in the skin were higher for HG, showing the maximum biological effect at 30 min, similar to topical first generation H1-antihistamines commercially available. These results suggest that CTZ-HG could be a promising system for the treatment of topical allergy bringing rapid antihistaminic relief.

The potential role of omalizumab in the treatment of chronic urticaria.

Treatment of chronic urticaria refractory to antihistamines presents a challenge to both people affected with the disease as well as the physicians who treat them. Omalizumab, a monoclonal antibody against IgE, has emerged as one potential solution to this challenge. In several clinical trials published between 2011 and 2013, omalizumab significantly reduced or eliminated symptoms of chronic urticaria. The optimal dose for chronic urticaria is 300 mg administered every 4 weeks, a dose that differs from those used in asthma, which are based on the patient's weight and IgE level. Omalizumab does not appear to cause lasting symptom remission, and the ideal duration of treatment for chronic urticaria has not been defined.

Evaluation of CCR3 as a Basophil Activation Marker

Recent reports have provided conflicting evidence on the stability of CCR3 expression on the surface of basophils. Hence we wanted to independently evaluate the diagnostic usefulness of CCR3 as a surrogate marker of basophil activation and function. We examined the correlative relationship between CCR3 expression on the surface of donor basophils and histamine release after donor basophils were treated with agonistic antibodies directed against the high-affinity IgE-Fc receptor and serum samples from 80 individuals displaying symptoms of chronic urticaria (CU). We observed that CCR3 was significantly downregulated on donor basophils treated with the agonistic antibody and CU-patient serum that demonstrated positive "histamine-releasing activity" (HRA scores >10). However, CCR3 downregulation was also observed on donor basophils incubated with more than 40% of CU-patient serum samples with HRA scores less than or equal to 10. Overall our data show that CCR3 demonstrates adequate sensitivity (83%) but weak specificity (59%) in its ability to reliably identify histamine-releasing activated basophils.

Angioedema Associated with Urticaria can be a Silent Killer

Urticaria and angioedema are common diseases in children and adults. Erythematous swelling of the deeper cutaneous and subcutaneous tissue is called angioedema. Urticaria is characterized as the appearance of erythematous, circumscribed, elevated, pruritic, edematous swelling of the upper dermal tissue. Urticaria may occur in any part of the body, whereas angioedema often involves face, extremities or genitalia. Urticaria is considered acute if symptoms are present for less than 6 weeks. In chronic urticaria symptoms are longer than 6 weeks. Acute urticaria has been reported to be the common type in childhood and chronic urticaria is more frequent in adults. Urticaria and angioedema are a frequent cause of emergency room visit but few patients need to be admitted. The basic mechanism involves the release of diverse vasoactive mediators that arise from the activation of cells or enzymatic pathways. Histamine is the best known of these substances, and response consisting of vasodilatation (erythema), increased vascular permeability (edema) and an axon reflex that increases reaction. The most common etiological factors for angioedema and urticaria have been identified as infection, physical urticaria, food allergy, drug adverse reaction, parasitic infestation and papular urticaria. The aim of this study is to define, describe and discuss etiology, diagnostic, treatment and severity.

Chronic urticaria and irregular menstrual cycle: A case report of effective therapy with oral contraception

It has been reported that urticaria may be associated with some conditions characterized by sex hormone changes. The case presented concerns a 19-year-old patient who had severe symptoms of chronic urticaria for 3 years, concomitant with an irregular menstrual cycle and functional ovarian cysts. After a laparoscopic ovarian cystectomy the patient was treated with hormonal contraceptives. After 3 weeks the symptoms of urticaria withdrew. The patient continues to receive oral contraceptive treatment, has regular menstruation and shows no symptoms of urticaria. A diagnosis with an urticaria origin should take into consideration any changes in hormone balance as one of the possible reasons for the disease. In such cases, treatment with sex hormones may positively influence the course of the illness.