Urticaria Symptoms Research Articles

Pathophysiological Mechanisms of the Onset, Development, and Disappearance Phases of Skin Eruptions in Chronic Spontaneous Urticaria.

Chronic spontaneous urticaria (CSU) is a typical example of an intractable skin disease with no clear cause and significantly affects daily life of patients. Because CSU is a human-specific disease and lacks proper animal model, there are many questions regarding its pathophysiological dynamics. On the other hand, most clinical symptoms of urticaria are notable as dynamic appearance of skin eruptions called wheals. In this study, we explored dynamics of wheal by dividing it into three phases using a mathematical model: onset, development, and disappearance. Our results suggest that CSU onset is critically associated with endovascular dynamics triggered by basophils positive feedback. In contrast, the development phase is regulated by mast cell dynamics via vascular gap formation. We also suggest a disappearance mechanism of skin eruptions in CSU through an extension of the mathematical model using qualitative and quantitative comparisons of wheal expansion data of real patients with urticaria. Our results suggest that the wheal dynamics of the three phases and CSU development are hierarchically related to endovascular and extravascular pathophysiological networks.

Clinical factors as predictors of the development of severe recurrence of chronic spontaneous urticaria after completion of omalizumab therapy

Chronic spontaneous urticaria (CSU) affects about 1% of population, and its prevalence is increasing. The disease occurs in both children and adults, with predominance among women. At least two possible causes of CSU have been identified, two autoimmune endotypes, with different types of autoantibodies associated with activation of skin mast cells. In clinical practice, patients with CSU receive therapy accordance the clinical recommendations of the Ministry of Health of Russia for treatment of urticaria, according to the doctor’s algorithm of actions. In patients with CSU, symptoms are difficult to relieve due to special mechanisms of development this variant of disease. In recent years, specific markers, including clinical and laboratory parameters, have been described that can predict response to treatment patients with CSU. In clinical practice, we encounter difficulties in managing these patients. One of these is recurrence of urticaria symptoms after cessation of omalizumab treatment, which negatively affects compliance of patients and its psycho-emotional background. A retrospective analysis of 14 patients with CSU with resumption symptoms after completion of omalizumab treatment was carried out. Patients were divided into two groups: 1 group – 10 patients that symptoms began controlled with antihistamines (go to 1st therapy stage); and 2 group – 4 patients who need re-prescription of omalizumab (stay on 3rd treatment stage). The duration of CSU, activity according to UAS7, combination with development of angioedema, presence of concomitant allergic and autoimmune pathologies, level of CRP, total IgE, and presence of TPO antibodies were analyzed. There was no tendency relapses severity CSU after omalizumab discontinuation with age, gender, duration of the disease, presence of concomitant allergic diseases and drug hypersensitivity. In patients with high disease activity was tendency toward more severe relapses of CSU. The search and study of predictors response to treatment of CSC remains actual task. Further research to identify predictors of response to treatment and relapses severity help identify groups of patients for early transition to more effective treatment methods, which optimize and personalize management of patients with CSU.

A study to evaluate the effectiveness of Xyzal UC cream in participants with urticaria

Objectives: This study aimed to assess the effectiveness and acceptability of Xyzal UC cream, containing the active component Tazman pepper (Tasmanian pepper berry), in alleviating the symptoms of urticaria. Materials and Methods: A prospective, single-center trial was conducted, involving 30 volunteers aged between 18 and 55 years with mild-to-moderate urticaria. Participants were chosen based on specific inclusion and exclusion criteria, which included a recent history of urticaria episodes supported by photographic evidence. The participants were instructed to apply a sufficient quantity of Xyzal UC cream on affected areas during urticaria episodes. Primary endpoints included grading for urticarial symptoms (redness, swelling, and itching) over 90 min and instant cooling and soothing effects of the cream over 15 min post-application using a Likert scale questionnaire. The secondary endpoint was to assess the tolerability of the test product. Photographs of the same site were taken at baseline (before product application), post-application, and after 90 min (or earlier, whenever resolved) by the participants. Results: The average age of participants as per the demographic data was found to be 33.33 years. The study found significant improvements in urticaria symptoms post-application of Xyzal UC cream. At 15 min post-application, 60% of participants agreed that redness had reduced, increasing to 93.3% of the total number of participants at 90 min. Similarly, 66.6% agreed to strongly agreed to a reduction in swelling at 15 min, with this figure rising to 93.3% at 90 min. The itching was notably reduced, with 83.4% of participants agreeing to strongly agreeing for relief from itching at 15 min, and 96.7% at 90 min. Participants also experienced a strong cooling and soothing effect immediately within 1 min post-application with 100% patient agreement. No adverse events or serious adverse events were reported, indicating a good tolerability profile for the cream. Conclusion: Xyzal UC cream exhibited substantial efficacy in promptly alleviating urticaria symptoms, including redness, swelling, and itching, with high levels of participant satisfaction and a positive tolerance profile. The instant cooling and soothing properties of the cream offer immediate relief, positioning it as a promising substitute for conventional therapies often associated with adverse effects. These findings highlight the potential of Xyzal UC cream as a viable and patient-compliant choice for managing mild-to-moderate urticaria.

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.

A highly sensitive spectrofluorimetric method for the determination of bilastine in human plasma: Application of content uniformity testing.

Bilastine, a new second generation antihistaminic drug, has been widely used for relieving symptoms of allergic rhinitis and urticaria without a sedative effect. A simple, cost-effective, and highly sensitive fluorimetric method was developed for the estimation of bilastine in human plasma, in addition to its pure state and tablets. The suggested method depended on binary complex formation of eosin with bilastine in a buffered medium at pH 4.2. The formed complex resulted in quantitative quenching of eosin emission at 538 nm after excitation at 335 nm. This method demonstrates a broad range of linearity, spanning from 200 to 1000 ng/mL, and exhibits exceptional sensitivity, with a limit of detection and quantitation of 30.85 and 93.48 ng/mL, respectively. In addition, this spectrofluorimetric method may be employed to determine the amount of bilastine in human plasma and tablets with satisfactory accuracy and excellent precision. Furthermore, the content uniformity of bilastine in commercially available tablets was successfully tested by this approach. Compared with the reference method, there were no significant variations in terms of precision or accuracy. In conclusion, the proposed protocol is highly recommended to quantitatively estimate bilastine in different quality control settings.

The role of Bruton's tyrosine kinase in pathogenesis of chronic spontaneous urticaria and the prospects for the use of new treatment

Chronic spontaneous urticaria is a fairly common disease with an unpredictable course, burdensome symptoms and a significant negative impact on patients` quality of life. Despite the established stepwise approach to treatment with antihistamines in standard and increased dosages, anti-IgE therapy, there remains a portion of patients with unsatisfactory control of urticaria symptoms, with the need to develop drugs that target new therapeutic targets. Mast cells, basophils and B cells are key cells involved in the pathogenesis of urticaria; activation, differentiation, proliferation, cytokine secretion and degranulation in all three types of cells is regulated via Bruton's tyrosine kinase signalling pathway through FcεRI and BCR receptors respectively. Inhibition of Bruton's tyrosine kinase is being developed as a new therapeutic strategy for chronic spontaneous urticaria. Here we present overview of the current understanding of chronic spontaneous urticarial`s pathogenesis, the role of Bruton's tyrosine kinase, the history of medical use of Bruton's tyrosine kinase inhibitors, as well as clinical data on the use of new Bruton's tyrosine kinase inhibitors in patients with chronic spontaneous urticaria who have not achieved adequate disease control with antihistamines.

Anti-edematous effects of epinastine, cetirizine and its enantiomers in λ-carrageenan-induced edema in rat hind paw.

Urticaria is induced by the histamine released from mast cells which develops wheals (edema) as a visual feature. In clinical practice, second-generation histamine H1 -receptor blockers are routinely used as the first-line symptomatic treatment for urticaria. Nevertheless, not much research has directly examined the second-generation histamine H1-receptor blockers' ability to reduce edema. In this study, we directly evaluated the anti-edematous activities of three second-generation histamine H1-receptor blockers available in the market (epinastine hydrochloride, cetirizine hydrochloride, and levocetirizine hydrochloride) using a λ-carrageenan-induced footpad edema model. One hour before the induction of edema with 1% λ -carrageenan injection, all second-generation histamine H1 -receptor blockers (5, 10, 50 and 100 mg/kg) were subcutaneously administered to rats. At 0.5 and 3 hours after λ -carrageenan administration, the edema volume was evaluated using a Plethysmometer. Epinastine hydrochloride significantly suppressed the edema growth in a dose-dependent manner. Cetirizine hydrochloride showed a slight anti-edematous effect, while levocetirizine significantly inhibited the development of edema in a dose-dependent manner. On the other hand, dextrocetirizine did not prevent edema from growing. In summary, second-generation histamine H1 -receptor blockers, at least those examined in this study, may be able to reduce the clinical symptoms of urticaria associated with edema. Levocetirizine hydrochloride is also anticipated to have stronger anti-edematous effects than cetirizine hydrochloride because levocetirizine is responsible for cetirizine's anti-edematous activity.

IgE Neutralization Reverses Trimellitic Anhydride-Induced Urticaria in Humanized CD34+ Mice

Abstract Urticaria is a significant challenge affecting the quality of life for a substantial population worldwide, manifested by the sudden appearance of wheals, erythema, and pruritus triggered by allergic reactions, infections, or physical stimuli. Immunoglobulin E (IgE) plays a pivotal role in urticaria pathogenesis by mediating mast cell accumulation and degranulation to regulate the release of inflammatory mediators such as histamine. We developed a humanized CD34+ mouse model of urticaria by sensitizing the depilated skin topically with Trimellitic anhydride (TMA) on four occasions, with anti-human IgE as the positive control. Four consecutive days after the final sensitization, we observed and scored animal ear conditions, and enumerated scratching frequency. Additionally, mast cell counts in the skin and ear were evaluated. TMA-sensitized animals exhibited increased ear thickness, scoring, scratching frequency, and mast cell numbers in both skin and ear compared to normal animals. Toluidine blue staining confirmed a significant rise in mast cell numbers in TMA-sensitized mice, correlating with elevated histamine levels. Treatment with anti-human IgE ameliorated urticaria symptoms, showcasing comparable ear thickness, mast cell numbers in the ear and skin, and scratching frequencies to the normal animals. Our findings indicate that IgE neutralization effectively reversed TMA-induced urticaria in humanized CD34+ mice.

Stressful life events, psychiatric comorbidities and serum neuromediator levels in patients with chronic spontaneous urticaria treated with omalizumab.

Many chronic spontaneous urticaria (CSU) patients have highly stressful life events and exhibit psychiatric comorbidities. Emotional stress can cause or exacerbate urticaria symptoms by causing mast cell degranulation via neuromediators. To investigate the frequency of stressful life events and compare psychiatric comorbidities and serum neuromediator levels in patients with CSU who responded to omalizumab with healthy controls. In this cross-sectional study, we included 42 patients with CSU who received at least 6 months of omalizumab treatment and a control group of 42 healthy controls. Stressful life events were evaluated with the Life Events Checklist for DSM-5 (LEC-5). The Depression Anxiety Stress Scale-42 (DASS-42) was used to evaluate depression, anxiety and stress levels. Serum nerve growth factor (NGF), calcitonin gene-related peptide (CGRP) and substance P (SP) levels were measured using the enzyme-linked immunosorbent assay (ELISA) technique. Twenty-six (62%) patients reported at least one stressful life event a median of 3.5 months before the onset of CSU. There were no significant differences in all three variables in the DASS subscales between the patient and control groups. Serum NGF levels were found to be significantly lower in patients with CSU (p <0.001), whereas CGRP levels were found to be significantly higher (p <0.001). There was no significant difference for SP. The psychological status of patients with CSU who benefited from omalizumab was similar to that of healthy controls. Omalizumab may affect stress-related neuromediator levels.

Approved therapies and their effects on the main symptoms of urticaria : When symptom control of itchy wheals is not adequate-does updosing help?

International guidelines for the treatment of chronic spontaneous urticaria support the updosing of second-generation antihistamines to four times of the approved dose when adequate symptom control cannot be achieved with the standard dosage. However, this recommendation is primarily based on expert opinions, and there is alack of large, well-designed, double-blind clinical trials. Most the existing trials provide insufficient data, and due to the heterogeneity of the conducted trials on antihistamine effects (definition of control, design, quality, lack of an active comparator, no placebo arm, small sample size, outcomes) and their short duration, comparative analysis is challenging. However, it can be concluded that the use of modern second-generation antihistamines is both effective and safe based on the available data and our own long-term experiences in the specialized outpatient clinic of auniversity dermatology department, even though increased dosages (up to fourfold as per the current international guidelines) may be necessary for symptom control. Another therapeutic option for refractory symptoms in chronic spontaneous urticaria is subcutaneous administration of omalizumab at adosage of 300 mg at 4‑week intervals as avery safe and effective treatment.

What are the main symptoms of urticaria and how are they systematically recorded?

Wheals or angioedema or both are the main symptoms of urticaria. The small number of the symptoms usually makes diagnosis easy. What is not trivial, however, is the comprehensive systematic recording and assessment of these symptoms and, above all, their sequelae, which affect many areas of the patient's life. Disease activity, quality of life and disease control can and should be measured before and during treatment in order to optimally adapt therapeutic measures. The instruments developed for this purpose have become easier and more convenient to use in recent years thanks to user-friendly platforms such as mobile health apps.

Comparing transfusion reactions between pre-storage and post-storage leukoreduced apheresis platelets: an analysis using propensity score matching

Transfusion reactions induced by platelet transfusions may be reduced and alleviated by leukocyte reduction of platelets. Although leukoreduction of apheresis platelets can be performed either pre-storage or post-storage, seldom studies directly compare the incidence of transfusion reaction in these two different blood products. We conducted a retrospective study to compare the transfusion reactions between pre-storage and post-storage leukoreduced apheresis platelets. We reviewed the general characteristics and the transfusion reactions, symptoms, and categories for inpatients who received pre-storage or post-storage leukoreduced apheresis platelets. Propensity-score matching was performed to adjust for baseline differences between groups. A total of 40,837 leukoreduction apheresis platelet orders were reviewed. 116 (0.53%) transfusion reactions were reported in 21,884 transfusions with pre-storage leukoreduction, and 174 (0.91%) reactions were reported in 18,953 transfusions with post-storage leukoreduction. Before propensity-score matching, the odds ratio for transfusion reactions in the pre-storage group relative to the post-storage group was 0.57 (95% confidence interval [CI] 0.45–0.72, P < 0.01); the odds ratio after matching was 0.63 (95% CI 0.49–0.80, P < 0.01). A two-proportion z-test revealed pre-storage leukoreduction significantly decreases the symptoms of chills, fever, itching, urticaria, dyspnea, and hypertension as compared with those in post-storage leukoreduction. Pre-storage leukoreduced apheresis platelet significantly decreased febrile non-hemolytic transfusion reaction as compared with post-storage groups. This study suggests pre-storage leukoreduction apheresis platelet significantly decreases the transfusion reaction as compared with those in post-storage leukoreduction.

Sustained control of recalcitrant chronic spontaneous urticaria after initiation of inflammatory airway diseases treatment: two case reports

BackgroundCurrent classification of chronic urticaria is primarily based on clinical presentation of skin manifestations. Hence, therapeutic treatment is primarily aimed locally for immediate symptom relief. We reason that limiting therapeutic strategies to the skin pathology might be inadequate since cellular activation and inflammation might be triggered remotely.Case presentationIn this series two patients had exhausted all current treatments for recalcitrant urticaria but remained symptomatic. The first case was 26-year-old Caucasian female and the second was 63-year-old African American female. Both cases had frequent breakthrough urticaria requiring frequent pulsating courses of prednisone to control urticaria despite treatment with omalizumab and antihistamines. When inflammatory airway disease was discovered and managed with inhaled corticosteroid, urticaria is controlled much faster without the need of high dose immunosuppression over several years of observation. Coincidentally, autoimmune thyroiditis and anti-immunogobulin-E immunoglobulin-G titers dropped significantly in one case with sustained inhaled corticosteroid therapy.ConclusionsWe suggest a novel approach of controlling remote epithelial site inflammation in these two cases that resulted in sustained-control of urticaria symptoms without the need for systemic corticosteroids or immunosuppressant. The changes of autoimmune antibodies might be the consequences of tolerance breaking from chronic lower airway inflammation as observed in other epithelial inflammatory condition like in celiac disease and rheumatoid arthritis.

Social Media and Urticaria - A Data Audit of Facebook®, LinkedIn®, and Twitter® Posts.

Urticaria is a common debilitating dermatological disorder impairing a patient's quality of life. Such patients are increasingly using socialmedia to manage their health and interact with peers, particularly during the ongoing COVID-19 pandemic. To explore and analyse the quality of urticaria related social-media information available to patients. An in-depth data audit of the three most commonly used social networks viz. Facebook®, LinkedIn®, and Twitter® were done on a single day, as posts may change or lose relevance over time. The word "urticaria" was searched on three social media, and the first 100 posts in each were further analysed. The post-creator was either categorised as "individual" or "group", and non-English posts were excluded. All types of posts have been analysed, including text, images, video, and website links. We also collected the comments/replies, share/re-tweet, and likes on the posts. Among the total 300 social-media posts, the highest number of "individual" posts was on LinkedIn® followed by Twitter® and Facebook® (χ2 = 82.86, P < 0.0001). Regarding thematic content, most Facebook® posts discussed disease symptoms, followed by the promotion of journal or blog posts, and discussion about causative and triggering agents. LinkedIn® was primarily used for the promotion of journal articles or blog posts, followed by educational webinars and urticaria treatment stories. Twitter® users mostly interacted with peers about their urticaria symptoms and perceived etiologic and triggering factors. Regarding the type of post, images were maximally shared on Facebook®, while video/video links and web links were highest on LinkedIn® (χ2 = 21.59, P < 0.0001). The overall quality of urticaria related information on these 3 social media platforms is satisfactory for patients. Dermatologists may consider utilising social media to further educate such patients and improve the overall treatment outcome. The use of such networking channels will continue to grow, as communication remains crucial for urticaria management.

Serum ferritin levels in chronic spontaneous urticaria in association with autologous serum skin test: A cross-sectional study

Abstract BACKGROUND: Chronic spontaneous urticaria (CSU) is a common clinical condition presenting with wheals or along with angioedema. It has a complex pathogenesis having a considerable impact on quality of life. In patients with chronic spontaneous urticaria (CSU) exhibiting poor response to conventional treatments, the presence of hyposiderinemia suggests that oral iron therapy could potentially lead to resolution of the urticaria symptoms. OBJECTIVES: (1). To estimate serum ferritin levels in patients with CSU. (2) To assess the correlation between urticarial activity score, autologous serum skin test (ASST), and serum ferritin levels in CSU. MATERIALS AND METHODS: This prospective study enrolled 37 cases of clinically diagnosed CSU attending the dermatology outpatient department from December 2019 to November 2020 after Institutional Ethics Committee approval. ASST and serum ferritin level estimation were done on all patients. The severity of urticaria was calculated using the Urticaria Activity Score. Statistical analysis was done by frequency, standard deviation, and Chi-square test. RESULTS: Among ASST-positive patients, only 4 (19%) had low ferritin levels. No association was found between ASST and serum ferritin levels (P = 0.342). Mean serum ferritin levels in ASST-positive patients were high 91.34 ± 87.24 μg/L which was statistically significant compared to mean serum ferritin levels in ASST-negative patients 49.64 ± 46.91 μg/L. There was significant involvement of palms and soles in ASST-positive patients (P = 0.038). CONCLUSION: Although there was no significant correlation of serum ferritin levels with CSU, oral iron supplementation may be considered an add-on treatment in case of refractory urticaria.

Efficacy and safety of ligelizumab in adults and adolescents with chronic spontaneous urticaria: results of two phase 3 randomised controlled trials

Many patients with chronic spontaneous urticaria (CSU) do not achieve complete control of their symptoms with current available treatments. In a dose-finding phase 2b study, ligelizumab improved urticaria symptoms in patients with H1-antihistamine (H1-AH) refractory CSU. Here, we report the efficacy and safety outcomes from two ligelizumab phase 3 studies. PEARL-1 and PEARL-2 were identically designed randomised, double-blind, active-controlled and placebo-controlled parallel-group studies. Patients aged 12 years or older with moderate-to-severe H1-AH refractory CSU were recruited from 347 sites in 46 countries and randomly allocated in a 3:3:3:1 ratio via Interactive Response Technology to 72 mg ligelizumab, 120 mg ligelizumab, 300 mg omalizumab, or placebo, dosed every 4 weeks, for 52 weeks. Patients allocated to placebo received 120 mg ligelizumab from week 24. The primary endpoint was change-from-baseline (CFB) in weekly Urticaria Activity Score (UAS7) at week 12, and was analysed in all eligible adult patients according to the treatment assigned at random allocation. Safety was assessed throughout the study in all patients who received at least one dose of the study drug. The studies were registered with ClinicalTrials.gov, NCT03580369 (PEARL-1) and NCT03580356 (PEARL-2). Both trials are now complete. Between Oct 17, 2018, and Oct 26, 2021, 2057 adult patients were randomly allocated across both studies (72 mg ligelizumab n=614; 120 mg ligelizumab n=616; 300 mg omalizumab n=618, and placebo n=209). A total of 1480 (72%) of 2057 were female, and 577 (28%) of 2057 were male. Mean UAS7 at baseline across study groups ranged from 29·37 to 31·10. At week 12, estimated treatment differences in mean CFB-UAS7 were as follows: for 72 mg ligelizumab versus placebo, -8·0 (95% CI -10·6 to -5·4; PEARL-1), -10·0 (-12·6 to -7·4; PEARL-2); 72 mg ligelizumab versus omalizumab 0·7 (-1·2 to 2·5; PEARL-1), 0·4 (-1·4 to 2·2; PEARL-2); 120 mg ligelizumab versus placebo -8·0 (-10·5 to -5·4; PEARL-1), -11·1 (-13·7 to -8·5; PEARL-2); 120 mg ligelizumab versus omalizumab 0·7 (-1·1 to 2·5; PEARL-1), -0·7 (-2·5 to 1·1; PEARL-2). Both doses of ligelizumab were superior to placebo (p<0·0001), but not to omalizumab, in both studies. No new safety signals were identified for ligelizumab or omalizumab. In the phase 3 PEARL studies, ligelizumab demonstrated superior efficacy versus placebo but not versus omalizumab. The safety profile of ligelizumab was consistent with previous studies. Novartis Pharma.

AN AYURVEDIC APPROACH IN THE MANAGEMENT OF URTICARIA (SHEETPITTA): A CASE STUDY

Purpose: Urticaria is a vascular reaction of the skin characterised by sudden, short-lived itchy wheals which may be pale or pink in the centre, surrounded by red flare. Urticaria is a type 1 hypersensitivity reaction which is caused be-cause of exposure to allergence. Epidemologically urticaria is increasing now days due to industrialization, pol-lution, increased use of various skin products, changes in lifestyle. Sign and symptoms of urticaria resembles with ‘Sheetpitta’ one of the vyadhi described by our acharyas caused by ‘Asatmya ahara and vihara’ results in vitiation of kapha and vata.our ancient acharyas has mentioned shamna and shodhana kriya as well as various Classical formulations for sheetpitta. Ayurvedic managemrent helps to cure urticaria by restoring equilibrium of tridosha and sapta dhatus, restores healthy skin. The present paper intends to highlight the ayurvedic manage-ment in reducing sign-symptoms and recurrence of the disease. Method: The present case study is on 28yr old male who is having complaint of on and off eruption of reddish, smooth slightly elevated wheals on trunk and upper extrimities associated with localized itching and burning sensation. He was clinically diagnosed as sheetpitta or urticaria.The patient was treated with Panchakarma chikitsa includ-ing vaman karma followed by virechan karma and some Ayurvediac shaman drugs. The patient was also advised some lifestyle and dietary adoptions. Results: The follow up was done for three months during which the patient had only one episode of rashes and itching. The patient got moderate relief in all the symptoms with appreciable changes. Conclusion: Urticaria can be successfully treated with an ayurvedic line of treatment and changes in daily lifestyle habits and diet.

INCIDENCE OF INTESTINAL PARASITES IN CHILDREN WITH CHRONIC SPONTANEOUS URTICARIA

This study aimed to investigate the incidence of intestinal parasites in children who have been diagnosed with chronic spontaneous urticaria. A prospective control study was conducted at the Pathology Department of MMDC, Multan. The study included a total of 150 children, both from government and private schools. The children were divided into two groups: group A comprised 80 children diagnosed with chronic spontaneous urticaria, and group B included 70 healthy children. Group A was assessed for intestinal infections, and those with parasites were given anti-parasitic therapy. The outcomes were then evaluated. Out of the participants in group A, 18 (22.5%) had intestinal parasitic infections (IPI), compared to 10 (14.2%) in group B. Although the incidence of IPI was higher in group A, the difference was not statistically significant (P=.181). Blastocystis sp. was found in 14 (17.5%) patients in group A and 10 (14.2%) in group B. The eosinophil percentage in group A was 2% (.6% - 3.7%), and in group B was 1.5% (.6% - 2.2%) (P= .045). The total IgE value in group A was 97.6 IU/mL (ranging from 29-246 IU/mL), and in group B was 31.6 IU/mL (ranging from 14.2-65.8 IU/mL) (P &lt;.001). Patients diagnosed with IPI were treated with metronidazole; out of the 18 patients, 10 (55.5%) saw an end to their urticaria symptoms. The results of this study suggest that Blastocystis sp. and D. fragilis were the most common parasites found in children with urticaria, which can disrupt their lifestyle.

Optimization of the treatment of patients with severe chronic urticaria

Severe chronic urticaria (SCU) is a common disease that burdens the lives of millions of people, reduces their quality of life, and imposes a significant economic burden not only on the health care system, but also directly on the patient. To date, a single approach regarding the optimal dosing of omalizumab in this cohort of patients has not been determined. The purpose of the work: based on the assessment of the quality of life of patients with SCU and dynamic clinical and laboratory observation, to study the effectiveness and prove the feasibility of using the minimum dose of 150 mg for omalizumab according to the scheme every 21 days intramuscularly three times, which will allow to optimize the treatment tactics of these patients and reduce the economic burden of the cost of their treatment. In a prospective single-center study lasting 33 weeks, 104 patients with a diagnosis of SCU were included. All patients underwent a general clinical examination, quality of life indicators using the SKINDEX-29 questionnaire were studied; blood tryptase level once before the start of treatment using ImmunoCAP was determined, the level of total IgE in blood serum using an immunochemical method with electrochemiluminescence detection before and after the end of treatment was determined. The patients were divided into two groups: Group 1 (54 people) had a relapse of urticaria within 3 to 6 months after completing a course of second-generation histamine H1-receptor blockers and received a course of omalizumab at a dose of 150 mg intramuscularly every three weeks three times. Group 2 (50 people) had a relapse of urticaria no earlier than 6 months after the previous course of second-generation histamine H1-receptor blockers and received desloratadine, 5 mg during the first four weeks and 20 mg during the next four weeks. Indicators of urticaria activity (UAS7) and quality of life (SKINDEX-29) in patients were determined before the start of treatment and at each of the visits (on the 10th, 31st and 52nd days of therapy when treated with omalizumab and five and nine weeks after initiation of desloratadine therapy), and UAS7 was assessed six months after the end of treatment. Methods of descriptive and analytical statistics were used to process the obtained data. According to our data, patients with SCU are mostly people of working age, more than half of whom have a history of the disease for five years or more, in 70% of cases of a valid study, they are characterized by an increased content of total IgE and have a low level of indicators according to the questionnaire SKINDEX-29 at the level of physical symptoms, emotional sphere and functioning. We found that in patients of observation Groups 1 and 2, after the treatment, the level of total IgE in blood serum decreased statistically significantly. In patients of Group 1, the appointment of omalizumab in the minimum dose made it possible to ensure the control of urticaria symptoms already after the first injection in 15% of cases, and after the third injection there was a stable remission with the absence of urticaria symptoms during six months of follow-up in 92.3% of patients, against the existing 24% of subjects of Group 2, who after therapy according to UAS7 had very severe and severe symptoms. After the completion of treatment in patients of Group 2, nine weeks after the initiation of desloratadine therapy according to the SKINDEX-29 questionnaire, 44% of cases and 46% of very severe negative effects of urticaria on the emotional sphere and functioning remained, respectively; and in 46% of cases there was a low quality of life according to the generalized assessment of the impact of the disease at the level of "severe". At the same time, among the patients of Group 1, after completion of omalizumab therapy on the 52nd day of observation, no case of severe or very severe negative impact of urticaria on the quality of life was registered in any of the domains. Thus, the effectiveness and justified expediency of prescribing omalizumab treatment of 150 mg with an interval of 21 days three times in patients with SCU, who have a recurrence of chronic dermatosis within 3 to 6 months after the second-generation histamine H1-receptor blocker therapy has been confirmed.

Antihistamine: New Advancement in H1&amp;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