Urticaria Symptoms Research Articles

Omalizumab in the treatment of various forms of chronic urticaria

BACKGROUND: Chronic urticaria is a skin disease characterized by the appearance of itchy weals and/or angioedema for 6 or more weeks. Chronic urticaria is subdivided into chronic spontaneous urticaria, which occurs due to an unknown cause, and chronic inducible urticaria, which occurs as a result of exposure to various physical factors (water, cold, heat, pressure, mechanical irritation), can occur simultaneously or independently of each other. Omalizumab, anti-IgE monoclonal antibody, is approved for the treatment of patients with chronic spontaneous urticaria and is the second choice in cases of resistance to antihistamine treatment. In patients with a combination of chronic spontaneous urticaria and chronic inducible urticaria, the effectiveness of treatment with omalizumab has been little studied.
 AIM: compare the effectiveness of omalizumab treatment in patients with chronic spontaneous urticaria and patients with a combination of chronic spontaneous and chronic induced urticaria.
 MATERIALS AND METHODS: Under supervision there were 30 patients with chronic spontaneous urticaria and combined chronic spontaneous and inducible urticaria (15 patients in each group). Evaluation of the effectiveness of treatment was carried out according to the results of the questionnaires DLQI (dermatological index of quality of life), CU-Q2oL (questionnaire for quality of life in chronic urticaria), UCT (urticaria control test), UAS (urticaria activity scale), HADS (Hospital Anxiety and Depression Scale) and provocation tests in dynamics before and during treatment.
 RESULTS: All patients received omalizumab 300 mg subcutaneously once a month for 6 to 12 months. After the first injection of omalizumab, we noted a decrease in the severity of urticaria, an increase in the level of disease control and quality of life when comparing parameters before and during treatment in more than 90% of patients. Improved performance remained at this level throughout all subsequent months of treatment.
 CONCLUSION: Omalizumab is equally effective in patients with an isolated form of chronic spontaneous urticaria and in patients with a combined form of chronic spontaneous and inducible urticaria. The use of omalizumab allows you to control the symptoms of chronic spontaneous and inducible urticaria, even with prolonged use.

Autoinflammatory Conditions May Increase Risk of Adverse Drug Reactions

In this case report, we will describe a patient who has been diagnosed with cryopyrin associated autoinflammatory syndrome (CAPS), with a history consistent with familial cold autoinflammatory syndrome (FCAS). The patient experienced drug reactions to multiple treatments highlighting how autoinflammatory conditions may increase the risk of drug reactions in patients.CAPS is a rare genetic autoinflammatory condition caused by gain of function mutation in NLRP3 leading to the activation of the cryopyrin inflammasome which causes release of many cytokines including IL-1β. Patients experience systemic symptoms involving the musculoskeletal, nervous system, and cutaneous systems. This patient is a 32-year-old female with no past medical history who presented with symptoms of recurrent cold urticaria, arthralgias, and frequent conjunctivitis since she was 15 years old. Her father and brother also experienced similar symptoms. Patient’s genetic testing revealed a pathogenic variant in the NLRP3 gene (Variant c1322C>T (p.Ala441Val)) consistent with CAPS. The patient was initially treated with canakinumab, a monoclonal antibody to IL-β, the cytokine implicated in CAPS. During the three months of therapy, the patient’s symptoms abated, however, she experienced increased bruising and heavier menstrual cycles. Her laboratory testing at the time revealed a stable platelet count of 157 000 µL (106 000 µL prior to treatment) and stable hemoglobin level of 11.6 g/dL (10.9 g/dL prior to treatment). Due to her significant symptoms, canakinumab was discontinued and she was trialed on Anakinra, an IL-1 receptor antagonist. After a week of daily injections, the patient developed bullous urticaria at the injection site. Skin biopsy of the lesions confirmed the presence of eosinophils within the dermis consistent with a drug eruption to Anakinra. Currently, the patient is trialing Rilocept, a dimeric fusion protein that prevents IL-β signaling, with close monitoring for any adverse effects.The immune modulation which occurs in patients with autoinflammatory conditions may predispose them to various adverse drug effects. This could be explained by the cytokine up-regulation which causes increased sensitization to various other inflammatory pathways including histamine and coagulopathy pathways. This case highlights the need for further research about drug reactions in autoinflammatory conditions.

Features of diagnostic search and experience inthetreatment of chronic urticaria in obese patients withpulmonary pathology

Background. In recent decades, along with the growth of allergic diseases, there has been a progressive increase in the number of people with overweight of varying severity, as evidenced by numerous epidemiological studies. Therefore, both allergies and obesity are among the global problems of modern healthcare due to their high prevalence and medical and social significance. The purpose of the study was analysis of the etiological factors of chronic urticaria (CU) in obese patients with pulmonary pathology, optimization of diagnosis and treatment of CU for further planning of preventive measures. Materials and methods. We examined 250 patients who applied for medical care to the regional clinical hospital in Chernivtsi and had CU associated with pulmonary pathology and obesity. Based on the analysis of the obtained data, a group of 140 patients was formed for further clinical and anamnestic examination: analysis of the anamnesis, determination of the severity of urticaria, assessment of quality of life, control of urticaria symptoms, general clinical laboratory studies, tests for verification of urticaria. Allergy testing was carried out when the patient’s anamnestic data indicated its expediency. The survey was carried out for one month and included a diagnostic period and 3 consultations every 7–10 days. Results. Among the causes of CU in patients with pulmonary disease, drug intolerance and parasitic infection dominate. Polyetiology is observed in 60% of cases. Differences in CU in obese patients are the long-term persistence of urticaria or other elements of the rash, the lack of effectiveness of therapy with the second- and third-generation antihistamines and glucocorticosteroids. Conclusions. The results obtained indicate a positive effect of the quinuclidine derivative quifenadine for the treatment of CU in patients with pulmonary pathology and obesity. Complete and significant effects were obtained in 91.43% of patients. The worst results (8.57%) were demonstrated by patients with the etiological significance of chemical factors (including occupational ones), which is associated with more problematic compliance with the elimination regimen in this category of patients.

100 Basopenia during the symptoms of chronic spontaneous urticaria reflects migration of basophils from the peripheral blood to the skin

100 Basopenia during the symptoms of chronic spontaneous urticaria reflects migration of basophils from the peripheral blood to the skin

Cholinergic urticaria: search for predictors of course severity and response to therapy

BACKGROUND: Cholinergic urticaria has affected 0.0211.2% of the population. Young adults are the most frequently affected age group, and the long-term duration of the disease is typical. Urticarial elements can often be generalized, and systemic reactions are often present in patients with cholinergic urticaria, significantly reducing their quality of life. At present, no clear predictors of anaphylaxis and a severe disease course have been identified.
 AIM: To evaluate the clinical, laboratory, and pathogenetic features of patients with cholinergic urticaria and identify correlations between them, disease prognosis/severity, and effectiveness of therapy.
 MATERIALS AND METHODS: A retrospective-prospective analysis of data from the Moscow EMIAS electronic medical data system recorded between 2017 and 2021 was performed, of which 613 patients were presumed to have cholinergic urticaria by outpatient specialists. During the interview, 86 people qualified for and accepted the screening. Between January 2022 and December 2022, patients were invited to outpatient appointments/hospitalization and underwent a comprehensive evaluation. In 38 patients with a relevant trigger-associated history, the diagnosis of cholinergic urticaria was verified by provocation testing.
 RESULTS: Women predominated in the study (68.4%). The mean patient age was 26.5 years, the age at disease onset was 18 years, and the disease duration was 57.5 months. Allergic diseases were diagnosed in 50% of the patients. Anaphylaxis was recorded in 26% of the cases, and angioedema was significantly more frequently observed in these patients. Patients who tested positive with autologous serum were characterized by older age, longer disease duration, and lower efficacy with standard doses of antihistamines. In an analysis of the Dermatology Life Quality Index validated questionnaire, nearly 80% of the patients reported a moderate, strong, or extremely strong effect on their quality of life.
 CONCLUSIONS: The results showed a significant effect of cholinergic urticaria on the quality of life. This analysis reveals important correlations and patterns an association between early age at disease onset and longer disease duration, presence of angioedema and anaphylaxis, a positive test with autologous serum and duration of urticaria symptoms, and response to antihistamine therapy. Patients with a history of anaphylaxis must be identified as a separate high-risk group to increase the awareness of medical staff and educate such patients on the use of epinephrine.

Cold-induced anaphylaxis triggered by drinking cold water

Cold urticaria is an inducible urticaria in which hives and angioedema appear after exposure to cold. The symptoms of cold urticaria often are limited to hives/angioedema. However, in up to 20% of cases, cold exposure may trigger anaphylaxis. We report the case of an 11-year-old boy previously diagnosed with chronic spontaneous urticaria who developed facial swelling, itchy hives, difficulty in breathing, vomiting and abdominal pain within 5 minutes of drinking cold water. He received a standard dose of non-sedating second-generation antihistamines at home. He was observed in the emergency room for 2 hours and discharged with an epinephrin autoinjector. During the subsequent outpatient clinic visit, an ice cube test was performed which confirmed the new diagnosis of comorbid cold-induced chronic urticaria. On further questioning, the parents reported occurrence of hives following swimming in the swimming pool. Cold-induced urticaria should be suspected in cases of anaphylaxis associated with cold exposure. Patients with chronic forms of urticaria who present with new anaphylaxis should be assessed for a potential concomitant cold-induced form.

Covid-19 Vaccination and Chronic Urticaria: A Paradigm Study.

Multiple vaccines were introduced during 2020-2021 to combat Covid-19 pandemic, being one of the successful vaccine programmes in the present era. Very few studies are available on status of chronic urticaria (CU) post Covid-19 vaccination. The aim of this study was to study effect of Covid-19 vaccination on our urticaria cohort. In this retrospective study, case records of CU patients registered in urticaria clinic, who had received any type of Covid-19 vaccine during the interval of March 2021-2022 were retrieved. Patients were classified as 'vaccine induced urticaria' (VIU) when CU developed for first time post-vaccination and 'vaccine exacerbated urticaria' (VEU) when administration of vaccine exacerbated disease activity in previously diagnosed CU. Overall, 353 CU patients registered with us during this period, 265 had received atleast one dose of a Covid-19 vaccine, of which 12 reported VEU (ten of whom had received adenovirus vector vaccine), and three patients were diagnosed with VIU (all had received inactivated virus vaccine). Mean vitamin D3 levels were significantly higher in patients who had VEU as compared to those CU patients without exacerbation (p = 0.003). Significant correlation was observed between level of concern regarding adverse effects of vaccination, pre-vaccination, and post-vaccination urticaria activity score (UAS-7), (Pearson correlation coefficient = 0.66, P = 0.007) in both VEU and VIU. Urticaria symptoms were controlled in 75% and 66.6% patients, respectively, of VEU and VIU, after one month of initiating standard antihistamine treatment. Hence, we conclude that though Covid-19 vaccines can trigger CU, standard treatment protocols control disease activity in most patients.

Autologous serum therapy reduces the symptoms and antihistamine burden in patients with chronic urticaria.

Autologous serum therapy (AST) is considered a potentially curative therapeutic option in the treatment of chronic urticaria, especially in the autoreactive type. To determine the ratio of patients with a positive autologous serum skin test (ASST) in chronic urticaria and the efficacy of AST. A total of 77 (29 male and 48 female) patients with chronic urticaria were enrolled in the study. The autologous serum skin test (ASST) was performed for all patients and the patients were classified into two groups: ASST positive and ASST negative. Intramuscular injection of AST was administered and the total severity score (TSS) of the urticaria was calculated weekly for ten weeks. The TSS was calculated for another ten weeks without AST. There were 34 patients (11 men and 23 women) in the positive group and 43 (18 men and 25 women) in the negative group. Reduction of symptoms of urticaria begins in the fourth week of the study in both groups. At week 20, 21 (61.7%) patients of the ASST (+) group and 12 (27.2%) patients of the ASST (-) group showed complete clearance. The use of antihistamines decreased from 100% at baseline in both groups to 8.82% and 25.58% in the ASST (+) and ASST (-) groups, respectively, at the end of the study. AST is a low-cost, cost-effective and potentially curative treatment with no adverse effects in these patients. It can reduce the burden of antihistamines.

Artemisinic acid attenuated symptoms of substance P-induced chronic urticaria in a mice model and mast cell degranulation via Lyn/PLC-p38 signal pathway.

Chronic urticaria (CU) is a common skin disease that affects about 1% of the world's population of all ages and seriously affects patients' quality of life. Therefore, further safe and effective treatments are urgently needed. Therefore, artemisinic acid was investigated in the present study due to its pharmacologic effect on inhibiting mast cell degranulation and chronic urticaria in a mouse model. 4Artemisinic acid decreased the symptoms of substance P-induced chronic urticaria in the mouse model and alleviated secretagogue-induced local cutaneous and systemic anaphylaxis through the Lyn-PLC-p38-NF-κB signaling pathway. Artemisinic acid inhibited mast cell degranulation and pro-inflammatory cytokine production in vitro. Mechanism analysis demonstrated that it could arrest mast cell activation through the Lyn-PLC-p38/ERK1/2/AKT-NF-κB signaling pathway. Based on the results of in vitro kinase assay of Lyn and PLC, artemisinic acid was a potential small molecule inhibitor of Lyn. Artemisinic acid displayed good structural affinity (KD=2.64×10-6) with Lyn SPR results. Artemisinic acid can attenuate substance P/MRGPRX2-mediated chronic urticaria and mast cell activation. Artemisinic acid is an antagonist of Lyn kinase and can be developed as a drug candidate to treat allergic diseases.

Ligelizumab improves angioedema, disease severity and quality-of-life in patients with chronic spontaneous urticaria

BackgroundDisease burden is particularly high in Chronic Spontaneous Urticaria (CSU) patients with angioedema, and patients whose signs and symptoms are inadequately controlled by H1-antihistamines need new treatment options. Here we report an exploratory analysis, from the ligelizumab Phase 2b study, investigating angioedema occurrence in patients with CSU and describe the changes in angioedema following treatment with ligelizumab, omalizumab, or placebo. MethodsData from the ligelizumab Phase 2b core (ligelizumab 72 mg, 240 mg, omalizumab 300 mg and placebo) and extension study (ligelizumab 240 mg) were used. Changes in Weekly Angioedema Activity Score (AAS7), the Dermatology Life Quality Index (DLQI), and Weekly Urticaria Activity Score (UAS7) among each time point were analyzed for each treatment arm. ResultsFrom a total of 297 patients analyzed, 165 (55.6%) reported angioedema occurrence at baseline, with mean AAS7 ranging 30.6—42.2 across treatment arms. At Week 12 of the core study 87.5%, 84.6%, 75.0%, and 61.0% of patients were angioedema free for ligelizumab 72 mg, 240 mg, omalizumab 300 mg, and placebo arms, respectively. In CSU patients with angioedema at baseline, the largest change from baseline in AAS7 score was observed with ligelizumab 72 mg (−31.9) at week 16 in the core study. Patients with angioedema had a higher mean DLQI at baseline (14.9—16.1) vs. patients without angioedema (10.6—12.0). In patients with angioedema, low AAS7 was significantly associated with complete response on UAS7 (UAS7 = 0) and complete normalization of DLQI (DLQI 0—1). ConclusionIn the Phase 2b study, ligelizumab effectively reduced angioedema and urticaria symptoms, and improved health related quality of life in patients with moderate-to-severe CSU. Clinicaltrails.gov NCT numberNCT02477332; NCT02649218.

TIME TO CLINICALLY MEANINGFUL RESPONSE TO OMALIZUMAB IN PATIENTS WITH CHRONIC SPONTANEOUS URTICARIA

<h3>Introduction</h3> Chronic spontaneous urticaria (CSU) is a debilitating skin disorder associated with decreased quality of life and psychological comorbidities. Omalizumab is currently the only biologic approved for the treatment of CSU, however data is lacking describing the pattern of response to omalizumab, including the time to a clinically meaningful response. <h3>Methods</h3> Post-hoc analysis examined pooled data from ASTERIA-I (N=319; NCT01287117) and ASTERIA-II (N=323; NCT01292473; for both studies - injections every 4 weeks of omalizumab 150mg, 300mg, or placebo). Time to minimally important difference (MID) (reduction from baseline ≥11) analyses were performed via Kaplan-Meier curves, and percent responders/complete responders to 12 weeks (weekly). Responders were defined as Urticaria Activity Score (UAS; range 0 [no symptoms] to 42)7≤6; complete responders defined as UAS7=0. <h3>Results</h3> Time to MID analyses revealed statistical superiority of omalizumab compared with placebo (P<0.0001 for both doses); median time to MID, 5 weeks for placebo and 2 weeks for 150mg/300 mg omalizumab (Figure). The percent of responders/complete responders to omalizumab increased dose-dependently over time. At Week 1, percent of responders was greater for omalizumab (150mg 6.2%, 300mg 6.3%) than placebo (1.9%). By Week 12, percent of both responders and complete responders was greater for omalizumab (150mg 41.4%/18.5%, 300mg 58.8%/40.0%) than placebo (15.1%/6.9%). Overall safety results are available (Saini JID 2015;135;67-75; Maurer NEJM 2013;368:924-935). <h3>Conclusions</h3> Patients with moderator-severe CSU on omalizumab had a significantly superior time to clinically meaningful response compared with placebo, and improvements in urticaria symptoms were observed as early as 1 week after omalizumab initiation.

FREEDOM FROM ITCH AND HIVES IN CHRONIC SPONTANEOUS URTICARIA IS ASSOCIATED WITH IMPROVED QUALITY-OF-LIFE MEASURES

<h3>Introduction</h3> Patients' sleep, daily activities, and work are negatively impacted in chronic spontaneous urticaria. We evaluated the association between complete response (Urticaria Activity Score [UAS7]=0) and various patient reported outcomes (PRO) using the ligelizumab Phase 2b data (NCT02477332). <h3>Methods</h3> Data from patients treated with ligelizumab 72mg or 240mg, omalizumab 300mg, or placebo every 4 weeks for 20 weeks were used for this analysis. The percentage of evaluations achieving Weekly Sleep Interference Score (SIS7)=0 response, Weekly Activity Interference (WAI)=0 response, and Overall Work Impairment (OAI)=0 response per UAS7 disease activity band (wheal and itch free=0, well-controlled=1–6, mild=7–15, moderate=16–27 and severe=28–42) were assessed. Odds ratios (ORs), 95% confidence intervals, and nominal P values for UAS7=0 (complete response) vs UAS7=1–6 (well-controlled disease) were estimated. <h3>Results</h3> Data from 382 patients were analyzed. At any timepoint, UAS7=0 was strongly associated with evaluations of complete response on other PROs: 99.7% (total number of evaluations [N]=2,895) with SIS7=0; 99.7% (N=2,898) with WAI=0; and 85.3% (N=209) with OWI=0. In patients with UAS7=0 vs. those with UAS7 1–6, there was 137 times (95% CI 37.2 – 502.8) higher likelihood of having SIS7=0, 178 times (95% CI 29.2 – 1085.8) higher likelihood of having WAI=0, and 3 times (95% CI 1.8 – 5.1) higher likelihood of having OWI=0. <h3>Conclusion</h3> Control of urticaria symptoms leads to improvements in daily activities, sleep, and work, with best outcomes observed in patients with complete response to treatment.

Investigating the relationship between consultation length and quality of tele-dermatology E-consults in China: a cross-sectional standardized patient study

BackgroundConsultation length, the time a health provider spend with the patient during a consultation, is a crucial aspect of patient-physician interaction. Prior studies that assessed the relationship between consultation length and quality of care were mainly based on offline visits. Research was lacking in E-consults settings, an emerging modality for primary health care. This study aims to examine the association between consultation length and the quality of E-consults services.MethodsWe defined as standardized patient script to present classic urticaria symptoms in asynchronous E-consults at tertiary public hospitals in Beijing and Hangzhou, China. We appraised consultation length using six indicators, time waiting for first response, time waiting for each response, time for consultation, total times of provider’s responses, total words of provider’s all responses, and average words of provider’s each response. We appraised E-consults services quality using five indicators building on China’s clinical guidelines (adherence to checklist; accurate diagnosis; appropriate prescription; providing lifestyle modification advice; and patient satisfaction). We performed ordinary least squares (OLS) regressions and logistic regressions to investigate the association between each indictor of consultation length and E-consults services quality.ResultsProviders who responded more quickly were more likely to provide lifestyle modification advice and achieve better patient satisfaction, without compromising process, diagnosis, and prescribing quality; Providers who spent more time with patients were likely to adhere to clinical checklists; Providers with more times and words of responses were significantly more likely to adhere to the clinical checklist, provide an accurate diagnosis, appropriate prescription, and lifestyle modification advice, which achieved better satisfaction rate from the patient as well.ConclusionsThe times and words that health providers provide in E-consult can serve as a proxy measure for quality of care. It is essential and urgent to establish rules to regulate the consultation length for Direct-to-consumer telemedicine to ensure adequate patient-provider interaction and improve service quality to promote digital health better.

The effectiveness of bilastine and fexofenadine updosing in the management of chronic spontaneous urticaria

Objectives: In patients not responding to standard dosages of second-generation antihistamines (SGAHs), updosing up to 4-fold is recommended. Even though SGAHs are safe, the concerns regarding their safety after updosing still remain and the studies directly comparing the updosing of different SGAHs are lacking thus making the choice of drug difficult. Material and Methods: Eighty patients with chronic spontaneous urticaria (CSU) were randomized to receive either bilastine or fexofenadine (40 in each group). Patients were started on conventional dose of either drug (bilastine 20 mg or fexofenadine 180 mg) for the first 2 weeks. Those patients who remained symptomatic after 2 weeks (UAS ≥ 7) were given double dose of bilastine (20 mg BD) or fexofenadine (180 mg BD), respectively, for another 2 weeks. Control of urticaria was assessed by evaluating UAS score. Patients’ quality of life was assessed by CU-Q2oL questionnaire. Safety was evaluated by analyzing the adverse events (AEs) reported by the patients. Results: Seventy-four patients completed the study. Forty-one patients (bilastine – 23 and fexofenadine – 18) achieved adequate control of urticaria (UAS ≤ 6) at week 2. Out of 33 patients who were given high dose of bilastine or fexofenadine, 17 patients (bilastine – 9 and fexofenadine – 8) achieved adequate control of urticaria at week 4. Bilastine was associated with significant improvement in quality of life of patients compared to fexofenadine (32.38 ± 5.83 vs. 38.71 ± 5.92.; P &lt; 0.005). Thirteen patients (six in bilastine group and seven in fexofenadine group) reported one or more AEs with sedation being the most common side effect. Conclusion: Updosing of bilastine provided relief from urticaria symptoms, improved quality of life in the majority of the patients without compromising somnolence or safety. Bilastine was associated with improved quality of life and less sedation compared to fexofenadine.

33583 Patients treated with ligelizumab achieve freedom from signs and symptoms of chronic spontaneous urticaria regardless of the angioedema status at baseline

Introduction: Presence of angioedema is an indicator of more severe disease in patients with chronic spontaneous urticaria. From the Phase-2b study data, we assess the effect of ligelizumab (a next-generation anti-IgE antibody) and omalizumab in subsets of patients, with or without angioedema at baseline.

IgE-neutralizing UB-221 mAb, distinct from omalizumab and ligelizumab, exhibits CD23-mediated IgE downregulation and relieves urticaria symptoms.

Over the last 2 decades, omalizumab is the only anti-IgE antibody that has been approved for asthma and chronic spontaneous urticaria (CSU). Ligelizumab, a higher-affinity anti-IgE mAb and the only rival viable candidate in late-stage clinical trials, showed anti-CSU efficacy superior to that of omalizumab in phase IIb but not in phase III. This report features the antigenic-functional characteristics of UB-221, an anti-IgE mAb of a newer class that is distinct from omalizumab and ligelizumab. UB-221, in free form, bound abundantly to CD23-occupied IgE and, in oligomeric mAb-IgE complex forms, freely engaged CD23, while ligelizumab reacted limitedly and omalizumab stayed inert toward CD23; these observations are consistent with UB-221 outperforming ligelizumab and omalizumab in CD23-mediated downregulation of IgE production. UB-221 bound IgE with a strong affinity to prevent FcԑRI-mediated basophil activation and degranulation, exhibiting superior IgE-neutralizing activity to that of omalizumab. UB-221 and ligelizumab bound cellular IgE and effectively neutralized IgE in sera of patients with atopic dermatitis with equal strength, while omalizumab lagged behind. A single UB-221 dose administered to cynomolgus macaques and human IgE (ε, κ)–knockin mice could induce rapid, pronounced serum-IgE reduction. A single UB-221 dose administered to patients with CSU in a first-in-human trial exhibited durable disease symptom relief in parallel with a rapid reduction in serum free-IgE level.

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.

Current and Future Approaches in Management of Chronic Spontaneous Urticaria Using Anti-IgE Antibodies.

Chronic spontaneous urticaria (CSU) considerably alters patients’ quality of life, often for extended periods, due to pruriginous skin lesions, impaired sleep, unexpected development of angioedema, and failure of conventional treatments in properly controlling signs and symptoms. Recent research focused on the development of new therapeutic agents with higher efficacy. Although the production of specific immunoglobulin E (IgE) antibodies against certain allergens is not a characteristic of the disease, treatment with omalizumab, a monoclonal anti-IgE antibody, proved efficient and safe in patients with moderate to severe chronic spontaneous urticaria uncontrolled by H1-antihistamines. Ligelizumab, a high-affinity monoclonal anti-IgE antibody, may also efficiently relieve symptoms of unresponsive chronic urticaria to standard therapies. This comprehensive review aims to present recently acquired knowledge on managing chronic spontaneous urticaria with new anti-IgE antibodies. We conducted extensive research on the main databases (PubMed, Google Scholar, and Web of Science) with no restrictions on the years covered, using the search terms “anti-IgE antibodies”, “omalizumab”, “ligelizumab”, and “chronic spontaneous urticaria”. The inclusion criteria were English written articles, and the exclusion criteria were animal-related studies. ClinicalTrials.gov was also reviewed for recent relevant clinical trials related to CSU treatment. CSU is a challenging disease with a significant effect on patients’ quality of life. Current therapies often fail to control signs and symptoms, and additional treatment is needed. New biologic therapies against IgE antibodies and FcεRIα receptors are currently under investigation in advanced clinical trials. We reviewed recently published data on CSU management using these novel treatments. The development of new and improved treatments for CSU will lead to a more personalized therapeutical approach for patients and provide guidance for physicians in better understanding disease mechanisms. However, some agents are still in clinical trials, and more research is needed to establish the safety and efficacy of these treatments.

Cold urticaria in the doctor’s practice

Objective — to improve the methods of differential diagnosis and management of patients with cold urticaria.&#x0D; Materials and methods. A review of the literature is presented and diagnostic approaches and principles of management of patients with cold urticaria are analyzed.&#x0D; Results and discussion. Cold urticaria is characterized by itching, angioneurotic edema, or both, with or without anaphylaxis which occurs in response to cooling of the skin and/or mucous membranes. The incidence of cold urticaria is estimated at 0.05 %, with higher rates in cold climates. It is believed that the symptoms of urticaria are primarily related to the activation of mast cells in the skin. However, in recent years, data have emerged highlighting the possible role of blood coagulation in the pathophysiology of the disease. In some patients, in parallel with the development of cold urticaria in response to cold factors, especially cold air, there may be reactions that are clinically similar to sinusitis, conjunctivitis and bronchial asthma, although it may coexist with other types of urticaria. The main principles of treatment of patients with urticaria are: identification of causative factors, education of patients and prevention of contact with causative factors, and stepwise pharmacotherapy.&#x0D; Conclusions. Cold urticaria is a subtype of chronic induced urticaria that has all the features of this heterogeneous group of diseases, but is still poorly understood in terms of both pathogenesis and real epidemiology. Elimination measures, patient education and treatment according to existing algorithms can significantly improve the quality of life of patients, which is a priority for the treatment of any chronic disease.

The Impact of Bilastine on Symptoms of Allergic Rhinitis and Chronic Urticaria: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Allergic diseases are immunological exaggerations with symptoms that may interfere with life quality. Bilastine, a novel oral second-generation H-1 antihistamine, is highly selective to H-1 receptors and has anti inflammatory properties. The present evidence regarding the drug efficacy is inconsistent. We aimed to evaluate the efficacy and safety of bilastine compared with the placebo and other active antihistamines in patients who complained either from AR or chronic urticaria. We systematically searched the Medline, Scopus, Web of Science, and Cochrane databases for randomized controlled trials (RCTs) evaluating bilastine effects on symptomatic hyper histaminic allergic conditions. We collected data on total symptoms scores (TSS), total nasal symptom scores (TNSS), discomfort associated with these allergic conditions measured by visual analog score (VAS), and quality of life (QOL) for AR and urticaria. Other outcomes such as clinical global impression and safety profiles were reported as well. We pooled the studies in a random effect model using RevMan 5.4 software. We included 9 RCTs comprising 3801 participants. The meta-analysis revealed that bilastine was superior to placebo, improving TSS, TNSS, VAS, and QOL in AR or chronic urticaria participants. Moreover, the bilastine was comparable to active antihistamines such as cetirizine, fexofenadine, and loratadine regarding mentioned outcomes. In addition, the novel drug was safe and tolerable with no difference in the incidence of adverse events with a placebo. Bilastine safely improved TSS in hyper histaminic allergic conditions involving nasal symptoms in AR. It decreases the discomfort associated with the disease resulting in improving the QOL of the participants.