Therapy For Chronic Urticaria Research Articles

Consensus on the Definition of Control and Remission in Chronic Urticaria.

The terms control and remission and other key terms used in chronic urticaria (CU) such as flare-up, relapse, exacerbation, and recurrence have not been fully defined in the literature. Disease monitoring and treatment goals in clinical practice are not well established. After a qualitative appraisal of available evidence, we aimed to find a consensus definition of control and remission, clarify key terminology, provide guidance on how to monitor the disease, and establish treatment goals in clinical practice. A modified Delphi consensus approach was used. Based on a literature review, a scientific committee provided 137 statements addressing controversial definitions and terms, available patient-reported outcomes (PROs), and recommendations on how to measure therapeutic objectives in CU. The questionnaire was evaluated by 138 expert allergists and dermatologists. A consensus was reached on 105 out of the 137 proposed items (76.6%). The experts agreed that complete control and remission of CU could be defined as the absence of signs or symptoms while on treatment and in the absence of treatment, respectively. Consensus was not reached on the definition of other key terms such as flare-up, exacerbation, and recurrence. The panel agreed that the objective of therapy in CU should be to achieve complete control. PROs that define the degree of control (complete, good, partial, or absence) were established. An algorithm for disease assessment is provided. In conclusion, this work offers consensus definitions and tools that may be useful in the management of patients with CU.

Probiotic as an adjuvant therapy in chronic urticaria: a blinded randomized controlled clinical trial.

Background. Chronic spontaneous urticaria (CSU) is a common and treatment challenging disorder which may involve about 2% of normal population and in 50% do not respond properly even to the second line therapies. We aimed to evaluate the efficacy and safety of a synbiotic (prebiotic + probiotic) named as LactoCare in treatment of CSU in the RCT for the first time. Methods. This blinded RCT conducted on 42 patients (21 patients in control antihistamine group and 21 in intervention antihistamine + probiotic group) with CSU during 8 weeks. The efficacy assessed by Urticaria Activity Score (UAS7) and quality of life measured by Persian validated Dermatology Life Quality Index (DLQI). Results. Before and after UAS7 score in control group was 35.33 ± 7.81 and 16.86 ± 13.54, respectively. There was 53% score reduction in control group. Before and after UAS7 score in intervention group was 32 ± 7.84 and 11 ± 11.41, respectively. There was 66% score reduction in intervention group. Improvement of DLQI in control and intervention group was 44% and 66%, respectively. At the end, UAS7 score reduction and DLQI improvement in both groups was statistically significant. Conclusions. Probiotics are effective, safe and satisfactory adjuvant therapy for CSU. Combination of probiotic and antihistamines had no statistically significant different efficacy than the antihistamine alone, based on UAS7 score. But Patients with combination therapy may experience higher reduction rate of itch, number of urticaria and total UAS7 score that is clinically of great value and is really practical by itself. Patients with combination therapy experienced more improvement of quality of life (DLQI).

Comparison of Clinical Efficacy of Acupoint Autoblood Therapy and Muscular Injection Autoblood Therapy in Chronic Urticaria

Comparison of Clinical Efficacy of Acupoint Autoblood Therapy and Muscular Injection Autoblood Therapy in Chronic Urticaria

Modern approaches to treatment of chronic spontaneous urticaria in adult patients

Objective — to study and analyze thematic publications on aspects of etiopathogenesis and modern approaches to the treatment of chronic spontaneous urticaria in adult patients.Materials and methods. A study and analysis of current domestic and foreign publications was conducted on aspects of the etiopathogenesis and treatment of chronic urticaria, including the recommendations of the National Health Service of the United Kingdom (NHS, 2020) for the treatment of chronic spontaneous urticaria in adult patients, based on principles of evidence­based medicine.Results and discussion. According to domestic and foreign publications, urticaria affects about 15—20 % of the population, while in recent years the number of chronic forms of dermatosis resistant to treatment (registered in about 2 % of the population) is increasing, which reduces the capability for work and quality of life of patients. In more than half of the patients the probable cause of chronic urticaria cannot be determined, which indicates the development of a spontaneous (idiopathic) form of dermatosis. First­line drugs for the treatment of chronic urticaria are non­sedative H1­antihistamines of the second generation, which, however, in many patients do not provide a positive clinical effect in standard doses. In the European recommendations, to increase the effectiveness of treatment of patients with torpid forms of chronic urticaria, it is proposed to increase the daily dose of antihistamines by 4 times. According to NHS recommendations (2020), created on evidence­based medicine, adult patients with chronic spontaneous urticaria are recommended to use a cost­ and clinically effective second­generation antihistamine cetirizine as first­line therapy which is prescribed step by step with increasing daily dose by 2—4 times.Conclusions. Chronic urticaria is a serious medical and social problem today. More than half of patients with chronic urticaria are those having spontaneous (idiopathic) form of dermatosis. H1­antihistamines of the second generation are the first­line therapy for chronic urticaria, but due to the lack of a positive effect in some patients when using their standard doses, it is recommended to increase their daily doses by 4 times. According to NHS recommendations (2020), adult patients with chronic spontaneous urticaria are recommended an efficient and cost­effective second­generation antihistamine cetirizine as first­line (dose­increasing) therapy.

Exploring the safety and effectiveness of subcutaneous autologous serum therapy versus conventional intramuscular autologous serum therapy in chronic urticaria: An observer-blind, randomized, controlled study.

Autologous serum therapy aims to supplement the existing pharmacotherapy in chronic urticaria by decreasing the antihistamine pill-burden and maintaining symptom-free interval. Subcutaneous autologous serum therapy further modifies the amount of serum (2 mL to 1 mL) and gauge of a needle (24G to 31G) to improve compliance and facilitate ease of application. To assess clinical effectiveness and safety of subcutaneous autologous serum therapy versus conventional intramuscular autologous serum therapy and to compare the quality of life in the two treatment arms. Institution-based, assessor-blind, prospective, randomized, parallel-group, active-controlled trial with 32 patients in each treatment arm and analyzed on a modified intention to treat principle. After baseline autologous serum skin test, autologous serum was injected as per randomization every week for 9 consecutive weeks. Among the study population, conventional intramuscular autologous serum therapy and subcutaneous autologous serum therapy had a comparable duration of disease (P = 0.164, Mann-Whitney U test), autoreactive status (P = 0.796), urticaria total severity score (P = 0.637) and urticaria activity score summed up over 7 days (P = 0.982). Both urticaria activity score summed up over 7 days and total severity score along with antihistamine pill-burden reduced significantly (P < 0.001, Friedman's analysis of variance) in both subcutaneous autologous serum therapy and conventional intramuscular autologous serum therapy from first follow-up onwards (P < 0.05, Post hoc Dunn's test). Significant improvement was noted in patient's as well as physician's global assessment of disease activity improvement scale (P < 0.001, Friedman's analysis of variance). Intergroup analysis showed that there was no significant difference in urticaria activity score summed up over 7 days either at baseline (P = 0.982, Mann-Whitney U test) or at study end (P = 0.398, Mann-Whitney U test). Similar comparable results were found in the total severity score at the end of the study (P = 0.345, Mann-Whitney U test). Dermatology life quality index showed marked improvement with both types of treatment (P < 0.0001, Wilcoxon test), and the intergroup comparison showed comparable dermatology life quality index values (P = 0.994, Mann-Whitney U test). The pain score at the injection site was more with conventional intramuscular autologous serum therapy than subcutaneous autologous serum therapy (P = 0.0115, Mann-Whitney test). Younger age and lower baseline total severity scores were associated with a better therapeutic response. Baseline urticaria activity score added up over a period of 7 days and total severity scores and the diameter of lesions showed a positive correlation with response pattern. Basophil histamine release assay not done. Logistics could not support follow-up beyond the end of treatment. Subcutaneous autologous serum therapy is not inferior to conventional intramuscular autologous serum therapy with the additional advantage of less pain and operational feasibility.

Diet and Chronic Urticaria: Dietary Modification as a Treatment Strategy.

Patients with chronic urticaria (CU) often ask about dietary modification. Research has indicated that specific dietary changes may be helpful in a subset of patients. Immunological food reactions are rare, but potential triggers of CU include those seen in certain settings, as in patients with a history of tick bites, a history of raw or marinated fish ingestion, or those with celiac disease. Nonimmunological food intolerances may also contribute, although mechanism of action is not well understood. Trials of pseudoallergen-free diets and low-histamine diets have resulted in partial remission in a subset of patients, while oral provocation testing has confirmed that some patients experience worsening of symptoms after ingestion of food additives, tomatoes, herbs, seafood, alcohol, and other foods. An increased prevalence of vitamin D deficiency has also been noted in patients with CU compared with healthy controls. While oral antihistamines remain the mainstay of therapy in CU, education on potential dietary factors may be offered to a selection of the group of patients. For those at risk or reporting symptoms suggestive of celiac disease, vitamin D deficiency, delayed reactions to mammalian meat, or exposure to raw fish, further workup is recommended. While education on dietary modification may be offered to other patients, this approach may benefit only a subset, and no test is available to identify these patients. A minimum of 3 weeks may be needed to determine response, and only specific diets that have been systematically studied should be considered. Any elimination diet should be used with caution because of the potential for nutritional deficiencies.

Autologous whole-blood or autologous serum acupoint injection therapy for chronic urticaria: A systematic review protocol.

Background:Chronic urticaria (CU) is a common and easily recurring skin disease in the world. Many trials have shown that autologous whole-blood or autologous serum acupoint injection therapy is effective in treating CU. There is currently no systematic review of this therapy. The program aims to evaluate the effectiveness and safety of this therapy in patients with CU.Methods:Literature search will be conducted at Medline, PubMed, Excerpt Medica Database, Springer, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journal Database, and other databases. The search date is until May 2019. We will search for popular terms including CU and this therapy. Import the literature electronically. Duplicate documents will be deleted. The primary outcome is the urticaria activity score or other validated scales. Secondary outcomes included response rate, quality of life scale, recurrence rate, and adverse events. A systematic review and search for a randomized controlled trial of this therapy for CU. Implement the Cochrane RevMan V5.3 bias assessment tool to assess bias assessment risk, data integration risk, meta-analysis risk, and subgroup analysis risk (if conditions are met). The mean difference, standard MD, and binary data will be used to represent continuous results.Results:This study will provide a comprehensive review of the available evidence for the treatment of CU with this therapy.Conclusion:This study will provide new evidence for assessing the effectiveness and side effects of this therapy for CU. Since the data is not individualized, there is no need for formal ethical approval.PROSPERO registration number:CRD42019128364.

Bloodletting Therapy for Patients with Chronic Urticaria: A Systematic Review and Meta-Analysis.

Background Many trials have reported that bloodletting therapy is effective when treating chronic urticaria. There are currently no systematic reviews of bloodletting therapy for chronic urticaria. Objective The aim of this review is to assess the effectiveness and safety of bloodletting therapy for chronic urticaria. Methods A systematic review and meta-analysis of randomized controlled trials were performed. Disease activity control was assessed as the primary outcome. Response rate, recurrence rate, and adverse events were assessed as secondary outcomes. Results Seven studies with 512 participants were included. One trial showed a significant difference between bloodletting therapy plus medicine and medicine alone in disease activity control (MD 0.67; 95% CI 0.03 to 1.31; p=0.04). Six trials (372 participants) showed a significant difference between bloodletting therapy and pharmacological medication in response rate (RR 1.10; 95% CI 0.97-1.26; P =0.15). Two studies (170 participants) showed a significant difference between bloodletting therapy plus pharmacological medication and pharmacological medication in response rate (RR 1.34; 95% CI 1.10-1.63; p=0.003). Two studies (126 participants) reported a statistically significant difference between bloodletting therapy and pharmacological medication in recurrence rate. No serious adverse events related to bloodletting therapy were reported. Conclusions Bloodletting therapy might be an effective and safe treatment for chronic urticaria, but the evidence is scarce. More high quality trials are needed in the future.

Learnings from real-life experience of using omalizumab for chronic urticaria in Latin America

BackgroundUpdated urticaria guidelines recommend that patients should be assessed for disease activity, severity, control, and quality of life at baseline and follow up. Regarding treatment, guidelines consider second generation antihistamines as the cornerstone in therapy for chronic urticaria (CU), while other drugs, such as omalizumab, are conceived as second-line alternatives. In regards to omalizumab, despite advances in the management of CU, there are still open questions about timing, dosing, and objective measures for clinical response. This study was designed to portray the use of patient-reported outcomes (PROs) in chronic urticaria management, as well as the effectiveness and treatment patterns of omalizumab in CU, as seen in a real-life setting in Latin America. MethodsThis is a retrospective observational study, involving 72 Latin American patients with chronic urticaria treated with omalizumab. Patient reported outcomes and treatment patterns, response, quality of life improvement and discontinuation were analyzed. ResultsFrom the 72 patients, 91.7% (n = 66) were assessed through PROs, where urticaria control test (UCT) was the most used (79.2%; n = 57). Overall, 80.0% (n = 44) responded to omalizumab at some point of the treatment. Omalizumab 300 mg was associated with earlier response compared to lower doses. Regardless of dosage, most patients assessed with CU-Q2oL improved quality of life (80.8%; n = 21). With respect to omalizumab discontinuation, 20.8% (n = 15) patients interrupted omalizumab before the 3rd month of treatment (p = .000). ConclusionsThe present study highlights how the use of PROs and omalizumab in Latin America differ from guidelines’ recommendations and clinical trials. Even though most patients were initiated under omalizumab 300 mg, most of them finished with lower doses. Regardless of dosage, most patients responded to omalizumab and improved quality of life at some point during treatment. However, such features were seen earlier with omalizumab 300 mg. Regarding treatment discontinuation, one-fifth of patients interrupted omalizumab before the third month.

Efficacy of Montelukast and Ranitidine as an Add on Therapy for Chronic Urticaria

Efficacy of Montelukast and Ranitidine as an Add on Therapy for Chronic Urticaria

Role of biologics in intractable urticaria.

Chronic urticaria (CU) is a common condition faced by many clinicians. CU has been estimated to affect approximately 0.5%–1% of the population, with nearly 20% of sufferers remaining symptomatic 20 years after onset. Antihistamines are the first-line therapy for CU. Unfortunately, nearly half of these patients will fail this first-line therapy and require other medication, including immune response modifiers or biologics. Recent advances in our understanding of urticarial disorders have led to more targeted therapeutic options for CU and other urticarial diseases. The specific biologic agents most investigated for antihistamine-refractory CU are omalizumab, rituximab, and intravenous immunoglobulin (IVIG). Of these, the anti-IgE monoclonal antibody omalizumab is the best studied, and has recently been approved for the management of CU. Other agents, such as interleukin-1 inhibitors, have proved beneficial for Schnitzler syndrome and cryopyrin-associated periodic syndromes (CAPS), diseases associated with urticaria. This review summarizes the relevant data regarding the efficacy of biologics in antihistamine-refractory CU.

Rationale for selecting antihistamine drugs for the therapy of chronic urticaria in terms of efficacy and safety

Goal of the study. To compare the efficacy of antihistamine drugs for the therapy of chronic urticaria taking into consideration their effect on the patients’ cognitive functions. Materials and methods. The study involved 178 patients with chronic urticaria who were divided into six groups taking second generation antihistamine drugs: Cetirizine (n = 38), Levocetirizine (n = 27), Fexofenadine (n=26), Ebastine (n = 33), Loratadine (n = 26) and Desloratadine (n = 28). The patients recorded dynamic changes in clinical symptoms of the disease (number of urticarial components, skin itching intensity, availability or absence of urticarial derniographism, angioedema signs and signs of the shortness of breath and reduced blood pressure) in their individual diaries. Baseline signs of the patients’ cognitive condition and those recorded during the treatment were studied using the Kraepelin’s arithmetic test (modified by Schulte), I.M. Lushchikhina’s verbal and visual thinking assessment method and method for memorizing ten words. The control group comprised 31 subjects without chronic urticaria. Results of the study. Ebastine and Fexofenadine are the most efficient antihistamine drugs for the treatment of chronic urticaria. At the same time, they do not have any negative effect on the patients’ cognitive functions so they can be recommended for long-term treatment of chronic urticaria. In spite of its evident positive therapeutic effect, Cetirizine reduces mental alertness and deteriorates thinking in patients with chronic urticaria. Because of this, the drug must be prescribed with care for long-term administration to those patients whose professional activities demand increased attention concentration. Loratadine has a positive effect on the patients’ attention and thinking. However, taking into consideration its low efficacy, the drug can be prescribed as the basis therapy for the treatment of light forms of chronic urticaria.

Revisions to the international guidelines on the diagnosis and therapy of chronic urticaria

At the end of 2012, more than 300 participants discussed and agreed on the update of the international guidelines on urticaria at the 4th International Consensus Meeting (URTICARIA 2012). Currently, the recommendations are in the final process of international coordination. In preparation for the update, questions were prepared by an expert panel; this was followed by a systematic literature search. The questions and the resulting recommendations were discussed by the participants and decided upon in an open vote. Consensus was defined as at least 75% agreement. The updated guidelines will modify and improve the currently available guidelines in various areas, especially in therapy. For the treatment of chronic urticaria, the new algorithm recommends a three-step process starting with a standard dose of a non-sedating H1 antihistamine. If there is an insufficient treatment response, the dosage should be increased up to four times. In, therapy refractory patients, omalizumab, cyclosporine A, or montelukast are advised in the third step. Short-term corticosteroid treatment for a maximum of 10 days may be considered. H2 antihistamines and dapsone, which were included in the previous version of the guidelines, are absent in the updated and revised version because of changes in the evidence level.

Therapeutic efficacy observation on integrative acupuncture therapy for chronic urticaria

To observe the clinical effect of comprehensive acupuncture therapy for chronic urticaria. A total of 70 patients with chronic urticaria were treated with acupuncture, bloodletting after pricking and cupping [on Shenque (CV 8)]. The changes of signs and symptoms were observed before and after treatment. The therapeutic efficacy was then assessed according to the change rate of clinical symptoms scoring. After treatment, 11 of the 70 cases got basic recovery, 21 cases got marked effectiveness, 27 cases got improvement and 11 cases got no effect. The total effective rate was 84.3%. There was statistical significance in symptoms score between before and after treatment (P<0.01). Combining acupuncture, bloodletting after pricking and cupping on Shenque (CV 8) is effective for chronic urticaria.

Octreotide therapy of chronic urticaria and angioedema after gastric bypass procedure

Octreotide therapy of chronic urticaria and angioedema after gastric bypass procedure

Evidence-Based Management of Chronic Urticaria in Children

Chronic urticaria (CU) in children is a distressful disorder that can often be challenging to treat. Elimination or treatment of eliciting stimulus is the first step in the management of CU; however, in the majority of cases, the cause remains unknown. According to currently available guidelines, H1-antihistamines are still first-line therapy for CU in children. Unfortunately, regularly approved doses relieve symptoms in <50% of patients, necessitating an up to 4-fold dose increase. However, in some patients, even high doses of H1-antihistamines fail to produce satisfactory results, leaving place for new therapeutic strategies in the treatment of CU; first to add either leukotriene antagonist or H2-antihistamine. In severe, unresponsive cases, other therapeutic approaches should be considered. However, it is important to be familiar with the possible side effects, because some of these approaches imply off-label use of drugs. This review presents a summary of the evidence on the treatment of CU in pediatr...

Efficacy ofTripterygium hypoglaucumHutch in Adults with Chronic Urticaria

The study objectives were to evaluate the efficacy and safety of Tripterygium hypoglaucum Hutch (THH) in adult with severe chronic urticaria (CU) by performing a randomized, double-blind, placebo-controlled clinical trial. Seventy-eight (78) adult patients with severe CU, 21-58 years of age, responding poorly to antihistamines alone, were randomly divided into two groups: the therapeutic group with THH 3 tablets 3 times daily (n = 40) and the control group with placebo 3 tablets 3 times daily (n = 38). Meanwhile, all patients jointly received cetirizine hydrochloride (HCl) 10 mg once daily throughout the study period. The efficacy of THH was assessed by the scoring system of 4-point scale and the subject's global assessment of relief. Sixty-nine (69) of 78 patients (37 in the therapeutic group, 32 in the control group) completed the study. By the end of the fourth week, there was a 67% improvement of total effective rate (TER) with THH compared with a 28% improvement with placebo by per-protocol analysis (χ(2) = 10.68, p = 0.0011), while by intention-to-treat analysis, 63% and 24% improvements of TER were respectively observed in the therapeutic group and the control group (χ(2) = 11.36, p = 0.001). THH with cetirizine showed statistical superiority to placebo with cetirizine during each study week for changes in total severity scores (p ≤ 0.001). In weekly analyses, THH was also statistically superior to placebo in reducing the mean pruritus scores during each study week (p ≤ 0.005). This study shows that the therapeutic effect of THH with cetirizine is predominant over that of cetirizine alone in adult CU. THH with cetirizine may play an important role in the therapy of CU and be a useful treatment for CU.

The Effect of Combined H1-and H2-Receptor Antagonists Therapy in Chronic Urticaria

The Effect of Combined H1-and H2-Receptor Antagonists Therapy in Chronic Urticaria

Combined H1 and H2 Receptor Antagonists Therapy in Chronic Urticaria and Pruritus

Combined H1 and H2 Receptor Antagonists Therapy in Chronic Urticaria and Pruritus

Dietary Therapy for Chronic Urticaria

Dietary Therapy for Chronic Urticaria