Types Of Urticaria Research Articles

Efficacy and safety of combinations of H1 antihistamines in the treatment of urticaria: A scoping review.

The efficacy and safety of combining H1 antihistamines (AHs) for treating urticaria are currently unclear. This scoping review aims to provide a comprehensive overview of the evidence regarding the efficacy and safety of H1 AH combinations in the management of urticaria up to May 2023. The search encompassed databases such as PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, and the China Biological Medicine Database. The inclusion criteria comprised randomised controlled trials (RCTs), non-randomised trials (NRTs), case reports, and case series focusing on urticaria treatment. Initially screening 12,887 studies, this review ultimately selected 109 studies involving 11,435 patients. These studies documented 43 different combination treatments across 11 types of urticaria. In comparison to monotherapy, combination therapy exhibited superior efficacy in 94 studies that reported treatment efficacy. Regarding adverse drug reactions (ADRs), 67 studies disclosed ADR incidences, with combination therapy showing lower ADR rates in 32 studies. Additionally, 7 studies reported similar ADR rates between combination therapy and monotherapy with AHs. Common ADRs included symptoms such as drowsiness, nausea, fatigue, dry mouth, dizziness, and headache, while less frequent side effects encompassed hypotension, otitis media, polyuria, rhinorrhoea, abnormal liver function, and rash. ADR rates ranged from 0% to 21% in the treatment group, and from 0.5% to 75% in the control group. Importantly, patients generally tolerated these ADRs well, with symptoms resolving upon discontinuation of treatment. The study's findings suggest that combining AHs leads to enhanced efficacy and reduced safety risks compared to monotherapy in the context of urticaria treatment. These results advocate for considering combination therapy as a viable option in clinical practice, especially for chronic urticaria cases. Nonetheless, caution is advised, and close monitoring for potential ADRs is crucial during treatment.

Diagnosis and Treatment of Typical Cold-Induced Urticaria: A Case Reports

Background: Urticaria is a common disease in society. 15-25% of individuals must have experienced urticaria at least once in their life. Cold urticaria is included in the type of chronic inducible urticaria and is a type of urticaria that accounts for 3% of cases of all types of chronic urticaria that occur. The age group that most suffers from urticaria is the age 12-25 years. This study was aimed at presenting the diagnosis and treatment of cold urticaria.
 Case presentation: A 29-year-old woman came with complaints of itching and redness on the hands, feet, and neck, starting with a small round reddish rash that widened and the center was paler than the edges, then disappeared within 1-2 hours, there is no a history of infectious or autoimmune diseases but has a family history of the same complaint. Examination of the ice cube test obtained positive results after 7 minutes of contact with ice cubes. Patients were given therapy in the form of cetirizine 10 mg per day for 2 weeks, which was then increased by a dose of 20 mg with a combination of cetirizine 10 mg in the morning and loratadine 10 mg at night.
 Conclusion: Exploration of precipitating factors through detailed anamnesis and supporting examinations with a cold stimulation test can establish a diagnosis of typical cold-induced urticaria.

Characterization of Chronic Urticaria and Associated Conditions - A Web-Based Survey.

Chronic urticaria is a common disease, characterized by the development of wheals, angioedema, or both, which can be associated with several comorbidities. Most of the available studies have focused on specific common comorbidities and their association with CU, but have seldom reported the overall burden of comorbidities. This study aimed to investigate and analyze self-reported comorbidities in Polish patients with CU. An anonymous online survey consisting of 20 questions was conducted on members of an Urticaria group on the social media platform Facebook. A total of 102 people took part in this survey. The results were analyzed in Microsoft Excel 2016. In the group, 95.1% were females and 4.9% males, with a mean age of 33.8 years. The most common diagnosed type of urticaria was spontaneous (52.9%). Angioedema accompanied urticaria in 68.6% of the respondents, mainly those with delayed pressure urticaria (86.4%). 85.3% of respondents reported comorbidities, most often atopic diseases and allergies (49%), chronic inflammation and infections (36.3%), thyroid (36.3%) and psychiatric disorders (25.5%). Moreover, in 30.4% of patients, at least one autoimmune disease was noted. As compared to the patients without autoimmune urticaria, many more with autoimmune urticaria had a coexisting autoimmune disease (50% vs. 23.7%). Family history of autoimmune diseases was positive in 42.2%, and the familial history of urticaria and atopy was positive in 7.8% and 25.5%, respectively. The knowledge of comorbidities of chronic urticaria may support clinicians to manage and treat patients with this common condition.

SEVERE ATOPIC DERMATITIS IMPROVED WITH OMALIZUMAB TREATMENT OF CHOLINERGIC URTICARIA

<h3>Introduction</h3> Interrupting the itch-scratch cycle can be key to managing atopic dermatitis (AD). We present a patient with severe AD who improved with omalizumab treatment of coexistent cholinergic urticaria (CholU). <h3>Case Description</h3> A 17-year-old girl with longstanding AD, on dupilumab for two years, presented for recurrent hives and anaphylaxis. Patient's mother described several episodes of itching, small wheals, and "fainting" over the previous 18 months. All episodes occurred when the patient was "feeling hot" and had been engaged either in strenuous physical exertion or light exertion in heat. With one episode, she received intramuscular epinephrine and returned to baseline; others resolved after cooling. Her AD control had deteriorated since episodes began. CholU was considered in the differential. After four months of daily second-generation antihistamine, she reported worsening eczema and no change in urticaria/anaphylaxis episodes. Urticaria treatment was escalated to maximal daily doses of fexofenadine, famotidine, and montelukast, with minimal improvement. She underwent provocation skin testing with methacholine, off antihistamines. Histamine prick was positive with wheal/flare of 7/26mm. Methacholine intradermal tests were positive at two concentrations: 0.1 mg/ml (5/13mm) and 1.0 mg/ml (8/20mm). Intradermal saline control was non-reactive. CholU was definitively diagnosed. The patient stopped dupilumab and initiated omalizumab 300 mg every four weeks. Her urticaria and eczema improved dramatically, and she had no further anaphylaxis. <h3>Discussion</h3> CholU is a type of urticaria induced by increase in core body temperature. Anaphylaxis may occur in advanced cases. In patients unresponsive to antihistamines, omalizumab has proven effective.

Dermatographism in popular culture.

Dermatographism was first described by William Heberden (1710-1801) more than 250 years ago as a type of urticaria brought on by rubbing or scratching the skin. In 1859, William Gull (1816-1890) gave it the name factitious urticaria, distinguishing dermatographism from chronic urticaria, in which the skin lesions appear spontaneously. During the 1870s French physicians at the Salpetriere Hospital in Paris became impressed by their ability to write words on the bodies of patients admitted with hysteria and other psychiatric disorders, who also exhibited dermatographism. At first, they described this phenomenon as "autographisme," but by 1890 it became known as "dermographisme," the forerunner of the current term "dermatographism." At the Salpetriere and elsewhere in the world, it became fashionable to photograph patients with dermatographism, to capture the striking urticarial writing on their skin. These photographs were used in atlases and to illustrate dermatology texts and medical journals as well as popular magazines. This contribution presents several vintage photographs of dermatographism from the late 19th century to the early 20th century. Dermatographism has also become featured in popular culture including film, comic books, poetry, and body art, examples of which are provided in this contribution with the assistance of two of our authors, Ariana Page Russell and Jeannine Hall Gailey, who have embraced their dermatographism and have used their artistic and poetic talents to educate and inspire patients about this common skin condition.

Polymorphic dermal vasculitis flare up after COVID-19: case report

Several types of antiviral vaccines have been developed to control the spread of the disease since COVID-19 pandemic onset. Currently, many countries are taking measures aimed at increasing vaccination rates for herd immunity formation. However, with increased number of vaccinated individuals, there are more reports of possible adverse events after vaccination, including chronic dermatoses aggravation.&#x0D; The article describes a clinical case of polymorphic dermal vasculitis (hemorrhagic and urticaria types combination) flare up after COVID-19 vaccination in a 73-year-old woman, who was admitted to Department of Dermatology and Venereology (Sechenov University) with complaints of skin rashes in the trunk, upper and lower extremities and intense itching. The presence of comorbid diseases (ischemic heart disease; atrial fibrillation; chronic gastritis; diverticular colon disease; chronic kidney disease) and wide range of drugs intake on a regular basis made it difficult to diagnose. Due to appropriate therapy, clinical remission was achieved 2.5 months after treatment onset as a complete rashes regression on the trunk and upper extremities. The patient was given recommendations to maintain achieved therapeutic effect.&#x0D; The Discussion section provides up to date statistical data on the frequency of skin reactions adverse events after various COVID-19 vaccines administration and discusses possible hypotheses for such side reactions manifestation. Recommendations are given to practicing dermatologist about possible chronic dermatoses exacerbation after vaccine administration. When deciding on vaccination, potential risks should be assessed individually and each patient should be informed accordingly. Despite developed management protocols for patients with a new coronavirus infection, treatment options are still limited. The clinical experience accumulated during the pandemic period shows that COVID-19 vaccination significantly reduces disease severity, minimizes lethal outcome and restrains pandemic outbreak. Therefore, there are no certain dermatological diseases as absolute contraindications to COVID-19 vaccination.

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.

Urticarial drug eruption following tocilizumab administration

Tocilizumab is a humanized anti-IL-6 receptor antibody that exerts its immunosuppressive effect by blocking IL-6 receptor-mediated signal transduction and shows therapeutic anti-inflammatory action in autoimmune diseases. On the contrary, several cutaneous adverse reactions have been reported in patients treated with tocilizumab administration. Herein, we report a case of urticarial drug eruption following tocilizumab administration. Interleukin 6 (IL-6) plays a vital role in the pathogenesis of various inflammatory diseases, especially rheumatoid arthritis.1 Tocilizumab is a humanized anti-IL-6 receptor antibody that exerts its immunosuppressive effect by blocking IL-6 receptor-mediated signal transduction2, 3 and shows therapeutic anti-inflammatory action in autoimmune diseases. On the contrary, several cutaneous adverse reactions have been reported in patients treated with tocilizumab administration.4 Herein, we report a case of urticarial drug eruption following tocilizumab administration. A 50-year-old woman had developed rheumatoid arthritis 5 years ago and was treated with methotrexate and certolizumab. She had no history of urticaria. Because her arthritis was intractable by these treatments, tocilizumab was administrated. One month after the repeated tocilizumab administration, she recognized urticarial eruption in trunk and extremities after the second-time administration of tocilizumab (Figure 1). Her eruption occurred in several hours and disappeared within 24 h after the tocilizumab administration. Her eruption continued to repeat the occurrence of urticaria following repeated tocilizumab administration. Blood examination showed that eosinophil frequency in peripheral blood (11.9%) and IgE-RAST (443 U/ml) were elevated, while the white blood cell count (6,000/μl) and CRP (0.04 mg/dl) were within normal ranges. Although an anti-histamine agent showed less response to her eruption, her urticaria completely diminished after switching into certolizumab without the recurrence of her eruption. Tocilizumab was administrated in total 12 times before switching into certolizumab. Because her urticaria was reproducible following every tocilizumab administration recognized as a positive reaction to challenge test, we diagnosed her skin eruption as urticaria following tocilizumab administration. Tocilizumab shows various cutaneous adverse reactions, and the majority of these cases are type IV delayed hypersensitivity reactions. However, this case showed an unusual clinical manifestation of type I allergic reaction. As a reason to cause urticarial eruption, we thought there were several possibilities. The first one is an immune response to additives in this drug. Tocilizumab contains polysorbate 80, which is a synthetic nonionic surfactant and is used in various medications. Polysorbate 80 is also known as one of the representative agents to cause type I allergic reactions.5 Indeed, polysorbate 80 containing medication induces urticaria.6 Although allergic skin test could be conducted in our case, it should be kept in mind a possibility to cause the same skin eruption following polysorbate 80 containing biologic agents. The second one is a pharmacological effect of tocilizumab mediated by the IL-6 blocking pathway. However, IL-6 increases in various types of urticaria,7 suggesting that a pharmacological effect of tocilizumab mediated by the IL-6 blocking pathway might not contribute to the development of urticaria. As another possibility, tocilizumab might become a trigger to produce tocilizumab-specific anti-IgE production and contribute to the development of urticaria. Since there is no case report of urticaria responding to biologics itself, a further case study is expected to conclude the possibility. The authors declare no conflicts of interest. Approval of the research protocol: No. Informed Consent: N/A. Registry and the Registration: N/A. Animal Studies: N/A.

Chronic Urticaria: A Swedish Registry-based Cohort Study on Population, Comorbidities and Treatment Characteristics.

Swedish databases present unique opportunities to research population data on diseases and treatments. The current study is, to our knowledge, the most comprehensive registry-based study on a chronic urticaria population in Sweden to date. The aim of this study was to describe the chronic urticaria population in Stockholm County regarding epidemiology, demographics, comorbidity, healthcare usage and treatment patterns in relation to current international guidelines. Real-world data were extracted between 2013 and 2019, yielding 10,642 adult patients. Study period prevalence of chronic urticaria was 0.53%, the mean annual incidence was approximately 0.08%, and 68% of patients were female. Regarding diagnosis, 58% were first diagnosed in primary care, approximately 50% were diagnosed before the age of 40 years. Regarding type of urticaria, 89% had chronic spontaneous urticaria, 11% had chronic inducible urticaria, and 5% of patients with chronic urticaria had coexisting angioedema. Common coexisting diagnoses were, for example, asthma, allergy, psychiatric and behavioural disorders and cardiometabolic disorders. Treatment patterns generally followed guidelines, yet data indicated that guidelines were not fully implemented, especially in primary care.

Chronic urticaria patients are interested in apps to monitor their disease activity and control: A UCARE CURICT analysis.

BackgroundInformation/communication technologies such as mobile phone applications (apps) would enable chronic urticaria (CU) patients to self‐evaluate their disease activity and control. Yet, recently Antó et al (2021) reported a global paucity of such apps for patients with CU. In this analysis, we assessed patient interest in using apps to monitor CU disease activity and control using questions from the chronic urticaria information and communication technologies (CURICT) study.MethodsThe methodology for CURICT has been reported. Briefly, a 23‐item questionnaire was completed by 1841 CU patients from 17 UCAREs across 17 countries. Here, we analyzed patient responses to the CURICT questions on the use of apps for urticaria‐related purposes.ResultsAs previously published, the majority of respondents had chronic spontaneous urticaria (CSU; 63%; 18% chronic inducible urticaria (CIndU) [CIndu]; 19% with both), were female (70%) and in urban areas (75%). Over half of patients were very/extremely interested in an app to monitor disease activity (51%) and control (53%), while only ∼1/10 were not. Patients with both urticaria types versus those with CSU only (odds ratio [OR], 1.36 [1.03–1.79]) and females versus males (OR [95% CI], 1.47 [1.17–1.85]) were more likely to be very to extremely interested in an app to assess disease control.ConclusionsOverall, half of the patients with CU were very to extremely interested in using an app to assess their disease activity and control. Development of well‐designed apps, specific to disease types (CSU, CIndU, CSU + CIndU, etc), validated by experts across platforms would help improve the management and possibly outcomes of CU treatment while providing important patient information to be used in future research.

Symptomatic dermographism in Chinese population: an epidemiological study of hospital-based multicenter questionnaire survey

Objective There are few epidemiological studies on SD in China. This study aims to clarify the epidemic distribution characteristics of SD in China and provide ideas and clues for the prevention and treatment of the disease. Methods The cross-sectional study was conducted in 2019 based on the hospital's epidemiological questionnaire. All enrolled patients completed a specific survey with 39 questions, related to demographic characteristics and the relative symptoms. Demographics, disease symptoms were characterized with descriptive statistics. The differences in the symptoms between different genders, disease courses, and regions were compared. Results A total of 1800 patients were recruited, of which 615 patients were diagnosed with SD. Among 615 SD patients, the proportion of patients with chronic spontaneous urticaria was the highest, with 437 cases (71.1%). There is a female predominance (female/male ratio is 1.27:1), but there is no statistically significant difference between genders. The average disease course was 2.23 years. Among them, 429 patients had a course less than one year, accounting for about 2/3, and patients with a course more than one year accounted for less than 1/3. The clinical characteristics of patients with different course of disease were statistically different. The initial age is mainly concentrated in the 20–40 years old, accounting for 46.5% (286) of the total number. There are certain differences in incidence due to the different geographical conditions in north and south. Multiple types of urticaria may coexist in the same patient, and the number of patients with multiple urticaria is higher than the number of patients with simple SD. There are differences in the clinical manifestations of SD between north and south. Conclusions Environmental factors may affect the occurrence of SD, which may have a similar etiology to other types of urticaria and the cause of SD can be explored from more perspectives.

What lessons can we learn? Clinical and epidemiological retrospective analysis of 267 patients with urticaria in a Brazilian tertiary center

BackgroundThere are few epidemiological studies of urticaria, published in the indexed literature (PubMed/Medline). ObjectiveThe study aimed to evaluate the epidemiological and clinical data among patients with urticaria/angioedema attending a reference clinic in Brazil. MethodsTwo hundred sixty-seven patients were evaluated retrospectively considering demographic data, time course of the disease, triggering symptoms, the presence of angioedema, complementary laboratory tests including total blood count, reactive-C protein, erythrocyte sedimentation rate, IgE serum levels, and other, as necessary. ResultsThe most commonly diagnosed type of urticaria was chronic spontaneous urticaria (56.93%). Angioedema was associated with chronic urticaria in 108 patients (40.08%). Study limitationsUnicentered and retrospective. ConclusionSome relevant findings in this study are the observation of a female prevalence of cases (4-females: 1-man), a result more elevated than demonstrated in previous studies in Europe and Asia, the median age was 43-years old and the delay of time between the diagnosis of urticaria and the admission for treatment in a specialized center was approximately 2-years. Other multicenter studies can better establish these differences in Brazilian patients.

Management of Hypersensitivity Reactions to Nondextran Iron Products: New Insights Into Predisposing Risk Factors

Hypersensitivity reactions (HSRs) to non-dextran iron products (NDIPs) are rare, but can manifest with severe signs and symptoms. Predisposing risk factors are not well understood. We aimed to characterize patients with HSRs to NDIPs, with a special focus on possible risk factors. We analyzed clinical characteristics of patients with HSRs to NDIPs referred to our allergy division between 2007 and 2019 compared to tolerant controls, including the type of the eliciting NDIP, severity and characteristics of the HSR, atopy status, history of allergies and urticaria, laboratory and skin test results and outcome of re-exposure with NDIPs. We evaluated the data of 59 patients and 21 controls. Sixteen patients and 4 controls received the NDIP iron sucrose and 41 patients and 15 controls received ferric carboxymaltose. In 2 patients and in 2 controls the culprit NDIP was not known. Twenty-seven patients (46%) experienced an anaphylactic reaction grade I, 15 (25%) a grade II reaction and 17 (29%) a grade III reaction according to Ring and Messmer. Analyzing the history, 22 patients (37%) and 3 controls (14%) reported previous HSRs to other medications. Interestingly, more than half of the patients (n=35, 59%) compared to only 7 controls (33%) reported an episode of any type of urticaria in their previous history. Most patients (n=15; 79%) tolerated re-exposure of an NDIP using a low-reactogenic administration protocol (LRP). A history of drug hypersensitivity and urticaria represent potential risk factors for HSRs to NDIPs. Based on our findings, we propose an algorithm for practical management of patients receiving NDIPs aiming to prevent HSRs.

Pathogenetic aspects of chronic urticaria. Retrospective and prospective analysis of the patients of the Department of Dermatology, Poznan University of Medical Sciences.

IntroductionUrticaria is a disease with a complex pathomechanism. Confirmation of the cause in chronic urticaria seems to be a great challenge for specialists.AimTo assess the frequency of different types of urticaria and their coexistence in 1 patient, diseases associated with chronic urticaria and the frequency of accompanying oedema.Material and methodsThe study was divided into two parts. Retrospective analysis included 441 chronic urticaria patients at the age of 15 or older hospitalized in 10 years. Information from history of the disease has been placed in a specially designed form. For the prospective analysis 78 patients have been chosen out of 441 subjects previously qualified for retrospective analysis.ResultsThe most common type of urticaria was autoimmune (27.9% R; 30.8% P), spontaneous (19.3% R; 39.7% P) and aspirin-induced urticaria (17.5% R; 25.6% P). The most common coexisting types of urticaria were autoimmune with aspirin-induced (7.5% R; 10.3% P) and autoimmune with dermographic urticaria (3.2% R; 5.1% P). In more than half of the patients (66.7%) one type occurs only. Angioedema coexisted in over half of the patients (58% R; 69.2% P) Among the coexisting comorbidities in people with accompanying angioedema, statistically significant differences appeared in patients with thyroid diseases (19.9% with oedema and 4.9% without oedema). Among drug users, there was a greater difference between the percentage of patients with or without angioedema than among non-drug users.ConclusionsIt was found that among the inducing factors – pressure and stress and among drugs taken for diseases other than urticaria – NSAIDs had an influence on the persistence of symptoms in P patients.

Leukotriene Antagonists in Dermatology.

Leukotriene antagonists constitute an important group of drugs in the therapeutic armamentarium of all dermatologists. It has been quite valuable in the management of various types of urticaria and atopic dermatitis. Recently, the role of zileuton in the management of acne has been elaborated, and in the near future it could be used as a first-line agent for the same, thereby preventing adverse effects and antibiotic resistance encountered following antibiotic use. This review will throw light on the dermatologic aspects of leukotriene antagonists.

Urticaria: clinical profile, laboratory evaluation, serum IgE evaluation and its significance

Background: Urticaria is a recurrent pruritic skin disease characterised by wheals and or angioedema. The recurrent nature of urticaria, pruritus and wheals impacts negatively on the quality of life of patients. Prevalence studies, type, trigger factors and patient related factors including serum IgE vary depending on site of study. These factors were not documented in our patients. The aim of this study is to determine the clinical characteristics of our urticaria patients and determine the proportion of urticaria patients who have elevated Sr IgE, Eosinophilia, Basophilia, Hepatitis B and C virus seropositivity. Also, to correlate elevated Sr IgE with age, gender, presence of atopy, dermographism, type of urticaria, raised eosinophil count and resolution with anti-histamines.&#x0D; Methods: A retrospective case review was conducted on 43 patients who attended the dermatology outpatient clinic from January 2017 to December 2018. The sociodemographic and clinical parameters of patients was documented using a questionnaire. Investigation results (Sr IgE levels, Eosinophil and Basophil counts, Hepatitis B and C virus seropositivity, stool ova and parasite) were extracted from cases records. Data was analyzed using SPSS version 22. Univariate descriptive statistics such as means, medians, frequencies and proportions are presented.&#x0D; Results: Prevalence of urticaria was 4.2% and the mean age of the patients was 40.6±15.6 years. Patients were made up 62.8% males and 37.2% females. A history of atopy was noted in 34.9%, urticaria was acute and chronic in 4.7% and 95.3% respectively. Angioedema was present in 44.2% and absent in 53.5%. Majority of the patients (67.4%) were treated with anti-histamines. Serum IgE was elevated in 43.8%, Eosinophilia in 27.30%, Basophilia in 0%, hepatitis B seropositivity in 10%, hepatitis C seropositivity in 0% and a positive stool ova/parasite test in 2.3%.&#x0D; Conclusions: Urticaria is more prevalent in males. Prevalence is more in those over 40 years of age and prevalence increases with age. Atopy and angioedema is demonstrable in some patients. Basophilia is low in urticaria. Eosinophilia and a raised serum IgE is found in some patients. Parasitology is low in urticaria.

Adapting epicutaneous patch testing protocols to assess immediate-type skin reactions.

During the development of cosmetic formulations, in vitro and in vivo methods are essential tools used to reliably assess the skin irritation potential of a product or ingredient. Epicutaneous patch testing (single and/or multiple application protocols) has long been used as an initial in vivo method to screen for possible skin irritation properties of a substance or formulation. To confirm the mildness and dermatological and/or consumer acceptance of a product, use tests are often subsequently conducted. A study was therefore initiated to see how well patch test results correlate with use tests with respect to irritation elicited by skincare (leave-on) products. A number of different cosmetic formulations were assessed in both tests. Although the patch test results did not indicate substantial irritation potentials, immediate-type reactions (stinging and redness) were observed in some volunteers which disappeared within approx. 1h. Although transient, these reactions suggested that consumer acceptance would probably be low and the studies were discontinued. Immediate-type reactions are rare but have been described for some substances used in cosmetics. These unexpected results were nevertheless intriguing and prompted the start of a journey to see if patch test protocols could be modified to assess these reactions. An occlusive short-term patch test protocol with an application period of 20min was developed. Successful identification of the spontaneous reactions became possible. Furthermore, there was a correlation between the intensity of reactions observed in the short-term patch test and those observed in the controlled in-use studies. Short-term patch testing using the developed protocol can therefore reliably be used as a screening method, for example in the development and optimization of cosmetic formulations containing ingredients that could cause spontaneous reactions, for instance of non-immunological contact urticaria type. The lessons learned from this studies indicate that simple modifications of existing test protocols can lead to important insights into skin reactions. These modifications can then be used to create further building blocks in the development and optimization of test strategies for cosmetic formulations which offer reliable study designs for possible reactions product developers may encounter.

Chinese Guidelines for the Diagnosis and Treatment of Urticaria: 2018 Update

Abstract Urticaria is a common dermatological condition that is characterized by wheals and pruritus. Certain types of urticaria can be resistant to treatment, and recurrence is common. These guidelines supplement and improve upon the previous version (published in 2014) of the Guidelines for the Diagnosis and Treatment of Urticaria in China, and incorporate recent research advances in urticaria. These guidelines are suitable for both Chinese adults and children of Han nationality with urticaria. These guidelines update and broaden the definition, pathogenesis, classification, diagnosis, and treatment of urticaria, and serve as a scientific and authoritative reference for the diagnosis and management of urticaria.

Epidemiology of urticaria including physical urticaria and angioedema in Korea.

Background/AimsDespite the high burden and frequency of urticaria, its epidemiology is not well known. We investigated the epidemiology of various type of urticaria in Korea and changes in its annual prevalence over 5 years.MethodsWe used data from the 2010 to 2014 Health Insurance Review and Assessment database, which covers the claims of 97.0% of the South Korean population. Patients aged > 10 years old were included in this study. The presence of urticaria was identified on physician-certified diagnoses using the International Classification of Diseases 10th Revision (ICD-10) codes that include various type of urticaria (L500–L509) and angioedema (T783). Epidemiology of all type of urticaria, physical urticaria and angioedema were investigated.ResultsThe prevalence of all-type urticaria over the 5 years was 4.5% with a peak in individuals, especially females, aged 30 to 59 years. The age-specific prevalence of all-type urticaria increased with age from the 10- to 19-year age group to the 70- to 79-year age group. The prevalence of dermographism, cholinergic urticaria, and angioedema were 0.12%, 0.025%, and 0.027%, respectively. Cholinergic urticaria was most prevalent in those aged 10 to 29 years with male predominance. The annual prevalence of all-type urticaria, dermographism, and angioedema increased over the 5 years.ConclusionsThe prevalence of urticaria has increased annually in Korea. Cholinergic urticaria showed unique distribution in its age and gender, and angioedema showed remarkable increases in annual prevalence, although the prevalence estimation is still exploratory and diagnosis of urticaria based on ICD-10 codes need to be validated.

Acute-phase response and its biomarkers in acute and chronic urticaria.

IntroductionSince urticaria is a persisting inflammatory disease it is important to establish the prognostic factors for the duration and severity of the disease.AimTo evaluate serum concentrations of selected acute-phase proteins (APP) in patients with various forms of urticaria as compared to healthy volunteers and also to analyze these concentrations in different types of urticaria. Additionally, to evaluate the correlation between serum levels of selected APP and disease activity.Material and methodsSerum concentrations of C-reactive protein (CRP), α1-acid glycoprotein (AGP), α1-antichymotrypsin (ACT), α1-antitrypsin (AT), ceruloplasmin (Cp), transferrin (Tf), α2-macroglobulin (α2M) and haptoglobin (Hp) were measured. Quantitative measurement was conducted using the rocket immunoelectrophoresis. Disease activity was assessed with the use of total symptom score.ResultsAnalysis of serum APP concentrations revealed statistically higher serum concentrations of CRP, AGP and ACT in the entire group of patients with urticaria in comparison with the control group. In the entire group of patients with urticaria, CRP, AGP, ACT, Cp and Hp correlated positively with disease activity, intensity of pruritus and the number and size of urticarial wheals. Statistically lower serum concentrations of CRP, ACT, Cp and Hp were detected in the group of patients with acute urticaria (AU) and angioedema together, compared to the patients suffering from AU only.ConclusionsPatients with symptoms of various forms of urticaria present a distinct profile of serum APP concentrations. A significant correlation observed between CRP, AGP, ACT, Cp, Hp and clinical activity score points to the potential role of APP as markers of the urticarial activity.