Urticaria Patients Research Articles

Management of Chronic Urticaria

The management of urticaria, although complex, relies on two postulates: • Recognition and eradication of the triggering factor(s) • Provision of symptomatic relief Recognition and eradication of the triggering factors(s) Factors known are drugs, food, infections, and physical stimuli. Drugs: Analgesics and NSAIDs can exacerbate already present urticaria and are also recognized triggers of new-onset urticaria.2 When suspected, they should be withdrawn entirely or can be replaced. ACE inhibitors can cause angioedema. Eradication of infectious agents Infections and infestations should be treated where suspected, including infections of the GI tract e.g., H Pylori associated gastritis3, nasopharyngeal bacterial infections, and intestinal worms.8 Management of diet The allergens in food need to be avoided if a patient has type I hypersensitivity to any one of these allergens. Pseudo-allergic reactions5 which are not IgE mediated have been described for organic foods and food additives.9-13 Physical stimuli They are usually recognized and controlled, e.g., in chronic pressure urticaria patients are advised to use bags with a wide handle and similarly, in symptomatic dermographism, simple avoidance of friction can give relief from symptoms.15 Symptomatic therapy One of the objectives of symptomatic therapy is to mask the effects of histamine, platelet-activating factor, and other mast cell mediators. Histamine plays a primary role in inducing the symptoms associated with urticaria. The activation of receptors on endothelial cells by histamine results in wheals whereas this histamine receptor activation on sensory nerves results in itching. Different guidelines have been proposed for managing chronic urticaria including the EACCI [5] and BSACI [4].

SNPs of Thymic stromal lymphopoietin (TSLP) in Colombian chronic spontaneous urticaria patients.

Thymic stromal lymphopoietin (TSLP) is an epithelial cell-derived and Th2-initiating cytokine. Previous studies have shown an increasing number of TSLP+ cells in the dermis of lesional skin of patients with chronic spontaneous urticaria (CSU). Single nucleotide polymorphisms (SNP) in TSLP could be influencing these findings on the skin of those patients; besides that, other dermato-allergopaties had been associated with SNPs of TSLP. In this first study, we described the distribution of SNPs of TSLP in chronic spontaneous urticaria patients. We performed an exploratory descriptive study with 102 CSU-patients from the Colombian Caribbean coast. The SNPs: rs1837253, rs17551370, rs3806933, rs2289276 of TSLP were genotyped by qPCR. Clinical characteristics and serum total IgE [normal values <100 IU/ml] were also evaluated. We estimated allelic, genotypic, and haplotypic frequencies; also Hardy-Weinberg equilibrium and linkage disequilibrium. Eighty-two percent of CSU-patients were female gender. 25.7% (n: 19/74) of patients had high levels of total IgE, and the angioedema was present in 69.5% of them (n: 66/95). The less frequent alleles were T-rs1837253 (27.5%), A-rs17551370 (12.5%), T-rs3806933 (50%), and T-rs2289276 (32.4%). Only rs3806933 was not in H-W equilibrium. The more frequent haplotypes were C/G/T/C (18%) and C/G/C/C (18%). These SNPs were not in linkage disequilibrium D´:0.592, LOD: 1.5, R2:0.063. Our results showed the distribution of SNPs of TSLP gen in this multi-ethnic group. We are planning to continue this study comparing these findings with a control group (healthy-individuals) in order to establish the influence of these SNPs with CSU.

Homoeopathic treatment of chronic urticaria – A case series

Introduction: Urticaria is a kind of skin complaint with red, raised and itchy bumps. Urticaria frequently occurs after an infection or as a result of an allergic response to some medication, insect bites or food. Psychological stress, exposure to cold or vibration may also trigger urticaria. Urticaria occurs with a lifetime prevalence of around 20%. In around 30% patients of urticaria, attacks often recur for months or years. Cases summary: This is a case series of five patients suffering from chronic urticaria having erythematous lesions, intense itching, redness and swelling treated at the Dermatology outpatient department of Dr D. P. Rastogi Central Research Institute for Homoeopathy, Noida, Uttar Pradesh, India. The patients were prescribed indicated constitutional Homoeopathic medicines. Changes in haematological and serological tests, Measure Yourself Medical Outcome Profile 2 and Urticaria Activity Score summed over 7 days at baseline and at the end of treatment showed reasonable improvement in disease as well as in the quality of life. Homoeopathic medicines such as Apis mellifica, Calcarea carbonica, Rumex crispus, Pulsatilla and Histamine were found useful.

Carmine allergy in urticaria patients.

IntroductionCarmine, a commonly used natural red dye, can cause immediate and delayed allergic reactions, which are frequently overlooked.AimTo assess the incidence of carmine allergy and its clinical significance based on the placebo-controlled oral challenge in urticaria patients and suspected hypersensitivity to food additives.Material and methodsPatients’ histories were recorded by means of a standardized questionnaire. The subjects underwent skin prick tests and patch tests for carmine, while the level of specific IgE was measured in 52 patients. The patients with at least one positive carmine test or with suspected hypersensitivity to carmine were suggested to undergo a placebo-controlled oral challenge test.ResultsOne hundred and ten patients were enrolled in the study. Carmine skin testing was positive in 22 patients: skin prick tests were positive in 17% (n = 19), while patch tests were doubtful in 6% (n = 6). In 25/52 patients, the level of specific IgE was min. 0.01 kU/l. Oral challenge was performed in 33 subjects. Allergy to carmine was diagnosed in 9 (8%) patients; all of them suffered from chronic inducible urticaria.ConclusionsCarmine is a potential allergen in patients with chronic inducible urticaria especially with concomitant systemic symptoms. Skin tests and specific IgE level measurement may be helpful tools to diagnose E120 hypersensitivity.

To Evaluate the Role and Relevance of Cytokines IL-17, IL-18, IL-23 and TNF-α and Their Correlation with Disease Severity in Chronic Urticaria.

Introduction:The basic event in the pathogenesis of urticaria is inappropriate activation and degranulation of dermal mast cells. Cytokines are soluble polypeptide mediators that play a key role in immunological, inflammatory and reparative host responses including chronic urticaria.Objective:The aim of this study was to evaluate the role and relevance of cytokines interleukin-17 (IL-17), interleukin-18(IL-18), interleukin-23(IL-23) and tumor necrosis factor-alpha (TNF-α) and their correlation with disease severity in patients with chronic urticaria.Materials and Methods:A prospective cross-sectional study was conducted to measure the serum concentration of IL-17, IL-18, IL-23 and TNF-α in 50 chronic urticaria patients and in 30 healthy controls. Disease activity was assessed by using urticaria activity score (UAS).Results:Serum concentration of IL-17, IL-18, IL-23 and TNF-α were significantly higher during the acute episode in chronic urticaria patients as compared with the healthy control subjects (mean: 1.84 ± 0.81 vs 0.03 ± 0.02 pg/ml; P < 0.001, 501.41 ± 208.98 vs 218.39 ± 39.83 pg/ml; P < 0.001; 25.57 ± 10.79 vs 0.15 ± 0.14 pg/ml, P < 0.001; and 455.54 ± 253.54 vs 8.498 ± 3.644 pg/ml, P < 0.001, respectively). There was a significant positive correlation between serum levels of IL-17, IL-18, IL-23 and TNF-α and severity of disease.Conclusion:The serum levels of IL-17, IL-18, IL-23 and TNF-α were raised in patients of chronic urticaria and positively correlated with the severity of urticaria.

Risk of comorbidities in patients diagnosed with chronic urticaria: A nationwide registry-study

BackgroundThe autoimmune profile of Chronic Urticaria (CU) patients is an increasing topic of interest. Associated diseases suggest shared pathogenic pathways, and they may provide important knowledge on specific targets for future treatment models. In this study we examined the prevalence and risk of comorbidities in CU. MethodsThe Danish National Patient Registry was used to identify all CU patients from 1994 to 2015. Five of 5 specialized dermatological units in Denmark were covered. Analyses were conducted as a nested case control study and a matched cohort study. CSU patients were matched 1:10 on age and sex to an otherwise random group of people from the background population. ResultsA total of 12,185 CU patients were identified, with an overweight of female cases (69% versus 32%). There was an overrepresentation of mast cell mediated diseases including mastocytosis and anaphylaxis, as well as atopic diseases including type 1 allergies and atopic dermatitis. The prevalence of rheumatoid arthritis, systemic lupus erythematosus, thyroiditis and vitiligo was also increased, as was the prevalence of depression. CU patients who did not have any of the co-morbidities at the time of their CU diagnosis had an increased risk of developing both mast cell mediated diseases, atopic diseases, and autoimmune diseases excluding thyroiditis and diabetes. ConclusionThe autoimmune profile of the comorbidities of CU was demonstrated with an evident risk of developing rheumatoid arthritis. CU patients were also at increased risk of either having or achieving depression. Mast cell related diseases seemed to be overrepresented, although registry data within this disease category are questionable and similar to symptoms of CU to the untrained eye. Thus, CU patients constitute a multimorbid group of patients, which must be recognized among treating physicians.

Does adiponectin play a role in the pathogenesis of chronic spontaneous urticaria?

IntroductionChronic spontaneous urticaria constitutes an interdisciplinary problem and its pathogenesis is still a subject of debate. Overweight and hyperlipidemia are supposed to be related to chronic spontaneous urticaria. Fatty tissue can be the source of adipokines.Aim of the studyTo assess the potential role of adiponectin in chronic spontaneous urticaria pathogenesis.Material and methodsThe study included 52 chronic spontaneous urticaria patients and 43 healthy controls. The patients were divided into two subgroups: patients with wheals only, and patients with urticaria and an accompanying angioedema. The adiponectin concentration was measured in all studied subjects.ResultsNo statistically significant difference in adiponectin level was determined between the studied groups and subgroups.ConclusionsWe are among the first to present the results of study to determine a possible role of adipokines in chronic spontaneous urticaria pathogenesis. We did not observe any difference in adiponectin level. In our opinion, it is necessary to conduct further analyses in this field.

Frequency of depression and anxiety among patients with chronic spontaneous urticaria visiting a tertiary care hospital in Karachi, Pakistan.

To determine the frequency of anxiety and depression among chronic spontaneous urticarial patients presenting at a tertiary care hospital. The prospective, cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from February to August 2015, and comprised patients diagnosed with chronic spontaneous urticaria at the dermatology clinic. All the participants were assessed for anxiety and depression using Aga Khan University-Anxiety Depression Scale. Data was collected in face-to-face interview using a structured questionnaire. The association of the condition with different characteristics were calculated after stratification for age, gender, occupation and monthly income. SPSS 19 was used for data analysis.. Of the 146 study participants, 84(57.5%) were males and 62(42.5%) were females. The overall mean age was 39±15.6 years. Of the total, 39(26.7%) had depression and anxiety. Depression and anxiety were more frequent among patients with a positive family history of mental disorders (p=0.02). Anxiety and depression were found to be considerably common among chronic spontaneous urticaria patients, with patients having a positive family history for mental illnesses particularly vulnerable.

CUTANEOUS MANIFESTATIONS IN BLASTOCYSTIS SPP. INFECTION

The pathogenic potential of Blastocystis spp. is extremely controversial. Recently, many researchers have discussed its inductive role in the etiology of various dermatological syndromes such as palmoplantar pruritus, acute, and chronic urticaria. The growing number of urticaria patients showing improvement after eradication of Blastocystis spp. infection, has proven its causative nature. Herein, we present a broad overview of the modern concept of the precise parasitological verification in the routine work-up of urticaria patients.

Risk of Urticaria in Children with Type 1 Diabetes Mellitus: A Nationwide Cohort Study.

Type 1 diabetes mellitus (T1DM) has been linked to many autoimmune problems. The association between T1DM and urticaria warrants investigation. Data were extracted from the National Health Insurance Research Database (NHIRD) of Taiwan. Participants with T1DM were recruited as the case group, and that group was matched by sex and age at a ratio of 1:4 to the control group comprising those without T1DM. The study period was 1998–2011. All participants were followed up to the diagnosis of urticaria, withdrawal from the insurance program, death, or the end of the study. A multivariable Cox proportional hazard model was used to calculate the adjusted and crude hazard ratios for urticaria. A total of 5895 participants (1179 in the case group and 4716 in the control group) were followed up in the study. The total incidence rate of urticaria in patients with type 1 DM was 26.6 per 1000 person-years, and that in controls was 6.85 per 1000 person-years. Compared with the control group, the hazard ratio of urticaria in the case group was 2.84 (95% CI = 2.27–3.56). Compared with age-matched participants without T1DM, patients with type 1 DM aged <18 years had a 3.62-fold higher risk of urticaria (95% CI = 2.85–4.59). The hazard ratio in patients with an adjusted Diabetes Complications Severity Index (aDCSI) score of 1.01–2.00 per year was 2.57 (95% CI = 1.18–5.57), and that in patients with an aDCSI score of >2.00 per year was 4.47 (95% CI = 2.68–7.47). T1DM patients aged <18 years had an increased risk of urticaria, but a similar phenomenon was not observed among T1DM patients older than 18 years.

Study of Efficacy and Safety of Ligelizumab in Chronic Spontaneous Urticaria Patients Who Completed a Previous Study With Ligelizumab

Study of Efficacy and Safety of Ligelizumab in Chronic Spontaneous Urticaria Patients Who Completed a Previous Study With Ligelizumab

Clinicoepidemiological study of chronic urticaria in a government tertiary care centre in South India

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; According to the consensus statement 2017, urticaria is a common skin condition with a lifetime prevalence of 22% and point prevalence of 1%. This study aims to study the clinico epidemiological presentation of chronic urticaria in patients attending a govt. tertiary care center and to assess absolute eosinophil count.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This observational study was conducted in patients with chronic urticaria presenting to the outpatient clinic of Dermatology department. Patients details including demographics, clinical manifestations, investigations, associated comorbidities, and therapeutic were collected.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Chronic urticaria is commonly present in females-appears commonly in 4th decade but patients present to tertiary care center only in 5&lt;sup&gt;th&lt;/sup&gt; decade-duration was less than 1 year in males, but it was equally between 1-2 and 2-4 years in females. Ear, nose, throat and dental involvement are negligible and common comorbidities are diabetes mellitus, hypertension and hypothyroidism. 42% of patients present with more than normal absolute eosinophil count.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Chronic urticaria was common in females with 5&lt;sup&gt;th&lt;/sup&gt; decade being the common age of presentation to the tertiary care center and 4&lt;sup&gt;th&lt;/sup&gt; decade being the common age of disease onset. Paediatric population is less affected. Common comorbidities like diabetes mellitus, hypertension and hypothyroidism are to be ruled out. Raised absolute eosinophil count has to be looked for.&lt;/p&gt;

Prevalence of allergen sensitization among 1,091 patients with urticaria.

The etiology of urticaria is heterogeneous and allergic responses may be involved in it. The aim of the present study was to investigate the prevalence and distribution of sensitivity to inhaled and food allergens among patients with urticaria in Henan province (China). The levels of specific immunoglobulin E (sIgE) were detected using the AllergyScreen test and a total of 524/1,091 cases (48.0%) tested positive for sIgE to at least one of the 19 allergens. The most common inhaled allergens the urticaria patients were sensitive to were D. pteronyssinus (34.5%), cockroach (12.5%) and tree pollen mix (11.1%), while the food allergens with the highest rate of allergic reactions were cashew nut (8.1%), shrimp (6.8%) and crab (6.4%). The positive rates for D. pteronyssinus, dog hair, cockroach, mold mix, tree pollen mix and shrimp in the chronic urticaria group were higher than those in the acute urticaria group (P<0.05). Furthermore, positive rates for the majority of allergens were higher in males than in females and were significantly different between age groups (P<0.05). The results of the present study provided information on the characteristics of allergen sensitization of patients with urticaria and may facilitate the prevention, diagnosis and management of urticaria in Henan province.

Karakteristik profil pasien urtikaria akut di poliklinik kulit dan kelamin Rumah Sakit Umum Pusat (RSUP) Sanglah periode Oktober 2017- 2018

Background: Acute urticaria is a skin disorder that is often encountered that can cause redness to respiratory obstruction so that emergency emergencies and urticaria lesions that last more than 72 hours are indicative of hospitalized patients. This study aims to describe the characteristics of acute urticaria at Dermato-Venerology Polyclinic, Sanglah General Hospital during October 2017-2018 period.Methods: A cross-sectional study was conducted using secondary data from medical records of patients with urticaria in Sanglah General Hospital in the October 2017-2018 period. Data retrieval was taken by the Total Sampling method. Distribution of research variables namely, gender, age, genetic, causative factors, were collected. Data analysis is described in the form of tables and narratives using SPSS version 20 for Windows.Results: The results showed that there were 23 acute urticaria patients in this study, the age of the most research samples was in the Adult age category with a large percentage of 60.87%, the most gender-based study sample was female gender with a percentage of 78.3%, research genetic samples most of them are in the absence of genetics, with a percentage of 91.3%, the work of most research samples in housewives with a percentage of 34.8%, the most common cause of acute urticaria is in food allergies with a percentage of 56.5%.Conclusion: The incidence of acute urticaria is most common in adulthood, female sex, housewives, and food allergies.

Dupilumab for the Treatment of Chronic Spontaneous Urticaria in Patients Who Remain Symptomatic Despite the Use of H1 Antihistamine and Who Are naïve to, Intolerant of, or Incomplete Responders to Omalizumab

Dupilumab for the Treatment of Chronic Spontaneous Urticaria in Patients Who Remain Symptomatic Despite the Use of H1 Antihistamine and Who Are naïve to, Intolerant of, or Incomplete Responders to Omalizumab

A comparative study of effectiveness of autologus serum therapy with oral antihistamines versus oral methotrexate and oral antihistamines in chronic urticaria patients

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic urticaria (CU) is a worrisome problem and patients of CU suffer from the morbidity that arises from irritable itch thus they are subjected to a huge antihistamine pill burden. The symptoms are more prominent in autoreactive urticaria (AU) where auto-antibodies in blood causing recurrent flares. Therefore a need of adjunctive drug to reduce the pill burden is felt need.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A randomized, controlled study was done. 50 patients were given AST and 50 patients were given oral pulse methotrexate (10-15 mg once weekly) along with levocetrizine in an on-demand basis in both groups. AST was given weekly for nine weeks and followed-up for a total period of 24 weeks. Urticaria total severity score (UTSS) was used to evaluate the effectiveness of treatment. Safety parameters assessed were the spontaneously reported adverse events and laboratory parameters.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; UTSS showed significant improvement from baseline, 7th week and 8th week onwards in AST group and methotrexate group respectively. Group comparison showed significant improvement 4th week onwards.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Autologous serum therapy as well as methotrexate both proved effective in chronic urticaria patients. On follow-up improvement is sustained for at least 3-4 months after the last injection in case of AST. &lt;/p&gt;

Intramuscular autologous blood therapy - a systematic review of controlled trials

BackgroundAutologous whole blood (AWB) is used in complementary medicine for the treatment of infections and skin disorders. So far, the efficacy of AWB is discussed controversially.MethodsTo estimate the efficacy of AWB therapy and to gather evidence in regard to effector mechanisms, we effected a systematic review of articles accessible through Pubmed and Cambase. Further trials were identified through references and by contacting study authors. Prospective controlled trials concerning intramuscular AWB therapy were included with the exception of trials using oxygenated, UV radiated or heated blood. Information was extracted on the indication, design, additions to AWB and outcome. Full texts were screened for information about the effector mechanisms.ResultsEight trials suited our criteria. In three controlled trials about atopic dermatitis and urticaria, AWB therapy showed beneficial effects. In five randomized controlled trials (RCTs), two of which concerned respiratory tract infections, two urticaria and one ankylosing spondylitis, no efficacy could be found. A quantitative assessment was not possible due to the heterogeneity of the included studies. We only found four controlled trials with sample sizes bigger than 37 individuals per group. Only one study investigated the effector mechanisms of AWB.ConclusionsThere is some evidence for efficacy of AWB therapy in urticaria patients and patients with atopic eczema. Firm conclusions can, however, not be drawn. We see a great need for further RCTs with adequate sample sizes and for investigation of the effector mechanisms of AWB therapy.

Disease activity and stress are linked in a subpopulation of chronic spontaneous urticaria patients

Disease activity and stress are linked in a subpopulation of chronic spontaneous urticaria patients

Allergology-dermatology expert consensus document for the management and treatment of chronic urticaria patients in Andalusia

Allergology-dermatology expert consensus document for the management and treatment of chronic urticaria patients in Andalusia

Clinical features and skin prick test in chronic urticarial patients at Hue University of Medicine and Pharmacy Hospital

Background: Chronic urticaria is an allergic skin condition that significantly affects the quality of life. Skin prick test determines allergens in order to prevent recurrent urticaria. Materials and methods: 43 chronic urticaria patients visiting the Dermatology Clinic from 09/2017 to 09/2018 were tested for 16 allergens on the skin at the Immunology Department, Hue University of Medicine and Pharmacy. Results: 30 females and 13 males participated in the study (female/male 2.3/1). The average number of disease episodes was 3.1 ± 1.4 times; with the other allergic diseases accompanied by 41.9% of patients; the average severity score was 10.0 ± 2.0 with the serious condition accounting for 60.5%. 86.0% of patients had a positive skin prick test, of which the positive rate for respiratory allergens (mites with the highest rate was 34.9%) was higher than the food allergens (crab 30.2%). There is a correlation between positive skin prick results and atopic allergies. Conclusion: The majority of chronic urticaria patients were severe and had positive skin prick results, in which mites had the highest incidence of allergy. Key words: urticaria, chronic urticaria, skin prick test, allergen, allergic