Urticaria Patients Research Articles

Relevance of patch testing in patients of chronic spontaneous urticaria and its correlation with serum IgE level

Objectives: Chronic spontaneous urticaria (CSU) is defined as short lived (< 24h) wheals occurring spontaneously without any triggering factors, daily or almost daily for at least 6 weeks. Though CSU is mainly a Type 1 hypersensitivity reaction, earlier studies suggested contact allergy may have some role to play an important role in the etiopathogenesis of CSU. The objective of the study is to find out the relevance of patch test in the etiopathogenesis of and its correlation with serum IgE level. Materials and Methods: Thirty-one patients of CSU were thoroughly evaluated for clinical and laboratory parameters. We conducted patch testing with Indian Standard Series (ISS) in all of them and tried to find out the relevance of every positive reaction. Relevant positive cases were asked to avoid exposure for 2 months and were maintained only in breakthrough antihistamines. Furthermore, correlation of positive patch test reaction with high IgE and eosinophil count were studied. Results: Seventeen (55%) cases came positive for patch test. Potassium dichromate, lanolin, benzocaine, and fragrance mix were the most common offenders. Patients with very high IgE count had patch test positivity with multiple allergens. Seven of the fifteen patients who had relevant positive patch results could be followed up to remission; three were lost to follow-up. Conclusion: Patch test with ISS may give important clue to in a subset of patients of CSU and thus may be considered an important part of routine investigations of CSU.

Chronic urticaria in the real-life clinical practice setting in Portugal: 2-years results from the non-interventional multicenter AWARE study.

Information regarding chronic urticaria patients in the real-world setting is scarce. This analysis reports the two-year results of Portuguese patients included in the AWARE study. Non-interventional cohort study. Adult patients with a diagnosis of chronic urticaria with symptoms for at least two months, refractory to H1-antihistamines, consulting one of the 10 participating urticaria centers throughout Portugal, from the 31st October 2014 to 31st July 2015, have been included in the study. Clinical parameters, medicines taken for urticaria symptom relief, weekly urticaria activity score, and dermatology quality of life index have been collected throughout the two years of the study. Seventy-six patients were enrolled in the study. Results showed that the proportion of patients with omalizumab therapy almost duplicated after two years of the AWARE study, which was accompanied by the decrease of medical resources use and absenteeism. Moreover, urticaria severity and impact on quality of life both decreased after one year and continued to decrease at two years, although decreased severity was significant at both time points and quality of life was only significant at two years. At the end of two years, 79.0% of patients had their disease controlled compared to 29.3% at baseline (p < 0.001). At the end of the AWARE study a significant proportion of patients had their disease controlled allowing for decreased use of medical resources. Chronic urticaria still has a significant impact on quality of life and therefore there is opportunity for further therapy optimization.

A double-arm, randomized, and controlled trial to compare the efficacy and safety of bepotastine with levocetirizine in patients of chronic spontaneous urticaria

Background: Second generation antihistamines are first line therapy for chronic spontaneous urticaria (CSU). Sedation has been always a concern as a side effect of antihistamine for both patients and treating dermatologist. It is always better to prefer non-sedative antihistamine for CSU. Bepotastine is such promising non-sedative agent. Aim and Objectives: The objective of the study was to compare the efficacy and safety of bepotastine and levocetirizine in patients of CSU. Materials and Methods: This is a double arm, open label, randomized, and controlled study. Out of 99 patients, 50 patients belonged to Group A while 49 belonged to Group B. Subjects in Group A received bepotastine 10 mg twice daily while subjects in Group B received levocetirizine 5 mg once daily for 8 weeks. Patients were evaluated at baseline, day 14, day 28, and day 56 using Urticaria Activity Score (UAS) and Urticaria Control Test (UCT) for efficacy; and visual analog scale (VAS) for safety, that is, sedation. Results: The fall in mean UAS scores was statistically significant at day 14, day 28, and day 56 for both Groups A and B (P &lt; 0.05) on intragroup comparison. While comparing the overall improvement between the two groups, there was no significant difference in UAS and UCT score at day 14, day 28, and day 56 between Group A and Group B, respectively (P &gt; 0.05). At day 56, there was significant difference in mean VAS of Group A and B. Only one patient in Group B developed headache. Conclusion: Thus, both levocetirizine and bepotastine are equally effective for the treatment of CSU. Bepotastine has less sedative potential than levocetirizine.

Atopik Dermatit ve Kronik Spontan Ürtikerde Hastalık Aktivite Skoru, Serum Parametreleri ve Deri Prick Testi Arasındaki İlişkinin Araştırılması: Kesitsel Çalışma

Objective: Atopic dermatitis and chronic spontaneous urticaria are allergic skin diseases with recurrent attacks. In this study, disease activity score and laboratory parameters were investigated in patients with atopic dermatitis and chronic spontaneous urticaria. Material and Methods: A total of 68 patients including 33 atopic dermatitis and 35 chronic spontaneous urticaria patients from the dermatology outpatient clinics were enrolled in this study. Serum levels of total immunoglobulin E (IgE), blood eosinophil and basophil counts; prevalence of sensitization to aeroallergens, and disease activity scores were compared between the two groups. Results: A higher eosinophil count in the peripheral blood was observed in atopic dermatitis patients compared to chronic spontaneous urticaria patients. Disease activity scores (SCORAD index) were positively correlated with the eosinophil count and total IgE levels. Furthermore, it was found that the basophil count increased while total IgE levels and SCORAD index scores decreased in the chronic period of the disease. Total IgE levels and SCORAD index scores were higher in atopic dermatitis patients with a positive skin prick test. In chronic spontaneous urticaria patients, it was observed that basophil counts and total IgE levels were correlated, but there was not a correlation between disease activity scores, skin prick test results, and levels of other laboratory parameters. Conclusion: The relationship of serum parameters, especially IgE levels, with the disease activity was found to be significant only in atopic dermatitis.

Clinical Effects of BNT162b2 Vaccine on the Short-Term Course of Chronic Spontaneous Urticaria Patients.

The clinical effects of Pfizer-BioNTech coronavirus disease 2019 (COVID-19; BNT162b2) vaccine on the clinical course of chronic spontaneous urticaria (CSU) is unclear. To evaluate the clinical effects of BNT162b2 vaccine on the clinical course of CSU. In this study, 90 CSU patients vaccinated with one or two repeated doses of BNT162b2 vaccine were included. Urticaria Activity Score over 28 days (UAS28), Urticaria Control Test (UCT), Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL), and Medication Scores (MSs) were obtained before the vaccination, 28 days after the first and, if available, after the second dose of BNT162b2 vaccine. The demographic, clinical, and laboratory features were compared between the subjects with exacerbated (group A) and non-exacerbated (group B) disease activity. Among the 90 study participants, 14 (15.5%) experienced exacerbations in their urticarial activity after the first or repeated doses of BNT162b2 vaccinations. The demographic, clinical, and laboratory features were similar between the exacerbated and non-exacerbated CSU patients. However, the rate of adverse reactions within 48 hours, such as hives, injection site reactions and wheals lasting <1 hour, were significantly higher in group A than in group B (P = 0.004, P < 0.001, P = 0.001, P = 0.018). BNT162b2 vaccination caused an exacerbation in 15.5% of CSU patients during the short-term follow-up. The long-term evaluation can be informative about the lasting effects of BNT162b2 vaccine on the clinical course of CSU patients.

The validity and reliability of the Thai-version of 5-D itch scale.

Pruritus is commonly associated with skin disorders. The 5-D itch scale was developed as a specific questionnaire for pruritus. This study aimed to evaluate the validity, reliability, and sensitivity to change of the Thai 5-D itch scale in Thai patients. The Thai Dermatology Life Quality Index (DLQI), patient's global assessment of disease severity (PatGA-VAS), Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL), and seven-day urticaria activity score (UAS7) were evaluated as correlation with Thai 5-D itch scale. Seventy-five stable patients (42 chronic urticaria patients and 33 eczema patients), who had no change in disease severity after 4-weeks were assessed for test-retest reliability. Of 130 pruritus patients who were treated at Department of Dermatology, Siriraj Hospital, 65 patients were diagnosed with chronic urticaria. The others were diagnosed with eczema. The validity of Thai 5-D itch scale correlated strongly with Thai DLQI total score (r = 0.76, p < 0.0001) and PatGA-VAS (r = 0.79, p < 0.0001). The strong reliability of Thai 5-D itch scale was demonstrated as intraclass correlation coefficient of 0.90. The changes in Thai 5-D itch scale was correlated with the changes in PatGA-VAS and UAS7 which indicated that the Thai 5-D itch scale had good sensitivity to change (r = 0.66) and (r = 0.67), respectively. The Thai 5-D itch scale is a questionnaire with good validity, reliability and sensitivity to change to evaluate pruritus in Thai patients. This will support the use of 5-D itch scale in practice, in other languages.

Study of prevalence of skin prick test positivity for food allergens in chronic urticaria patients attending a tertiary care center in South India

Study of prevalence of skin prick test positivity for food allergens in chronic urticaria patients attending a tertiary care center in South India

A comparison of autologous serum, plasma, and whole blood for intradermal autoreactivity testing in patients with chronic spontaneous urticarial: A cross-sectional study

Background: Autologous serum (ASST) and plasma (APST) skin testing confirm autoreactivity in chronic spontaneous urticaria (CSU). Whole blood autohemotherapy has been used. Plasma and even whole blood may be used instead of serum with relatively quicker preparation and cheaper method especially using the latter in centers with limited resources. Purpose: The purpose of the study is to determine if similar intradermal skin reactions can be observed when using either serum, plasma, or whole blood in autologous skin tests and to determine factors associated with positive tests and wheal diameter. Methods: We performed a cross-sectional study of chronic urticaria patients in a dermatology clinic. Tests were performed according to EAACI/GA2 LEN Task Force recommendations. Urticaria Activity Score over 7 days (UAS7) was assessed. Statistical analyses included Chi-square, Mann–Whitney U, Spearman's, and Wilcoxon rank tests. Results: Twenty-six (77%) females and 8 (24%) males mean age 34 (26–42) years participated. ASST, APST and autologous whole blood for skin testing (AWBST) positivity rates were 24%, 29% and 27%, respectively (P = 0.86). 13 (38%) had at least 1 positive test; all tests were negative in 21 (62%). All tests were positive in 7 (21%), 3 (23%) were positive APST alone, 2 (15%) AWBST, 1 (8%) ASST. Pretest UAS7 was higher with those with test positive (P = 0.04). Test results were unaffected by age, gender, disease duration, atopy, anti-nuclear antibody, and thyroid status. Wheal diameter correlated with thyroid-stimulating hormone (P = 0.04). Conclusion: Autoreactivity rates were similar with ASST, APST, and AWBST. Positive tests were associated with severe CSU. Autologous whole blood may be a simpler and less costly alternative to plasma and serum for autoreactivity skin testing in patients with chronic urticaria.

Omalizumab treatment for chronic spontaneous urticaria: data from Turkey.

AimThe aim of the study was to investigate data from patients suffering from chronic spontaneous urticaria refractory to conventional therapy, and to document outcomes of omalizumab use.Material and methodsWe conducted a single-centre retrospective study with 175 chronic spontaneous urticaria patients who were treated with 300 mg omalizumab subcutaneously every 4 weeks for at least 6 months. Efficacy, factors affecting outcome, and complications were examined.ResultsThe complete response rate was 70.9%. Minor complications were observed in 12% of our patients. Anaphylaxis occurred in 1 patient as a major complication. We did not notice any clinical or laboratory factors predicting response to omalizumab treatment.ConclusionsThe findings show that omalizumab is effective and safe for the treatment of chronic spontaneous urticaria with a dosing of 300 mg/month subcutaneously. However, due to 1 case of anaphylaxis in this small group, we must still remind practitioners to be alert for this possible complication.

Clinical characteristics of chronic spontaneous urticaria in patients with Common variable immune deficiency and hypogammaglobulinemia

Chronic spontaneous urticaria is a prevalent disease that is associated with various autoimmune, infectious (viral, bacterial, parasitic), and non-infectious inflammatory pathologies, and could occur in the symptom complex of other diseases, such as primary immunodeficiencies. Nowadays, data on the features of chronic spontaneous urticaria in patients with primary immunodeficiencies are accumulating. Common variable immune deficiency takes a special place in clinical practice among primary immunodeficiencies with impaired antibody synthesis and is associated with late-onset in adulthood, as well as the heterogeneity of its clinical manifestations, such as infectious and non-infectious complications, which can serve as a background for chronic urticaria development. Intravenous Immunoglobulin (IVIg) replacement therapy is the mainstay of treatment and prevention of infectious complications in these patients; however, immunomodulatory and anti-inflammatory effects can occur in high doses. Herein, presented two clinical cases of patients with common variable immune deficiency and one with hypogammaglobulinemia who suffer from chronic spontaneous urticaria. The peculiarities of IVIg replacement therapy at urticaria were noted in these patients. The discussion presents the review of world literature and proposes key features for further investigations.

Impact of comorbidities on risk of angioedema without urticaria in elderly patients

BackgroundAngioedema without urticaria (AWU) is a disease found in the elderly population but is still poorly studied. The aim of this study was to investigate potential factors, especially comorbidities, that may affect the induction of angioedema without urticaria in patients over 60 years of age.MethodsThis was an observational, retrospective study of 242 patients with a diagnosis of AWU and 263 controls. The inclusion criteria were as follows: at least one episode of confirmed AWU based on the ICD-10 code (T78.3) that required treatment in the last 15 years (2004–2019); age above 60 years; detailed medical history of comorbidities; and details regarding the use of drugs at that time. Serum functional and quantitative C1 inhibitor assays were performed, and serum C4 was measured.Comorbidities were grouped into the following panels: autoimmune, cancer, cardiac, metabolic, respiratory and allergic, liver failure and renal failure. Individual diseases were checked according to ICD code and treatment.ResultsIn 1 (0.4%) patient, hereditary angioedema was confirmed. Decreased levels of C1INH were observed in 4 (1.65%) patients, dysfunction of C1INH was observed in 5 (1.76%) patients, and low levels of C4 were observed in 9 (3.71%) patients in the study group. The multiple logistic regression model revealed that patients with hyperuricemia or Hashimoto’s disease had a significantly higher chance of angioedema (OR = 3.21, 95% CI 2.92–3.66, p = 0.002; OR = 1.78 95% CI 1.37–2.21, p = 0.034, respectively).ConclusionThe obtained results may indicate a significant influence of hyperuricemia or Hashimoto’s disease on angioedema manifestations.

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.

High-dose non-sedating antihistamines are used insufficiently in chronic urticaria patients treated with omalizumab.

BackgroundThe lifetime prevalence of chronic urticaria (CU) is 0.5%–1%. In some patients with CU, symptomatic control is not achieved with non‐sedating second‐generation H1 antihistamines (nsAH1) alone, even with quadrupled standard doses as recommended in international guidelines. In these cases, biological treatment with omalizumab can be added. Since omalizumab is expensive compared to antihistamines, lack of adherence to guidelines for high dose nsAH1 (up to four‐fold standard dose per day) may be associated with substantial unnecessary costs. The aim was to measure the use nsAH1 before and during omalizumab use for the first time in an omalizumab treated CU population.MethodsWe identified all Danish patients with CU who initiated omalizumab from March 2014 to December 2018 and evaluated new and ongoing nsAH1 treatments using the Danish nationwide registries.ResultsA total of 955 CU patients initiated treatment with omalizumab within the study period (median age 40 years [IQR 28–50], 74.5% females). During the 12 months prior to omalizumab initiation, 95.6% of the patients filled at least one prescription with nsAH1 at some point, while 84.7% filled at least one prescription during the three months before omalizumab. From 3 months before omalizumab initiation till 3 months after, the proportions of users of high‐dose nsAH1 was maximum 31.1%.ConclusionsOmalizumab was usually administered before sufficient nsAH1 treatment was tried. In despite of the labelling that omalizumab should be co‐administered with high dose nsAH1, this does not happen This may lead to substantial unnecessary costs.

Pathogenesis of solar urticaria: Classic perspectives and emerging concepts.

Solar urticaria is a rare, immunologically mediated photodermatosis in which activation of cutaneous mast cells is triggered by specific wavelengths of solar electromagnetic radiation. This manifests clinically as the rapid development of cutaneous itch, erythema and wheal formation after several minutes of sun exposure. Disease mechanisms in solar urticaria remain incompletely elucidated and there have been few recent investigations of its pathobiology. Historic passive transfer experiments performed during the twentieth century provide support for a 'photoallergy' model of disease pathogenesis, wherein molecular alteration of a putative chromophore by solar electromagnetic radiation produces mast cell activation via an IgE-dependent mechanism. However, this model does not account for several observations made during passive transfer experiments nor does it explain a range of subsequent clinical and photobiological observations made in solar urticaria patients. Furthermore, increased understanding of the molecular dynamics underpinning cutaneous mast cell responses highlights the need to reformulate our understanding of solar urticaria pathogenesis in the context of this contemporary scientific landscape. In this review, we discuss the current understanding of solar urticaria pathogenesis and, by incorporating recent scientific and clinical observations, develop new hypotheses to drive future investigation into this intriguing disorder.

Chinese version of the chronic urticaria quality of life questionnaire: cultural adaptation, factor analysis, assessment of reliability and validity.

Chronic urticaria is a common skin disorder that contributes profound impact on patients' quality of life (QoL). However, the cause of the disease is not clear, and the treatment still faces challenges. To better evaluate the effectiveness of treatment, an effective questionnaire survey on quality of life is needed. For the first time in Italy, a new questionnaire for chronic spontaneous urticaria, the chronic urticaria quality of life questionnaire (CU-Q2oL), has been developed. The purpose of this study was to develop and verify the Chinese version of the chronic urticaria quality of life questionnaire (CU-Q2oL). Three hundred and twenty-eight chronic urticaria patients were prospectively recruited and evaluated by the translated Chinese version of CU-Q2oL along with the Dermatology Life Quality Index (DLQI). Factor analysis, internal consistency, convergent validity, sensitivity to change and known-group validity were determined. Multiple linear regressions were used to determine the predicting factors of CU-Q2oL results. Factor analysis revealed a six-dimensional structure, and five of the six scales showed good internal consistency. Convergent validity and know-group validity showed good correlations. It was found to distinguish well between patients with different levels of urticaria activity and those to be sensitive to change in the Chinese CU-Q2oL. Disease severity was highly significantly predictive of the CU-Q2oL score on all scales. The CU-Q2oL Chinese version is a valid, reliable and sensitive instrument. It can be widely adopted to evaluate treatment outcomes and be applied in clinical research in Chinese patients.

Knowledge, attitude and behaviour study on urticaria patients towards urticaria and diet

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Urticaria (‘hives’ or ‘nettle rash’) consists of blanchable, erythematous, edematous papules or wheals. These wheals vary in size from 1 mm to many centimetres, and are usually very itchy. They are caused by vasoactive mediators, predominantly histamine, released from mast cells. In majority of cases, the wheals are transient, lasting for only a few hours in any one place, but with new wheals appearing in other places. The aim of the study was to assess the knowledge, attitude and behaviour towards urticaria and diet among patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A cross sectional study was done among urticarial patients visiting DVL OPD at Sree Balaji medical college and hospital using self-reported questionnaire from January to February 2021. Questionnaire was designed in manner that general population can understand and was distributed randomly irrespective of gender. Sample size of 50 was taken.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The results of the study revealed that most of the patient had the knowledge about urticaria and were aware about their trigger factors. Regarding behaviour most of the patients were ready to do lifestyle modifications. Regarding attitude urticarial patient had no problems mingling with the normal people.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Urticaria is a relapsing condition with impact on quality of life. Specific elimination diets have observed high rates of response after a duration of 3 weeks. It has been confirmed that some patients experience worsening of symptoms after ingestion of foods including food additives as well as foods such as tomatoes, herbs, seafood, alcohol, and others.&lt;/p&gt;

Prevalence of chronic urticaria in a medical unit

To determine the prevalence of chronic urticaria in patients diagnosed with an allergic pathology; to know the most affected sex and age group. A descriptive, observational, and retrospective cross-sectional study. Clinical records of patients diagnosed with chronic urticaria in Unidad de Medicina Integral (Integrated Care Unit) of Tehuacan, Puebla were reviewed. They were selected by age, sex, and diagnosed allergic pathology. In the period of January 1st, 2015, to December 31st, 2020, 373 patients were diagnosed with chronic urticaria, with a prevalence of 10.5%. The average age of the population was 26.05 years. Women were the most prevalent, with 59.5% of the total studied population. The results reflect a prevalence of 10.5%, with a higher frequency in women at a ratio of 1.4: 1 with regard to males. The prevalence of chronic urticaria has increased significantly in recent years and especially in young patients (infants, preschoolers, and school-age children).

Plasma matrix metalloproteinase-9 level change with omalizumab treatment in chronic spontaneous urticaria.

Matrix metalloproteinase-9 (MMP-9) is an enzyme that contributes to inflammation and tissue remodelling. In chronic urticaria, increased plasma levels of MMP-9 and its correlation with disease severity have been shown in several studies, suggesting that MMP-9 could be used to evaluate the effects of new treatments. We aimed to compare MMP-9 levels in chronic urticaria patients with those of healthy patients. Then we planned to investigate the changes in plasma MMP-9 levels with chronic urticaria treatment, the role of this enzyme in demonstrating the efficacy of treatment, and its correlation with C-reactive protein (CRP). Forty-one patients with chronic urticaria who were scheduled for omalizumab treatment and 41 sex- and age-matched healthy volunteers were included in the study. In the patient group, before treatment and at the end of the 12th week, the urticaria activity score used for 7 consecutive days (UAS7) was calculated, and the MMP-9 and CRP levels were measured. Plasma MMP-9 levels were measured from venous blood in the control group. The plasma MMP-9 levels of the patients before treatment were significantly higher than those of the control group (P<.01). In the patient group, there was no significant relationship between the UAS7 score and the MMP-9 and CRP levels before treatment. The UAS7 values were 28±7 before omalizumab treatment and 5±6 at the end of the 12th week (P<.0001). The post-treatment MMP-9 levels (1818±297pg/mL) were higher compared with the pre-treatment values (1617±380) (P<.05). The post-treatment CRP levels of the patients (2.41±2.17mg/L) were lower than their pre-treatment CRP levels (8.20±19.70) (P<.05). MMP-9 levels were not associated with the severity of disease, and MMP-9 levels were not decreased with treatment response. Therefore, MMP-9 cannot be used as a parameter of disease activity in chronic urticaria or to evaluate the efficacy of new treatments.

Gender Variations in Pharmacokinetics of Paracetamol in Hausa/Fulani Ethnic group in Northwest Nigeria - A Two-stage Approach.

Background:Paracetamol is one of the most commonly used drugs worldwide and has been linked to drug-related liver damage, even when taken at recommended doses. Ingesting the upper limit of recommended doses of the drug produced a doubling of mortality when compared to not taking the drug. Acetaminophen ingestion has been implicated in the development of angioedema, the exasperation of asthma, and urticaria in patients with aspirin intolerance.Aim:This study aimed at assessing gender variations in the pharmacokinetics of paracetamol in Hausa/Fulani, the most populous ethnic group in Nigeria and determines a possibility of toxicity in the group.Methods:It was an exploratory study involving twenty participants selected by criterion sampling who satisfied inclusion criteria. They were fasted 11-h preceding acetaminophen administration to 3 h after administration. A single dose of acetaminophen, 1 g orally with 300 ml of distilled water, was administered at 8 A. M. Blood was obtained before the administration and 15, 30, and 45 min, and 1, 2, 3, 4, 5, and 6 h after the administration. Acetaminophen plasma concentrations were determined by validated reverse-phase high-performance liquid chromatography Food and Drug Administration guidelines.Results:Six out of 19 (31.6%) participants have higher than maximum therapeutic plasma concentration (>20 μg/ml). Pharmacokinetics parameters were higher in males except for clearance and volume of distribution.Conclusion:Clearance from the plasma tends to be more for females than their male counterparts. A good proportion of Hausa/Fulani is prone to acetaminophen toxicity at a therapeutic dose.

The level of anti-thyroperoxidase antibodies in chronic urticaria patients

Abstract Introduction Chronic urticaria is a skin disorder characterized by swollen pruritic plaques and papules last long at least for 6-weeks. The aim of this study is to determine the anti TPO level in patients diagnosed with chronic urticaria, resistant to conventional treatments in order to test the possibility of thyroid hormone replacement with the aim of accelerating healing process. Materials and methods In this case-control study, 63 patients with chronic urticarial and 63 controls without chronic urticarial were studied bye anti TPO measurement.Anti TPO level upper than 40 IU/ has been recognized as positive. Results The prevalence of chronic urticaria among the case group was 3.5 times higher in women rather than men. Mean age of patients who have been diagnosed with chronic urticaria was 40.52±15.12 years. Mean Time of disease period was about 21.40±3.75 months. In this study, there has been no statistically significant association between age, Sex, TSH level and anti TPO concentration in both groups. Conclusion Anti TPO level in patients with chronic urticaria was not significantly different from the control group. However, Anti-TPO levels were significantly higher in patients with longer duration of disease.