The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria.

This evidence- and consensus-based guideline was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. The conference was held on 1 December 2016. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-founded network of excellence, the Global Allergy and Asthma European Network (GA²LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO) with the participation of 48 delegates of 42 national and international societies. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria are disabling, impair quality of life and affect performance at work and school. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.

The definition, diagnostic testing, and management of chronic inducible urticarias - The EAACI/GA(2) LEN/EDF/UNEV consensus recommendations 2016 update and revision.

These recommendations for the definition, diagnosis and management of chronic inducible urticaria (CIndU) extend, revise and update our previous consensus report on physical urticarias and cholinergic urticaria (Allergy, 2009). The aim of these recommendations is to improve the diagnosis and management of patients with CIndU. Our recommendations acknowledge the latest changes in our understanding of CIndU, and the available therapeutic options, as well as the development of novel diagnostic tools.

Definition, aims, and implementation of GA(2) LEN Urticaria Centers of Reference and Excellence.

BACKGROUND: GA²LEN, the Global Allergy and Asthma European Network, has recently launched a program for the development, interaction, and accreditation of centers of reference and excellence in special areas of allergy embedded in its overall quality management of allergy centers of excellence. The first area chosen is urticaria. Urticaria is a common and debilitating condition and can be a challenge for both patients and treating physicians, especially when chronic. Centers of reference and excellence in urticaria (UCAREs) can help to improve the management of hard-to-treat conditions such as urticaria. AIMS: Here, we describe the aims, the requirements and deliverables, the application process, and the audit and accreditation protocol for GA²LEN UCAREs. RESULTS: The main aims of GA²LEN UCAREs are to provide excellence in urticaria management, to increase the knowledge of urticaria by research and education, and to promote the awareness of urticaria by advocacy activities. To become a certified GA²LEN UCARE, urticaria centers have to apply and fulfill 32 requirements, defined by specific deliverables that are assessed during an audit visit. DISCUSSION AND CONCLUSION: The GA²LEN UCARE program will result in a strong network of urticaria specialists, promote urticaria research, and harmonize and improve urticaria management globally.

Differences in chronic spontaneous urticaria between Europe and Central/South America: results of the multi-center real world AWARE study.

BACKGROUND: Global chronic urticaria (CU) disease experience and management is not well documented. This study descriptively compares these aspects among CU patients residing in Europe (EU) and Central and South America (C/SA). METHODS: AWARE (A World-wide Antihistamine-Refractory chronic urticaria patient Evaluation) is a global prospective, non-interventional study of CU in the real-world setting. Patients were ≥ 18 years with a diagnosis of H1-antihistamine-refractory CU for > 2 months. Differences between the EU and C/SA regions in demographic and clinical characteristics, quality of life (QoL), work and activity impairment, pharmacological treatment, and healthcare resource use were examined. RESULTS: In total, 4224 patients were included in the analysis (C/SA 492; EU 3732). Rates of untreated patients were greater in the C/SA region (45.1% vs. 31.9%; P < 0.005) and escalation to third-line therapy was rare in both regions. Differences in disease experience emerged, with C/SA patients more commonly experiencing angioedema (C/SA 50.8% vs. EU 46.1%; P = 0.03) or comorbid chronic inducible urticaria (C/SA 30% vs. EU 22%; P < 0.001). Correspondingly, rates of uncontrolled urticaria were higher among C/SA patients (82.8% vs. 77.5%; P = 0.017) and patients in the C/SA region showed significantly greater work and activity impairment (absenteeism: 10.4 ± 19.7 vs. 6.7 ± 19.0, P = 0.004; presenteeism: 30.3 ± 31.9 vs. 24.4 ± 25.8, P = 0.001; work productivity loss: 33.9 ± 33.9 vs. 26.5 ± 27.5, P < 0.001; activity impairment: 37.7 ± 34.7 vs. 32.7 ± 30.1, P = 0.001). However, QoL impairment was greater in the EU region (Dermatology Life Quality Index: C/SA 6.5 ± 5.9 vs. EU 8.3 ± 7.0; P < 0.001). There was a significant difference in use of healthcare resources, including emergency services (39.6% vs. 29.3%; P < 0.001), hospitalization (7.7% vs 21.9%; P < 0.001) general practitioners (31.7% vs 57.3%; P < 0.001), and additional allergists or dermatologists (50.6% vs. 47.3%, P < 0.001), among patients in the C/SA and EU region, respectively. In both regions, patients with a primary diagnosis of CU with angioedema had significantly greater impairment in work and non-work activities and healthcare resource utilization compared to those without angioedema. CONCLUSIONS: This study revealed that CU is a heterogeneous condition with differences in healthcare utilization and outcomes between EU and C/SA. However, overall there is a high unmet need of H1-antihistamine-refractory CU patients, which is associated with high use of healthcare resources, and has a large negative effect on QoL and work productivity.

[The efficacy of conservative and surgical methods of treating periodontitis in patients with chronic obstructive bronchitis]. / Effektivnost' konservativnogo i khirurgicheskogo metodov lecheniia periodontita u bol'nykh khronicheskim obstruktivnym bronkhitom.

The effectiveness of drug and surgical treatments for chronic destructive types of periodontitis was examined in 64 patients with chronic obstructive bronchitis by using clinical, X-ray, and immunological data. The findings suggest that surgical management is more preferable for treating prolonged destructive periodontitis in patients with chronic bronchitis.

[Increased resistance of (CBAxC57BL/6)Fl hybrids to the graft-versus-host reaction during spleen regeneration]. / Povyshenie rezistentnosti gibridov (CBAxC57BL/6)Fl k sistemnoi reaktsii transplantat protiv khoziaina usloviiakh regeneratsii selezenki.

Partial splenectomy was performed in CBAXXC57BL/6/F1 hybrids 2, 12, 15 and 20 days before the graft-versus-host reaction induction (GVHR) and 2, 10 days after administration of parenteral immunocompentent cells. The recipients with the intact spleen or complete splenectomy and sham operated recipients served as control. Hybrids with the regenerating spleen were more resistant to GVHR within 12 days of regeneration, while splenectomy increased hybrid resistance to GVHR only when performed 2 days before or 2 days following the GVHR induction.

[Effect of hemopoietic regeneration on the course of a systemic "graft vs host" reaction]. / Izuchenie vliianiia regeneratsii krovetvoreniia na techenie sistemnoi reaktsii "transplantat protiv khoziaina".

Acute hemorrhage of varying severity was produced in (CBA x C57BL/6)F1 hybrids. Then it was followed by the induced systemic graft-versus-host reaction (GVHR). The increased intensity of the hemorrhage made the course of the systemic GVNR more severe. The 10th day after GVHR induction no significant differences were found in the peripheral blood of experimental or control animals. However, the hybrids demonstrated a significant rise in the number of exogenic stem cells in the spleens during hemopoietic regeneration and diminution of the immunocompetence of splenic T cells.

[Secondary immunodeficiency and its myelopid correction in patients with infiltrative and disseminated pulmonary tuberculosis]. / Vtorichnaia immunnaia nedostatochnost' i ee korrektsiia mielopidom u bol'nykh infil'trativnym i disseminirovannym tuberkulezom legkikh.

The immunity of patients with infiltrative and disseminated pulmonary tuberculosis may be characterized as secondary immunodeficiency by the T-cell type and neutrophilic phagocytic activity. Myelopid has a stimulating effect on the humoral and cellular immunities, restores the baseline reduced functional parameters of neutrophilic activity.