Combined differentiated therapy in patients with urticaria.

OBJECTIVE: Introduction: The necessity of the study of urticaria is called for by its high specific gravity in the structure of dermatoses, lack of effective therapies and, consequently, negative impact on the quality of life of patients and members of their families. Among the factors that initiate clinical manifestations of urticaria are autoimmune disorders, diseases of the gastrointestinal tract, nervous system, bacterial and viral infections, helminth infestation. However, the state of the internal secretion glands in such patients is understudied. Although, it is recognised that thyroid gland plays an important role in the development of allergic dermatitis, but its role in the formation of autoimmune processes at urticaria is still unclear. Such diversity of mechanisms of urticaria development considerably complicates the choice of rational ways of effective therapy. In particular, traditional agents (antihistamine and other hyposensitizing ones) often do not have the desired effect. Due to such complicated current condition of treatment of patients with urticaria, non-medicated methods of treatment seem to be getting more and more prospective. The aim:To develop differentiated treatment of urticaria patients, taking into account the functional state of the thyroid gland and its participation in the formation of autoimmune processes. PATIENTS AND METHODS: Materials and methods: We had been supervising 127 patients with chronic idiopathic urticaria (49 men and 78 women) of the age range from 15 to 67 years old with the disease duration from 5 months to 29 years. The control group consisted of 20 healthy individuals. The mild degree of severity of dermatosis was diagnosed in 43 (33.9%) patients, the average degree of the disease severity - in 41 (32.2%), and severe form of the disease was observed in 43 (33.9%) patients. The functional state of thyroid gland was evaluated by determining the level of thyroxine, triiodothyronine, thyroglobulin, and autoantibodies to thyroperoxidase and thyroglobulin in serum. RESULTS: Results: It was discovered that in patients with urticaria, dysfunctional state of thyroid gland is observed, which is manifested by a probable increase in thyroxine content up to 107.52±4.20 nmol/l (in healthy individuals - 78.13±3.65 nmol/l; p<0.05) and thyroglobulin - up to 29.73±2.51 ng/ml (in healthy individuals - 20.16±1.34 ng/ml; p<0.05), which is associated with a decrease in the level of triiodothyronine - up to 1.33±0.06 nmol/l (in healthy individuals - 1.52±0.04 nmol/l; p<0.05). In order to evaluate the effectiveness of this approach, all patients were divided into 4 groups. The first group, with the total amount of 32 patients were prescribed only traditional standard treatment, according to the guidelines. The pations of second group (31 patients) were prescribed specific phototherapy (once a week, 6-8 sessions) after traditional medication and afterward absence of clinical manifestations of pathological process. 31 рatients of the third group were prescribed balneo- and halotherapy after traditional medication and no afterward clinical manifestations of urticaria. The fourth group (33 patients) prescribed combined treatment in the way of combined application of specific therapy, phototherapy, balneotherapy and halotherapy, after the elimination of clinical manifestations of dermatosis by means of 2 month traditional medication. It was established that patients with mild dermatosis were exposed to a probable correction of the functional state of the thyroid gland, improved clinical course and quality of life after medication, balneo- and halomethods of treatment, patients with moderate and severe degree - after combined application of medication, specific photo-, balneoand halotherapy. CONCLUSION: Conclusions: Thus, the therapy of patients with urticaria requires a differentiated approach. Patients with mild dermatosis, after traditional medication, should be prescribed balneo- and halomethods of treatment. Patients with moderate to severe degree of the disease require more intensive medical intervention. They should be prescribed a combined application of specific photo-, balneo- and halotherapy. This approach allows eliminating the pathological process.

Efficacy of autologous whole blood or serum therapy for chronic spontaneous urticaria: a systematic review and meta-analysis.

Background: Chronic spontaneous urticaria (CSU) is chronic wheals without identifiable exogenous stimuli. Autologous whole blood (AWB) injection and autologous serum therapy (AST) are alternative therapies for CSU that induce tolerance to circulating histamine-releasing factors. Objective: We elucidated currently available evidence for the efficacy and safety of AWB therapy and AST for CSU. Methods: We systematically searched four databases for eligible studies to perform meta-analysis. The primary outcome was the efficacy of AST or AWB therapy, and the secondary outcome was improvement after intervention based on the autologous serum skin test (ASST) status of patients. Results: Eight clinical trials, including four randomized controlled trials and 529 CSU patients, were identified. AST was not more effective than the placebo treatment in alleviating CSU symptoms at the end of treatment (p = .161), and AWB injection was also not more effective in response rates than the placebo at the end of follow-up (p = .099). Furthermore, the efficacy of AST or AWB injection for CSU and the ASST status were not significantly related. No remarkable adverse events were recorded during therapy. Conclusions: Our meta-analysis suggested that AWB therapy and AST are not significantly more effective in alleviating CSU symptoms than the placebo treatment.

Omalizumab in patients with chronic spontaneous urticaria nonresponsive to H1-antihistamine treatment: results of the phase IV open-label SUNRISE study.

BACKGROUND: Omalizumab is approved as an add-on therapy for the treatment of chronic spontaneous urticaria (CSU) in patients with inadequate response to H1-antihistamine treatment. The urticaria control test (UCT) is a reliable, concise tool developed as an alternative to the 7-day urticaria activity score (UAS7) - the standard for CSU disease activity assessment. OBJECTIVES: This prospective, open-label, phase IV study evaluated the efficacy and safety of omalizumab in French adult patients with CSU nonresponsive to H1-antihistamine treatment. MATERIALS AND METHODS: Patients [n = 136; stratified 1 : 2 (with angio-oedema : without angioedema)] received omalizumab 300 mg subcutaneously every 4 weeks for 12 weeks. Study assessments included UCT, UAS7, angio-oedema activity score and d-dimer levels (exploratory objective). RESULTS: At Week 12, 74·6% of the patients achieved disease control [UCT score ≥ 12 (primary endpoint)] and 67·7% of patients showed well-controlled disease (UAS7 ≤ 6). There was a strong negative correlation between UCT score and UAS7 at Week 12 (Spearman's correlation coefficient -0·839). Mean plasma d-dimer concentration was elevated at baseline (1002·1 ng mL-1 ) and decreased notably at Week 8 (455 ng mL-1 ). Among the nine patients with a very high baseline d-dimer concentration (> 3000 ng mL-1 ), eight were responders (UAS7 ≤ 6) at Week 12. CONCLUSIONS: Omalizumab was efficacious in patients with CSU nonresponsive to H1-antihistamines. The UCT was a reliable tool for disease assessment and the scores correlated well with UAS7. This study does not support the usefulness of d-dimer to monitor long-term disease prognosis in adult urticaria; however, it may indicate patients who respond to omalizumab.

Urticaria solar. Epidemiología y fenotipos clínicos en una serie española de 224 pacientes / Solar urticaria: epidemiology and clinical phenotypes in a Spanish series of 224 patients

ANTECEDENTES: La urticaria solar es una urticaria crónica inducible física clasificada también como fotodermatosis idiopática. El objetivo de este trabajo es definir las características fenotípicas y valorar su incidencia. MATERIAL Y MÉTODO: Estudio multicéntrico retrospectivo en el que recogen datos epidemiológicos, características clínicas, fotobiológicas, analíticas y terapéuticas. RESULTADOS: Se ha incluido a 224 pacientes procedentes de 9 Unidades de Fotobiología. La distribución por sexos correspondió a 141 mujeres y 83 varones con una edad media al diagnóstico de 37,9 ańos (rango 3-73). El 26,7% presentaba antecedentes de atopia, con la rinitis alérgica como la manifestación más frecuente (16,5%). Un 75,9% de los pacientes refería clínica solo en zonas fotoexpuestas. El espectro implicado con más frecuencia fue la luz visible aisladamente (31,7%). En el 21% la urticaria solar solo fue posible desencadenarla con luz natural. El tratamiento más empleado por los expertos fueron los antihistamínicos por vía oral (65,46%) seguido por diferentes modalidades de fototerapia (34%). La resolución completa se observó con mayor frecuencia en urticaria solar desencadenada exclusivamente por luz visible o luz natural, con diferencias estadísticamente significativas (p < 0,05) con respecto a otras longitudes de onda. No se observa un incremento de la incidencia anual. CONCLUSIONES: Presentamos la serie de urticaria solar más larga hasta ahora publicada. Las características epidemiológicas, clínicas y fotobiológicas confirman los datos ya conocidos, aunque en nuestra serie destaca un alto índice de fototest negativos. La reactividad exclusiva a luz visible o luz natural se asocia a mayores probabilidades de resolución. No se observa una tendencia al aumento en la incidencia anual

BACKGROUND: Solar urticaria is a chronic inducible urticaria also classified as an idiopathic dermatosis. The objective of this paper is to define the phenotypic characteristics of solar urticaria and to evaluate its incidence. Material and method. This was a retrospective multicenter study in which data were gathered on the epidemiology and clinical, photobiologic, laboratory, and therapeutic characteristics of solar urticaria. RESULTS: A total of 224 patients (141 women and 83 men) were included from 9 photobiology units. The mean age of the patients was 37.9 years (range, 3-73 years). A history of atopy was detected in 26.7%, and the most common presentation was allergic rhinitis (16.5%). Clinical signs were limited to sun-exposed areas in 75.9% of patients. The light spectrum most commonly implicated was visible light only (31.7%), and in 21% of cases it was only possible to trigger solar urticaria with natural light. The treatments most widely used by photobiology experts were oral antihistamines (65.46%), followed by different forms of phototherapy (34%). Complete resolution was observed most often in patients with solar urticaria triggered exclusively by visible or natural light, with statistically significant differences with respect to other wavelengths (P<.05). No increase in the annual incidence of solar urticaria was observed. CONCLUSIONS: We have presented the largest series of solar urticaria published to date. The epidemiological, clinical, and photobiologic findings confirm previously reported data, although there was a particularly high rate of negative phototests in our series. Reactivity exclusively to visible or natural light was associated with a higher probability of resolution. No increasing trend was observed in the annual incidence

Bariatric Surgery: A Novel Risk Factor for Food Allergy?

In this case report, we describe a birch pollen-allergic patient in whom a Fobi pouch gastric bypass was associated with the transition from a mild, localized, birch pollen-related oral allergy syndrome to more severe, generalized allergic reactions to peach.

Solar urticaria: Epidemiology and clinical phenotypes in a Spanish series of 224 patients. / Urticaria solar. Epidemiología y fenotipos clínicos en una serie española de 224 pacientes.

BACKGROUND: Solar urticaria is a chronic inducible urticaria also classified as an idiopathic dermatosis. The objective of this paper is to define the phenotypic characteristics of solar urticaria and to evaluate its incidence. MATERIAL AND METHOD: This was a retrospective multicenter study in which data were gathered on the epidemiology and clinical, photobiologic, laboratory, and therapeutic characteristics of solar urticaria. RESULTS: A total of 224 patients (141 women and 83 men) were included from 9 photobiology units. The mean age of the patients was 37.9 years (range, 3-73 years). A history of atopy was detected in 26.7%, and the most common presentation was allergic rhinitis (16.5%). Clinical signs were limited to sun-exposed areas in 75.9% of patients. The light spectrum most commonly implicated was visible light only (31.7%), and in 21% of cases it was only possible to trigger solar urticaria with natural light. The treatments most widely used by photobiology experts were oral antihistamines (65.46%), followed by different forms of phototherapy (34%). Complete resolution was observed most often in patients with solar urticaria triggered exclusively by visible or natural light, with statistically significant differences with respect to other wavelengths (P<.05). No increase in the annual incidence of solar urticaria was observed. CONCLUSIONS: We have presented the largest series of solar urticaria published to date. The epidemiological, clinical, and photobiologic findings confirm previously reported data, although there was a particularly high rate of negative phototests in our series. Reactivity exclusively to visible or natural light was associated with a higher probability of resolution. No increasing trend was observed in the annual incidence.

The Effect of Autologous Serum Therapy on Disease Severity in Patients with Chronic Urticaria.

Limited evidence has been obtained concerning the beneficial effects of autologous serum therapy in treatment of skin disorders particularly chronic urticaria. In the present study, we have assessed the effect of this treatment method in patients with chronic urticaria (CU). This randomized single-blind controlled trial was performed on fifty consecutive patients with chronic urticaria. The patients were randomly assigned to receive autologous serum (as the case group, n=35) or normal saline (as the control group, n=15) and treated with monthly autologous serum therapy or normal saline for 6 months. The considered study endpoint was changes in total severity score (TSS) at the 6 months follow-up visit. The TSS score was assessed at baseline as well as at the ninth week and the sixth month of interventions. The mean±SD of TSS at the ninth week of intervention was 10.94±3.92 in autologous serum therapy group and 11.67±2.72 in the normal saline group (p=0.458). Furthermore, the mean values of TSS at the sixth month of treatment in the study groups were 8.29±6.29 and 9.27±4.89 respectively (p=0.593). A downward trend in TSS, from baseline to the end of treatment, was seen in the case and control groups (p<0.001 for both), however the trend of this decline was insignificant between the two groups (p=0.592). The change in the trend of TSS after 6 months of treatment was independent from the administration of autologous serum when compared with normal saline administration (beta=-0.962, p=0.630). Multivariate linear regression model with the presence of baseline factors including gender, age, disease duration and history of atopy was performed to assess difference in TSS at six-month follow-up visit compared with the baseline value. Only young age was associated with more reduction of TSS (beta=0.163, p=0.023). We found no difference in the effects of autologous serum therapy and normal saline on the trend of the changes in disease severity in patients with chronic urticaria.

Urticaria acuagénica / Aquagenic urticaria

Presentamos el caso de una mujer de 30 años con urticaria acuagénica; también su madre presenta el mismo diagnóstico. La urticaria acuagénica es una forma rara de urticaria física que cursa con habones que afectan generalmente la parte superior del cuerpo. Es importante hacer diagnóstico diferencial con otros tipos de urticaria. La etiopatogenia no está clara. Los antihistamínicos mejoran la clínica. (AU)

The present is the case of a 30 year-old woman with aquagenic urticaria; her mother has the same diagnosis. Aquagenic urticaria is a rare form of physical urticaria which causes wheals that usually affect the upper body. Differential diagnosis with other types of urticaria is important. Etiopathogenesis is not well known. Treatment with antihistamines improves clinical attention (AU)

[VISIBLE LIGHT AND HUMAN SKIN (REVIEW)].

Biological effect of a visible light depends on extend of its property to penetrate into the tissues: the greater is a wavelength the more is an effect of a radiation. An impact of a visible light on the skin is evident by wave and quantum effects. Quanta of a visible radiation carry more energy than infrared radiation, although an influence of such radiation on the skin is produced by the light spectrum on the boarder of the ultraviolet and the infrared rays and is manifested by thermal and chemical effects. It is determined that large doses of a visible light (405-436 nm) can cause skin erythema. At this time, the ratio of generation of free radicals in the skin during an exposure to the ultraviolet and the visible light range from 67-33% respectively. Visible rays of 400-500 nm length of wave cause an increase of the concentration of oxygen's active form and mutation of DNA and proteins in the skin. The urticaria in 4-18% of young people induced by photodermatosis is described. As a result of a direct exposure to sunlight photosensitive eczema is more common in elderly. Special place holds a hereditary disease - porphyria, caused by a visible light. In recent years, dermatologists widely use phototherapy. The method uses polychromatic, non-coherent (wavelength of 515-1200 nm) pulsating beam. During phototherapy/light treatment a patient is being exposed to sunlight or bright artificial light. Sources of visible light are lasers, LEDs and fluorescent lamps which have the full range of a visible light. Phototherapy is used in the treatment of acne vulgaris, seasonal affective disorders, depression, psoriasis, eczema and neurodermities. LED of the red and near infrared range also is characterized by the therapeutic effect. They have an ability to influence cromatophores and enhance ATP synthesis in mitochondria. To speed up the healing of wounds and stimulate hair growth light sources of a weak intensity are used. The light of blue-green spectrum is widely used for the treatment of neonatal hyperbilirubinemy. A photodynamic therapy takes a special place. The third generation of the blue (410 nm), yellow (595 nm) and red photosensitors are used. Photodynamic therapy is used in the treatment of cancer as well.

Retrospective chart review in a cohort of patients with urticarial dermatitis.

Urticarial dermatitis is a poorly understood skin condition while it seems to be much more common than the paucity of reports suggest. It manifests with severely pruritic papules and plaques that resemble eczematous and urticarial lesions morphologically. The key clues to diagnosis are the urticarial appearance and overlap with an eczematous reaction. Here, we present a series of 19 cases (13 women and six men) with urticarial dermatitis clinically and histologically. The patients' average age was 58 and most of the cases were idiopathic. Trunk and proximal extremities were the most common sites involved followed by the distal extremities. Poor response to potent topical corticosteroids and antihistamines was usual and many patients required oral prednisone or other immunosuppressant agents or phototherapy.

Urticaria crónica / Chronic urticaria

La urticaria crónica (VC), es una variante común de la urticaria que se define como un síndrome reactivo de la piel y mucosas caracterizado por la presencia de placas eritematosas, habones o ronchas edematosas y pruriginosas que se prolonga durante más de seis semanas. La etiología de la VC no es muy clara en la mayoría de los casos, multitud de causas se han implicado. La patogenia es compleja. El conocimiento y estudio de cada uno de los factores celulares y solubles, su interacción dinámica, vías efectoras y trama de citoquinas conducirá al logro de una terapéutica efectiva y racional de la urticaria crónica.

Chronic urticaria (VC) is a common variant of urticaria which is defined as a reactive skin and mucous membranes syndrome characterized by the presence of plaques erythematous, wheals, or swollen and itchy hives that lasts more than six weeks. The etiology of the VC is not very clear in the majority of cases, multitude of causes have been implicated. The pathogenesis is complex. Knowledge and study of each cell and soluble factors, their dynamic interaction, effector pathways and cytokines plot will lead to the achievement of an effective and rational therapy of chronic urticaria.

[Influence of penetrative needling of Shendao (GV 11) on the symptom score and serum IgE content in chronic urticaria patients].

OBJECTIVE: To observe the changes of symptom scores and serum IgE level after treatment with thick-needle subcutaneous penetration of Shendao (GV 11) in chronic urticaria patients. METHODS: A total of 60 chronic urticaria patients were randomly divided into acupuncture group (n = 30) and medication group (n = 30). Subcutaneous penetrative needling was applied to GV 11 with thick acupuncture needle (retained for 4 h/time, once daily, 5 times/week) for patients of acupuncture group and Levocetirizine Hydrochloride tablets (5 mg/time, once daily in the first two weeks, then, once every other day in the 3rd and 41th weeks, and once every 3 days in the last two weeks) were given to patients of medication group. Serum IgE content was assayed before and 2,6, 12 weeks after the treatment by chemiluminescent technique. Symptom scores were obtained by "0-3 four levels assessment" method in the light of the size of the wheal and the itching severity. RESULTS: Self-comparison indicated that the symptom scores and serum IgE levels declined significantly (P < 0.01) 2 and 6 weeks (Wks) after the treatment in both acupuncture and medication groups,and 12 Wks after the treatment in the acupuncture group (P < 0.01). Comparison between two groups showed that the symptom score and serum IgE content of acupuncture group were significant lower than those of medication group 12 Wks after the treatment (P < 0.05). No significant differences were found between two groups in the symptom scores and serum IgE levels before, 2 and 6 Wks after the treatment (P > 0.05). A positive correlation exists between the symptom score and the serum IgE level before and after the treatment in both groups. CONCLUSION: Thick-needle subcutaneous penetration of Shendao (GV 11) can effectively improve clinical symptoms of chronic urticaria patients, which may be closely related to its effect in lowering peripheral blood IgE level.

Intrafamilial variable phenotypic expression of a CIAS1 mutation: from Muckle-Wells to chronic infantile neurological cutaneous and articular syndrome.

Among hereditary inflammatory disorders, Muckle-Wells syndrome, chronic infantile neurological cutaneous and articular syndrome (CINCA), and familial cold urticaria have recently been shown to be caused by dominantly inherited mutations in the CIAS1 gene. Reports suggest that these 3 diseases result from distinct missense mutations, with very few overlapping symptoms. We describe a French family presenting an intrafamilial overlapping clinical phenotype of CINCA and Muckle-Wells syndrome, caused by a mutation in CIAS1 gene. Clinical and genetic observations suggest that Muckle-Wells syndrome, CINCA, and familial cold urticaria are various phenotypic expressions of the same disease.

Desloratadine in combination with montelukast in the treatment of chronic urticaria: a randomized, double-blind, placebo-controlled study.

BACKGROUND: Chronic urticaria (CU) is a common skin condition. It is frequently a disabling disease due to the persistency of clinical symptoms, the unpredictable course and negative influence on the quality of life. OBJECTIVE: The aim of this study is to determine whether montelukast, a LTD4 receptor antagonist, plus desloratadine, is more efficacious than desloratadine alone in the treatment of chronic urticaria. MATERIALS: A randomized, double-blind, placebo-controlled study was conducted on 81 patients with a diagnosis of CU. A 1-week single-blind placebo run-in period (baseline) was followed by a 6-weeks double blind active treatment period. The patients were randomized to receive the following treatment once daily: (a) oral desloratadine (5 mg) plus placebo; (b) desloratadine (5 mg) plus montelukast (10 mg); (c) oral placebo alone. The study ended after another 1-week single-blind placebo washout period. RESULTS: The evaluable population thus consisted of 76 patients. Both desloratadine alone and desloratadine plus montelukast administered once daily yielded improvements with respect to the baseline assessment as regards pruritus, number of separate episodes, size and number of weals, visual analogue score and patients' quality of life and with respect to the placebo group both in the active treatment period and in the run-out period. However, desloratadine plus montelukast was shown to improve the symptoms and patients' quality of life significantly more than desloratadine alone, although it did not have a significant effect on the number of urticarial episodes. CONCLUSION: The combination of desloratadine plus montelukast is effective in the treatment of CU. It may therefore be a valid alternative in patients with relatively mild CU, in view of its efficacy and the lack of adverse events.