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1.
PLoS One ; 15(10): e0239962, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33022026

RESUMO

Chronic urticaria causes a significant limitation to quality of life. In the literature, various studies can be found that have reviewed several clinical and laboratory markers, but none of these variables alone is sufficient to predict the patient's prognosis. In this study, we present a protocol to develop a prognostic model that can predict the clinical response of urticaria patients to antihistamines. This is a protocol for a bidirectional cohort study. Urticaria data will be routinely collected from a population of patients over 18 years old. A full multivariable logistic regression model will be fitted, following five steps: 1) Selection of predictive variables for the model; 2) Evaluation of the quality of the collected data and control of lost data; 3) Data statistical management; 4) Strategies to select the variables to include at the end of the model; 5) Evaluation of the performance of the different possible models (predictive accuracy) and selection of the best model. The performance and internal validation of the model will be assessed. Some clinical and paraclinical variables will be measured for further exploration.


Assuntos
Urticária Crônica/tratamento farmacológico , Antagonistas dos Receptores Histamínicos/uso terapêutico , Modelos Logísticos , Adolescente , Adulto , Urticária Crônica/epidemiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Prognóstico , Estudos de Validação como Assunto , Adulto Jovem
3.
Acta Parasitol ; 65(1): 90-96, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31602552

RESUMO

BACKGROUND: Blastocystis is a parasite that colonizes in the human intestine. Its clinical features include diarrhea, abdominal pain, or urticarial and irritable bowel syndrome (IBS). Spite of being significant genetic diversity and numerous subtypes within the genus there were no associations between its subtypes and symptomatology. MATERIALS AND METHODS: Aim of this project was subtyping of the protozoa in 184 Iranian people with history of IBS/IBD (n = 74) or chronic urticaria (n = 59) and individuals referred to general clinic (n = 51). Microscopic and molecular examinations used for identifying and subtyping of Blastocystis. RESULTS: Overall, frequency of the parasite was 24.46% while, 29.41% of people who referred to general clinic, 20.27%, and 25.42% of IBS/IBD and urticarial cases were infected, respectively. Subtyping result showed that 28.89% of all people were infected with Blastocystis sp. while the prevalence of ST3, ST2 and ST1 were 22.22%, 22.22%, and 17.78%, respectively. Blastocystis sp., was identified in most IBS/IBD cases (46.7%) followed with ST2 and ST3 (13.3 and 13.3, respectively). Whereas, in chronic urticaria group ST2(33.3%) was the major subtype and most individuals in control group were infected with ST3 (33.3%). Pearson's Chi Square test showed no significant differences between the parasite or subtype prevalence and diseases (p > 0.05). CONCLUSION: Given significant factors have effect on clinical signs including host or parasite genetics, microbiota, as well as environmental factors, it seems that further studies are needed to find out different markers of host susceptibility to diverse parasite genotypes in patients with irritable bowel syndrome or urticaria.


Assuntos
Blastocystis/classificação , Blastocystis/genética , Urticária Crônica/parasitologia , Doenças Inflamatórias Intestinais/parasitologia , Síndrome do Intestino Irritável/parasitologia , Infecções por Blastocystis/epidemiologia , Infecções por Blastocystis/parasitologia , Urticária Crônica/epidemiologia , Fezes/parasitologia , Variação Genética , Genótipo , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Irã (Geográfico)/epidemiologia , Síndrome do Intestino Irritável/epidemiologia , Filogenia , Prevalência , Análise de Sequência de DNA
4.
Artigo em Inglês | MEDLINE | ID: mdl-30264742

RESUMO

Background: Urticaria is a common dermatosis affecting approximately 25% of the population. Childhood chronic urticaria is frequently encountered, however, epidemiologic data on pediatric urticaria are limited. Aim: The objective of this study was to study the clinico-epidemiological profile of children with chronic urticaria. Methods: A retrospective study including children less than 14 years with chronic urticaria was conducted from January 2010 to December 2015. Detailed history, clinical examination, investigation results, treatment taken, and follow-up details were recorded on a prefixed proforma. As per the practice of the urticaria clinic, the children were investigated only in case of inadequate therapeutic response or had features of atopy/autoimmune disorders. Results: Two hundred and ninety-six children (166 boys, 130 girls; mean age, 11.3 years) with chronic urticaria were included in the study. Urticaria was spontaneous in onset in 57.1% (169) children; precipitating factors were reported in 42.9% children, most common being physical factors, food allergy, drug intake and infections. Investigations were done in 48 (16.2%) patients; Antinuclear antibody was negative in all patients, raised serum IgE in 20/48 (41.6%), positive autologous serum skin test in 32/48 (66.6%) and raised anti-TPO titre in 10/48 (20.8%) children. A diagnosis of chronic spontaneous urticaria was made in 245 (82.77%) children, chronic dermographic urticaria in 35 (11.82%), cholinergic urticaria and drug-induced urticaria in 5 (1.69%) each, aquagenic urticaria in 4 (1.35%) and cold-induced urticaria in 2 (0.68%) children. Two hundred and fifteen (72.6%) children responded to nonsedating antihistamines alone, 61 (20.6%) required addition of a sedating antihistamine, 7 (0.02%) required addition of montelukast, 3 (0.01%) ranitidine and 10 (20.8%) required a short course of oral corticosteroids to control acute flare. None of the patients required any long-term immunomodulatory or immunosuppressive agent. The mean duration of treatment required was 3 to 12 months. Limitations: The main limitation is the study being retrospective in nature with associated drawbacks of data loss. In addition, we did not use objective scoring system such as urticaria severity score and not all children were extensively investigated. Conclusions: Chronic spontaneous urticaria is the most common type of chronic urticaria in children. Majority of these children can be managed conservatively with long-term antihistamines.


Assuntos
Urticária Crônica/epidemiologia , Adolescente , Criança , Urticária Crônica/diagnóstico , Urticária Crônica/terapia , Feminino , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Índia , Masculino , Estudos Retrospectivos , Atenção Terciária à Saúde
5.
Medicine (Baltimore) ; 98(49): e18059, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804312

RESUMO

Chronic urticaria has a high economic burden and reduces patient's quality of life. Nurses experience insomnia because of their shifting work, especially if they work night shifts and 3-shift rotational schedules. This study aimed to examine whether insomnia is a risk factor of chronic urticaria in nurses.Data were obtained from the Registry for Medical Personnel, which contains all registered medical staff between 2007 and 2008. All study subjects were divided into those with insomnia and without insomnia. The primary exposure of interest was chronic urticaria. In addition, potential comorbidities including diabetes mellitus, hypertension, hyperlipidemia, anxiety, and depression were estimated.A total of 103,242 registered nurses between 2007 and 2008 were enrolled. Around 97,899 (94.8%) nurses did not have insomnia, and 5343 (5.2%) had insomnia. The proportion of chronic urticaria in nurses with insomnia was significantly higher than those without (0.92% vs 0.50%, P < .0001). The odds ratio of chronic urticaria in nurses with insomnia was 1.67 (95% confidence interval: 1.22-2.29, P = 0.0014) compared to those without insomnia after adjusting for age, sex, hospital level, and comorbidities.The risk of chronic urticaria was higher in nurses with insomnia than in those without insomnia. The relationship between insomnia and chronic urticaria might not be a direct causal association. Other contributing factors of insomnia include different perceptions of stress from night shift work, stress coping and adaptation, positive self-image, and emotional equilibrium related to person's capacity to adapt to change. The same situation may have different effects on different individuals.


Assuntos
Urticária Crônica/epidemiologia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Adaptação Psicológica , Fatores Etários , Comorbidade , Emoções , Feminino , Humanos , Masculino , Estresse Ocupacional/epidemiologia , Qualidade de Vida , Fatores de Risco , Autoimagem , Fatores Sexuais , Jornada de Trabalho em Turnos , Tolerância ao Trabalho Programado
6.
Dis Markers ; 2019: 6417471, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31827639

RESUMO

Background: The pathogenesis of chronic urticaria (CU) is closely related to imbalances in immunity. The gastrointestinal microflora provides a vast and continuous stimulation for the immune system. However, the composition and diversity of gut microflora in CU patients are rarely reported. Methods: 10 CU patients and 10 healthy individuals were selected in this study, and their intestinal microbiome was detected by 16S rRNA sequencing. The data were analyzed using R language software. Results: 392 bacterial OTUs were common in the CU and healthy groups, but there were 159 OTUs particularly existing in the CU group, while 87 OTUs only were observed in healthy individuals. The bacterial diversity was reduced in CU patients compared with healthy individuals. The principal component analysis (PCA) and principal coordinate analysis (PCoA) revealed that the bacterial cluster in CU patients and the healthy controls were divided into different branches. Pathogenic strains including Escherichia coli were significantly higher in CU, while Faecalibacterium prausnitzii, Prevotella copri, and Bacteroides sp. were significantly lower in CU when compared with the healthy controls. CU patients with a high abundance of Escherichia coli had no ideal effect for probiotic therapy. Conclusion: Our results demonstrated that the microbial composition was significantly different between CU patients and the healthy individual, which may be the reason leading to the various outcomes of probiotic treatment.


Assuntos
Bactérias/classificação , Biodiversidade , Urticária Crônica/microbiologia , Fezes/microbiologia , Microbioma Gastrointestinal , Adolescente , Adulto , Bactérias/genética , Bactérias/isolamento & purificação , Estudos de Casos e Controles , Criança , China/epidemiologia , Urticária Crônica/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , RNA Ribossômico 16S/genética , Adulto Jovem
7.
Allergy Asthma Proc ; 40(4): 273-278, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262381

RESUMO

Background: Omalizumab resistance (OmR) in chronic spontaneous urticaria (CSU) remains poorly understood. Objective: To identify clinical and laboratory attributes of patients that may be predictive of OmR in CSU. Methods: We conducted a retrospective observational study by using an electronic patient record data base of patients with severe CSU refractory to a fourfold H1-antihistamine dose, treated with omalizumab 300 mg every 4 weeks for at least 24 weeks. Complete response (CR) was defined as the reduction of baseline urticaria activity score by ≥ 90%, partial response (PR) by ≥ 30% to <90%, and OmR by <30% at 24 weeks. The patient characteristics of the CR, PR, and OmR groups were compared. Results: Sixty-three patients (58.9%) had a complete remission at 24 weeks of omalizumab therapy, and 16 patients (14.9%) had OmR. The patients who were OmR were characterized by a higher rate of arterial hypertension 7 (43.8%), higher mean ± standard deviation (SD) high-sensitivity C-reactive protein (hs-CRP) level (10.3 ± 8.2 mg/L), mean ± SD white blood cell (WBC) count (9.1 ± 2.8 × 10³ cells/mL), and higher mean ± SD C3 level (164.3 ± 45.4 mg/dL) at baseline than the patients with CR (arterial hypertension, 9 [13.1%], p = 0.009; mean ± SD hs-CRP, 3.4 ± 10.1, p = 0.014; mean ± SD WBC count, 6.5 ± 3.8 × 10³ cells/mL, p = 0.012; and mean ± SD C3 level, 121.8 ± 42.1 m/dL, p < 0.001). In multivariable analysis adjusted for age, sex, and body mass index, OmR was associated with an hs-CRP level of >3.0 mg/L (odds ratio 1.94 [95% confidence interval, 1.28-3.15], p = 0.009) and with C3 > 160 mg/dL (odds ratio 1.54 [95% confidence interval, 1.05-2.36], p = .017). Conclusion: Obesity, arterial hypertension, high plasma C3 level, and high-CRP level were associated with OmR in severe CSU.


Assuntos
Antialérgicos/uso terapêutico , Biomarcadores Farmacológicos/metabolismo , Urticária Crônica/tratamento farmacológico , Obesidade/epidemiologia , Omalizumab/uso terapêutico , Adulto , Proteína C-Reativa/metabolismo , Urticária Crônica/epidemiologia , Complemento C3/metabolismo , Resistência a Medicamentos , Feminino , Humanos , Hipertensão , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Risco , Falha de Tratamento
8.
Clin Exp Allergy ; 49(10): 1291-1305, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31295369

RESUMO

OBJECTIVE: We investigated whether prolonged treatment with omalizumab influences development or progression of solid epithelial cancer in patients with atopic asthma or chronic idiopathic urticaria. DESIGN: Systematic review and meta-analysis of intervention and observational studies. Randomized controlled trials were assessed for risk of bias using the Cochrane Risk of Bias tool, comparative observational studies were assessed using the Newcastle-Ottawa Scale, and non-comparative observational studies were assessed using the Joanna Briggs Institute Checklist for Prevalence Studies. DATA SOURCES: We searched MEDLINE, EMBASE, Cochrane Library and grey literature for eligible studies to November 2017. All searches were updated in January 2019. ELIGIBILITY CRITERIA FOR INCLUDED STUDIES: Randomized, quasi-randomized, controlled clinical trials and observational studies were included if they involved patients ≥ 12 years with moderate-to-severe persistent asthma or chronic idiopathic urticaria treated with omalizumab for ≥ 40 weeks. Eligible comparators included standard of care, placebo, cromoglycate or no treatment. RESULTS: One hundred and sixty seven unique studies were eligible for inclusion; however, only twelve (7.2%, n = 11 758) reported any outcome of interest, none of which involved patients with urticaria. 195 cancer events were reported. We found no statistically significant increase in the odds of study-emergent solid epithelial cancer in patients randomized to long-term treatment with omalizumab compared to standard of care (Peto OR: 0.65, 95% CI: 0.11, 3.74, I2  = 41%). Less than one per cent of participants of non-comparative observational studies (n = 2350) were diagnosed with a solid epithelial tumour (meta-proportion: 0.86% [95% CI: 0.24, 1.86%, I2  = 56%]). In the only comparative observational study reporting on cancer, the proportion of study-emergent solid epithelial tumour events was nearly identical in both study groups (omalizumab: 2.3%, standard of care: 2.2%). CONCLUSIONS: There is insufficient evidence to determine whether long-term treatment with omalizumab influences development or progression of solid epithelial cancer in these patient populations. PROSPERO registration # CRD 42018082211.


Assuntos
Asma , Urticária Crônica , Neoplasias Epiteliais e Glandulares , Segunda Neoplasia Primária , Omalizumab , Asma/tratamento farmacológico , Asma/epidemiologia , Urticária Crônica/tratamento farmacológico , Urticária Crônica/epidemiologia , Feminino , Humanos , Masculino , Neoplasias Epiteliais e Glandulares/induzido quimicamente , Neoplasias Epiteliais e Glandulares/epidemiologia , Segunda Neoplasia Primária/induzido quimicamente , Segunda Neoplasia Primária/epidemiologia , Omalizumab/efeitos adversos , Omalizumab/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo
10.
Acta Biomed ; 90(3-S): 61-65, 2019 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-30830063

RESUMO

The cause of chronic urticaria remains often elusive. The association between chronic urticaria and intake of medications have been reported in children. However, the causative role of drugs has been rarely ascertained by onset of symptoms on drug provocation test. Chronic urticaria can be mediated by immunologic and nonimmunologic mechanisms. The diagnostic work-up of chronic urticaria includes a comprehensive evaluation of triggering factors such as drugs. A diagnosis is necessary in order to permit a safely administration of drugs in children with chronic urticaria.


Assuntos
Urticária Crônica/etiologia , Hipersensibilidade a Drogas/complicações , Criança , Urticária Crônica/diagnóstico , Urticária Crônica/epidemiologia , Urticária Crônica/terapia , Humanos
11.
Curr Med Res Opin ; 35(8): 1387-1395, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30793986

RESUMO

Introduction: Chronic idiopathic/spontaneous urticaria (CIU/CSU) is a debilitating skin condition that is burdensome for patients and healthcare providers. We aimed to describe clinical characteristics, consultation patterns and healthcare resource utilization in real-world US patients with refractory and non-refractory CIU/CSU. Methods: Data was collected from the Adelphi Real World 2015 Urticaria Disease Specific Programme. Physicians completed patient record forms (PRFs) for the next four patients consulting with non-refractory CIU/CSU and the next six with refractory CIU/CSU; patients were considered refractory if symptomatic and on treatment step ≥2. The same patients were asked to complete patient self-completion (PSC) forms describing how CIU/CSU affected them. Results: Seventeen physicians (15 allergists; 2 dermatologists) completed 184 PRFs (108 refractory CIU/CSU; 76 non-refractory CIU/CSU); 140 patients completed PSC forms (93 refractory CIU/CSU; 47 non-refractory CIU/CSU). Mean time from first consultation to diagnosis was 13.5 (SD 28.3) weeks; mean time from diagnosis to first treatment was 16.0 (SD 37.9) weeks. Patients with refractory CIU/CSU were more likely to initially consult primary care physicians than those with non-refractory CIU/CSU (51% and 28%, respectively). The most common symptoms were itching, sleep problems and anxiety/distress, affecting 75%, 23% and 18%, respectively. Patient-perceived disease severity was greater than physician-perceived severity (refractory CIU/CSU kappa 0.1512; non-refractory CIU/CSU 0.1590). Conclusions: Patients with CIU/CSU in this real-world study - particularly those with refractory CIU/CSU - were slow to receive specialist care and had substantial symptom burdens; patient-physician perception of disease severity was discordant. Earlier diagnosis of CIU/CSU may lead to timely use of CIU/CSU therapies.


Assuntos
Urticária Crônica , Alergistas , Urticária Crônica/epidemiologia , Urticária Crônica/psicologia , Urticária Crônica/terapia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estados Unidos/epidemiologia
12.
J Allergy Clin Immunol Pract ; 7(5): 1619-1626.e1, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30685572

RESUMO

BACKGROUND: The high-affinity IgE receptor (FcεRI) expression on effector cells has been poorly characterized in patients with chronic urticaria (CU) to date. OBJECTIVES: To investigate the FcεRI expression on blood basophils in a large cohort of patients with CU and its potential relationship with relevant features of the disease. METHODS: Basophil FcεRI expression was measured by flow cytometry in 287 patients with CU (192 with chronic spontaneous urticaria and 95 with chronic inducible urticaria) at their initial evaluation in our department. A control group of healthy nonatopic individuals was included to provide reference data, and the effect of antihistamine and anti-IgE therapy on the basophil FcεRI expression was also evaluated in a cohort of patients with CU. RESULTS: The median FcεRI expression was found significantly higher in patients with CU compared with healthy controls (P < .0001). A positive correlation was found between serum IgE levels and basophil FcεRI expression (R = 0.422; P < .001). Significantly higher FcεRI levels on basophils were detected in patients with CU who presented with concomitant atopic features (P = .003), negative autologous serum skin test (P = .002), negative autologous plasma skin test (P = .009), or undetected levels of antithyroid antibodies (P = 0.01). Baseline FcεRI expression was not related to the activity and duration of the disease, and was not significantly modified during antihistamine therapy; however, it correlated with the clinical response to omalizumab (P = .003). CONCLUSIONS: Although further multicenter studies are needed to corroborate these findings, the assessment of basophil FcεRI levels might be relevant in daily clinical practice supporting an autoimmune pathogenesis and predicting response to anti-IgE treatment.


Assuntos
Basófilos/metabolismo , Urticária Crônica/metabolismo , Receptores de IgE/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antialérgicos/uso terapêutico , Asma/epidemiologia , Asma/imunologia , Asma/metabolismo , Autoanticorpos/imunologia , Basófilos/imunologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Urticária Crônica/epidemiologia , Urticária Crônica/imunologia , Comorbidade , Dermatite Atópica/epidemiologia , Dermatite Atópica/imunologia , Dermatite Atópica/metabolismo , Feminino , Citometria de Fluxo , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Imunoglobulina E/imunologia , Iodeto Peroxidase/imunologia , Masculino , Pessoa de Meia-Idade , Omalizumab/uso terapêutico , Receptores de IgE/imunologia , Rinite Alérgica/epidemiologia , Rinite Alérgica/imunologia , Rinite Alérgica/metabolismo , Índice de Gravidade de Doença , Testes Cutâneos , Adulto Jovem
13.
Acta Clin Croat ; 58(4): 595-603, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32595243

RESUMO

When working with dermatology patients, the question sometimes arises which diagnostic tests and tools should be used for workup, particularly in cases of chronic urticaria (CU) and discoid nummular eczema, where the treatment of associated systemic diseases and infections may be crucial for patient outcome. The aim was to investigate retrospectively the influence of associated diseases on skin disease outcomes based on medical records of CU and nummular eczema patients in comparison to controls. We included patients admitted to our Dermatology Department over a 6-year period and analyzed their laboratory findings, related factors and outcomes recorded after two years of workup and treatment. Compared to controls, CU patients had a significantly higher prevalence of positive Helicobacter (H.) pylori findings (p=0.020), confirmed allergies (p=0.006), increased IgE (p=0.011) and pathologic thyroid findings (p=0.049), whereas nummular eczema patients only had significantly higher positive H. pylori findings (p=0.046). Meaningful regression of both dermatoses was recorded after treatment of associated diseases, with significant benefit from H. pylori treatment. This indicated that the diagnosis of associated infections (particularly H. pylori and urogenital infections), confirmed allergies, endocrine disorders (particularly of thyroid gland in CU patients) and serum malignancy markers could play a crucial role, as their treatment may improve disease outcomes.


Assuntos
Angioedema/diagnóstico , Angioedema/terapia , Urticária Crônica/diagnóstico , Urticária Crônica/terapia , Eczema/diagnóstico , Eczema/terapia , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Angioedema/epidemiologia , Urticária Crônica/epidemiologia , Croácia/epidemiologia , Eczema/epidemiologia , Feminino , Infecções por Helicobacter/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Adulto Jovem
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