Efficacy of methotrexate as add on therapy to H1 antihistamine in difficult to treat chronic urticaria: A systematic review and meta-analysis of randomized clinical trials.

A systematic review and meta-analysis of randomized clinical trials (RCTs) to evaluate efficacy of add on methotrexate in chronic urticaria. "PubMed" and "Google Scholar" were systematically searched to identify randomized clinical trials with methotrexate in patients with chronic urticaria not responding to second generation antihistamines. Odds ratios and 95% confidence interval were calculated for estimation of efficacy. Heterogeneity among studies was tested using Tau squared (τ2 ) and I2 . Two RCTs (n = 104) were included. For primary outcome that is, complete remission at 18 weeks in Leducq et al study and patients achieving more than two third reduction in wheal score that is, one of the primary outcomes in Sharma et al study there was no significant difference in methotrexate vs placebo (OR [95%CI] 1.64[0.34, 7.90]). There was no significant difference for complete remission at 18 weeks in Leducq et al study and patients achieving more than two third reduction in the pruritus score (one of the primary outcomes in Sharma et al study) (OR [95%CI] 1.03 [0.24, 4.38]) too. In both studies, methotrexate was well tolerated. There was no significant benefit of add on methotrexate to antihistamine in the treatment of difficult to treat urticaria. Inclusion of only two randomized controlled trials is the limitation of this meta-analysis.

Clinical Characteristics of Patients with Chronic Urticaria and Adherence to Management Guidelines by Postgraduate Students in Dermatology: A Retrospective Single Center Study.

Background: Chronic urticaria is a heterogenous skin disorder representing one of the important reasons for consultation with a dermatologist. Dermatology post-graduate students play an importanrt role in the treatment of patients with chronic urticaria. Objective: The objective of the study was to describe clinical characteristics of patients with chronic urticaria and assess adherence to the guidelines by postgraduate students in the department of dermatology of a tertiary care center. Materials and Methods: In this retrospective study, prescriptions of patients with chronic urticaria and/or angioedema presenting to the outpatient department for 5 months were analyzed. Percentage of prescriptions adhering to international urticaria management guidelines was calculated. Urticaria Activity Score, percentage of patients receiving second-generation antihistamines, first-generation antihistamines, and other drugs was recorded. Comorbidities in patients with chronic urticaria were also noted. Results: A total of 60 patients (mean age 32.1 years; 58.3% male) were included in. Mean (SD) duration of urticaria at the time of study was 4.7 (2.7) months. Demographism and history of allergy to drugs was present in 45 (75%) and 4 (6.7%) patients. Mean (SD) Urticaria Activity Score was 12.5 (6.5). A total of 12 (20%) patients had comorbidities. Mean number of drugs received per patient was 1.7 (0.5). A total of 47 (78.3%) patients received second-generation antihistamines, whereas 11 (18.3%) received first-generation antihistamines. Two (3.3%) patients received combination of first-generation and second-generation antihistamines. Fexofenadine, levocetirizine, bilastine, and cetirizine was prescribed to 24 (40%), 26 (43.3%), 18 (30%), and 14 (23.3%) patients. There was no significant difference in male and female patients receiving fexofenadine (P = 0.59) or levocetirizine (P = 0.13). Conclusion: Adherence to urticaria management guidelines by resident doctors in dermatology department in our institute was satisfactory.

Light-Based Devices for the Treatment of Facial Erythema and Telangiectasia.

Facial erythema is one of the most common outpatient complaints in dermatology. There are various causes of facial erythema and several devices are available for its treatment. Pulsed dye laser (PDL) and intense pulsed light (IPL) are the two common light devices used for these conditions. In this review, we evaluated the literature to assess efficacy of IPL versus PDL in facial erythema and telangiectasia. We searched published articles including clinical trials or reviews articles, case series, and case reports. Electronic databases (MEDLINE and PubMed) were searched to retrieve the articles. Reference lists of selected articles were also considered for the review. Articles published in English language until June 2021 were considered for this review.

Link between hypothyroidism and small intestinal bacterial overgrowth.

Altered gastrointestinal (GI) motility is seen in many pathological conditions. Reduced motility is one of the risk factors for development of a small intestinal bacterial overgrowth (SIBO). Hypothyroidism is associated with altered GI motility. The aim of this article was to study the link between hypothyroidism, altered GI motility and development of SIBO. Published literature was reviewed to study the association of altered GI motility, SIBO and hypothyroidism. Altered GI motility leads to SIBO. SIBO is common in patients with hypothyroidism. Patients with chronic GI symptoms in hypothyroidism should be evaluated for the possibility of SIBO. Both antibiotics and probiotics have been studied and found to be effective in management of SIBO.

Up-dosing of non-sedating antihistamines in chronic urticaria: Need for well-designed clinical trials in India.

Urticaria is a heterogeneous group of diseases. Chronic urticaria significantly impacts quality-of-life of patients. Second generation, non-sedating antihistamines are recommended as first line treatment for chronic spontaneous urticaria. In patients with inadequate control of symptoms, increase in dosage of non-sedating antihistamines up to four fold has been recommended. This recommendation is based on low cost, good safety and good evidence of efficacy of non-sedating, second generation antihistamines. This article reviewed Indian data on up-dosing of antihistamines in chronic urticaria. There is a need for well-designed clinical trials with -up-dosing of individual antihistamines in Indian patients.