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Monthly Archives

August 2020

Clinical Control of CSU with Antihistamines Allows for Tolerance of NSAID-Exacerbated Cutaneous Disease

By Selected articles

Jorge Sánchez

J Allergy Clin Immunol Pract . 2020 Jul 14;S2213-2198(20)30700-5. doi: 10.1016/j.jaip.2020.06.057. Online ahead of print.

A great number of patients with chronic spontaneous urticaria experience exacerbations after treatment with non-steroidal anti-inflammatory drug (NSAID). Although international guidelines suggest that people with urticaria avoid NSAIDs, this is sometimes difficult. Some case reports recommend that H1-antihistamines can help prevent these exacerbations.

The objective of this study was to evaluate if H1-antihistamines can help prevent NSAID-exacerbated reactions in people with chronic spontaneous urticaria.

This was a cross-over, multi-center, and ambispective study in 3 centers in Medellín, Colombia that included 121 participants with chronic spontaneous urticaria and a history of NSAIDs exacerbations. A diagnostic challenge test without the use of antihistamines and a challenge test using antihistamines were performed using the NSAID reported in the medical record. The order in which test were performed in each participant was determined by the investigator: participants with a positive first diagnostic challenge, were subject to a second challenge using H1-antihistamines, those with a negative first challenge using H1-antihistamines, were subject to a second one without the use of H1-antihistamines, and those with a negative first diagnostic challenge or a positive first challenge using H1-antihistamines, did not undergo a second challenge. Some patients were subject to an alternative NSAID before the diagnostic challenge test or the challenge test using H1-antihistamines.

The diagnostic challenge test retrieved 96 participants testing positive, with 75 % (72 participants) tolerating the NSAID involved in the reaction when they added H1-antihistamines.

In conclusion, although NSAID may represent some restrictions for people with chronic spontaneous urticaria, the use of H1-antihistamines can help control further urticaria exacerbations due to NSAID treatment.

This document is only available for registered healthcare professionals


High dose Bilastine for the treatment of Bascule Syndrome

By Articles about Bilastine

L Cunningham

Clin Exp Dermatol . 2020 Jul 13. doi: 10.1111/ced.14377. Online ahead of print.

Bascule syndrome (bier anaemic spots and cyanosis with urticarial-like eruption) was described for the first time in 2016 and it remains to be fully elucidated. To date no successful treatment has been described.

This is a case study of a 16-year old boy who presented a patchy discolouration of the lower legs in a dependent position, associated with burning and stinging sensations and dizziness and light-headedness when moving from sitting to standing. These symptoms were present for a year. Allergy, neurology and cardiology consultations were inconclusive, Tilt table testing revealed no evidence of orthostatic hypotension or postural orthostatic tachycardic syndrome but triggered his symptoms. A dermatologist diagnosed him with Bascule syndrome, based on his clinical findings.

Different antihistamines were trialled (cetirizine 10 mg daily, bilastine 20 mg daily) with no success. A dose of bilastine 40 mg twice daily completely resolved his symptoms, but recurred when the dose was reduced to half.


This is the first documented case of a successful treatment of Bascule syndrome with bilastine. It is likely that the dose needed may be higher than usual dose antihistamines. Also, the decision to treat with antihistamines should be based on symptoms.

This document is only available for registered healthcare professionals


Characteristics and determinants of patient burden and needs in the treatment of chronic spontaneous urticaria

By Selected articles

Rachel Sommer, Neuza da Silva, Anna Langenbruch, Marcus Maurer, Petra Staubach-Renz, Matthias Augustin

Eur J Dermatol. 2020 Jun 1;30(3):259-266. doi: 10.1684/ejd.2020.3763

About 1 % of the population suffers from chronic spontaneous urticaria. The highest incidence is between 30 and 40 years of age, with women being most affected. The objective of this study was to characterise the specific needs and treatment objectives in chronic spontaneous urticaria from the view of the patient.

This was a cross-sectional study that included 103 participants from 4 German outpatient dermatology clinics. The validated Patient Needs Questionnaire (PNQ) for chronic spontaneous urticaria was used to determine patient needs and potential treatment objectives. To determine the relationship between patient needs and disease burden, different scales were used: disease-specific (CU-Q2oL), skin-generic (DLQI) and health generic (EQ VAS).

Most participants were female (71,4 %), with a mean age of 43,92 ± 14,96 years. The most important treatment objective was the absence of visible skin lesions (92,3 % considered important/ very important), then to be free of itching (91,5 %) and lately the desire to be healed of all skin defects (89,5 %). All other 26 items analysed, were considered to be quite important/ very important by, at least, 30 % of the participants. In relation to patient specific needs, this were related to gender and duration of disease.

In conclusion, these data show that people with chronic spontaneous urticaria have an individual broad range of needs, enabling specialists to adapt treatment to their needs. Innovative treatments may also help increase overall benefits. Independently of the treatment, the decision should be shared to help a better management of the condition.

This document is only available for registered healthcare professionals


Molecular mechanisms and epidemiology of COVID-19 from an allergist’s perspective

By Selected articles

Koa Hosoki, Abhijit Chakraborty, Sanjiv Sur.

J Allergy Clin Immunol. 2020 Jul 2;146(2):285-299. doi: 10.1016/j.jaci.2020.05.033. Online ahead of print.

Back in March 2020, the World Health Organization declared COVID-19 a global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The aim of this article was to discuss how the development in some allergic rhinitis symptoms can serve as clues for the onset of COVID-19, and also to understand why patients with asthma can be at a higher risk for severe COVID-19.

There are some differences in symptoms in people with allergic rhinitis and those infected with the SARS-CoV-2. The later usually develop symptoms such as dry cough, sore throat, nasal congestion, shortness of breath, myalgia, fatigue, fever and rarely conjuctival congestion. People who suffer from allergic rhinitis present with runny itchy nose, itchy eyes, sneezing, postnasal drip and conjunctival congestion. From an allergist’s perspective, a shift from common allergic rhinitis symptoms to those related in COVID-19 (fever, cough and shortness of breath), may suggest the onset of COVID-19 in people with allergic rhinitis. Also, the prevalence of taste or olfactory dysfunctions such as anosmia and dysgeusia is higher in COVID-19 patients than in allergic rhinitis.

Wheezing, which is common in asthma exacerbations, rarely occurs in hospitalized patients with COVID-19. However, as asthma and COVID-19 are associated with cough and shortness of breath, it is important to exclude COVID-19 in people with asthma exacerbations. The mechanisms underlying the association between asthma and COVID-19 are related to the attenuated IFN-I and IFN-III response to respiratory infections that people with asthma have. Because COVID-19 infects lung and airway cells, it also induces and attenuated IFN-I and IFN-III signature, similar to the one observed in people with asthma, the reason why it is expected that COVID-19 frequently triggers asthma exacerbations.

Until an effective vaccine and treatments develop, it is important to understand the scientific rationale of the disease and to maintain mitigation strategies such as wearing facemasks and social distancing.

This document is only available for registered healthcare professionals


Effectiveness, safety and tolerability of Bilastine 20 mg versus Levocetirizine 5 mg for the treatment of chronic spontaneous urticaria: a double-blind, parallel group, randomized controlled trial

By Articles about Bilastine

Indrashis Podder, Anupam Das, Shouvik Ghosh, Debalina Biswas, Sujata Sengupta, Satyendra Nath Chowdhury

Dermatol Ther. 2020 Jul 2;e13946. doi: 10.1111/dth.13946. Online ahead of print.

Chronic urticaria is characterized by wheals with or without angioedema for, at least, 6 weeks. It is a debilitating condition that affects people’s quality of life. Bilastine is a novel non-sedative H1 antihistamine approved for symptomatic treatment of allergic rhinoconjunctivitis and urticaria in patients older than 12 years old.

The objective of this study was to compare the effectiveness, safety and tolerability of bilastine 20 mg with levocetirizine 5 mg in moderate-to-severe chronic spontaneous urticaria.

This was a double-blind, randomized, controlled study with two arms: bilastine 20 mg once daily (31 participants) and levocetirizine 5 mg once daily (27 participants) for 42 days. The severity of urticaria, global urticaria-induced discomfort and quality of life were evaluated with UAS7 (urticaria activity score), VAS (visual analogue scale) and DLQI (dermatology life quality index) at baseline and follow-up visits.

Primary objective was to assess the variation of the UAS7, and secondary objectives assessed changes in DLQI and VAS. Safety, tolerability and compliance were evaluated by analysis of drug-related adverse events, biochemical investigations and electrocardiogram.

Both bilastine and levocetirizine improved UAS7, DLQI and VAS at the end of treatment. Also, all parameters showed greater improvement with bilastine, but only the UAS7 revealed a significant reduction (p = 0,03). Sedation was also significantly less with bilastine (p = 0,04). Both treatments improved UAS7 and VAS significantly from day 14. No serious adverse effects were registered.

In conclusion, bilastine demonstrated a better efficacy and less sedation for chronic spontaneous urticaria when compared to levocetirizine, however similar effect on quality of life.

This document is only available for registered healthcare professionals

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