December 2022

Dec 21

Cholinergic Urticaria: Subtype Classification and Clinical Approach

By Bilastina New, Selected articles

Atsushi Fukunaga

Am J Clin Dermatol . 2022 Sep 15;1-14. doi: 10.1007/s40257-022-00728-6. Online ahead of print.

Cholinergic urticaria is a subtype of chronic inducible urticaria with painful wheals with surrounding erythema which occur after sweating. The objective of this review was to analyze different subtypes of cholinergic urticaria and its correlation to anhidrosis.

Recent publications were reviewed to update evidence on epidemiology, clinical features, diagnostic approaches, physiopathology subtype classification and therapeutic approaches of cholinergic urticaria.

When examining patients who present with symptoms similar to cholinergic urticaria, it is important to run a differential diagnosis to screen for a sweating dysfunction.

There are different mechanisms that contribute to the development of cholinergic urticaria, namely histamine, sweat allergy, cholinergic-related substances, poral occlusion and hypohidrosis/anhidrosis. These mechanisms are important to focus on the subtypes of cholinergic urticaria so that it can be managed and treated adequately, given the fact that this condition does not present in a homogeneous way.

This document is only available for registered healthcare professionals

Dec 21

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Urticaria.

By Bilastina New, Selected articles

Pavel Kolkhir

Nat Rev Dis Primers. 2022 Sep 15;8(1):61. doi: 10.1038/s41572-022-00389-z

Urticaria is a common and heterogeneous inflammatory skin disease that affect up to 20% of the world population. Its symptoms include wheals, angioedema or both which are due to the stimulation and degranulation of skin mast cells and release of histamine and other mediators. Acute urticaria accounts for the majority of cases can last up to 6 weeks and be related to infections or intake of drugs or food. Chronic urticaria may be spontaneous or inducible, can last more than 6 weeks and persist for more than one year in most patients. Patients with chronic urticaria are deeply affected in their daily activities and may suffer from psychiatric comorbidities. Chronic inducible urticaria has different subtypes and triggers that lead to different symptoms.

The mechanism of chronic spontaneous urticaria includes autoantibodies, complement and coagulation cascades. Its diagnosis includes differential testing to identify underlying causes or triggers.

Urticaria treatment first line uses second-generation H1 antihistamines, and omalizumab and cyclosporine in a second line. Other new approaches focus on targeting mediators, signalling pathways and receptors of mast cells and other immune cells.

There’s still some research needed to define disease endotypes and their biomarkers, identifying new treatment targets and developing improved therapies.

This document is only available for registered healthcare professionals

Dec 21

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Control of allergic rhinitis in four latin american countries: Rinola study

By Bilastina New, Selected articles

Diana L Silva

Front Allergy . 2022 Aug 24;3:980515. doi: 10.3389/falgy.2022.980515. eCollection 2022

Up to 40% of people worldwide suffer from allergic rhinitis. Although there are clinical trials that describe its characteristics, there is a lack of real-world studies from Latin America. This manuscript describes a cross-sectional, descriptive, multicenter study that took place in 4 countries from Latin America (Colombia, Argentina, Cuba and Peru) and which included 412 patients diagnosed with allergic rhinitis between November 2017 and June 2020. Patients completed different assessment questionnaires and their sociodemographic and clinical data were collected.

This study included patients aged between 15 and 39 years old. Three quarters of the participants presented with nasal obstruction and 81% with persistent allergic rhinitis. 31% of them had associated asthma. Skin tests were positive in over 80% of the participants (81.3% were positive for Dermatophagoides farinae and 88.6% positive for Dermatophagoides pteronyssinus). All but one participant reported that allergic rhinitis affected their daily activities. Upon consultation, specialists started nasal corticosteroids in 72% of the patients, but only 17% patients were on immunotherapy. 60% of the patients were already on oral antihistamines only.

In conclusion, this study confirms that people with allergic rhinitis from Latin America have an impaired quality of life due to persistent disease. Dust mites are the main sensitizers.

This document is only available for registered healthcare professionals

Dec 21

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An evaluation of remission rates with first and second line treatments and indicators of antihistamine refractoriness in chronic urticaria

By Bilastina New, Selected articles

Sinem Ayse Ornek

Int Immunopharmacol . 2022 Sep 15;112:109198. doi: 10.1016/j.intimp.2022.109198. Online ahead of print.

Chronic urticaria is a common condition characterized by recurrent pruritic wheals and/or angioedema for more than 6 weeks. As a first-line treatment, guidelines recommend standard doses of antihistamines and as second-line an increase in antihistamines’ dose. There is a lack of studies on remission rates with first and second-line treatments as well as indicators of antihistamine response. The aim of this study was to assess response rates to chronic urticaria first and second-line treatments and to identify characteristics of the patients that can help estimate treatment outcomes.

Different types of urticaria outcomes were retrospectively analyzed: 556 chronic spontaneous urticaria and 101 chronic inducible urticaria cases on at least 3 months of follow-up data.

Results have shown that a standard dose of 2^nd generation antihistamines was proving efficacy in 43% of the patients. An additional 28.8% of patients were in remission with 2^nd line treatments. Increasing antihistamine dose, combining two different 2^nd generation antihistamines, combining 1^st and 2^nd generation antihistamines or combining leukotriene receptor antagonist offered remission in 38.3 %, 35.8 %, 37.5% and 25 % of patients who were given these treatments, respectively.

In conclusion, it is important to have a stepwise approach to managing chronic urticaria because the number of patients who respond to treatment increases with each step.

This document is only available for registered healthcare professionals

Dec 21

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Non-allergic Rhinitis, Allergic Rhinitis and Immunotherapy: Advances in the Last Decade

By Bilastina New, Selected articles

Punita Ponda

J Allergy Clin Immunol Pract . 2022 Sep 21;S2213-2198(22)00945-X. doi: 10.1016/j.jaip.2022.09.010. Online ahead of print

Allergic and nonallergic rhinitis are two of the most common diseases seen by immunoallergologists. These conditions have a huge impact on daily life activities and represent an economic burden to health systems globally. Immunotherapy is currently a common practice to address individual triggers of allergic rhinitis.

This review makes an approach to the most recent advances in these conditions, from diagnosis to treatment, allergen immunotherapy and global and digital health strategies. In the past 10 years there was a great growing understanding on these conditions, helping optimize patient care and outcomes.

This document is only available for registered healthcare professionals

Cholinergic Urticaria: Subtype Classification and Clinical Approach

Urticaria.

Control of allergic rhinitis in four latin american countries: Rinola study

An evaluation of remission rates with first and second line treatments and indicators of antihistamine refractoriness in chronic urticaria

Non-allergic Rhinitis, Allergic Rhinitis and Immunotherapy: Advances in the Last Decade

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