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Bilastina

The Impact of Bilastine on Symptoms of Allergic Rhinitis and Chronic Urticaria: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

By | Articles about Bilastine, Publicaciones sobre Bilastina

Abdelshafy AM, Abdallah SY, Hassan AF, Mohamed HA, Kamal NM, Ali ST, Abdelhaleem IA

Am J Rhinol Allergy. 2022 May 20:19458924221097449. doi: 10.1177/19458924221097449. Epub ahead of print. PMID: 35593100

Allergic diseases are immunological reactions with symptoms that may impact quality of life. Bilastine, is a novel oral second-generation H-1 antihistamine, with high selectivity to H1 receptors and with anti-inflammatory properties, however there is not enough evidence regarding the drug efficacy.

The objective of this study was to assess the efficacy and safety of bilastine compared with placebo and other active antihistamines in patients with allergic rhinitis or chronic urticaria.

A literature search was made for randomized controlled trials which assessed bilastine effects on symptomatic hyper histaminic allergic conditions. Data on total symptoms scores (TSS), total nasal symptom scores (TNSS), discomfort associated with these allergic conditions measured by visual analog score (VAS), and quality of life (QoL) for allergic rhinitis and urticaria was collected. Other outcomes such as clinical global impression and safety profiles were reported. The studies were statistically analysed.

The analysis included 9 randomized controlled trials which included 3801 participants. The meta-analysis shown that bilastine was superior to placebo, improving TSS, TNSS, VAS, and QoL in participants with allergic rhinitis or chronic urticaria. Furthermore, bilastine was comparable to other antihistamines such as cetirizine, fexofenadine, and loratadine regarding these outcomes, with a safe and tolerable profile and with no difference in the incidence of adverse events.

In conclusion, bilastine improved TSS in hyper histaminic allergic conditions involving nasal symptoms in allergic rhinitis with a safe and effective manner. It decreased the discomfort associated with the condition resulting in better QoL of the participants.

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Efficacy and Safety of Bilastine in the Treatment of Allergic Rhinitis: A Systematic Review and Meta-analysis

By | Articles about Bilastine, Publicaciones sobre Bilastina

Singh Randhawa A, Mohd Noor N, Md Daud MK, Abdullah B

Front Pharmacol. 2022 Jan 10;12:731201. doi: 10.3389/fphar.2021.731201. PMID: 35082662; PMCID: PMC8784885

Rhinitis is an inflammation of the nasal epithelium, leading to rhinorrhoea, nasal blockage, itching and sneezing. Allergic rhinitis is the most common form of rhinitis and occurs following exposure to allergens. Bilastine is one of the non-sedating second generation H1 oral antihistamines for allergic rhinitis. The objective of this study was to review the efficacy and safety of bilastine in treating allergic rhinitis.

This review was made after an electronic literature search of bilastine-related publications of randomized controlled trials comparing bilastine with placebo and standard pharmacotherapy up to March 2021. The included studies had to have description of diagnosis of AR established by clinicians and the outcomes with a minimum of 2 weeks of follow-up period.

The primary outcomes evaluated were total symptom score (TSS), nasal symptom score (NSS) and non-nasal symptom score (NNSS). The secondary outcomes were discomfort due to rhinitis, quality of life (QoL) and adverse events. The risk of bias and quality of evidence for all studies were also taken into consideration.

There were 135 records identified on the literature search after removal of duplicates. Following screening and review, 15 full-text articles were evaluated for eligibility. Five trials involving 3,329 patients met the inclusion criteria.

From the five trials included, bilastine was superior to placebo in improving TSS, NSS, NNSS, rhinitis discomfort score and QoL but demonstrated a comparable efficacy with other oral antihistamines in TSS, NSS, NNS, rhinitis discomfort score and QoL. The only adverse event where bilastine showed difference from placebo was in somnolence, and also with fewer incidence of somnolence compared to cetirizine. The overall quality of evidence ranged from moderate to high quality.

In conclusion, bilastine is safe and effective in the treatment of overall symptoms of allergic rhinitis with comparable efficacy and safety with other antihistamines except somnolence: while bilastine has a comparable efficacy to cetirizine, somnolence is notably fewer in bilastine.

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A Comparative, Three-Arm, Randomized Clinical Trial to Evaluate the Effectiveness and Tolerability of Bilastine vs Fexofenadine vs Levocetirizine

By | Articles about Bilastine, Publicaciones sobre Bilastina

Shah B, Dhoot D, Choudhary A, Jangid N, Mistry D, Shah S, Kamat S, Barkate H

Clin Cosmet Investig Dermatol. 2022 Feb 18;15:261-270. doi: 10.2147/CCID.S350122.

Chronic spontaneous urticaria (CSU) is a common skin condition associated with angioedema, wheals, or both. Although second-generation antihistamines (SGAH) are first-line drugs in CSU, half of the patients do not respond to them. Guidelines recommendation for these patients is to up-dose SGAH or combine different antihistamines. The objective of this study was to examine the effectiveness and tolerability of up-dosing of bilastine and fexofenadine up to two times and combination of non-sedating second-generation antihistamines; levocetirizine and first-generation antihistamine; and hydroxyzine in patients with CSU.

This was a comparative, three-arm study, which randomized CSU participants to receive standard dose of either bilastine, fexofenadine, or levocetirizine for 2 weeks. After 2 weeks of treatment, non-responders received double dose of either bilastine or fexofenadine, while hydroxyzine 25 mg once daily was added in the levocetirizine group. Participants were assessed for better outcomes in CSU, quality of life, and somnolence.

The study included 110 participants with CSU. At the end of 4 weeks, 33/39, 26/35, and 22/36 patients in the bilastine, fexofenadine, and levocetirizine groups indicated improvement in urticaria symptoms. At week 2, the urticaria activity score improvement showed no statistical difference between any of the groups; however, at week 4, there was a statistical difference between the bilastine and levocetirizine groups (p<0.05). Somnolence was significantly lower in the bilastine group (p<0.05). Bilastine was statistically significant (p<0.05) in the improvement of quality of life as compared to both groups. There was no report of major adverse events during the study period; however, bilastine was related to significantly lower levels of adverse events compared to levocetirizine (p<0.05).

In conclusion, a two-fold up-dosing of bilastine improves CSU symptoms with no changes in safety as compared to two-fold up-dosing of fexofenadine and combination of first- and second-generation antihistamines.

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Intralymphatic immunotherapy with one or two allergens renders similar clinical response in patients with allergic rhinitis due to birch and grass pollen

By | Artículos seleccionados, Selected articles

Ahlbeck L, Ahlberg E, Björkander J, Aldén C, Papapavlou G, Palmberg L, Nyström U, Retsas P, Nordenfelt P, Togö T, Johansen P, Rolander B, Duchén K, Jenmalm MC

Clin Exp Allergy. 2022 Jun;52(6):747-759. doi: 10.1111/cea.14138. Epub 2022 Apr 1. PMID: 35332591

Nearly 1/3 of the adult population of Sweden report allergic rhinitis. Although the prevalence of allergic sensitization is up to nearly half of the patients, there is a gap for a fast, efficient, and safe way to stimulate tolerance in patients with severe allergic rhinitis.

The aim of this study was to assess the safety and efficacy after intralymphatic immunotherapy with one or two allergens: birch- or grass pollen or both and to determine its immune modulatory effects including changes in spontaneous and allergen-induced cytokine and chemokine production, and proportions of T helper cell subsets in circulation.

People with severe birch and timothy allergy were randomized and received three doses of 0.1 ml of birch and 5-grass allergen extracts (10,000 SQ units/ml), or birch and placebo or 5-grass and placebo by ultrasound-guided injections into inguinal lymph nodes at monthly intervals. Characteristics reported before treatment and after each birch and grass pollen season included: rhinoconjunctivitis total symptom score, medication score and rhinoconjunctivitis quality of life questionnaire and circulating proportions of T helper subsets and allergen-induced cytokine and chemokine production (analysed by flow cytometry and Luminex).

After treatment with one or two allergens, the three groups related less symptoms, littler use of medication and better quality of life during the birch and grass pollen seasons, at an approximate rate. The most common adverse event reported was mild local pain. IgE levels to birch decreased, whereas birch-induced IL-10 secretion increased in all three groups. IgG4 levels to birch and timothy and skin prick test reactivity persisted mainly unaffected. Conjunctival challenge tests with timothy extract indicated a superior threshold for allergen. In all three groups, regulatory T cell frequencies were augmented 3 years after treatment.

In conclusion, intralymphatic immunotherapy with one or two allergens in people with grass and birch pollen allergy was effective and safe and may be associated with other immune modulatory responses.

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Experience with bilastine in the management of urticaria: Original Real-world cases of Bilastine In Treatment (ORBIT) in Asia

By | Articles about Bilastine, Publicaciones sobre Bilastina

Cheong WK, Chan AWM, Ch’ng CC, Chung WH, Gabriel MT, Godse K, Mitthamsiri W, Nguyen HT, Tiongco-Recto M, Nagrale D

Drugs Context. 2022 Mar 15;11:2021-12-2. doi: 10.7573/dic.2021-12-2. PMID: 35371270; PMCID: PMC8932249

People with urticaria have a compromised quality of life and sleep, and school/work due to its incapacitating condition. It presents with red and itchy rash with characteristic wheals, and/or angioedema. Current guidelines recommend second generation H1-antihistamine as first-line treatment of urticaria. Bilastine is a second-generation H1-antihistamine indicated in children aged ≥6 years and adults (Europe) for the symptomatic treatment of urticaria and allergic rhino-conjunctivitis. It has a well-documented efficacy and safety profile, with a rapid onset and a prolonged duration of action and a low sedative potential.

The objective of the Original Real-world cases of Bilastine In Treatment (ORBIT) study was to evaluate real-world cases published from the Asia-Pacific region in adults and children using bilastine for the long-term management of urticaria.

Eight cases diagnosed and classified according to international guidelines as chronic spontaneous urticaria or inducible urticaria were presented:

  • Case 1: 35-year-old man complaining of an itchy skin rash for the previous 6 months
  • Case 2: 10-year-old boy who developed recurrent hives over the past 3-4 years
  • Case 3: 54-year-old woman with poorly controlled chronic urticaria and intolerance to sedating antihistamines
  • Case 4: 33-year-old woman with cholinergic urticaria
  • Case 5: 20-year-old woman with intensely itchy rash
  • Case 6: 61-year-old woman with atopic (allergic rhinitis) with new-onset urticaria
  • Case 7: An elderly man with recalcitrant CSU unresponsive to second-generation antihistamines
  • Case 8: Chronic rash in an elderly man with multiple comorbidities

Although this was a small and diverse group of patients with urticaria considered difficult to treat, the administration of bilastine as per the approved label was well tolerated and effective in the long-term management of urticaria.

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Clinical and histological characteristics during chronic urticaria with dermal neutrophilic infiltrate: Proposal of a diagnostic score

By | Artículos seleccionados, Selected articles

A Brehon, P Moguelet, V Seta, E Amsler, A Fajac, A Barbaud, A Soria, JB Monfort

J Eur Acad Dermatol Venereol . 2021 Nov 6. doi: 10.1111/jdv.17788. Online ahead of print.

There are some arguments on whether neutrophilic urticaria (NU) is distinct from chronic spontaneous urticaria (CSU), although with no consensus. This study aimed to compare clinical, biological, and histological characteristics and therapeutic responses between NU and CSU.

This was an observational, retrospective study that included adults with chronic urticarial rash who had undergone a skin biopsy. One dermatologist and one cytopathologist blindly and independently reviewed the biopsies [cytology counting technique for a precise proportion of neutrophilic/eosinophilic polynuclear cells (PNN/PNEo)]. NU was defined by an inflammatory dermal infiltrate composed of at least 60% PNN, without leukocytoclasia/vasculitis.

Forty-four patients were included, and their biopsies were classified into two groups: NU (n=28) and CSU (n=16). From the bibliography, there are no characteristics related to PNN at histology, but an increase in erythrocyte sedimentation rate in the NU group (p=0.03). Colchicine also showed to be more effective in cases of significant neutrophilic infiltrate: 42.85% effectiveness in NU group versus 6.25% in CSU group.

Two other findings were a statistically associated relation with neutrophilic venulitis (p=0.04) (corresponding to an intraparietal aggregation of PNN without vasculitis) and a basophilic interstitial flame figure corresponding to degranulation of the PNN cytoplasm and exclusively associated with NU (p=0.04).

A diagnostic score was established using strict quantitative histological criteria (intensity of neutrophilic infiltrate, the existence of neutrophilic venulitis, basophilic flame figures, and intense leukocytoclasia), which allows the classification of urticarial eruptions into NU or UCS.

This score will allow diagnosis and homogenization of NU patients (it correctly classified 40 of the 44 patients from the study).

In conclusion, NU is an independent entity as some histological images were significantly (neutrophilic venulitis) or exclusively (basophilic flame figure) associated with an intense neutrophilic infiltrate. A prospective study is needed to validate this new score.

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Impact of Allergic Rhinitis and Asthma on COVID-19 Infection, Hospitalization and Mortality

By | Artículos seleccionados, Selected articles

Jianjun Ren, et al.

J Allergy Clin Immunol Pract . 2021 Oct 30;S2213-2198(21)01202-2. doi: 10.1016/j.jaip.2021.10.049. Online ahead of print.

The COVID-19 pandemic has impacted worldwide health. Underlying diseases have been shown to affect the prevalence and outcomes of COVID-19. Allergic rhinitis and asthma can increase the susceptibility and severity of COVID-19, but it is not known to which extension. This study aimed to study the role of allergic rhinitis and/or asthma in COVID-19 infection, severity, and mortality and evaluate whether its long-term medication can affect COVID-19 outcomes.

A total of 70,557 persons who had a SARS-CoV-2 test between March 16 and December 31, 2020, in the UK Biobank were analyzed. The rate of COVID-19 infection, hospitalization, and mortality concerning existing allergic rhinitis and/or asthma were statistically analyzed, together with the impact of long-term medications and the risk of hospitalization and death due to COVID-19 infection.

People with allergic rhinitis had lower positive rates of SARS-CoV-2 tests (RR:0.75; 95%CI, 0.69-0.81, p<0.001), with men having a lower susceptibility (RR:0.74; 95%CI, 0.65-0.85, p<0.001) than women (RR:0.8; 95%CI, 0.72-0.9, p<0.001). People with asthma had comparable results if they were <65 years-old (RR:0.93; 95%CI, 0.86-1, p=0.044). People with asthma who tested positive for SARS-CoV-2 had a higher risk of hospitalization (RR:1.42; 95%CI, 1.32-1.54, p<0.001). COVID-19 mortality was not impacted by allergic rhinitis or asthma. There was no relation between COVID-19 infection and severity and conventional medications for allergic rhinitis and/or asthma.

In conclusion, allergic rhinitis and asthma (<65 years old) may be a protective factor against COVID-19 infection, with asthma increasing the risk of hospitalization.

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What Basophil Testing Tells Us About CSU Patients – Results of the CORSA Study

By | Artículos seleccionados, Selected articles

João Marcelino, et al.

Front Immunol. 2021 Sep 28;12:742470. doi: 10.3389/fimmu.2021.742470. eCollection 2021

Chronic spontaneous urticaria (CSU) is a common condition in adults and children, impacting the quality of life. Recent studies characterized chronic spontaneous urticaria as an autoantibody-driven condition, with mast cells and basophils being activated through two distinct pathways: type I autoimmune CSU, where IgE autoantibodies are cross-linked by self-antigens; and type IIb autoimmune CSU, where IgG and IgM autoantibodies are directed against IgE receptors on the surface of mast cells and basophils. Basophil testing is the most effective way to diagnose type IIb autoimmune CSU: a positive basophil test correlates to long disease duration, higher disease activity, poor response to antihistamines and omalizumab, and a better response to cyclosporine and fenebrutinib.

The objective of this study was to identify features of basophil test-positive patients.

This was a cross-sectional study that included 85 participants with CSU. They were tested for basophils with the basophil-activation test (BAT), the basophil histamine release assay (BHRA), and data were statistically analyzed.

Of all the participants, 44% tested positive with the BAST, and 28% tested positive with BHRA. These participants had higher activity and impact of disease, less disease control, and lower total serum IgE. In contrast, they had a higher rate of positive autologous serum skin test (ASST), angioedema, nocturnal symptoms, symptoms more than five days/week, and thyroid autoantibodies. The ASST was a good predictor of a positive basophil test when combined with angioedema, thyroid autoantibodies, and low IgE.

This study showed that a positive basophil test is related to known characteristics of type II autoimmune CSU, allowing a better approach to these patients’ condition management.

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Prevalence, Management, and Anaphylaxis Risk of Cold Urticaria: A Systematic Review and Meta-Analysis

By | Artículos seleccionados, Selected articles

Connor Prosty, Sofianne Gabrielli, Michelle Le, Luis F. Ensina, Xun Zhang, Elena Netchiporouk and Moshe Ben-Shoshan.

J Allergy Clin Immunol Pract . 2021 Oct 18;S2213-2198(21)01129-6. doi: 10.1016/j.jaip.2021.10.012. Online ahead of print.

Chronic spontaneous urticaria can be caused by specific triggers, namely cold, exercise or heat. Chronic inducible urticaria (CIndU) can coexist with chronic spontaneous urticaria and is defined as a particular trigger that provokes the symptoms. Cold inducible urticaria is one example of physical urticaria caused by exposure to cold air, liquids, or objects and is associated with significant morbidity and risk for anaphylaxis.

The objective of this study was to evaluate the prevalence of cold urticaria among cases of chronic urticaria and chronic inducible urticaria, evaluate its management, and determine the rate of associate anaphylaxis.

The investigators did bibliographic research in PubMed and EMBASE for papers on cold urticaria and/or chronic inducible urticaria in the past ten years. An analysis was made to determine the prevalence of cold urticaria among CIndU and chronic urticaria cases, its management with H1-antihistamines and omalizumab, and the rate of associated anaphylaxis.

The research identified 22 studies, of which 14 were included in the meta-analysis. The pooled prevalence of cold urticaria among patients with chronic urticaria and CIndU was, respectively, 7.62% [CI95%; 3.45%-15.99%; I2=98%] and 26.10% [CI95%; 14.17%-43.05%; I2=97%]. 95.67% of the cases of cold urticaria were managed by H1-antihistamines [CI95%; 92.47%-97.54%; I2=38%], and by omalizumab in 5.85% of the cases [CI95%; 2.55%-13.22%; I2=83%]. The pooled prevalence of anaphylaxis was 21.49% [CI95%; 15.79%-28.54%; I2=69%].

In conclusion, cold urticaria is common in cases of chronic urticaria and CIndU and frequently triggers anaphylaxis. H1-antihistamines are commonly used for its management, followed by omalizumab.

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Particulate Matter Exposure and Allergic Rhinitis: The Role of Plasmatic Extracellular Vesicles and Bacterial Nasal Microbiome

By | Artículos seleccionados, Selected articles

Jacopo Mariani, Simona Iodice, Laura Cantone, Giulia Solazzo, Paolo Marraccini, Emanuele Conforti, Pallav A. Bulsara, Maria Stella Lombardi, Robert P. Howlin, Valentina Bollati and Luca Ferrari

Int J Environ Res Public Health. 2021 Oct 12;18(20):10689. doi: 10.3390/ijerph182010689.

Particulate matter (PM) exposure is known to worsen respiratory conditions, namely allergic rhinitis. Allergic rhinitis prevalence is rising, affecting the quality of life. The objective of this study was to investigate the molecular mechanisms beneath the triggering of nasal and systemic inflammation by particulate matter, specifically the release of plasmatic extracellular vesicles and the relation between the host and nasal microbiome.

The study included 26 participants with allergic rhinitis and 24 matched healthy participants, whose reaction to PM10 and PM25 exposure was assessed on the bacteria-derived-extracellular vesicles portion (bEV) and the host-derived-extracellular vesicles (hEV), and also on the bacterial nasal microbiome (bNM). The function of bNM as a modifier of PM effects on the extracellular vesicles signaling network in the context of allergic rhinitis was also evaluated.

This study has shown an association between particulate matter exposure in participants with allergic rhinitis, both in the context of bNM composition and plasmatic extracellular vesicles release, affecting in different ways the release of extracellular vesicles and the composition of bNM. More studies are needed to better understand the link between particulate matter exposure and bNM modulation and plasmatic extracellular vesicles release and characterize the different responses observed in participants after particulate matter exposure.

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Metabolomics Reveals Process of Allergic Rhinitis Patients with Single- and Double-Species Mite Subcutaneous Immunotherapy

By | Selected articles

Zheng, P., Yan, G., Zhang, Y., Huang, H., Luo, W., Xue, M., Li, N., Wu, J. L., & Sun, B.

Metabolites . 2021 Sep 9;11(9):613. doi: 10.3390/metabo11090613.

Allergic rhinitis is also known as anaphylactic rhinitis and includes infectious inflammatory conditions of the nasal mucosa triggered by exposure to atopic allergens. House dust mites are the most common allergens in patients with rhinitis. Allergen immunotherapy (AIT) is the only treatment that can change the course of allergic rhinitis, but there is a lack of knowledge in relation to AIT with single or mixed allergens. The aim of this study was to assess and compare the clinical efficacy of single-mite subcutaneous immunotherapy or double-mite subcutaneous immunotherapy using the visual analogue scale (VAS) score and rhinoconjunctivitis quality of life questionnaire score to evaluate and compare its clinical efficacy.

Patients with allergic rhinitis caused by Dermatophagoides pternussinus and Dermatophagoides farinae received a single-mite and double-mite subcutaneous immunotherapy, respectively.

There was no significant difference in efficacy between treatments. A total of 57 metabolites were identified, among which down-stream metabolites (5(S)-HETE (Hydroxyeicosatetraenoic acid), 8(S)-HETE, 11(S)-HETE, 15(S)-HETE and 11-hydro TXB2) in the ω-6-related arachidonic acid and linoleic acid pathway showed significant differences after approximately one year of treatment with single-mite or double-mite subcutaneous immunotherapy, and the changes of the above serum metabolic components were correlated with the magnitude of rhinoconjunctivitis quality of life questionnaire improvement, respectively.

The major difference found was with 11(S)-HETE, which decreased more with single-mite immunotherapy, having the possibility to be used as a biomarker to distinguish the two treatments.

In conclusion, both treatments showed therapeutic effects on patients with allergic rhinitis, with no differences in efficacy. The production of different inflammation-related metabolites can lead to potential biomarkers.

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Lachnospira is a signature of antihistamine efficacy in chronic spontaneous urticaria

By | Artículos seleccionados, Selected articles

Liu, R., Peng, C., Jing, D., Xiao, Y., Zhu, W., Zhao, S., Zhang, J., Chen, X., & Li, J.

Exp Dermatol. 2021 Sep 24. doi: 10.1111/exd.14460. Online ahead of print.

Chronic urticaria is a condition driven by mast cells, with an average lifetime prevalence of 1.4%. Chronic spontaneous urticaria is a common type of chronic urticaria that impacts quality of life and has a high economic and social burden. Chronic spontaneous urticaria is treated with oral second-generation antihistamines, however only half of the patients respond to up to quadruple doses of these antihistamines. It is known that gut microbiota can affect their efficacy. The objective of this study was to explore the relationship between gut microbiota and the efficacy of antihistamines in people with chronic spontaneous urticaria.

The gut microbiota of fecal samples from 15 responders to antihistamine monotherapy and 15 non-responders was assessed by 16S rDNA sequencing, and the differential bacterial species between them were confirmed by quantitative polymerase chain reaction (qPCR). Samples from 30 responders and 30 non-responders were used to confirm the differential bacterial species by qPCR.

The main difference between responders and non-responders was the presence of Lachnospiraceae and its subordinate taxa. The quantity of Lachnospira was higher in responders than non-responders.

In conclusion, the presence of Lachnospira has shown to have a moderate diagnostic value in assessing the efficacy of chronic urticaria with antihistamines.

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The International EAACI/GA²LEN/EuroGuiDerm/APAAACI Guideline for the Definition, Classification, Diagnosis and Management of Urticaria

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Zuberbier T, Abdul Latiff AH, Abuzakouk M, et al.

Allergy . 2021 Sep 18. doi: 10.1111/all.15090. Online ahead of print.

Urticaria is a mast-cell-driven condition with symptoms such as wheals, angioedema, or both. Chronic spontaneous urticaria and chronic inducible urticaria reduce the quality of life, affecting performance at school and work.

This document is an update and revision of the international guideline for urticaria, from a consensus conference held on the 3rd of December of 2020. It covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.

The objective of this guideline is to facilitate a definition and classification of urticaria, helping with data interpretation from different centers and areas of the world.

The table below summarizes the guideline.

How should urticaria be classified?

We recommend that urticaria is classified based on its duration as acute (<= 6 weeks) or chronic (> 6 weeks).

­­↑ ↑

Strong consensus*

Expert consensus

We recommend that urticaria is classified as spontaneous (no definite eliciting factor involved) or inducible (specific definite factor involved).

­­↑ ↑

Strong consensus*

Expert consensus

Should we maintain the current guideline classification of chronic urticaria?

We recommend that the current guideline classification of chronic urticaria should be maintained.

­­↑ ↑

Strong consensus*

Expert consensus

Should routine diagnostic measures be performed in acute urticaria?

We recommend against any routine diagnostic measures in acute spontaneous urticaria.

↓ ↓

Strong consensus*

Expert consensus

Should differential diagnoses be considered in patients with chronic spontaneous urticaria?

We recommend that differential diagnoses be considered in all patients with signs or symptoms suggestive of chronic urticaria based on the guideline algorithm.

­­↑ ↑

Strong consensus*

Expert consensus

What routine diagnostic measures should be performed in chronic spontaneous urticaria?

We recommend limited investigations. Basic tests include differential blood count, CRP and/or ESR, and in specialized care total IgE and IgG anti-TPO, and more biomarkers as appropriate.

We recommend performing further diagnostic measures based on the patient history and examination, especially in patients with long standing and/or uncontrolled disease.

↑ ↑­­

Consensus**

Expert consensus

Should routine diagnostic measures be performed in inducible urticaria?

We recommend using provocation testing to diagnose chronic inducible urticaria.

We recommend using provocation threshold measurements and the UCT to measure disease activity and control in patients with chronic inducible urticaria, respectively.

­­↑ ↑

Strong consensus*

Expert consensus

Should patients with chronic urticaria be assessed for disease activity, impact, and control?

We recommend that patients with CU be assessed for disease activity, impact, and control at every visit.

­­↑ ↑

Strong consensus*

Expert consensus

Which instruments should be used to assess and monitor disease activity in chronic spontaneous urticaria patients?

We recommend the use of the urticaria activity score, UAS7, and/or of the angioedema activity score, AAS, for assessing disease activity in patients with chronic spontaneous urticaria.

­­↑ ↑

Strong consensus*

Expert consensus

Which instruments should be used to assess and monitor quality of life impairment in chronic spontaneous urticaria patients?

We recommend the use of the chronic urticaria quality of life questionnaire, CU-Q2oL, and the angioedema quality of life questionnaire, AE-QoL, for assessing quality of life impairment in patients with chronic spontaneous urticaria.

­­↑ ↑

Strong consensus*

Expert consensus

Which instruments should be used to assess and monitor disease control in chronic spontaneous urticaria patients?

We recommend the use of the urticaria control test, UCT, and/or the angioedema control test, AECT, for assessing disease control in patients with CSU.

­­↑ ↑

Strong consensus*

Expert consensus

Should treatment aim at complete symptom control in urticaria?

We recommend aiming at complete symptom control in urticaria, considering as much as possible the safety and the quality of life of each individual patient.

­­↑ ↑

Strong consensus*

Expert consensus

Should patients with chronic spontaneous urticaria be advised to discontinue medication that is suspected to worsen the disease?

We recommend advising patients with chronic spontaneous urticaria to discontinue medication that is suspected to worsen the disease, e.g. NSAIDs.

­­↑ ↑

Strong consensus*

Expert consensus

Should modern 2nd generation H1-antihistamines be used as first-line treatment of urticaria?

We recommend a 2nd generation H1-antihistamine as first-line treatment for all types of urticaria.

­­↑ ↑

Strong consensus*

Evidence and consensus-based

Is an increase in the dose to up to four-fold of modern 2nd generation H1-antihistamines useful and to be preferred over other treatments in urticaria?

We recommend updosing of a 2nd generation H1-antihistamine up to 4-fold in patients with chronic urticaria unresponsive to a standard-dosed 2nd generation H1-antihistamines as second line treatment before other treatments are considered.

­­↑ ↑

Strong consensus*

Evidence and consensus-based

Should modern 2nd generation H1-antihistamines be taken regularly or as needed?

We suggest 2nd generation H1-antihistamines to be taken regularly for the treatment of patients with chronic urticaria.

­↑

Strong consensus*

Evidence and consensus-based

Should different 2nd generation H1-antihistamines be used at the same time?

We suggest against using different H1-antihistamines at the same time.

Consensus***

Evidence and consensus-based

If there is no improvement, should higher than fourfold doses of 2nd generation H1-antihistamines be used?

We recommend against using higher than 4-fold standard dosed H1-antihistamines in chronic urticaria

 ↓ ↓

Strong consensus*

Evidence and consensus-based

Is omalizumab useful as add-on treatment in patients unresponsive to high doses of H1-antihistamines?

We recommend adding on omalizumab* for the treatment of patients with CU unresponsive to high dose 2nd generation H1-antihistamines.

*currently licensed for chronic spontaneous urticaria

­­↑ ↑

Strong consensus*

Evidence and consensus-based

Is ciclosporin useful as add-on treatment in patients unresponsive to high doses of H1-antihistamine?

We suggest using ciclosporin for the treatment of patients with CU unresponsive to high dose of 2nd generation H1-antihistamine and omalizumab.

­↑

Strong consensus*

Evidence and consensus-based

Should oral corticosteroids be used as add-on treatment in the treatment of urticaria?

We recommend against the long-term use of systemic glucocorticosteroids in CU.

↓ ↓

Strong consensus*

Evidence and consensus-based

We suggest considering a short course of rescue systemic glucocorticosteroids in patients with an acute exacerbation of CU.

­ ↑

Strong consensus*

Evidence and consensus-based

Are H2-antihistamines useful as add-on treatment in patients unresponsive to low or high doses of H1-antihistamines?

We cannot make a recommendation for or against the combined use of H1- and H2-antihistamines in patients with chronic urticaria.

0

Strong consensus*

Expert consensus

Could any other treatment options be recommended for the treatment of urticaria?

We cannot make a recommendation with respect to further treatment options as standard therapies, but these may be considered in special cases, which also include those where financial or legal limitations for the recommended algorithm treatment exist.

0

Strong consensus*

Expert consensus

Should the same treatment algorithm be used in children?
We suggest using the same treatment algorithm with caution (e.g. weight adjusted dosage) in children with chronic urticaria

­ ↑

Strong consensus*

Expert consensus

Should the same treatment algorithm be used in pregnant women and during lactation?
We suggest using the same treatment algorithm with caution both in pregnant and lactating women after risk-benefit assessment. Drugs contraindicated or not suitable in pregnancy should not be used

­ ↑

Strong consensus*

Expert consensus

*≥90% agreement

**>75% agreement

***≥70% agreement

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Predictive features associated with chronic spontaneous urticaria recurrence

By | Artículos seleccionados, Selected articles

Elias Toubi, Zahava Vadasz

J Dermatol . 2021 Sep 14. doi: 10.1111/1346-8138.16119. Online ahead of print.

Chronic spontaneous urticaria is an autoimmune condition for, at least, 50% of the cases, and sometimes it is associated with other autoimmune diseases such as thyroid autoimmunity and systemic lupus erythematosus. They have an increased prevalence of autoreactive T-cell responses to FceRI and serum anti-thyroid antibodies. There are still a lot of unclear aspects to be determined, namely how long CSU will last. Most patients with chronic spontaneous urticaria are concerned about the probability of recurrence and wish for the existence of clinical or laboratory markers. The aim of this study was to understand the prevalence and characteristics of the recurrence of chronic spontaneous urticaria to prevent stressful comorbidities.

The study included 180 regular patients from the local registry. Chronic spontaneous urticaria lasted more than 5 years in 47 (26%) patients and was resolved during the first year in 23 (13%) patients. 21% of the patients reported recurrence of chronic spontaneous urticaria after a full remission between 1 and 10 years (mean 2.9 years).

In the search for predictive clinical or laboratory markers, the main differences found are registered in the table below.

Recurrent urticaria

General urticaria

P value

Bronchial asthma

10/25 (40%) 45/180 (25%)

p=0.049

Total immunoglobulin E

10/25 (40%) 34/150 (23%)

p=0.04

Anti-thyroid peroxidase antibodies

11/25 (44%) 32/160 (20%)

p=0.003

In conclusion, the prevalence of chronic spontaneous urticaria after a full remission is significantly higher in patients with bronchial asthma, increased levels of total IgE and autoimmunity. More studies are needed to support these findings.

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The effect of face mask usage on the allergic rhinitis symptoms in patients with pollen allergy during the covid-19 pandemic

By | Artículos seleccionados, Selected articles

Mengi E, Kara CO, Alptürk U, Topuz B

Am J Otolaryngol . 2021 Sep 10;43(1):103206. doi: 10.1016/j.amjoto.2021.103206. Online ahead of print.

Allergic rhinitis is an inflammation of the nasal mucosa mediated by IgE. It is characterized by nasal discharge, nasal obstruction, nasal itching, and sneezing. Allergic rhinitis prevalence has been increasing worldwide and it is believed that it affects up to 40% of the population. The objective of this study was to assess the use of face masks on allergic rhinitis symptomatology in people allergic to pollen and who were using face masks during the COVID-19 pandemic.

A total of 50 participants answered over the telephone a 15-item questionnaire which was developed by a team of allergic rhinitis experts. Participants were selected from those who had had allergy tests between 2013 and 2019.

The mean age of the participants was 34.34±9.41 years old and 60% were female. The number of participants who defined their nasal symptoms as severe-moderate in the pre-pandemic was higher (46 participants) than the number of participants with severe-moderate symptoms during the pandemic (28 participants). Patients who used mask had a statistically significant decrease in nasal and ocular symptoms (p<0,001), in sneezing (p=0,029) and nasal discharge (p=0,039).

In conclusion, the use of face mask reduced allergic rhinitis symptoms in people with pollen allergy, which supports the use of face masks for people with allergic rhinitis.

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