Niu XL, Zhu LL, Shi MH, Zhang YJ, Gao XH, Qi RQ.
Previous studies on the correlation between positive autologous serum skin test (ASST) responses and the clinical features of patients with chronic spontaneous urticaria (CSU) have provided conflicting results. To evaluate the significance of ASST responses in CSU, a variety of databases were searched from inception to March 2018 to identify relevant studies on CSU.
Wang WW, Pan YL, Yu HW, Zhang B, Shao SW.
Epithelial thymic stromal lymphopoietin (TSLP) promotes Th2 inflammatory responses through induction of OX40 ligand (OX40L) on dendritic cells in allergic rhinitis (AR). Emerging evidence supports the important role of histamine H4 receptor (H4R) in allergic inflammation. This study aimed to investigate the effects of H4R in Th2-cytokine profile mediated by TSLP in AR.
Costa C, Rosmaninho I, Guilherme A, Ferreira J, Antunes J, Pina A, Prates S, Marques JG, Azevedo F, Cunha AP, Brito C, Massa A, Sousa JT, Velho GC, Raposo I, Pinto GM, Sousa V, Martins AR.
There is a paucity of information regarding chronic urticaria patients’ care in a real-world setting. The objective of this study was to report and evaluate the baseline characteristics of Portuguese chronic urticaria patients refractory to H1-antihistamines included in the AWARE study.
Zubrinich CM, Puy RM, O’Hehir RE, Hew M.
Recurrent urticaria is a frequent presenting complaint in the Allergy Clinic, despite the fact that chronic urticaria (CU) is not an IgE-mediated (atopic) condition in most cases. We present four cases assessed over 5 years in our allergy service who were found to have evidence of strongyloidiasis and whose clinical features resolved with standard anti-helminth treatment.
Yang J, Zhong W, Xue K, Wang Z.
The importance of epigenetics has increased due to identification of its role in the pathophysiology of a number of diseases including allergic rhinitis. This review discusses the studies describing the epigenetic changes taking place in the host cells in response to allergen along with possible mechanisms.
Bousquet J, (…), Zuberbier T; ARIA Working Group.
Allergen immunotherapy (AIT) is a proven therapeutic option for the treatment of allergic rhinitis and/or asthma. Many guidelines or national practice guidelines have been produced but the evidence-based method varies, many are complex and none propose care pathways.
Bousquet J, (…)Okamoto Y, Wallace DV; The MASK study group.
Mobile Airways Sentinel NetworK (MASK) belongs to the Fondation Partenariale MACVIA-LR of Montpellier, France and aims to provide an active and healthy life to rhinitis sufferers and to those with asthma multimorbidity across the life cycle, whatever their gender or socio-economic status, in order to reduce health and social inequities incurred by the disease and to improve the digital transformation of health and care. The ultimate goal is to change the management strategy in chronic diseases.
Tantilipikorn P, Siriboonkoom P, Sookrung N, Thianboonsong A, Suwanwech T, Pinkaew B, Asanasaen P.
Local allergic rhinitis (LAR) is a localized nasal allergic response in the absence of systemic atopy that is characterized by local production of specific immunoglobulin E (sIgE), and a positive response to NAPT (nasal allergen provocation test). The objective of this study is to investigate the prevalence of LAR in adults with chronic rhinitis (CR) and negative skin prick test to Dermatophagoides pteronyssinus (Dp), and to assess the clinical characteristics of LAR, comparing to non-allergic rhinitis (NAR).
Hon KLE, Leung AKC, Ng WGG, Loo SK.
Chinese investigators provided an update on the epidemiology, pathogenesis, clinical manifestations, diagnosis, aggravating factors, complications, treatments and prognosis of chronic urticaria.
They searched for meta-analyses, randomized controlled trials, clinical trials, reviews and other pertinent references.
Chronic urticaria is a clinical diagnosis, based on the appearance of characteristic urticarial lesions that wax and wane rapidly, with or without angioedema, most days of the week for more than six weeks. It is a common, debilitating and hard to treat condition. Medications, physical stimuli and stress can be the trigger of 10-20% of cases. After ruling out an underlying disorder, second generation H1 antihistamines are the choice for initial therapy. These are often safe and effective.
When an improvement does not occur in 2-4 weeks of treatment, the dose can be increased up to fourfold the recommended dose. If improvement does not occur after increase in the dosage, omalizumab should be added.
When a satisfactory improvement does not happen after 6 months or earlier, or if symptoms are intolerable after omalizumab, there is still the possibility of treatment with cyclosporine and second generation H1 antihistamines.
Short-term use of oral corticosteroids may be considered for acute exacerbation of chronic urticaria or in refractory cases.
In conclusion, chronic urticaria is an idiopathic disease in most cases, with the average duration of two to five years. Complications may include skin excoriations, adverse effect on quality of life, anxiety and depression. Treatment is primarily symptomatic with second generation antihistamines on the first line of treatment. Omalizumab has been showing a good support in the management of chronic urticaria and improves patients’ quality of life.
Wertenteil S, Strunk A, Garg A.
Investigators made a cross-sectional analysis using electronic health records data for a demographically heterogeneous population-based sample of over 55 million patients in all four census regions the United States in order to understand the disease burden in chronic urticaria.
From the analysis of the available census data, they estimate that the overall chronic urticaria prevalence is 0,23% (or 230 patients per 100,000 adults). The adjusted prevalence in women was 310 per 100,000 adults, more than twice that of men (146 per 100,000 adults).
Patients aged 40-49 and 50-59 years old had a higher prevalence compared with all other age groups. Also, Caucasians had a lower prevalence of urticaria than African American and “other” people.
In conclusion, despite census data available may underestimate the burden of chronic urticaria, this team estimates that over 500,000 people have chronic urticaria in the United States, most of whom are women and adults over 40 years old.
Bédard A, (…); MASK study group.
A cross-sectional real-world observational study took place in 22 countries to complement a pilot study and provide new information on medication use, disease control and work productivity in people with allergic rhinitis.
A mobile phone app (“Allergy diary”, available for free on Google Play and Apple store) was used to collect data of daily visual analogue scale scores for overall allergic symptoms, nasal, ocular and asthma symptoms, work and medication used by choosing from a list that included all allergic rhinitis medications (prescribed and over-the-counter) available in 22 countries.
The 4 most common intranasal medications containing intranasal corticosteroids and 8 oral antihistamines were considered for the study.
9,122 people who used the mobile application filled the equivalent to 112,054 days of visual analogue scale scores in 2016 and 2017. All other assessments were informative. Users with allergic rhinitis selected between none, single, or multiple treatments, with those referring multiple treatments corresponding to the worst control of symptoms and increasing the range of treatments used.
The analysis also revealed a similar trend for asthma, eye symptoms and work productivity.
Conclusively, although differences between oral antihistamines were found, this study confirms the usefulness of the application Allergy Diary in accessing and assessing behaviour of people with allergic rhinitis.
Jimena Coimbra, Cristina Campo, Luis Labeaga, Montserrat Puntes, Ignasi Gich, Joan Martínez, Rosa Antonijoan.
The main objective of this study was to compare the efficacy of bilastine 20mg administered orally, under fasting and fed conditions, in the reduction of histamine-induced skin reactivity (wheal and flare response) in healthy volunteers, taking into account the first treatment day (Day1) and the steady state (Day4). The final aim of this study was to assess the clinical relevance of this food-drug interaction.
As a conclusión of the study, the pharmacokinetic interaction of bilastine with food does not imply a significant reduction of its antihistamine efficacy, and the interaction of bilastine with food lacks clinical relevance since no significant pharmacodynamic interaction was observed.
Esther Serra, Cristina Campo, Zoltan Novák, Bernardetta Majorek-Olechowska, G Pulka, Aintzane García-Bea & Luis Labeaga (2019)
Journal of Dermatological Treatment
An exploratory, international and multicenter study to evaluate the efficacy of bilastine in the relief of pruritus associated with urticaria and other skin diseases was performed in patients diagnosed of Chronic Spontaneous Urticaria (CSU), eczema/dermatitis, prurigo or cutaneous pruritus.
The first 2 weeks, they were treated with bilastine 20 mg daily. The daily pruritus severity score was assessed. Responders patients stayed on this treatment for the remaining 6 weeks while non-responders were updosed to 40 mg.
The mean change in weekly pruritus severity score from baseline to week 8 was -1.63 ± 0.77 for all patients (p<0.001). The mean change per group was: CSU (-2.1 ± 0.44), cutaneous pruritus (-1.66 ± 0.63), eczema/dermatitis (-1.36 ± 0.79) and prurigo (-1.30 ± 0.92) (all p-values <0.001).
Bilastine at 20 mg and 40 mg showed an excellent profile for both efficacy and safety in reducing pruritus in patients with CSU and other skin disorders.
Ahmed Hamed, DeVon C Preston, Will Eschenbacher, Dilawar Khokhar, Lisa Workman, John W Steinke, Peter Heymann, Monica Lawrence, Manuel Soto-Quiros, Thomas AE Platts-Mills, Spencer Payne, Larry Borish (2019)
Practitioners from various specialties investigated the presence of local IgE production in the nose of allergic and non-allergic people and assessed whether it was enhanced by rhinovirus.
Initial studies were performed in patients presenting to the emergency department for allergic and non-allergic respiratory complaints. Local production of specific IgE was determined by comparing ratios of specific to total IgE concentrations between nasal and serum samples.
The analysis revealed evidence of local sIgE production to Dermatophagoides pteronyssinus and Blomia tropicalis in 30.3 and 14.6% of allergic patients, respectively. Patients with active rhinovirus infection were more than twice as likely to have local sIgE, and those with sIgE being produced were three times more likely to have an asthma exacerbation.
In conclusion, local IgE production happens in allergic rhinitis and allergic asthmatics with local IgE are more likely to develop an asthma exacerbation when infected with rhinovirus.
Elisa Lakin, Martin K. Church, Marcus Maurer, Oliver Schmetzer (2019)
Theranostics
Investigators at the Department of Dermatology and Allergy of Berlin Charity University Hospital studied autoreactive IgE in chronic spontaneous urticaria patients.
The investigation had three main objectives: quantify and investigate chronic spontaneous urticaria autoreactive IgE physiochemical nature and recognize its patterns compared with healthy control IgE.
IgE autoreactivity, autoantigen recognition patterns and lipophilicity were assessed in sera from 7 chronic spontaneous urticaria and 7 healthy subjects. Although total IgE levels did not differ significantly, the autoreactive proportion of IgE in chronic spontaneous urticaria subjects was 1000-fold higher than that of healthy ones. Chronic spontaneous urticaria IgE differed from healthy control IgE by recognizing 7-fold more and different autoantigens. The median serum level of lipophilic IgE was 1,4-fold higher in chronic spontaneous urticaria subjects.
The analysis revealed that lipophilicity correlated with autoreactivity. Chronic spontaneous urticaria autoreactive IgE is more lipophilic than that of IgE from healthy individuals, which will lead to the development of new diagnostic tests and therapies.
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