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Sep 29
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Usage patterns of oral H1-antihistamines in 10 European countries: A study using MASK-air® and Google Trends real-world data

By Artículos seleccionados, Selected articles

Vieira RJ, Sousa-Pinto B, Anto JM, Sheikh A, Klimek L, Zuberbier T, Fonseca JA, Bousquet J

World Allergy Organ J. 2022 Jun 24;15(7):100660. doi: 10.1016/j.waojou.2022.100660. eCollection 2022 Jul.

Real-world data may help provide important data on different conditions, namely allergic rhinitis. However, evaluating this information can represent a challenge, as results from internet users may be influenced by different factors, from the real epidemiology of the conditions being evaluated, but also by the attention they get in the media.

This study compared real-world data from MASK-air®, a mobile app for allergic rhinitis on the usage of oral H1-antihistamines from 2016 to 2020 in 10 European countries with Google Trends data on the relative volume of search for these antihistamines.

5 different oral H1-antihistamines were selected for each country and the investigators perceived a perfect agreement on the order of antihistamine use in MASK-air® and Google Trends in France, Germany, Sweden, and the United Kingdom. Different levels of agreement were observed in the remaining countries (Italy, Poland, Portugal, Spain, Switzerland, Netherlands). Sales data-wise, there was a consistency in data from Google Trends and MASK-air® in France, Germany and the United Kingdom.

In conclusion, these results suggest that the mobile app MASK-air® data may have a common trend in relation to other real-world data, however, more studies are needed.

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Aug 11
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Lack of Clinical Relevance of Bilastine-Food Interaction in Healthy Volunteers: A Wheal and Flare Study

By Articles about Bilastine, Publicaciones sobre Bilastina

Coimbra J, Puntes M, Gich I, Martínez J, Molina P, Antonijoan R, Campo C, Labeaga L

Int Arch Allergy Immunol. 2022 Jun 14:1-10. doi: 10.1159/000524856. Publicación electrónica previa a la edición impresa. PMID: 35700691.

Bilastine is a second-generation antihistamine with good selectivity for H1-receptors, and no brain-penetration. The objective of this study was to compare the pharmacodynamic activity of bilastine administered under fasting and fed conditions in healthy volunteers.

This was a randomized, open-label, two-period, crossover study involving 24 healthy participants who were given 20 mg of once-daily oral bilastine for 4 days under fasting and fed conditions, with a 7-day washout period. The plasma concentrations of bilastine plasma were measured for 24 h after the first and fourth doses in each period. Pharmacodynamic activity was assessed by wheal and flare surface inhibition and subjective assessment of itching, after intradermal injection of histamine.

When administered under fed vs. fasting conditions, the exposure to bilastine 20 mg decreased (mean maximum plasma concentration and area under the curve from time 0 to 24 h decreased by 34.27% and 32.72% [day 1], respectively, and 33.08% and 28.87% [day 4]). Despite this decrease, the antihistaminic effect of bilastine 20 mg did not change with food. On day 1, as measured by wheal and flare surface inhibition,

the maximum effect and duration of action of bilastine did not differ significantly between fasting and fed conditions, with only a short 30-min delay in the onset of wheal inhibition. On day 4, bilastine’s pharmacodynamic effects were not significantly affected under any condition.

In conclusion, the pharmacokinetic interaction of bilastine with food does not mean a significant reduction of its peripheral antihistaminic efficacy.

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Aug 11
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Urticaria (angioedema) and COVID- 19 infection

Chronic Urticaria: The Need for Improved Definition

By Artículos seleccionados, Selected articles

Gómez RM, Bernstein JA, Ansotegui I, Maurer M

Front Allergy. 2022 Jun 9;3:905677. doi: 10.3389/falgy.2022.905677. PMID: 35769560; PMCID: PMC9234868.

Chronic urticaria is usually diagnosed after daily or almost daily presence of symptoms for more than 6 weeks. Urticaria symptoms include pruritic wheals or hives, accompanied by angioedema in 40% of cases. Up to 20% of patients have isolated angioedema. Chronic urticaria represents a significant burden which has been extensively reported with numerous validated patient-reported outcome measures that represent a significant impact on several aspects of life ranging from physical discomfort to personal mood changes (anxiety and depression) which frequently interferes with interpersonal relationships, daily activities including work and school. It is not a surprise that management of chronic urticaria is related to substantial

costs to health care systems due to recurrent medical visits and treatments. Consequently, it is crucial to generate awareness among healthcare payors and other stakeholders on the prevalence of chronic urticaria and its impact on quality of life and on the economic burden it has on society. There is no consensus on diagnostic and management criteria for CU, which makes this task more challenging.

In conclusion, the health and economic burden of chronic urticaria is significant and should not be underestimated. The significant impact of this condition requires that physicians and other health care providers understand how to properly identify and manage this condition.

An expert consensus on diagnostic and management criteria for chronic urticaria is needed.

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Aug 11
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Compositional alteration of the nasal microbiome and Staphylococcus aureus-characterized dysbiosis in the nasal mucosa of patients with allergic rhinitis

By Artículos seleccionados, Selected articles

Kim HJ, Kim JH, Han S, Kim W

Clin Exp Otorhinolaryngol. 2022 Jun 8. doi: 10.21053/ceo.2021.01928. Epub ahead of print. PMID: 35680131.

Allergic rhinitis (AR) is an IgE and Th2-mediated inflammatory nasal disease. It originates from a sensitized immune response to inhaled allergens, which is thought to result from an imbalance in the Th1-Th2 immune regulation, resulting in increased levels of Th2 cytokines. Nasal ephitelial cells exposed to allergens induce Th2 inflammatory responses that spread to the upper airway mucosa. A commensalism host-microbial can be the basis of the innate immune responses in the nasal mucosa, and the microbial characteristics of the nasal mucus can impact the mechanisms of the initial allergic response. The aim of this study was to evaluate changes in the microbial composition in the nasal mucus of patients with AR and to understand the relationship between dysbiosis of the nasal microbiome and allergic inflammation.

The investigators analyzed the microbiota of 104 samples (n=42 participants with AR vs. n=30 healthy participants), in a total of 364,923 high-quality bacterial 16S ribosomal RNA-encoding gene sequence reads. The nasal mucus of healthy participants had mainly Proteobacteria (Ralstonia genus) and Actinobacteria (Propionibacterium genus) phyla, whereas the Firmicutes (Staphylococcus genus) phylum was significantly abundant in the nasal mucus of participants with AR. More sequencing data from 32 participants (healthy participants: n=15, AR patients: n=17) shown a greater abundance of Staphylococcus epidermidis, Corynebacterium

accolens, and Nocardia coeliaca, in 41.55% of mapped sequences in the nasal mucus of healthy participants. Patients with AR had a more pronounced dysbiosis of nasal microbiome and Staphylococcus aureus exhibited the greatest abundance (37.69%).

In conclusion, this study demonstrated that the nasal mucus of patients with AR have S. aureus–dominant dysbiosis, which suggests a role of host–microbial commensalism in allergic inflammation.

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Aug 10
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Autoimmune chronic spontaneous urticaria

By Artículos seleccionados, Selected articles

Kolkhir P, Muñoz M, Asero R, Ferrer M, Kocatürk E, Metz M, Xiang YK, Maurer M

J Allergy Clin Immunol. 2022 Jun;149(6):1819-1831. doi: 10.1016/j.jaci.2022.04.010. PMID: 35667749.

Chronic spontaneous urticaria (CSU) symptoms include the recurrent spontaneous appearance of wheals and intense itch that may last from hours to days and occur for several years. Some patients develop localized and self-limiting angioedema. These manifestations result from a temporary increase in vascular permeability. Almost 13% of patients with CSU experience angioedema and do not develop wheals.

There are 2 main autoimmune mechanisms for CSU: type I autoimmune (autoallergic) CSU, which is associated with with IgE antibodies against autoantigens; and type IIb autoimmune CSU, which is mediated by autoantibodies that activate mast cells via IgE and FceRI. Type IIb autoimmune CSU is present in almost 10% of patients and is characterized by higher disease severity, concomitant autoimmune diseases, low levels of total IgE, elevated levels of IgG-anti–thyroid peroxidase, basopenia, eosinopenia, poor response to antihistamines and to omalizumab, and a good response to cyclosporine. Some new targeted therapies are under development, such as the anti-IgE, ligelizumab, and the Bruton’s tyrosine kinase inhibitors, fenebrutinib and remibrutinib, and an anti-IL-4Ra, dupilumab.

There are missing some studies on the overlap between autoallergic and type IIb autoimmune CSU and on the optimal management of both types of autoimmune CSU, with easy-to-perform, noninvasive and inexpensive markers to assess the treatment response.

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Aug 10
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Comorbid allergic rhinitis and asthma: important clinical considerations

By Artículos seleccionados, Selected articles

Nappi E, Paoletti G, Malvezzi L, Ferri S, Racca F, Messina MR, Puggioni F, Heffler E, Canonica GW

Expert Rev Clin Immunol. 2022 Jun 19:1-12. doi: 10.1080/1744666X.2022.2089654. Epub ahead of print. PMID: 35695326.

There are several links between asthma and allergic rhinitis in the same patient, although these conditions are frequently underdiagnosed with suboptimal clinical outcomes. The two conditions coexist and share clinical, pathogenic, and pathophysiological mechanisms.

The aim of this article was to review the major links between the mechanisms of allergic rhinitis and asthma, as well as their treatment according to existing guidelines, focusing on treatment of allergic rhinitis in patients with comorbid asthma.

The authors concluded there are some unmet needs for patients with asthma and allergic rhinitis. Not all allergic rhinitis patients are screened for asthma. This screening should be conducted with a multidisciplinary approach to characterize the journey of patients with respiratory allergies to subsequently refer adequately to Allergy/Asthma centers. There may be advantages in treatment with allergen immunotherapy and/or biosimilars, which might represent encouraging advances in the management of both conditions.

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Jul 01
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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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Jul 01
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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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Jun 30
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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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Jun 30
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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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Jun 30
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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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Dec 17
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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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Dec 17
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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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Dec 17
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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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Dec 16
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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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