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Sep 25
Love0
Urticaria Crónica Espontánea

Targeted Therapy for Chronic Spontaneous Urticaria: Rationale and Recent Progress

By Artículos seleccionados, Selected articles

Ana M. Giménez‑Arnau, Andaç Salman

Drugs . 2020 Aug 28. doi: 10.1007/s40265-020-01387-9. Online ahead of print.

Chronic spontaneous urticaria is characterized by wheals, angioedema, or both for at least 6 weeks and can last for a long time, up to 5 years. The effects of chronic spontaneous urticaria on quality of life are comparable to psoriasis, atopic dermatitis, or even ischemic heart disease.

Antihistamines continue to be the first choice for treatment of urticaria, however rates of response are low (ranging from 38.6% in standard doses to 63.2% in higher doses), some patients don’t experience a complete of symptoms. The use of omalizumab has shown a major advance in treating patients with chronic spontaneous urticaria, however, there is a subgroup of patients who have a partial or even lack of response to omalizumab.

Some of the upcoming targeted therapies for chronic spontaneous urticaria include:

  1. anti-IgE antibodies, such as ligelizumab, a monoclonal antibody directed against the Cε3 domain of IgE and which has shown a six- to ninefold greater potency in vivo compared to omalizumab; UB-221, another monoclonal antibody against IgE with up to eightfold greater affinity for free IgE, compared to omalizumab; quilizumab, a humanized monoclonal antibody directed against membrane-bound IgE.
  2. Anti-Siglec-8. Siglecs are a transmembrane family with regulatory effects on intercellular and intracellular signaling, with Siglec-8 having expression on eosinophils and mast cells.
  3. Bruton’s Tyrosine Kinase (BTK) inhibitors. BTK is a tyrosine kinase expressed in hematopoietic cells, including macrophages, mast cells and basophils. BTK inhibitors are used to treat different malignancies of B-cell origin. Ibrutinib, dasatinib, AVL-292 and CNX-774 effectively suppressed IgE-induced activation and histamine release from basophils and mast cells.
  4. Chemoattractant receptor-homologous molecule expresses on Th2 (CRTH2) inhibitors; Spleen Tyrosine Kinase (SYK) inhibitors; Anti-CD20; Anti-IL-1; Anti-IL-4/13; and Anti-IL-5.

The future treatment of chronic urticaria will probably change once potential new treatments are completely developed.

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Sep 25
Love0
rinitis alérgica y covid-19

Clinical presentation at the onset of COVID-19 and allergic rhinoconjunctivitis

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Fabio Ferreli, Francesca Gaino, Elena Russo, Matteo Di Bari, Francesca Pirola, Andrea Costantino, Luca Malvezzi, Armando De Virgilio, Giovanni Colombo, Giovanni Paoletti, Emanuela Morenghi, Giorgio Walter Canonica, Giuseppe Spriano, Enrico Heffler, Giuseppe Mercante

J Allergy Clin Immunol Pract . 2020 Aug 18;S2213-2198(20)30823-0. doi: 10.1016/j.jaip.2020.08.009. Online ahead of print.

COVID-19 is characterized by various clinical conditions, from mild symptoms to pneumonia and death. Mild symptoms, such as nasal and ocular manifestations, can be confused with allergic rhinoconjunctivitis at the onset. This article describes the differences that let one distinguish COVID-19 and allergic rhinoconjunctivitis.

This study included 204 patients that were infected with coronavirus were included. They were retrospectively studied via telephone interview, where they were requested to complete a validated questionnaire, The Mini Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ), which evaluated a series of 14 signs and symptoms on a scale from 0 to 6, indicating “not troubled” and “extremely troubled”, respectively. Patients were also asked to compare the manifestations of their last allergic symptomatic period with COVID-19 manifestations and to evaluate their sense of taste and/or smell.

Among all 204 participants, 22 were also affected by allergic rhinoconjunctivitis. Clinical manifestations of allergic rhinoconjunctivitis compared with those at the onset of COVID-19 were defined as “completely different” by 15 patients (68,2%), “different” by 3 (13.6%), and “similar” by 4 (18,2%). The two clinical presentations were never reported as “identical”.

Although COVID-19 may present some overlap in symptoms with seasonal allergies, the MiniRQLQ scored significantly different between allergic rhinoconjunctivitis and COVID-19. Also, in this study, there were no differences in taste and smell dysfunction reported. Patients with allergic rhinoconjunctivitis are familiar with its symptoms and were able to distinguish them from COVID-19 rhinoconjunctival manifestations.

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Dec 20
Love3
optimizacion evaluacion urticaria

Optimizing Value in the Evaluation of Chronic Spontaneous Urticaria: A Cost-effectiveness Analysis

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Shaker M, Oppenheimer J, Wallace D, Lang DM, Rambasek T, Dykewicz M, Greenhawt M.

J Allergy Clin Immunol Pract. 2019 Nov 18. pii: S2213-2198(19)30938-9. doi: 10.1016/j.jaip.2019.11.004. [Epub ahead of print]

Chronic spontaneous urticaria can occur in both children and adults, however it is more common in adults, affecting approximately 1% of the population. It usually has an impact in quality of life, sleep and anxiety.

The aim of this study was to assess the cost-effectiveness of routine laboratory testing for secondary causes of chronic spontaneous urticaria.

Patients with more than 20 years old, over a 10-year time horizon, were randomized to receive screening laboratory testing or a no-testing approach. Laboratory results were derived from previously published retrospective studies of patients with chronic spontaneous urticaria. Cost-effectiveness was evaluated at a Willingness to Pay (WTP) threshold of $100,000/quality-adjusted life-year (QALY) using the incremental cost-effectiveness ratio (ICER) in people with untreated urticaria, and patients treated with antihistamines, cyclosporine, or omalizumab.

Average laboratory costs per simulated urticaria patient were $572.97, with only 0.16% (SD, 3.99%) of tests resulting in improved clinical outcomes. Testing costs per laboratory-associated positive outcome were $358,052 (no therapy), $357,576 (antihistamine therapy), $354,115 (cyclosporine), and $262,121 (omalizumab). Screening tests were not cost effective, with ICERs of $856,905 (no therapy), $855,764 (antihistamine therapy), $847,483 (cyclosporine), and $627,318 (omalizumab). In the omalizumab-treated subgroup, testing could be cost-effective below $220 or if it resulted in a 0.73% rate of CSU resolution. From a simulated US population perspective, nation-wide screening costs could reach $941,750,741 – $1,833,501,483.

This study concluded that the likelihood of clinical improvement from laboratory testing is very low, and that testing is not cost-effective in people with urticaria. Therefore, it is not recommended to routinely perform laboratory testing in urticaria patients with normal clinical and physical evaluations.

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