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CSU archivos - Bilastina

Eosinopenia, in chronic spontaneous urticaria, is associated with high disease activity, autoimmunity and poor response to treatment

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Pavel Kolkhir, Martin K. Church, Sabine Altrichter, Per Stahl Skov, Tomasz Hawro, Stefan Frischbutter, Martin Metz, Marcus Maurer.

(2019) The Journal of Allergy and Clinical Immunology: In Practice

Chronic spontaneous urticaria is characterized by the degranulation of skin mast cells and the influx of basophils and eosinophils to affected skin sites. Blood basopenia has been linked to severe antihistamine-resistant urticaria and type IIb autoimmunity, whereas the role of eosinophils in chronic spontaneous urticaria is largely unknown.

This study analysed the prevalence, role and relevance of eosinopenia of 1613 patients with chronic spontaneous urticaria from two centres. Peripheral blood eosinophil and basophil counts were analysed, and patient files were screened for clinical characteristics, results of laboratory tests, the autologous serum skin test, the serum-induced basophil-histamine release assay, and response to second generation H1-antihistamines and omalizumab.

Ten percent of the patients analysed had eosinopenia. This was also associated with being female, high disease activity, autologous serum skin test and basophil-histamine release assay positivity, low total IgE and high levels of C-reative protein and IgG-anti-TPO. Non-responders to treatment had even lower eosinophils compared to responders. Blood eosinophil counts correlated with basophil counts and 81% of patients with undetectable eosinophils had basopenia.

Investigators concluded that the combination of eosinopenia and basopenia is a better predictor of non-response to sgAHs than eosinopenia alone and that eosinopenia in patients with chronic spontaneous urticaria is associated with type IIb autoimmunity, high disease activity and poor response to treatment. This makes eosinophils as excellent biomarkers for the management of people with chronic urticaria.

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Spontaneous Urticaria

Immunological effects and potential mechanisms of action of autologous serum therapy in chronic spontaneous urticaria

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Yu L, Buttgereit T, Stahl Skov P, Schmetzer O, Scheffel J, Kocatürk E, Zawar V, Magerl M, Maurer M.

The findings of this study suggest that the immunological effects of autologous serum therapy include a reduction of IgE-anti-IL24 autoantibodies, which may contribute to the pathogenesis of spontaneous chronic urticaria (CSU).

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Autoimmune theories of chronic spontaneous urticaria

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Sonali J. Bracken, Soman Abraham and Amanda S. MacLeod

Different theories exist to describe the pathogenesis of chronic spontaneous urticaria. A group of investigators highlighted in this study the evidence surrounding the autoimmune pathogenesis of chronic urticaria, a condition which persists for more than 6 weeks in duration and occurs in the absence of an identifiable provoking factor.

Chronic spontaneous urticaria results from pathogenic activation of mast cells and basophils, which releases proinflammatory mediators of urticaria. Recent data suggests that chronic spontaneous urticaria may involve contributions from both immunoglobin G (IgG)-specific and immunoglobulin E (IgE)-specific autoantibodies against a vast array of antigens that can span beyond those found on the surface of mast cells and basophils, contributing to the severity of the disease and predisposing people to the development of additional autoimmune diseases.

People with chronic spontaneous urticaria mediated by IgE autoantibodies appear to have a faster onset of improvement in response to omalizumab than those with IgG-mediated disease.

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Urticaria Espontánea Crónica

Tumor necrosis factor-alpha and Fas/Fas ligand signaling pathways in chronic spontaneous urticaria

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Grzanka R, Damasiewicz-Bodzek A, Kasperska-Zajac A.

Tumor necrosis factor-alpha (TNF-a) is a key inflammatory and apoptotic mediator in urticaria. However, its role is still unclear in the apoptosis-inducing pathways in chronic spontaneous urticaria.

A group of people with chronic spontaneous urticaria and healthy people had their circulating concentrations of TNF-a, soluble TNF-a receptor types 1 and 2 and soluble Fas and Fas Ligand measured using enzyme-linked immunosorbent assay.

TNF-a and soluble TNF-a receptor types 1 and 2 concentrations were significantly higher in people with moderate-to-severe chronic spontaneous urticaria than healthy people. No significant differences were found between people with mild urticaria and healthy people. There were no differences observed in Fas and Fas Ligand concentrations in all participants.

In conclusion, chronic spontaneous urticaria is associated with the activation of the TNF-a/receptors signalling pathway marked by increased circulating concentrations of TNF-a and soluble TNF-a receptor types 1 and 2. In contrast, the circulating soluble Fas/Fas Ligand system is not up-regulated in chronic urticaria and does not seem to be an useful marker for the disease.

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Estudio de bilastina en pacientes japoneses

Association of positive and negative autologous serum skin test responses with clinical features of chronic spontaneous urticaria in Asian patients: A systematic review and meta-analysis

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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.

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Urticaria Espontánea Crónica (UCE)

Diagnosis, pathogenosis, and treatment of chronic spontaneous urticaria (e-Print)

By | Eprint, Selected articles
Allen P, Kaplan M.D.

Diagnosis, pathogenosis, and treatment of chronic spontaneous urticaria (CSU)

High doses of antihistaminic, omalizumab and ciclosporina (in this order) are effective and advisable for Chronic Spontaneous Urticaria (CSU) therapy, an inflammatory skin disease associated to autoimmunity in 45% of patients.

e-Print. Free download until end of purchased units.
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Relación entre urticaria y osteoporosis

Psychometric properties of the Spanish version of the once-daily Urticaria Activity Score (UAS) in patients with chronic spontaneous urticaria managed in clinical practice (the EVALUAS study)

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Jauregui I, Gimenez-Arnau A, Bartra J, Labrador-Horrillo M, de Frutos JO, Silvestre JF, Sastre J, Velasco M, Ferrer M, Ballesteros C, Valero A.

The daily diary Urticaria Activity Score (UAS) and its weekly score (UAS7) are widely used to assess signs and symptoms in patients with chronic spontaneous urticaria (CSU). The objective of this study was to assess the psychometric properties of a Spanish version of the once-daily UAS.

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urticaria crónica

The burden of chronic spontaneous urticaria: unsatisfactory treatment and healthcare resource utilization in France (the ASSURE-CSU study).

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Lacour JP, Khemis A, Giordano-Labadie F, Martin L, Staumont-Salle D, Hacard F, Tian H, McBride D, Hollis K, Hunter S, Martin L, Lamirand A, Le Guen S, Balp MM, Berard F.

Data on the clinical burden of chronic spontaneous urticaria (CSU) and economic consequences are lacking in France. To characterize the clinical and economic burden of CSU in symptomatic patients despite treatment by analysing data of French patients from the ASSURE-CSU study.

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Nivel de dímero D en plasma

Efficacy of autologous whole blood or serum therapy for chronic spontaneous urticaria: A systematic review and meta-analysis

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Chang HC, Sung CW, Lin MH.

Chronic spontaneous urticaria (CSU) is chronic wheals without identifiable exogenous stimuli. Autologous whole blood (AWB) injection and autologous serum therapy (AST) are alternative therapies for CSU that induce tolerance to circulating histamine-releasing factors.

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