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Background: Urticaria is a common disease with a marked influence on quality of life. The key cell involved is the mast cell, which can be activated by a vast variety of stimuli, and the major mediator is histamine. Allergic urticaria is a disorder with a large variety of causes: food, drugs, insect venom, skin contact with allergens, and physical exercise. Buckwheat consumption has increased in European countries and the USA because it is gluten-free. It can trigger anaphylactic shock if ingested, inhaled, or handled with the hands. Five common buckwheat allergens named Fag e1 to 5 (Fag e1, 2, and 3 are considered the major allergens) and two tartary buckwheat allergens named Fag t1 and Fag t2 have been described. Method: We present the case of a patient who experienced two anaphylactic shocks and in whom the etiological factor was buckwheat. The patient presented to the Allergology department for the evaluation of two episodes of severe allergic reactions that required emergency therapy, episodes that involved the loss of consciousness and were of major severity. At each anaphylactic shock, an ambulance was requested, and emergency therapy was administered, leading to the patient's recovery within a few hours. Diagnosis: Since each episode occurred a few minutes after eating, the diagnosis was established based on a detailed anamnesis and prick skin tests, followed by specific IgE dosages. Other foods consumed by the patient, assessed by prick skin testing and specific IgE dosages of suspected foods, were excluded as the etiological cause. Increased levels of buckwheat-specific immunoglobulin E were highlighted, thus identifying the etiological agent. The treatment of anaphylactic shock was performed urgently by the ambulance crew with adrenaline, infusion solutions, cortisone preparations, and antihistamines. Result: Following the treatment that was initiated, there was a partial remission of the lesions after a few hours. Conclusions: Buckwheat allergy is rare, but it produces symptoms that affect the skin, gastrointestinal tract, and respiratory tract, as well as anaphylaxis. In a professional environment, it can trigger allergic rhinitis, asthma, and hives. Although buckwheat allergens have been described, their clinical relevance has only been studied in a small number cases. In current practice, the only commercially available allergen is Beech e2 per the ImmunoCAP ISAC microarray. Diagnosis can be difficult in clinical practice. This reported case suggests the need for a thorough anamnesis, since buckwheat is consumed as a hidden allergen, and in Europe, it is not necessary to label foods containing this allergen. [ABSTRACT FROM AUTHOR]

Introduction: Chronic urticaria is defined as the almost daily occurrence of wheals and pruritus for a minimum of six weeks, adversely affecting the quality of life and necessitating management with a drug with better efficacy and a high safety profile. This study was designed to determine how monotherapy with newer antihistamines benefits chronic spontaneous urticaria by producing earlier and longer periods of remission. Additionally, the study aimed to assess the adverse effects associated with the drugs. Aim: To compare the efficacy of Levocetirizine and Bilastine in chronic spontaneous urticaria. Materials and Methods: The study was a single-blinded randomised controlled trial conducted in the Department of Dermatology at Madras Medical College, Chennai, Tamil Nadu, India over 24 months from January 2020 to December 2021. A total of 163 patients with chronic urticaria were randomly divided into two groups: Group A with 82 patients and group B with 81 patients. The patients were treated with tablet Levocetirizine 5 mg and tablet Bilastine 20 mg for six months (with up-dosing to four-fold maximum) in Group A and Group B, respectively. The treatment response was assessed using the Urticaria Activity Score (UAS) at each follow-up. Patients were followed-up for an additional six months to observe the time of recurrence. Total 15 patients were lost to follow-up and were consequently excluded from the statistical analysis. Results: At the end of six months, the improvement observed in UAS was statistically similar in both groups (p-value=0.513). The time taken for remission was shorter with Levocetirizine (11.19±5.31 weeks) compared to Bilastine (14.59±5.02 weeks). Recurrence occurred earlier with Bilastine compared to Levocetirizine. Conclusion: Levocetirizine and Bilastine are equally effective in controlling urticaria at the end of six months of treatment. Patients on Levocetirizine experienced earlier remission as well as late recurrence compared to those on Bilastine.

This document is a letter discussing the incidence and risk factors of cutaneous reactions to the first COVID-19 booster vaccine. The study included healthcare employees who received the first mRNA COVID-19 booster and completed a symptom survey within 3 days post-vaccination. The results showed that 2.4% of recipients experienced cutaneous reactions, such as itching, rash, hives, and swelling. Asian race was associated with a higher risk of cutaneous reactions, particularly itching and swelling. The study suggests that additional research is needed to investigate Asian race as a potential risk factor for cutaneous reactions after mRNA vaccines. [Extracted from the article]

The current paper represents a study accomplished on the territory of Tăcuta commune, in Vaslui County, to estimate the honey potential of the area. The results showed that here lives a spontaneous, diversified, and cultivated flora, among which exist also species of honey interest (acacia, linden, rapeseed, sunflower, etc.); they can provide up to 153 tons of honey, which would ensure conditions for the maintenance of 1260 stationary bee families. The area can also assure good conditions for capitalizing on the honey potential by pastoral beekeeping, especially for: acacia harvesting, where could be moved up to 3000 hives, linden harvesting, where could be moved up to 2700 hives, and sunflower harvesting, where could be moved up to 970 hives. [ABSTRACT FROM AUTHOR]

Background/Aim: Google Trends is a powerful tool for health information access and disease surveillance, including COVID-19 data forecasting. Cutaneous manifestations of COVID-19 include urticarial rash, which is multifactorial and may indicate a better prognosis. Aim of this study was to analyse the search queries for the term “urticaria” during the six years period (2017-2022) and assess the relationship between relative search volume (RSV) and a global rise in COVID-19 cases. Methods: This study examined search queries for "urticaria" from 2017 to 2022, exploring the relationship between RSV and global COVID-19 cases. Data on "urticaria" search volume in various countries were collected using Google Trends. Microsoft Excel and correlation analysis were used to analyse the data and investigate the association between search volume and monthly COVID-19 case rise. Results: During 2017-2019, the mean RSV for "urticaria" was 69.9 ± 10.1, which increased to 84.1 ± 8.6 during 2020-2022. The difference in means was statistically significant (p < 0.001). The mean RSV in 2022 (94.3) was the highest among all years studied. The increase in RSV from 2020 to 2022 moderately correlated (r = 0.56) with monthly COVID-19 case rise (p < 0.001). Nicaragua showed the highest search interest, while Africa, North America, Asia and Pacific, the Middle East and Europe had low search interest. Conclusions: This study identified a significant increase in search volume for "urticaria" during the COVID-19 pandemic. Nicaragua had the highest search interest, while English-speaking countries displayed low interest. Language variation, cultural differences and COVID-19-related health concerns may influence public interest in urticaria. These findings can aid public health officials in understanding public health concerns and tailoring effective health communication strategies. [ABSTRACT FROM AUTHOR]

Urticaria commonly occurs in childhood, affecting up to 15% of British children. It is characterized by the sudden onset of wheals, angioedema, or both. Episodes are usually acute, often triggered by viral infections or antibiotics, with approximately a third progressing to chronic or recurrent urticaria. This review focuses on chronic urticaria subtypes, diagnosis and treatment options for children. The diagnosis is usually made clinically, and a focused history is key. Detailed investigation is usually unnecessary. Chronic urticaria is divided into chronic spontaneous urticaria and the inducible urticarias. Chronic spontaneous urticaria is autoimmune in origin, in approximately 40% of older children. Cold urticaria and dermographism are the most common inducible urticarias. Isolated angioedema should prompt consideration of hereditary angioedema. The mainstay of treatment is trigger avoidance combined with non-sedating antihistamines. Higher doses of antihistamines may be required but these are usually tolerated well. We provide guidance on antihistamine updosing strategies. There is an improvement in symptoms for most children, but leukotriene receptor antagonists can provide additional improvements in some children. Tranexamic acid may provide symptomatic relief for isolated angioedema. Short courses of oral steroids may be used in acute episodes or highly symptomatic patients with chronic urticaria. Second line treatment for non-responders is primarily monoclonal anti-IgE antibody therapy but a small number of children and young people continue to have significant symptoms despite this and in these children ciclosporin may be useful. Urticaria usually resolves and almost all children and young people are disease free after 7 years. [ABSTRACT FROM AUTHOR]

Introduction: Chronic urticaria is defined as the almost daily occurrence of wheals and pruritus for a minimum of six weeks, adversely affecting the quality of life and necessitating management with a drug with better efficacy and a high safety profile. This study was designed to determine how monotherapy with newer antihistamines benefits chronic spontaneous urticaria by producing earlier and longer periods of remission. Additionally, the study aimed to assess the adverse effects associated with the drugs. Aim: To compare the efficacy of Levocetirizine and Bilastine in chronic spontaneous urticaria. Materials and Methods: The study was a single-blinded randomised controlled trial conducted in the Department of Dermatology at Madras Medical College, Chennai, Tamil Nadu, India over 24 months from January 2020 to December 2021. A total of 163 patients with chronic urticaria were randomly divided into two groups: Group A with 82 patients and group B with 81 patients. The patients were treated with tablet Levocetirizine 5 mg and tablet Bilastine 20 mg for six months (with up-dosing to four-fold maximum) in Group A and Group B, respectively. The treatment response was assessed using the Urticaria Activity Score (UAS) at each follow-up. Patients were followed-up for an additional six months to observe the time of recurrence. Total 15 patients were lost to follow-up and were consequently excluded from the statistical analysis. Results: At the end of six months, the improvement observed in UAS was statistically similar in both groups (p-value=0.513). The time taken for remission was shorter with Levocetirizine (11.19±5.31 weeks) compared to Bilastine (14.59±5.02 weeks). Recurrence occurred earlier with Bilastine compared to Levocetirizine. Conclusion: Levocetirizine and Bilastine are equally effective in controlling urticaria at the end of six months of treatment. Patients on Levocetirizine experienced earlier remission as well as late recurrence compared to those on Bilastine. [ABSTRACT FROM AUTHOR]

Modern beekeeping uses various technological solutions to control and manage apiaries, but many need help with problems related to energy consumption and the inability to adapt to changing conditions. This article presents the development of the conceptual model of hardware-software complex architecture, focusing on the modularity and flexibility of the system. The main idea is to use a universal programmable logic controller with a modular architecture, which allows users to quickly adapt the system to new tasks by adding or replacing sensors and control mechanisms. The proposed approach considers minimizing energy consumption using energy-efficient LoRa technology for data transmission. Such a system's main advantages and potential risks are considered, and formulas for calculating energy consumption during data transmission are presented. The article can serve as a guide for specialists in the field of beekeeping and developers of automation systems. [ABSTRACT FROM AUTHOR]

Chronic urticaria (CU) is the recurring development of wheals (aka "hives" or "welts"), angioedema, or both for more than 6 weeks. Wheals and angioedema occur with no definite triggers in chronic spontaneous urticaria, and in response to known and definite physical triggers in chronic inducible urticaria. Approximately 1.4% of individuals globally will have CU during their lifetime. The itching and physical discomfort associated with CU have a profound impact on daily activities, sexual function, work or school performance, and sleep, causing significant impairment in a patient's physical and mental quality of life. CU also places a financial burden on patients and healthcare systems. Patients should feel empowered to self-advocate to receive the best care. The voice of the patient in navigating the journey of CU diagnosis and management may improve patient–provider communication, thereby improving diagnosis and outcomes. A collaboration of patients, providers, advocacy organizations, and pharmaceutical representatives have created a patient charter to define the realistic and achievable principles of care that patients with CU should expect to receive. Principle (1): I deserve an accurate and timely diagnosis of my CU; Principle (2): I deserve access to specialty care for my CU; Principle (3): I deserve access to innovative treatments that reduce the burden of CU on my daily life; Principle (4): I deserve to be free of unnecessary treatment-related side-effects during the management of my CU; and Principle (5): I expect a holistic treatment approach to address all the components of my life impacted by CU. The stated principles may serve as a guide for healthcare providers who care for patients with CU and translate into better patient–physician communication. In addition, we urge policymakers and authors of CU treatment guidelines to consider these principles in their decision-making to ensure the goals of the patient are achievable. [ABSTRACT FROM AUTHOR]

Chronic spontaneous urticaria (CSU) is a common skin disease without an etiology in the vast majority of cases. The similarity of symptoms and pathology to allergen-induced skin reactions supports that skin mast cell IgE receptor activation is also involved in CSU. Accumulating evidence also supports a role for blood basophils in disease expression. Blood basopenia is noted in active CSU disease with the recruitment of blood basophils to skin lesion sites. Blood basophils further display altered IgE receptor mediated degranulation patterns in two phenotypes that improve in remission. In active CSU subjects, changes in IgE receptor signaling molecule expression levels accompany the altered degranulation function in blood basophils. The success of therapies targeting IgE in CSU patients have also shown that altered blood basophil phenotypes and enumeration have potential use as a disease biomarker.

BackgroundUrticaria (defined as the presence of hives, angioedema, or both) can be caused by a variety of etiologies ranging from more common conditions such as chronic spontaneous urticaria (CSU) to rarer conditions such as hereditary angioedema (HAE). Specialist referral may be necessary in cases of severe urticaria or HAE, but access to specialist services remains limited in certain regions, such as the Greater Bay Area (GBA) of China. To address this, the Hong Kong–Macau Severe Hives and Angioedema Referral Pathway (SHARP) was initiated by the Hong Kong Institute of Allergy and Macau Society of Dermatology to promote multidisciplinary collaboration and regional exchange of expertise in the diagnosis and management of severe urticaria.MethodsA nominated task force of dermatologists and immunologists who manage patients with severe urticaria formulated the consensus statements (CS) using the Delphi method. The consensus was defined a priori as an agreement of ≥80%.ResultsA total of 24 CS were formulated, including four statements on classifications and definitions, seven statements on diagnosis, and 13 statements on management and referral. The definitions for acute/chronic urticaria and severe CSU were stated. Unnecessary investigations and inappropriate medications were discouraged. The characteristics and recommended approach to suspected bradykinergic angioedema were specified. Stepwise treatment options using second-generation antihistamines, omalizumab, or cyclosporin for patients with CSU were addressed, and the importance of access to HAE-specific medications was emphasized. Furthermore, an integrated referral pathway for patients with severe hives and angioedema was constructed.ConclusionThe SHARP provides guidance for the management and specialist referral of patients with severe hives and angioedema in Hong Kong and Macau.

Abstract Background Food allergy is becoming increasingly common among the pediatric population. Despite strict avoidance of food allergens, a subgroup of sensitive individuals still develops frequent, persistent, and difficult to treat hives (FPDTH) for which there is no curative therapy. Although these cases are rare, these patients are in most need of therapy. Case presentations This is a retrospective review of 3 pediatric patients with highly sensitive food allergies who initially presented with hives daily or every other day, or multiple times a day, but achieved marked remission after traditional Chinese medicine (TCM) therapies. Patient 1 (P1) is a 5-year-old who has experienced 140 reactions in his lifetime. Reactions were mostly hives with 4 episodes of anaphylaxis. P1 had used Prednisone 20 times, had an Epinephrine injection 4 times, and had 3 emergency room (ER) visits. Patient 2 (P2) is a 12-year-old who had experienced hives since age 3. Despite daily antihistamine use, P2 had > 730 reactions in his lifetime at the time of presentation including 2 episodes of anaphylaxis. He had been prescribed prednisone 4 times, an Epinephrine injection 2 times, and had 1 ER visit. Patient 3 (P3) is a 20-month-old girl who had experienced > 120 reactions including 1 episode of anaphylaxis. She was on daily desonide and frequently used an antihistamine, yet still had required a course of prednisone once, an Epinephrine injection once, and had 1 ER visit to manage her reaction. After presenting to our clinic, patients received internal and external TCM treatments, including herbal baths and creams (Remedy A-D) as basic remedies to reduce food reactions, including but not limited to frequent hives. Within 7–9 months of TCM treatment, remarkably all patients had complete remission of atopic symptoms. All three patients also experienced an improvement in other conditions including food intolerance, diarrhea, anxiety, eczema, and environmental allergies. After 1 year of treatment, all three patients had reductions in food-specific IgE levels that had been previously elevated, and additionally, P1 and P3, who initially had high total IgE levels, experienced a marked decrease in total IgE levels as well. All three patients continued to introduce foods into their diet that they previously had reactions to, and all 3 patients remain symptom-free. Conclusions Three pediatric patients with a known history of multiple food sensitivities and physician-diagnosed food allergies that presented with FPDTH underwent a TCM regimen and experienced dramatic improvement in symptoms and reduction in their IgE levels. This regimen appears to be effective in FPDTH population although a further study in a controlled clinical setting is required.

Background Chronic urticaria symptoms are benign and self-limiting. However, chronic urticaria with systemic symptoms can be life-threatening and may be an early sign of anaphylactic shock. This systematic review was conducted to recognize and understand the clinical features of urticaria and the role of diet modification in chronic urticaria to minimise the side effect of long-term therapy. Methods A primary literature search using preferred reporting items for systematic reviews and meta-analyses (PRISMA) was conducted using PubMed and Science Direct databases in January 2021. Results A total of 10 articles were included in this study. Some diets and conditions were recommended to be avoided in patients with chronic urticaria are galactose-a-1,3-galactose allergy (a-gal), Anisakis simplex, pseudo allergens, gluten, food additives and histamine. Supplementation with diamine oxidase, vitamin D and probiotics was beneficial. Conclusion Diet modification in chronic urticaria patients receiving long-term medical therapy must be done to reduce drug side effects. Consumption of foods suspected of causing urticaria should be avoided for three consecutive weeks, especially for pseudoallergenic foods and histamine-containing foods. Moreover, patients should avoid consuming certain foods that can cause nutritional deficiencies, so further consultation with a nutritionist is needed. [ABSTRACT FROM AUTHOR]

Urticaria is a heterogeneous inflammatory disorder that can be acute or chronic and is defined by the appearance of wheals, angioedema, or both. Very recently, the newest update and revision of the international European Academy of Allergy and Clinical Immunology/Global Allergy and Asthma European Network/European Dermatology Forum/Asia Pacific Association of Allergy Asthma Clinical Immunology guideline for the definition, classification, diagnosis, and management of urticaria was published. It aims to help primary care physicians and specialists in the management of their patients with urticaria. The guideline applied the Grading of Recommendations Assessment Development and Evaluations approach to developing consensus recommendations. These recommendations were then discussed in a Delphi conference that included more than 250 specialists in the field, and they are endorsed by more than 50 international societies. Here, we highlight changes from previous versions of the international urticaria guideline and their impact on clinical practice. [ABSTRACT FROM AUTHOR]

Toxicity of neem oil on developmental stages of Apis mellifera L. was evaluated by applying three concentrations within the marked comb cells with micropipette as single (applied only once) and multiple exposures (at one day interval up to capping of cells) on different age groups of larvae (1-2, 3-4 and 5-6 days). Results revealed that maximum survival was observed in controls (both negative and positive) and at par with 0.05% (T1) and 0.1 % (T2) concentrations. Minimum survival of larval stage was found in 1% (T3). Same trend was also observed in emerged pupae (CD=17.9) and in mortality of adult bees (CD=15.3). Significant difference in the survival of larval (p<0.05), emerged pupae (p<0.05) and mortality of adult (p<0.05) honey bees was found within stages originating from treated larvae. Both in single or multiple doses, it was found that larvae treated at 1-2 days age group was significantly affected as compared to other stages. [ABSTRACT FROM AUTHOR]

Background: Food allergy is becoming increasingly common among the pediatric population. Despite strict avoidance of food allergens, a subgroup of sensitive individuals still develops frequent, persistent, and difficult to treat hives (FPDTH) for which there is no curative therapy. Although these cases are rare, these patients are in most need of therapy. Case presentations: This is a retrospective review of 3 pediatric patients with highly sensitive food allergies who initially presented with hives daily or every other day, or multiple times a day, but achieved marked remission after traditional Chinese medicine (TCM) therapies. Patient 1 (P1) is a 5-year-old who has experienced 140 reactions in his lifetime. Reactions were mostly hives with 4 episodes of anaphylaxis. P1 had used Prednisone 20 times, had an Epinephrine injection 4 times, and had 3 emergency room (ER) visits. Patient 2 (P2) is a 12-year-old who had experienced hives since age 3. Despite daily antihistamine use, P2 had > 730 reactions in his lifetime at the time of presentation including 2 episodes of anaphylaxis. He had been prescribed prednisone 4 times, an Epinephrine injection 2 times, and had 1 ER visit. Patient 3 (P3) is a 20-month-old girl who had experienced > 120 reactions including 1 episode of anaphylaxis. She was on daily desonide and frequently used an antihistamine, yet still had required a course of prednisone once, an Epinephrine injection once, and had 1 ER visit to manage her reaction. After presenting to our clinic, patients received internal and external TCM treatments, including herbal baths and creams (Remedy A-D) as basic remedies to reduce food reactions, including but not limited to frequent hives. Within 7–9 months of TCM treatment, remarkably all patients had complete remission of atopic symptoms. All three patients also experienced an improvement in other conditions including food intolerance, diarrhea, anxiety, eczema, and environmental allergies. After 1 year of treatment, all three patients had reductions in food-specific IgE levels that had been previously elevated, and additionally, P1 and P3, who initially had high total IgE levels, experienced a marked decrease in total IgE levels as well. All three patients continued to introduce foods into their diet that they previously had reactions to, and all 3 patients remain symptom-free. Conclusions: Three pediatric patients with a known history of multiple food sensitivities and physician-diagnosed food allergies that presented with FPDTH underwent a TCM regimen and experienced dramatic improvement in symptoms and reduction in their IgE levels. This regimen appears to be effective in FPDTH population although a further study in a controlled clinical setting is required. [ABSTRACT FROM AUTHOR]

Purpose of Review: While aeroallergens are a well-established trigger of asthma and allergic rhinitis, their role in allergic skin diseases such as atopic dermatitis and chronic urticaria remains controversial. This paper reviews the pathophysiology and clinical evidence for aeroallergens in these allergic skin diseases and summarizes current strategies for evaluation and management. Recent Findings: Current evidence implicates aeroallergens as triggers of cutaneous reactions in atopic dermatitis. Direct skin contact is the likely route of trigger. Aeroallergens may also trigger chronic urticaria, though mechanistic studies are limited. These allergens may cross the skin barrier and directly trigger neurons to release substance P, resulting in mast cell degranulation and dumping of histamine and prostaglandin D2. Many studies link aeroallergen sensitization to chronic urticaria, and case reports suggest the utility of avoidance strategies. Summary: The role of aeroallergens as a trigger is clear in atopic dermatitis and becoming emergent in chronic urticaria. Skin prick testing or serum-specific immunoglobulin E testing may be used to determine sensitivities. Management at this time centers on avoidance, and further studies are necessary to evaluate the efficacy of aeroallergen immunotherapy for both conditions. [ABSTRACT FROM AUTHOR]

BackgroundCholinergic urticaria (CholU) is a common type of chronic inducible urticaria. Little is known about the burden of the disease and its unmet medical needs.AimTo characterize the unmet medical needs of patients with CholU.MethodsPatients with CholU (n = 111) took part in a German online survey that assessed their symptoms, diagnostic delay, impact on daily life, quality of life (QoL), and their experience with physician care.ResultsVirtually all patients reported typical signs and symptoms of CholU, i.e., whealing (93.7%) and itching (91.9%), in response to typical trigger situations, such as physical activity, passive warming, or stress. Despite this, patients reported a marked diagnostic delay of 30.2 months (range from 0 to 279 months). Only 38% of the patients received a blood examination, and only 16% underwent provocation testing for diagnosing CholU, as recommended by the international guidelines. Physician contacts were common, but patient satisfaction with their disease management was low. In total, 90.1% of the patients stated to have an uncontrolled disease, resulting in a strong impact on their everyday activities, sleep, and QoL.ConclusionPatients with CholU exhibit many important unmet needs, and improvement in the diagnostic workup and patient care is needed, as are better treatment options.

This update and revision of the international guideline for urticaria was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the Global Allergy and Asthma European Network (GA²LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), the European Dermatology Forum (EDF; EuroGuiDerm), and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology with the participation of 64 delegates of 50 national and international societies and from 31 countries. The consensus conference was held on 3 December 2020. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell–driven disease that presents with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous or inducible urticaria is disabling, impairs quality of life, and affects performance at work and school. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert‐guided and evidence‐based diagnostic and therapeutic approaches for the different subtypes of urticaria. [ABSTRACT FROM AUTHOR]

The term "urticaria" was first introduced by William Cullen in the eighteenth century. Urticaria is a common mast cell-mediated cutaneous disease presenting with pruritic wheals, angioedema, or both. It is classified as acute (≤6 weeks) or chronic (>6 weeks) and as spontaneous (no definite triggers) or inducible (definite and subtype-specific triggers). The international urticaria guideline on the definition, classification, diagnosis, and management of urticaria is revised every 4 years. The global network of Urticaria Centers of Reference and Excellence, the biggest and most active consortium of urticaria specialists, offers physicians and patients several research, educational, and digital care initiatives., Competing Interests: Disclosure M. Maurer is or recently was a speaker and/or advisor for and/or has received research funding from Allakos, Almirall, Spaim, Alvotech, Amgen, United States, Aquestive, Aralez, AstraZeneca, United Kingdom, Bayer, Germany, Celldex, United States, Celltrion, South Korea, Evommune, GSK, Ipsen, France, Janssen, United States, Kyowa Kirin, LEO Pharma, Denmark, Lilly, Menarini, Mitsubishi Tanabe Pharma, Japan, Moxie, Noucor, Novartis, Switzerland, Orion, Pfizer, United States, Resoncance Medicine, Sanofi/Regeneron, Septerna, Third Harmonic Bio, ValenzaBio, Yuhan Corporation, South Korea, and Zurabio. M.P. Pereira is an investigator for Allakos, Celldex Therapeutics, Incyte, Sanofi and Trevi Therapeutics and is/was an advisor and/or speaker and/or has received research funding from AbbVie, United States, Almirall, Beiersdorf, Germany, Eli Lilly, GA(2)LEN, Galderma, Switzerland, Menlo Therapeutics, Novartis, P.G. Unna Academy, Sanofi, United States and Trevi Therapeutics. P. Kolkhir is or recently was a speaker and/or advisor for and/or has received research funding from Novartis, Roche, Switzerland, and ValenzaBio outside of submitted work., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Honey bees preferentially occupy thick walled tall narrow tree cavities and attach their combs directly to the nest wall, leaving periodic gaps. However, academic research and beekeeping are conducted in squat, thin walled man made hives, with a continuous gap between the combs and the walls and roof. Utilising a computational fluid dynamics (CFD) model of thermoregulating bees in complete nests in trees and thin walled man made hives, with the average size of tree comb gaps determined from honey bee occupied synthetic tree nests, this research compared the metabolic energy impacts of comb gaps and vertical movement of the thermoregulated brood area. This shows their heat transfer regimes are disparate, including: bee space above combs increases heat loss by up to ∼70%; hives, compared to tree nests, require at least 150% the density of honey bees to arrest convection across the brood area. Tree cavities have a larger vertical freedom, a greater thermal resistance and can make dense clustering redundant. With the thermal environment being critical to honey bees, the magnitude and scope of these differences suggest that some hive based behavioural research needs extra validation to be considered non-anthropogenic, and some bee keeping practices are sub-optimal. [ABSTRACT FROM AUTHOR]

Chronic spontaneous urticaria is challenging to manage and substantially affects quality of life. This US, non-interventional qualitative study examined patients’ clinical journeys and emotional burden from symptom onset through disease management. Chronic spontaneous urticaria patients participated in interviews and completed diaries focusing on disease and treatment history/perspectives, impact on personal/family life, and relationships with physicians/other healthcare providers. Physicians were interviewed about their views on disease management and patient care. Twenty-five patients, previously or currently receiving chronic spontaneous urticaria treatment(s), and 12 physicians participated. Key stages following symptom onset were identified: Crisis (associated with feelings of torment/disorientation/shock); Searching for answers (puzzlement/frustration/anxiety); Diagnosis (relief/satisfaction/fear/isolation); and Disease management (frustration/hope/powerlessness). Findings revealed patients’ perceptions and experiences of chronic spontaneous urticaria, including living with a ‘skinemy’, experiencing their ‘own personal hell’ and feeling ‘like an experiment’. Awareness of unmet needs in patient care/management identified in this study may ultimately improve patient support and enhance physicians’ understanding of disease burden.

Abstract Recognize that delayed hypersensitivity reactions to sulfonamides may present as urticated plaques with hyperpigmentation and purpura for which a diagnosis of urticarial vasculitis should be considered.

Objective Chronic spontaneous urticaria is one of the most troubling symptoms in autoimmune connective tissue diseases (ACTDs). Our aim is to better characterize the association between chronic spontaneous urticaria and ACTDs. Methods A retrospective study of patients seen at ACTDs clinic at Massachusetts General Hospital. Results Of the 41 patients who fit our criteria, 58% had no underlying ACTDs, 22% had systemic lupus erythematosus (SLE), and only 4% had other types of ACTDs. Conclusion Chronic spontaneous urticaria is a frequent condition in SLE. We did not find a strong association between other ACTDs and chronic spontaneous urticaria. [ABSTRACT FROM AUTHOR]

Background: Acute urticaria is a common dermatological condition in emergency departments (EDs). The main therapy involves controlling pruritus with antihistamines. Although guidelines have promoted the use of corticosteroids in addition to H1 antihistamines, well-designed clinical trials evaluating this approach are scarce.Methods: Adult ED patients with acute urticaria and a pruritus score > 5 on a visual analog scale (VAS) were randomized into three groups: (i) IV chlorpheniramine (CPM) treatment, (ii) IV CPM and IV dexamethasone (CPM/Dex) and (iii) IV CPM and IV dexamethasone with oral prednisolone as discharge medication for 5 days (CPM/Dex/Pred). The primary outcomes were self-reported pruritus VAS scores at 60 min after treatment. We also evaluated 1-week and 1-month urticaria activity scores for 7 days and adverse events.Results: Seventy-five patients (25 per group) were enrolled. The VAS scores of all groups decreased, but no significant difference was found in the VAS scores at 60 min after treatment between patients in the CPM group (n = 25) and those who received both CPM and dexamethasone (n = 50). At the 1-week and 1-month follow-ups, active urticaria (indicated by the urticaria activity score at 7 days) was more prevalent in the CPM/Dex/Pred group (n = 25) than in the control group.Conclusions: The present study did not find evidence that adding IV dexamethasone improves the treatment of severe pruritus from uncomplicated acute urticaria. Oral corticosteroid therapy may be associated with persistent urticaria activity. Due to the lack of clinical benefits and the potential for side effects, using corticosteroids as an adjunctive treatment is discouraged. [ABSTRACT FROM AUTHOR]

Background: Short courses of adjunctive systemic corticosteroids are commonly used to treat acute urticaria and chronic urticaria flares (both with and without mast cell-mediated angioedema), but their benefits and harms are unclear., Objective: To evaluate the efficacy and safety of treating acute urticaria or chronic urticaria flares with versus without systemic corticosteroids., Methods: We searched the MEDLINE, EMBASE, CENTRAL, CNKI, VIP, Wanfang, and CBM databases from inception to July 8, 2023, for randomized controlled trials of treating urticaria with versus without systemic corticosteroids. Paired reviewers independently screened records, extracted data, and appraised risk of bias with the Cochrane 2.0 tool. We performed random-effects meta-analyses of urticaria activity, itch severity, and adverse events. We assessed certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) approach., Results: We identified 12 randomized trials enrolling 944 patients. For patients with low or moderate probability (17.5%-64%) to improve with antihistamines alone, add-on systemic corticosteroids likely improve urticaria activity by a 14% to 15% absolute difference (odds ratio [OR], 2.17, 95% confidence interval [CI]: 1.43-3.31; number needed to treat [NNT], 7; moderate certainty). Among patients with a high chance (95.8%) for urticaria to improve with antihistamines alone, add-on systemic corticosteroids likely improved urticaria activity by a 2.2% absolute difference (NNT, 45; moderate certainty). Corticosteroids may improve itch severity (OR, 2.44; 95% CI: 0.87-6.83; risk difference, 9%; NNT, 11; low certainty). Systemic corticosteroids also likely increase adverse events (OR, 2.76; 95% CI: 1.00-7.62; risk difference, 15%; number needed to harm, 9; moderate certainty)., Conclusions: Systemic corticosteroids for acute urticaria or chronic urticaria exacerbations likely improve urticaria, depending on antihistamine responsiveness, but also likely increase adverse effects in approximately 15% more., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose of Review: Both adults and children are frequently affected by symptoms of itchy urticarial lesions that cause considerable distress and impact nearly all their daily activities. A comprehensive history is critical to identify the etiology in patients who have chronic spontaneous urticaria (CSU) (those with symptoms for > 6 weeks) and is more important than extensive laboratory serum tests. Unfortunately, most of the current treatment guidelines have been based on data from adult studies since there is rare data on children. These treatment algorithms have been subsequently used to extrapolate treatments for children. Recent Findings: Current treatment regiments do not achieve complete success in all patients, neither adults nor children. As the pathophysiology of chronic urticaria slowly becomes defined, novel therapies are being tested which target these individual molecular pathways to treat those that continue to experience symptoms. Summary: Future studies are required to establish the natural history, risks/benefits and efficacy of current medications, and biologics used to treat CSU in children. [ABSTRACT FROM AUTHOR]

Introduction Chronic spontaneous urticaria (CSU) is a chronic inflammatory disease characterized by wheals and/or angioedema recurring for >6 weeks. Cumulative distribution function (CDF) curves compare cumulative probabilities of response between treatments across responder definition spectrums. Methods: LIBERTY-CSU CUPID Study A (NCT04180488) was a randomized, placebo-controlled, phase 3 trial of dupilumab treatment for 24 weeks in patients with CSU remaining symptomatic despite standard-of-care (SOC) H1-antihistamines. Patients were randomized to receive add-on dupilumab (dupilumab/SOC) or placebo (placebo/SOC) subcutaneously every 2 weeks. CDF curves were plotted for the distribution of possible within-patient response for Urticaria Activity Score over 7 days (UAS7), Itch Severity Score over 7 days (ISS7), and Hives Severity Score over 7 days (HSS7) for dupilumab/SOC and placebo/SOC arms. Results: In CDF analysis at Week 24, more patients experienced UAS7, ISS7, and HSS7 improvements with dupilumab/SOC than placebo/SOC; 74.2% vs 50.0% of patients (dupilumab/SOC vs placebo/SOC) achieved ≥11-point reductions (minimal important difference [MID] threshold) in UAS7. Similarly, 78.8% vs 51.7% of patients (dupilumab/SOC vs placebo/SOC) reached ≥5-point reductions (MID threshold) in ISS7 and HSS7. The responder proportion was ≥20% greater for dupilumab/SOC vs placebo/SOC for response thresholds of 9.5- to 22-point reductions for UAS7, 4.5- to 11-point reductions for ISS7, and 5- to 11-point reductions for HSS7. Conclusion: Irrespective of within-patient responder thresholds, greater proportions of patients experienced improvement in UAS7, ISS7, and HSS7 with dupilumab/SOC vs placebo/SOC at Week 24. Overall safety was consistent with the known dupilumab safety profile. [ABSTRACT FROM AUTHOR]

Chronic urticaria (CU) is characterised by the recurrence of hives/angioedema for >6 weeks. It affects children and adults and has a worldwide distribution. In children, CU is substantially less common than acute urticaria but is associated with larger decrease in quality of life. The current classification divides CU into two groups: 1) chronic spontaneous urticaria, which includes idiopathic urticaria (by far the most common type), autoimmune urticaria, and those associated with drugs, food, or additives allergies; and 2) chronic inducible urticaria, constituted by cholinergic urticaria and physical urticarias. Diagnosis of CU is based on the history and characteristics of the lesions. Although laboratory and specific testing could establish the diagnosis of some subtypes of CU, frequently the aetiology is never found; therefore, an extensive workup is not recommended. Once the trigger has been identified, it must be avoided. Specific treatment may be tried, but unfortunately this is not always possible. Currently, the first-line treatment for children with CU are second generation H1-antihistamines (SG-H1AH), such as cetirizine, fexofenadine, desloratadine, and rupatadine, among others. If, after 2–4 weeks, the patient has not improved, an increment from 2 to 4-times the regular dose is recommended. Patients that fail to respond to this treatment may be switched to another SG-H1AH or a second agent, such as H2-antihistamines (e.g., cimetidine, ranitidine), ketotifen, cyclosporine, or a leukotriene receptor inhibitor (e.g., montelukast), may be added to the H1-antihistamine therapy. Recently, omalizumab, an anti-immunoglobin-E monoclonal antibody has been approved in several jurisdictions for patients 12 years or older with recalcitrant CU; however, its high cost has limited its use.

This revised 9-page illustrated fact sheet by James D. Ellis discusses the merits of using nucleus colonies, or nucs, which are smaller versions of full-sized Langstroth hives. The publication explains how to create and manage nucs and how to use them to control swarming, strengthen production colonies, re-queen hives, hive swarms, produce queens to sell to other beekeepers, and in general strengthen and expand a beekeeping operation. Published by the UF Department of Entomology and Nematology. http://edis.ifas.ufl.edu/in869 Original Publication: Ellis, James, and Catherine Nalen. 2010. “The Advantages of Using Nucs in Beekeeping Operations”. EDIS 2010 (7). https://journals.flvc.org/edis/article/view/118804.

Copyright of Lucrari Stiintifice, Universitatea de Stiinte Agricole Si Medicina Veterinara Ion Ionescu de la Brad Iasi, Seria Horticultura is the property of University of Agricultural Sciences and Veterinary Medicine (Editura Ion Ionescu de la Brad) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Chronic spontaneous urticaria is challenging to manage and substantially affects quality of life. This US, non-interventional qualitative study examined patients' clinical journeys and emotional burden from symptom onset through disease management. Chronic spontaneous urticaria patients participated in interviews and completed diaries focusing on disease and treatment history/perspectives, impact on personal/family life, and relationships with physicians/other healthcare providers. Physicians were interviewed about their views on disease management and patient care. Twenty-five patients, previously or currently receiving chronic spontaneous urticaria treatment(s), and 12 physicians participated. Key stages following symptom onset were identified: Crisis (associated with feelings of torment/disorientation/shock); Searching for answers (puzzlement/frustration/anxiety); Diagnosis (relief/satisfaction/fear/isolation); and Disease management (frustration/hope/powerlessness). Findings revealed patients' perceptions and experiences of chronic spontaneous urticaria, including living with a 'skinemy', experiencing their 'own personal hell' and feeling 'like an experiment'. Awareness of unmet needs in patient care/management identified in this study may ultimately improve patient support and enhance physicians' understanding of disease burden. [ABSTRACT FROM AUTHOR]

Urticaria is classified as a sever, chronic, allergic disease with a phase of remission and exacerbation. The basic dermatitis is wheal. The classification of urticaria is based on the causing factor and the duration of symptoms. The UAS-7 score is used to assess the severity of symptoms. It is as a simple tool used by patients and physicians. In the diagnosis of urticaria, the most important element is a meticulous interview, which may indicate the cause of the disease but usually it remains unknown. Treatment is based on H1 receptor antagonists usually in high dosage - even 4 time higher than the standard one.

This guideline is the result of a systematic literature review using the ‘Grading of Recommendations Assessment, Development and Evaluation’ (GRADE) methodology and a structured consensus conference held on 28 and 29 November 2012, in Berlin. It is a joint initiative of the Dermatology Section of the European Academy of Allergy and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA2LEN), the European Dermatology Forum (EDF), and the World Allergy Organization (WAO) with the participation of delegates of 21 national and international societies. Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The life-time prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria do not only cause a decrease in quality of life, but also affect performance at work and school and, as such, are members of the group of severe allergic diseases. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS).

It has been 3 years since the coronavirus disease 2019 (COVID-19) pandemic was initially declared, and 2 years have passed since the first COVID-19 vaccines were introduced. Since then, 13.2 billion COVID-19 vaccine doses have been administered worldwide, largely with multiple doses of messenger RNA vaccines. Although mild local and systemic adverse effects after COVID-19 vaccination are common, serious adverse effects following immunization are rare, particularly when compared with the large number of vaccine doses administered. Immediate and delayed reactions are relatively common and present similarly to allergic and hypersensitivity reactions. Despite this, reactions generally do not commonly recur, cause sequelae, or contraindicate revaccination. In this Clinical Management Review, we provide an updated perspective of COVID-19 vaccine reactions, their spectrum and epidemiology, and recommended approaches to evaluation and management., (Copyright © 2023 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Abstract: This evidence‐ and consensus‐based guideline was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. The conference was held on 1 December 2016. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU‐founded network of excellence, the Global Allergy and Asthma European Network (GA²LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO) with the participation of 48 delegates of 42 national and international societies. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell‐driven disease, presenting with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria are disabling, impair quality of life and affect performance at work and school. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence‐based diagnostic and therapeutic approaches for the different subtypes of urticaria. [ABSTRACT FROM AUTHOR]

Chronic idiopathic urticaria (CIU), also known as chronic spontaneous urticaria, is characterized by the presence of hives on most days of the week, for 6 weeks or longer, and without an identifiable or consistent cause. Evaluation is clinical and based on the presence of episodic urticarial lesions. Although patients are subject to overtesting during the diagnosis of CIU, guidelines suggest starting with three basic laboratory tests. Treatment is a stepwise approach, involving second-generation antihistamines, histamine2 antagonists, leukotriene receptor antagonists, first-generation antihistamines, and potent antihistamines. Refractory CIU requires adding alternative agents such as omalizumab, antiinflammatory agents, and immunosuppressants. [ABSTRACT FROM AUTHOR]

Different combinations of medications are utilized during wrist access for radial artery (RA) or ulnar artery (UA) catheterization in neuroendovascular procedures to preclude vasospasm. These “cocktails” commonly include the calcium channel blocker Verapamil, without established benefit. We analyze outcomes in patients with and without Verapamil in their “cocktail” by using a case-control cohort of our single-center experience.A prospective log of consecutive patients who underwent diagnostic cerebral angiograms using RA/UA access was retrospectively reviewed, and patients were grouped into Verapamil and non-Verapamil cohorts. The primary outcomes assessed were the presence of forearm skin rashes (hives) and RA/UA spasms. Our initial management included Verapamil (5 mg) in the cocktail, but Verapamil was removed after we noticed the development of hives in multiple patients immediately following its injection.A total of 221 patients underwent 241 RA/UA diagnostic cerebral angiograms and were included in our analysis. One hundred and forty-nine patients (61.8%) underwent catheterization with Verapamil and 92 (38.2%) were catheterized without it. Four of the 149 patients in the Verapamil group (2.7%) developed hives during the procedure and were treated with Benadryl (25 mg). Of the 92 patients who did not receive Verapamil, there were zero (0%) cases of hives and one (1.1%) case of vasospasm.Verapamil in the “cocktail” for wrist access diagnostic cerebral angiograms was associated with periprocedural hives, but not associated with a significant reduction in spasm compared to the non-Verapamil group. Our findings suggest that the administration of prophylactic Verapamil for these procedures may not be necessary. [ABSTRACT FROM AUTHOR]

In recent years, it has become customary in the treatment of chronic spontaneous urticaria (CSU) to prescribe secondgeneration antihistamines in dosages higher than the authorised dosage. The efficacy of this off-label updosing has only been shown in patients responding insufficiently to the usual dosages. The available evidence is, however, of low quality, and there are also disadvantages to this updosing. Is it definitely advisable to increase the dosage of antihistamines in patients with CSU who respond insufficiently to the usual dosage? [ABSTRACT FROM AUTHOR]

Both spontaneous and inducible forms of chronic urticaria pose a significant economic burden and have an adverse effect on patients' quality of life. The international guidelines and US practice parameters for the diagnosis and management of chronic urticaria both recommend performing a thorough patient history and physical examination, conducting limited routine laboratory testing, and taking a stepwise approach to treatment. These documents differ in several areas, such as the order of diagnostic procedures and the treatment for patients non-responsive to standard dose H1-antihistamines. Patients with chronic urticaria who visit a specialist have typically been treated with second-generation H1-antihistamines - the recommended first-line treatments. The advantages and disadvantages of each treatment option should be taken into consideration when selecting therapies beyond H1-antihistamines. Greater awareness of the international guidelines and US practice parameters will likely improve the quality of care for patients with chronic urticaria. [ABSTRACT FROM AUTHOR]

Background: Beta-lactam antibiotics (eg, penicillins, cephalosporins, and carbapenems) are preferred for group B streptococcus prophylaxis, intra-amniotic infection, and cesarean surgical site infection prophylaxis. Non-beta-lactam alternatives are associated with inferior efficacy and contribute to higher rates of surgical site infection and longer lengths of stay. Most patients who report a penicillin allergy can tolerate penicillins without any adverse reaction. There are low rates of cross-reactivity between penicillins and other beta-lactams, including cephalosporins and carbapenems. Efforts to evaluate penicillin allergy and promote the use of beta-lactams are needed., Objective: This study aimed to evaluate whether an antimicrobial stewardship intervention improved the use of first-line antibiotics for peripartum indications in patients with a reported penicillin allergy, following updates to institutional guidelines., Study Design: This was a retrospective study of adult patients presenting for vaginal or cesarean delivery at 2 hospitals within a healthcare system. Patients received at least 1 dose of antibiotics for a peripartum indication between May 1, 2018, and October 31, 2018 (preintervention group) and May 1, 2020, to October 31, 2020 (postintervention group). The stewardship intervention bundle, which was implemented between March 2019 and April 2020, included updates to institutional antibiotic guidelines, reclassification of severe penicillin allergy, development of obstetrical prophylaxis and treatment order sets, promotion of allergy referral services, and establishment of a physician champion. The primary outcome was the composite rates of patients with reported penicillin allergy who received a preferred antibiotic for a peripartum indication. The secondary measures included maternal and neonatal outcomes., Results: A total of 192 patients with a history of documented penicillin allergy were evaluated (96 patients in the preintervention group and 96 patients in the postintervention group). Hives were the most commonly reported index symptom in both groups (40/96 [41.7%] vs 39/96 [40.6%]; P=.883). After stewardship interventions, there was a significant increase in the rate of preferred antibiotic use (33/96 [34.3%] vs 81/96 [84.3%]; P<.001). The effect was the greatest in patients with nonsevere allergy (14/76 [18.4%] vs 68/82 [82.9%]; P<.001). There was no difference in the rates of postpartum endometritis, 30-day readmission, 90-day surgical site infection, or neonatal early-onset sepsis between the pre- and postintervention groups. Of note, 1 patient in the postintervention group experienced itching, and another patient developed a rash, both of which resolved with medical management., Conclusion: A comprehensive antibiotic stewardship intervention was associated with a 50% increase in the use of preferred antibiotics for peripartum indications in patients with penicillin allergy. Allergic reactions with first-line beta-lactams were minimal and manageable., (Copyright © 2023 Elsevier Inc. All rights reserved.)