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[Display omitted] Population-based studies have highlighted the link between chronic urticaria (CU) and metabolic syndrome, and metabolic alterations have been revealed in CU. However, to our knowledge, a comprehensive metabolomics study on a large cohort of patients with CU has not been reported. We sought to explore the underlying metabolic subtypes and novel metabolite biomarkers for CU diagnosis and therapy. Plasma samples from 80 patients with CU and 82 healthy controls were collected for metabolomics quantification and bioinformatics analysis. Another independent cohort consisting of 144 patients with CU was studied to validate the findings. Bone marrow–derived mast cells and mice with IgE-induced passive cutaneous anaphylaxis were used for in vitro and in vivo experiments, respectively. We observed clear metabolome differences between CU patients and healthy controls. Meanwhile, differential metabolites N6-acetyl- l -lysine, l -aspartate, maleic acid, and pyruvic acid were used to construct random forest classifiers and achieved area under receiver operating characteristic curve values greater than 0.85, suggesting their potential as diagnostic biomarkers of CU. More importantly, by exploring the underlying metabolic subtypes of CU, we found that the low abundance of pyruvic acid and maleic acid was significantly related to the activity of CU, poor efficacy of second-generation H 1 antihistamines, and short relapse-free time. The results were validated in the independent cohort. Moreover, supplementation with pyruvate or maleate could significantly attenuate IgE-mediated mast cell activation in vitro and in vivo. Plasma pyruvic acid and maleic acid may be effective biomarkers for predicting disease activity, therapeutic efficacy, and prognosis for patients with CU. [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]

The SOCS proteins act as suppressors of cytokine signaling by impeding certain signaling pathways. SOCS5, a constituent of the SOCS family, has been associated with the management of allergic reactions, primarily by impeding the signaling of interleukin-4 (IL-4), which is known to have a cardinal function in accelerating the development of an allergic reaction. The key goal of our research was to explore the probable ramifications of the SOCS5 single nucleotide polymorphism (SNP) namely rs41379147 on the expression of SOCS5 mRNA and serum IL-12 levels, as well as to analyze the interaction between SOCS5 genotypes and various clinicopathological parameters in atopic diseases. The study involved the enrollment of 314 subjects comprising 154 atopic individuals and 160 healthy controls. PCR-RFLP was employed to conduct SNP analysis. Real-Time PCR was employed to quantify SOCS5 mRNA. The enzyme-linked immunosorbent assay (ELISA) technique was used for the quantification of interleukin-12 and total IgE levels in the serum while as chemiluminescence was used to determine Vitamin D levels. The PCR-RFLP analysis indicated a lack of statistically significant variation in genotypic and allelic frequencies between the cases and controls (p > 0.05) for − 9147 C/T SNP either in total atopy (OR-0.70, 95% CI=0.43-1.12, p =0.15), and on subgroup stratifications of chronic urticaria (OR-0.81, 95 % CI = 0.42–1.59, p = 0.61), allergic rhinitis (OR-0.63, 95 % CI = 0.33–1.19, p = 0.16) and bronchial asthma (OR-0.66,95% CI = 0.29–1.4, p=0.32). There was reduced mRNA expression of SOCS5 in total atopic cases, allergic rhinitis, bronchial asthma and chronic urticaria in comparison to controls which advocates the fact that SOCS5 has a protective role in allergic disease development. Despite the reduced amounts of IL-12 in total atopic cases and different allergic disorders in comparison to controls, IL-12 showed significant positive correlation with SOCS5 mRNA expression (p < 0.05). SOCS5 SNP rs41379147(C/T) does not pose any significant risk towards the development of any allergic disorder and has no impact on the expression of SOCS5 and IL-12. Our study has shown the reduced mRNA expression of SOCS5 among individuals diagnosed with chronic urticaria, allergic rhinitis and bronchial asthma and the expression of SOCS5 showed complete dependence on the cytokine milieu of IL12. The modulation of SOCS5 and IL-12 may represent potential curative targets for treating the menace of allergic diseases and present promising avenues for future investigation. ● Reduced expression of SOCS5 mRNA in total atopic cases and various subsets. ● Decreased IL-12 levels among individuals with total atopic conditions, and various subsets. ● Levels of serum IL-12 showed a statistically significant and positive correlation with the SOCS5 mRNA expression. [ABSTRACT FROM AUTHOR]

The aim of the study was to focus on children with both chronic spontaneous urticaria (CSU) and autoimmune thyroiditis (AT) as this topic is rarely studied in children although some publications show a higher proportion of antithyroid antibodies in children with CSU. We highlight two cases of children with both CSU and AT and compare their data with reports from the literature. Since only case reports or case series were available, we performed a descriptive analysis of 15 patients. There were 7 (46.7%) cases of hypothyroidism and the rest were euthyroid. Hypothyroidism appears before, during, and after the diagnostic of CSU. One patient with hypothyroidism and one with euthyroidism receiving l -thyroxine experienced remission of urticaria. Three patients over 12 years of age (20%) received omalizumab. Three patients (20%) had another autoimmune disease and seven (58.3%) had a family history of thyroid disease or autoimmune disease. Children with CSU need repeated testing for antithyroid antibodies. Children with both CSU and AT require close medical supervision focused on the development of other autoimmune diseases. l -thyroxine may improve urticaria in patients with hypothyroidism, but there is not enough evidence for patients with euthyroidism. Omalizumab may be of benefit in this population but well-controlled studies in children with AT and CSU are needed. [ABSTRACT FROM AUTHOR]

The link between chronic urticaria and accompanying thyroid disease is still not understood, with current treatment focusing on antihistamines and levothyroxine. A 35-year-old female patient presented with chronic idiopathic urticaria and facial angioedema for 9 months prior to evaluation. Oral corticosteroid therapy, antihistamines, leukotriene-antagonists, selenium, and omalizumab were all administered, with the disease relapsing within several days, accompanied with facial angioedema of varying severity. Laboratory results were negative for antinuclear antibodies (ANA) and cytoplasmic antineutrophil antibodies (ANCA). Immunoglobulins and complement levels were normal. Autologous serum testing, and skin-prick test for common inhalatory allergens were all normal. Levothyroxine was then administered with no effect on the symptoms. After considering all of the available treatment options, the patient decided to undergo total thyroidectomy. Urticaria and angioedema subsided on the third postoperative day, and she remains free of symptom recurrence during 10 months of postoperative follow-up. Her antiTPO titer decreased from > 1300 to 31.1 kIU/L and antiTG decreased from 272 to 4.9 kIU/L three months after the surgery. The most important element in this case report is an unexpected extra-thyroid presentation of an autoimmune thyroid disease, with a newly described association with facial angioedema. Additional important evidence may confirm the hypothesis that both conditions are indeed caused by a common immunological patohogenetic pathway that should be routinely evaluated in patients presenting with chronic idiopathic urticaria. [ABSTRACT FROM AUTHOR]

L'urticaire est une dermatose inflammatoire qui constitue un motif de consultation fréquent en dermatologie. L'urticaire chronique (UC) est définie par la présence quotidienne ou de poussées récidivantes d'urticaire superficielle et/ou d'angio-œdèmes pendant une période qui dépasse 6 semaines. L'UC regroupe 2 catégories : l'UC spontané (UCS) et l'UC inductible (UI). Le but de ce travail est de connaître les caractéristiques épidémiologiques, cliniques et étiologiques de cette affection dans la population tunisienne afin d'améliorer le prise en charge. Il s'agit d'une étude rétrospective descriptive incluant 200 patients ayant une UC, suivis à la consultation externe de dermatologie ou hospitalisés dans le service de dermatologie du CHU Fattouma Bourguiba de Monastir durant une période de 7 ans, allant de 2010 à 2016. Nos patients étaient répartis en 132 femmes et 68 hommes. Leur âge moyen était de 36,3 ans. Tous les patients avaient les signes cutanés typiques d'urticaire. Dans notre série, l'UC était spontanée dans 64 % des cas et inductible dans 26 % des cas. Le stress était rapporté comme un facteur déclenchant de poussées de l'UC spontanée (UCS) par 12 %. Les facteurs déclenchants de l'UC inductible (UI) les plus rapportés chez nos patients étaient la chaleur et la pression. Tous les patients avaient reçu un traitement à base d'antihistaminiques avec une évolution favorable chez 45 % des patients. Un renforcement du traitement était préconisé chez les patients qui échappaient au traitement de première intention. Une découverte fortuite de dysthyroïdies était faite chez 5 % des patients. Nous suggérons qu'une recherche d'anticorps antithyroïdien et de signes biologiques et cliniques de dysthyroïdies chez les patients consultant pour UC serait très intéressante. Urticaria is an inflammatory skin disease and is a common reason of consultation in dermatology. Chronic Urticaria (CU) is defined by recurrent episodes repeated iteratively for at least 6 weeks. Chronic Urticaria is classified according to whether it is inducible or not into chronic spontaneous Urticaria or chronic inducible Urticaria. The aim of this study is to determinate epidemiological, clinical and etiological characteristics of chronic Urticaria in the Tunisian population in order to ameliorate the treatment. The study was performed as a case-series study of 200 newly referred patients to our dermatology unit in Fattouma Bourguiba university hospital over a period of 7 years (2010–2016). The total number of patients was: 132 females and 68 males. The average age of the total population was 36.3 years. All patients had typical skin rash and clinical signs of Urticaria. In our study, CU was spontaneous in 64% of patients and inducible in 26% of patients. Stress was reported as a trigger for chronic spontaneous urticaria (CSU) by several patients (12%). The most common trigger for chronic inducible urticaria (IU) was heat followed by pressure. All patients had been treated by antihistamine drugs with a favorable outcome in 45% of patients. Strengthening of treatment was recommended in patients who escaped first-line treatment. A fortunate discovery of dysthyroidism was made in 5% of patients. We suggest further investigate the role of dysthyroidism clinical and biological signs in chronic Urticaria. [ABSTRACT FROM AUTHOR]

• Chronic urticaria (CU) is a debilitating inflammatory skin disease. • This study assessed the effect of vitamin D supplementation on outcomes in CU. • Decrease in UAS7 and medication usage was seen in the intervention group, compared with placebo. • Vitamin D supplementation led to decreased systemic inflammation, hence improving disease course and quality of life in CU. Chronic urticaria (CU) is a debilitating inflammatory skin disease. Prior studies have shown reduced concentrations of vitamin D in CU and there are limited reports of potential beneficial role for vitamin D supplementation in the treatment of subjects with CU. We assessed the effect of vitamin D supplementation in vitamin D deficient CU patients on the clinical outcome and inflammatory markers in South Indian patients with CU. This randomized controlled trial involved 120 vitamin-D deficient CU patients. Urticaria activity score (UAS7) and autologous plasma skin test (APST) status was assessed in all cases. CU patients were supplemented with vitamin D with a dose of 60,000 IU fortnightly for a period of 12 weeks and those in the placebo arm received matched placebo. Five milliliters of blood was drawn from all study subjects at baseline and after 12 weeks for assessing inflammatory markers. We observed a significant reduction in UAS7 scores after 12 weeks in the vitamin D treated group in comparison to that of placebo. We also noted a significant reduction of the inflammatory cytokines in the vitamin D treated group. Supplementation with vitamin D among patients with vitamin D deficient CU significantly decreases disease severity which is probably mediated through reduction of systemic inflammation. [ABSTRACT FROM AUTHOR]

• Anti- Anisakis IgA/IgG4 ratio is associated with chronic urticaria. • Anti- Anisakis IgA plays an important role in the recognition of larval allergens. • Ani s 3 immunoreactivity differs from other Anisakis allergens. The phenotype of allergic diseases associated with Anisakis determines the pattern of cytokines related to antibody production. However, the role of serum IgA and the immunomodulatory mechanisms exerted by active infection of L3 or passive mucosal contact with A. simplex specific antigens has not been studied before. We measured serum cytokine by flow cytometry (IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ, IL-17A, TGF-β1) and antibody levels (IgE, IgG4, IgA) by ELISA against total and excretory-secretory (ES) antigens, Ani s 3,and the group of major allergens Ani s 1, Ani s 7, and Ani s 13 in sera from 10 patients with gastro-allergic anisakiasis (GAA), 11 Anisakis sensitization associated chronic urticaria (CU+) as well as 17 non- Anisakis -sensitized patients with chronic urticaria (CU-), compared with the urticaria control group (18 subjects). Specific IgE, IgG4 and IgA were high in the GAA, but IgA levels were significantly higher in the CU+ with respect the CONTROL group. We observed higher levels of the ratio IgA/IgG4 in CU+ than GAA group for Ani s 1, Ani s 7, Ani s 13 and ES. Furthermore, chronic urticaria (CU) patients showed significant lower levels of IL-10, IFN-γ and IL-17A than patients without CU. The anti-Ani s 13 IgA/IgG4 ratio correlated positively with pro-inflammatory cytokines and ratios (TNF-α, IL-17A, Th17/Th2, Type1/Type2 and TNF-α/IL-10) in CONTROL group. In general, Anti- Anisakis IgA/G4 ratio was high in CU patients. In conclusion, this study demonstrates the importance of serum IgA because it is associated with chronic urticaria independently of Anisakis sensitization. [ABSTRACT FROM AUTHOR]

Background: Disease burden in chronic urticaria (CU) is poorly understood.Objective: To estimate standardized overall and sex-, age-, and race-specific prevalence estimates for CU among adults in the United States.Methods: A cross-sectional analysis with electronic health records data for a demographically heterogeneous population-based sample of >55 million patients across all 4 census regions.Results: The overall CU prevalence was 0.23%, or 230 CU cases/100,000 adults. The adjusted prevalence in women was 310 (95% confidence interval [CI] 307-312) cases/100,000 adults, more than twice that of men (146 [95% CI 143-148] cases/100,000 adults, P < .001). CU prevalence was highest among patients aged 40-49 years (256 [95% CI 252-261] cases/100,000 adults) and 50-59 years (246 [95% CI 242-251] cases/100,000 adults) compared with all other age groups (P < .0001). Adjusted prevalences for black (292 [95% CI 285-298] cases/100,000 adults) and other (331 [95% CI 323-338] cases/100,000 adults) patients were higher than that for white patients (262 [95% CI 260-264] cases/100,000 adults; P < .001).Limitations: Use of administrative data has the potential to underestimate burden.Conclusion: There are >500,000 people estimated to have CU in the United States, most of whom are women or adults ≥40 years of age. [ABSTRACT FROM AUTHOR]

Urticaria is a frequent-occurring disease in dermatology. Yupingfeng granules are commonly used effective and safe Chinese patent medicine in chronic urticaria. In this review, a systematic review of Yupingfeng granules combined with western medicines was conducted to evaluate the total clinical efficacy. Cochrane Library, PubMed, Chinese Science and Technology Periodical Database, Wanfang Database, and China National Knowledge Infrastructure were searched forrandomisedcontrolled trials. The primary outcome was clinical effective rate, and the secondary outcomes include recurrence rate, clinical symptom score, and cytokine level. Sixty-four eligible randomised controlled trials were retrieved, and data from 1278 patients were studied. Compared to conventional western medicine, Yupingfeng granules improved total clinical efficacy rate by a risk ratio of 1.13, 95% CI (1.10, 1.16), P < 0.00001. It also exhibited clinically relevant improvement regarding all secondary outcomes. Grading of Recommendation, Assessment, Development and Evaluation ratings indicated evidence was very low to moderate quality. The combination of Yupingfeng granules with western medicine has a certain curative effect in the treatment of chronic urticaria. It may serve as a good adjuvant therapy to chronic urticaria with few adverse effects. ● Our study declared that the combination of Yupingfeng granules with western medicine has a certain curative effect in the treatment of chronic urticaria. ● It may serve as a good adjuvant therapy to chronic urticaria with few adverse effects. [ABSTRACT FROM AUTHOR]

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The Urticaria Control Test (UCT) is a well-established, very easy to use and calculate 4-item patient-reported outcome measure to assess chronic urticaria disease control during the previous 4 weeks. Clinical trials and practice may benefit from the use of a UCT version with a shorter recall period, but this does not exist. We sought to develop and validate a UCT version with a 7-day recall period, the UCT7. The UCT7 was developed, based on the UCT, and tested, in 152 patients with chronic urticaria (spontaneous: n = 101, inducible: n = 51) for its reliability, validity and screening accuracy, and clinimetric properties, in other words, the cutoff for well-controlled disease and the minimal clinically important difference. The UCT7 showed excellent internal consistency reliability with a Cronbach αvalue of 0.91 and test-retest reliability with an intraclass correlation coefficient of 0.83. Convergent validity was high and strongly correlated with anchors of disease control, wheal and angioedema frequency, and urticaria-related quality of life impairment. The UCT7 showed excellent sensitivity to change; however, changes in angioedema activity and impact did not correlate well with changes in UCT7. Based on receiver-operating characteristic curve analysis, the proportion of correctly classified patients, and patients' assessment of treatment efficacy, we recommend a cutoff value of 12 points for identifying patients with well-controlled disease. The UCT7 minimal clinically important difference for improvement was estimated to be 2 points. The UCT7 is a validated 7-day recall period version of the UCT. It is ideal for the assessment of disease control at short intervals in patients with chronic urticaria in clinical studies and practice. [ABSTRACT FROM AUTHOR]

Background Basophil activation contributes to inflammatory reactions, especially in allergy. It is controlled, both positively and negatively, by several mechanisms. High-affinity IgE receptors (FcεRI) generate a mixture of activation and inhibition signals when aggregated, the ratio of which depends on the concentration of allergen recognized by receptor-bound IgE. Low-affinity IgG receptors (FcγRIIA/B) generate inhibition signals when coengaged with FcεRI by allergen-antibody immune complexes. Commensal and probiotic bacteria, such as Lactobacillus paracasei , generate inhibition signals through still unclear mechanisms. Objective We sought to investigate whether mechanisms that control, both positively and negatively, basophil activation, which were unraveled and studied in basophils from healthy donors, are functional in allergic patients. Methods FcεRI and FcγRIIA/B expression, FcεRI-dependent activation, FcεRI-dependent inhibition, and FcγRIIB-dependent inhibition were examined in blood basophils incubated overnight with or without L paracasei and challenged under 10 experimental conditions. Basophils from healthy donors were compared with basophils from patients who consulted an allergology outpatient clinic over a period of 3 months with respiratory allergy, anaphylaxis antecedents, chronic urticaria, and/or atopic dermatitis. Results Patients' basophils expressed neither more FcεRI nor less FcγRIIB than basophils from healthy donors. They were neither hyperreactive to positive regulation nor hyporeactive to negative regulation, irrespective of the receptors or mechanisms involved and the allergic manifestations of the patients. Conclusion Regulatory mechanisms that control basophil activation are fully functional in allergic patients. Intrinsic defects in these mechanisms do not explain allergic manifestations. Based on these mechanisms, immune checkpoint modifiers can be developed as novel therapeutic tools for allergy. [ABSTRACT FROM AUTHOR]

Background Chronic Urticaria is a common disorder which is defined by recurrent occurrence of wheals and sometimes angioedema. It has a notable influence on the patients' quality of life. Regulation of the immune system is one of the important roles of the gut microbiota. The effect of dysbiosis considering some members of gut microbiota in patients with chronic urticaria has been demonstrated in our previous study. Objective Comparing the frequency and bacterial load of Lactobacillus , Bifidobacterium , and Bacteroides between patients with chronic urticaria and healthy controls. Methods 20 patients with chronic urticaria and 20 age and sex matched healthy individuals were included in the present study. Stool samples were analyzed for determining the frequency and bacterial load of Lactobacillus , Bifidobacterium , and Bacteroides genera. Results There were no significant differences among the frequencies of detectable Lactobacillus , Bifidobacterium , or Bacteroides in stool samples of patients with chronic urticaria and healthy controls. The relative amounts of Lactobacillus and Bifidobacterium were significantly higher in fecal samples from controls compared to patients with chronic urticaria (P = 0.038 and 0.039, respectively). Conclusion It is the first study on the implication of Lactobacillus , Bifidobacterium , and Bacteroides genera as gut microbiota members in patients with chronic urticaria. [ABSTRACT FROM AUTHOR]

Résumé Introduction L’urticaire chronique est une maladie dermatologique fréquente. Elle demeure mal cernée au Maghreb faute de données fiables. Le but de l’étude est d’évaluer le profil clinique et les modalités de prise en charge de l’urticaire chronique au Maghreb (Tunisie, Algérie, Maroc et Mauritanie). Patients et méthodes Étude multicentrique, prospective, descriptive transversale qui a inclus une cohorte de 211 cas urticaire chronique, âgés de 16 à 94 ans, enquête réalisée du 15 septembre au 20 décembre 2015, dans les 4 pays du Maghreb. Résultats Cohorte de 152 femmes (72 %) et 59 hommes (28 %), avec un âge moyen de 38 ans. La manifestation la plus fréquente est le prurit qui est présent dans 95 % des cas et un angio-œdème dans 36 % des cas. Soixante-quatorze pour cent des patients ont bénéficié d’un bilan biologique. Les antihistaminiques ont été prescrits dans 95 % des cas, avec une dose élevée dans 32 % des cas. Pour la qualité de vie évaluée par l’Urticaria Control Test (UCT), seuls 45 % des patients ont un bon contrôle de la maladie. Pour le contrôle des symptômes sous traitement, on note une rémission complète chez 40 %, une rémission partielle chez 55 % et une aggravation chez 5 % des patients. Conclusion L’urticaire chronique est une affection fréquente, sous diagnostiqué dans nos pays du Maghreb et sa prise en charge difficile du fait de sa chronicité et de la méconnaissance des recommandations actuelles la régissant. Aim The aim of the study was to evaluate the profile of and treatment modalities for chronic spontaneous urticaria in the Maghreb. Patients and methods A prospective multicenter, descriptive study conducted in a cohort of 211 chronic urticaria patients aged between 16 and 94 years between September 15 and December 20, 2015, in the 4 countries of the Maghreb. Results The study was carried out in 152 women (72%) and 59 men (28%) of average age of 38 years. The most common symptom was pruritus, which was present in 95% of all patients and in 36% of angioedema patients. Seventy-four percent of patients underwent laboratory tests. Antihistamines were prescribed in 95% of patients, at high dose in 32% of patients. Regarding quality of life as assessed by the Urticaria Control Test (UCT), only 45% of patients had well-controlled disease. Regarding therapeutic control of symptoms, complete remission was observed in 40% of patients, with partial remission in 55% and worsening in 5%. Conclusion Chronic urticaria was characterized in our study by significant clinical symptoms having a significant impact on patients’ quality of life. Therapeutic management consisted primarily of prescription of antihistamines (95%), with corticosteroids being administered to 44% of patients, contrary to the international recommendations. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to identify chronic urticaria (CU) etiologies and treatment modalities in Ecuador. We propose that the sample distribution fits the expected one, and that there is an association between the etiology and its treatment. Methods: We performed a retrospective study involving 112 patients diagnosed with CU using a Checklist for a complete chronic urticaria medical history. Demographic and clinical variables were collected. The etiology of CU was classified using the EAACI/GA2LEN/EDF/WAO guideline. Descriptive analyses were performed for demographical and clinical variables. Chi square tests were applied to analyze the fit of distribution and the independence of variables. P values less than 0.05 were considered significant. Results: Among all the patients, 76.8% were diagnosed with chronic spontaneous urticaria (CSU), of which 22.3% had a known etiology or possible exacerbating condition. Food allergy was identified as the most common accompanying condition in patients with CSU (10.7%) (p < 0.01).. On the other hand, 23.2% inducible urticarias (CIndU) were indentified; dermographism was the most common (10.7%) (p < 0.01). Regarding treatment regimens, sg-H1-antihistamines alone represented the highest proportion (44.6%). The combination of any H1-antihistamine plus other drug was a close second (42.0%) (p < 0.01). Almost 48% of CSUs of unknown etiology were treated with any antihistamine plus another drug. In patients with known etiology, sg-antihistamines alone (44.0%) was the most common management. In addition, 53.8% of CIndUs were treated with sg-antihistamines alone. Though, these associations were not statistically significant. Conclusion: CSU is the most frequent subtype of CU. Modern non-sedating antihistamines in licensed doses are the drug of choice. Nevertheless, a great proportion of patients require the addition of another type of medication. [ABSTRACT FROM AUTHOR]

A case study is reported whereby a patient with no prior allergies developed a strong and spreading delayed-type hypersensitivity reaction to Melianthus plants, nectar and synthetic pigment derived from it after frequent handling of these substances. The lesions improved after treatment with topical steroids and allergen avoidance within 1–2 weeks. Subsequent patch testing with the plants, nectar and synthetic ingredients identified ellagic acid (EA) as the sensitizing agent. This is the first proven case of allergic contact dermatitis to EA, a phenolic substance present in numerous plants, fruits, and nuts regularly consumed by humans. Melianthus use is growing worldwide as an ornamental plant. Moreover, it is used in traditional South African medicine for its anti-inflammatory effects. In recent years, these extracts and EA have been added to natural, plant-based topical formulations for the treatment of inflammatory skin disorders. Our observation that the EA found in Melianthus can induce severe contact allergy should caution for the possible dangers of specific allergic sensitizations to these increasingly used additives in natural medicines. • The first case of allergic contact dermatitis to Melianthus and ellagic acid (EA). • Melianthus is used increasingly worldwide as an ornamental plant. • EA is included in natural topical medications to treat inflammatory skin diseases. • We observed that the EA found in Melianthus can induce severe contact allergy. • Cautions for the possible dangers of allergic sensitization to EA in products. [ABSTRACT FROM AUTHOR]

Background: Existing guidelines do not offer a quick, efficient alternative to the patient's recollection of relevant clinical features during anamnesis and physical examination for chronic urticaria (CU). This study aimed to identify specific items reflecting the main characteristics of CU that should be included in a comprehensive medical history for patients with CU. We also aimed to clarify possible eliciting factors for CU to support accurate diagnosis of the disease. Methods: A panel of postgraduate dermatologists conducted a literature search for relevant studies on CU using Medline, the Cochrane database, and PubMed. Results: We identified82 articles from which we drew a collection of items to inform development of an easy-touse checklist and collection of items that should be included in a correct medical history. The final version of the checklist included42 items across two areas: essential clues for anamnesis and diagnosis of CU; and typical symptoms/parameters or characteristics according to subtype, etiology, and laboratory findings. Items included time of disease onset; duration, shape, size, color, and distribution of wheals; associated angioedema; atopy; and triggering factors. Conclusions: Our guide provides an easy-to-use tool to support clinicians to focus, orient themselves, and save time in medical consultations for CU, allowing better diagnosis and management of this disease. [ABSTRACT FROM AUTHOR]

Background: The current EAACI/GA2LEN/EDF/WAO guideline for urticaria provide specific recommendations for the diagnostic workup and treatment of patients with chronic spontaneous urticaria (CsU). This study explored if physicians in Ecuador know these recommendations and implement them in their actual clinical practice for CsU. Methods: We investigated physicians who treat CsU patients in a cross-sectional study using a standardized questionnaire. Descriptive statistics were employed, adjusted logistic regression was performed to assess the link of guideline knowledge and use of therapy. Results: Seven hundred forty surveys were collected and analyzed. The mean age of physicians was 42.3 (±12.5) years. Most of the participants (65.1%) were general physicians (GP), 13.7% were pediatricians, 11.0% internists, 6.8% dermatologists or allergists (D/A). Only 18.8% knew the EAACI/GA²LEN/EDF/WAO guideline. 44.5% of GPs searched for CsU etiology in contrast to 90% of D/A. Most common diagnostic test was total serum IgE (83.5%). Most common first line symptomatic treatment was oral corticoids (46.3%), followed by second generation antihistamines (sgAHs, 36.8%). A/D prescribed more sgAHs (regular doses) (74.1 vs 28.6% of GP) (p < 0.05). Experience with omalizumab was reported only by 3.5%, of physicians, and higher rates among who were familiar with the guideline. Conclusion: This study shows that the knowledge of guideline recommendations in physicians who treat urticaria patients in Ecuador is low. The diagnostic workup and treatment of CsU patients are largely not in line with guideline recommendations in real life practice settings. We were able to compare results between German and Ecuadorian physicians and found that Ecuadorian physicians have lower awareness of the current guideline (33 vs 18%). Only one-third of physicians reported using regular doses of sgAHs as the first line treatment. Also, only 12.9% of physicians use sgAHs in higher doses and physicians still use fgAHs, particularly pediatricians (42.9%). Our results suggest that disparities in knowledge between physicians from different countries could influence the management of CsU. Knowledge of the guidelines is linked to better choices of treatments. Awareness of guidelines needs to be promoted for better management of chronic urticaria. [ABSTRACT FROM AUTHOR]

Chronic urticaria (CU) has a major effect on patients' quality of life. While there have been progressive advances regarding its pathogenesis and treatment, much remains to be done. Registries of other chronic non-communicable diseases have shown many benefits, such as additional basic knowledge and management approaches to diabetes mellitus. Standards of care as well as diagnostic approaches can be elaborated and compared from different sites, using validated instruments. Registries in allergic diseases are also becoming well recognized, and the first registry on CU, accessible from SLaai's webpage, includes parameters for identification, evaluation and management. In our vision, informatics strategies have the potential to improve care for chronic illnesses such as CU. The registry represents a valid instrument from which to obtain a sufficient sample size for epidemiological studies and/or clinical research planning, including feasibility and potential enrollment. It can also provide invaluable data for adapting guidelines to local populations, as well as diagnostic approaches and cost-effective interventions in the context of organizational efforts to improve patient care. [ABSTRACT FROM AUTHOR]

Résumé L’intolérance à l’histamine ou fausse allergie alimentaire de mécanisme histaminique correspond à l’apparition de symptômes lors de l’ingestion d’aliments contenant de l’histamine à des doses bien tolérées par des sujets sains. Les réactions d’intolérance à l’histamine se manifestent par des pathologies relativement fréquentes que sont l’urticaire chronique et les céphalées. Sa prévalence est estimée à 1 %. Les auteurs exposent les mécanismes physiopathogéniques : anomalies de l’absorption intestinale de l’histamine, déficit des systèmes de dégradation enzymatique (diamine oxydase et histamine-N-méthyl-transférase), hyperréactivité à l’histamine et/ou facilité à l’histaminolibération non spécifique. Les éléments du diagnostic se basent sur la réalisation d’une enquête catégorielle alimentaire, l’exclusion du principal diagnostic différentiel qu’est l’allergie alimentaire et sur un régime d’épreuve pauvre en histamine, équilibré sans excès de consommation catégorielle selon les recommandations du Programme national nutrition santé. Histamine intolerance or false food allergy with histamine mechanism is defined as symptoms caused by ingestion of food containing histamine at dose well tolerated by healthy subjects. These reactions consist in relatively frequent disease such as chronic urticaria or headache. Prevalence is estimated at 1%. The authors highlight the pathophysiological mechanisms: abnormalities of intestinal absorption of histamine or enzymatic catabolism (diamine oxidase and histamine-N-methyl-transferase), hyper-reactivity to histamine and/or increase of non-specific histamine release. Diagnosis is based on food diary, the exclusion of the main differential diagnosis that is food allergy, and histamine restricted diet. The authors suggest a diet poor in histamine, balanced without excess biogenic amines consumption as recommended by the National health nutrition programme. [ABSTRACT FROM AUTHOR]

• SOCS3 promoter SNP viz rs8074003 poses a convincing risk of atopic disease development. • SOCS3 (rs8074003C/G) polymorphism shows an association with total serum IgE levels and eosinophil count. • The SOCS3 mRNA and serum IL-4 levels are up-regulated in total atopy and in its different presentations. • The SOCS3 expression and IL-4 serum levels show a positive correlation with each other. The suppressors of cytokine signaling (SOCS) are a class of negative regulators for several aspects of cytokine signaling that have been attributed to the pathophysiology of inflammatory disorders. Given the role of the SOCS3 gene in regulating Th2 cell proliferation, our study aimed to analyze two SOCS3 SNPs viz. rs8074003 and rs7222391, and their potential influence on IL-4 levels and SOCS3 mRNA expression besides analyzing the interaction of the SOCS3 genotypes with the various clinicopathological parameters. A total of 314 subjects including 154 atopic cases and 160 healthy controls were genotyped for SOCS3 polymorphisms by PCR-RFLP. SOCS3 mRNA was quantified by Real-Time PCR. The serum IL-4 and total IgE levels were determined by ELISA and Vitamin-D levels were quantified by chemiluminescence. The CC genotype of rs8074003 was more frequent in atopic cases and posed a 3- fold risk of atopy (p = 0.001) whereas CG and GG genotypes were widespread in the controls (p = 0.1). For the other SNP rs7222391, there was no difference in genotypic and allelic distribution. The SOCS3 mRNA expression and serum IL-4 levels were substantially increased in the atopic cases with a significant positive correlation between them (p < 0.05). SOCS3 SNP rs8074003 poses a convincing risk of atopic disease development. The SOCS3 expression and IL-4 levels were up-regulated in total atopy and in its different presentations. It seems plausible to target SOCS3 and IL-4 as a potential target for the diagnosis of atopy and for the development of reliable personalized therapeutic strategies to control atopic conditions. [ABSTRACT FROM AUTHOR]

Background: Chronic urticaria (CU) is defined as the spontaneous appearance of wheals, with or without angioedema, persisting for =6 weeks. Chronic Spontaneous Urticaria (CSU) is a type of CU which affects 0.5-1 % of the global population, but it represents a high burden to patients. In recent years, omalizumab is available as treatment of disease. Our aim is to extend previous findings, analyzing effects of omalizumab on symptoms in Latin American patients with CSU. Methods: Retrospective analysis of patients treated with omalizumab in Cuenca-Ecuador. 150 mg omalizumab was administered every 4 weeks, and its effects were measured by Urticaria Activity Score (UAS) at baseline and each month in follow up. Complete response was defined as a UAS of 0 or 1, and partial response was classified as a UAS of 2 or more. Also, demographic and clinical variables were collected. Descriptive analyses were employed. Response rates were summarized as counts and percentages after 3 and 5 months. Related Samples Wilcoxon signed rank tests were used to compare UAS at baseline and after 3 months. P values <0.05 indicated statistical significance. Results: 26 subjects were enrolled, almost half were female individuals (57.7 %), with mean age 47.8 years (range, 18-81 years). Mean duration of CU after diagnosis was 23.3 months (range, 2-180 months). Mean UAS at baseline was 5.7 points (range, 4-6 points). Nine patients (34.6 %) completed 3 months of treatment (33 % reported a complete response), with a mean difference in UAS of 3.33 (p = 0.01). Four patients completed 5 months of treatment (75.0 % showed a complete response). All patients previously treated with first-generation antihistamines plus corticosteroids showed no responses at neither 3 nor 5 months of treatment. Conclusion: Omalizumab is an effective treatment for patients with CU. It is necessary to conduct some future investigations where we can establish if 150 mg could be an option in developing countries. [ABSTRACT FROM AUTHOR]

Mast cells (MCs), which are granulated tissue-resident cells of hematopoietic lineage, contribute to vascular homeostasis, innate/adaptive immunity, and wound healing. However, MCs are best known for their roles in allergic and inflammatory diseases, such as anaphylaxis, food allergy, rhinitis, itch, urticaria, atopic dermatitis, and asthma. In addition to the high-affinity IgE receptor (FcεRI), MCs express numerous G protein–coupled receptors (GPCRs), which are the largest group of membrane receptor proteins and the most common targets of drug therapy. Antimicrobial host defense peptides, neuropeptides, major basic protein, eosinophil peroxidase, and many US Food and Drug Administration–approved peptidergic drugs activate human MCs through a novel GPCR known as Mas-related G protein–coupled receptor X2 (MRGPRX2; formerly known as MrgX2). Unique features of MRGPRX2 that distinguish it from other GPCRs include their presence both on the plasma membrane and intracellular sites and their selective expression in MCs. In this article we review the possible roles of MRGPRX2 on host defense, drug-induced anaphylactoid reactions, neurogenic inflammation, pain, itch, and chronic inflammatory diseases, such as urticaria and asthma. We propose that host defense peptides that kill microbes directly and activate MCs through MRGPRX2 could serve as novel GPCR targets to modulate host defense against microbial infection. Furthermore, mAbs or small-molecule inhibitors of MRGPRX2 could be developed for the treatment of MC-dependent allergic and inflammatory disorders. [ABSTRACT FROM AUTHOR]

Molecular mechanism of artemisinic acid in the prevention of substance P-induced chronic urticaria. [Display omitted] • Artemisinic acid have the therapeutic effect in substance P induced urticaria model. • Artemisinic acid regulate the downstream signaling pathway of MRGPRX2 in mast cells. • Artemisinic acid attenuates substance P induced urticaria via Lyn kinase in mast cells. Chronic urticaria (CU) is a common skin disease that affects about 1% of the world's population of all ages and seriously affects patients' quality of life. Therefore, further safe and effective treatments are urgently needed. Therefore, artemisinic acid was investigated in the present study due to its pharmacologic effect on inhibiting mast cell degranulation and chronic urticaria in a mouse model. 4Artemisinic acid decreased the symptoms of substance P-induced chronic urticaria in the mouse model and alleviated secretagogue-induced local cutaneous and systemic anaphylaxis through the Lyn-PLC-p38-NF-κB signaling pathway. Artemisinic acid inhibited mast cell degranulation and pro-inflammatory cytokine production in vitro. Mechanism analysis demonstrated that it could arrest mast cell activation through the Lyn-PLC-p38/ERK1/2/AKT-NF-κB signaling pathway. Based on the results of in vitro kinase assay of Lyn and PLC, artemisinic acid was a potential small molecule inhibitor of Lyn. Artemisinic acid displayed good structural affinity (K D = 2.64 × 10−6) with Lyn SPR results. Artemisinic acid can attenuate substance P/MRGPRX2-mediated chronic urticaria and mast cell activation. Artemisinic acid is an antagonist of Lyn kinase and can be developed as a drug candidate to treat allergic diseases. [ABSTRACT FROM AUTHOR]

Chronic spontaneous urticaria is defined as migratory evanescent pruritic blanching wheals that occur with variable frequency for 6 weeks or more, with or without accompanying angioedema. This condition affects approximately 0.1% to 1.4% of persons worldwide. Second-generation H1 antihistamines are the mainstay of management, with refractory cases often managed with an array of options, including H2 antihistamines, leukotriene receptor antagonists, glucocorticosteroids, immunosuppressive agents, and omalizumab. However, the degree of practice variation as to what treatments are prescribed is poorly understood, given that clinical care could be driven by patient preferences or lack of clarity as to best practices for refractory cases. We conducted a small, exploratory study of the role of race, ethnicity, and regional geographic distance to specialist care on chronic spontaneous urticaria prescribing practices. A small-area geographic variation in chronic spontaneous urticaria management in a large Chicago-area health care system was identified. Rates of omalizumab use varied by patient zip code, with more omalizumab prescriptions being associated with zip codes closer to the main office of an academic medical center–affiliated allergist-immunologist practice. Higher rates of omalizumab use were associated with White race in regional and patient-level analyses, though the reasons for this race-based finding are not clear. [ABSTRACT FROM AUTHOR]

Guben Xiaozhen prescription (GXP), a prescription of traditional Chinese medicine, has been used to treat skin diseases for a long history and achieved satisfactory therapeutic effects. However, its active ingredients and targets remain to be further elucidated. Identify activity ingredients of GXP for the treatment of chronic urticaria (CU) and further validate the efficacy and targets of the selected component. Firstly, the pharmacokinetics of different disassemble groups of GXP was investigated to screen for active ingredients with improved bioavailability. Then, shared targets between active ingredients and CU were performed by network pharmacology. Finally, the ovalbumin (OVA) induced CU model was used to verify the efficacy and targets of the screened active ingredient. Pharmacokinetic results showed that, compared with sub-division groups, the maximum concentration (C max) and blood concentration-time curve (AUC 0-t) of eight ingredients, including 6-shogaol, 6-gingerol, calycosin, dictamnine, fraxinellone, schizandrin, cimifugin, and sec-o-glucosylhamaudol were increased in the GXP group. Then, 218 CU-related targets and 20 shared targets with six potential active compounds were screened by network pharmacology. Further analysis found that fraxinellone was not reported to be associated with CU in the literature. Therefore, the present study employed an OVA-induced CU model and found that fraxinellone could dose-dependently inhibit the locus coeruleus reaction, mast cell degranulation, and pathological skin damage. Moreover, we further verified the ADRB2 and its downstream target caspase3 predicted by network pharmacology, and fraxinellone inhibited the expression of ADRB2 and caspase3 in high dose group, suggesting that fraxinellone may play an anti-CU role by inhibiting inflammation and cell apoptosis. In this study, integrated pharmacokinetics and network pharmacology methods were established to screen out six effective active ingredients in GXP for the treatment of CU. This study provides a new idea for screening active substances in traditional Chinese medicine. [Display omitted] • An integrated method for screening active ingredients and targets of GXP was established. • Six active ingredients in GXP with therapeutic effects on chronic urticaria were screened out. • Discovered and reported the therapeutic effect of fraxinellone and its targets in treating chronic urticaria. [ABSTRACT FROM AUTHOR]

Introduction: Chronic urticaria (CU) is characterized by repeated occurrence of wheals or itching for more than 6 weeks. When urticarial symptoms repeatedly occur despite taking western medicines such as antihistamines, herbal medicines have potential as an alternative for them. Among various herbal medications for CU, we mostly prescribe Gwakhyangjeonggi-san (GJS) made by Lee Je-ma, the founder of Sasang Constitutional Medicine (SCM) in Korea. The purpose of this study is to investigate whether GJS actually helps in treating CU.Methods: We performed a retrospective review of the medical records of 30 patients to whom GJS was administered in order to compare the changes in urticaria activity scores (UAS) and in western medicines taken at the beginning of treatment of GJS and at 6 months after completion of the treatment.Results: The UAS after 6 months from treatment (1.63 ± 2.06) with GJS for an average of 57.30 ± 35.88 days was significantly decreased compared to the score before treatment (5.10 ± 0.99), showing a statistically significant difference (p< 0.001). 46.67% of the patients (14/30 patients) reported that their symptoms were completely eliminated, and 66.67% of the patients taking anti-histamines (18/27 patients) were able to stop it completely.Discussion: Based on the findings, GJS helps patients reduce taking western medicines such as anti-histamines, and we hypothesize that GJS improves symptoms of CU by the gastrointestinal protective activity and anti-oxidative/depressive effect. Further clinical study is warranted. [ABSTRACT FROM AUTHOR]

Introduction Standard treatments are often unsatisfactory on chronic urticaria (CU). Acupoint stimulation, including acupuncture, electroacupuncture, acupoint catgut embedding, acupoint injection, has shown benefit about alleviating itching, reducing amount and range of the lesions. However, the methodological quality of these trials is unknown. Thus, the objective of this review is to evaluate the quality and effectiveness of acupoint stimulation for chronic urticaria. Methods We searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, CNKI, CBM, VIP, Wanfang databases from January 1966 to June 2015. Randomized controlled trials (RCTs) on acupoint stimulation for CU were included. The Cochrane risk of bias tool was used to evaluate methodological quality. Results Eight RCTs met the inclusion criteria, which were all low quality. Acupuncture plus other treatment was significantly superior to western medicine alone and autologous blood injection plus herbal medicine was better than herbal medicine alone in increasing the number of cured patients. Conclusions Acupoint stimulation may provide benefit in CU; however, more large scale, high quality studies are needed for assessing the effects before it is recommended. [ABSTRACT FROM AUTHOR]

Background: Several studies suggest that Vitamin D (Vit-D3) supplementation reduces Chronic Urticaria (CU) symptoms. Objectives: Evaluation of serum 25-hydroxyvitamin-D (25 (OH)2D) level and assessment of therapeutic effect of VitD3 in CU patients. Methods: 192 subjects were stratified according to the baseline 25(OH)2D levels and subsequently randomized into three subgroups to receive Vit-D3 alone (VD) or antihistamine and systemic corticosteroid (H+S) or VitD3 with antihistamine and systemic corticosteroid (VD+H+S) for 6 weeks between July 2012 to Oct 2014. 130 healthy controls (HC) were followed without any intervention. The patients were evaluated for reduction in urticarial symptoms using visual analogue scale (VAS) and 5-D itch score. Results: Low serum levels of 25 (OH)2D was observed in 91% of CU patients and 64% of the healthy controls (P < 0.0001). VAS and 5-D Score in subgroups VD, H + S and VD + H + S decreased significantly from 6·7 ± 0·043, 6·6 ± 0·42 and 6·68 ± 0·40 at baseline to 5·2 ± 0·70 (P = 0·0088), 3·3 ± 0·50 (P < 0·0001) and 1·86 ± 0·39 (P < 0·0001) after treatment and from 14·5 ± 0·72, 13·9 ± 0·77 and 13·9 ± 0·221 to 12·06 ± 1·10 (P = 0·0072), 8·1 ± 1·13 (P < 0·0001) and 5·01 ± 0·94 (P < 0·0001) respectively. Conclusions: CU patients have low serum 25(OH)2D levels and Vit-D3 supplementation in combination with antihistamine and systemic corticosteroid show elevated response in resolving the symptoms of CU. This study also warrants that each subject with CU should be screened for serum 25 (OH)2D levels before starting a treatment. [ABSTRACT FROM AUTHOR]

Background There are few prospective studies on the natural course of chronic urticaria (CU) in children. Objective We sought to examine the natural history of CU in children and to identify predictors for remission. Methods Children 4 to 15 years of age with CU were investigated with a complete blood cell count, erythrocyte sedimentation rate, antinuclear antibody titer, complement CH 50 level, thyroid studies, autologous serum skin test, skin-prick tests, food challenges, and stool examination for parasites. They were considered to be in remission if symptoms did not recur for at least 12 months without medication. Results In all, 92 children (53.3% female) with CU were recruited and followed up for a median duration of 4.3 years (range 2.5-5.8 years). Chronic autoimmune urticaria (CAU) was identified in 40% of the patients. Food allergy was found in 8.7% and parasitic infestations in 5.4%. Remission rates at 1, 3, and 5 years after the onset of CU symptoms were 18.5%, 54%, and 67.7%, respectively. The remission rate did not differ in CAU compared with non-CAU. No predictor of CU remission was identified. Limitations The basophil histamine release assay was not performed. Conclusion Children with CU have a favorable outcome. CAU did not have an intractable course. [ABSTRACT FROM AUTHOR]

Urticaria is a common inflammatory skin disease. It is clinically defined as the occurrence of transient papular skin and/or mucosal lesions or subcutaneous lesions called angioedema. Chronic urticaria is defined as a clinical course over more than 6 weeks. Different clinical forms of urticaria can coexist in the same patient. Urticaria results of mast cell activation. The diagnosis of urticaria is based on clinical examination. An allergic etiology for acute urticaria, although rare, is always to find and remove. Chronic urticaria is not allergic. Diagnosis is based on questioning and a careful clinical examination to rule out differential diagnoses. Few diagnostic tests are necessary for diagnosis and management, and are especially useful in case of doubtful diagnosis. The treatment of urticaria is symptomatic and based on anti-H1 second generation antihistamines as first-line therapy. In some chronic urticarial, antihistamines up dosing may be necessary. In the majority of patients, this treatment is sufficient to control chronic urticaria. In case of antihistamines failure, other treatment particularly immunomodulatory treatments can be offered in specialized departments. [ABSTRACT FROM AUTHOR]

These parameters were developed by the Joint Task Force on Practice Parameters (JTFPP), representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology. The AAAAI and ACAAI have jointly accepted responsibility for establishing “The diagnosis and management of acute and chronic urticaria: 2014 update.” This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the JTFPP, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. The JTFPP understands that the cost of diagnostic tests and therapeutic agents is an important concern that might appropriately influence the work-up and treatment chosen for a given patient. The JTFPP recognizes that the emphasis of our primary recommendations regarding a medication might vary, for example, depending on third-party payer issues and product patent expiration dates. However, because a given test or agent's cost is so widely variable and there is a paucity of pharmacoeconomic data, the JTFPP generally does not consider cost when formulating practice parameter recommendations. In extraordinary circumstances, when the cost/benefit ratio of an intervention is prohibitive, as supported by pharmacoeconomic data, commentary might be provided. These parameters are not designed for use by pharmaceutical companies in drug promotion. The JTFPP is committed to ensuring that the practice parameters are based on the best scientific evidence that is free of commercial bias. To this end, the parameter development process includes multiple layers of rigorous review. These layers include the workgroup convened to draft the parameter, the task force reviewers, and peer review by members of each sponsoring society. Although the task force has the final responsibility for the content of the documents submitted for publication, each reviewer comment will be discussed, and reviewers will receive written responses to comments, when appropriate. To preserve the greatest transparency regarding potential conflicts of interest, all members of the JTFPP and the practice parameter workgroups will complete a standard potential conflict of interest disclosure form, which will be available for external review by the sponsoring organization and any other interested individual. In addition, before confirming the selection of a Work Group chairperson, the Joint Task Force will discuss and resolve all relevant potential conflicts of interest associated with this selection. Finally, all members of parameter workgroups will be provided a written statement regarding the importance of ensuring that the parameter development process is free of commercial bias. Practice parameters are available online at www.jcaai.org and www.allergyparameters.org. [Copyright &y& Elsevier]

Résumé: La dermatite atopique (DA) et l’urticaire chronique spontanée (UCS) sont deux dermatoses inflammatoires chroniques fréquentes, qui peuvent altérer considérablement la qualité de vie. Il n’est pas rare de se trouver en situation d’échec avec les traitements dits conventionnels, à savoir les dermocorticoïdes pour la DA et les antihistaminiques de seconde génération pour l’UCS. Le recours à des traitements immunosuppresseurs peut alors être envisagé, mais leur mode d’action n’est pas spécifique de l’affection et leur utilisation non dénuée d’effets indésirables. La révolution thérapeutique que nous avons connue avec l’arrivée des biomédicaments dans le psoriasis nous incite à porter notre espoir dans le développement de thérapies davantage ciblées sur la physiopathologie de la DA et de l’UCS. [ABSTRACT FROM AUTHOR]

Background and Aims: Elevated prolactin and reduced dehydroepiandrosterone sulfate (DHEA-S) levels are associated with autoimmune diseases. A limited number of studies have investigated these hormones in chronic urticaria (CU). The autologous serum skin test (ASST) reaction has also been linked to autoimmune diseases, and a positive reaction is usually associated with a more severe disease. We aimed to compare serum prolactin and DHEA-S levels between female CU patients with positive and negative ASST reactions and healthy controls. Methods: The study included 30 female CU patients with a positive ASST reaction, 30 female CU patients with a negative ASST reaction, and 30 healthy female controls. All identifiable causes of urticaria were excluded. Serum prolactin and DHEA-S levels were measured in all subjects. Results: Prolactin was significantly higher among ASST positive patients than among ASST negative patients and controls but did not differ between ASST negative patients or controls. Higher prolactin levels were associated with increasing disease severity among ASST positive patients. DHEA-S levels did not differ between ASST positive or negative patients but were significantly lower among both patient subgroups than controls. DHEA-S levels did not differ according to the severity of disease among either of the patient subgroups. DHEA-S levels did not correlate with prolactin among any group. Conclusion: We demonstrate for the first time a possible role for prolactin in ASST-positive CU patients and its association with disease severity. We recommend larger prospective studies to assess changes in prolactin and DHEA-S levels after complete disease remission. [Copyright &y& Elsevier]

Background: Previous studies provide evidence that there is a greater frequency of autoimmune diseases among patients with psoriasis than in the general population. Objective: This study examined the association between psoriasis and 21 common autoimmune diseases, specified a priori. Methods: A retrospective cohort study was conducted among persons who were members of Kaiser Permanente Southern California from 2004 to 2011. A total of 25,341 patients with 2 or more diagnosis codes for any psoriatic disease were evaluated. Five persons not meeting this case definition were matched to each psoriatic patient based on age, sex, and length of enrollment. Results: Patients with psoriasis were more likely to have at least 1 other autoimmune disease (odds ratio [OR] 1.6; 95% confidence interval [CI] 1.5-1.7) and to have at least 2 other autoimmune diseases (1.9; 95% CI 1.6-2.4). Of the 17 conditions evaluated, associations with 14 were found to be statistically significant. The strongest association was with rheumatoid arthritis (3.6; 95% CI 3.4-3.9). Limitations: Patients with autoimmune conditions are likely to have a greater number of health care encounters, which may result in overascertainment and misascertainment of immune-mediated conditions, although the patients included in the study averaged 5.2 years of observation and the comparison subjects were matched on length of enrollment. Conclusions: The study suggests a genetic or environmental cause common across autoimmune diseases. Further investigation of individuals with multiple autoimmune diseases may yield important clues about the origin and pathogenesis of the disease. [ABSTRACT FROM AUTHOR]

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Background: Chronic urticaria (CU) is a common disease in which most cases were considered to be idiopathic. Recent evidence indicates that at least a subset of cases of chronic idiopathic urticaria are autoimmune in origin. Objective: We aimed to characterize the association between CU, autoimmune diseases, and autoimmune/inflammatory serologic markers in a large unselected population. Methods: Data on 12,778 patients given a diagnosis of CU by either allergy or dermatology specialists during 17 years in a large health maintenance organization in Israel were collected. For each patient, we collected information on diagnosis of major, well-defined autoimmune diseases and autoimmunity- and inflammatory-related serologic markers. Similar data were collected for a control group comprised of 10,714 patients who visited dermatologists, family physicians, or allergy specialists and had no indication of CU. Results: Having CU was associated with an increased odds ratio for hypothyroidism, hyperthyroidism, and antithyroid antibodies. Female patients with CU had a significantly higher incidence of rheumatoid arthritis, Sjögren syndrome, celiac disease, type I diabetes mellitus, and systemic lupus erythematosus, mostly diagnosed during the 10 years after the diagnosis of CU. High mean platelet volume, positive rheumatoid factor, and antinuclear antibodies were all significantly more prevalent in patients with CU. Conclusions: A strong association was found between CU and major autoimmune diseases. A common pathogenic mechanism is implied by the high prevalence of autoantibodies and the existence of a chronic inflammatory process expressed by the high mean platelet volume. These findings have implications for the diagnosis, management, and prognosis of patients with CU. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine the frequency and significance of thyroid auto-antibodies and antinuclear antibody among Saudi patients with chronic urticaria and to identify markers of chronic urticaria disease. Materials and methods: Non-interventional, prospective analytical study carried out among consecutive patients with chronic urticaria in the Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia between January 2005 and December 2007. Patients were divided into two groups: Group 1 – with hypothyroidism, Group 2 – without hypothyroidism, both age-matched to normal healthy controls. All patients were investigated for the presence of antithyroglobulin (ATG), antimicrosomal (AMA), antinuclear antibodies (ANA) as well as rheumatoid factor (RF) and antibodies to hepatitis B and C. Results: A total of 90 participants were included in the study. Significant elevation of anti thyroglobulin antibodies was found in patients with hypothyroidism than in those without hypothyroidism and in the control group (30.4% vs. 24.4% vs. nil, p =0.022). Elevated titers of antimicrosomal antibodies were seen in chronic urticaria patients with or without hypothyroidism compared to control group. Positive antinuclear antibodies were detected in all groups. There were no significant differences in the severity of the disease in between study groups (p =0.234). Chronic urticaria was statistically significantly associated with hypothyroidism (p =0.0014) and with the presence of antithyroglobulin antibodies (p =0.022). The duration of urticaria was significantly associated with positive antithyroid and anti-nuclear antibodies (p =0.0315 and p =0.0056, respectively). Disease severity was not significantly associated with elevations of ANA, TMA and TGA titers (p =0.558, 0.827 and 0.324, respectively). Conclusion: Chronic immunologic urticaria may be entertained in patients with long standing urticaria especially in the presence of hypothyroidism and elevated antithyroid antibodies. Assays for thyroid antibodies, TSH and ANA may be justified for early diagnosis of autoimmune urticaria to institute appropriate treatment modalities, hence improve the quality of life. [Copyright &y& Elsevier]

Abstract: Chronic urticaria (CU) is an inflammatory skin disease which expression may be under the combined influence of several co-factors in predisposed individuals. There is great confusion between the cause of the disease (supposed to be a mast cell fragility, partly constitutional) and the aggravating factors. About 1% of UC are associated with systemic disease (mainly autoimmune disorders, dysglobulinemia and other hematological diseases). The clinical features are most often very different from those of a common UC except when it becomes severe with a pseudosystemic misrepresentation. The diagnostic tests, including pathology, can also be misleading, wrongly directing to a systemic disease, especially in steroid-dependant UC or delayed pressure urticaria. Great caution and long-term follow up are therefore required before asserting the diagnosis of systemic urticaria. [Copyright &y& Elsevier]

Abstract: Background: Strong negative influence upon the quality of life in chronic urticaria is well proved. Before the GA2LEN Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) was introduced, the quality of life in chronic urticaria had been measured with general or dermatology specific questionnaires. CU-Q2oL was initially developed in Italy and consisted of 23 items divided into 6 quality of life dimensions. Objective: The aim of our study was to adapt the Polish version of CU-Q2oL and to provide initial results from the Polish sample. Methods: To prepare the Polish version forward and back translation was prepared. After cognitive debriefing, we collected a group of 126 chronic urticaria patients who completed Polish CU-Q2oL, Dermatology Life Quality Index (DLQI) and Skindex-29 questionnaire. Disease severity was assessed with Urticaria Activity Score (UAS). We performed the factorial analysis to identify CU-Q2oL subscales in our study, internal consistency and convergent validity assessment as well as factors driving the results. Moreover, we analysed tool''s reproducibility and responsiveness. Results: The factor analysis resulted in six subscales of Polish CU-Q2oL version with satisfying face validity: Itching, Swelling/Mental status, Functioning, Sleep, Eating/Limits, Embarrassment. All subscales presented recommended internal consistency and convergent validity. Disease severity was the only factor predicting results of all the subscales. Polish CU-Q2oL version was reproducible and sensitive to change. We noticed the highest quality of life impairment in Itching and Embarrassment subscales whereas Eating/Limits was the least affected. Conclusions: Our study supports reliability, responsiveness and validity of the Polish version of CU-Q2oL – easy in use, non time-consuming instrument to be used in research, clinical management and treatment outcome assessment and is one more step to confirm quality of life impairment in chronic urticaria. [Copyright &y& Elsevier]

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. 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.)

Cyclosporine is a calcineurin inhibitor that acts selectively on T cells. It has been used in dermatology since 1997 for its US Food and Drug Administration indication of psoriasis and off-label for various other inflammatory skin conditions, including atopic dermatitis, blistering disorders, and connective tissue diseases. In the last decade, many dermatologists have hesitated to use this important drug in their clinical practices because of its toxicity profile. The purpose of this article is to review the mechanism of action of cyclosporine and its current uses and dosing schedules. It is our goal to create a framework in which dermatologists feel comfortable and safe incorporating cyclosporine into their prescribing regimens. Learning objectives: After completing this learning activity, participants should be able to describe the mechanism of action of cyclosporine, recognize the potential role of cyclosporine in dermatology and the evidence to support this role, and incorporate cyclosporine into his or her prescribing regimens. [ABSTRACT FROM AUTHOR]

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. 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.)

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. 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.)

Background Scarce studies address the issue of resource consumption and direct health care costs of patients diagnosed with adult-onset chronic urticaria (CU). Objectives To estimate medical resource consumption and direct health care costs of affected patients in a private health maintenance organization in Buenos Aires, Argentina. Methods Patients diagnosed with adult-onset CU ( International Classification of Diseases, Ninth Revision, Clinical Modification code 708.1, 708.8, or 708.9) and who were members of the Italian Hospital Medical Care Program were included in the study. All data on hospitalizations, drug prescription, outpatient episodes, consultations, and investigations/tests in the 12 months before inclusion in the study were considered for the estimation of medical resource consumption and direct health care costs. Third-quarter 2014 costs were obtained from the Italian Hospital Medical Care Program and converted into US dollars (using the November 2014 exchange rate). Results A total of 232 patients were included in the study. The mean age at diagnosis was 54.2 ± 20.0 years, and the mean disease duration was 5.4 ± 2.6 years (range, 2–22 years). Of the total number of patients, 75% had allergists as their usual source of care, 23% had dermatologists, 18% had internists, and 3% had rheumatologists. Only 7.8% of the patients had an emergency room admission to manage CU symptoms. To manage the disease, 57.8% of patients used antihistamines and 11.6% used oral corticosteroids. The most relevant source of cost was the medical treatment received, followed by physician visits. The average yearly direct cost per patient was US $1015 ± $752 (95% confidence interval 803–2003). Conclusions This is the first Argentine study that evaluated the costs of CU considering the direct medical costs of the disease. The study provides information on resource utilization and the disease-related economic burden, which is valuable to better understand CU in the local setting. Future research that takes into consideration the direct and indirect costs of the disease will expand knowledge and improve management of the disease. [ABSTRACT FROM AUTHOR]