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(1) Background: To assess the relationship between serum interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values and disease severity in patients with chronic spontaneous urticaria (CSU) and to examine which of these serum biomarkers better indicates disease severity. (2) Methods: Our pilot study included 20 patients with CSU who filled out questionnaires concerning disease severity and quality of life (the Urticaria Activity Score summed over 7 days [UAS7], the once-daily Urticaria Activity Score [UAS], the Urticaria Control Test [UCT], and the Dermatology Life Quality Index [DLQI]). Blood samples were taken to measure IL-6, ESR and CRP. (3) Results: ESR significantly correlated with the UAS7 (linear and moderate correlation; r = 0.496; p = 0.026), while CRP did not correlate with disease severity. IL-6 correlated with the once-daily UAS (r = 0.472; p = 0.036) and DLQI (r = 0.504; p = 0.023) (linear and moderate correlation) but not the UAS7 or UCT. (4) Conclusions: IL-6 was a better indicator of the once-daily UAS and DLQI, while ESR was a better indicator of the UAS7 (there was no correlation between IL-6, CRP and ESR parameters). Although our results are promising, this study should be conducted with a larger number of CSU patients. [ABSTRACT FROM AUTHOR]

Background: Panic disorder and panic attacks are two of the most common problems in psychiatry. A psychoimmunological correlation between allergic diseases and panic disorder has been strongly suggested. Histamine H1 receptor antagonists have been suggested as alternative drugs for the treatment of panic disorder. Chronic spontaneous urticaria (CSU) and panic disorder improved simultaneously with selective serotonin reuptake inhibitor antidepressants. Panic disorder has also been treated with the antihistamine chlorpheniramine. The immunoglobulin/histamine complex is a histamine-fixed immunoglobulin preparation that was reported to be effective in treating CSU. This case report describes the successful treatment of a patient with concomitant panic disorder and CSU for 23 years using immunoglobulin/histamine complex therapy. Case presentation: This report describes a 52-year-old female Korean patient who suffered from CSU with panic disorder for 23 years. Basic allergy tests (blood tests and skin prick tests) were conducted before and after treatment for the evaluation of allergic conditions. A multiple allergosorbent test (MAST) for the detection of allergen-specific IgE levels was also performed. The clinical severity of CSU was evaluated using the urticaria severity score system. Diagnostic interviews systematically assessed the diagnostic criteria outlined by the DSM-V, and the patient was evaluated before, during and after treatment using the Beck Depression Inventory (BDI-2) for depression, the State-Trait Anxiety Inventory (STAI) for anxiety and the Beck Hopelessness Score (BHS) for hopelessness. The patient received 2 ml of Histobulin™ (12 mg human immunoglobulin/0.15 µg histamine complex) once a week by subcutaneous injection for the treatment of CSU. Initial improvement of CSU was achieved after the third injection. After the twenty-seventh injection of Histobulin™, she showed no symptoms or signs and ceased allergic medication use. With the remission of CSU, allergic rhinitis was also completely resolved. The frequency of the common cold was significantly decreased during and after treatment. The medication frequency and development of clinical manifestations of panic disorder changed in parallel with the clinical severity of CSU. Moreover, the patient exhibited no clinical manifestations and ceased medication for panic disorder and sleeping pills for insomnia simultaneously with the remission of CSU. In the psychological evaluation, the BDI, STAI and BHS scores improved accordingly. Conclusions: The immunoglobulin/histamine complex was effective in treating CSU and concomitant panic disorder in this patient and could be effective in treating some types of panic disorder. Considering the mechanisms of action of histamine and the immunoglobulin/histamine complex together with the patient's clinical progress, histamine seemed to be related to panic disorder in this case. The concept of histamine-mediated syndromes, including allergies and psychiatric disorders, shows that a wider disease identity may be needed. Further studies on the immunopathogenesis of panic disorder and the mechanisms of action of the immunoglobulin/histamine complex are necessary. [ABSTRACT FROM AUTHOR]

Background: Recurring therapy resistant hives, accompanied by IgM-gammopathy, fever and joint pain can indicate Schnitzler syndrome, a rare autoimmune disorder. There is currently no approved treatment, but complete remission of symptoms can be induced with IL-1 antagonists. Case presentation: A patient with a history of chronic urticaria presented frequently at the outpatient clinic with severe hives and was treated unsuccessfully with antihistamines and omalizumab. After several years, additional symptoms such as joint pain, recurrent fever, and IgM-gammopathy developed. After the diagnostic criteria for Schnitzler syndrome were met, treatment with anakinra was initiated and resulted in an improvement of the symptoms. Shortly after the first injection, the patient developed large and painful erythematous lesions at the injection sites, leading to discontinuation of treatment and a rapid recurrence of symptoms. Subsequently, treatment with a longer-acting IL-1 antagonist (canakinumab) was initiated, resulting in a complete remission of symptoms. Conclusion: This case report demonstrates that patients with urticarial symptoms that are not relieved by typical treatments should prompt repeated reassessments of the diagnosis, even years later, because gammopathy and other diagnostic criteria for Schnitzler syndrome can occur with a delay. [ABSTRACT FROM AUTHOR]

Chronic urticaria (CU) is a debilitating skin disease affecting around 1% of the population. CU can be subdivided into chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU). Different pathophysiological mechanisms have been proposed to play a role in the development of CU, and these are also being investigated as potential biomarkers in the diagnosis and management of the disease. As of now the only assessment tools available for treatment response are patient reported outcomes (PROs). Although these tools are both validated and widely used, they leave a desire for more objective measurements. A biomarker is a broad subcategory of observations that can be used as an accurate, reproducible, and objective indicator of clinically relevant outcomes. This could be normal biological or pathogenic processes, or a response to an intervention or exposure, e.g., treatment response. Herein we provide an overview of biomarkers for CU, with a focus on prognostic biomarkers for treatment response to omalizumab, thereby potentially aiding physicians in personalizing treatments. [ABSTRACT FROM AUTHOR]

Background: Chronic urticaria (CU) is characterized as the recurrent occurrence of wheals, angioedema, or both on most days of the week, for more than six weeks. Information available on this disease is mainly based on foreign studies. We observed the clinical characteristics of this disease among our population to fill the shortage of information. Materials and Methods: It was a hospital-based, cross-sectional, descriptive study conducted at the Department of Dermatology from July 2022 to March 2023. Patients diagnosed with CU were enrolled in this study after obtaining ethical approval from the Institutional Review Committee (IRC). The calculated sample size was 123. Sociodemographic features and clinical characteristics were recorded after taking consent from the patients. A descriptive analysis was performed and presented in frequency tables. Results: The majority (61%) had chronic spontaneous urticaria (CSU), 13.8% had chronic inducible urticaria (CINDU), and 25.2% had both CSU and CINDU. The mean age of participants was 35.86 ± 13.45 years. Females comprised 72.4% of the patients. A family history of urticaria was found in 16.2% of patients. The mean disease duration was 35.88 ± 60.2 months. Wheals occurred in the evening in 24.3% of cases. Angioedema was reported by 18.6% of the patients. Gastritis was the most common (11.4%) comorbidity. Physical factors precipitated urticaria in 39% of cases. Recurrence of the disease was seen in 17.8%. Prior to visiting the dermatologist, 76.4% had been taking antihistamines and 15% attempting an alternative medicine. Conclusion: Our findings were consistent with those of previous reports. CSU is more than three times more common than CINDU. Females and young adults were more affected by CU. Concomitant CSU and CINDU is also possible. As a chronic condition, it is often difficult to manage, and patients tend to explore alternative options. [ABSTRACT FROM AUTHOR]

Spiramycin is a macrolide antibiotic with a bacteriostatic action and is used as a toxoplasmosis treatment since the FDA considers it safe and can be taken throughout early pregnancy. As the therapeutic use of spiramycin increases, reports of hypersensitivity responses, characterized as urticaria, are also on the rise. A 27-year-old woman presented to the hospital with chief complaints of recurrent rash with redness and severe itch on her entire body for one week. The rash appeared after the patient was diagnosed with toxoplasmosis and instructed to take spiramycin regularly. Two months ago, the patient experienced the same complaints. The patient was diagnosed with spiramycin-induced chronic urticaria and administered dexamethasone, diphenhydramine, and fexofenadine orally. Clinical improvement is evident after three days of treatment, as evidenced by a weekly decrease in the UAS-7 score. Urticaria is a hypersensitivity reaction that can be triggered by antibiotic consumption. A comprehensive diagnosis is needed to determine the etiology of urticaria, including the history of drug consumption. Treatment of urticaria includes education and the administration of antihistamines and corticosteroids. Chronic urticaria requires special treatment from a dermato-venerologist. [ABSTRACT FROM AUTHOR]

Introduction: Chronic urticaria (CU) is a common skin condition that can be divided into chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU). Omalizumab is one treatment option for CU, but currently there are limited clinical studies of omalizumab's efficacy for treating CU in Chinese patients. This study sought to investigate the efficacy and safety of omalizumab treatment for CU patients in a Chinese patient population. Specifically, we aimed to compare the differential efficacy of omalizumab for CSU and CIndU patients and predict risk factors for recurrence. Methods: We completed a retrospective clinical data review of 130 CU patients who received omalizumab treatment from August 2020 to May 2022, with a maximum follow-up period of 18 months. Results: A total of 108 CSU patients and 22 CIndU patients were included in the study. After treatment with omalizumab, the response rate in the CSU group was higher than that in the CIndU group (93.5% vs. 68.2%), and CSU patients accounted for a higher proportion of responders and early responders (responders: 87.1% vs. 12.9%, p < 0.001; early responders: 95.7% vs. 4.3%, p = 0.001). Nonresponders had lower total immunoglobulin E (IgE) levels (75.0 vs. 167.5 IU/mL, p = 0.046) and a relatively shorter duration of treatment (1.0 vs. 3.0 months, p = 0.009) compared to responders. Early responders had shorter disease duration (1.0 vs. 3.0 years, p = 0.028), higher baseline UCT (4.0 vs. 2.0, p = 0.034), lower baseline DLQI (18.0 vs. 18.5, p = 0.026), and shorter total treatment time (2.0 vs. 4.0 months, p < 0.001) compared to late responders. All adverse events reported during treatment were mild. Seventy-four patients with CU discontinued the drug after achieving complete disease control, of which 26 (35.1%) relapsed for 2.0 months (interquartile range: 1.0–3.0 months). Compared with nonrelapsed patients, relapsed patients often had other allergic diseases (42.3% vs. 18.8%, p = 0.029), higher basal levels of total IgE (263.0 vs. 140.0 IU/mL, p = 0.033), and longer disease duration (4.2 vs. 1.0 years, p = 0.002). Relapsed patients could still achieve good disease control after restarting omalizumab therapy. Conclusion: Omalizumab was effective and safe for CSU and CIndU patients. Patients with CSU responded more quickly to omalizumab and showed a relatively better treatment effect. However, there was a possibility of relapse after discontinuation of omalizumab after complete control of CU, and in these cases, restarting omalizumab treatment after relapse was effective. [ABSTRACT FROM AUTHOR]

Several epidemiological studies have described childhood obesity as a risk factor for atopic disease, particularly asthma. At the same time, this association seems to be more conflicting for allergic rhinitis, atopic dermatitis, and chronic urticaria. This article aims to deepen the possibility of a relationship between childhood obesity and allergic diseases. As regards asthma, the mechanical and inflammatory effects of obesity can lead to its development. In addition, excess adiposity is associated with increased production of inflammatory cytokines and adipokines, leading to low-grade systemic inflammation and an increased risk of asthma exacerbations. Allergic rhinitis, atopic dermatitis, food allergies, and chronic urticaria also seem to be related to this state of chronic low-grade systemic inflammation typical of obese children. Vitamin D deficiency appears to play a role in allergic rhinitis, while dyslipidemia and skin barrier defects could explain the link between obesity and atopic dermatitis. Starting from this evidence, it becomes of fundamental importance to act on body weight control to achieve general and allergic health, disentangling the detrimental link between obesity allergic diseases and childhood obesity. Further studies on the association between adiposity and atopy are needed, confirming the biologically active role of fat tissue in the development of allergic diseases and exploring the possibility of new therapeutic strategies. [ABSTRACT FROM AUTHOR]

Background: The prevailing etiological model of both acute and chronic urticaria implicates specific allergen exposure that triggers the local release of vasoactive factors and inflammatory adhesion molecules, including vascular cell adhesion molecule 1 (VCAM-1), intercellular adhesion molecule 1 (ICAM-1), endothelial leukocyte adhesion molecule 1 (ELAM-1), P-selectin and E-selectin in the superficial dermis. This study focused on the possible role of VCAM-1 and ICAM-1 as biomarkers in children with acute and chronic urticaria. Methods: This study involved 184 children, 40 with acute urticaria, 71 with chronic urticaria, and 73 matched comparison subjects. The serum levels of ICAM-1 and VCAM-1 were determined in venous blood in all the participants on enrollment. Antihistamine treatment was administered to all the patients. In the children with chronic urticaria, the Urticaria Activity Score Questionnaire (UAS7) was completed daily by the parents. In 16 of the patients with acute urticaria and 43 with chronic urticaria, the serum levels of ICAM-1 and VCAM-1 were determined at follow-up after 6–8 weeks of treatment. Results: The mean serum levels of both VCAM-1 and ICAM-1 were higher in both groups of children with urticaria than in the comparison subjects at the start of the study. In the chronic urticaria group, the levels decreased significantly (p = 0.03 and p = 0.01, respectively) following treatment. Similarly, the acute urticaria group exhibited significant reduction in the mean levels of VCAM and ICAM (p < 0.001). In both groups, the mean level of ICAM after treatment was comparable with that of the comparison group. Conclusions: VCAM-1 and ICAM-1 are suggested as promising biomarkers for monitoring both acute and chronic urticaria in children. Future research should explore their utility in larger cohorts and investigate their role in personalized treatment strategies.

Background and Objectives: The guidelines for chronic urticaria in children contain recommendations that are often based on adult studies. The diagnostic pathway has not been standardized and the effectiveness of anti-H1, omalizumab, montelukast, and systemic glucocorticoids is rarely reported in the pediatric population. There is a wide variation in the rate of remission of chronic urticaria between studies. The aim of this study is to enhance our understanding of pediatric chronic urticaria. Materials and Methods: This study enrolled 37 children with chronic urticaria aged from 0 to 18 years. Demographic parameters, medical history, clinical features, laboratory data and treatment information were collected. Children were treated with the recommended dosage of second-generation H1-antihistamines, which was increased by up to twofold. Omalizumab was added for refractory anti-H1 patients. A three-day course with systemic glucocorticoids was administered for severe exacerbations. Montelukast was administered to some children. Results: Wheals without angioedema were common. Chronic urticaria was spontaneous in 32 children (86.48%), inducible in 2 (5.41%), induced by a parasite in 1 and vasculitic in 2. Treatment of the potential causes of chronic urticaria was of no benefit, except for eradication of Dientamoeba fragilis. Chronic urticaria was resolved within three years in 45.9% of cases. Allergic diseases were present in nine children (24.32%) and autoimmune diseases were present in three (8.11%). All children were treated with anti-H1 at the licensed dose or at a higher dose. A partial or complete response to anti-H1 was observed in 29 (78.38%) patients. Montelukast showed no benefit. All children treated with omalizumab responded. Systemic glucocorticoids were successfully used to treat exacerbations. Conclusions: Our findings indicate that laboratory tests should not be routinely performed in children with chronic urticaria without clinical suspicion. However, comorbidities such as thyroid autoimmune disease and coeliac disease are suggested to be monitored over the chronic urticaria course. These clinical conditions could be diagnosed from the diagnostic framework of chronic urticaria. Increasing the dosage of anti-H1 and omalizumab was effective in children resistant to standard treatment but we still need further studies to generate a standard patient-centered treatment.

Background: Brief erythematous-papular skin rashes suggest the diagnosis of urticaria; However, it may be another type of dermatitis, and complementary examinations must be carried out to establish its diagnosis. Case report: 53-year-old female patient, diagnosed in 2016 with diffuse large B cell lymphoma, in complete remission. Since 2010, he has had episodes of erythematous-papular lesions lasting 24-36 hours. He received antihistamines, corticosteroids and omalizumab without clinical improvement. The ANA determination was positive (1/320), nuclear mitotic pattern. The skin biopsy was compatible with dermatitis herpetiformis. The study of celiac and locus antibodies showed positivity for HLA-DQ2 and DQ2.5 in heterozygosity. The diagnosis of dermatitis herpetiformis was established. Treatment consisted of a gluten-free diet and prescription of dapsone, with satisfactory results. Conclusion: It is important to establish the differential diagnosis of patients with chronic urticaria who do not respond to the reference treatment, in addition to carrying out a thorough clinical examination and physical examination before starting treatment and relying on a multidisciplinary team to establish an accurate diagnosis and treatment. appropriate. Due to the side effects of dapsone, subsequent follow-up of patients is essential. [ABSTRACT FROM AUTHOR]

Chronic Urticaria (CU) is a skin disorder characterized by wheal and flare with a duration of more than 6 weeks affecting 1%-2% of the population (more common in women). Thirty to 35% of cases of CU have angioedema [1]. The etiology of chronic spontaneous urticarial is not usually clear, 40%-50% are idiopathic and 30%-40% are autoimmune [2, 3]. Quality of life in CU is usually disturbed which has a direct relation with severity [4].

Background and Design: Chronic spontaneous urticaria (CSU) is a common disease characterized by erythematous and itchy wheals, angioedema, or both that last for >6 weeks. Its etiology is not yet fully determined. This study aimed to analyze the distress tolerance (DT) levels of patients with CSU and correlations between DT and clinical parameters and other psychological symptoms. Materials and Methods: Fifty-two patients with CSU without any concomitant diseases were included in the study. The control group included 50 healthy volunteers with similar baseline demographics but without physical or psychiatric diseases. The urticaria activity score 7 (UAS7) was used to determine the disease severity in the patient group. In both groups, Sociodemographic and Clinical Data Form, Distress Tolerance Scale (DTS), Beck Depression Inventory (BDI), and state and trait anxiety inventory were used. Statistical differences in psychiatric scale scores were found between the patient and control groups, and a correlation was found between UAS7 and scale scores in the patient group. Results: No differences in sociodemographic variables were found between the patient and control groups. The DTS and subgroup score analysis revealed statistically significant differences between the patient and control groups. The DTS-total scores (p

Chronic urticaria is a dermatological condition characterized by the appearance of wheals or angioedema longer than 6 weeks. It could cause serious complications such as laryngeal edema, vasculitis, and diarrhea. However, the pathologic changes of the ocular fundus caused by chronic urticaria are rarely reported. In this study, we described the pathologic changes of ocular fundus in a patient with history of chronic urticaria and central serous chorioretinopathy. A 28-year-old female was presented with blurred vision and distorted images in her right eye for 6 days. The patient was diagnosed with choroidal neovascularization. She received an intravitreal injection of conbercept (0.5 mg/eye/time) monthly. Finally, no abnormality was found in her ocular examination after 4 months of first injection. In conclusion, chronic urticaria could cause central serous chorioretinopathy, leading to choroidal neovascularization. Intravitreal conbercept injection showed an excellent local therapeutic efficacy for this eye condition.

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.

Kanokvalai Kulthanan,1 Chuda Rujitharanawong,1 Kanyalak Munprom,1 Suphattra Trakanwittayarak,1 Phumithep Phumariyapong,1 Suthasanee Prasertsook,1 Patompong Ungprasert2 1Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 2Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USACorrespondence: Patompong Ungprasert, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA, Tel +1 216 986 4000, Fax +1 216 986 4953, Email p.ungprasert@gmail.comPurpose: Data specific to the epidemiology, clinical features, and management of chronic urticaria (CU) in the geriatric population remain limited and not well understood. We aim to systematically review the prevalence, clinical manifestations, treatment, and clinical course of elderly patients with CU.Patients and methods: Original articles that included data of elderly (aged > 60 years) with CU that were published until February 2021 were searched in PubMed, Scopus, and Embase using predfefined search terms. Related articles were evaluated according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations.Results: Among the included 85 studies and 1,112,066 elderly CU patients, most (57.4%) were women. The prevalence of elderly CU in the general population ranged from 0.2– 2.8%, and from 0.7– 33.3% among all CU patients. Compared to adult CU, elderly CU patients had a higher percentage of wheal alone (73.9%), and lower rate of positive autologous serum skin test and atopy. Gastrointestinal diseases were the most common comorbidity (71.9%), and there was a high rate of malignancies and autoimmune diseases. Second generation H1-antihistamines were commonly used, and achievement of complete control was most often reported. Omalizumab was prescribed in 59 refractory patients, and a significant response to treatment was reported in most patients. The treatment of comorbidities also yielded significant improvement in CU.Conclusion: Elderly CU was found to be different from adult CU in both clinical and laboratory aspects. H1- antihistamines are effective as first-line therapy with minimal side-effects at licensed doses. Treatment of secondary causes is important since the elderly usually have age-related comorbidities.Keywords: prevalence, clinical manifestations, treatment, chronic urticaria, elderly, systematic review

Objective: To evaluate the effectiveness and safety of acupoint catgut embedding (ACE) in combination with Chinese herbal medicine (CHM) in treating chronic urticaria (CU). Methods: We thoroughly searched Embase, PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wangfang database, Chinese Scientific Journal Database (VIP), and Chinese biomedical literature database (SinoMed) for relevant studies from inception until May 2022. Randomized controlled trials (RCTs) on ACE combined with CHM for CU were included. Literature search, data extraction, and risk of bias assessment were independently conducted by two authors. Results: A total of 15 RCTs with 1065 participants were included in this review. Five trials reported that the combined therapy showed a higher total effective rate, and four trials reported that the combined therapy was associated with a lower level of serum immunoglobulin E. Furthermore, two, four, and four trials reported that the combined therapy was more effective in reducing itching degree, size, and number of wheals, respectively. The combined therapy was reported to be associated with a lower recurrence rate in three trials, and with a fewer adverse reaction rate in two trials. Conclusions: ACE in combination with CHM appears to be a safe and effective therapy for patients with CU. Given the relatively low quality of the included trials, these findings should be interpreted cautiously. Further high-quality RCTs are needed to confirm our findings.

Omalizumab is effective in chronic spontaneous urticaria unresponsive to antihistamines. Of the licensed dosing schedules, Korean patients prefer a low dose, of 150 mg/month, for financial reasons. However, real-world experiences of low-dose omalizumab consumption have not been reported. The aim of this retrospective study was to assess the treatment outcomes and long-term clinical course of patients with chronic spontaneous urticaria who were treated with low-dose omalizumab. The study included 179 patients aged ≥ 20 years who were treated with omalizumab 150 mg/month for ≥ 12 weeks. Baseline disease activity was mild, moderate, and severe in 54.7%, 35.2%, and 10.1% of patients, respectively. A complete response was observed in 133 patients at 12 weeks, among whom 88 patients showed early responses within 4 weeks. Overall, 158 patients finally achieved a complete response. Multivariate analyses revealed that baseline disease activity is more likely to be mild in patients who experience early and final complete responses. The absence of atopic comorbidities correlated with an early response. Smoking was associated with a final complete response. This study shows that low-dose omalizumab provides favourable treatment outcomes in antihistamine-refractory chronic spontaneous urticaria. Disease severity, atopic comorbidity, and smoking may be predictive factors for studying the response to omalizumab.

Introduction: Autologous serum therapy (AST) is considered a potentially curative therapeutic option in the treatment of chronic urticaria, especially in the autoreactive type. Aim: To determine the ratio of patients with a positive autologous serum skin test (ASST) in chronic urticaria and the efficacy of AST. Material and methods: A total of 77 (29 male and 48 female) patients with chronic urticaria were enrolled in the study. The autologous serum skin test (ASST) was performed for all patients and the patients were classified into two groups: ASST positive and ASST negative. Intramuscular injection of AST was administered and the total severity score (TSS) of the urticaria was calculated weekly for ten weeks. The TSS was calculated for another ten weeks without AST. Results: There were 34 patients (11 men and 23 women) in the positive group and 43 (18 men and 25 women) in the negative group. Reduction of symptoms of urticaria begins in the fourth week of the study in both groups. At week 20, 21 (61.7%) patients of the ASST (+) group and 12 (27.2%) patients of the ASST (-) group showed complete clearance. The use of antihistamines decreased from 100% at baseline in both groups to 8.82% and 25.58% in the ASST (+) and ASST (-) groups, respectively, at the end of the study. Conclusions: AST is a low-cost, cost-effective and potentially curative treatment with no adverse effects in these patients. It can reduce the burden of antihistamines. [ABSTRACT FROM AUTHOR]

Recruitment to the local tissue and alerted phenotype are the hallmarks of basophils in chronic urticaria (CU). Chemokine receptors such as chemokine (C-C motif) receptor 4 (CCR4) or CCR8 have been studied in skin diseases, e.g., atopic dermatitis, but not in CU. In this study, we aimed to define CU's basophil homing potential and receptor profile and the effect of Omalizumab treatment on these. Unstimulated and activated (anti-IgE, fMLP, C5a, and Substance P) whole blood basophils from 11 Omalizumab-treated CU patients and 10 healthy subjects were investigated with flow cytometry. Unstimulated basophils in CU showed higher expression of the skin-associated (CCR8) and scavenger (CCX-CKR) receptors and lower expression of the lung-associated (CCR3) receptor in contrast to healthy ones. IgE-mediated activation increased the percentage of CCR8 and CCX-CKR in CU compared to healthy group and elevated the expression of the lung-associated chemokine receptor, XCR1, in all groups. A trend of augmented expression of the coagulation cascade (CD87) and fMLP (FPR1) receptors was seen on basophils in CU, while a tendency of reduced expression was seen for itch (IL-31RA) and immunotolerance (CD109) receptors. fMLP and C5a increased the expression of CCR4, CCR8, CCX-CKR, and CD87 and decreased CCR2 and CCR3, though no changes between the groups were found. In conclusion, CU basophils exhibit skin-homing potential amplified by IgE-mediated stimulation. [ABSTRACT FROM AUTHOR]

Chronic urticaria (CU) is a pathologic condition marked by the emergence of wheals, angioedema, or both for more than six weeks. The improper activation and degranulation of mast cells is the triggering event, which results in the production of various mediators such as histamine, leukotrienes, PAF, chemokines, and cytokines. Antihistamines are currently the most common pharmacological treatment for urticaria, but corticosteroids and monoclonal antibodies can also be employed. Patients who have been taking antihistamines for a long time are often looking for alternatives. Whole plants, portions of plants, or single extracted active compounds are all used in phytomedicine. Plant elements are frequently combined to create formulations that can be utilized to treat a variety of pathological disorders. Anti-inflammatory and/or anti-allergic properties are found in several herbs regularly used in herbal formulations. Antioxidant properties are also present in some of the constituents. Exogenous antioxidants have been shown to improve the progression of autoimmune disorders in numerous studies. The aim of this review is to identify the most common herbs used to treat chronic urticaria, and to characterize their efficacy, mechanisms of action, and risk/benefit ratio in comparison to western treatment, and also to find less often used formulations and assess their therapeutic efficacy, safety profile, and potential for wider use. [ABSTRACT FROM AUTHOR]

The present study aims to evaluate the efficacy of an anti‐immunoglobulin E monoclonal antibody (omalizumab) in the treatment of allergic asthma (AS). A total of 34 patients with moderate‐to‐severe bronchial asthma admitted to the Respiratory Department of Tianjin First Central Hospital between September 2019 and September 2021 were enrolled in this study. The patients were treated with omalizumab in addition to conventional inhaled corticosteroids + long‐acting β2 agonist treatment. The therapeutic effects before and after the addition of omalizumab were compared. The lung function indicators (ratio of the forced expiratory volume [FEV] in the first second to the forced vital capacity, FEV in the first second, forced expiratory flow [FEF] at 50% of vital capacity, FEF at 75% of vital capacity, and maximum mid‐expiratory flow), fractionated exhaled nitric oxide values, asthma control test scores, rhinoconjunctivitis quality of life questionnaire scores, and urticaria control test scores were significantly different after 4 months of the regular administration of omalizumab (p < 0.05) compared with before administration. The use of omalizumab had a significant efficacy in the treatment of patients with AS, and the effects were obvious in the subgroups of patients with a combination of AS and atopic dermatitis, chronic urticaria, and allergic rhinitis. These results indicate that the treatment is worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

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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]

Background: Urticaria is a common itchy skin condition characterized by swelling and erythema. A variety of treatments is available today. The purpose of this study was to evaluate the clinical effects of probiotic use in patients with chronic resistant urticaria. Methods: This four-way blind randomized clinical trial was conducted between June 2019 and June 2020. Study population consisted of patients with chronic urticaria who did not respond well to first line treatment with antihistamines. For the intervention group, antihistamine (cetirizine) and probiotics (femilact capsule) and for the control group, antihistamine (cetirizine) and placebo were administered twice a day for 8 weeks. The "Urticarial Activity for 7 Days" (UAS7) questionnaire was used to assess urticaria activity and the Dermatology Life Quality Index (DLQI) questionnaire was used to assess the quality of life of patients. Results: Patients' age range was 7 to 30 years with a mean and standard deviation of 23.6±9.2 years. 31 (81.57%) cases were females and 7 (18.42%) cases were males. Twenty patients were in the intervention group and eighteen patients were in the control group. The mean scores of UAS7 questionnaire were reduced in both groups, but it was more significant in the intervention group (9.6±6.4) compared to the control group (12.7±8.1) at the end of week eight of treatment (P=0.036). Also, there was no significant difference in the quality of life between the two groups after 8 weeks (P=0.805). Conclusion: This study showed that probiotic consumption along with antihistamines significantly improved the activity of urticaria but not the quality of life of patients. Keywords: Chronic urticaria, Histamine antagonists, Probiotics, Therapeutics. [ABSTRACT FROM AUTHOR]

Background: Chronic urticaria (CU) has been shown to impact patients' quality of life negatively and may coexist with psychiatric disorders. We systematically reviewed the published evidence of comorbid psychiatric disorders in children and adolescents with CU. Methods: A systematic review of studies published until February 2022 in PubMed, Google Scholar, and Scopus was performed. An a priori set of inclusion criteria was predefined for the studies to be included: (1) clear distinction between urticaria and other allergies; (2) precise distinction between acute and CU; (3) participants younger than 18 years old, exclusively; (4) use of appropriate standardized questionnaires, psychometric tools, and standard diagnostic nomenclature for the mental health and behavioral disorders diagnosis; and (5) manuscripts written or published in the English language. Results: Our search identified 582 potentially relevant papers. Only eight of them satisfied the inclusion criteria. Quantitative meta-analysis was not deemed appropriate, given the lack of relevant randomized control trials, the small number of relevant shortlisted, the small sample size of the patients included in each study, and the remarkable heterogeneity of the studies' protocols. Conclusions: The included studies suggest an increased incidence of psychopathology among children and adolescents with CU as opposed to healthy age-matched individuals, but the data are scarce. Further research is required to clarify whether psychopathology is just a comorbid entity, the cause, or the consequence of CU. Meanwhile an interdisciplinary collaboration between allergists/dermatologists and psychiatrists is expected to substantially minimize CU burden and improve patients' quality of life. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Health Sciences / Sağlık Bilimleri Dergisi is the property of Erciyes Universitesi Saglik Bilimleri Dergisi 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.)

Introduction: Schnitzler syndrome (SchS), first described in 1972, is a rare autoinflammatory condition characterized by chronic urticaria and monoclonal gammopathy of IgM or, exceptionally, IgG profile. Additional features include recurrent fever, evidence of abnormal bone remodeling, a neutrophilic dermal infiltrate on skin biopsy, leukocytosis or elevated C-reactive protein, according to the Strasbourg criteria.

Background/Aims Chronic spontaneous urticaria (CSU) poses a considerable burden both on the quality of life (QoL) of individual patients and on healthcare systems. Real‑world data evaluating the disease burden of CSU are limited in this country. This study evaluated the disease burden and healthcare resource utilization (HRU) among symptomatic CSU patients. Methods This multicenter, noninterventional, retrospective, and cross-sectional study assessed CSU patients symptomatic for more than 6 months despite step-wise H1-antihistamine medications. Primary outcomes included Urticaria Activity Score over 7 days (UAS7) and Chronic Urticaria QoL scale (CU-QoL). Secondary outcomes included EuroQol 5-Dimension 5-Level (EQ-5D-5L), Dermatology Life Quality Index (DLQI), association of disease activity with QoL, medications used for the past 6 months, and HRU. Results Five hundred patients with CSU were enrolled. Mean disease duration was 3.7 years. Based on UAS7, 22.2% of patients were in well-controlled status and 31.2%, 28.4%, and 18.2% of them had mild, moderate, and severe disease, respectively. Mean CU-QoL and DLQI scores were 57.5 ± 29.7 and 10.2 ± 7.6, respectively, while the EQ-5D-5L utility score was 0.8 ± 0.2. H1-antihistamines were prescribed to 95% of patients, while omalizumab was prescribed to 33% of patients. Most patients (98%) had outpatient visits in the past 6 months. Negative correlations were noted between UAS7 and CU-QoL, EQ-5D-5L, EQ-5D-5L visual analog scale scores, but a positive correlation was noted with DLQI score (p < 0.001 for all). The number of outpatient department visits increased with disease activity (p = 0.001). Conclusions CSU affects QoL, leading to increased HRU, particularly in patients with severe disease.

Abstract Background: Chronic Spontaneous Urticaria (CSU) is characterized by recurrent wheals and/or angioedema for longer than 6-weeks. Guidelines recommend Omalizumab (Oma) as first-line and Cyclosporine-A (Cs-A) as second-line treatment in antihistamine resistant CSU. This step-wise algorithm might be time-consuming and costly. Objective: To determine indicators of response to Oma or Cs-A in CSU patients. Methods: We retrospectively analyzed data from seven centers in Turkey; the inclusion criteria for patients were to receive both Oma and Cs-A treatment (not concurrently) at some point in time during their follow-up. Clinical and laboratory features were compared between groups. Results: Among 110 CSU patients; 47 (42.7%) were Oma-responders, 15 (13.6%) were Cs-A-responders, and 24 (21.8%) were both Oma and Cs-A responders and 24 (21.8%) were non-responders to either drug. High CRP levels were more frequent in Cs-A-responders (72.7% vs. 40.3%; p = 0.055). Oma-responders had higher baseline UCT (Urticaria Control Test) scores (6 vs. 4.5; p = 0.045). Responders to both drugs had less angioedema and higher baseline UCT scores compared to other groups (33.3% vs. 62.8%; p = 0.01 and 8 vs. 5; p = 0.017). Non-responders to both drugs had an increased frequency in the female gender and lower baseline UCT scores compared to other groups (87.5% vs. 61.6%; p = 0.017 and 5 vs. 7; p = 0.06). Study Limitations: Retrospective nature, limited number of patients, no control group, the lack of the basophil activation (BAT) or BHRA (basophil histamine release assay) tests. Conclusions: Baseline disease activity assessment, which considers the presence of angioedema and disease activity scores, gender, and CRP levels might be helpful to predict treatment outcomes in CSU patients and to choose the right treatment for each patient. Categorizing patients into particular endotypes could provide treatment optimization and increase treatment success. © 2022 Published by Elsevier España, S.L.U. on behalf of Sociedade Brasileira de Dermatologia. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/).

The document titled "Risk Factors for Chronic Urticaria: A Systematic Review and Meta-Analysis" published in the Journal of Cutaneous Medicine & Surgery discusses the impact of chronic urticaria (CU) on health-related quality of life and the identification of potential risk factors for its development. The study found that allergic rhinitis, asthma, atopic dermatitis, and autoimmune thyroid disorders are associated with an increased risk of CU. Additionally, female sex, food allergy, and positive autologous serum skin test are probably associated with an increased risk, while living in a rural area may decrease the risk of CU. The study highlights the need for further research to validate other potential risk factors for CU. [Extracted from the article]

Background: Despite the increasing interest in biologics for the management of allergic diseases, sparse real-world data are still available in the pediatric population. This study aimed to evaluate the early real-life efficacy and safety of omalizumab for patients with moderate-to-severe asthma and chronic spontaneous urticaria (CSU), and Dupilumab for patients with moderate-to-severe atopic dermatitis (AD). Methods: A prospective study enrolling children aged 6–18 years was designed to assess the efficacy and safety of biologic drugs at 16 weeks of treatment (T1). The effectiveness was measured using validated questionnaires (ACQ-5 for asthma, UAS7 for CSU, and EASI score for AD). Secondary outcome measures included reductions in inhaled corticosteroid (ICS) dosages, asthma-related hospitalizations/exacerbations, and quality of life (QoL) indicators (iNRS, sNRS, DLQI/cDLQI) for CSU and AD. Safety was expressed according to the descriptions of adverse events provided by EMA and FDA. Results: The study cohort consisted of eighteen children (mean age 12.9 ± 3.4 years). The omalizumab treatment significantly reduced ACQ-5 and UAS7 scores (p = 0.002 and p < 0.001, respectively). In patients with asthma, decreased ICS dosage and hospitalization/exacerbation rates were observed. QoL parameters significantly improved in CSU and AD patients. No severe adverse events were reported for either treatment. Conclusions: Our findings validate omalizumab and dupilumab as effective and safe therapeutic options for managing moderate-to-severe allergic diseases in children and adolescents.

Data on how the heart is affected in Chronic Urticaria (CU), a common annoying chronic dermatological disease, is quite limited. The electrocardiographic parameters; P wave dispersion (PWD) and QT dispersion (QTD) have been consistently reported to be predictive for cardiac arrhythmias and morbidity. We aimed to detect asymptomatic cardiovascular involvement in terms of predisposition to arrhythmias in chronic urticaria. This cross-sectional study included 128 individuals: 64 with CU and 64 healthy controls. 12-lead surface electrocardiogram and Doppler echocardiography were performed on patients and controls. All of the cardiologic parameters such as P wave, PWD, QTD and corrected QTD (QTDc) parameters were obtained from ECG measurements. Maximum P wave duration and PWD were found to be higher in CU patients than controls (P= 0.035 and P [Med-Science 2022; 11(2.000): 574-80]

This article shows a case report of exercise-induced urticaria diagnosis in an 8-year-old boy. The aim of this work is to show diagnostic peculiarities of chronic urticaria with known trigger. The necessity of diagnostic algorithm fully implementation is emphasized, even in presence of a clear correlation with trigger factor (in this case – physical exertion). The described case is interesting because previously healthy child without anamnesis of allergic and another chronic disease developed urticaria and symptoms of angioedema without visible cause. Objective examination did not reveal any clinically significant abnormalities except moderate nasal congestion, which was neglected by both the patient and his parents. His was without a past medical history of fever. The child underwent laboratory and instrumental examinations: clinical blood, urine and biochemical tests, immunological tests (cell-mediated and humoral immunity, phagocytosis). Acute phase response was within normal ranges. Total IgE was increased to 100.5 IU/ml, increased levels of specific IgE to cat allergen (41.13 кU/l), serum ß-lactoglobulin of cow’s milk (2.95 кU/l) and lamb meat (0.41 кU/l) were detected. Autoserum test was positive (histamine – papula of 5 mm, hyperemia of 15 mm, negative control – 0, patient’s serum – papula of 16.5 mm, hyperemia of 24 mm); thyroid autoantibodies and thyroid hormone levels were within normal ranges. Tests for physical urticarial were performed: aquagenic, cold, heat, vibratory were negative, dermographic urticaria was positive, test with physical exercise (treadmill) was positive (small-sized wheals and lower eyelid angioedema developed on the 14th minute of sweating). Detailing of anamnestic data revealed an appearance of small wheals after emotional sufferings, and a single episode of difficulty breathing with urticaria and angioedema symptoms while playing football). Conclusions. Thus, extended detailed diagnostics of this clinical case has revealed the combined influence of several factors (dermographic, physical exertion, sensitization to some allergens, autoimmune variant of urticaria/angioedema) clarifying that symptoms could be mediated by both IgE- and non-IgE-dependent mechanism in the same patient. Primary diagnosis of “chronic exercise-induced urticaria” has been changed to “anaphylaxis” requiring another approach to treatment and follow-up.

Purpose: Chronic urticaria is a skin disease with unknown etiology. Autoimmunity and psychogenic factors have been suggested to play a role in pathogenesis. Fibromyalgia is a rheumatic disease that may be associated with psychogenic factors. The aim of the study was to determine the frequency and severity of fibromyalgia and the effect of fibromyalgia coexistence on clinical features and dermatology life quality index in urticaria patients. Materials and Methods: One hundred patients with chronic urticaria and no history of any systemic disease and 100 age and sexmatched healthy controls were included. Urticaria severity was evaluated by the dermatology life quality index (DLQI). Clinical severity and disability status were evaluated by the visual analog scale (VAS) and fibromyalgia impact questionnaire (FIQ). Results: The mean age of the chronic urticaria patient group was 37.7±1.32, and that was 40.7±11.2 in the control group (p=0.09). Fibromyalgia frequency (45%) in the chronic urticaria group was significantly higher than in the control group (13%) (p=0.00). The duration of chronic urticaria was significantly higher in the patients with FMS than in the patients without FMS (p=0.001). There was a statistically significant correlation between FIQ and DLQI (p=0.019). No significant differences in terms of FMS durations, VAS, and FIQ values were detected between groups (p=0.432, p=0.201, p=0.332). Conclusion: High frequency of fibromyalgia in chronic urticaria patients was found. This may be related to the chronic effect of neuromediators involved in chronic urticaria pathogenesis.

OBJECTIVE: To identify the correlation between control levels of spontaneous chronic urticaria and symptoms of anxiety and depression in a dermatologic center in Bogota, Colombia. MATERIALS AND METHODS: A cross-sectional analytical study was done in Bogota, Colombia, from July 2021 to March 2022. Adult patients who attended a dermatological institution with a diagnosis of spontaneous chronic urticaria were included. UCT scales, Hamilton for anxiety, PHQ2 and PHQ9 for depression were applied. RESULTS: Twenty-four patients diagnosed with spontaneous chronic urticaria who consulted the dermatological center were selected. The prevalence of spontaneous chronic urticaria was 8.5% of a total of 2046 patient who consulted in the same period, 17/24 were women, more frequently between 18 and 39 years old (13/24), the average evolution time of spontaneous chronic urticaria was 83 months; 13 patients had uncontrolled spontaneous chronic urticaria and 3 had a good response to treatment. The prevalence of depression symptoms in patients with spontaneous chronic urticaria was of 3/24 and anxiety of 14/24. CONCLUSIONS: It was identified that there is a knowledge gap in terms of the perception and experience of patients with chronic spontaneous urticaria that allows providing a better understanding and support by health personnel and thus contributes to an optimal doctor-patient relationship, with benefit in the outcome of the disease. [ABSTRACT FROM AUTHOR]

Chronic urticaria is a mast cell-mediated condition, with episodes of urticaria (with or without angioedema) lasting for longer than 6 weeks. It leads to significant patient morbidity and affects both social and occupational functioning. Recurrent episodes of angioedema can also occur in isolation and may be life-threatening. Although state-of-the-art targeted treatments have been published globally, third- and fourth-line treatment options are not always accessible and affordable to patients in South Africa. The immediate availability of emergency medicines for acute, life-threatening angioedema episodes, also remains a major concern, and in the private healthcare sector, medical schemes often requiring extensive authorisation processes before these drugs can be administered to patients. Although medical practitioners are advised to adhere to international management guidelines on urticaria and angioedema, in South Africa, 'off-label', less effective medications are often used in an attempt to achieve symptom control and to treat life-threatening attacks of angioedema. [ABSTRACT FROM AUTHOR]

Background: Chronic urticaria (CU) is defined as the occurrence of wheals/angioedema for ≥6 consecutive weeks. Until now, guidelines and publications addressing CU have focused mainly on adults. As a result, evidence and guidance in the pediatric population are scarce. Methods: This study aims to describe clinical and laboratory findings in pediatric CU and to determine factors associated with remission. Results: 185 patients, 54% female, median age at onset of 8.8 years. Angioedema was present in almost half. The most common type of CU was chronic spontaneous urticaria (CSU) in 74%. At least one atopic comorbidity was found in almost a third (35%). In addition, 8% had an autoimmune disorder (exclusively in CSU) and 9% had a psychiatric condition. Basopenia was found in 67% and was more frequently associated with CSU. The basophil activation test (BAT) was positive in 40%. With regard to remission, being of male sex, angioedema absence, the absence of physical triggers, and eosinophil counts >0.51 × 109/L were associated with shorter CU duration. Conclusion: Atopy is a common condition in pediatric CU. CSU is the most common type. Autoimmune comorbidities and basopenia were significantly more common in CSU. In addition, ours is one of the few studies, assessing BAT utility in the pediatric population, being positive in a relevant percentage (40%). BAT positivity was more frequent in CSU. Our results suggest that the absence of angioedema and physical triggers, male sex, and eosinophil counts >0.51 × 109/L appear to be associated with a better prognosis in terms of remission. [ABSTRACT FROM AUTHOR]

Background: Despite advances in the treatment of chronic urticaria, in a significant percentage of the patients symptoms are not fully controlled with conventional approaches. New strategies under development include blocking intracellular mediators of mast cell and basophil activation. Objective: We aim to investigate the effects of the Bruton's tyrosine kinase (BTK) inhibitor remibrutinib on human blood basophils and CD34+‐derived mast cells activation induced by serum obtained from chronic urticaria patients. Methods: Twenty‐two patients with chronic spontaneous urticaria (mean age 52 years, 27% women) and 22 patients with chronic inducible urticaria (46 years, 27% women) were included in the study together with a sex‐matched control group. Patients were classified as responders or non‐responders to anti‐IgE therapy on the basis of their clinical data, FcεR1a expression on blood basophils and total IgE levels. Changes on CD63 expression—as an activation marker‐, were used to evaluate in vitro the response of basophils and mast cells to serum exposure and the inhibitory effects of remibrutinib. Results: Remibrutinib inhibits degranulation induced by IgE cross‐linking in mast cells and basophils and also the activation triggered by factors present in the sera of spontaneous and inducible chronic urticaria patients. Patient's serum induces a greater degranulation of effector cells than controls. Activation of mast cells and basophils by patient sera and remibrutinib effects were not related to omalizumab responsiveness. Conclusion: Remibrutinib inhibits activation of human basophils and mast cells induced in vitro by exposure to the serum of chronic urticaria patients independently of their response to omalizumab. [ABSTRACT FROM AUTHOR]

Objective: Chronic urticaria is a systemic inflammatory disease. Atopic dermatitis is a chronic immunological disease that is characterized by an increase in systemic inflammatory response. In several studies, chronic urticaria and atopic dermatitis were reported to be associated metabolic syndrome (MetS). In this study, we aimed to investigate the serum ghrelin levels in the patients with chronic urticaria and atopic dermatitis. Methods: Thirty patients with chronic urticaria, 30 patients with atopic dermatitis and 30 control subjects participated in this study. Blood fasting glucose and serum lipids, insulin, C-peptide levels and thyroid function tests were measured. The homeostasis model assessment of insulin resistance (HOMA-IR) was used to calculate insulin resistance. Ghrelin levels were determined by an enzyme-linked immunosorbent assay (ELISA) according to the manufacturer's protocol. Results: The mean serum ghrelin levels in the patients with chronic urticaria (54.13 ± 40.94 pg/mL) and atopic dermatitis (65.33 ± 93.54 pg/mL) were significantly higher than those of the controls (30.36 ± 17.13 pg/mL) (p = 0.003, p = 0.04, respectively). Conclusion: We detected higher serum ghrelin levels in the patients with chronic urticaria and atopic dermatitis than the controls. However, we failed to find any association between serum ghrelin levels and insulin resistance or MetS. We think that the high levels of serum ghrelin in the patients with chronic urticaria and atopic dermatitis may be related to the mechanisms independent of insulin resistance. [ABSTRACT FROM AUTHOR]

Background: Allergic diseases are a public health problem with the largest number of patients and the widest age distribution. Chronic urticaria (CU) is a common clinical allergic disease. Bilastine is effective in the treatment of CU, especially skin wind masses and erythema. The purpose of this study was to systematically evaluate the efficacy and safety of Bilastine in the treatment of CU symptoms and to provide an evidence-based reference for clinical rational drug use. Methods: PubMed, Scopus, the Cochrane Library, Embase, EBSCO, and other databases were searched by computer to collect the trials on the effect of bilastine on patients with CU. The retrieval time limit was established until November 2021. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias in the included study. Meta-analysis was performed using RevMan5.4 software. Results: A total of 7 studies were included, including 975 patients. Meta-analysis results showed that compared to the control group, bilastine significantly improved the skin quality of life index, Total Symptom Score (TSS), and weekly urticaria activity score. The skin quality of life index DLQI score (MD = −4.98, 95% CI: −8.09 to −1.86, p = 0.002), skin symptom score TSS (MD = −1.62, 95% CI −2.29 to −0.94, p < 0.00001), the number of hives in a week UAS-7 score (MD = −25.28, 95% CI −32.36 to −18.19, p < 0.00001), and the differences were statistically significant. Conclusions: Bilastine has a better therapeutic effect on CU and can also significantly improve the clinical symptoms and quality of life of CU. [ABSTRACT FROM AUTHOR]