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Background: IgE bound on the surface of mast cells contributes to the pathogenesis of chronic spontaneous urticaria (CSU). Atopy is a predisposing factor for CSU, where omalizumab is a widely used monoclonal antibody to control urticaria symptoms via capturing serum free IgE. However, the role of serum free IgE is not clarified in CSU. The present study evaluated the clinical relevance of serum free IgE in patients with CSU. Methods: Eighty-eight patients with CSU and 76 healthy controls (HCs) were enrolled in this study. Serum total and Dermatophagoides pteronyssinus (Der p)-specific IgE levels were measured by ImmunoCAPs. The serum free IgE levels were measured by ELISA using a novel IgETRAP, and their associations with clinical parameters, including urticaria activity score (UAS), were evaluated. Changes in serum free and total IgE levels after omalizumab treatment were observed in 23 CSU patients in comparison between responders (≥50% reduction in UAS) and non-responders (

Swedish databases present unique opportunities to research population data on diseases and treatments. The current study is, to our knowledge, the most comprehensive registry-based study on a chronic urticaria population in Sweden to date. The aim of this study was to describe the chronic urticaria population in Stockholm County regarding epidemiology, demographics, comorbidity, healthcare usage and treatment patterns in relation to current international guidelines. Real-world data were extracted between 2013 and 2019, yielding 10,642 adult patients. Study period prevalence of chronic urticaria was 0.53%, the mean annual incidence was approximately 0.08%, and 68% of patients were female. Regarding diagnosis, 58% were first diagnosed in primary care, approximately 50% were diagnosed before the age of 40 years. Regarding type of urticaria, 89% had chronic spontaneous urticaria, 11% had chronic inducible urticaria, and 5% of patients with chronic urticaria had coexisting angioedema. Common coexisting diagnoses were, for example, asthma, allergy, psychiatric and behavioural disorders and cardiometabolic disorders. Treatment patterns generally followed guidelines, yet data indicated that guidelines were not fully implemented, especially in primary care.

Background: Cold urticaria (coldU) is associated with substantial morbidity and risk of fatality. Data on coldU in children are sparse. We aimed to evaluate the clinical characteristics, management, risk of associated anaphylaxis, and resolution rate of coldU in a pediatric cohort. Additionally, we sought to compare these metrics to children with chronic spontaneous urticaria (CSU). Methods: We prospectively enrolled children with coldU from 2013–2021 in a cohort study at the Montreal Children's Hospital and an affiliated allergy clinic. Data for comparison with participants with solely CSU were extracted from a previous study. Data on demographics, comorbidities, severity of presentation, management, and laboratory values were collected at study entry. Patients were contacted yearly to assess for resolution. Results: Fifty‐two children with cold urticaria were recruited, 51.9% were female and the median age of symptom onset was 9.5 years. Most patients were managed with second‐generation H1‐antihistamines (sgAHs). Well‐controlled disease on sgAHs was negatively associated with concomitant CSU (adjusted odds ratio (aOR) = 0.69 [95%CI: 0.53, 0.92]). Elevated eosinophils were associated with cold‐induced anaphylaxis (coldA; aOR = 1.38 [95%CI: 1.04, 1.83]), which occurred in 17.3% of patients. The resolution rate of coldU was 4.8 per 100 patient‐years, which was lower than that of CSU (adjusted hazard ratio = 0.43 [95%CI: 0.21, 0.89], p < 10−2). Conclusion: Pediatric coldU bears a substantial risk of anaphylaxis and a low‐resolution rate. Absolute eosinophil count and co‐existing CSU may be useful predictive factors. [ABSTRACT FROM AUTHOR]

Copyright of Farmacia is the property of Societatea de Stiinte Farmaceutice Romania 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.)

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]

Objectives: This study aimed to evaluate the correlation of serum biochemical indexes with disease activity and pruritus in patients with chronic spontaneous urticaria (CSU). Methods: Fifty CSU patients were enrolled and 50 health screen examinees were recruited as the control group. Peripheral blood samples were collected, and thyroid colour Doppler ultrasounds were recorded. Body mass index (BMI) was calculated for both groups. The urticaria activity score over 7 days (UAS-7) was used to evaluate the disease activity and degree of pruritus. Results: There was no significant difference in BMI between CSU patients and control (p > .05). The serum WBC, NEU, CRP (all p = .000) and ALT levels (p = .013) in the CSU patients were significantly higher than those in the healthy control group, and the UAS-7 score was positively correlated with WBC and NEU in the CSU patient group. The TG level of the CSU group was higher than healthy controls, albeit no statistical significance (p = .522). The levels of T3 and TSH were significantly lower in the CSU group (p = .000). The incidence rate of thyroid nodules in the CSU patients was significantly higher (p = .045), and four CSU patients showed papillary carcinoma by pathology examination. The average UAS-7 score of patients with complications was significantly higher than that of patients without complications. Conclusion: Patients experiencing CSU generally exhibit abnormal serum biochemical indexes and thyroid function. Their incidence rates of thyroid nodule and thyroid papillary carcinoma are significantly higher than that of healthy subjects, which should be considered in clinical practice. [ABSTRACT FROM AUTHOR]

Background Great scientific interest has grown around the role of vitamin D in many chronic diseases, due to its reported immunomodulatory effects and its association with several autoimmune and allergic diseases, including chronic urticaria (CU). Previous studies have shown low serum 25-hydroxyvitamin D [25(OH)D] or calcidiol levels in CU patients, with clinical improvements after vitamin D supplementation. However, data on the correlation between levels of vitamin D in the serum and CU disease activity are still limited, especially in low-middle income tropical countries like Indonesia. Objective We proposed to investigate the correlation between serum calcidiol levels and clinical disease activity in patients with CU. Methods We performed an analytic-descriptive cross-sectional study. Disease activity in CU patients, measured using the Urticaria Activity Score 7 (UAS 7) questionnaire, and serum calcidiol levels were assessed in 30 patients aged 18-59 years with CU. Results Mean UAS7 score was 14.6, median duration of illness was 12 months, and the median serum calcidiol level was 12.1 ng/mL. Most subjects (80%) were vitamin D deficient. We found no statistically significant correlations between serum calcidiol and CU disease activity (r=0.151; p=0.425). However, in subjects with severe vitamin D deficiency, a significant negative correlation was found (r=-0.916; p=0.001). Significant moderate correlation was also found between CU disease activity and illness duration (r=0.391; p=0.033). Conclusion We found no correlations between serum calcidiol levels and CU activity, however there was a tendency of increased CU disease activity in vitamin D deficient patients. [ABSTRACT FROM AUTHOR]

The close relationship between the intestine and the skin has been widely stated, seen from gastrointestinal (GI) disorders often accompanied by skin manifestations. Exactly how the gut microbiome is related to skin inflammation and influences the pathophysiology mechanism of skin disorders are still unclear. Many studies have shown a two-way relationship between gut and skin associated with GI health and skin homeostasis and allostasis. This systematic review aimed to explore the associations between the gut microbiome with inflammatory skin disorders, such as acne, psoriasis, atopic dermatitis, and urticaria, and to discover the advanced concept of this relationship. The literature search was limited to any articles published up to December 2020 using PubMed and EBSCOHost. The review followed the PRISMA guidelines for conducting a systematic review. Of the 319 articles screened based on title and abstract, 111 articles underwent full-text screening. Of these, 23 articles met our inclusion criteria, comprising 13 atopic dermatitis (AD), three psoriasis, four acne vulgaris, and four chronic urticaria articles. Acne vulgaris, atopic dermatitis, psoriasis, and chronic urticaria are inflammation skin disorders that were studied recently to ascertain the relationship of these disorders with dysbiosis of the GI microbiome. All acne vulgaris, psoriasis, and chronic urticaria studies stated the association of gut microbiome with skin manifestations. However, the results in atopic dermatitis are still conflicting. Most of the articles agree that Bifidobacterium plays an essential role as anti-inflammation bacteria, and Proteobacteria and Enterobacteria impact inflammation in inflammatory skin disorders. [ABSTRACT FROM AUTHOR]

Chronic spontaneous urticaria is a condition that persists for more than six weeks, it occurs in the absence of an identifiable triggering factor and from the pathogenic activation of mast cells and basophils. The possibility of autoimmune etiology in up to 40 % of patients is presented, followed by subclinical infections and psychological factors. Two main mechanisms of the pathogenesis of chronic urticaria have been proposed: the former is the dysregulation of intracellular signaling pathways within mast cells and basophils, which leads to defects in the traffic or function of these cells. The latter is the development of autoantibodies against FcεRIα or IgE, in both mast cells and basophils. Numerous autoimmune diseases such as systemic lupus erythematosus, polymyositis, dermatomyositis, and rheumatoid arthritis have been associated with chronic urticaria; however, autoimmune thyroid disease deserves a special mention. A higher prevalence of antithyroid antibodies has been found, regardless of thyroid function (euthyroidism, hypo and hyperthyroidism) in patients with chronic spontaneous urticaria. Several infections have been linked to chronic urticaria. The best evidence is for Helicobacter pylori infection. Finally, stress is associated with the onset of the disease through the activation of the sympathetic and adrenomedullary system and the hypothalamic-pituitary- adrenal axis. Diagnosis may vary in different regions of the world, but the common feature is the completion of a thorough medical history. [ABSTRACT FROM AUTHOR]

Background: Although well described in adults, there are scarce and heterogeneous data on the diagnosis and management of chronic urticaria (CU) in children (0–18 years) throughout Europe. Our aim was to explore country differences and identify the extent to which the EAACI/GA²LEN/EDF/WAO guideline recommendations for pediatric urticaria are implemented. Methods: The EAACI Task Force for pediatric CU disseminated an online clinical survey among EAACI pediatric section members. Members were asked to answer 35 multiple choice questions on current practices in their respective centers. Results: The survey was sent to 2,773 physicians of whom 358 (13.8%) responded, mainly pediatric allergists (80%) and pediatricians (49.7%), working in 69 countries. For diagnosis, Southern European countries used significantly more routine tests (eg, autoimmune testing, allergological tests, and parasitic investigation) than Northern European countries. Most respondents (60.3%) used a 2nd‐generation antihistamine as first‐line treatment of whom 64.8% updosed as a second line. Omalizumab was used as a second‐line treatment by 1.7% and third line by 20.7% of respondents. Most clinicians (65%) follow EAACI/WAO/GA2LEN/EDF guidelines when diagnosing CU, and only 7.3% follow no specific guidelines. Some clinicians prefer to follow national guidelines (18.4%, mainly Northern European) or the AAAAI practice parameter (1.7%). Conclusions: Even though most members of the Pediatric Section of EAACI are familiar with the EAACI/WAO/GA2LEN/EDF guidelines, a significant number do not follow them. Also, the large variation in diagnosis and treatment strengthens the need to re‐evaluate, update, and standardize guidelines on the diagnosis and management of CU in children. [ABSTRACT FROM AUTHOR]

Background ‒ Chronic urticaria is a common disease. Plasmapheresis is an alternative treatment that can be appropriate for patients who are resistant to treatment with 2nd generation antihistamines or for whom treatment with omalizumab is unsuitable. Objective ‒ To investigate the effect of plasmapheresis treatment in chronic urticaria. Methods ‒ A retrospective analysis was performed based on the data of 98 patients suffering from refractory chronic urticaria who received plasmapheresis as an alternative treatment in Vilnius University’s Hospital Santaros Clinics from 2000 to 2020. The efficiency of the treatment was evaluated by clinical judgment. Results ‒ 58.2% of the patients exhibited a complete or significant response; of these, 37.8% had temporary relief of symptoms and 20.4% achieved disease remission; 41.8% showed no response to the plasmapheresis. Men (34.8%) had a tendency to achieve disease remission more often than women (16%) (p < 0.05). One patient did not finish the plasmapheresis treatment due to the symptoms’ exacerbation and treatment with omalizumab was initiated. Conclusion ‒ Plasmapheresis is a safe and effective alternative treatment when traditional treatment is unavailable or does not relieve symptoms completely. Our data showed that plasmapheresis was effective in more than half of our patients. [ABSTRACT FROM AUTHOR]

The AWARE (A World-wide Antihistamine-Refractory chronic urticaria patient Evaluation) study investigated outcomes in patients with chronic urticaria refractory to H1-antihistamine. The objective of the current study was to analyse the effects of treatment on patients' symptoms and quality of life for a period of up to 2 years. Over the 2 years, there was clear improvement in the high rates of disease burden from baseline, as evidenced by lower scores for disease severity scales, better quality of life, and a decreasing rate of medical resource utilization. However, this is the result of treatment adherence to the guidelines in highly specialized Scandinavian urticaria centres, and has its basis in the relatively low treatment intensity and control at enrolment. There is a need for greater adherence to the treatment guidelines and better management of antihistamine-refractory chronic urticaria. [ABSTRACT FROM AUTHOR]

Swedish databases present unique opportunities to research population data on diseases and treatments. The current study is, to our knowledge, the most comprehensive registry-based study on a chronic urticaria population in Sweden to date. The aim of this study was to describe the chronic urticaria population in Stockholm County regarding epidemiology, demographics, comorbidity, healthcare usage and treatment patterns in relation to current international guidelines. Realworld data were extracted between 2013 and 2019, yielding 10,642 adult patients. Study period prevalence of chronic urticaria was 0.53%, the mean annual incidence was approximately 0.08%, and 68% of patients were female. Regarding diagnosis, 58% were first diagnosed in primary care, approximately 50% were diagnosed before the age of 40 years. Regarding type of urticaria, 89% had chronic spontaneous urticaria, 11% had chronic inducible urticaria, and 5% of patients with chronic urticaria had coexisting angioedema. Common coexisting diagnoses were, for example, asthma, allergy, psychiatric and behavioural disorders and cardiometabolic disorders. Treatment patterns generally followed guidelines, yet data indicated that guidelines were not fully implemented, especially in primary care. [ABSTRACT FROM AUTHOR]

Copyright of Osmangazi Journal of Medicine / Osmangazi Tip Dergisi is the property of Eskisehir Osmangazi University 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.)

Efforts to reduce non-urgent hospital attendances during the COVID-19 pandemic have been the focus of much attention from healthcare professionals worldwide. In Ireland, due to funding constraints omalizumab is only available for hospital-based administration. Fifty-eight patients with chronic spontaneous urticaria and angioedema (CSU) receiving omalizumab in our centre were rapidly transitioned to home self-administration at the start of the pandemic. We conducted an anonymised patient survey after 3 months of home therapy with the aim of characterizing the patient experience throughout this period. 41 patients participated in our questionnaire (71% response rate). 93% of patients favored self-injection of omalizumab from home, with respondents citing cost savings, time savings, improved flexibility, fewer hospital visits, and less risk of exposure to COVID-19 infection as particular benefits. Concerns regarding home administration including injecting incorrectly, forgetting a dose, or having a reaction were reported very infrequently. Eighty-three percent (83%) of patients wished to continue with home therapy long-term. This survey highlights broadly positive experiences for patients rapidly transitioning to home omalizumab administration. This data will be useful to inform healthcare funders in decisions regarding patient-centred care in CSU. Facilitating home omalizumab therapy in suitable CSU patients should be strongly considered in the post-pandemic setting.

Background: Information/communication technologies such as mobile phone applications (apps) would enable chronic urticaria (CU) patients to self‐evaluate their disease activity and control. Yet, recently Antó et al (2021) reported a global paucity of such apps for patients with CU. In this analysis, we assessed patient interest in using apps to monitor CU disease activity and control using questions from the chronic urticaria information and communication technologies (CURICT) study. Methods: The methodology for CURICT has been reported. Briefly, a 23‐item questionnaire was completed by 1841 CU patients from 17 UCAREs across 17 countries. Here, we analyzed patient responses to the CURICT questions on the use of apps for urticaria‐related purposes. Results: As previously published, the majority of respondents had chronic spontaneous urticaria (CSU; 63%; 18% chronic inducible urticaria (CIndU) [CIndu]; 19% with both), were female (70%) and in urban areas (75%). Over half of patients were very/extremely interested in an app to monitor disease activity (51%) and control (53%), while only ∼1/10 were not. Patients with both urticaria types versus those with CSU only (odds ratio [OR], 1.36 [1.03–1.79]) and females versus males (OR [95% CI], 1.47 [1.17–1.85]) were more likely to be very to extremely interested in an app to assess disease control. Conclusions: Overall, half of the patients with CU were very to extremely interested in using an app to assess their disease activity and control. Development of well‐designed apps, specific to disease types (CSU, CIndU, CSU + CIndU, etc), validated by experts across platforms would help improve the management and possibly outcomes of CU treatment while providing important patient information to be used in future research. [ABSTRACT FROM AUTHOR]

Background: The lifetime prevalence of chronic urticaria (CU) is 0.5%–1%. In some patients with CU, symptomatic control is not achieved with non‐sedating second‐generation H1 antihistamines (nsAH1) alone, even with quadrupled standard doses as recommended in international guidelines. In these cases, biological treatment with omalizumab can be added. Since omalizumab is expensive compared to antihistamines, lack of adherence to guidelines for high dose nsAH1 (up to four‐fold standard dose per day) may be associated with substantial unnecessary costs. The aim was to measure the use nsAH1 before and during omalizumab use for the first time in an omalizumab treated CU population. Methods: We identified all Danish patients with CU who initiated omalizumab from March 2014 to December 2018 and evaluated new and ongoing nsAH1 treatments using the Danish nationwide registries. Results: A total of 955 CU patients initiated treatment with omalizumab within the study period (median age 40 years [IQR 28–50], 74.5% females). During the 12 months prior to omalizumab initiation, 95.6% of the patients filled at least one prescription with nsAH1 at some point, while 84.7% filled at least one prescription during the three months before omalizumab. From 3 months before omalizumab initiation till 3 months after, the proportions of users of high‐dose nsAH1 was maximum 31.1%. Conclusions: Omalizumab was usually administered before sufficient nsAH1 treatment was tried. In despite of the labelling that omalizumab should be co‐administered with high dose nsAH1, this does not happen This may lead to substantial unnecessary costs. [ABSTRACT FROM AUTHOR]

Chronic urticaria is in some cases very difficult to treat, we aimed to evaluate the effect of colchicine on chronic urticaria management. Fifty‐five euthyroid patients with chronic urticaria were examined based on UQL and UAS7 questionnaires. The overall UQL‐Q score after 3 months has not any statistical difference between groups. The overall UQL‐Q score changes between groups was not statistically different. However, the UQL‐Q score significantly reduces during study period in each group. In conclusion, colchicine can manage the sign and symptoms of chronic urticaria, which improve the patients' quality of life. [ABSTRACT FROM AUTHOR]

Introduction: Chronic spontaneous urticaria (CSU) is defined as recurrent attacks of urticaria present for more than six weeks. The monoclonal anti‐immunoglobulin E antibody, omalizumab, was approved for the treatment of CSU in patients who remain refractory to H1‐antihistamines. Biologic agents are shown not to increase the risk of COVID‐19 infection in different studies. Objective: In the present study, we aimed to determine the prevalance of COVID‐19 infection in relation to the age, gender, presence of other comorbidities, and treatment given for CSU. Methods: We conducted a descriptive cross‐sectional study of 233 patients diagnosed with CSU in a tertiary referral hospital. Demographical data, treatment given for CSU, the presence of COVID‐19‐related symptoms, history of close contact to a person with COVID‐19 and COVID‐19 real‐time polymerase chain reaction (RT‐PCR) results were determined via a telephone survey and checked from medical data records. Results: One hundred sixty patients were female; whereas 73 were male. The mean age was 44.76. Out of 233 patients with chronic urticaria, 125 had symptoms related to COVID‐19 infection. RT‐PCR testing for COVID‐19 was performed in 156 patients. Of 156 patients with COVID‐19 RT‐PCR test, RT‐PCR result was positive in 15 cases. Conclusions: No statistically significant relationship was found between COVID‐19 RT‐PCR positivity and the type of treatment administered for chronic urticaria when the patients are divided into omalizumab ± oral antihistamines and only oral antihistamines treatment groups (p = 0.150). Omalizumab seems to be safe in the era of COVID‐19. [ABSTRACT FROM AUTHOR]

Women with abnormal uterine bleeding (AUB) have been reported to develop chronic spontaneous urticaria (CSU). Nevertheless, whether or not AUB women have an increased risk of CSU has not been examined in large‐scale epidemiologic studies. This study aimed to investigate the risk of CSU among reproductive‐aged women with AUB. A total of 79 595 patients and 79 107 propensity‐score matched controls were recruited from Taiwan's National Health Insurance Research Database to conduct a nationwide cohort study. The Cox proportional‐hazard regression model was applied to examine the adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for CSU in relation to AUB. We found that women with AUB had a higher risk for CSU (aHR = 1.83; 95% CI, 1.76–1.90) than women without AUB. Subgroup analyses revealed that AUB with an abnormal bleeding frequency (aHR = 1.70; 95% CI, 1.60–1.79), irregular bleeding (aHR = 1.80; 95% CI, 1.71–1.89), and intermenstrual bleeding (aHR = 1.65; 95% CI, 1.49–1.83) were associated with an increased risk of CSU compared with those without abnormalities. The Kaplan–Meier analysis revealed that the cumulative incidence of developing CSU was consistently higher in the AUB cohort than in the non‐AUB cohort during the entire follow‐up period (log‐rank test, p < 0.001). In conclusion, reproductive‐aged women with AUB were found to have a higher risk of developing CSU. This study emphasizes the importance of enquiring CSU patients about menstrual problems in clinical practice. Further consultation with obstetrician‐gynecologists may be beneficial. [ABSTRACT FROM AUTHOR]

Allergic diseases are immune-mediated diseases. Allergies share a common immunopathogenesis, with specific differences according to the specific disease. Mesenchymal stem/stromal cells (MSCs) have been applied to people suffering from allergic and many other diseases. In this review, the immunologic roles of MSCs are systemically reviewed according to disease immunopathogenesis from a clinical viewpoint. MSCs seem to be a promising therapeutic modality not only as symptomatic treatments but also as causative and even preventive treatments for allergic diseases, including atopic dermatitis and chronic urticaria. [ABSTRACT FROM AUTHOR]

Chronic urticaria (CU) is a chronic inflammatory mast cell‐driven disorder. Endothelial cells (ECs) contribute importantly to key features of CU. Several markers of EC (dys)function in CU have been reported, but have not yet been systematically reviewed. In this study, we systematically reviewed and categorized all published markers of EC functions in CU through a comprehensive search in Pubmed, The Cochrane Library, Web of Science, and SCOPUS using the following Mesh terms: CU AND pathogenesis AND (vasculopathy OR microangiopathy OR ECs OR marker). In total, 79 articles were selected and the identified biomarkers were categorized according to EC (dys)function in CU. The most frequent and consistently reported upregulated biomarkers in CU skin were adhesion molecules, TF, and P‐selectin. The most frequently reported upregulated and reliable biomarkers in sera of CU patients were F1+2 for coagulation cascade involvement, D‐dimers for fibrinolysis, and MMP‐9 for vascular permeability. Emerging biomarkers described in the selected articles were endostatin, heat shock proteins, cleaved high molecular weight kininogen, and adipokines. This systematic review contributes to the pool of growing evidence for vascular involvement in CU where EC dysfunction is present in different aspects of cell survival, maintenance of vascular structure, and coagulation/fibrinolysis balance. [ABSTRACT FROM AUTHOR]

Chronic urticaria is a well-defined disease in adult patients, but there are limited data in the pediatric population and in inducible urticaria. This leads to delays in the diagnosis and treatment of the disease in this age group, generating great alterations in the quality of life of patients. A case of aquagenic urticaria and a case of cholinergic urticaria in children are presented. A rare case of pressure urticaria during sexual activity in an adult is also described. Documentation of cases that describes the presentation of chronic inducible urticaria is important to establish a better approach. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to evaluate the effect of omalizumab use on hematological parameters, inflammatory markers, and immunoglobulin E (IgE) in patients with chronic spontaneous urticaria and to determine whether there would be any difference between patient and control groups in terms of these values and whether IgE levels before and after omalizumab treatment are correlated with the Urticaria Control Test (UCT). Materials And Methods: Forty-five patients with chronic spontaneous urticaria and 45 healthy controls who presented to the dermatology outpatient clinic of Yozgat Bozok University Research and Training Hospital were analyzed retrospectively. Age, gender, neutrophil, lymphocyte, monocyte, eosinophil, basophil, and thrombocyte counts and IgE values before and after 24 weeks of treatment were recorded, and IgE ratios before and after treatment were calculated. The UCT was performed on the patients. The neutrophil/lymphocyte, platelet/lymphocyte, lymphocyte/monocyte, eosinophil/basophil, and eosinophil/lymphocyte ratios were calculated for the control group and the patient group, both before and after treatment. Mean platelet volume (MPV), which is also considered an inflammatory marker, was recorded before treatment, in both the control group and the patient group. Results: The patients' median pre-treatment IgE level [189.0 (1.0-1824.0)] was significantly lower than the posttreatment level [561.0 (2.0-4301.0)] (P<0.001). No significant difference was determined in basophil, platelet, eosinophil, monocyte, lymphocyte, and neutrophil counts and neutrophil/lymphocyte, platelet/lymphocyte, lymphocyte/monocyte, eosinophil/basophil, and eosinophil/lymphocyte ratios before and after omalizumab treatment. The mean UCT score of the patients was found to be 11.5 (± 3.9). The mean IgE ratio post-omalizumab treatment/pre-omalizumab treatment was 5.8. No significant difference was found between the patient and control groups regarding neutrophil/lymphocyte, platelet/lymphocyte, lymphocyte/monocyte, eosinophil/basophil, and eosinophil/lymphocyte ratios, as well as MPVs. A significant correlation was found between the patients' UCT scores and IgE levels after omalizumab treatment (r=0.313; P=0.046). Conclusion: No changes were observed in hematological inflammatory markers of patients with chronic spontaneous urticaria, compared with healthy controls. Besides, no changes were observed in either inflammatory markers or hematological parameters, following the use of omalizumab in these patients. Hence, it is considered that there is no harm in using omalizumab in diseases such as chronic disease anemia, chronic idiopathic neutropenia, and idiopathic thrombocytopenic purpura. The fact that omalizumab treatment caused a significant increase in IgE levels, in correlation with previous studies, made us think that the methods of reducing the dose or extending the dose interval should be preferred, instead of abruptly interrupting the treatment during the discontinuation period to prevent relapses. [ABSTRACT FROM AUTHOR]

Background. Chronic urticaria is a skin disorder characterized by swollen pruritic plaques and papules last long at least for 6-weeks. The aim of this study was to determine the anti-TPO level in patients diagnosed with chronic urticaria, resistant to conventional treatments in order to test the possibility of thyroid hormone replacement with the aim of accelerating healing process. Methods. In this case-control study, 63 patients with chronic urticarial and 63 controls without chronic urticarial were studied bye anti-TPO measurement. Anti-TPO level upper than 40 IU/ has been recognized as positive. Results. The prevalence of chronic urticaria among the case group was 3.5 times higher in women rather than men. Mean time of disease period was about 21.40±3.75 months. In this study, there was been no statistically significant association between age, sex, TSH level and anti-TPO concentration in both groups. Conclusion. Anti-TPO level in patients with chronic urticaria was not significantly different from the control group. However, Anti-TPO levels were significantly higher in patients with longer duration of disease. [ABSTRACT FROM AUTHOR]

The studies on childhood chronic urticaria (CU) are limited. We aimed to investigate the epidemiological and etiological factors of children with CU. Demographic characteristics, laboratory findings, and etiological factors of patients diagnosed with CU younger than the age of 18 were retrospectively evaluated. Of the 124 participants, 68 (54.8%) were aged 12 and older. Angioedema accompanied 18.5% of the patients. Chronic spontaneous urticaria (CSU) was found in 75%, while 24.2% had chronic inducible urticaria. Symptomatic dermographism (16.1%) was the most common among chronic inducible urticaria, followed by cholinergic urticaria (4.8%). No etiological factor could be detected in 56.5% of the children. Infections (29.8%) were the most common etiological factor, followed by drugs (8%). Dental problems (16.9%) were the primary infections associated with CU. Chronic urticaria prevalence in children increased with age, with CSU being the most common type. Infections played a significant role in childhood CU. [ABSTRACT FROM AUTHOR]

Introduction: Chronic urticaria (CU) is as a distressing condition that may present with short-lived itchy weal, angioedema, or both. Autologous serum skin test (ASST) is a simple in vivo clinical test for the detection of basophil histamine-releasing activity. ASST is a very simple, quick test which consists of intradermal injection of patient's own serum into the volar aspect of forearm. A significant association between increased total IgE and CU severity was found. The present study was done to find out the clinical profiles of CU in MGM Medical College and LSK Hospital. ASST was done, and serum IgE level in patients with chronic spontaneous urticaria estimated and to give an insight on degree of serum IgE level with ASST positivity. Materials and Methods: This was a cross-sectional study where a total of 100 patients were enrolled. Detailed history, physical examination, and routine investigations were recorded for all patients. ASST and serum IgE were done in all patients. Results: Of total of 100 patients enrolled in the study, ASST positive group consists of 29 patients and ASST negative group consists of 71 patients. A total of 46 patients got raised IgE, and the rest 54 had normal IgE level; out of IgE positive, 34 patients were ASST negative, and rest 12 patients were ASST positive. Majority of ASST positive patients had normal serum IgE level (n = 17). Nine and three patient's IgE level were in the range of 200–300 and 300–400 IU/ml, respectively. Conclusion: The ASST is a simple, practicable in vivo intradermal test for the detection of autoimmune urticaria. There was significant association seen with the duration of disease and ASST positivity. The present study did not show any association between increased serum IgE and ASST positivity.

Objective: To compare the efficacy of autologous serum with Antihistamine therapy in treating chronic urticaria. Study Design: Quasi-experimental study. Place and Duration of Study: Dermatology Department, Pak Emirate Military Hospital, Rawalpindi Pakistan, from Jul 2018 to Jan 2019. Methodology: One hundred four patients of chronic urticaria (>3 times/week for >6 weeks) with ages ranging from 16 to 70 years were assigned the treatment groups using a lottery method. i.e., Group-A (autologous serum therapy) and Group-B therapy). During the eight weeks of therapy, weekly Urticaria Activity Scoring (UAS-7) was utilized to quantify response in terms of the number of weals and pruritus. Results: Of 104 patients, 75(72.12%) were females, and 29(27.88%) were males. Sixty-nine patients were between 18 to 35 years of age, with a mean age of 37.79±10.15 years in Group-A and 38.04±10.98 years in Group-B. Efficacy of Group-A (autologous serum therapy) was seen in 40(76.92%) patients while in Group-B (Antihistamine therapy) it was seen in 25(48.08%) patients (p-value =0.002). Conclusion: Autologous serum therapy is more effective than Antihistamine therapy in treating chronic urticaria. [ABSTRACT FROM AUTHOR]

Background: Chronic urticaria (CU) is a common skin condition, affecting 0.5-1% of the population. Multiple studies have demonstrated that plasma D-dimer levels could be employed as a biomarker for disease activity and treatment response in patients with CU. Aim: The aim was to evaluate the correlation between D-dimer levels and the disease activity of CU. Materials and Methods: This study was a case-control study conducted on 120 patients suffering from CU and 50 healthy subjects. Plasma D-dimer levels were measured using ELISA. Results: Mean plasma D-dimer levels in the patients with CU (720.5 ng/mL) were significantly higher than those in the controls (405.6 ng/mL) (p < 0.001). A significant correlation was observed between plasma D-dimer levels and the UAS (urticaria activity score). Conclusion: The patients with CU had higher plasma D-dimer levels than the control group. A positive statistical correlation was observed between plasma D-dimer levels and the severity of CU. [ABSTRACT FROM AUTHOR]

The article presents summarized materials on etiology, pathogenesis, classification, clinical manifestations and treatment of chronic urticuria, The management of patients with this pathology at Dniprovsky Allergological Center was analyzed. For assessment of quality of life SKINDEX-29 questionnaire was used. The questionnaire includes three sections: symptoms, emotions and functions. Physical symptoms include six points: tenderness, heartburn or tingling, itching unpleasant sensations when cotacting with water, skin irritation, sensitivity. The emotional sphere is characterized by such ten points as: concern about the condition of the skin; deppression; feeling of shame; concern that scars can remain after skin disease; feelings about worsening of the skin; anxious mood; embarrassment, feeling of humiliation; skin irritation; rejection of oneself. “Features” section has twelve items: sleep quality; work and hobbies; social activity; sex life; solitude; fatigue; unwillingness to leave home; limiting intimacy with others; complexity in carrying out daily activities; difficulty in expressing feelings; obstruction to create relationships with others; limiting close communication with relatives. Gastrointestinal system was also examined: fibrogastroduodenoscopy with determination of Helicobacter Pylori, ultrasound diagnosis of abdominal organs, the intensity of clinical symptoms was determined on a UAS7 scale. Fifteen patients (including eight women and seven men) were successfully treated with omalizumab. The mean age was 39.1 ± 3.6 years. The average duration of the disease in patients was 5.1 ± 0.9 years. The intensity of symptoms was determined before treatment after the first and second injection of Omalizumab. After the first injection, there was a positive trend. The clinical effect occurred in seventy-two hours. Statistical processing of the study results was performed using Statistica v.6.1® software. (StatSoft, USA). The inclusion of omalizumab is an effective treatment for chronic urticaria in the absence of an effect from antihistamines.

Abstract Background Chronic urticaria is defined as the appearance of urticarial lesions and/or angioedema during a period of more than six weeks. We aimed at developing the Portuguese version of the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) and at testing its reliability and the content, construct and criterion validity. Methods The forward-backward approach to a linguistic equivalence was followed, after which a clinical review and a cognitive debriefing with patients were performed. The intraclass correlation coefficient checked test-retest reliability with patients filling the same questionnaire with one week apart and the Cronbach’s alpha indicator assessed the internal consistency. Construct validity was tested by an exploratory factor analysis and by hypothesis tests involving sociodemographic and clinical patient characteristics, including the urticaria control test (UCT). On the other hand, criterion validity was tested through correlations with the Short-Form Health Survey SF-36, EQ-5D-5 L, and the Dermatology Quality of Life Index (DLQI). Results A total of 162 patients from seven hospital units were included. The mean (standard deviation) age was 42.6 (13.3) and 81.6% were female. CU-Q2oL was entirely filled by all respondents. Internal consistency was 0.947 for the overall score, ranging from 0.661 (limits) to 0.899 (sleep problems) and the corresponding reproducibility indicator was 0.910, based on 23 patients and ranging from 0.711 (swelling) and 0.957 (looks). Exploratory factor analysis in general confirmed the original structure originally obtained by the authors. All CU-Q2oL dimensions were highly correlated with DLQI Index and differentiated well between males and females, and between different levels of wheals and pruritus. In addition, moderate negative correlations were found between Cu-Q2oL scores and the dimensions from SF-36 and EQ-5D-5 L. Conclusions The satisfactory metric properties confirmed the cultural adaptation and validity of CU-Q2oL into Portuguese population, providing the clinicians with a valid tool to evaluate the impact of chronic urticaria on patient’s QoL and therefore adjust their treatment. Trial registration number Not applicable.

Chronic spontaneous urticaria (CSU) can be associated with some autoimmune diseases which may affect the CSU course. Autoimmune thyroiditis can cause severe CSC. 2nd generation antihistamines are the golden standard of CSY therapy. However, even dose-escalation in some cases will not lead significant improvement. Nowadays there are not enough studies about other medications administration in children with CSU. Omalizumab is the only genetically engineered biologic drug for treatment of resistant (to standard therapy) forms of CSU, it can be used in children over 12 years old. We would like to present our data on one adolescent girl with CSU and comorbid autoimmune thyroiditis with thyroid function abnormality. The multidisciplinary approach to diagnostics and management of this patient as well as Omalizumab administration let us achieve total disease control and, finally, its remission.

The aim of the study was to study trigger factors in chronic urticaria, peculiarities in the expression of Toll-like receptors, clinical and immunological efficacy of microbial antigens in patients with chronic urticaria.Materials and methods. Patients with chronic urticaria (134 patients). A study of the expression of TLR2, TLR3, TLR4, TLR9 on blood cells using flow cytometry. 62 patients received polyvalent bacterial lysate against baseline therapy per os, 72 patients received monotherapy with basic drugs.Results. In patients with bacterial infection, high levels of TLR2, TLR4 expression were detected. In the presence of viral infections, high TLR3 expression values were observed. The use of PBL contributed to an increase in the number of patients with clinical remission, decreased urticaria activity, led to a correction in TLR2 and TLR4, and decreased the level of total IgE.Conclusion. Inclusion in the complex of therapeutic and prophylactic measures in patients with urticaria of a chronic drug based on microbial antigens (polyvalent bacterial lysate) contributes to the increase of clinical effectiveness and activation of the links of innate immunity.

Abstract Background Urticaria is a condition defined by the development of wheals, angioedema or both. It is classified based on its duration as acute (≤ 6 weeks) or chronic (> 6 weeks). Chronic urticaria is less frequent than acute one in children, but it represents a debilitating condition, always needing treatment. Symptoms affect child’s daily activities and disturb sleeping patterns, causing emotional distress and negatively influencing learning and cognition. Therefore, the management of chronic urticaria must point to a complete control of symptoms, taking into account tolerability and the patient quality of life. Review of literature The recently revised version of EAACI/GA2LEN/EDF/WAO guideline on the management of urticaria, in addition to recommending the use of second-generation H1 antihistamines as the treatment of choice, gives particular attention to their use in the paediatric population. Bilastine has been studied in children; at the dose of 10 mg/once daily, it is licenced for the symptomatic relief of urticaria in children ≥ 6 to 11 years, in the European Union, in appropriate formulation, as oral solution or orodispersible tablet. Conclusions In line with the recent guideline recommendation for the use of second generation H1 antihistamines in children we have reviewed the safety and tolerability profile of bilastine in children with chronic urticaria.

Abstract Chronic spontaneous urticaria (CSU) is often associated with organ specific autoimmunity but is rarely caused by food allergy. Colourings and preservatives in pre-packaged foods, so called pseudoallergens, have also been implicated. Factors that promote inflammation or reduce anti-inflammatory mechanisms may however, predispose susceptible individuals to CSU. Chronic underlying infection and mental and emotional stress can sometimes precede the onset of CSU and once established can exacerbate the symptoms. There is early evidence of dysbiosis within the gastrointestinal tract in people with CSU and reduced levels of vitamin D are also evident. The latter may be related to the importance of vitamin D3 in increasing T regulatory function which can control a tendency to autoimmunity. It is quite possible that a state of on-going chronic inflammation with reduced anti-oxidant mechanisms may underlie the not infrequent association between CSU and metabolic syndrome. Effective treatment of CSU should involve the use of anti-histamines, intermittent steroids and anti-IgE therapy. For recalcitrant disease immune modulatory therapy has a place. However, talking therapies that reduce stress and anxiety, vitamin D3 supplementation, correction of intestinal dysbiosis and treatment of any chronic infection should also be considered.

Ilaria Puxeddu, Fiorella Petrelli, Francesca Angelotti, Cristina Croia, Paola Migliorini Clinical Immunology Unit, Department of Clinical and Experimental Medicine, Pisa University, Pisa, ItalyCorrespondence: Ilaria PuxedduClinical Immunology Unit, Department of Clinical and Experimental Medicine, Pisa University, Via Roma 67, Pisa 56126, ItalyTel +39-50-558628Fax +39-50-558630Email ilaria.puxeddu@unipi.itAbstract: Chronic urticaria (CU) is a mast cell-driven disease characterized by the development of wheals, angioedema, or both for more than 6 weeks. The two major sub-types are chronic spontaneous urticaria (CSU) and inducible urticaria. In the last decade different pathophysiological mechanisms, potentially responsible for the development of the disease, have been described. It is likely that the activation of mast cells and basophils in CSU can be the results of immune system dysregulation, activation of the inflammatory cascade, and of the extrinsic coagulation pathway. Some of the mediators involved in the pathophysiological mechanisms of CSU have recently been identified as potential biomarkers useful for the diagnosis, follow-up, and management of the disease, even if they are not yet available in clinical practice. Thus, in this review we discuss new insights in the mediators involved in the pathogenesis of CSU, highlighting their potential role as biomarkers in the activity and progression of the disease and response to therapies.Keywords: chronic urticaria, inflammation, biomarkers, angiogenesis

Aim:Recently, it has been reported that the mean platelet volume (MPV) and neutrophil-to-lymphocyte ratio (NLR) can be used as indicators of inflammation in various inflammatory diseases such as psoriasis, ankylosing spondylitis and ulcerative colitis. In this study, we aimed to assess MPV levels and NLR in children with chronic urticaria (CU) and to compare them with healthy controls.Materials and Methods:The cases of 46 children with CU [11 with inducible urticaria (IU) and 35 with chronic spontaneous urticaria (CSU)] admitted to our outpatient clinics, and 30 healthy children were evaluated retrospectively.Results:No statistically significant differences among the CU, CSU, and IU and the control groups were found in terms of NLR and MPV levels (p>0.05). The platelet counts in the CU, CSU, and IU and control groups were not statistically significantly different (p>0.05).Conclusion:We found that MPV levels and NLR were not different in children with CU, CSU, and IU and in healthy children. It seems that the MPV and NLR cannot be used as inflammatory markers of CU in children. We believe that further studies are required in this field.

Abstract The aim of this guidance is to provide recommendations to clinicians and other interested parties on chronic urticaria in children. The Italian Society for Pediatrics (SIP), the Italian Society for Allergy and Immunology (SIAIP), the Italian Society for Pediatric dermatology (SIDerP) convened a multidisciplinary panel that prepared clinical guidelines for diagnosis and management of chronic urticaria in childhood. Key questions on epidemiology, natural history, diagnosis, and management were developed. The literature was systematically searched and evaluated, recommendations were rated and algorithms for diagnosis and treatment were developed. The recommendations focus on identification of diseases and comorbidities, strategies to recognize triggering factors, improvement of treatment by individualized care.

Abstract Background Chronic urticaria (CU) is a refractory skin disease with long duration and a high recurrence rate. Acupuncture has been widely used for the treatment of CU in clinical practice in China. However, until now, there has been no appropriately designed randomized controlled trial (RCT) to provide explicit evidence about the effectiveness of acupuncture for the treatment of CU worldwide. Therefore, we plan to conduct a pilot study to explore its effectiveness and safety and determine the feasibility of studying acupuncture in a future, full-scale, RCT of CU. Methods/design This randomized, sham-controlled, participant-blinded and assessor-blinded pilot trial is underway in China. A total of 60 participants with CU will be randomly assigned to two groups in a 1:1 ratio: one treated with real acupuncture and the other with sham acupuncture, for 10 sessions over 2 weeks. The experimental group will receive acupuncture on a fixed prescription of acupoints, whereas the control group will receive sham acupuncture, namely minimal acupuncture on non-acupuncture points. The primary outcome will be the urticaria activity score (UAS). The secondary outcomes will include a visual analogue scale (VAS) score for itching intensity, the Dermatology Life Quality Index (DLQI), the Hamilton Depression Scale (HAMD), the Hamilton Anxiety Scale (HAMA), the humoral immunity index, serum total IgE, and adverse events. The UAS, VAS for itching and the DLQI will be conducted at baseline and at 1, 2, 3, and 4 weeks after randomization. The HAMD, HAMA, humoral immunity index, and serum total IgE will be assessed at baseline and at 2 weeks after randomization. Adverse events will be summarized at 1 week and 2 weeks after randomization. Discussion The pilot study mainly aims to investigate trial feasibility, and confirm basic information about its effects and safety. Results of this trial will help clarify whether the acupuncture treatment is beneficial for symptom improvement in patients with CU. The finding of this study will provide preliminary evidence on the effectiveness and safety of acupuncture for CU. Trial registration Acupuncture-Moxibustion Clinical Trial Registry, AMCTR-ICR-18000190. Registered on 19 June 2018.

Yan Lei Chen,1 Weirong Joshua Sng,2 De Yun Wang,2 Xue Yan Wang11Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Otolaryngology, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeBackground: Several studies have shown that the use of antibiotics early in life significantly increases the risk of asthma in children. It is unclear whether antibiotics are more commonly used in patients with allergy-related diseases.Methods: A multistage, clustered and random sampling with a field-interviewer-administrated survey study was performed to investigate if there was multiple use of antibiotics (MUA) in patients with allergic rhinitis (AR), conjunctivitis, chronic urticaria (CU), and asthma in the grasslands of northern China. MUA was defined as antibiotic usage for at least 3 days and for more than 3 times a year in the past 2 years.Results: A total of 5,787 subjects completed the study, with 1,079 subjects (18.6%) identified as MUA. MUA was more common in patients with AR (23.7% vs 16.2%, P

Background: Few studies have explored the association between obstructive sleep apnea (OSA) and chronic urticaria (CU). Our study aims to fill this gap by determining the frequency of the risk categories for OSA and how they might correlate with the specific CU patient reported outcome measures urticaria activity score (UAS7), urticaria control test (UCT) and CU quality of life questionnaire (CU-Q2oL). Methods: We conducted a cross-sectional study involving a cohort of 171 Latin American CU patients. Descriptive statistics were used to determine frequency and proportions for demographic and clinical variables, while a chi-squared test for association between STOP-Bang OSA questionnaire categories and both UAS7 and UCT categories was performed to analyze how such variables interact. To further assess the strength of the correlation a Cramer's V coefficient was reported. Finally, a Kendall-Tau b correlation coefficient was performed to measure the correlation between the STOP-Bang score and other independent continuous variables. Results: The average STOP-Bang score was 2.5, with 24% and 21% of patients falling into the intermediate and high-risk category for moderate-to-severe OSA, respectively. There was a strong statistically significant association (Cramer's V = 0.263; p = .000) between UAS-7 categories and STOP-Bang risk categories. A similar pattern of strong significant association (Cramer's V = .269; p = .002) was observed between UCT categories and STOP-Bang risk categories. A weak positive correlation between the STOP-Bang score and the CU-Q2oL average score (τb = 0.188, p = .001) was identified. Overall, 72.5% patients reported limitations with respect to sleep in a varied degree according to the CU-Q2oL. Conclusions: Our results suggest that a considerable proportion of patients with CU are at intermediate to high risk for OSA. Higher disease activity, poor CU control, and worse quality of life were all found to be associated with an increased risk. Additional studies are needed to determine the exact link between these conditions, and to determine whether screening and treatment for OSA might benefit patients with CU.

Omalizumab (humanized anti-immunoglobulin IgE) is currently the first choice of treatment for chronic urticaria refractory to high-dose second-generation antihistamines (sgAH). Despite its high safety profile, response to omalizumab is insufficient in one-third of patients. Some studies have suggested that methotrexate is effective in antihistamine-refractory chronic urticaria, but there are no studies on its efficacy and safety in patients unresponsive to omalizumab. This retrospective study aimed to investigate the clinical effectiveness and adverse effects of methotrexate in patients with chronic urticaria unresponsive to omalizumab + high-dose sgAH. The patients were evaluated in terms of age at disease onset, duration of the urticaria episode before methotrexate therapy, treatment before methotrexate therapy, final treatment, treatment responses, 7-day urticaria activity score (UAS7) before and after treatment, and total IgE levels. Methotrexate was administered subcutaneously at a dose of 15 mg once weekly as monotherapy or in combination with other drugs to 10 chronic urticaria patients with a history of nonresponse to omalizumab + high-dose sgAH. The mean age of the patients was 44.6±11.5 (31-65) years, and 9 (90%) of the patients were female. The mean duration of methotrexate therapy was 5.1±2.4 months (1.5-9 months). Complete response or well-controlled response was observed in 70% of the patients and partial response was observed in 1 patient (10%). Methotrexate was well tolerated by 80% of the patients. Methotrexate seems to be a useful treatment option both as monotherapy or combined therapy in patients resistant to omalizumab + sgAH.