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

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

Background: Omalizumab treatment has shown promise in managing Chronic spontaneous urticaria (CSU). This study focuses on evaluating its effect on improving the quality of life and reducing CSU activity and severity in patients of different age groups. Material and Method: Conducted at Derince Training and Research Hospital, this observational study involved 50 CSU patients, categorized into adolescents (≤18years, n=15) and adults (>18years, n=35). Data were collected through clinical and demographic assessments, including Urticaria Activity Score (UAS), Urticaria Control Test (UCT), and Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) questionnaires, at the beginning and the third month of Omalizumab treatment. Result: Significant improvements were observed in UAS, UCT, and CU-Q2oL scores post-Omalizumab treatment, indicating reduced symptom severity and enhanced quality of life. The median UAS at the start was 35 (28-35); at the third month, 7 (0-7); median UCT at the start was 2 (1.25-3), at the third month 16 (13-16); median CU-Q2oL at the start was 70.5 (66-74), at the third month 23 (23-28); (p<0.001, p<0.001, and p<0.001, respectively). In adult patients, levels of anti-TPO and anti-TG were significantly higher compared to adolescents with CSU (anti-TPO 28 (0.92-47.4) IU/mL vs. 1.73 (0.79-27.1) IU/mL, p=0.066; anti-TG 12.6 (1.4-31.5) IU/mL vs. 1.08 (0.74-9.66) IU/mL, p=0.007). Conclusion: Omalizumab treatment improves the quality of life and reduces disease activity in CSU, demonstrating its efficacy as a therapeutic option for those resistant to antihistamines across all age groups. Further research is warranted to explore the long-term effects of Omalizumab and its potential in personalized CSU management strategies. [ABSTRACT FROM AUTHOR]

Background The autologous plasma skin test (APST) and autologous serum skin test (ASST) are simple, semi-invasive, inexpensive, and easy to perform diagnostic test for chronic spontaneous urticaria (CSU). However, the positivity rate of both tests was varied. The study aims to compare APST and ASST positivity rate in CSU patients, and correlate with urticaria activity. Methods This study included 36 CSU patients underwent testing with APST and ASST. Urticaria activity was assessed by weekly urticaria activity score (UAS7). We observed positivity APST and ASST among moderate-severe and mild urticaria activity. Results Twenty-two of 36 CSU patients was female, with mean age was 28± 9.969 years old. The positivity rate of APST was higher than ASST (83.33% vs. 66.67%). Positive APST with negative ASST were 25%, meanwhile negative APST with positive ASST were 8.33%. Not only were no statistically significant differences in APST and ASST, but also age, sex, and ASST diameter with urticaria activity (p = 0,378, p = 0.968, p = 1.000, p = 0.826, respectively). The positiveness rates of APST were statistically significant higher in moderate-severe activity than mild activity CSU patients (p = 0.008). Conclusion In conclusion, positivity rate of APST was higher than ASST among patients with CSU. Furthermore, positivity APST was associated with moderate-severe urticaria activity, and may considered as a screening test to predict urticaria activity in CSU patients. [ABSTRACT FROM AUTHOR]

(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: Management of chronic spontaneous urticaria (CSU) is challenging because of its unpredictable course and negative influence on the quality of life. Second-generation antihistaminics are the first-line treatment. Levocetirizine, a time-tested antihistaminic, has proven efficacy in CSU. Bepotastine, which was previously used for allergic rhinitis and conjunctivitis, has recently been tried in urticaria. It may be a better alternative to levocetirizine because of its long-term safety. Objectives: The aim of this study was to compare the efficacy and safety of levocetirizine and bepotastine in CSU. Materials and Methods: A randomized, active-controlled, open-label, prospective, interventional study was conducted on 70 patients of CSU. After initial clinical assessment and baseline investigations, bepotastine and levocetirizine were prescribed to separate groups of 35 patients for a period of 12 weeks. Urticaria Activity Score (UAS) and Dermatology Life Quality Index (DLQI) were used for assessing the severity of disease. Follow-up visits were planned for evaluating clinical improvement and adverse effects. Results were compared using Mann–Whitney U test and Fisher's exact test. P < 0.05 was considered statistically significant. Results: The reduction in UAS and DLQI score in levocetirizine group was better than bepotastine group, and the results were statistically significant at 12 weeks (P = 0.0001). Incidence of adverse effects such as sedation and weight gain was higher in levocetirizine group at 12th week (P = 0.0003). Conclusion: The result of the study reveals the superiority of levocetirizine in terms of efficacy, i.e., reduction of UAS and DLQI scores. Bepotastine although slightly lower in efficacy shows better safety profile.

Objective: Although the factors that trigger and exacerbate chronic spontaneous urticaria (CSU) are well known, there is still a lack of information about the effects of COVID-19 vaccines on CSU. This study aimed to investigate exacerbations/relapses triggered by COVID-19 vaccines in patients with CSU who are well controlled with treatment or in remission. Materials and Methods: The study included 350 CSU patients. Demographic and clinical characteristics were collected from patients' medical records. The seven-day urticaria activity score (UAS7) and urticaria control test (UCT) were evaluated separately during the onset of the disease, pre-vaccination, and post-vaccination periods. Results: The mean age was 39.89±13.30 years and 74.6% of the patients were female. A total of 227 patients were vaccinated with the Pfizer/BioNTech mRNA vaccine, 67 with the Sinovac/CoronaVac inactivated vaccine, and 54 with both vaccines. Urticaria exacerbations/relapses were observed in a total of 76 patients, and most CSU exacerbations/relapses occurred after the first dose (n=46). Median UAS7 scores increased significantly in the post-vaccination period in patients who experienced urticaria exacerbation (p<0.0001). Median UCT scores were significantly decreased due to urticaria exacerbation with vaccination (p<0.0001). Conclusion: Both mRNA and inactivated COVID-19 vaccine may lead to exacerbations or relapses in patients with CSU. Even so, exacerbations/relapses associated with COVID-19 vaccines can be easily controlled with treatments and do not preclude subsequent doses. [ABSTRACT FROM AUTHOR]

Background: Chronic spontaneous urticaria (CSU) is an immune-inflammatory disorder. The urticaria activity score (UAS 7) is used to assess urticaria activity. The neutrophil to lymphocyte ratio (NLR) is a reliable indicator for inflammatory conditions. Parameters useful for the evaluation of patients with CSU are not currently available. Objectives: To assess NLR in CSU patients and its correlation with urticaria activity score. Patients and methods: Of the patients attending the allergy clinic of Ain Shams University Hospital, 200 patients with CSU, including 62 patients with mild disease, 68 with moderate disease, and 70 with severe disease according to urticaria activity score 7 (UAS7), and 200 controls, were included in this study. NLR values were compared among various study groups. Results: NLR values were significantly higher among CSU patients than controls (p<0.001), with no significant correlation with urticaria activity score. Conclusion: NLR is a rapid, simple, and low-cost blood marker that can be used to detect systemic inflammatory processes in patients with CSU. [ABSTRACT FROM AUTHOR]

Introduction: Chronic spontaneous urticaria (CSU) can occur at every age, however, knowledge of the elderly with CSU is limited. Aim: To examine the relationship between the onset of CSU and previous stressful life events, disease activity, and perceived general stress in the elderly age group. Material and methods: A hundred and sixty-four elderly patients with CSU were included. To evaluate urticaria activity, Turkish-validated seven days Urticaria Activity Score (UAS7) was used. Patients were questioned by physicians to respond "yes" or "no" to evaluate having stress, and their opinion on the relationship between a stressful event and onset of urticaria. Severity of stress level was assessed by using 10-point Visual Analogue Scale (VAS). Patients were divided into two groups according to the VAS. VAS = 5 and > 5 were considered as patients with no stress (Group 1, n = 66), and patients with stress (Group 2, n = 98), respectively. Results: A hundred patients had at least one stressful life event within three months of the onset of CSU. There was a strong correlation between having stress and onset of CSU (r = 0.871, p < 0.001), a positive correlation was determined between VAS and UAS7 (r = 0.418, p < 0.001). Concomitant disease history and UAS7 were significantly higher in Group 2 than in Group 1 (p = 0.018 and p < 0.001, respectively). Conclusions: Stressful life events and perceived high stress may be a trigger for CSU in the elderly. To control CSU in the elderly, having stressful life events should be questioned and multidisciplinary management including psychiatry consultation should be done. [ABSTRACT FROM AUTHOR]

(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.

Chronic spontaneous urticaria (CSU) is a heterogeneous, systemic, primarily mast cell-driven disease with sudden appearance of wheals with or without angioedema with pruritus for more than 6 weeks. It affects 0.3%–0.6% of the general population. CSU is a complex immune-mediated disease due to induction of basophil and mast cell degranulation with more than one mechanism of auto-allergy Type I (mediated by specific immunoglobulin E (IgE) targeting auto-allergens as thyroperoxidase, etc.) and auto-immunity Type II (mediated by IgG auto-antibodies binding to alpha-subunit of high affinity IgE receptor [FcERI]) with increased expression of Type II cytokines and activation of coagulation cascade. Pruritus is due to sensory nerve activation by histaminergic pathway (Histamine receptors- H1R and H4R) and histamine-independent pathway (Substance P, Capsacin, and Reactive oxygen species, etc.). The international guidelines on CSU recommend to treat CSU until it is gone. The use of second-generation anti-histamine in effective dose as the first-line treatment and up-dosing of second generation (SgAH) up to four-fold is recommended in treatment-resistant patients. The humanized anti-IgE monoclonal antibody Omalizumab has been shown to have both excellent safety profiles as the only third-line treatment option in anti-histamine-resistant urticaria (approved by United States Food and Drug Administration in August, 2014). However, there are several questions to be answered with reference to the optimal dose, duration, and the rates of long-term remission with omalizumab. Other biologics as Ligelizumab are less well studied but have an important role in the specific type of omalizumab-resistant CSU. In this review, we will summarize the role of omalizumab in anti-histamine resistant CSU.

Background: Urticaria frequently causes pediatric emergency department (PED) admissions. Children with urticaria may unnecessarily avoid suspected allergens. We aimed to investigate the possible and exact triggers of urticaria in children admitted to the PED. Methods: Medical records of children admitted to the PED within a 1‐year period were evaluated for the International Classification of Diseases 10 (ICD‐10) L50 urticaria code, noting symptoms, and possible triggers of urticaria. We performed telephone interviews to complete the missing data and further diagnostic tests for IgE‐mediated allergies to identify the exact triggers of urticaria. Results: Among 60,142 children, 462 (0.8%) with the L50 code were evaluated. Possible triggers based on the history and physical examination could be identified in 46%: infections (18%), drugs (11%), foods (8%), infections and drugs (3%), insects (3%), pollen (1%), blood products (0.4%), and vaccines (0.4%). The most frequent infections related to urticaria were upper respiratory tract infections (74.5%), urinary tract infections (13.2%), gastroenteritis (8.2%), and otitis media (4.1%). After a diagnostic workup, IgE‐mediated allergic diseases were diagnosed in 6% of patients. Twenty‐two percent of the patients had multiple PED admission for the same urticaria flare. Urticaria severity was found to be the most important risk factor for readmissions to the PED (odds ratio: 3.86; 95% confidence interval: 2.39–6.23; p <.001). No relationship between urticaria severity, duration, and the triggers was present. Conclusions: Despite detailed diagnostic tests, IgE‐mediated allergic triggers were rarely the cause of urticaria in children admitted to the PED. Infections are the most frequent trigger. Severe urticaria causes more frequent readmissions to the PED. [ABSTRACT FROM AUTHOR]

Omalizumab has high treatment efficacy in patients with chronic spontaneous urticaria (CSU) who do not respond to high doses of antihistamines. Systemic immune‐inflammation index (SII) and systemic inflammation response index (SIRI) were described as novel inflammatory and prognostic biomarkers. The present study aimed to evaluate the effectiveness of SII and SIRI in patients with CSU who receive omalizumab therapy. A total of 124 patients with severe urticaria who had an urticaria activity score over 7 days (UAS‐7) ≥28 were included in the study. UAS‐7, C‐reactive protein (CRP), SII, and SIRI values ​​were recorded before and after omalizumab treatment. Patients with UAS‐7 ≤6 at week 12 and/or week 24 of omalizumab treatment were considered responders. Three months after omalizumab treatment, significant decreases were observed in SII, SIRI, CRP, and UAS‐7 compared to pre‐treatment values ​​(p = 0.003, p < 0.001, p = 0.006, and p < 0.001, respectively). At the third and sixth months of treatment, baseline SII and SIRI levels of the omalizumab responder group were significantly higher than the non‐responder group (p < 0.001). However, there was no difference in baseline CRP and UAS‐7 levels between responders and non‐responders (p ˃ 0.05). After adjusting for confounding factors, only pre‐treatment SII (OR: 1.002, 95% CI: 1.000–1.004, p = 0.036) and SIRI (OR: 4.334, 95% CI: 1.751–10.726, p = 0.002) values were independently associated with response to omalizumab at 3 months in multivariate regression analysis. SII and SIRI could be effectively used to predict the response to omalizumab therapy. More comprehensive studies are needed to validate and elaborate on this relationship. [ABSTRACT FROM AUTHOR]

Background: Cold urticaria (ColdU) is a form of inducible urticaria where cold induces wheals and/or angioedema. The burden of disease is high and linked to trigger thresholds, exposure, and avoidance. There are presently no validated patient‐reported outcome measures (PROMs) to assess and monitor disease activity. Our objective was to develop a disease‐specific activity score for ColdU that is easy to administer and evaluate. Methods: A Cold Urticaria Activity Score (ColdUAS) questionnaire was developed, directed by PROM developing guidelines. After the generation of a conceptional framework, the item generation phase included the literature research on ColdU signs and symptoms and on comparable tools for similar diseases and 47 ColdU patient interviews. Subsequently, an impact analysis for content validity was performed. The final selection of items underwent expert review for face validity and cognitive debriefing. Results: The ColdUAS, a self‐administered questionnaire for the prospective assessment of disease activity in patients with ColdU, consists of 4 items: 1. the frequency and severity of the signs (wheals and/or angioedema), 2. the frequency and severity of the symptoms (e.g., itch and burn), 3. the exposure to specific triggers, and 4. the avoidance of these triggers. The recall period for each item is the last 24 h. Conclusions: The ColdUAS is the first disease‐specific PROM to assess ColdU disease activity. It may help to better assess patients' disease status in routine clinical practice as well as in clinical trials. Anchor‐based approaches are currently used to validate the ColdUAS. [ABSTRACT FROM AUTHOR]

Background: In cholinergic urticaria (CholU), itchy wheal and flare-type skin reactions are triggered by sweat-inducing activities. The CholU activity score, CholUAS, is used to assess disease activity, but has not yet been validated. The aim of the study was to validate the CholUAS, develop an English version, and provide instructions for scoring., Methods: Cognitive debriefing of CholUAS was performed. CholU patients (n =75) used the CholUAS on 7 consecutive days, underwent provocation testing, and completed additional anchor instrument questionnaires including global evaluation tools and established quality of life instruments. A scoring protocol for the calculation of the weekly CholUAS, the CholUAS7, was developed. The CholUAS7 was tested for validity, reliability, and influencing factors. An English version of the CholUAS was developed., Results: The final CholUAS contains 3 questions that are used for scoring as well as one global question. The weekly CholUAS, CholUAS7, showed excellent test-retest reliability and good correlations with anchor instruments. Statistical analysis showed no significant influence of age or duration of disease on CholUAS7 results., Conclusion: The validated CholUAS is ready for use in clinical trials and routine clinical practice., (Copyright © 2024. Published by Elsevier Inc.)

Chronic spontaneous urticaria (CSU) is a heterogeneous, systemic, primarily mast cell-driven disease with sudden appearance of wheals with or without angioedema with pruritus for more than 6 weeks. It affects 0.3%–0.6% of the general population. CSU is a complex immune-mediated disease due to induction of basophil and mast cell degranulation with more than one mechanism of auto-allergy Type I (mediated by specific immunoglobulin E (IgE) targeting auto-allergens as thyroperoxidase, etc.) and auto-immunity Type II (mediated by IgG auto-antibodies binding to alpha-subunit of high affinity IgE receptor [FcERI]) with increased expression of Type II cytokines and activation of coagulation cascade. Pruritus is due to sensory nerve activation by histaminergic pathway (Histamine receptors- H1R and H4R) and histamine-independent pathway (Substance P, Capsacin, and Reactive oxygen species, etc.). The international guidelines on CSU recommend to treat CSU until it is gone. The use of second-generation anti-histamine in effective dose as the first-line treatment and up-dosing of second generation (SgAH) up to four-fold is recommended in treatment-resistant patients. The humanized anti-IgE monoclonal antibody Omalizumab has been shown to have both excellent safety profiles as the only third-line treatment option in anti-histamine-resistant urticaria (approved by United States Food and Drug Administration in August, 2014). However, there are several questions to be answered with reference to the optimal dose, duration, and the rates of long-term remission with omalizumab. Other biologics as Ligelizumab are less well studied but have an important role in the specific type of omalizumab-resistant CSU. In this review, we will summarize the role of omalizumab in anti-histamine resistant CSU. [ABSTRACT FROM AUTHOR]

BACKGROUND: Chronic spontaneous urticaria (CSU) poses a therapeutic challenge by dermatologists and patients alike. OBJECTIVES: This study aimed to find the prevalence of functional autoantibodies among patients using autologous serum skin test (ASST) and to evaluate the efficacy of autologous serum therapy (AST) as an adjuvant in CSU. MATERIALS AND METHODS: An open-labeled, single-centered, prospective, interventional study of 1 year was performed after institutional ethical approval among 55 consenting patients of CSU. ASST was performed to find the prevalence of functional autoantibodies and those positive were given weekly intramuscular AST for the next 9 weeks. For clinical outcome, weekly urticaria activity score (UAS7) was recorded at baseline and at week 10. Any adverse effects were recorded. Wilcoxon sign-ranked test and Fisher's exact test were used to demonstrate equal variance. Results: Fifty-five CSU patients consented to participate in the study; 41 were ASST+ and six were dropped out; hence, the prevalence of autoreactivity was 74.54%. Four of seven who presented with angioedema were ASST+. Thus, the prevalence of angioedema in ASST+ patients of CSU was 11.4%. At the end of 10th week, on comparing individual components of UAS7, there was a statistical significant difference (P < 0.05) in the number of wheals (P = 0.00001), pruritus (P = 0.00001), frequency of wheals (P = 0.00001), as well as the overall UAS7 (P = 0.0001) scores. The effect size is 1.23 (Cohen's d). On grading the improvement at week 10, marked (>75%), good (50%–74%), satisfactory (25%–49%), and poor (

Background: Chronic urticaria (CU) is one of the most common case found in dermatology and venereology and it decreases the quality of life. Autohemotherapy (AHT) is an innovative therapy that works by desensitization and activation of the local immune system, and it is effective for recurrent or refractory urticaria. AHT technique is simple, inexpensive, and does not require special expertise that can be done at all levels of health services in Indonesia. Purpose: to determine the effectiveness of AHT in the CU treatment. Methods: This was a clinical trial research with involving patients with CU in the Allergo-Immunology Clinic of Department of Dermatology and Venereology Dr. Mohammad Hoesin General Hospital (DV RSMH) and Pertamina Hospital Palembang. The Urticaria Activity Score (UAS7) and Dermatology Life Quality Index (DLQI) assessments were carried out on week 1 and week 10. Result: The research was conducted from 1 July - 30 September 2019 involving 72 eligible patients with 2 dropouts (2.8%). The mean age was 47 years (15-72 years), with 46 (63.9%) are women. Chronic spontaneous urticaria (CSU) was the most frequent diagnosis observed in 64 people (88.9%). Adverse events included bruises at the injection site (n=1; 1.4%) and at the blood draw location (n=1; 1.4%). On week 1, mean UAS7 was 30.77 ± 2.46, mean DLQI 21.66 ± 3.60. By week 10, UAS7 and DLQI significantly decrease to 4.12 ± 2.89 and 2.51 ± 1.53 (p

BACKGROUND: Chronic spontaneous urticaria (CSU) poses a therapeutic challenge by dermatologists and patients alike. OBJECTIVES: This study aimed to find the prevalence of functional autoantibodies among patients using autologous serum skin test (ASST) and to evaluate the efficacy of autologous serum therapy (AST) as an adjuvant in CSU. MATERIALS AND METHODS: An open-labeled, single-centered, prospective, interventional study of 1 year was performed after institutional ethical approval among 55 consenting patients of CSU. ASST was performed to find the prevalence of functional autoantibodies and those positive were given weekly intramuscular AST for the next 9 weeks. For clinical outcome, weekly urticaria activity score (UAS7) was recorded at baseline and at week 10. Any adverse effects were recorded. Wilcoxon sign-ranked test and Fisher's exact test were used to demonstrate equal variance. RESULTS: Fifty-five CSU patients consented to participate in the study; 41 were ASST+ and six were dropped out; hence, the prevalence of autoreactivity was 74.54%. Four of seven who presented with angioedema were ASST+. Thus, the prevalence of angioedema in ASST+ patients of CSU was 11.4%. At the end of 10th week, on comparing individual components of UAS7, there was a statistical significant difference (P < 0.05) in the number of wheals (P = 0.00001), pruritus (P = 0.00001), frequency of wheals (P = 0.00001), as well as the overall UAS7 (P = 0.0001) scores. The effect size is 1.23 (Cohen's d). On grading the improvement at week 10, marked (>75%), good (50%-74%), satisfactory (25%-49%), and poor (<25%) improvement were observed in 8 (22.9%), 12 (34.3%), 11 (31.4%), and 4 (11.4%) patients, respectively. CONCLUSION: AST is effective in significantly reducing wheals and pruritus and improves quality of life. It can be tried as an adjuvant before switching patient to other immunosuppressants or expensive biologicals in this current COVID-19 pandemic. Large long-term prospective randomized controlled trials with follow-up are required to conclusively ascertain the efficacy of AST as an adjuvant in CSU. [ABSTRACT FROM AUTHOR]

Relevance. Omalizumab is recommended for treatment of severe forms of recurrent urticaria in children since 12 years old. Though the Omalizumab efficiency and safety in children with recurrent urticaria have not been studied specifically.Objective. To estimate results of the therapy including Omalizumab in adolescents with recurrent urticaria.Methods. We have studied clinical records of day hospital patients aged from 12 to 17 with recurrent urticaria uncontrolled with second-generation antihistamines and/or immunosuppressive drugs at least for a month (in standard or higher dose), but receiving Omalizumab (300 mg once in 4 weeks subcutaneously). The main result of this therapy is disease control (urticaria activity score over 7 days, UAS7, equal to zero) at 3 and 6 months of therapy. Additional outcomes of therapy: number of significant recrudescence (use of glucocorticosteroids or emergency hospitalization) at 6th month of therapy and in 6 and 12 months after its end; end of concomitant treatment (antihistamines and/or immunosuppressive drugs) at 3 and 6 months and genetically engineered biological agent (GEBD); remission (UAS7 = 0) after 6 and 12 months after GEBD cessation; adverse effects of Omalizumab therapy (any medical cases connected with GEBD).Results. The disease control at 3 months of treatment was reached in 12 (67%) patients out of 18 children with recurrent urticaria, at 6 months — at 13 (72%) patients. During Omalizumab therapy and at 6 months after therapy cessation there were no significant recrudescence, at 12 months after therapy cessation — at 1 (6%) adolescent. The concomitant treatment was ended after 3 months at 3 (17%) patients, after 6 months — at 10 (56%) patients. Remission was sustained at 11 (61%) out of 18 patients at 6 months and at 9 (60%) out of 15 patients at 12 months after the therapy end. Adverse effects of Omalizumab have not been noted.Conclusion. Addition of Omalizumab to the therapy in adolescents with uncontrolled recurrent urticaria let us reach remission of disease in most cases by 6 months of treatment.

Background: Activated coagulation cascade is implicated in urticaria pathogenesis marked by high plasma D-dimer, a marker of fibrinolysis, levels correlating with high urticaria activity score (UAS) and poor therapeutic outcome. Methods: Quantitative plasma D-dimer levels and coagulation parameters in 100 (male:female ratio 1:3) Indian patients with chronic spontaneous urticaria and age- and gender-matched healthy controls were compared. The clinicoepidemiologic features of chronic urticaria were then compared among patients with normal (≤0.2 mg/L) and elevated (≥0.3 mg/L) plasma D-dimer levels. Results: Plasma D-dimer in 23% patients and 4% controls and prothrombin time and activated partial thromboplastin time in 63% and 5% patients, respectively, were significantly higher compared with 58% and 1% of controls, respectively. About 18 of 72 (25%) patients with high UAS of ≥16–42 were compared with 5 of 28 (17.8%) patients with UAS7 of ≤15. Patients with elevated plasma D-dimer levels had significantly more systemic symptoms (86.9% vs. 81.8%) compared with patients with normal plasma D-dimer levels. Conclusion: A subset of patients with chronic urticaria have elevated plasma D-dimer levels and exhibit higher UAS7 and systemic symptoms that may influence long-term prognosis and therapeutic choices. Small number of patients, a cross-sectional nature of study, lack of treatment outcome measures, information on self-medication, and unavailability of specific parameters for coagulation pathway activation remain few limitations of this study.

Introduction: Patients of Chronic Urticaria (CU) suffer from the morbidity that arise from irritable itch and wheals and it also shows a poor response to drug treatment. Treatment options which increase the duration of remission and those which address the key factors involved in the disease pathogenesis are the need of the hour. Aim: To assess the efficacy of injection histaglobulin a complex of histamine and human immunoglobulin in producing relief in patients with CU and to compare effect of histaglobulin in between Autologous Serum Skin Test (ASST) positive and ASST negative group of CU patients. Materials and Methods: This was a single centre, open label, non-randomised prospective clinical study in which 40 patients with CU were enrolled. Patients were administered injection histaglobulin as a weekly dose of 1 mL subcutaneously for eight consecutive weeks. Patients were permitted to take tab. levocetirizine 5 mg as and when required not exceeding the recommended permitted dose. The efficacy of the drug was assessed using Urticaria Activity Score (UAS 7) a unified, validated and simple scoring system. The assessment was done at every weekly visit and the final assessment was done after 24 weeks. Results: Out of 40 patients enrolled, 32 patients had completed the entire schedule of dosage of eight weeks and final followup at 24th week. The mean basal UAS 7 was 12.6 at the time of enrolment to the study and it reduced to 2.57 at the end of 8th week which marginally increased to 2.8 at the end of 24 weeks, the antihistamine pill burden also reduced. No adverse effects were observed in the study group. Conclusion: Histaglobulin was found to be effective in producing long term remission and it reduced the antihistamine need as well. Thus, it can be an effective alternative to existing treatment modalities.

Introduction: Patients of Chronic Urticaria (CU) suffer from the morbidity that arise from irritable itch and wheals and it also shows a poor response to drug treatment. Treatment options which increase the duration of remission and those which address the key factors involved in the disease pathogenesis are the need of the hour. Aim: To assess the efficacy of injection histaglobulin a complex of histamine and human immunoglobulin in producing relief in patients with CU. Secondary objective was to compare effect of histaglobulin in between Autologous Serum Skin Test (ASST) positive and ASST negative group of CU patients. Materials and Methods: The present study was a prospective clinical study in which 40 patients with CU were enrolled. Patients were administered injection histaglobulin as a weekly dose of 1 mL subcutaneously for eight consecutive weeks. Patients were permitted to take Tab Levocetirizine 5 mg as and when required not exceeding the recommended permitted dose. The efficacy of the drug was assessed using Urticaria Activity Score (UAS 7) a unified, validated and simple scoring system. The assessment was done at every weekly visit and the final assessment was done after 24 weeks. Results: Out of 40 patients enrolled, 32 patients had completed the entire schedule of dosage of eight weeks and final followup at 24th week. The mean basal UAS 7 was 12.6 at the time of enrolment to the study and it reduced to 2.57 at the end of 8th week which marginally increased to 2.8 at the end of 24 weeks, the antihistamine pill burden also reduced. No adverse effects were observed in the study group. Conclusion: Histaglobulin was found to be effective in producing long term remission and it reduced the antihistamine need as well. Thus, it can be an effective alternative to existing treatment modalities. [ABSTRACT FROM AUTHOR]

This systematic review evaluates the efficacy and safety of omalizumab for chronic spontaneous urticaria (CSU). PubMed, Embase, and Cochrane Library were searched for RCTs. Critical and important CSU‐related outcomes were considered. The risk of bias and the certainty of the evidence were assessed using GRADE. Ten RCTs including 1620 subjects aged 12 to 75 years old treated with omalizumab for 16 to 40 weeks were evaluated. Omalizumab 150 mg does not result in clinically meaningful improvement (high certainty) of the urticaria activity score (UAS)7 (mean difference (MD) −5; 95%CI −7.75 to −2.25), and the itch severity score (ISS)7 (MD −2.15; 95% CI −3.2 to −1.1) does not increase (moderate certainty) quality of life (QoL) (Dermatology Life Quality Index (DLQI); MD −2.01; 95%CI −3.22 to −0.81) and decreases (moderate certainty) rescue medication use (MD −1.68; 95%CI −2.95 to −0.4). Omalizumab 300 mg results in clinically meaningful improvements (moderate certainty) of the UAS7 (MD −11.05; 95%CI −12.87 to −9.24), the ISS7 (MD −4.45; 95%CI −5.39 to −3.51), and QoL (high certainty) (DLQI; MD −4.03; 95% CI −5.56 to −2.5) and decreases (moderate certainty) rescue medication use (MD −2.04; 95%CI −3.19 to −0.88) and drug‐related serious AEs (RR 0.77; 95%CI 0.20 to 2.91). [ABSTRACT FROM AUTHOR]

Chronic spontaneous urticaria (CSU) lacks a specific trigger. The urticaria activity score (UAS) is used to evaluate disease status. Some studies have reported elevated serum levels of high‐sensitivity C‐reactive protein (hsCRP) in CSU patients, which is correlated with disease severity. The neutrophil/lymphocyte (N/L) ratio is a significant indicator of systemic inflammation. We investigated the potential correlation between serum levels of hsCRP and N/L ratio, as well as urticaria activity, in CSU patients. We included 52 CSU patients treated at the Dermatology Polyclinic of Beysehir State Hospital between August and October 2020, and 50 controls. The 7‐day UAS were graded mild, moderate, or intense. We measured N/L ratios, erythrocyte sedimentation rates (ESRs), and the levels of hsCRP, T4, and thyroid‐stimulating hormone (TSH) in each group. The anti‐thyroglobulin (anti‐TG) and anti‐microsomal antibody (anti‐TPO) levels of CSU patients were also assayed. There were no significant differences in hsCRP, T4, or TSH levels between the groups; however, both the ESR and N/L ratio were significantly higher in CSU patients hsCRP (P =.96), T4 (P =.07), TSH (P =.67), ESR (P <.001), N/L(P <.001). No correlation was evident between the UAS day 7 (UAS7) score and the hsCRP level or the N/L ratio (P =.528 and P =.387). Of all the CSU patients, 19.2% tested positive for anti‐TPO and 9.6% were positive for anti‐TG; these data were not correlated with the UAS7 (P = 1 and P =.637). Inflammation plays a role in CSU. Although we did not find a correlation between the UAS and either the hsCRP level or the N/L ratio, the ESR and N/L ratio were higher in CSU patients than in controls. [ABSTRACT FROM AUTHOR]

Chronic Spontaneous Urticaria (CSU) is one of the most challenging therapeutic problems faced by dermatologists. Omalizumab is a third line drug for CSU which is currently recommended as monthly injections for 6 months. To study the efficacy of single injection of Omalizumab in the treatment of CSU. This was a prospective single center observational study. Single dose of injection Omalizumab 300 mg was administered to 30 patients of CSU on double the dose of tablet Fexofenadine 180 mg with Urticaria Activity Score (UAS‐7) more than 15 and their response was assessed using UAS‐7 up to 6 months. The mean duration of response of early and late responders were analyzed. Of the 30 patients who completed the study, 29 patients (96.7%) were responders and one (3.3%) was nonresponder. Of the 29 responders, 21 (70%) were early responders and eight (26.7%) late responders. The mean total symptom free durations amongst early and late responders were analyzed and were found significant. The prolonged symptom free intervals in early responders after single injection of Omalizumab followed by antihistamines not only prevented over treatment with Omalizumab but was also cost saving in the long‐term management of these cases. With careful monitoring of UAS7 scores an individualized, cost‐effective approach can be adopted in the treatment of CSU. This study provides a basis for larger studies and may eventually determine a new standard of care with respect to limiting the doses of a biologic. [ABSTRACT FROM AUTHOR]

The pathogenesis chronic urticaria (CU) hasn't been fully understood. In recent years, it has been shown that thiol-disulphide homoeostasis, as an antioxidant system, plays important roles in both healthy individuals and various diseases. In different ischaemia-reperfusion states, high oxidative stress causes ischaemia-modified albumin (IMA) generation. To investigate thiol/disulphide balance and IMA level in children with CU and their association with disease severity. Thirty children with CU and 20 healthy children as controls, aged 1–18 years, were included in this cross-sectional study. In all subjects, total thiol, native thiol, disulphide levels and IMA levels were measured in plasma by spectrophotometry. Disulphide/native thiol, disulphide/total thiol and native thiol/total thiol ratios were calculated. The disease severity was rated by Urticaria Activity Score (UAS). In the children with CU, the levels of native thiol (375.56 ± 56.22 μmol/L) and total thiol (415.69 ± 54.75 μmol/L) were significantly lower than the control group (475.20 ± 71.87 and 511.20 ± 73.73 μmol/L, respectively) (p = 0.000, p = 0.000). The ratio of native/total thiol * 100 was lower in patients than the control group (p = 0.002). IMA was significantly higher in the patient group than control group (p = 0.000). No significant correlation was found between UAS and thiol/disulphide homoeostasis (p > 0.05). The disulphide levels, disulphide/native thiol and disulphide/total thiol levels were found to be higher in patients with positive family history for autoimmune disorders than those without (p < 0.05). In children with CU, impaired thiol/disulphide homoeostasis and increased IMA suggest that oxidative stress may play role in the disease pathogenesis. [ABSTRACT FROM AUTHOR]

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

INTRODUCTION: We aimed to contribute to the limited number of studies that investigated the association between autologous serum test positivity and the severity of childhood chronic spontaneous urticaria. MATERIALS and METHODS: Eighty-seven pediatric patients who underwent autologous serum test for chronic spontaneous urticaria were retrospectively investigated. Urticaria severity was assessed according to urticaria activity score. RESULTS: In 19 of our patients (21.83%), the autologous serum test was positive. When clinical and laboratory parameters of patients with positive and negative autologous serum test are evaluated; age, sex, onset of symptoms, total IgE and eosinophil (%) were not statistically significant. Patients with positive autologous serum test had significantly higher urticaria activity scores (p 0.001). CONCLUSIONS: In our study, urticaria activity score was found higher in patients with autologous serum test positive. The choice of treatment for patients with a positive autologous serum test will ensure that symptoms and the quality of life of the patients will be improved faster if they are taken into consideration that the disease may be more severe. [ABSTRACT FROM AUTHOR]

Background: Activated coagulation cascade is implicated in urticaria pathogenesis marked by high plasma D-dimer, a marker of fibrinolysis, levels correlating with high urticaria activity score (UAS) and poor therapeutic outcome. Methods: Quantitative plasma D-dimer levels and coagulation parameters in 100 (male:female ratio 1:3) Indian patients with chronic spontaneous urticaria and age- and gender-matched healthy controls were compared. The clinicoepidemiologic features of chronic urticaria were then compared among patients with normal (≤0.2 mg/L) and elevated (≥0.3 mg/L) plasma D-dimer levels. Results: Plasma D-dimer in 23% patients and 4% controls and prothrombin time and activated partial thromboplastin time in 63% and 5% patients, respectively, were significantly higher compared with 58% and 1% of controls, respectively. About 18 of 72 (25%) patients with high UAS of ≥16–42 were compared with 5 of 28 (17.8%) patients with UAS7 of ≤15. Patients with elevated plasma D-dimer levels had significantly more systemic symptoms (86.9% vs. 81.8%) compared with patients with normal plasma D-dimer levels. Conclusion: A subset of patients with chronic urticaria have elevated plasma D-dimer levels and exhibit higher UAS7 and systemic symptoms that may influence long-term prognosis and therapeutic choices. Small number of patients, a cross-sectional nature of study, lack of treatment outcome measures, information on self-medication, and unavailability of specific parameters for coagulation pathway activation remain few limitations of this study. [ABSTRACT FROM AUTHOR]

Abstract Background Treat-to-target therapy approaches are established for chronic diseases such as diabetes, hypertension, and more recently rheumatoid arthritis, resulting in improved patient outcomes. These approaches do not use patient reported outcomes (PRO) as targets of therapy. Chronic spontaneous urticaria (CSU), also called chronic idiopathic urticaria (CIU), is defined as recurrent urticaria of known and unknown cause, lasting more than 6 weeks. Treatment of CSU can be challenging. However, with the advent of proven therapies and validated instruments for measuring disease activity, the concept of treat-to-target (T2T) can be successfully applied to CSU. Herein, we propose a potential PRO therapeutic target and suggest a T2T approach for the management of patients with CSU. Methods Principles and recommendations for a treat-to-target approach in CSU (T2T/CSU) were developed by a Canadian task force, consisting of dermatologists, immunologists, and allergists. The task force formulated recommendations for therapeutic targets in CSU on the basis of a systematic literature review and expert opinion. Results The key features of these T2T/CSU recommendations are the use of a PRO as the principal target, with symptom control as measured by Urticaria Activity Score 7 (UAS7 ≤ 6), targeting symptom remission (UAS7 = 0). Conclusion Treatment targets such as UAS7 ≤ 6 and UAS7 = 0 provide a benchmark for success in the care of patients with CSU, and will permit the evaluation of a PRO-based T2T approach in the care of these patients and the effect of this approach on improved patient care as seen in other chronic diseases.

Background: Chronic spontaneous urticaria (CSU) is a debilitating affliction that affects diverse quality of life (QoL) parameters such as sleep, self-esteem, and daily activities. Second-generation antihistamines, such as desloratadine, are more effective and safer in managing CSU. Desloratadine is a nonsedating, potent, and highly selective H1 receptor antagonist. At its daily dose of 5 mg, almost half of CSU patients do not show symptomatic improvement. European Academy of Allergy and Clinical Immunology (EAACI)/Global Allergy and Asthma European Network (GA2LEN)/European Dermatology Forum (EDF) (EuroGuiDerm)/Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI) guidelines recommend increasing the dosage to up to four times in such nonresponsive patients. However, there is insufficient clinical evidence in Indian settings., Method: We evaluated the efficacy and safety of 10 mg desloratadine (OD) in 256 nonresponsive patients with moderate to severe CSU. The primary outcome was the change in Urticaria Activity Score (UAS7) from baseline to four weeks. Additionally, change in Chronic Urticaria Quality of Life (CU-Q2oL) scores during the course of treatment was also evaluated., Result: The mean UAS7 scores showed a significant reduction from 31.9 ± 4.8 at baseline to 18.2 ± 8.1 at the end of the study (p < 0.0001). The use of a higher dose of desloratadine also decreased the CU-Q2oL scores significantly from 59.8 ± 14.7 at baseline to 35.4 ± 10 at four weeks (p < 0.0001). The incidence of adverse events (AEs) possibly linked to the drug was low (1.6%), and no serious adverse events were reported., Conclusion: Results indicated improvements in the disease severity as well as its positive impact on participants' QoL. This study confirms the efficacy and safety of daily use of a twofold dose of desloratadine in nonresponsive moderate to severe CSU patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Kapadia et al.)

Previous studies on the correlation between positive autologous serum skin test (ASST) responses and the clinical features of patients with chronic spontaneous urticaria (CSU) have provided conflicting results. To evaluate the significance of ASST responses in CSU, a variety of databases were searched from inception to March 2018 to identify relevant studies on CSU. Data were analyzed with use of the Cochrane Collaboration's Review Manager 5.2. Multiple relevant factors of CSU were evaluated by calculating the weighted mean difference, odds ratio and 95% confidence interval. The results indicated that CSU cases with positive ASST responses had higher urticaria activity scores and higher levels of total serum immunoglobulin E than CSU cases with negative responses in the ASST. In addition, a positive ASST response was more likely to be accompanied with the presence of thyroid autoantibodies and angioedema. An increased prevalence of CSU was identified in females, who were more likely to have a positive response in the ASST. It was also indicated that a greater incidence of positive ASST responses was present in CSU patients as compared with that in healthy controls. No statistically significant differences were obtained between positive and negative ASST responses with regard to age and duration of disease. Based on these results, it was concluded that the ASST provides an effective means of predicting urticaria activity and recurrence in CSU patients. [ABSTRACT FROM AUTHOR]

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Background The efficacy of omalizumab (anti-IgE) and increased IgE levels in patients with chronic spontaneous urticaria (CSU) suggest autoallergic mechanisms. Objective We sought to identify autoallergic targets of IgE in patients with CSU. Methods Serum samples of patients with CSU together with those of patients with idiopathic anaphylaxis and healthy control subjects (7 of each) were screened for IgE autoantibodies by using an array of more than 9000 proteins. Sera of 1062 patients with CSU and 482 healthy control subjects were used in an IgE-anti–IL-24–specific ELISA to investigate the association of IgE-anti-IL-24 and CSU. Results By using array analyses, more than 200 IgE autoantigens were found in patients with CSU that were not found in control subjects. Of the 31 IgE autoantigens detected in more than 70% of patients, 8 were soluble or membrane bound and expressed in the skin. Of these, only IgE autoantibodies to IL-24 were found in all patients with CSU. In vitro studies showed IL-24 to release histamine from human mast cells sensitized with purified IgE of patients with CSU but not control subjects. By using ELISA, mean ± SD levels of IgE-anti–IL-24 were 0.52 ± 0.24 IU/mL in patients with CSU and 0.27 ± 0.08 IU/mL in control subjects, with 80% of patients with CSU but only 20% of control subjects having levels greater than 0.33 IU/mL ( P < .0001). IgE-anti–IL-24 showed acceptable predictive properties for CSU, with a likelihood ratio of 3.9. Clinically, IgE-anti–IL-24 levels showed an association with disease activity, as assessed by the urticaria activity score and with reduced basophil counts. Conclusion Our findings show that patients with CSU frequently exhibit IgE autoantibodies against many autoantigens and that IL-24 is a common, specific, and functional autoantigen of IgE antibodies in patients with CSU. [ABSTRACT FROM AUTHOR]

Background: The Helicobacter pylori infection is linked to chronic urticaria in nearly 60% of patients. We studied clinicoepidemiologic features in patients with chronic urticaria with and without H. pylori infection. Methods: Endoscopic antral biopsy for the rapid urease test (RUT) and histopathology, and serum IgG ELISA for H. pylori infection were performed in 150 patients (male:female ratio 1:2.4) of chronic urticaria aged 18-68 years. Clinicoepidemiologic features including age, gender, age of onset and duration, frequency and distribution of wheals, urticaria severity score, and systemic symptoms were analyzed in patients with and without H. pylori. The results of serum IgG ELISA for H. pylori were compared with 106 age- and gender-matched healthy adult controls. Results: The RUT in 84 patients (56%), histopathology in 76 patients (50.6%), and H. pylori IgG ELISA in 94 patients (62.6%) were positive. H. pylori IgG ELISA was positive only in 35 (33%) controls, suggesting that chronic urticaria patients were more likely to have asymptomatic H. pylori infection than normal controls. Although not statistically significant, patients with H. pylori had a higher mean urticaria severity score, number of urticaria/angioedema episodes per year, and involvement of more body sites, particularly the scalp, palms, and soles. The constitutional or gastrointestinal symptoms were statistically higher in patients with H. pylori infection than those without it. Conclusion: A subset of chronic urticaria patients appears to have asymptomatic H. pylori infection. However, its implications in chronicity, recurrences, the severity of urticaria, other systemic manifestations, and management remains conjectural in view of 33% of controls also having positive H. pylori ELISA and the endemicity of infection in developing countries. [ABSTRACT FROM AUTHOR]

The urticaria activity score ( UAS) is the gold standard for assessing disease activity in patients with chronic spontaneous urticaria ( CSU). Two different versions, the UAS7 and UAS7 TD, are currently used in clinical trials and routine care. To compare both versions and to obtain data on their interpretability, 130 CSU patients applied both versions and globally rated their disease activity as none, mild, moderate, or severe. UAS7 and UAS7 TD values correlated strongly ( r = .90, P < .001). Interquartile ranges for UAS7 and UAS7 TD values for mild, moderate, and severe CSU were 11-20 and 10-24, 16-30 and 16-32, and 27-37 and 28-40. UAS7 values were slightly, but significantly lower as compared to UAS7 TD values (mean difference: 1.6 ± 4.6, P < .001). This difference was driven by lower wheal subscores (2.1 ± 3.5, P < .001) and was most pronounced in patients with severe CSU (2.5 ± 5.6, P < .01). The UAS7/ UAS7 TD ratio was 0.96 ± 0.21 and did not differ significantly between mild, moderate, and severe CSU. Since the results of both UAS versions are comparable, we recommend the use of the UAS7, which is less burdensome in administration and scoring. [ABSTRACT FROM AUTHOR]

Background: Vitamin D has been reported to be associated with many allergic diseases. There are a limited number of the studies of vitamin D supplementation in patients with chronic spontaneous urticaria (CSU). This study aims to study the relationship between vitamin D and CSU in terms of serum vitamin D levels, and the outcomes of vitamin D supplementation. Methods: A literature search of electronic databases for all relevant articles published between 1966 and 2018 was performed. The systematic literature review was done following Preferred Reporting Items for Systematic Reviews and Meta‐analysis recommendations. Results: Seventeen eligible studies were included. Fourteen (1321 CSU cases and 6100 controls) were concerned with serum vitamin D levels in CSU patients. Twelve studies showed statistically significant lower serum vitamin D levels in CSU patients than the controls. Vitamin D deficiency was reported more commonly for CSU patients (34.3–89.7%) than controls (0.0–68.9%) in 6 studies. Seven studies concerned with vitamin D supplementation in CSU patients showed disease improvement after high‐dosages of vitamin D supplementation. Conclusion: CSU patients had significantly lower serum vitamin D levels than the controls in most studies. However, the results did not prove causation, and the mechanisms were not clearly explained. Despite the scarcity of available studies, this systematic review showed that a high dosage of vitamin D supplementation for 4–12 weeks might help to decrease the disease activity in some CSU patients. Well‐designed randomized placebo‐controlled studies are needed to determine the cut‐off levels of vitamin D for supplementation and treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: Treat-to-target therapy approaches are established for chronic diseases such as diabetes, hypertension, and more recently rheumatoid arthritis, resulting in improved patient outcomes. These approaches do not use patient reported outcomes (PRO) as targets of therapy. Chronic spontaneous urticaria (CSU), also called chronic idiopathic urticaria (CIU), is defined as recurrent urticaria of known and unknown cause, lasting more than 6 weeks. Treatment of CSU can be challenging. However, with the advent of proven therapies and validated instruments for measuring disease activity, the concept of treat-to-target (T2T) can be successfully applied to CSU. Herein, we propose a potential PRO therapeutic target and suggest a T2T approach for the management of patients with CSU. Methods: Principles and recommendations for a treat-to-target approach in CSU (T2T/CSU) were developed by a Canadian task force, consisting of dermatologists, immunologists and allergists. The task force formulated recommendations for therapeutic targets in CSU on the basis of a systematic literature review and expert opinion. Results: The key features of these T2T/CSU recommendations are the use of a PRO as the principal target, with symptom control as measured by Urticaria Activity Score 7 (UAS7 ≤ 6), targeting symptom remission (UAS7 = 0). Conclusion: Treatment targets such as UAS7 ≤ 6 and UAS7 = 0 provide a benchmark for success in the care of patients with CSU and will permit the evaluation of a PRO-based T2T approach in the care of these patients and the effect of this approach on improved patient care as seen in other chronic diseases. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Dermatology / Turk Dermatoloji Dergisis is the property of Galenos Yayinevi Tic. LTD. STI 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: Pentraxin-3 (PTX3) is a soluble long pentraxin molecule that regulates inflammatory responses. This study aimed to determine the plasma levels of plasma PTX-3 as an inflammation marker in chronic spontaneous urticaria (CSU) and whether the PTX3 levels correlate with disease activity and other clinical parameters, including acute phase reactants and biomarkers., Methods: The study included 70 CSU patients and 30 healthy controls. Plasma PTX3 levels were measured by ELISA. CSU disease activity was evaluated with the urticaria activity score summed over 7 days. Complete blood count, C-reactive protein (CRP), transaminases, total IgE, antinuclear antibody, anti-thyroid peroxidase, anti-thyroglobulin, and D-dimer levels were recorded., Results: Of the 70 patients, 52 (74.3%) were female, with a mean age of 37.51 ± 11.80 years. Disease activity was severe in 43, moderate in 15, and mild in 12 patients. Mean PTX3 levels were elevated in CSU patients compared to healthy controls (0.81 vs. 0.55 ng/mL, p = 0.031). The mean CRP levels were higher in patients than in the controls (4.26 vs. 1.57 mg/L, p = 0.023). Patients also had higher D-dimer levels than the controls (5.96 vs. 0.59 mg/L, p < 0.001). A significant positive correlation was found between PTX3 and CRP levels ( r = 0.508, p < 0.001) and between D-dimer levels and UAS7 ( r = 0.338, p = 0.004) and CRP ( r = 0.213, p = 0.034) levels. A multivariable stepwise regression analysis showed that the one-unit increase in the CRP level increased to 38.19 units in the PTX3 level (95% confidence interval [17.40-58.98], p < 0.001)., Conclusion: Circulating levels of CRP and PTX3, two members of the pentraxin family, are significantly correlated and elevated in CSU patients with increasing disease activity, indicating their utility as inflammatory markers in CSU., Competing Interests: The authors declare no conflict of interest.

Acute urticaria do not need extensive diagnostic procedures. Urticaria activity score is a useful tool for evaluation of urticaria. Complete blood count, Erythrocyte sedimentation rate and C reactive protein are important investigations for diagnosis of infections in urticaria. Autologous serum skin test is a simple office procedure for diagnosis of auto reactive urticaria. Closed ball point pen tip is a simple test to diagnose dermographism.