Omalizumab Administration for Refractory to H1-antihistamines Chronic Urticaria Prevents Respiratory Illnesses

2017 ◽  
Vol 139 (2) ◽  
pp. AB247
Author(s):  
George N. Konstantinou
Keyword(s):  
Chronic Urticaria ◽  
Respiratory Illnesses ◽  
H1 Antihistamines

scholarly journals Clinical Outcome of Autologous Serum Therapy in Chronic Idiopathic Urticaria

2017 ◽  
Vol 15 (1) ◽  
pp. 71-74 ◽  
Author(s):  
Dharmendra Karn ◽  
Shekhar KC
Keyword(s):  
Skin Prick Test ◽  
Chronic Urticaria ◽  
Statistical Significance ◽  
Cost Effective ◽  
Chronic Idiopathic Urticaria ◽  
Autologous Serum ◽  
P Value ◽  
Prick Test ◽  
H1 Antihistamines ◽  
Serum Therapy

Background: Quality of life in chronic idiopathic urticaria is hampered as efficacy of H1-antihistamines is limited. Autologous serum containing tolerance-generating anti-idiotype antibodies is a novel and cost-effective therapy. This study was conducted to evaluate the efficacy of autologous serum therapy (AST) among chronic urticaria patients with autologous skin prick test positive and negative status.Methods: Untreated 102 patients of chronic urticaria were enrolled in a non-randomized interventional study. Patients were categorized into two groups based on autologous serum skin prick test as test positive (ASST +) and test negative (ASST -). Patients were then treated with intramuscular injection of 0.05ml per kg body weight of autologous serum weekly for 10 weeks. Urticaria activity scoring (UAS) tool was used for quantification of the symptoms. Weekly recording of UAS (range: 0-42) was made before the therapy (baseline) and during the therapy for 10 weeks.Results: Significant improvement with AST in the mean UAS was noted from baseline to 10 weeks in both the group of patients (14.6 ± 6.3 and 10.2 ± 5.1 for ASST+ group; 16.9 ± 7.8 and 8.6 ± 4.8 for ASST- group; at baseline and 10 weeks, respectively (p-value for both <0.05)). However no statistical significance was found while comparing the efficacy of the therapy against ASST + and ASST - Groups (p-value > 0.05).Conclusions: Irrespective of autologous skin prick test results, autologous serum therapy showed significant improvement in patients with chornic idiopathic urticaria. AST can, thus, be an effective treatment modality for it.

H1-antihistamines for chronic urticaria

2006 ◽  
Author(s):  
Amy D Stanway ◽  
Stuart N Cohen ◽  
Chih-Mei Chen ◽  
Conrad Hauser ◽  
Lynda Binney
Keyword(s):  
Chronic Urticaria ◽  
H1 Antihistamines

scholarly journals Chronic Urticaria: An Overview of Treatment and Recent Patents

2019 ◽  
Vol 13 (1) ◽  
pp. 27-37 ◽  
Author(s):  
Kam L. Hon ◽  
Alexander K.C. Leung ◽  
Wing G.G. Ng ◽  
Steven K. Loo
Keyword(s):  
Quality Of Life ◽  
Adverse Effect ◽  
Chronic Urticaria ◽  
Second Generation ◽  
Symptom Control ◽  
Clinical Manifestations ◽  
Screening Tests ◽  
Fourfold Increase ◽  
H1 Antihistamines

Background: Up to 1% of the general population in the USA and Europe suffer from chronic urticaria (CU) at some point in their lifetime. CU has an adverse effect on the quality of life. Objectives: This study aims to provide an update on the epidemiology, pathogenesis, clinical manifestations, diagnosis, aggravating factors, complications, treatment and prognosis of CU. Methods: The search strategy included meta-analyses, randomized controlled trials, clinical trials, reviews and pertinent references. Patents were searched using the key term "chronic urticaria" at the following links: www.google.com/patents, www.uspto.gov, and www.freepatentsonline.com. Results: CU is a clinical diagnosis, based on the episodic appearance of characteristic urticarial lesions that wax and wane rapidly, with or without angioedema, on most days of the week, for a period of six weeks or longer. Triggers such as medications, physical stimuli, and stress can be identified in 10 to 20% of cases. C-reactive protein/erythrocyte sedimentation rate, and complete blood cell count with differential are the screening tests that may be used to rule out an underlying disorder. The mainstay of therapy is reassurance, patient education, avoidance of known triggers, and pharmacotherapy. Secondgeneration H1 antihistamines are the drugs of choice for initial therapy because of their safety and efficacy profile. If satisfactory improvement does not occur after 2 to 4 weeks or earlier if the symptoms are intolerable, the dose of second-generation H1 antihistamines can be increased up to fourfold the manufacturer’s recommended dose (all be it off license). If satisfactory improvement does not occur after 2 to 4 weeks or earlier if the symptoms are intolerable after the fourfold increase in the dosage of second-generation H1 antihistamines, omalizumab should be added. If satisfactory improvement does not occur after 6 months or earlier if the symptoms are intolerable after omalizumab has been added, treatment with cyclosporine and second-generation H1 antihistamines is recommended. Short-term use of systemic corticosteroids may be considered for acute exacerbation of CU and in refractory cases. Recent patents for the management of chronic urticaria are also discussed. Complications of CU may include skin excoriations, adverse effect on quality of life, anxiety, depression, and considerable humanistic and economic impacts. On average, the duration of CU is around two to five years. Disease severity has an association with disease duration. Conclusion: CU is idiopathic in the majority of cases. On average, the duration of CU is around two to five years. Treatment is primarily symptomatic with second generation antihistamines being the first line. Omalizumab has been a remarkable advancement in the management of CU and improves the quality of life beyond symptom control.

scholarly journals The Use of Omalizumab in Chronic Urticaria: Available Data and Future Aspects of Anti-IgE Treatment

2021 ◽  
Author(s):  
Young-Min Ye
Keyword(s):  
Chronic Urticaria ◽  
Efficacy And Safety ◽  
Chronic Inducible Urticaria ◽  
First Choice ◽  
H1 Antihistamines ◽  
Choice Of Treatment ◽  
Inducible Urticaria ◽  
Disease Modifying ◽  
Impaired Quality

Chronic urticaria (CU) defined as repeatedly occurred itchy wheals and/or angioedema for at least 6 weeks. Due to the unpredictability, recurrent and disabling symptoms, and a considerably impaired quality of life, effective and tolerable treatment for CU patients is crucial. Almost a half of patients with CU are refractory to H1-antihistamines, even though the dose of antihistamines is increased up to 4-fold. Recently treatment modulating IgE levels and activities provides an efficient therapeutic approach. Omalizumab, the only approved anti-IgE treatment for chronic spontaneous urticaria (CSU) patients until now, with a strong evidence of the efficacy and safety, opened a new horizon in the care of the patients whose urticaria is not controlled with antihistamines. Recent international guidelines recommend omalizumab as the first choice of treatment for antihistamine-refractory CSU. However, as it is not curative neither disease-modifying agent, there is a subpopulation of CSU patients responding partly or never to omalizumab. The other things to be solved in the treatment of CU is that clinical evidence is still limited on chronic inducible urticaria (CIndU) and special populations. Thus, a new anti-IgE treatment, ligelizumab is actively evaluated in the efficacy compared with both placebo and omalizumab. Further understandings on the pathogenesis of CU can lead to the development of new mechanism-based therapeutics for CU patients.

scholarly journals CSACI position statement: Newer generation H1-antihistamines are safer than first-generation H1-antihistamines and should be the first-line antihistamines for the treatment of allergic rhinitis and urticaria

2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Michael N. Fein ◽  
David A. Fischer ◽  
Andrew W. O’Keefe ◽  
Gord L. Sussman
Keyword(s):  
Allergic Rhinitis ◽  
Chronic Urticaria ◽  
First Generation ◽  
Position Statement ◽  
Poor Sleep ◽  
Third Generation ◽  
First Line ◽  
H1 Antihistamines ◽  
History Of ◽  
History Of Use

Abstract Oral H1-antihistamines (AHs) are the most commonly used therapy to treat allergic rhinitis and chronic urticaria. Older, first-generation AHs (e.g. diphenhydramine, hydroxyzine) have significant and common side effects including sedation, impairment with decreased cognitive function, poor sleep quality, dry mouth, dizziness, and orthostatic hypotension. These drugs have also been found to result in death from accidents, intentional or unintentional overdoses, and sudden cardiac death. The unfavourable risk–benefit profile of first-generation AHs led to the development of newer, less-sedating second- and third-generation AHs, which first became available in Canada in the 1980s. High-quality trials have proven that newer generation AHs are superior in safety compared to older first-generation AHs. On average, they have improved potency and efficacy. Second- and third-generation AHs are the recommended first-line treatment for mild allergic rhinitis and acute and chronic urticaria. Despite this evidence, older first-generation AHs continue to be over-utilized because of their over-the-counter (OTC) status and long history of use. The Canadian Society of Allergy Clinical Immunology (CSACI) recommends that newer generation AHs should be preferred over first-generation AHs for the treatment of allergic rhino-conjunctivitis and urticaria. To promote this recommendation, education of health professionals and the public is necessary. Further, given the dangers of older first-generation AHs, we believe they should be used only as a last resort with eventual consideration given to having them only available behind the counter in pharmacies.

scholarly journals Expert consensus on practical aspects in the treatment of chronic urticaria

2021 ◽  
Vol 30 (2) ◽  
pp. 64-75
Author(s):  
Andrea Bauer ◽  
Heinrich Dickel ◽  
Thilo Jakob ◽  
Andreas Kleinheinz ◽  
Undine Lippert ◽  
...  
Keyword(s):  
Chronic Urticaria ◽  
Cardiac Risk ◽  
Treatment Recommendations ◽  
Everyday Practice ◽  
Common Disease ◽  
Symptomatic Therapy ◽  
Self Administration ◽  
H1 Antihistamines ◽  
Short Time ◽  
Practical Recommendations

Abstract Background Chronic urticaria (CU) is a common disease which represents a considerable burden for many patients. The current urticaria guideline describes the evidence-based diagnosis and treatment of CU. In addition, however, questions often arise in everyday practice that are not addressed by the guideline. Methods In May 2020, a digital meeting with German urticaria experts was held, in which practical aspects of CU treatment were discussed and supporting aids for everyday clinical treatment formulated. The resulting advice in this document focus on practical questions and the available literature and experiences of the participants. Results The diagnosis of CU can be made in a short time by means of a thorough anamnesis, a physical examination, and a basic laboratory chemical diagnosis. For this purpose, practical recommendations for everyday practice are given in this paper. An extended diagnosis is only indicated in a few cases and should always be carried out in parallel with an effective therapy. In general, CU should always be treated in the same way, regardless of whether wheals, angioedema or both occur. Symptomatic therapy should be carried out according to the treatment steps recommended by the guidelines. This publication provides practical advice on issues in everyday practice, such as the procedure in the current coronavirus disease 2019 (COVID-19) pandemic, the cardiac risk under higher dosed H1 antihistamines, the self-administration of omalizumab as well as vaccination under omalizumab therapy. In addition to treatment recommendations, topics such as documentation in the practice and family planning with urticaria will be discussed. Discussion These supporting treatment recommendations serve as an addendum to the current CU guideline and provide support in dealing with CU patients in everyday practice. The aim is to ensure that patients suffering from CU achieve complete freedom of symptoms with the help of an optimal therapy.

scholarly journals The Role of Anti-IgE Antibodies in Urticaria

2021 ◽  
Author(s):  
Patrizia Pepe ◽  
Victor Desmond Mandel
Keyword(s):  
Chronic Urticaria ◽  
Symptom Control ◽  
Symptomatic Treatment ◽  
Line Treatment ◽  
Ige Antibodies ◽  
H1 Antihistamines ◽  
Inducible Urticaria ◽  
Third Line ◽  
Third Line Treatment

Chronic urticaria, a common mast cell driven disease, has been considered so far an underestimated and difficult to treat disease, very often resulting in high physical, psychological and socio-economic burden. More than 60% of these patients are unresponsive to second generation H1 antihistamines, the first-line symptomatic treatment for urticaria. However, anti-IgE drugs (omalizumab and ligelizumab) showed improved activity in urticaria-treated patients with inadequate symptom control. Omalizumab has been widely proven to be very effective and well-tolerated in patients with antihistamine-refractory chronic spontaneous urticaria and inducible urticaria and is currently licensed for these indication as third-line treatment. Ligelizumab, a next-generation monoclonal anti-IgE antibody with higher affinity to IgE compared to omalizumab and a similar safety profile, has recently demonstrated to be even more effective than omalizumab. This review is focused on the role of anti-IgE antibodies in chronic urticaria.

Modern anti-IgE therapies in children with chronic spontaneous urticaria: clinical cases

2021 ◽  
Vol 17 (4) ◽  
pp. 85-89
Author(s):  
Inna A. Larkova ◽  
Vera A. Revyakina
Keyword(s):  
Chronic Urticaria ◽  
Clinical Manifestations ◽  
Chronic Spontaneous Urticaria ◽  
First Line ◽  
Therapy Efficacy ◽  
Number Of Patients ◽  
H1 Antihistamines ◽  
Urticaria Treatment ◽  
Clinical Cases

The diagnostics and treatment of chronic urticaria is still a pressing problem for specialists of different profiles. Despite the fact that the first line drugs for urticaria treatment are non-sedating H1- antihistamines, there are a number of patients who do not respond to these medications even in their increased doses. This article presents clinical cases of anti-IgE-therapy efficacy in children suffering from urticaria and angioedema. CONCLUSION: The clinical cases demonstrate current possibilities of successful and safe anti-IgE-therapy of various clinical manifestations of chronic spontaneous urticaria and angioedema in children.

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