Chronic Urticaria: An Overview of Treatment and Recent Patents

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.

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A Specialized Therapeutic Approach to Chronic Urticaria Patient’s Refractory to H1-Antihistamines Improves the Burden of the Disease. The Spanish AWARE Experience

Journal of Investigational Allergology and Clinical Immunology ◽

10.18176/jiaci.0661 ◽

2020 ◽

Vol 32 (3) ◽

Author(s):

A Gimenez-Arnau ◽

J Bartra ◽

M Ferrer ◽

I Jauregui ◽

J Borbujo ◽

...

Keyword(s):

Quality Of Life ◽

Disease Activity ◽

Chronic Urticaria ◽

Life Quality ◽

Life Questionnaire ◽

H1 Antihistamines ◽

Third Line ◽

International Multicenter Study ◽

Urticaria Activity Score

Objective: AWARE study assesses disease activity, patient’s quality of life (QoL) and treatment patterns in chronic urticaria (CU) patient’s refractory to H1-antihistamines (H1-AH) in clinical practice during the first year of the study. Methods: Observational, prospective (24 months), international, multicenter study. Patients ≥18 years with H1-AH-refractory CU diagnosis (>2 months). At each visit, patients completed questionnaires to assess disease burden (Urticaria Control Test [UCT]), disease activity (7 day-Urticaria Activity Score [UAS7]), QoL (Dermatology Life Quality index [DLQI], Chronic Urticaria Quality of Life Questionnaire [CU-Q2oL], Angioedema Quality of Life [AE-QoL]). We present Spanish data. Results: 270 evaluable patients included (73.3% female, mean age [SD] 48.9 [14.7] years). At baseline, 89.3% were prescribed a CU treatment. After 1-year, first/second line treatments tended to decrease and third line to increase. 47.0% patients experienced angioedema at baseline, being 11.8% at 1-year. Mean (SD) AE-QoL went from 45.2 (28.7) to 24.0 (25.8). Mean (SD) UCT went from 7.0 (4.5) to 12.1 (4.1). According to UAS7, 38.2% patients reported absence of wheals and itch in the last 7 days at 1-year versus 8.3% at baseline. Mean (SD) DLQI went from 8.0 (7.4) to 2.8 (4.6). At 1-year visit, the percentage of patients reporting high/very high QoL impact went from 29.9% to 9.6%. Conclusions: Spanish H1-AH-refractory CU patients present a lack of symptomatology control with an important impact in their QoL. Continuous follow-up of chronic spontaneous urticaria patients and third line therapies have shown a tendency to reduce the burden of the disease and to improve patients’ QoL.

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Chronic Urticaria in the Real-Life Clinical Practice Setting in Portugal: Baseline Results from the Non-Interventional Multicentre AWARE Study

Acta Médica Portuguesa ◽

10.20344/amp.9496 ◽

2019 ◽

Vol 32 (2) ◽

pp. 133 ◽

Cited By ~ 4

Author(s):

Ana Célia Costa ◽

Isabel Rosmaninho ◽

Arminda Guilherme ◽

José Ferreira ◽

Joana Antunes ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Urticaria ◽

Real World ◽

Life Index ◽

The Real ◽

Real World Setting ◽

H1 Antihistamines ◽

Quality Of Life Index ◽

Urticaria Activity Score

Introduction: There is a paucity of information regarding chronic urticaria patients’ care in a real-world setting. The objective of this study was to report and evaluate the baseline characteristics of Portuguese chronic urticaria patients refractory to H1-antihistamines included in the AWARE study. Material and Methods: This is a non-interventional cohort study. Adult patients with a diagnosis of chronic urticaria with symptoms for at least two months, refractory to H1-antihistamines, consulting one of the 10 participating urticaria centers throughout Portugal have been included in the study. Baseline sociodemographic data, medical history, clinical parameters, medication, weekly urticaria activity score, and dermatology quality of life index have been collected. Results: Seventy six patients were included, of which 76.3% were women. The majority of patients had a diagnosis of chronic spontaneous urticaria (88.2%) and 39.5% had angioedema. Around 91.0% of patients were medicated with non-sedative H1-antihistamines and 35.4% with a third line therapy. Median dermatology quality of life index was 5.0 and median weekly urticaria activity score was 13.0. Discussion: The baseline results suggest that patients with chronic urticaria refractory to H1-antihistamines are being under-treated in the real-world setting. Conclusion: The AWARE study demonstrates the real impact of chronic urticaria on Portuguese patients refractory to H1-antihistamines treatment, and 30% report a very large or extremely large deleterious effect on their quality of life. The follow-up of these patients will allow evaluating strategies aimed at optimizing disease control.

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The Prevalence of Sarcopenia and Its Impact on Clinical Outcomes in Lumbar Degenerative Spine Disease—A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10040773 ◽

2021 ◽

Vol 10 (4) ◽

pp. 773

Author(s):

Wei-Ting Wu ◽

Tsung-Min Lee ◽

Der-Sheng Han ◽

Ke-Vin Chang

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Clinical Outcomes ◽

Meta Analysis ◽

Clinical Manifestations ◽

Current Evidence ◽

Degenerative Spine ◽

Degenerative Spine Disease ◽

Spine Disease

The association of sarcopenia with poor clinical outcomes has been identified in various medical conditions, although there is a lack of quantitative analysis to validate the influence of sarcopenia on patients with lumbar degenerative spine disease (LDSD) from the available literature. Therefore, this systematic review and meta-analysis aimed to summarize the prevalence of sarcopenia in patients with LDSD and examine its impact on clinical outcomes. The electronic databases (PubMed and Embase) were systematically searched from inception through December 2020 for clinical studies investigating the association of sarcopenia with clinical outcomes in patients with LDSD. A random-effects model meta-analysis was carried out for data synthesis. This meta-analysis included 14 studies, comprising 1953 participants. The overall prevalence of sarcopenia among patients with LDSD was 24.8% (95% confidence interval [CI], 17.3%–34.3%). The relative risk of sarcopenia was not significantly increased in patients with LDSD compared with controls (risk ratio, 1.605; 95% CI, 0.321–8.022). The patients with sarcopenia did not experience an increase in low back and leg pain. However, lower quality of life (SMD, −0.627; 95% CI, −0.844–−0.410) were identified postoperatively. Sarcopenia did not lead to an elevated rate of complications after lumbar surgeries. Sarcopenia accounts for approximately one-quarter of the population with LDSD. The clinical manifestations are less influenced by sarcopenia, whereas sarcopenia is associated with poorer quality of life after lumbar surgeries. The current evidence is still insufficient to support sarcopenia as a predictor of postoperative complications.

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Intractable Itch in Atopic Dermatitis: Causes and Treatments

Biomedicines ◽

10.3390/biomedicines9030229 ◽

2021 ◽

Vol 9 (3) ◽

pp. 229

Author(s):

Yoshie Umehara ◽

Chanisa Kiatsurayanon ◽

Juan Valentin Trujillo-Paez ◽

Panjit Chieosilapatham ◽

Ge Peng ◽

...

Keyword(s):

Quality Of Life ◽

Atopic Dermatitis ◽

Transient Receptor Potential ◽

Receptor Potential ◽

Clinical Problem ◽

Transient Receptor Potential Channels ◽

Protease Activated Receptors ◽

H1 Antihistamines ◽

Potential Channels

Itch or pruritus is the hallmark of atopic dermatitis and is defined as an unpleasant sensation that evokes the desire to scratch. It is also believed that itch is a signal of danger from various environmental factors or physiological abnormalities. Because histamine is a well-known substance inducing itch, H1-antihistamines are the most frequently used drugs to treat pruritus. However, H1-antihistamines are not fully effective against intractable itch in patients with atopic dermatitis. Given that intractable itch is a clinical problem that markedly decreases quality of life, its treatment in atopic dermatitis is of high importance. Histamine-independent itch may be elicited by various pruritogens, including proteases, cytokines, neuropeptides, lipids, and opioids, and their cognate receptors, such as protease-activated receptors, cytokine receptors, Mas-related G protein-coupled receptors, opioid receptors, and transient receptor potential channels. In addition, cutaneous hyperinnervation is partly involved in itch sensitization in the periphery. It is believed that dry skin is a key feature of intractable itch in atopic dermatitis. Treatment of the underlying conditions that cause itch is necessary to improve the quality of life of patients with atopic dermatitis. This review describes current insights into the pathophysiology of itch and its treatment in atopic dermatitis.

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