scholarly journals Clinical difference between single subtype and mixed subtype chronic urticaria: A retrospective study

2021 ◽  
Vol 0 ◽  
pp. 1-6
Author(s):  
Manyun Mao ◽  
Yan Yuan ◽  
Yangjian Xiao ◽  
Cong Peng ◽  
Xiang Chen ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Chronic Urticaria ◽  
Symptom Control ◽  
Life Quality ◽  
Clinical Difference ◽  
Improve Symptom ◽  
Comprehensive Knowledge ◽  
Positive Rate ◽  
Common Group ◽  
Urticaria Activity Score

Background: The subtypes of chronic urticaria share a common clinical expression, but may show differences phenotypically. Meanwhile, two or more different subtypes of chronic urticaria can coexist in any given patient which may involve different phenotypes. Aims: The study aims to compare the two phenotypes in terms of demographics, clinical profile and treatment response. Methods: In this retrospective study, 2678 chronic urticaria patients were divided into the single subtype chronic urticaria group and mixed subtype chronic urticaria group as was appropriate.The differences in the clinical features, possible causes, urticaria activity score of seven days, dermatology life quality index score, laboratory investigations and response to treatments were evaluated among the two groups. Results: An obvious female predominance was detected in chronic urticaria, especially in mixed subtype chronic urticaria patients. Of the 2678 chronic urticaria patients, there were 837(31.25%) mixed subtype chronic urticaria. Chronic spontaneous urticaria combined with symptomatic dermographism was the most common group in the mixed subtype chronic urticaria. Patients with mixed subtype chronic urticaria were more likely to have associated chest tightness/shortness of breath and showed greater urticaria activity. In patients with single subtype chronic urticaria, the positive rate of family history with allergic rhinitis, asthma or urticaria was lower. Based on evaluation of the treatment, control with second-generation antihistamines at licensed doses was achieved in only 38.83% of mixed subtype chronic urticaria patients, compared with 56.32% of patients with single subtype. Limitations: First, this study was a single-center design retrospective study. Second, omalizumab treatment was not included. Third, the differences between different subtypes of mixed subtype chronic urticaria were not discussed in detail. Conclusion: This study showed that mixed subtype chronic urticaria had some distinct features. Comprehensive knowledge about it may help us define effective therapeutic strategies and improve symptom control and the quality of life for chronic urticaria patients.

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

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.

scholarly journals The Effectiveness of Autohemotherapy in Chronic Urticaria Treatment in the Dr. Mohammad Hoesin General Hospital and Pertamina Hospital Palembang

2020 ◽  
Vol 32 (3) ◽  
pp. 206
Author(s):  
Nopriyati Husan ◽  
Sarah Diba Zulkarnain ◽  
Athuf Thaha ◽  
Maria Mayfinna Gozali ◽  
Tiar Marina Octyvani
Keyword(s):  
General Hospital ◽  
Chronic Urticaria ◽  
Life Quality ◽  
Blood Draw ◽  
Clinical Trial Research ◽  
Innovative Therapy ◽  
Special Expertise ◽  
Urticaria Treatment ◽  
Urticaria Activity Score

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 <0.005). Conclusion: There was a significant decrease in UAS7 and DLQI in chronic urticaria patients after receiving AHT therapy for 10 weeks. This research concluded AHT can serve as an option in chronic urticaria treatment.

Advance care planning for patients with COVID-19: a communication guide

2021 ◽  
pp. 1-6
Author(s):  
Natasha Palipane ◽  
Abi Ponnampalampillai ◽  
Srirupa Gupta
Keyword(s):  
Advance Care Planning ◽  
Symptom Control ◽  
Patient Choice ◽  
High Morbidity ◽  
Care Planning ◽  
Goals Of Care ◽  
Disease Trajectory ◽  
Improve Symptom ◽  
Inappropriate Admissions ◽  
Advance Care

In view of the high morbidity and mortality associated with COVID-19, early and honest conversations with patients about goals of care are vital. Advance care planning in its traditional manner may be difficult to achieve given the unpredictability of the disease trajectory. Despite this, it is crucial that patients' care wishes are explored as this will help prevent inappropriate admissions to hospital and to critical care, improve symptom control and advocate for patient choice. This article provides practical tips on how to translate decisions around treatment escalation plans into conversations, both face-to-face and over the phone, in a sensitive and compassionate manner. Care planning conversations for patients with COVID-19 should be individualised and actively involve the patient. Focusing on goals of care rather than ceilings of treatment can help to alleviate anxiety around these conversations and will remind patients that their care will never cease. Using a framework such as the ‘SPIKES’ mnemonic can help to structure this conversation. Verbally conveying empathy will be key, particularly when wearing personal protective equipment or speaking to relatives over the phone. It is also important to make time to recognise your own emotions during and/or after these conversations.

scholarly journals Visual Design and Anthropomorphism in a Mobile Pulmonary Rehabilitation Support Intervention

2021 ◽  
Author(s):  
Cindy Chong ◽  
Danielle Lottridge ◽  
Jim Warren ◽  
Rosie Dobson
Keyword(s):  
Pilot Study ◽  
Pulmonary Rehabilitation ◽  
Symptom Control ◽  
Exercise Program ◽  
Smartphone Application ◽  
Study Data ◽  
Text Messages ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Improve Symptom

Pulmonary rehabilitation is a behavioral intervention that can improve symptom control and quality of life for patients with chronic obstructive pulmonary disease (COPD), but access, uptake and adherence are problematic. Our team has pursued the development of a mobile phone-based intervention (mobile pulmonary rehabilitation, mPR) with iterative design and a pilot study. The mPR intervention is delivered through two technologies: text messages (SMS) and a smartphone application. Our user-centered design analysis of pilot study data led to several insights. First, patients’ replies to the SMS suggested that messages were anthropomorphised and provided social support. Second, the smartphone application could help patients by clearly visualizing the exercise program, alternative exercises, and progress to date. We demonstrate the design iterations made to meet these requirements and we present feedback obtained from experts and from four COPD patients. We discuss implications for the design of mobile pulmonary rehabilitation interventions.

scholarly journals Integration of palliative care into the neuro-oncology practice: patterns in the United States

2014 ◽  
Vol 1 (1) ◽  
pp. 3-7 ◽  
Author(s):  
Tobias Walbert
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Brain Tumor ◽  
End Of Life ◽  
Symptom Control ◽  
Tumor Patients ◽  
Life Phase ◽  
Improve Symptom ◽  
Oncology Practice

Abstract Background Between 80%–85 percent of all adult brain tumors are high-grade gliomas (HGGs). Despite aggressive treatment with surgical resection, radiotherapy and chemotherapy, the survival of patients with HGG is limited. Brain tumor patients develop unique symptoms and needs throughout their disease trajectory, and the majority lose the ability to communicate during the end-of-life phase. Palliative care (PC) is a proactive and systematic approach to manage issues that are important to patients and families affected by serious illness. The goal is to improve quality of life and symptom control and thereby reduce suffering. Most PC interventions take place during the end-of-life phase; however, newer data suggest that early PC interventions might improve symptom control and quality of life. Methods A literature review focusing on PC, hospice care, and end-of-life care was performed with the aim to describe the integration of PC into neuro-oncology practice. Results Recently there has been increased interest in the effects of PC and brain tumor patients. The origins, methodology, and conceptual models of delivering PC and how it might be applied to the field of neuro-oncology were reviewed. Patterns of referral and utilization in neuro-oncology are described based on the findings of a recent survey. Conclusions Despite a very high symptom burden, many HGG patients do not receive the same level of PC and have fewer interactions with PC services than other cancer populations. Early PC interventions and structured advance-care planning might improve symptom control and quality of life for brain tumor patients.

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.

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