Chronic Spontaneous Urticaria – Diagnosis and Management

Specific Stimulus ◽

Number Of Patients ◽

Chronic urticaria can be subclassified into chronic spontaneous urticaria and chronic inducible urticaria. Up to 30% of cases are associated with functional immunoglobulin G antibodies to the high affinity immunoglobulin E receptor FcεRIα or to immunoglobulin A. Pathogenic activation of mast cells and basophils gives rise to release of pro-inflammatory mediators that lead to development of hives. CSU is a debilitating disease with a relapsing course. It affects 0.5–1% of the population at any given time. The duration of CSU is generally 1–5 years but can be longer in cases associated with angioedema and autoreactivity. CSU has detrimental effects on life quality with sleep-deprivation and psychiatric disorders being the most frequent. In a great number of patients an underlying cause or eliciting factor cannot be identified. Among the patients in which an aetiology is suspected, infections, medication, food and psychological factors are most commonly associated. A potential autoimmune cause has been reported in up to 50% of patients. Chronic inducible urticaria is characterised by its ability to be triggered consistently and reproducibly in response to a specific stimulus (pressure, temperature, vibration, water, heat, light). Antihistamines form the mainstay of therapy. In recalcitrant chronic urticaria, a variety of other drugs have been tried.

Advances in Understanding and Managing Chronic Urticaria

F1000Research ◽

10.12688/f1000research.7246.1 ◽

2016 ◽

Vol 5 ◽

pp. 177 ◽

Cited By ~ 11

Author(s):

Yasmin Moolani ◽

Charles Lynde ◽

Gordon Sussman

Keyword(s):

Chronic Urticaria ◽

Immunoglobulin E ◽

Treatment Options ◽

Treatment Algorithm ◽

Fold Increase ◽

Line Treatment ◽

Physical Urticaria ◽

Autoimmune Urticaria ◽

There have been recent advances in the classification and management of chronic urticaria. The new term chronic spontaneous urticaria (CSU) has replaced chronic idiopathic urticaria and chronic autoimmune urticaria. In addition, chronic inducible urticaria (CINDU) has replaced physical urticaria and includes other forms of inducible urticaria, such as cholinergic and aquagenic urticaria. Furthermore, novel research has resulted in a new understanding with guidelines being revised in the past year by both the American Academy of Allergy, Asthma, and Immunology (AAAAI) and the European Academy of Allergy and Clinical Immunology (EAACI)/Global Allergy and Asthma European Network (GA2LEN)/European Dermatology Forum (EDF)/World Allergy Organization (WAO). There are some differences in the recommendations, which will be discussed, but the core updates are common to both groups. The basic treatment for chronic urticaria involves second-generation non-sedating non-impairing H1 antihistamines as first-line treatment. This is followed by up to a 4-fold increase in the licensed dose of these H1 antihistamines. The major therapeutic advance in recent years has been in third-line treatment with omalizumab, a humanized monoclonal anti-immunoglobulin E (anti-IgE) antibody that prevents binding of IgE to the high-affinity IgE receptor. Several multicenter randomized controlled trials have shown safety and efficacy of omalizumab for CSU. There are also some small studies showing efficacy of omalizumab in CINDU. While there were previously many treatment options which were lacking in strong evidence, we are moving into an era where the treatment algorithm for chronic urticaria is simplified and contains more evidence-based, effective, and less toxic treatment options.

Russian experience of refractory chronic urticaria treatment with omalizumab

Rossiiskii Allergologicheskii ZHurnal ◽

10.36691/rja437 ◽

2015 ◽

Vol 12 (3) ◽

pp. 16-21

Author(s):

I V Danilycheva ◽

O G Elisyutina ◽

N I Ilina ◽

E A Latysheva ◽

T V Latysheva ◽

...

Keyword(s):

Chronic Urticaria ◽

Marked Effect ◽

Clinical Analysis ◽

Efficacy And Safety ◽

Inducible Urticaria ◽

Urticaria Treatment ◽

Practice Methods ◽

Dose Change

Background. To study the efficacy and safety of omalizumab in patients with chronic urticaria, refractory to antihistamines in clinical practice. Methods. In this retrospective clinical analysis, we assessed effectiveness, time to relief of symptoms, dose change after omalizumab administration, and safety in 17 CU patients, 16 with chronic spontaneous urticaria (CSU), 1 with different forms of chronic inducible urticaria (CindU) and 4 with both. Results. Treatment with omalizumab showed excellent effect in 70,6%, significant - in 17,7%, no effect - in 11,7% of CU patients. Eight patients marked effect for 24 hours, 2 - within 2-3 days, 2 - during 2 weeks, 1 - 4 weeks, and 2 patients - for 8 weeks. Eleven patients were receiving omalizumab 300 mg once per 4 weeks, one patient - 150 mg, 4 patients 2 injections of 300 mg, followed by 150 mg of 2, one patient had started treatment with a dose of 150 mg, continued treatment with omalizumab 300 mg. Omalizumab was safe. There was no influence of baseline total IgE levels and the results of test with autosera on the efficacy of omalizumab treatment. Conclusion. Our observation of patients with chronic spontaneous urticaria, with the concomitant or separate physical (induced) hives can resume high efficacy and safety of omalizumab treatment which can be recommended for CU patients, torpid to the first and secondline therapy.

Prevalence of Chronic Inducible Urticaria in Elderly Patients

Journal of Clinical Medicine ◽

10.3390/jcm10020247 ◽

2021 ◽

Vol 10 (2) ◽

pp. 247

Author(s):

Maddalena Napolitano ◽

Gabriella Fabbrocini ◽

Luca Stingeni ◽

Cataldo Patruno

Keyword(s):

Elderly Patients ◽

Chronic Urticaria ◽

Medical Records ◽

Age Groups ◽

The Elderly ◽

Cold Urticaria ◽

Number Of Patients ◽

Study Results ◽

Background: No data currently exist regarding the epidemiology of chronic inducible urticarias (CIndUs) in the ≥65-year-old population. Objective: The study aimed to determine the prevalence of CIndUs among elderly patients affected by chronic urticaria (CU). Methods: The medical records of all patients referred to us with a diagnosis of CU from January 2008 to September 2020 were retrospectively reviewed, and the patients with CIndUs were identified. The subjects aged 65 years or above were included in the study. Results: The number of patients aged 65 years or above was 153 out of 1970 subjects affected by CU (7.77%; 92 females (60.13%); mean age 70.96 ± 4.22). Out of 153, 26 patients (16.99%; 20 females (76.9%); mean age 71.23 ± 2.6 years) were diagnosed with CIndUs. Most subjects (25/26; 96.15%) suffered from physical urticarias. Symptomatic dermographism was the most frequent, affecting 65.38% (17/26) of our patients, followed by cold urticaria (6/26 (23.08%) cases). Conclusion: Our data seem to indicate that CIndUs may also affect the elderly, although it occurs less frequently in aging patients than in lower age groups.

Efficacy of omalizumab in chronic spontaneous urticaria associated with chronic inducible urticaria

Annals of Allergy Asthma & Immunology ◽

10.1016/j.anai.2020.06.011 ◽

2020 ◽

Vol 125 (4) ◽

pp. 486-487 ◽

Cited By ~ 1

Author(s):

Sérgio Dortas Junior ◽

Guilherme Azizi ◽

Solange Valle

Keyword(s):

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

10.5772/intechopen.97226 ◽

2021 ◽

Author(s):

Young-Min Ye

Keyword(s):

Chronic Urticaria ◽

Efficacy And Safety ◽

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.

Refractory Chronic Urticaria in Adults: Clinical Characterization and Predictors of Severity

10.21203/rs.3.rs-33896/v1 ◽

2020 ◽

Author(s):

Iolanda Alen Coutinho ◽

Frederico Soares Regateiro ◽

Rosa Anita Fernandes ◽

Joana Sofia Pita ◽

Raquel Gomes ◽

...

Keyword(s):

Disease Control ◽

Chronic Urticaria ◽

Standard Dose ◽

Symptom Control ◽

Autologous Serum ◽

Thyroid Peroxidase ◽

Clinical Predictors ◽

Inducible Urticaria ◽

One Year

Abstract Background: Chronic urticaria (CU) is defined as recurrent urticaria lasting for more than 6 weeks. Objectives: We aimed to characterize the phenotypesof patients with CU refractory to standard dose anti-H1 antihistamine treatment and search for clinical predictors of poor disease control.Methods: Retrospective collection of data regarding clinical characteristics, manifestations, comorbidities, treatment,and disease control of all adult CU patients presenting to the Allergy and Immunology Department during one year. Descriptive and inferential analysis was performed to search for factors associated with disease control.Results: Sixty-one adult patients were included, 74% females, average age 44.5 years (18 to 84 years old). Most patients (78.7%) had initiated CU less than 1 year before enrolment. Chronic spontaneous urticaria (CSU) accounted for 55.7% of the patients and chronic inducible urticaria (ClndU)for44.3%. Angioedema was present in 55.7% of the patients. Evidence for autoimmunity (positive anti-thyroid peroxidase antibodies, anti-nuclear antibodies or autologous serum test) was found in38.8% (n=19)of 49 tested patients.High C-reactive protein was presenti in 20.7% of 29 patients evaluated; half of these also had positive antinuclear antibodies.Forty-six patients (75.4%) had at least one significant exacerbation, requiring medical appointment, emergency room, hospitalization or job absenteeism. The number of exacerbations correlated with the presence of angioedema (p=0.022), with a recent diagnosis (<1 year), and with higher UAS7 severity (p=0.006). Clnd Uassociated with poor symptom control(p=0.022) buthad less exacerbations requiring medical observation or hospitalization (p=0.015).Conclusions: About one thirdof patients with CU presented autoimmunity. UAS7 severity and Angioedema are associated with disease exacebations. UAS7 and UCT presented unequal accuracy, with UAS7 better associating with the occurrence of exacerbations and treatment dosis. Accurate diagnostic tests, namely autoimmune parameters and inflammatory markers, should be recommended in some individual cases.

Experience with anti – IgE – therapy in children with chronic inducible urticaria: clinical cases.

Rossiiskii Allergologicheskii ZHurnal ◽

10.36691/rja1467 ◽

2021 ◽

Author(s):

Inna Larkova

Keyword(s):

Clinical Manifestations ◽

Off Label ◽

Inducible Urticaria ◽

Clinical Cases

Abstract. Introduction: in children with chronic inducible urticaria, anti-IgE therapy is possible when combined with chronic spontaneous urticaria, otherwise the treatment is considered "off label", since there are no approved recommendations for this category of patients due to insufficient research on the effectiveness, prescription and duration of such treatment Conclusion: Based on clinical cases, the authors present there own experience of successful anti-IgE- therapy of various clinical manifestations of chronic inducible urticaria in children.

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

Rossiiskii Allergologicheskii ZHurnal ◽

10.36691/rja1392 ◽

2021 ◽

Vol 17 (4) ◽

pp. 85-89

Author(s):

Inna A. Larkova ◽

Vera A. Revyakina

Keyword(s):

Chronic Urticaria ◽

Clinical Manifestations ◽

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.