Use of levocetrizine in the management of type IV hypersensitivity to lidocaine: a case report

Lidocaine is a commonly used local anesthetic in the field of dentistry. It has been known to cause allergic reactions, mainly immunoglobulin (IgE)-mediated and T-cell –mediated type IV reactions, which require the use of alternative drugs without adverse effects. Here we present the case of a 29 year old female patient who developed Type IV hypersensitivity reaction in the vicinity of the injection site after the administration of lidocaine local anesthetic for performing exodontia. Levocetrizine tablet was prescribed in order to relieve the symptoms of the reaction. Levocetrizine is a selective, potent, oral histamine H(1) receptor antagonist that is used for the symptomatic treatment of allergic rhinitis and chronic idiopathic urticaria. It has been reported to be effective and generally well tolerated by the patients. In our case also it was able to cure Type IV hypersensitivity reaction to lidocaine without producing any adverse events. Apart from curing allergic rhinitis and urticaria, levocetrizine is a wonderful option for treating Type IV hypersensitivity reaction to a local anesthetic, and it hardly produces any adverse effect. More cases are required to be reported in the future in order to support this article.

Chronic urticaria and inflammatory bowel disease — is it worth looking further?

Chronic urticaria is a common disease that also occurs against the background of inflammatory bowel disease. This case draws attention to the common pathophysiology between autoimmune and autoinflammatory diseases and the need for careful differential diagnosis and further research, which can significantly influence the choice of treatment tactics. Clinical case. An 9-year-old girl with chronic urticaria from birth and recurrent episodes of fever and conjunctivitis was examined at the pediatric ward of the National Children's Specialized Hospital «OKHMATDYT». On the basis of negative results of determination of serum level of immunoglobulins A to gliadin and endomysia celiac disease is excluded, and also by means of modern methods of allergodiagnostics (skin prick-tests, cold test, molecular allergodiagnostics, elimination dietodiagnostics) influence of various is excluded. The girl was diagnosed with chronic idiopathic urticaria with inflammatory bowel disease with trial treatment with ketatifen, bilastine and mesalazine. Due to complaints of recurrent rashes and fever on the background of this therapy, the anamnesis of the disease was re-analyzed and the material was sent for genetic sequencing, which allowed to change the diagnosis to auto-inflammatory disease and prescribed therapy — daily administration of anakinra. Since then, she no longer has recurrent febrile fever or urticaria, and the level of markers of inflammation has returned to normal. Conclusions. This clinical example is interesting for a complex diagnostic search, when a combination of chronic urticaria and inflammatory bowel disease was observed without effect on therapy, which forced to reconsider the diagnosis, which turned out to be even rarer and was finally confirmed by genome sequencing. But despite the fact that the diagnosis was different, it is interesting that on the background of taking mesalazine the girl's condition still improved slightly: became less likely to bother urticarial rash and fever on the background of the rash, which may indicate some common pathogenetic features of inflammation in intestines and chronic idiopathic urticaria, which has an indisputable scientific and practical interest. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: urticaria, inflammatory bowel disease, autoinflammatory diseases, interleukinE1, Biologics, anakinra.

STUDY OF THE CLINICAL CHARACTERISTICS OF INDIVIDUALS WITH CHRONIC URTICARIA: A CROSS SECTIONAL STUDY

Introduction: Because of its continuous relapsing pattern and poor response to medication, chronic urticaria has a detrimental impact on sufferers' professional and social lives. Despite research improvements, the origin and cause of the varied intensity and frequency of clinical manifestation remains a mystery. Aim: The goal of this study was to look at the clinical profile of chronic urticaria in a tertiary care setting. Methods: The study comprised patients of both sexes aged 12 to 60 years old with a clinical diagnosis of chronic urticaria for which no cause could be identified using a standard technique. Results: The average age of the patients with chronic urticaria was 30.44 years, and females predominated, with a male to female ratio of 1:3. The average duration of urticaria was 27.84 months, and urticaria lesions disappeared in less than 30 minutes in 48% of patients. In 38 percent of cases, there was accompanied angioedema, and in 46 percent, there was delayed pressure urticaria. Limitations: The study's sample size was tiny, which constituted a constraint. Conclusions: Our study's clinical profile of chronic idiopathic urticaria is comparable to that of prior research. Keywords: Chronic urticaria, chronic idiopathic urticaria, chronic spontaneous urticaria

Correlation of serum IgG antibodies to helicobacter pylori in chronic skin disorders: A case-control study

It is known that chronic idiopathic urticaria occasionally develops in association with Helicobacter pylori infection, but this relationship remains unproven. Also, many studies show. We investigated the role of H. pylori infection in patients of chronic idiopathic urticaria, other chronic skin disorders as well as healthy controls using urease breath test and immunoturbidimetry for anti H. pylori IgG antibodies. Three groups of eighty-nine patients each were taken as cases, controls and placebo controls respectively. All patients having IgG titer of 10U/ml or above and Urease Breath Test Positivity were considered positive. : The positive rate of anti H. Pylori IgG antibodies was 78.65% (70/89) in case group, 84.71% (22/89) in controls with other skin disorders and 32.58% (29/89) in placebo control group. While positive rate for Urease Breath Test were found to be 79.8% (71/89) in cases, 35.95% (32/89) in controls with other skin diseases and 32.58% (29/89) in placebo controls. In chronic idiopathic urticaria a high titer of anti H. pylori IgG and Urease Breath Test positivity suggests that inclusion of anti H. pylori therapy in it’s the management would be beneficial and would lead to lower rates of recurrence. Also, low positivity rates of Urease Breath Test and Anti H. pylori IgG in controls with other chronic skin diseases and placebo controls points towards no clear evidence to prove a causal relationship between these diseases and H. pylori infection.

Comparison of Rupatadine Monotherapy and Combined Levocetirizine with Ranitidine Dual Therapy for the Treatment of Chronic Idiopathic Urticaria

Background: Effective treatment for chronic idiopathic urticaria (CIU) with conventional combined therapy comprising H1 and H2 antihistamine is effective but associated with high relapse rate. Newer H1 blocker rupatadine alone is similarly effective with less relapse rate. Also it is convenient for the patient as similar efficacy is obtained with single dosage compared to 3 times dosing in combined therapy. This study was done to compare the traditional treatment with levocetirizine and ranitidine to a newly introduced antihistamine rupatadine for CIU. Materials and Methods: The study was a hospital based prospective randomized control trial among 40 patients with CIU in Dermatology and Venereology department of Bangabandhu Sheikh Mujib Medical University(BSMMU), Dhaka from April 2020 to September 2020.Forty patients of CIU were randomly enrolled into two equal groups (group A and B). Patients of group-A were treated with 5 mg of levocetirizine once daily plus 150 mg of ranitidine twice orally daily and group-B were treated with rupatadine 10 mg once daily for one month. The efficacy was assessed 1st and 4th week during treatment and 4 weeks after completion of treatment by observing reduction of itching, regression of the size and shape of lesions and appearance of new lesions. Adverse effects and patient satisfaction were also noted. Results: 75% patients in group A and 80% patients in group B responded to treatment (p>0.05).80% in group A and 85% in group B showed improvement in itching in the first week (p>0.05). . At the end of 4 weeks 95% showed improvement in each group. Appearance of new lesions in first week was 10% and 5% (p>0.05) and at 4th week, 5% and 0% respectively (p>0.05). 75% in group A and 80% in group B had regression in their lesions at the end of first week (p>0.05). At the end of 4th week, it was 85% and 90% (p>0.05). 40% in group A and 25% in group B had relapse of itching at follow up (p<0.05). Relapse of lesions were 35% and 20% (p<0.05). Overall occurrence of side effects (3 compared to 1) was more in group A. Conclusion: The result of the present study show that both conventional treatment with levocetirizine and ranitidine combination and newer agent rupatadine alone has similar efficacy in reducing clinical sign and symptoms of CIU. But rupatadine has significantly reduced the relapse rate and so it is a more efficacious and also safer option with less adverse effects for the treatment of CIU in comparison to conventional treatment. Rupatadine is also more convenient option for patients in term of dosage schedule.

Impact of chronic idiopathic urticaria on patients' quality of life in Jeddah, Saudi Arabia

<p class="abstract"><strong>Background:</strong> Urticaria is a common chronic dermatological disease that has a negative impact on the psychological status and the social interaction of the patients’ quality of life. The dermatology life quality index (DLQI) is one of the dermatology-specific instruments to evaluate the extent of the quality of life (QoL) impairment in the patients with skin diseases and provide an additional evaluation for the overall effectiveness of the treatment.</p><p class="abstract"><strong>Methods:</strong> This study was designed as a descriptive cross-sectional which was conducted in Jeddah city. Questionnaires with verified Arabic version of the DLQI were distributed and collected to the patients by dermatologists.<strong></strong></p><p class="abstract"><strong>Results:</strong> A total 79 patients were enrolled in the study. Male patients represented 48.1%, while female represented 51.9% and sex ratio was 1:1.1. The mean DLQI score in all patients was 10.67±5.54. 51.9% of the patients unfortunately with score of 11-20 had very large effect on their life.</p><p class="abstract"><strong>Conclusions:</strong> Chronic idiopathic urticaria (CIU) has a significant negative impact on the quality of life. In Saudi Arabia, few studies only have been done to evaluate the impact of CIU on patients’ life and more studies are needed to help the patient to improve the management’s strategy and the patients’ life.</p>

Chronic urticaria: a clinico-etiological study and autologous serum skin test role in chronic idiopathic urticaria

<p class="abstract"><strong>Background:</strong> Appearance of wheals daily for more than six weeks is chronic urticarial (CU). No cause is identified in about 50-70% of chronic urticaria patients and are labelled as chronic idiopathic urticaria (CIU). The aim of the present study is to study the clinical and etiological pattern of chronic urticaria and to find out the incidence of autoimmune urticaria by performing autologous serum skin test (ASST) in patients with CIU.</p><p class="abstract"><strong>Methods:</strong> This was a cross sectional study enrolling 100 chronic urticaria patients satisfying including and excluding criteria. The study was done for a period of 1 year. ASST was done in all the CIU patients after recording detailed history, complete physical and systemic examination.</p><p class="abstract"><strong>Results:</strong> Most of the patients (33%) were in 21-30 years age group with female preponderance (66%). Students (38%) followed by house wives (27%) were majorly involved. 21% patients had history of atopy and 8% had abnormal thyroid function tests. Causative factors noticed in 46% patients and remaining were idiopathic (54%). Infections (32.6%) constituted the major etiological factor followed by physical urticaria (30.4%), food (23.9%), medication (11%) and inhalants (2.1%). In infective agents, 46.6% were bacterial followed by helminthic (33.3%). In 29.6% of CIU patients, the ASST was positive indicating auto-immune urticaria.</p><p class="abstract"><strong>Conclusions:</strong> The etiology cannot be identified in most number of patients and hence they were labelled as CIU and the common causative agents observed were infections followed by physical urticaria, food and medication. ASST is considered as the relevant screening test to detect autoimmune urticaria.</p>