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

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

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.

Fresh look on the urticaria problem.

Introduction. Nowadays urticaria is one of the most common diseases. According to the International Guidelines for the definition, classification, diagnosis and management of urticaria, 2nd-generation H1-antihistamines are recommended to be used as the first-line and second-line therapy. Omalizumab, a humanized monoclonal anti-IgE antibody, is assumed to be the third-line therapy in urticaria treatment. Summary. In this review we discuss the latest data on pathogenetic mechanisms of urticaria, focusing on the search of the new targets for the therapy. We represent the latest clinical trials of the new biological treatment for urticaria. Safety and efficiency of 4-folds higher therapeutical dose of the 2nd generation H1-antihistamines, and criteria for personalized selection of the antihistamines are discussed.

Omalizumab for treatment of chronic urticaria: A review of effective dose

Omalizumab (Xolair®), a humanized anti-IgE monoclonal antibody, is effective and well-tolerated in patients with chronic spontaneous urticaria refractory to H1 antihistamines. The aim of this review was to present the effective dose of omalizumab for urticaria treatment in patients. Several databases, including PubMed, EMBASE, Scopus, Google, SID, Magiran, and Irandoc, were selected. The search process was performed using the keywords of Xolair, omalizumab, urticaria, chronic urticaria, effect, and treatment. Sixty related articles were found. All studies have been conducted on people over 12 years of age with the exception of 2 articles investigating patients over 7 years old. Most studies have been performed on patients within the age range of 12-75 years and the maximum age of 81 years. Omalizumab has been administered at different doses for patients with chronic urticaria (75-600 mg). Omalizumab has shown a treatment effect at all administered doses; however, it has the greatest effect when administered at the dose of 300 mg. The interval of subcutaneous injections was 2-6 weeks. In conclusion, the administration of omalizumab is effective at doses of 150 and 300 mg although the most effective dose is 300 mg.

Pruritus after discontinuation of cetirizine

Background: Intense pruritus or itching emerging after discontinuation of cetirizine has been the subject of postmarketing reports submitted to the U.S. Food and Drug Administration (FDA), published in the medical literature, and discussed on the internet. To better understand and further investigate this adverse event, we analyzed cases of pruritus occurring after discontinuation of cetirizine in the FDA Adverse Event Reporting System (FAERS) database and medical literature. Methods: We conducted a retrospective study to identify and describe cases of pruritus occurring after discontinuation of cetirizine in the FAERS database and medical literature through April 24, 2017. Data collected from the reports included demographic information, reason for use, serious outcome, report source, duration of cetirizine use, time to onset of pruritus after cetirizine discontinuation, presence of associated urticaria, treatment for pruritus, concomitant comorbidities and medications associated with pruritus, rechallenge information, and patient outcome information. Results: We identified 146 cases of pruritus after discontinuation of cetirizine. Reporting frequency increased starting in 2008. The median patient age was 38 years ( n = 141), ranging from 6 to 71 years, and cases were predominantly reported in females ( n = 110). Most cases ( n = 115) were submitted directly to the FDA from consumers or healthcare providers. The median duration of use of cetirizine prior to discontinuation was 24 months ( n = 130), ranging from 0.3 to 172.2 months. The median time to onset of pruritus from discontinuation was 2 days ( n = 91), ranging from 0.5 to 5 days. Of the 55 cases that reported discontinuation of cetirizine again after restarting, 54 reported pruritus recurrence. Conclusions: Our case series provided evidence of an association between the discontinuation of cetirizine and the development of pruritus. The mechanism by which cetirizine causes pruritus upon discontinuation is unknown. Patients and prescribers should have knowledge of this adverse event, given the widespread use and availability of cetirizine, and potential impact on patient quality of life.