Chronic urticaria (CU) is a common condition faced by many clinicians. CU has been estimated to affect approximately 0.5%–1% of the population, with nearly 20% of sufferers remaining symptomatic 20 years after onset. Antihistamines are the first-line therapy for CU. Unfortunately, nearly half of these patients will fail this first-line therapy and require other medication, including immune response modifiers or biologics. Recent advances in our understanding of urticarial disorders have led to more targeted therapeutic options for CU and other urticarial diseases. The specific biologic agents most investigated for antihistamine-refractory CU are omalizumab, rituximab, and intravenous immunoglobulin (IVIG). Of these, the anti-IgE monoclonal antibody omalizumab is the best studied, and has recently been approved for the management of CU. Other agents, such as interleukin-1 inhibitors, have proved beneficial for Schnitzler syndrome and cryopyrin-associated periodic syndromes (CAPS), diseases associated with urticaria. This review summarizes the relevant data regarding the efficacy of biologics in antihistamine-refractory CU.
Background: Asthma prevalence decreases post-puberty in males. Testosterone inhibits airway smooth muscle contraction and attenuates type 2 inflammation.Objective: To investigate the relationship between serum testosterone and current asthma prevalence and lung function in a nationally-representative dataset.Methods: Serum testosterone and self-reported physician-diagnosed current asthma were obtained from 7,584 participants ages 6-80 years from the cross-sectional 2011-2012 National Health and Nutrition Examination Survey (NHANES). We used logistic regression to test associations between testosterone and current asthma, adjusting for demographics and stratifying by sex and age; linear regression to evaluate correlations between testosterone and lung function among asthmatic patients; and interaction terms to test for effect modification by blood eosinophils and FeNO.Results: Serum testosterone inversely associated with odds of current asthma in both men and women but this association was nonlinear. Similar protective effect sizes were observed for both sexes after log 2 -transformation of serum testosterone. For every 1-unit increase in log 2 testosterone, the odds of current asthma decreased by 11% in men and 10% in women, although the association was statistically significant in women only among those ≥12 years old after multiple imputation. Serum testosterone did not associate with current asthma prevalence among those <12 years old.
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