Introduction: There is a paucity of information regarding chronic urticaria patients’ care in a real-world setting. The objective of this study was to report and evaluate the baseline characteristics of Portuguese chronic urticaria patients refractory to H1-antihistamines included in the AWARE study. Material and Methods: This is a non-interventional cohort study. Adult patients with a diagnosis of chronic urticaria with symptoms for at least two months, refractory to H1-antihistamines, consulting one of the 10 participating urticaria centers throughout Portugal have been included in the study. Baseline sociodemographic data, medical history, clinical parameters, medication, weekly urticaria activity score, and dermatology quality of life index have been collected. Results: Seventy six patients were included, of which 76.3% were women. The majority of patients had a diagnosis of chronic spontaneous urticaria (88.2%) and 39.5% had angioedema. Around 91.0% of patients were medicated with non-sedative H1-antihistamines and 35.4% with a third line therapy. Median dermatology quality of life index was 5.0 and median weekly urticaria activity score was 13.0. Discussion: The baseline results suggest that patients with chronic urticaria refractory to H1-antihistamines are being under-treated in the real-world setting. Conclusion: The AWARE study demonstrates the real impact of chronic urticaria on Portuguese patients refractory to H1-antihistamines treatment, and 30% report a very large or extremely large deleterious effect on their quality of life. The follow-up of these patients will allow evaluating strategies aimed at optimizing disease control.

Chronic pruritus-From etiology to treatment RESUMO O prurido é uma sensação desagradável na pele que provoca o desejo de coçar, designando-se prurido crónico quando os sintomas têm uma duração superior a 6 semanas; é um sintoma muito incapacitante, afetando negativamente a qualidade de vida. Estima-se que cerca de 60% da população com idade igual ou superior a 65 anos sofra de prurido. Neste artigo, os autores fazem uma revisão da fisiopatologia, da etiologia, do diagnóstico e do tratamento do prurido crónico.

Most cases reported are attributable to fragrances, cosmetics, or topical non-steroidal anti-inflammatory agents. [2][3][4][5] We report connubial dermatitis in a man caused by his wife's hair products. CASE REPORTA 49-year-old man, a locksmith with no significant prior medical history, presented with a 2-year history of recurrent pruritic eczema involving the left arm (Figure 1), left chest, and back. Initially, atopic dermatitis was suspected by the attending dermatologists. Repeated treatments with topical corticosteroids, oral corticosteroids and cyclosporin proved effective, but with immediate recurrence after cessation. The patient was referred to our immunoallergology clinic for patch testing, as contact allergy was suspected. Physical examination showed coarse, small erythematous papules coalescing into eczematous plaques involving the back, left chest, and flexor surface of the left forearm. The presentation was suggestive of contact dermatitis.Patch testing was performed with the European/Portuguese baseline series and a hairdressing series (Vila Nova de Gaia, Roxall Aristegui, Portugal). Allergens were applied on the back with Finn Chambers (Chemotechnique Diagnostics, Vellinge, Sweden) on Scanpor tape (Bastos Viegas, Penafiel, Portugal). Readings were performed on day (D) 2 and D3, according to ICDRG criteria, and showed strong positive reactions to p-phenylenediamine (PPD) 1% pet., methylisothiazolinone 0.2% aq., p-aminodiphenylamine 0.25% pet., o-nitro-PPD 1% pet., PPD dihydrochloride 0.5% pet., and diaminotoluene sulfate 1% pet. ( Figure S1).The patient denied dyeing his hair, having tattoos, or having contact with ink or textiles at work. However, his wife dyed her hair regularly with various products. The patient reported direct contact with his wife's hair, especially while sleeping at night, because she slept on his left side. Our recommendations included the use of PPD-free hair dye for his wife, additional avoidance of the other components identified above, and the use of topical corticosteroids as needed. In a reassessment 2 months later, the patient reported resolution of the lesions since his wife had been avoiding the culprit products and had cut her hair. DISCUSSIONThis clinical case shows that a unilateral pattern can be an important indicator of connubial contact dermatitis. In the present case, the patient's lesions were on the left side where his wife slept, leading to exposure to his allergens. We highlight the importance of enquiring about any products used not only by the patients but 186 FERREIRA ET AL. also by relatives, and of maintaining a high degree of suspicion for connubial dermatitis. The correct, early diagnosis is essential for adequate treatment, to avoid worsening of symptoms, and to avoid the use of drugs that are not effective or are even contraindicated in this clinical situation. Many cases are possibly over-looked or misdiagnosed, as had happened with our patient for 2 years. CONFLICTS OF INTERESTThe authors have no conflicts of interest to report. ORCIDCristia...

Introduction: Information regarding chronic urticaria patients in the real-world setting is scarce. This analysis reports the two-year results of Portuguese patients included in the AWARE study.Material and Methods: Non-interventional cohort study. Adult patients with a diagnosis of chronic urticaria with symptoms for at least two months, refractory to H1-antihistamines, consulting one of the 10 participating urticaria centers throughout Portugal, from the 31st October 2014 to 31st July 2015, have been included in the study. Clinical parameters, medicines taken for urticaria symptom relief, weekly urticaria activity score, and dermatology quality of life index have been collected throughout the two years of the study.Results: Seventy-six patients were enrolled in the study. Results showed that the proportion of patients with omalizumab therapy almost duplicated after two years of the AWARE study, which was accompanied by the decrease of medical resources use and absenteeism. Moreover, urticaria severity and impact on quality of life both decreased after one year and continued to decrease at two years, although decreased severity was significant at both time points and quality of life was only significant at two years. At the end of two years, 79.0% of patients had their disease controlled compared to 29.3% at baseline (p < 0.001).Discussion: At the end of the AWARE study a significant proportion of patients had their disease controlled allowing for decreased use of medical resources.Conclusion: Chronic urticaria still has a significant impact on quality of life and therefore there is opportunity for further therapy optimization.

Aquagenic urticaria (AU) is a rare form of chronic inducible urticaria elicited by water at any temperature. We describe the case of a 25-year-old atopic woman who presented to our unit with a 4-year history of recurrent urticarial rashes, highly pruritic, confined to the neck and lower part of the face, occurring solely on contact with sea water. The lesions were reproduced by challenge tests with aqueous 3.5% NaCl and other hypertonic aqueous solutions but not with 20% glucose neither tap water. Our case supports the existence of a distinct salt-dependent subtype of aquagenic urticaria (SDAU), which seems to be triggered mostly by sea bathing, affects young women and has a characteristic localization on the inferior facial contours and neck. To the best of our knowledge, only eight cases of SDAU have been reported in the literature.