Objective:Treatment of chronic urticaria (CU) can be difficult in many patients. Achieving long-term remission and reducing the requirement of antihistamines are vital in CU. The objective of this study was to assess the effectiveness of injection histaglobulin, a complex of histamine and human immunoglobulin, in producing relief in patients with CU.Materials and Methods:Fifty-one patients with CU were enrolled into this prospective clinical study. Patients were administered 1 ml of injection histaglobulin subcutaneous for 8 consecutive weeks. They were also prescribed tablet levocetirizine 5 mg to be taken when required (but not more than the permitted dosage). Efficacy was assessed using urticaria activity score (UAS) which has a maximum score of 33/day, during each weekly visit. Final assessment was done after 24 weeks.Results:Twenty-nine patients had completed the entire 8-week drug regimen. Mean basal UAS was 18.9 ± 6.3 and it reduced to 80.4% by 8 weeks. The angioedema sub-score reduced by 89.8%. Anti-histamine pill burden also reduced significantly. By 24 weeks of starting the therapy, 23 patients (45%) had attained complete remission. No adverse effects to the drug were observed.Conclusions:Histaglobulin was found to be effective in producing long-term remission and it reduced the antihistamine requirement as well. Thus, it can serve as an effective alternative to existing treatment modalities.
A 30-year-old man presented with multiple, bilaterally symmetrical, erythematous papular-vesicular lesions distributed over his neck, anterior trunk, posterior trunk, and upper arms (Figures 1 and 2). Face, mucosa, and lower limbs were spared. The skin lesions were mildly pruritic, appeared 4 days after the onset of fever, cough, and malaise. He had a history of varicella in childhood. His complete blood count, liver and kidney parameters, and C-reactive protein were within normal limits. IgM antibodies were negative for varicella infection. Tzanck smear, carried out from a vesicle, showed many acantholytic cells with lymphocytes. Giant cells suggestive of herpes simplex virus infections were not found (Figure 3). SARS-CoV-2 real-time polymerase chain reaction of his nasopharyngeal swab showed COVID-19 positivity. A diagnosis of varicella-like exanthem secondary to COVID-19 was made. The patient was advised home isolation and managed conservatively. The patient's skin and systemic symptoms subsided within 1 week.The vesicular lesions in COVID-19 are uncommon, typically seen in middle-aged patients, associated with intermediately severe disease. The prevalence of vesicular rash ranges from 3.77% to 15% in this disease. 1 The cytokine storm secondary to immune hyperresponse, and direct cytopathic effect of SARS-CoV-2 on endothelium of dermal blood vessels, may form the pathophysiological basis of vesicular lesions. 2 The rash usually appears 3 days after the onset of systemic symptoms and disappears by 8 days. The characteristic features of this vesicular exanthem are mild/absent pruritus, frequent trunk involvement, small size, scattered distribution of lesions, and heals without scar. 3 Two morphological patterns of this rash are 1) widespread polymorphic pattern-more common, consisting of small papules, vesicles, and pustules, FIGURE 1. Multiple erythematous papular-vesicular lesions over neck, anterior trunk, and posterior trunk.
Pustular psoriasis is characterized by abrupt onset of macroscopic pustules associated with erythema and symptoms of burning pain and constitutional symptoms. There are several precipitating factors, both physiological such as pregnancy and routinely prescribed drugs like antihypertensives, antifungals, corticosteroids and progesterone. We present a case of a 50-year-old male patient with pustular psoriasis, well controlled on oral methotrexate, who presented with sudden exacerbation of pustular psoriasis following the use of telmisartan. This case is presented due to the absence of prior reports of telmisartan aggravating pustular psoriasis.
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