In CSU, total IgE levels and their change predict the response to treatment with omalizumab. The assessment of pre- and post-treatment IgE levels and their ratio may help to improve the management of CSU in patients who require omalizumab treatment.

Introduction The COVID‐19 pandemic dramatically disrupts health care around the globe. The impact of the pandemic on chronic urticaria (CU) and its management are largely unknown. Aim To understand how CU patients are affected by the COVID‐19 pandemic; how specialists alter CU patient management; and the course of CU in patients with COVID‐19. Materials and Methods Our cross‐sectional, international, questionnaire‐based, multicenter UCARE COVID‐CU study assessed the impact of the pandemic on patient consultations, remote treatment, changes in medications, and clinical consequences. Results The COVID‐19 pandemic severely impairs CU patient care, with less than 50% of the weekly numbers of patients treated as compared to before the pandemic. Reduced patient referrals and clinic hours were the major reasons. Almost half of responding UCARE physicians were involved in COVID‐19 patient care, which negatively impacted on the care of urticaria patients. The rate of face‐to‐face consultations decreased by 62%, from 90% to less than half, whereas the rate of remote consultations increased by more than 600%, from one in 10 to more than two thirds. Cyclosporine and systemic corticosteroids, but not antihistamines or omalizumab, are used less during the pandemic. CU does not affect the course of COVID‐19, but COVID‐19 results in CU exacerbation in one of three patients, with higher rates in patients with severe COVID‐19. Conclusions The COVID‐19 pandemic brings major changes and challenges for CU patients and their physicians. The long‐term consequences of these changes, especially the increased use of remote consultations, require careful evaluation.

[Epub ahead of print]. 8. Van Gasse AL, Ebo DG, Chiriac AM, et al. The limited value of prolonged drug challenges in nonimmediate amoxicillin (clavulanic acid) hypersensitivity.

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Background/aim: Spontaneous wheals and/or angioedema lasting longer than six weeks are described as chronic spontaneous urticaria (CSU). Omalizumab is used for the treatment of antihistamine-resistant CSU. The neutrophil-lymphocyte ratio (NLR), plateletlymphocyte ratio (PLR), mean platelet volume (MPV), and platelet distribution width (PDW) are considered important indicators of inflammation and platelet activation in chronic diseases. We aimed to determine the NLR, PLR, MPV, and PDW levels in patients with CSU compared with healthy controls. We also aimed to investigate the effects of omalizumab therapy on these parameters in CSU patients. Materials and methods: This hospital-based, retrospective study included 143 patients with CSU and 132 healthy controls with a mean age of 40.0 ± 13.17 and 42.0 ± 16.34, respectively. Patients with equal or higher-than-baseline UAS scores at week 12 of omalizumab treatment were considered nonresponders, others were considered responders. We analyzed the neutrophils, lymphocytes, platelet counts, NLR, PLR, MPV, and PDW before, during, and after omalizumab treatment and compared the results with those of healthy controls. Results: CSU patients presented higher baseline MPV (P = 0.035) and lower baseline PDW values (P < 0.001) than healthy controls. There were statistically significant increases in the MPV (P < 0.001), MPV/platelet count (P = 0.005), and PDW (P = 0.003) and there was a statistically significant decrease in the NLR (P = 0.018) during omalizumab treatment. The percent increase of MPV was low in nonresponders (P = 0.009). Nonresponders had lower PDW values than responders (P = 0.040). Conclusion: The increase in the MPV and PDW may be due to platelet activation during omalizumab treatment. The decrease in the NLR may be regarded as an antiinflammatory effect of omalizumab. The effect of omalizumab on platelet and inflammatory markers may be used to discriminate the responders from nonresponders.

Numerous studies have investigated a probable association between androgenetic alopecia (AGA) and cardiovascular disease (CVD) by researching limited and dispersed parameters. We aimed to evaluate both traditional and non-traditional cardiovascular risk factors in male patients with early-onset AGA. This case-control study included 68 participants: 51 male patients with early-onset AGA and 17 healthy male controls. Patients with AGA were classified into three groups according to the Hamilton-Norwood scale and the presence of vertex hair loss. Traditional and non-traditional cardiovascular risk factors were examined in all study subjects. Metabolic syndrome was diagnosed in 25 patients with AGA and in two control subjects (p < 0.05). The carotid intima-media thickness values were found to be significantly higher in patients with vertex pattern AGA than in patients without vertex baldness and controls (p < 0.05). The pulse-wave velocity values were also found to be significantly higher in patients (p < 0.001). A limitation of this study was the small study population. In conclusion, vertex pattern AGA appears to be a marker for early atherosclerosis. This finding supports the hypothesis that early-onset AGA alone could be an independent risk factor for CVD and metabolic syndrome.

ANA (−) patients, n = 340 202 (59.4%) 138 (40.6%) Abbreviations: CR, complete responder; CSU, chronic spontaneous urticaria; NR, nonresponder; PR, partial responder. a Chi-square test. *Response to omalizumab treatment was assessed by measuring disease activity at baseline and week 12 of omalizumab treatment by visual analog scale (VAS). Patients who had a more than 80% improvement and a 20%-80% improvement at week 12 were considered complete and partial responders, respectively (nonresponders = VAS improvement < 20% at week12).