Chronic urticaria in adults: state-of-the-art in the new millennium

Criado, Paulo Ricardo; Criado, Roberta F. J.; Maruta, Celina Wakisaka; Reis, Vítor Manoel Silva dos

doi:10.1590/abd1806-4841.20153509

Cited by 35 publications

(40 citation statements)

References 91 publications

(179 reference statements)

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“…The autologous serum skin test is the only available diagnostic tool in everyday practice. The sensitivity and the specificity of this method are 70% and 80%, respectively . A positive autologous serum skin test was observed with similar frequency in the population of both children and adults (40%‐45%).…”

Section: Possible Causes/triggers Of Chronic Urticariamentioning

confidence: 82%

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Urticaria in children and adolescents: An updated review of the pathogenesis and management

Kudryavtseva

Нескородова

Staubach

2018

Pediatric Allergy Immunology

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The present survey represents the latest data on diagnosis and management of childhood urticaria. It has been observed that urticaria occurs less often in children than adults, with symptoms rarely lasting for over 6 weeks. Triggers or aggravating factors can be found only in 21%-55% of cases. Finding autoantibodies in children does not impact a disease prognosis, unlike in adult patients, where the presence of autoantibodies is associated with a more prolonged run of the disease, a more severe prognosis and more intensive treatment methods. The incidence of food allergy equals to 8%-10% of cases. The incidence of Helicobacter Pylori infection in children is lower than that in adults and comes to 10%-18%. Medical experts recommend using the same treatment schemes for adults and children. This survey describes different urticaria management patterns suggested by experts from Europe, America, and Russia in their recent guidelines. It has been noted that unlike the guidelines from 2014, the 2018 clinical practice guidelines for the diagnosis and management of urticarial once again suggest a four-step treatment scheme with assigning omalizumab for Step 3 and cyclosporine A for Step 4 in the event of low therapeutic efficacy of the previous step or its impossibility. Leukotriene antagonists (LTRAs) are currently removed from basic management to alternative programs.

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Section: Possible Causes/triggers Of Chronic Urticariamentioning

confidence: 82%

“…Isolated wheals appear in 78.4% of cases, angioedema in 6.65%, while both symptoms are observed in 15% of cases. 15 In children, accompanying angioedema was reported in 48.2% cases. 16…”

Section: His Tolog I C Al and Clini C Al Char Ac Teriz Ationmentioning

confidence: 99%

Urticaria in children and adolescents: An updated review of the pathogenesis and management

Kudryavtseva

Нескородова

Staubach

2018

Pediatric Allergy Immunology

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“…Bacterial and viral investigations were excluded by a normal and complete blood count. Frequently implicated pathogens in CU include Helicobacter pylori, Giardia lamblia, Fasciola hepatica, Echinococcus granulosus and Strongyloides stercoralis (7). Thyroid function was within normal limits, no specific antibodies could be identified, and no tumor markers were elevated.…”

Section: Discussionmentioning

confidence: 97%

Chronic Urticaria: A Rare Case Presentation

2018

RoJCED

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Introduction. Urticaria is a frequent condition, characterized by the pre sence of highly pruritic, erythematous-edematous, disseminated lesions, that affects up to 20% of the general population at least once during lifetime. Chronic urticaria implies intermittent lesions, at least twice a week, for at least six weeks. It remains a significant problem in terms of etiology and diagnosis. Management of urticaria is complex and complete remission is rarely obtained. Material and methods. A 66-year-old female presented for consultation with multiple, erythematous, well-circumscribed, highly pruritic papules and plaques localized on the thorax and lower limbs, with an intermittent evolution for one year.Also, an episode of angioedema five months prior was mentioned. No specific provoking factor could be identified at initial admission. Results. Laboratory investigations were negative for infections, autoimmune or thyroid disorders. Tumor markers (CEA, CA 15.3, CA 125, CA19.9) were within normal limits. The level of Ig E antibodies was normal. However, the level of IgG antibodies to Toxoplasma gondii was found to be extremely high, reaching 46.398 UI/mL.The therapeutic approach was the administration of azithromycin 500 mg daily for 21 days and oral antihistamines, with favorable evolution. Discussions. Urticaria is one of the 10 most common dermatoses and is defined by the presence of pruritic wheal-like lesions and angioedema. In a state hospital from Bucharest, in 2017, 67% of patients presented as emergencies at the Consultation Room with acute urticaria, 21% of patients were treated as out-patients with different forms of acute and chronic urticaria, whereas 12% of admitted, in-patients presented with some form of chronic urticaria. This paper reports a severe case of chronic urticaria, with a long history of recurring, disseminated lesions for almost one year. Specific associations and aspects were identified. A correct and rapid diagnosis is essential in this pathology for improving quality of life for these patients. Conclusions. CU is a frequent condition with a major impact on the quality of life for patients. Although most cases remain without a known cause, a correct and thorough approach of the patient should be chosen. Peculiar causes should be taken into consideration and frequently a multidisciplinary perspective is the best choice.In this case report, a long-term evolution of CU with a significant impact on the quality of life for this patient identified a rare association with a Toxoplasma gondii infection with a favorable outcome.

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“…z chorobami tarczycy, pseudoalergią, procesami autoimmunologicznymi, przewlekłymi infekcjami (np. Helicobacter pylori, Anisakis simplex, Giardia lamblia) [5]. Podkreśla się duże zróżnicowanie przyczyn pokrzywki w zależności od regionu geograficznego [2].…”

Section: Badania Diagnostyczneunclassified

“…Obejmuje ona: poszukiwanie utajonego zakażenia, w tym infestacji pasożytniczych, uczulenia typu I, obecność funkcjonalnych autoprzeciwciał, stężenie hormonów tarczycy i autoprzeciwciał tarczycowych, testy skórne i fizykalne próby prowokacyjne, dietę z eliminacją pseudoalergenów, śródskórny test z surowicą autologiczną, stężenie tryptazy [2]. Jeżeli bąble pokrzywkowe utrzymują się w tej samej lokalizacji przez ponad 24 godziny i istnieje podejrzenie pokrzywki naczyniowej, zaleca się pobranie biopsji skóry [5]. W pokrzywce wywołanej zaleca się badania pozwalające określić wartość progową bodźca wywołującego określony typ pokrzywki [2].…”

Section: Badania Diagnostyczneunclassified

Omalizumab in the treatment of chronic spontaneous urticaria – literature review and own experience

Dawicka¹,

Wilkowska²,

Grubska-Suchanek³

et al. 2016

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StreSzczeniePokrzywka przewlekła charakteryzuje się występowaniem bąbli pokrzywkowych i/lub obrzęku naczynioruchowego w ciągu przynajmniej 6 tygodni. Według obecnych wytycznych, jeżeli terapia lekami przeciwhistaminowymi anty-H1 II generacji w czterokrotnych zalecanych dawkach jest nieskuteczna, zaleca się dołączenie do leków przeciwhistaminowych omalizumabu, cyklosporyny A lub montelukastu. Niniejsza praca przedstawia przegląd piśmiennictwa oraz doświad-czenia własne w zakresie możliwości zastosowania omalizumabu u dwóch pacjentek z rozpoznaniem pokrzywki przewlekłej spontanicznej. U obu chorych zastosowano rozmaite metody terapeutyczne, w tym leki przeciwhistaminowe anty-H1 w zalecanych przez europejskie wytyczne dużych dawkach (czterokrotnie większych od dawki podstawowej), glikokortykosteroidy doustne, montelukast oraz metotreksat, nie osiągnięto jednak zadowalającej kontroli objawów. Podczas leczenia omalizumabem u obu pacjentek udało się osiągnąć zdecydowaną poprawę stanu klinicznego, a mianowicie redukcję w Skali średniego nasilenia objawów pokrzywki w ciągu 7 dni (UAS7) -u pierwszej chorej z 34 do 11,8 pkt, a u drugiej z 41 do 5,76 pkt. AbStrActChronic urticaria is a condition characterized by the appearance of wheals and/or angioedema that last for at least 6 weeks. According to the recent recommendations, if H1-antihistamines used in four times licensed doses remain ineffective, add-on treatment with omalizumab, cyclosporine A or montelukast should be applied. This paper offers a literature review of the studies on using omalizumab in chronic spontaneous urticaria (CSU) treatment. Moreover, it presents our own experience with the use of omalizumab in the treatment of two patients with CSU. Both patients were treated with H1-antihistamines in four times licensed doses recommended by European guidelines, oral corticosteroids, montelukast, and methotrexate -all without satisfactory results. During the time of the omalizumab therapy both patients achieved a significant improvement measured by the decrease in the Average Urticaria Activity Score for 7 days (UAS7) -the first patient from 34 to 11.8 points, the second one from 41 to 5.76.

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Chronic urticaria in adults: state-of-the-art in the new millennium

Cited by 35 publications

References 91 publications

Urticaria in children and adolescents: An updated review of the pathogenesis and management

Urticaria in children and adolescents: An updated review of the pathogenesis and management

Chronic Urticaria: A Rare Case Presentation

Omalizumab in the treatment of chronic spontaneous urticaria – literature review and own experience

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