Comparison and interpretability of the available urticaria activity scores

Hawro, Tomasz; Ohanyan, Tatevik; Schoepke, Nicole; Metz, Martin; Peveling‐Oberhag, Adriane; Staubach, Petra; Maurer, Marcus; Weller, Karsten

doi:10.1111/all.13271

Cited by 67 publications

(53 citation statements)

References 13 publications

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“…In contrast, TRPV1, the receptor of capsaicin, is not involved in wheal formation, though expressed on endothelial cells, where it controls the vascular tone . Interestingly, in patients with chronic spontaneous urticaria, pruritus, but not the number of wheals, is increased in the evening, possibly due to increased body temperature and bed warmth or lack of other stimuli . TRPV1 activation by its agonists, temperature exceeding 43°C or pH changes, may decrease the threshold for histamine‐induced itch and/or directly induce itch in patients with urticaria.…”

Section: Discussionmentioning

confidence: 98%

Comparison of pruritus and sensory qualities induced by capsaicin, histamine and cowhage

Hawro

Lehmann

Deuring

et al. 2019

Acad Dermatol Venereol

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Background In skin diseases and experimental models of pruritus, pure itch is accompanied by additional sensations that are poorly characterized. Objectives This study compared the sensory qualities evoked by different models of experimentally induced pruritus including skin prick testing (SPT) with histamine or capsaicin and application of cowhage spicules. SPT as a method of capsaicin application was validated for this purpose. Methods Two pilot experiments were performed in eight healthy volunteers. First, a concentration of 8% capsaicin was identified as evoking a reproducible itch using SPT. Further, a list of the seven most frequently reported sensations was chosen after SPT with 10 mg/mL histamine, 8% capsaicin and application of 40–45 cowhage spicules. Finally, 31 subjects were challenged with the same itch‐inducers. Wheal and flare were measured at 10, 20, 40, 60 and 90 min, itch intensity every minute for 30 min, and the overall evaluation of sensory descriptors were recorded on a 100‐mm visual analogue scale once itching had subsided. Results Skin prick testing with histamine and capsaicin resulted in flare reactions, which were 23% smaller for capsaicin (P < 0.001). Histamine, capsaicin and cowhage‐induced pruritus, the duration of which was shorter for cowhage than for histamine (13.5 ± 1.4 vs. 8.8 ± 1.2 min, P = 0.005). Different mediators induced sensations of different intensities. Capsaicin produced less itch and physical urge to scratch than histamine (P = 0.001) and cowhage (P < 0.001). However, both capsaicin and cowhage induced more burning than histamine (P = 0.002 and P = 0.04, respectively). Provocation with cowhage caused more intense sensations of pricking than histamine (P = 0.033). Conclusion This study shows that provocation with histamine, capsaicin and cowhage results in itch responses that are different in their duration, the profile of accompanying sensations, and the flare that comes with the itch.

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Section: Discussionmentioning

confidence: 98%

Comparison of pruritus and sensory qualities induced by capsaicin, histamine and cowhage

Hawro

Lehmann

Deuring

et al. 2019

Acad Dermatol Venereol

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“…We also analyzed whether nonresponders or partial responders would benefit from updosing. The criteria to define patients as minimal responders were a minimal change of 3 points in UCT and 11 points in UAS7 from baseline to the 6th month of treatment [3, 4]. Nonresponders were defined as those without any of the improvements described.…”

Section: Methodsmentioning

confidence: 99%

Omalizumab Updosing for Better Disease Control in Chronic Spontaneous Urticaria Patients

Kocatürk

Deza

Kızıltaç

et al. 2018

Int Arch Allergy Immunol

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The recommended dose of omalizumab for the treatment of chronic spontaneous urticaria (CSU) is 300 mg every 4 weeks, but there is no recommendation for patients who do not benefit from this dose. Our aim is to present the experiences on the use of doses of omalizumab higher than those recommended for CSU patients and to propose a protocol for updosing. This was a retrospective analysis of patients treated with omalizumab for CSU from 2 urticaria centers in Istanbul and Barcelona. The weekly urticaria activity score and/or the Urticaria Control Test (UCT) were used to monitor response. In Barcelona, a stepwise updosing regimen was preferred (450 mg first, then increasing to 600 mg), while in Istanbul, direct updosing to 600 mg was chosen. In Istanbul, 81 (88%) patients were treated with 300 mg, while 11 (12%) received 600 mg of omalizumab. In Barcelona, 7 (8.8%), 45 (56.3%), 17 (21.3%), and 11 (13.8%) patients received 150, 300, 450, and 600 mg of omalizumab, respectively. Urticaria control was achieved in 82.6% of the patients with 300 mg and in 8.7% of the patients with 600 mg in Istanbul, while it was achieved with 150 mg in 10%, with 300 mg in 48.8%, with 450 mg in 16.3%, and with 600 mg in 6.3% of the patients in Barcelona. In total, 123 (71.5%) patients responded to 150–300 mg and 26 (15.1%) to 450–600 mg. When responders to 150–300 mg (n = 123) were compared with responders to 450–600 mg (n = 26), BMI was found to be higher, and pre-omalizumab UCT was found to be lower in patients receiving updosed omalizumab (p = 0.029). Baseline data of the patients, especially BMI and pre-oma UCT, might be useful to determine if the patient will require higher doses of omalizumab. We recommend a stepwise approach starting from 450 mg and then updosing to 600 mg in CSU patients who do not respond or partially respond to 300 mg of omalizumab after 3–6 months of treatment.

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“…The current guideline endorses the urticaria activity score (UAS) and/or the angioedema activity score (AAS) to assess disease activity in CSU patients. The current guideline endorses the urticaria activity score (UAS) and/or the angioedema activity score (AAS) to assess disease activity in CSU patients. In order to calculate the UAS, patients record and quantify their symptoms (wheals and pruritus) on a daily basis in a diary; the same applies to angioedema using the angioedema activity score.…”

Section: Diagnostic Approach To Chronic Spontaneous Urticariamentioning

confidence: 99%

“…Given that the majority of CSU patients exhibit considerable variability in daily symptoms, it is recommended to employ patient-reported outcome (PRO) tools. The current guideline endorses the urticaria activity score (UAS) [19][20][21][22] and/or the angioedema activity score (AAS) [ 23 ] to assess disease activity in CSU patients. In order to calculate the UAS, patients record and quantify their symptoms (wheals and pruritus) on a daily basis in a diary; the same applies to angioedema using the angioedema activity score.…”

Section: Diagnostic Approach To Chronic Spontaneous Urticariamentioning

confidence: 99%

Chronic urticaria – What does the new guideline tell us?

Maurer

Zuberbier

Siebenhaar

et al. 2018

J Deutsche Derma Gesell

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Patients with chronic urticaria experience significant impairment, and require an effective treatment. Such treatment is preceded by a thorough diagnostic workup and measurement of disease activity, disease burden and disease control using well--established tools. Treatment is subsequently adjusted according to patient needs and therapeutic response, based on the tenet "as much as necessary, as little as possible" (in that order). Once disease control has been achieved, it is recommended that intermittent attempts at medication withdrawal be made in order to identify spontaneous disease remission. Chronic urticaria should be treated until spontaneous remission occurs.

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Comparison and interpretability of the available urticaria activity scores

Cited by 67 publications

References 13 publications

Comparison of pruritus and sensory qualities induced by capsaicin, histamine and cowhage

Comparison of pruritus and sensory qualities induced by capsaicin, histamine and cowhage

Omalizumab Updosing for Better Disease Control in Chronic Spontaneous Urticaria Patients

Chronic urticaria – What does the new guideline tell us?

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