Biomarcadores na urticária crônica: qual o seu papel? / Biomarkers of chronic urticaria: what are their role?

A urticária é uma doença com comprometimento universal, e debilitante para a maioria dos pacientes. Caracteriza-se pela ocorrência de episódios de urticas, angioedema ou ambos, determinados pela ativação de mastócitos e outras células inflamatórias com a liberação de vários mediadores. Apresenta etiologia complexa com fenótipos e terapias bem específicas. A urticária crônica possui evolução recorrente e imprevisível, podendo estender-se por anos. Caracteristicamente possui maior prevalência no sexo feminino, com pico de ocorrência entre 20 e 40 anos. A doença pode ser diferenciada pela gravidade, impacto na qualidade de vida do paciente e resposta terapêutica. Biomarcador é uma característica clínica ou laboratorial mensurável de algum estado ou condição biológica, o qual pode influenciar ou prever a incidência de desfecho ou doença. O objetivo deste artigo é realizar uma revisão dos principais biomarcadores promissores e com melhor evidência relacionados à duração, atividade da doença e resposta terapêutica.

Urticaria is a disease of global importance that can be debilitating for most patients. It is characterized by episodes of wheals, angioedema, or both, determined by the activation of mast cells and other inflammatory cells with the release of several mediators. The etiology is complex, involving specific phenotypes and therapies. Chronic urticaria has a recurrent and unpredictable course that can last for years. The prevalence is typically higher in females, with a peak incidence between 20 and 40 years of age. The disease can be classified by severity, impact on quality of life, and therapeutic response. A biomarker is a measurable clinical or laboratory characteristic of a biological state or condition that can influence or predict the incidence of outcome or disease. This study provides a review of the main biomarkers considered promising and with the best evidence related to duration, disease activity, and therapeutic response.

Adaptation and validation of the Bengali version of the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL)

Background: Chronic urticaria exerts a profound impact on quality of life. Recent guidelines recommend its evaluation in all chronic urticaria patients. Currently, the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) is the only validated tool to assess chronic urticaria-specific quality of life. Objective: To validate and adapt the CU-Q2oL to the Bengali language for its widespread use. Methods: The CU-Q2oL questionnaire was translated into Bengali. Its internal consistency and reliability were tested by asking 42 chronic urticaria patients to complete this version. They completed the validated Bengali Dermatology Life Quality Index and Urticaria Control test questionnaires, and their scores were correlated with CU-Q2oL score to assess the validity of our Bengali version. Results: The mean CU-Q2oL score of our patients (mean age 38.41 ± 13.4 years, male: female 29:13) was 48.8 ± 16.5. Domain 4 (sleep problems) was worst affected, followed by domain 1 (pruritus), while domain 2 (swelling) was least affected. We detected an excellent overall internal consistency (Cronbach’s alpha = 0.93) of our version and nearly complete agreement (intra-class correlation coefficient = 0.91) between the test-retest scores. We found a significant positive correlation between the overall CU-Q2oL and Dermatology Life Quality Index scores (rs = 0.53, P = 0.0002), thus implying the validity of our version. Additionally, we noted a significant negative correlation between the overall CU-Q2oL and Urticaria Control test scores (rs = -0.48, P = 0.0007), suggestive of a more severe impairment of quality of life with poorer disease control. Limitations: Small sample size, observational design and bias in test-retest reliability analysis due to the use of rescue therapy in-between assessment sessions were important limitations of our study. Conclusion: The Bengali version of CU-Q2oL questio

Treatment of chronic urticaria with acupuncture and moxibustion by "mind-body regulation" based on "psychosomatic medicine" / 中国针灸

The treatment idea for chronic urticaria with acupuncture and moxibustion by "mind-body regulation" is explored in reference with "psychosomatic medicine". Chronic urticaria refers to "mind and body comorbidity" because qi and blood dysfunction and emotional abnormality are presented simultaneously in the disease and affected each other. In clinical diagnosis and treatment, the mutual regulation of mind and body should be considered to improve the curative effect. In treatment with acupuncture and moxibustion, through regulating the mind of brain, heart and zang organs, as well as qi movement, the mental activity is adjusted; through harmonizing the defensive qi and the nutrient blood, eliminating wind and stopping itching, the unhealthy conditions of body are treated. The comprehensive therapy of acupuncture is adopted in combination with moxibustion, bloodletting and auricular point therapy, in which, "regulating the mind" goes through the whole process of treatment, and the doctors and patients are well cooperated to ensure the qi-blood harmonization and the mind-body wellness.

Autoimmune pathogenesis of chronic spontaneous urticarial / 中华皮肤科杂志

The autoimmune pathogenesis of chronic spontaneous urticaria was first proposed in 2013 by Konstantinou et al. In recent years, genetic, epigenetic, and immunological studies have provided supporting evidence for the autoimmune pathogenesis of chronic spontaneous urticaria, and this review summarizes relevant research progress.

Efficacy and safety of omalizumab in the treatment of chronic urticaria: a retrospective analysis / 中华皮肤科杂志

Objective:To retrospectively analyze clinical efficacy and safety of omalizumab in the treatment of chronic urticaria (CU) in southern Zhejiang, China.Methods:A retrospective observational study was conducted on CU patients who received omalizumab treatment at the First Affiliated Hospital of Wenzhou Medical University from January 1st, 2018 to August 1st, 2021. Through the outpatient follow-up visits, the disease activity, condition control, and quality of life were evaluated using the 7-day urticaria activity score (UAS7) , urticaria control test (UCT) , and dermatology life quality index (DLQI) . In addition, changes in disease condition, recurrence after withdrawal, and adverse events were assessed. Independent-sample t test was used for intergroup comparisons of normally distributed measurement data, Wilcoxon signed-rank sum test or Kruskal-Wallis H test was used for comparisons of non-normally distributed measurement data, and chi-square test or Fisher′s exact test was used for comparisons of enumeration data. Results:A total of 252 CU patients with poor response to antihistamines were included, with a baseline UCT score of 5.0 ± 2.4 points, a UAS7 score of 25.6 ± 6.2 points, and a DLQI score of 17.5 ± 4.7 points; among them, 204 (81.0%) were treated with omalizumab at an initial dose of 300 mg, and 48 (19.0%) with omalizumab at an initial dose of 150 mg. At the end points (12.0 ± 1.4 months after the start of treatment) , an overall control rate of 90.3% (224/248) was achieved after the omalizumab treatment; concretely, 137 (55.2%) patients achieved complete control (UCT = 16 points) , 87 (35.1%) achieved partial control (12 points ≤ UCT < 16 points) , and 24 (9.7%) showed no response (UCT < 12 points) , while 10 with partial response shifted to complete control after dose increase. During the treatment period, recurrence occurred in 50 patients (36.5%) , of whom 32 patients opted for retreatment with omalizumab, and then 30 (93.8%) achieved partial or complete control. Adverse events were reported in 8 patients (3.2%) , and all were mild or moderate.Conclusion:Omalizumab was effective in the real-world treatment of CU, and could improve patients′ quality of life, with a favorable safety profile.

Testes de provocação para urticárias crônicas induzidas: a experiência de um centro de referência e excelência em urticária - UCARE / Provocation tests for chronic inducible urticaria: the experience of a urticaria center of reference and excellence

Introdução: A urticária é determinada pela ativação de mastócitos que se apresenta por urticas, angioedema ou ambos. A urticária é classificada de acordo quanto a sua duração, em duas formas: aguda (UA < 6 semanas) e crônica (UC > 6 semanas). A UC compreende Urticária Crônica Espontânea (UCE) e Urticárias Crônicas Induzidas (UCInd). Entre as UCInd estão o dermografismo, urticária por pressão tardia (UPT), frio, calor, solar, aquagênica, colinérgica e urticária/angioedema vibratório. As UCInd podem ser diagnosticadas por meio da história clínica, exame físico e da reprodução das lesões através dos testes de provocação. Objetivo: Descrever o perfil dos testes de provocação positivos para UCInd realizados em um Centro de Referência e Excelência em Urticária (GA2LEN UCARE). Métodos: Foram avaliados, retrospectivamente, os resultados dos testes de provocação para UCInd, realizados de dezembro de 2017 a setembro de 2021, de 114 pacientes que apresentavam história sugestiva de uma ou mais UCInd. Resultados: Dos 114 pacientes avaliados, oitenta e oito (77%) eram do sexo feminino e 26 (23%) do masculino. Foram diagnosticados, através de testes de provocação positivos: 65 dermografismos (FricTest® e/ou dermografômetro); 23 UPT (23 diagnosticados com o uso do dermografômetro e 11 também confirmados através do teste de Warin); 11 urticárias ao frio (temperaturas iguais ou inferiores a 27 °C) e 3 urticárias ao calor (temperaturas iguais ou superiores a 38 °C), todos diagnosticados com o TempTest® versão 4.0; 4 urticárias colinérgicas, diagnosticados através do Teste Modificado para Urticária Colinérgica - HUCFF-UFRJ e 1 urticária vibratória. Nenhum paciente apresentou teste positivo para urticária solar ou aquagênica. Sete pacientes foram negativos. Conclusão: Os testes de provocação, através do estímulo direto e seguro com o desencadeante, permitem ao médico avaliador e ao paciente a compreensão e a confirmação do estímulo causador da enfermidade em questão e seus limiares.

Introduction: Urticaria is determined by mast cell activation that presents as wheals, angioedema, or both. Urticaria is classified according to its duration into two forms: acute (< 6 weeks) and chronic (> 6 weeks). Chronic urticaria includes chronic spontaneous urticaria and chronic inducible urticaria. Chronic inducible urticarias include dermographism, delayed pressure urticaria, cold, heat, solar, aquagenic, cholinergic, and vibratory urticaria/angioedema. Chronic inducible urticaria can be diagnosed through clinical history, physical examination, and the reproduction of lesions through provocation tests. Objective: To describe the profile of positive provocation tests for chronic inducible urticaria performed at an urticaria center of reference and excellence (GA2LEN UCARE). Methods: We retrospectively evaluated the results of provocation tests performed between December 2017 and September 2021 in 114 patients with a history suggestive of one or more types of chronic inducible urticaria. Results: The sample included 88 (77%) female and 26 (23%) male patients. The following were diagnosed through positive provocation tests: 65 cases of dermographism (FricTest® and/or dermographometer); 23 cases of delayed pressure urticaria (all diagnosed with a dermographometer and 11 confirmed with the Warin test); 11 cases of cold urticaria (temperatures ≤ 27°C) and 3 cases of heat urticaria (temperatures ≥ 38°C), all diagnosed with TempTest® 4.0; 4 cases of cholinergic urticaria, all diagnosed with the Modified Test for Cholinergic Urticaria-HUCFFUFRJ, and 1 case of vibratory urticaria. No patient tested positive for solar or aquagenic urticaria. Seven patients have been negative. Conclusion: Provocation tests, which use direct and safe stimuli as triggers, allow physicians and patients to confirm the disease's causative stimulus and its thresholds.

Omalizumab versus cyclosporin-A for the treatment of chronic spontaneous urticaria: can we define better-responding endotypes?

Abstract Background: Chronic Spontaneous Urticaria (CSU) is characterized by recurrent wheals and/or angioedema for longer than 6-weeks. Guidelines recommend Omalizumab (Oma) as first-line and Cyclosporine-A (Cs-A) as second-line treatment in antihistamine resistant CSU. This step-wise algorithm might be time-consuming and costly. Objective: To determine indicators of response to Oma or Cs-A in CSU patients. Methods: We retrospectively analyzed data from seven centers in Turkey; the inclusion criteria for patients were to receive both Oma and Cs-A treatment (not concurrently) at some point in time during their follow-up. Clinical and laboratory features were compared between groups. Results: Among 110 CSU patients; 47 (42.7%) were Oma-responders, 15 (13.6%) were Cs-A-responders, and 24 (21.8%) were both Oma and Cs-A responders and 24 (21.8%) were non-responders to either drug. High CRP levels were more frequent in Cs-A-responders (72.7% vs. 40.3%; p = 0.055). Oma-responders had higher baseline UCT (Urticaria Control Test) scores (6 vs. 4.5; p = 0.045). Responders to both drugs had less angioedema and higher baseline UCT scores compared to other groups (33.3% vs. 62.8%; p = 0.01 and 8 vs. 5; p = 0.017). Non-responders to both drugs had an increased frequency in the female gender and lower baseline UCT scores compared to other groups (87.5% vs. 61.6%; p = 0.017 and 5 vs. 7; p = 0.06). Study Limitations: Retrospective nature, limited number of patients, no control group, the lack of the basophil activation (BAT) or BHRA (basophil histamine release assay) tests. Conclusions: Baseline disease activity assessment, which considers the presence of angioedema and disease activity scores, gender, and CRP levels might be helpful to predict treatment outcomes in CSU patients and to choose the right treatment for each patient. Categorizing patients into particular endotypes could provide treatment optimization and increase treatment success. © 2022 Published by Elsevier España, S.L.U. on behalf of Sociedade Brasileira de Dermatologia. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/).

Perfil clínico de pacientes con urticaria crónica en el Hospital Militar Principal, Guinea-Bisáu / Clinical profile of patients with chronic urticaria at the Main Military Hospital, Guinea-Bissau / Perfil clínico dos doentes com urticária crónica no Hospital Militar Principal, Guiné-Bissau

RESUMEN Introducción: La urticaria crónica es una enfermedad heterogénea delimitada de la piel caracterizada por el desarrollo de ronchas o habones. Objetivo: Determinar las características clínicas y el tratamiento farmacológico indicado en pacientes con diagnóstico de urticaria crónica. Método: Se realizó un estudio cuantitativo, prospectivo, observacional y descriptivo en un universo de 48 pacientes con diagnóstico de urticaria crónica, Hospital Militar Principal, Guinea-Bisáu, 2018-2020. Se midieron las variables: edad, sexo, tipo de urticaria, tiempo de evolución, comorbilidad y tratamiento utilizado en la primera y última consulta registrada, así como la actividad de la enfermedad. Resultados: La edad media fue de 38,52 años con predomino del sexo femenino. El tiempo medio de evolución de la enfermedad fue de 4,67 años y el 70,83 % no presentó angioedema. La urticaria crónica espontánea fue el tipo predominante. La ciproheptadina fue el tratamiento más indicado al inicio del tratamiento y al término del seguimiento su uso se incrementó. El montelukast fue el otro medicamento que incremento su uso al término del seguimiento. La actividad de la enfermedad se redujo con el tratamiento a índices reconocidos como urticaria crónica espontánea controlada. Conclusiones: La urticaria crónica en Guinea-Bisáu tiene una prevalencia y manifestaciones clínicas acorde a lo reportado a nivel mundial con esquemas de tratamiento susceptibles de modificaciones según el inicio del uso de medicamentos recomendados como ciclosporina u omalizumab.

ABSTRACT Introduction: Chronic urticaria is a heterogeneous demarcated skin disease characterized by the development of wheals or hives. Objective: Determination of the clinical characteristics and the pharmacological treatment indicated in patients diagnosed with chronic urticaria. Method: A quantitative, prospective, observational and descriptive study was conducted in a total of 48 patients (the universe) diagnosed with chronic urticaria, Main Military Hospital, Guinea-Bissau, 2018-2020. The following variables were used: age, sex, type of urticaria, time of evolution, comorbidity and treatment used in the first and last recorded consultation, as well as disease activity. Results: The mean age was 38.52 years with a female predominance. The mean time of evolution of the disease was 4.67 years and 70.83% did not present angioedema. Chronic spontaneous urticaria was the predominant type. cyproheptadine was the treatment most indicated to be used at baseline and at the end of treatment follow-up its use increased. montelukast was the other drug that increased its use at the end of follow-up. With the treatment used disease activity was reduced up to rates recognized as controlled chronic spontaneous urticaria. Conclusions: Chronic urticaria in Guinea-Bissau has prevalence and clinical manifestations in line with those reported worldwide, with treatment regimens susceptible to modifications depending on the early use of recommended drugs such as cyclosporine or omalizumab.

RESUMO Introdução: A urticária crônica é uma doença heterogênea delimitada da pele caracterizada pelo desenvolvimento de urticária ou urticária. Objetivo: Determinar as características clínicas e o tratamento farmacológico indicado em pacientes com diagnóstico de urticária crônica. Método: Estudo quantitativo, prospectivo, observacional e descritivo realizado em um universo de 48 pacientes com diagnóstico de urticária crônica, Hospital Militar Principal, Guiné-Bissau, 2018-2020. As variáveis foram mensuradas: idade, sexo, tipo de urticária, tempo de evolução, comorbidade e tratamento utilizado na primeira e última consulta registrada, bem como a atividade da doença. Resultados: A média de idade foi de 38,52 anos com predomínio do sexo feminino. O tempo médio de evolução da doença foi de 4,67 anos e 70,83% não apresentavam angioedema. A urticária crônica espontânea foi o tipo predominante. A ciproeptadina foi o tratamento mais indicado no início do tratamento e ao final do seguimento seu uso aumentou. O montelucaste foi a outra droga que aumentou seu uso ao final do seguimento. A atividade da doença foi reduzida com o tratamento para taxas reconhecidas como urticária crônica espontânea controlada. Conclusões: A urticária crônica na Guiné-Bissau tem prevalência e manifestações clínicas compatíveis com a relatada mundialmente, com esquemas de tratamento que podem ser modificados dependendo do início do uso de medicamentos recomendados como ciclosporina ou omalizumabe.

The therapeutic role of methotrexate in chronic urticaria: A systematic review

Background: Chronic urticaria, in many cases, has an unsatisfactory response to antihistamines. The current recommendations in urticaria do not mention the dose and duration for methotrexate. Aims: This study aims to systematically review the use/efficacy of methotrexate in chronic urticaria. Methods: A systematic search in four databases, that is, PubMed/Medline, Cochrane central, Google Scholar and Clinicaltrials.gov was done to identify studies on the use of methotrexate in chronic urticaria using key words “methotrexate [MeSH terms]” and “urticaria” or “urticaria, chronic” or “urticaria, chronic spontaneous.” Results: Nine articles (study participants 127), including three randomized control trials, one prospective interventional trial without control, three retrospective reviews and two case reports, were identified and finally included in the systematic review. There was a paucity of literature and the three randomized control trials did not show any benefit of methotrexate over antihistamines alone. However, in studies where steroid- dependent cases were given methotrexate, marked benefit was reported with steroid-sparing effect, particularly on methotrexate dose escalation. Limitations: Due to a paucity of published literature on methotrexate in urticaria, a meta-analysis could not be done. Conclusion: In chronic recalcitrant or steroid-dependent cases, methotrexate may be a therapeutic agent of interest; however, current evidence does not point to any added advantage in efficacy over antihistamines. More evidence based on larger, well-executed randomized control trials is needed in the future to get more definitive answers

Guia prático de urticária para grupos especiais de pacientes / Practical guide to urticaria for special patient groups

A urticária crônica é uma condição que afeta mais de um milhão de brasileiros, com grande impacto na qualidade de vida. Mesmo com diretrizes bem difundidas para o seu diagnóstico e tratamento, seu manejo pode ser desafiador em pacientes pediátricos, idosos e gestantes. Para auxiliar o médico especialista nestes casos, o Departamento Científico de Urticária da Associação Brasileira de Alergia e Imunologia elaborou esta revisão com as principais dúvidas e dificuldades referentes ao tema nestes grupos de pacientes.

Chronic urticaria is a condition that affects more than a million Brazilians with a significant impact on quality of life. Although there are well-established guidelines for diagnosis and treatment, the management of chronic urticaria may be challenging in pediatric, older, and pregnant patients. With the purpose of helping specialists manage these cases, the Urticaria Scientific Department of the Brazilian Association of Allergy and Immunology prepared this review with the most common doubts and difficulties about this topic in those patient groups.

Avaliação da qualidade de vida de pacientes com urticária crônica em Aracaju - Sergipe / Analysis of the quality of life of patients with chronic urticaria in Aracaju - Sergipe

Introdução: A urticária crônica é uma doença com prevalência em pelo menos 0,1% da população, definida pela presença de pápulas pruriginosas, angioedema ou ambos por período superior a seis semanas. Os pacientes com urticária crônica têm um severo prejuízo na qualidade de vida. Objetivo: Avaliar o impacto da urticária crônica na qualidade de vida dos portadores da doença dentro de um serviço especializado no estado de Sergipe. Métodos: Trata-se de um estudo descritivo observacional a partir de dados coletados de 40 pacientes atendidos, em 2021, no Serviço de Alergia e Imunologia do Ambulatório de Alergia e Imunologia do Decós Day Hospital, através de dois questionários específicos para a avaliação da qualidade de vida na urticária crônica: o Chronic Urticaria Quality of Life Questionnaire e o Urticaria Control Test. Resultados: Foi possível identificar uma correlação positiva, através do questionário Urticaria Control Test, entre a intensidade dos sintomas e a piora da qualidade de vida (r = 0,774; p < 0,001). Também foi possível identificar uma correlação positiva entre a intensidade dos sintomas e a piora da qualidade de vida, desta vez mensurada pela escala Chronic Urticaria Quality of Life Questionnaire (r = 0,768; p < 0,001). Noventa por cento dos pacientes afirmaram se sentir cansados durante o dia porque não dormiram bem, 87,5% sentem dificuldade para se concentrar, 90% sentem-se nervosos, 80% afirmaram sentirem-se para baixo, 75% disseram ter vergonha das lesões da urticária que aparecem no corpo, e 60% tem vergonha de frequentar lugares públicos. Conclusões: A urticária crônica compromete a qualidade de vida, medida pelos questionários Urticaria Control Test e Chronic Urticaria Quality of Life Questionnaire. O comprometimento da qualidade de vida dos doentes com urticária crônica ocorre principalmente nos aspectos psicológicos, nos relacionamentos sociais e na qualidade do sono.

Introduction: Chronic urticaria is a disease with a prevalence in at least 0.1% of the population, defined by the presence of pruritic papules, angioedema or both for a period longer than six weeks. Patients with chronic urticaria have a severe loss in quality of life. Objective: To assess the impact of chronic urticaria on the quality of life of patients with the disease within a specialized service in the state of Sergipe. Methods: This is a descriptive observational study based on data collected from 40 patients treated, in 2021, at the Allergy and Immunology Service of the Allergy and Immunology Outpatient Clinic of Decós Day Hospital, using two specific questionnaires for quality assessment of life in chronic urticaria: the Chronic Urticaria Quality of Life Questionnaire and the Urticaria Control Test. Results: It was possible to identify a positive correlation, through the Urticaria Control Test questionnaire, between the intensity of symptoms and the worsening of quality of life (r = 0.774, p < 0.001). It was also possible to identify a positive correlation between the intensity of symptoms and worsening quality of life, this time measured by the Chronic Urticaria Quality of Life Questionnaire scale (r = 0.768, p < 0.001). 90% said they felt tired during the day because they didnt sleep well, 87.5% found it difficult to concentrate, 90% felt nervous, 80% said they felt down, 75% said they were ashamed of the urticaria lesions that appear on the body and 60% are ashamed to go to public places. Conclusions: Chronic urticaria compromises quality of life, as measured by the Urticaria Control Test and the Chronic Urticaria Quality of Life Questionnaire. The impairment of the quality of life of patients with chronic urticaria occurs mainly in the psychological aspects, in social relationships and in the quality of sleep.

Urticária aquagênica: relato de caso e revisão de literatura / Aquagenic urticaria: a case report and literature review

A urticária aquagênica é uma forma rara de urticária crônica induzida (UCInd) desencadeada por um estímulo específico. A patogênese não é totalmente compreendida, mas os sintomas se iniciam minutos após a exposição cutânea à água, independentemente de sua temperatura, e as urticas têm o padrão foliculocêntricas. O diagnóstico é confirmado através do teste de provocação, e o tratamento de primeira linha são os anti-histamínicos de segunda geração. Neste artigo, relatamos um caso de urticária aquagênica e fazemos uma breve revisão da literatura sobre o tema.

Aquagenic urticaria is a rare form of chronic inducible urticaria (CIndU) triggered by a specific stimulus. Pathogenesis is not fully understood, but symptoms appear minutes after cutaneous exposure to water, regardless of temperature, and wheals have a folliculocentric pattern. The diagnosis of CIndU is confirmed by provocation testing using established protocols, and first-line treatment is second-generation antihistamines. In this article, we report a case of aquagenic urticaria and provide a brief review of the relevant literature.

Omalizumabe no tratamento de urticária solar refratária aos anti-histamínicos: relato de caso e revisão da literatura / Omalizumab in the treatment of solar urticaria refractory to antihistamines: a case report and literature review

A urticária solar é uma forma rara de urticária crônica induzida (UCInd). Os sintomas se iniciam minutos após a exposição ao sol e persistem por até 2 horas, interferindo nas atividades diárias do paciente, e consequentemente na sua qualidade de vida. O omalizumabe, anticorpo monoclonal anti-IgE já aprovado para o tratamento da urticária crônica espontânea, tem sido utilizado no tratamento das urticárias crônicas induzidas com boa resposta, inclusive na urticária solar. Neste artigo, relatamos um caso de urticária solar refratária aos anti-histaminicos, sua evolução após o uso do omalizumabe, e fazemos uma breve revisão da literatura sobre o tema.

Solar urticaria is a rare form of chronic inducible urticaria. Symptoms start minutes after exposure to the sun and persist for up to 2 hours, interfering with the patients' daily activities and, consequently, their quality of life. Omalizumab, a monoclonal anti-IgE antibody already approved for the treatment of chronic spontaneous urticaria, has been used in the treatment of chronic inducible urticaria, including solar urticaria, with good response. In this article, we report a case of solar urticaria refractory to antihistamines, show the patient's evolution after the use of omalizumab, and briefly review the literature on the subject.

Urticária e a COVID-19 / Urticaria and COVID-19

A pandemia de COVID-19 afetou drasticamente a vida de todos ao redor do planeta, interferindo também na forma de atuarmos como médicos e especialistas. Neste artigo revisamos aspectos importantes da infecção pelo novo coronavírus e sua relação com a urticária.

The COVID-19 pandemic has dramatically affected people's lives around the world and has interfered with how we act as physicians and specialists. In this paper, we review important aspects of the new coronavirus infection and its connection with urticaria.

O estresse diante da pandemia de COVID-19 como fator exacerbador da urticária / Stress during the COVID-19 pandemic as an exacerbating factor for urticaria

Introdução: Os sintomas gerados pela urticária crônica (UC) afetam significativamente a qualidade de vida dos pacientes, e o estresse pode ser um fator de exacerbação. Isso se torna ainda mais importante no atual cenário de pandemia da doença causada pelo coronavírus (COVID-19). Diante da impossibilidade de manter a mesma quantidade de consultas presenciais, surgiu a necessidade de saber como estariam os pacientes com UC: se apresentariam exacerbação da doença de base caso se infectassem com o SARS-CoV-2, se a UC predisporia os pacientes a um quadro mais grave de COVID-19, e se o estresse emocional a que os pacientes estariam sujeitos exacerbaria sua doença de base. Métodos: Trata-se de um estudo observacional retrospectivo com dados coletados através do registro das informações coletadas de pacientes com UC durante remarcação de suas consultas, através de ligações telefônicas. Resultados: Foram incluídos 140 pacientes no estudo, no período de 29/04/2020 a 15/07/2020. O estresse emocional estava presente em 80 pacientes (57,1%), sendo que destes, 30% relataram piora da urticária. A obesidade foi a outra comorbidade mais relatada pelos pacientes com UC (35%). Dos 22 pacientes que procuraram o Pronto-Socorro, 9 (40,9%) foram investigados. Destes, 5 (55,6%) realizaram investigação específica para COVID-19. Conclusões: Durante a pandemia da COVID-19, os nossos pacientes com UC se encontraram mais estressados emocionalmente, e isso foi um fator associado à piora da urticária. A obesidade, no nosso grupo de pacientes, foi muito prevalente.

Introduction: Chronic urticaria (CU) symptoms significantly affect patient quality of life, and stress can be an exacerbating factor. This becomes even more important in the current pandemic setting of the novel coronavirus disease 2019 (COVID-19). Given the impossibility of maintaining the same schedule of in-person medical appointments, there was a need to know how patients with CU would behave: if they would have an exacerbation of the underlying disease if they became infected with SARS-CoV-2, if CU would predispose patients to a more severe form of COVID- 19, and if emotional stress would exacerbate their underlying disease. Methods: This is a retrospective observational study of data collected from records of patients with CU when their medical appointments were rescheduled via telephone call. Results: One hundred and forty patients were included in the study from 4/29/2020 to 7/15/2020. Stress was present in 80 patients (57.1%), of which 30% reported worsening of urticaria. Obesity was the most reported comorbidity in patients with CU (35%). Of the 22 patients who sought emergency care, 9 (40.9%) were investigated. Of these, 5 (55.6%) underwent specific investigation for COVID-19. Conclusions: During the COVID-19 pandemic, our CU patients were found to be more emotionally stressed, and this factor was associated with worsening of urticaria. Obesity, in our group of patients, was very prevalent.

Clinical analysis of Omalizumab in treatment of 28 children with allergic diseases / 中华实用儿科临床杂志

Objective:To investigate the therapeutic effects of Omalizumab in children suffering from multiple allergic diseases.Methods:All children who developed with multiple allergic diseases and were treated with Omalizumab in Department of Pediatrics, Peking University Third Hospital from September 2018 to December 2020 were retrospectively analyzed.Their gender, age, type of allergic disease, serum total IgE (TIgE) and serum allergen-specific IgE (sIgE) levels before treatment, Omalizumab dosage, therapeutic effect and adverse drug reactions were analyzed.Results:In terms of the 28 children who were treated with Omalizumab, the male/female ratio was 17/11, and the age was (9.6±2.7)years.There were 24 cases of asthma (85.7%), 24 cases of allergic rhinitis (85.7%), 9 cases of food allergy (32.1%), 7 cases of atopic dermatitis (25.0%), and 2 cases of chronic urticaria (7.1%), with 26 cases (92.8%) having more than two kinds of allergic diseases, and 28 children having elevated TIgE or sIgE.TIgE was between 39.5 to 3 826.0 kU/L, and the median was 611 kU/L.After treatment, the frequency of wheezing attacks in 24 children with asthma was reduced, the nasal symptoms in 24 children with allergic rhinitis were alleviated, the skin it-ching in 6 children with atopic dermatitis was alleviated, and 1 case had poor improvement, the symptoms in 2 cases with chronic urticaria were alleviated, 9 children had food allergy and 3 cases reached tolerance.Conclusions:The treatment of allergic diseases in children, apart from asthma, Omalizumab is suitable for allergic rhinitis, atopic dermatitis and chronic urticaria.In the treatment of food allergy, it also has the function of increasing the threshold of food allergen tolerance.There are significant therapeutic benefits in children with multiple allergic diseases or being allergic to multiple allergens.

Effects of Yinlian Qufeng decoction on chronic urticaria and the level of IgE and T cell subsets / 药学实践杂志

Objective To study the clinical effects of Yinlian Qufeng decoction in the treatment of chronic urticaria (CU) and the effects on the changes of serum IgE and T cell subsets (CD4+, CD8+). Methods 96 patients were randomly divided into two groups, treatment group and control group, with 48 cases in each group. The treatment group was treated with Yinlian Qufeng decoction, while the control group was treated with desloratadine dispersible tablets for 8 weeks. The clinical symptom score, TCM syndrome score and quality of life [skin disease quality of life index (DLQI)] of the two groups were evaluated before and after treatment. The serum levels of IgE and CD4+ and CD8+ were measured by ELISA and flow cytometry. Clinical effect was observed and the rate of adverse reactions was counted. Results There was no statistically difference between two groups in clinical symptom scores, TCM syndrome scores, DLQI, the levels of IgE, CD4+, CD8+, and the ratio of CD4+/CD8+ before treatment (P>0.05). After treatment, the clinical symptoms, TCM syndromes and DLQI were reduced in both groups. The treatment group had lower scores than that in control group with statistical significance（P < 0.05). CD4+ level and ratio of CD4+/CD8+ were increased, while IgE and CD8+ levels were decreased in both groups after treatment with statistical significance (P < 0.01). The changes of above indexes in the treatment group were better than those in the control group with statistical significance (P < 0.01). The effective rates of the two groups were 91.67% and 77.08% and rates of adverse reactions were 6.25% and 20.83% separately with statistical difference (P < 0.05). Conclusion Yinlian Qufeng decoction can effectively regulate the cellular immune function, alleviate the disease symptoms and improve life quality with few adverse reactions. This decoction deserves the promotion for clinical application.

A Case Report of Chronic Idiopathic Urticaria Successfully Treated with Kampo Formula, Seijobofuto and Inchingoreisan / 日本東洋医学雑誌

We report a case of a 51-year-old male who suffered from chronic idiopathic urticaria on every part of his body. Urticaria appeared especially in the morning and evening. He visited our Kampo clinic because of insufficient effect of antihistamine drug and tokiinshi that had been prescribed by a dermatologist for about a half year. We thought this might be caused by blood deficiency, blood stasis and liver qi depression because he had symptoms of sensitiveness of heat, dry skin, purple tongue with yellow fur, a deeply located string-like pulse,and fullness in the chest and hypochondrium. Therefore, we administered keigairengyoto and ryutanshakanto but the effect was insufficient. During this treatment, we revealed his state of having thick fur in tonguediagnosis. Finally we prescribed him seijobofuto and inchingoreisan because we concluded that it might be necessary to remove dampness-heat in this case. His symptom improved within about a week after taking this formulation. Some cases of chronic urticaria are resistant to standard treatments in modern western medicine. Kampo medicine may be useful and hopeful in these cases.

Regulatory Effect of Qingzhenfang on Cellular Immune Function of Patients with Chronic Urticaria / 中国实验方剂学杂志

Objective:To observe the clinical efficacy of Qingzhenfang for plasmoby （chronic urticaria）， and to investigate its effect on cellular immune function. Method:One hundred and thirty-two cases patients were divided into control group and observation group evenly according to random number table. The 60 patients in control group finished the study because of 6 cases of dropout， loss of follow-up and withdrawal， and 62 patients in observation group finished the study. Patients in both groups got Yiebastine tablets， 10-20 mg/time， 1 time/day. Patients in control group additionally got Piminxiao capsule， 4 grains/time， 3 times/day， while patients in observation additionally got Qingzhenfang， 1 dose/day. The treatment continued for 8 weeks in both groups. Before the treatment， and at the second， fourth， and eighth week after treatment， scores of urticaria activity for 7 days （USA7） and total symptom score （TSS） were graded. Before and after treatment， scores of chronic urticaria quality of life scale （CU-Q2oL） and syndrome of rheumatic fever were graded. A follow-up of 3 months was conducted for the patients whose score of USA7 was less than 7 to record the recurrence. Complement 3 and 4 （C3， C4）， CD4⁺， CD8⁺ cells were detected， and Th17/ CD4⁺ and Treg/ CD4⁺， CD4⁺/CD8⁺ and Th17/Treg were calculated. Levels of peripheral blood interleukin-10 （IL-10）， IL-17 and IL-23 were detected， and safety was evaluated after the treatment. Result:At the second， fourth and eighth week after the treatment， scores of USA7， TSS， CU-Q2oL and syndrome of rheumatic fever in observation group were lower than those in the control group （<italic>P</italic><0.01）. Levels of C3， C4， CD4⁺， Treg， CD4⁺/CD8⁺and IL-35 in observation group were higher than those levels detected in control group （<italic>P</italic><0.01）， while levels of CD8⁺， Th17， Th17/Treg， IL-10， IL-17 and IL-23 were lower than those in the control group （<italic>P</italic><0.01）. Recurrence rate was 25.58% （11/43） in observation group， lower than 48.48% （16/33） in control group （<inline-formula><alternatives><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:msup><mml:mrow><mml:mi>χ</mml:mi></mml:mrow><mml:mrow><mml:mn mathvariant="normal">2</mml:mn></mml:mrow></mml:msup></mml:math><graphic specific-use="big" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/19F4CEA3-4719-4fe6-AFE8-81E481AA497E-M002.jpg"><?fx-imagestate width="3.30199981" height="3.64066648"?></graphic><graphic specific-use="small" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/19F4CEA3-4719-4fe6-AFE8-81E481AA497E-M002c.jpg"><?fx-imagestate width="3.30199981" height="3.64066648"?></graphic></alternatives></inline-formula>=4.276， <italic>P</italic><0.05）， and the clinical efficacy in observation group was superior to that in control group （<italic>Z</italic>=2.021， <italic>P</italic><0.05）. Conclusion:Yaoyi Qingzhenfang can control the degree of disease and improve the quality of life for patients with chronic urticaria， with superior clinical efficacy. In addition， it can reduce recurrence rate， increase the levels of C3， C4， regulate cellular immune function， and reduce immune inflammatory response， so it is worthy of further clinical research and use.

Chronic urticaria in a two year old child: a diagnostic dilemma

A 2 year old child presented with history of recurrent urticaria for 2 months. The cause was initially idiopathic. On close questioning about diet and observation it was found that mother started using a coriander based masala powder 2 months back and it was found that the child was allergic to coriander. Chronic urticaria should be dealt with extreme caution and careful elicitation of history for the offending agent should be taken in a case of urticaria which poses as a diagnostic dilemma.