Topical corticosteroids for hives and itch (urticaria): systematic review and Bayesian meta-analysis of randomized trials.

BACKGROUND: Topical corticosteroids are widely used as a treatment for itch and wheals (urticaria), but their benefits and harms are unclear. OBJECTIVE: To systematically synthesize the benefits and harms of topical corticosteroids for the treatment of urticaria. METHODS: We searched MEDLINE, EMBASE, and CENTRAL from database inception to March 23, 2024, for randomized trials addressing comparing topical corticosteroid to placebo for patients with urticaria (either chronic spontaneous or inducible urticaria or acute urticaria elicited from skin/intradermal allergy testing). Paired reviewers independently screened records, extracted data, and assessed risk of bias. Random-effects meta-analyses addressed urticaria severity, itch severity (numeric rating scale; range 0-10; higher is worse), and adverse events. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach informed certainty of evidence ratings. PROSPERO registration: CRD42023455182. RESULTS: Nineteen RCTs enrolled 379 participants with a median of mean age of 30.1 years (range 21.1 to 44.0). Compared to placebo, topical corticosteroids may reduce wheal size (ratio of means 0.47, 95%CI 0.38 to 0.59; low certainty) and itch severity (mean difference -1.30, 95%CI -5.07 to 2.46; very low certainty). Topical corticosteroids result in little to no difference in overall adverse events (94 fewer patients per 1000, 95%CrI 172 fewer to 12 more; high certainty). CONCLUSION: Compared to placebo, topical corticosteroids may result in a reduction of wheal size, and result in little to no difference in overall adverse events. Topical corticosteroids may reduce itch severity, but the evidence is very uncertain. Future large, randomized trials addressing the use of topical corticosteroids would further support optimal urticaria management.

Leukotriene receptor antagonists as add-on therapy to antihistamines for urticaria: a systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: The benefits and harms of adding antileukotrienes to H1-antihistamines for the management of urticaria (hives, itch, and/or angioedema) remain unclear. OBJECTIVE: We sought to systematically synthesize the treatment outcomes of antileukotrienes in combination with H1-antihistamines versus H1-antihistamines alone for acute and chronic urticaria. METHODS: As part of updating American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma, and Immunology Joint Task Force on Practice Parameters urticaria guidelines, we searched MEDLINE, Embase, CENTRAL, LILACS, WPRIM, IBECS, ICTRP, CBM, CNKI, VIP, Wanfang, FDA, and EMA databases from inception to December 18th, 2023 for randomized controlled trials (RCTs) evaluating antileukotrienes and H1-antihistamines versus H1-antihistamines alone in patients with urticaria. Paired reviewers independently screened citations, extracted data, and assessed risk of bias. Random effects models pooled effect estimates for urticaria activity, itch, wheal, sleep, quality of life, and harms. The GRADE approach informed certainty of evidence ratings. Open Science Framework registration: https://osf.io/h2bfx/. RESULTS: Thirty-four RCTs enrolled 3,324 children and adults. Compared to H1-antihistamines alone, the combination of a leukotriene receptor antagonist (LTRA) with H1-antihistamines probably modestly reduces urticaria activity (mean difference: -5.04, 95%CI -6.36 to -3.71; 7-day Urticaria Activity Score) with moderate certainty. We made similar findings for itch and wheal severity, and quality of life. Adverse events were probably not different between groups (moderate certainty), however, no RCT reported on neuropsychiatric adverse events. CONCLUSION: Among patients with urticaria, adding LTRAs to H1-antihistamines probably modestly improves urticaria activity with little to no increase in overall adverse events. The added risk of neuropsychiatric adverse events in this population with LTRAs is small and uncertain.

Efficacy and Safety of Systemic Corticosteroids for Urticaria: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

BACKGROUND: Short courses of adjunctive systemic corticosteroids are commonly used to treat acute urticaria and chronic urticaria flares (both with and without mast cell-mediated angioedema), but their benefits and harms are unclear. OBJECTIVE: To evaluate the efficacy and safety of treating acute urticaria or chronic urticaria flares with versus without systemic corticosteroids. METHODS: We searched the MEDLINE, EMBASE, CENTRAL, CNKI, VIP, Wanfang, and CBM databases from inception to July 8, 2023, for randomized controlled trials of treating urticaria with versus without systemic corticosteroids. Paired reviewers independently screened records, extracted data, and appraised risk of bias with the Cochrane 2.0 tool. We performed random-effects meta-analyses of urticaria activity, itch severity, and adverse events. We assessed certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) approach. RESULTS: We identified 12 randomized trials enrolling 944 patients. For patients with low or moderate probability (17.5%-64%) to improve with antihistamines alone, add-on systemic corticosteroids likely improve urticaria activity by a 14% to 15% absolute difference (odds ratio [OR], 2.17, 95% confidence interval [CI]: 1.43-3.31; number needed to treat [NNT], 7; moderate certainty). Among patients with a high chance (95.8%) for urticaria to improve with antihistamines alone, add-on systemic corticosteroids likely improved urticaria activity by a 2.2% absolute difference (NNT, 45; moderate certainty). Corticosteroids may improve itch severity (OR, 2.44; 95% CI: 0.87-6.83; risk difference, 9%; NNT, 11; low certainty). Systemic corticosteroids also likely increase adverse events (OR, 2.76; 95% CI: 1.00-7.62; risk difference, 15%; number needed to harm, 9; moderate certainty). CONCLUSIONS: Systemic corticosteroids for acute urticaria or chronic urticaria exacerbations likely improve urticaria, depending on antihistamine responsiveness, but also likely increase adverse effects in approximately 15% more.

Boric acid crosslinked chitosan microcapsules loaded with frankincense oil for the development of mosquito-repellent, antibacterial, antioxidant, and flame-retardant cotton.

In ancient times, textiles were only used for covering the human body. Nowadays, people are looking for functional textiles to provide additional functional properties. In the present work, an attempt was made to develop chitosan and boric acid-based microcapsules loaded with frankincense oil. Application of these microcapsules was done on cotton using a pad-dry method. The release rate, encapsulation efficiency and microencapsulation yield of microcapsules, and functional properties of finished fabric were studied. The prepared microcapsules were also characterised by different techniques like SEM, FTIR, TGA, and EDX. The finished fabric exhibited mosquito repellency (100 %), antioxidant activity (>66 %), antibacterial activity against E. coli (88.69 %) and S. aureus (94.5 %), and LOI of 24 with a pleasant aroma.

Laccase-assisted colouration of wool fabric using green tea extract for imparting antioxidant, antibacterial, and UV protection activities.

The demand for natural dyes for imparting sustainable dyeing effects to textiles is increasing. Metal mordants generate an unstainable impact in the natural dyeing of textiles. In order to avoid the toxic effect due to the use of metal mordants, the present work uses enzyme for sustainable natural dyeing of wool. The current study is aimed at preparing multifunctional wool fabric using natural dye green tea (Camellia sinensis). Laccase (an enzyme) was used to polymerise the phenolic compounds of Camellia sinensis in situ on wool. The in situ colouration of wool fabric was performed at various varying dyeing conditions (temperature, time, and concentrations) using laccase. Colouration properties (colour values and strength) were examined to estimate the appearance of dyed fabrics. The evaluation of dyed fabrics for functional properties such as antibacterial, antioxidant, and UV protection was done. The efficient functional properties viz, antibacterial activity (> 75%), antioxidant property (> 90%), and excellent UV protection, were obtained. FTIR analysis of separately prepared polymeric dye and the dyed fabric was also done to confirm the laccase-assisted polymerisation. Thus, a novel approach of enzymatic functional natural dyeing of wool was explored.

Synthesis of a Novel Cationic Dye to Impart Mosquito-Repellent and UV Protection to an Acrylic Fabric.

The growing demand for innovative routes to develop functional textiles initiated the necessity of new efficient functional molecules. Dyes can provide durable functional protection to textiles due to their ability to generate strong dye-fiber interaction. New dyes to improve a dyed substrate's quality and aesthetic appearance are in huge demand. This research aims to prepare a mosquito-repellent and UV-protective acrylic fabric using a novel cationic (basic) dye. The cationic dye was synthesized and thoroughly characterized with the help of FTIR, 1H NMR, 13C NMR, and CHN analysis. The dye was further used for the dyeing of the acrylic fabric by using an infrared dyeing machine. To analyze the suitability of dyed fabrics for daily use, washing, rubbing, and light fastness of dyed fabrics were determined. The amount of dye (%) taken up by the acrylic fabric (exhaustion %) was determined, and more than 72% of exhaustion was obtained. The fixation (%) of the dye on acrylic fabrics was also quantified, and more than 80% fixation was obtained. The coloration properties of the dyed fabrics (L*, a*, b*, and K/S) were examined. The dyed fabrics showed a K/S of more than 3. The mosquito-repellent action provided by the dyed fabrics was also analyzed, and 100% repellency was obtained. The dyed fabrics provided an excellent UV-protective property. The multifunctional properties of dyed fabrics were retained significantly even after laundering treatments. The dyed fabrics were characterized using X-ray diffraction and thermogravimetric analysis. A reduction in crystalline peak intensity after dyeing was obtained. The dyed and undyed fabrics were also tested for their tensile strength.

Thermostable bacterial laccase for sustainable dyeing using plant phenols.

Laccase is regarded as an efficacious eco-friendly enzyme in various industries. Thus, various laccases have been explored to mitigate the environmental effects of conventional industrial processing; however, the prospects of laccase in hair dyeing have not been thoroughly explored to date. On account of the adverse environmental and health-related issues posed by chemical hair dyeing, laccase as a natural alternative in dyeing hair has recently gained attention. In this study, we executed hair dyeing with different colours and shades of hair dyes developed from natural plant phenols, including ferulic acid, gallic acid, catechol, and syringaldehyde, catalysed by a novel thermostable bacterial laccase (LacT) from Brevibacillus agri. The dyed hair was characterised in terms of its colourimetric parameters (L*, a*, and b*), colour strength (K/S), reflectance (R) and colour durability. L* means luminosity and is defined by L* values from 0 (black) to 100 (white). A positive value of a* means red shades and a negative value indicates green shades. A positive value of b* shows yellow shades and a negative value indicates blue shades. Optical microscopy of circular and longitudinal sections of the dyed hair revealed that the laccase-catalysed dyes did not merely stick to the surface; instead, they well-penetrated the hair. Furthermore, the dyeing process did not affect the surface morphology of the dyed hair. The dyed hair also exhibited a desirable range of colour diversity in terms of market-driven demands and showed considerable resistance to fading during shampooing and pH alterations. Post-dyeing, the texture and tensile strength of the dyed hair remained nearly unchanged. Overall, the outcomes suggest that LacT holds high potential to be exploited extensively in the hair dyeing industry as an alternative to chemical hair dyes.

Preparation of mosquito repellent, antibacterial and UV protective cotton using a novel, chitosan-based polymeric dye.

With the increasing population of mosquitoes due to urbanisation, requirement for effective mosquito repellent gadgets is rising. To guarantee the security from mosquitoes, dire need is felt to build productive innovations. In the current work, a carbohydrate-based textile fibre was functionalised for imparting colour, mosquito repellency, antibacterial activity and UV protection using a novel polymeric dye. Mosquito repellent 4-amino N,N-diethyl-meta-toluamide (DEET-NH2) was diazotised and reacted with chitosan for the in-situ preparation of azo polymeric dye. The separately prepared polymeric dye was characterised using FTIR (Fourier Transform Infrared Spectroscopy) analysis. In-situ dyed fabric was thoroughly characterised and evaluated for colouration, mechanical and functional properties. The dyed cotton showed an outstanding mosquito repellency (100%) with good durability. Moreover, antibacterial activity (>78%) and UV protection (good to very good) were also displayed by the dyed cotton. An innovative technique to develop multifunctional carbohydrate-based fibre is developed.

Population-Based Incidence, Severity, and Risk Factors Associated with Treated Acute-Onset COVID-19 mRNA Vaccination-Associated Hypersensitivity Reactions.

BACKGROUND: COVID-19 mRNA vaccination-associated acute-onset hypersensitivity reactions have caused anxiety and may be contributing to vaccine hesitancy. OBJECTIVE: To determine the incidence, severity, and risk factors for treated acute-onset COVID-19 mRNA vaccination-associated hypersensitivity reactions in a well-characterized population. METHODS: All Kaiser Permanente Southern California (KPSC) members who received COVID-19 mRNA vaccinations between December 15, 2020, and March 11, 2021, at a KPSC facility were identified and characterized, along with all treated acute-onset vaccination-associated hypersensitivity events. RESULTS: We identified 391,123 unique vaccine recipients (59.18% female, age 64.19 ± 17.86 years); 215,156 received 2 doses (53.54% Moderna), 157,615 only a first dose (50.13% Moderna) (1961 [1.46%] >2 weeks late getting a second dose), and 18,352 (74.43% Moderna) only a second dose. Only 104 (0.028%) (85.58% female, age 53.18 ± 15.96 years) had treated first dose events, 68 (0.030%) Moderna. Only 32 (0.014%) (93.75% female, age 57.28 ± 17.09 years) had treated second dose events, 21 (0.016%) Moderna. Only 2 (0.00033%) vaccinations resulted in anaphylaxis. Only 27 (20.77%) of those with treated first dose reactions failed to get a second dose. Only 6 of 77 (7.8%) with first dose reactions also had second dose reactions. Individuals with treated events were more likely to be female (P < .0001), younger (P < .0001), and had more pre-existing drug "allergies" (2.11 ± 2.12 vs 1.02 ± 1.41 [P < .0001] for average recipients). CONCLUSIONS: Treated acute-onset hypersensitivity events were mostly benign, more common with first COVID-19 mRNA vaccine doses, more likely to occur in younger females with typical risk factors associated with multiple drug intolerance syndrome, and very unlikely to be primarily immunologically mediated.

The Risk of Allergic Reaction to SARS-CoV-2 Vaccines and Recommended Evaluation and Management: A Systematic Review, Meta-Analysis, GRADE Assessment, and International Consensus Approach.

Concerns for anaphylaxis may hamper severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunization efforts. We convened a multidisciplinary group of international experts in anaphylaxis composed of allergy, infectious disease, emergency medicine, and front-line clinicians to systematically develop recommendations regarding SARS-CoV-2 vaccine immediate allergic reactions. Medline, EMBASE, Web of Science, the World Health Organizstion (WHO) global coronavirus database, and the gray literature (inception, March 19, 2021) were systematically searched. Paired reviewers independently selected studies addressing anaphylaxis after SARS-CoV-2 vaccination, polyethylene glycol (PEG) and polysorbate allergy, and accuracy of allergy testing for SARS-CoV-2 vaccine allergy. Random effects models synthesized the data to inform recommendations based on the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach, agreed upon using a modified Delphi panel. The incidence of SARS-CoV-2 vaccine anaphylaxis is 7.91 cases per million (n = 41,000,000 vaccinations; 95% confidence interval [95% CI] 4.02-15.59; 26 studies, moderate certainty), the incidence of 0.15 cases per million patient-years (95% CI 0.11-0.2), and the sensitivity for PEG skin testing is poor, although specificity is high (15 studies, very low certainty). We recommend vaccination over either no vaccination or performing SARS-CoV-2 vaccine/excipient screening allergy testing for individuals without history of a severe allergic reaction to the SARS-CoV-2 vaccine/excipient, and a shared decision-making paradigm in consultation with an allergy specialist for individuals with a history of a severe allergic reaction to the SARS-CoV-2 vaccine/excipient. We recommend further research to clarify SARS-CoV-2 vaccine/vaccine excipient testing utility in individuals potentially allergic to SARS-CoV2 vaccines or their excipients.

Sustainable Denim Bleaching by a Novel Thermostable Bacterial Laccase.

Laccases have emerged as environment-friendly multifaceted biocatalysts for diverse biotechnological applications. Here, we isolated a high molecular weight (88 kDa) extremophilic laccase (LacT) from Brevibacillus agri, with the aim to exploit its extreme characters in denim bleaching. LacT has been characterized as a thermostable, acidophilic enzyme with high salt, organic solvent, and divalent metal tolerance properties. Denim bleaching efficiency of LacT was optimum at pH 4.0 and appeared to be surpassing over other reported laccases. LacT also exhibited remarkable efficacy in the decolorization of water-soluble health hazardous azo-dyes, and thus transpired to be a promising bio-bleaching and dye decolorizing agent.

Multifunctional modification of cotton using layer-by-layer finishing with chitosan, sodium lignin sulphonate and boric acid.

Functionally modified fabrics produced using sustainable techniques are in huge demand in today's world. In the present work, cotton fabric was modified using layer-by-layer two-stage finishing method using a solution of chitosan in citric acid (CS) and sodium lignin sulphonate (SLS) with boric acid (BA), thus granting several performance traits like wrinkle-free, antibacterial, flame retardant, UV protection and antioxidant properties. The finished fabric was evaluated for several textile properties like tensile strength, bending length, crease recovery, whiteness index and functional properties like antibacterial activity, UV protection, flame retardancy and antioxidant properties under standard conditions. The finished cotton showed an increase in CRA, antibacterial activity in the range 70-89%, UPF in the excellent range, much higher LOI values with a decrease in heat release and antioxidant activity of higher than 93%. The novel method of multifunctional finishing of cotton by layer-by-layer technique is explored.

Functionalization of wool fabric using lignin biomolecules extracted from groundnut shells.

Food and agro-processing industries generate a huge quantity of solid waste which is rich in bio-macromolecules like lignin. The extraction of lignin biomolecules can help in the efficient management of such waste along with the generation of wealth from the waste. The groundnut shells are one of the lignin-rich wastes which could be utilized for the extraction of lignin biomolecules. The present work investigates an innovative approach involving the application of extracted lignin biomolecules for the value-addition to wool fabrics. Metallic mordants were utilized to get a wash-fast attachment of lignin with wool. The change in the appearance of wool fabrics was analyzed using reflectance spectroscopy. The finished fabrics were further evaluated for the functional properties like antioxidant activity, antibacterial activity and UV protection. The functionalized wool fabrics displayed a variety of shades with different combinations of groundnut shell lignin (GSL) and mordant. Thermal stability of treated wool fabrics was analyzed by thermogravimetric analysis. The functionalized wool fabrics showed significant antioxidant activity (69.5-84.5%), antibacterial activity (79.7-86.3%) and UV protection (UPF ratings of 50+).

Effect of omalizumab on outcomes in patients with aspirin-exacerbated respiratory disease.

Background: The current treatment for patients with aspirin-exacerbated respiratory disease (AERD) who have uncontrolled asthma or chronic rhinosinusitis is aspirin desensitization. For patients who are unable to undergo or do not benefit from aspirin desensitization, treatment with biologics is an option, although efficacy data for AERD is scarce. Objective: We reported a series of patients with AERD who were started on omalizumab and measured the outcomes to assess improvement. Methods: Adult patients with AERD who were initiated on omalizumab from January 2007 to January 2018 were included. We compared outcomes 6-12 months before initiating biologic therapy and during the last 6-12 months while they were on biologic therapy. Our study investigated the number of oral steroid courses, short-acting beta-agonists (SABA), antibiotics for sinusitis or pneumonia, emergency department visits, hospitalizations, pulmonary function tests, and changes in controller medications. Results: Twenty-nine patients were placed on omalizumab. Sixty-two percent demonstrated a reduction in the number of steroid courses (p = 0.0014) and number of SABA canisters used (p = 0.0005) during their last 12 months while on omalizumab. Eighty-six percent of the patients with AERD and on omalizumab demonstrated either a decrease in the number of steroid courses or number of SABA canisters used in the last year of the study. The patients with AERD and with concomitant immunoglobulin E (IgE) mediated respiratory disease showed a statistically significant reduction in the number of steroid courses and number of SABA canisters used while on omalizumab for 1 year (p = 0.002 and p = 0.005, respectively), whereas those without concomitant IgE-mediated respiratory disease did not have a substantial reduction in steroids or SABA canisters used. Conclusion: Our case series reported that omalizumab could effectively be used as an adjunct treatment for AERD, but additional larger and longitudinal studies are needed to corroborate these findings.

Synthesis of New ß-Lactams Bearing the Biologically Important Morpholine Ring and POM Analyses of Their Antimicrobial and Antimalarial Activities.

Some new ß-lactams bearing biologically important morpholine ring have been synthesized by acylation of amino ß-lactams in the presence of morpholine-4-carbonyl chloride. These novel ß-lactams were prepared under mild reaction conditions without any solvent in short reaction times. Their biological activities have been examined against microbial agents such as Staphylococcus aureus (S. aureus), Escherichia coli (E. coli), Pseudomonas aeruginosa (P. aeruginosa) and fungi such as Candida albicans (C. albicans) and Candida glabrata (C. glabrata). They have been also tested against Plasmodium falciparum K14 resistant strain and showed moderate to good IC50 values.

Development of multifunctional linen fabric using chitosan film as a template for immobilization of in-situ generated CeO2 nanoparticles.

Linen fabric lacks functional properties which can be imparted using CeO2 nanoparticles; however, the efficiency and durability against the repeated washing is always a big limitation. Wash-durable functionalization thus can be achieved by surface modification using chitosan-based recipes which can also impart additional functional properties to linen. In the present work, the modification of linen fabric was achieved using a chitosan-based recipe followed by in-situ synthesis of CeO2 nanoparticles on chitosan-treated fabrics. The modified fabric was characterized using FTIR, TGA, SEM and EDX techniques and further evaluated towards functional properties. The modified linen displayed highly effective antibacterial activity against S. aureus and E. coli bacteria. The additional functional properties like wrinkle resistance, UV protection and flame retardancy were also achieved using such dual modification. Most of the functional properties were retained in a satisfactory level after five subsequent washes. The modified linen thus can be claimed as a suitable candidate for functional apparels and technical textiles.

Development of a pediatric asthma predictive index for hospitalization.

BACKGROUND: Variation in emergency department (ED) management for asthma exacerbation leads to disparities in care. Current asthma severity scores are insufficient to be used for hospitalization decisions. OBJECTIVE: To develop and internally validate an asthma predictive index for hospitalization (APIH) to guide practitioners in their admission decision for children with asthma exacerbations. METHODS: Data were collected from 12,066 children between 5 and 18 years old diagnosed with asthma exacerbation in the ED. Epidemiologic findings, number of inhaled corticosteroid canisters, short-acting ß-blocker canisters, oral steroids, coexisting atopy, family history of atopy, insurance, and prior asthma ED visits or hospitalizations were compared between patients hospitalized and discharged. We used univariate analysis and multivariate analysis to determine the best predictor variables for hospitalization. Our study internally validated the prediction index to estimate future performance of the prediction rule. RESULTS: The highest risk factors associated with asthma hospitalization from the ED are oxygen saturation less than 94%, respiratory rate greater than 31/min, history of pneumonia, and asthma ED visits in past 12 months. With a reduced predictive model that combined these risk factors, the odds ratio was 44.9 (95% CI, 32.8-61.4), which is extremely significant. Our C index of discrimination of 0.77 was similar to the validation C index of 0.78, which confirms a solid prediction model. CONCLUSION: We have developed and internally validated a pediatric hospitalization prediction index for acute asthma exacerbation in the ED. Further studies are needed to externally validate the APIH before its implementation into clinical practice.