Acquired Cold Urticaria: Clinical Features, Particular Phenotypes, and Disease Course in a Tertiary Care Center Cohort

BACKGROUND: Data about special phenotypes, natural course, and prognostic variables of patients with acquired cold urticaria (ACU) are scarce. OBJECTIVES: We sought to describe the clinical features and disease course of patients with ACU, with special attention paid to particular phenotypes, and to examine possible parameters that could predict the evolution of the disease. METHODS: This study was a retrospective chart review of 74 patients with ACU who visited a tertiary referral center of urticaria between 2005 and 2015. RESULTS: Fourteen patients (18.9%) presented with life-threatening reactions after cold exposure, and 21 (28.4%) showed negative results after cold stimulation tests (classified as atypical ACU). Nineteen patients (25.7%) achieved complete symptoms resolution at the end of the surveillance period and had no subsequent recurrences. Higher rates of atypical ACU along with a lower likelihood of achieving complete symptom resolution was observed in patients who had an onset of symptoms during childhood (P < .05). In patients with atypical ACU, shorter disease duration and lower doses of antihistamines required for achieving disease control were detected (P < .05). Age at disease onset, symptom severity, and cold urticaria threshold values were found to be related to disease evolution (P < .05). LIMITATIONS: This study was limited by its retrospective nature. CONCLUSIONS: The knowledge of the clinical predictors of the disease evolution along with the clinical features of ACU phenotypes would allow for the establishment of an early and proper therapeutic strategy

Allergen sensitization stratifies IL-31 production by memory T cells in atopic dermatitis patients

Background:The role of allergen sensitization in IL-31 production by T cells and specifically in the clinical context of atopic dermatitis (AD) has not been characterized. MethodsThe response to house dust mite (HDM) in purified memory T cells cocultured with epidermal cells from AD patients (n=58) and control subjects (n=11) was evaluated. AD-associated cytokines from culture supernatants, plasma proteins and mRNA expression from cutaneous lesions were assessed and related with the clinical features of the patients. ResultsHDM-induced IL-31 production by memory T cells defined two subsets of AD patients according to the presence or absence of IL-31 response. Patients in the IL-31 producing group showed a more inflammatory profile, and increased HDM-specific (sp) and total IgE levels compared to the IL-31 non-producing group. A correlation between IL-31 production and patient's pruritus intensity, plasma CCL27 and periostin was detected. When the same patients were analyzed based on sp IgE and total IgE levels, an increased IL-31 in vitro response, as well as type 2 markers in plasma and cutaneous lesions, was found in patients with sp IgE levels > 100 kUA/L and total IgE levels > 1000 kU/L. The IL-31 response by memory T cells was restricted to the cutaneous lymphocyte-associated antigen (CLA)(+) T-cell subset. ConclusionIgE sensitization to HDM allows stratifying IL-31 production by memory T cells in AD patients and relating it to particular clinical phenotypes of the disease

Pruritic nodular secondary syphilis in a 61-year-old man with HIV infection

The typical finding in secondary syphilis stage is a generalized non-pruritic maculopapular eruption. We report a case of secondary syphilis in an HIV-infected patient presenting with pruritic crusted nodules showing numerous eosinophils on the histopathological examinatio

Adaptación transcultural del cuestionario Mastocytosis Quality of Life questionnaire (MC-QoL) del alemán al castellano

Introducción: Las mastocitosis son un grupo de proliferaciones clonales de mastocitos que pueden afectar a distintos órganos y tejidos, siendo la piel uno de los implicados con mayor frecuencia. La clínica está relacionada con la liberación de mediadores proinflamatorios. Diversos estudios han señalado la afectación en la calidad de vida de estos pacientes. El reciente desarrollo en Alemania de un cuestionario específico sobre calidad de vida en pacientes con mastocitosis (Mastocytosis Quality of Life questionnaire [MC-QoL]), con una versión en inglés, supone un paso significativo en la valoración del impacto psicosocial. Objetivo: Realizar la adaptación transcultural al castellano del MC-QoL, garantizando su equivalencia con la versión original. Material y métodos: Metodología de traducción directa, entrevistas cognitivas y traducción inversa, siguiendo los principios de buena práctica de la International Society for Pharmacoeconomics and Outcomes Research. El MC-QoL incluye 27 preguntas estructuradas en 4 dominios: síntomas, emociones, funcionamiento/vida social y sintomatología cutánea. Resultados: La primera versión del cuestionario en español, obtenida por traducción directa de la versión en alemán, se sometió a entrevistas cognitivas, modificándose 3 preguntas para hacerlas más comprensibles. Posteriormente, los autores originales modificaron una pregunta de la versión obtenida por retrotraducción al considerar que había perdido especificidad. Tras mínimas modificaciones en consenso con los autores originales, se obtuvo la versión definitiva en castellano. Conclusión: Se obtiene la adaptación transcultural en castellano de un cuestionario de calidad de vida específico para pacientes con mastocitosis, que podrá ser utilizado en la práctica clínica para una valoración más completa de este grupo de pacientes

Basophil FcεRI expression in chronic spontaneous urticaria: A potential immunological predictor of response to omalizumab therapy.

Although the efficacy of omalizumab has been clearly demonstrated in the treatment of chronic spontaneous urticaria (CSU), its mechanism of action, which results in improvement in CSU symptoms, is not entirely understood. This study investigated the effect of omalizumab on expression of the high-affinity IgE receptor (FcεRI) on blood basophils from patients with active CSU, and its association with the clinical response. Patients exhibiting significant clinical improvement showed a sharp reduction in the levels of basophil FcεRI after 4 weeks, which was maintained throughout the total duration of the treatment. Such evolution was not observed in non-responder patients. Furthermore, non-responders showed significantly lower baseline levels of FcεRI than responders. Baseline basophil FcεRI expression was found to be a potential immunological predictor of response to omalizumab (100% sensitivity and 73.2% specificity). The results of this study contribute to our knowledge of the therapeutic benefit and mechanism of action of anti-IgE therapy in CSU

SEB-induced IL-13 production in CLA+ memory T cells defines Th2 high and Th2 low responders in atopic dermatitis

Data de publicació electrónica: 30-06-202