Anti IgE Therapy in Chronic Urticaria

The crucial position of IgE within the pathogenesis of allergic diseases made it a key target for therapy. The inhibition of the allergic inflammatory cascade by anti-immunoglobulin E (IgE) therapy is a new and promising concept in the treatment of these diseases. Currently available anti-IgE agent omalizumab has been started to be used in past 3 years in the cases of chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CINDU), resistant to the first-, second-, and some third-line treatments. The use of omalizumab as an effective and safe biological therapy for inadequately controlled severe, persistent patients with CSU and CINDU provided a valuable new treatment option for these patients. However, the data about possible mechanisms of anti-IgE therapy in these patients, treatment strategies and dose regimens of anti-IgE therapy are different, and special patient groups and possible side effects are still insufficient. Also, studies about possible future anti-IgE treatment options are ongoing in CSU

Clinical effects of COVID-19 vaccines on chronic spontaneous urticaria patients: a study on two Turkish centers

BackgroundThe relationship between CSU and vaccines is reported in the literature. The post-vaccine clinical effect of COVİD-19 vaccines on CSU patients is still unclear. we aimed to evaluate clinical effects of COVID-19 Vaccines on CSU patients.Materials and methodsCSU patients under treatment and follow-up in our outpatient clinic were evaluated retrospectively. To determine disease activity the urticaria activity score over seven days (UAS7) was used. The details of demographic information, CSU treatment, history of COVID-19 infection and exacerbation of urticaria during infection, COVID-19 vaccinations, type of vaccine, side effect reaction time after vaccination, hospital admission requirement were also assessed.ResultsTotal of 190 patients with a mean age of The mean age of patients was 41,7±14,0 years (range = 18–72) were enrooled. The patient sample consisted of 50 males and 140 females (male/female ratio 1:2.8). 181 (CoronaVac 77, Pfizer-BioNTech 104) patients were vaccinated. Urticarial exacerbation was occurred in 25 patients. The median UAS value was 5 before vaccination, it was 12 in patients with post-vaccine urticaria. Two patients had angioedema and one patient had anaphylaxis after vaccinated with Pfizer-BioNTech.ConclusionCOVID-19 vaccination in the CSU can be considered safe. Cases with urticarial exacerbation appear to be transient and can be managed by antihistamine and/or systemic steroid therapies. More extensive studies are needed for the relationship with CSU and post-coronavirus vaccination anaphylaxy

Identification of chronic urticaria subtypes using machine learning algorithms

Chronic urticaria (CU) comes as chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU). Across its types and subtypes, CU is a heterogeneous disease that has different phenotypes with distinct clinical characteristics and different endotypes with distinct underlying pathophysiological mechanisms. It may be possible that subtypes of CU patients exhibit distinct phenotypic disease signatures that can point to differences in what drives their condition and in their response to treatments. Cluster analysis is a popular unsupervised machine learning (ML) method for discovering previously undetected data patterns. ML-based cluster analysis has been used in several diseases for the identification and characterization of patient subgroups. As of now, no study has attempted to identify CU subtypes with this method. Here, we performed a proof-of-concept study to test whether cluster analysis using ML algorithms can identify subgroups of CU patients based on clinical and routine laboratory characteristics.This project benefitted from the support (non-financial) of the GA2LEN network of urticaria centers of reference and excellence (UCARE, www.ga2len-ucare.com)

The COVID-19 Pandemic Affects Male Patients With Chronic Spontaneous Urticaria More Than Female Patients

Introduction: The COVID-19 pandemic dramatically disrupts health care for patients with chronic diseases including chronic spontaneous urticaria (CSU). As of now, it is unknown if the effects of the pandemic in CSU are different than in other chronic diseases. We also do not know, if different groups of CSU patients, for example female and male patients, are affected differently. Aim: To understand how CSU patients and subgroups are affected by the COVID-19 pandemic in their disease activity and control and treatment, using psoriasis as control. Patients and Methods: We analyzed 399 patients (450 visits) with CSU or psoriasis assessed during August 2019, i.e. before the pandemic, or August 2020, i.e. during the pandemic, for changes in disease activity, disease control, and the treatment they used, and how these changes are linked to age, gender, and disease duration. Results: Male but not female patients with CSU had markedly increased disease activity during the pandemic. CSU patients' age or disease duration were not linked to changes. Male and female patients with psoriasis showed similar increases in disease activity and decreases in disease control. The rate of omalizumab treatment, during the pandemic, was unchanged in male patients and increased in female patients with CSU. The efficacy of omalizumab treatment, during the pandemic, was reduced in male patients but not female patients with CSU. Conclusion: Male but not female CSU patients, during the COVID-19 pandemic, show loss of disease control linked to loss of omalizumab efficacy. The reasons for this need to be investigated

In Chronic Spontaneous Urticaria, Complete Response to Antihistamine Treatment Is Linked to Low Disease Activity

Introduction: The use of predictors of response to a specific treatment in patients with chronic spontaneous urticaria (CSU) can improve disease management, help prevent unnecessary healthcare costs, and save time. In this study, we aimed to identify predictors of complete response to standard-dosed and higher than standard-dosed antihistamine treatments in patients with CSU. Methods: Medical records of 475 CSU patients, 120 of them <18 years old, from 3 different centers were analyzed. We used 15 machine learning (ML) models as well as traditional statistical methods to predict complete response to standard-dosed and higher than standard-dosed antihistamine treatment based on 17 clinical parameters. Results: CSU disease activity, which was assessed by urticaria activity score (UAS), was the only clinical parameter that predicted complete response to standard-dosed and higher than standard-dosed antihistamine treatment, with ML models and traditional statistics, for all age groups. Based on ROC analyses, optimal cut-off values of disease activity to predict complete response were UAS <3 and UAS <4 for standard-dosed (area under the ROC curve [AUC] = 0.69; p = 0.001) and higher than standard-dosed (AUC = 0.79; p = 0.001) antihistamine treatments, respectively. Also, ML models identified lower total IgE (<150 IU/mL) as a predictor of complete response to a standard-dosed antihistamine and lower CRP (<3.4 mg/mL) as a predictor of complete response to higher than standard-dose antihistamine treatment. Discussion: In this study, we showed that patients with UAS <3 are highly likely to have complete response to standard-dosed AH and those with a UAS <4 are highly likely to have complete response to higher than standard-dosed AH treatment. Low CSU disease activity is the only universal predictor of complete response to AH treatment with both ML models and traditional statistics for all age groups