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

Eating Increases and Exercise Decreases Disease Activity in Patients With Symptomatic Dermographism

© 2022 American Academy of Allergy, Asthma & ImmunologyBackground: Eating can increase disease activity in patients with symptomatic dermographism, the most common subtype of chronic inducible urticaria, but it is unclear how common this is. The effects of exercising on symptomatic dermographism disease activity have also not yet been determined. Objective: To assess the impact of exercise and nonspecific carbohydrate-rich food intake on the severity and intensity of symptomatic dermographism after exercise and nonspecific carbohydrate-rich food intake. Methods: We assessed disease activity by FricTest provocation testing in 75 symptomatic dermographism patients before and after eating, exercising, or both. We determined the rates of food-dependent (FD) symptomatic dermographism and food-exacerbated (FE) symptomatic dermographism. By comparing post- and pre-exercise FricTest scores, we identified complete responders: that is, patients with a negative FricTest response after exercising and partial responders. Finally, we evaluated whether exercise protects patients with FD-symptomatic dermographism or FE-symptomatic dermographism from eating-induced worsening of symptomatic dermographism. Results: Of 64 symptomatic dermographism patients, eight had FD-symptomatic dermographism (13%), 42 had FE-symptomatic dermographism (66%), and 14 patients showed no negative impact of eating on disease activity (21%). Physical exercise reduced FricTest skin provocation test responses in 83% of 58 patients. Exercising protected patients with FD/FE-symptomatic dermographism from worsening of symptomatic dermographism owing to eating in half of cases, with higher rates for exercise after eating (67%) compared with exercise before eating (35%). Conclusions: Our study shows that eating often worsen symptomatic dermographism symptoms, and exercise often improves it. Our findings might aid patients in controlling symptoms better