Search

Background: Omalizumab is the only licensed drug that serves as a third‐line treatment for chronic idiopathic urticaria (CIU). The optimum doses of omalizumab remain controversial. Therefore, this study aims to estimate the efficacy and safety of different doses of omalizumab in the treatment of CIU patients. Materials and methods: Four databases were searched from the database's creation to April 8, 2023. Several keywords such as omalizumab and urticarias were used to retrieve related studies. The meta‐analytical outcomes were analyzed in R 4.2.1 software and Stata 15.1 software. Cochrane risk‐of‐bias tool Ver. 2 was used to evaluate the risk of bias in randomized controlled trials (RCTs). Results: In total, 2331 patients were included. Five indexes were employed to assess, including weekly Itch Severity Score (ISS7), weekly Hive Severity Score (HSS7), weekly Urticaria Activity Score (UAS7), Dermatology Life Quality Index (DLQI), and adverse events (AE). A 300 mg dose of omalizumab was the optimum dose to treat CIU, followed by the 150 mg dose. Furthermore, 600 mg of omalizumab only showed a significant difference from the placebo in HSS7. No significant statistical difference was observed in AE. Meta‐regression analysis revealed that time, as a covariate, was statistically significant in the comparison of omalizumab 150 mg with placebo. Conclusion: 300 mg of omalizumab was the optimum dosage to treat CIU patients, with a 150 mg dose also exhibiting good efficacy. Further studies are required to explore the efficacy and safety of different doses of omalizumab in the treatment of CIU patients. [ABSTRACT FROM AUTHOR]

Introduction: Chronic spontaneous urticaria (CSU) with autoreactivity is often resistant to antihistamines. Autologous whole blood injection (AWBI) has shown potential efficacy in the treatment of this disease, but it is controversial. It is necessary to screen patients who are suitable for this therapy in advance. This study aimed to identify biomarkers that predict the efficacy of AWBI treatment in CSU patients with autoreactivity. Methods: A total of 30 patients with autologous serum skin test-positive CSU treated with AWBI were included in this study; urticaria activity score (UAS7) was recorded and the treatment response was judged based on it. Levels of total serum IgE, anti-high-affinity IgE receptor (FcεRI) IgG, and basophils CD63 and FcεRI expressions, and D-dimer of all patients were determined and analyzed. Results: Baseline levels of total IgE, D-dimer, basophil FcεRI and CD63 expressions showed good correlations with UAS7 variations. D-dimer, basophil FcεRI and CD63 expressions changed significantly before and after AWBI treatment in AWBI responders, and the basophil FcεRI and CD63 expressions consistently and dynamically decreased in AWBI responders during the treatment. Baseline levels of total IgE, D-dimer, basophil FcεRI and CD63 expressions showed certain predictive values for AWBI response. Conclusions: Baseline levels of total IgE, D-dimer, basophil FcεRI and CD63 expressions could be biomarkers of predicting AWBI efficacy in patients with CSU with autoreactivity. [ABSTRACT FROM AUTHOR]

Copyright of Lijecnicki Vjesnik is the property of Croatian Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Fexofenadine hydrochloride (HCl) is a second‐generation, nonsedating, histamine H1‐receptor antagonist used to manage seasonal allergic rhinitis and chronic idiopathic urticaria. A new oral pediatric suspension of fexofenadine HCl has been developed, with the preservative potassium sorbate replacing parabens. The objective of this phase 1 single‐center, open‐label, randomized, 2‐treatment, full‐replicated, 4‐period, 2‐sequence crossover study in healthy adult volunteers was to assess the bioequivalence of 30 mg of the new oral suspension of fexofenadine HCl (test) versus 30 mg of the marketed pediatric oral suspension of fexofenadine HCl (reference). The replicate design was based on the high intra‐individual variability of fexofenadine (>30% on Cmax). The study comprised 68 randomized and treated volunteers. Plasma concentrations of fexofenadine were similar following the administration of a single dose of each formulation. Cmax, AUClast, AUC, median tmax, and mean t1/2z were similar between administrations of the same fexofenadine formulation and between formulations. A high intra‐individual variability was confirmed with both formulations. Bioequivalence of the test and reference fexofenadine HCl formulations was demonstrated as the 90% confidence intervals of the geometric least squares mean ratio for Cmax, AUClast, and AUC of fexofenadine were all within the bioequivalence range of 0.80‐1.25. There were no serious adverse events (AEs) or study discontinuations due to treatment‐emergent AEs with either fexofenadine HCl formulation. The new paraben‐free fexofenadine HCl 30‐mg oral suspension and marketed fexofenadine HCl 30‐mg pediatric oral suspension are bioequivalent under fasting conditions, with no safety concerns and a safety profile consistent with the known profile of fexofenadine. [ABSTRACT FROM AUTHOR]

Not available

Chronic spontaneous urticaria (CSU) is characterized by recurring wheals that last 6 weeks or longer without an identifiable cause. The estimated point prevalence of CSU worldwide is 1%. Furthermore, it has a significant impact on quality of life in both adults and pediatric patients and their families. Although it is most often a self-limited disease, some patients have urticaria refractory to first-line treatment: second-generation H1 antihistamines. In these patients, the use of targeted monoclonal antibodies is necessary. While omalizumab is the only Food and Drug Administration-approved monoclonal antibody for CSU, others, including ligelizumab, dupilumab, benralizumab, and several orally administered Bruton's tyrosine kinase inhibitors, are also promising therapeutics for reducing the morbidity of CSU. Novel therapies, among others discussed here, are rapidly being developed with new trials and therapeutics being released nearly monthly. Thus, we performed a scoping literature review of randomized controlled trials studying targeted therapies for CSU. We also discuss the pathophysiology, diagnosis, prognosis, and future research directions in CSU. [ABSTRACT FROM AUTHOR]

Context: Chronic idiopathic urticaria (CIU) is a common clinical condition with a significant impact on the quality of life of its sufferies. Skin prick test (SPT) is a reliable method to detect the allergens and thereby contributing to diagnose of this Type I hypersensitivity. Aims: The aim of this study is to retrospectively analyze the incidence of positive SPT to various allergens in patients with CIU. Subjects and Methods: The data of patients of CIU who had undergone SPT in the dermatology department of a tertiary hospital during the period from July 1, 2018 to December 31, 2019 were reviewed. Evaluation of their history was done with respect to the possible causes and investigations excluding those with a documented history of anaphylaxis, asthma, atopic dermatitis, and dermographism. The results of SPT performed with a battery of 40 allergens (22 aeroallergens and 18 food allergens) obtained from Allergo SPT (Merck specialty Pvt. Ltd., Allergopharma, Darmstadt, Germany), were retrieved and analyzed. Statistical Analysis Used: The data of the 38 patients with CIU who had undergone SPT was entered in Microsoft Excel (MS Office 2016) and then analyzed with descriptive statistics. Results: Overall SPT positivity of these 38 patients was 73.68% and that to food allergens (10.53%), aeroallergens (26.31%), and both aero and food allergens (36.84%). Conclusions: Our study unlike earlier reports in literature ruled out those with clinical as well as laboratory evidence of a topic, disorders which secondarily cause urticaria, thus emphasizing SPT to be an important add-on diagnostic tool even in those cases of CIU which have no obvious exacerbating factors. A significant number of CIU patients of our study showed sensitivity to house dust mite, molds, pollen, food items, and animal epithelia on SPT.

Background : there are many causes involved recently to explain the mechanism of chronic idiopathic urticarial or its resistant to treatment one of these is the presence of Helicobacter pylori which related to GIT infections in these patients, they may complaining it like nausea, vomiting or abdominal pain or may be asymptomatic.multiple methods could be used to confirm the diagnosis; invasive and non - invasive maneuvers the most cheap and available one is the stool antigen test from stool analysis which give real Results from the intial days of infection and used to follow up the patients. The aim of this review article is to evaluate the effect of eradication therapy for H.pylori on chronic urticarial patients Conclusion: There is significant association of Helicobacter pylori infection with chronic urticaria. Eradication of H. pylori using triple or most Recent quadrable therapy is a valid therapeutic option for patients with chronic idiopathic urticaria and positive stool antigen test.

This article, published in Dermatology Reports, presents two case reports of patients with chronic spontaneous urticaria (CSU) who were treated with omalizumab and subsequently contracted COVID-19. In both cases, the patients experienced mild symptoms and their urticaria remained under control. The authors suggest that omalizumab may be safe and potentially beneficial for patients with CSU who contract COVID-19, although further research is needed. They also note that the literature indicates a tendency for CSU to worsen during COVID-19 infection, but in these cases, the protective action of omalizumab may have prevented exacerbation of symptoms. [Extracted from the article]

Context: Chronic idiopathic urticaria (CIU) is a common clinical condition with a significant impact on the quality of life of its sufferies. Skin prick test (SPT) is a reliable method to detect the allergens and thereby contributing to diagnose of this Type I hypersensitivity. Aims: The aim of this study is to retrospectively analyze the incidence of positive SPT to various allergens in patients with CIU. Subjects and Methods: The data of patients of CIU who had undergone SPT in the dermatology department of a tertiary hospital during the period from July 1, 2018 to December 31, 2019 were reviewed. Evaluation of their history was done with respect to the possible causes and investigations excluding those with a documented history of anaphylaxis, asthma, atopic dermatitis, and dermographism. The results of SPT performed with a battery of 40 allergens (22 aeroallergens and 18 food allergens) obtained from Allergo SPT (Merck specialty Pvt. Ltd., Allergopharma, Darmstadt, Germany), were retrieved and analyzed. Statistical Analysis Used: The data of the 38 patients with CIU who had undergone SPT was entered in Microsoft Excel (MS Office 2016) and then analyzed with descriptive statistics. Results: Overall SPT positivity of these 38 patients was 73.68% and that to food allergens (10.53%), aeroallergens (26.31%), and both aero and food allergens (36.84%). Conclusions: Our study unlike earlier reports in literature ruled out those with clinical as well as laboratory evidence of a topic, disorders which secondarily cause urticaria, thus emphasizing SPT to be an important add-on diagnostic tool even in those cases of CIU which have no obvious exacerbating factors. A significant number of CIU patients of our study showed sensitivity to house dust mite, molds, pollen, food items, and animal epithelia on SPT. [ABSTRACT FROM AUTHOR]

Introduction: Urticaria is a frequent and heterogeneous skin disease characterised by the development of wheals (hives), angioedema, or both. Chronic urticaria is characterised by the occurrence of wheals lasting less than 24 hours, with or without angioedema occurring daily or almost daily lasting more than six weeks. The two subtypes of chronic urticaria are Chronic Spontaneous Urticaria (CSU) and Chronic Inducible Urticaria (CIU). Autologous Serum Skin Test (ASST) is the simplest and the best in-vivo clinical test for the detection of basophil histaminereleasing activity. ASST has a sensitivity of approximately 70% and a specificity of 80%. Aim: To study the association between clinico-epidemiological features of CSU with positive and negative ASST. Materials and Methods: The cross-sectional study was conducted on 80 clinically diagnosed cases of CSU attending the Department of Dermatology Venereology Leprology Outpatient Department at Mahatma Gandhi Memorial Hospital (Kakatiya Medical College), Warangal, Telangana, India; during the period of January 2016 to September 2017. The detailed history was taken; complete physical and cutaneous examination and laboratory investigations like Complete Blood Picture (CBP), Absolute Eosinophil Count (AEC), Erythrocytic Sedimentation Rate (ESR), Thyroid Function Test (TFT) were carried out. ASST was done and read after 30 minutes. Chi-square test was applied and the results analysed using Statistical Package for the Social Sciences (SPSS) version 10.0. Results: Out of total 80 patients included in the study, ASST was positive in 36 (45%) and negative in 44 (55%). ASST positive patients showed longer duration of the disease with increased frequency of attacks and longer duration of wheals. However, both ASST positive and negative groups did not show statistically significant difference in the age of occurrence, gender, angioedema, dermographism. Conclusion: Autoimmune urticaria has no distinctive clinical features. ASST positive, autoimmune urticaria patients have more severe disease with greater impact on quality of life. Thus, they may need more aggressive treatment.

BackgroundThe immunopathogenesis of chronic spontaneous urticaria (CSU) is poorly understood, but recent research suggests that patients can be divided into autoallergic and autoimmune subtypes. Given that not all patients can be controlled with current treatment regimens, including anti-IgE monoclonal antibodies, a better understanding of the immune pathways involved in CSU may enable the repurposing of monoclonal antibodies used for other dermatologic diseases (e.g., Th2 and Th17 inhibitors). Therefore, we investigated the implicated immune cells and pathways by reanalyzing publicly available transcriptomic data.MethodsMicroarray data of CSU and healthy control (HC) skin and blood were obtained from the Gene Expression Omnibus (GSE72542, GSE57178). Differentially expressed genes were defined as a false discovery rate

Introduction: Urticaria is a frequent and heterogeneous skin disease characterised by the development of wheals (hives), angioedema, or both. Chronic urticaria is characterised by the occurrence of wheals lasting less than 24 hours, with or without angioedema occurring daily or almost daily lasting more than six weeks. The two subtypes of chronic urticaria are Chronic Spontaneous Urticaria (CSU) and Chronic Inducible Urticaria (CIU). Autologous Serum Skin Test (ASST) is the simplest and the best in-vivo clinical test for the detection of basophil histaminereleasing activity. ASST has a sensitivity of approximately 70% and a specificity of 80%. Aim: To study the association between clinico-epidemiological features of CSU with positive and negative ASST. Materials and Methods: The cross-sectional study was conducted on 80 clinically diagnosed cases of CSU attending the Department of Dermatology Venereology Leprology Out Patient Department at Mahatma Gandhi Memorial Hospital (Kakatiya Medical College), Warangal, Telangana, India; during the period of January 2016 to September 2017. The detailed history was taken; complete physical and cutaneous examination and laboratory investigations like Complete Blood Picture (CBP), Absolute Eosinophil Count (AEC), Erythrocytic Sedimentation Rate (ESR), Thyroid Function Test (TFT) were carried out. ASST was done and read after 30 minutes. Chi-square test was applied and the results analysed using Statistical Package for the Social Sciences version 10.0. Results: Out of total 80 patients included in the study, ASST was positive in 36 (45%) and negative in 44 (55%). ASST positive patients showed longer duration of the disease with increased frequency of attacks and longer duration of wheals. However, both ASST positive and negative groups did not show statistically significant difference in the age of occurrence, gender, angioedema, dermographism. Conclusion: Autoimmune urticaria has no distinctive clinical features. ASST positive, autoimmune urticaria patients have more severe disease with greater impact on quality of life. Thus, they may need more aggressive treatment. [ABSTRACT FROM AUTHOR]

Introduction: Chronic idiopathic urticaria is a kind of urticaria, although it doesn’t have known external factor cause, but many studies have shown the role of psychological factors in development of allergic diseases, including the disease. The aim of this study is to compare the anxiety, depression and mental pressures caused by stressful life events in patients with chronic idiopathic urticaria and healthy people. Materials and Methods: This case-control study was performed on 22 patients with chronic idiopathic urticaria compared with 22 healthy subjects. Both groups responded to the checklist for demographic characteristics, Spielberger state/trait personality inventory, Beck Depression and Payckle scale of stressful life events. And the severity of the urticaria rash was recorded. Results: Results showed no meaningful difference in terms of age, gender, marital status and education level between the two groups. State/trait anxiety and depression scores were significantly higher in the case group than control group. In the case of stressful life events, the mean scores of patients did not reach to the meaningful level. On the other hand, the results of the study showed that with increasing the level of state/trait anxiety and depression in patients, the severity of urticaria rash has been significantly increased as well. Conclusion: Regarding the higher level of anxiety and depression in patients with chronic idiopathic urticaria, mental interventions are necessary for the treatment of these patients.

Chronic spontaneous urticaria (CSU) is a common skin disorder associated with autoimmunity. MicroRNAs (miRNAs) are endogenous noncoding RNA molecules reported to be potential biomarkers for some autoimmune diseases. In this study, we investigated the association of miRNAs with CSU. A quantitative PCR (qPCR)-based array was generated from sera as obtained from 20 active CSU patients and 20 healthy controls. Upregulated or downregulated miRNAs were validated by reverse transcription qPCR in sera from 59 active CSU patients and 58 healthy controls. The expression of miR-125a-5p was significantly upregulated in CSU sera and serum levels of CCL17 were also significantly increased in CSU patients. Serum miR-125a-5p expressions were found to be further upregulated in refractory CSU cases (n = 10). In 12 CSU patients in remission, serum miR-125a-5p expression and CCL17 levels were significantly decreased as compared with that obtained in active phase patients. These results indicated that miR-125a-5p and CCL17 can serve as potential serum biomarkers for CSU.

INTRODUCTION: Urticaria is a transient eruption of erythematous or edematous swellings of the dermis and is usually associated with itching. Angioedema consists of transient swellings in the deeper dermal, subcutaneous, and submucosal tissues. Urticaria and angioedema occur as clinical manifestations of various immunological and inflammatory mechanisms, or they may be idiopathic. MATERIALS AND METHODS: The study included 500 patients of chronic urticaria who were recruited from the outpatient department. The detailed history, cutaneous, and systemic examination was done. All patients should be subjected to a complete blood count, absolute eosinophil count, ESR, urine analysis, stool examination, liver function test, blood sugar, and renal function test. In the patients where history will be suggestive of any specific disease, screening for hepatitis B and C, antinuclear antibody test, and rheumatoid factor. Autologous serum skin test (ASST) will be performed in all the patients with chronic urticaria. RESULTS: Out of 500 patients, 211 were female and 289 were male. Most common age group was 21–40 years (58%). Most cases (60%) of chronic urticaria were of 2–6 months duration. Most patients (47%) were worse in the evening and night time. A personal history of atopy was present in 6.6% patients. A total of 38 (7.6%) had chronic urticaria with evidence of a focus of infection. In the present study, food items were observed to be aggravating chronic urticaria in 10 (2%) patients. 19 patients of chronic urticaria were found to have concomitant systemic disease, which included 16 with thyroid disease and 3 with rheumatoid arthritis. ASST was found to be positive in 172 patients with raised serum IgE levels in 120 patients. CONCLUSION: The present study demonstrates that an extended diagnostic workup may be helpful in patients with chronic urticaria in addition to thorough history taking and physical examination for proper treatment.

Background:Chronic idiopathic urticaria (CIU) represents a common skin disorder often characterized by mast cell activation and secretion of histamine and other proinflammatory factors. E-selectin (SELE) has been implicated in the pathogenesis of common inflammatory cutaneous disorders, while the role of SELE in CIU is yet to be fully understood. Thus, we aimed to investigate the mechanism by which SELE influences CIU in connection with the involvement of mast cells. Methods: SELE expression was measured in blood samples obtained from CIU patients and normal individuals. A CIU mouse model was subsequently established by intradermally injecting a normal saline solution with ovalbumin IgE antiserum into the mice. Loss- and gain-of-function investigations were conducted on the mouse models. The number of degranulated mast cells and the amount of histamine release in vitro were determined. The levels of SELE, tumor necrosis factor (TNF)-α, homologous restriction factor (HRF), and interleukin (IL)-6 levels were determined. Results: The CIU clinical samples exhibited upregulated SELE, while the CIU mice showed increased mast cell degranulation and an increased rate of histamine directional release, as well as an elevated expression of SELE, TNF-α, HRF, and IL-6. SELE silencing was found to decrease the number of degranulated mast cells and reduce the rate of histamine directional release, along with suppressed TNF-α, HRF, and IL-6 expression, in the serum of CIU mice. Ketotifen was observed to rescue the increased expression of TNF-α, HRF, and IL-6 caused by SELE overexpression. Conclusions:This study highlights the potential of SELE downregulation to repress inflammatory factor secretion caused by the accumulation of mast cells, which ultimately inhibits the development of CIU. [ABSTRACT FROM AUTHOR]

This systematic review evaluates the efficacy and safety of omalizumab for chronic spontaneous urticaria (CSU). PubMed, Embase, and Cochrane Library were searched for RCTs. Critical and important CSU‐related outcomes were considered. The risk of bias and the certainty of the evidence were assessed using GRADE. Ten RCTs including 1620 subjects aged 12 to 75 years old treated with omalizumab for 16 to 40 weeks were evaluated. Omalizumab 150 mg does not result in clinically meaningful improvement (high certainty) of the urticaria activity score (UAS)7 (mean difference (MD) −5; 95%CI −7.75 to −2.25), and the itch severity score (ISS)7 (MD −2.15; 95% CI −3.2 to −1.1) does not increase (moderate certainty) quality of life (QoL) (Dermatology Life Quality Index (DLQI); MD −2.01; 95%CI −3.22 to −0.81) and decreases (moderate certainty) rescue medication use (MD −1.68; 95%CI −2.95 to −0.4). Omalizumab 300 mg results in clinically meaningful improvements (moderate certainty) of the UAS7 (MD −11.05; 95%CI −12.87 to −9.24), the ISS7 (MD −4.45; 95%CI −5.39 to −3.51), and QoL (high certainty) (DLQI; MD −4.03; 95% CI −5.56 to −2.5) and decreases (moderate certainty) rescue medication use (MD −2.04; 95%CI −3.19 to −0.88) and drug‐related serious AEs (RR 0.77; 95%CI 0.20 to 2.91). [ABSTRACT FROM AUTHOR]

Background Chronic urticaria is a common immunological disorder, with a prevalence of 15–25%. Several exogenous and endogenous causes have been proposed as causative agents; one of them is infection of the gastrointestinal tract. Despite thorough investigation, the etiology remains unresolved in more than 80% of the cases. Objective The aim of the present study was to assess the prevalence of chronic idiopathic urticarial (CIU) patients presented with Helicobacter pylori infection and to study the effect of H. pylori eradication on the skin lesion in patients with CIU. Methodology This prospective study was carried out at the outpatient clinic of Dermatology Department of Al Azhar Assuit University Hospital on 30 patients with chronic urticaria (20 women and 10 men); their ages ranged from 16 to 65 years. The duration of the disease ranged from 6 weeks to 18 years. A primary diagnosis of CIU was made when an etiological factor accounting for the majority of the lesions could not be elucidated during the history-taking and physical examination. All the patients were subjected to careful history-taking at initial visit; physical examination to assess the number of urticaria wheals, size, and distribution, and associated angioedema; gastroscopy to obtain gastric mucosal biopsy from the antrum; and histopathological assessment of the gastric mucosal biopsy using hematoxylin and eosin, and Giemsa stains. The patients were scored according to the severity of disease (number of wheals, area of distribution, and the duration of the disease; itching and style of life; history of angioedema). The patients were treated for 2 weeks with amoxicillin (1 g/twice daily), metronidazole (500 mg/three doses daily), and omeprazole (20 mg/twice daily). All patients were followed up during the study duration of 3 months. To assess eradication efficacy, a repeated H. pylori stool antigen test was carried out for each patient 6 weeks after the end of anti-H. pylori therapy. Statistical analysis of the data was performed by using the SPSS_16 software. Results Fourteen patients (46.7%), aged less than 30 years, and 16 patients (53.3%), aged equal to or more than 30 years, were included in the present study. The mean of the ages of all patients was 34.9 years, and their age ranged from 16 to 65 years. There were 10 men (33.3%) and 20 women (66.7%). The mean of the duration of disease in all cases was 4 years, and ranged from 2 to 15 years. Nineteen patients presented with gastric symptoms. Seven patients (23.3%) had mild urticaria, 15 (50.0%) had moderate urticaria, and the remaining 8 (26.7%) had severe urticaria. Treatment results showed that 13 patients (43.3%) had complete remission, 12 patients (40.0%) had partial remission, and five patients (16.7%) showed no response. There was no statistically significant difference between age, sex, duration of illness, and gastric symptoms on the prognosis of urticaria after treatment. In addition, the results showed a highly statistically significant (P

Chronic spontaneous urticaria (CSU) is defined as the spontaneous development of itchy hives and/or angioedema due to known or unknown causes that last for at least 6 weeks. At any given time, CSU is believed to affect 0.5–1% of the global population. Omalizumab (a recombinant, humanized anti-immunoglobulin-E antibody) is the only approved treatment for antihistamine refractory CSU. However, ~ 30% of patients remain symptomatic at licensed doses of omalizumab 150 mg and 300 mg, even after a treatment period of over 6 months. In the recent years, there have been several studies on updosing of the drug, suggesting that the individualized approach for urticaria treatment with omalizumab is useful. In this article, we provide an overview of these studies and the real-world data on omalizumab updosing as it became necessary to obtain complete CSU symptom control in a proportion of patients. Published observational studies (from June 2003 to October 2019) on the updosing of omalizumab in CSU were identified using PubMed and Ovid databases. Reports mainly show that updosing/dose adjustment evaluated with the assessment of disease activity (Urticaria Activity Score) and control (Urticaria Control Test) achieves better clinical response to omalizumab with a good safety profile in a pool of patients with CSU. These real-world data will provide an overview of updosing of omalizumab in CSU and aid in setting informed clinical practice treatment expectations. [ABSTRACT FROM AUTHOR]

The main pathology involved in chronic idiopathic urticaria (CIU) is immunological dysfunction which mainly adapts to the immune system of body. Pseudomonas aeruginosa-mannose-sensitive hemagglutinin (PA) is an inactivated Pseudomonas aeruginosa biological product which displays a broad immune regulatory effect. The current study was designed to explore the protective nature of PA as an immune regulator in CIU. The participants were randomly divided into CIU + PA, CIU, control + PA and control group. lg E, anti FcεRI, anti IgE antibody, IL-4, IL-17, TGF-β1 and interferon-γ in the sera were assayed by ELISA. Then CD4+ T cells and CD19+ B cells were isolated from peripheral blood of patients with CIU (n = 10) and healthy control (n = 10). CD4+ T cells and CD19+ B proliferation and apoptosis were analyzed through CCK-8 and flow cytometry respectively. T helper cells differentiations were assessed by real-time PCR. The results revealed that compared with the control group, the curative effect of CIU + PA group was more effective than that of the CIU control group. There was a hyper proliferation of CD19+ B cells in the CIU patients. Moreover, it was also discovered that presence of Th1 decreased while Th2 cells increased in CIU patients. PA significantly inhibited the proliferation of CD19+ B and Th2 cells but at the same time promoted the proliferation of Th1 compared to healthy control. The conclusion arrived at from this study is that the PA displayed a remarkable regulatory effect in CD4+ T cells and CD19+ B cells function by promoting Th1 but inhibited Th2 and the hyperfunction of B cells of CIU patients. [ABSTRACT FROM AUTHOR]

Chronic spontaneous urticaria (CSU) is a clinical condition characterized by spontaneous or inducible recurrent wheals. This condition may significantly affect quality of life of patients and of their families. Etiology is not identified in 25–85% of cases that are indicated as ‘idiopathic’, because all diagnostic tests are negative. Autoimmune processes may be present in 30–50% of patients, although a definite etiological diagnosis is seldom possible. Some patients, in fact, have autoantibodies against the high-affinity IgE receptor FcεR1 or IgE. These patients show an increased incidence of anti-thyroid autoantibodies and represent 30–50% of the patients designated as having CSU. Familial cold autoinflammatory syndrome (FCAS) must be distinguished from acquired cold urticaria, which is characterized by a rash occurring within a few minutes after cold exposure, and is often described as ‘allergy to cold’. Cold urticaria (CU) is rare in childhood and is not linked to inflammatory markers. The treatment is based on antihistamines. However, in non-responders, a second-line treatment with omalizumab can show efficacy. We describe the clinical case of a 9-year-old-female with recurrent monthly episodes of fever, arthralgia, abdominal pain, and urticaria-angioedema who did not respond to steroids associated with antihistamines, however, showed the complete resolution of the disease with omalizumab.