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Background: Atopic dermatitis (AD) is a common chronic eczematous skin disease with severe pruritus. Several new therapeutic agents for AD such as dupilumab, an anti–IL-4Rα antibody, have been developed in recent years. We need to predict which agent is the best choice for each patient, but this remains difficult. Objective: Our aim was to examine clinical background factors and baseline biomarkers that could predict the achievement of improved clinical outcomes in patients with AD treated with dupilumab. Methods: A multicenter, prospective observational study was conducted on 110 patients with AD. The Eczema Area and Severity Index was used as an objective assessment, and the Patient-Oriented Eczema Measure and Numerical Rating Scale for Pruritus were used as patient-reported outcomes. In addition, some clinical background factors were evaluated. Results: The achievement of an absolute Eczema Area and Severity Index of 7 or less was negatively associated with current comorbidity of food allergy and baseline serum lactate dehydrogenase (LDH) levels. There were negative associations between achievement of a Patient-Oriented Eczema Measure score of 7 or less and duration of severe AD and between achievement of an itching Numerical Rating Scale for Pruritus score of 1 or less and current comorbidity of allergic conjunctivitis or baseline serum periostin level. Furthermore, signal detection analysis showed that a baseline serum LDH level less than 328 U/L could potentially be used as a cutoff value for predicting the efficacy of dupilumab. Conclusion: Baseline biomarkers such as LDH and periostin and clinical background factors such as current comorbidity of food allergy and a long period of severe disease may be useful indicators when choosing dupilumab for systemic treatment for AD, as they can predict the efficacy of dupilumab.

BackgroundFor treating patients with refractory chronic spontaneous urticaria (CSU) resistant to standard doses of 2nd generation H1-antihistamines (H1AH) the International and Japanese guidelines recommend increasing H1AH dose. The latter also recommends switching to a different H1AH. This study explored if the efficacy of the standard dose of bilastine 20 mg is non-inferior to that of double-dose of H1AH in patients with refractory CSU.MethodsThis phase IV, multicenter, open-label, randomized, parallel-group trial evaluated the efficacy and safety of switching treatment to bilastine compared to treatment with a 2-fold dose of H1AH in patients with CSU refractory to standard dose H1AH. The primary endpoint was the mean total symptom score (TSS) at Day 5-7 after the start of administration.ResultsTreatment efficacy and safety were evaluated in 128 patients (bilastine, n=64; 2-fold dose of H1AH, n=64). The mean TSS at Day 5-7 after the start of administration was smaller than the non-inferiority margin of 0.8, demonstrating non-inferiority of the bilastine switching group to the double-dose H1AH group (0.17 (95% CI -0.32, 0.67)). No difference in Japanese version of Epworth Sleepiness Scale (JESS), DLQI, and urticaria activity score over 7 consecutive days (UAS7) was observed between the two groups. There were no serious adverse events in either group. H1AH-related adverse events occurred in 5 subjects (8 cases) and 2 subjects (3 cases) in the double-dose H1AH and bilastine groups, respectively.ConclusionsSwitching treatment to bilastine demonstrated non-inferiority to a double-dose of H1AH in terms of efficacy in patients with CSU refractory to standard dose H1AH with a favorable safety profile.Clinical trial registrationhttps://jrct.niph.go.jp/latest-detail/jRCTs051180105, identifier jRCTs051180105.

The timing of market entry is important for companies to achieve commercial success. The relationship between good market entry timing and the emergence of a dominant design was discussed. However, the dominant design was assumed to be known only in retrospect. In this study, targeting the projector industry, we demonstrate that the timing of the emergence of the dominant design can be forecast in advance by deriving the time relationship between product launch and patent application. The emergence of dominant designs and the timing of their emergence were identified based on the analysis of product trends in the market. The timing of the patent application that the dominant design will emerge was forecast based on the analysis of technology trends using patent information. The cycle type of the projector industry was considered, and the time lag between patent application and product launch was inferred. This study provides a useful insight into the dominant design.

Microreactor technologies have emerged as versatile platforms with the potential to revolutionize chemistry and materials research, offering sustainable solutions to global challenges in environmental and health domains. This survey paper provides an in-depth review of recent advancements in microreactor technologies, focusing on their role in facilitating accelerated discoveries in chemistry and materials. Specifically, we examine the convergence of microfluidics with machine intelligence and automation, enabling the exploitation of the cyber-physical environment as a highly integrated experimentation platform for rapid scientific discovery and process development. We investigate the applicability and limitations of microreactor-enabled discovery accelerators in various chemistry and materials contexts. Despite their tremendous potential, the integration of machine intelligence and automation into microreactor-based experiments presents challenges in establishing fully integrated, automated, and intelligent systems. These challenges can hinder the broader adoption of microreactor technologies within the research community. To address this, we review emerging technologies that can help lower barriers and facilitate the implementation of microreactor-enabled discovery accelerators. Lastly, we provide our perspective on future research directions for democratizing microreactor technologies, with the aim of accelerating scientific discoveries and promoting widespread adoption of these transformative platforms.

Background: To develop precision medicine for atopic dermatitis (AD), it is critical to establish relevant biomarkers. However, the characteristics of various biomarkers have not been fully understood. We previously carried out the Biomarkers to Predict Clinical Improvement of AD in Patients Treated with Dupilumab (B-PAD) study, a comprehensive nationwide study in Japan, to explore biomarkers for AD. Objective: The aim of this study is to find biomarkers associated with objective and subjective clinical findings in patients with moderate-to-severe AD based on the B-PAD study and to identify biomarkers sensitive enough to assess the severity of AD. Methods: We performed the B-PAD study as a consortium composed of 19 medical facilities in Japan, enrolling 110 patients with moderate-to-severe AD. We evaluated the Eczema Area and Severity Index (EASI) for objective assessment as well as the Patient-Oriented Eczema Measure (POEM) and a numeric rating scale for pruritus (pruritis-NRS) for subjective assessment, measuring 19 biomarkers at baseline. Results: We found that 12, 6, and 7 biomarkers showed significant and positive associations with the EASI, POEM, and pruritis-NRS, respectively. Most of the biomarkers associated with either the POEM or the pruritis-NRS were included among the biomarkers associated with EASI. Of the biomarkers examined, CCL26/eotaxin-3 and SCCA2 were the most capable of assessing severity for EASI, as shown by the 2 kinds of receiver operating characteristic analyses, respectively, whereas lactate dehydrogenase was the best for both the POEM and pruritis-NRS, again using the 2 analyses. Conclusion: We found biomarkers associated with the EASI, POEM, and pruritis-NRS, respectively, based on the B-PAD study. Moreover, we identified CCL26/eotaxin-3 and/or SCCA2 as the biomarkers having the greatest ability to assess severity in the EASI; lactate dehydrogenase did the same for the POEM and pruritis-NRS. These findings will be useful in treating patients with moderate-to-severe AD.

Abstract Excipient allergies are rare and difficult to diagnose. Carboxymethylcellulose (CMC, carmellose sodium) is an anionic water‐soluble polymer derived from native cellulose, that is, used as an excipient. Here, we report a case of urticaria caused by the CMC in lidocaine jelly and dimethicone drops, which had used for upper gastrointestinal endoscopy. CMC is widely used in pharmaceutical preparations, food additives, and other pharmaceuticals, and its use is increasing. However, there are few reports on immediate hypersensitivity reactions because substances containing CMC. Previous reports and our case suggest that excipients, such as CMC, can be potential hidden allergens.

Abstract Erythema exudativum multiforme (EM), Stevens‐Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN) are acute inflammatory diseases of the skin and mucous membranes. EM with mucosal eruptions is sometimes difficult to differentiate from SJS or TEN. This study aimed to understand the characteristics of these diseases by evaluating the backgrounds, clinical symptoms, and disease courses of EM/SJS/TEN patients treated at our hospital. It shows that persistent fevers and erosion are common in SJS/TEN. Therefore, we must pay attention to whether they become more severe.

This is an abridged edition of English version of the Clinical Practice Guidelines for the Management of Atopic Dermatitis 2021. Atopic dermatitis (AD) is a disease characterized by relapsing eczema with pruritus as a primary lesion. In Japan, from the perspective of evidence-based medicine, the current strategies for the treatment of AD consist of three primary measures: (i) use of topical corticosteroids, tacrolimus ointment, and delgocitinib ointment as the main treatment of the inflammation; (ii) topical application of emollients to treat the cutaneous barrier dysfunction; and (iii) avoidance of apparent exacerbating factors, psychological counseling, and advice about daily life. In the present revised guidelines, the description about three new drugs, namely, dupilumab, delgocitinib, and baricitinib, has been added. The guidelines present recommendations to review clinical research articles, evaluate the balance between the advantages and disadvantages of medical activities, and optimize medical activity-related patient outcomes with respect to several important points requiring decision-making in clinical practice.

Abstract Objectives The satisfaction level of adult patients receiving drugs for atopic dermatitis and chronic urticaria is unclear. The objective of this multicenter study was to assess the satisfaction level of adult patients receiving treatment for allergic skin diseases, primarily atopic dermatitis and chronic urticaria. Methods We developed a self‐administered questionnaire with multiple‐choice questions on patient characteristics, quality of life (QOL), and Abbreviated Treatment Satisfaction Questionnaire for Medication (TSQM‐9). We surveyed 302 patients receiving dermatological treatment. Results The global satisfaction of patients (TSQM‐9) was lower for atopic dermatitis treatment compared with that for chronic urticaria. For atopic dermatitis, dupilumab had higher scores for effectiveness and global satisfaction, whereas topical tacrolimus and moisturizers had higher scores for convenience. For chronic urticaria, omalizumab had higher scores for effectiveness and global satisfaction, while antihistamines had a higher score for convenience. The Dermatology Life Quality Index was significantly associated with treatment effectiveness and global satisfaction, and patient satisfaction improved with the corresponding improvement in the QOL. For atopic dermatitis, satisfaction with dupilumab was higher than that with conventional standard therapy, after the confounding factors were eliminated. However, the same trend was not observed for chronic spontaneous urticaria. Conclusions The satisfaction of the effectiveness for the biologic agents was higher, compared to that with conventional standard therapy. Treatment with biologics is worth exploring for patients who are not satisfied with their existing treatments.

Background: Recurrent angioedema (RecAE) has a substantial impact on patients’ daily lives. However, there have been no disease-specific patient-reported outcomes (PROs) available in Japan to measure disease activity and health-related QoL impairment in such patients. Methods: Japanese versions of the Angioedema Activity Score (AAS) and the Angioedema Quality of Life Questionnaire (AE-QoL) were examined for their validity and reliability. By using these questionnaires, the relationship between disease activity and QoL impairment among the Japanese population of RecAE were analyzed in real-world setting. Results: The Japanese AAS and AE-QoL domains showed good internal consistency of 0.967 and > 0.835. For known group validity, AAS28 and AE-QoL total scores were higher in more severe patients than those with milder disease and QoL impairment, respectively. AAS28 showed strong correlation with indexes of disease activity, while the AE-QoL total score correlated with Dermatology Life Quality Index (DLQI). Sufficient reproductivity of the AAS and AE-QoL was shown by their intraclass correlation coefficients of 0.890 and 0.700. The Japanese population is characterized by the total score of AAS28, 34.3 ± 38.8 (mean ± SD); and AE-QoL, 38.7 ± 25.2. Each domain score of AE-QoL was 32.4 ± 29.7 in “Functioning”, 35.0 ± 27.8 in “Fatigue/mood”, 50.7 ± 30.6 in “Fears/shame”, or 24.7 ± 29.8 in “Food”. Changes in AAS28 and AE-QoL positively correlated to Patient global assessment of disease activity and DLQI, respectively. Conclusions: The Japanese AAS and AE-QoL are valid and reliable instruments for Japanese patients with RecAE, and active disease affecting QoL. They help assess disease activity and QoL of RecAE in routine patient care and clinical trials.

Interactions with animals, including cats, is believed to influence human health. However, studies that investigate the psychological and physiological effects of interacting with cats in their household environment are limited. In this remote study, 32 cat owners in Japan participated from June to October 2021. They completed two tasks, each on separate days in their homes: one simulating daily cat communication (Interaction condition) and another with no interactions (Rest condition). We quantified emotions (arousal level and pleasure level) before and after each condition using the Two-Dimensional Mood Scale Short-term as well as salivary cortisol and oxytocin levels of owners using enzyme-linked immune-sorbent assay. Autonomic nervous activity (sympathetic and parasympathetic) was also quantified by heart rate variability analysis. The free interaction with cats decreased emotional arousal and parasympathetic activity, and lead to increased heart rates in owners. There was a positive correlation between heart rate and cortisol concentration, and between cortisol and oxytocin concentration. Furthermore, the frequency of petting the cats was negatively correlated with the rate of change in the parasympathetic activity. In contrast, the parasympathetic nerves in the owners were activated under the Rest condition. Hence, the mechanism of health-enhancing effects of cat ownership includes an arousing effect, in contrast to the previously proposed stress-reduction effect. This result can aid in future developments in cat–human relationship studies. However, a detailed study with a larger sample size is needed to draw definite conclusions.

Abstract Earthquake magnitude is closely related to the depth extent of the seismogenic zone, and higher magnitude earthquakes occur where the seismogenic zone is thicker. The frictional properties of the dominant mineral constituents of the crust, such as feldspar-group minerals, control the depth extent of the seismogenic zone. Here, the velocity dependence of the steady-state friction of anorthite, the calcic endmember of the feldspar mineral series, was measured at temperatures from 20 to 600 °C, pore pressures of 0 (“dry”) and 50 MPa (“wet”), and an effective pressure of 150 MPa. The results support previous findings that the frictional properties of feldspar play a dominant role in limiting the depth extent of the seismogenic zone. This evidence suggests that brittle deformation of anorthite may be responsible for brittle fault movements in the brittle–plastic transition zone.

Atopic dermatitis (AD) is a disease characterized by relapsing eczema with pruritus as a primary lesion, which is frequently encountered in clinical practice. Skin barrier dysfunction leads to enhanced skin irritability to non-specific stimuli and epicutaneous sensitization. In the lesion site, a further inflammation-related reduction in skin barrier function, enhanced irritability and scratching-related stimuli deteriorate eczema, leading to vicious cycle of inflammation. The current strategies to treat AD in Japan from the perspective of evidence-based medicine consist of three primary measures: (i) the use of topical corticosteroids and tacrolimus ointment as the main treatment for the inflammation; (ii) topical application of emollients to treat the cutaneous barrier dysfunction; and (iii) avoidance of apparent exacerbating factors, psychological counseling and advice about daily life. The guidelines present recommendations to review clinical research articles, evaluate the balance between the advantages and disadvantages of medical activities, and optimize medical activity-related patient outcomes with respect to several important points requiring decision-making in clinical practice.

Physiological samples are beneficial in assessing the health and welfare of cats. However, most studies have been conducted in specialized environments, such as shelters or laboratories, and have not focused on cats living in domestic settings. In addition, most studies have assessed physiological stress states in cats based on cortisol, and none have quantified positive indicators, such as oxytocin. Here, we collected urine samples from 49 domestic cats and quantified urinary cortisol, oxytocin, and creatinine using ELISA. To identify factors influencing hormone levels, owners responded to questionnaires regarding their housing environment, individual cat information, and the frequency of daily interactions with their cats. Using principal component analysis, principal component scores for daily interactions were extracted. These results showed that the frequency of tactile and auditory signal-based communication by owners was positively correlated with the mean concentration of oxytocin in the urine. Additionally, this communication was more frequent in younger cats or cats that had experienced a shorter length of cohabitation with the owner. However, no factors associated with urinary cortisol concentration were identified. Our study indicates that interactions and relationships with the owner influence the physiological status of cats and suggests that oxytocin is a valuable parameter for assessing their health and welfare.

Abstract The depth extent of the crustal seismogenic zone is closely related to the size of earthquakes. The mechanisms that control the depth of the lower transition of the seismogenic zone are important issues in seismology and disaster mitigation. Laboratory studies have shown that the mechanism of earthquake nucleation is controlled by the frictional properties of fault materials. We measured the velocity dependences of the steady-state friction of quartz and feldspar, two major components of crustal rocks, under dry and wet conditions at temperatures up to 600 °C. In the presence of water, the temperature range over which the velocity dependence of steady-state friction was negative was wider for feldspar than for quartz, thus indicating that the temperature range of earthquake nucleation is wider for feldspar than for quartz. Considering that temperature increases with depth, our findings indicate that the material properties of feldspar likely play a dominant role in limiting the depth extent of the seismogenic zone.

Replication origins in eukaryotes form a base for assembly of the pre-replication complex (pre-RC), thereby serving as an initiation site of DNA replication. Characteristics of replication origin vary among species. In fission yeast Schizosaccharomyces pombe, DNA of high AT content is a distinct feature of replication origins; however, it remains to be understood what the general molecular architecture of fission yeast origin is. Here, we performed ChIP-seq mapping of Orc4 and Mcm2, two representative components of the pre-RC, and described the characteristics of their binding sites. The analysis revealed that fission yeast efficient origins are associated with two similar but independent features: a ≥15 bp-long motif with stretches of As and an AT-rich region of a few hundred bp. The A-rich motif was correlated with chromosomal binding of Orc, a DNA-binding component in the pre-RC, whereas the AT-rich region was associated with efficient binding of the DNA replicative helicase Mcm. These two features, in combination with the third feature, a transcription-poor region of approximately 1 kb, enabled to distinguish efficient replication origins from the rest of chromosome arms with high accuracy. This study, hence, provides a model that describes how multiple functional elements specify DNA replication origins in fission yeast genome.

Background: Interleukin (IL)-21 is a member of the type I cytokine family and plays a role in the pathogenesis of T helper type 2 allergic diseases. It has been reported that IL-21 expression is upregulated in acute skin lesions in atopic dermatitis (AD) patients; however, little is known about the serum IL-21 levels of AD patients. The aim of this study was to quantify the serum IL-21 levels of AD patients and to evaluate the relationships between the serum IL-21 level and disease severity, laboratory markers, and eruption type in AD patients. Methods: We measured the serum IL-21 levels of adult AD patients and healthy control subjects using an enzyme-linked immunosorbent assay. Results: The adult AD patients exhibited significantly higher serum IL-21 levels than the healthy control subjects. A comparison of the patients' serum IL-21 levels based on the clinical severity of their AD revealed that the patients with severe AD demonstrated significantly higher serum IL-21 levels than those with mild AD and the healthy control subjects. The serum IL-21 levels were significantly correlated with the skin severity score, and especially with the degree of acute lesions such as erythema and edema/papules. The serum IL-21 level was not associated with laboratory markers, such as the serum IgE level, the serum thymus and activation-related chemokine level, blood eosinophilia, and the serum lactate dehydrogenase level. Conclusions: These results suggest that IL-21 might be involved in the pathogenesis of AD, especially the development of acute skin lesions.

The study aimed to clarify the regularity of the motions of horse's back, rider's pelvis and spine associated with improvement of rider's dynamic trunk alignment. The study used a crossover design, with exercise using the horseback riding simulator (simulator hereafter) as the control condition. The experiments were conducted at Tokyo University of Agriculture Bio-therapy Center. The sample consisted of 20 healthy volunteers age 20–23 years. Participants performed 15-min sessions of horseback riding with a Hokkaido Pony and exercise using the simulator in experiments separated by ≥2 weeks. Surface electromyography (EMG) after horseback riding revealed decreased activity in the erector spinae. Exploratory data analysis of acceleration and angular velocity inferred associations between acceleration (Rider's neck/longitudinal axis [Y hereafter]) and angular velocity (Horse saddle/Y) as well as angular velocity (Rider's pelvis/Y) and angular velocity (Horse saddle/Y). Acceleration (Rider's neck/Y) tended to be associated with angular velocity (Rider's pelvis/Y). Surface EMG following exercise revealed decreased activity in the rectus abdominis and erector spinae after the simulator exercise. Horseback riding improved the rider's dynamic trunk alignment with a clear underlying mechanism, which was not observed with the simulator.

Summary: The development of cancer is driven not only by genetic mutations but also by epigenetic alterations. Here, we show that TET1-mediated production of 5-hydroxymethylcytosine (5hmC) is required for the tumorigenicity of glioblastoma cells. Furthermore, we demonstrate that chromatin target of PRMT1 (CHTOP) binds to 5hmC. We found that CHTOP is associated with an arginine methyltransferase complex, termed the methylosome, and that this promotes the PRMT1-mediated methylation of arginine 3 of histone H4 (H4R3) in genes involved in glioblastomagenesis, including EGFR, AKT3, CDK6, CCND2, and BRAF. Moreover, we found that CHTOP and PRMT1 are essential for the expression of these genes and that CHTOP is required for the tumorigenicity of glioblastoma cells. These results suggest that 5hmC plays a critical role in glioblastomagenesis by recruiting the CHTOP-methylosome complex to selective sites on the chromosome, where it methylates H4R3 and activates the transcription of cancer-related genes. : The development of cancer is driven not only by genetic mutations but also by chromatin and DNA modification changes. Takai et al. now show that proneural glioblastomas contain high levels of 5hmC and TET1. Production of 5hmC is required for the tumorigenicity of glioblastoma cells. Furthermore, 5hmC recruits the CHTOP-methylosome complex to selective sites on the chromosome, where it methylates H4R3 and activates the transcription of cancer-related genes.

Kindler syndrome is a rare autosomal recessive genodermatosis characterized by trauma-induced acral blisters in infancy and childhood, photosensitivity, and progressive poikiloderma. Other clinical features include chronic erosive gingivitis, dysphagia, esophageal and urethral strictures, ectropion, and an increased risk of mucocutaneous squamous cell carcinoma. We describe a patient with Kindler syndrome associated with squamous cell carcinoma of the skin and larynx. He had squamous cell carcinoma on his left knee with simultaneous unresectable laryngeal carcinoma at the age of 43 years. The squamous cell carcinoma on his knee was excised and the laryngeal carcinoma was treated with radiation therapy. Although pathophysiology of Kindler syndrome and its frequency of association with cancer are still not fully elucidated, we speculate that long-term erosion and regeneration of mucosal and cutaneous surfaces may have induced squamous cell carcinoma on the patient’s knee and larynx.

Background: Beyond their role in hemostasis and thrombosis, platelets are important for modulating inflammatory reactions. Activated platelets play a role in the pathomechanism of inflammatory diseases such as asthma, but little is known about platelet activation in chronic skin inflammation, including atopic dermatitis (AD) and psoriasis. Furthermore, the relationship between platelet activation and disease severity is not understood. This work was performed to investigate plasma levels of β-thromboglobulin (β-TG) and platelet factor 4 (PF4) as platelet activation markers in patients with AD or psoriasis, and to determine the relationships between these markers and disease severity. Methods: Plasma levels of β-TG and PF4 were measured by enzyme-linked immunoassay in 22 healthy controls, 44 patients with AD, and 16 patients with psoriasis. The relationships between these markers and the scoring AD (SCORAD) index, blood eosinophilia, serum IgE and serum lactate dehydrogenase were investigated in AD patients, and relationships with the psoriasis area and severity index (PASI) score were examined in psoriatic patients. Results: Plasma β-TG and PF4 levels were significantly higher in patients with AD or psoriasis compared with healthy controls. β-TG and PF4 levels correlated with the SCORAD index, and PF4 levels correlated with PASI scores. Elevated β-TG and PF4 levels were significantly reduced after treatments. Conclusions: Our results show that blood platelets are activated in patients with AD or psoriasis, suggesting that activated platelets play a role in the pathomechanism of chronic skin inflammation. Furthermore, plasma β-TG and PF4 may be markers for the severity of AD and psoriasis.

A study of imaging the Fukushima Daiichi reactors with cosmic-ray muons to assess the damage to the reactors is presented. Muon scattering imaging has high sensitivity for detecting uranium fuel and debris even through thick concrete walls and a reactor pressure vessel. Technical demonstrations using a reactor mockup, detector radiation test at Fukushima Daiichi, and simulation studies have been carried out. These studies establish feasibility for the reactor imaging. A few months of measurement will reveal the spatial distribution of the reactor fuel. The muon scattering technique would be the best and probably the only way for Fukushima Daiichi to make this determination in the near future.

The opinions of patients with allergic skin diseases often determine their attitudes to treatment. However, little is known about the viewpoints of patients and their concerns regarding their conditions. This novel study is the first to compare relationships between the opinions of patients and their concerns regarding the severity of atopic dermatitis or chronic spontaneous urticaria and the presence or absence of biologics. We also compared and clarified the characteristics of these diseases using a questionnaire that was completed by 359 patients treated at university and city hospitals, as well as dermatology clinics. Covariance analysis was performed to compare both diseases with different backgrounds. Patients with adult atopic dermatitis were more likely than those with chronic idiopathic urticaria to believe that treatment must be continued and that the disease will not spontaneously improve. Patients with severe or poorly controlled atopic dermatitis or chronic spontaneous urticaria often had psychosomatic symptoms and also believed that the disease required continued treatment. Social factors related to wait times and medication were not associated with disease severity. Patients receiving treatment had significantly less anxiety associated with biologics than those who did not receive treatment. Patients with atopic dermatitis had higher physical and mental burden than those with chronic spontaneous urticaria. Therefore, effective treatments must be prescribed. Consideration of these disease-specific characteristics regarding the opinions and concerns of patients can improve patient satisfaction and compliance with treatment, which results in favorable outcomes. [ABSTRACT FROM AUTHOR]