Modern anti-IgE therapies in children with chronic spontaneous urticaria: clinical cases

2021 ◽  
Vol 17 (4) ◽  
pp. 85-89
Author(s):  
Inna A. Larkova ◽  
Vera A. Revyakina
Keyword(s):  
Chronic Urticaria ◽  
Clinical Manifestations ◽  
Chronic Spontaneous Urticaria ◽  
First Line ◽  
Therapy Efficacy ◽  
Number Of Patients ◽  
H1 Antihistamines ◽  
Urticaria Treatment ◽  
Clinical Cases

The diagnostics and treatment of chronic urticaria is still a pressing problem for specialists of different profiles. Despite the fact that the first line drugs for urticaria treatment are non-sedating H1- antihistamines, there are a number of patients who do not respond to these medications even in their increased doses. This article presents clinical cases of anti-IgE-therapy efficacy in children suffering from urticaria and angioedema. CONCLUSION: The clinical cases demonstrate current possibilities of successful and safe anti-IgE-therapy of various clinical manifestations of chronic spontaneous urticaria and angioedema in children.

scholarly journals Urticaria is not a sentence. The clinical cases

2016 ◽  
Vol 13 (2) ◽  
pp. 23-26
Author(s):  
I V Danilycheva ◽  
A E Shulzhenko ◽  
N G Bondarenko
Keyword(s):  
Effective Treatment ◽  
Therapeutic Antibody ◽  
Chronic Spontaneous Urticaria ◽  
Receptor Antagonists ◽  
Long Period ◽  
Leukotriene Receptor Antagonists ◽  
H1 Antihistamines ◽  
Leukotriene Receptor ◽  
Clinical Cases

Omalizumab - monoclonal therapeutic antibody to human IgE, is effectively used for the treatment of patients with chronic spontaneous urticaria (HSC), refractory to 4 times increased doses of antihistamines. The article describes two cases of effective treatment of patients (HSC) with omalizumab (Xolair® «Novartis Pharma» LLC) after a long period of unsuccessful therapy with H1-antihistamines, leukotriene receptor antagonists, and corticosteroids.

scholarly journals Fresh look on the urticaria problem.

2020 ◽  
Vol 17 (2) ◽  
pp. 33-43
Author(s):  
Alla O. Litovkina ◽  
Eugenii V. Smolnikov ◽  
Olga G. Elisyutina ◽  
Elena S. Fedenko
Keyword(s):  
Biological Treatment ◽  
First Line ◽  
Second Line Therapy ◽  
2Nd Generation ◽  
Line Therapy ◽  
H1 Antihistamines ◽  
Third Line Therapy ◽  
Third Line ◽  
Urticaria Treatment ◽  
Selection Of

Introduction. Nowadays urticaria is one of the most common diseases. According to the International Guidelines for the definition, classification, diagnosis and management of urticaria, 2nd-generation H1-antihistamines are recommended to be used as the first-line and second-line therapy. Omalizumab, a humanized monoclonal anti-IgE antibody, is assumed to be the third-line therapy in urticaria treatment. Summary. In this review we discuss the latest data on pathogenetic mechanisms of urticaria, focusing on the search of the new targets for the therapy. We represent the latest clinical trials of the new biological treatment for urticaria. Safety and efficiency of 4-folds higher therapeutical dose of the 2nd generation H1-antihistamines, and criteria for personalized selection of the antihistamines are discussed.

scholarly journals Chronic Urticaria: An Overview of Treatment and Recent Patents

2019 ◽  
Vol 13 (1) ◽  
pp. 27-37 ◽  
Author(s):  
Kam L. Hon ◽  
Alexander K.C. Leung ◽  
Wing G.G. Ng ◽  
Steven K. Loo
Keyword(s):  
Quality Of Life ◽  
Adverse Effect ◽  
Chronic Urticaria ◽  
Second Generation ◽  
Symptom Control ◽  
Clinical Manifestations ◽  
Screening Tests ◽  
Fourfold Increase ◽  
H1 Antihistamines

Background: Up to 1% of the general population in the USA and Europe suffer from chronic urticaria (CU) at some point in their lifetime. CU has an adverse effect on the quality of life. Objectives: This study aims to provide an update on the epidemiology, pathogenesis, clinical manifestations, diagnosis, aggravating factors, complications, treatment and prognosis of CU. Methods: The search strategy included meta-analyses, randomized controlled trials, clinical trials, reviews and pertinent references. Patents were searched using the key term "chronic urticaria" at the following links: www.google.com/patents, www.uspto.gov, and www.freepatentsonline.com. Results: CU is a clinical diagnosis, based on the episodic appearance of characteristic urticarial lesions that wax and wane rapidly, with or without angioedema, on most days of the week, for a period of six weeks or longer. Triggers such as medications, physical stimuli, and stress can be identified in 10 to 20% of cases. C-reactive protein/erythrocyte sedimentation rate, and complete blood cell count with differential are the screening tests that may be used to rule out an underlying disorder. The mainstay of therapy is reassurance, patient education, avoidance of known triggers, and pharmacotherapy. Secondgeneration H1 antihistamines are the drugs of choice for initial therapy because of their safety and efficacy profile. If satisfactory improvement does not occur after 2 to 4 weeks or earlier if the symptoms are intolerable, the dose of second-generation H1 antihistamines can be increased up to fourfold the manufacturer’s recommended dose (all be it off license). If satisfactory improvement does not occur after 2 to 4 weeks or earlier if the symptoms are intolerable after the fourfold increase in the dosage of second-generation H1 antihistamines, omalizumab should be added. If satisfactory improvement does not occur after 6 months or earlier if the symptoms are intolerable after omalizumab has been added, treatment with cyclosporine and second-generation H1 antihistamines is recommended. Short-term use of systemic corticosteroids may be considered for acute exacerbation of CU and in refractory cases. Recent patents for the management of chronic urticaria are also discussed. Complications of CU may include skin excoriations, adverse effect on quality of life, anxiety, depression, and considerable humanistic and economic impacts. On average, the duration of CU is around two to five years. Disease severity has an association with disease duration. Conclusion: CU is idiopathic in the majority of cases. On average, the duration of CU is around two to five years. Treatment is primarily symptomatic with second generation antihistamines being the first line. Omalizumab has been a remarkable advancement in the management of CU and improves the quality of life beyond symptom control.

scholarly journals CSACI position statement: Newer generation H1-antihistamines are safer than first-generation H1-antihistamines and should be the first-line antihistamines for the treatment of allergic rhinitis and urticaria

2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Michael N. Fein ◽  
David A. Fischer ◽  
Andrew W. O’Keefe ◽  
Gord L. Sussman
Keyword(s):  
Allergic Rhinitis ◽  
Chronic Urticaria ◽  
First Generation ◽  
Position Statement ◽  
Poor Sleep ◽  
Third Generation ◽  
First Line ◽  
H1 Antihistamines ◽  
History Of ◽  
History Of Use

Abstract Oral H1-antihistamines (AHs) are the most commonly used therapy to treat allergic rhinitis and chronic urticaria. Older, first-generation AHs (e.g. diphenhydramine, hydroxyzine) have significant and common side effects including sedation, impairment with decreased cognitive function, poor sleep quality, dry mouth, dizziness, and orthostatic hypotension. These drugs have also been found to result in death from accidents, intentional or unintentional overdoses, and sudden cardiac death. The unfavourable risk–benefit profile of first-generation AHs led to the development of newer, less-sedating second- and third-generation AHs, which first became available in Canada in the 1980s. High-quality trials have proven that newer generation AHs are superior in safety compared to older first-generation AHs. On average, they have improved potency and efficacy. Second- and third-generation AHs are the recommended first-line treatment for mild allergic rhinitis and acute and chronic urticaria. Despite this evidence, older first-generation AHs continue to be over-utilized because of their over-the-counter (OTC) status and long history of use. The Canadian Society of Allergy Clinical Immunology (CSACI) recommends that newer generation AHs should be preferred over first-generation AHs for the treatment of allergic rhino-conjunctivitis and urticaria. To promote this recommendation, education of health professionals and the public is necessary. Further, given the dangers of older first-generation AHs, we believe they should be used only as a last resort with eventual consideration given to having them only available behind the counter in pharmacies.

Experience with anti – IgE – therapy in children with chronic inducible urticaria: clinical cases.

2021 ◽  
Author(s):  
Inna Larkova
Keyword(s):  
Clinical Manifestations ◽  
Chronic Spontaneous Urticaria ◽  
Off Label ◽  
Chronic Inducible Urticaria ◽  
Inducible Urticaria ◽  
Clinical Cases

Abstract. Introduction: in children with chronic inducible urticaria, anti-IgE therapy is possible when combined with chronic spontaneous urticaria, otherwise the treatment is considered "off label", since there are no approved recommendations for this category of patients due to insufficient research on the effectiveness, prescription and duration of such treatment Conclusion: Based on clinical cases, the authors present there own experience of successful anti-IgE- therapy of various clinical manifestations of chronic inducible urticaria in children.

scholarly journals Chronic Spontaneous Urticaria – Diagnosis and Management

2021 ◽  
Author(s):  
Evmorfia Ladoyanni
Keyword(s):  
Chronic Urticaria ◽  
Psychological Factors ◽  
Immunoglobulin E ◽  
Immunoglobulin A ◽  
Life Quality ◽  
Chronic Spontaneous Urticaria ◽  
Specific Stimulus ◽  
Chronic Inducible Urticaria ◽  
Number Of Patients ◽  
Inducible Urticaria

Chronic urticaria can be subclassified into chronic spontaneous urticaria and chronic inducible urticaria. Up to 30% of cases are associated with functional immunoglobulin G antibodies to the high affinity immunoglobulin E receptor FcεRIα or to immunoglobulin A. Pathogenic activation of mast cells and basophils gives rise to release of pro-inflammatory mediators that lead to development of hives. CSU is a debilitating disease with a relapsing course. It affects 0.5–1% of the population at any given time. The duration of CSU is generally 1–5 years but can be longer in cases associated with angioedema and autoreactivity. CSU has detrimental effects on life quality with sleep-deprivation and psychiatric disorders being the most frequent. In a great number of patients an underlying cause or eliciting factor cannot be identified. Among the patients in which an aetiology is suspected, infections, medication, food and psychological factors are most commonly associated. A potential autoimmune cause has been reported in up to 50% of patients. Chronic inducible urticaria is characterised by its ability to be triggered consistently and reproducibly in response to a specific stimulus (pressure, temperature, vibration, water, heat, light). Antihistamines form the mainstay of therapy. In recalcitrant chronic urticaria, a variety of other drugs have been tried.

scholarly journals Omalizumab for treatment of chronic urticaria: A review of effective dose

2019 ◽  
Author(s):  
Javad Ghaffari ◽  
Negar Ghaffari
Keyword(s):  
Monoclonal Antibody ◽  
Effective Dose ◽  
Chronic Urticaria ◽  
Treatment Effect ◽  
Search Process ◽  
Subcutaneous Injections ◽  
H1 Antihistamines ◽  
Urticaria Treatment ◽  
Age Range ◽  
Different Doses

Omalizumab (Xolair®), a humanized anti-IgE monoclonal antibody, is effective and well-tolerated in patients with chronic spontaneous urticaria refractory to H1 antihistamines. The aim of this review was to present the effective dose of omalizumab for urticaria treatment in patients. Several databases, including PubMed, EMBASE, Scopus, Google, SID, Magiran, and Irandoc, were selected. The search process was performed using the keywords of Xolair, omalizumab, urticaria, chronic urticaria, effect, and treatment. Sixty related articles were found. All studies have been conducted on people over 12 years of age with the exception of 2 articles investigating patients over 7 years old. Most studies have been performed on patients within the age range of 12-75 years and the maximum age of 81 years. Omalizumab has been administered at different doses for patients with chronic urticaria (75-600 mg). Omalizumab has shown a treatment effect at all administered doses; however, it has the greatest effect when administered at the dose of 300 mg. The interval of subcutaneous injections was 2-6 weeks. In conclusion, the administration of omalizumab is effective at doses of 150 and 300 mg although the most effective dose is 300 mg.

scholarly journals Russian experience of refractory chronic urticaria treatment with omalizumab

2015 ◽  
Vol 12 (3) ◽  
pp. 16-21
Author(s):  
I V Danilycheva ◽  
O G Elisyutina ◽  
N I Ilina ◽  
E A Latysheva ◽  
T V Latysheva ◽  
...  
Keyword(s):  
Chronic Urticaria ◽  
Marked Effect ◽  
Clinical Analysis ◽  
Chronic Spontaneous Urticaria ◽  
Efficacy And Safety ◽  
Chronic Inducible Urticaria ◽  
Inducible Urticaria ◽  
Urticaria Treatment ◽  
Practice Methods ◽  
Dose Change

Background. To study the efficacy and safety of omalizumab in patients with chronic urticaria, refractory to antihistamines in clinical practice. Methods. In this retrospective clinical analysis, we assessed effectiveness, time to relief of symptoms, dose change after omalizumab administration, and safety in 17 CU patients, 16 with chronic spontaneous urticaria (CSU), 1 with different forms of chronic inducible urticaria (CindU) and 4 with both. Results. Treatment with omalizumab showed excellent effect in 70,6%, significant - in 17,7%, no effect - in 11,7% of CU patients. Eight patients marked effect for 24 hours, 2 - within 2-3 days, 2 - during 2 weeks, 1 - 4 weeks, and 2 patients - for 8 weeks. Eleven patients were receiving omalizumab 300 mg once per 4 weeks, one patient - 150 mg, 4 patients 2 injections of 300 mg, followed by 150 mg of 2, one patient had started treatment with a dose of 150 mg, continued treatment with omalizumab 300 mg. Omalizumab was safe. There was no influence of baseline total IgE levels and the results of test with autosera on the efficacy of omalizumab treatment. Conclusion. Our observation of patients with chronic spontaneous urticaria, with the concomitant or separate physical (induced) hives can resume high efficacy and safety of omalizumab treatment which can be recommended for CU patients, torpid to the first and secondline therapy.

Comparative analysis of polymorphic variants of IL-17A and MMP-1 genes with the risk of developing chronic periodontitis in petrochemical workers

2020 ◽  
Vol 60 (10) ◽  
pp. 687-693
Author(s):  
Iskander I. Zaidullin ◽  
Denis O. Karimov ◽  
Lilija K. Karimova ◽  
Milyausha F. Kabirova ◽  
Rasima R. Galimova ◽  
...  
Keyword(s):  
Ethylene Oxide ◽  
Chronic Periodontitis ◽  
Periodontal Diseases ◽  
Clinical Manifestations ◽  
Control Group ◽  
Periodontal Tissues ◽  
Dental Examination ◽  
Number Of Patients ◽  
Increased Risk ◽  
Harmful Substances

The susceptibility to the development and progression of inflammatory periodontal diseases, which depends on genetic and external factors (smoking, stress, oral hygiene), varies widely. In the development of these diseases, an important role is played not only by the presence of periodontal pathogenic microorganisms, but also by the presence of congenital or acquired immunodeficiency, immunoregulatory defects. The immune system plays a key role in the physiological and pathological processes of periodontal tissues. In this regard, IL17, produced by CD4+ Th cells, which has both Pro-inflammatory and protective activity, is of particular interest in the pathogenesis of periodontitis. The aim of study was to identify the relationship between polymorphic loci of the IL-17A (rs2275913) and MMP-1 (rs1799750) genes and clinical manifestations of chronic periodontitis in petrochemical workers. Dental examination was performed in 92 ethylene oxide production workers with chronic periodontitis and 74 patients with chronic periodontitis who did not come into contact with chemical factors (control group). Genotyping of polymorphisms rs2275913 of the IL17A gene and rs1799750 of the MMP1 gene was performed by allele-specific real-time polymerase chain reaction (PCR). Hygienic assessment of the degree of air pollution of the working area with harmful substances was carried out by gas chromatography according to the guidelines for the determination of harmful substances in the air № 5098-89, № 3119-84. When comparing the results of studies of both groups, there were no statistically significant differences in the frequency distributions of allelic variants and genotypes of the IL-17A and MMP-1 genes. The AA/AG genotypes of the IL-17A gene were associated with an increased risk of severe disease compared to the GG genotype in workers in the main group (OR=6.1; 95% CI 1.33-28.5; p=0.021) and in the control group (OR=7.26; 95% CI 1.34-39.25; p=0.016). Carriers of the A allele in the control group increased the risk of severe chronic periodontitis by 2.4 times compared to carriers of the G allele (OR=2.41; 95% CI 1.19-4.87; p=0.014). During the dental examination of employees of the ethylene oxide plant, the clinical course of periodontal diseases was more severe in comparison with the control group, and the number of patients with severe periodontitis was twice as high. It was found that the AA/AG genotypes of the IL-17A gene and the carrier of the A allele are associated with increased susceptibility to the development of severe chronic periodontitis. The association between the MMP-1 gene polymorphism and the risk of severe forms of chronic periodontitis has not been established. A risk factor for the development of inflammatory periodontal diseases in employees of the petrochemical complex is a complex of harmful production factors.

scholarly journals AB0520 FIVE-YEAR RATE OF HOSPITALIZATIONS IN ANCA-ASSOCIATED VASCULITIDES IN THE ITALIAN REGION OF FRIULI VENEZIA GIULIA (2013-2017)

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1557.2-1558
Author(s):  
L. Quartuccio ◽  
E. Treppo ◽  
S. De Vita ◽  
F. Valent
Keyword(s):  
Health Care ◽  
Granulomatosis With Polyangiitis ◽  
Burden Of Illness ◽  
Clinical Manifestations ◽  
Administrative Databases ◽  
Eosinophilic Granulomatosis With Polyangiitis ◽  
Italian Region ◽  
Potential Health ◽  
Number Of Patients ◽  
Friuli Venezia Giulia

Background:ANCA-associated vasculitides (AAV) are a group of systemic vasculitis carrying a high risk of hospitalization because the multiorgan involvement, the acute nature of some clinical manifestations, the chronic but very disabling course of some other manifestations and finally the risk of severe infections due to chronic glucocorticoid and immunosuppressor administration. However, data on hospitalization due to ANCA-associated vasculitis are still scarce.Objectives:to estimate the rate of the first hospitalization or the death in patients suffering from AAV in the Italian region of Friuli Venezia Giulia (about 1,200,000 inhabitants) from year 2013 to 2017.Methods:integration of the information coming from many administrative databases were used to this end. The Regional Health Information System of Friuli Venezia Giulia was used as the source of information for this retrospective cohort study. The system covers the entire regional population and includes various electronic health administrative databases that can be linked with one another on an individual basis through a unique encrypted identifier. In particular, the following databases were matched: the database of the regional potential health care beneficiaries (including demographic information and the residential history of all of the subjects living in the region), the hospital discharge database, the database of exemptions from medical charges were used for this study, the database of the different regional laboratories. The population under study was selected based on the following inclusion criteria: patients were residents in Friuli Venezia Giulia and they had to carry the exemption code for AAV, including Granulomatosis with Polyangiitis (GPA), or Eosinophilic Granulomatosis with Polyangiitis (EGPA), or Microscopic Polyangiitis (MPA). This population was observed from 2013 to 2017. The coded event was the occurrence of the first hospitalization or the death. Also, all the hospitalization and their main discharge diagnoses were registered.Results:103 patient with AAV were identified. The number of patients with at least one hospitalization/death was 74/103 (71,8%). Seven patients died during the observation period (6,6%). The whole number of hospitalizations was 285 in 74 patients. 55/74 (74,3%) patients experienced more than one hospitalization. In the majority of the hospitalizations (119/285, 41,7%), the cause of hospitalization was directly attributable to the disease itself, while the second cause of hospitalization was the infections (26/285, 9,1%). In 10/103 patients (9,7%), an end stage renal disease was recorded as event. The presence of at least one positivity for ANCA antibodies was documented in 76/103 patients (73,8%), mainly in patients carrying GPA. Globally, the presence of ANCA antibody seems to be associated with greater likelihood of an event (p=0,07, log-rank test). The first event occurred in 50% of ANCA-positive patients within 180 days from diagnosis, while in 50% of ANCA negative patients in 859 days. 6 out of the 7 deaths occurred in ANCA positive patients.Conclusion:the rate of hospitalization in AAV is very high confirming the high health care burden of illness. The disease itself is often the cause of the hospitalization, as well as the infectious complication, highlighting the need for more effective treatments, and glucocorticoid sparing therapies. ANCA antibody may represent a biomarker of a more serious disease.Disclosure of Interests:Luca Quartuccio Consultant of: Abbvie, Bristol, Speakers bureau: Abbvie, Pfizer, Elena Treppo: None declared, Salvatore De Vita Consultant of: Roche, GSK, Speakers bureau: Roche, GSK, Novartis, Francesca Valent: None declared

Sign in / Sign up

Export Citation Format

Share Document