Effectiveness of as‐needed antihistamines in chronic spontaneous urticaria patients under omalizumab treatment

The question how second‐generation antihistamines (sgAHs) should be used when chronic spontaneous urticaria (CSU) is under control with omalizumab is still unanswered. This study aimed to investigate the effectiveness of as‐needed sgAHs in patients with well‐controlled urticaria under omalizumab treatment. Patients from four different urticaria centers who were treated with omalizumab 300 mg/4 weeks for at least 3 months, had well‐controlled urticaria (Urticaria Control Test: 16 > UCT≥12) and were using sgAHs only if needed, were included in this study. In order to assess effectiveness of sgAHs, change in the itch, hives, and total itch‐hives scores before and after sgAHs were evaluated using modified urticaria activity score‐twice daily. Fifty‐three patients [38 female (71.7%)] with mean age 41.1 ± 11.4 years were included in this study. Median sgAH intake per patient throughout the 4 week‐intervals was 3 (2–5) tablets. sgAH intake decreased itch, hives and total itch‐hives scores 45.7% ± 52.9, 42.4% ± 39.1, and 50.2% ± 51.1, respectively (P < .001 for all). This decrease was similar in both isolated‐urticaria and urticaria‐and‐angioedema phenotypes. Baseline IgE levels were positively correlated with the decrease of three symptom scores (r = 0.31, P = .05; r = 0.375, P = .017; r = 0.31, P = .05, respectively) that showed in patients with higher baseline total IgE levels, as needed sgAH intake decreased the symptom scores less. Our study showed that sgAHs may still be an effective option for the treatment of the intermittent symptoms in patients with well‐controlled urticaria under omalizumab treatment. Baseline total IgE levels may be used as a potential biomarker for sgAH effectiveness in these patients.     

苦参素联合抗组胺药治疗慢性荨麻疹疗效的Meta分析

目的:评价苦参素联合抗组胺药治疗慢性荨麻疹的疗效及不良反应。方法:检索中国知网、万方、维普、Pubmed、EMbase及Cochrane library等数据库,筛选符合标准的文献,采用RevM an 4.2进行Meta分析。结果:共纳入14篇文献,入选文献发表偏倚较小,无明显异质性(P=0.34)。Meta分析结果显示,苦参素联合抗组胺药组与单用抗组胺药组比较,有效率高[P0.00001,RR=1.40,95%CI(1.30~1.51)],复发率低[P0.00001,RR=0.19,95%CI(0.10-0.37)]。结论:苦参素联合抗组胺药治疗慢性荨麻疹疗效优于单用抗组胺药。     

Stanozolol in chronic urticaria: a double blind, placebo controlled trial

H1-type antihistamine drugs are mainstays in the management of chronic urticaria. For patients with refractory, chronic, idiopathic urticaria who have failed to benefit from conventional therapy, other safe therapeutic modalities are required. To evaluate the role of stanozolol as an adjunctive therapeutic agent with H1-antihistamine in refractory chronic idiopathic urticaria, we conducted this study. Fifty-eight patients with chronic refractory urticaria were enrolled in this trial and were randomly assigned to two groups (A and B). Patients in group A received 2 mg stanozolol twice daily along with cetrizine 10 mg daily. Patients in group B received cetrizine 10 mg daily and placebo tablets twice daily. The improvement was monitored by estimation of severity score. Of the 58 patients, 26 in group A and 24 in group B could be evaluated. At the end of 12 weeks, 17 patients in group A showed marked to complete resolution as compared to 7 patients in group B (chi-square p<0.01). The intention to treat analysis p value was a found to be <0.007. There was a highly significant decrease in mean severity score at 12 weeks (p<0.001) in group A patients. The present study demonstrated that stanozolol is an effective and safe adjuvant therapy for treatment of chronic refractory urticaria.     

3种抗组胺药治疗慢性特发性荨麻疹的临床研究

目的:评价第2代抗组胺药咪唑斯汀、西替利嗪、氯雷他定治疗慢性特发性荨麻疹的疗效和安全性。方法:采用随机开放平行对照的方法,对96例慢性特发性荨麻疹患者进行随机分组,分别予以咪唑斯汀10mg、西替利嗪10mg、氯雷他定10mg,均每日1次口服,观察治疗第14天、第28天的临床疗效及停药1周后的复发率。结果:三者治疗慢性特发性荨麻疹第14天和第28天的有效率分别为:咪唑斯汀组90.0%和96.7%,西替利嗪组85.3%和94.2%,氯雷他定组90.6%和93.8%,三者之间差异无显著性(P>0.05)。停药1周后的复发率,咪唑斯汀组为40.0%,西替利嗪组为35.3%,氯雷他定组为28.1%。整个试验过程中均无明显严重不良反应出现。结论:咪唑斯汀、西替利嗪和氯雷他定治疗慢性特发性荨麻疹临床疗效好,安全性高,在改善临床症状及控制复发方面各有所长。     

Chronic idiopathic urticaria and its management

ABSTRACT: Chronic urticaria is defined as the daily or almost daily occurrence of wheals for at least 6 weeks. This disorder affects 0.1% of the general population and is more common in females. Recently a subgroup of patients with chronic urticaria has been found to have circulating autoantibodies directed against the high-affinity IgE receptor (Fc∍RI) or against IgE antibodies. These "autoantibodies" are felt to play a role in mast cell histamine release. Urticaria patients with these circulating antibodies also have a higher prevalence of other autoimmune diseases. The management of patients with chronic urticaria is to identify and eliminate the underlying cause, however, an etiology for chronic urticaria is rarely identified. Thus the approach to treatment usually centers on the use of antihistamines initially with the addition of other immune modulating agents as necessary.     

Antihistamines and alternatives in physical urticaria

ABSTRACT: The mainstay of management of physical urticaria is symptomatic therapy with H₁-type antihistamines, with preference being given to the nonsedating drugs. Patients vary in their responsiveness, in dependence of the type of physical urticaria. If even higher doses of H₁ blockers fail, dapsone, sulfazalazine, chloroquine, and danazol may be tried as alternatives. Corticosteroids, though highly effective, are contraindicated because of long-term adverse effects. Patients should also be advised to avoid eliciting stimuli or to use exposure only to induce the so-called hardening, under medical supervision. Physicians should exclude sustaining diseases or drug intake. In cold urticaria, a trial with antibiotics is worthwhile. If all these possibilities are utilized to the advantage of the individual patient, physical urticaria is a generally well-managed disease.     

玉屏风散加味联合抗组胺药治疗慢性荨麻疹疗效与安全性Meta分析

目的： 评价玉屏风散联合抗组胺药治疗慢性荨麻疹的临床疗效及 安全性。方法： 检索中国知网、万方、维普、PubMed、EMbase 及 Cochrane library 等数据库建库至2017年11月期间发表的使用玉屏风散加味联合抗组胺药治疗慢性荨麻疹的随机对照试验（RCTs）。由两名研究者独立筛选文献并提取数据,根据Cochrane 偏倚风险评估工具对纳入研究进行方法学质量评估,用Rev Man 5.3软件进行Meta分析。结果：共纳入15篇文献, 133 6例患者。Meta分析结果显示,玉屏风散联合抗组胺药组与单用抗组胺药组比较,有效率高（P<0.00001）,复发率低（P<0.00001）,不良反应发生率低（P=0.003）。结论：玉屏风散加味联合抗组胺药治疗慢性荨麻疹疗效优于单用抗组胺药,且更安全。     

关注抗组胺药治疗慢性荨麻疹应用的策略

抗组胺药通过拮抗H1受体来阻断组胺与受体的结合,从而影响变态反应发生的过程,是治疗慢性荨麻疹的基本药物。最新研究表明,抗组胺药还可通过其他机制发挥更广泛的药理作用。本文就目前临床抗组胺药物选择及使用的策略进行探讨。     

不同剂量氮斯汀及联合西咪替丁治疗慢性荨麻疹疗效观察

目的:对比不同剂量氮斯汀及联合西咪替丁治疗慢性荨麻疹的疗效及不良反应。方法:采用随机入组开放观察同样疗程不同剂量氮斯汀(A、B两组)及联合西咪替丁(B C组)治疗慢性荨麻疹的疗效及不良反应。A组患者采用氮斯汀4mg/d治疗;B组患者采用氮斯汀2mg/d治疗;B C组患者采用氮斯汀2mg/d联合西咪替丁400mg/d治疗。3组患者均在28d时观察疗效及不良反应。结果:A组显效27例(81.8%),良效4例(12.1%),微效2例(6.1%);B组显效21例(61.8%),良效6例(17.6%),微效7例(2.06%);B C组显效26例(78.8%),良效3例(9.1%),微效4例(12.1%)。A组出现口干1例,困倦2例;B组出现口干3例,头昏、困倦1例;B C组出现困倦3例,口干1例。均不影响疗效。结论:A组及B C组患者的疗效相似,且高于B组,差异有统计学意义(P<0.05)。     

不同剂量氮(艹卓)斯汀及联合西咪替丁治疗慢性荨麻疹疗效观察

目的:对比不同剂量氮(艹卓)斯汀及联合西咪替丁治疗慢性荨麻疹的疗效及不良反应.方法:采用随机人组开放观察同样疗程不同剂量氮(艹卓)斯汀(A、B两组)及联合西咪替丁(B c组)治疗慢性荨麻疹的疗效及不良反应.A组患者采用氮(艹卓)斯汀4mg/d治疗:B组患者采用氮(艹卓)斯汀2 mg/d治疗;B C组患者采用氮(艹卓)斯汀2 mg/d联合西咪替丁400 mg/d治疗.3组胄者均在28 d时观察疗效及不良反应.结果:A组显效27例(81.8%),良效4例(12.1%),微效2例(6.1%);B组显效21例(61.8%),良效6例(17.6%).微效7例(2.06%);B C组显效26例(78.8%),良效3例(9.1%),微效4例(12.1%).A组出现口干1例,困倦2例;B组出现口干3例,头昏、困倦1例;B C组出现困倦3例,口干1例.均不影响疗效.结论:A组及B C组患者的疗效相似,且高于B组,差异有统计学意义(P<0.05).     

窄谱中波紫外线联合抗组胺药治疗慢性自发性荨麻疹的疗效观察

目的观察窄谱中波紫外线(NB-UVB)联合抗组胺药治疗慢性自发性荨麻疹的疗效。方法 80例慢性荨麻疹患者,随机分为试验组和对照组,每组各40例。试验组采用NB-UVB光疗,每周2次,共24次,同时口服抗组胺药;对照组仅口服抗组胺药。比较两组治疗后的临床疗效以及随访12周内的复发情况。结果两组患者的症状和体征评分明显下降,且试验组下降更为明显(t=46.37,P0.05)。试验组的临床疗效明显优于对照组(χ~2=6.76,P0.05);且复发率明显低于对照组(χ~2=9.83,P0.01)。结论 NB-UVB安全有效,可作为慢性自发性荨麻疹的辅助治疗手段。     

依巴斯汀联合卡介菌多糖核酸针治疗慢性荨麻疹56例疗效评价

目的:评价依巴斯汀联合卡介菌多糖核酸针(BCG-PSN)治疗慢性荨麻疹的临床疗效。方法:将112例慢性荨麻疹患者随机分为治疗组(56例)和对照组(56例),两组均给予依巴斯汀片10mg口服,每日1次,治疗组同时给予卡介菌多糖核酸针1 mL肌肉注射,隔日1次;8周后评价疗效。随访1个月,评价复发。结果:治疗8周后,治疗组和对照组总有效率分别为91.08%和75.00%,两组比较有显著性差异(P0.05)。随访1个月后,治疗组和对照组复发率分别为1.79%和14.29%,两组比较有显著性差异(P0.05)。结论:依巴斯汀联合卡介菌多糖核酸针治疗慢性荨麻疹较单独应用依巴斯汀疗效好,复发率低。     

几种炎症因子与慢性荨麻疹的相关性

目的:明确几种炎症因子与慢性荨麻疹(CU)的相关性。方法:采用ELISA法检测40例CU患者以及40名正常对照者血浆C5a水平以及血清C3、C4、ESR、抗溶血性链球菌O(ASO)、C-反应蛋白(CRP)、类风湿因子(RF)水平,分析其与CU症状评分的相关性。结果:与正常对照者比较,CU患者血浆C5a水平以及血清C4水平明显升高(P0.01),而血清C3水平无统计学差异(P0.05);患者ESR以及CRP水平明显升高(P0.01和P0.05);血清ASO以及RF水平无统计学差异(P0.05)。CU患者的ESR以及CRP水平与症状评分相关(P0.01)。结论:慢性荨麻疹患者中存在补体激活和系统性炎症反应。     

阿伐斯汀联合玉屏风颗粒治疗慢性荨麻疹临床研究

目的:评价阿伐斯汀胶囊联合玉屏风颗粒治疗慢性荨麻疹的疗效及安全性。方法:将入选的63例慢性荨麻疹患者分为治疗组(34例)和对照组(29例)。治疗组患者口服阿伐斯汀胶囊联合玉屏风颗粒,对照组口服阿伐斯汀胶囊。结果:治疗4周后,治疗组症状体征评分为2.2±1.6,明显低于对照组的3.9±2.1,差异有统计学意义(P0.05)。治疗组有效率为70.58%,高于对照组的48.27%,差异有统计学意义(P0.05)。两组患者均未见明显不良反应。结论:阿伐斯汀胶囊联合玉屏风颗粒治疗慢性荨麻疹疗效优于单用阿伐斯汀胶囊。     

Clinical and aetiological aspects in urticaria and angio-oedema

BACKGROUND: Urticaria is a common disorder that affects as many as 20% of all people at some time during their lifetime. OBJECTIVES: To analyse the prevalence of various forms of urticaria according to an aetiological and clinical classification, we carried out a 4-year study in an outpatient clinic. METHODS: The study was carried out on 562 consecutive patients (178 males and 384 females; mean age 35.4 +/- 16), who had been referred to our unit for the study of urticaria and angio-oedema. Baseline investigations included: the patient's family and personal history of allergy; duration of symptoms, presence of associated symptoms and objective signs of the current episode; clinical, laboratory and instrumental investigations; assessment of response to antihistamine treatment. RESULTS: A family history of atopy was present in 35% of patients and a personal history of allergy in 24%. We subdivided urticaria and angio-oedema into several groups on the basis of their clinical and aetiological aspects. Of the 562 patients, 424 (76%) presented with ordinary urticaria (43 acute urticaria, 311 chronic urticaria, 70 episodic urticaria), 80 (14%) physical urticaria, 49 (9%) angio-oedema without weals, six (1%) IgE-mediated contact urticaria and three (0.5%) urticarial vasculitis. In 64 cases (11%) urticaria/angio-oedema was associated with one or more symptoms. We identified 394 cases (82%) of idiopathic urticaria, 42 (9%) of immunological urticaria, 29 (6%) of non-immunological urticaria and 17 (3%) of urticaria secondary to infections. Of the treated subjects, 54% showed a good response to treatment with antihistamines. CONCLUSIONS: Our data provide an overview of urticaria/angio-oedema in a large series of patients, based on clinical-aetiological aspects, and related to recent diagnostic guidelines.     

Cellular adhesion molecules in chronic urticaria: modulation of serum levels occurs during levocetirizine treatment

BACKGROUND: Some antihistamines are capable of reducing levels of adhesion molecules in wealing tissues of patients with chronic urticaria (CU). OBJECTIVES: To determine if 6 weeks of therapy with levocetirizine 5 mg once daily would also induce any decrease in serum levels of intercellular adhesion molecule-1, vascular cell adhesion molecule-1, endothelial leucocyte adhesion molecule-1 (ELAM-1) or P-selectin in subjects with CU and chronic autoimmune urticaria. METHODS: Thirty-six patients with CU (18 with positive and 18 with negative autologous serum skin test) were studied, together with 10 control healthy subjects. All patients received levocetirizine 5 mg daily. Serum soluble cellular adhesion molecule (CAM) levels were determined by immunoenzymatic assay before and after the end of the study period. Disease activity was recorded according to the EAACI/GA(2)LEN/EDF scoring system. RESULTS: After levocetirizine therapy CAM levels decreased in patients with CU, significantly in the cases of ELAM-1 and P-selectin. Patients' clinical scores improved during regular antihistamine therapy. CONCLUSIONS: Levocetirizine 5 mg daily demonstrated a broad anti-inflammatory effect in patients with CU. The significant decrease in serum levels of ELAM-1 and P-selectin might reflect the inhibitory activity on neutrophil rolling and extravasation towards inflamed skin.     

荨麻疹患者血清特异性IgE过敏原检测及两种氯雷他定的疗效比较

目的:了解322例荨麻疹患者的致病因素及各种因素之间的相互关系,比较2种氯雷他定治疗84例慢性特发性荨麻疹患者的疗效。方法:采用德国“敏筛”定量过敏原检测系统对322例荨麻疹患者进行了特异性IgE及过敏原的检测和分析,应用2种氯雷他定片治疗84例慢性特发性荨麻疹患者,并进行疗效对比和随访观察。结果:322例患者中有159例至少对1项过敏原阳性,阳性率为49.4%。平均阳性过敏原为(1.36±1.70)项;78例患者血清特异性总IgE阳性,阳性率为24.2%。2种氯雷他定片治疗前后患者症状和体征评分指数下降差异无统计学意义。治疗后,治疗组基愈率为37.2%,有效率为72.2%;对照组基愈率为39.0%,有效率为78.0%,两组疗效比较差异无统计学意义。结论:德国“敏筛”定量过敏原检测系统能较简便地检测特异性IgE和过敏原;国产氯雷他定治疗慢性特发性荨麻疹安全有效。