Therapy of acute and chronic urticaria

Background The drug management of chronic urticaria can be divided into three approaches: (i) blockade of released histamine at the receptor sites; (ii) blockade of histamine release from mast cells; and (iii) blockade of other mediators and possible inflammatory and cellular components. The first approach is the most successful and widely used. It primarily involves the use of H₁-antihistamines, although tricyclic antidepressants and H₂-antihistamines also have a place. Treatments The usefulness of classic H₁-antihistamines, such as hydroxyzine, may be limited by side-effects (most notably, sedation). The four most widely used of the newer antihistamines are loratadine, terfenadine, astemizole and cetirizine. These antihistamines are significantly superior to placebo and have similar efficacies comparable with hydroxyzine. Novel agents and methods, including nifedipine, sulphasalazine and plasmapheresis have been tried with some success in refractory patients. Guidelines If acute cases are inadequately controlled, short-term oral corticosteroids may be added. Systemic corticosteroids are occasionally indicated for the management of severe acute urticaria, severe serum sickness, pressure urticaria or urticarial vasculitis, or to break the cycle of a resistant case, but have no place in regular therapy for chronic urticaria. For those with severe acute urticaria with signs of respiratory distress, possible treatments include subcutaneous epinephrine, systemic corticosteroids and intramuscular H₁-antihistamines. Patients with chronic urticaria inadequately controlled on H₁-antihistamines alone may benefit from the addition of a classic antihistamine, a tricyclic antidepressant or an H₂-antihistamine. A short course of systemic corticosteroids may help those with severe chronic refractory disease.     

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。     

慢性可诱导性荨麻疹的治疗进展

【摘要】 慢性可诱导性荨麻疹（CIndU）的发病机制目前尚未完全清楚,仅仅靠针对诱因的规避常常无法达到满意的症状控制效果。近年来国内外在CIndU的治疗方面取得一定进展,如传统的抗组胺药、非抗组胺药、生物制剂及小分子靶向药等药物治疗,以及诱因脱敏治疗等物理治疗等,本文对这些进展进行全面系统的梳理和总结。     

盐酸非索非那定治疗126例慢性特发性荨麻疹

目的:评价盐酸非索非那定片治疗慢性特发性荨麻疹的有效性和安全性。方法:多双盲、随机、平行组对照的临床试验,以盐酸西替利嗪片为对照药。结果:共完成病例126例,试验组63例,对照组63例。试验组有效率为88.89%,对照组有效率为80.95%,两组无显著性差异(P >0.05)。试验组不良反应发生率为4.76%;对照组不良反应发生率为9.52%,两组无显著性差异(P>0.05)。结论：:盐酸非索非那定片治疗慢性特发性荨麻疹的有效性与盐酸西替利嗪片相当。     

165例慢性荨麻疹患者食物过敏原检测结果分析

目的探讨食物过敏原与慢性荨麻疹的相关性。方法对我科165例慢性荨麻疹病人进行食物过敏原半定量检测。结果引起慢性荨麻疹的前3位食物依次为蟹、蛋、虾,阳性率分别是67.95%、64.11%、52.56%。结论检测食物过敏原在慢性荨麻疹的诊治中有重要意义。     

奥马珠单抗治疗慢性自发性荨麻疹的进展

【摘要】 慢性自发性荨麻疹指不明原因反复发作风团超过6周,伴或不伴血管神经性水肿。其发病的中心环节是肥大细胞和嗜碱性粒细胞激活、脱颗粒。奥马珠单抗是一种人源化、重组单克隆IgG抗体,能选择性结合游离IgE抗体Fc段,阻断IgE?FCεRⅠ轴所引起的肥大细胞、嗜碱性粒细胞激活。已发布评价奥马珠单抗治疗慢性自发性荨麻疹的Ⅲ期临床试验有3项,证实了奥马珠单抗在治疗难治型慢性自发性荨麻疹的有效性和安全性。     

地氯雷他定治疗慢性荨麻疹临床研究

目的评价地氯雷他定治疗慢性荨麻疹的疗效与安全性。方法采用随机开放平行对照的方法,对78例慢性荨麻疹患者随机分组,分别给予地氯雷他定5mg、西替利嗪10mg,均每日一次口服,观察治疗第14d、第28d的临床疗效及停药1w后的复发率。结果两者第14d、第28d的有效率分别为:地氯雷他定组68.89%和91.11%,西替利嗪组60.67%和84.85%,两者间无显著性差异(P>0.05)。停药1w后复发率,地氯雷他定组28.89%,西替利嗪组36.36%。两者试验过程中均无明显不良反应。结论地氯雷他定、西替利嗪治疗慢性荨麻疹疗效好,安全性高。     

Loratadine and cetirizine in the treatment of chronic urticaria

Aim This study was designed to compare loratadine and cetirizine in controlling the symptoms of chronic urticaria. Subjects One hundred and sixteen adult patients with chronic urticaria. Methods In this double-blind study the patients were randomly divided into three therapeutic groups: 38 received loratadine (10 mg), 40 cetirizine (10 mg) and 38 placebo tablets once daily for 28 days. Steroid-dependent subjects and patients with physical urticaria or with angioncurotic hereditary oedema as well as pregnant or breast-feeding women were excluded from the study. A suitable wash-out period was observed in case of previous treatments for the same disease. Itching, erythema, number of lesions and diameter of the largest one were evaluated according to a scale from 0 (absent) to 3 (severe). The minimum entry study score for itching plus number of lesions had to be at least equal to three. Control visits were scheduled after 3, 7 and 14 days of therapy. Symptoms, disease status, therapeutic response, side effects and compliance were evaluated at each visit. Diary cards were filled in by patients at home. Results Active drugs compared to placebo significantly reduced global clinical symptoms (p < 0.05). Loratadine was more rapid in developing its activity than the other two agents (p < 0.01 at day 3). Each single symptom showed the same trend. At the end of the study 24 (63%) patients treated with loratadine, 18 (45%) with cetirizine and 5 (13%) with placebo were free from symptoms. Four failures occurred with loratadine, six with cetirizine and seventeen with placebo. The tolerability profile was similar for all three groups. One patient receiving cetirizine dropped out due to severe gastric pain. Conclusions Loratadine is more active and safer than cetirizine in the treatment of chronic urticaria.     

咪唑斯汀每日/隔日疗法治疗慢性荨麻疹疗效观察

目的比较咪唑斯汀每日/隔日疗法与每日疗法治疗慢性荨麻疹的疗效。方法将患者随机分为两组,分别使用每日/隔日疗法和每日疗法治疗。结果两组有效率的差异无统计学意义。结论本研究结果提示咪唑斯汀每日/隔日疗法治疗慢性荨麻疹,有效率与每日疗法疗效相当,既能达到治疗作用,又能减轻患者经济压力。     

Markers of antioxidant defence system and lipid peroxidation in peripheral blood of female patients with chronic idiopathic urticaria

Oxidative stress is an important event in lesional skin of patients with chronic idiopathic urticaria (CIU). In the present study, we assessed blood oxidant/antioxidant status of patients suffering from CIU with positive response to autologous serum skin test (ASST) and with negative ASST, to improve our understanding of biological processes and the part of oxidative stress in this disease. Activities of manganese superoxide dismutase (MnSOD), copper–zinc superoxide dismutase (Cu/ZnSOD), glutathione peroxidase (GSH-PX), and catalase (CAT) as indices of enzymatic antioxidant capacity, as well as malondialdehyde (MDA) level as a maker of lipid peroxidation were measured in plasma and erythrocytes from 14 CIU female patients showing positive ASST, 31 CIU female patients with negative ASST and in 19 sex- and age- matched healthy subjects. The antioxidant enzyme activity in plasma and in erythrocytes did not differ significantly among the three groups. Also, the plasma and erythrocytes MDA levels were similar in the three groups. Based on our results, it seems that systemic activity of the enzymatic antioxidants (CuZn/SOD, MnSOD, GSH-Px, and CAT) as well as level of lipid peroxidation determined by MDA may not be increased in the course of immune-inflammatory processes associated with CIU. We also suggest that the systemic oxidant/antioxidant status of CIU patients, showing positive response to ASST, may not be different from that of CIU patients with negative ASST.     

奥马珠单抗治疗慢性自发性荨麻疹的疗效及安全性分析

【摘要】 目的 回顾分析奥马珠单抗治疗慢性自发性荨麻疹（CSU）的疗效、安全性及停药复发情况。方法 回顾北京大学第一医院皮肤科门诊2018年2月至2021年1月使用奥马珠单抗治疗的CSU病例,分析其临床特征,采用门诊随访形式,通过荨麻疹控制评分（UCT）、皮肤病生活质量指数（DLQI）评估疾病严重程度,监测不良事件及停药后复发情况。正态分布的计量资料组间比较采用独立样本t检验或方差分析,非正态分布的计量资料组间比较采用Mann-Whitney U检验、Wilcoxon符号秩和检验或Kruskal-Wallis H检验,计数资料组间比较采用卡方检验或Fisher 精确检验。结果 纳入59例CSU患者,奥马珠单抗治疗至少3个月,其中45例治疗达6个月,15例达12个月。经奥马珠单抗治疗,UCT从基线期3.0（1.0,6.0）分上升至第1个月11.0 （3.0,14.0）分和第3个月15.0 （12.0,16.0）分（均P < 0.05）。DLQI从基线期16.0（12.0,20.0）分下降至第1个月7.0 （1.0,13.0）分和第3个月1.0 （0.0,4.0）分（均P < 0.05）。疾病部分或完全控制的比例在基线期为0,第1个月上升至44.1%,第3个月达78.0%,第6个月达88.9%。疾病对生活质量存在重度或极重度影响的比例在基线期为84.7%,第1个月降至30.5%,第3个月降至15.3%,第6个月降至4.4%。对奥马珠单抗治疗完全反应组和部分反应组比无反应组病程更短（t = -2.894,P = 0.011;t = -2.511,P = 0.036）;完全反应组比部分反应组和无反应组治疗时间更长（t = 2.479,P = 0.039;t = 2.677,P = 0.022）。慢反应组与快反应组相比,基线DLQI更高（Z = -2.622,P = 0.009）,基线UCT更低（Z = -2.746,P = 0.006）。19例患者病情完全控制后停药,其中13例（68.4%）在停药7（5,8）周后复发,复发后UCT评分高于治疗前（Z = 3.172,P = 0.001）,复发组比未复发组病程更长（Z = -2.635,P = 0.007）。复发后5例重新开始奥马珠单抗治疗,均再次得到部分或完全控制。治疗期间报告不良反应事件均为轻中度。结论 奥马珠单抗能够有效控制CSU症状,提高患者生活质量,且安全性较好,但停药后复发率高,复发后重新开始奥马珠单抗治疗仍有效。     

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。     

慢性自身免疫性荨麻疹的研究进展

慢性自身免疫性荨麻疹（CAU）是慢性自发性荨麻疹（CSU）的一种特殊类型，其特征是风团和/或血管性水肿反复发作，常伴有全身症状，病程超过6周。本文就该疾病的临床表现、发病机制、诊断及治疗做一综述。     

幽门螺杆菌感染致慢性荨麻疹诱发或加重的机制探讨

目的观察幽门螺杆菌(Helicobacter pylori,Hp)感染的BALB/c小鼠模型外周血及胃黏膜组胺和类胰蛋白酶的变化,以探讨Hp在诱发慢性荨麻疹(CU)或使病情加重过程中的机制。方法 90只健康BALB/c小鼠随机分成3组(实验1组、实验2组和对照组),每组各30只。实验1、2两组分别灌胃高毒力株(VacA+CagA+)和低毒力株(VacA-CagA+)Hp菌悬液,对照组灌胃牛血清白蛋白(BAS)。分别采用组胺荧光测定法、类胰蛋白酶免疫组化法及ELISA法检测三组标本灌胃前后外周血、胃黏膜组胺和类胰蛋白酶含量。结果实验1、2组小鼠外周血及胃黏膜组胺含量均高于对照组(P<0.01),实验1、2两组小鼠外周血组胺含量无显著性差异(P>0.01),但实验1组小鼠胃黏膜内组胺含量低于实验2组(P<0.01);实验1、2两组小鼠外周血及胃黏膜类胰蛋白酶含量均高于对照组(P<0.01),实验1组小鼠胃黏膜类胰蛋白酶含量低于实验2组(P<0.01),但外周血类胰蛋白酶含量高于实验2组(P<0.01)。结论 Hp感染可导致小鼠模型外周血及胃黏膜组胺和类胰蛋白酶含量均增加,这可能是Hp诱发或加重CU的重要原因之一。     

178例急性自发性荨麻疹转归为慢性的危险因素回顾性分析

目的：分析影响急性自发性荨麻疹（ASU）转归为慢性自发性荨麻疹（CSU）的危险因素。方法：回顾性分析本院2018年11月至2019年10月178例ASU患者的人口学信息、发病季节、初发病程、自诉可疑过敏原、自体血清皮肤试验（ASST）、7日荨麻疹活动度评分（UAS7）、血常规、血清总IgE测定、治疗药物,Logistic回归分析ASU转归为CSU的危险因素。结果：178例ASU中42例（23.60%）转归为CSU,单因素分析自诉食物过敏（P<0.001）、 ASST试验阳性（P<0.001）、初发病程（P＜0.001）与ASU患者转归为CSU具有相关性;多因素Logistics回归分析示自诉食物过敏（P=0.029）、ASST试验阳性（P=0.043）、初发病程长（P＜0.001）均是影响ASU转归为CSU的独立危险因素。结论：食物过敏、ASST试验阳性、初发病程长是ASU患者转归为CSU的危险因素。     

Clinical characteristics of pruritus in chronic idiopathic urticaria

BACKGROUND: Although pruritus is a predominant symptom of chronic idiopathic urticaria (CIU) its clinical characteristics have not been explored. OBJECTIVES: To characterize the clinical pattern and sensory and affective dimensions of the itch experience, utilizing a comprehensive itch questionnaire. METHODS: A structured questionnaire based on the McGill pain questionnaire was used in 100 patients suffering from CIU randomly recruited from a tertiary referral centre. RESULTS: All 100 patients recruited with CIU completed the questionnaire. In 68 patients pruritus appeared on a daily basis. Most patients experienced their pruritus at night and in the evening (n = 83), and 62 reported difficulty in falling asleep. Pruritus involved all body areas, but mostly the arms (n = 86), back (n = 78) and legs (n = 75). Accompanying symptoms were a sensation of heat in 45 patients and sweating in 15. Most patients (n = 98) were prescribed antihistamines (mainly sedating), of whom 34 experienced long-term relief. The sensation of itch was reported to be stinging (n = 27), tickling (n = 25) and burning (n = 23). Seventy-six patients found their pruritus bothersome, 66 annoying and 14 complained of depression. The itch intensity at its peak was more than double that felt after a mosquito bite. The worst itch scores of those who felt depressed were significantly higher than of those who did not (P = 0.018). There was a positive correlation between the sensory and affective scores during worst itch (P < 0.001). CONCLUSIONS: This study describes the itch experienced in CIU, highlighting sensory and affective dimensions. The itch questionnaire was found to be a valuable tool for evaluating pruritus in CIU and its unique features.     

儿童慢性荨麻疹血清嗜酸细胞阳离子蛋白（ECP）和血清总IgE的检测及其意义

应用了 ECP FEI荧光酶标法检测了 32例典型慢性荨麻疹患儿及 13名正常儿童的血清嗜酸细胞阳离子蛋白 (ECP)值,同时还检测了患儿和正常儿童血清总 IgE值及外周血嗜酸粒细胞 (EOS)计数,并比较了它们之间的联系。结果显示：患儿血清 ECP值为 12.96± 9.72μ g/L、血清总 IgE值为 970.10± 312.61IU/mL,二者均明显高于正常对照组 (P< 0.05);而患儿的血 EOS计数与正常儿童相比增高不明显 (P >0.05)。慢性荨麻疹患儿血清 ECP和血清总 IgE与外周血 EOS计数之间无相关性。提示儿童慢性荨麻疹中血清 ECP和血清总 IgE的变化可能较血 EOS计数变化更灵敏,更能反映 EOS的活化程度。     

Methotrexate: a useful steroid-sparing agent in recalcitrant chronic urticaria

Background Reports of methotrexate for chronic urticaria are anecdotal. Objectives To assess the effectiveness of methotrexate in steroid‐dependent chronic urticaria, its impact on steroid reduction and any differences in response between patients with and without functional autoantibodies. Methods A retrospective case‐note review of 16 patients with steroid‐dependent chronic urticaria treated with methotrexate was carried out. Ten patients had chronic ordinary/spontaneous urticaria (CU), including three with associated delayed‐pressure urticaria; four patients had normocomplementaemic urticarial vasculitis (UV); and two patients had idiopathic angio‐oedema without weals. Median disease duration before methotrexate was 48·5 months (range 12–164). All were unresponsive to antihistamines and second‐line agents, except prednisolone. Eleven were assessed for autoimmune urticaria with the basophil histamine release assay (n = 5), autologous serum skin test (n = 5) or both (n = 1). Response to methotrexate was scored: no benefit; some benefit (fewer weals and symptomatic improvement but no steroid reduction); considerable benefit (improvement with steroid reduction); or clear (no symptoms, off steroids but on antihistamines). Results Twelve of 16 patients (eight CU, three UV, one idiopathic angio‐oedema) responded. Three showed some benefit, seven considerable benefit and two cleared. Four of eight responders and three out of three nonresponders showed evidence of functional autoantibodies. The dose to achieve a steroid‐sparing effect was 10–15 mg weekly (cumulative dose range 15–600 mg, median 135 mg). Methotrexate was well tolerated. Conclusions Methotrexate may be a useful treatment for steroid‐dependent chronic urticaria. Functional autoantibodies do not correlate with response. The beneficial effects of methotrexate may be anti‐inflammatory and immunosuppressive. It may therefore benefit chronic urticaria independently of the pathogenic mechanism, whether autoimmune or not.     

慢性特发性荨麻疹患者血清IL-2、4、6、8、10、12及IFN-γ的检测及临床意义

目的探讨慢性特发性荨麻疹患者血清细胞因子水平测定的临床意义。方法随机选择慢性特发性荨麻疹患者48例,健康检查的正常A．48例,分为两组,分别测定其血清中IL-2、4、6、8、10、12及IFN-γ的含量。结果慢性特发性荨麻疹患者组血清中IL-4、IL-8水平显著高于正常对照组（P〈0．01）;IL-6、IL-10水平略高于对照组,但差异无统计学意义（P〉0．05）;IL-2、IL-12、IFN-γ水平明显低于正常对照组（P〈0．01）。结论慢性特发性荨麻疹患者血清IL-2、IL-4、IL-8、IL—12及IFN-γ水平异常,提示慢性特发性荨麻疹的发病与免疫相关。     

奥马珠单抗治疗难治性慢性自发性荨麻疹的疗效预判分析

目的探索预测奥马珠单抗治疗难治性慢性自发性荨麻疹(CSU)疗效的因子。方法收集2019—2021年苏州大学附属第二医院皮肤科门诊和病房收治的经奥马珠单抗治疗的难治性CSU患者40例, 收集患者的临床资料、治疗前7天荨麻疹活动度评分(UAS7)、皮肤病生活质量指数(DLQI)。治疗前测定基线免疫球蛋白E(IgE)、嗜酸性粒细胞及嗜碱性粒细胞数、IgG型抗甲状腺过氧化物酶(TPO)抗体、平均血小板体积、C反应蛋白、D-二聚体、补体C3、C4、白细胞介素(IL)-2、IL-4、IL-6、IL-10、IL-17A、肿瘤坏死因子(TNF)-α、γ干扰素(IFN-γ)水平、CD4+ T细胞及CD8+ T细胞百分比, 并进行自体血清皮肤试验(ASST)。奥马珠单抗治疗12周后, 根据UAS7评分将40例CSU患者分为应答良好组和应答不佳组, 比较两组患者上述指标的差异。采用受试者工作曲线(ROC)分析两组间差异有统计学意义的连续型变量指标, 测定预测因子的准确度并确定连续型变量指标的最佳临界值;对组间差异有统计学意义的分类变量, 计算其预测应答不佳的灵敏度和特异度;采用Pearson相关分析法分析各...