CRP relevance in clinical assessment of chronic spontaneous urticaria Tunisian patients

Background: Chronic spontaneous urticaria (CSU) is a common dermatological condition defined by the sudden occurrence of daily wheals and pruritus for at least six weeks. Multifactorial origin is suggested such as oxidative stress. This latter may play a double role as a trigger and remnant agent.

Objectives: The first aim of this study is to investigate antioxidant status, inflammatory proteins, hematologic counts and clinical assessment in CSU patients. The second aim is to evaluate the effect of a first-line treatment: desloratadine 5?mg/d on these different parameters.

Patients and Methods: This study enrolled 30 CSU patients and same number of controls. We assessed the urticaria activity score (UAS), total antioxidant status (TAS), glutathione S-transferase (GST), superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT), albumin, alpha1, alpha2, beta1 beta2, gamma globulins, c-reactive protein (CRP) and hematologic numeration.

Results: At baseline alpha1, alpha2, beta1, beta2, gamma globulins, CRP, SOD activity, leukocytes and basophils were significantly higher in patients versus controls (p?p?p?p?r?=?0.3; p?=?0.011) was noted. UAS assessment revealed the efficacy of 30 d-antihistaminic treatment.

Conclusions: Desloratadine exerted anti-inflammatory and antioxidant effects on CSU patients revealed by CRP. Patients’ remission was synergistic to CRP attenuation emphasizing CRP relevance for CSU clinical assessment.     

Oxidative stress status in patients with acute urticaria

Background: The conflicting information related to oxidative stress status in patients with chronic idiopathic urticaria has been reported in several studies. However, the association between acute urticaria (AU) and oxidative stress has not been investigated exhaustively.

Objectives: To evaluate the role of the oxidative stress in the patients with AU by determining the oxidant/antioxidant activity in AU and to establish its clinical significance.

Methods: About 50 patients with AU, (10 males, 40 females) and 30 unrelated healthy controls (4 males, 26 females) were enrolled into the study. The activity of the antioxidant enzymes copper-zinc superoxide dismutase (Cu-Zn-SOD), glutathione peroxidase (GSH-Px) and catalase, and the levels of malondialdehyde (MDA), serum NO and protein carbonyls levels in the plasma were measured spectrophotometrically at samples.

Results: A statistically significant increase was observed in serum Cu-ZnSOD activities of the patients when compared with that of the controls (p?p?=?0.002). Serum MDA and NO levels were significantly higher in patients with AU when compared with control group (p?p?Conclusion: It seems there is an oxidative burden in the patients with AU. Cutaneous oxidative stress may play a role in pathogenesis of the disease.     

Current and future therapies for treating chronic spontaneous urticaria

Introduction: Chronic spontaneous urticaria (CSU) is a disabling condition that causes deterioration of quality of life.

Areas covered: The international EAACI/GA²LEN/EDF/WAO guidelines have provided a stepwise treatment algorithm for CSU management. Second-generation H₁-antihistamines are the first-line treatment, and the second step is the up-dosing of the same drugs. In refractory patients, the guidelines recommend the addition of omalizumab, ciclosporin A or montelukast. Systemic corticosteroids can be used as a short course during acute exacerbations. A plethora of alternative treatments has been evaluated, although the overall level of evidence for such treatments is low. Future treatment options may include inhibitors of skin mast cells and antagonists to mast cell-activating signals that are relevant for the induction of CSU signs and symptoms.

Expert opinion: The only licensed options included in the guidelines algorithm are standard-dosed second-generation H₁-antihistamines and omalizumab. High-quality evidence has documented a rapid and strong symptomatic effect of omalizumab in CSU, although the optimal long-term regimens should be further investigated. The role of alternative drugs deserves additional studies. The potential of the existing treatments for inducing remission of CSU is unknown, and this is an important area of research, as is the evaluation of predictors of response, prognostic factors, and pathomechanisms.     

Effectiveness of the new inflammatory parameters in patients with chronic spontaneous urticaria

Abstract

In recent years, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio have been studied in many dermatological diseases as various parameters indicating inflammation, and found to be associated with disease activity, prognosis and spread of disease 2,3. In the present study, authors found a significant decrease in the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and C-Reactive Protein after omalizumab treatment. However, a limited number of patients had C-Reactive Protein levels. Since no correlation analysis was performed in the study, the significance of these results remains weak. Moreover, it was not specified whether there were any other drugs used by the patients. In spontaneous urticaria, disease activity is assessed by a robust and simple scoring system named as Urticaria Activity Score 4. In the present study, Urticaria Activity Score was not mentioned, and no information was given about the severity of the disease in these population. The post-treatment change in Urticaria Activity Score will be more valuable for both to evaluate the response to treatment and to demonstrate the usefulness of these parameters. Future studies should focus on randomized trials with more detailed information, with greater emphasis on clinical endpoints.     

慢性荨麻疹患者心理健康状况调查及心理干预对慢性荨麻疹疗效的影响

目的探讨慢性荨麻疹患者心理健康状况及心理干预对慢性荨麻疹疗效的影响。方法对80例慢性荨麻疹患者进行汉密顿焦虑量表（HAMA）问卷调查;并将患者随机分为两组,对照组仅给予药物治疗;治疗组给予药物＋心理干预治疗。结果慢性荨麻疹患者存在不同程度心理健康障碍,表现在焦虑心境、紧张、失眠、记忆或注意障碍、抑郁心境、呼吸系症状和植物神经症状方面与对照组有显著差异（P〈0.05）;治疗组疗效优于对照组（P〈0.05）。结论心理干预对提高慢性荨麻疹疗效有一定的积极意义。     

Pharmacotherapy of chronic spontaneous urticaria

Introduction: Urticaria, by definition, is a disease presenting with wheals, angioedema or both. In patients with recurrent angioedema without wheals, urticaria needs to be distinguished from bradykinin-mediated angioedema, for example, hereditary angioedema or ACE inhibitor-induced angioedema.

Areas covered: Urticaria is comprised of acute and chronic forms. The latter group of chronic urticaria has many different subtypes needing partly different therapeutic approaches. However, all therapeutic approaches for symptomatic treatment center on reducing mast cell-mediator-release and preventing its effect.

Expert opinion: The current guidelines recommend non-sedating, second generation H1-antihistamines (nsAHs) as the first-line treatment. If needed, nsAHs are to be used at higher doses (up to fourfold the standard dose), and Omalizumab, Montelukast or Cyclosporin A (not in preferred order) are recommended as third-line options. Many alternative treatments have been reported but not tested in randomized controlled trials. These include among others dapsone, H2-antihistamines, anticoagulants and methotrexate. Some therapies should no longer be used according to current guidelines, since studies have shown their inefficacy or because new safety concerns have emerged. This mainly refers to the formally propagated use of sedating antihistamines at night, which change REM-sleeping-patterns and learning curves and have been shown in head-to-head trials to not be superior in efficacy to non-sedating antihistamines.     

Assessment of thiol/disulphide homoeostasis and ischaemia-modified albumin and their relationship with disease severity in children with chronic urticaria

Abstract

Background

The pathogenesis chronic urticaria (CU) hasn't been fully understood. In recent years, it has been shown that thiol-disulphide homoeostasis, as an antioxidant system, plays important roles in both healthy individuals and various diseases. In different ischaemia-reperfusion states, high oxidative stress causes ischaemia-modified albumin (IMA) generation.     

The effect of omalizumab on hematological and inflammatory parameters in patients with chronic spontaneous urticaria

Purpose: The mechanism of action of omalizumab in chronic spontaneous urticaria (CSU) is not exactly known. In previous studies, d-dimer which is a fibrin-degradation product and interleukin-31 which has a role in inflammation were found to be decreased in patients with chronic urticaria treated with omalizumab. However, to our knowledge, there is no study on the effects of omalizumab on the ratio of neutrophil to lymphocyte (NLR) and the ratio of platelet to lymphocyte (PLR) which are inflammatory parameters in patients with CSU in the PubMed database. In this study, we aimed to evaluate the effects of omalizumab on hematological and inflammatory parameters in patients with CSU.

Materials and Methods: One hundred six CSU patients treated with omalizumab were evaluated retrospectively. Complete blood count (CBC) and C-reactive protein (CRP) levels before treatment and at the third month of treatment were recorded. NLR and PLR were calculated from the CBC results. CBC parameters, CRP levels, NLR and PLR of the patients before treatment and at the end of third month of treatment were compared.

Results: There was a significant decrease in white blood cell count, platelet count, neutrophil count, CRP level, NLR and PLR and a significant increase in mean platelet volume and eosinophil count with omalizumab treatment in CSU patients (p?p?=?0.293).

Conclusion: This study shows that omalizumab has not only anti Ig E effect, but also it may have inhibitory effects on inflammation and coagulation in patients with CSU.

Further prospective studies are warranted in order to evaluate the effect of omalizumab on hematological and inflammatory parameters and correlation between omalizumab response rate and these inflammatory parameters in patients with CSU.     

Exploring the real-world profile of refractory and non-refractory chronic idiopathic urticaria in the USA: clinical burden and healthcare resource use

Introduction: Chronic idiopathic/spontaneous urticaria (CIU/CSU) is a debilitating skin condition that is burdensome for patients and healthcare providers. We aimed to describe clinical characteristics, consultation patterns and healthcare resource utilization in real-world US patients with refractory and non-refractory CIU/CSU.

Methods: Data was collected from the Adelphi Real World 2015 Urticaria Disease Specific Programme. Physicians completed patient record forms (PRFs) for the next four patients consulting with non-refractory CIU/CSU and the next six with refractory CIU/CSU; patients were considered refractory if symptomatic and on treatment step ≥2. The same patients were asked to complete patient self-completion (PSC) forms describing how CIU/CSU affected them.

Results: Seventeen physicians (15 allergists; 2 dermatologists) completed 184 PRFs (108 refractory CIU/CSU; 76 non-refractory CIU/CSU); 140 patients completed PSC forms (93 refractory CIU/CSU; 47 non-refractory CIU/CSU). Mean time from first consultation to diagnosis was 13.5 (SD 28.3) weeks; mean time from diagnosis to first treatment was 16.0 (SD 37.9) weeks. Patients with refractory CIU/CSU were more likely to initially consult primary care physicians than those with non-refractory CIU/CSU (51% and 28%, respectively). The most common symptoms were itching, sleep problems and anxiety/distress, affecting 75%, 23% and 18%, respectively. Patient-perceived disease severity was greater than physician-perceived severity (refractory CIU/CSU kappa 0.1512; non-refractory CIU/CSU 0.1590).

Conclusions: Patients with CIU/CSU in this real-world study – particularly those with refractory CIU/CSU – were slow to receive specialist care and had substantial symptom burdens; patient–physician perception of disease severity was discordant. Earlier diagnosis of CIU/CSU may lead to timely use of CIU/CSU therapies.     

依巴斯汀治疗慢性荨麻疹临床疗效观察

目的探讨依巴斯汀治疗慢性荨麻疹的临床疗效。方法将68例慢性荨麻疹患者随机分为2组,试验组给予口服依巴斯汀,对照组口服氯雷他定。结果试验组治愈15例,显效14例,有效4例,无效1例,总有效率为85．3％。对照组痊愈13例,显效13例,有效4例,无效4例,总有效率为76．4％。结论口服依巴斯汀治疗慢性荨麻疹疗效优于氯雷他定。     

成人急性荨麻疹与急性细菌性咽炎的关系

目的：了解急性荨麻疹发作与急性细菌性咽炎的关系。方法：选择观察组100例急性荨麻疹患者,对照组101例慢性荨麻疹患者,均进行全身体格检查及外周血全血细胞分类计数、咽拭子细菌培养,以观察荨麻疹发作与急性细菌性咽炎的关系。结果：治疗组中发现有27例有急性细菌性咽炎,而对照组中只发现有6例有急性细菌性咽炎,两组比较差异有统计学意义（χ2=14.742,P〈0.01）。结论：急性细菌性咽炎是急性荨麻疹发作的病因之一。     

Experience with Omalizumab for the treatment of chronic spontaneous urticaria in a tertiary center: real life experience

Abstract

Purpose

Chronic spontaneous urticaria (CSU) is defined as urticaria and/or angioedema that appears spontaneously due to known or unknown causes and lasts for at least 6?weeks. Omalizumab, an anti-IgE antibody that binds circulating free IgE, has recently emerged as a promising treatment for CSU, a condition which impairs patients’ quality of life. We aimed to contribute real life data by reporting our experience with omalizumab in the treatment of intractable CSU.     

安徽省1062例慢性荨麻疹过敏原检测结果分析

目的了解安徽省慢性荨麻疹患者的食人性与吸人性过敏原情况,为该病的预防和治疗提供依据。方法采用酶联免疫分析法,对1062例慢性荨麻疹患者进行吸入性过敏原和食人性过敏原特异性lgE抗体检测。结果1062例慢性荨麻疹患者过敏原阳性检出率为48．78％（518例）,吸入组过敏原的阳性率明显高于食人组,其中粉螨、尘螨（34．56％）、屋尘（10．73％）为主要过敏原。结论安徽省慢性荨麻疹患者吸人性过敏原的检出率明显高于食入性,过敏原以尘螨、粉螨和屋尘多见,找出致病因素对临床治疗慢性荨麻疹有较好的指导意义。     

盐酸左西替利嗪治疗慢性荨麻疹疗效观察

目的观察盐酸左西替利嗪治疗慢性荨麻疹的疗效。方法将106例慢性荨麻疹患者随机分为盐酸左西替利嗪组（治疗组）和盐酸西替利嗪组（对照组）,治疗组54例,对照组52例,治疗组使用盐酸左西替利嗪5mg.次-1,1次.d-1,对照组使用盐酸西替利嗪10mg.次-1,1次.d-1,均连续服用28d。分别于用药后第7、14、28日随访,观察临床疗效及不良反应。结果治疗组与对照组治疗后第7、14、28日有效率分别为66.7%、79.6%、90.7%和67.3%、76.9%、88.5%,治疗组略高于对照组,但2组疗效差异无显著性。结论盐酸左西替利嗪治疗慢性荨麻疹安全有效。     

芪防消瘾汤治疗小儿慢性荨麻疹52例

目的:观察芪防消瘾汤治疗小儿慢性荨麻疹的临床疗效。方法:52例慢性荨麻疹患儿采用芪防消瘾汤治疗,随证加减,10 d为1个疗程。结果:痊愈48例,占92.30%;有效2例,占3.85%;无效2例,占3.85%。总有效率为96.15%。结论:芪防消瘾汤治疗小儿慢性荨麻疹具有显著的治疗作用,临床疗效满意。     

依巴斯汀治疗慢性特发性荨麻疹的疗效及安全性

目的：观察依巴斯汀治疗慢性特发性荨麻疹患者的疗效及安全性。方法：对68例慢性特发性荨麻疹患者应用依巴斯汀10mg，qd，连续治疗4周，干治疗后2，4和8周时复诊观察记录疗效及不良反应。结果：用药2周时痊愈32例（47．1％），显效41例（显效率60．3％）；4周时痊愈38例（55．9％），显效46例（显效率67．6％）：8周时痊愈41例（60．3％），显效48例（显效率70．1％）。2周时3例出现轻度头晕（4．4％），4周复诊时消失．8周时无明显不良反应。结论：依巴斯汀治疗慢性特发性荨麻疹安全有效。     

咪唑斯汀治疗慢性荨麻疹临床疗效评价及对血清IL-4水平的影响

目的：评价咪唑斯汀治疗慢性荨麻疹的疗效，探讨IL-4在慢性荨麻疹发病中的作用。方法：对32例慢性荨麻疹患用咪唑斯汀治疗，评价疗效，记录不良反应。同时用ELISA法检测慢性荨麻疹患治疗前后及正常人血清IL-4的水平。结果：治疗1、2wk后总有效率分别为62．5％、84．4％(P＜0．01)，不良反应3例。治疗前血清IL-4水平较正常人明显升高(P＜0．01)；治疗后IL-4水平下降(P＜0．01)，与正常人比较差异不甚明显(P＞0．05)。结论：咪唑斯汀是一种有效、安全的治疗慢性荨麻疹的药物，能降低慢性荨麻疹患血清IL-4的水平。     

慢性荨麻疹患者健康教育需求的调查分析

目的 了解慢性荨麻疹患者对健康教育知识的需求情况,通过对健康教育需求的调查分析,为今后有针对性地开展健康教育提供依据.方法 采用自行设计的健康教育需求问卷对本所门诊178例慢性荨麻疹患者进行随机抽样调查.结果 患者对发病原因及治疗效果、预后相关知识的需求率达85.3％;药物副作用与不良反应的需求率为85.9％;皮肤自我护理知识为88.7％;随访指导方面中服药提醒80.9％;健康教育指导方式中年轻患者倾向于QQ、微信,占92.7％,中医康复指导方面四季调养的需求程度高为92.7％.结论 慢性荨麻疹患者对疾病相关知识普遍缺乏,秉承需要有针对性地开展个体化的健康教育,通过不同的教育方式和途径普及疾病相关知识,促进其建立健康行为和生活方式,提高生活质量.     

Comment on “The effect of omalizumab on hematological and inflammatory parameters in patients with chronic spontaneous urticarial”: reply from authors

Abstract

We read Cosansu’s commentary entitled “Effectiveness of the new inflammatory parameters in patients with chronic spontaneous urticarial” to our study with great interest. The author remarked that a limited number of patients had C-reactive protein levels and it was not specified whether there were any other drugs used by the patients and no information was given about the severity of the disease in our study.