The EAACI/GA²LEN/EDF/WAO guideline for the definition,classification, diagnosis and management of urticaria

This evidence‐ and consensus‐based guideline was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. The conference was held on 1 December 2016. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU‐founded network of excellence, the Global Allergy and Asthma European Network (GA²LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO) with the participation of 48 delegates of 42 national and international societies. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell‐driven disease, presenting with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria are disabling, impair quality of life and affect performance at work and school. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence‐based diagnostic and therapeutic approaches for the different subtypes of urticaria.     

银连祛风汤对慢性荨麻疹动物模型的治疗作用

目的：研究银连祛风汤对慢性荨麻疹动物模型的治疗作用并探讨其作用机制。方法：将实验动物随机分为6组：空白组、模型组、阳性对照（地氯雷他啶）组，银连祛风汤低、中、高3个剂量组，每组10只，造模成功后，模型组灌胃等量生理盐水，药物组灌胃给药，而空白组不需造模仅灌胃等量生理盐水。观察银连祛风汤对实验动物的止痒作用和抗过敏作用，检测血清及血管壁组织IgE、TNF-γ、IL-4的含量。结果：银连祛风汤能明显减少小鼠搔抓次数和搔抓的持续时间；延缓豚鼠发敏时间，降低小鼠血清及血管壁组织IgE、IL-4含量，升高TNF-γ含量，以上指标均呈良好的量效依赖关系。结论：银连祛风汤具有良好的抗敏止痒作用和对细胞因子的调节作用，为临床治疗慢性荨麻疹提供了实验依据。     

Angioedema and urticaria as acute and late phase reactions to zinc fume exposure, with associated metal fume fever-like symptoms

IgE-mediated acute and late phase reactions associated with occupational metal fume exposure are rare compared with the more common metal fume fever. The latter is a common acute industrial disease caused by inhalation of oxides of metals, especially zinc. It is a flu-like illness and is thought to be self-limited. This article describes the first case, to my knowledge, of an immediate and a late phase reaction (urticaria and angioedema) to zinc fumes, associated with a metal fume fever-like reaction. Hives and angioedema developed immediately and in a delayed fashion in a 34-year-old man after he had welded zinc at his job. There also was an associated metal fume fever-like reaction. The relationship was proved by a challenge test done at home. The patient has been asymptomatic since using complete protective measures while welding zinc. Possible immunologic mechanisms are discussed.     

Histopathology of chronic urticaria

Urticaria of undetermined cause persisting longer than 6 wk is known as chronic idiopathic urticaria (CIU). The differential diagnosis of CIU is lengthy and a skin biopsy may be of value in making a more precise diagnosis. The histopathologic feature that differentiates chronic urticarial lesions from acute urticarial lesions is the presence of a mixed cellular perivascular infiltration, composed mostly of mononuclear cells, surrounding the dermal postcapillary venules. Mast cell numbers in CIU lesions may be increased compared to normal dermis. Various patterns of histopathologic findings have been described in CIU. An understanding of these patterns of infiltrating cells, mediators, cytokines, chemokines and adhesion molecules may provide insight into the mechanism of the cutaneous disease and provide valuable information that will help in the selection of a more effective therapeutic intervention.     

Common Skin Diseases

This continuation of the discussion of common skin dermatoses includes the diagnosis and treatment of warts, seborrheic dermatitis, rosacea, seborrheic and actinic keratoses, and common skin malignancies. Skin cancers affect innumerable guises and may derive from various tissues. The family physician should be familiar with the more common types and be alert to the possibility of rarer kinds.     

Omalizumab markedly improves urticaria activity scores and quality of life scores in chronic spontaneous urticaria patients: a real life survey

Treatment of chronic urticaria consists of antihistamines as the first-line treatment. For more severe symptoms, combinations can be necessary as well as dose augmentations. The recent guidelines suggest the possibility of using omalizumab in resistant cases, but this therapy is still investigational. We treated two patients with idiopathic recurrent angioedema and 12 patients with chronic spontaneous urticaria (CSU) with omalizumab, who had not benefited from the recommended first-line, second-line and third-line treatments. To evaluate the efficacy of the omalizumab treatment, urticaria activity scores (UAS) and chronic urticaria quality of life (CU-Q2oL) scores were measured at baseline, and at the end of the first and sixth month of the therapy. The dosage and intervals of omalizumab therapy were determined according to the rules suggested for severe asthma treatment. CU-Q2oL scores and UAS displayed significant improvements in all 14 patients. None of the patients reported any adverse effect during the treatment until the submission of this data. Our results show that omalizumab apparently improves CU-Q2oL as well as UAS in treatment-resistant CSU in a real life setting.     

桂枝汤加减在损容性疾病治疗中的应用

桂枝汤出自张仲景所著的《伤寒论》,具有解肌发表、调和营卫的功效,主治外感表虚之证。随着后世医家对桂枝汤的推演发挥,其临床应用范围不断扩大,前人用其治疗皮肤病也不乏先例。笔者就桂枝汤在损容性皮肤病治疗中的应用,及中、西医理论方面进行了探讨。     

Differences in gut microbiota between allergic rhinitis,atopic dermatitis,and skin urticaria: A pilot study

Introduction.Several forms of allergy have been clinically presented, including, among others, atopic dermatitis (eczema), urticaria (hives), and allergic rhinitis (rhinitis). As their detailed pathogenesis continues to be researched, we aimed in the current study to compare gut microbiota differences between eczema, hives, and rhinitis patients.Methods.We enrolled 19 eczemas, nine hives, and 11 allergic rhinitis patients in this study. Fecal samples were examined using 16S ribosomal ribonucleic acid amplicon sequencing, followed by bioinformatics and statistical analyses. We compared microbiota in dermatitis (eczema), chronic urticaria (hives), and allergic rhinitis (rhinitis).Results.All clinical data were similar between the subgroups. The microbiota results indicated that Bacteroidales species were found in skin allergies, both urticaria and eczema, when compared to rhinitis. The microbiota differs substantially between those patients with atopic dermatitis (eczema), chronic urticaria (hives), and allergic rhinitis (rhinitis), thus indicating that the gut-skin and gut-nose axes exist. Gut flora colonies differ significantly between skin allergy and nose allergy. Bacteroidales species could be a clinical link between gut flora and skin allergy; of those, Bacteroids Plebeius DSM 17135 is significantly associated with the urticaria (hives) subgroup.Conclusion. Our results demonstrated high intra-group homogeneous and high inter-group heterogeneous microbiota. The clinical symptoms of eczema, hives, and rhinitis can all be linked to specific microbiota in the current study. In this pilot study, the Ruminococcaceae and Bacteroidales species are associated with allergic disease, in line with several previous published articles, and the abundance of Firmicutes Phylum is representative of intestinal dysbiosis. In the future, a larger cohort and thorough biochemical studies are needed for confirmation.     

The EAACI/GA2LEN/EDF/WAO Guideline for the definition,classification, diagnosis,and management of urticaria: the 2013 revision and update

This guideline is the result of a systematic literature review using the ‘Grading of Recommendations Assessment, Development and Evaluation’ (GRADE) methodology and a structured consensus conference held on 28 and 29 November 2012, in Berlin. It is a joint initiative of the Dermatology Section of the European Academy of Allergy and Clinical Immunology (EAACI), the EU‐funded network of excellence, the Global Allergy and Asthma European Network (GA²LEN), the European Dermatology Forum (EDF), and the World Allergy Organization (WAO) with the participation of delegates of 21 national and international societies. Urticaria is a frequent, mast cell‐driven disease, presenting with wheals, angioedema, or both. The life‐time prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria do not only cause a decrease in quality of life, but also affect performance at work and school and, as such, are members of the group of severe allergic diseases. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence‐based diagnostic and therapeutic approaches for the different subtypes of urticaria. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS).