Hydroxychloroquine: A Safe, Effective and Inexpensive Maintenance Therapy for Chronic Spontaneous Urticaria

Background: Chronic spontaneous urticaria (CSU) is an autoimmune skin disorder that lasts for >6 weeks and may last for years. It is a disabling skin disease that impairs quality of life. Set-up treatment with antihistamines, immunosuppressives, immune modulators and lately Omalizumab are expensive or have significant side effects. In this retrospective study, we describe our experience with the use of hydroxychloroquine (HCQ) as a maintenance therapy for those with severe forms of CSU after Corticosteroids (C) induction phase. Patients and Methods: 16 adult patients (aged 44 ± 7) with severe CSU for 5 ± 1 months, were included in the study. Eight patients had attacks of angioneurotic oedema. Their previous treatments were antihistaminic and short-courses of C. Results: After 2 weeks of remission with C and HCQ 200 mg twice daily, the dose of C was tapered down and discontinued by the end of the first month. The seven days Urticaria Activity Score decreased from 30 ± 3 to 6 ± 1 by the first month and remained low at 3 ± 1 by the end of 2 years of follow-up. Moreover, IgE levels and CRP had similar trends. Remission persisted after 37 ± 9 months of follow-up. Conclusion: HCQ is a safe, efficacious and inexpensive drug for the treatment of CSU.

Chronic Refractory Idiopathic Urticaria

Background: Chronic spontaneous urticaria (CSU) is a complex medical condition characterized by substantial morbidity and a negative impact on one’s quality of life. There are several treatment approaches available, tailored to the severity of the condition, which can enhance overall quality of life. Aim: In this article, we outline a systematic approach to managing chronic urticaria, while also elucidating the available treatment strategies for cases that prove resistant to conventional therapies. To illustrate our points, we present a clinical case as a practical example. Case Presentation: Here, we present a patient with CSU since childhood who presented in the context of refractory hives and generalized arthralgia that responded well to omalizumab therapy with no further relapse. Conclusion: Omalizumab is a biological agent that offers a potential treatment option for CSU. It is available for individuals twelve years and older who have not responded well to conventional treatments. It has demonstrated good efficacy with a relatively low rate of clinically significant adverse effects. Nonetheless, there is a dearth of research regarding the optimal method for tapering the dosage and determining the duration of treatment.

Cost of Treatment of Chronic Spontaneous Urticaria in Turkey

Chronic Spontaneous Urticaria (CSU) is a chronic disease with significant negative impact on quality of life of patients. The direct and indirect costs of the disease can be substantial both for the health care system and society. The aim of this research is to estimate the cost of mild, moderate and severe CSU in Turkey and to forecast the cost of the disease from the payer (Social Security Institution—SSI) perspective. Expert opinions with Delphi technique were used in order to determine the cost items and their frequency. A questionnaire was designed to outline resources used in the out-patient, inpatient and emergency care episodes and was answered by dermatologists followed by a consensus meeting. Unit costs were calculated from the price list of the SSI. The annual total cost of treating the disease to the SSI was estimated as 262,111,978TL (94,417,870€) comprising 0.06% of the total healthcare budget in 2013. Since there is limited information about the cost of CSU in Turkey, the methodology and results of this study are unique and very important.

Evaluation of chronic idiopathic tinnitus and its psychosocial triggers

BACKGROUND The tinnitus susceptibility patterns in relation to different psychological and life stressors are unknown in different cultures.AIM To determine the comorbid psychosocial factors and behaviors associated with tinnitus and the predictors for the increase in its severity.METHODS Participants were 230 adults(males=70;females=160;mean age=38.6±3.3).They underwent audiograms,speech discrimination and masking testing,and neuropsychiatric evaluation.Measures used for assessment included tinnitus handicap inventory,depression anxiety stress scale 21(DASS-21),perceived stress scale(PSS),and insomnia severity index(ISI).RESULTS Patients had mean duration of tinnitus of 11.5±2.5 mo.They had intact hearing perception at 250-8000 Hz and 95(41.3%)had aggravation of tinnitus loudness by masking noise.Decompensated tinnitus was reported in 77%(n=177).The majority had clinically significant insomnia(81.3%),somatic symptoms(75%)other than tinnitus and perceived moderate(46.1%)and high(44.3%)stress to tinnitus.The severe/extremely severe symptoms of depression,anxiety and stress were reported in 17.4%,35.7%and 44.3%,respectively.Patients with decompensated type had significantly higher scores for ISI(P=0.001)and DASS-21(depression=0.02,anxiety=0.01,stress=0.001)compared to those with compensated tinnitus.Psychiatric interviewing showed that 35.7%had non-specific anxiety disorder,17.4%had major depression,and 19.6%fulfilled the criteria of somatization disorder.Multivariate analysis showed that the only independent predictors for tinnitus severity were the duration of tinnitus[odd ratios(OR)=0.832,95%CI:0.640-1.158;P=0.001]and PSS(OR=0.835,95%CI:0.540-1.125;P=0.001)scores.CONCLUSION To the best of our knowledge,this is the first study in our culture to evaluate the causal relationship between psychological factors and tinnitus onset,severity and persistence.Tinnitus could be the earliest and dominant somatic symptom induced by life stressors and psychological vulnerabilities.Therefore,multidisciplinary consultation(psychologists,psychiatrists,and neurologists)is important to acknowledge among the audiologists and otolaryngologists who primarily consult patients.

Association of HLA-DRB1, DQB1 Alleles with Chronic Urticaria

In order to investigate the association of genotypes of HLA-DRB1 and HLA-DQB1 alleles with the genetic susceptibility of chronic urticaria (CU), genotypes of HLA-DRB1 and HLA-DQB1 genes were detected by polymerase chain reactions with sequence-specific primers (PCR-SSP) in 42 patients with CU (19 men and 23 women, mean age 30.67±12.45 y old as well as 193 racially matched healthy persons in ethnic Han from Hubei provinece. Gene frequencies of HLA-DRB1*12, *0901 (RR=3.11, χ2=7.579, P=0.006; RR=2.47, χ2=5.684, P=0.017) were significantly increased in CU patients as compared with that in healthy people. Gene frequencies of HLA-DQB1*05 (RR=0.26, χ2=6.683, P=0.01) were significantly decreased in CU patients. It was suggested that CU was found strongly associated with HLA-DRB1*12, *0901 and HLA-DQB1*05, the former might be the genetic markers for susceptibility to CU, but the latter might play a resistive role.

Pricking,Cupping and Qu Feng Tiao Ying Decoction for Treatment of Chronic Urticaria

Chronic urticaria is a commonly encountered skin illness characterized by protracted course and recurrent episodes. The author had treated 26 cases of chronic urticaria by pricking, cupping and Qu Feng Tiao Ying (QFTY) decoction (祛风调营汤the Wind-dispelling and Ying system-regulating Decoction) with satisfactory results. A report is as follows.……

The Effect of Costimulatory Factors in the Pathogenesis of Chronic Idiopathic Thrombocytopenic Purpura

To investigate the effect of costimulatory factors in the pathogenesis of chronic idiopathic thrombocytopenic purpura(CITP), we examined the expression of CD80 on platelets and megakaryocytes in patients with CITP and the controls by FACS. By using CD80 monoclonal antibody (McAb) to inhibit interaction among cells which is mediated by costimulatory factors, we observed the effect of CD80 McAb on the growth and maturation of megakaryocytic progenitors of patients with CITP in vitro . The results showed the expression of CD80 on platelets and megakaryocytes in CITP group was significantly higher than that in controls ( P <0.01). There was a significantly positive correlation between the expression of CD80 on platelets and serum PAIgG in CITP (r=0.86, P <0.05). The mean of various clone numbers (CFU MK, BFU MK and mCFU MK) in CITP were all lower than those in controls ( P <0.05). In megakaryocytes co cultured with CD80 McAb, there was an increasing tendency of the number of CFU MK and big CFU MK (the number of megakaryocyte with GPⅢ a positive was more than 20) and mediate CFU MK (the number of megakaryocyte with GPⅢ a positive was 11-20). When the concentration of CD80 McAb was 10 μg/L, there was a significant difference in the number of megakaryocytic colony formation (CFU MK, BFU MK and mCFU MK) between the group with CD80 McAb and that without it ( P <0.05).These showed the abnormality of costimulatory factors had important effect in the pathogenesis of CITP.

Association between Helicobacter Pylori Infection and Chronic Idiopathic Neutropenia

Summary： The possible association between Helicobacter pylori （H. pylori） infection and chronic idiopathic neutropenia （ClN） was investigated. A total of 78 subjects with CIN were recruited in this case-control study. As a control group, 40 subjects without ClN were selected for comparison with the case group. All participants were evaluated for the prevalence of H. pylori infection by 14C-urea breath test. The corrected splenic index （CSI） was calculated, and serum IL-6, IL-8, IL-10 and HsCRP levels were measured. The differences in CSI, serum IL-6, IL-8, IL-10 and HsCRP levels were compared between CIN patients and controls, as well as between subjects with and without H. pylori infection. The positive rate ofH. pylori was 87.18% in ClN group and 52.50% in control group, showing a significant difference （Fisher＇s exact, P=0.000）. CSI values, and serum IL-6 and HsCRP levels in H. pylori positive-CIN patients were significantly higher than those in negative subjects （Mann-whitney U-test, P=-0.016, P=0.001 and P=0.000 respectively）, while IL-10 level declined sig- nificantly in H, pylori negative-CIN patients （Mann-whimey U-test, P=0.000）. In control group, se- rum IL-6 and HsCRP levels in H. pylori positive individuals were also increased significantly （Mann-whitney U-test, P=0.000）, while IL-10 level declined （Mann-whimey U-test, P=0.018）. Mul- tivariate regression analysis revealed that H. pylori infection and IL-10 were significant risk factors for CIN with odds ratio （OR）： 3.09, 95.0% CI： 1.22-6.93; P=0.019, and OR： 0.17, 95.0% CI： 0.05-0.94; P=0.021, respectively. This prospective study confirmed the existence of an association between H. pylori infection and CIN, suggesting the screening for H. pylori infection and eradicating bacterium in positive cases seem appropriate and beneficial for those patients with CIN diagnosis.

Efficacy of the H2-receptor antagonist famotidine on chronic spontaneous urticaria in children

Urticaria is a common pediatric skin disorder. Histamine H1-receptor antagonists are effective in chronic as well as acute urticaria. When H1-anti-histamines are ineffective, add-on use of H2-receptor antagonists is thought to give better symptom relief. However, there are few reports on the therapeutic efficacy in pediatric patients. We retrospectively reviewed the medical records of pediatric patients with chronic spontaneous urticaria (csU) who met the following criteria. They were consulted our outpatient clinic between April 2010 and March 2012;were unsuccessfully treated with H1 antihistamines;and were treated with add-on H2-receptor antagonist (famotidine). In six patients who met the inclusion criteria (mean age 6.1 ± 5.1 years), urticaria activity score was significantly decreased from 4.3 ± 0.8 just before administration of famotidine to 1.3 ± 1.0 on the first outpatient visit within 4 weeks after the first administration of famotidine

Effectiveness and safety of acupoint catgut embedding combined with Chinese herbal medicine in chronic urticaria: A systematic review of randomized controlled trials

Objective:To evaluate the effectiveness and safety of acupoint catgut embedding(ACE)in combination with Chinese herbal medicine(CHM)in treating chronic urticaria(CU).Methods:We thoroughly searched Embase,PubMed,Cochrane Library,Web of Science,China National Knowledge Infrastructure(CNKI),Wangfang database,Chinese Scientific Journal Database(VIP),and Chinese biomedical literature database(SinoMed)for relevant studies from inception until May 2022.Randomized controlled trials(RCTs)on ACE combined with CHM for CU were included.Literature search,data extraction,and risk of bias assessment were independently conducted by two authors.Results:A total of 15 RCTs with 1065 participants were included in this review.Five trials reported that the combined therapy showed a higher total effective rate,and four trials reported that the combined therapy was associated with a lower level of serum immunoglobulin E.Furthermore,two,four,and four trials reported that the combined therapy was more effective in reducing itching degree,size,and number of wheals,respectively.The combined therapy was reported to be associated with a lower recurrence rate in three trials,and with a fewer adverse reaction rate in two trials.Conclusions:ACE in combination with CHM appears to be a safe and effective therapy for patients with CU.Given the relatively low quality of the included trials,these findings should be interpreted cautiously.Further high-quality RCTs are needed to confirm our findings.

Based on data mining,the drug law of clinical treatment of chronic urticaria

Background:Based on clinical data mining,we introduce the medication rule and clinical application of Professor Wang Lifen in the treatment of chronic urticaria,as the reference of clinical treatment of chronic urticaria.Methods:we collected 110 traditional Chinese medicine prescriptions for the treatment of chronic urticaria,and found out tastes,functions and channel tropism of Chinese medicine.After collecting and sorting,we inputted the data into excel 2010 software and established drug electronic database.We calculated the frequency of tastes,functions and channel tropism using the Spss 20.0 and analyzed the potential relationship between the drugs using Weka 3.8.We used Cytoscape 3.6.1 to draw the related network and combine it into a new prescription.Then the clinical data of prescriptions were statistically analyzed.Results:The statistical analysis showed that the high-frequency drugs for the treatment of the disease were Gancao(Glycyrrhizae radix et rhizoma),Huangqin(Radix scutellariae),Desmopeel,Jingjie(Herba schizonepetae),parsnip,etc.,accounting for more than 69.50%of the total frequency.Moreover,the combination and drug pairs with the strongest and most commonly used high-frequency drugs were found.From the point of medicinal properties of these drugs in the treatment of chronic urticaria,the main drugs are cold,followed by warm and smooth,accounting for 70.75%of the total frequency.From the perspective of the efficacy of these drugs in the treatment of chronic urticaria,heat-clearing drugs are the main ones,followed by relieving drugs and Tonic drugs,accounting for 68.25%of the total frequency.From the perspective of medicine taste,sweet taste is the most important,followed by bitter and pungent taste,accounting for 68.00%of the total frequency.From the perspective of drugs channel tropism,the meridian of spleen is the most important,followed by the meridian of lung,liver,heart,stomach,etc.,accounting for 71.62%of the total frequency.Conclusion:According to the data mining results,traditional Chinese medicine treatment of chronic urticaria is mainly based on dispelling wind,clearing heat and removing dampness,cooling blood and detoxifying,supplemented by nourishing blood and nourishing deficiency.This data mining conforms to the law and principle of traditional Chinese medicine treatment of chronic urticaria,which has certain reference and enlightenment significance for clinical treatment of chronic urticaria.

A Rare Case of Chronic Recurrent Multifocal Osteomyelitis with Undifferentiated Juvenile Idiopathic Arthritis, Uveitis, and Psoriasis

We report here a 17-year-old boy with a complicated presentation of undifferentiated juvenile idiopathic arthritis, vision-threatening uveitis and chronic recurrent multifocal osteomyelitis (CRMO) in the pelvis. His severe iritis needed subtenon injections and only responded to infliximab after failing multiple biologics. Unfortunately he later developed infliximab-associated psoriasis. A combination of infliximab and ustekinumab induced remission of his arthritis, osteomyelitis, uveitis and psoriasis without experiencing severe infections.

Inhibition of ileal bile acid transporter:An emerging therapeutic strategy for chronic idiopathic constipation

Chronic idiopathic constipation is a common disorder of the gastrointestinal tract that encompasses a wide profile of symptoms. Current treatment options for chronic idiopathic constipation are of limited value; therefore, a novel strategy is necessary with an increased effectiveness and safety. Recently, the inhibition of the ileal bile acid transporter has become a promising target for constipation-associated diseases. Enhanced delivery of bile acids into the colon achieves an accelerated colonic transit, increased stool frequency, and relief of constipationrelated symptoms. This article provides insight into the mechanism of action of ileal bile acid transporter inhibitors and discusses their potential clinical use for pharmacotherapy of constipation in chronic idiopathic constipation.

Long-term liver allograft fibrosis:A review with emphasis on idiopathic post-transplant hepatitis and chronic antibody mediated rejection

Liver transplantation(LT)is a life-saving surgical procedure and the current standard of care for most patients with end stage liver disease.With improvements in organ preservation techniques,perioperative care,and immunosuppression,there is better patient and graft survival following LT,and assessment of the liver allograft in long-term survivors is becoming increasingly important.Recurrent or de novo viral or autoimmune injury remains the most common causes of chronic hepatitis and fibrosis following liver transplantation in adults.However,no obvious cause can be identified in many adults with controlled recurrent disease and the majority of pediatric LT recipients,as they have been transplanted for non-recurrent liver diseases.Serial surveillance liver biopsies post LT have been evaluated in several adult and pediatric centers to identify long-term pathological changes.Pathological findings are frequently present in liver biopsies obtained after a year post LT.The significance of these findings is uncertain as many of these are seen in protocol liver biopsies from patients with clinically good allograft function and normal liver chemistry parameters.This narrative review summaries the factors predisposing to long-term liver allograft fibrosis,highlighting the putative role of idiopathic post-LT hepatitis and chronic antibody mediated rejection in its pathogenesis.

Chronic Spontaneous Urticaria on Omalizumab Therapy and Latent Tuberculosis Infection: A New Case Report

Background: Chronic Spontaneous urticarial (CSU) is a common dermatological problem characterized by recurrent pruritic or burning wheals last less than 24 hours and treated by many modalities of therapy including systemic antihistamines and in refractory cases with Omalizumab anti-IgE antibody biological injection. Latent tuberculosis infection (LTBI) is diagnosed based on a positive tuberculin skin test or QuantiFERON-TB test without evidence of active tuberculosis. Aim: To document a new case report of a patient with a history of CSU and latent tuberculosis on Omalizumab therapy during Isoniazid (INH) prophylaxis. Case Report: A-53-year-old woman with a history of CSU and newly identified LTBI who have been treated with INH monotherapy before starting Omalizumab injection followed up over 24 weeks course of therapy for any sign of tuberculosis reinfection. Conclusion: Omalizumab injection was used effectively for the treatment of CSU in a patient with latent tuberculosis infection with minimal risk of tuberculosis reactivation.

Quality of Life of Patients with Urticaria in Ouagadougou (Burkina Faso)

Introduction: The prevalence of urticaria is increasing. Approximately 20% of individuals have suffered from an acute episode of urticaria at least at some point in their lives. The objective of this study was to evaluate the clinical and therapeutic socio-demographic profile and quality of live of patients followed for urticaria in the dermatology-venereology department of the Yalgado Ouédraogo University Hospital in Ouagadougou. Methodology: We conducted a descriptive cross-sectional study over a 5-year period from 1 January 2015 to 31 December 2019. The data were collected retrospectively by analysing the files and prospectively by evaluating the quality of life with DLQI. All the records of patients treated for urticaria at the Dermatology-Venerology Department of the Yalgado Ouédraogo University Hospital during the period were included. Results: Urticarial frequency is 1.91%. There were 36 men (25.71%) and 104 women (74.28%), i.e. a sex ratio of 0.34. The median age was 31 years with extremes of 4 to 70 years. The 30 - 45 age group accounted for 51.42%, followed by the 16 - 29 age group (31.42%), then the 46 - 65 age group (9.28%), the 4 - 15 age group (5.71%) and the over 66 age group (2.14%). In terms of occupation, pupils/students accounted for 37.1%, housewives for 18.6% and workers for 44.3%. As for the residence of the patients, 88.57% lived in Ouagadougou Personal history of atopy, it concerned 19.26% of patients, with precisely 9.28% having asthma history, 7.14% having rhino-sinusitis history, 1.42% of atopic dermatitis and allergic conjunctivitis respectively. For clinical aspects, 97.14% of the patients had superficial urticaria, and 2.86% had facial angioedema. There were 35% (49) patients with acute urticaria and 65% (91) with chronic urticaria. Chronic urticaria was spontaneous in 55% (50) and physically inducible in 10% (9) (sweating, pressure or friction). 97.14% of patients received antihistamines associated with systemic corticoids in 2.86%. For Quality of life, the mean DLQI score was 7.51, indicating a moderate effect of urticaria on patients’ quality of life. The quality of life of women was more affected than that of men, especially in the professional and social spheres. Conclusion: In hospital frequency of urticaria is low in Ouagadougou, a predominance of chronic spontaneous urticaria whose management involves the use of second generation antihistamines at a dosage and duration that do not meet international recommendations. The patients’ quality of life was moderately impaired.

Psychiatric comorbidities in children and adolescents with chronic urticaria

Background Chronic urticaria(CU)has been shown to impact patients'quality of life negatively and may coexist with psychiatric disorders.We systematically reviewed the published evidence of comorbid psychiatric disorders in children and adolescents with CU.Methods A systematic review of studies published until February 2022 in PubMed,Google Scholar,and Scopus was performed.An a priori set of inclusion criteria was predefined for the studies to be included:(1)clear distinction between urticaria and other allergies;(2)precise distinction between acute and CU;(3)participants younger than 18 years old,exclusively;(4)use of appropriate standardized questionnaires,psychometric tools,and standard diagnostic nomenclature for the mental health and behavioral disorders diagnosis;and(5)manuscripts written or published in the English language.Results Our search identified 582 potentially relevant papers.Only eight of them satisfied the inclusion criteria.Quantita-tive meta-analysis was not deemed appropriate,given the lack of relevant randomized control trials,the small number of relevant shortlisted,the small sample size of the patients included in each study,and the remarkable heterogeneity of the studies'protocols.Conclusions The included studies suggest an increased incidence of psychopathology among children and adolescents with CU as opposed to healthy age-matched individuals,but the data are scarce.Further research is required to clarify whether psychopathology is just a comorbid entity,the cause,or the consequence of CU.Meanwhile an interdisciplinary collaboration between allergists/dermatologists and psychiatrists is expected to substantially minimize CU burden and improve patients'quality of life.

Chronic Urticaria Due to Allergy to Wheat Alpha-Amylase Inhibitor Proteins

Chronic spontaneous urticaria (CSU) is defined as the spontaneous appearance of wheals, angioedema, or both, for at least 6 weeks, due to known or unknown causes [1]. In some patients who present a CSU with daily or almost daily symptoms a type I allergy could be the underlying cause. We present one adult patient with chronic urticaria who was finally diagnosed as a non-occupational case of IgE-mediated wheat allergy manifested following exposure by 3 different routes: inhalation (rhinitis and bronchial asthma), dermal absorption (contact urticaria) and ingestion (systemic chronic urticaria). We were able to detect the culprit proteins by immunoblotting. Serum IgE binds mainly to alpha-amylase/trypsin inhibitors and, to a lesser extent, to other proteins associated with food allergy to grains (e.g. beta-glucanase, serpin, peroxidase). In our opinion, skin prick tests with a food standard battery could help in the etiological diagnosis of chronic urticaria. The identification of responsible allergens could be difficult because only a few complex in vitro techniques allow detecting the allergy to several proteins.

Acupuncture for Patients with Chronic Spontaneous Urticaria:A Randomized,Sham-Controlled Pilot Trial

Objective: To determine the feasibility of conducting a full-scale randomized controlled trial(RCT)and investigate the basic information and safety of acupuncture for patients with chronic spontaneous urticaria(CSU). Methods: A total of 80 participants with CSU from July 2018 to July 2019 were randomly assigned to receive active acupuncture(n=41) on a fixed prescription of acupoints or sham acupuncture(n=39) with superficial acupuncture on non-acupuncture points through the completely randomized design. Patients in both groups received 5 sessions per week for 2 weeks, and participants were followed for a further 2 weeks.Feasibility was assessed by recruitment and randomization rates, retention of participants, treatment protocol adherence, and the incidence of adverse events(AEs). The clinical primary outcome was the changes from baseline weekly urticaria activity scores(UAS7) after treatment at 2 weeks. Secondary outcomes included the Visual Analogue Scale(VAS) score of itching intensity, Dermatology Life Quality Index(DLQI), Hamilton Depression Scale(HAMD), and Hamilton Anxiety Scale(HAMA). Results: A total of 80 participants were enrolled. The recruitment rate of 24.02%, randomization rate of 100%, a loss rate of 6.25%, and no obvious AEs were observed in either group. The decrease from baseline in the mean UAS7 total score at week 2 in the active acupuncture group was –8.63(95%CI, –11.78 to –5.49) and –6.21(95%CI, –9.43 to –2.98) in the sham acupuncture group for a between-group difference of –2.42(95% CI, –6.93 to 2.07). The change in the DLQI,VAS of itching intensity, HAMA, and HAMD were a slightly better improvement trend in the active acupuncture group than the sham acupuncture group, but the between-group difference was not significant. Conclusion:Active acupuncture had a better improvement trend in alleviating symptoms, improving quality of life and regulating the mood of anxiety and depression in patients with CSU than sham acupuncture.(Registration Nos.AMCTR-ICR-18000190 and ChiCTR2100054776)