Urticaria

In patients given a diagnosis of chronic spontaneous urticaria (CSU), there are no obvious external triggers, and the factors that initiate the clinical symptoms of wheal, flare, and itch arise from within the patient. Most patients with CSU have an autoimmune cause: some patients produce IgE autoantibodies against autoantigens, such as thyroperoxidase or double-stranded DNA, whereas other patients make IgG autoantibodies against FcεRI, IgE, or both, which might chronically activate mast cells and basophils. In the remainder of patients with CSU, the nature of the abnormalities has not yet been identified. Accumulating evidence has shown that IgE, by binding to FcεRI on mast cells without FcεRI cross-linking, can promote the proliferation and survival of mast cells and thus maintain and expand the pool of mast cells. IgE and FcεRI engagement can also decrease the release threshold of mast cells and increase their sensitivity to various stimuli through either FcεRI or other receptors...

Chronic spontaneous urticaria (CSU) is a debilitating condition that affects individuals for an extended period of time. Chronic urticaria is characterized by the presence of characteristic wheal and flare lesions for greater than six weeks. This inflammatory reaction is primarily mediated by histamine release from mast cell degranulation although multiple other physiologic factors are involved. CSU is a diagnosis of exclusion where definitive triggers are not identified, however, associations with autoimmune conditions have been investigated. Second-generation antihistamines are the recommended primary treatment for CSU, but a significant number of cases are refractory to conventional treatments. Omalizumab (Xolair)
is an anti-IgE biologic agent recently approved by the Federal Drug Administration for the treatment of CSU. Studies have
shown favourable safety profiles and efficacy. Omalizumab shows promise as an agent for the management of recalcitrant symptoms and overall improvement of quality of life.
Keywords: Urticaria; Omalizumab; Xolair; Biologics; Pruritus.

Summary. Based on the clinical picture and triggering drugs, allergic and pseudoallergic adverse reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) can be classified in four patterns : respiratory, cutaneous, mixed and systemic. This categorization is useful for the purpose of describing patient populations included in studies about NSAID adverse reactions as well as for the routine management of the patient in

Background:  Health-related quality of Life in patients with chronic urticaria is evaluated by mean of generic instruments or questionnaire designed for skin diseases. No disease-specific tool is now available for the assessment of chronic urticaria impact from patients’ viewpoint.Objective:  The aim of our study is to develop and validate a new questionnaire specifically designed for the assessment of quality of life in chronic urticaria (Chronic Urticaria Quality of Life Questionnaire – CU-Q2oL)Methods:  In the development phase of CU-Q2oL an initial list of items of 37 items was compiled and given to 80 patients with chronic urticaria; the 23 most significant items were selected and converted into questions evaluating the answers on a Likert scale of five steps. The validation procedure involved 125 patients (86 F and 39 M) (age 42.17 ± 9.24 years).Results:  Following a statistical analysis, CU-Q2oL showed a six-dimensional structure and good levels of internal consistency for the extracted factors: Pruritus (0.79), Swelling (0.65), Impact on life activities (0.83), Sleep problems (0.77), Looks (0.83) and Limits (0.74). In stable conditions CU-Q2oL showed a good reliability, ranged between 0.64 and 0.92. Responsiveness to clinical changes was accomplished.Discussion:  These results provide evidence that CU-Q2oL has specificity enough for being a valid tool for detecting the relative burden of CU on subjective wellbeing, and for obtaining a global evaluation both of CU impact and of treatments, taking into account the patient's point of view. The CU-Q2oL was easily and quickly filled up and well accepted by the patients.

Listening and paying attention to our patients is crucial for understanding a disease. A good example is Immediate Contact Skin Reactions (ICSR) which manifest as Contact Urticaria Syndrome (CUS), Contact Urticaria (CU) and Protein Contact Dermatitis (PCD). These entities are characterized by the immediate skin development of itchy flares, wheals, and/or dermatitis. All conditions usually appear within minutes of contact with various substances, including chemicals, animal products, antibiotics, cosmetics, and many other materials. From the clinical and diagnostic viewpoint, the patient's clinical report is critical to its description, definition and classification. Its pathogenesis still remains a challenge and our knowledge of the agents potentially responsible is slowly increasing over time, based on the descriptions of a few isolated cases. This text reviews the classic concepts, introduces new compounds responsible for these immediate skin reactions, and suggests further in...

Adult-onset Still’s disease (AOSD) patients typically present with arthralgia, fever, lymphadenopathy and a transient salmon maculopapular rash. Only approximately 25 cases of AOSD with urticaria were described in the literature. In this article, the authors report three additional cases of AOSD with urticarial and dermographic lesions who had a good clinical response to glucocorticoid and antihistamines. A review of the literature concerning this issue is also herein written.

Celiac disease (CD) is an autoimmune gluten-dependent enteropathy characterized by atrophy of intestinal villi that improves after gluten-free diet (GFD). CD is often associated with extra-intestinal manifestations; among them, several skin diseases are described in CD patients. The present review reports all CD-associated skin manifestations described in the literature and tries to analyze the possible mechanisms involved in this association. The opportunity to evaluate the possible presence of CD in patients affected by skin disorders is discussed.

H1-antihistamines are probably the most frequently used drugs in allergic diseases, with widely established efficacy, tolerance, and safety. We report a patient with urticaria due to ingestion of ebastine and fexofenadine. Skin prick tests, patch tests, and basophil activation tests with the implicated drugs and antihistamines from other families were negative. The oral challenges with the implicated antihistamines and other antihistamines tested were positive, but the patient tolerated an oral challenge with cetirizine. We present a patient with urticaria induced by different antihistamines in whom the diagnosis was established by oral challenge. The mechanism of sensitization remains unclear.