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At least 19 recordsLinked to original sources
PubMed2004

Is there any relationship between human leucocyte antigen class II and chronic urticaria? (chronic urticaria and HLA class II).

The Human Leukocyte Antigen (HLA) typing of large groups of patients with various autoimmune diseases has demonstrated that some HLA alleles occur at higher frequencies in specific diseases than in the general population. Chronic urticaria has been shown to have an autoimmune basis by a previous study which found an association between chronic urticaria and specific HLA groups. We investigated the HLA subtypes of Turkish chronic urticaria patients. For this purpose 42 Turkish patients with chronic urticaria and 115 healthy controls were typed for HLA-DR and DQ by PCR-SSP (Polymerase Chain Reaction Sequence Specific Primers) low resolution DNA technique. We found an increased frequency of DR4 (42.9%, p=0.01) in chronic urticaria patients in comparison with that in healthy controls. This study supports the hypothesis that HLA alleles may be involved in the pathogenesis of chronic urticaria and that they appear to be directly involved in the initiation of the immune response.

Chronic Disease↗
PubMed2004

Impact of hydroxychloroquine therapy on chronic urticaria: chronic autoimmune urticaria study and evaluation.

BACKGROUND: Chronic urticaria (CU) imposes profound impairment on quality of life. Up to 60% of idiopathic CU is associated with autoimmune phenomena, and may respond to immunomodulation. Hydroxychloroquine offers potential efficacy for CU and is relatively benign compared with most other therapeutic approaches. OBJECTIVE: The aim of the chronic autoimmune urticaria study and evaluation was to evaluate the efficacy of hydroxychloroquine in patients with chronic idiopathic urticaria. METHODS: Twenty-one patients referred to the Immunology and Allergy Unit at John Hunter Hospital, New South Wales, Australia, with idiopathic CU were randomised to receive treatment with standard urticaria therapies (corticosteroids, H2-antihistamines, H1--antihistamines, doxepin) with or without hydroxychloroquine. Markers of autoimmunity, thyroid disease and mast-cell autoreactivity (autologous serum skin-prick testing (ASPT)) were assessed. Measures of urticaria control were compared at baseline and at 12 weeks for the 18 individuals who completed the study. These included urticaria scores, medication scores and quality-of-life indices. RESULTS: The hydroxychloroquine-treated group achieved significant improvements in quality of life as assessed by the global symptom severity score and the LAMY-7 (a quality of life index designed by Lamy, 7th revision) at 12 weeks (P < 0.01 and P < 0.05, respectively). No significant treatment effect on medication requirements or urticaria score was detected, although differences between treatment groups approached statistical significance for urticaria score and medication requirements (0.05 < P < 0.10). ASPT-reactivity did not correlate to hydroxychloroquine-responsiveness. Hydroxychloroquine was well tolerated. CONCLUSION: Immunomodulation with hydroxychloroquine is safe and appears to offer some efficacy as an intervention in CU.

Adult↗
PubMed2003

Tissue parasites in patients with chronic urticaria.

Chronic urticaria is an important diagnostic and therapeutic problem. We aimed to investigate the sero-prevalence of tissue parasites causing toxocariasis and fasciolosis in patients with chronic urticaria. All cases were analyzed for antibodies against Toxocara canis and Fasciola hepatica by modified (homemade) ELISA. The excretory/secretory products of Toxocara and Fasciola were used as antigens (ES-ELISA) in the test. In this study, the highest toxocariasis seropositivity (29.0%) rate and the highest fasciolosis seropositivity (14.5%) rate were found in patients with chronic urticaria. Fasciolosis seropositivity and total seropositivity of toxocariasis and fasciolosis in patients with chronic urticaria was significantly higher than in healthy controls (p<0.05). Toxocariasis seropositivity in patients with chronic urticaria was not significantly higher than that in healthy controls (p>0.05). We suggest that parasitic infections should be considered as an important cause of chronic urticaria. Serological methods should be used to expose the diagnosis of tissue parasites in such cases.

Adult↗
PubMed1995

[Immunologic studies in chronic urticaria].

Chronic urticaria is considered to be a heterogeneous disease, which can be divided into several subclasses. The authors investigated 126 patients suffering from chronic urticaria with 41 of unknown origin. The aim of the present study was to work out a strategy for the complete investigation of patients with chronic urticaria. The findings of the immunological study modified the results obtained by medical assessment of the 126 chronic urticaria cases, diminished the number of the patient with chronic urticaria unknown etiology.

Adolescent↗
PubMed1996

Cetirizine: a new therapeutic alternative for chronic urticaria.

Chronic urticaria represents a cutaneous reaction pattern that may last for slightly more than six weeks to more than five years. Treatment of patients with chronic urticaria can be a problem for both physician and patient because of the significant side effects that may be caused by first-generation H1 antihistamines or long-term corticosteroid therapy. Newer antihistamines represent a major advance for the treatment of patients with chronic urticaria. Of this group, cetirizine appears to offer some distinct pharmacokinetic and pharmacodynamic advantages. An open-label multicenter trial of 217 patients with chronic idiopathic urticaria demonstrated that cetirizine was effective, rapid in onset, and well tolerated. Thus, cetirizine was shown to be an attractive alternative treatment for patients with chronic idiopathic urticaria.

Adolescent↗
PubMed2003

[Allergy in chronic urticaria].

Chronic urticaria is an intricate pathology, caused by numerous factors. The number of tests depend on the practitioner but very often no aetiology is found. Allergologist play a role in this research of an aetiology that can be cured. The rate of an allergic aetiology in chronic urticaria is not known but remains weak. Allergy to the aeroallergens has not shown any responsibility in chronic urticaria. Total IgE count is not a major tool in the allergologic investigation. If needed, skin tests confirmed by specific IgE, remains the best way to confirm an allergy. The result will always be interpreted in relation with the clinical history. In addition a double blind versus placebo provocation could be realised. Diets did not show their efficiency. The role of additives are much debated as well. However if they have an influence, this is only through a non-allergic mechanism. Concerning autologous serum skin test, it should allow to identify among chronic idiopathic urticaria, those for which the aetiology could be auto immune. For half of the positive results, an histaminoliberation could be found highlighting the presence of functional autoantibodies anti FcepsilonRIalpha, anti IgE less frequently or both. Progresses are expected before proving their pathogenic role and to define when this test must be done.

Adult↗
PubMed2003

[Psychological factors in chronic urticaria].

Chronic urticaria is above all a cutaneous disease, affecting the skin, a visible organ, which plays a privileged role in relational life. Like any chronic disease, it raises two principal problems: preservation of the quality of life and therapeutic compliance. In chronic urticaria, psychological factors intervene on several levels: the doctor-patient relationship, the urticarian crisis itself, the onset and/or the aggravation of the disease, and the psychosocial consequences of urticaria. The role of psychological factors in the onset and/or the aggravation of the disease is variously estimated, generally based on retrospective studies and without consensus between the authors. On the other hand, the psychosocial impact of the disease is regularly mentioned: 30 to 40 p. 100 of the patients presenting with an associated depressive state. Quality of life is especially impaired in case of an associated physical urticaria. These data plead in favour of taking into account the psychological factors involved in the disease in order to propose, combined with the classical treatments of chronic urticaria and before the use of heavier treatments, a psychological treatment, i.e. a prescription of psychotropic drugs (especially antidepressants), alone or associated to a psychotherapy (a relaxation technique for example), without forgetting health education sessions.

Antidepressive Agents, Tricyclic↗
PubMed2003

[Contribution of anamnesis and clinical examination in the assessment of chronic urticaria].

Chronic urticaria is defined as an eruption of oedematous and pruriginous papules, localized or widespread, evolving for more than 6 weeks. Cutaneous lesions occurs daily or recurs with remissions of a few days at a few weeks. Diagnosing chronic urticaria is easy, but to find an etiology is much more tiresome. This is why a detailed anamnesis and a clinical examination are significant elements in the assessment of chronic urticaria. The analysis of the literature according to criteria's of the National Agency of Accreditation and Evaluation in Health shows that the anamnesis and the clinical examination are sufficient to carry a diagnosis in the majority of physical urticaria. However, they bring elements to suspect an urticarial vasculitis, a systemic disease or another etiology, allowing orientation of complementary examinations. The anamnesis permits to detect worsening factors, in particular drugs and/or food, their suppression leading to an improvement of symptomatology.

Angioedema↗
PubMed2002

Pathophysiology of chronic urticaria.

Chronic urticaria includes several different subsets with distinct pathophysiologies, and with important implications for investigation and treatment. Chronic 'idiopathic' urticaria represents a special challenge, which, until recently, was not taken up by dermatological or immunological investigators. However, it has now emerged that at least 30% of patients possess histamine-releasing autoantibodies against Fc epsilon R1, or less commonly IgE itself. These autoantibodies are causative. Recent work implicates complement activation in most cases. Functional (i.e. histamine releasing) autoantibodies are specific to chronic urticaria. However, immunoreactive (non-histamine-releasing) anti-Fc epsilon R1 autoantibodies can be found in sera of patients with physical urticarias and with autoimmune connective tissue and bullous diseases. The reason for the occurrence of this disease type in some individuals but not others is unclear. One possibility is the development, in genetically predisposed persons, of autoantibodies by molecular mimicry - perhaps against lipopolysaccharide of Helicobacter pylori, an organism frequently infecting the upper gastrointestinal tract of chronic urticaria patients.

Autoimmunity↗
PubMed2002

Desloratidine for the treatment of chronic urticaria.

Chronic urticaria is a common dermatologic condition that is idiopathic in most cases. Antihistamines are the mainstays of treatment for this condition. The newer, second and third generation antihistamines are the preferred agents because of their improved safety profile and comparable efficacy to the first generation antihistamines. Desloratadine is a new non-sedating H1-receptor agonist. Based on clinical studies, desloratadine is a valuable new addition to the available treatment options and should be considered as a first-line therapy for patients with chronic urticaria.

Chronic Disease↗
PubMed1981

Combined H1 and H2 antihistamine therapy in chronic urticaria.

Chronic urticaria is a frustrating problem for the patient and the physician. The cause is usually undetermined, and the therapy is directed toward controlling symptoms. Recent evidence that human skin blood vessels possess H2 receptors, as well as the commonly recognized H1 receptors, suggests a possible reason for the frequent failure of H1 antihistamines in controlling this disorder. Eighteen patients with refractory chronic idiopathic urticaria participated in a double-blind, cross-over study to evaluate the efficacy of combined H1 (hydroxyzine hydrochloride) and H2 (cimetidine) antihistamines vs H1 antihistamines alone. This study indicates that combined H1 and H2 antihistamine therapy is statistically more effective than H1 antihistamines alone in controlling the symptoms of chronic urticaria.

Adult↗
PubMed2000

Chronic urticaria.

Chronic urticaria remains a major problem in terms of etiology, investigation, and management. It is important to identify patients in whom physical urticaria is the principal cause of disability. Once confirmed by appropriate challenge testing, no further investigation is required. Urticarial vasculitis (UV) is a major differential diagnosis of "idiopathic" urticaria (CIU). I perform biopsy of most patients in this category because UV cannot be considered confirmed in the absence of histologic evidence. Patients with confirmed UV need to be thoroughly investigated for paraproteins, lupus erythematosus hepatitis B and C, and inflammatory bowel disease. Of patients with CIU, a few (<5%) prove to have food additive reactivity confirmed by placebo-controlled challenge testing. There is no convincing evidence of the involvement of Helicobacter pylori or parasite infestation as a cause of chronic urticaria, although H pylori could have an indirect role. Recently it has become clear that 27% to 50% of patients with CIU have functional autoantibodies directed against the alpha-chain of the high-affinity IgE receptor or less commonly against IgG. These antibodies, whose involvement has now been independently confirmed in several centers, are identified by autologous serum skin testing and confirmed by histamine release studies or immunoblotting. Their removal (by intravenous Ig or plasmapheresis) or treatment by cyclosporine has proved highly beneficial in severely affected patients. However, the routine treatment of all CIU patients, irrespective of etiology, remains the judicious use of H(1) antihistamines.

Chronic Disease↗
PubMed2006

Emerging drugs for chronic urticaria.

Chronic urticaria (CU), with or without angioedema, is a frequent disorder defined as the occurrence of pruritic wheals for > 6 weeks. Studies carried out in the last two decades showed that the origin of the disease is autoimmune in up to 50% of cases. Currently available treatments include antihistamines, corticosteroids and ciclosporin; recently, leukotriene receptor antagonists proved effective in a subset of patients as well. For patients with an unremitting and extremely severe disease unresponsive to standard treatments, plasmapheresis and immunosuppressive drugs have been successfully attempted. Recent findings that the autologous plasma skin test scores positive in nearly all patients and that plasmas from patients with both autoimmune and 'idiopathic' chronic urticaria are frequently characterised by signs of thrombin activation (plasma levels of prothrombin fragment F(1.2) are significantly increased) suggest that clotting cascade might be somehow involved in the pathogenesis of CU. These findings put under a new light some rather sparse studies of the effect of drugs active on the coagulation system (heparin and oral anticoagulants) in patients with CU.

Chronic Disease↗
PubMed2006

Autoimmunity and complement in the pathogenesis of chronic urticaria.

Chronic urticaria is a debilitating skin disease that is believed to have an underlying autoimmune etiology in 35% to 50% of cases. Patients with autoimmune urticaria have functional antibodies in their sera that release histamine from basophils and mast cells. The C5a component of complement is required for mast cell degranulation in this process and at least augments basophil histamine release. In this article, the evidence that is key to our understanding of autoimmunity and complement in the pathogenesis of a subset of patients with chronic urticaria is outlined. Some of the issues in testing for and treating autoimmune urticaria are discussed.

Autoimmunity↗
PubMed2003

[Which investigations should be performed in chronic urticaria?].

Chronic urticaria is frequent. Apart from physical and allergic urticaria, a cause is infrequently identified. A lot of causes are suspected but frequently not well documented. As a consequence, very different diagnostic recommendations are proposed to the clinician. We have performed an extensive review of the literature, in order to determine the quality of evidence for each suspected etiology. The search has been performed in the following data base Embase, Pascal, Cochrane Library and Medline, on a ten years period. It has been completed with data from the selected articles. Infectious diseases, thyroid diseases, systemic diseases and cancer have been reviewed. When possible, only comparative articles have been included (case-control studies mainly). When not, articles with poor methodology have been included. For each article, methodology and results are reported.

Adult↗
PubMed2005

A new tool to evaluate the impact of chronic urticaria on quality of life: chronic urticaria quality of life questionnaire (CU-QoL).

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-Q(2)oL). METHODS: In the development phase of CU-Q(2)oL 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-Q(2)oL 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-Q(2)oL showed a good reliability, ranged between 0.64 and 0.92. Responsiveness to clinical changes was accomplished. DISCUSSION: These results provide evidence that CU-Q(2)oL 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-Q(2)oL was easily and quickly filled up and well accepted by the patients.

Adult↗
PubMed1995

[Chronic urticaria caused by penicillin. Results of monitoring cases of acute penicillin urticaria which developed into chronic urticaria].

Penicillin is known to cause allergic reactions with different clinical manifestations and possible immunologic mechanisms. The purpose of this study was to follow cases of established hypersensitivity to penicillin and its possible development into chronic urticaria. 35 patients with a clinical picture of acute urticaria and with or without angioedema were examined. Three kinds of tests to penicillin were performed: patch test, scarification test and PPL test. Hypersensitivity to penicillin was confirmed in 12 (34.27%) patients with positive PPL test. Seven (58.33%) out of these 12 developed the clinical picture of chronic urticaria. As food was assumed to be the hidden source of penicillin, eliminatory diet was included. In 4 (57.14%) patients there was a complete remission of the disease during the course of diet without milk and milk products (intradermal test to milk and specific IgE antibodies were negative). The gathered results show that acute urticaria caused by penicillin can get a chronic character. It is the consequence of prolonged penicillin's activity in some so called "hidden sources of penicillin".

Acute Disease↗