INTRODUCTION:

Chronic idiopathic urticaria is a frequent disease witch treatment is often disappointing. Psychological factors seem to be frequently associated to it. In what cases consider psychological treatment? And according to what modalities?

METHOD:

Review of the literature in search of articles in both French and English concerning psychological factors associated to chronic urticaria, either as responsible factors, or as aggravating factors, or as a consequence of the urticaria, with the study of the impact on the quality of life. We also studied articles analyzing various types of psychology-targeted treatments. We use a serie of keywords on following data banks: Medline (1970-2002), Embase, Pascal and Cochrane Library (period 1995-2002).

RESULTS:

Very few controlled studies were published.: Various studies are found reporting an association between stress, anxiety or depressive symptomatology and CIU, but none can assert a causality. Three controlled opened studies show significantly more anxiety and\or depression in the chronic urticaria patients. Three studies analyze the psychopathological personalities of the patients with urticaria. Two studies focus specifically on the impact of the CIU on the quality of life. Various psychotropic drugs (mainly tricyclic antidepressants) have been tested, mostly because of their anti-H1 activity. There is no study on psychological support, psychotherapies, behavioral therapies, technique of biofeedback and group therapies. A particular attention is focused to hypnosis and relaxation techniques because of the improvement of the urticarial wheals reported in studies of cutaneous ability to react in subcutaneous injections of histamine.

CONCLUSION:

A complementary psychological treatment of patients suffering from CIU seems necessary, because of the high frequency of psychological symptoms. Published studies concern essentially the prescription of psychotropic drugs and the use of therapies with suggestion or relaxation under hypnosis. Prospective studies on the impact of an adapted psychological treatment on the CIU evolution are not available.

Omalizumab (Xolair) is intended to be used as second line therapy for the treatment of chronic spontaneous urticaria (CSU) that is refractory to H1 antihistamines. If licensed, it would provide an alternative treatment option beyond antihistamines, the only licensed treatment for CSU. Omalizumab is a recombinant, human monoclonal antibody that selectively binds to human immunoglobulin E (IgE) preventing binding to high affinity receptors on the surface of mast cells and basophils, thus reducing receptor expression and the release of inflammatory mediators. It is currently licensed as add-on therapy to improve asthma control in patients with severe, persistent allergic asthma who have a positive skin test or in vitro reactivity to a perennial aeroallergen. In the UK, approximately 15% of people experience urticaria at some time in their lives, with a chronic urticaria point prevalence of 1-5 per 1,000. CSU symptoms may be short-lived, resolving completely after a few months; however symptoms can persist for more than 10 years. Patients with chronic urticaria often have a severely impaired quality of life, with negative effects on sleep, daily activities, school or work life, and social interactions. Treatment options for CSU refractory to antihistamines include leukotriene receptor antagonists (i.e. montelukast, zafirlukast), dapsone and immunomodulatory medication (i.e. cyclosporin A, sulfasalazine, hydroxychloroquine, methotrexate, azathioprine, mycophenolate mofetil intravenous immunoglobulin, corticosteroids). Omalizumab is currently in phase III clinical trials comparing its effect on weekly itch scores against treatment with placebo. The trials are expected to complete in June 2013.

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.

BACKGROUND:

The association between urticaria and virus infections has rarely been reported in the literature. The lack of reported cases is probably due to the difficulty in establishing a cause-and-effect relationship. It is not possible to challenge the patient with an etiologic agent.

OBJECTIVE:

The purpose of this work was to perform a systematic review on the association between urticaria and virus infections.

METHODS:

This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched for articles from January 1, 2008, through May 2015, by using two key terms related to urticaria and virus diseases, "urticaria" and one key term related to virus infections, "virus disease," then "urticaria" and the name of each virus family, and of the most representative virus serotypes.

RESULTS:

We reported cases of patients affected either by acute or chronic urticaria with a concurrent virus infection. Previous other causes of urticaria had to be excluded. Herpesviridae infections and urticaria were the most frequently reported associations in children. However, hepatitis virus infections would appear to be the most-frequent cause of urticaria in adults.

CONCLUSIONS:

Data obtained indicated viral infection as a potential trigger and sometimes as the main etiologic agent in causing acute or chronic urticaria. In every case, urticarial manifestation cleared up after either healing or controlling of the viral infection. However, prospective studies and well-structured research is needed to better clarify the role of viruses in the pathogenesis of urticaria and their relative prevalence.

Se presenta el caso clínico de un paciente blanco de 17 años de edad, campesino, con antecedente de rinitis alérgica desde hacía aproximadamente 4 años, quien acudió a la consulta de Alergología del Hospital Provincial Eduardo Agramonte Piña de Camagüey, por presentar un cuadro urticariforme exacerbado en el tiempo que, a pesar de la dieta y de las medidas generales, se mantenía. Se realizó una prueba de provocación específica que resultó positiva; por tanto, se diagnosticó una urticaria crónica inducible de tipo físico, específicamente por frío. Se le indicó tratamiento con ketotifeno y a los 6 meses se repitió la prueba que mostró un resultado favorable.

Los objetivos, de este trabajo observacional, descriptivo de corte trasnversal y retrospectivo, sondescribir las características clínicas y laboratoriales, los antecedentes de atopia y las etiologías en72 pacientes con el diagnóstico de urticaria aguda y angioedema remitidos a la Clínica Alergodermaentre los años 2002 a 2005. El 63% eran mayores de 15 años y el 67% del sexo femenino, lasetiologías relacionadas con la presencia de urticaria aguda y angioedema fueron: 46% infecciosas,32% fármacos y 7%, alimentos 7%. El 25% de las patologías infecciosas fueron debidas a cuadrosrespiratorios,y entre los de origen farmacológico las drogas anti-inflamatorias no esteroideas sepresentaron en el 61% y en el 11% de las etiologías fue considerada idiopática. El 29% de lospacientes presentó antecedentes personales de atopía y el 53% urticaria aguda como únicapresentación cutánea. Los casos de urticaria y angioedema se observaron principalmente en losmeses de junio y julio, lo cual coincide con períodos del año en que las infecciones respiratorias sonmás abundantes que genera una mayor demanda en la utilización de drogas antipiréticas,analgésicas y antibióticos, siendo esto ultimo un factor de confusión acerca de la etiología de laurticaria aguda y el angioedema para atribuir como causante al fármaco o al proceso infeccioso.Resalta la importancia de la identificación etiológica para indicar el tratamiento adecuado enpacientes con esta patología cutánea a fin de proporcionar un rápido bienestar al paciente

La urticaria es una afección común de la piel que puede presentarse en un 15 a un 20 por ciento de la población general. La desloratadina es un nuevo antagonista de los receptortes periféricos H1, de histamina, sin efectos sedantes. Estudios internacionales en urticaria crónica han demostrado que la desloratadina es segura y eficaz. El presente estudio observacional, fase IV, prospectivo, abierto multicéntrico evalúa la eficacia y seguridad y reporta la experiencia local con la desloratadina en el manejo de la urticaria crónica idiopática. Se administraron 5 mg de Desloratadina vía oral, una vez al día durante un período total de 30 días. La respesta clínica se evaluó de acuerdo a una escala que tomó en cuenta 4 parámetros: número de habones, severidad del prurito, interrupción de la actividad diaria e interrupción del sueño; cada parámetro con 4 grados en la evaluación (0-3). Se incluyeron 86 pacientes entre 12 y 73 años (39 ± 15). Sesenta y cinco por ciento de los sujetos fueron del sexo femenino. El Puntaje Total de Síntomas tuvo un promedio de 7,56 ± 2,32 al inicio, disminuyendo hasta 1,26 ± 1,59, al completar la terapia; la diferencia promedio observada resultó 6,20 (p<0,001). La propuesta fue señalada como excelente y buena por 76 médicos (88,37 por ciento) mientras que 75 pacientes se manifestaron como satisfechos o con resolución total de su enfermedad (87,2 por ciento). La incidencia de eventos adversos fue de 6,9 por ciento (ninguno serio). Así, Desloratadina, 5 mg diariamente, resulta una opción eficaz para controlar los síntomas de la urticaria idiopática crónica y los efectos que la misma produce en las actividades cotidianas y el sueño con baja incidencia de eventos adversos

A significant proportion of patients with chronic urticaria respond inadequately to first line treatment with antihistamines. Leukotreine receptor antagonists (LTRA) are also used for chronic urticaria, although firm recommendations on their use are lacking. We performed a systematic review of randomised trials to determine the role of LTRA in treatment of chronic urticaria. A search of PUBMED, EMBASE, SCOPUS, LILACS, the Cochrane Central Register of Controlled Trials, and the Web of Science for relevant randomized control trials or cross over studies yielded 10 eligible studies. The heterogeneity of trials were high, preventing valid meta-analysis of data. Most trials indicated that LTRA are not superior to placebo or antihistamine therapy, while combination therapy of LTRA and antihistamines appear to be more efficacious compared to antihistamine alone. The side effect profile and tolerability of this group of drugs is acceptable. The use of LTRA as monotherapy cannot be recommended. LTRA are effective add-on therapy to anti-histamines, and their use in patients responding poorly to antihistamines is justifiable. Further well designed randomized controlled trials with clear and standardized outcome measures are needed to determine the role of LTRA in chronic urticaria. © 2014 de Silva et al.; licensee BioMed Central Ltd.

Chronic spontaneous urticaria (CSU) is defined as persistent wheals, angioedema, or both lasting for >6 weeks due to known or unknown causes. Some epidemiological studies and case reports suggest that internal parasite infections (PI) can cause CSU. Here, we provide a systematic overview of published findings on the prevalence and relevance of PI in CSU and we discuss possible pathomechanisms. The prevalence of PI in CSU was investigated by 39 independent studies and comorbidity reportedly ranged from 0-75.4% (two thirds of these studies reported infection rates of 10% or less). The prevalence of PI in adult and pediatric CSU patients ranged from 0 to 75.4%, and from 0 to 37.8%, respectively. CSU patients were more often diagnosed with protozoa, had a significantly higher risk of toxocariasis seropositivity and Anisakis simplex sensitization when compared to healthy controls. Patients with chronic urticaria more frequently had seropositivity of fasciolosis, Anisakis simplex sensitization and presence of Blastocystis hominis allele 34 (ST3) as compared with control subjects. In 21 studies, efficacy of treatment with anti-parasitic drugs ranged from 0 to 100% (35.7% of 269 CSU patients benefitted). In 9 (42.8%) of 21 studies more than 50% of efficacy was observed. The reported rate of urticaria comorbidity in PI patients in 18 independent studies is 1-66.7%. Urticaria including CSU might be a quite common symptom of strongyloidiasis and blastocytosis. Pathogenic mechanisms in CSU due to PI may include specific IgE, Th2 cytokine skewing, eosinophils, activation of the complement and the coagulation systems. This article is protected by copyright. All rights reserved.

We conducted a prospective study at King Chulalongkorn Memorial Hospital, from June 2001 to November 2003, to identify the contribution of food allergy to urticaria in children. During the study period, 100 children with urticaria were enrolled, 36 of whom had a history suspicious of food allergy. Fifteen of 100 patients had fever (9 from upper respiratory tract infections, 4 from diarrhea and 2 from skin infections). A skin prick test (SPT) was positive in 15 of the 36 children who were suspected of having food allergy; 5 patients out of the positive SPT group had anaphylaxis due to food (2 from cow milk, 2 from wheat and 1 from egg). Six patients in the positive SPT group had a negative food challenge test (4 from open challenges and 2 from double-blind placebo-controlled food challenges [DBPCFC]). The other 4 patients of the positive SPT group refused the food challenge test. The parents of a patient who had urticaria from egg refused the skin prick test; an oral challenge test confirmed the diagnosis of egg allergy. One of the 21 patients that had a negative SPT had shrimp allergy proven by DBPCFC. Of the 64 patients who had no history related to food, SPT was done in 27 patients and revealed a positive result in 7 patients, all of whom had a negative food challenge test (4 with open challenge and 3 with DBPCFC). Urticaria from food was found in 7% and was suspected in another 4% of the patients. Severe reactions to food like anaphylaxis may occur. SPT alone is not adequate in making the diagnosis of food allergy; it must be confirmed by a food challenge test. Thirty percent of patients that did not have a history related to food had false positive SPT. Without a history suspicious of food allergy, SPT yields only minimal benefit.