Urticaria: Clinical Updates on the Cause, Diagnosis, and Treatment

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Immunology".

Deadline for manuscript submissions: closed (10 March 2023) | Viewed by 13009

Special Issue Editor


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Guest Editor
Department of Internal Diseases with Division of Allergology, Institute of Medical Sciences, University of Opole, Opole, Poland
Interests: urticaria; angioedema; allergic diseases; asthma
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Special Issue Information

Dear Colleagues,

Urticaria is a disorder that still causes many problems in general, allergological, and dermatological practice. Its pathophysiology includes genetic, hormonal, and inflammatory abnormalities. The symptoms of urticaria are undoubtedly the cause of distress for patients, having a detrimental influence on patients’ quality of life and resulting in emotional disturbances. Previous analyses proved significant psychological and psychiatric comorbidity in the course of urticaria. Accompanying pruritus often disturbs the sleep cycle. Recurrent angioedema, often coexisting with wheals, is an important problem in daily practice and emergency medicine and one of the most important symptoms of urticaria. 

Progress in urticaria therapy seems to be connected to the effectiveness of antihistamines in appropriate doses, anti-IgE treatment, as well as novel therapies. Analyses of the response to treatment in urticaria patients are absolutely essential for both patients and physicians. Nowadays, we have several tools to assess disease activity, impact and control.

Additionally, the course of urticaria in children, during pregnancy and lactation, as well as a wide spectrum of comorbidities are still not deeply explored.

In this Special Issue, we will focus on innovations and advancements in urticaria pathogenesis and management, and we hope to provide more information that will be useful for daily practice and future research.

Prof. Dr. Zenon Brzoza
Guest Editor

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Keywords

  • urticaria
  • angioedema
  • pathogenesis
  • diagnostics
  • treatment
  • comorbidity
  • quality of life

Published Papers (6 papers)

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Editorial

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4 pages, 203 KiB  
Editorial
Chronic Urticaria—Pathogenesis, Diagnostics, Therapy and Influence of Coexisting Angioedema
by Marzena Pluta-Kubicz and Zenon Brzoza
J. Clin. Med. 2023, 12(2), 688; https://doi.org/10.3390/jcm12020688 - 15 Jan 2023
Cited by 1 | Viewed by 1331
Abstract
Urticaria is one of the most frequent dermatological diseases and it usually occurs in paroxysmal, recurrent form [...] Full article
(This article belongs to the Special Issue Urticaria: Clinical Updates on the Cause, Diagnosis, and Treatment)

Research

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12 pages, 1977 KiB  
Article
Why a Complete Response Is the Treatment Aim in Chronic Spontaneous Urticaria
by Jonathan A. Bernstein, Ana Giménez-Arnau, Marcus Maurer, Petra Staubach, Nathalie Barbier, Eva Hua, Thomas Severin, Pedro A. Laires and Maria-Magdalena Balp
J. Clin. Med. 2023, 12(10), 3561; https://doi.org/10.3390/jcm12103561 - 19 May 2023
Cited by 2 | Viewed by 1554
Abstract
This study investigated the association between urticaria activity and health-related quality of life (HRQoL). Patient evaluations from the ligelizumab Phase 2b clinical trial (N = 382) were pooled (NCT02477332). Daily patient diaries assessed urticaria activity, sleep and activity interference, the dermatology life quality [...] Read more.
This study investigated the association between urticaria activity and health-related quality of life (HRQoL). Patient evaluations from the ligelizumab Phase 2b clinical trial (N = 382) were pooled (NCT02477332). Daily patient diaries assessed urticaria activity, sleep and activity interference, the dermatology life quality index (DLQI), and work productivity and activity impairment-chronic urticaria (WPAI-CU). The number of DLQI scores, weekly sleep interference scores (SIS7), weekly activity interference scores (AIS7), and overall work impairment (OWI) evaluations with a complete response per weekly urticaria activity score (UAS7) using bands (0, 1–6, 7–15, 16–27, and 28–42) were reported. Over 50% of the patients had a mean DLQI of > 10 at baseline, indicating a significant effect of chronic spontaneous urticaria (CSU) on their HRQoL. Complete response (UAS7 = 0) evaluations corresponded with no impacts on other patient-reported outcomes. In total, 91.1% of UAS7 = 0 evaluations corresponded to DLQI scores of 0–1, 99.7% to SIS7 scores of 0, 99.7% to AIS7 scores of 0, and 85.3% to OWI scores of 0. This was significantly different compared with the UAS7 = 1–6 evaluations (61.9%, 68.5%, 67.7%, and 65.4%, respectively; p < 0.0001). Complete responses to treatment were associated with no impairments on the dermatology-QoL, no interferences with sleep and activity, and significantly improved capacities to work compared to patients who continued to have signs and symptoms, even for those with minimal disease activity. Full article
(This article belongs to the Special Issue Urticaria: Clinical Updates on the Cause, Diagnosis, and Treatment)
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9 pages, 247 KiB  
Article
Chronic Urticaria Treatment with Omalizumab—Verification of NLR, PLR, SIRI and SII as Biomarkers and Predictors of Treatment Efficacy
by Bartłomiej Tarkowski, Julia Ławniczak, Katarzyna Tomaszewska, Marcin Kurowski and Anna Zalewska-Janowska
J. Clin. Med. 2023, 12(7), 2639; https://doi.org/10.3390/jcm12072639 - 1 Apr 2023
Cited by 5 | Viewed by 1465
Abstract
Biomarkers that are able to predict the response to omalizumab (OMA) in chronic spontaneous urticaria (CSU) are highly valued. The aim of our study was to evaluate the UAS7 (urticaria activity score assessed for 7 days), DLQI (dermatology life quality index), SII (systemic [...] Read more.
Biomarkers that are able to predict the response to omalizumab (OMA) in chronic spontaneous urticaria (CSU) are highly valued. The aim of our study was to evaluate the UAS7 (urticaria activity score assessed for 7 days), DLQI (dermatology life quality index), SII (systemic immune-inflammation index), SIRI (systemic inflammation response index), PLR (platelet/lymphocyte ratio) and NLR (neutrophil/lymphocyte ratio) in a group of 46 CSU a patients treated for 24 weeks with OMA (300 mg every 4 weeks). There were no statistically significant differences observed at the start nor at the end of the treatment between the two groups (responders vs. non-responders) and SII, SIRI, PLR and NLR. However, a statistically significant correlation was observed between severity of urticaria expressed in UAS7 scores and the quality of life (evaluated by DLQI). Furthermore, at week 24, both groups demonstrated significant improvement in quality of life. Our single center study did not confirm the usefulness of SII, SIRI, NLR or PLR as predictors of the response to OMA in CSU. However, it is of importance that even patients who did not respond to the treatment presented a significant improvement in quality of life. Additionally, we also observed that the efficacy of treatment was unchanged amongst patients who underwent a second series of treatment in cases of relapse. Full article
(This article belongs to the Special Issue Urticaria: Clinical Updates on the Cause, Diagnosis, and Treatment)
10 pages, 279 KiB  
Article
The Burden on Cohabitants of Patients with Chronic Spontaneous Urticaria: A Cross-Sectional Study
by Manuel Sánchez-Díaz, Maria-Carmen Salazar-Nievas, Alejandro Molina-Leyva and Salvador Arias-Santiago
J. Clin. Med. 2022, 11(11), 3228; https://doi.org/10.3390/jcm11113228 - 6 Jun 2022
Cited by 6 | Viewed by 1823
Abstract
Chronic Spontaneous Urticaria (CSU) has been associated with patients’ poor quality of life. Despite being a chronic disease that could alter the quality of life of the people who live with patients, the potential burden on their cohabitants has not been studied to [...] Read more.
Chronic Spontaneous Urticaria (CSU) has been associated with patients’ poor quality of life. Despite being a chronic disease that could alter the quality of life of the people who live with patients, the potential burden on their cohabitants has not been studied to date. The aim of this study is to analyze the relationship between the patient’s quality of life, disease control, disease duration and family quality of life and the cohabitant’s mood disturbances, sexual dysfunction, type D personality and sleep quality. A cross-sectional study including patients suffering from CSU and their cohabitants was performed. Sociodemographic variables and disease activity, quality of life, sleep, sexual disfunction, anxiety, depression and type D personality were collected using validated questionnaires. Sixty-two subjects, 31 CSU patients and 31 cohabitants, were included in the study. Worse disease control and poorer quality of life in patients were associated with poorer family quality of life and higher rates of anxiety among the cohabitants (p < 0.05). Patients’ poor quality of life was associated with reduced sexual satisfaction among the cohabitants (p < 0.05). Long disease duration (>10 years) was associated with an increased prevalence of type D personality among the cohabitants (prevalence ratio: 2.59, CI 95% 1.03–7.21). CSU seems to have an impact on the quality of life of cohabitants, especially in terms of increased rates of anxiety, poorer quality of life and reduced sexual satisfaction. The prolonged course of the disease could be associated with the increased presence of non-adaptative personality traits. Full article
(This article belongs to the Special Issue Urticaria: Clinical Updates on the Cause, Diagnosis, and Treatment)
7 pages, 428 KiB  
Article
Exhaled Nitric Oxide Level in Pharynx Angioedema
by Łukasz Moos, Magdalena Zajac and Zenon Brzoza
J. Clin. Med. 2022, 11(3), 637; https://doi.org/10.3390/jcm11030637 - 27 Jan 2022
Viewed by 1337
Abstract
Airway inflammation is related to increased nitric oxide production. It can be assessed noninvasively with exhaled nitric oxide measurement. As airway inflammation was supposed to be present in chronic urticaria and angioedema patients we hypothesized increased exhaled nitric oxide in this group. Twenty-six [...] Read more.
Airway inflammation is related to increased nitric oxide production. It can be assessed noninvasively with exhaled nitric oxide measurement. As airway inflammation was supposed to be present in chronic urticaria and angioedema patients we hypothesized increased exhaled nitric oxide in this group. Twenty-six symptomatic chronic urticaria patients with an acute episode of pharynx angioedema (17 women and 9 men, median age 35) were included in the study group. None of the patients reported a history of asthma, allergic rhinitis or cigarette smoking. The control group consisted of 29 non-smoking healthy subjects (19 women and 10 men, median age 22) without any history of atopy. Exhaled nitric oxide measurement was performed in all subjects. Exhaled nitric oxide levels in the angioedema group did not differ statistically significantly from those detected in healthy subjects (15.5 ppb and 17.0 ppb respectively). Our results indicate the lack of airway inflammation in chronic urticaria patients with pharynx angioedema. Full article
(This article belongs to the Special Issue Urticaria: Clinical Updates on the Cause, Diagnosis, and Treatment)
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Review

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15 pages, 1760 KiB  
Review
Neuro–Immuno–Psychological Aspects of Chronic Urticaria
by Katarzyna Tomaszewska, Aleksandra Słodka, Bartłomiej Tarkowski and Anna Zalewska-Janowska
J. Clin. Med. 2023, 12(9), 3134; https://doi.org/10.3390/jcm12093134 - 26 Apr 2023
Cited by 7 | Viewed by 4468
Abstract
Urticaria is a condition characterized by the development of itchy wheals (hives), angioedema, or both. The pathophysiology of chronic spontaneous urticaria (CSU) is still poorly understood. It is suggested that there is no dominant and independent mechanism of CSU; however, there are different [...] Read more.
Urticaria is a condition characterized by the development of itchy wheals (hives), angioedema, or both. The pathophysiology of chronic spontaneous urticaria (CSU) is still poorly understood. It is suggested that there is no dominant and independent mechanism of CSU; however, there are different immunological and non-immunological abnormalities that act simultaneously or/and follow each other resulting in clinical symptoms. The latest hypothesis points out that mast cells (MCs) to be activated via autoantibodies in autoallergic or autoimmune mechanism mediators released from degranulated MCs are responsible for the vasoactive and neurospecific effect in CSU. According to many clinical observations, it is suggested that psychological stress can be both a triggering factor in the onset of CSU and a modulating one in the course of the disease and therapy effectiveness. Of importance, the mechanistic background of the psychological stress response in the skin has not yet been fully elucidated. However, of note, a variety of inflammatory mediators, neuropeptides, and neurotransmitters facilitate this phenomenon. This review presents recent findings on the neuro–immuno–psychological aspects of CSU, highlighting an emerging role of neuro–immune interactions. It also points out the usefulness of psychological tools employment for the baseline diagnosis of perceived stress level and the presence of its symptoms. Furthermore, it proposes the implementation of non-invasive interventions to reduce psychological stress and anxiety. A bio–psycho–social approach including psychological support and patient education seems to be as important as traditional pharmacotherapy for CSU. It facilitates the effective control of active disease and a prolonged remission time in this disease. Full article
(This article belongs to the Special Issue Urticaria: Clinical Updates on the Cause, Diagnosis, and Treatment)
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