ALERGOLOGÍA PARA MÉDICOS Y PACIENTES 2021

The International EAACI/GA²LEN/EuroGuiDerm/APAAACI Guideline for the Definition, Classification, Diagnosis and Management of Urticaria Authors: T. Zuberbier, A.H. Abdul Latiff, M. Abuzakouk, S. Aquilina, R. Asero, D. Baker, B. Ballmer-Weber, C. Bangert, M. Ben-Shoshan, J.A. Bernstein, C. Bindslev-Jensen, K. Brockow, Z. Brzoza, H.J. Chong Neto, M. Church, P.R. Criado, I.V. Danilycheva, C. Dressler, L.F. Ensina, L. Fonacier, M. Gaskins, K. Gáspár, A. Gelincik, A. Giménez-Arnau, K. Godse, M. Gonçalo, C. Grattan, M. Grosber, E. Hamelmann, J. Hébert, M. Hide, A. Kaplan, A. Kapp, A. Kessel, E. Kocatürk, K. Kulthanan, D. Larenas-Linnemann, A. Lauerma, T. Leslie, M. Magerl, M. Makris, R.Y. Meshkova, M. Metz, D. Micallef, C.G. Mortz, A. Nast, H. Oude-Elberink, R. Pawankar, P. Pigatto, H. Ratti Sisa, M.I. Rojo Gutiérrez, S.S. Saini, P. Schmid-Grendelmeier, B. Sekerel, F. Siebenhaar, H. Siiskonen, A. Soria, P. Staubach-Renz, L. Stingeni, G. Sussman, A. Szegedi, S.F. Thomsen, Z. Vadas, C. Vesterga...

 Autoimmune Diseases Are Linked to Type IIb Autoimmune Chronic Spontaneous Urticaria Authors: Pavel Kolkhir, Sabine Altrichter, Riccardo Asero , Alvaro Daschner, Marta Ferrer , Ana Giménez-Arnau, Tomasz Hawro, Thilo Jakob, Tamar Kinaciyan, Arno Kromminga, George N Konstantinou, Michael Makris, Martin Metz , Per Stahl Skov, Petra Staubach, Gordon Sussman , Ke Zhang, Marcus Maurer Abstract: Purpose: Patients with chronic spontaneous urticaria (CSU) have an increased risk for comorbid autoimmune diseases. In this retrospective multicenter study of CSU patients, we evaluated clinical and laboratory features of CSU associated with a higher risk of comorbid autoimmune diseases. Methods: We analyzed records of CSU patients (n = 1,199) for a history or presence of autoimmune diseases. Patients were diagnosed with type IIb autoimmune CSU (aiCSU) if all 3 tests were positive: autologous serum skin test (ASST), basophil histamine release assay (BHRA) and/or basophil activation test (BAT), an...

 Effects of pregnancy on chronic urticaria: Results of the PREG-CU UCARE study Authors: Emek Kocatürk, Mona Al-Ahmad, Karoline Krause, Ana M Gimenez-Arnau, Simon Francis Thomsen, Niall Conlon, Alexander Marsland, Ekin Savk, Roberta F Criado, Inna Danilycheva, Daria Fomina, Kiran Godse, Maryam Khoshkhui, Aslı Gelincik, Ece Nur Degirmentepe, Semra Demir, Luis Felipe Ensina, Alicja Kasperska-Zajac, Michael Rudenko, Solange Valle, Iris Medina, Andrea Bauer, Zuotao Zhao, Petra Staubach, Laurence Bouillet, Özlem Su Küçük, Can Ateş, Marcus Maurer Abstract: Background: Chronic urticaria (CU) predominantly affects women, and sex hormones can modulate disease activity in female CU patients. As of now, the impact of pregnancy on CU is largely unknown. Aim: To analyze the course and features of CU during and after pregnancy. Patients and methods: PREG-CU is an international, multicenter study of the Urticaria Centers of Reference and Excellence (UCARE) network. Data were collected via a 47-ite...

Transitioning From Immunosuppressants to Dupilumab in Pediatric Atopic Dermatitis Authors: Catherine M. Ludwig,  Jennifer L. Hsiao, Peter A. Lio, and Vivian Y. Shi Abstract: Dupilumab has recently been approved by the Food and Drug Administration for use for treatment of moderate to severe atopic dermatitis in children aged 6 to 11 years. It presents a novel treatment option with a favorable safety profile for patients who are currently reliant on immunosuppressants, including cyclosporine A, methotrexate, and mycophenolate mofetil. Particularly during the current COVID-19 pandemic, immunosuppression should be avoided to retain intrinsic antiviral immunity. Transitioning to dupilumab should be executed strategically tapering immunosuppressants and minimizing risk of flare by overlapping with the biologic. Herein, we use results of outcome measurements from LIBERTY AD ADOL and LIBERTY AD PEDS trials of dupilumab in adolescents aged 12 to 18 years and children aged 6 to 11 years, res...

Wet Wrap Therapy in Moderate to Severe Atopic Dermatitis Authors:   Noreen Heer Nicol, Mark Boguniewicz Key points: - Atopic dermatitis (AD) remains a complex, common, chronic, and relapsing skin disorder, and a global public health problem. - National and international guidelines address AD care in a stepwise fashion. Wet wrap therapy (WWT) is a therapeutic intervention for moderate to severe AD. - WWT plays an important role as an acute therapeutic intervention for management of moderate to severe AD used with undiluted topical corticosteroids of appropriate potency. - WWT should not be used for mild AD or as a chronic or maintenance therapy. - WWT should be considered as a treatment option ahead of the systemic therapies for pa- tients failing conventional topical therapy. DOI:   10.1016/j.iac.2016.08.003

Contact urticaria: Frequency, elicitors and cofactors in three cohorts (Information Network of Departments of Dermatology; Network of Anaphylaxis; and Department of Dermatology, University Hospital Erlangen, Germany) Authors: Helene Süß, Sabine Dölle-Bierke,  Johannes Geier, Burkhard Kreft, Eva Oppel, Claudia Pföhler, Christoph Skudlik, Margitta Worm, Vera Mahler Abstract:   Background: Contact urticaria (CU) is an infrequent, mostly occupational disease that may be life-threatening (CU syndrome stage 4). Objectives: To identify the current frequency, elicitors and cofactors of CU. Patients: Three cohorts were retrospectively analysed for CU: (a) patients from the Information Network of Departments of Dermatology (IVDK) database (2000-2014; n = 159 947); (b) patients from an allergy unit (Department of Dermatology, University Hospital Erlangen, 2000-2015; n = 4741); and (c) patients from the Anaphylaxis Registry (2007-2015: 6365 reported cases, in...

Crisaborole Ointment, 2%, for Treatment of Patients with Mild-to-Moderate Atopic Dermatitis: Systematic Literature Review and Network Meta-Analysis Authors: Kyle Fahrbach . Jialu Tarpey . Evelien Bergrath Washington . Rachel Hughes . Howard Thom . Maureen P. Neary . Amy Cha . Robert Gerber . Joseph C. Cappelleri Abstract:  Introduction: There is a need to compare efficacy and safety profiles of crisaborole ointment, 2%, versus other topical treatments across randomized clinical trials (RCTs). We performed this review/network meta-analysis to evaluate the comparative efficacy and safety of crisaborole versus other topical pharmacologic therapies for mild-to-moderate atopic dermatitis (AD) among patients aged >2 years Methods: Searches were conducted in MEDLINE, Embase, the Cochrane Collection Central Register of Clinical Trials, and the Database of Abstracts of Reviews of Effects using Ovid to identify English language articles reporting RCTs of topical anti-inflammatory agents i...

Triggers of Exacerbation in Chronic Urticaria and Recurrent Angioedema—Prevalence and Relevance Authors:  Anete Sevciovic Grumach, MD, MS, PhD , Petra Staubach-Renz, MD, Ricardo Cardona Villa, MD, MS, Susana Diez-Zuluaga, MD, Imke Reese, PhD, and William R. Lumry, MD Abstract: Patients with urticaria and angioedema often have triggers that cause an outbreak or a swelling episode or worsen their chronic condition. Exploring these factors with each patient may result in better understanding and control of their disease. Patients should be advised to avoid known triggers, if feasible, or prepare to prevent or control an exacerbation with appropriate pretreatment if avoidance is not possible. In this review, we describe and discuss a variety of factors for which there is evidence that they cause or exacerbate chronic spontaneous urticaria and angioedema. These potentially exacerbating factors include drugs, food additives, and naturally occurring pseudoallergens, mental stress, and tra...

 Clinical Control of CSU with Antihistamines Allows for Tolerance of NSAID-Exacerbated Cutaneous Disease Authors: Jorge Sánchez  1 , Susana Diez  2 , Ricardo Cardona  2 Abstract Background: Many patients with chronic spontaneous urticaria (CSU) experience exacerbations after the administration of nonsteroidal anti-inflammatory drugs (NSAIDs), with clinical implications for the selection of therapeutic options for pain management. Case reports suggest that antihistamines could prevent these reactions. Objective: To determine whether antihistamines can prevent NSAID-exacerbated reactions in patients with CSU. Methods: Data on 121 patients with CSU and a history of NSAID exacerbations were evaluated. Two types of challenge with NSAIDs were performed using the NSAIDs reported in the medical record (a diagnostic challenge test without the use of antihistamines and a challenge test using antihistamines). The order in which the tests were performed in each patient was depen...

 Delayed Pressure Urticaria: A Systematic Review of Treatment Options Authors: Kanokvalai Kulthanan  1 , Patompong Ungprasert  2 , Papapit Tuchinda  1 , Leena Chularojanamontri  1 , Norramon Charoenpipatsin  1 , Marcus Maurer  3 Abstract Background: Delayed pressure urticaria (DPU) is characterized by recurrent erythematous and often painful swelling after the skin is exposed to sustained pressure. Treatment is challenging. Antihistamines, the first-line and only approved treatment, are often not effective. Objective: To systematically review the treatment options for DPU. Method: A literature search of electronic databases for all relevant articles published till April 29, 2019, was conducted using the search terms "delayed pressure urticaria" and "pressure urticaria." This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Results: Twenty-one studies (8 randomized...

 Peptic Ulcer Disease is Associated with Increased Risk of Chronic Urticaria Independent of Helicobacter pylori Infection: A Population-Based Cohort Study Authors: Chun-Ming Chen  1   2 , Wan-Ting Huang  3 , Li-Jen Chang  4 , Chih-Cheng Hsu  5   6 , Yueh-Han Hsu   Abstract Background: Some studies showed patients with chronic urticaria have a higher rate of peptic ulcer disease (PUD). Whether PUD is a risk factor for chronic urticaria is unclear. Objective: The objective of this study was to evaluate the incidence of and risk factors for chronic urticaria in patients with PUD using the Taiwan National Health Insurance Research Database. Methods: We conducted a retrospective nationwide cohort study of the period 2000-2012 and involving 11,901 patients with PUD who underwent Helicobacter pylori (HP) therapy (PUD + HP group) and an equal number of matched patients without HP infection (PUD - HP group). Furthermore, we enrolled 23,802 patients without...

 Chronic urticaria and thyroid pathology Authors: Sandra Nora Gonzalez-Diaz,a Mario Sanchez-Borges,b Diana Maria Rangel-Gonzalez,a,∗ Rosa Ivett Guzman-Avilan,a Jose Ignacio Canseco-Villarreal,a and Alfredo Arias-Cruza Abstract Urticaria is defined as the sudden appearance of erythematous, itchy wheals of variable size, with or without angioedema (AE) (swelling of the deeper layers of the skin). Its classification depends on time course of symptoms and the presence of eliciting factors. When it lasts less than 6 weeks it is classified as acute urticaria (AU), and if the symptoms persist for more than 6 weeks, it is classified as chronic urticaria (CU). Current International Guidelines also classify CU as chronic spontaneous urticaria (CSU) and inducible urticarial, according to the absence or presence of environmental triggering factors. CSU is defined as urticaria and/or angioedema in which there is no evidence of a specific eliciting factor. CSU is associated with autoimmunity in ...

 Therapeutic Strategy According to Differences in Response to Omalizumab in Patients With Chronic Spontaneous Urticaria Authors: A M Giménez Arnau  1 , A Valero Santiago  2 , J Bartra Tomás  3 , I Jáuregui Presa  4 , M Labrador Horrillo  5 , F J Miquel Miquel  6 , J Ortiz de Frutos  7 , J Sastre  8 , J F Silvestre Salvador  9 , M Ferrer Puga  10 Abstract Chronic spontaneous urticaria (CSU) is a heterogeneous condition that can severely impact quality of life. Consequently, rapid disease control is essential. First-line treatment of the symptoms of CSU is the licensed dose of second-generation H1 antihistamines. For second-line treatment, this dose may be increased by up to 4 times. In patients who fail to respond to higher doses of H1 antihistamines, omalizumab for up to 24 weeks is recommended to achieve disease control. After this 24-week period, the patient's response to omalizumab should be assessed in order to identify refracto...

Atopic Dermatitis Is a Barrier Issue, Not an Allergy Issue Authors: Monica T Kraft  1 , Benjamin T Prince  2 Abstract Atopic dermatitis (AD) is a chronic, relapsing disease that typically manifests in childhood and improves with age. Studies have demonstrated that the presence of AD increases the risk of developing food allergy, allergic rhinitis, and asthma later in life. Although children with AD are more likely to produce allergen-specific immunoglobulin E, there is conflicting evidence that allergen avoidance improves disease severity. Furthermore, food-elimination diets in patients with AD may increase the risk of developing immediate, life-threatening reactions to the removed food. The most effective treatments of AD aim to repair and protect the skin barrier and decrease inflammation. Keywords: Allergic rhinitis; Asthma; Atopic dermatitis; Atopic march; Eczema; Food allergy. DOI  10.1016/j.iac.2019.07.005

Predictors of severe anaphylaxis in Hymenoptera venom allergy The importance of absence of urticaria and angioedema Authors: Maria Chapsa, MD Henriette Roensch, MSScMathias Langner, MScStefan Beissert, MDAndrea Bauer, MD Abstract Background Severe anaphylaxis (SA) in Hymenoptera venom allergy has been associated with a number of risk factors. However, the effect of several of those risk factors on the severity of anaphylaxis is poorly defined. Objective To evaluate risk factors for SA in Hymenoptera venom allergy. Methods We evaluated data from 500 patients who were referred to our department for the diagnosis of Hymenoptera venom allergy during a period of 11 years to identify risk factors for SA. Results Six significant risk factors for SA were identified ( P < .05): short interval from sting to reaction, absence of urticaria or angioedema (U/A) during anaphylaxis, older age, male sex, elevation of baseline serum tryptase (BST) level, and diagnosis of systemic mastocytosis. Moreov...

Biomarkers and clinical characteristics of autoimmune chronic spontaneous urticaria: Results of the PURIST Study Authors: Nicole Schoepke  1 , Riccardo Asero  2 , André Ellrich  1 , Marta Ferrer  3 , Ana Gimenez-Arnau  4 , Clive E H Grattan  5 , Thilo Jakob  6   7 , George N Konstantinou  8 , Ulrike Raap  9 , Per Stahl Skov  10   11 , Petra Staubach  12 , Arno Kromminga  13   14 , Ke Zhang  15 , Carsten Bindslev-Jensen  16 , Alvaro Daschner  17 , Tamar Kinaciyan  18 , Edward F Knol  19 , Michael Makris  20 , Nadine Marrouche  21 , Peter Schmid-Grendelmeier  22   23 , Gordon Sussman  24 , Elias Toubi  25 , Martin K Church  1 , Marcus Maurer  1 Abstract Background: Autoimmune chronic spontaneous urticaria (aiCSU) is an important subtype of chronic spontaneous urticaria (CSU) in which functional IgG autoantibodies to IgE or its high-affinity re...

Anaphylaxis-a 2020 Practice Parameter Update, Systematic Review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Analysis Authors: Marcus S Shaker 1, Dana V Wallace 2, David B K Golden 3, John Oppenheimer 4, Jonathan A Bernstein 5, Ronna L Campbell 6, Chitra Dinakar 7, Anne Ellis 8, Matthew Greenhawt 9, David A Khan 10, David M Lang 11, Eddy S Lang 12, Jay A Lieberman 13, Jay Portnoy 14, Matthew A Rank 15, David R Stukus 16, Julie Wang 17, Collaborators; Natalie Riblet 18, Aiyana M P Bobrownicki 18, Teresa Bontrager 19, Jarrod Dusin 19, Jennifer Foley 19, Becky Frederick 19, Eyitemi Fregene 18, Sage Hellerstedt 18, Ferdaus Hassan 19, Kori Hess 19, Caroline Horner 20, Kelly Huntington 19, Poojita Kasireddy 18, David Keeler 19, Bertha Kim 18, Phil Lieberman 13, Erin Lindhorst 19, Fiona McEnany 18, Jennifer Milbank 18, Helen Murphy 19, Oriana Pando 18, Ami K Patel 18, Nicole Ratliff 19, Robert Rhodes 19, Kim Robertson 19, Hope Scott 19, Audrey Snell 19, ...

ACE Inhibitor-Mediated Angioedema Authors: Vincenzo Montinaro  1 , Marco Cicardi  2 Abstract Angioedema (AE) occurring during ACE inhibitor therapy (ACEi-AE) is a rare complication involving between 0.1 and 0.7% of treated patients. AE can also complicate other therapeutic regimens that block the renin-angiotensin aldosterone system. Other drugs, such as immune suppressors, some type of antidiabetics or calcium antagonists, can increase the likelihood of ACEi-AE when associated to ACEi. There is a clear ethnic predisposition, since African-Americans or Hispanics show a higher prevalence of this condition compared to Caucasians. At least in African-Americans the genetic predisposition accounts for a general higher prevalence of AE, independently from the cause. People that experience ACEi-AE may have some recurrence when they are switched to an angiotensin-receptor blocker (ARB); however, epidemiological studies on large cohorts have shown that angiotensin receptor bloc...

Treatment of Chronic Spontaneous Urticaria: a Focused Update in Omalizumab Authors: Whitney A. Blackwell MD & David A. Khan MD  Abstract Chronic spontaneous urticaria (CSU) is a common disease in the general population that causes significant effects on quality of life and a financial burden on the health care system. Guidelines are essential to assure patients are being managed appropriately, although given the rigor to develop these reviews they are not as up to date as cutting-edge scientific evidence. This review details the most recent phase II, III, and IV clinical trials that have been published since the development of the US practice parameters. Recent findings Phase II, III, and IV clinical trials, ASTERIA I, POLARIS, X-ACT, MoA, and CTEND-CIU, demonstrate safety, long-term efficacy, and improvement in patient’s quality of life by decreasing disease-burdened days and severity of disease in comparison with placebo, as well as transcriptional level changes in ...

The rash that presents as target lesions. Authors:  Wolf R1, Parish JL2, Parish LC3. Abstract We have explored the rash that appears as target lesions, with the central and dominant diseases belonging to the Stevens-Johnson syndrome/toxic epidermal necrolysis group. After presenting the clinical patterns of an individual target lesion and classifying them into different types of lesions, the contribution has been organized with groups characterized by such specific findings according to the type of lesion: flat or raised, typical or atypical, presence or absence of fever, presence or absence of mucosal ulcerations, presence or absence of arthralgias, and/or internal organ involvement. Other specific features, such as histologic appearance, immunofluorescence findings, and laboratory changes, are considered. We provide clinicians with an algorithmic, systematic, and logical approach to diagnose the condition of the patients who present with targetoid lesions, and enable them t...