Karoline Krause

Anti-Immunoglobulin E Treatment of Patients with Recalcitrant Physical Urticaria

In physical urticaria, exogenous physical factors such as thermal triggers, solar radiation and mechanic triggers including friction or pressure are responsible for the elicitation of symptoms in the skin of patients. Avoidance of the respective stimulus is usually difficult or impossible, and many patients are not sufficiently treated with standard antihistamines. We report that treatment with omalizumab (Xolair®) of 7 patients with physical urticarias [solar urticaria (n = 2), urticaria factitia/symptomatic dermographism (n = 2), cold urticaria, delayed pressure urticaria and localized heat urticaria] resulted in complete symptom control within days after the first injection in 5 patients. In 1 patient, symptoms improved after increasing the dose of omalizumab, and 1 patient with localized heat urticaria did not respond significantly to treatment. Before anti-immunoglobulin E treatment, all patients had suffered from their physical urticaria for years and had had numerous unsuccessful therapies. The overall excellent responses to omalizumab treatment reported here indicate that anti-immunoglobulin E is a safe and effective treatment for recalcitrant physical urticarias.

Development and construct validation of the angioedema quality of life questionnaire

Recurrent angioedema is a frequent clinical problem characterized by unpredictably and rapidly occurring cutaneous and mucosal swellings. These swellings may be painful and/or disfiguring. Upper airway involvement can also lead to dyspnea and suffocation. Although the disease burden is high, there is currently no specific instrument to measure health‐related quality of life (QoL) impairment.

Development, validation, and initial results of the Angioedema Activity Score

Recurrent angioedema (RecA) is a frequent clinical problem characterized by suddenly occurring cutaneous and/or mucosal swellings. Depending on their location, RecA may be painful, hindering, disfiguring, or even life‐threatening. The assessment of disease activity in affected patients is important to guide treatment decisions. Currently, however, there is no standardized and validated outcome measure available to do so.

Up-dosing with bilastine results in improved effectiveness in cold contact urticaria

Cold contact urticaria (CCU) is characterized by itchy wheal and flare responses due to the release of histamine and other pro‐inflammatory mediators after exposure to cold. The treatment of choice is nonsedating antihistamines, dosages of which may be increased up to fourfold if standard doses are ineffective. Here, we assess the effects of a standard 20 mg dose and up‐dosing to 40 and 80 mg of bilastine in reducing the symptoms of CCU and inflammatory mediator release following cold challenge.

Efficacy and safety of the interleukin-1 antagonist rilonacept in Schnitzler syndrome: an open-label study

Schnitzler syndrome (SchS) is a rare disease with suspected autoinflammatory background that shares several clinical symptoms, including urticarial rash, fever episodes, arthralgia, and bone and muscle pain with cryopyrin‐associated periodic syndromes (CAPS). Cryopyrin‐associated periodic syndromes respond to treatment with interleukin‐1 antagonists, and single case reports of Schnitzler syndrome have shown improvement following treatment with the interleukin‐1 blocker anakinra. This study evaluated the effects of the interleukin‐1 antagonist rilonacept on the clinical signs and symptoms of SchS.

The role of interleukin-1 in allergy-related disorders.

Purpose of reviewInterleukin-1&bgr; (IL-1&bgr;) is a potent proinflammatory cytokine, which is involved in many inflammatory conditions including autoinflammatory and allergic disorders. This review provides insights into recent advances of our understanding of the pathogenesis of IL-1&bgr;-associated allergy-related disorders. Recent findingsIn autoinflammatory as well as allergic diseases such as contact hypersensitivity, atopic dermatitis and bronchial asthma, dysfunctional inflammasome processing has been demonstrated to account for IL-1&bgr;-induced inflammation. IL-1-neutralizing drugs have been shown to completely suppress or markedly reduce inflammatory responses in clinical studies and experimental models of urticarial autoinflammatory diseases as well as common allergic disorders. SummaryThe recent findings support a crucial role for IL-1&bgr; and inflammasome components in a variety of allergy-related disorders.

Antihistamine‐resistant urticaria factitia successfully treated with anti‐immunoglobulin E therapy

tion of humidified sugar to reduce local symptoms after bee stings does not seem to work in individuals with normal sting reactions to bees. We did not test the concept in patients with allergy– but would not expect it to benefit such patients either. Persons with known large local reactions to insect stings should carry antihistamine and maybe corticosteroid tablets to use when stung (2). The study was supported by Bee-Patch Aps, Lejre, Denmark.

Management of chronic spontaneous urticaria in real life - in accordance with the guidelines? A cross-sectional physician-based survey study

Background  Recently, the updated EAACI/GA2LEN/EDF/WAO guidelines for urticaria have been published.

Practical algorithm for diagnosing patients with recurrent wheals or angioedema

Chronic urticaria is a common disorder characterized by recurrent wheals, angioedema, or both. Several differential diagnoses need to be considered in patients presenting with wheals and/or angioedema. These include rare diseases such as autoinflammatory syndromes and urticarial vasculitis in patients with recurrent wheals and bradykinin‐mediated angioedema in patients with recurrent swellings.

Selected urticaria patients benefit from a referral to tertiary care centres – results of an expert survey

Background  Urticaria is a frequent reason for consultations. Recently, it has been demonstrated that the management of chronic spontaneous urticaria (csU) in the practice setting does not fully comply with published guidelines. In addition, it was shown that one of four csU patients is referred to specialized centres.