Nicole Schoepke

Symptomatic dermographism: an inadequately described disease

Symptomatic dermographism is the most common form of physical urticaria with a prevalence of 2–5%. However, its clinical picture has rarely been described.

Responsiveness and minimal important difference of the urticaria control test

This study demonstrates the responsiveness of the Urticaria Control Test (UCT). Changes of its score by 3 points or more reflect a clinically relevant change of disease control (minimal important difference).

The inhibition by levocetirizine and fexofenadine of the histamine-induced wheal and flare response in healthy Caucasian and Japanese volunteers.

This randomized, double-blind, placebo-controlled crossover study compared inhibition by one 5 mg dose of levocetirizine with two 60 mg doses of fexofenadine separated by 12 h of histamine-induced wheal and flare responses in 9 Caucasian and 9 Japanese healthy male volunteers. Levocetirizine was more inhibitory than fexofenadine on wheal, flare and pruritus (p < 0.005). Variability, evaluated from the standard deviation of inhibition, ranged from 14% to 23.2% for levocetirizine and 65.4% to 112.4% for fexofenadine. Levocetirizine had a faster onset of action (30-90 min versus 2 h), shorter time to maximum effect (3-4 versus 3-6 h) and longer duration of action (at least 24 h versus ~12 h) than fexofenadine. The plasma levels of levocetirizine rose more quickly, reached higher levels, were more consistent and decreased slower than those of fexofenadine. There were no clinically significant ethnic differences in responsiveness to the drugs.

Validation of a simplified provocation instrument for diagnosis and threshold testing of symptomatic dermographism.

Symptomatic dermographism is a common urticarial condition, which requires determination of provocation thresholds to confirm diagnosis and allow physicians to individualize management and therapy for optimal control of symptoms. To determine provocation thresholds, we have developed a provocation test device, the FricTest® 4.0. This simple and inexpensive device, which is stroked across the skin to produce a response, consists of a flat plastic comb with four round‐ended plastic pins, 3 mm in diameter, and of differing lengths.

Clinical Measures of Chronic Urticaria

The use of standardized, valid, and reliable clinical measures is an important element in modern patient management, particularly in diseases that are not objectively assessable and are associated with a high disease burden. Chronic urticaria is such a disorder for which several new and well-developed clinical measures became available. These measures comprise tools to assess disease activity, disease control, and health-related quality-of-life impairment. This review provides an overview of the currently available clinical measures for chronic urticaria. In addition, it provides information on their strengths and limitations and how to best use them and evaluate their results.

Comparison and Interpretability of the available Urticaria Activity Scores

The urticaria activity score (UAS) is the gold standard for assessing disease activity in patients with chronic spontaneous urticaria (CSU). Two different versions, the UAS7 and UAS7TD, are currently used in clinical trials and routine care. To compare both versions and to obtain data on their interpretability, 130 CSU patients applied both versions and globally rated their disease activity as none, mild, moderate, or severe. UAS7 and UAS7TD values correlated strongly (r = .90, P < .001). Interquartile ranges for UAS7 and UAS7TD values for mild, moderate, and severe CSU were 11‐20 and 10‐24, 16‐30 and 16‐32, and 27‐37 and 28‐40. UAS7 values were slightly, but significantly lower as compared to UAS7TD values (mean difference: 1.6 ± 4.6, P < .001). This difference was driven by lower wheal subscores (2.1 ± 3.5, P < .001) and was most pronounced in patients with severe CSU (2.5 ± 5.6, P < .01). The UAS7/UAS7TD ratio was 0.96 ± 0.21 and did not differ significantly between mild, moderate, and severe CSU. Since the results of both UAS versions are comparable, we recommend the use of the UAS7, which is less burdensome in administration and scoring.

Patients with chronic cold urticaria may benefit from doxycycline therapy.

Chronic cold urticaria (ColdU) is a rare but severe and potentially life-threatening form of chronic urticaria characterized by the development of wheal and flare type skin reactions or angioedema after skin exposure to cold1. Extensive cold contact (e.g. swimming in cold water) and low trigger thresholds (i.e. wheal responses to temperatures of 20°C or higher) may lead to systemic reactions including anaphylactic shock2. This article is protected by copyright. All rights reserved.

Diagnosis of urticaria.

Acute urticaria do not need extensive diagnostic procedures. Urticaria activity score is a useful tool for evaluation of urticaria. Complete blood count, Erythrocyte sedimentation rate and C reactive protein are important investigations for diagnosis of infections in urticaria. Autologous serum skin test is a simple office procedure for diagnosis of auto reactive urticaria. Closed ball point pen tip is a simple test to diagnose dermographism.

Increased angiogenesis and VEGF expression correlates with disease severity in prurigo patients

Vascular endothelial growth factor‐A (VEGF‐A) is known as the major skin angiogenesis factor and can be produced by various resident skin cells including keratinocytes.

Effects of a Novel GA2LEN Training Program on Urticaria on the Knowledge of General Practitioners in Saudi-Arabia

Continued education in allergology of both general practitioners and specialists can be achieved by various measures including publications, online tools, and lectures. GA2LEN, the Global Allergy and Asthma European Network, has developed 1-day training programs on a number of allergic diseases including asthma, allergic rhinitis, pruritus, angioedema, and urticaria. Here, we assessed the impact of one of these training programs (on urticaria) on the knowledge of 100 participating physicians in Saudi-Arabia by repeated multiple choice examinations. We found that only 5.7% of 70 participants, who took both the pretraining and posttraining examination, passed the pretraining test, that is, answered 70% of the questions correctly. Notably, 68.6% of these participants passed the examination after participating in the 1-day training program (P < 0.001). Participation in the training program also resulted in a significant increase of questions answered correctly (P < 0.001). Taken together, the GA2LEN 1-day training programs on selected allergic diseases are an effective means to improve levels of knowledge on these diseases in physicians including general practitioners and the use of these training programs should be promoted and increased.