RESUMO
BACKGROUND: Information/communication technologies such as mobile phone applications (apps) would enable chronic urticaria (CU) patients to self-evaluate their disease activity and control. Yet, recently Antó et al (2021) reported a global paucity of such apps for patients with CU. In this analysis, we assessed patient interest in using apps to monitor CU disease activity and control using questions from the chronic urticaria information and communication technologies (CURICT) study. METHODS: The methodology for CURICT has been reported. Briefly, a 23-item questionnaire was completed by 1841 CU patients from 17 UCAREs across 17 countries. Here, we analyzed patient responses to the CURICT questions on the use of apps for urticaria-related purposes. RESULTS: As previously published, the majority of respondents had chronic spontaneous urticaria (CSU; 63%; 18% chronic inducible urticaria (CIndU) [CIndu]; 19% with both), were female (70%) and in urban areas (75%). Over half of patients were very/extremely interested in an app to monitor disease activity (51%) and control (53%), while only â¼1/10 were not. Patients with both urticaria types versus those with CSU only (odds ratio [OR], 1.36 [1.03-1.79]) and females versus males (OR [95% CI], 1.47 [1.17-1.85]) were more likely to be very to extremely interested in an app to assess disease control. CONCLUSIONS: Overall, half of the patients with CU were very to extremely interested in using an app to assess their disease activity and control. Development of well-designed apps, specific to disease types (CSU, CIndU, CSU + CIndU, etc), validated by experts across platforms would help improve the management and possibly outcomes of CU treatment while providing important patient information to be used in future research.
Assuntos
Antialérgicos/administração & dosagem , COVID-19/imunologia , Urticária Crônica/tratamento farmacológico , Omalizumab/administração & dosagem , Exacerbação dos Sintomas , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/virologia , Urticária Crônica/imunologia , Feminino , Humanos , Injeções Subcutâneas , Pulmão/diagnóstico por imagem , Pessoa de Meia-Idade , SARS-CoV-2/imunologia , SARS-CoV-2/isolamento & purificação , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Anticorpos Monoclonais Humanizados , Dermatite Atópica , Prurigo , Idoso , Anticorpos Monoclonais Humanizados/uso terapêutico , Dermatite Atópica/complicações , Dermatite Atópica/tratamento farmacológico , Suscetibilidade a Doenças , Humanos , Prurigo/complicações , Prurigo/tratamento farmacológicoAssuntos
Neoplasias da Mama/radioterapia , Carcinoma Intraductal não Infiltrante/radioterapia , Pênfigo/etiologia , Pênfigo/patologia , Radiodermite/etiologia , Radiodermite/patologia , Idoso , Complemento C3/análise , Epiderme/patologia , Feminino , Seguimentos , Glucocorticoides/uso terapêutico , Humanos , Imunoglobulina G/análise , Pênfigo/tratamento farmacológico , Prurido/etiologia , Radiodermite/tratamento farmacológico , Radioterapia/efeitos adversos , Resultado do Tratamento , Triancinolona/uso terapêuticoRESUMO
BACKGROUND: Few studies have addressed the ultrastructure of vascular permeability in urticaria. OBJECTIVES: To describe the types of endothelial cell organelles involved in vascular permeability in drug-induced acute urticaria (DIAU). METHODS: Seven patients with DIAU were enrolled in the study. Biopsies of urticarial lesions and apparently normal skin were performed. The 14 collected fragmentswere processed with immunogold electron microscopy using single stains for tryptase and factor XIIIa (FXIIIa) and double immunogold labeling for both tryptase and FXIIIa. RESULTS: Some sections demonstrated mast cells in the degranulation process, in both anaphylactic and piecemeal degranulation. After double immunogold staining, 10 nm (FXIIIa) and 15 nm (tryptase) gold particles wereboth present, covering the granules in the mast cells, indicating that both tryptase and FXIIIa were localized within the granules of these cells. Interestingly, we found strong evidence of the presence of caveolae and vesico-vacuolar organelles (VVOs) in the endothelial cells of the biopsies. In addition to these findings, we were able to demonstrate the presence of tryptase and FXIIIa in the endothelial celIs, in urticarial lesions and in apparently normal skin. CONCLUSIONS: VVOs are present in the endothelial cells of post-capillary venules in DIAU. This is the first report on the expression of FXIIIa and tryptase in the cytoplasm of endothelial cells in urticaria.
Assuntos
Permeabilidade Capilar , Hipersensibilidade a Drogas/imunologia , Urticária/induzido quimicamente , Doença Aguda , Adulto , Criança , Citoplasma/metabolismo , Citoplasma/ultraestrutura , Hipersensibilidade a Drogas/etiologia , Células Endoteliais/metabolismo , Células Endoteliais/ultraestrutura , Fator XIIIa/metabolismo , Feminino , Humanos , Microscopia Eletrônica , Pessoa de Meia-Idade , Organelas/metabolismo , Organelas/ultraestrutura , Coloração e Rotulagem , Triptases/metabolismo , Urticária/imunologiaRESUMO
BACKGROUND: The non- or low-sedating H1 receptor antagonists represent the basic therapy for urticaria. OBJECTIVE: To test an alternative approach to patients unresponsive to conventional treatment. MATERIALS AND METHODS: A total of 22 patients with chronic urticaria unresponsive to conventional antihistamine treatment were enrolled for this study. They had uncontrolled urticaria even using multiple combinations of antihistamines on maximum doses and corticosteroids in short cycles (prednisone 20-40 mg, per os once a day, 3-7 days per month). Cutaneous biopsies of the urticaria lesions were taken. These findings were classified as: (I) a mixture of perivascular dermal inflammatory infiltrate composed of lymphocytes, monocytes and neutrophils and/or eosinophils; (II) inflammatory infiltrate composed chiefly of neutrophils; and (III) inflammatory infiltrate composed mainly of eosinophils. According to histology, the patients were submitted to one of the following therapeutic schemes: class A - antihistamine treatment plus dapsone; class B - colchicine or dapsone; class C - montelukast. RESULTS: Four patients in class A, 08 in class B and seven in class C displayed complete control of urticaria after 12 weeks of treatment; one patient in class B and two in class C did not respond to treatment. Two years after discontinuation, 16 patients are still free of urticaria. CONCLUSIONS: This study suggests an alternative approach for treating unresponsive chronic urticaria.
Assuntos
Anti-Infecciosos/uso terapêutico , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Antagonistas de Leucotrienos/uso terapêutico , Moduladores de Tubulina/uso terapêutico , Urticária/tratamento farmacológico , Urticária/patologia , Acetatos/uso terapêutico , Adulto , Doença Crônica , Colchicina/uso terapêutico , Ciclopropanos , Dapsona/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Quinolinas/uso terapêutico , SulfetosRESUMO
BACKGROUND: The cardinal signs and symptoms of adult-onset Still's disease (AOSD) include periodic fever, arthralgia and arthritis, lymphadenopathy, hepatosplenomegaly, an evanescent rash accompanied by neutrophilic granulocytosis, and a negative rheumatoid factor and antinuclear antibody test. OBJECTIVE: To alert clinicians and dermatologists to internal diseases such as AOSD when assisting patients with urticarial eruptions and systemic symptoms. METHODS: A case report of a 52-year-old white woman who received conventional therapy for urticaria for 3 years, with no improvement. Following this period, a diagnosis of AOSD was performed based on the presence of systemic symptoms. RESULTS: The inflammatory activity markers decreased by the second month of methotrexate therapy; however, the cutaneous lesions failed to disappear. Thalidomide was initiated, and total improvement of the cutaneous lesions was observed after 2 weeks. CONCLUSION: Urticarial rash is an uncommon presentation of AOSD, and clinicians must be alert to the possibility of a misdiagnosis in these cases.
Assuntos
Doença de Still de Início Tardio/diagnóstico , Urticária/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Doença de Still de Início Tardio/complicações , Urticária/etiologiaRESUMO
A urticária constitui uma das dermatoses mais freqüentes: 15 por cento a 20 por cento da população têm pelo menos um episódio agudo da doença em sua vida. Hoje a tendência é defini-la como síndrome que tem em comum o aparecimento da lesão elementar Urtica. É classificada segundo a evolução em aguda (duração menor que seis semanas) ou crônica (além de seis semanas). O tratamento da urticária pode compreender medidas não farmacológicas e intervenções medicamentosas, as quais são agrupadas em tratamentos de primeira (anti-histamínicos), segunda (corticosteróides e anti-leucotrienos) e terceira linha (medicamentos imunomoduladores).
Assuntos
Humanos , Antagonistas dos Receptores Histamínicos , Mastócitos , Dermatopatias , Urticária , Técnicas e Procedimentos DiagnósticosRESUMO
Drug-induced hypersensitivity syndrome (DIHS) usually refers to severe cutaneous drug eruption associated with systemic involvement and potentially fatal outcome. We report a 2-year-old Caucasian boy who developed DIHS due to phenytoin and phenobarbital and who showed extensive internal organ involvement. We are alerting that failure to recognize this drug eruption and discontinue the culprit drug may result in increased severity, greater extent of internal organ involvement, and fatal outcome. The recent research about the influence of human herpesvirus 6 co-infection on the pathogenesis of DIHS is also discussed by the authors in this paper.
Assuntos
Anticonvulsivantes/efeitos adversos , Toxidermias/diagnóstico , Pré-Escolar , Diagnóstico Diferencial , Toxidermias/etiologia , Humanos , Masculino , Fenobarbital/efeitos adversos , Fenitoína/efeitos adversos , Convulsões/tratamento farmacológicoRESUMO
Objetivo: Descrever a experiência com o uso de antileucotrienos em seis pacientes com asma grave corticodependente, acompanhados no Serviço de Alergia e Imunopatologia do Hospital do Servidor Público Estadual de São Paulo. Pacientes e métodos: Por um período de três meses os pacientes maiores de doze anos receberam aleatoriamente zafirlucaste 20mg de 12/12h ou montelucaste 10mg/dia e os menores de 12 anos montelucaste 5mg/dia. Os parâmetros avaliados foram: necessidade do uso diário de corticosteróides sistêmicos (oral), escore clínico de sintomas, prova de função pulmonar realizada antes da introdução da medicação e após três meses de acompanhamento. Resultados: Houve melhora do escore clínico em todos os pacientes (exceto um), melhora da prova de função pulmonar em apenas três dos pacientes, porém todos reduziram de forma significativa o uso diário de corticosteróides sistêmicos. Conclusão: Concluímos que na população avaliada, os pacientes em muito se beneficiaram com o uso de antileucotrienos, sugerindo que esta medicação tenha um papel no tratamento da asma grave corticodependente, para tanto, novos estudos serão necessários.