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Certain guidelines recommend a second-generation H1-antihistamine (AH) as first-line treatment for patients with chronic urticaria (CU). However, some patients show insufficient response to a standard dose of this therapy and might benefit from adding leukotriene receptor antagonists (LTA). Therefore, we aimed to perform a systematic review and meta-analysis comparing LTA plus antihistamines with antihistamines alone. We performed a systematic review and meta-analysis, searching PubMed, EMBASE, and Cochrane Central for randomized clinical trial (RCT) data comparing LTA plus AH treatment to AH alone in patients with CU. Statistical analysis was performed using R Studio 4.3.2. Heterogeneity was assessed with I2 statistics. Three studies comprising 234 patients with urticaria were included. The mean age was 37.23 years in the leukotriene antagonist + antihistamines (LTA + AH) group and 39.14 years in the antihistamines (AH) group. Follow-up ranged from 2 to 18 months between studies. There was no statistically significant difference between groups in terms of TSS level (SMD: -74.82; 95% CI: -222.66 to 73.02; P = 0.32; I2 = 98%), neither in terms of pruritus (MD: -0.07; 95% CI: -0.42 to 0.28; P = 0.70; I2 = 74%). After sensitivity analysis, with the systematic exclusion of each study from the grouped estimates, the result for TSS level did not change. These findings suggest that leukotriene receptor antagonists with antihistamines do not have better outcomes than antihistamines alone regarding TSS and pruritus in patients with CU.

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BACKGROUND: Brief erythematous-papular skin rashes suggest the diagnosis of urticaria; However, it may be another type of dermatitis, and complementary examinations must be carried out to establish its diagnosis. CASE REPORT: 53-year-old female patient, diagnosed in 2016 with diffuse large B cell lymphoma, in complete remission. Since 2010, he has had episodes of erythematous-papular lesions lasting 24-36 hours. He received antihistamines, corticosteroids and omalizumab without clinical improvement. The ANA determination was positive (1/320), nuclear mitotic pattern. The skin biopsy was compatible with dermatitis herpetiformis. The study of celiac and locus antibodies showed positivity for HLA-DQ2 and DQ2.5 in heterozygosity. The diagnosis of dermatitis herpetiformis was established. Treatment consisted of a gluten-free diet and prescription of dapsone, with satisfactory results. CONCLUSION: It is important to establish the differential diagnosis of patients with chronic urticaria who do not respond to the reference treatment, in addition to carrying out a thorough clinical examination and physical examination before starting treatment and relying on a multidisciplinary team to establish an accurate diagnosis and treatment. appropriate. Due to the side effects of dapsone, subsequent follow-up of patients is essential.

ANTECEDENTES: Los exantemas cutáneos eritemato-papulares de breve duración sugieren el diagnóstico clínico de urticaria; no obstante, puede tratarse de otro tipo de dermatitis, y para establecer el diagnóstico deben llevarse a cabo exploraciones complementarias. REPORTE DE CASO: Paciente femenina de 53 años, diagnosticada en 2016 con linfoma difuso de células B grandes, en remisión completa. Desde el 2010 manifestó episodios de lesiones eritemato-papulosas, de 24-36 horas de duración. Recibió antihistamínicos, corticoides y omalizumab sin mejoría clínica. La determinación de ANA resultó positiva (1/320), con patrón mitótico nuclear. La biopsia cutánea fue compatible con dermatitis herpetiforme. El estudio de anticuerpos de celiaquía y locus mostró positividad para HLA-DQ2 y DQ2.5 con heterocigosis. Se estableció el diagnosticó de dermatitis herpetiforme. El tratamiento consistió en dieta exenta de gluten y prescripción de dapsona, con resultados satisfactorios. CONCLUSIÓN: Es importante establecer el diagnóstico diferencial de pacientes con urticaria crónica que no responden al tratamiento de referencia, además de efectuar el examen clínico y la exploración física exhaustivos antes de iniciar el protocolo, y apoyarse de un equipo multidisciplinario para establecer el diagnóstico certero y tratamiento adecuado. Debido a los efectos secundarios de la dapsona, es imprescindible el seguimiento posterior de los pacientes.

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A síndrome da urticária de contato (SUC), a urticária de contato (UCO) e a dermatite de contato por proteínas (DCP) são entidades descritas sob o rótulo de reações cutâneas imediatas por contato. Geralmente as urticas surgem 20-30 minutos após a exposição por contato com uma substância, e desaparecem por completo em algumas horas, sem deixar lesão residual.Entretanto, a SUC pode apresentar sintomas generalizados graves. Estima-se uma prevalência, entre trabalhadores europeus, entre 5-10%, enquanto na população geral estima-se de que seja de 1-3%. Os mecanismos envolvidos na patogênese da SUC não foram totalmente elucidados. Uma abordagem inicial, para melhorar a sua compreensão, pode ser dividir esta condição em urticária não imunológica (UCNI) e imunológica (UCI). A primeira não necessita de sensibilização prévia ao alérgeno, enquanto a segunda necessita. O diagnóstico da SUC necessita de uma anamnese detalhada e exame físico seguido de teste cutâneo com as substâncias suspeitas. O afastamento do agente desencadeante é o melhor tratamento. Para isso é necessário o diagnóstico apropriado e precoce, a confecção de relatórios ocupacionais e o desenvolvimento de medidas preventivas.

Contact urticaria syndrome (CUS), contact urticaria, and protein contact dermatitis (PCD) are entities described under the umbrella term of immediate contact skin reactions (ICSR). Generally, hives appear 20-30 minutes after contact with the offending substance, and disappear completely in a few hours, without leaving residual lesions. However, the CUS may be associated with severe systemic symptoms. A prevalence of 5-10% has been estimated among European workers; in the general population it is 1-3%. The mechanisms involved in CUS pathogenesis have not been fully elucidated. An initial approach to improving its understanding involves dividing this condition into non-immune and immune contact urticaria. The former does not require prior sensitization to the allergen, while the latter does. Diagnosis of CUS is established by a detailed history and physical examination, followed by skin tests with suspected substances. Removal of the triggering agent is the best treatment. This requires early proper diagnosis, occupational reporting, and development of preventive measures.

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A urticária é uma doença com comprometimento universal, e debilitante para a maioria dos pacientes. Caracteriza-se pela ocorrência de episódios de urticas, angioedema ou ambos, determinados pela ativação de mastócitos e outras células inflamatórias com a liberação de vários mediadores. Apresenta etiologia complexa com fenótipos e terapias bem específicas. A urticária crônica possui evolução recorrente e imprevisível, podendo estender-se por anos. Caracteristicamente possui maior prevalência no sexo feminino, com pico de ocorrência entre 20 e 40 anos. A doença pode ser diferenciada pela gravidade, impacto na qualidade de vida do paciente e resposta terapêutica. Biomarcador é uma característica clínica ou laboratorial mensurável de algum estado ou condição biológica, o qual pode influenciar ou prever a incidência de desfecho ou doença. O objetivo deste artigo é realizar uma revisão dos principais biomarcadores promissores e com melhor evidência relacionados à duração, atividade da doença e resposta terapêutica.

Urticaria is a disease of global importance that can be debilitating for most patients. It is characterized by episodes of wheals, angioedema, or both, determined by the activation of mast cells and other inflammatory cells with the release of several mediators. The etiology is complex, involving specific phenotypes and therapies. Chronic urticaria has a recurrent and unpredictable course that can last for years. The prevalence is typically higher in females, with a peak incidence between 20 and 40 years of age. The disease can be classified by severity, impact on quality of life, and therapeutic response. A biomarker is a measurable clinical or laboratory characteristic of a biological state or condition that can influence or predict the incidence of outcome or disease. This study provides a review of the main biomarkers considered promising and with the best evidence related to duration, disease activity, and therapeutic response.

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Introdução: A urticária é determinada pela ativação de mastócitos que se apresenta por urticas, angioedema ou ambos. A urticária é classificada de acordo quanto a sua duração, em duas formas: aguda (UA < 6 semanas) e crônica (UC > 6 semanas). A UC compreende Urticária Crônica Espontânea (UCE) e Urticárias Crônicas Induzidas (UCInd). Entre as UCInd estão o dermografismo, urticária por pressão tardia (UPT), frio, calor, solar, aquagênica, colinérgica e urticária/angioedema vibratório. As UCInd podem ser diagnosticadas por meio da história clínica, exame físico e da reprodução das lesões através dos testes de provocação. Objetivo: Descrever o perfil dos testes de provocação positivos para UCInd realizados em um Centro de Referência e Excelência em Urticária (GA2LEN UCARE). Métodos: Foram avaliados, retrospectivamente, os resultados dos testes de provocação para UCInd, realizados de dezembro de 2017 a setembro de 2021, de 114 pacientes que apresentavam história sugestiva de uma ou mais UCInd. Resultados: Dos 114 pacientes avaliados, oitenta e oito (77%) eram do sexo feminino e 26 (23%) do masculino. Foram diagnosticados, através de testes de provocação positivos: 65 dermografismos (FricTest® e/ou dermografômetro); 23 UPT (23 diagnosticados com o uso do dermografômetro e 11 também confirmados através do teste de Warin); 11 urticárias ao frio (temperaturas iguais ou inferiores a 27 °C) e 3 urticárias ao calor (temperaturas iguais ou superiores a 38 °C), todos diagnosticados com o TempTest® versão 4.0; 4 urticárias colinérgicas, diagnosticados através do Teste Modificado para Urticária Colinérgica - HUCFF-UFRJ e 1 urticária vibratória. Nenhum paciente apresentou teste positivo para urticária solar ou aquagênica. Sete pacientes foram negativos. Conclusão: Os testes de provocação, através do estímulo direto e seguro com o desencadeante, permitem ao médico avaliador e ao paciente a compreensão e a confirmação do estímulo causador da enfermidade em questão e seus limiares.

Introduction: Urticaria is determined by mast cell activation that presents as wheals, angioedema, or both. Urticaria is classified according to its duration into two forms: acute (< 6 weeks) and chronic (> 6 weeks). Chronic urticaria includes chronic spontaneous urticaria and chronic inducible urticaria. Chronic inducible urticarias include dermographism, delayed pressure urticaria, cold, heat, solar, aquagenic, cholinergic, and vibratory urticaria/angioedema. Chronic inducible urticaria can be diagnosed through clinical history, physical examination, and the reproduction of lesions through provocation tests. Objective: To describe the profile of positive provocation tests for chronic inducible urticaria performed at an urticaria center of reference and excellence (GA2LEN UCARE). Methods: We retrospectively evaluated the results of provocation tests performed between December 2017 and September 2021 in 114 patients with a history suggestive of one or more types of chronic inducible urticaria. Results: The sample included 88 (77%) female and 26 (23%) male patients. The following were diagnosed through positive provocation tests: 65 cases of dermographism (FricTest® and/or dermographometer); 23 cases of delayed pressure urticaria (all diagnosed with a dermographometer and 11 confirmed with the Warin test); 11 cases of cold urticaria (temperatures ≤ 27°C) and 3 cases of heat urticaria (temperatures ≥ 38°C), all diagnosed with TempTest® 4.0; 4 cases of cholinergic urticaria, all diagnosed with the Modified Test for Cholinergic Urticaria-HUCFFUFRJ, and 1 case of vibratory urticaria. No patient tested positive for solar or aquagenic urticaria. Seven patients have been negative. Conclusion: Provocation tests, which use direct and safe stimuli as triggers, allow physicians and patients to confirm the disease's causative stimulus and its thresholds.

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Abstract Background: Chronic Spontaneous Urticaria (CSU) is characterized by recurrent wheals and/or angioedema for longer than 6-weeks. Guidelines recommend Omalizumab (Oma) as first-line and Cyclosporine-A (Cs-A) as second-line treatment in antihistamine resistant CSU. This step-wise algorithm might be time-consuming and costly. Objective: To determine indicators of response to Oma or Cs-A in CSU patients. Methods: We retrospectively analyzed data from seven centers in Turkey; the inclusion criteria for patients were to receive both Oma and Cs-A treatment (not concurrently) at some point in time during their follow-up. Clinical and laboratory features were compared between groups. Results: Among 110 CSU patients; 47 (42.7%) were Oma-responders, 15 (13.6%) were Cs-A-responders, and 24 (21.8%) were both Oma and Cs-A responders and 24 (21.8%) were non-responders to either drug. High CRP levels were more frequent in Cs-A-responders (72.7% vs. 40.3%; p = 0.055). Oma-responders had higher baseline UCT (Urticaria Control Test) scores (6 vs. 4.5; p = 0.045). Responders to both drugs had less angioedema and higher baseline UCT scores compared to other groups (33.3% vs. 62.8%; p = 0.01 and 8 vs. 5; p = 0.017). Non-responders to both drugs had an increased frequency in the female gender and lower baseline UCT scores compared to other groups (87.5% vs. 61.6%; p = 0.017 and 5 vs. 7; p = 0.06). Study Limitations: Retrospective nature, limited number of patients, no control group, the lack of the basophil activation (BAT) or BHRA (basophil histamine release assay) tests. Conclusions: Baseline disease activity assessment, which considers the presence of angioedema and disease activity scores, gender, and CRP levels might be helpful to predict treatment outcomes in CSU patients and to choose the right treatment for each patient. Categorizing patients into particular endotypes could provide treatment optimization and increase treatment success. © 2022 Published by Elsevier España, S.L.U. on behalf of Sociedade Brasileira de Dermatologia. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/).

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RESUMEN Introducción: La urticaria crónica es una enfermedad heterogénea delimitada de la piel caracterizada por el desarrollo de ronchas o habones. Objetivo: Determinar las características clínicas y el tratamiento farmacológico indicado en pacientes con diagnóstico de urticaria crónica. Método: Se realizó un estudio cuantitativo, prospectivo, observacional y descriptivo en un universo de 48 pacientes con diagnóstico de urticaria crónica, Hospital Militar Principal, Guinea-Bisáu, 2018-2020. Se midieron las variables: edad, sexo, tipo de urticaria, tiempo de evolución, comorbilidad y tratamiento utilizado en la primera y última consulta registrada, así como la actividad de la enfermedad. Resultados: La edad media fue de 38,52 años con predomino del sexo femenino. El tiempo medio de evolución de la enfermedad fue de 4,67 años y el 70,83 % no presentó angioedema. La urticaria crónica espontánea fue el tipo predominante. La ciproheptadina fue el tratamiento más indicado al inicio del tratamiento y al término del seguimiento su uso se incrementó. El montelukast fue el otro medicamento que incremento su uso al término del seguimiento. La actividad de la enfermedad se redujo con el tratamiento a índices reconocidos como urticaria crónica espontánea controlada. Conclusiones: La urticaria crónica en Guinea-Bisáu tiene una prevalencia y manifestaciones clínicas acorde a lo reportado a nivel mundial con esquemas de tratamiento susceptibles de modificaciones según el inicio del uso de medicamentos recomendados como ciclosporina u omalizumab.

ABSTRACT Introduction: Chronic urticaria is a heterogeneous demarcated skin disease characterized by the development of wheals or hives. Objective: Determination of the clinical characteristics and the pharmacological treatment indicated in patients diagnosed with chronic urticaria. Method: A quantitative, prospective, observational and descriptive study was conducted in a total of 48 patients (the universe) diagnosed with chronic urticaria, Main Military Hospital, Guinea-Bissau, 2018-2020. The following variables were used: age, sex, type of urticaria, time of evolution, comorbidity and treatment used in the first and last recorded consultation, as well as disease activity. Results: The mean age was 38.52 years with a female predominance. The mean time of evolution of the disease was 4.67 years and 70.83% did not present angioedema. Chronic spontaneous urticaria was the predominant type. cyproheptadine was the treatment most indicated to be used at baseline and at the end of treatment follow-up its use increased. montelukast was the other drug that increased its use at the end of follow-up. With the treatment used disease activity was reduced up to rates recognized as controlled chronic spontaneous urticaria. Conclusions: Chronic urticaria in Guinea-Bissau has prevalence and clinical manifestations in line with those reported worldwide, with treatment regimens susceptible to modifications depending on the early use of recommended drugs such as cyclosporine or omalizumab.

RESUMO Introdução: A urticária crônica é uma doença heterogênea delimitada da pele caracterizada pelo desenvolvimento de urticária ou urticária. Objetivo: Determinar as características clínicas e o tratamento farmacológico indicado em pacientes com diagnóstico de urticária crônica. Método: Estudo quantitativo, prospectivo, observacional e descritivo realizado em um universo de 48 pacientes com diagnóstico de urticária crônica, Hospital Militar Principal, Guiné-Bissau, 2018-2020. As variáveis foram mensuradas: idade, sexo, tipo de urticária, tempo de evolução, comorbidade e tratamento utilizado na primeira e última consulta registrada, bem como a atividade da doença. Resultados: A média de idade foi de 38,52 anos com predomínio do sexo feminino. O tempo médio de evolução da doença foi de 4,67 anos e 70,83% não apresentavam angioedema. A urticária crônica espontânea foi o tipo predominante. A ciproeptadina foi o tratamento mais indicado no início do tratamento e ao final do seguimento seu uso aumentou. O montelucaste foi a outra droga que aumentou seu uso ao final do seguimento. A atividade da doença foi reduzida com o tratamento para taxas reconhecidas como urticária crônica espontânea controlada. Conclusões: A urticária crônica na Guiné-Bissau tem prevalência e manifestações clínicas compatíveis com a relatada mundialmente, com esquemas de tratamento que podem ser modificados dependendo do início do uso de medicamentos recomendados como ciclosporina ou omalizumabe.

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BACKGROUND: Chronic Spontaneous Urticaria (CSU) is characterized by recurrent wheals and/or angioedema for longer than 6-weeks. Guidelines recommend Omalizumab (Oma) as first-line and Cyclosporine-A (Cs-A) as second-line treatment in antihistamine resistant CSU. This step-wise algorithm might be time-consuming and costly. OBJECTIVE: To determine indicators of response to Oma or Cs-A in CSU patients. METHODS: We retrospectively analyzed data from seven centers in Turkey; the inclusion criteria for patients were to receive both Oma and Cs-A treatment (not concurrently) at some point in time during their follow-up. Clinical and laboratory features were compared between groups. RESULTS: Among 110 CSU patients; 47 (42.7%) were Oma-responders, 15 (13.6%) were Cs-A-responders, and 24 (21.8%) were both Oma and Cs-A responders and 24 (21.8%) were non-responders to either drug. High CRP levels were more frequent in Cs-A-responders (72.7% vs. 40.3%; p = 0.055). Oma-responders had higher baseline UCT (Urticaria Control Test) scores (6 vs. 4.5; p = 0.045). Responders to both drugs had less angioedema and higher baseline UCT scores compared to other groups (33.3% vs. 62.8%; p = 0.01 and 8 vs. 5; p = 0.017). Non-responders to both drugs had an increased frequency in the female gender and lower baseline UCT scores compared to other groups (87.5% vs. 61.6%; p = 0.017 and 5 vs. 7; p = 0.06). STUDY LIMITATIONS: Retrospective nature, limited number of patients, no control group, the lack of the basophil activation (BAT) or BHRA (basophil histamine release assay) tests. CONCLUSIONS: Baseline disease activity assessment, which considers the presence of angioedema and disease activity scores, gender, and CRP levels might be helpful to predict treatment outcomes in CSU patients and to choose the right treatment for each patient. Categorizing patients into particular endotypes could provide treatment optimization and increase treatment success.

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A urticária crônica é uma condição que afeta mais de um milhão de brasileiros, com grande impacto na qualidade de vida. Mesmo com diretrizes bem difundidas para o seu diagnóstico e tratamento, seu manejo pode ser desafiador em pacientes pediátricos, idosos e gestantes. Para auxiliar o médico especialista nestes casos, o Departamento Científico de Urticária da Associação Brasileira de Alergia e Imunologia elaborou esta revisão com as principais dúvidas e dificuldades referentes ao tema nestes grupos de pacientes.

Chronic urticaria is a condition that affects more than a million Brazilians with a significant impact on quality of life. Although there are well-established guidelines for diagnosis and treatment, the management of chronic urticaria may be challenging in pediatric, older, and pregnant patients. With the purpose of helping specialists manage these cases, the Urticaria Scientific Department of the Brazilian Association of Allergy and Immunology prepared this review with the most common doubts and difficulties about this topic in those patient groups.

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Introdução: A urticária crônica é uma doença com prevalência em pelo menos 0,1% da população, definida pela presença de pápulas pruriginosas, angioedema ou ambos por período superior a seis semanas. Os pacientes com urticária crônica têm um severo prejuízo na qualidade de vida. Objetivo: Avaliar o impacto da urticária crônica na qualidade de vida dos portadores da doença dentro de um serviço especializado no estado de Sergipe. Métodos: Trata-se de um estudo descritivo observacional a partir de dados coletados de 40 pacientes atendidos, em 2021, no Serviço de Alergia e Imunologia do Ambulatório de Alergia e Imunologia do Decós Day Hospital, através de dois questionários específicos para a avaliação da qualidade de vida na urticária crônica: o Chronic Urticaria Quality of Life Questionnaire e o Urticaria Control Test. Resultados: Foi possível identificar uma correlação positiva, através do questionário Urticaria Control Test, entre a intensidade dos sintomas e a piora da qualidade de vida (r = 0,774; p < 0,001). Também foi possível identificar uma correlação positiva entre a intensidade dos sintomas e a piora da qualidade de vida, desta vez mensurada pela escala Chronic Urticaria Quality of Life Questionnaire (r = 0,768; p < 0,001). Noventa por cento dos pacientes afirmaram se sentir cansados durante o dia porque não dormiram bem, 87,5% sentem dificuldade para se concentrar, 90% sentem-se nervosos, 80% afirmaram sentirem-se para baixo, 75% disseram ter vergonha das lesões da urticária que aparecem no corpo, e 60% tem vergonha de frequentar lugares públicos. Conclusões: A urticária crônica compromete a qualidade de vida, medida pelos questionários Urticaria Control Test e Chronic Urticaria Quality of Life Questionnaire. O comprometimento da qualidade de vida dos doentes com urticária crônica ocorre principalmente nos aspectos psicológicos, nos relacionamentos sociais e na qualidade do sono.

Introduction: Chronic urticaria is a disease with a prevalence in at least 0.1% of the population, defined by the presence of pruritic papules, angioedema or both for a period longer than six weeks. Patients with chronic urticaria have a severe loss in quality of life. Objective: To assess the impact of chronic urticaria on the quality of life of patients with the disease within a specialized service in the state of Sergipe. Methods: This is a descriptive observational study based on data collected from 40 patients treated, in 2021, at the Allergy and Immunology Service of the Allergy and Immunology Outpatient Clinic of Decós Day Hospital, using two specific questionnaires for quality assessment of life in chronic urticaria: the Chronic Urticaria Quality of Life Questionnaire and the Urticaria Control Test. Results: It was possible to identify a positive correlation, through the Urticaria Control Test questionnaire, between the intensity of symptoms and the worsening of quality of life (r = 0.774, p < 0.001). It was also possible to identify a positive correlation between the intensity of symptoms and worsening quality of life, this time measured by the Chronic Urticaria Quality of Life Questionnaire scale (r = 0.768, p < 0.001). 90% said they felt tired during the day because they didnt sleep well, 87.5% found it difficult to concentrate, 90% felt nervous, 80% said they felt down, 75% said they were ashamed of the urticaria lesions that appear on the body and 60% are ashamed to go to public places. Conclusions: Chronic urticaria compromises quality of life, as measured by the Urticaria Control Test and the Chronic Urticaria Quality of Life Questionnaire. The impairment of the quality of life of patients with chronic urticaria occurs mainly in the psychological aspects, in social relationships and in the quality of sleep.

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A urticária aquagênica é uma forma rara de urticária crônica induzida (UCInd) desencadeada por um estímulo específico. A patogênese não é totalmente compreendida, mas os sintomas se iniciam minutos após a exposição cutânea à água, independentemente de sua temperatura, e as urticas têm o padrão foliculocêntricas. O diagnóstico é confirmado através do teste de provocação, e o tratamento de primeira linha são os anti-histamínicos de segunda geração. Neste artigo, relatamos um caso de urticária aquagênica e fazemos uma breve revisão da literatura sobre o tema.

Aquagenic urticaria is a rare form of chronic inducible urticaria (CIndU) triggered by a specific stimulus. Pathogenesis is not fully understood, but symptoms appear minutes after cutaneous exposure to water, regardless of temperature, and wheals have a folliculocentric pattern. The diagnosis of CIndU is confirmed by provocation testing using established protocols, and first-line treatment is second-generation antihistamines. In this article, we report a case of aquagenic urticaria and provide a brief review of the relevant literature.

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Chronic spontaneous urticaria is a condition that persists for more than six weeks, it occurs in the absence of an identifiable triggering factor and from the pathogenic activation of mast cells and basophils. The possibility of autoimmune etiology in up to 40 % of patients is presented, followed by subclinical infections and psychological factors. Two main mechanisms of the pathogenesis of chronic urticaria have been proposed: the former is the dysregulation of intracellular signaling pathways within mast cells and basophils, which leads to defects in the traffic or function of these cells. The latter is the development of autoantibodies against FcεRIα or IgE, in both mast cells and basophils. Numerous autoimmune diseases such as systemic lupus erythematosus, polymyositis, dermatomyositis, and rheumatoid arthritis have been associated with chronic urticaria; however, autoimmune thyroid disease deserves a special mention. A higher prevalence of antithyroid antibodies has been found, regardless of thyroid function (euthyroidism, hypo and hyperthyroidism) in patients with chronic spontaneous urticaria. Several infections have been linked to chronic urticaria. The best evidence is for Helicobacter pylori infection. Finally, stress is associated with the onset of the disease through the activation of the sympathetic and adrenomedullary system and the hypothalamic-pituitary- adrenal axis. Diagnosis may vary in different regions of the world, but the common feature is the completion of a thorough medical history.

La urticaria crónica espontánea es una afección que persiste durante más de seis semanas y ocurre en ausencia de un factor desencadenante identificable y resulta de la activación patógena de células cebadas y basófilos. Se plantea la posible etiología autoinmune hasta en 40 % de los pacientes, seguida de infecciones subclínicas y factores psicológicos. Se han propuesto dos mecanismos principales de la patogénesis de la urticaria crónica: la desregulación de las vías de señalización intracelular dentro de las células cebadas y basófilos que conduce a defectos en el tráfico o la función de estas células, así como el desarrollo de autoanticuerpos contra FcεRIα o IgE, tanto en células cebadas como en basófilos. Numerosas enfermedades autoinmunes como lupus eritematoso sistémico, polimiositis, dermatomiositis y artritis reumatoide se han asociado a urticaria crónica; sin embargo, la enfermedad tiroidea autoinmune merece una mención especial. Se ha encontrado una mayor prevalencia de anticuerpos antitiroideos, independientemente de la función tiroidea (eutiroidismo, hipo e hipertiroidismo), en pacientes con urticaria crónica espontánea. Varias infecciones se han relacionado a urticaria crónica. Existe la mejor evidencia de infección por Helicobacter pylori. Por último, el estrés está asociado al inicio de la enfermedad mediante la activación del sistema simpático y adrenomedular y el eje hipotálamo hipófisis suprarrenal. El diagnóstico puede variar en las diferentes regiones del mundo, pero el rasgo común es la realización de una historia clínica completa.

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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 ∼1/10 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.

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OBJECTIVES: To determine the prevalence of chronic urticaria in patients diagnosed with an allergic pathology; to know the most affected sex and age group. METHODS: A descriptive, observational, and retrospective cross-sectional study. Clinical records of patients diagnosed with chronic urticaria in Unidad de Medicina Integral (Integrated Care Unit) of Tehuacan, Puebla were reviewed. They were selected by age, sex, and diagnosed allergic pathology. RESULTS: In the period of January 1st, 2015, to December 31st, 2020, 373 patients were diagnosed with chronic urticaria, with a prevalence of 10.5%. The average age of the population was 26.05 years. Women were the most prevalent, with 59.5% of the total studied population. CONCLUSIONS: The results reflect a prevalence of 10.5%, with a higher frequency in women at a ratio of 1.4: 1 with regard to males. The prevalence of chronic urticaria has increased significantly in recent years and especially in young patients (infants, preschoolers, and school-age children).

Objetivos: Determinar la prevalencia de urticaria crónica en pacientes diagnosticados con alguna patología alérgica, y conocer el sexo y grupo etario más afectado. Métodos: Estudio descriptivo de corte trasversal, observacional y retrospectivo. Se revisaron expedientes clínicos de pacientes diagnosticados con urticaria crónica en la Unidad de Medicina Integral de Tehuacán, Puebla. Seleccionados por criterios de edad, sexo y patología alérgica diagnosticada. Resultados: En el periodo comprendido del primero de enero de 2015 al 31 de diciembre de 2020, se diagnosticaron 373 pacientes con urticaria crónica, con una prevalencia de 10.5 %. Una edad media de la población de 26.05 años. El sexo femenino fue el más prevalente con 59.5 % del total de la población estudiada. Conclusiones: Los resultados reflejan una prevalencia de 10.5 %, con mayor frecuencia en el sexo femenino a una razón de 1.4:1 con respecto al sexo masculino. La prevalencia de urticaria crónica ha aumentado significativamente en los últimos años y en especial en pacientes jóvenes (lactantes, preescolares y escolares).

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OBJECTIVE: To estimate the frequency of chronic urticaria in patients who attended an allergy service in a tertiary care hospital; in addition, the main clinical characteristics are described. METHODS: In a period of 7 months, a total of 96 patients who were over 18 years of age were analyzed; they had been diagnosed with chronic spontaneous urticaria and chronic inducible urticaria. RESULTS: The frequency of chronic urticaria was of 1.31 % (n=98); 53 % were associated with some allergic pathology, and 54 % showed an alteration in the paraclinical tests. Chronic spontaneous urticaria was found in 80 % of the patients; and in 62 % of them, the urticaria was associated with angioedema. Chronic urticaria was controlled in 19 % of the studied population with the use of a single antihistamine. CONCLUSIONS: The frequency of chronic urticaria in our study was lower than the frequency reported nationwide.

Objetivo: Estimar la frecuencia de la urticaria crónica en pacientes que acudieron a un servicio de alergología en un hospital de tercer nivel; complementariamente, se hace una descripción de las principales características clínicas. Métodos: Se analizaron un total de 96 pacientes con UC espontánea y UC inducible, con edad > 18 años, en un lapso de 7 meses. Resultados: La frecuencia de UC fue de 1.31 % (n = 98); 53 % se asociaron con alguna enfermedad alérgica y 54 % mostró algún tipo de alteración en los estudios paraclínicos. En 80 % de los pacientes, la urticaria fue crónica espontánea y en 62 % se vio asociada con angioedema. El 19 % de los casos obtuvo control de la UC con el uso de un solo antihistamínico. Conclusiones: La frecuencia de UC en nuestro estudio fue inferior con respecto a la informada a nivel nacional.

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BACKGROUND: Few studies have explored the association between obstructive sleep apnea (OSA) and chronic urticaria (CU). Our study aims to fill this gap by determining the frequency of the risk categories for OSA and how they might correlate with the specific CU patient reported outcome measures urticaria activity score (UAS7), urticaria control test (UCT) and CU quality of life questionnaire (CU-Q2oL). METHODS: We conducted a cross-sectional study involving a cohort of 171 Latin American CU patients. Descriptive statistics were used to determine frequency and proportions for demographic and clinical variables, while a chi-squared test for association between STOP-Bang OSA questionnaire categories and both UAS7 and UCT categories was performed to analyze how such variables interact. To further assess the strength of the correlation a Cramer's V coefficient was reported. Finally, a Kendall-Tau b correlation coefficient was performed to measure the correlation between the STOP-Bang score and other independent continuous variables. RESULTS: The average STOP-Bang score was 2.5, with 24% and 21% of patients falling into the intermediate and high-risk category for moderate-to-severe OSA, respectively. There was a strong statistically significant association (Cramer's V = 0.263; p = .000) between UAS-7 categories and STOP-Bang risk categories. A similar pattern of strong significant association (Cramer's V = .269; p = .002) was observed between UCT categories and STOP-Bang risk categories. A weak positive correlation between the STOP-Bang score and the CU-Q2oL average score (τb = 0.188, p = .001) was identified. Overall, 72.5% patients reported limitations with respect to sleep in a varied degree according to the CU-Q2oL. CONCLUSIONS: Our results suggest that a considerable proportion of patients with CU are at intermediate to high risk for OSA. Higher disease activity, poor CU control, and worse quality of life were all found to be associated with an increased risk. Additional studies are needed to determine the exact link between these conditions, and to determine whether screening and treatment for OSA might benefit patients with CU.

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PURPOSE: Eosinophils are frequently found in atopic dermatitis (AD) and chronic spontaneous urticaria (CSU) that release eosinophil peroxidase (EPX) and eosinophil cationic protein (ECP). Continuous exposure to these proteins could trigger an autoimmune response which may contribute to the pathogenesis and severity of skin inflammation. In this study, we investigate the immunoglobulin E (IgE) response against eosinophil proteins in CSU and AD. METHODS: We recruited patients with severe AD, severe CSU and healthy subjects to explore the presence of IgE autoantibodies and cross-reactivity against EPX, ECP and thyroid peroxidase (TPO). The potential cross-reactive epitopes among the peroxidase family were determined using in silico tools. RESULTS: The frequencies of anti-EPX IgE (28.8%) and anti-ECP IgE (26.6%) were higher in the AD group, and anti-TPO IgE was higher in the CSU group (27.2%). In the CSU group, there was a correlation between the anti-EPX IgE and anti-TPO IgE levels (r = 0.542, P < 0.001); TPO inhibited 42% of IgE binding to EPX, while EPX inhibited 59% of IgE binding to TPO, suggesting a cross-reactivity with EPX as a primary sensitizer. There was greater inhibition when we used a pool of sera CSU and AD, TPO inhibited 52% of IgE binding to EPX, while EPX inhibited 78% of IgE binding to TPO. In silico analysis showed a possible shared epitope in the peroxidase protein family. CONCLUSIONS: IgE against eosinophil proteins may contribute to chronic inflammation in patients with AD and CSU. Cross-reactivity between EPX and TPO could explain thyroid problems in CSU patients.

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A urticária solar é uma forma rara de urticária crônica induzida (UCInd). Os sintomas se iniciam minutos após a exposição ao sol e persistem por até 2 horas, interferindo nas atividades diárias do paciente, e consequentemente na sua qualidade de vida. O omalizumabe, anticorpo monoclonal anti-IgE já aprovado para o tratamento da urticária crônica espontânea, tem sido utilizado no tratamento das urticárias crônicas induzidas com boa resposta, inclusive na urticária solar. Neste artigo, relatamos um caso de urticária solar refratária aos anti-histaminicos, sua evolução após o uso do omalizumabe, e fazemos uma breve revisão da literatura sobre o tema.

Solar urticaria is a rare form of chronic inducible urticaria. Symptoms start minutes after exposure to the sun and persist for up to 2 hours, interfering with the patients' daily activities and, consequently, their quality of life. Omalizumab, a monoclonal anti-IgE antibody already approved for the treatment of chronic spontaneous urticaria, has been used in the treatment of chronic inducible urticaria, including solar urticaria, with good response. In this article, we report a case of solar urticaria refractory to antihistamines, show the patient's evolution after the use of omalizumab, and briefly review the literature on the subject.

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BACKGROUND: Patients with chronic urticaria (CU) are increasingly using information and communication technologies (ICTs) to manage their health. What CU patients expect from ICTs and which ICTs they prefer remains unknown. We assessed why CU patients use ICTs, which ones they prefer, and what drives their expectations and choices. METHODS: In this cross-sectional study, 1841 patients across 17 countries were recruited at UCAREs (Urticaria Centers of Reference and Excellence). Patients with CU who were >12 years old completed a 23-item questionnaire. RESULTS: Most patients were interested in receiving disease information (87.3%), asking physicians about CU (84.1%), and communicating with other patients through ICTs (65.6%). For receiving disease information, patients preferred one-to-one and one-to-many ICTs, especially web browsers. One-to-one ICTs were also the ICTs of choice for asking physicians about urticaria and for communicating with other patients, and e-mail and WhatsApp were the preferred ICTs, respectively. Many-to-many ICTs such as Facebook, Instagram, LinkedIn, and Twitter were least preferred for all 3 purposes. Living in rural areas and higher education were linked to higher odds of being interested in receiving disease information, asking physicians, and communicating with patients through ICTs. CONCLUSIONS: Most patients and especially patients with higher education who live in rural areas are interested in using ICTs for their healthcare, but prefer different ICTs for different purposes, ie, web browsers for obtaining information, e-mail for asking physicians, and WhatsApp for communicating with other patients. Our findings may help to improve ICTs for CU.