Priyal Amin1, Linda Levin2, Sarah J Holmes1, Jillian Picard3, Jonathan A Bernstein4. 1. Division of Immunology, Allergy & Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio. 2. Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio. 3. Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio. 4. Division of Immunology, Allergy & Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio. Electronic address: BERNSTJA@ucmail.uc.edu.
Abstract
BACKGROUND: Identifying clinical characteristics of patients with chronic urticaria (CU) responsive to medication may help guide clinicians select treatment. OBJECTIVE: The objective of this study was to investigate patient characteristics and medication use associated with urticaria control. METHODS: A retrospective longitudinal chart review of adult patients with CU was conducted at a multisite allergy practice. Inclusion criteria required at least 4 CU office visits to allow for pre- and posttreatment assessment. Control corresponding to medication(s) used was assessed each visit. Univariate analysis followed by multiple logistic regression was performed. RESULTS: A total of 221 patients with CU were included; 140 (63%) achieved complete control. The average time to control was 1.4 ± 2.7 years, which required 1-3 classes of medications. Dermatographia odds ratio (OR) = 1.85 (95% CI 1.3-2.7) or other physical urticarias, OR = 1.51 (1-2.4) and neutrophilic infiltrates on skin biopsy were markers of poor control. Thyroid autoantibodies were associated with better control using an H1-antihistamine. Whereas 22% were controlled on a second-generation H1-receptor antagonist plus a leukotriene receptor antagonist (LTRA), an additional 33% were controlled when cyclosporine was added. Use of a first or second H1-antagonist or LTRA was associated with a 3.5-16.9 times higher odds of complete CU control in those with dermatographia. The odds of achieving control for other forms of physical urticaria was greatest when colchicine was added (aOR = 32.6 [12.7-83.2]). CONCLUSIONS: Patient-specific CU characteristics associated with medication-disease control may be useful for selecting treatment regimens. A subset of CU patients remains poorly controlled that indicates an unmet need for novel therapeutic agents.
BACKGROUND: Identifying clinical characteristics of patients with chronic urticaria (CU) responsive to medication may help guide clinicians select treatment. OBJECTIVE: The objective of this study was to investigate patient characteristics and medication use associated with urticaria control. METHODS: A retrospective longitudinal chart review of adult patients with CU was conducted at a multisite allergy practice. Inclusion criteria required at least 4 CU office visits to allow for pre- and posttreatment assessment. Control corresponding to medication(s) used was assessed each visit. Univariate analysis followed by multiple logistic regression was performed. RESULTS: A total of 221 patients with CU were included; 140 (63%) achieved complete control. The average time to control was 1.4 ± 2.7 years, which required 1-3 classes of medications. Dermatographia odds ratio (OR) = 1.85 (95% CI 1.3-2.7) or other physical urticarias, OR = 1.51 (1-2.4) and neutrophilic infiltrates on skin biopsy were markers of poor control. Thyroid autoantibodies were associated with better control using an H1-antihistamine. Whereas 22% were controlled on a second-generation H1-receptor antagonist plus a leukotriene receptor antagonist (LTRA), an additional 33% were controlled when cyclosporine was added. Use of a first or second H1-antagonist or LTRA was associated with a 3.5-16.9 times higher odds of complete CU control in those with dermatographia. The odds of achieving control for other forms of physical urticaria was greatest when colchicine was added (aOR = 32.6 [12.7-83.2]). CONCLUSIONS:Patient-specific CU characteristics associated with medication-disease control may be useful for selecting treatment regimens. A subset of CUpatients remains poorly controlled that indicates an unmet need for novel therapeutic agents.
Authors: N Hani; K Hartmann; C Casper; T Peters; L A Schneider; N Hunzelmann; K Scharffetter-Kochanek Journal: Acta Derm Venereol Date: 2000-05 Impact factor: 4.437
Authors: Jonathan A Bernstein; David M Lang; David A Khan; Timothy Craig; David Dreyfus; Fred Hsieh; Javed Sheikh; David Weldon; Bruce Zuraw; David I Bernstein; Joann Blessing-Moore; Linda Cox; Richard A Nicklas; John Oppenheimer; Jay M Portnoy; Christopher R Randolph; Diane E Schuller; Sheldon L Spector; Stephen A Tilles; Dana Wallace Journal: J Allergy Clin Immunol Date: 2014-05 Impact factor: 10.793