Modern approaches to the treatment of chronic urticaria

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Abstract

The article provides modern definitions and classification of urticaria. The general provisions of the treatment of chronic urticaria, the treatment of which is often very difficult, are outlined. The main provisions of the treatment of urticaria were formulated, according to which the patient should be treated until the rash is completely resolved. In chronic urticaria, it is necessary to identify and eliminate the causes of dermatosis; avoid exposure to identified triggers; increase tolerance; pharmacological treatment should be aimed at preventing the release of mast cell mediators and/or the effects of mast cell mediators. The goal of treatment should be to relieve the symptoms of urticaria as completely as possible, taking into account the safety and quality of life of the patient in each individual case. The importance of identifying and addressing underlying causes and avoiding identified triggers is emphasized. The therapy algorithm is considered in detail, including 4 lines according to the European guidelines and domestic clinical guidelines. Particular attention is paid to the treatment of various subtypes of chronic urticaria. A comparative description of the most effective antihistamines is given.

About the authors

Alexey V. Samtsov

S.M. Kirov Military Medical Academy

Author for correspondence.
Email: avsamtsov@mail.ru
ORCID iD: 0000-0002-9458-0872
SPIN-code: 2287-5062

MD, Dr. Sci. (Med.), Professor

Russian Federation, Saint Petersburg

References

  1. Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer-Weber B, et al. The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018;73(7):1393–1414. doi: 10.1111/all.13397
  2. Кубанов А.А., Аравийская Е.А., Галлямова Ю.А., и др. Крапивница: Клинические рекомендации. М., 2020. 54 с. [Kubanov AA, Aravijskaya EA, Gallyamova YuA, et al. Hives: Clinical guidelines. Мoscow; 2020. 54 p. (In Russ.)]
  3. Ring J. Chronic urticaria: new hope for an old disease. J Eur Acad Dermatol Venereol. 2016;30(Suppl5):3–4. doi: 10.1111/jdv.13742
  4. Shakouri A, Compalati E, Lang DM, Khan DA. Effectiveness of Helicobacter pylori eradication in chronic urticaria: evidence-based analysis using the Grading of Recommendations Assessment, Development, and Evaluation system. Curr Opin Allergy Clin Immunol. 2010;10(4):362–369. doi: 10.1097/ACI.0b013e32833c79d7
  5. Grattan CE, Francis DM, Slater NG, Barlow RJ, Greaves MW. Plasmapheresis for severe, unremitting, chronic urticaria. Lancet. 1992;339(8801):1078–1080. doi: 10.1016/0140-6736(92)90666-q
  6. Wagner N, Dirk D, Peveling-Oberhag A, Reese I, Rady-Pizarro U, Mitzel H, et al. A Popular myth — low-histamine diet improves chronic spontaneous urticaria — fact or fiction? J Eur Acad Dermatol Venereol. 2016;31(4):650–655. doi: 10.1111/jdv.13966
  7. Beissert S, Ständer H, Schwarz T. UVA rush hardening for the treatment of solar urticaria. J Am Acad Dermatol. 2000;42(6):1030–1032. doi: 10.1016/s0190-9622(00)90299-8
  8. Kaplan AP. Clinical practice. Chronic urticaria and angioedema. N Engl J Med. 2002;346(3):175–179. doi: 10.1056/NEJMcp011186
  9. Федеральные клинические рекомендации по диагностике и лечению крапивницы. М.: Российская ассоциация аллергологов и клинических иммунологов, 2015. 34 c. [Federal clinical guidelines for the diagnosis and treatment of urticaria. Moscow: Russian Association of Allergists and Clinical Immunologists; 2015. 34 p. (In Russ.)]
  10. Grob J-J, Auquier P, Dreyfus I, Ortonne J-P. How to prescribe antihistamines for chronic idiopathic urticaria: desloratadine daily vs PRN and quality of life. Allergy. 2009;64(4):605–612. doi: 10.1111/j.1398-9995.2008.01913.x
  11. Weller K, Ardelean E, Scholz E, Martus P, Zuberbier T, Maurer M. Can on-demand non-sedating antihistamines improve urticaria symptoms? A double-blind, randomized, single-dose study. Acta Derm Venereol. 2013;93(2):168–174. doi: 10.2340/00015555-1434
  12. Kaplan AP. Clinical practice. Chronic urticaria and angioedema. N Engl J Med. 2002;346(3):175–179. doi: 10.1056/NEJMcp011186
  13. Saini S, Rosen KE, Hsieh H-J, Wong DA, Conner E, Kaplan A, et al. A randomized, placebo-controlled, dose-ranging study of single-dose omalizumab in patients with H1-antihistamine-refractory chronic idiopathic urticaria. J Allergy Clin Immunol. 2011;128(3):567–573.e1. doi: 10.1016/j.jaci.2011.06.010
  14. Maurer M, Altrichter S, Bieber T, Biedermann T, Bräutigam M, Seyfried S, et al. Efficacy and safety of omalizumab in patients with chronic urticaria who exhibit IgE against thyroperoxidase. J Allergy Clin Immunol. 2011;128(1):202–209.e5. doi: 10.1016/j.jaci.2011.04.038
  15. Harrison CA, Bastan R, Peirce MJ, Munday MR, Peachell PT. Role of calcineurin in the regulation of human lung mast cell and basophil function by cyclosporine and FK506. Br J Pharmacol. 2007;150(4):509–518. doi: 10.1038/sj.bjp.0707002
  16. Grattan CE, O’Donnell BF, Francis DM, Niimi N, Barlow RJ, Seed PT, et al. Randomized double-blind study of cyclosporin in chronic "idiopathic" urticaria. Br J Dermatol. 2000;143(2):365–372. doi: 10.1046/j.1365-2133.2000.03664.x
  17. Vena GA, Cassano N, Colombo D, Peruzzi E, Pigatto P. Neo-I-30 Study Group. Cyclosporine in chronic idiopathic urticaria: a double-blind, randomized, placebo-controlled trial. J Am Acad Dermatol. 2006;55(4):705–709. doi: 10.1016/j.jaad.2006.04.078
  18. Doshi DR, Weinberger MM. Experience with cyclosporine in children with chronic idiopathic urticaria. Pediatr Dermatol. 2009;26(4):409–413. doi: 10.1111/j.1525-1470.2009.00869.x
  19. Zuberbier T, Iffländer J, Semmler C, Henz BM. Acute urticaria: clinical aspects and therapeutic responsiveness. Acta Derm Venereol. 1996;76(4):295–297. doi: 10.2340/0001555576295297
  20. Asero R, Tedeschi A. Usefulness of a short course of oral prednisone in antihistamine-resistant chronic urticaria: a retrospective analysis. J Investig Allergol Clin Immunol. 2010;20(5):386–390.
  21. Antia C, Baquerizo K, Korman A, Alikhan A, Bernstein JA. Urticaria: A comprehensive review: Treatment of chronic urticaria, special populations, and disease outcomes. J Am Acad Dermatol. 2018;79(4):617–633. doi: 10.1016/j.jaad.2018.01.023
  22. Система поддержки принятия врачебных решений аллергология-иммунология. Клинические протоколы лечения. M., 2021. C. 57–80. [Medical decision support system allergology-immunology. Clinical treatment protocols. Moscow; 2021. P. 57–80. (In Russ.)]
  23. Dermatology Daily 2016, Febr 2.
  24. Maurer M, Church MK, Gonçalo M, Sussman G, Sánchez-Borges M. Management and treatment of chronic urticaria (CU). J Eur Acad Dermatol Venereol. 2015;29(Suppl3):16–32. doi: 10.1111/jdv.13198
  25. Гущин И.С Цетиризин — эталон Н1 антигистаминного средства. Методические рекомендации. М., 2010. [Gushchin IS. Cetirizine is the H1 standard of an antihistamine: Methodological recommendations. Moscow; 2010. (In Russ.)]
  26. Карева Е.Н. Выбор антигистаминного препарата: взгляд фармаколога. РМЖ. Медицинское обозрение. 2016;12:811–816. [Kareva EN. The choice of an antihistamine drug: the view of a pharmacologist, breast cancer. RMJ. Medical Review. 2016;12:811–816. (In Russ.)]
  27. Bocşan CI, Bujor AI, Miron N, Vesa ŞC, Deleanu D, Buzoianu AD. In Vivo Anti-Inflammatory Effect of H1 Antihistamines in Allergic Rhinitis: A Randomized Clinical Trial. Balkan Med J. 2015;32(4):352–358. doi: 10.5152/balkanmedj.2015.15884
  28. Gillard M, Christophe B, Wels B, Peck M, Massingham R, Chatelain P. H1 antagonists: receptor affinity versus selectivity. Inflamm Res. 2003;52(Suppl1):S49–50. doi: 10.1007/s000110300050
  29. Molimard M, Diquet B, Benedetti MS. Comparison of pharmacokinetics and metabolism of desloratadine, fexofenadine, levocetirizine and mizolastine in humans. Fundam Clin Pharmacol. 2004;18(4):399–411. doi: 10.1111/j.1472-8206.2004.00254.x
  30. Staevska M, Popov TA, Kralimarkova T, Lazarova C, Kraeva S, Popova D, et al. The effectiveness of levocetirizine and desloratadine in up to 4 times conventional doses in difficult-to-treat urticaria. J Allergy Clin Immunol. 2010;125(3):676–682. doi: 10.1016/j.jaci.2009.11.047
  31. Phinyo P, Koompawichit P, Nochaiwong S, Tovanabutra N, Chiewchanvit S, Chuamanochan M. Comparative Efficacy and Acceptability of Licensed Dose Second-Generation Antihistamines in Chronic Spontaneous Urticaria: A Network Meta-Analysis. J Allergy Clin Immunol Pract. 2021;9(2):956–970.e57. doi: 10.1016/j.jaip.2020.08.055
  32. Sharma M, Bennett C, Cohen SN, Carter B. H1-antihistamines for chronic spontaneous urticaria. Cochrane Database Syst Rev. 2014;2014(11):CD006137. doi: 10.1002/14651858.CD006137.pub2

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