Comment on “The effect of omalizumab on hematological and inflammatory parameters in patients with chronic spontaneous urticarial”: reply from authors

Abstract

We read Cosansu’s commentary entitled “Effectiveness of the new inflammatory parameters in patients with chronic spontaneous urticarial” to our study with great interest. The author remarked that a limited number of patients had C-reactive protein levels and it was not specified whether there were any other drugs used by the patients and no information was given about the severity of the disease in our study.     

Effectiveness of the new inflammatory parameters in patients with chronic spontaneous urticaria

Abstract

In recent years, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio have been studied in many dermatological diseases as various parameters indicating inflammation, and found to be associated with disease activity, prognosis and spread of disease 2,3. In the present study, authors found a significant decrease in the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and C-Reactive Protein after omalizumab treatment. However, a limited number of patients had C-Reactive Protein levels. Since no correlation analysis was performed in the study, the significance of these results remains weak. Moreover, it was not specified whether there were any other drugs used by the patients. In spontaneous urticaria, disease activity is assessed by a robust and simple scoring system named as Urticaria Activity Score 4. In the present study, Urticaria Activity Score was not mentioned, and no information was given about the severity of the disease in these population. The post-treatment change in Urticaria Activity Score will be more valuable for both to evaluate the response to treatment and to demonstrate the usefulness of these parameters. Future studies should focus on randomized trials with more detailed information, with greater emphasis on clinical endpoints.     

Experience with Omalizumab for the treatment of chronic spontaneous urticaria in a tertiary center: real life experience

Abstract

Purpose

Chronic spontaneous urticaria (CSU) is defined as urticaria and/or angioedema that appears spontaneously due to known or unknown causes and lasts for at least 6?weeks. Omalizumab, an anti-IgE antibody that binds circulating free IgE, has recently emerged as a promising treatment for CSU, a condition which impairs patients’ quality of life. We aimed to contribute real life data by reporting our experience with omalizumab in the treatment of intractable CSU.     

CRP relevance in clinical assessment of chronic spontaneous urticaria Tunisian patients

Background: Chronic spontaneous urticaria (CSU) is a common dermatological condition defined by the sudden occurrence of daily wheals and pruritus for at least six weeks. Multifactorial origin is suggested such as oxidative stress. This latter may play a double role as a trigger and remnant agent.

Objectives: The first aim of this study is to investigate antioxidant status, inflammatory proteins, hematologic counts and clinical assessment in CSU patients. The second aim is to evaluate the effect of a first-line treatment: desloratadine 5?mg/d on these different parameters.

Patients and Methods: This study enrolled 30 CSU patients and same number of controls. We assessed the urticaria activity score (UAS), total antioxidant status (TAS), glutathione S-transferase (GST), superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT), albumin, alpha1, alpha2, beta1 beta2, gamma globulins, c-reactive protein (CRP) and hematologic numeration.

Results: At baseline alpha1, alpha2, beta1, beta2, gamma globulins, CRP, SOD activity, leukocytes and basophils were significantly higher in patients versus controls (p?p?p?p?r?=?0.3; p?=?0.011) was noted. UAS assessment revealed the efficacy of 30 d-antihistaminic treatment.

Conclusions: Desloratadine exerted anti-inflammatory and antioxidant effects on CSU patients revealed by CRP. Patients’ remission was synergistic to CRP attenuation emphasizing CRP relevance for CSU clinical assessment.     

Investigation of thiol-disulphide balance in patients with acute urticaria and chronic spontaneous urticaria

Background: Thiol–disulphide balance plays a major role in health and diseases. This balance may be disrupted by various diseases. We aimed to determine status of the effect of thiol–disulphide balance in urticaria.

Objectives: We aimed to investigate the thiol–disulphide balance in patients with acute urticaria (AUP) and chronic spontaneous urticaria (CSU).

Methods: Study included 53 AUP and 47 healthy controls plus 57 patients with chronic spontaneous urticaria (CSUP) and 57 healthy controls. Levels of native thiols, disulphides and total thiols were evaluated in plasma using a new and automated spectrophotometric method. Ratios of disulphides/total thiols, disulphides/native thiols and native thiols/total thiols were calculated.

Results: For AU, there was no statistical difference compared to control group in levels of native thiols, disulphides and total thiols. For CSU, however, there was an increase in levels of native thiols, disulphides and total thiols and the ratio of thiol/disulphide in favour of disulphide.

Conclusion: Thiol–disulphide balance was not affected by AU but shifted towards to disulphide in CSU indicating the presence of oxidative stress (OS).     

Omalizumab does not lead to a distinct alteration in hematological parameters and complete blood count-derived inflammation biomarkers except for basophil count

Abstract

Purpose

Omalizumab is a monoclonal anti-IgE antibody used to treat patients with chronic spontaneous urticaria by decreasing free IgE levels. Omalizumab may have an anti-inflammatory effect by inhibiting T-cell activation and inducing eosinophil apoptosis. In this study, we evaluated the effect of omalizumab on hematological parameters and inflammation biomarkers in patients with chronic spontaneous urticaria.     

咪唑斯汀联合卡介菌多糖核酸治疗慢性荨麻疹

目的 评价咪唑斯汀和卡介菌多糖核酸注射液治疗慢性荨麻疹的疗效。方法 对照组单用咪唑斯汀口服,10mg/次,1次/d;试验组在此基础上加用卡介菌多糖核酸注射液1.0mg,隔日1次,肌肉注射,2周1疗程,共计3个疗程。结果 共完成76例,实验组39例,对照组37例,试验组有效率为89.7%,对照组有效率为70.3%,两组比较差异有统计学意义(P<0.05)。结论 咪唑斯汀治疗慢性荨麻疹有效,联合应用卡介菌多糖核酸注射液治疗可提高慢性荨麻疹疗效,减少复发率。     

NLR 和 hs-CRP 在 NSTEMI 患者行冠状动脉介入术后造影剂肾病的预测价值

目的：探讨中性粒细胞／淋巴细胞比值（neutrophil／lymphocyte ratio,NLR）、高敏C-反应蛋白（hs-CRP）对于非ST段抬高心肌梗死（NSTEMI）患者行皮冠状动脉介入治疗（PCI）术后发生对比剂肾病（contrast-induced nephrop-athy,CIN）的预测价值。方法入选400例行PCI的患者,CIN定义为使用对比剂后48～72 h内血肌酐值较基线值升高超过44？．2μmol／L或者较原基础值升高25％以上。比较CIN组与非CIN 组之间的基线资料。采用多因素Logistic回归分析评估NLR、hsCRP与CIN的相关性。结果 NLR、hsCRP在CIN组明显升高。肾功能不全、糖尿病和CIN相关具有统计学意义（ P ＜0．05）,高龄、糖尿病、肾小球滤过率减低、大剂量造影剂、心力衰竭是CIN的独立危险因素。NLR＞5．1及hsCRP＞16 mg／dl也是CIN的独立危险因素。结论 NLR及hsCRP可能成为NSTEMI患者冠脉介入术后发生CIN简捷、可靠的指标。     

依巴斯汀联合雷尼替丁在慢性荨麻疹中的综合疗效

目的：探讨依巴斯汀联合雷尼替丁在慢性荨麻疹中的综合疗效。方法：选取2008年6月～2010年11月于本院进行治疗的86例慢性荨麻疹患者为研究对象,将其随机分为对照组（西替利嗪联合雷尼替丁组）43例和观察组（依巴斯汀联合雷尼替丁组）43例,后将两组患者的治疗总有效率、不良反应发生率及治疗前后的血清总IgE、HA、ECP、5-HT、LT水平进行统计及比较。结果：观察组的治疗总有效率高于对照组,不良反应发生率低于对照组,血清总IgE、HA、ECP、LT水平低于对照组,血清5-HT高于对照组,P〈0.05或P〈0.01,差异有统计学意义或显著统计学意义。结论：依巴斯汀联合雷尼替丁在慢性荨麻疹中的综合疗效较佳,可影响血清总IgE、HA、ECP、5-HT、LT水平,可以作为治疗慢性荨麻疹的方案。     

依巴斯汀治疗慢性特发性荨麻疹65例临床疗效分析

目的探讨依巴斯汀治疗慢性特发性荨麻疹的临床疗效。方法选择我院慢性荨麻疹患者126例,随机分为治疗组和对照组。治疗组给予依巴斯汀治疗,对照组给予氯雷他定治疗,疗程均为2周。疗程结束后,观察两组的临床治疗效果。结果治疗组总有效率为76．9％,对照组总有效率为50．8％,两组总有效率比较,差异有统计学意义（P〈0．05）。结论依巴斯汀治疗慢性特发性荨麻疹疗效显著,不良反应少,值得临床借鉴。     

左西替利嗪联合雷尼替丁治疗慢性荨麻疹的疗效观察

目的:观察左西替利嗪联合雷尼替丁治疗慢性荨麻疹的疗效.方法:采用随机对照临床试验,分2组,治疗组口服左西替利嗪每日1次,每次5 mg;雷尼替丁每日2次,每次150 mg;对照组仅口服左西替利嗪每日1次,每次5 mg.均连续服药2周为一疗程.结果:116例中治疗组59例,有效率91.5%,对照组57例,有效率73.7%,治疗组显著优于对照组(P＜0.05).结论:左西替利嗪联合雷尼替丁是治疗慢性荨麻疹安全有效的方法.     

免疫抑制酸性蛋白与中性粒细胞/淋巴细胞比值及血清C-反应蛋白检测对急性阑尾炎诊断的意义

目的探讨急性阑尾炎(AA)患者血清免疫抑制酸性蛋白(IAP)与外周血中性粒细胞/淋巴比值(N/L比值)以及血清C-反应蛋白(CRP)变化及对诊断的意义。方法检测AA患者术前血清IAP、CRP水平和外周WBC,并计算N/L。结果AA患者血清IAP水平均较对照组明显升高(P<0.01),坏疽或穿孔性组较急性单纯性与化脓性阑尾炎组明显升高(P<0.01)。N/L比值明显高于对照组;病情越严重,N/L比值越高。AA患者CRP水平高于对照组(P<0.01),坏疽或穿孔性组CRP水平较急性单纯性与化脓性阑尾炎组又有明显升高(P<0.01)。IAP、CRP与N/L比值联合检测对白细胞计数正常的AA诊断有重要意义,对这部分AA预测的准确率达100%(42/42)。结论IAP、N/L比值及CRP能比较准确地反映AA的病情,三者联合检测能进一步提高对AA诊断的准确性。     

个性化护理干预在慢性荨麻疹患者护理中的效果

目的：探讨个性化护理干预对慢性荨麻疹患者的临床疗效。方法选取72例慢性荨麻疹患者随机分为两组，对照组36例给予常规的药物治疗，研究组36例给予除药物治疗外，给予个性化护理干预，比较两组患者疗效。结果经过不同治疗，两组患者生活质量均有所提高，而研究组的提高水平显著高于对照组；同时，研究组的有效率（94.44%）明显高于对照组（77.78%），两组之间的差异具有统计学意义（P＜0.05）。结论对慢性荨麻疹患者实施个性化护理干预，可以显著增强治疗效果，提高生活质量，适合推广。     

衣巴斯汀联合皮敏消胶囊治疗慢性荨麻疹的效果观察

目的探讨依巴斯汀联合皮敏消胶囊治疗慢性荨麻疹的效果。方法选取2011年10月～2013年1月采用依巴斯汀治疗的51例慢性荨麻疹患者为对照组,另将同-时期采用依巴斯汀联合皮敏消胶囊治疗的51例患者设为观察组,然后将两组患者治疗4周后的总有效率、用药期间的不良反应发生情况与治疗用药前后的血清5-羟色胺（5-HT）、嗜酸粒细胞阳离子蛋白（ECP）、透明质酸（HA）及外周血嗜酸粒细胞（EOS）水平进行对比。结果观察组治疗4周后的总有效率高于对照组,血清5-HT、ECP、HA及EOS均低于对照组．差异均有统计学意义（P〈0．05）,而两组用药期间的不良反应发生率差异无统计学意义（P〉0．05）。结论依巴斯汀联合皮敏消胶囊治疗慢性荨麻疹的效果好,安全性较高,对于降低疾病相关指标发挥着积极的作用。     

广州地区糖尿病患者牙周炎症程度对血清超敏C反应蛋白水平的影响

目的分析广州地区糖尿病患者牙周炎症严重程度对血清超敏C反应蛋白水平的影响。方法对123名糖尿病伴牙周炎患者,145名慢性牙周炎患者进行全口牙周检查,记录PD和AL,并检测其血清hs-CRP水平。结果糖尿病伴慢性牙周炎组血清hs-CRP水平以及PD显著高于慢性牙周炎组,差异有统计学意义(P<0.05)。结论糖尿病能够使血清hs-CRP水平升高,可能会加重牙周炎症程度。     

他汀类药物对慢性肾功能衰竭患者炎性反应的影响

目的 观察慢性肾功能衰竭(CRF)患者C-反应蛋白(CRP)、纤维蛋白原(Fg)的变化,探讨他汀类药物对CRF患者炎性反应的影响.方法 将54例CRF患者随机平均分为两组:非他汀组予常规治疗;他汀组予常规治疗加普伐他汀20 mg/d或辛伐他汀20 mg/d.同时设健康对照组20例.测定各组治疗前和治疗4周后CRP、Fg水平.结果 CRF患者治疗前CRP、Fg显著高于对照组,差异有统计学意义(P＜0.05).治疗4周后,他汀组CRP、Fg水平下降,与治疗前及同期非他汀组相比,差异有统计学意义(P＜0.05).结论 (1)CRF患者中存在CRP水平升高的炎性反应;(2)他汀类药物可以降低CRP、Fg水平,提示其具有降脂以外的抗炎作用.     

Exploring the real-world profile of refractory and non-refractory chronic idiopathic urticaria in the USA: clinical burden and healthcare resource use

Introduction: Chronic idiopathic/spontaneous urticaria (CIU/CSU) is a debilitating skin condition that is burdensome for patients and healthcare providers. We aimed to describe clinical characteristics, consultation patterns and healthcare resource utilization in real-world US patients with refractory and non-refractory CIU/CSU.

Methods: Data was collected from the Adelphi Real World 2015 Urticaria Disease Specific Programme. Physicians completed patient record forms (PRFs) for the next four patients consulting with non-refractory CIU/CSU and the next six with refractory CIU/CSU; patients were considered refractory if symptomatic and on treatment step ≥2. The same patients were asked to complete patient self-completion (PSC) forms describing how CIU/CSU affected them.

Results: Seventeen physicians (15 allergists; 2 dermatologists) completed 184 PRFs (108 refractory CIU/CSU; 76 non-refractory CIU/CSU); 140 patients completed PSC forms (93 refractory CIU/CSU; 47 non-refractory CIU/CSU). Mean time from first consultation to diagnosis was 13.5 (SD 28.3) weeks; mean time from diagnosis to first treatment was 16.0 (SD 37.9) weeks. Patients with refractory CIU/CSU were more likely to initially consult primary care physicians than those with non-refractory CIU/CSU (51% and 28%, respectively). The most common symptoms were itching, sleep problems and anxiety/distress, affecting 75%, 23% and 18%, respectively. Patient-perceived disease severity was greater than physician-perceived severity (refractory CIU/CSU kappa 0.1512; non-refractory CIU/CSU 0.1590).

Conclusions: Patients with CIU/CSU in this real-world study – particularly those with refractory CIU/CSU – were slow to receive specialist care and had substantial symptom burdens; patient–physician perception of disease severity was discordant. Earlier diagnosis of CIU/CSU may lead to timely use of CIU/CSU therapies.     

慢性荨麻疹患者健康教育需求的调查分析

目的 了解慢性荨麻疹患者对健康教育知识的需求情况,通过对健康教育需求的调查分析,为今后有针对性地开展健康教育提供依据.方法 采用自行设计的健康教育需求问卷对本所门诊178例慢性荨麻疹患者进行随机抽样调查.结果 患者对发病原因及治疗效果、预后相关知识的需求率达85.3％;药物副作用与不良反应的需求率为85.9％;皮肤自我护理知识为88.7％;随访指导方面中服药提醒80.9％;健康教育指导方式中年轻患者倾向于QQ、微信,占92.7％,中医康复指导方面四季调养的需求程度高为92.7％.结论 慢性荨麻疹患者对疾病相关知识普遍缺乏,秉承需要有针对性地开展个体化的健康教育,通过不同的教育方式和途径普及疾病相关知识,促进其建立健康行为和生活方式,提高生活质量.     

昆明山海棠片联合特非那定片治疗慢性荨麻疹的临床疗效观察

目的观察昆明山海棠片联合特非那定片治疗慢性荨麻疹的临床疗效。方法选择门诊慢性荨麻疹患者95例,采用随机对照分组试验,其中治疗组48例,对照组47例,治疗组内服昆明山海棠片联合特非那定片,对照组单服特非那丁片。结果 4周后,治疗组的痊愈率为35.4%(18/48),对照组为19.1%,(9/47),两组比较差异有统计学意义(χ2=3.93,P<0.05);治疗组的总有效率93.8%(45/48),对照组的总有效率为68.1%(32/47),两组比较差异有统计学意义(χ2=8.58,P<0.05)。两组均未见明显副反应。结论昆明山海棠片联合特非那定片治疗慢性荨麻疹疗效显著。