Urticaria (hives) - top articles in September 2014

Here are my suggestions for some of the top articles about urticaria published recently:

Prognosis of chronic urticaria, not controlled by antihistamine: improved rates at 1 year, 2 years, and 5 years were 37%, 51%, and 66%, respectively http://buff.ly/UkIQLN

Practical algorithm for diagnosing patients with recurrent wheals or angioedema (article beind paywall) http://buff.ly/10xUTUw

Omalizumab in chronic urticaria refractory to conventional therapy: 82% of patients exhibited significant response http://buff.ly/1e7ldMI

Patients with chronic urticaria often have elevated D-dimer, some may benefit from anticoagulant therapy http://buff.ly/1hgPBFV

Sulfasalazine effective in 84% of patients with antihistamine resistant chronic urticaria (monitor for AE) http://buff.ly/1h6CwAI

Eradication Therapy for Urticaria with High Titers of Anti H. pylori IgG Antibody http://buff.ly/19zioFY

A series on urticaria in Clinic of North America, Feb 2014:

2014 review of Pediatric Urticaria: Although not life-threatening, impact on quality of life should not be overlooked http://buff.ly/MkS4ai

Diagnosis and Treatment of Urticaria and Angioedema - World Allergy Organization Journal 2012 update http://buff.ly/YBis2W

Hives on direct contact with a chemical/protein is contact urticaria. It can be either nonimmunologic or immunologic http://buff.ly/1dIHnDM

Diagnostic Tests for Urticaria: labs and skin biopsy should be performed only if "necessity" of these examinations http://buff.ly/1dIHfUU

Urticaria: Impact on Quality of Life and Economic Cost http://buff.ly/MkXthE - Patients suffer disruption of many facets of their lives

Chronic urticaria in China: positive autologous serum skin tests (ASSTs) in 67%, prediicted more severe disease http://buff.ly/1ntYIGs

The vast majority of cases of recalcitrant urticaria are idiopathic. What to do? AAAAI Ask the Expert replies: http://buff.ly/NanVub

Chronic urticaria and coagulation. Will blood thinners help? http://buff.ly/1jSDm55 free review article

The maddening itch: an approach to chronic urticaria - J Investig Allergol Clin Immunol. Chronic spontaneous urticaria (CSU) is defined as the presence of urticaria with daily or almost daily symptoms for 6 weeks or more. CSU affects 0.1%-0.8% of the population. http://buff.ly/1rDwQ4P

The articles were selected from Twitter @Allergy and RSS subscriptions. Some of the top allergy accounts on Twitter contributed links. I appreciate the curation provided by @Aller_MD @IgECPD @DrAnneEllis @mrathkopf.

Please feel free to send suggestions for articles to AllergyGoAway AT gmail DOT com and you will receive an acknowledgement in the next edition of this publication.



Chronic Urticaria Treatment Options in 6 Steps (click to enlarge the image).

Image source: Urticaria, Wikipedia, public domain.

Comments from Google Plus:

Gary Levin: Nice treatment algo, has come a long way since I started practicing in 1970

DrVes: Yes, Xolair is the biggest new development. It was approved for urticaria in 03/2014 and it works.

Toll Like Receptors (TLR) - Immunology Animation



This is part of series of videos from the Armando Hasudungan's YouTube channel:

https://www.youtube.com/user/armandohasudungan/videos

Signaling pattern-recognition molecules, for example, toll-like receptors (TLRs), lead to activation of genes which in turn lead to a specific immune response. TLRs got their name from toll, a membrane receptor in the Drosophila fly which provides resistance to fungi. TLRs are the first point of contact between the immune system and a pathogen.


The curved leucine-rich repeat region of toll-like receptors, represented here by TLR3. Image source: Wikipedia.

Mnemonics: Toll-like receptors (TLRs)

TLR 2
Two
TB and other mycobacteria

TLR4 (for LPS)
CD14

TLR 5
Five
Flagellin
Flagelated bacteria

TLR 7
Seven
SS RNA

TLR 9
Nine
Nonmethylated
Nucleotide motifs - CpG

TLR 3
Three is "Free" of MyD88

Comments from Twitter:

Roisin Thomas @RoisinThomas: @Allergy There is a mistake in that video. TLR-4 recognises lipopolysaccharide from gram negative bacteria not gram positive.

@Allergy: yes, TLR-4 binds to LPS (Gram neg) - explanation added in the text, with your comment: http://allergynotes.blogspot.com/2014/09/toll-like-receptors-tlr-immunology.html

Philippe Auriol @PhilAllergie: #fun #Biology

Dr John Weiner @AllergyNet: Spellbinding video and summary, loved it, I must get a life

References:

Toll-like receptors (TLRs) http://buff.ly/1mapOI7
Mnemonics: Toll-like receptors (TLRs) http://buff.ly/XBMo0Q

ABCs of Asthma and Allergies in Children - ACAAI video

From ACAAI: ABCs of Asthma and Allergies in Children -- "What are the most common asthma and allergy symptoms in children? How is allergy testing in children done? Will your child always be at risk in school and every new environment? Get answers to these and many other allergy and asthma questions in this segment of "Why See an Allergist."

Children treated daily with ICS grow 0.5 cm less during the first year of treatment, no difference second year

Two literature reviews by The Cochrane Collaboration evaluated the effect of inhaled corticosteroids (ICS) on growth in children with asthma. The first review included 25 trials with 8471 children (5128 ICS-treated and 3343 control) with mild to moderate persistent asthma. The second review included 17 group comparisons derived from 10 trials (3394 children with mild to moderate asthma). Trials used ICS (beclomethasone, budesonide, ciclesonide, fluticasone or mometasone) as monotherapy or as combination therapy.

Regular use of ICS at low or medium daily doses was associated with a mean reduction of 0.48 cm/y in linear growth velocity and a 0.61-cm change from baseline in height during a one-year treatment period in children with mild to moderate persistent asthma. The effect size of ICS on linear growth velocity appears to be associated more strongly with the ICS molecule than with the device or dose. ICS-induced growth suppression seems to be maximal during the first year of therapy and less pronounced in subsequent years of treatment. Findings support use of the minimal effective ICS dose in children with asthma.



Asthma Inhalers (click to enlarge the image).

References:

Inhaled corticosteroids in children with persistent asthma: effects on growth. Linjie Zhang et al. DOI: 10.1002/14651858.CD009471.pub2
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009471.pub2/abstract

Inhaled corticosteroids in children with persistent asthma: dose-response effects on growth. Aniela I Pruteanu et al. DOI: 10.1002/14651858.CD009878.pub2
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009878.pub2/abstract

Role of macrolides in asthma: promise of efficacy, search for responsive phenotype continues

Macrolides, such as clarithromycin and azithromycin, possess antimicrobial, immunomodulatory, and potential antiviral properties. They are a potential therapeutic option for asthma but the results from clinical trials have been contentious. The findings could be confounded by many factors, including the heterogeneity of asthma, treatment duration and dose.

Recent evidence suggests effectiveness of macrolides in patients with uncontrolled severe neutrophilic asthma and in asthma exacerbations.

At present, the use of macrolides in chronic asthma or acute exacerbations is not justified.

Further work, including proteomic, genomic, and microbiome studies, will advance our knowledge of asthma phenotypes, and help to identify a macrolide-responsive subgroup.

References:

The role of macrolides in asthma. The Lancet Respiratory Medicine, Early Online Publication, 17 June 2014, doi:10.1016/S2213-2600(14)70107-9
http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70107-9/fulltext
(free full text after registration)

Image source: Clarithromycin structure, Wikipedia, public domain.

Comments from Twitter:

Dr John Weiner @AllergyNet: 40 yrs of reports but unsolved
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