The EAACI/GA2LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update

The link between chronic spontaneous urticaria and metabolic syndrome

“…Disease pathogenesis remains incompletely understood, although an autoimmune basis is increasingly being recognized based on the presence of functional histamine-releasing autoantibodies in a subset of patients (2,3). The autologous serum skin test (ASST) is a simple screening tool able to detect autoreactivity related to the presence of circulating histamine-releasing factors of any type, and not only of functional autoantibodies (1). Current evidence supports the possible contribution of other pathomechanisms, including the dysregulation of intracellular signalling pathways in basophils and mast cells, an abnormal innate immunity response, and the simultaneous activation of inflammatory response and coagulation system (2)(3)(4).…”

Clinical use of H1-antihistamines

“…Крапивница является одним из показаний для назна-чения H 1 -антигистаминных препаратов II поколения [13]. Они уменьшают зуд, количество волдырей и их размеры, улучшают качество жизни пациентов.…”

“…В соответствии с международными рекомендациями при недостаточном эффекте H 1 -антигистаминных препа-ратов II поколения при хронической крапивнице их дозу увеличивают в 4 раза [13]. Высокие дозы этих средств позволяют повысить их эффективность без увеличения риска развития побочных эффектов.…”

Justification for IgE as a therapeutic target in chronic spontaneous urticaria

“…For second-line therapy, if symptoms persist after 2 weeks, up-dosing of H1 antihistamines (up to 4 times the licensed dose) is recommended. In patients with refractory urticaria after 1-4 weeks, omalizumab, cyclosporine A or leukotriene receptor antagonists are added to the antihistamine (54). The efficacy and safety of monoclonal anti-IgE (omalizumab) was clearly established in double-blind placebo-controlled studies such as ASTERIA I, ASTERIA II, and GLACIAL (55-7),…”