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Marcus Maurer - One of the best experts on this subject based on the ideXlab platform.

  • sensitization against skin resident fungi is associated with atopy in Cholinergic Urticaria patients
    Clinical and Translational Allergy, 2020
    Co-Authors: Sabine Altrichter, Makiko Hiragun, Michihiro Hide, Pia Schumacher, Ola Alraboni, Yiyu Wang, Marcus Maurer
    Abstract:

    Background Cholinergic Urticaria (CholU) is a common type of chronic inducible Urticaria, characterized by small itchy wheals that appear upon physical exercise or passive warming. Malassezia globosa, a skin resident fungus, has been identified as an antigen that induces mast cell/basophil degranulation and wheal formation through specific IgE, in Japanese patients with atopic dermatitis and CholU. In this study we aimed in assessing the rate of IgE sensitizations against skin resident fungi in European CholU patients. Methods We assessed serum IgE levels to Malassezia furfur, Candida albicans and Trichophyton mentagrophytes using routine lab testing and Malassezia globosa using a newly established ELISA. We correlated the results to wheal formation and other clinical features. Results Four patients (of 30 tested) had elevated levels of IgE against Malassezia furfur and Candida albicans and two had elevated levels of IgE against Trichophyton mentagrophytes. Four sera (of 25 tested) had elevated levels of IgE to the Malassezia globosa antigen supMGL_1304. Sensitization to one skin fungus was highly correlated with sensitization to the other tested fungi. We saw highly significant correlations of sensitization to supMGL_1304 with wheal size in the autologous sweat skin test (rs = 0.7, P = 0.002, n = 19), the Erlangen atopy score (rs = 0.5, P = 0.03, n = 19), total IgE serum levels (rs = 0.5, P = 0.04, n = 19) and a positive screen for IgE against common airborne/inhalant allergens s (sx1; rs = 0.54, P = 0.02, n = 19). Conclusions Sensitization to skin resident fungi including Malassezia globosa is uncommon in European CholU patients, but is associated with atopy and pronounced wheal formation upon dermal contact with their own sweat.Trial registration German Clinical Trials Registry DRKS-ID: DRKS00004277.

  • real life treatment of patients with Cholinergic Urticaria in german speaking countries
    Journal Der Deutschen Dermatologischen Gesellschaft, 2019
    Co-Authors: Emilia Mellerowicz, Marcus Maurer, Torsten Zuberbier, Karsten Weller, Sabine Altrichter
    Abstract:

    BACKGROUND Cholinergic Urticaria (CholU) is a frequent type of chronic inducible Urticaria. Symptomatic treatment with second-generation antihistamines (sgAH) is recommended by current guidelines as first-line therapy, but little is known about how patients with CholU are treated in real life and how they respond to treatment. AIM To assess real-life treatment of CholU in German-speaking countries. METHODS Patients with CholU (n = 111) took part in an online survey study that assessed their treatments and their treatment responses. RESULTS Virtually all patients (97 %) had used antihistamines, 87 % of them sgAH; 23 % had also taken first-generation antihistamines (fgAH). The proportion of patients who benefited from standard-dosed antihistamine treatment was low (sgAH: 32 % vs. fgAH: 16 %), and side effects of sgAH and fgAH were comparable. Updosing of antihistamines had been tried by 66 patients (59 %) (most commonly [98 %, n = 65] with sgAH) and resulted in marginally better responses (sgAH: 38 % vs. fgAH: 32 %). Only very few patients had used other treatments, mostly corticosteroids (30 %) and omalizumab (5 %). CONCLUSIONS SgAH were commonly used, but insufficient in about two thirds of CholU patients. Accordingly, improved use of third-line and fourth-line treatment options and development of better therapies for patients with CholU are needed.

  • real life treatment of Cholinergic Urticaria with omalizumab
    The Journal of Allergy and Clinical Immunology, 2019
    Co-Authors: Sabine Altrichter, Martin Metz, Aida Asady, Mati Chuamanochan, Henriette Knoth, Tatevik Ohanyan, Marcus Maurer
    Abstract:

    Abstract Background Cholinergic Urticaria (CholU), a frequent type of chronic inducible Urticaria, presents with small itchy wheals upon physical exercise or passive warming. Omalizumab has been shown to be very effective in patients with chronic spontaneous Urticaria. Whether or not omalizumab is also effective in CholU is largely unknown. Aim To assess the effectiveness of omalizumab treatment in CholU Method We assessed the effects of real life omalizumab treatment at standard and higher than standard doses in CholU patients including their time to response, the effects on concomitant Urticaria forms and links to clinical features. Results Of 16 CholU patients treated with omalizumab, 11 (68%) reported a major or complete response, 2 patients reported a minor effect (13 %) and 3 patients (19%) showed no benefit. Omalizumab updosing led to complete response in 4 of 6 patients, who did not achieve controlled disease on standard dosed omalizumab therapy, i.e. 300 mg/4wks. Time to onset of benefit was fast, and concomitant Urticaria forms showed similar response patterns. Treatment effects were linked to patient gender, with better responses in female patients (p Conclusion Omalizumab treatment is effective in the majority of CholU patients, especially in female patients. Most non-responders to standard-dosed omalizumab benefit from updosing. Our findings call for controlled clinical trials of omalizumab and other IgE-targeted treatments in CholU.

  • How to Approach Chronic Inducible Urticaria.
    The Journal of Allergy and Clinical Immunology: In Practice, 2018
    Co-Authors: Marcus Maurer, Joachim W. Fluhr, David A. Khan
    Abstract:

    Chronic inducible Urticaria (CIndU) is a group of chronic Urticarias characterized by the appearance of recurrent wheals, recurrent angioedema or both, as a response to specific triggers. CIndU includes both physical (symptomatic dermographism, cold and heat Urticaria, delayed pressure Urticaria, solar Urticaria, and vibratory Urticaria) and nonphysical Urticarias (Cholinergic Urticaria, contact and aquagenic Urticaria). Here, we review the different forms of CIndU with an emphasis on symptomatic dermographism, cold Urticaria, Cholinergic Urticaria, and delayed pressure Urticaria. We discuss the clinical features, the diagnostic workup including provocation and threshold testing, and available treatment options.

  • development and validation of the Cholinergic Urticaria quality of life questionnaire cholu qol
    Clinical & Experimental Allergy, 2018
    Co-Authors: J Ruft, Marcus Maurer, Torsten Zuberbier, Aida Asady, Petra Staubach, Thomas B Casale, G Sussmann, Karsten Weller, Sabine Altrichter
    Abstract:

    SummaryBackground Cholinergic Urticaria (CholU), a common form of chronic inducible Urticaria, is characterized by itchy weals that occur in response to physical exercise or passive warming. CholU patients frequently exhibit a high burden of disease. As of yet, no specific instrument is available to assess their disease-related quality-of-life (QoL) impairment. Objective The aim of this study was to develop and validate the first disease-specific QoL instrument for CholU patients, the Cholinergic Urticaria Quality-of-Life Questionnaire (CholU-QoL). Methods Using a combined approach of the literature search, semistructured patient interviews and expert opinion, we developed 96 potential CholU-QoL items. Subsequent item selection was performed by means of impact analysis complemented by an expert review for face validity. The resulting final CholU-QoL was then tested for levels of validity, reliability and influence factors in 88 CholU patients. In parallel, an US American-Canadian English version of the CholU-QoL was developed. Results The final 28-item CholU-QoL was found to have a 5-domain structure (“symptoms,” “functional life,” “social interaction,” “therapy,” “emotions”) with excellent internal consistency. The CholU-QoL also showed a valid total score, and good levels of convergent validity, known-groups validity, as well as test-retest reliability. Multiple regression analysis found no significant drivers of the CholU-QoL total score. Conclusions and Clinical Relevance The CholU-QoL is the first disease-specific QoL instrument for CholU and also the first specific QoL measure in the field of chronic inducible Urticarias. It may serve as a valuable tool for clinical trials and improve routine patient management.

Sabine Altrichter - One of the best experts on this subject based on the ideXlab platform.

  • sensitization against skin resident fungi is associated with atopy in Cholinergic Urticaria patients
    Clinical and Translational Allergy, 2020
    Co-Authors: Sabine Altrichter, Makiko Hiragun, Michihiro Hide, Pia Schumacher, Ola Alraboni, Yiyu Wang, Marcus Maurer
    Abstract:

    Background Cholinergic Urticaria (CholU) is a common type of chronic inducible Urticaria, characterized by small itchy wheals that appear upon physical exercise or passive warming. Malassezia globosa, a skin resident fungus, has been identified as an antigen that induces mast cell/basophil degranulation and wheal formation through specific IgE, in Japanese patients with atopic dermatitis and CholU. In this study we aimed in assessing the rate of IgE sensitizations against skin resident fungi in European CholU patients. Methods We assessed serum IgE levels to Malassezia furfur, Candida albicans and Trichophyton mentagrophytes using routine lab testing and Malassezia globosa using a newly established ELISA. We correlated the results to wheal formation and other clinical features. Results Four patients (of 30 tested) had elevated levels of IgE against Malassezia furfur and Candida albicans and two had elevated levels of IgE against Trichophyton mentagrophytes. Four sera (of 25 tested) had elevated levels of IgE to the Malassezia globosa antigen supMGL_1304. Sensitization to one skin fungus was highly correlated with sensitization to the other tested fungi. We saw highly significant correlations of sensitization to supMGL_1304 with wheal size in the autologous sweat skin test (rs = 0.7, P = 0.002, n = 19), the Erlangen atopy score (rs = 0.5, P = 0.03, n = 19), total IgE serum levels (rs = 0.5, P = 0.04, n = 19) and a positive screen for IgE against common airborne/inhalant allergens s (sx1; rs = 0.54, P = 0.02, n = 19). Conclusions Sensitization to skin resident fungi including Malassezia globosa is uncommon in European CholU patients, but is associated with atopy and pronounced wheal formation upon dermal contact with their own sweat.Trial registration German Clinical Trials Registry DRKS-ID: DRKS00004277.

  • real life treatment of patients with Cholinergic Urticaria in german speaking countries
    Journal Der Deutschen Dermatologischen Gesellschaft, 2019
    Co-Authors: Emilia Mellerowicz, Marcus Maurer, Torsten Zuberbier, Karsten Weller, Sabine Altrichter
    Abstract:

    BACKGROUND Cholinergic Urticaria (CholU) is a frequent type of chronic inducible Urticaria. Symptomatic treatment with second-generation antihistamines (sgAH) is recommended by current guidelines as first-line therapy, but little is known about how patients with CholU are treated in real life and how they respond to treatment. AIM To assess real-life treatment of CholU in German-speaking countries. METHODS Patients with CholU (n = 111) took part in an online survey study that assessed their treatments and their treatment responses. RESULTS Virtually all patients (97 %) had used antihistamines, 87 % of them sgAH; 23 % had also taken first-generation antihistamines (fgAH). The proportion of patients who benefited from standard-dosed antihistamine treatment was low (sgAH: 32 % vs. fgAH: 16 %), and side effects of sgAH and fgAH were comparable. Updosing of antihistamines had been tried by 66 patients (59 %) (most commonly [98 %, n = 65] with sgAH) and resulted in marginally better responses (sgAH: 38 % vs. fgAH: 32 %). Only very few patients had used other treatments, mostly corticosteroids (30 %) and omalizumab (5 %). CONCLUSIONS SgAH were commonly used, but insufficient in about two thirds of CholU patients. Accordingly, improved use of third-line and fourth-line treatment options and development of better therapies for patients with CholU are needed.

  • real life treatment of Cholinergic Urticaria with omalizumab
    The Journal of Allergy and Clinical Immunology, 2019
    Co-Authors: Sabine Altrichter, Martin Metz, Aida Asady, Mati Chuamanochan, Henriette Knoth, Tatevik Ohanyan, Marcus Maurer
    Abstract:

    Abstract Background Cholinergic Urticaria (CholU), a frequent type of chronic inducible Urticaria, presents with small itchy wheals upon physical exercise or passive warming. Omalizumab has been shown to be very effective in patients with chronic spontaneous Urticaria. Whether or not omalizumab is also effective in CholU is largely unknown. Aim To assess the effectiveness of omalizumab treatment in CholU Method We assessed the effects of real life omalizumab treatment at standard and higher than standard doses in CholU patients including their time to response, the effects on concomitant Urticaria forms and links to clinical features. Results Of 16 CholU patients treated with omalizumab, 11 (68%) reported a major or complete response, 2 patients reported a minor effect (13 %) and 3 patients (19%) showed no benefit. Omalizumab updosing led to complete response in 4 of 6 patients, who did not achieve controlled disease on standard dosed omalizumab therapy, i.e. 300 mg/4wks. Time to onset of benefit was fast, and concomitant Urticaria forms showed similar response patterns. Treatment effects were linked to patient gender, with better responses in female patients (p Conclusion Omalizumab treatment is effective in the majority of CholU patients, especially in female patients. Most non-responders to standard-dosed omalizumab benefit from updosing. Our findings call for controlled clinical trials of omalizumab and other IgE-targeted treatments in CholU.

  • development and validation of the Cholinergic Urticaria quality of life questionnaire cholu qol
    Clinical & Experimental Allergy, 2018
    Co-Authors: J Ruft, Marcus Maurer, Torsten Zuberbier, Aida Asady, Petra Staubach, Thomas B Casale, G Sussmann, Karsten Weller, Sabine Altrichter
    Abstract:

    SummaryBackground Cholinergic Urticaria (CholU), a common form of chronic inducible Urticaria, is characterized by itchy weals that occur in response to physical exercise or passive warming. CholU patients frequently exhibit a high burden of disease. As of yet, no specific instrument is available to assess their disease-related quality-of-life (QoL) impairment. Objective The aim of this study was to develop and validate the first disease-specific QoL instrument for CholU patients, the Cholinergic Urticaria Quality-of-Life Questionnaire (CholU-QoL). Methods Using a combined approach of the literature search, semistructured patient interviews and expert opinion, we developed 96 potential CholU-QoL items. Subsequent item selection was performed by means of impact analysis complemented by an expert review for face validity. The resulting final CholU-QoL was then tested for levels of validity, reliability and influence factors in 88 CholU patients. In parallel, an US American-Canadian English version of the CholU-QoL was developed. Results The final 28-item CholU-QoL was found to have a 5-domain structure (“symptoms,” “functional life,” “social interaction,” “therapy,” “emotions”) with excellent internal consistency. The CholU-QoL also showed a valid total score, and good levels of convergent validity, known-groups validity, as well as test-retest reliability. Multiple regression analysis found no significant drivers of the CholU-QoL total score. Conclusions and Clinical Relevance The CholU-QoL is the first disease-specific QoL instrument for CholU and also the first specific QoL measure in the field of chronic inducible Urticarias. It may serve as a valuable tool for clinical trials and improve routine patient management.

  • Cholinergic Urticaria patients of different age groups have distinct features
    Clinical & Experimental Allergy, 2017
    Co-Authors: Aida Asady, Marcus Maurer, J Ruft, Andre Ellrich, Tomasz Hawro, Sabine Altrichter
    Abstract:

    Background Cholinergic Urticaria (CholU) is a common skin disease characterized by the development of pinpoint sized wheals and severe itch upon physical exercise. Little is known about the epidemiology of CholU. CholU can occur at any age and has the highest prevalence among young adults. As of now, it is unclear if patients of different age show differences in the clinical manifestation of CholU, duration of disease, comorbidities or response to treatment. Methods Here, we analysed the demographic data and clinical characteristics including disease duration and comorbidities of 200 CholU patients, 12 to 76 years of age. Results We identified two distinct types of CholU, one with early onset (EO, 71%) and one with late onset (LO, 29%). EO and LO CholU patients markedly differ in key characteristics: EO patients, who had a disease onset before the age of 36, showed no gender preponderance, and had a significantly higher rate of concomitant atopic dermatitis (16.9 vs. 5.2%; p= 0.028) and higher IgE-Levels (295.5 vs. 267.1 IU/ml; p= 0.020) as compared to LO patients, who were mainly female (69%), had a shorter duration of disease (33.3 vs. 63.7 months; p= 0.005), a higher rate of concomitant other forms of Urticaria (48.3 vs. 33.1%; p=0.044), and a higher rate of psychiatric comorbidities (12.1 vs 1.4%; p= 0.001).. Conclusion There are two subtypes of CholU patients with different gender ratios, disease duration, and comorbidities. These findings suggest that two distinct underlying pathogenetic pathways are relevant in these two subgroups of CholU patients. This article is protected by copyright. All rights reserved.

Torsten Zuberbier - One of the best experts on this subject based on the ideXlab platform.

  • real life treatment of patients with Cholinergic Urticaria in german speaking countries
    Journal Der Deutschen Dermatologischen Gesellschaft, 2019
    Co-Authors: Emilia Mellerowicz, Marcus Maurer, Torsten Zuberbier, Karsten Weller, Sabine Altrichter
    Abstract:

    BACKGROUND Cholinergic Urticaria (CholU) is a frequent type of chronic inducible Urticaria. Symptomatic treatment with second-generation antihistamines (sgAH) is recommended by current guidelines as first-line therapy, but little is known about how patients with CholU are treated in real life and how they respond to treatment. AIM To assess real-life treatment of CholU in German-speaking countries. METHODS Patients with CholU (n = 111) took part in an online survey study that assessed their treatments and their treatment responses. RESULTS Virtually all patients (97 %) had used antihistamines, 87 % of them sgAH; 23 % had also taken first-generation antihistamines (fgAH). The proportion of patients who benefited from standard-dosed antihistamine treatment was low (sgAH: 32 % vs. fgAH: 16 %), and side effects of sgAH and fgAH were comparable. Updosing of antihistamines had been tried by 66 patients (59 %) (most commonly [98 %, n = 65] with sgAH) and resulted in marginally better responses (sgAH: 38 % vs. fgAH: 32 %). Only very few patients had used other treatments, mostly corticosteroids (30 %) and omalizumab (5 %). CONCLUSIONS SgAH were commonly used, but insufficient in about two thirds of CholU patients. Accordingly, improved use of third-line and fourth-line treatment options and development of better therapies for patients with CholU are needed.

  • development and validation of the Cholinergic Urticaria quality of life questionnaire cholu qol
    Clinical & Experimental Allergy, 2018
    Co-Authors: J Ruft, Marcus Maurer, Torsten Zuberbier, Aida Asady, Petra Staubach, Thomas B Casale, G Sussmann, Karsten Weller, Sabine Altrichter
    Abstract:

    SummaryBackground Cholinergic Urticaria (CholU), a common form of chronic inducible Urticaria, is characterized by itchy weals that occur in response to physical exercise or passive warming. CholU patients frequently exhibit a high burden of disease. As of yet, no specific instrument is available to assess their disease-related quality-of-life (QoL) impairment. Objective The aim of this study was to develop and validate the first disease-specific QoL instrument for CholU patients, the Cholinergic Urticaria Quality-of-Life Questionnaire (CholU-QoL). Methods Using a combined approach of the literature search, semistructured patient interviews and expert opinion, we developed 96 potential CholU-QoL items. Subsequent item selection was performed by means of impact analysis complemented by an expert review for face validity. The resulting final CholU-QoL was then tested for levels of validity, reliability and influence factors in 88 CholU patients. In parallel, an US American-Canadian English version of the CholU-QoL was developed. Results The final 28-item CholU-QoL was found to have a 5-domain structure (“symptoms,” “functional life,” “social interaction,” “therapy,” “emotions”) with excellent internal consistency. The CholU-QoL also showed a valid total score, and good levels of convergent validity, known-groups validity, as well as test-retest reliability. Multiple regression analysis found no significant drivers of the CholU-QoL total score. Conclusions and Clinical Relevance The CholU-QoL is the first disease-specific QoL instrument for CholU and also the first specific QoL measure in the field of chronic inducible Urticarias. It may serve as a valuable tool for clinical trials and improve routine patient management.

  • physical Urticarias and Cholinergic Urticaria
    Immunology and Allergy Clinics of North America, 2014
    Co-Authors: M Abajian, Sabine Altrichter, Torsten Zuberbier, N Schoepke, Marcus Maurer
    Abstract:

    : Physical Urticarias are a unique subgroup of chronic Urticaria in which Urticarial responses can be reproducibly induced by different specific physical stimuli acting on the skin. These conditions include Urticaria factitia/symptomatic dermographism, delayed pressure Urticaria, cold contact Urticaria, heat contact Urticaria, solar Urticaria, and vibratory Urticaria/angioedema. Physical Urticarias and Cholinergic Urticarias are diagnosed based on the patients' history and provocation tests including trigger threshold testing where possible. Treatment is mainly symptomatic. Many patients benefit from avoiding eliciting triggers, and desensitization to these triggers can be helpful in some physical Urticarias and in Cholinergic Urticaria.

  • double blind crossover study of high dose cetirizine in Cholinergic Urticaria
    Dermatology, 1996
    Co-Authors: Torsten Zuberbier, B Burtin, C Munzberger, U Haustein, E Trippas, S D Mariz, Beate M Henz
    Abstract:

    Background: Cholinergic Urticaria does not respond well to treatment with conventional antihistamines and is difficult to study because of its highly variable clinical expression wh

  • efficacy of cetirizine in Cholinergic Urticaria
    Acta Dermato-venereologica, 1995
    Co-Authors: Torsten Zuberbier, W Aberer, B Burtin, J P Rihoux, Beate M Czarnetzki
    Abstract:

    : In order to examine the efficacy of cetirizine in Cholinergic Urticaria, we studied 24 patients in a double-blind crossover design during 3-week treatment periods, with either 10 or 20 mg/d cetirizine or placebo. The placebo period was always placed in between the two verum treatments to allow for a washout of the drug. Evaluation of the patients' daily symptom scores based on itching, erythema and whealing showed a highly significant improvement (p < 0.01). The percentage of days with mild or no symptoms was also increased significantly with the drug (p < 0.05). Except for whealing (p < 0.05), no significant differences between the two dosages of cetirizine could be determined. Since antihistamines have previously been shown to be frequently unsatisfactory in the treatment of Cholinergic Urticaria, the present data are encouraging regarding the control of symptoms in this condition.

Chikako Nishigori - One of the best experts on this subject based on the ideXlab platform.

  • Cholinergic Urticaria epidemiology physiopathology new categorization and management
    Clinical Autonomic Research, 2018
    Co-Authors: Atsushi Fukunaga, Ken Washio, Mayumi Hatakeyama, Kanako Ogura, Tatsuya Horikawa, Chikako Nishigori
    Abstract:

    The aim of this study was to review the evidence on the epidemiology, physiopathology, categorization, and management of Cholinergic Urticaria. We specifically focused on several subtypes of Cholinergic Urticaria and investigated the relationship between Cholinergic Urticaria and idiopathic anhidrosis. Using an integrative approach, we reviewed publications addressing the epidemiology, clinical features, diagnostic approach, physiopathology, subtype classification, and therapeutic approach to Cholinergic Urticaria. Multiple mechanisms were found to contribute to the development of Cholinergic Urticaria. This disorder should be classified based on the pathogenesis and clinical characteristics of each subtype. Such a classification system would lead to better management of this resistant condition. In particular, sweating function should be given more attention when examining patients with Cholinergic Urticaria. Because Cholinergic Urticaria is not a homogeneous disease, its subtype classification is essential for selection of the most suitable therapeutic method.

  • addition of lafutidine can improve disease activity and lead to better quality of life in refractory Cholinergic Urticaria unresponsive to histamine h1 antagonists
    Journal of Dermatological Science, 2016
    Co-Authors: Mayumi Hatakeyama, Atsushi Fukunaga, Ken Washio, Kanako Ogura, Tatsuya Horikawa, Yozo Yamada, Chikako Nishigori
    Abstract:

    Abbreviations: CU, Cholinergic Urticaria; H1RA, H1 receptor antagonists; H2RA, H2 receptor antagonists; QoL, quality of life; DLQI-J, Dermatology Life Quality Index. * Corresponding author at: Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, 67 Asahimachi, Kurume, Fukuoka 8300011, Japan. Fax: +81 942 31 7853. E-mail address: hashimot@med.kurume-u.ac.jp (T. Hashimoto).

  • rapid desensitization with autologous sweat in Cholinergic Urticaria
    Allergology International, 2011
    Co-Authors: Takeshi Kozaru, Atsushi Fukunaga, Kanako Ogura, Tatsuya Horikawa, Kumiko Taguchi, Tohru Nagano, Chikako Nishigori
    Abstract:

    ABSTRACT Background The majority of patients with Cholinergic Urticaria presents with strong hypersensitivity to autologous sweat. Patients with severe Cholinergic Urticaria are frequently resistant to H1 antagonists which are used in conventional therapies for various types of Urticaria. It has been reported that desensitization using partially purified sweat antigen was effective in a patient with Cholinergic Urticaria. Methods The aim of this study is to determine the usefulness of rapid desensitization with autologous sweat in severe Cholinergic Urticaria, because rapid desensitization has proven to be a quick and effective immunotherapy for allergies to various allergens. Six patients with severe Cholinergic Urticaria who are resistant to H1 antagonists and have sweat hypersensitivity were enrolled in a rapid desensitization protocol. Results In all six patients, the responses for skin tests with autologous sweat were attenuated after rapid desensitization with autologous sweat. Two of the three Cholinergic Urticaria patients showed reduced histamine release with autologous sweat after the rapid desensitization with autologous sweat. Further, the rapid desensitization and subsequent maintenance treatment reduced the symptoms in five of the six patients. Conclusions This study provides evidence that rapid desensitization with autologous sweat is beneficial for treating Cholinergic Urticaria patients resistant to conventional therapy who have sweat hypersensitivity.

  • New concepts of hive formation in Cholinergic Urticaria
    Current Allergy and Asthma Reports, 2009
    Co-Authors: Tastuya Horikawa, Atsushi Fukunaga, Chikako Nishigori
    Abstract:

    Patients with Cholinergic Urticaria (CU) show a number of small, short-lasting hives when their body core temperature increases, usually during sweating following exercise or bathing. The precise mechanism(s) of hive formation in CU has been unclear except for the involvement of acetylcholine. We recently reported that most CU patients show immediate-type skin responses to their own sweat, whereas the rest of CU patients have positive autologous serum skin tests (ASSTs). The former group produced satellite wheals following acetylcholine injection, whereas the latter group produced hives in conjunction with hair follicles. We propose two subtypes of CU: 1) a sweat-hypersensitivity type with strong hypersensitivity to autologous sweat, nonfollicular hives, development of satellite wheals, and lack of positive ASST; and 2) a follicular type with follicular hives and positive ASST, but no hypersensitivity to autologous sweat or satellite wheals. We discuss the mechanisms of hive formation in these subtypes.

  • responsiveness to autologous sweat and serum in Cholinergic Urticaria classifies its clinical subtypes
    The Journal of Allergy and Clinical Immunology, 2005
    Co-Authors: Atsushi Fukunaga, Chikako Nishigori, Toshinori Bito, Kenta Tsuru, Akiko Oohashi, Xijun Yu, Masamitsu Ichihashi, Tatsuya Horikawa
    Abstract:

    Background It has been reported that patients with Cholinergic Urticaria have a type 1 allergy to autologous sweat; however, the pathogenesis of that disorder has not been fully elucidated. Objective We investigated the responsiveness to autologous sweat and serum in patients with Cholinergic Urticaria in relation to their clinical characteristics. We further classified the clinical subtypes that are clearly characterized by responsiveness to in vivo and in vitro tests as well as their clinical features. Methods Intradermal tests with autologous sweat and serum were performed in 18 patients with Cholinergic Urticaria. Histamine release from peripheral blood basophils induced by autologous sweat was measured. Results Eleven of 17 patients with Cholinergic Urticaria showed positive reactions in skin tests with their own diluted sweat. Substantial amounts of sweat-induced histamine release from autologous basophils were observed in 10 of 17 patients. Eight of 15 patients with Cholinergic Urticaria showed positive reactions in the autologous serum skin tests. All 6 patients who developed satellite wheals after the acetylcholine test showed hypersensitivity to sweat. Further, patients whose eruptions were coincident with hair follicles showed positive responses to the skin test with autologous serum, whereas patients whose eruptions were not coincident with hair follicles did not. Conclusion On the basis of these findings, we propose that Cholinergic Urticaria should be classified into 2 distinct subtypes. The first (nonfollicular) subtype shows strong positive reactions to autologous sweat and negative reactions to autologous serum. The second (follicular) subtype shows weak reactions to autologous sweat and positive reactions to autologous serum.

Michihiro Hide - One of the best experts on this subject based on the ideXlab platform.

  • sensitization against skin resident fungi is associated with atopy in Cholinergic Urticaria patients
    Clinical and Translational Allergy, 2020
    Co-Authors: Sabine Altrichter, Makiko Hiragun, Michihiro Hide, Pia Schumacher, Ola Alraboni, Yiyu Wang, Marcus Maurer
    Abstract:

    Background Cholinergic Urticaria (CholU) is a common type of chronic inducible Urticaria, characterized by small itchy wheals that appear upon physical exercise or passive warming. Malassezia globosa, a skin resident fungus, has been identified as an antigen that induces mast cell/basophil degranulation and wheal formation through specific IgE, in Japanese patients with atopic dermatitis and CholU. In this study we aimed in assessing the rate of IgE sensitizations against skin resident fungi in European CholU patients. Methods We assessed serum IgE levels to Malassezia furfur, Candida albicans and Trichophyton mentagrophytes using routine lab testing and Malassezia globosa using a newly established ELISA. We correlated the results to wheal formation and other clinical features. Results Four patients (of 30 tested) had elevated levels of IgE against Malassezia furfur and Candida albicans and two had elevated levels of IgE against Trichophyton mentagrophytes. Four sera (of 25 tested) had elevated levels of IgE to the Malassezia globosa antigen supMGL_1304. Sensitization to one skin fungus was highly correlated with sensitization to the other tested fungi. We saw highly significant correlations of sensitization to supMGL_1304 with wheal size in the autologous sweat skin test (rs = 0.7, P = 0.002, n = 19), the Erlangen atopy score (rs = 0.5, P = 0.03, n = 19), total IgE serum levels (rs = 0.5, P = 0.04, n = 19) and a positive screen for IgE against common airborne/inhalant allergens s (sx1; rs = 0.54, P = 0.02, n = 19). Conclusions Sensitization to skin resident fungi including Malassezia globosa is uncommon in European CholU patients, but is associated with atopy and pronounced wheal formation upon dermal contact with their own sweat.Trial registration German Clinical Trials Registry DRKS-ID: DRKS00004277.

  • case of Cholinergic Urticaria accompanied by anaphylaxis
    Journal of Dermatology, 2017
    Co-Authors: Shigeruko Iijima, Kazumi Kojo, Noriko Takayama, Makiko Hiragun, Michihiro Hide
    Abstract:

    Cholinergic Urticaria occasionally occurs in combination with anaphylactic symptoms. However, this has not been widely reported. Herein, we report the case of a 14-year-old Japanese male who was diagnosed with Cholinergic Urticaria accompanied by anaphylaxis. The patient, who was suffering from atopic dermatitis and bronchial asthma, had developed wheals after exercising or bathing, which would have increased his core body temperature, since summer 2014. He experienced two episodes of severe systemic symptoms and wheal development when he took a bath after eating in December 2014 and the following January. His symptoms included wheezing, numbness of the lips, respiratory distress, blindness and fainting. Laboratory tests revealed the following results: serum IgE level, 7060 IU/mL; titers of specific immunoglobulin E antibodies against Malassezia and MGL_1304, 31.70 UA/mL and 112.5 ng/mL, respectively. A histamine release test against human sweat revealed a class 4 response. Skin prick and intradermal tests against autologous sweat produced immediate-type positive reactions. According to these findings, we diagnosed him with the sweat-hypersensitivity type of Cholinergic Urticaria accompanied by anaphylaxis. He was successfully treated with lafutidine, a histamine H2 receptor antagonist, in combination with fexofenadine. It is important for dermatologists to be aware that Cholinergic Urticaria can progress to anaphylaxis.

  • histamine release neutralization assay for sera of patients with atopic dermatitis and or Cholinergic Urticaria is useful to screen type i hypersensitivity against sweat antigens
    Archives of Dermatological Research, 2012
    Co-Authors: Hajime Shindo, Hidenori Suzuki, Kaori Ishii, Yuhki Yanase, Michihiro Hide
    Abstract:

    We previously reported that about 80 % of patients with atopic dermatitis and 60 % with Cholinergic Urticaria revealed type I allergy against sweat, by means of skin test against autologous sweat and/or histamine-release test for peripheral blood basophils with semi-purified sweat antigen. In this study, we developed an assay for sera to neutralize histamine-releasing activity of semi-purified sweat antigen. The semi-purified sweat antigen was pre-incubated with serially diluted sera for 30 min at 37 °C and was subjected to histamine-release activity. Histamine release-neutralization (HRN) activities were calculated by measuring the amount of histamine release from basophils in the presence or absence of semi-purified sweat antigen. Of 62 subjects, 39 showed positive histamine release (≥5 %) from their basophils in response to semi-purified sweat antigen, and sera of 34 out of 39 subjects (87.2 %) were also positive in HRN activity (≥10 %). The specificity of the HRN assay was 0.522. Moreover, HRN activities in sera were largely correlated with degrees of histamine release from peripheral blood basophils of the same donors in response to sweat antigen. To identify the substance that neutralizes histamine-release activity, we removed IgE and IgG from the sera of HRN (+) subjects by column chromatography. The HRN activities in 30 out of 42 sera were largely reduced by the removal of IgG. On the other hand, sera of four subjects lost HRN activity by the removal of IgE, suggesting that the majority of HRN (+) subjects have serum IgG against the sweat antigen as well as IgE bound to peripheral basophils. Thus, the HRN assay maybe useful for the screening of type I allergy against sweat antigen.

  • Histamine release-neutralization assay for sera of patients with atopic dermatitis and/or Cholinergic Urticaria is useful to screen type I hypersensitivity against sweat antigens.
    Archives of Dermatological Research, 2012
    Co-Authors: Hajime Shindo, Hidenori Suzuki, Kaori Ishii, Yuhki Yanase, Michihiro Hide
    Abstract:

    We previously reported that about 80 % of patients with atopic dermatitis and 60 % with Cholinergic Urticaria revealed type I allergy against sweat, by means of skin test against autologous sweat and/or histamine-release test for peripheral blood basophils with semi-purified sweat antigen. In this study, we developed an assay for sera to neutralize histamine-releasing activity of semi-purified sweat antigen. The semi-purified sweat antigen was pre-incubated with serially diluted sera for 30 min at 37 °C and was subjected to histamine-release activity. Histamine release-neutralization (HRN) activities were calculated by measuring the amount of histamine release from basophils in the presence or absence of semi-purified sweat antigen. Of 62 subjects, 39 showed positive histamine release (≥5 %) from their basophils in response to semi-purified sweat antigen, and sera of 34 out of 39 subjects (87.2 %) were also positive in HRN activity (≥10 %). The specificity of the HRN assay was 0.522. Moreover, HRN activities in sera were largely correlated with degrees of histamine release from peripheral blood basophils of the same donors in response to sweat antigen. To identify the substance that neutralizes histamine-release activity, we removed IgE and IgG from the sera of HRN (+) subjects by column chromatography. The HRN activities in 30 out of 42 sera were largely reduced by the removal of IgG. On the other hand, sera of four subjects lost HRN activity by the removal of IgE, suggesting that the majority of HRN (+) subjects have serum IgG against the sweat antigen as well as IgE bound to peripheral basophils. Thus, the HRN assay maybe useful for the screening of type I allergy against sweat antigen.

  • sweat antigen induces histamine release from basophils of patients with Cholinergic Urticaria associated with atopic diathesis
    British Journal of Dermatology, 2009
    Co-Authors: Shunsuke Takahagi, Toshihiko Tanaka, Kaori Ishii, Hidenori Suzuki, Yoshikazu Kameyoshi, Hajime Shindo, Michihiro Hide
    Abstract:

    Summary Background  We previously demonstrated that the semipurified human sweat antigen causes skin reactions and histamine release from basophils via specific IgE in patients with atopic dermatitis (AD). Patients with Cholinergic Urticaria (ChU) also develop skin reactions and histamine release of basophils in response to autologous sweat. Objectives  To study whether or not patients with ChU share sensitivity for the sweat antigen with patients with AD and to study the clinical characteristics among patients with ChU and the relationship with histamine-release activity of basophils. Methods  The sweat antigen that induces histamine release from basophils of patients with AD was prepared by Con-A, anion-exchange and reverse-phase chromatography. Relationships between histamine-release activity against the sweat antigen and clinical features of patients with ChU were analysed. Results  Twenty-three of 35 patients with ChU showed > 5% net histamine release in response to the semipurified sweat antigen, whereas none of healthy controls did so. In patients with ChU, histamine release in response to semipurified sweat antigen significantly correlated with the level of serum IgE and eosinophil numbers in peripheral blood. Incidence of each atopic disease in patients with ChU tended to be higher than in the general Japanese population. When the patients were categorized according to their responses in the histamine release test, the positive group tended to show a higher incidence of AD and bronchial asthma compared with the negative group. Conclusions  ChU and AD may share hypersensitivity to common antigens in sweat. The sweat allergy and atopic diathesis are associated with each other.