Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0042109 (urticaria)
 6,569 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An open comparative trial of nizatidine in the treatment of duodenal ulcer (DU) was carried out with cimetidine as control. Forty-three patients with endoscopically proven DU were recruited into the study. Twenty-three patients were assigned to treatment with nizatidine 300 mg daily and 20 patients (controls) were on cimetidine 800 mg daily. Both groups were comparable in age and sex distribution - age range 21 to 74 years; mean 53.4 years and 43 years in the nizatidine and cimetidine groups respectively. Liver function tests, full blood counts, platelets, urea, electrolytes were done together with endoscopy at four, eight, twelve weeks. In the nizatidine group, 16 patients completed the study whilst 17 patients on cimetidine completed the study. Healing rates at four and eight weeks on nizatidine were 9/16 (56%) and 14/16 (87.5%) respectively. On cimetidine, healing rates at four and eight weeks were 14/17 (80%) and 16/17 (94%) respectively. There was no statistical difference in healing rates between the two groups at four and eight weeks (p = 0.1, p = 0.47). One patient on nizatidine developed urticaria rash which resolved on drug withdrawal. No other adverse clinical or biochemical effects were observed in the cohort after twelve weeks of treatment. Nizatidine is as effective as cimetidine in healing DU at four and eight weeks.
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PMID:Nizatidine versus cimetidine in the treatment of duodenal ulcers. 167 16

Minocycline is widely used as a second-line antimicrobial for acne vulgaris. Some patients require doses of up to 200 mg daily to control their acne. To assess the long-term safety of minocycline when used at higher doses, 700 patients treated with minocycline at doses of 100 mg daily, 100/200 mg on alternate days and 200 mg daily, were recruited. The mean duration of treatment was 10.5 months. Side-effects were monitored and full blood count, blood urea, electrolytes and liver function tests were carried out on 200 of the 700 patients. Side-effects were recorded in 13.6%, and included vestibular disturbance, candida infection, gastrointestinal disturbance, cutaneous symptoms (pigmentation, pruritus, photosensitive rash and urticaria) and benign intracranial hypertension. Pigmentation was the only side-effect found to be significantly increased in patients taking higher doses of minocycline, as compared with lower doses (P < 0.01). All patients with pigmentation had taken a total cumulative dose of over 70 g. No significant abnormalities were found in any of the haematological and biochemical profiles. We conclude that minocycline, at doses of up to 200 mg/day, is safe, long-term, for acne, when such doses are clinically necessary.
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PMID:Safety of long-term high-dose minocycline in the treatment of acne. 873 73

Standard prophylaxis and treatment of malignancy-associated hyperuricemia in the USA has been allopurinol with vigorous hydration, urinary alkalinization and osmotic diuresis. Urate oxidase, the enzyme that converts uric acid to allantoin (a readily excreted metabolite that has 5- to 10-fold higher solubility than uric acid), is an alternative therapy; however, few published findings support this practice. Between February 1994 and December 1996, we administered non-recombinant urate oxidase (Uricozyme) to 126 children with newly diagnosed non-B cell acute lymphoblastic leukemia (ALL) during the first 5 days of chemotherapy with methotrexate, 6-mercaptopurine or both. Their blood levels of uric acid and other indicators of tumor lysis were measured at diagnosis and during treatment and then compared with findings in 129 similarly treated historical controls who had received allopurinol to control hyperuricemia. Clinical responses to urate oxidase were also determined in eight patients with newly diagnosed B cell ALL or advanced-stage non-Hodgkin lymphoma. Patients treated with urate oxidase had rapid and significantly greater decreases in their blood uric acid levels than did the historical controls (median maximal level during treatment, 2.3 vs 3.9 mg/dl, P < 0.001). They also had lower creatinine (0.6 vs 0.7 mg/dl, P = 0.01) and blood urea nitrogen (11 vs 24 mg/dl, P < 0.001) levels. Similar findings were made in the eight cases of B cell ALL or non-Hodgkin lymphoma. None of the patients required dialysis for acute renal failure. Six (4.5%) of the 134 children given urate oxidase had allergic reactions, manifested primarily by urticaria, bronchospasm and hypoxemia. Thus, non-recombinant urate oxidase is a more effective uricolytic agent than allopurinol but is associated with acute hypersensitivity reactions, even in patients without a history of allergy.
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PMID:Urate oxidase in prevention and treatment of hyperuricemia associated with lymphoid malignancies. 936 11

Helicobacter pylori, the most important cause of gastritis and peptic ulcer, recently has been associated with several extradigestive diseases. The aim of this study was to assess the prevalence of Helicobacter pylori infection and the effects of bacterium eradication in 42 consecutive patients affected by idiopathic chronic urticaria. Helicobacter pylori was assessed by [13C]urea breath test. Amoxicillin, clarithromycin, and lansoprazole were given to infected patients for seven days. Urticaria and gastrointestinal symptoms were assessed on enrollment and after eradication. Fifty-five percent of patients proved to be infected by Helicobacter pylori. Prevalence of gastrointestinal symptoms did not differ between infected and uninfected patients. Eighty-eight percent of infected patients in whom the bacterium was eradicated after therapy showed a total or partial remission of urticaria symptoms. Conversely, symptoms remained unchanged in all uninfected patients. In conclusion, Helicobacter pylori affects a high percentage of patients with idiopathic chronic urticaria; however, typical gastrointestinal symptoms do not identify infection status. Bacterium eradication is associated with a remission of urticaria symptoms, suggesting a possible role of Helicobacter pylori in the pathogenesis of this skin disorder.
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PMID:Beneficial effects of Helicobacter pylori eradication on idiopathic chronic urticaria. 1008 Jan 38

Chronic urticaria can result from multiple causes. A number of factors have been identified that can appear to be important in the pathogenesis of individual cases, including intolerance to food, drugs, some internal diseases and some infections. Recently a possible relationship between chronic urticaria and Helicobacter pylori has been suggested. One hundred and twenty-five patients were investigated for Helicobacter pylori infection by means of ELISA assay and 13C urea-breath tests. When the two tests were positive, gastric biopsy was performed after informed consent. Patients with Helicobacter pylori infection were randomly assigned to receive triple therapy for the eradication of bacterium for one week, or no treatment. As controls, 25 patients with chronic urticaria and with negative results on ELISA and urea-breath tests were treated with the same triple therapy course. Forty-six unrelated blood donors of both sexes were examined for the presence of anti-Helicobacter pylori antibodies in the normal population. Seventy-eight patients had circulating specific IgG antibodies against the bacterium and positive urea-breath tests. Among these patients, 31 received eradication therapy, 34 were enrolled in the control group, and 13 patients neglected the study. Three patients in the eradication therapy group showed complete remission of urticaria after 12 months of follow-up as compared with 1 patient in the control group. Twenty blood donors out of 46 were IgG anti-Helicobacter pylori positive. In conclusion, our data show that the prevalence of Helicobacter pylori infection is high in chronic urticaria patients, but eradication of the bacterium does not appear to influence the skin disorders nor the symptoms.
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PMID:Chronic urticaria and Helicobacter pylori. 983 44

In ordinary urticaria, individual lesions disappear within 24 hours. However, we sometimes encounter patients whose eruptions last longer than 24 hours, but without evidence of vasculitis or a history of exposure to pressure. In these patients, histology reveals a perivascular infiltration, predominantly of eosinophils, depending on the timing of the biopsy. Unlike urticarial vasculitis, no immunoglobulins, complement deposition, or endothelial fibrinoid degeneration is observed. The peripheral eosinophil counts and serum complement levels appear within normal range. No protein urea or joint pain is observed, and the lesions can be controlled only by systemic glucocorticoids. We recognize such a urticarial reaction as a different clinical entity than usual urticaria, which is presumably mediated by late-phase inflammatory reaction in immediate hypersensitivity.
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PMID:Late-phase urticaria Update. 1204 62

Helicobacter pylori has been involved in the pathogenesis of chronic idiopathic urticaria (CIU) in patients suffering both CIU and H. pylori infection. We selected 49 patients with 13C urea breath test positive, long-lasting CIU and H. pylori infection; 20 remained symptomatic, had positive urease test or H. pylori histologic identification in gastric biopsy material and accepted to participate in a pacebo-controlled treatment trial. They were randomized for a 7-day, double-blind, placebo-controlled H. pylori eradication treatment with amoxicillin, clarithromycin and omeprazol or placebo. H. pylori eradication was assessed by a second 13C urea breath test six weeks after the end of treatment. We observed a significant improvement of more than 70 % of CIU; baseline clinical score was seen in 4 of the 9 (44 %) patients who eradicated H. pylori after active treatment and in 1 of the 7 (12,3 %) of those who did not (p = 0.19). No clinical differences in CIU characteristics were found between patients with and without improvement. No serious adverse effects were observed in either treatment group. We conclude that the eradication of H. pylori may be useful for patients suffering long-lasting CIU and H. pylori infection, although theses results did not reach statistical significance probably owing to the strict conditions of the recruitment.
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PMID:Efficacy of the eradication of Helicobacter pylori infection in patients with chronic urticaria. A placebo-controlled double blind study. 1239 58

Recent studies suggest that autoimmune mechanisms may be involved in the etiology of chronic idiopathic urticaria (CIU). There is a higher prevalence of B12 deficiency in autoimmune diseases and possibly in gastric Helicobacter pylori (H. pylori) infection. The frequency of B12 deficiency in CIU is unknown. Our objective in this study was to determine the prevalence of B12 deficiency in patients with CIU and also its relationship to gastric H. pylori infection and serologic markers of autoimmunity in these groups. Thirty-three patients with CIU and 27 healthy controls were included in the study. Serum vitamin B12 levels, H. pylori infection and serological markers of autoimmunity (anti-thyroglobulin, thyroid microsomal, gastric parietal cell and antinuclear autoantibodies) were investigated. H. pylori infection was determined according to serology and gastric biopsy in 19 patients, serology and urea breath test in 4 patients and serology alone in the remaining 10 patients. Serum B12 levels were below the normal reference range in 11/33 (33.3%) patients with CIU. The mean serum B12 levels among patients with CIU and the controls were 281+/-127.5 pg/ml and 465.1+/-140.3 pg/ml (p=0.0001), respectively. Anti-thyroid antibodies were positive in 6 of 11 patients (54.5%) with low B12 levels, but only in 4 of 27 (14.8%) healthy controls (p=0.019). Anti-GPC antibodies were positive in 4 of 11 (36.4%) patients with CIU and low B12 levels, but only in 2 of 27 (7.4%) healthy controls (p=0.047). In CIU patients, there was no difference in the frequency of IgG H. pylori antibodies between those with low B12 levels and normal B12 levels. Among the 19 patients who had been performed gastric endoscopy, 15 patients (78.9%) had chronic antral gastritis, 2 patients (10.5%) had atrophic gastritis and there were normal findings in 2 patients (10.5%). In conclusion, serum B12 levels were found to be below the normal reference range in 33% of the patients with CIU. An association between low B12 levels and H. pylori could not be shown. The higher frequency of antithyroid and anti-GPC antibodies in patients with low B12 levels suggest that low B12 levels in CIU may be autoimmune in nature.
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PMID:Low B12 levels in chronic idiopathic urticaria. 1573 14

Pruritus can be a symptom of a distinct dermatologic condition or of an occult underlying systemic disease. Of the patients referred to a dermatologist for generalized pruritus with no apparent primary cutaneous cause, 14 to 24 percent have a systemic etiology. In the absence of a primary skin lesion, the review of systems should include evaluation for thyroid disorders, lymphoma, kidney and liver diseases, and diabetes mellitus. Findings suggestive of less serious etiologies include younger age, localized symptoms, acute onset, involvement limited to exposed areas, and a clear association with a sick contact or recent travel. Chronic or generalized pruritus, older age, and abnormal physical findings should increase concern for underlying systemic conditions. Initial evaluation for systemic disease includes complete blood count and measurement of thyroid-stimulating hormone, fasting glucose, alkaline phosphatase, bilirubin, creatinine, and blood urea nitrogen. Hodgkin lymphoma is the malignant disease most strongly associated with pruritus, which affects up to 30 percent of patients with the disease. Chest radiography is needed when lymphoma is suspected. A wheal and flare response indicates histamine-induced pruritus in patients with urticaria or an allergic dermatitis. These patients benefit from continuous dosing of a long-acting antihistamine. Second-generation antihistamines, such as cetirizine, loratadine, and fexofenadine, may be more effective because of improved patient compliance.
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PMID:A diagnostic approach to pruritus. 2176 70

Chronic spontaneous urticaria is defined as persistent symptoms of urticaria for 6 weeks or more. It is associated with autoimmunity in approximately 45 percent of patients. Therapy is often difficult however the initial approach should employ high-dose non-sedating antihistamines; 4-6 tablets/day may be necessary. It has been shown that the response to 4 tablets/day exceeds 3, and exceeds 2, which exceeds 1. However the dose that corresponds to the maximal dose of first generation antihistamines (hydroxyzine, diphenhydramine) used previously, is 6/day. Yet over half the patients are refractory to antihistamines and other agents should be tried next. Whereas current guidelines (published) often add leukotriene antagonists and/or H(2) receptor antogonists next, these are of little utility. Likewise drugs effective for urticarial vasculitis (colchicine, dapsone, sulfasalazine, hydroxychloroquine) are effective in a small percentage of patients and no study suggests that the response rate of any of them exceeds the 30% placebo responses seen in most double-blind, placebo controlled studies. The drugs that are effective for antihistamine-resistant chronic spontaneous urticaria are corticosteroids, cyclosporine, and Omalizumab. Use of steroids is limited by toxicity. If used at all, a dose of no more than 10 mg/day should be employed with a weekly reduction of 1 mg. The response rates to cyclosporine and Omalizumab are each close to 75%. Cyclosporine can be used effectively if care is taken to monitor blood pressure, urine protein, blood urea nitrogen, and creatinine, every 6 weeks. Omalizumab has the best profile in terms of efficacy/toxicity and, once approved by federal agencies for use in chronic spontaneous urticaria, a dramatic change in the treatment paradigm, whether associated with autoimmunity or not, is predicted. A phase 3 trial is currently in place. Refractoriness to both Omalizumab and cyclosporine is expected to be less than 5 percent of patients. Other agents, can then be tried.
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PMID:Treatment of chronic spontaneous urticaria. 2311 28


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