October Newsletter II

Chronic Hives (urticaria)

Chronic hives (urticaria) is defined by the presence of hives on most days for a duration of longer than six weeks [1]. Some patients may have angioedema or swelling of body tissue associated with urticaria as well

Chronic urticaria is initially treated with H1 antihistamines, such as Zyrtec or Allegra, sometimes at higher than usual doses. In addition, many patients may need a combination with H2 antihistamines and Singulair as well [2]. It is not uncommon to need short courses of systemic glucocorticoids to control severe exacerbations, however, long-term oral glucocorticoids should be avoided if possible, as they may have severe side effects and there is not any evidence that they alter the natural history of chronic urticaria [2,3].

In treating patients with chronic urticaria, our goal of therapy is to achieve symptom control which is tolerable for the patient and an improvement in his or her quality of life. Choices of treatment options are made carefully as minimizing therapy-related side effects is a priority in treating a patient with chronic urticaria.

Omalizumab is a monoclonal antibody against immunoglobulin E (IgE), and was approved for chronic urticaria that doesn't respond to H1 antihistamines by the US Food and Drug Administration earlier this year [1]. Omalizumab is safe and effective for most patients and has been used to treat many different types of urticaria, including autoimmune, solar, cholinergic, dermatographism and angioedema without urticaria. Dr. Baker has been using Xolair since 2008 for the treatment of both chronic urticaria, urticaria with associated angioedema and histaminergic angioedema without urticaria. If you or someone you know is interested in receiving treatment or more information about chronic urticaria, please notify us at (503)636-9011.

1. http://www.gene.com/media/press-releases/14563/2014-03-21/fda-approves-xolair-omalizumab-for-peopl (Accessed on October 21, 2014).

2. Kaplan AP. Clinical practice. Chronic urticaria and angioedema. N Engl J Med 2002; 346:175.

Bernstein JA, Lang DM, Khan DA, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol 2014; 133:1270.

3. Kim S, Baek S, Shin B, et al. Influence of initial treatment modality on long-term control of chronic idiopathic urticaria. PLoS One 2013; 8:e69345. US Food and Drug Administration (FDA) new and generic drug approvals.

Halloween and Food Allergies

With the celebration of Halloween coming up, so does the associated concern of accidental exposure to food allergies for our patients. Many types of candy given out during trick or treating contain the most common food allergens, such as milk, egg, soy, peanuts, tree nuts and wheat. It is important to take time to read labels prior to allowing children with food allergies ingesting halloween treats. This year, The Food Allergy, Research & Education (FARE) network is encouraging families to paint a pumpkin teal and place it on their doorsteps to notify trick or treaters that they offer non-food treats, such as:

•Glow sticks, bracelets, or necklaces
•Pencils, pens, crayons or markers
•Bubbles
•Halloween erasers or pencil toppers
•Whistles, kazoos, or noisemakers
•Finger puppets or novelty toys
•Mini Slinkies
•Bouncy balls
•Coins
•Spider rings
•Vampire fangs
•Mini notepads
•Playing cards
•Bookmarks
•Stickers
•Stencils

According to FARE, the Teal Pumpkin Project is aimed at promoting inclusion and respect for all children with food allergies. In addition, it may help to increase safety for those with food allergies who would like to participate in trick or treating [1].

You can print your own Teal Pumpkin Project sign and place it on you door to raise awareness using the following link:

http://blogdotfoodallergydotorg.files.wordpress.com/2014/10/teal-pumpkin-sign.pdf

1. http://www.foodallergy.org/teal-pumpkin-project (Accessed on October 21, 2014).