EXCITING TRIALS UNDERWAY TO BETTER TREAT CHRONIC URTICARIA
The 1st of October marks World Urticaria Day, which kicks off a month-long campaign aimed at raising greater public awareness around chronic urticaria – a debilitating skin condition characterised by the recurrent appearance of hives (urticaria) that last for six weeks or longer.
The persistent and unpredictable nature of chronic urticaria severely impacts a sufferer’s quality of life, with random, often daily episodes of intense itching, hives and or swellings that disrupt sleep and interfere with physical, social and emotional functioning.
Up to four times the recommended dose of antihistamine is typically prescribed, but even at increased doses, it’s often not effective. However, a number of exciting new trials are currently underway to help scientists find more effective treatments.
Prof Jonny Peter, head of the Division of Allergology and Clinical Immunology at Groote Schuur and the UCT Lung Institute, says up till a few years ago, little was understood about the condition, but as more data has been collected through the Urticaria Centers of Reference and Excellence (UCARE) – a global network of urticaria care clinics – more effective treatments are being trialled.
One such treatment involves a humanised monoclonal antibody that interferes with mast cell survival – the primary immune cell that leads to hives and wheal formation.
Prof Peter and other experts believe the mast cell depleting mechanism has the potential to completely control the condition. “The first set of trials conducted on this type of therapy overseas have already demonstrated remarkable response rates and impressive improvements in the quality of life in tough to treat forms of urticaria. The treatment has a rapid onset and sustained durability with a well-tolerated initial safety profile, which supports the ongoing Phase 2 studies in urticaria currently in progress across the world, including South Africa.
“The two most common types of chronic urticaria are symptomatic dermographism (SD) and cold urticaria (ColdU).
“Symptomatic dermographism occurs in approximately 2-5% of the population, where hives are triggered upon rubbing, pressure or mild trauma to the skin. The literal meaning is ‘to write on the skin’. Downward pressure on the skin produces a linear wheal in the shape of the applied external force. Other forms of chronic inducible urticarias result from specific physical or environmental stimuli like cold, heat, exercise, sunlight, water or sweating”.
Symptomatic dermographism (left) is triggered after pressure is applied to the skin, while chronic spontaneous urticaria (right) causes hives that come and go unexpectedly.
Cold urticaria is known as a type of physical urticaria that presents as wheals, in which red allergic skin lesions and itching are produced by exposure to heat or cold. A temperature device, such as TempTest® is used to evaluate and determine a patient’s allergy to cold contact urticaria. The test provides temperatures of 4°- 44° C, which transfers to the patient’s skin by placing the inner forearm on a U-shape aluminium stencil on the device for 5 minutes. The U-stencil indicates the temperature range continuously. This method makes it possible to easily specify at which threshold temperature wheals are triggered.
To help patients better manage chronic urticaria, a special chronic urticaria self-evaluation app, called, CRUSE® has been developed by renowned dermatologists and allergists.
The app allows sufferers to record symptoms as and when they happen, while also detailing how it impacts their quality of life in a matter of minutes. By giving doctors access to their CRUSE® profile, patients will be able to work with their healthcare team to track when symptoms flare up and what could have triggered the response, how they respond to treatment and how it can be improved. CRUSE® can be downloaded free of charge from any App Store.
The new chronic urticaria self-evaluation app, CRUSE® can help patients and doctors to better treat the condition.
Prof Peter says the app is vitally important in their quest to better understand and treat the condition. “One of the biggest challenges is that by the time patients get to see their doctor, they appear to be completely fine with no symptoms at all, yet the day before they were unable to go to work, because they were swollen or covered in hives. CRUSE® offers patients an easy way to track their symptoms on their devices in real time, which in turn allow doctors to make a more informed decision about what treatment should be prescribed. Another advantage of the app is that it gives doctors a record that they can produce to medical aids to motivate for better coverage as treatments can be expensive.”
Urticaria is intensely itchy and occurs anywhere on the body. Other ways that may provide relief include:
· Applying a cold compress like a cool, damp cloth to the affected area to reduce inflammation and swelling.
· Avoiding irritants, such as perfumes, fragranced soaps or moisturisers and staying out of the sun or cold – depending on what a patient’s triggers are.
Chronic urticaria affects up to 5% of the population, across ages and genders, but is more common in adult women.
The theme for this world urticaria day is “Access to care”, so If you or anyone you know, suffers from chronic urticaria, contact Noejfah Jardien at 021 406 6889 or Noejfah.Jardien@uct.ac.za, who will direct patients to their closest UCARE facility where a team of allergologists – doctors specialising in urticaria and other forms of allergy – will be able to give patients expert advice on how to manage the condition.