Bay Biosciences provides high quality, clinical grade, fresh frozen biopsy bio-specimens, cryogenically preserved sera (serum), plasma and peripheral blood mononuclear cells (PBMC) biofluid samples from patients diagnosed with Chronic Idiopathic Urticaria.
The sera (serum), plasma and PBMC biofluid specimens are processed from patient’s peripheral whole-blood using customized collection and processing protocols. The chronic idiopathic urticaria biopsy and biofluid samples are collected from unique patients diagnosed with chronic idiopathic urticaria and are provided to a valued pharmaceutical customer for research, diagnostics, discovery and drug development.
Detailed clinical data, chronic idiopathic urticaria patients history, symptoms, complete blood count (CBC), biopsy tissue, elevated biomarker levels, genetic and metabolic information, histopathological findings, annotations associated with chronic idiopathic urticaria specimens is provided to a valued customer for research, development and drug discovery.
The chronic idiopathic urticaria sera (serum), plasma and peripheral blood mononuclear cells (PBMC) biofluid are processed from patients peripheral whole-blood using customized collection and processing protocols.
Chronic Idiopathic Urticaria Overview
Urticaria is a skin condition characterized by hives (wheals) angioedema (swellings ) or both. There are several types of urticaria. Urticaria is the medical term for hives. These are itchy reddish bumps, or welts, on your skin which range in size from small spots to large blotches. Dermatologist may call the bumps wheals.
Many people get hives, itchy red or skin-colored welts also known as urticaria, defined as a widespread, fugacious, itchy cutaneous swelling. It is one of the most frequent dermatosis, being its prevalence in general population estimated about 20%. Urticaria is regarded as idiopathic in approximately 75% of affected patients. They’re often caused by an allergic reaction to a food or drug. Usually, they go away quickly. For a small number of people, though, hives come back again and again, with no known cause. When new outbreaks happen almost every day for 6 weeks or more, it’s called chronic idiopathic urticaria (CIU). When the hives last for more than six weeks, they’re called chronic. And when the cause is unknown, they’re called idiopathic. About 25% of the cases are chronic urticaria (CU). Hives can be very uncomfortable, interfering with sleep and normal daily activity. Chronic hives don’t pose an immediate risk. But the sudden appearance of hives can be a sign of an allergic reaction that could lead to anaphylactic shock. This is a serious condition that can close off the throat and lead to strangulation.
Signs and Symptoms of Chronic Idiopathic Urticaria
Following are the common signs and symptoms of chronic idiopathic urticaria:
- Raised or swollen red welts on the skin (hives or wheals) that last for more than six weeks
- Itching, sometimes severe
- Swelling of the lips, eyelids, or throat (angioedema)
The hives may change size, fade, and reappear. Heat, exercise, or stress may aggravate the symptoms.
Some patients with chronic idiopathic urticaria report various associated systemic symptoms. These include:
- Headaches
- Fatigue
- Joint pain or swelling
- Wheezing
- Shortness of breath
- Flushing and palpitations
- Gastrointestinal symptoms
- Diarrhea
- Constipation
Causes of Chronic Idiopathic Urticaria
Chronic idiopathic urticaria is caused by a combination of factors, it is not an allergy and is not contagious. Causes may include something in the environmental irritants, the immune system, and persons genetic makeup. It can also be a response to a bacterial, fungal, or viral infection. Chronic idiopathic urticaria involves activation of the immune response system. It also affects the nerve hormone and the clotting processes in your blood.
Hives (wheals) are developed due to release of chemical mediators from tissue mast cells and circulating basophils. These chemical mediators include histamine, platelet-activating factor and cytokines. The mediators activate sensory nerves and cause dilation of blood vessels and leakage of fluid into surrounding tissues. Bradykinin release causes angioedema. Several hypotheses have been proposed to explain urticaria. The immune, arachidonic acid and coagulation systems are involved, and genetic mutations are under investigation.
Chronic spontaneous urticaria is mainly idiopathic (cause unknown). An autoimmune disease cause is likely. About half of investigated patients carry functional IgG autoantibodies to immunoglobulin IgE or high-affinity receptor FcεRIα.
Following factors may trigger chronic idiopathic urticaria (CIU) causing an outbreak of hives:
- Alcohol consumption or certain foods
- Infection
- Pain medications
- Stress
- Exposure to heat or cold
- Exposure to sunlight
- Exercise
- Pressure on your skin from wearing tight clothing
- Scratching
- Insects, bugs or parasites
Thyroid Link Chronic Idiopathic Urticaria
Chronic urticaria may be a symptom of a thyroid problem, this is more common in women patients. Studies suggests that some patients with chronic urticaria had thyroid (anti-TPO) antibodies in their blood. Some of these women patients were found to have hyperthyroidism and were treated for it. Anti-TPO antibodies may also indicate the presence of an autoimmune thyroid disease, such as Graves disease or Hashimoto’s Thyroiditis.
Diagnosis of Chronic Idiopathic Urticaria
Chronic urticaria is diagnosed in patients with a long history of daily or episodic hives (wheals) that last less than 24 hours, with or without angioedema. A family history should be elicited. A thorough physical examination should be undertaken to evaluate the cause. Inducible urticaria is often confirmed by inducing the reaction, such as scratching the skin in dermatographia or applying an ice cube in suspected cold urticaria.
There are no routine diagnostic tests in chronic spontaneous urticaria apart from blood count and C-reactive protein (CBC, CRP), but investigations may be undertaken if an underlying disorder is suspected.
- The autologous serum skin test is sometimes carried out in chronic spontaneous urticaria, but its value is uncertain. It is positive if an injection of the patient’s serum under the skin causes a red weal.
- Investigations for a systemic condition or autoinflammatory disease should be undertaken in urticaria patients with fever, joint or bone pain, and malaise.
- Patients with angioedema without hives (wheals) should be asked if they take ACE–inhibitor drugs and should be tested for complement C4; C1-INH levels, function and antibodies; and C1q.
- Biopsy of urticaria can be non-specific and difficult to interpret. The pathology shows edema in the dermis and dilated blood vessels, with a variable mixed inflammatory infiltrate. Vessel-wall damage indicates urticarial vasculitis.
Treatment of Chronic Idiopathic Urticaria
The main treatment for chronic urticaria is oral over the counter (OTC) antihistamines (allergy medication), these are usually the first-line of treatment for chronic hives. If the standard dose (eg, 10 mg for cetirizine) is not effective, the dose can be increased fourfold (eg, 40 mg cetirizine daily). There is not thought to be any benefit from adding a second antihistamine.
Non-drowsy over the counter (OTC) antihistamines with less side effects include:
- Cetirizine (Zyrtec)
- Loratadine (Claritin)
- Fexofenadine (Allegra)
- Desloratadine (Clarinex)
If your hives don’t clear up with over the counter (OTC) antihistamines, your doctor may try one or more other types of the following treatments:
- H2 blockers: These are drugs that block the production of histamines that can cause hives or overproduction of stomach acids. Common versions are ranitidine (Zantac), cimetidine (Tagamet HB), and famotidine (Pepcid).
- Short-term oral corticosteroids, such as prednisone: These are especially useful for reducing the swelling around eyes, lips, or throat (angioedema) that can accompany hives.
- Antidepressants, such as doxepin cream (Zonalon).
- Immune suppressants: These include cyclosporine (Gengraf, Neoral) and tacrolimus (Astagraft XL, Prograf).
- Monoclonal antibodies: Omalizumab (Xolair) is an expensive, newer drug that has proved to be very effective against chronic idiopathic urticaria. It’s typically injected once a month.
In one study, over 80 % of the patients with chronic urticaria had a complete remission after treatment with omalizumab. However, symptoms returned within four to seven weeks after the drug was stopped.
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