Future strategies may harness cannabinoids for the treatment of inflammatory skin diseases. Chronic spontaneous urticaria (CU) has a point prevalence of 0.5�C1% of buy Volasertib
the population and a high socioeconomic impact on direct and indirect healthcare costs . Psychosocial factors are estimated to contribute to the pathogenesis and exacerbation of CSU in about half of the cases according to a recent systematic review . According to a consensus report of the Global Allergy and Asthma European Network, patient-reported outcomes should be used in clinical trials and routine practice for the evaluation of urticaria patients and actually be considered as the primary outcome of future clinical trials . The Chronic Urticaria Questionnaire on Quality of Life, CU-QoL, was specifically developed and validated for the investigation of patients with CU. It is available in many languages . Nonsedating H1R antagonists are the mainstay of symptomatic therapy, but effective in <50% of patients. Although guideline-recommended updosing up to fourfold increases symptom control, new therapeutic strategies <a href="http://www.selleckchem.com/products/RO4929097.html
are needed . Updosing of nonsedative antihistamines up to fourfold may also work in cold contact urticaria without sedation, as recently shown in a randomized, crossover, double-blind, placebo-controlled 12-week study with the nonsedating H1R antagonist bilastine . The anti-IgE antibody omalizumab could be another worthwhile treatment option for CU . Evidence from Japan indicates that about one-third of CU patients not controlled by oral H1R antagonists will spontaneously be cured after one year, whereas about two-third will have lost their symptoms after 5?years . Thrombin generation through the extrinsic coagulation pathway has been linked to CU previously. Increased blood coagulation potential with involvement of intrinsic coagulation Fleroxacin
factors has recently been shown in CU, which may contribute in vivo to the generation of fibrin even by small amounts of thrombin . The differential diagnosis of CU involves urticaria vasculitis and autoinflammatory disorders like cryopyrin-associated periodic syndrome and Schnitzler's syndrome . Using a symptom-based diagnostic algorithm for management of patients with wheals or angioedema may help physicians diagnosing CU in a cost- and time-effective way . Systemic symptoms including recurrent fever attacks, arthralgia or arthritis, and fatigue in patients presenting with an urticarial rash should raise a suspicion of autoinflammatory disorders. Clinical clues and tips for identifying and managing patients presenting with a chronic urticarial rash (Fig.?2) have recently been published .