Evidence-based Study Of Non-antihistamine Treatment For Chronic Urticaria And Investigations Of Relapse-related Factors In Lanzhou Area

BACKGROUNDChronic urticaria (CU) also known as chronic spontaneous urticaria (CSU) is a common allergic disease of dermatology, characteristic by reoccurring itching and wheal lasting longer than six weeks, which accompanied by angioedema in40%of patients. It has became a very serious worldwide health problem and burden increasingly. The incidence of CU is increasing year by year because of environmental and food contamination, accelerating by the process of industrialization. By now,0.5-1.0%of the population suffers from CU in the world. CU impact patients’quality of life (QOL) seriously. There are high direct and indirect healthcare costs of this disease due to the large socioeconomic implications of reduction in performance. Although antihistamines as mainstay of treatment for CU can alleviate some symptoms, factors such as capricious course, intermittent attack, poor responsiveness to treatment, and ongoing recurrence trouble both clinicians and patients. Thus, new therapy strategies and etiology research of CU constitute our most urgent problem.OBJECTIVESThe study systematically reviewed allergen specific immunotherapy (SIT) and Chinese angelica decoction (CAD) for CU by meta-analysis, to evaluate the efficacy and safety of SIT and CAD versus conventional treatment (CT) in the treatment of CU. To investigate relapse-related risk factors of patients with urticaria in Lanzhou area, provide clinical evidence and information to the prevention of relapse of this disease.METHODSThe comprehensive search strategies of various electronic databases (MEDLINE, EMBASE, the Cochrane Library, ISI Web of Knowledge, China National Knowledge Infrastructure, CNKI, CBMWeb and Chinese Scientific Journals Full Text Database) were used in this study to evaluate the efficiency and safety of SIT and CAD versus conventional treatment (CT) in patients with CU. In addition, manual searched reference lists from original studies and review articles. Only randomized controlled trials (RCT) included our searching criteria but not limited language. Upon strictly included and excluded standard, the primary outcomes were efficacy and quality of life (QOL) and the secondary outcomes were relapse rate and adverse events (AEs).Case-control study was used to collect the information from222CU cases and163controls that were all Lanzhou dwellers. The information including general social and demographic characteristics, eating habits, diet history, drugs using history, vaccination history, sleep and mental condition, physical stimulation, et al. were investigated retrospectively. Then, SPSS13.0software was used for statistical analysis.RESULTSFourteen studies (1,838patients) were included in systematical review of SIT. Our study demonstrated that SIT seemed to show more clinical efficacy rate (OR2.39;95%CI,1.73to3.30;I2=55%), more complete recovery rate (OR2.13;95%CI,1.55to2.91;I2=61%), and less relapse rate two weeks after treatment (OR0.38;95%CI,0.24to0.61;I2=36%) than CT. However, the pooled results of studies using urticaria activity score (UAS) were different from those of studies using non-UAS. Only one study reported improved QOL and no study reported serious AEs after SIT.Eleven studies (1,081patients) were included in systematical review of CAD. Our study demonstrated that CAD seemed to show more complete recovery rate (OR2.36;95%CI,1.80to3.10; I2=22%), more clinical efficacy rate (OR4.56;95%CI,2.65to7.87; I2=0%), and less relapse rate the third month after treatment (OR0.43;95%CI,0.22to0.82;I2=0%) than CT. No study reported QOL and serious AEs after CAD.After logistic regression analysis, the results of the survey with double entry and validation showed:there were statistically significant different between the case and control group on eating seafood (P<0.001), insomnia (P<0.001), using drugs (P<0.002), and the physical factors, such as hot (P<0.036), cold (P<0.001), wind (P<0.003) and friction (P<0.000).CONCLUSIONSCurrent evidences indicate that IgE-mediated allergy may be causative in a small number of CU patients and specific immunotherapy with these allergens may be beneficial in those patients. However, the number of included studies was small and the quality was low. So, available evidence is not adequate to draw an affirmative conclusion and larger studies of high quality are needed to provide increasingly convincing data and cases.CAD might show better clinical efficacy than CT for CU patients. However, the number of included studies was small and the quality was low. So current evidence is not adequate to draw an affirmative conclusion and larger studies of high quality are needed to provide increasingly convincing data and cases. Nevertheless, the advantages of CAD was considered worthy of further investigation, and the strict design of the multi-center, large sample, randomized, double-blind controlled trials to support this conclusion were extremely needed.The relapse-related risk factors:seafood eating, drugs using, insomnia, physical stimulation such as encountered cold, heat and wind, friction were showed on patients with CU in Lanzhou area, which should be avoided to prevent disease recurrence.