Chronic spontaneous urticaria (CSU) is defined as itchy hives with or without angioedema with a burning sensation that last for six weeks or longer and have no apparent external trigger. The disease occurs in about 1 % of the population. The itching and burning symptoms affect the patient’s quality of life in a negative way which makes a treatment highly needed. The first-line medication for the treatment of CSU is non-sedating H1-antihistamines in recommended doses and the second line of treatment is an increased dose of H1-antihistamines, up to four-fold the approved doses. However, many patients do not response to these therapies whereas a third-line treatment, an add-on therapy with omalizumab, is necessary. Omalizumab is a monoclonal anti-IgE-antibody that binds to free IgE and prevents them to attach to FcεRI-receptors on inflammatory cells like mast cells. This leads to a lower activation of mast cells and less histamine gets released. The definite mechanism of action of CSU-symptoms relief is still unclear but it is thought to be due to decreased levels of IgE and FcεRI-receptors. The symptoms of CSU can be scored using weekly itch severity score (ISS7) which scores the pruritus, weekly hive severity score (HSS7) which scores the number of hives and weekly urticaria activity score (UAS7) that scores both pruritus and number of hives together. The aim of this literature review was to evaluate the efficacy and safety of omalizumab in patients diagnosed with CSU. A search on PubMed was conducted with the search terms "omalizumab" AND "chronic spontaneous urticaria" and "omalizumab" AND "chronic idiopathic urticaria". The articles were limited to randomized, controlled and double-blinded trials that were published 2010 or later. A total of five studies were included for further analysis; MYSTIQUE, ASTERIA II, ASTERIA I, POLARIS and GLACIAL. The studies showed that omalizumab 300 mg and 150 mg reduced the symptoms of CSU significantly compared with placebo, whereas 300 mg had the best efficacy in decreasing the values of ISS7, HSS7 and UAS7. The patients went from having severe urticaria to mild urticaria after treatment with omalizumab. The degree of itching improved from severe itching to mild itching. The side effects were mild to moderate, the most common were nasopharyngitis, headache, arthralgia and upper respiratory tract infection. Omalizumab showed to be effective and safe as an add-on therapy for the treatment of patients with chronic spontaneous urticaria who did not respond adequately to treatment with H1-antihistamines.

Introduktion: Grundläggande för operationssjukvård är att kunna använda sina händer för att utföra god specialistsjukvård och omvårdnad av patienten. Att drabbas av eksem på händer, handleder, underarmar eller urtikaria till följd av kontaktallergi kan medföra att händernas funktion påverkas. Syfte: Syftet med studien var att undersöka prevalensen av självrapporterade handeksem, urtikaria och möjliga riskfaktorer hos verksamma operationssjuksköterskor och kirurger samt identifiera statistiska samband hos respondenterna. Metod: Studien genomfördes med kvantitativ metod. Data samlades in via elektroniska enkäter. Sammanlagt samlades 150 enkäter in. För statistisk bearbetning och analys användes ett statistiskt dataprogram. Resultat: Förekomst av eksem på händer, handleder eller underarmar vid något tillfälle självrapporterades av 44% av respondenterna, varav 24% upplevt eksem de senaste två åren. Uppkomst av urtikaria på händer, handleder eller underarmar vid något tillfälle självrapporterades av 28,7% respondenter. En högre andel av de som självrapporterat eksem och urtikaria hade också åtminstone en övrig allergi. Konklusion: I studien framkom att nästan var femte personal på operationsavdelningar inom Region Östergötland hade haft handeksem någon gång under de senaste två åren. Denna siffra är i enighet med tidigare forskning, dock är bortfallet i denna undersökningsgrupp för stort för att kunna generalisera resultatet. / Introduction: To be able to use your hands to carry out perioperative care and nursing is fundamental. To suffer from eczema on your hands, wrists, forearms or urticaria as a consequence of contact allergy, can affect the function of the hands. Aim: The aim of the study was to research the prevalence of self-reported hand eczema, urticaria and risk factors among working operating room nurses and surgeons in the region of Östergötland and to identify statistical relations among the respondents. Method: The study was carried out with a quantitative method. Data was gathered through electronic questionnaires. A total of 150 questionnaires were collected. For statistical processing and analyse, a statistic computer program were used. Result: Prevalence of eczema on hands, wrists and forearms at any time were self-reported among 44% of the respondents, and 24% had experienced eczema during the last two years. Experience of urticaria on hands, wrists and forearms at any time were reported by 28,7% respondents. A greater amount of the respondents who self-reported eczema and urticarial also described at least one additional allergy. Conclusion: The study showed that almost every fifth personnel on the surgical ward in the region of Östergötland, had self-reported hand eczema at some time during the two last years. Former research has shown similar data, but the number of non-respondents were too high to be able to generalize the result of this study.