Chronic hives: Researchers identify most effective, safest treatments

A new international study led by researchers at McMaster University has identified the most effective and safest treatments for people suffering from chronic urticaria, more commonly known as chronic hives.

Published in The Journal of Allergy and Clinical Immunology on July 15, 2025, the study is the first comprehensive network meta-analysis to compare more than 40 treatment options for chronic hives, a condition that affects about one per cent of people and can severely impact quality of life, sleep, and productivity. The study examined 93 randomized controlled trials involving over 11,000 participants.

Prior to now, patients and clinicians had to consult a growing list of treatment options without up-to-date evidence.

The research identified the following treatments as most effective:

  • Omalizumab, an injectable antibody, and remibrutinib, a new oral medication, are among the most effective treatments for reducing hives, itch, and swelling.
  • Dupilumab, another injectable antibody, also showed promise, particularly for reducing hives.
  • Cyclosporine may be effective but carries a higher risk of side-effects such as kidney toxicity and high blood pressure.

“This first comprehensive analysis of all advanced treatment options for chronic urticaria provides a clear and evidence-based ‘menu of treatment options’ for patients and their clinicians to choose from,” says Derek Chu, senior author and assistant professor with McMaster’s Department of Medicine.

Chu says the study makes clear which treatment options were the most effective and safe.

Reference:

Chu, Alexandro W.L. et al., Comparative efficacy and safety of biologics and systemic immunomodulatory treatments for chronic urticaria: Systematic review and network meta-analysis, Journal of Allergy and Clinical Immunology.

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Updated Clinical Practice Guideline on Adult Sinusitis: Emphasis on Patient Education, Shared Decision-Making, and Evidence-Based Treatment

The American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) published the Clinical Practice Guideline (CPG): Adult Sinusitis Update today in Otolaryngology–Head and Neck Surgery. The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing adult sinusitis and to provide explicit and actionable guidance that can be implemented across all clinical practices.

“With sinusitis affecting about one in eight adults in the United States each year, this CPG update empowers both patients and their healthcare providers with evidence-based recommendations that can lead to better outcomes,” said Spencer C. Payne, MD, Chair of the Guideline Update Group.

“Key changes from the 2015 guideline include expanding ‘watchful waiting’ as the preferred initial approach for most bacterial sinus infections, since most people get better on their own. We’ve also provided clearer guidance on when antibiotics are truly needed, what the first-choice antibiotic should be, and new information about advanced treatments like biologics for chronic sinusitis with nasal polyps. Most importantly, we’ve emphasized that not all sinus symptoms require antibiotics, and there are effective symptomatic treatments like nasal saline rinses and steroid sprays that can provide relief. We encourage patients to have open conversations with their healthcare providers about these options to find the right treatment approach for their specific situation.”

Sinusitis affects approximately 12% of adults in the United States resulting in over 30 million annual diagnoses. The direct cost of managing acute and chronic sinusitis exceeds $11 billion per year, with additional expense from lost productivity, reduced job effectiveness, and impaired quality of life ranging from $12 to 20 billion. One in five antibiotics prescribed in adults are for sinusitis, making it the fifth most common diagnosis responsible for antibiotic therapy. Despite the high prevalence and economic impact of sinusitis, considerable practice variations exist across and within the multiple disciplines involved in managing the condition.

This CPG update provides 14 research-based key action statements that address such areas as unnecessary antibiotic use, conservative-treatment first approaches, objective confirmation for chronic cases, and targeted therapy options based on specific patient characteristics.

In the development of this CPG update, the guideline update group considered new evidence from 14 guidelines, 194 systematic reviews, and 133 randomized controlled trials. The group, which was led by AAO-HNSF, included representatives from the fields of otolaryngology, infectious disease, family medicine, allergy and immunology, advanced practice nursing, a patient advocate, and staff. Before the guideline was published, it went through public and peer review for comments.

Reference:

Spencer C. Payne, Margo McKenna, Jennifer Buckley, Clinical Practice Guideline: Adult Sinusitis Update, Otolaryngology–Head and Neck Surgery, https://doi.org/10.1002/ohn.1344.

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Depression often associated with early menopause: Why some women are at greater risk?

Premature menopause has been described as a life-changing diagnosis with profound physical, psychological, and social consequences. Affected women not only experience the effects of estrogen deficiency, but they also experience the unanticipated loss of reproductive function. However, some women are more adversely affected by these changes than others. A new study helps explore reasons for these differences. Results are published online today in Menopause, the journal of The Menopause Society.

Premature menopause, medically known as premature or primary ovarian insufficiency (POI), is a condition in which the ovaries cease to function normally before the age of 40. It has been linked to an elevated lifetime risk for depression and anxiety. A recent meta-analysis revealed an odds ratio of 3.3 for depression and 4.9 for anxiety in women with POI compared with those without the condition. The increased risk is understandable given the combined experience of infertility and the additional burdens resulting from estrogen deficiency, such as hot flashes, vaginal dryness, reduced bone mineral density, and an increased risk of cardiovascular disease, among others. For some women, infertility means altered life goals, loss of sense of control, social stigma, and disrupted social roles.

However, not all women experience depression or the same level of depression when presented with the same diagnosis. In this new study, researchers gathered data from nearly 350 women with POI to try to identify the specific variables that contribute to the likelihood of depressive symptoms. Their first observation was the high prevalence of depression among participants. Nearly one-third (29.9%) of the women with POI suffered from depressive symptoms.

The researchers additionally found that a younger age at POI diagnosis, severe menopause symptoms, fertility-related grief, and lack of emotional support were risk factors. No significant difference was found in depressive symptoms between women using estrogen plus progestogen therapy and those not using hormone therapy, underscoring the role of psychosocial factors. Interestingly, a genetic cause for POI was associated with lower depressive symptoms. Another unexpected result was that, even though a higher burden of menopause symptoms was independently associated with depressive symptoms, hot flashes (specifically night sweats) were not.

This is the first known large-scale study to investigate specific variables that are associated with depressive symptoms in women with POI. The researchers believe its results highlight the importance of comprehensive care addressing both physical and psychological aspects of menopause at an early age.

Survey results are published in the article “Depressive symptoms in women with premature ovarian insufficiency (POI): a cross-sectional observational study.”

“The high prevalence of depressive symptoms in those with POI highlights the importance of routine screening in this vulnerable population. Although hormone therapy is recognized as the standard of care for those with POI for management of some menopause-related symptoms and preventive care, it is not first-line treatment for mood disorders. This was evident in this study in which there was no difference in depressive symptoms between those using hormones and those not using hormone therapy. Addressing behavioral-health concerns with evidence-based interventions should be part of any comprehensive POI care plan,” says Dr. Monica Christmas, associate medical director for The Menopause Society.

Reference:

van Zwol‐Janssens, Charissa MD; Louwers, Yvonne V. MD, PhD; Laven, Joop S.E. MD, PhD; Schipper, Jits MD, PhD; Jiskoot, Geranne PhD. Depressive symptoms in women with premature ovarian insufficiency (POI): a cross-sectional observational study. Menopause ():10.1097/GME.0000000000002614, July 15, 2025. | DOI: 10.1097/GME.0000000000002614

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Acid Reflux Medication Linked to Supraglottoplasty in Infants with Laryngomalacia: JAMA

USA: A recent study published in JAMA Otolaryngology-Head & Neck Surgery has found a connection between the use of acid reflux medications and the likelihood of undergoing supraglottoplasty in infants diagnosed with laryngomalacia.

The research, led by Dr. Habib Zalzal from the Department of Otolaryngology at Children’s National Hospital, Washington, DC, sought to determine whether gastroesophageal reflux disease (GERD) medications influence the need for surgical intervention in infants with nonsevere laryngomalacia—a condition characterized by noisy breathing due to soft, floppy tissue above the vocal cords.

The retrospective cohort study analyzed medical records from 395 infants under six months of age who were initially evaluated for nonsevere laryngomalacia at a pediatric otolaryngology airway clinic between 2014 and 2023. Participants were divided into two groups based on the initial management approach: those treated conservatively through observation (n=320) and those who received GERD medications (n=75).

The primary focus of the study was to compare how often infants in each group eventually required supraglottoplasty, a surgical procedure performed to relieve airway obstruction caused by laryngomalacia.

The key findings of the study were as follows:

  • The overall rate of supraglottoplasty among all infants analyzed was 4.1%.
  • In the observation-only group, 3.4% of infants underwent surgery.
  • In the GERD medication group, 6.7% of infants required supraglottoplasty.
  • This reflects a modest increase in surgery among infants treated with acid suppression therapy.
  • The difference in surgery rates between the two groups was −3.2%, indicating limited statistical precision.
  • Female sex and the severity of laryngomalacia based on endoscopic findings were stronger predictors of surgery than GERD medication use.

Despite its limitations, including the retrospective design and single-institution data, the study highlights an important clinical consideration: acid reflux medications, commonly prescribed for infants with laryngomalacia despite limited evidence of benefit, may not significantly reduce the need for surgery and could be associated with a slightly higher likelihood of surgical intervention.

Ultimately, the findings support a more cautious approach to prescribing GERD medications in this population, especially for those with mild symptoms who are otherwise stable. Clinicians are encouraged to weigh the potential risks and benefits of acid suppression therapy and continue relying on individualized assessment, including endoscopic findings, when deciding the best course of treatment.

The researchers concluded, “The study found that infants with nonsevere laryngomalacia had similar rates of supraglottoplasty whether they were treated with GERD medications or simply observed. Female infants and those with more severe laryngomalacia seen on endoscopy were more likely to need surgery after a period of watchful waiting.”

Reference:

Zalzal H, Pershad A, Behzadpour H, Rana MS, Zalzal G. Association Between Acid Reflux Medication and Supraglottoplasty in Infant Laryngomalacia. JAMA Otolaryngol Head Neck Surg. Published online May 29, 2025. doi:10.1001/jamaoto.2025.1201

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Behavioral Therapy Noninferior to Drug Treatment for Overactive Bladder in Parkinson’s Disease: JAMA

A new study published in the Journal of American Medical Association showed that behavioral therapy is as effective as drug therapy in managing overactive bladder (OAB) symptoms in patients with Parkinson’s disease. These results support considering behavioral therapy as a first-line treatment option in clinical guidelines for urinary symptoms in PD.

The symptoms of OAB in PD might be exacerbated by the negative effects of medication. Exercise-based behavioral treatment for the pelvic floor muscles prevents drug side effects. Thus, to determine if behavioral treatment is superior than solifenacin medication therapy for OAB symptoms in people with Parkinson’s disease, this study was carried out.

In 4 US Veterans Affairs health care systems, a 12-week randomized noninferiority experiment comparing behavioral treatment to solifenacin was carried out between 2018 and 2023. In addition to having a Montreal Cognitive Assessment (MOCA) score of 18 or higher (range: 0-30) and an International Consultation on Incontinence Questionnaire OAB module (ICIQ-OAB) symptom score of 7 or higher (range: 0-16; a higher score indicates worse symptoms), eligible participants were diagnosed with PD by a movement disorder neurologist. Following stratification by sex, recruitment site, severity of OAB, and severity of PD motor symptoms, participants were randomized 1:1. Analysis took place between October 2023 and April 2024.

The behavioral treatment included urge suppression techniques and training for the pelvic floor muscles. Starting at 5 mg per day, solifenacin treatment can be increased to 10 mg per day as necessary. The main result was the 12-week ICIQ-OAB score, which was within a 15% noninferiority margin for all groups. For eight weeks, adverse events were evaluated every two weeks and then again at twelve weeks.

A total of 77 individuals with Parkinson’s disease (65 [84%] men; mean [SD] age, 71.3 [8.9] years; mean [SD] years with PD, 6.6 [5.8]) were randomly assigned to either behavioral therapy (n = 36) or medication therapy (n = 41). The trial was finished by 73 individuals (4 dropped out in the drug group). MOCA score (mean [SD], drug, 23.9 [3.1]; behavioral, 24.8 [3.3]) and ICIQ-OAB score (mean [SD], drug, 9.1 [1.7]; behavioral, 8.5 [1.4]) were among the baseline variables that were equal for each group.

Within the a priori noninferiority margin of 15%, ICIQ-OAB scores at 12 weeks post-randomization showed clinically meaningful improvement across groups (mean [SD] score, drug, 5.8 [2.4]; behavioral, 5.5 [2.0]; P =.02). Falls and dry mouth were reported more often in the medication group than in the behavioral group. Overall, the findings of this trial found that behavioral treatment can help PD patients with their OAB symptoms just as well as medication therapy.

Reference:

Vaughan, C. P., Morley, J. F., Lehosit, J., McGwin, G., Muirhead, L., Khakharia, A., Johnson, T. M., 2nd, Evatt, M. L., Sergent, T., Burgio, K. L., & Markland, A. D. (2025). Behavioral compared with drug therapy for overactive bladder symptoms in Parkinson disease: A randomized noninferiority trial: A randomized noninferiority trial. JAMA Neurology. https://doi.org/10.1001/jamaneurol.2025.1904

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Placental Extract Gel Enhances Periodontal Healing; Periostin Emerges as Promising Biomarker: Study

According to a new study adjunctive application of placental extract gel in surgical periodontal therapy significantly improved healing outcomes. Additionally, periostin has shown potential as a reliable biomarker for monitoring periodontal wound healing.

The elimination of the causative agent and the facilitation of tissue regeneration are the fundamental objectives of periodontal therapy. Various adjunctive agents have been investigated to optimize treatment outcomes with surgical interventions. Periostin is a matricellular protein predominantly expressed in periodontal tissues, playing a key role in tissue remodeling, inflammation, and wound healing. The human placental extract has been used in periodontal surgery and compared with open flap debridement alone, with gingival crevicular fluid (GCF) periostin levels assessed to gauge periodontal wound healing. Sixteen systemically healthy patients diagnosed with Stage III Grade C periodontitis were enrolled in the study. Participants were randomly assigned to either the test group (n = 8) or the control group (n = 8), with a total of nine males and seven females distributed across the groups. The test group underwent open flap debridement (OFD), followed by applying human placental extract gel absorbed into a gelatin sponge, while the control group received only OFD. Clinical parameters were assessed at baseline and 3 month post-treatment. GCF periostin levels were measured at baseline, 6 weeks, and 3 months. Results: The test group demonstrated a mean probing pocket depth (PPD) reduction of 4.75 ± 1.28 mm, compared to 3.12 ± 1.12 mm in the control group, with the difference being statistically significant. The relative attachment level (RAL) gain was 4.37 ± 1.18 mm in the test group and 2.75 ± 0.70 mm in the control group; however, this difference was not statistically significant. At 3 months, the mean healing index score was 4.50 ± 0.53 in the test group and 3.62 ± 0.51 in the control group, with a statistically significant intergroup difference. The Plaque Index (PI), Gingival Index (GI), and Gingival Bleeding Index (BI) showed moderate reductions at 3 months; however, intergroup differences were not statistically significant, except for BI, where the difference at 3 months was -0.180. The adjunctive use of placental extract gel in surgical periodontal therapy demonstrated beneficial effects on healing outcomes. In addition, periostin shows promise as a biomarker for periodontal wound healing.

Reference:

Rathana, M., Paramashivaiah, R., Prabhuji, M.L.V. et al. Role of placental extracts in enhancing periodontal flap surgery healing: insights from periostin biomarker analysis. Eur J Med Res 30, 623 (2025). https://doi.org/10.1186/s40001-025-02891-y

Keywords:

Placental, Extract, Gel, Enhances, Periodontal, Healing, Periostin, Emerges, Promising, Biomarker, Rathana, M., Paramashivaiah, R., Prabhuji, M.L.V, Periodontitis, Surgical periodontal therapy, Human placental extract, Periostin, Wound healing, Marker

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NPPA Slapped Rs 9,950 Cr Penalty On Pharma Firms, Recovered Only 14.25%

New Delhi: The National Pharmaceutical Pricing Authority (NPPA) has initiated action in 2,605 cases of drug overpricing from 31st March 1979 to 31st March 2025, involving an overcharged amount, along with interest and penalty, totaling Rs 9,950.10 crore. Of this, the government has so far recovered Rs 1,418.80 crore (ie. 14.25 percent) from the pharmaceutical companies concerned, informed the Minister of State for Chemicals and Fertilizers, Anupriya Patel, in a written reply during the recent Lok Sabha session.

Responding to a question raised by MPs Azad Kirti Jha, Chandra Prakash Choudhary, and Sanatan Pandey, Patel stated that the NPPA monitors medicine prices on an ongoing basis and acts wherever overcharging is found.

“The National Pharmaceutical Pricing Authority (NPPA) monitors the prices of medicines on an ongoing basis and wherever pharmaceutical companies are found to be overcharging the consumer in sale of medicine, it initiates action against such companies in accordance with the provisions of the Drugs (Prices Control) Order, 2013,” she said.

Providing a detailed account of enforcement, she added, “During the period from 31.3.1979 to 31.3.2025, NPPA has initiated action in 2,605 cases of overcharging, involving overcharged amount, along with interest and penalty thereon, of Rs 9,950.10 crore. During the said period, an amount of Rs 1,418.80 crore has been recovered from the companies concerned in these cases.”

The government clarified that NPPA does not maintain State-wise data of overcharging cases. However, the full list of companies and demand notices issued in such cases is available on the NPPA’s website at www.nppa.gov.in.

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Hyderabad’s Medical College 32 students Found Consuming Ganja: Report

Hyderabad- In a shocking incident, as many as 32 students of a medical college in Hyderabad were found consuming drugs. This has come to light after Telangana’s Elite Action Group for Drug Law Enforcement (EAGLE) recently arrested two people on charges of supplying drugs.

According to Omcomnews report, a total of 82 people have been identified as having consumed ganja (cannabis). This includes 32 students of Telangana’s Medicity Medical College. This was revealed when the authorities conducted a drug test of 24 students, and nine of them, including two girls, tested positive. All of them stayed in the college hostel.

Also Read: HC Relief to Medical College, Stays KNRUHS Rs 20 Lakh Penalty over ‘Minor Deficiencies’

Following this, EAGLE officials, along with the college management, counselled the students in the presence of their parents. Currently, the nine students who tested positive have been sent to a de-addiction centre; the next 30 days will be crucial for their recovery and reintegration.

As per Omcomnews news report, the consumption of drugs by the medical college students came to light when the EAGLE arrested two people, including a woman, on charges of drug trafficking. They were found supplying ganja (cannabis) to several consumers, including doctors. The drug suppliers were identified as Arfat Ahmed Khan (23), resident of Risala Bazar, Bolarum, Hyderabad, and Zarina Banu (46), resident of Bidar, Karnataka.

The drug addict, Khan, got into drug trafficking to satisfy his addiction. He contacted Banu and purchased a large quantity of ganja for local sale in Hyderabad. Between August 2024 and August 2025, he transferred a large amount of marijuana to her UPI account.

After interrogation, the police found six kg of ganja worth Rs 1.5 lakh from them, which has now been seized. Based on the confession of the accused, the Eagle team identified the consumers, including medicos. Eagle’s investigation also revealed Bano’s involvement in drug trafficking since 2010. She was previously also found involved in four other cases.

Meanwhile, following the incident, the anti-drug agency has announced that surprise inspections will continue in all institutions.

Also Read: NEET: Supreme Court reserves verdict on Telangana’s domicile policy

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Caught on camera: Quack impersonates medical intern at PGIMS Rohtak

Rohtak: In a disturbing incident that has raised serious concerns about patient safety, a young man holding only a diploma in patient care assistance was caught treating patients at the Post-Graduate Institute of Medical Sciences (PGIMS) in Rohtak, pretending to be his friend, who is a medical intern at the hospital. 

He was seen roaming around the OPD ward and even the trauma centre, wearing a white coat with a stethoscope around his neck, and attending to patients. His behaviour and way of speaking raised suspicion among the security guards. When he was asked for his ID card, he was unable to show it.

Also read- Quack poses as Radiologist for 2 years using Rs 50 lakh fake degree

After confirming that he was not a doctor, the guards took him out of the premises after taking the stethoscope from him. A video of him treating patients and getting escorted outside the hospital by the security has gone viral on social media.

As per the HT media report, the accused has been identified as Sahad from Nizampur Majra village in Sonepat. Sahad was impersonating his friend Krishan Gehlawat, who is currently doing a one-year internship at PGIMS after completing his MBBS from the United Kingdom. 

The fake doctor was caught at the orthopaedics department during a routine security check when he was asked for his name. However, while going through the duty roster, the security guards did not find his name. Therefore, they asked him to show his ID card, which he failed to do.

During questioning, Sahad reportedly told authorities that he had a diploma in patient care assistance and claimed he was asked by Krishan to fill in for him. 

Dr Rohit, the security in-charge at PGIMS, confirmed the arrest and said that Sahad was immediately handed over to the police. He also said that efforts are underway to nab Krishan. “Sahad will be produced in court on Friday. A thorough investigation is being conducted,” he said.

Medical Dialogues recently reported that a senior contractual doctor who worked in the ICU ward of V N Desai Hospital, Santacruz, for nearly two years, was recently found to be a fake doctor and unregistered with the Maharashtra Medical Council (MMC).

Also read- Fake Doctor Found Working at Mumbai Hospital ICU for 2 years

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Exercise linked to decreased mortality, heart events in those with new type 2 diabetes but no previous heart disease

New research to be presented at this year’s Annual Meeting of the European Association for the Study of Diabetes (EASD) in Vienna, Austria (15-19 September) shows that among people recently diagnosed with type 2 diabetes and no previous cardiovascular disease, a clear association exists between a person’s self-reported physical activity and their risk of all-cause mortality and major adverse cardiac events (MACE), which includes heart attacks and strokes.

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