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Tayefi M, Bradley M, Neijber A, Fastberg A, Ceynowa D, Eriksson M. Chronic Urticaria: A Swedish Registry-based Cohort Study on Population, Comorbidities and Treatment Characteristics. Acta Derm Venereol 2021; 102:adv00624. [PMID: 34877606 PMCID: PMC9631294 DOI: 10.2340/actadv.v101.737] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Swedish databases present unique opportunities to research population data on diseases and treatments. The current study is, to our knowledge, the most comprehensive registry-based study on a chronic urticaria population in Sweden to date. The aim of this study was to describe the chronic urticaria population in Stockholm County regarding epidemiology, demographics, comorbidity, healthcare usage and treatment patterns in relation to current international guidelines. Real-world data were extracted between 2013 and 2019, yielding 10,642 adult patients. Study period prevalence of chronic urticaria was 0.53%, the mean annual incidence was approximately 0.08%, and 68% of patients were female. Regarding diagnosis, 58% were first diagnosed in primary care, approximately 50% were diagnosed before the age of 40 years. Regarding type of urticaria, 89% had chronic spontaneous urticaria, 11% had chronic inducible urticaria, and 5% of patients with chronic urticaria had coexisting angioedema. Common coexisting diagnoses were, for example, asthma, allergy, psychiatric and behavioural disorders and cardiometabolic disorders. Treatment patterns generally followed guidelines, yet data indicated that guidelines were not fully implemented, especially in primary care.
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Affiliation(s)
- Mahsa Tayefi
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
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Patil A, Reddy S, Manchanda I, Godse K. Clinical characteristics of patients with chronic urticaria and adherence to management guidelines by postgraduate students in dermatology: A retrospective single center study. Indian J Dermatol 2021; 66:705. [PMID: 35283531 PMCID: PMC8906287 DOI: 10.4103/ijd.ijd_446_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Chronic urticaria is a heterogenous skin disorder representing one of the important reasons for consultation with a dermatologist. Dermatology post-graduate students play an importanrt role in the treatment of patients with chronic urticaria. Objective: The objective of the study was to describe clinical characteristics of patients with chronic urticaria and assess adherence to the guidelines by postgraduate students in the department of dermatology of a tertiary care center. Materials and Methods: In this retrospective study, prescriptions of patients with chronic urticaria and/or angioedema presenting to the outpatient department for 5 months were analyzed. Percentage of prescriptions adhering to international urticaria management guidelines was calculated. Urticaria Activity Score, percentage of patients receiving second-generation antihistamines, first-generation antihistamines, and other drugs was recorded. Comorbidities in patients with chronic urticaria were also noted. Results: A total of 60 patients (mean age 32.1 years; 58.3% male) were included in. Mean (SD) duration of urticaria at the time of study was 4.7 (2.7) months. Demographism and history of allergy to drugs was present in 45 (75%) and 4 (6.7%) patients. Mean (SD) Urticaria Activity Score was 12.5 (6.5). A total of 12 (20%) patients had comorbidities. Mean number of drugs received per patient was 1.7 (0.5). A total of 47 (78.3%) patients received second-generation antihistamines, whereas 11 (18.3%) received first-generation antihistamines. Two (3.3%) patients received combination of first-generation and second-generation antihistamines. Fexofenadine, levocetirizine, bilastine, and cetirizine was prescribed to 24 (40%), 26 (43.3%), 18 (30%), and 14 (23.3%) patients. There was no significant difference in male and female patients receiving fexofenadine (P = 0.59) or levocetirizine (P = 0.13). Conclusion: Adherence to urticaria management guidelines by resident doctors in dermatology department in our institute was satisfactory.
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Kolkhir P, Pogorelov D, Darlenski R, Caminati M, Tanno LK, Le Pham D, Gonzalez-Estrada A, Antolín-Amérigo D, Dimov V, Weller K, Sánchez-Borges M, Ansotegui I, Maurer M. Management of chronic spontaneous urticaria: a worldwide perspective. World Allergy Organ J 2018; 11:14. [PMID: 29988758 PMCID: PMC6030778 DOI: 10.1186/s40413-018-0193-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background The approaches to the diagnosis and treatment of chronic spontaneous urticaria (CSU) differ in various parts of the world. We sought to determine the adherence to international and national urticaria guidelines as well as the motives to deviate from the guidelines among physicians worldwide. Methods A web-based questionnaire was created and launched via e-mail by the World Allergy Organization (WAO) to representatives of all WAO Member Societies, the members of the American Academy of Allergy, Asthma & Immunology (AAAAI) and the members of the WAO Junior Members Group (JMG), regardless of the specialty, affiliation, or nationality in March 2017. Results We received 1140 completed surveys from participating physicians from 99 countries. Virtually all participants (96%) were aware of at least one urticaria guideline and reported that they follow a guideline. However, one in five physicians who follow a guideline (22%) reported to deviate from it. Reliance on own clinical experience is the most frequent reason for deviation from guidelines or not following them (44%). Young (< 40 years) and less experienced physicians more often follow a guideline and less often deviate than older and experienced ones. Physicians who follow a urticaria guideline showed higher rates of routinely ordering a complete blood count, the erythrocyte sedimentation rate, C-reactive protein, anti-thyroid antibodies, and thyroid-stimulating hormone and of performing the autologous serum skin test as compared to those who do not. Physicians who follow a urticaria guideline showed higher rates of using second generation antihistamines as their first-line treatment of CSU (p = 0.001) and more frequently observed higher efficacy of these drugs (or had more confidence that it would work, p < 0.019) as compared to those who do not follow the guidelines. Conclusions Physicians’ characteristics (e.g. age, clinical experience, and specialty) and country specifics and regional features (e.g. availability of drugs for CSU treatment) importantly influence adherence to urticaria guidelines and CSU patient care and should be addressed in more detail in future research. Electronic supplementary material The online version of this article (10.1186/s40413-018-0193-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pavel Kolkhir
- 1Division of Immune-mediated skin diseases, I.M. Sechenov First Moscow State Medical University, 119991, Trubeckaya str., 8/2, Moscow, Russian Federation
| | - Dmitry Pogorelov
- 2Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Razvigor Darlenski
- 3Department of Dermatology and Venereology, Trakia University, Stara Zagora, Bulgaria
| | - Marco Caminati
- 4Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
| | - Luciana Kase Tanno
- 5Hospital Sírio Libanês and Post-graduation Program in Health Sciences of IAMSPE São Paulo, São Paulo, Brazil.,6University Hospital of Montpellier, Montpellier and Sorbonne Universités, Paris, France
| | - Duy Le Pham
- 7Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Alexei Gonzalez-Estrada
- 8Division of Allergy, Pulmonary and Sleep Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Darío Antolín-Amérigo
- 9Servicio de Enfermedades del Sistema Inmune-Alergia, Hospital Universitario Príncipe de Asturias, Madrid, Spain.,10Departamento de Medicina y Especialidades Médicas, Facultad de Medicina, Universidad de Alcalá, Madrid, Spain
| | - Ves Dimov
- 11Department of Allergy and Immunology, Cleveland Clinic Florida, Weston, Florida, USA
| | - Karsten Weller
- 12Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mario Sánchez-Borges
- 13Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Caracas, Venezuela
| | - Ignacio Ansotegui
- Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia, Bilbao, Spain
| | - Marcus Maurer
- 12Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Akdogan N, Incel-Uysal P, Oktem A, Hayran Y, Yalcin B. Educational level and job status are the most important factors affecting compliance with oral antihistamine therapy for patients with chronic urticaria. J DERMATOL TREAT 2018; 30:183-188. [PMID: 29757034 DOI: 10.1080/09546634.2018.1476651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Management of chronic urticaria (CU) is often difficult with oral antihistamines (OAs) despite long-term use. OBJECTIVE The aim of this study was to determine the extent of medication compliance (MC) and to assess the factors affecting the MC of patients with CU toward OA therapy. METHODS A 43-item questionnaire was administered to 201 adult patients. A compliance score (CS) of 6 points was chosen as a cutoff point. A CS of 0-6 corresponds to poor compliance and score of 6-9, to good compliance. Subsequently, associations with compliant and poorly compliant groups were made by univariate and multivariate analyses. RESULTS The median age and disease duration of all patients were 47 years (range: 18-88) and 15 months (range: 1.5-480), respectively. Overall, the rate of compliant and poorly compliant patients was 53.2% and 46.8%, respectively. Educational level and job status were significantly associated with MC. To have graduated from university and high school increased MC by 9.1-fold (p = .002, 95% confidence interval (CI): 2.26-36.37) and 3.6-fold (p = .019, 95% CI: 1.26-13.47), respectively, compared with illiterates. Patients who had worked previously and were currently looking for work were 4.8-fold (p = .032, 95% CI: 1.14-19.97) more compliant than patients who had never worked. CONCLUSION Most patients with CU had good compliance with OAs. Educational level and job status were significant predictors of MC to OAs in CU. The impact and long-term effects of education and job status should be evaluated in different patient groups.
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Affiliation(s)
- Neslihan Akdogan
- a Department of Dermatology and Venereology , Ankara Numune Training and Research Hospital , Ankara , Turkey
| | - Pinar Incel-Uysal
- a Department of Dermatology and Venereology , Ankara Numune Training and Research Hospital , Ankara , Turkey
| | - Ayşe Oktem
- a Department of Dermatology and Venereology , Ankara Numune Training and Research Hospital , Ankara , Turkey
| | - Yildiz Hayran
- a Department of Dermatology and Venereology , Ankara Numune Training and Research Hospital , Ankara , Turkey
| | - Basak Yalcin
- a Department of Dermatology and Venereology , Ankara Numune Training and Research Hospital , Ankara , Turkey
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Cherrez Ojeda I, Vanegas E, Felix M, Mata V, Cherrez S, Simancas-Racines D, Greiding L, Cano J, Cherrez A, Calderon JC. Etiology of chronic urticaria: the Ecuadorian experience. World Allergy Organ J 2018; 11:1. [PMID: 29308115 PMCID: PMC5753451 DOI: 10.1186/s40413-017-0181-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 12/07/2017] [Indexed: 02/07/2023] Open
Abstract
Background The purpose of this study was to identify chronic urticaria (CU) etiologies and treatment modalities in Ecuador. We propose that the sample distribution fits the expected one, and that there is an association between the etiology and its treatment. Methods We performed a retrospective study involving 112 patients diagnosed with CU using a Checklist for a complete chronic urticaria medical history. Demographic and clinical variables were collected. The etiology of CU was classified using the EAACI/GA2LEN/EDF/WAO guideline. Descriptive analyses were performed for demographical and clinical variables. Chi square tests were applied to analyze the fit of distribution and the independence of variables. P values less than 0.05 were considered significant. Results Among all the patients, 76.8% were diagnosed with chronic spontaneous urticaria (CSU), of which 22.3% had a known etiology or possible exacerbating condition. Food allergy was identified as the most common accompanying condition in patients with CSU (10.7%) (p < 0.01).. On the other hand, 23.2% inducible urticarias (CIndU) were indentified; dermographism was the most common (10.7%) (p < 0.01). Regarding treatment regimens, sg-H1-antihistamines alone represented the highest proportion (44.6%). The combination of any H1-antihistamine plus other drug was a close second (42.0%) (p < 0.01). Almost 48% of CSUs of unknown etiology were treated with any antihistamine plus another drug. In patients with known etiology, sg-antihistamines alone (44.0%) was the most common management. In addition, 53.8% of CIndUs were treated with sg-antihistamines alone. Though, these associations were not statistically significant. Conclusion CSU is the most frequent subtype of CU. Modern non-sedating antihistamines in licensed doses are the drug of choice. Nevertheless, a great proportion of patients require the addition of another type of medication.
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Affiliation(s)
- I Cherrez Ojeda
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Código postal: 0901-952 Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - E Vanegas
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Código postal: 0901-952 Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - M Felix
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - V Mata
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - S Cherrez
- School of Medicine, University of Heidelberg, Heidelberg, Germany
| | - D Simancas-Racines
- Centro de Investigación en Salud Pública y Epidemiología Clínica. Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito, Ecuador
| | - L Greiding
- Instituto Argentino de Alergia e Inmunología, Buenos Aires, Argentina
| | - J Cano
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Código postal: 0901-952 Samborondón, Ecuador
| | - A Cherrez
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador.,University Hospital, Dermatology Department, Rostock, Germany
| | - Juan Carlos Calderon
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Código postal: 0901-952 Samborondón, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
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Cherrez A, Maurer M, Weller K, Calderon JC, Simancas-Racines D, Cherrez Ojeda I. Knowledge and management of chronic spontaneous urticaria in Latin America: a cross-sectional study in Ecuador. World Allergy Organ J 2017; 10:21. [PMID: 28546850 PMCID: PMC5440895 DOI: 10.1186/s40413-017-0150-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/07/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The current EAACI/GA2LEN/EDF/WAO guideline for urticaria provide specific recommendations for the diagnostic workup and treatment of patients with chronic spontaneous urticaria (CsU). This study explored if physicians in Ecuador know these recommendations and implement them in their actual clinical practice for CsU. METHODS We investigated physicians who treat CsU patients in a cross-sectional study using a standardized questionnaire. Descriptive statistics were employed, adjusted logistic regression was performed to assess the link of guideline knowledge and use of therapy. RESULTS Seven hundred forty surveys were collected and analyzed. The mean age of physicians was 42.3 (±12.5) years. Most of the participants (65.1%) were general physicians (GP), 13.7% were pediatricians, 11.0% internists, 6.8% dermatologists or allergists (D/A). Only 18.8% knew the EAACI/GA2LEN/EDF/WAO guideline. 44.5% of GPs searched for CsU etiology in contrast to 90% of D/A. Most common diagnostic test was total serum IgE (83.5%). Most common first line symptomatic treatment was oral corticoids (46.3%), followed by second generation antihistamines (sgAHs, 36.8%). A/D prescribed more sgAHs (regular doses) (74.1 vs 28.6% of GP) (p < 0.05). Experience with omalizumab was reported only by 3.5%, of physicians, and higher rates among who were familiar with the guideline. CONCLUSION This study shows that the knowledge of guideline recommendations in physicians who treat urticaria patients in Ecuador is low. The diagnostic workup and treatment of CsU patients are largely not in line with guideline recommendations in real life practice settings. We were able to compare results between German and Ecuadorian physicians and found that Ecuadorian physicians have lower awareness of the current guideline (33 vs 18%). Only one-third of physicians reported using regular doses of sgAHs as the first line treatment. Also, only 12.9% of physicians use sgAHs in higher doses and physicians still use fgAHs, particularly pediatricians (42.9%). Our results suggest that disparities in knowledge between physicians from different countries could influence the management of CsU. Knowledge of the guidelines is linked to better choices of treatments. Awareness of guidelines needs to be promoted for better management of chronic urticaria.
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Affiliation(s)
- A. Cherrez
- Respiralab Research Group, Respiralab, Guayaquil, Ecuador
- School of Medicine, University of Heidelberg, Heidelberg, Germany
| | - M. Maurer
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - K. Weller
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - J. C. Calderon
- Respiralab Research Group, Respiralab, Guayaquil, Ecuador
- School of Medicine, Universidad Espiritu Santo, Samborondón, Guayas Ecuador
| | - D. Simancas-Racines
- Centro de Investigación en Salud Pública y Epidemiologia Clínica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito, Ecuador
| | - I. Cherrez Ojeda
- Respiralab Research Group, Respiralab, Guayaquil, Ecuador
- School of Medicine, Universidad Espiritu Santo, Samborondón, Guayas Ecuador
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Toubi E, Grattan C, Zuberbier T. Diagnostic dilemmas in chronic urticaria. J Eur Acad Dermatol Venereol 2016; 29 Suppl 3:12-5. [PMID: 26053291 DOI: 10.1111/jdv.13197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 04/14/2015] [Indexed: 11/29/2022]
Abstract
The European Academy of Allergy and Clinical Immunology (EAACI)/Global Allergy and Asthma European Network (GA(2) LEN)/European Dermatology Forum (EDF)/World Allergy Organization (WAO) recently published updated recommendations for the classification, diagnosis and management of chronic urticaria (CU). This article discusses several cases of CU that provide examples of how the recommendations in the guidelines can be implemented in the diagnosis of chronic spontaneous urticaria (CSU) (also called chronic idiopathic urticaria [CIU]), chronic inducible urticaria (CINDU) or CU with comorbidities.
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Affiliation(s)
- E Toubi
- Division of Allergy and Clinical Immunology, Bnai-Zion Medical Centre, Haifa, Israel
| | - C Grattan
- Norfolk & Norwich University Hospital and St John's Institute of Dermatology, Norwich, UK
| | - T Zuberbier
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Wu CH, Ardern-Jones MR, Eren E, Venter C. An Observational Study of the Diagnosis and Management of Chronic Urticaria in the UK. Int Arch Allergy Immunol 2015; 167:1-8. [PMID: 26045080 DOI: 10.1159/000430442] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/10/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with chronic urticaria (CU) in the UK could be referred to health care professionals (HCPs) with diverse specialties using different guidelines. The aims of the present study were to determine which CU guidelines HCPs in the UK use, which tests they use for the diagnosis of CU, and how they manage CU. METHODS In this UK-wide survey, we designed a questionnaire covering the diagnosis and management of CU based on current guidelines. The link to the questionnaire was sent to the British Society for Allergy and Clinical Immunology (BSACI), the British Association of Dermatologists (BAD), the British Society of Immunology (BSI), and the Food Allergy and Intolerance Specialist Group (FAISG) of the British Dietetic Association (BDA), who distributed the link to their members. RESULTS The questionnaire was completed by 55 allergists/immunologists, 64 dermatologists, and 43 dietitians. More dermatologists used the BAD guidelines in comparison with allergists and immunologists (93.6 vs. 12.5%; p < 0.001). On the other hand, the BSACI guidelines (83.3 vs. 14.9%; p < 0.001) and the European Academy of Allergy and Clinical Immunology (EAACI)/Global Allergy and Asthma European Network (GA(2)LEN)/European Dermatology Forum (EDF)/World Allergy Organization (WAO) guidelines (2013) (52.1 vs. 10.6%; p < 0.001) were used by more allergists and immunologists compared to dermatologists. Differences were found between allergists/immunologists and dermatologists with regard to guidelines used, investigations performed, preference of first-line antihistamine, and prescription of alternative treatment methods. CONCLUSION In conclusion, differences in the diagnosis and management of CU between HCPs of diverse specialties were identified, which reflected differences among the guidelines used.
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Affiliation(s)
- Cheng-Han Wu
- MSc Allergy, Faculty of Medicine, University of Southampton, Southampton, UK
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Abstract
The term "chronic idiopathic urticaria" denotes a spectrum of conditions with different poorly understood pathogenetic mechanisms in which the release of histamine plays a role. Nonsedating second-generation H1 antihistamines are postulated to be the first line of treatment of chronic idiopathic urticaria by national and international guidelines, but as control is not always achievable with the usually recommended doses, first-generation sedating antihistamines like hydroxyzine and diphenhydramine at high daily doses (200 mg) have been proposed as an alternative before resorting to treatment with systemic corticosteroids and other potentially hazardous agents. Our long time experience and recent research give us grounds to believe that increasing the doses of nonsedating H1 antihistamines up to fourfold improves significantly the chances of successful treatment. Our data suggest that the urticaria-associated discomfort is relieved by higher than conventional doses of levocetirizine and desloratadine in about 75% of the patients and that sedation/somnolence does not seem to be a major deterrent. The dose increase also improves the urticaria-specific quality of life. Contrary to the belief that individual patients may benefit from one antihistamine or another, we demonstrate that the drug with better ability to suppress the histamine skin effects in experiments in healthy volunteers (levocetirizine) is also superior in improving the different aspects of control of chronic urticaria (subjective and objective symptoms, quality of life) and that increasing its dose of up to fourfold may even paradoxically reduce the sense of sedation/somnolence in parallel with the relief of urticaria discomfort.
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Waclawski ER, Beach J. Using a symptom diary to investigate work-related urticaria. Occup Med (Lond) 2012; 63:160-1. [PMID: 23257120 DOI: 10.1093/occmed/kqs207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The strategy of keeping a diary may not be considered by many treating clinicians, but this approach has been recommended for occupational asthma and proved useful in this case of chronic urticaria associated with work. AIMS To report a case of a health care worker who had significant allergic reactions that were found to be associated with exposure to test allergens while working in an asthma clinic. METHODS The patient, a nurse working in a paediatric asthma clinic, was known to be allergic to common allergens that were used to test patients in the clinic. She developed reactions including swelling of the eyelids and urticarial reactions on the forehead, torso and upper and lower limbs on different occasions. A symptom diary was used to collect information on the reactions and the activity performed at the time they occurred. RESULTS She recorded symptoms that were mainly urticarial, with additional rhinitis or wheeze on occasion, on 20 (74%) working days and only 5 (28%) non-work days, indicating a significant association (P < 0.01) between her symptoms and working days. CONCLUSIONS Medical management had not controlled her symptoms, which improved on removal from the work activity and was confirmed by further diary recording.
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Affiliation(s)
- E R Waclawski
- Division of Preventive Medicine, University of Alberta, Edmonton T6G 2T4, Canada.
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Abstract
INTRODUCTION Chronic urticaria is characterized by recurring episodes of spontaneous transient dermal wheals and pruritus, with or without angioedema, which can persist for ≥ 6 weeks. Chronic urticaria impairs quality of life, emphasizing the need for effective treatments. Professional societies and clinical experts have issued evidence-based recommendations for the management of chronic urticaria, including recommending the use of second-generation antihistamines as a first-line therapy. AREAS COVERED A Medline search was conducted from 2000 to 2011 using the following terms, alone or in combination: 'chronic urticaria', 'management guidelines', 'consensus guidelines' and 'expert opinions'. Ten management guidelines/expert opinions met the inclusion criteria. EXPERT OPINION There was a universal agreement among the articles reviewed, that low-sedating, second-generation antihistamines should be prescribed as a first-line treatment of chronic urticaria. For refractory urticaria, however, recommendations varied and included dose escalation of second-generation antihistamines and adjunctive treatments with other agents of the same class, such as sedating antihistamines or leukotriene receptor antagonists. More research into effective second-line treatments and consistent implementation of current guidelines is needed, to ensure that treatment is based on clinical evidence.
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Affiliation(s)
- Jean-Paul Ortonne
- Service de Dermatologie, Hôpital de l'Archet, 151, route de Saint-Antoine-de-Ginèstre, F-06202, Nice cedex 03, France.
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Ferrer M, Morais-Almeida M, Guizova M, Khanferyan R. Evaluation of treatment satisfaction in children with allergic disease treated with an antihistamine: an international, non-interventional, retrospective study. Clin Drug Investig 2010; 30:15-34. [PMID: 19995095 DOI: 10.2165/11530910-000000000-00000] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVES Histamine H(1)-receptor antagonists (antihistamines) have been shown to be efficacious and safe in children and are recommended as first-line treatment for the symptoms of allergic rhinitis and urticaria. No published study to date has directly compared satisfaction with the different antihistamines in children in a real-life clinical setting. This study aimed to investigate parent and physician satisfaction with the efficacy and tolerability of oral antihistamine treatment in children and to compare satisfaction between levocetirizine and the other antihistamines used by children in this cohort. METHODS This was an international Observational Survey in Children with Allergic Rhinitis (OSCAR). Children aged 2-12 years, with a history of an allergic condition leading to a consultation, were enrolled from 424 primary-care/specialist allergy clinics across Bulgaria, India, Portugal, Romania, Russia, South Korea and Spain. At the consultation, parents and physicians of eligible children completed questionnaires evaluating their satisfaction with specific antihistamines currently employed for management of the child's allergic condition, as well as their intention for future use of that treatment. Parents' satisfaction scores for efficacy, tolerability and global satisfaction with the antihistamine used were primary study outcomes, while physicians' satisfaction scores for the same measures were secondary outcomes. Other secondary outcomes were parents' rating of the impact of the antihistamine treatment on their child's sleep and school performance, and parents' and physicians' willingness to use/recommend the same antihistamine in the future. RESULTS A total of 4581 patients were enrolled; 3048 (66.5%) had allergic rhinitis (55.9% persistent allergic rhinitis and 44.1% intermittent allergic rhinitis), and 663 (14.5%) had urticaria as primary conditions. Additionally, 2465 patients (53.8%) suffered from other allergic diseases, including allergic asthma (33.3%), atopic dermatitis (17.6%), food allergy (5.3%), other allergies (5.0%) and drug hypersensitivity (2.0%). Parents' and physicians' satisfaction scores were closely concordant and demonstrated significantly greater global satisfaction for the second-generation antihistamines than for the first-generation antihistamines. Levocetirizine (n = 2339) and fexofenadine (n = 42) generally scored highest for efficacy, tolerability and global satisfaction, as well as for impact on the child's ability to function at school, quality of school activities and quality of sleep. Furthermore, >97% of parents and physicians indicated their desire to continue or recommend the use of levocetirizine in the future. Somnolence, the most commonly reported adverse event in this survey, was observed predominantly in patients treated with first-generation antihistamines. Among second-generation antihistamines, reports of somnolence were most frequent in the cetirizine group. CONCLUSION Second-generation antihistamines have a better risk:benefit ratio than first-generation antihistamines, indicating that the latter should be avoided or their use limited in children whenever possible. Levocetirizine and fexofenadine were perceived by parents and physicians to produce significantly higher treatment satisfaction than the majority of the other antihistamines with respect to overall efficacy and tolerability, and impact on the child's sleep and school activities. The newer antihistamine levocetirizine seems to be a preferred and appropriate future treatment choice for children with allergic diseases.
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Affiliation(s)
- Marta Ferrer
- Department of Allergy, Clinica Universidad de Navarra Medical School, 31080 Pamplona, Spain.
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Quoi de neuf en thérapeutique dermatologique ? Ann Dermatol Venereol 2009; 136 Suppl 7:S445-59. [DOI: 10.1016/s0151-9638(09)73386-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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