Consensus on the diagnostic and therapeutic management of chronic spontaneous urticaria in adults - Brazilian Society of Dermatology

Abstract

Background Urticarias are frequent diseases, with 15% to 20% of the population presenting at least one acute episode in their lifetime. Urticaria are classified in acute ( ≤ 6 weeks) or chronic (> 6 weeks). They may be induced or spontaneous. Objectives To verify the diagnostic and therapeutic recommendations in chronic spontaneous urticaria (CSU), according to the experience of Brazilian experts, regarding the available guidelines (international and US). Methods A questionnaire was sent to Brazilian experts, with questions concerning diagnostic and therapeutic recommendations for CSU in adults. Results Sixteen Brazilian experts answered the questionnaire related to diagnosis and therapy of CSU in adults and data were analyzed. Final text was written, considering the available guidelines (International and US), adapted to the medical practices in Brazil. Diagnostic work up in CSU is rarely necessary. Biopsy of skin lesion and histopathology may be indicated to rule out other diseases, such as, urticarial vasculitis. Other laboratory tests, such as complete blood count, CRP, ESR and thyroid screening. Treatment of CSU includes second-generation anti-histamines (sgAH) at licensed doses, sgAH two, three to fourfold doses (non-licensed) and omalizumab. Other drugs, such as, cyclosporine, immunomodulatory drugs and immunosuppressants may be indicated (non-licensed and with limited scientific evidence). Conclusions Most of the Brazilian experts in this study partially agreed with the diagnostic and therapeutic recommendations of the International and US guidelines. They agreed with the use of sgAH at licensed doses. Increase in the dose to fourfold of sgAH may be suggested with restrictions, due to its non-licensed dose. Sedating anti-histamines, as suggested by the US guideline, are indicated by some of the Brazilian experts, due to its availability. Adaptations are mandatory in the treatment of CSU, due to scarce or lack of other therapeutic resources in the public health system in Brazil, such as omalizumab or cyclosporine.

Advanced Biomarkers: Therapeutic and Diagnostic Targets in Urticaria

“…Urticaria can be divided into AU and CU according to the course of the disease [4]. The cause of AU is relatively clear including drugs and food, and treatment is relatively easy.…”

“…Among CU including spontaneous urticaria and induced urticaria, chronic spontaneous urticaria (CSU) is the most common. According to the etiology, CSU can be induced by autoreactivity or other unknown causes [4,5]. The typical clinical presentation of CSU is recurrent attacks of spontaneous wheals and/or angioedema for >6 weeks, and it occurs at least twice a week [6].…”

Current view on urticaria - causes of urticaria occurrence, diagnosis and current treatment options

“…Nárazová léčba je nedostatečná a nedokáže ovlivnit dlouhý průběh nemoci. V současnosti se jedná o látky -bilastin, cetirizin/levocetirizin, desloratadin/loratadin, fexofenadin, rupatadin (5,6).…”

“…Pokud léčba výše uvedenými anti his taminiky v horizontu 2-4 týdnů nevede ke zlepšení, druhou linii léčby představuje zvýšení dávkování antihistaminika až na čtyřnásobek standardní dávky. Dle dostupných metaanalýz poukazuje na fakt, že více než 63 % pacientů reaguje až na vyšší dávky (5,6).…”