EAACI/GA²LEN/EDF guideline: management of urticaria

Abstract

This guideline is the result of a consensus reached during a panel discussion at the second International Consensus Meeting on Urticara, Urticaria 2004, a joint initiative of the EAACI Dermatology Section and GA2LEN. Urticaria has a profound impact on the quality of life, and effective treatment is therefore required. The recommended first line treatment are nonsedating H1 antihistamines. They have proven to be effective in double-blind controlled studies, but dosages increased up to fourfold over the recommended doses may be necessary. However, for different urticaria subtypes and in view of individual variation in the course of the disease and response to treatment, additional or alternative therapies may be required. Immunosuppressive drugs like cyclosporin A and corticosteroids are not recommended for long-term treatment due to unavoidable severe adverse effects. This guideline was, in addition, accepted by the European Dermatology Forum (EDF) and formally approved by the European Union of Medical Specialists (UEMS).

Triggers, risk factors and clinico‐pathological features of urticaria in dogs – a prospective observational study of 24 cases

“…Depending on the suspected cause, skin testing (prick and intradermal) for hymenoptera, nuts and aeroallergens, in vitro testing to food allergens (Cyno-DIAL© Western blot-based test, Gallileo Diagnostic by Genclis; Vandoeuvre-les-Nancy, France) 40 and aeroallergens (HESKA; Fribourg, Switzerland), elimination diet, ice cube test 41 , autologous serum test 4 and dermatographism 42 were performed.…”

“…[1][2][3][4] A wheal is a transient elevation of the skin due to dermal oedema. 5 Angioedema is characterized by a sudden, pronounced erythematous swelling of the lower dermis and subcutis with frequent involvement of the lower extremities and head, with or without associated wheals.…”

H1 Antihistamines: Current Status and Future Directions

“…They decrease itching, reduce the number, size, and duration of wheals and flares (erythema), and improve quality of life significantly [2,3,5,23-29]. They are not efficacious in urticarial vasculitis.…”

“…In 2 different large, randomized, double-masked, placebo-controlled studies in young atopic children in which efficacy in preventing and treating acute urticaria was a planned secondary outcome, cetirizine and levocetirizine had statistically significant and clinically relevant beneficial effects [23-26]. …”

“…None of the other pharmacological interventions used in chronic urticaria refractory to antihistamine treatment have been studied in randomized, placebo-controlled trials. With the exception of antihistamines and montelukast, immunomodulators used in chronic urticaria have potentially severe adverse effects, and individuals taking them need to be monitored on a regular basis [13,23,26]. …”