Methods report on the development of the 2013 revision and update of the EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria

Abstract

This methods report describes the process of guideline development in detail. It is the result of a systematic literature review using the 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE) methodology and a structured consensus conference held on 28 and 29 November 2012, in Berlin. It is a joint initiative of the Dermatology Section of the European Academy of Allergy and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA 2 LEN), the European Dermatology Forum (EDF), and the World Allergy Organization (WAO) with the participation of delegates of 21 national and international societies. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS) and is published in Allergy 2014; 69:868-887.Allergy 69 (2014) e1-e29

Detection of Low-Molecular-Weight Mast Cell–Activating Factors in Serum From Patients With Chronic Spontaneous Urticaria

“…We studied sera from 8 patients with CSU (5 women and 3 men; age range, 23-55 years) diagnosed according to generally accepted criteria [10] and from 5 healthy controls (3 women and 2 men; age range, 25-50 years). All patients underwent the ASST as previously described [6].…”

Prediction of the Efficacy of Antihistamines in Chronic Spontaneous Urticaria Based on Initial Suppression of the Histamine- Induced Wheal

“…The Ethics Committee of Universidad de Antioquia, Medellín, Colombia approved this protocol (Code: BE-IIM). We did not include a placebo group, since it would have provided little information on the primary outcome of the study and there is consistent evidence supporting the effectiveness of antihistamines as first-line treatment in patients with urticaria [3]. The control group comprised 30 individuals without urticaria who did not receive antihistamines during follow-up and were evaluated to determine whether histamineinduced wheal and flare measurements changed over time.…”

“…We used the Urticaria Activity Score (UAS) [3] to measure disease severity and monitor treatment results in daily practice.…”

“…Some clinical guidelines recommend the use of second-generation antihistamines over first-generation antihistamines owing to their excellent safety profile and clinical efficacy [3]. However, in many cases, disease cannot be controlled at conventional doses [4].…”

“…While increasing the dose of antihistamines seems to improve control, differences in pharmacokinetics and pharmacodynamics between agents may lead to different responses between patients [5][6][7][8]. According to clinical guidelines, it takes at least 1-4 weeks to evaluate the therapeutic efficacy or failure of an antihistamine [3,9]. In patients for whom therapy is unsuccessful, this trial period generates additional economic and time costs, and unresponsive patients must undergo a new test in which the dose of the same antihistamine is increased or a new antihistamine is introduced.…”