Questions and answers in chronic urticaria: where do we stand and where do we go?

Abstract

This supplement reports proceedings of the second international Global Urticaria Forum, which was held in Berlin, Germany in November 2015. In 2011, a report of the GA 2 LEN task force on urticaria outlined important and unanswered questions in chronic urticaria (CU). These included, but were not limited to, questions on the epidemiology and course of chronic spontaneous urticaria (CSU) [also called chronic idiopathic urticaria (CIU)], the resources allocated for the diagnosis and treatment of CSU, whether patients with angioedema as an isolated symptom can be regarded as a subgroup of CSU, and the efficacy and long-term safety of therapies. Many of these questions have been addressed by recent studies. Some of the answers obtained raise new questions. Here, we summarize some of the key insights on CU obtained over recent years, and we discuss old and new unmet needs and how to address them with future studies. We need to analyze the influence of recent advances in understanding of the burden of CU on patients and society, disease management and the CU patient journey. Our increased understanding of urticarial pathophysiology and consideration of the patient as a whole will need to be translated to better treatment algorithms and protocols. Actions to address these challenges include the 5th International Consensus Meeting on Urticaria, which will take place later this year. The formation of a global network of Urticaria Centers of Reference and Excellence over the next few years has also been proposed, with the aim of providing consistent excellence in urticaria management and a clear referral route, furthering knowledge of urticaria through additional research and educating/promoting awareness of urticaria.

Patient‐reported outcomes (PROs) in chronic urticaria

“…Despite international guidelines, urticaria is still treated and scored heterogeneously. There is a need to harmonize diagnostic and therapeutic approaches . GA 2 LEN recently began development of the pilot project Urticaria Center of Reference and Excellence Program to help combat this issue.…”

“…GA 2 LEN recently began development of the pilot project Urticaria Center of Reference and Excellence Program to help combat this issue. The goal is to establish specific urticaria referral centers providing excellence in urticaria management, increase the knowledge of urticaria by research and education, and promote awareness of urticaria by advocacy activities . Furthermore, the international Cochrane Skin Group Core Outcome Set Initiative (CSG‐COUSIN) is working on developing outcome measurement instruments in dermatology for use in every clinical study to ensure comparability of the results across the studies .…”

Efficacy of increased dose of rupatadine up to 20 mg on itching in Japanese patients due to chronic spontaneous urticaria, dermatitis, or pruritus: A post hoc analysis of phase III clinical trial

“…Allergic skin disorders are mostly accompanied by pruritus, causing aggravation of dermal and emotional conditions in patients, appreciably reducing the QoL . With the advancements in the studies on the pathophysiology of skin allergies, there are high demands for the translation of knowledge to future studies and improved treatment algorithms . In the EAACI/GA 2 LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria, updosing of second‐generation antihistamines up to fourfold is recommended .…”

“…1 With the advancements in the studies on the pathophysiology of skin allergies, there are high demands for the translation of knowledge to future studies and improved treatment algorithms. 2 In the EAACI/GA 2 LEN/EDF/ WAO Guideline for the definition, classification, diagnosis, and management of urticaria, updosing of second-generation antihistamines up to fourfold is recommended. 3 In patients with pruritus, antihistamines are recommended in addition to appropriate skin care and other protective measures in Japan.…”

Anti IgE Therapy in Chronic Urticaria

“…Its eicacy and safety proile have been also shown in a case study in patients with CU aged <12 years [28]. There are no safety warnings about omalizumab in the geriatric population [29].…”