The KAAACI/KDA Evidence-Based Practice Guidelines for Chronic Spontaneous Urticaria in Korean Adults and Children: Part 1. Definition, Methodology and First-line Management

Abstract

Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidencebased guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.

Natural History and Influencing Factors of Chronic Urticaria in Children

“…25 In recent guidelines, CU is defined only as symptoms lasting for more than 6 weeks, without specifying a frequency. 1 4 36 The guidelines of the British Society for Allergy and Clinical Immunology mention that CU is traditionally referred to as a case with symptoms lasting for more than 6 weeks, with daily or almost daily symptoms, but patients with urticaria that recured after over several days to months and years were also included in the definition of CU. 7 Some studies used the classification of CCU and CRU according to their frequency, 8 16 18 19 20 and both were considered CU.…”

“… 1 The prevalence of CU, which is currently increasing, was found to be 0.02%–5.0% globally and approximately 0.16%–2.3% in Korea. 4 It is known that children have lower prevalence of CU than adults. 5 CU is generally classified as chronic spontaneous urticaria (CSU) or inducible urticaria based on the triggering factors.…”

Increased serum free IgE levels in patients with chronic spontaneous urticaria (CSU)☆

“…The global prevalence of CSU is reported to range between 0.02% and 5.0%. 1 Recurrent and unpredictable characteristics substantially impact quality of life and decrease work productivity or daily activities. Recent international guidelines recommend non-sedating, second-generation H 1 -antihistamines as a first-line treatment for patients with CSU.…”

Clustering the clinical course of chronic urticaria using a longitudinal database: Effects on chronic urticaria remission

“…Chronic urticaria (CU) is defined as transient itchy wheals and/or angioedema present for at least 6 weeks. 1 A common allergic skin disease, CU affects between 0.5% and 5% of the general population, 2 and its prevalence in adults and children has been increasing worldwide. 3 Reportedly, CU poses significant impairments in quality of life, including loss of productivity, psychological distress, and sleep disturbance.…”

“…[6][7][8] Guidelines for urticaria recommend step-wise treatment. 1,2,9 In the first step, the use of approved doses of non-sedative antihistamines is recommended. For individuals whose urticaria remains uncontrolled after 2-4 weeks of treatment, increasing doses up to fourfold is considered.…”