Urticária Crónica - Do Diagnóstico ao Tratamento

Abstract

RESUMO -Cerca de 20 % da população sofre pelo menos um episódio de urticária e 0,5 a 1 % sofre de urticária crónica, com uma duração média entre 1 e 5 anos e uma maior incidência em mulheres entre os 20 e os 40 anos. Dada a publicação, em 2014, de recomendações europeias para a sua orientação diagnóstica e terapêutica, os autores fazem uma revisão dos vários aspetos da urticária crónica. A urticária crónica, resultante da libertação de mediadores pró-inflamatórios do mastócito, caracteriza-se pelo aparecimento diário ou quase diário, de lesões cutâneas maculopapulares, eritematosas, pruriginosas e/ou angioedema, que persistem por um período superior a 6 semanas. Classifica-se em urticária crónica espontânea ou indutível, sendo aconselhável a realização de exames complementares de acordo com a história clínica. O tratamento é sintomático, baseado em evidência, sendo a 1ª linha os anti-histamínicos H1 de 2ª geração, que podem ser aumentados até 4x a dose aprovada e numa 3ª linha, fármacos como o omalizumab ou a ciclosporina. Dado o impacto negativo na qualidade de vida e os custos que esta patologia crónica acarreta, é de extrema importância alertar os clínicos para a necessidade de diagnóstico e tratamento correcto precoces e, se necessário, referenciação atempada para centros especializados, tendo sempre como objetivo o controlo completo dos sintomas, da forma mais segura possível. PALAVRAS-CHAVE -Anti-Histamínicos H1; Ciclosporina; Doença Crónica; Omalizumab; Prurido; Urticária. Chronic Urticaria -From Diagnose to Treatment

Profile of patients with chronic spontaneous urticaria treated with omalizumab in Chapecó, south of Brazil

“…In addition, CSU produces a proliferated cytokine environment, indicating an activation of the innate interleukin (IL) response, especially IL-33 and IL-25. 1 The study included 34 patients who had CSU and had used omalizumab between July 2018 and May 2021. As shown in Table 1, 26 (76.5%) patients were women and 8 (23.5%) were men.…”

“…It is characterized by erythematous maculopapular lesions associated with pruritus, which may present angioedema and generally lasts less than 24 hours. 1 Urticaria can be classified into 2 main groups: acute urticaria (AU), which lasts 6 weeks or less, and chronic urticaria (CU), which lasts 6 weeks or more. Additionally, chronic urticaria can be divided into chronic inducible urticaria (CIndU), which has an identified exogenous causal factor, and chronic spontaneous urticaria (CSU), when there is no recognized external trigger, and both forms can occur simultaneously in the same individual.…”

“…4 Even so, a large proportion of patients remain refractory to H1-antihistamines and have to resort to second-or third-line treatments, which include omalizumab, cyclosporine, or montelukast. 1 Ciclosporin is an immunosuppressive and antiinflammatory medication. It has a better risk-benefit ratio than corticosteroids, though the incidence of side effects such as nephrotoxicity and hypertension are a cause for concern and require monitoring.…”

“…7 The use of systemic corticosteroids in exacerbations of CU is recommended for no longer than ten days and in the lowest possible dose, given the potential adverse effects of long-term treatment. 1 CSU has an autoimmune component associated with Immunoglobulin-E, which the immunobiological omalizumab (Anti-IgE) may have some effect, as it has a direct action on the pathophysiological mechanisms of the disease; it is considered the third-line treatment option to treat CSU. 3 However, even though the medication is safe with positive results, it has a high cost, ranging from R$1,795.83 to R$2,244.79 per vial, depending on the dose required, and SUS hardly makes it available, except for the treatment of severe asthma.…”

“…8 The patient's routine is affected due to unpredictable and chronic outbreaks and compromised body image, especially caused by pruritus and angioedema, which affect the performance of daily activities and the quantity and quality of sleep, causing direct costs in medication consumption, the use of health care services, and indirect costs associated with lower school and professional performance. 1 This study aims to evaluate patients with CSU who used or are currently using omalizumab, as well as to verify the positive and adverse effects and impacts in different cases of CSU, and to compare the efficacy of omalizumab with other medications in the treatment of CSU.…”