Chronic Urticaria: Following Practice Guidelines

Erin P. Westby, MD; Charles Lynde, MD, FRCPC; Gordon Sussman, MD, FRCPC, FACP, FAAAI

Disclosures

Skin Therapy Letter. 2018;23(3):1-4. 

In This Article

Abstract and Introduction

Abstract

Histamine is a key inflammatory player in the pathogenesis of urticaria, a mast-cell-driven disease characterized clinically by the development of wheals, angioedema, or both. Changes to the management of chronic spontaneous urticaria have recently been adopted due to increasing literature surrounding the efficacy and safety of up-dosing modern second-generation H1-antihistamines and the use of omalizamub, a biologic agent, as a third-line treatment. Given the prevalence of chronic urticaria and its impact on quality of life, this editorial aims to provide a summary of the proposed updated guidelines for the management of chronic urticaria as agreed upon at the 5th Consensus Conference on the Update and Revision of the EAACI/GA2LEN/EDF/WAO Guideline for Urticaria in Berlin in December 2016. The chronic urticaria treatment algorithm outlined here reflects the updates and revisions made by 43 international experts representing 40 societies from 25 countries. These guidelines have yet to be published and therefore will require approval by respective national and international boards before adoption.

Introduction

Urticaria is a common, mast-cell-driven disease, characterized clinically by the development of wheals, angioedema, or both. Histamine and other inflammatory mediators, including leukotrienes and prostaglandins, are considered major players in the development of symptoms. Intermittent urticaria and angioedema lasting greater than 6 weeks is defined as chronic urticaria and differentiates it from acute urticaria. The prevalence of chronic urticaria in the general population has been estimated to range between 0.5–1%.[1] Chronic urticaria has been shown to decrease quality of life and negatively impact performance at work and school. It has also been associated with increased levels of anxiety and depression, independently affecting quality of life.[2,3] Although self-limiting, the disease course can last longer than 5 years in an estimated 10–25% of people affected.[4] As such, current management aims to improve quality of life and reduce impairment through symptom relief. Urticaria guidelines have promoted changes in the classification, approach to diagnosis, and management of chronic urticaria. These evidenced based guidelines are updated every 4 years by a joint initiative of the European Academy of Allergy and Clinical immunology (EAACI) Dermatology Section, Global Allergy and Asthma European Network (GA2LEN), the European Dermatology Forum (EDF), the World Allergy Organization (WAO), and by the Canadian Society of Allergy and Clinical Immunology (CSACI). The most recently proposed guidelines were updated and presented at the URTICARIA 2016, GA2LEN Global Urticaria Forum: 5th Guideline Consensus Conference in Berlin in December 2016.[5] These updates and revisions reflect the work and collaboration made by a group of 43 international experts representing 40 societies from 25 countries. This review will summarize the current proposed consensus guidelines for the treatment algorithm of chronic urticaria. These guidelines have yet to be published and will require approval by respective national and international boards before adoption.

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