Diagnosis and Treatment of Urticaria and Angioedema: A Worldwide Perspective

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Abstract

Urticaria and angioedema are common clinical conditions representing a major concern for physicians and patients alike. The World Allergy Organization (WAO), recognizing the importance of these diseases, has contributed to previous guidelines for the diagnosis and management of urticaria. The Scientific and Clinical Issues Council of WAO proposed the development of this global Position Paper to further enhance the clinical management of these disorders through the participation of renowned experts from all WAO regions of the world. Sections on definition and classification, prevalence, etiology and pathogenesis, diagnosis, treatment, and prognosis are based on the best scientific evidence presently available. Additional sections devoted to urticaria and angioedema in children and pregnant women, quality of life and patient-reported outcomes, and physical urticarias have been incorporated into this document. It is expected that this article will supplement recent international guidelines with the contribution of an expert panel designated by the WAO, increasing awareness of the importance of urticaria and angioedema in medical practice and will become a useful source of information for optimum patient management worldwide.

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Most cited references 276

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Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy.

Michael F Marmor, Ulrich Kellner, Timothy Lai … (2011)

The American Academy of Ophthalmology recommendations for screening of chloroquine (CQ) and hydroxychloroquine (HCQ) retinopathy were published in 2002, but improved screening tools and new knowledge about the prevalence of toxicity have appeared in the ensuing years. No treatment exists as yet for this disorder, so it is imperative that patients and their physicians be aware of the best practices for minimizing toxic damage. New data have shown that the risk of toxicity increases sharply toward 1% after 5 to 7 years of use, or a cumulative dose of 1000 g, of HCQ. The risk increases further with continued use of the drug. The prior recommendation emphasized dosing by weight. However, most patients are routinely given 400 mg of HCQ daily (or 250 mg CQ). This dose is now considered acceptable, except for individuals of short stature, for whom the dose should be determined on the basis of ideal body weight to avoid overdosage. A baseline examination is advised for patients starting these drugs to serve as a reference point and to rule out maculopathy, which might be a contraindication to their use. Annual screening should begin after 5 years (or sooner if there are unusual risk factors). Newer objective tests, such as multifocal electroretinogram (mfERG), spectral domain optical coherence tomography (SD-OCT), and fundus autofluorescence (FAF), can be more sensitive than visual fields. It is now recommended that along with 10-2 automated fields, at least one of these procedures be used for routine screening where available. When fields are performed independently, even the most subtle 10-2 field changes should be taken seriously and are an indication for evaluation by objective testing. Because mfERG testing is an objective test that evaluates function, it may be used in place of visual fields. Amsler grid testing is no longer recommended. Fundus examinations are advised for documentation, but visible bull's-eye maculopathy is a late change, and the goal of screening is to recognize toxicity at an earlier stage. Patients should be aware of the risk of toxicity and the rationale for screening (to detect early changes and minimize visual loss, not necessarily to prevent it). The drugs should be stopped if possible when toxicity is recognized or strongly suspected, but this is a decision to be made in conjunction with patients and their medical physicians. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

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EAACI/GA(2)LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria.

T Zuberbier, R Asero, C Bindslev-Jensen … (2009)

This guideline, together with its sister guideline on the management of urticaria [Zuberbier T, Asero R, Bindslev-Jensen C, Canonica GW, Church MK, Giménez-Arnau AM et al. EAACI/GA(2)LEN/EDF/WAO Guideline: Management of urticaria. Allergy, 2009; 64:1427-1443] is the result of a consensus reached during a panel discussion at the 3rd International Consensus Meeting on Urticaria, Urticaria 2008, a joint initiative of the Dermatology Section of the European Academy of Allergology 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). Urticaria is a frequent disease. The life-time prevalence for any subtype of urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria do not only cause a decrease in quality of life, but also affect performance at work and school and, as such, are members of the group of severe allergic diseases. 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 approaches for different subtypes of urticaria. The correct management of urticaria, which is of paramount importance for patients, is very complex and is consequently covered in a separate guideline developed during the same consensus meeting. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS).

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The impact of chronic urticaria on the quality of life.

B F O'Donnell, F Lawlor, J Simpson … (1997)

The impact of chronic urticaria (CU) on the quality of life is undocumented. We assessed quality of life in patients with CU, including patients with associated delayed pressure urticaria (DPU). One hundred and forty-two out-patients completed self-administered questionnaires: a disease-specific, purpose designed questionnaire, and the Nottingham health profile (NHP). Many patients reported problems attributable to their skin condition in facets of everyday life including home management, personal care, recreation and social interaction, mobility, emotional factors, sleep, rest and work. The NHP part I scores showed restriction in the areas of mobility, sleep, energy, and demonstrated pain, social isolation and altered emotional reactions. Part II of the NHP showed that patients experienced difficulties in relation to work, looking after the home, social life, home relationships, sex life, hobbies and holidays. The patients with DPU had significantly more problems with mobility, gardening and choice of clothing than the uncomplicated CU patients. They also suffered more pain, had more problems with work and were more restricted in their hobbies.

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Author and article information

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Mario Sánchez-Borges

Journal

Journal ID (nlm-ta): World Allergy Organ J

Journal ID (iso-abbrev): World Allergy Organ J

Title: The World Allergy Organization Journal

Publisher: World Allergy Organization

ISSN (Electronic): 1939-4551

Publication date Collection: November 2012

Publication date (Electronic): 15 November 2012

Volume: 5

Issue: 11

Pages: 125-147

Affiliations

[1 ]Department of Allergy and Clinical Immunology, Centro Médico-Docente La Trinidad, Caracas, Venezuela

[2 ]Ambulatorio di Allergologia, Clinica San Carlo, Paderno-Dugnano, Milan, Italy

[3 ]Department of Allergy and Immunology, Hospital Quirón Bizkaia, Bilbao, Spain

[4 ]Allergy and Respiratory Disease Clinic, University of Genova, Ospedale S.Martino di Genova, Genoa, Italy

[5 ]Department of Internal Medicine, Division of Immunology/Allergy Section University of Cincinnati, Cincinnati, OH

[6 ]Department of Medicine, University of Washington, Spokane, WA

[7 ]Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX

[8 ]Division of Pulmonary and Critical Care Medicine and Allergy and Immunology, Department of Medicine, Medical University of South Carolina, Charleston, SC

[9 ]Department of Allergy and Immunology, University of Western Sydney and Campbelltown Hospital, Sydney, Australia

[10 ]Universitätsmedizin Berlin. Allergie-Centrum-Charité, Berlin, Germany

[11 ]Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea

[12 ]Allergy Diagnostic & Clinical Research Unit, University of Cape Town Lung Institute, Groote Schuur, South Africa

[13 ]Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University, Baltimore, MD

[14 ]Immunology Institute, Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela

[15 ]U.O. Allergologia e Immunologia Clinica, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy

Article

Publisher ID: 1939-4551-5-11-125

DOI: 10.1097/WOX.0b013e3182758d6c

PMC ID: 3651155

PubMed ID: 23282382

SO-VID: 10be3704-65a6-43e2-84bf-62810a47a964

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This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Diagnosis and Treatment of Urticaria and Angioedema: A Worldwide Perspective

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Most cited references 276

Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy.

EAACI/GA(2)LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria.

The impact of chronic urticaria on the quality of life.

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