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      The challenges of chronic urticaria part 1: Epidemiology, immunopathogenesis, comorbidities, quality of life, and management

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          Abstract

          This is Part 1 of an updated follow-up review of a World Allergy Organization (WAO) position paper published in 2012 on the diagnosis and treatment of urticaria and angioedema. Since 2012, there have been advances in the understanding of the pathogenesis of chronic urticaria, and greater experience with the use of biologics, such as omalizumab, in patients with severe refractory disease. For these reasons, the WAO decided to initiate an update targeted to general practitioners around the world, incorporating the most recent information on epidemiology, immunopathogenesis, comorbidities, quality of life, clinical case presentations, and the management of chronic spontaneous and chronic inducible urticaria, including urticaria in special situations such as childhood and pregnancy. A special task force of WAO experts was invited to write the different sections of the manuscript, and the final document was approved by the WAO Board of Directors. This paper is not intended to be a substitute for current national and international guidelines on the management of urticaria and angioedema but to provide an updated, simplified guidance for physicians around the world who manage patients with this common ailment.

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          GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.

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            Dermatology Life Quality Index (DLQI)--a simple practical measure for routine clinical use.

            A simple practical questionnaire technique for routine clinical use, the Dermatology Life Quality Index (DLQI) is described. One hundred and twenty patients with different skin diseases were asked about the impact of their disease and its treatment on their lives; a questionnaire, the DLQI, was developed based on their answers. The DLQI was then completed by 200 consecutive new patients attending a dermatology clinic. This study confirmed that atopic eczema, psoriasis and generalized pruritus have a greater impact on quality of life than acne, basal cell carcinomas and viral warts. The DLQI was also completed by 100 healthy volunteers; their mean score was very low (1.6%, s.d. 3.5) compared with the mean score for the dermatology patients (24.2%, s.d. 20.9). The reliability of the DLQI was examined in 53 patients using a 1 week test-retest method and reliability was found to be high (gamma s = 0.99).
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              The EAACI/GA²LEN/EDF/WAO Guideline for the Definition, Classification, Diagnosis and Management of Urticaria. The 2017 Revision and Update

              This evidence- and consensus-based guideline was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. The conference was held on 1 December 2016. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-founded network of excellence, the Global Allergy and Asthma European Network (GA²LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO) with the participation of 48 delegates of 42 national and international societies. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria are disabling, impair quality of life and affect performance at work and school. 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 and therapeutic approaches for the different subtypes of urticaria.
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                Author and article information

                Contributors
                Journal
                World Allergy Organ J
                World Allergy Organ J
                The World Allergy Organization Journal
                World Allergy Organization
                1939-4551
                01 June 2021
                June 2021
                01 June 2021
                : 14
                : 6
                : 100533
                Affiliations
                [a ]Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, and Clínica El Avila, Caracas, Venezuela
                [b ]Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia, Bilbao, Spain
                [c ]Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
                [d ]Department of Internal Medicine, Division of Immunology, Allergy Section, University of Cincinnati
                [e ]Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
                [f ]Ayre Foundation at Alas Medical Institute, Salta, Argentina
                [g ]Regional Center for Allergy and Clinical Immunology, Faculty of Medicine and “Dr. José Eleuterio González" University Hospital, Autonomous University of Nuevo León, Monterrey, México
                [h ]The Ohio State University, Columbus, OH, USA
                [i ]CUF Descobertas Hospital, Lisbon, Portugal
                [j ]Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, México
                Author notes
                []Corresponding author. Hospital Qurionsalud Bizkaia, Bilbao-Errandio, Spain. ignacioansotegui@ 123456gmail.com
                Article
                S1939-4551(21)00027-2 100533
                10.1016/j.waojou.2021.100533
                8233382
                34221215
                cf432efa-2fbc-4a5e-8c22-4a4e699885dd
                © 2021 Published by Elsevier Inc. on behalf of World Allergy Organization.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 7 January 2021
                : 18 February 2021
                : 8 March 2021
                Categories
                Article

                Immunology
                angioedema,chronic inducible urticaria,chronic spontaneous urticaria,omalizumab treatment,urticaria

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