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      Smartphone Photographs of Chronic Urticaria Taken by Patients Are of Good Quality and Useful in the Clinic

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          Abstract

          Background: Chronic urticaria (CU) is characterized by transient wheals and angioedema, which are often not present when patients see their treating physician. Objective: The objective of this study was to evaluate the diagnostic value of smartphone photographs captured by patients prior to their first visit at an urticaria outpatient clinic. Methods: A survey regarding the quality and utility of smartphone photographs of urticarial skin lesions in patients with CU attending the outpatient clinic for the first time was conducted. Up to three random patient-selected photographs of skin lesions were evaluated by a physician. Results: Of 148 patients, 118 (79.7%) had taken photographs of their skin lesions prior to the consultation, and 75% took photographs with the intention of presenting it to their physician. The photographs were of wheals in 90% of the cases and angioedema in 8%. In total, 72% of the smartphone photographs had the skin lesion in focus, 64% had good resolution, and 48% had good lighting. Only 9% of the smartphone photographs were blurred, 10% had bad lighting, 4% had bad resolution, and 8% did not have the lesion in focus. Moreover, 86% of the smartphone photographs were found to be useful for clinical evaluation. At least one photograph of good/very good quality was presented by 86% of the patients, and 97% had at least one photograph that was useful for clinical evaluation. Conclusion: Patients with CU often take smartphone photographs of their skin lesions on their own initiative prior to their first consultation to present the photographs to their physician. These smartphone photographs are very often of good quality and suitable for clinical evaluation.

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          Definition, aims, and implementation of GA(2) LEN Urticaria Centers of Reference and Excellence.

          GA²LEN, the Global Allergy and Asthma European Network, has recently launched a program for the development, interaction, and accreditation of centers of reference and excellence in special areas of allergy embedded in its overall quality management of allergy centers of excellence. The first area chosen is urticaria. Urticaria is a common and debilitating condition and can be a challenge for both patients and treating physicians, especially when chronic. Centers of reference and excellence in urticaria (UCAREs) can help to improve the management of hard-to-treat conditions such as urticaria.
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            An approach to the patient with urticaria.

            Patients with urticaria make up a large proportion of the referrals to allergy clinics. There are many causes of urticaria and it is the clinical history which is most important when attempting to identify potential causes; however, urticaria is very often idiopathic. In a small minority of patients urticaria may be a symptom of a serious underlying medical illness or the allergic symptoms may progress to cause systemic reactions, and it is important to identify these patients and to remember that severe urticaria is a distressing and disabling condition. This review will discuss classification, investigation and treatment of urticaria and will consider some of the more unusual types of urticaria that may be encountered in the out-patient clinic.
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              The effectiveness of a history-based diagnostic approach in chronic urticaria and angioedema.

              To assess the value of extensive laboratory screening for the identification of causes in patients with chronic urticaria and/or angioedema. In a prospective study involving 220 patients, 2 diagnostic strategies were compared: the combination of detailed history taking and limited laboratory investigations vs detailed history taking and extensive laboratory screening. The results of the extensive screening program were initially kept secret from the patients and the physicians. Later, all results were disclosed, and an investigation was undertaken to find out whether this information changed the initial diagnosis. The patients were followed up for 1 year to evaluate the results of interventions and to detect latent causes. The study was performed in the outpatient department of a secondary and tertiary care center with institutional practice. A total of 238 consecutive new patients with chronic urticaria and/or angioedema edema were referred; 18 of them refused participation. One patient was unavailable for follow-up. The difference in the number of identified causes between both approaches and the nature of the causes that would have been missed by omitting extensive laboratory screening. With a questionnaire and the limited laboratory tests, a cause was found in 45.9% of the patients, compared with 52.7% with the questionnaire and the extended screening program. Except for one parasitic infection, missed diagnoses were mainly adverse reactions to drugs or food detected by standard elimination procedures, not by laboratory investigations. Routine laboratory screening did not contribute substantially to the diagnosis of chronic urticaria or to the detection of underlying disorders.
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                Author and article information

                Journal
                DRM
                Dermatology
                10.1159/issn.1018-8665
                Dermatology
                Dermatology
                S. Karger AG
                1018-8665
                1421-9832
                2024
                June 2024
                04 November 2023
                : 240
                : 3
                : 357-361
                Affiliations
                [a ]Urticaria Center of Reference and Excellence (UCARE), Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
                [b ]Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
                [c ]Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
                [d ]Koç University School of Medicine, Department of Dermatology, Istanbul, Turkey
                [e ]Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
                [f ]Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
                Author notes
                *Zarqa Ali, zarqa_ali@hotmail.com
                Article
                535027 Dermatology 2024;240:357–361
                10.1159/000535027
                37926073
                de8a22f2-3c38-4308-b27c-b1074d35e55b
                © 2023 The Author(s). Published by S. Karger AG, Basel
                History
                : 25 May 2023
                : 02 November 2023
                Page count
                Tables: 2, Pages: 5
                Funding
                No funding was received for conducting this study.
                Categories
                Research Article

                Medicine
                Digital imaging,Smartphone,Image,Remote assessment,Photographs,Skin,Urticaria
                Medicine
                Digital imaging, Smartphone, Image, Remote assessment, Photographs, Skin, Urticaria

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