Urticaria Guidelines: Consensus and Controversies in the European and American Guidelines
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Urticaria can present acutely and be self-limiting or become chronic and persist for weeks, months, or years. In either case, the condition may have a significant impact on the patient’s quality of life. Two major consensus groups, the EAACI/WAO and the AAAAI/ACAAI Joint Task Force, have written guidelines on the diagnosis and management of urticaria. While both agree on most points regarding the definition, general evaluation, and treatment, there are some differences which exist. The guidelines, which are written to assist both primary practitioners and specialists in managing their patients with urticaria, have been developed based on scientific evidence, and when insufficient evidence is available, then recommendations are based on expert consensus opinion. The majority of the differences between the two guidelines pertain to recommendations based on expert opinion because of weak scientific evidence. Within this document, we compare the recommendations of these two groups, highlighting the key similarities and differences.
KeywordsUrticaria Hives Angioedema Guidelines for urticaria Diagnosis of urticaria Management of urticaria
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Conflict of Interest
Jonathan A. Bernstein reports speaker fees from Genentech and clinical trial and IIS grants from Genentech/Novartis. Lauren M. Fine declares no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 1.••Zuberbier T, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, Church MK, et al. The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014;69:868–87. This is the document outlining the European guidelines for urticaria.PubMedCrossRefGoogle Scholar
- 2.••Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol US Am Acad Allergy Asthma Immunol. 2014;133:1270–7. Published by Mosby, Inc. This is the document outlining the American guidelines for urticaria.Google Scholar
- 4.Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, et al. Methods report on the development of the 2013 revision and update of the EAACI/GA(2) LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria. Allergy. 2014;69:e1–e29.PubMedCrossRefGoogle Scholar
- 5.Shocket AL. Chronic urticaria: pathophysiology and etiology, or the what and why. Allergy Asthma Proc. 2006;27:90–5.Google Scholar
- 6.Confino-Cohen R, Chodick G, Shalev V, Leshno M, Kimhi O, Goldberg A. Chronic urticaria and autoimmunity: associations found in a large population study. J Allergy Clin. 2012;129:1307–13. ImmunolAllergy Clin Immunol Unit, Meir Medical Center, Kfar Saba, Israel. email@example.com: American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc.CrossRefGoogle Scholar
- 9.Chansakulporn S, Pongpreuksa S, Sangacharoenkit P, Pacharn P, Visitsunthorn N, Vichyanond P, et al. The natural history of chronic urticaria in childhood: a prospective study. J Am Acad Dermatol. 2014;71:663–8. The natural history of chronic urticaria in childhood: a prospective study. Division of Allergy and Immunology, Department of Pediatrics, Srinakarinwirot University, Bangkok, Thailand; Division of Allergy and Immunology, Department of Pediatrics, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Division of All (TRUNCATED: American Academy of Dermatology, Inc. Published by Elsevier Inc.PubMedCrossRefGoogle Scholar
- 12.Greenberger PA. Chronic urticaria: new management options. World Allergy Organ J. 2014;7:31–4551 – 7–31. eCollection 2014. Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, 676 N. St. Clair Street, # 14108, 60611 Chicago, IL USA.Google Scholar
- 13.Erbagci Z. The leukotriene receptor antagonist montelukast in the treatment of chronic idiopathic urticaria: a single-blind, placebo-controlled, crossover clinical study. J Allergy Clin Immunol. 2002;110:484–8. Department of Dermatology, Gaziantep University Medical Faculty, Turkey.PubMedCrossRefGoogle Scholar
- 14.Grattan CE, O’Donnell BF, Francis DM, Niimi N, Barlow RJ, Seed PT, et al. Randomized double-blind study of cyclosporin in chronic “idiopathic” urticaria. Br J Dermatol. 2000;143:365–72. Dermatology Centre, West Norwich Hospital, Norwich NR2 3TU, UK. firstname.lastname@example.org.PubMedCrossRefGoogle Scholar
- 18.Saini S, Rosen KE, Hsieh HJ, Wong DA, Conner E, Kaplan A, et al. A randomized, placebo-controlled, dose-ranging study of single-dose omalizumab in patients with H1-antihistamine-refractory chronic idiopathic urticaria. J Allergy Clin Immunol. 2011;128:567–73.e1. Johns Hopkins Asthma and Allergy Center, Baltimore, MD 21224, USA. email@example.com: American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc.PubMedCrossRefGoogle Scholar
- 20.Valero A, Herdman M, Bartra J, Ferrer M, Jáuregui I, Dávila I, et al. Adaptation and validation of the Spanish version of the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL). J Investig Allergol Clin Immunol [Internet]. 2008;18:426–32. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19123433.
- 21.Platzer MH, Grattan CEH, Poulsen LK, Skov PS. Validation of basophil histamine release against the autologous serum skin test and outcome of serum-induced basophil histamine release studies in a large population of chronic urticaria patients. Allergy Eur J Allergy Clin Immunol. 2005;60:1152–6.CrossRefGoogle Scholar
- 22.Konstantinou GN, Asero R, Maurer M, Sabroe RA, Schmid-Grendelmeier P, Grattan CE. EAACI/GA(2)LEN task force consensus report: the autologous serum skin test in urticaria. Allergy. 2009;64:1256–68. Allergy and Clinical Immunology Department, NIMTS, Army Hospital and Allergy Research Center National & Kapodistrian University of Athens, Greece.PubMedCrossRefGoogle Scholar
- 23.Maurer M, Weller K, Bindslev-Jensen C, Gimenez-Arnau A, Bousquet PJ, Bousquet J, et al. Unmet clinical needs in chronic spontaneous urticaria. A GA(2)LEN task force report. Allergy. 2011;66:317–30. Department of Dermatology and Allergy, Charite- Universitatsmedizin Berlin, Berlin, Germany. firstname.lastname@example.org: John Wiley & Sons A/S.PubMedCrossRefGoogle Scholar
- 26.Amin P, Levin L, Holmes SJ, Picard J, Bernstein JA. Investigation of patient-specific characteristics associated with treatment outcomes for chronic urticaria. J Allergy Clin Immunol Pr. 2015. doi: 10.1016/j.jaip.2014.12.007.
- 27.Ring J, Hein R, Gauger A, Bronsky E, Miller B. Once-daily desloratadine improves the signs and symptoms of chronic idiopathic urticaria: a randomized, double-blind, placebo-controlled study. Int J Dermatol [Internet]. 2001;40:72–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11277962\nhttp://apps.isiknowledge.com/full_record.do?product=UA&search_mode=GeneralSearch&qid=8&SID=T2FFQ4fEGczccZ8jE6Z&page=9&doc=419.Google Scholar
- 28.•Staevska M, Popov TA, Kralimarkova T, Lazarova C, Kraeva S, Popova D, et al. The effectiveness of levocetirizine and desloratadine in up to 4 times conventional doses in difficult-to-treat urticaria. J Allergy Clin Immunol. 2010;125:676–82. Evidence supporting step 2 of both the JTF and EAACI guidelines to increase 2nd generation antihistamines up to 4 times the conventional dose. This is generally very effective, safe and easy to manage for many patients.PubMedCrossRefGoogle Scholar
- 30.Sanada S, Tanaka T, Kameyoshi Y, Hide M. The effectiveness of montelukast for the treatment of anti-histamine-resistant chronic urticaria. Arch Dermatol Res. 2005;297:134–8. Department of Dermatology, Programs for Biomedical Research, Division of Molecular Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan.PubMedCrossRefGoogle Scholar
- 31.Nettis E, Colanardi MC, Paradiso MT, Ferrannini A. Desloratadine in combination with montelukast in the treatment of chronic urticaria: a randomized, double-blind, placebo-controlled study. Clin Exp Allergy. 2004;34:1401–7. Department of Medical Clinic, Immunology and Infectious Diseases, Section of Allergy and Clinical Immunology, University of Bari, Bari, Italy. email@example.com.PubMedCrossRefGoogle Scholar
- 34.•Maurer M, Rosen K, Hsieh HJ, Saini S, Grattan C, Gimenez-Arnau A, et al. Omalizumab for the treatment of chronic idiopathic or spontaneous urticaria. N Engl J Med. 2013;368:924–35. Highlights the most efficacious dose of omalizumab (300 mg SC every 4 weeks) and the use of the UAS7 score to quantify response to treatment. Department of Dermatology and Allergy, Charite-Universitatsmedizin, Berlin.PubMedCrossRefGoogle Scholar
- 38.Kar S, Krishnan A, Preetha K, Mohankar A. A review of antihistamines used during pregnancy. [Internet]. J. Pharmacol Pharmacother. 2012. p. 105–8. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3356948&tool=pmcentrez&rendertype=abstract