- An Bras Dermatol
- v.94(2 Suppl 1); Mar-Apr 2019
- PMC6544033
An Bras Dermatol. 2019 Mar-Apr; 94(2 Suppl 1): 56–66.
PMCID: PMC6544033
PMID: 31166404
Paulo Ricardo Criado,1,2 Celina Wakisaka Maruta,3 Alice de Oliveira de Avelar Alchorne,4,5Andréa Machado Coelho Ramos,6 Bernardo Gontijo,7 Josemir Belo dos Santos,8Luis Eduardo Agner Machado Martins,9 Maria Cecília Rivitti-Machado,10 Maria Regina Cavariani Silvares,11Mario Cezar Pires,12,13 Patricia Karla de Souza,14 Raquel Leão Orfali,10 Renan Rangel Bonamigo,15,16,17Roberta Buense Bedrikow,18,19 Roberta Fachini Jardim Criado,20 and Zilda Najjar Prado de Oliveira10
Abstract
Background
Urticarias are frequent diseases, with 15% to 20% of the population presenting at least one acute episode in their lifetime. Urticaria are classified in acute ( ≤ 6 weeks) or chronic (> 6 weeks). They may be induced or spontaneous.
Objectives
To verify the diagnostic and therapeutic recommendations in chronic spontaneous urticaria (CSU), according to the experience of Brazilian experts, regarding the available guidelines (international and US).
Methods
A questionnaire was sent to Brazilian experts, with questions concerning diagnostic and therapeutic recommendations for CSU in adults.
Results
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| Urticaria activity score for seven consecutive days (UAS7) |
Conclusions
Most of the Brazilian experts in this study partially agreed with the diagnostic and therapeutic recommendations of the International and US guidelines. They agreed with the use of sgAH at licensed doses. Increase in the dose to fourfold of sgAH may be suggested with restrictions, due to its non-licensed dose. Sedating anti-histamines, as suggested by the US guideline, are indicated by some of the Brazilian experts, due to its availability. Adaptations are mandatory in the treatment of CSU, due to scarce or lack of other therapeutic resources in the public health system in Brazil, such as omalizumab or cyclosporine.
Abstract
Background
Urticarias are frequent diseases, with 15% to 20% of the population presenting at least one acute episode in their lifetime. Urticaria are classified in acute ( ≤ 6 weeks) or chronic (> 6 weeks). They may be induced or spontaneous.
Objectives
To verify the diagnostic and therapeutic recommendations in chronic spontaneous urticaria (CSU), according to the experience of Brazilian experts, regarding the available guidelines (international and US).
Methods
A questionnaire was sent to Brazilian experts, with questions concerning diagnostic and therapeutic recommendations for CSU in adults.
Results
Sixteen Brazilian experts answered the questionnaire related to diagnosis and therapy of CSU in adults and data were analyzed. Final text was written, considering the available guidelines (International and US), adapted to the medical practices in Brazil. Diagnostic work up in CSU is rarely necessary. Biopsy of skin lesion and histopathology may be indicated to rule out other diseases, such as, urticarial vasculitis. Other laboratory tests, such as complete blood count, CRP, ESR and thyroid screening. Treatment of CSU includes second-generation anti-histamines (sgAH) at licensed doses, sgAH two, three to fourfold doses (non-licensed) and omalizumab. Other drugs, such as, cyclosporine, immunomodulatory drugs and immunosuppressants may be indicated (non-licensed and with limited scientific evidence).
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