Chronic spontaneous urticaria (CSU) is a heterogeneous condition that can severely impact quality of life, which is why rapid disease control is essential. Symptomatic first-line treatment of CSU is the licensed dose of second-generation H1 antihistamines. For second-line treatment, this dose may be increased by up to four times. In patients who fail to respond to these higher doses of H1 antihistamines, treatment with omalizumab (up to 24 weeks) is recommended to achieve disease control. After this 24-week period, the patient response profile to omalizumab should be defined in order to identify refractory patients. The optimal management approach for refractory patients has not been established. In this context, the aim of the present expert consensus study involving a group of specialists (allergists and dermatologists) with specific expertise in treating urticaria was to define specific patient profiles based on their differing responses to omalizumab. Another objective was to develop a treatment algorithm based on the specific response profile. First, a comprehensive literature review was conducted. Then, a group meeting was held to discuss all issues related to the therapeutic management of these patients that had not been addressed in any previous studies. In all cases, the experts considered both the available evidence and their own clinical experience with omalizumab. We believe that implementation of this proposed algorithm will help to optimise the management of CSU patients who are refractory to antihistamine treatment, reduce disease-related costs, and improve QoL.

INTRODUCTION: Inflammatory bowel disease is a chronic debilitating condition whose cause is still not completely understood. Goals of therapy include relief of symptoms, mucosal healing, decrease in need for hospitalization and surgery and improved quality of life. Giventhe varying results achieved with conventional medical therapy, patients are turning to a variety of complementary and alternative options for relief, cannabis products being one of the most common. In 2014, Puerto Rico (PR) legalized medicinal marijuana including Crohn's and ulcerative colitis as indications. We questioned whether the gastroenterology community was prepared to confidently and correctly answer the questions brought by their patients. The purpose of this study was to collect data regarding Puerto Rican gastroenterologists' knowledge, comfort and perceptions regarding medical cannabis use in patients with IBD. METHODS: An anonymous 20 question online survey was distributed among gastroenterologists and trainees who are members of the Puerto Rican Gastroenterology Association. The protocol was approved by the MSC IRB. RESULTS: Forty-five responses (25% response rate) were received and analyzed. Participants were mostly males (69%) between the ages of 25-45 (63%) and mainly have private practices (56%) in the metropolitan area (60%). 71% of physicians see less than 15 patients with IBD in one month. Most of the participants (85%) feel informed regarding IBD practice guidelines, and uninformed (51%) regarding their knowledge of the endocannabinoid system. 20% of participants are aware of the requirements to obtain medical marijuana in PR and only 42% know the approved indication. 75% of physicians think that cannabis should be a therapeutic option for IBD patients, however only 40% would recommend it to their patients. 46% of participants reported that their patients have used cannabis for IBD, and pain (80%) is the most common reason. 86% of gastroenterologists cite medical literature as the leading factor in their decision to recommend its use or not and 100% of them would be interested in receiving more information regarding this topic. CONCLUSION: Puerto Rican gastroenterologists are misinformed regarding medical cannabis use in patients with IBD. Although the study sample is small, it highlights the need for education in our community to improve patient care. Strategies to address this concern are needed and would be well received by physicians.

Background: Allergology has been a recognized medical specialty in Spain, with fully defined aims and competencies for more than 4 decades. However, in recent years, its visibility seems to have decreased somewhat. Objectives: To identify which specific factors have contributed to the waning of the importance of the specialty and find tangible solutions to consolidate its place as a front-line medical specialty. Material and methods: An online population survey comprising 60 items of interest was prepared. The degree of agreement and the level of satisfaction with each item were assessed, and implementable initiatives in the short, medium, and long terms were defined in order to provide solutions to the issues identified. Results: The survey was completed by a total of 167 specialists with an average of 18 years’ experience. Most were from public reference hospitals, and 29.3% were heads of department. The line of action for which a good degree of agreement was achieved was to promote the inclusion of an allergist in multidisciplinary teams. The priority lines of action were to improve undergraduate and graduate training in allergology and specialized nursing, to identify curricula in Spain, and to develop robust teaching projects. Conclusions: The results revealed a high degree of homogeneity between professionals. The basic pillars highlighted were as follows: quality training, knowledge, and research in immunotherapy; an innovative portfolio of services endorsed by clinical practice guidelines; and presence in multidisciplinary teams and relevant hospital committees.

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