Urticaria: A comprehensive review

Antia, Camila; Baquerizo, Katherine; Korman, Abraham M.; Alikhan, Ali; Bernstein, Jonathan A.

doi:10.1016/j.jaad.2018.01.023

Cited by 45 publications

(21 citation statements)

References 135 publications

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“…In children, as in adults, the treatment of urticaria is essentially the same, with a preference for second-generation over first-generation antihistamine, in order to avoid the sedating effects typical of the latter. Corticosteroids should be avoided, due to their growth-related side effects, or at least they should be used for short periods <10–14 days (12, 13).…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment With Omalizumab in a Child With Asthma and Urticaria: A Clinical Case Report

2019

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Childhood urticaria is not rare, although its persistence is less frequent. In children, chronic spontaneous urticaria (CSU) is associated with comorbidities, including asthma, allergic rhinitis, or atopic dermatitis, and many children with CSU have a family history of atopy. The therapeutic approach to CSU in children is the same one recommended by international guidelines for treatment of chronic urticaria in adults. In the European Union, according to the European Medicine Agency, omalizumab is the add-on drug of choice for the management of CSU in adult and adolescent patients (from 12 years of age) with inadequate response to H1 antihistamine therapy. In addition, in children (6 to <12 years of age), it is the add-on therapy of choice to improve asthma control. The management of children with urticaria under 12 is a therapeutic area with few certainties, where omalizumab can be administered only “off-label.”

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Section: Discussionmentioning

confidence: 99%

Successful Treatment With Omalizumab in a Child With Asthma and Urticaria: A Clinical Case Report

2019

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“…Careful and regular monitoring of patients receiving cyclosporine is required to identify any potential adverse events. 8 64 65 Based on a recent meta-analysis, when hypertension, renal impairment, and other severe uncontrolled adverse reactions of cyclosporine occur in patients with CSU, the discontinuation of cyclosporine should be considered. 63 In the 2018 revision and update of the EAACI/GA 2 LEN/EDF/WAO guidelines, cyclosporine is recommended for patients with severe disease refractory to H 1 -antihistamines and omalizumab because it is not licensed for urticaria and has an inferior side effect profile to omalizumab.…”

Section: Cyclosporinementioning

confidence: 99%

The KAAACI/KDA Evidence-Based Practice Guidelines for Chronic Spontaneous Urticaria in Korean Adults and Children: Part 2. Management of H1-Antihistamine-Refractory Chronic Urticaria

Choi

Lee

Song

et al. 2020

Allergy Asthma Immunol Res

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Quite a few patients with chronic spontaneous urticaria (CSU) are refractory to H 1 -antihistamines, even though the dose of H 1 -antihistamines is increased up to 4-fold. CSU that is not controlled with H 1 -antihistamines results in increased disease burden. Several immunomodulators have been used to manage these patients. The guidelines reported herein are connected to Part 1 of the KAAACI/KDA Evidence-Based Practice Guidelines for Chronic Spontaneous Urticaria in Korean Adults and Children, and aimed to provide evidence-based recommendations for the management of H 1 -antihistamine-refractory CSU. Part 2 focuses on the more commonly used additional treatment options for refractory CSU, including omalizumab, cyclosporine, leukotriene receptor antagonist, dapsone, methotrexate, and phototherapy. The evidence to support their efficacy, dosing, safety, and selection of these agents is systematically reviewed. To date, for patients with refractory CSU, the methodologically sound data to evaluate the use of omalizumab has been growing; however, the evidence of other immunomodulators and phototherapy is still insufficient. Therefore, an individualized stepwise approach with a goal of achieving complete symptom control and minimizing side effects can be recommended. Larger controlled studies are needed to elevate the level of evidence to select a rational therapeutic agent for patients with refractory CSU.

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“…As fourth-line of treatment, omalizumab or cyclosporine are indicated, as well as, other anti-inflammatory drugs, immunossupressants ou immunobiological drugs (dapsone, sulfasalazine, hydroxychloroquine, coclchicine, tacrolimus, mycophenolate mofetil, sirolimus, cyclophosphamide, methotrexate, IVIg, anti-TNF, anti-IL-1 receptor and anti-CD20. 31…”

Section: Us Guideline 2014- Treatment30mentioning

confidence: 99%

Consensus on the diagnostic and therapeutic management of chronic spontaneous urticaria in adults - Brazilian Society of Dermatology

Criado

Maruta

Alchorne

et al. 2019

An. Bras. Dermatol.

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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). 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.

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Urticaria: A comprehensive review

Cited by 45 publications

References 135 publications

Successful Treatment With Omalizumab in a Child With Asthma and Urticaria: A Clinical Case Report

Successful Treatment With Omalizumab in a Child With Asthma and Urticaria: A Clinical Case Report

The KAAACI/KDA Evidence-Based Practice Guidelines for Chronic Spontaneous Urticaria in Korean Adults and Children: Part 2. Management of H1-Antihistamine-Refractory Chronic Urticaria

Consensus on the diagnostic and therapeutic management of chronic spontaneous urticaria in adults - Brazilian Society of Dermatology

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