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Chronic urticaria: do urticaria nonexperts implement treatment guidelines? A survey of adherence to published guidelines by nonexperts.
Br J Dermatol. 2009 Apr; 160(4):823-7.BJ

Abstract

BACKGROUND

Guidelines including level of evidence and grade of recommendation were recently published for chronic urticaria (CU).

OBJECTIVES

To describe the therapeutic approach in patients with CU, and to depict how recent guidelines are implemented in the daily practice of management of CU.

METHODS

We performed a cross-sectional multicentre study through a questionnaire answered by 139 specialists. In total, 695 patients were evaluated, mean+/-SD age 42.3+/-15 years, 62.1% women. Of the patients, 168 were treated by an allergist, 473 by a dermatologist and in 54 cases the specialist was not stated. The drug prescribed was the main variable, and chi2 and Fisher's tests were utilized for the statistical analysis.

RESULTS

Nonsedating anti-H1 antihistamines taken regularly were the most common drugs prescribed, followed by nonsedating anti-H1 antihistamines taken as needed, corticosteroids, sedating antihistamines taken regularly, sedating antihistamines taken as needed, anti-H2 antihistamines, leukotriene antagonists, ciclosporin and doxepin. Nonsedating antihistamines plus corticosteroids was the most frequent drug combination prescribed. When comparing between allergists and dermatologists we found a positive and significant correlation only between prescription of cetirizine, dexchlorfeniramine, leukotriene antagonists and anti-H2 antihistamines and being treated by an allergist. A positive correlation was found with desloratadine and being seen by a dermatologist. We did not find any difference in CU management in the rest of the treatments studied.

CONCLUSIONS

It is surprising that a large amount of sedating antihistamines was prescribed. In many instances these were prescribed as needed. This fact could have a negative impact on urticaria control and patient satisfaction. It seems difficult for the nonexpert to differentiate between CU and any kind of physical urticaria.

Authors+Show Affiliations

Departamento de Alergología e Inmunología Clínica, Clínica Universitaria, Universidad de Navarra, 31080 Pamplona, Spain. mferrerp@unav.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19120332

Citation

Ferrer, M, et al. "Chronic Urticaria: Do Urticaria Nonexperts Implement Treatment Guidelines? a Survey of Adherence to Published Guidelines By Nonexperts." The British Journal of Dermatology, vol. 160, no. 4, 2009, pp. 823-7.
Ferrer M, Jáuregui I, Bartra J, et al. Chronic urticaria: do urticaria nonexperts implement treatment guidelines? A survey of adherence to published guidelines by nonexperts. Br J Dermatol. 2009;160(4):823-7.
Ferrer, M., Jáuregui, I., Bartra, J., Dávila, I., del Cuvillo, A., Montoro, J., Mullol, J., Valero, A., & Sastre, J. (2009). Chronic urticaria: do urticaria nonexperts implement treatment guidelines? A survey of adherence to published guidelines by nonexperts. The British Journal of Dermatology, 160(4), 823-7. https://doi.org/10.1111/j.1365-2133.2008.08985.x
Ferrer M, et al. Chronic Urticaria: Do Urticaria Nonexperts Implement Treatment Guidelines? a Survey of Adherence to Published Guidelines By Nonexperts. Br J Dermatol. 2009;160(4):823-7. PubMed PMID: 19120332.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chronic urticaria: do urticaria nonexperts implement treatment guidelines? A survey of adherence to published guidelines by nonexperts. AU - Ferrer,M, AU - Jáuregui,I, AU - Bartra,J, AU - Dávila,I, AU - del Cuvillo,A, AU - Montoro,J, AU - Mullol,J, AU - Valero,A, AU - Sastre,J, Y1 - 2008/12/16/ PY - 2009/1/6/entrez PY - 2009/1/6/pubmed PY - 2009/7/14/medline SP - 823 EP - 7 JF - The British journal of dermatology JO - Br J Dermatol VL - 160 IS - 4 N2 - BACKGROUND: Guidelines including level of evidence and grade of recommendation were recently published for chronic urticaria (CU). OBJECTIVES: To describe the therapeutic approach in patients with CU, and to depict how recent guidelines are implemented in the daily practice of management of CU. METHODS: We performed a cross-sectional multicentre study through a questionnaire answered by 139 specialists. In total, 695 patients were evaluated, mean+/-SD age 42.3+/-15 years, 62.1% women. Of the patients, 168 were treated by an allergist, 473 by a dermatologist and in 54 cases the specialist was not stated. The drug prescribed was the main variable, and chi2 and Fisher's tests were utilized for the statistical analysis. RESULTS: Nonsedating anti-H1 antihistamines taken regularly were the most common drugs prescribed, followed by nonsedating anti-H1 antihistamines taken as needed, corticosteroids, sedating antihistamines taken regularly, sedating antihistamines taken as needed, anti-H2 antihistamines, leukotriene antagonists, ciclosporin and doxepin. Nonsedating antihistamines plus corticosteroids was the most frequent drug combination prescribed. When comparing between allergists and dermatologists we found a positive and significant correlation only between prescription of cetirizine, dexchlorfeniramine, leukotriene antagonists and anti-H2 antihistamines and being treated by an allergist. A positive correlation was found with desloratadine and being seen by a dermatologist. We did not find any difference in CU management in the rest of the treatments studied. CONCLUSIONS: It is surprising that a large amount of sedating antihistamines was prescribed. In many instances these were prescribed as needed. This fact could have a negative impact on urticaria control and patient satisfaction. It seems difficult for the nonexpert to differentiate between CU and any kind of physical urticaria. SN - 1365-2133 UR - https://www.unboundmedicine.com/medline/citation/19120332/Chronic_urticaria:_do_urticaria_nonexperts_implement_treatment_guidelines_A_survey_of_adherence_to_published_guidelines_by_nonexperts_ L2 - https://doi.org/10.1111/j.1365-2133.2008.08985.x DB - PRIME DP - Unbound Medicine ER -