Analysis of changes in the new edition of the European Clinical Guidelines on urticaria 2020 revision

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Abstract

The current European Clinical Guidelines on urticaria have been initiated by the European Academy of Allergy and Clinical Immunology (EAACI), Dermatology Section of the EAACI, Global Allergy and Asthma European Network, Urticaria and Angioedema Centers of Reference and Excellence, European Dermatology Forum (EuroGuiDerm), Asia Pacific Association of Allergy, and Asthma and Clinical immunology (Asia Pacific Association of Allergy, Asthma and Clinical Immunology). These guidelines have been adopted by the European Union of Medical Specialists. The purpose of the manual is to define and categorize urticaria (with the focus on chronic urticaria), causes, triggers, comorbidities, and burden on patients and society to present the latest advances in the diagnosis and management of patients with chronic urticaria.

This study analyzes the changes in the new edition of the European Clinical Guidelines on urticaria 2020 revision. The changes relate to expanding the goals of the diagnostic examination of patients and quantity of mandatory examinations. The level of persuasiveness of recommendations for assessing the activity and control of chronic spontaneous urticaria and the impact of the disease on the quality of life of patients has been increased. Treatment should correspond to the level of control of the disease and change according to the principle “assess–act–adjust.” In the new edition, the scheme of the stepwise approach to the treatment of urticaria has been changed: the first line is combined with the second. A significant change is the recommendation to increase the dose of omalizumab to 600 mg and reduce the interval to 2 weeks in patients with insufficient response.

The purpose of creating clinical guidelines is to provide information support for physicians to make decisions that improve the quality of medical care for the patient with a particular disease/condition/syndrome, taking into account the latest clinical data and principles of evidence-based medicine.

About the authors

Inna V. Danilycheva

National Research Center ― Institute of Immunology Federal Medical-Biological Agency of Russia

Author for correspondence.
Email: ivdanilycheva@mail.ru
ORCID iD: 0000-0002-8279-2173
SPIN-code: 4547-3948

MD, Cand. Sci. (Med.)

Russian Federation, 24, Kashyrskoe shosse, Moscow, 115522

Andrey E. Shulzhenko

National Research Center ― Institute of Immunology Federal Medical-Biological Agency of Russia

Email: shulzhenko_ae@mail.ru
ORCID iD: 0000-0003-0268-9350
SPIN-code: 4584-4915

MD, Dr. Sci. (Med.), Professor

Russian Federation, 24, Kashyrskoe shosse, Moscow, 115522

References

  1. Zuberbier T, Greaves MW, Juhlin L, et al. Management of urticaria: a consensus report. J Investig Dermatol Symp Proc. 2001;6(2): 128–231. doi: 10.1046/j.0022-202x.2001.00023.x
  2. Zuberbier T, Latiff AH, Abuzakouk M, et al. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy. 2022;77(3):734–766. doi: 10.1111/all.15090
  3. Andreeva NS, Rebrova OYu, Zorin NA, et al. Systems for assessing the reliability of scientific evidence and the credibility of recommendations: comparative characteristics and prospects for unification. Medical Technologies: Assessment and Choice. 2012;(4):10–24.
  4. Zuberbier T, Aberer W, Asero R, 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(7):868–887. doi: 10.1111/all.12313
  5. Kolkhir P, Kovalkova E, Chernov A, et al. Autoimmune chronic spontaneous urticaria detection with IgG anti-TPO and total IgE. J Allergy Clin Immunol Pract. 2021;9(11):4138–4146.e8. doi: 10.1016/j.jaip.2021.07.043
  6. Türk M, Carneiro-Leão L, Kolkhir P, et al. How to treat patients with chronic spontaneous urticaria with omalizumab: questions and answers. J Allergy Clin Immunol Pract. 2020;8(1):113–124. doi: 10.1016/j.jaip.2019.07.021

Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. International Consensus Conference on Urticaria (2020).

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3. Fig. 2. Treatment of chronic urticaria: "assess-act-adjust" [2].

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4. Fig. 3. Chronic urticaria: therapy and level of control [2]. Note. * For chronic induced urticaria individual decisions are based on estimated trigger exposure (e.g. cold-urticaria in winter). ОМА ― omalizumab; Н1-АГП2 ― 2nd generation H1-antihistamine; UCT ― Urticaria Control Test.

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5. Fig. 4. Recommended treatment algorithm for urticaria [2]. Note: A short course of glucocorticosteroids may be considered in the case of severe exacerbation. a ― Second line and third line treatment apply only for CU; b ― Omalizumab 300 mg every 4 weeks; c ― Omalizumab up 600 mg every 2 weeks; d ― Cyclosporin up to 5mg/kg body weight.

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