Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Allergy and Asthma Reports
Published in: Current Allergy and Asthma Reports 7/2018

01-07-2018 | Allergic Skin Diseases (L Fonacier, Section Editor)

Chronic Urticaria: Comparisons of US, European, and Asian Guidelines

Authors: S. Shahzad Mustafa, Mario Sánchez-Borges

Published in: Current Allergy and Asthma Reports | Issue 7/2018

Login to get access

Abstract

Purpose of Review

Chronic urticaria is a common dermatological condition that has significant impact on quality of life. Multiple international societies have published guidelines, and although these guidelines generally agree on the definition of urticaria, as well as approach to diagnosis and management, there have been notable differences to date. These differences have been reconciled by the recent publication of the 2017 revision and update published by the EAACI/GA2LEN/EDF/WAO.

Recent Findings

The 2017 revision and update to the guidelines for chronic urticaria are the most comprehensive consensus document to date, and reconcile previously existing differences between the US, European, and Asian guidelines.

Summary

The purpose of our review is to present basic background on urticaria and discuss classification, diagnosis, and most importantly, management. We present differences from previous US, European, and Asian guidelines and reconcile the previous differences by summarizing the 2017 revision and update published by the EAACI/GA2LEN/EDF/WAO.
Literature
1.
Kaplan A. Clinical practice: chronic urticaria and angioedema. NEJM. 2002;64:1427–43.
2.
Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, et al. Methods report on the development of the 2013 revision and update of the EAACI/GA2 LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria. Allergy. 2014;69(7):e1–29.CrossRefPubMed
3.
4.
Zuberbier T, Balke M, Worm M, Edenharter G, Maurer M. Epidemiology of urticaria: a representative cross-sectional population survey. Clin Exp Dematol. 2010;35:869–73.CrossRef
5.
Toubi E, Kessel A, Avshovich N, Bamberger E, Sabo E, Nusem D, et al. Clinical and laboratory parameters in predicting chronic urticaria duration: a prospective study of 139 patients. Allergy. 2004;59(8):869–73.CrossRefPubMed
6.
Amin P, Levin L, Holmes SJ, Picard J, Bernstein JA. Investigation of patient-specific characteristics associated with treatment outcomes for chronic urticaria. J Allergy Clin Immunol Pract. 2015;3(3):400–7.CrossRefPubMedPubMedCentral
7.
Poulos LM, Waters AM, Pop Htlh GD, Correll PK, Loblay RH, Marks GB. Trends in hospitalizations for anaphylaxis, angioedema, and urticaria in Australia, 1993-1994 to 2004-2005. J Allergy Clin Immunol. 2007;120:878–84.CrossRefPubMed
8.
O’ Donnell BF, Lawlor F, Simpson J, Morgan M, Greaves MW. The impact of chronic urticaria on quality of life. Brit J of Dermatol. 1997;136(2):197–201.CrossRef
9.
• Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J allergy Clin Immunol. 2014;133:1270–7. Practice parameters outlining the 2014 US guidelines on the diagnosis and management of chronic urticaria CrossRefPubMed
10.
• Zuberbier T, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, Church MK. The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy 2014: 69: 868-87. Document outlining the 2013 European guidelines on the diagnosis and management of chronic urticaria.
11.
•• Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer-Weber B, et al. The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria: the 2017 revision and update. Allergy 2018: Epub ahead of print. 2017 revision and update to urticaria guidelines, the most comprehensive consensus document to date.
12.
• Chow SK. Management of chronic urticaria in Asia: 2010 AADV consensus guidelines. Asia Pac Allergy. 2012;2:149–60. Document outlining the 2010 Asian guidelines on the diagnosis and management of chronic urticaria CrossRefPubMedPubMedCentral
13.
Hide M, Hiragun T. Japanese guidelines for diagnosis and treatment of urticaria in comparison with other countries. Allergol Int. 2012;61:517–27.CrossRefPubMed
14.
Mlynek A, Zalewska-Janowska A, Martus P, Staubach P, Zuberbier T, Maurer M. How to assess disease activity in patients with chronic urticaria. Allergy. 2008;63:777–80.CrossRefPubMed
15.
Weller KG, Magerl M, Tohme M, Martus N, Krause P, Metz K, et al. Development, validation, and initial results of the angioedema activity score. Allergy. 2013;68(9):1185–92.PubMed
16.
Weller K, Groffik A, Church MK, Hawro T, Krause K, Metz M, et al. Development and validation of the urticaria control test: a patient-reported outcome instrument for assessing urticaria control. J Allergy Clin Immunol. 2014;133(5):1365–72.CrossRefPubMed
17.
Ohanyan T, Schoepke N, Bolukbasi B, Metz M, Hawro T, Zuberbier T, et al. Responsiveness and minimal important difference of the urticaria control test. J Allergy Clin Immunol. 2017;140(6):1710–3.CrossRefPubMed
18.
Kowalski ML, Woessner K, Sanak M. Approaches to the diagnosis and management of patients with a history of nonsteroidal anti-inflammatory drug-related urticaria and angioedema. J Allergy and Clin Immunol. 2015;136(2):245–51.CrossRef
19.
Tarbox JA, Gutta RC, Radojicic C, Lang DM. Utility of routine laboratory testing in management of chronic urticaria/angioedema. Ann Allergy Asthma Immunol. 2011;107:239–43.CrossRefPubMed
20.
Magerl M, Pisurevokaja D, Scheufele R, Zuberbier T, Manner M. Effects pf pseudoallergen diet on chronic spontaneous urticaria: a prospective trial. Allergy. 2010;65:78–83.CrossRefPubMed
21.
Maurer M, Keller W, Bindslev-Jensen C, Gimenez-Arnau A, Bousquet PJ, Bousquet J, et al. Unmet clinical needs in chronic spontaneous urticaria. A Galen task force report. Allergy. 2010;66:317–30.CrossRefPubMed
22.
• Sanchez-Borges M, Asero R, Ansotegui IJ, Baiardino I, Bernstein JA, Canonica GW, et al. Diagnosis and treatment of urticaria and angioedema: a worldwide perspective. WAO Journal. 2012;5:125–47. Document outlining the 2012 global guidelines on the diagnosis and management of chronic urticaria PubMedPubMedCentral
23.
Handa S, Dogra S, Kumar B. Comparative efficacy of cetirizine and fexofenadine in the treatment of chronic idiopathic urticaria. J Dermatolog Treat. 2004;15:55–7.CrossRefPubMed
24.
Potter PC, Kapp A, Maurer M, Guillet G, Jian AM, Hauptmann P, et al. Comparison of the efficacy of levocetirizine 5 mg and desloratadine 5 mg in chronic idiopathic urticaria patients. Allergy. 2009;64:596–604.CrossRefPubMed
25.
Zuberbier T, Oanta A, Bogacka E, Medina I, Wesel F, Uhl P, et al. Comparison of the efficacy and safety of bilastine 20 mg versus levocetirizine 5 mg for the treatment of chronic idiopathic urticaria: a multi-Centre, double-blind, randomized, placebo-controlled study. Allergy. 2010;65:516–28.CrossRefPubMed
26.
Grant JA, Riethuisen JM, Moulaert B, DeVos C. A double-blind, randomized, single-dose, crossover comparison of levocetirizine with ebastine, fexofenadine, loratadine, mizolastine, and placebo: suppression of histamine-induced wheal-and-flare response during 24 hours in healthy male subjects. Ann Allergy Asthma Immunol. 2002;88:190–7.CrossRefPubMed
27.
Staevska M, Popov TA, Kralimarkova T, Lazarova C, Kraeva S, Popova D. The effectiveness of levocetirizine and desloratadine in up to 4 times conventional doses in difficult-to-treat urticaria. J Allergy Clin Immunol. 2010;125:676–82.CrossRefPubMed
28.
Asero R. Chronic unremitting urticaria: is the use of antihistamine above licensed dose effective? A preliminary study of cetirizine at licensed and above-licensed doses. Clin Exp Dermatol. 2007;32:34–8.CrossRefPubMed
29.
Monroe EW. Relative efficacy and safety of loratadine, hydroxyzine, and placebo in chronic idiopathic urticaria. Clin Ther. 1992;14:17–21.PubMed
30.
Schweitzer PK, Muehlbach MJ, Walsh JK. Sleepiness and performance during three-day administration of cetirizine or diphenhydramine. J Allergy Clin Immunol. 1994;94:716–24.CrossRefPubMed
31.
Nettis E, Dambra P, D’Oronzio L, Loria MP, Ferrannino A, Tursi A. Comparison of montelukast and fexofenadine for chronic idiopathic urticaria. Arch Dermatol. 2001;137:99–100.PubMed
32.
Bagenstose SE, Levin L, Bernstein JA. The addition of zafirlukast to cetirizine improves the treatment of chronic urticaria in patients with positive autologous serum skin test results. J Allergy Clin Immunol. 2004;113:134–40.CrossRefPubMed
33.
Nettis E, Colanardi MC, Paradiso MT, Ferrannini A. Desloratadine in combination with montelukast in the treatment of chronic urticaria: a randomized, double-blind, placebo-controlled study. Clin Exp Allergy. 2004;34:1401–7.CrossRefPubMed
34.
Sanada S, Tanaka T, Kameyoshi Y, Hide M. The effectiveness of montelukast for the treatment of anti-histamine-resistant chronic urticaria. Arch Dermtol Res. 2005;297:134–8.CrossRef
35.
DiLorenzo G, D’Alcamo A, Rizzo M, Leto-Barone MS, Bianco CL, DItta V, et al. Leukotriene receptor antagonists in monotherapy or in combination with antihistamines in the treatment of chronic urticaria: a systemic review. J Asthma Allergy. 2008;9:9–16.CrossRef
36.
Harvey PR, Wegs J, Shocket AL. A controlled trial of therapy in chronic urticaria. J Allergy Clin Immunol. 1981;68:262–6.CrossRefPubMed
37.
Monroe EW, Cohen SH, Kalbfleisch J, Schulz CI. Combined H1 and H2 antihistamine therapy in chronic urticaria. Arch Dermatol. 1981;117:404–7.CrossRefPubMed
38.
Bleehan SS, Thomas SE, Greaves MW, Newton J, Kennedy CT, Hindley F, et al. Cimetidine and chlorpheniramine in the treatment of chronic idiopathic urticaria: a multi-Centre randomized double-blind study. Br J Dermatol. 1987;117:81–8.CrossRef
39.
Paul E, Bodeker RH. Treatment of chronic urticaria with terfenadine and ranitidine. A randomized, double-blind study in 45 patients. Eur J Clin Phamacol. 1986;31:277–80.CrossRef
40.
Sharpe GR, Shuster R. In dermographic urticaria H2 receptor antagonists have a small but therapeutically irrelevant additional effect compared to H1 antagonists alone. Br J Dermatol. 1993;129:575–9.CrossRefPubMed
41.
Salo OP, Kauppinen K, Mannisto PT. Cimetidine increases the plasma concentration of hydroxyzine. Acta Derm Venereol. 1986;66:349–50.PubMed
42.
Simons FE, Sussman GL, Simons KJ. Effect of the H2-antagonist cimetidine on the pharmacokinetics and pharmacodynamics of the H2 antagonists hydroxyzine and cetirizine in patients with chronic urticaria. J Allergy Clin Immunol. 1995;95:685–93.CrossRefPubMed
43.
• Khan DA. Alternative agents in refractory chronic urticaria: evidence and considerations on the selection and use. J Allergy Clin Immunol Prac. 2013;1:433–40. Review of alternative agents used in the management of refractory cases of chronic urticaria CrossRef
44.
Saini S, Rosen KE, Hsieh HJ, Wong DA, Conner E, Kaplan A, et al. A randomized, placebo-controlled, dose-ranging study of single-dose omalizumab in patients with H-1-antihistamine-refractory chronic idiopathic urticaria. J Allergy Clin Immunol. 2011;128(3):567–U195.CrossRefPubMed
45.
•• Maurer M, Rosen K, Hsieh HJ, Saini S, Grattan C, Gimenez-Arnau A, et al. Omalizumab for the treatment of chronic idiopathic or spontaneous urticaria. N Engl J Med. 2013;368(10):924–35. Landmark study demonstrating the efficacy of omalizumab in chronic urticaria CrossRefPubMed
46.
Zhao ZT, Ji CM, Yu WJ, Meng L, Hawro T, Wei JF, et al. Omalizumab for the treatment of chronic spontaneous urticaria: a meta-analysis of randomized clinical trials. J Allergy Clin Immunol. 2016;137(6):1742–50.CrossRefPubMed
47.
Grattan CE, O'Donnell BF, Francis DM, Niimi N, Barlow RJ, Seed PT, et al. Randomized double-blind study of cyclosporin in chronic 'idiopathic' urticaria. Br J Dermatol. 2000;143(2):365–72.CrossRefPubMed
48.
Vena GA, Cassano N, Colombo D, Peruzzi E, Pigatto P. Cyclosporine in chronic idiopathic urticaria: a double-blind, randomized, placebo-controlled trial. J Am Acad Dermatol. 2006;55(4):705–9.CrossRefPubMed
49.
• Kulthanan K, Chaweekulrat P, Komoltri C, Hunnangkul S, Tuchinda P, Chularojanamontri L, et al. Cyclosporine for chronic spontaneous urticaria: a meta-analysis and systematic review. J Allergy Clin Immunol Pract. 2018;6(2):586–99. Meta-analysis reviewing the literature for cyclosporine in refractory cases of chronic urticaria CrossRefPubMed
50.
Yang K. Placental 11 beta-hydroxysteroid dehydrogenase: barrier to maternal glucocorticoids. Rev Reprod. 1997;2:129–32.CrossRefPubMed
51.
Ost L, Wettrell G, Bjorkman I, Rane A. Prednisolone excretion in human milk. J Pediatr. 1985;106:1008–11.CrossRefPubMed
Metadata
Title
Chronic Urticaria: Comparisons of US, European, and Asian Guidelines
Authors
S. Shahzad Mustafa
Mario Sánchez-Borges
Publication date
01-07-2018
Publisher
Springer US
Published in
Current Allergy and Asthma Reports / Issue 7/2018
Print ISSN: 1529-7322
Electronic ISSN: 1534-6315
DOI
https://doi.org/10.1007/s11882-018-0789-3