Zuberbier / Grattan / Maurer Urticaria and Angioedema

2010
ISBN: 978-3-540-79048-8
Verlag: Springer
Format: PDF
Kopierschutz: Wasserzeichen (»Systemvoraussetzungen)

E-Book, Englisch, 158 Seiten, eBook

Urticaria is one of the most common diseases in dermatology and allergy. Unlike many other diseases, the ? eeting nature of the wheals makes ? rst diagnosis by both patients and phy- cians in many cases easy. However, this only refers to the ordinary wheals. The disease itself is highly complex in nature, with variety of clinical manifestations ranging from pinpoi- sized wheals to extensive angiodema. Complexity is also seen in the diversity of possible eliciting factors, the many different clinical subtypes and the therapeutic responsiveness. Only in recent years has a better understanding of the diversity in the different subtypes led to new classi? cations and new evidence-based guidelines for diagnostics and mana- ment of the disease. While mast cells are in the center of most urticaria reactions, it is now clearly understood that the responsible mediators are not only limited to histamines. The current book appears in a series of books by Springer. In 1986, the ? rst monograph was edited by Professor Henz née Chanewsky. Since then, two updates of the book have appeared in the German language with Professor Henz as ? rst editor and T. Zuberbier, J. Grabbe, and E. Monroe as the co-editors of the most recent English version, published in 1998. All these books have been written as a joint effort of Professor Henz together with her team at the Department of Dermatology at the Virchow Clinic, Humboldt University, Berlin.

Zielgruppe

Professional/practitioner

Autoren/Hrsg.

Zuberbier, Torsten

Grattan, Clive

Maurer, Marcus

Inhaltsverzeichnis

History of Urticaria.- Aetiopathogenesis of Urticaria.- Classification of Urticaria.- Impact of Urticaria: QOL and Performance.- Acute Urticaria.- Chronic Urticaria.- Dermographic and Delayed Pressure Urticaria.- Heat and Cold Urticaria.- Solar Urticaria.- Cholinergic Urticaria and Exercise-Induced Anaphylaxis.- Contact Urticaria.- Urticarial Syndromes and Autoinflammation.- Urticaria Vasculitis.- Angioedema.- Therapy of Urticaria.- Standard Operating Procedures: A Practical Approach.

Leseproben

"6 Therapy of Urticaria (p. 129-130)

Bettina Wedi

Core Messages

The different urticaria subtypes are common skin diseases persisting often for › years with multifactorial triggering factors and greatly reduced quality of life as well as occupational disability. Therapy can be problematic and is not standardised. Regarding the long duration › of this annoying skin disease, every attempt should be made to identify and avoid speci? c or unspeci? c triggering factors. The treatment goal is to maximise the quality of life, to maintain vigilance and ability to work or to attend school and to minimise drug-related side effects.

Besides antihistamines and the eradication or avoidance of identi? ed triggering › factors, many drugs, most of which are not licensed for urticaria, are administered. The highest grade of recommendation (GoR) according to the criteria of › evidence-based medicine can only be given for second-generation H1 antihistamines. They should be administered in an adequate dose, up to fourfold the normal dose while considering potential side effects. The data on treatment alternatives are totally insuf? cient. Good evidence exists in › severely affected patients for cyclosporin A. Subgroups might bene? t from addition of leukotrienes antagonists. Chloroquine and dapsone may be worthy of further investigation within randomised controlled trials.

The risk–bene? t pro? le of each alternative (off-label use) to second-generation › H1 antihistamines should be carefully considered before treatment. This applies especially to immunosuppressive agents. The clinical pictures of urticaria are of heterogeneous aetiology and therefore subclassi? ed into distinct groups, which can coexist: spontaneous urticaria, physical urticaria and special types. To optimise urticaria treatment, the ? rst strategy should be to correctly classify the respective urticaria subtype. The treatment goal is to maximise the quality of life and ability to work or to attend school and to minimise drug-related side effects.

This is of particular importance regarding the long year duration of many urticaria subtypes. Relevant outcomes of treatment trials include pruritus, weal size, number and frequency, loss of awakening, overall physician and patient assessment and permanent remission of disease. This chapter is based on the results of two recent publications evaluating randomised controlled trials (RCTs) of urticaria therapy (until October 2004) according to the criteria of evidence-based medicine [1, 2 ].

Details of the individual studies, inclusion and exclusion criteria as well as the cited literature are available in the publications [1, 2 ], if not otherwise cited. Additionally, this review includes at least the RCTs published until December 2006 [3–7 ] and also interesting treatment approaches. In the text, the respective GoR according to the criteria of evidence-based medicine of the Scottish Intercollegiate Guidelines Network (SIGN; www.sign.ac.uk, GoR A to D, whereas A represents best evidence) is given in parentheses. Table 6.1 summarises the recommended therapeutic approaches."