title: Selected urticaria patients benefit from a referral to tertiary care centres--results of an expert survey.
abstract: BACKGROUND
  Urticaria is a frequent reason for consultations. Recently, it has been demonstrated that the management of chronic spontaneous urticaria (csU) in the practice setting does not fully comply with published guidelines. In addition, it was shown that one of four csU patients is referred to specialized centres.
  
  
  OBJECTIVE
  To analyse the management of urticaria patients in tertiary referral centres.
  
  
  METHODS
  During a standardized expert-to-expert interview, 41 specialists from German tertiary care centres were asked for different aspects of urticaria patient care with a special focus on csU.
  
  
  RESULTS
  On average, the participating centres saw 25 csU patients per month. All ran programmes for the identification of underlying causes with an average success rate of 45 ± 3% which is considerably higher as has been found in the practice setting. In those patients where an identification succeeds, infections, drugs, intolerance and autoreactivity were reported to be causes in 41%, 20%, 17% and 16%. In their symptomatic treatment the majority of centres (71%) followed the guidelines by using regular dosed non-sedating H(1)-antihistamines as first line and higher doses (61%) as second line option. In contrast to the practice setting, meaningful experience also existed for alternative therapies in antihistamine-resistant patients, such as dapsone, cyclosporin and omalizumab. The expenditure of time, laboratory costs and frequency of follow-up visits was reported to be above average in case of csU.
  
  
  CONCLUSIONS
  This study indicates that some urticaria patients, especially those with unknown causes or with an H(1)-antihistamine-resistant disease, may benefit from a referral to tertiary care centres.
authors.affiliation: Department of Dermatology and Allergy, Charité- Universitätsmedizin Berlin, Berlin, Germany             Clinical Development, Novartis Pharma, Nürnberg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Weller
authors.forename: N
authors.initials: N
authors.lastname: Schoepke
authors.forename: K
authors.initials: K
authors.lastname: Krause
authors.forename: E
authors.initials: E
authors.lastname: Ardelean
authors.forename: M
authors.initials: M
authors.lastname: Bräutigam
authors.forename: M
authors.initials: M
authors.lastname: Maurer
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D016572:Cyclosporine / Q000627:therapeutic use; D003880:Dermatology / Q000592:standards / Q000639:trends; D005260:Female; D005858:Germany; D019538:Health Care Surveys; D006633:Histamine Antagonists / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014581:Urticaria / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D006633:Histamine Antagonists; D016572:Cyclosporine