Clinical practice guideline for diagnosis and management of urticaria.
Urticaria is a common skin condition that can compromise quality of life and may affect individual performance at work or school. Remission is common in majority of patients with acute spontaneous urticaria (ASU); however, in chronic cases, less than 50% had remission. Angioedema either alone or with urticaria is associated with a much lower remission rate. Proper investigation and treatment is thus required. This guideline, a joint development of the Dermatological Society of Thailand, the Allergy, Asthma, and Immunology Association of Thailand and the Pediatric Dermatological Society of Thailand, is graded and recommended based on published evidence and expert opinion. With simple algorithms, it is aimed to help guiding both adult and pediatric physicians to better managing patients who have urticaria with/without angioedema. Like other recent guideline, urticaria is classified into spontaneous versus inducible types. Patients present with angioedema or angioedema alone, drug association should be excluded, acetyl esterase inhibitors (ACEIs) and non-steroidal anti-inflammatory drugs (NSAIDs) in particular. Routine laboratory investigation is not cost-effective in chronic spontaneous urticaria (CSU), unless patients have clinical suggesting autoimmune diseases. Non-sedating H1-antihistamine is the first-line treatment for 2-4 weeks; if urticaria was not controlled, increasing the dose up to 4 times is recommended. Sedating first-generation antihistamines have not been proven more advantage than non-sedating antihistamines. The only strong evidence-based alternative regimen for CSU is an anti-IgE: omalizumab; due to very high cost it however might not be accessible in low-middle income countries. Non-pharmacotherapeutic means to minimize hyper-responsive skin are also important and recommended, such as prevention skin from drying, avoidance of hot shower, scrubbing, and excessive sun exposure.
Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Kanokvalai
K
Kulthanan
Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Papapit
P
Tuchinda
Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Leena
L
Chularojanamontri
Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Pattriya
P
Chanyachailert
Division of Dermatology, Department of Medicine, Faculty of Medicine Chulalongkorn University, Bangkok, Thailand.
Wiwat
W
Korkij
Division of Pediatric Dermatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Amornsri
A
Chunharas
Division of Pediatric Dermatology, Department of Pediatrics, Faculty of Medicine Chulalongkorn University, Bangkok, Thailand.
Siriwan
S
Wananukul
Dermatology Unit, Queen Sirikit National Institute of Child Health, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand.
Wanida
W
Limpongsanurak
Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Suwat
S
Benjaponpitak
Division of Pediatric Dermatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Wanee
W
Wisuthsarewong
Division of Dermatology, Department of Medicine, Faculty of Medicine Phramongkutklao Hospital, Bangkok, Thailand.
Kobkul
K
Aunhachoke
Institute of Dermatology, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand.
Vesarat
V
Wessagowit
Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Chulalongkorn University, Bangkok, Thailand.
Pantipa
P
Chatchatee
Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Penpun
P
Wattanakrai
Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Orathai
O
Jirapongsananuruk
Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Chulalongkorn University, Bangkok, Thailand.
Jettanong
J
Klaewsongkram
Division of Dermatology, Department of Medicine, Faculty of Medicine Chulalongkorn University, Bangkok, Thailand.
Nopadon
N
Noppakun
Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Pakit
P
Vichyanond
College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani, Thailand.
Puan
P
Suthipinittharm
Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Chulalongkorn University, Bangkok, Thailand.
Kiat
K
Ruxrungtham
Dermatology Unit, Queen Sirikit National Institute of Child Health, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand.
Srisupalak
S
Singalavanija
Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Chulalongkorn University, Bangkok, Thailand.
Jarungchit
J
Ngamphaiboon
D000799:Angioedema / Q000175:diagnosis / Q000188:drug therapy; D018926:Anti-Allergic Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D039563:Histamine H1 Antagonists, Non-Sedating / Q000627:therapeutic use; D006801:Humans; D000069444:Omalizumab / Q000627:therapeutic use; D014581:Urticaria / Q000175:diagnosis* / Q000188:drug therapy*
D018926:Anti-Allergic Agents; D039563:Histamine H1 Antagonists, Non-Sedating; D000069444:Omalizumab