title: Management of chronic spontaneous urticaria in routine clinical practice: A Delphi-method questionnaire among specialists to test agreement with current European guidelines statements.
abstract: BACKGROUND
  Chronic spontaneous urticaria (CSU) is a frequent clinical entity that often presents a diagnostic and therapeutic challenge.
  
  
  OBJECTIVE
  To explore the degree of agreement that exists among the experts caring for patients with CSU diagnosis, evaluation, and management.
  
  
  METHODS
  An online survey was conducted to explore the opinions of experts in CSU, address controversial issues, and provide recommendations regarding its definition, natural history, diagnosis, and treatment. A modified Delphi method was used for the consensus.
  
  
  RESULTS
  The questionnaire was answered by 68 experts (dermatologists, allergologists, and primary care physicians). A consensus was reached on 54 of the 65 items posed (96.4%). The experts concluded that CSU is a difficult-to-control disease of unpredictable evolution. Diagnostic tests should be limited and based on clinical history and should not be indiscriminate. Autoinflammatory syndromes and urticarial vasculitis must be ruled out in the differential diagnosis. A cutaneous biopsy is only recommended when wheals last more than 24h, to rule out urticarial vasculitis. The use of specific scales to assess the severity of the disease and the quality of life is recommended. In patients with severe and resistant CSU, second-generation H1-antihistamines could be used at doses up to four times the standard dose before giving second-line treatments. Omalizumab is a safe and effective treatment for CSU that is refractory to H1-antihistamines treatment. In general, diagnosis and treatment recommendations given for adults could be extrapolated to children.
  
  
  CONCLUSIONS
  This work offers consensus recommendations that may be useful in the management of CSU.
authors.affiliation: Dermatology Service, Hospital del Mar, Parc de Salut Mar, Universitat Autonoma Barcelona [Autonomous University of Barcelona], Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Giménez-Arnau
authors.affiliation: Allergology Department, Clínica Universidad de Navarra [University Clinic of Navarra], Pamplona, Spain. Electronic address: mferrerp@unav.edu.
authors.forename: M
authors.initials: M
authors.lastname: Ferrer
authors.affiliation: Pneumology and Allergy Service, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) [August Pi i Sunyer Biomedical Research Institute], Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Bartra
authors.affiliation: Allergology Service, Hospital Universitario Basurto [Basurto University Hospital], Bilbao, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Jáuregui
authors.affiliation: Allergology Section, Medicine Department, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona [Autonomous University of Barcelona], Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Labrador-Horrillo
authors.affiliation: Dermatology Service, Hospital Universitario 12 de Octubre [University Hospital 12 of October], Madrid, Spain.
authors.forename: J Ortiz de
authors.initials: JO
authors.lastname: Frutos
authors.affiliation: Dermatology Service, Hospital General Universitario de Alicante [University of Alicante General Hospital], Alicante, Spain.
authors.forename: J F
authors.initials: JF
authors.lastname: Silvestre
authors.affiliation: Allergology Service, Fundación Jiménez Diaz [Jiménez Diaz Foundation], Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Sastre
authors.affiliation: Dermatology Service, Hospital Arnau de Vilanova, Valencia, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Velasco
authors.affiliation: Pneumology and Allergy Service, Hospital Clinic (ICT), University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) [August Pi i Sunyer Biomedical Research Institute], Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Valero
mesh_terms: D000328:Adult; D000072223:Allergists / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D032921:Consensus; D003697:Delphi Technique; D000072085:Dermatologists / Q000706:statistics & numerical data; D003937:Diagnosis, Differential; D005060:Europe; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D000069444:Omalizumab / Q000627:therapeutic use; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D012720:Severity of Illness Index; D014581:Urticaria / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D006634:Histamine H1 Antagonists; D000069444:Omalizumab
keywords: Angio-oedema; Consensus; Delphi; Delphi technique; Omalizumab; Urticaria