title: Management of Chronic Spontaneous Urticaria in Routine Clinical Practice Following the EAACI/GA(2)LEN/EDF/WAO Guidelines.
abstract: BACKGROUND
  Chronic spontaneous urticaria is a prevalent and difficult-to-treat condition that has a very negative impact on patient quality of life.
  
  
  OBJECTIVE
  To describe the epidemiological and clinical characteristics of patients presenting with chronic spontaneous urticaria and the response to treatment administered according to the EAACI/GA(2)LEN/EDF/WAO consensus guideline.
  
  
  METHODS
  Descriptive cross-sectional study of all the patients with chronic spontaneous urticaria who consulted a skin allergy unit in the dermatology department of a tertiary hospital in Spain between July 2011 and July 2015.
  
  
  RESULTS
  The study included 100 patients with chronic spontaneous urticaria; inducible urticaria was present in 43% of cases, and angioedema in 40%. On diagnosis, 53% of patients were taking nonsteroidal anti-inflammatory drugs. All patients were treated with second generation H1-antihistamines, but the standard dose was sufficient in only 18% of cases. Higher doses (up to 4 times the standard dose) achieved control of the urticaria in 74% of the patients studied. Higher doses of second generation H1-antihistamines were required to control the condition in patients with angioedema, and the presence of angioedema was associated with a lack of response to treatment with these drugs (OR, 6.1%; P<.001). One in 4 patients failed to respond to second generation H1-antihistamines and required treatment with omalizumab or ciclosporin to control their condition.
  
  
  CONCLUSIONS
  Doses of H1-antihistamines higher than the standard dose are required in most cases to achieve control of chronic spontaneous urticaria. Angioedema is associated with failure to respond to treatment with antihistamines. In refractory cases, control of the condition can be achieved with omalizumab or ciclosporin. Patients with chronic spontaneous urticaria do not generally avoid the use of nonsteroidal anti-inflammatory agents.
authors.affiliation: Servicio de Dermatología, Hospital General Universitario de Elda, Elda, Alicante, España. Electronic address: Irene.marin.cabanas@gmail.com.
authors.forename: I
authors.initials: I
authors.lastname: Marín-Cabañas
authors.affiliation: Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España.
authors.forename: L
authors.initials: L
authors.lastname: Berbegal-de Gracia
authors.affiliation: Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España.
authors.forename: F
authors.initials: F
authors.lastname: de León-Marrero
authors.affiliation: Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España.
authors.forename: P
authors.initials: P
authors.lastname: Hispán
authors.affiliation: Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España.
authors.forename: J F
authors.initials: JF
authors.lastname: Silvestre
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000799:Angioedema / Q000150:complications / Q000188:drug therapy; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000453:epidemiology; D002908:Chronic Disease; D015897:Comorbidity; D003430:Cross-Sectional Studies; D016572:Cyclosporine / Q000627:therapeutic use; D003880:Dermatology / Q000379:methods; D019468:Disease Management; D004359:Drug Therapy, Combination; D006525:Hepatitis, Viral, Human / Q000453:epidemiology; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use; D000069444:Omalizumab / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D062606:Tertiary Care Centers; D014581:Urticaria / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D006634:Histamine H1 Antagonists; D020024:Leukotriene Antagonists; D000069444:Omalizumab; D016572:Cyclosporine
keywords: Antiinflamatorios no esteroideos; Chronic spontaneous urticaria; Consensus guidelines; Factores desencadenantes; Guía de consenso; Nonsteroidal anti-inflammatory agents; Tratamiento; Treatment; Triggers; Urticaria crónica espontánea