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Consensus on the diagnostic and therapeutic management of chronic spontaneous urticaria in adults - Brazilian Society of Dermatology
Criado, Paulo Ricardo; Maruta, Celina Wakisaka; Alchorne, Alice de Oliveira de Avelar; Ramos, Andréa Machado Coelho; Gontijo, Bernardo; Santos, Josemir Belo dos; Martins, Luis Eduardo Agner Machado; Rivitti-Machado, Maria Cecília; Silvares, Maria Regina Cavariani; Pires, Mario Cezar; Souza, Patricia Karla de; Orfali, Raquel Leão; Bonamigo, Renan Rangel; Bedrikow, Roberta Buense; Criado, Roberta Fachini Jardim; Oliveira, Zilda Najjar Prado de.
  • Criado, Paulo Ricardo; Universidade de São Paulo. Faculdade de Medicina. São Paulo. BR
  • Maruta, Celina Wakisaka; Universidade de São Paulo. Faculdade de Medicina. Department of Dermatology. São Paulo. BR
  • Alchorne, Alice de Oliveira de Avelar; Universidade Federal de Pernambuco. Recife. BR
  • Ramos, Andréa Machado Coelho; Universidade Federal de Minas Gerais. Hospital das Clinicas. Dermatology Service. Belo Horizonte. BR
  • Gontijo, Bernardo; Universidade Federal de Minas Gerais. Faculdade de Medicina. Belo Horizonte. BR
  • Santos, Josemir Belo dos; Universidade Federal de Pernambuco. Faculdade de Medicina. Centro de Ciências Médicas. Recife. BR
  • Martins, Luis Eduardo Agner Machado; Faculdade Evangélica de Curitiba. Dermatology Service. Curitiba. BR
  • Rivitti-Machado, Maria Cecília; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. São Paulo. BR
  • Silvares, Maria Regina Cavariani; Universidade Estadual Paulista. Department of Dermatology and Radiotherapy. Botucatu. BR
  • Pires, Mario Cezar; Hospital Padre Bento de Guarulhos. São Paulo. BR
  • Souza, Patricia Karla de; Universidade Federal de São Paulo. Department of Dermatology. Urticaria Outpatient Clinic. São Paulo. BR
  • Orfali, Raquel Leão; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. São Paulo. BR
  • Bonamigo, Renan Rangel; Universidade Federal do Rio Grande do Sul. Faculdade de Medicina. Hospital de Clínicas de Porto Alegre. Porto Alegre. BR
  • Bedrikow, Roberta Buense; Santa Casa de Misericórdia de São Paulo. Dermatology Clinic. São Paulo. BR
  • Criado, Roberta Fachini Jardim; Faculdade de Medicina do ABC. São Paulo. BR
  • Oliveira, Zilda Najjar Prado de; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. São Paulo. BR
An. bras. dermatol ; 94(2,supl.1): 56-66, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1011090
Responsible library: BR1.1
ABSTRACT
Abstract

Background:

Urticarias are frequent diseases, with 15% to 20% of the population presenting at least one acute episode in their lifetime. Urticaria are classified in acute ( ≤ 6 weeks) or chronic (> 6 weeks). They may be induced or spontaneous.

Objectives:

To verify the diagnostic and therapeutic recommendations in chronic spontaneous urticaria (CSU), according to the experience of Brazilian experts, regarding the available guidelines (international and US).

Methods:

A questionnaire was sent to Brazilian experts, with questions concerning diagnostic and therapeutic recommendations for CSU in adults.

Results:

Sixteen Brazilian experts answered the questionnaire related to diagnosis and therapy of CSU in adults and data were analyzed. Final text was written, considering the available guidelines (International and US), adapted to the medical practices in Brazil. Diagnostic work up in CSU is rarely necessary. Biopsy of skin lesion and histopathology may be indicated to rule out other diseases, such as, urticarial vasculitis. Other laboratory tests, such as complete blood count, CRP, ESR and thyroid screening. Treatment of CSU includes second-generation anti-histamines (sgAH) at licensed doses, sgAH two, three to fourfold doses (non-licensed) and omalizumab. Other drugs, such as, cyclosporine, immunomodulatory drugs and immunosuppressants may be indicated (non-licensed and with limited scientific evidence).

Conclusions:

Most of the Brazilian experts in this study partially agreed with the diagnostic and therapeutic recommendations of the International and US guidelines. They agreed with the use of sgAH at licensed doses. Increase in the dose to fourfold of sgAH may be suggested with restrictions, due to its non-licensed dose. Sedating anti-histamines, as suggested by the US guideline, are indicated by some of the Brazilian experts, due to its availability. Adaptations are mandatory in the treatment of CSU, due to scarce or lack of other therapeutic resources in the public health system in Brazil, such as omalizumab or cyclosporine.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Urticaria / Consensus Type of study: Practice guideline Limits: Adult / Humans Country/Region as subject: South America / Brazil Language: English Journal: An. bras. dermatol Journal subject: Dermatology Year: 2019 Type: Article Affiliation country: Brazil Institution/Affiliation country: Faculdade Evangélica de Curitiba/BR / Faculdade de Medicina do ABC/BR / Hospital Padre Bento de Guarulhos/BR / Santa Casa de Misericórdia de São Paulo/BR / Universidade Estadual Paulista/BR / Universidade Federal de Minas Gerais/BR / Universidade Federal de Pernambuco/BR / Universidade Federal de São Paulo/BR / Universidade Federal do Rio Grande do Sul/BR / Universidade de São Paulo/BR

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Full text: Available Index: LILACS (Americas) Main subject: Urticaria / Consensus Type of study: Practice guideline Limits: Adult / Humans Country/Region as subject: South America / Brazil Language: English Journal: An. bras. dermatol Journal subject: Dermatology Year: 2019 Type: Article Affiliation country: Brazil Institution/Affiliation country: Faculdade Evangélica de Curitiba/BR / Faculdade de Medicina do ABC/BR / Hospital Padre Bento de Guarulhos/BR / Santa Casa de Misericórdia de São Paulo/BR / Universidade Estadual Paulista/BR / Universidade Federal de Minas Gerais/BR / Universidade Federal de Pernambuco/BR / Universidade Federal de São Paulo/BR / Universidade Federal do Rio Grande do Sul/BR / Universidade de São Paulo/BR