RESUMO
Introducción: La urticaria crónica espontánea es una enfermedad prevalente, de difícil manejo terapéutico y con una importante repercusión en la calidad de vida del paciente. Objetivo: Describir las características epidemiológicas, clínicas y la respuesta terapéutica de los pacientes con urticaria crónica espontánea actuando según la guía de consenso EAACI/GA(2)LEN/EDF/WAO. Material y método: Estudio descriptivo transversal que incluyó todos los pacientes con urticaria crónica espontánea visitados en una consulta específica de alergia cutánea de un servicio de dermatología de un hospital terciario en España desde julio de 2011 hasta julio de 2015. Resultados: Cien pacientes con urticaria crónica espontánea participaron en el estudio. El 43% asociaba una urticaria inducible. El 40% asociaba angioedema. El 53% de los pacientes tomaba antiinflamatorios no esteroideos en el momento del diagnóstico. Todos los pacientes fueron tratados con antihistamínicos-H1 de segunda generación, pero solo un 18% se controló con dosis licenciadas, mientras que el aumento hasta 4 veces la dosis logró controlar el 74% de los pacientes. Los pacientes con angioedema requirieron dosis mayores de antihistamínicos-H1 de segunda generación que los pacientes sin angioedema para el control de la urticaria crónica espontánea, siendo el angioedema un factor asociado a falta de respuesta a tratamiento con antihistamínicos-H1 de segunda generación (OR 6,1%, p < 0,001). Uno de cada 4 pacientes no respondió a antihistamínicos-H1 de segunda generación y requirió omalizumab o ciclosporina para su control. Conclusiones: El control de la urticaria crónica espontánea precisa de la utilización de antihistamínicos-H1 de segunda generación a dosis más altas de las licenciadas en la mayoría de los casos. El angioedema se asocia a falta de respuesta al tratamiento con antihistamínicos. El omalizumab y la ciclosporina logran controlar los casos refractarios. La evitación de antiinflamatorios no esteroideos no es una práctica habitual en los pacientes con urticaria crónica espontánea (AU)
Introduction: 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. Material and method: 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 (AU)
Assuntos
Humanos , Urticária/epidemiologia , Hipersensibilidade/epidemiologia , Antagonistas dos Receptores Histamínicos/uso terapêutico , Corticosteroides/uso terapêutico , Doença Crônica , Qualidade de Vida , Hipersensibilidade Imediata/epidemiologia , Comorbidade , Padrões de Prática Médica , Anti-Inflamatórios não Esteroides/efeitos adversosRESUMO
INTRODUCTION: 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. MATERIAL AND METHOD: 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.
