Department of Dermatology and Allergy, Allergy-Centrum-Charité, Charité-Universitätsmedizin, Berlin, Germany.
J Eur Acad Dermatol Venereol. 2013 Jan;27(1):43-50. doi: 10.1111/j.1468-3083.2011.04370.x. Epub 2011 Dec 8.
Recently, the updated EAACI/GA(2) LEN/EDF/WAO guidelines for urticaria have been published.
To examine how chronic spontaneous urticaria (csU) patients in Germany are diagnosed and treated, and to compare the outcome to the guideline recommendations.
During this cross-sectional survey study, most dermatologists, paediatricians and 5149 general practitioners in private practice in Germany were asked to participate. All physicians who agreed were requested to complete a standardized questionnaire about their diagnostic and therapeutic management of csU.
A total of 776 questionnaires were available for analysis. Most physicians (82%) were attempting to identify underlying causes in their csU patients, but with only limited success. More than 70% reported to check for total serum IgE and to do skin prick testing (not suggested in first line by guideline). In contrast, only 10% applied the autologous serum skin test. The most common first-line treatments were non-sedating antihistamines in standard or higher doses (as recommended). However, many physicians reported still using first generation sedating antihistamines (23%) (not recommended) or systemic steroids (18%). Experience with alternative options was low. Less than one-third of the participants reported to be familiar with the guidelines. Those who did, were found to be more likely to check for underlying causes, to be more experienced with antihistamine updosing and to be more reluctant to use sedating antihistamines or systemic steroids.
The diagnostic and therapeutic management of csU by private practice physicians does not sufficiently comply with the guidelines. Awareness of the guidelines can lead to improved care.
最近，更新后的 EAACI/GA(2)LEN/EDF/WAO 荨麻疹指南已经发布。
检查德国慢性自发性荨麻疹 (csU) 患者的诊断和治疗方法，并将结果与指南建议进行比较。
在这项横断面调查研究中，德国的大多数皮肤科医生、儿科医生和 5149 名私人执业的全科医生被要求参与。所有同意参与的医生都被要求填写一份关于 csU 诊断和治疗管理的标准化问卷。
共收到 776 份问卷进行分析。大多数医生（82%）试图在 csU 患者中找出潜在原因，但效果有限。超过 70%的医生报告会检查总血清 IgE 和进行皮肤点刺试验（指南不建议一线检查）。相比之下，只有 10%的医生会进行自体血清皮肤试验。最常见的一线治疗是标准或更高剂量的非镇静抗组胺药（如指南推荐）。然而，许多医生仍报告使用第一代镇静抗组胺药（23%）（不推荐）或全身类固醇（18%）。替代方案的经验很少。不到三分之一的参与者报告熟悉该指南。那些熟悉该指南的人更有可能检查潜在原因，更有经验进行抗组胺药加量，并且更不愿意使用镇静抗组胺药或全身类固醇。
私人执业医生对 csU 的诊断和治疗管理不符合指南要求。对指南的认识可以提高治疗质量。
