Department of Dermatology and Allergy, Charité- Universitätsmedizin Berlin, Berlin, Germany Clinical Development, Novartis Pharma, Nürnberg, Germany.
J Eur Acad Dermatol Venereol. 2013 Jan;27(1):e8-16. doi: 10.1111/j.1468-3083.2011.04387.x. Epub 2011 Dec 17.
Urticaria is a frequent reason for consultations. Recently, it has been demonstrated that the management of chronic spontaneous urticaria (csU) in the practice setting does not fully comply with published guidelines. In addition, it was shown that one of four csU patients is referred to specialized centres.
To analyse the management of urticaria patients in tertiary referral centres.
During a standardized expert-to-expert interview, 41 specialists from German tertiary care centres were asked for different aspects of urticaria patient care with a special focus on csU.
On average, the participating centres saw 25 csU patients per month. All ran programmes for the identification of underlying causes with an average success rate of 45 ± 3% which is considerably higher as has been found in the practice setting. In those patients where an identification succeeds, infections, drugs, intolerance and autoreactivity were reported to be causes in 41%, 20%, 17% and 16%. In their symptomatic treatment the majority of centres (71%) followed the guidelines by using regular dosed non-sedating H(1)-antihistamines as first line and higher doses (61%) as second line option. In contrast to the practice setting, meaningful experience also existed for alternative therapies in antihistamine-resistant patients, such as dapsone, cyclosporin and omalizumab. The expenditure of time, laboratory costs and frequency of follow-up visits was reported to be above average in case of csU.
This study indicates that some urticaria patients, especially those with unknown causes or with an H(1)-antihistamine-resistant disease, may benefit from a referral to tertiary care centres.
荨麻疹是常见的就诊原因。最近，研究表明，慢性自发性荨麻疹（csU）的临床管理并未完全符合已发布的指南。此外，有研究表明，每四名 csU 患者中就有一名会被转诊至专科中心。
分析三级转诊中心中荨麻疹患者的管理情况。
在标准化的专家间访谈中，来自德国三级医疗中心的 41 名专家被问及荨麻疹患者护理的不同方面，特别关注 csU。
平均而言，参与研究的中心每月诊治 25 名 csU 患者。所有中心都开展了识别潜在病因的项目，平均成功率为 45±3%，明显高于实践中所报告的成功率。在那些成功识别病因的患者中，感染、药物、不耐受和自身免疫被报告为病因的比例分别为 41%、20%、17%和 16%。在对症治疗中，大多数中心（71%）遵循指南，首选常规剂量、无镇静作用的 H1 抗组胺药，其次是较高剂量的 H1 抗组胺药。与实践环境不同，在抗组胺药耐药的患者中，替代疗法（如达普司酮、环孢素和奥马珠单抗）也具有一定的应用经验。在 csU 患者中，报告的时间投入、实验室成本和随访就诊频率均高于平均水平。
本研究表明，某些荨麻疹患者，尤其是病因不明或 H1 抗组胺药耐药的患者，可能受益于转诊至三级医疗中心。
