针对儿科医生、过敏学家和皮肤科医生的 CME 建议，由一项关于荨麻疹知识的在线调查指导。
CME suggestions for pediatricians, allergists, and dermatologists, directed by an online survey on urticaria knowledge.
机构信息
Teaching and Research Unit, Hospital de Especialidades Juan María de Salvatierra, La Paz Baja California Sur, México.
Research Unit, Médica Sur, Clinical Foundation and Hospital, México City, Mexico;
出版信息
Allergol Immunopathol (Madr). 2021 Jan 2;49(1):87-94. doi: 10.15586/aei.v49i1.26. eCollection 2021.
BACKGROUND
The Mexican Guidelines for the diagnosis and treatment of urticaria have been published. Just before their launch, physicians' knowledge was explored relating to key issues of the guidelines.
OBJECTIVE
The aim of this study was to investigate the opinion of medical specialists concerning urticaria management.
METHODS
A SurveyMonkey survey was sent out to board-certified physicians of three medical specialties treating urticaria. Replies were analyzed per specialty against the evidence-based recommendations.
RESULTS
Sixty-five allergists (ALLERG), 24 dermatologists (DERM), and 120 pediatricians (PED) sent their replies. As for diagnosis: ALERG 42% and PED 76% believe cutaneous mastocytosis, urticarial vasculitis, and hereditary angioedema are forms of urticaria, versus DERM 29% (P < 0.005). Most of the specialties find that the clinical history and physical examination are enough to diagnose acute urticaria, except DERM 45% (P < 0.01). DERM 45% believe laboratory-tests are necessary, as opposed to <15% ALLERG-PED (P < 0.005). However, PED 69% did not know that the most frequent cause of acute urticaria in children is infections, versus ALLERG-DERM 30% (P < 0.005). Many erroneously do laboratory testing in physical urticaria and ALLERG 51%, DERM 59%, and PED 37% do extensive laboratory testing in chronic spontaneous urticaria (CSU); many more PED 59% take Immunoglobulin G (IgG) against foods (P < 0.005). More than half of non-allergists do not know about autologous serum testing nor autoimmunity (P < 0.05). As for treatment, there were a few major gaps: when CSU was controlled, >75% prescribed antihistamines pro re nata, and >85% gave first-generation antiH1 for insomnia. Finally, >40% of DERM did not know that cyclosporine A, omalizumab, or other immunosuppressants could be used in recalcitrant cases.
CONCLUSION
Specialty-specific continuous medical education might enhance urticaria management.
背景
墨西哥荨麻疹诊断和治疗指南已经发布。在发布之前，我们探讨了医生对指南关键问题的了解。
目的
本研究旨在调查医学专家对荨麻疹管理的意见。
方法
我们向三位治疗荨麻疹的医学专家的委员会认证医生发送了 SurveyMonkey 调查。根据循证建议，对各专业的答复进行了分析。
结果
65 名过敏专家（ALLERG）、24 名皮肤科医生（DERM）和 120 名儿科医生（PED）回复了调查。在诊断方面：42%的 ALLERG 和 76%的 PED 认为皮肤肥大细胞增多症、荨麻疹性血管炎和遗传性血管性水肿是荨麻疹的一种形式，而 DERM 为 29%（P<0.005）。除了 DERM 的 45%（P<0.01）外，大多数专业人员认为临床病史和体检足以诊断急性荨麻疹。只有不到 15%的 ALLERG-PED（P<0.005）认为实验室检查是必要的，而 DERM 为 45%。然而，69%的 PED 不知道儿童急性荨麻疹最常见的原因是感染，而 ALLERG-DERM 为 30%（P<0.005）。许多人在物理性荨麻疹时错误地进行实验室检测，而 ALLERG 为 51%，DERM 为 59%，PED 为 37%在慢性自发性荨麻疹（CSU）中进行广泛的实验室检测；更多的 PED 为 59%服用针对食物的免疫球蛋白 G（IgG）（P<0.005）。超过一半的非过敏专家不知道自身血清检测或自身免疫（P<0.05）。在治疗方面，存在一些重大差距：当 CSU 得到控制时，超过 75%的人开了按需抗组胺药，超过 85%的人开了第一代抗 H1 治疗失眠。最后，超过 40%的 DERM 不知道环孢素 A、奥马珠单抗或其他免疫抑制剂可用于难治性病例。
结论
针对特定专业的持续医学教育可能会提高荨麻疹的管理水平。
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