Asia Pac Allergy.  2012 Apr;2(2):149-160. 10.5415/apallergy.2012.2.2.149.

Management of chronic urticaria in Asia: 2010 AADV consensus guidelines

• Chow SK

• KMID: 2397369
• DOI: http://doi.org/10.5415/apallergy.2012.2.2.149

Abstract

This guideline is a result of a consensus reached during the 19th Asian-Australasian Regional Conference of Dermatology by the Asian Academy of Dermatology and Venereology Study Group in collaboration with the League of Asian Dermatological Societies in 2010. Urticaria has a profound impact on the quality of life in Asia and the need for effective treatment is required. In line with the EAACI/GA2LEN/EDF/WAO guideline for the management of urticaria the recommended first-line treatment is new generation, non-sedating H1-antihistamines. If standard dosing is ineffective, increasing the dosage up to four-fold is recommended. For patients who do not respond to a four-fold increase in dosage of non-sedating H1-antihistamines, it is recommended that therapies such as H2-antihistamine, leukotriene antagonist, and cyclosporine A should be added to the antihistamine treatment. In the choice of second-line treatment, both their costs and risk/benefit profiles are the most important considerations.

Keyword

Asia; Consensus; Guideline; Wheal; Treatment; Urticaria

MeSH Terms

Asia*
Asian Continental Ancestry Group
Consensus*
Cooperative Behavior
Cyclosporine
Dermatology
Humans
Quality of Life
Urticaria*
Venereology
Cyclosporine

Figure

• 

  Fig. 1 Recommended treatment algorithm for chronic urticaria. (Taken from Fig. 1: EAACI/GA2LEN/EDF/WAO guideline: management of urticaria [1]).

Reference

1. Zuberbier T, Asero R, Bindslev-Jensen C, Walter Canonica G, Church MK, Giménez-Arnau AM, Grattan CE, Kapp A, Maurer M, Merk HF, Rogala B, Saini S, Sánchez-Borges M, Schmid-Grendelmeier P, Schünemann H, Staubach P, Vena GA, Wedi B. EAACI/GA²LEN/EDF/WAO guideline: management of urticaria. Allergy. 2009. 64:1427–1443.

2. Zuberbier T, Greaves MW, Juhlin L, Merk H, Stingl G, Henz BM. Management of urticaria: a consensus report. J Investig Dermatol Symp Proc. 2001. 6:128–131.

3. Zuberbier T, Greaves MW, Juhlin L, Kobza-Black A, Maurer D, Stingl G, Henz BM. Definition, classification, and routine diagnosis of urticaria: a consensus report. J Investig Dermatol Symp Proc. 2001. 6:123–127.

4. Yadav MK, Rishi JP, Nijawan S. Chronic urticaria and Helicobacter pylori. Indian J Med Sci. 2008. 62:157–162.

5. Godse KV. Can worms cause chronic urticaria? Indian J Dermatol. 2006. 51:153–154.

6. Yadav S, Upadhyay A, Bajaj AK. Chronic uricaria: an overview. Indian J Dermatol. 2006. 51:171–177.

7. Zuberbier T. The role of allergens and pseudoallergens in urticaria. J Investig Dermatol Symp Proc. 2001. 6:132–134.

8. Yadav S, Bajaj AK. Management of difficult urticaria. Indian J Dermatol. 2009. 54:275–279.

9. Grattan CE, Sabroe RA, Greaves MW. Chronic Urticaria. J Am Acad Dermatol. 2002. 46:645–657.

10. Stevenson DD. Aspirin and NSAID sensitivity. Immunol Allergy Clin North Am. 2004. 24:491–505. vii

11. Kasperska-Zajac A, Brzoza Z, Rogala B. Sex hormones and urticaria. J Dermatol Sci. 2008. 52:79–86.

12. Poole JA, Rosenwasser LJ. Chronic idiopathic urticaria exacerbated with progesterone therapy treated with novel desensitization protocol. J Allergy Clin Immunol. 2004. 114:456–457.

13. André F, Veysseyre-Balter C, Rousset H, Descos L, André C. Exogenous oestrogen as an alternative to food allergy in the aetiology of angioneurotic oedema. Toxicology. 2003. 185:155–160.

14. Mahesh PA, Kushalappa PA, Holla AD, Vedanthan PK. House dust mite sensitivity is a factor in chronic urticaria. Indian J Dermatol Venereol Leprol. 2005. 71:99–101.

15. Stadler BM, Pachlopnik J, Vogel M, Horn M, Dahinden M, Miescher S. Conditional autoantibodies in urticaria patients: a unifying hypothesis. J Investig Dermatol Symp Proc. 2001. 6:150–152.

16. Stöckli SS, Bircher AJ. Generalized pruritus in a patient sensitized to tobacco and cannabis. J Dtsch Dermatol Ges. 2007. 5:303–304.

17. Plaza T, Nist G, Stetter C, von den Driesch P. Angioedema due to type I allergy to snuff tobacco. J Dtsch Dermatol Ges. 2007. 5:300–302.

18. Hallab N, Merritt K, Jacobs JJ. Metal sensitivity in patients with orthopaedic implants. J Bone Joint Surg Am. 2001. 83:428–436.

19. Axéll T. Hypersensitivity of the oral mucosa: clinics and pathology. Acta Odontol Scand. 2001. 59:315–319.

20. Malhotra SK, Mehta V. Role of stressful life events in induction or exacerbation of psoriasis and chronic urticaria. Indian J Dermatol Venereol Leprol. 2008. 74:594–599.

21. Reich A, Wójcik-Maciejewicz A, Slominski AT. Stress and the skin. G Ital Dermatol Venereol. 2010. 145:213–219.

22. Yang HY, Sun CC, Wu YC, Wang JD. Stress, insomnia, and chronic idiopathic urticaria--a case-control study. J Formos Med Assoc. 2005. 104:254–263.

23. Kulthanan K, Jiamton S, Thumpimukvatana N, Pinkaew S. Chronic idiopathic urticaria: prevalence and clinical course. J Dermatol. 2007. 34:294–301.

24. Merk HF. Standard treatment: the role of antihistamines. J Investig Dermatol Symp Proc. 2001. 6:153–156.

25. Staevska M, Popov TA, Kralimarkova T, Lazarova C, Kraeva S, Popova D, Church DS, Dimitrov V, Church MK. The effectiveness of levocetirizine and desloratadine in up to 4 times conventional doses in difficult-to-treat urticaria. J Allergy Clin Immunol. 2010. 125:676–682.

26. Siebenhaar F, Degener F, Zuberbier T, Martus P, Maurer M. High-dose desloratadine decreases wheal volume and improves cold provocation thresholds compared with standard-dose treatment in patients with acquired cold urticaria: a randomized, placebo-controlled, crossover study. J Allergy Clin Immunol. 2009. 123:672–679.

27. Mahesh PA, Pudupakkam VK, Holla AD, Dande T. Effect of warfarin on chronic idiopathic urticaria. Indian J Dermatol Venereol Leprol. 2009. 75:187–189.

28. Juhlin L. Alternative treatments for severely affected patients with urticaria. J Investig Dermatol Symp Proc. 2001. 6:157–159.

29. Kobza-Black A. Delayed pressure urticaria. J Investig Dermatol Symp Proc. 2001. 6:148–149.

30. Stone KD, Prussin C, Metcalfe DD. IgE, mast cells, basophils, and eosinophils. J Allergy Clin Immunol. 2010. 125:S73–S80.

31. Church MK, Maurer M, Simons FE, Bindslev-Jensen C, van Cauwenberge P, Bousquet J, Holgate ST, Zuberbier T. Risk of first-generation H₁-antihistamines: a GA²LEN position paper. Allergy. 2010. 65:459–466.

32. Godse KV. Chronic urticaria and treatment options. Indian J Dermatol. 2009. 54:310–312.

33. Goh CL, Tan KT. Chronic autoimmune urticaria: where we stand? Indian J Dermatol. 2009. 54:269–274.