Clinical experience of a chronic urticaria referral university center

Abstract

Objective. Describing routine procedures, clinical profile and evolution of patients treated in a chronic urticaria (CU) reference center of a university hospital. Methods. Retrospective analysis of clinical records and database of CU patients registered between March 2011 and February 2016 in a reference center. Besides demographic characteristics, disease duration, comorbidities, angioedema, thyroid lab tests, urticaria subtypes, provocation tests, UAS and CUQ2oL scores were recorded. Patients with 3 or more visits were included in analysis regarding the first and last visits, to evaluate pharmacological treatment and differences of UAS/ CUQ2oL scores, antihistamines (anti-H1) dosages and need of other medications, according urticaria subtypes. Results. During the study, 252 patients were attended, 200 with CU, including 162 women, median age 45 years (perc 25 -75 = 27 -58) and median duration of symptoms before diagnosis 24 months (perc 25 -75 = 9 -60). Regarding the etiology, 166 (83%) patients had chronic spontaneous urticaria (CSU), 34 (17%) had isolated chronic inducible urticaria (CIndU) and 66 (33%), CSU with CIndU. Among the 123 patients followed up for 3 or more visits, first prescription to 106 (86.2%) patients was monotherapy with anti-H1, and associations with other medications were prescribed to 17 (13.8%). At the last visit, 94 (76.5%) received antihistamines, and 29 (23.5%) used associations. Patients with CSU + CIndU + ASST positive need more association of anti-H1 with other medications than patients with CSU + CIndU and only CIndU (2 = 7.998; p 0.01). Between first and last visits, CUQ2oL mean scores changed from 35.7 ( 21.9) to 22.6 ( 21.0) (Z = -4.833 p < 0.000). Conclusions. Most of the patients presented CSU, frequently associated with CIndU. There was an improvement in the patients' quality of life during the follow-up period. All patients were treated with antihistamines and there was a great need for doses above the standardized and also for combination with other medications, especially in patients with concomitance of urticaria subtypes.. Etiological investigation and treatment are a challenge for physicians and patients, since about 50% of patients present CSU due to unknown causes (2), leading to great frustration. Firstline treatment is second-generation antihistamines (anti-H1) at licensed dose. However, response to this therapy is not always satisfactory, and further medication is often required (1). Chronic urticaria interferes with well-being and daily life, causing a decrease in quality of life (QoL) and affecting school, work and leisure activities. Analysis of disease severity and its impact on QoL are indispensable tools in the global evaluation of these