1 - Allergy and Clinical Immunology Department, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, E.P.E, Lisboa, Portugal
- EAACI Congress 2021, reunião internacional, apresentação sob a forma de poster
Resumo:
Introdução: Chronic urticaria (CU) is defined by the recurrence of wheals, angioedema or both over more than 6 weeks; it is classified as chronic spontaneous (CSU) or inducible urticaria (CIndU).
Objetivos: Our goal was to characterize the patients followed in our department with the diagnosis of CU over a 17-year (y) period.
Métodos: Retrospective analysis of patients with CU evaluated between 2004 and 2020. Data regarding CU classification, other allergic or autoimmune conditions, time between symptoms and specialist evaluation, past and current treatment, response to therapy, and disease activity and control, was collected from clinical records.
Resultados: We included 310 patients; median age (P25-P75) was 37 y (19-55) and 70% were female. 158 (51%) patients had only CSU (o-CSU), 82 (26%) only CIndU (o-CIndU) and 70 (23%) had both forms (CSU+CIndU). 69 patients (22%) also had angioedema. 172 (56%) had other allergic pathologies (asthma, rhinitis, atopic dermatitis, food, or drug allergy) and 34 (11%) had an autoimmune disease. The median time (P25-P75) between first symptoms and specialist appointment (TFS-SA) was 12 (5-24) months (m). 93 patients (30%) abandoned follow up appointments; median time (P25-75) until abandonment was 12 m (3-24). From the remaining (n=217), 123 (57%) are currently medicated with daily second generation H1-antihistamines (sgAH1), 34 (16%) with as-needed sgAH1, 12 (5%) with sgAH1 plus another medication (mostly montelukast), 11 (5%) with omalizumab, and 37 (17%) are no longer medicated. Previous treatments included: montelukast (30;14%), ciclosporin (13; 6%), prolonged courses of corticosteroids (8; 4%) and antidepressants (9;4%). 37% o-CSU, 69% o-CIndU and 33% CSU+CIndU patients responded to 1st line treatment (1LT); there was a statistically significant lower response in CSU patients (both p <0,05). Response rates to second and third-line treatment were 80-90% in all groups. 180 (83%) patients still have active disease, mostly controlled (89%).
Conclusões: The median age and female predominance are in line with the literature. As expected, most patients presented with CSU, frequently associated with CIndU. TFS-SA was relatively high, which can indicate a lack of recognition and referral. CSU patients have a worse response to 1LT compared to patients with o-CIndU. Most CU patients still showed active disease; nevertheless, the majority was controlled with sgAH1 daily.
Palavras Chave: Chronic Urticaria, Epidemiology, Treatment