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Italian Journal of Dermatology and Venereology 2021 December;156(6):659-64

DOI: 10.23736/S2784-8671.20.06760-7


language: English

Chronic spontaneous urticaria in clinical practice: a pilot survey about attitudes and perceptions on assessment, diagnostic work-up and dietary management

Nicoletta CASSANO 1, Giovanni GENOVESE 2, 3, Riccardo ASERO 4, Nunzio CRIMI 5, Antonio CRISTAUDO 6, Paolo DAPAVO 7, Ornella DE PITÀ 8, Silvia M. FERRUCCI 2, Maria T. FIERRO 7, Caterina FOTI 9, Giampiero GIROLOMONI 10, Eustachio NETTIS 11, Annamaria OFFIDANI 12, Annalisa PATRIZI 13, Patrizia PEPE 14, Paolo PIGATTO 15, Luca STINGENI 16, Angelo V. MARZANO 2, 3 , Gino A. VENA 1

1 Private Practitioner, Bari, Italy; 2 Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 3 Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; 4 Outpatient Service of Allergology, San Carlo Clinic, Paderno Dugnano, Milan, Italy; 5 Department of Clinical and Experimental Medicine-Respiratory Medicine and Allergy, University of Catania, Catania, Italy; 6 Service of Occupational and Environmental Allergic Dermatology, San Gallicano Dermatology Institute for Research and Care, Rome, Italy; 7 Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy; 8 Department of Dermatology and Allergy, Cristo Re Hospital, Rome, Italy; 9 Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy; 10 Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy; 11 Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, Aldo Moro University, Bari, Italy; 12 Dermatology Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy; 13 Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy; 14 Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy; 15 Clinical Dermatology, Department of Biomedical, Surgical and Dental Sciences, IRCCS Galeazzi Orthopedic Institute, University of Milan, Milan, Italy; 16 Section of Clinical, Allergological and Venereological Dermatology, Department of Medicine, University of Perugia, Perugia, Italy

BACKGROUND: Chronic spontaneous urticaria (CSU) is a heterogeneous condition whose management can be complex and challenging. The aim of this study is to evaluate physicians’ attitudes regarding practical aspects of CSU management, including adherence to international guidelines, criteria and instruments for CSU assessment, prescription of laboratory investigations and role of dietary measures.
METHODS: A cross-sectional survey was conducted using a study-specific questionnaire. It was administered to a group of physicians with a specialist interest in CSU from different areas of Italy definable as “CSU experts” (group A; N.=21) and subsequently to other physicians who managed CSU only occasionally in their clinical activity (group B; N.=25).
RESULTS: The EAACI/GA2LEN/EDF/WAO guidelines were considered very or moderately useful by the majority of participants. Significantly more physicians in group A reported that such guidelines were always followed in clinical practice (P=0.0008). Instruments for the assessment of CSU severity/activity and quality of life were used in clinical practice significantly more often by CSU experts as compared to group B. Dietary measures were frequently suggested for CSU patients by nearly three quarters of group B members and by only 5% of CSU experts (P<0.00001). When physicians were asked to indicate the type of laboratory examinations that were commonly performed in patients with longstanding and/or uncontrolled CSU, regardless of history, the investigations most frequently reported were full blood count and thyroid autoantibodies, followed by erythrocyte sedimentation rate and/or C-reactive protein and thyroid function tests.
CONCLUSIONS: The results of the present pilot survey seem to suggest the heterogeneity of the approaches used for CSU management in clinical practice.

KEY WORDS: Chronic spontaneous urticaria; Clinical practice; Guidelines; Assessment; Disease severity; Diet; Laboratory examinations

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