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Giornale Italiano di Dermatologia e Venereologia 2020 Nov 23

DOI: 10.23736/S0392-0488.20.06761-9


language: English

Therapeutic management of chronic spontaneous urticaria in clinical practice: results from a pilot survey

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 Teresa 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 Dermatology Private Practice, Bari and Barletta, Italy; 2 Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 3 Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy; 4 Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Milan, Italy; 5 Department of Clinical and Experimental Medicine-Respiratory Medicine & 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 Department of Medical Sciences, Section of Dermatology, 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, University of Bari Aldo Moro, 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 Orthopaedic Institute, Università degli Studi di Milano, Milan, Italy; 16 Section of Clinical, Allergological and Venereological Dermatology, Department of Medicine, University of Perugia, Perugia, Italy


BACKGROUND: The therapeutic approaches to patients with chronic spontaneous urticaria (CSU) differ among health care professionals and may be influenced by many factors.
OBJECTIVES: This cross-sectional survey was aimed at evaluating physicians’ attitudes regarding therapeutic management of CSU on clinical practice.
METHODS: A study-specific questionnaire was administered to a group of physicians (n=21) with a specialist interest in CSU from different areas of Italy (Group A) and also to other physicians (n=25) who manage CSU only occasionally in their clinical activity (Group B).
RESULTS: In case of ineffectiveness of second-generation antihistamines at standard doses, higher doses of the same drug were always or frequently prescribed by most physicians in both groups, and 64% in group B and one third in group A usually increased the dose up to twice. Old-generation antihistamines were never used in clinical practice by 14% of survey participants in group A and 24% in group B, with the remaining physicians reporting rare or occasional uses. The prescription of systemic corticosteroids appeared to be more common among physicians in group B. The question concerning the use of alternative drugs in refractory CSU produced different answers between the two groups. Costs and access to specialist reference centers were indicated as the most important barriers to the use of medications different from antihistamines.
CONCLUSIONS: These preliminary results suggest that therapeutic approaches to CSU seem to be heterogeneous in clinical practice and could be at least in part conditioned by the different medical settings where physicians usually work.

KEY WORDS: Chronic spontaneous urticaria; Clinical practice; Guidelines; Treatment; Antihistamines; Corticosteroids; Omalizumab; Cyclosporine

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