Management of chronic spontaneous urticaria in real life - in accordance with the guidelines? A cross-sectional physician-based survey study
Management of chronic spontaneous urticaria in real life - in accordance with the guidelines? A cross-sectional physician-based survey study
复制标题
DOI：
10.1111/j.1468-3083.2011.04370.x
复制
发表时间：
2013-01-01
影响因子：
9.2
通讯作者：
Maurer, M.
中科院分区：
文献类型：
--
作者：
Weller, K.;Viehmann, K.;Maurer, M.
最近，更新的EAACI/GA 2LEN/EDF/WAO荨麻疹指南已经出版。目的探讨德国慢性自发性荨麻疹（csU）患者的诊断和治疗方法，并将结果与指南建议进行比较。方法在这项横断面调查研究中，大多数皮肤科医生，儿科医生和5149名全科医生在私人执业德国被要求参加。所有同意的医生都被要求完成一份关于csU诊断和治疗管理的标准化问卷。结果共回收问卷776份。大多数医生（82%）试图确定其csU患者的根本原因，但只有有限的成功。超过70%的人报告检查血清总IgE和做皮肤点刺试验（指南未建议一线）。相比之下，只有10%的人进行了自体血清皮肤试验。最常见的一线治疗是标准或更高剂量的非镇静性抗组胺药（推荐）。然而，许多医生报告仍在使用第一代镇静抗组胺药（23%）（不推荐）或全身性类固醇（18%）。替代方案的经验很少。不到三分之一的参与者报告说熟悉这些准则。那些这样做的人，被发现更有可能检查潜在的原因，更有经验的抗组胺剂剂量增加，更不愿意使用镇静抗组胺剂或全身类固醇。结论私人执业医师对csU的诊断和治疗管理不完全符合指南。了解这些指南可以改善护理。
Background Recently, the updated EAACI/GA2LEN/EDF/WAO guidelines for urticaria have been published. Objective To examine how chronic spontaneous urticaria (csU) patients in Germany are diagnosed and treated, and to compare the outcome to the guideline recommendations. Methods During this cross-sectional survey study, most dermatologists, paediatricians and 5149 general practitioners in private practice in Germany were asked to participate. All physicians who agreed were requested to complete a standardized questionnaire about their diagnostic and therapeutic management of csU. Results A total of 776 questionnaires were available for analysis. Most physicians (82%) were attempting to identify underlying causes in their csU patients, but with only limited success. More than 70% reported to check for total serum IgE and to do skin prick testing (not suggested in first line by guideline). In contrast, only 10% applied the autologous serum skin test. The most common first-line treatments were non-sedating antihistamines in standard or higher doses (as recommended). However, many physicians reported still using first generation sedating antihistamines (23%) (not recommended) or systemic steroids (18%). Experience with alternative options was low. Less than one-third of the participants reported to be familiar with the guidelines. Those who did, were found to be more likely to check for underlying causes, to be more experienced with antihistamine updosing and to be more reluctant to use sedating antihistamines or systemic steroids. Conclusion The diagnostic and therapeutic management of csU by private practice physicians does not sufficiently comply with the guidelines. Awareness of the guidelines can lead to improved care.