State of the art of chronic spontaneous urticaria in Italy: a multicentre survey to evaluate physicians' and patients' perspectives
State of the art of chronic spontaneous urticaria in Italy: a multicentre survey to evaluate physicians' and patients' perspectives
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DOI：
10.1136/bmjopen-2016-012378
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发表时间：
2016-01-01
期刊：
影响因子：
2.9
通讯作者：
Rota, Nadia
中科院分区：
文献类型：
--
作者：
Rimoldi, Marco;Rossi, Oliviero;Rota, Nadia
目的：评估慢性自发性荨麻疹（CSU）的临床状况，并通过治疗CSU的专家了解意大利的治疗方法设计：多中心调查。设置：在线结构式问卷（一个用于医生，一个用于患者）。参与者：意大利的医生和CSU患者。干预：无。主要/次要结局：结果：从160过敏和160皮肤科专家的调查结果显示，专家看到的中位数为40（IQR 20-80）CSU患者/年。虽然大多数专家（56%）知道CSU指南，但只有27%的人经常使用它们（36%的过敏专家和18%的皮肤科医生）。这反映在治疗选择上，定期使用指南的医生和不使用指南的医生之间存在差异：91.6% vs 71.7%选择标准剂量，非镇静抗组胺药作为一线治疗; 85.9% vs 56.0%选择二线治疗的剂量增加，65.3% vs 37.2%添加白三烯受体拮抗剂或H-2-抗组胺药作为三线治疗。来自1385例患者的日记强调，无论治疗方案如何，目前接受治疗的患者中有29.4%对治疗难治。专家的目标是解决症状，只有7.8%的人报告改善生活质量（QoL）作为优先事项。只有16.6%的专家熟悉并使用荨麻疹活动评分，而46.9%的专家不知道。总体而言，调查了537例CSU患者（中位年龄37岁，IQR 30-46; 44.3%为男性;中位病程5年，IQR 3-20）。大约62%的人确认CSU对其QoL产生负面影响。患者还抱怨难以获得信息和支持：
Objective: To assess the clinical status of chronic spontaneous urticaria (CSU) and understand treatment approaches in Italy through specialists who treat CSU (dermatologists and allergy specialists) and CSU patients' experience.Design: Multicentre survey.Setting: Online structured questionnaires (one for physicians and one for patients).Participants: Physicians and patients with CSU in Italy.Interventions: None.Primary/secondary outcomes: Physician and patient attitudes/experiences.Results: Survey results from 160 allergy and 160 dermatology specialists show that specialists see a median of 40 (IQR 20-80) patients with CSU/year. While most specialists (56%) know the CSU guidelines, only 27% use them regularly (36% of allergy specialists vs 18% of dermatologists). This is reflected in treatment choices with differences between physicians who use guidelines regularly and those who do not: 91.6% vs 71.7% choose standard-dose, non-sedating antihistamines as first-line treatment; 85.9% vs 56.0% select up-dosing for second-line treatment and 65.3% vs 37.2% add leukotriene receptor antagonists or H-2-antihistamines as third-line treatment. The diaries from 1385 patients highlight that, regardless of treatment regimen, 29.4% of currently treated patients are refractory to therapy. Specialists aim to resolve symptoms and only 7.8% report improving quality of life (QoL) as a priority. Only 16.6% of specialists are familiar with and use the Urticaria Activity Score while 46.9% do not know it. Overall, 537 patients with CSU were surveyed (median age 37 years, IQR 30-46; 44.3% men; median disease duration 5 years, IQR 3-20). Approximately 62% confirm that CSU negatively impacts their QoL. Patients also complain of difficulties in getting information and support: