Knowledge and management of chronic spontaneous urticaria in Latin America: a cross-sectional study in Ecuador.
Knowledge and management of chronic spontaneous urticaria in Latin America: a cross-sectional study in Ecuador.
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DOI：
10.1186/s40413-017-0150-7
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Cherrez Ojeda I
中科院分区：
文献类型：
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作者：
Cherrez A;Maurer M;Weller K;Calderon JC;Simancas-Racines D;Cherrez Ojeda I
现行EAACI/GA 2LEN/EDF/WAO荨麻疹指南为慢性自发性荨麻疹（CsU）患者的诊断检查和治疗提供了具体建议。本研究探讨了厄瓜多尔的医生是否知道这些建议，并在CsU的实际临床实践中实施这些建议。我们采用标准化问卷调查了一项横断面研究中治疗CsU患者的医生。采用描述性统计，进行校正的逻辑回归，以评估指南知识和治疗使用的联系。共收集和分析了740份调查问卷。医生的平均年龄为42.3（±12.5）岁。参与调查的人员以普通科医生（65.1%）、儿科医生（13.7%）、内科医生（11.0%）、皮肤科医生或变态反应科医生（6.8%）为主。只有18.8%的人知道EAACI/GA 2LEN/EDF/WAO指南。44.5%的GP搜索CsU病因，而D/A为90%。最常见的诊断试验是血清总IgE（83.5%）。最常见的一线对症治疗是口服皮质激素（46.3%），其次是第二代抗组胺药（sgAH，36.8%）。A/D处方更多的sgAH（常规剂量）（GP的74.1%对28.6%）（p < 0.05）。只有3.5%的医生报告了奥马珠单抗的使用经验，熟悉该指南的医生报告率更高。这项研究表明，在厄瓜多尔治疗荨麻疹患者的医生指南建议的知识是低的。CsU患者的诊断检查和治疗在很大程度上不符合真实的生活实践环境中的指南建议。我们能够比较德国和厄瓜多尔医生之间的结果，发现厄瓜多尔医生对现行指南的认识较低（33%对18%）。只有三分之一的医生报告使用常规剂量的sgAH作为一线治疗。此外，只有12.9%的医生使用更高剂量的sgAH，医生仍然使用fgAH，特别是儿科医生（42.9%）。我们的研究结果表明，来自不同国家的医生之间的知识差距可能会影响CsU的管理。对指南的了解与更好的治疗选择有关。认识指南需要促进更好地管理慢性荨麻疹。本文的在线版本（doi：10.1186/s40413-017-0150-7）包含补充材料，可供授权用户使用。
The current EAACI/GA2LEN/EDF/WAO guideline for urticaria provide specific recommendations for the diagnostic workup and treatment of patients with chronic spontaneous urticaria (CsU). This study explored if physicians in Ecuador know these recommendations and implement them in their actual clinical practice for CsU. We investigated physicians who treat CsU patients in a cross-sectional study using a standardized questionnaire. Descriptive statistics were employed, adjusted logistic regression was performed to assess the link of guideline knowledge and use of therapy. Seven hundred forty surveys were collected and analyzed. The mean age of physicians was 42.3 (±12.5) years. Most of the participants (65.1%) were general physicians (GP), 13.7% were pediatricians, 11.0% internists, 6.8% dermatologists or allergists (D/A). Only 18.8% knew the EAACI/GA2LEN/EDF/WAO guideline. 44.5% of GPs searched for CsU etiology in contrast to 90% of D/A. Most common diagnostic test was total serum IgE (83.5%). Most common first line symptomatic treatment was oral corticoids (46.3%), followed by second generation antihistamines (sgAHs, 36.8%). A/D prescribed more sgAHs (regular doses) (74.1 vs 28.6% of GP) (p < 0.05). Experience with omalizumab was reported only by 3.5%, of physicians, and higher rates among who were familiar with the guideline. This study shows that the knowledge of guideline recommendations in physicians who treat urticaria patients in Ecuador is low. The diagnostic workup and treatment of CsU patients are largely not in line with guideline recommendations in real life practice settings. We were able to compare results between German and Ecuadorian physicians and found that Ecuadorian physicians have lower awareness of the current guideline (33 vs 18%). Only one-third of physicians reported using regular doses of sgAHs as the first line treatment. Also, only 12.9% of physicians use sgAHs in higher doses and physicians still use fgAHs, particularly pediatricians (42.9%). Our results suggest that disparities in knowledge between physicians from different countries could influence the management of CsU. Knowledge of the guidelines is linked to better choices of treatments. Awareness of guidelines needs to be promoted for better management of chronic urticaria. The online version of this article (doi:10.1186/s40413-017-0150-7) contains supplementary material, which is available to authorized users.