Resumen
Objetivo: Describir el perfil clínico y de laboratorio de los pacientes diagnosticados con urticaria crónica en la consulta externa de alergología en un hospital de tercer nivel de atención del sistema de seguridad social de Costa Rica.
Métodos: Se incluyeron todos los pacientes mayores de 13 años diagnosticados con urticaria crónica entre el 1 de enero de 2014 y el 31 de diciembre de 2018. Se analizaron estadísticamente variables de datos clínicos y de laboratorio y se comparó el tratamiento de los pacientes entre la primera y última consulta.
Resultados: Se trató de 160 pacientes con diagnóstico de urticaria crónica: 129 del sexo femenino, 45.7 % con edad entre 30 y 49 años, en 17.5 % (28 pacientes) se asoció urticaria inducible, 54.8 % (46/84) presentó anticuerpo antitiroperoxidasa positivo, 16.9 % (27 pacientes) se mantuvo en la última consulta con una dosis de antihistamínicos anti-H1 de segunda generación; 16.3 % (26 pacientes) ya no requería tratamiento antihistamínico en la última consulta. En 8.8 % de los casos (14 pacientes) se utilizó ciclosporina y en 2.5 % (cuatro pacientes), omalizumab.
Conclusión: Al tratarse de un estudio de vida real en una región geográfica con limitadas publicaciones sobre esta patología, confiamos que la información provista contribuya a la comunidad científica a mejorar la calidad de vida de los pacientes con urticaria crónica mediante un diagnóstico oportuno y un tratamiento eficaz y efectivo.
Referencias
Zuberbier T, Aberer W, Asero R, Abdul-Laiff AH, Baker D, Ballmer-Weber B, et al. The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018;73(7):1393-1414. DOI: 10.1111/all.13397
O’Donnell BF. Urticaria: impact on quality of life and economic cost. Immunol Allergy Clin North Am. 2014;34:89-104. DOI: 10.1016/j.iac.2013.09.011
Kanani A, Betschel SD, Warrington R. Urticaria and angioedema. Allergy Asthma Clin Immunol. 2018;14(Suppl 2):59. DOI: 10.1186/s13223-018-0288-z
Greaves MW. Pathology and classification of urticaria. Immunol Allergy Clin North Am. 2014;34(1):1-9. DOI: 10.1016/j.iac.2013.07.009
Le Fourn E, Giraudeau B, Chosidow O, Marie-Sylvie D, Lorette G. Study design and quality of reporting of randomized controlled trials of chronic idiopathic or autoimmune urticaria: review. PLoS One. 2013;8(8):e701717. DOI: 10.1371/journal.pone.0070717
Itakura A, Tani Y, Kaneko, Hide M. Impact of chronic urticaria on quality of life and work in Japan: Results of a real-world study. J Dermatol. 2018;45(8):963-970. DOI: 10.1111/1346-8138.14502
Jariwala SP, Moday H, de Asis ML, Fodeman J, Hudes G, de Vos G, et al. The Urticaria Severity Score: a sensitive questionnaire/index for monitoring response to therapy in patients with chronic urticaria. Ann Allergy Asthma Immunol. 2018;102(6):475-482. DOI: 10.1016/S1081-1206(10)60120-2
Coelho-Dias GA, Cunha-Coelho F, Filippo P, Lacerda-Pedrazzi D, Nogueira-Arraes AC, Perelló MI, et al. Clinical experience of a chronic urticaria university referral center. Eur Ann Allergy Clin Immunol. 2020;52(3):112-120. DOI: 10.23822/EurAnnACI.1764-1489.103
Gómez RM, Jares E, Borges MS, Baiardini I, Walter-Canonica G, Passalacqua G, et al. Latin American chronic urticaria registry (CUR) contribution to the understanding and knowledge of the disease in the region. World Allergy Organ J. 2019;12(6):100042. DOI: 10.1016/j.waojou.2019.100042
Fairweather D, Frisancho-Kiss S, Rose NR. Sex differences in autoimmune disease from a pathological perspective. Am J Pathol. 2008;173(3): 600-609. DOI: 10.2353/ajpath.2008.071008
Klein SL, Flanagan KL. Sex differences in immune responses. Nat Rev Immunol. 2016;16(10):626-638. DOI: 10.1038/nri.2016.90
Costa C, Rosmaninho I, Guilherme A, Ferreira J, Antunes J, Pina A, et al. Chronic urticaria in the real-life clinical practice setting in Portugal: baseline results from the non-interventional multicentre AWARE study. Acta Med Port. 2019;32(2):133-140. DOI: 10.20344/amp.9496
Hoskin B, Ortiz B, Paknis B, Kavati A. Exploring the real-world profile of refractory and non-refractory chronic idiopathic urticaria in the USA: clinical burden and healthcare resource use. Curr Med Res Opin. 2019;35(8):1387-1395. DOI: 10.1080/03007995.2019.1586222
Cherrez-Ojeda I, Maurer M, Bernstein JA, Vanegas E, Felix M, Ramon GD, et al. Learnings from real-life experience of using omalizumab for chronic urticaria in Latin America. World Allergy Organ J. 2019;12(2):168-172. DOI: 10.1016/j.jaip.2019.08.025
Curto-Barredo L, Riba-Archilla L, Roura-Vives G, Pujol RM, Giménez-Arnau AM. Clinical features of chronic spontaneous urticaria that predict disease prognosis and refractoriness to standard treatment. Acta Derm Venereol. 2018;98(7):641-647. DOI: 10.2340/00015555-2941
Maurer M, Houghton K, Costa C, Dabove F, Ensina LF, Giménez-Arnau A, et al. Differences in chronic spontaneous urticaria between Europe and Central/South America: results of the multi-center real world AWARE study. World Allergy Organ J. 2018;11(1):32. DOI: 10.1186/s40413-018-0216-1
Amin P, Levin L, Holmes SJ, Picard J, Bernstein JA. Investigation of patient-specific characteristics associated with treatment outcomes for chronic urticaria. J Allergy Clin Immunol Pract. 2015;3(3):400-4007. DOI: 10.1016/j.jaip.2014.12.007
Lee H-C, Hong J-B, Chu C-Y. Chronic idiopathic urticaria in Taiwan: a clinical study of demographics, aggravating factors, laboratory findings, serum autoreactivity and treatment response. J Formos Med Assoc. 2011;110(3):175-182. DOI: 10.1016/S0929-6646(11)60028-4
Sussman G, Abuzakouk M, Bérard F, Canonica W, Oude-Elberink HO, Giménez-Arnau A, et al. Angioedema in chronic spontaneous urticaria is underdiagnosed and has a substantial impact: analyses from ASSURE-CSU. Allergy. 2018;73(8):1724-1734. DOI: 10.1111/all.13430
Kolkhir P, Metz M, Altrichter S, Maurer M. Comorbidity of chronic spontaneous urticaria and autoimmune thyroid diseases: a systematic review. Allergy. 2017;72(10):1440-1460. DOI: 10.1111/all.13182
Chanprapaph K, Iamsumang W, Wattanakrai P, Vachiramon V. Thyroid autoimmunity and autoimmunity in chronic spontaneous urticaria linked to disease severity, therapeutic response, and time to remission in patients with chronic spontaneous urticaria. Biomed Res Int. 2018;2018:9856843. DOI: 10.1155/2018/9856843
Pardo V, Hernández F. Prevalencia de parásitos intestinales en una población atendida en la Clínica de Hatillo del Ministerio de Salud, 1995-1996. Rev Costarric Cienc MEd. 1997;18(2):45-50. Disponible en: https://www.scielo.sa.cr/scielo.php?script=sci_arttext&pid=S0253-29481997000200005
Kolkhir P, Balakirski G, Merk HF, Olisova O, Maurer M. Chronic spontaneous urticaria and internal parasites - a systematic review. Allergy. 2016;71(3):308-322. DOI: 10.1111/all.12818
Magen E, Mishal J, Schlesinger M, Scharf S. Eradication of Helicobacter pylori infection equally improves chronic urticaria with positive and negative autologous serum skin test. Helicobacter. 2007;12(5):567-571. DOI: 10.1111/j.1523-5378.2007.00522.x
Rasooly MM, Moye NA, Kirshenbaum AS. Helicobacter pylori: a significant and treatable cause of chronic urticaria and angioedema. Nurse Pract. 2015;40(10):1-6. DOI: 10.1097/01.NPR.0000471366.32982.f2
Hagaga MM, Faraga A, Elhelbaw NG, El-Gendy EGD. A study on chronic idiopathic urticaria and Helicobacter pylori infection. Menoufia Med J. 2019;32(1):226-230. DOI: 10.4103/mmj.mmj_247_17
Mogaddam MR, Yazdanbod A, Ardabili NS, Maleki N, Isazadeh S. Relationship between Helicobacter pylori and idiopathic chronic urticaria: effectiveness of Helicobacter pylori eradication. Postepy Dermatol Alergol. 2015;32(1):15-20. DOI: 10.5114/pdia.2015.48729
Rona RJ, Keil T, Summers C, Gislason D, Zuidmeer L, Sodergren E, et al. The prevalence of food allergy: a meta-analysis. J Allergy Clin Immunol. 2007;120(3):638-646. DOI: 10.1016/j.jaci.2007.05.026
Chung BY, Cho YS, Kim HO,Park CW. Food allergy in Korean patients with chronic urticaria. Ann Dermatol. 2016; 28(5):562-568. DOI: 10.5021/ad.2016.28.5.562
Marín-Cabañas I, Berbegal-de Gracia L, de León-Marrero F, Hispán P, Silvestre JF. Management of chronic spontaneous urticaria in routine clinical practice following the EAACI/GA(2)LEN/EDF/WAO guidelines. Actas Dermosifiliogr. 2017;108(4):346-353. DOI: 10.1016/j.ad.2016.12.012
Zuberbier T, Aberer W, Asero R, et al. The EAACI/GA2LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: The 2013 revision and update. Allergy Eur J Allergy Clin Immunol. 2014;69(7):868–87.
Staevska M, Gugutkova M, Lazarova C, et al. Night-time sedating H1-antihistamine increases daytime somnolence but not treatment efficacy in chronic spontaneous urticaria: A randomized controlled trial. Br J Dermatol. 2014; 171(1):148-54.
Kulthanan K, Chaweekulrat P, Komoltri C, Hunnangkul S, Tuchinda P, Chularojanamontri L, et al. Cyclosporine for chronic spontaneous urticaria: a meta-analysis and systematic review. J Allergy Clin Immunol Pract. 2018;6(2):586-599. DOI: 10.1016/j.jaip.2017.07.017
Vena GA, Maurer M, Cassano N,Zuberbier T. Alternative treatments for chronic spontaneous urticaria beyond the guideline algorithm. Curr Opin Allergy Clin Immunol. 2017;17(4):278-285. DOI: 10.1097/ACI.0000000000000372
Salman A, Demir G, Bekiroglu N. The impact of omalizumab on quality of life and its predictors in patients with chronic spontaneous urticaria: real-life data. Dermatol Ther. 2019;32(4):e12975. DOI: 10.1111/dth.12975
Finlay AY, Kaplan AP, Beck LA, Antonova EN, Balp M-M, Zazali J, et al. Omalizumab substantially improves dermatology-related quality of life in patients with chronic spontaneous urticaria. J Eur Acad Dermatol Venereol. 2017;31(10):1715-1721. DOI: 10.1111/jdv.14384
Zhao Z-T, Ji C-M, Yu W-J, Meng L, Hawro T, Wei J-F, et al. Omalizumab for the treatment of chronic spontaneous urticaria: a meta-analysis of randomized clinical trials. J Allergy Clin Immunol. 2016;137(6):1742-1750.e4. DOI: 10.1016/j.jaci.2015.12.1342
Min TK, Saini SS. Emerging therapies in chronic spontaneous urticaria. Allergy Asthma Immunol Res. 2019;11(4):470-481. DOI: 10.4168/aair.2019.11.4.470
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.
Derechos de autor 2021 Revista Alergia México