CME suggestions for pediatricians, allergists, and dermatologists, directed by an online survey on urticaria knowledge

Main Article Content

Cesar Fireth Pozo-Beltrán
Désirée Larenas-Linnemann
Johanna Danielle Cardoza Arteche


urticaria, allergists, continuous medical education, dermatologists, pediatricians


Background: The Mexican Guidelines for the diagnosis and treatment of urticaria have been published. Just before their launch, physicians’ knowledge was explored relating to key issues of the guidelines.

Objective: The aim of this study was to investigate the opinion of medical specialists concerning urticaria management.

Methods: A SurveyMonkey® survey was sent out to board-certified physicians of three medical specialties treating urticaria. Replies were analyzed per specialty against the evidence-based recommendations.

Results: Sixty-five allergists (ALLERG), 24 dermatologists (DERM), and 120 pediatricians (PED) sent their replies. As for diagnosis: ALERG 42% and PED 76% believe cutaneous mastocytosis, urticarial vasculitis, and hereditary angioedema are forms of urticaria, versus DERM 29% (P < 0.005). Most of the specialties find that the clinical history and physical examination are enough to diagnose acute urticaria, except DERM 45% (P < 0.01). DERM 45% believe laboratory-tests are necessary, as opposed to <15% ALLERG–PED (P < 0.005). However, PED 69% did not know that the most frequent cause of acute urticaria in children is infections, versus ALLERG–DERM 30% (P < 0.005). Many erroneously do laboratory testing in physical urticaria and ALLERG 51%, DERM 59%, and PED 37% do extensive laboratory testing in chronic spontaneous urticaria (CSU); many more PED 59% take Immunoglobulin G (IgG) against foods (P < 0.005). More than half of non-allergists do not know about autologous serum testing nor autoimmunity (P < 0.05). As for treatment, there were a few major gaps: when CSU was controlled, >75% prescribed antihistamines pro re nata, and >85% gave first-generation antiH1 for insomnia. Finally, >40% of DERM did not know that cyclosporine A, omalizumab, or other immunosuppressants could be used in recalcitrant cases.

Conclusion: Specialty-specific continuous medical education might enhance urticaria management.

Abstract 873 | PDF Downloads 659 HTML Downloads 119 XML Downloads 9


1. Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer-Weber B, et al. The EAACI/GA (2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis and management of urticaria. The 2017 revision and update. Allergy. 2018;73:1393–414. 10.1111/all.13397

2. Sanchez-Borges M, Asero R, Ansotegui IJ, Baiardini I, Bernstein JA, Canonica GW, et al. Diagnosis and treatment of urticaria and angioedema: A worldwide perspective. World Allergy Organ J. 2012;5:125–47. 10.1097/WOX.0b013e3182758d6c

3. Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol. 2014;133:1270–7. 10.1016/j.jaci.2014.02.036

4. Larenas-Linnemann D, Medina-Avalos MA, Ortega-Martell JA, Beirana-Palencia AM, Rojo-Gutierrez MI, Morales-Sanchez MA, et al. Mexican guidelines on the diagnosis and treatment of urticaria. Rev Alerg Mex. 2014;61(Suppl 2):S118–93.

5. Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, et al. The EAACI/GA LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria: The 2013 revision and update. Allergy. 2014;69:868–87. 10.1111/all.12370; 10.1111/all.12313

6. Powell RJ, Du Toit GL, Siddique N, Leech SC, Dixon TA, Clark AT, et al. BSACI guidelines for the management of chronic urticaria and angio-oedema. Clin Exp Allergy. 2007;37:631–50. 10.1111/j.1365-2222.2007.02678.x

7. Maurer M, Kaplan A, Rosen K, Holden M, Iqbal A, Trzaskoma BL, et al. The XTEND-CIU study: Long-term use of omalizumab in chronic idiopathic urticaria. J Allergy Clin Immunol. 2018;141:1138–9 e7. 10.1016/j.jaci.2017.10.018

8. Kaplan A, Ledford D, Ashby M, Canvin J, Zazzali JL, Conner E, et al. Omalizumab in patients with symptomatic chronic idiopathic/spontaneous urticaria despite standard combination therapy. J Allergy Clin Immunol. 2013;132:101–9. 10.1016/j.jaci.2013.05.013

9. Cicardi M, Zuraw BL. Angioedema due to bradykinin dysregulation. J Allergy Clin Immunol Pract. 2018;6:1132–41. 10.1016/j.jaip.2018.04.022

10. Sag E, Bilginer Y, Ozen S. Autoinflammatory diseases with periodic fevers. Curr Rheumatol Rep. 2017;19:41. 10.1007/s11926-017-0670-8

11. Church MK, Maurer M. H(1)-antihistamines and urticaria: How can we predict the best drug for our patient? Clin Exp Allergy. 2012;42:1423–9. 10.1111/j.1365-2222.2012.03957.x

12. Unno K, Ozaki T, Mohammad S, Tsuno S, Ikeda-Sagara M, Honda K, et al. First and second generation H(1) histamine receptor antagonists produce different sleep-inducing profiles in rats. Europ J Pharmacol. 2012;683:179–85. 10.1016/j.ejphar.2012.03.017

13. Gray SL, Anderson ML, Dublin S, Hanlon JT, Hubbard R, Walker R, et al. Cumulative use of strong anticholinergics and incident dementia: A prospective cohort study. JAMA Intern Med. 2015;175:401–7. 10.1001/jamainternmed.2014.7663

14. Gimenez-Arnau A, Ferrer M, Bartra J, Jauregui I, Labrador-Horrillo M, Frutos JO, et al. Management of chronic spontaneous urticaria in routine clinical practice: A Delphi-method questionnaire among specialists to test agreement with current European guidelines statements. Allergol Immunopathol. 2017;45:134–44. 10.1016/j.aller.2016.06.007