The Turkish Guideline for the Diagnosis and Management of Urticaria-2016

Kocat�rk G�nc�, Emek; Aktan, �ebnem; Atakan, Nilg�n; B�lb�l Ba�kan, Emel; Erdem, Teoman; Koca, Rafet; �avk, Ekin; Ta�kapan, Oktay; Uta�, All Authors Have Contributed On An Equal Basis To This Article., Serap

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The Turkish Guideline for the Diagnosis and Management of Urticaria-2016 [Turkderm-Turk Arch Dermatol Venereol]

Turkderm-Turk Arch Dermatol Venereol. 2016; 50(3): 82-98 | DOI: 10.4274/turkderm.22438

The Turkish Guideline for the Diagnosis and Management of Urticaria-2016

Emek Kocat�rk G�nc�¹, �ebnem Aktan², Nilg�n Atakan³, Emel B�lb�l Ba�kan⁴, Teoman Erdem⁵, Rafet Koca⁶, Ekin �avk⁷, Oktay Ta�kapan⁸, Serap Uta�, All Authors Have Contributed On An Equal Basis To This Article.⁹
¹Okmeydan� Training and Research Hospital Department of Dermatology
²Department of Dermatology, Dokuz Eyl�l University, �zmir, Turkey
³Department of Dermatology, Hacettepe University, Ankara, Turkey
⁴Department of Dermatology, Uluda� University, Bursa, Turkey
⁵Department of Dermatology, Sakarya University, Sakarya, Turkey
⁶Department of Dermatology, B�lent Ecevit University, Zonguldak, Turkey
⁷Department of Dermatology, Adnan Menderes University, Ayd�n, Turkey
⁸Department of Dermatology, Yeditepe University, �stanbul, Turkey
⁹Department of Dermatology, Ac�badem University, �stanbul, Turkey

Background and Design: Albeit an easily recognized disease, urticaria features many diverse approaches which rationalize the need for an algorithm for the diagnosis, classification, etiopathogenesis, diagnostic evaluation and therapeutic approach. Therefore, authors from Dermatoallergy Working Group of the Turkish Society of Dermatology and the Turkish Dermatoimmunology and Allergy Association aimed to create an urticaria guideline for the diagnosis, treatment and followup
of urticaria.
Materials and Methods: Each section of the guideline has been written by a different author. The prepared sections were evaluated in part by e-mail correspondence and have taken its final form after revision in the last meeting held by the participation of all authors.
Results: The guideline includes the description, classification, pathophysiology as well as diagnosis and treatment of urticaria. Urticaria is classified into two main types: acute urticaria and chronic urticaria while chronic urticaria is further subdivided into spontaneous urticaria and inducible urticaria. The first step of treatment includes standard doses of H1-blockers. In patients who do not respond to the first step, antihistamine dose is increased up to four times; if unsuccessful, another second-generation antihistamine is given in the same dose. In antihistamine-resistant cases, introduction of omalizumab is required. Omalizumab dose may be increased in patients failing to respond to the standard dose. In patients unresponsive to omalizumab, cyclosporine-A may be given. Routine diagnostic tests are not recommended in acute urticaria. In chronic urticaria, erythrocyte sedimentation rate, differential blood count and C-reactive protein testing are the only investigations that are needed routinely.
Conclusion: Chronic urticaria is a disease that can be challenging for the physician in terms of treatment and follow-up. Depending on evidence-based data (and individual experiences), this guideline will have a leading role in the diagnosis and treatment of urticaria and help the physician to overcome the challenges in the management. All authors have contributed on an equal basis to this article.

Keywords: Acute urticaria, algorithm, angioedema, chronic idiopathic urticaria, chronic spontaneous urticaria, guideline, physical urticaria, treatment urticaria, Turkey

T�rkiye �rtiker Tan� ve Tedavi K�lavuzu-2016

Emek Kocat�rk G�nc�¹, �ebnem Aktan², Nilg�n Atakan³, Emel B�lb�l Ba�kan⁴, Teoman Erdem⁵, Rafet Koca⁶, Ekin �avk⁷, Oktay Ta�kapan⁸, Serap Uta�, All Authors Have Contributed On An Equal Basis To This Article.⁹
¹Okmeydan� E�itim ve Ara�t�rma Hastanesi, Dermatoloji Klini�i, �stanbul, T�rkiye
²Dokuz Eyl�l �niversitesi T�p Fak�ltesi, Dermatoloji Anabilim Dal�, �zmir, T�rkiye
³Hacettepe �niversitesi T�p Fak�ltesi, Dermatoloji Anabilim Dal�, Ankara, T�rkiye
⁴Uluda� �niversitesi T�p Fak�ltesi, Dermatoloji Anabilim Dal�, Bursa, T�rkiye
⁵Sakarya �niversitesi T�p Fak�ltesi, Dermatoloji Anabilim Dal�, Sakarya, T�rkiye
⁶B�lent Ecevit Universitesi T�p Fak�ltesi, Dermatoloji Anabilim Dal�, Zonguldak, T�rkiye
⁷Adnan Menderes �niversitesi T�p Fak�ltesi, Dermatoloji Anabilim Dal�, Ayd�n, T�rkiye
⁸Yeditepe �niversitesi T�p Fak�ltesi, Dermatoloji Anabilim Dal�, �stanbul, T�rkiye
⁹Ac�badem Fulya Hastanesi, Dermatoloji Klini�i, �stanbul, T�rkiye

Ama�: �rtikerin kolay tan� konulabilen ancak �ok farkl� yakla��mlar�n g�r�lebildi�i bir hastal�k olmas�, son y�llarda hastal��n tan�m, s�n�flama, etiyopatogenez, tan�sal testler ve tedavi yakla��mlar� a��s�ndan bir algoritma i�erisinde de�erlendirilmesi gereklili�ini do�urmu�tur. Bu ama�la Dermatoimm�noloji ve Allerji Derne�i ile T�rk Dermatoloji Derne�i Dermatoallerji �al��ma Grubu i�erisinde yer alan yazarlar, �rtikerin izleminde
kan�ta dayal� bir yol g�sterici olmas� a��s�ndan bu �rtiker k�lavuzunu olu�turmay� hedeflemi�tir.
Gere� ve Y�ntem: Bu k�lavuz, her b�l�m� ayr� bir yazar taraf�ndan yaz�lacak bi�imde planlanm��; �rtikerle ilgili Medline verileri ve 2000-2016 y�llar� aras�nda yay�mlanan t�m �rtiker tan� ve tedavi k�lavuzlar� ve uzman g�r��leri incelenmi� ve �� ayr� toplant�da t�m bu veriler ayr�nt�l� olarak tart��lm��t�r. Dermatoloji uzmanlar�na y�nelik haz�rlanan anket sonu�lar�n�n de�erlendirilmesinin ard�ndan k�lavuzun ana hatlar� belirlenmi�, haz�rlanan b�l�mler e-posta yaz��malar� ile di�er yazarlar taraf�ndan da de�erlendirilmi� ve t�m yazarlarla yap�lan son toplant�da k�lavuz t�m�yle g�zden ge�irilerek haz�r hale getirilmi�tir.
Bulgular: K�lavuz, tan�m, s�n�flama, fizyopatoloji, etiyoloji ve tetikleyici fakt�rler ile tan� ve tedavi yakla��mlar�n� i�ermektedir. �rtiker, akut ve kronik olarak, kronik �rtiker (K�) ise �spontan� ve �uyar�labilir� olmak �zere s�n�flanm��t�r. Tedavinin ilk basama��n� standart doz ikinci ku�ak antihistaminler olu�turmaktad�r. �lk basamakta yan�t al�namayan hastalarda antihistamin dozu d�rt kat�na kadar art�r�l�r. Yan�t al�namayan durumlarda, ba�ka bir ikinci ku�ak antihistamin ayn� dozda verilir. Yine yan�t al�namayan olgularda omalizumab tedavisine ge�ilir. Omalizumab�n �nerilen dozuna yan�t vermeyen olgularda doz art�r�labilir. Omalizumaba yan�t al�namayan hastalarda ise siklosporin verilmesi �nerilir. Rutin tan�sal tetkikler Aܒde �nerilmezken, Kܒde rutin tetkik olarak eritrosit sedimentasyon h�z�, tam kan say�m� ve C-reaktif protein tetkiklerinin istenmesi yeterlidir.
Sonu�: �rtiker �zellikle kronikle�ti�inde hekimler i�in tedavi ve izlem a��s�ndan g��l�kler do�urabilen bir hastal�kt�r. Olabildi�ince kan�ta dayal� verilerden (ve ki�isel deneyimlerden) yola ��karak haz�rlanan bu k�lavuz, �rtikerli olgularda hem tan� ve tedavi yakla��mlar�n�n y�nlendirilmesinde yol g�sterici olacak, hem de hekimlerin bu s�re�lerde ya�ad�klar� zorluklar�n a��lmas�na katk� sunacakt�r. T�m yazarlar�n katk�s� e�ittir.

Anahtar Kelimeler: Akut �rtiker, algoritma, anjiyo�dem, fiziksel �rtiker, k�lavuz, kronik spontan �rtiker, kronik idiyopatik �rtiker, T�rkiye, tedavi, �rtiker

Emek Kocat�rk G�nc�, �ebnem Aktan, Nilg�n Atakan, Emel B�lb�l Ba�kan, Teoman Erdem, Rafet Koca, Ekin �avk, Oktay Ta�kapan, Serap Uta�, All Authors Have Contributed On An Equal Basis To This Article.. The Turkish Guideline for the Diagnosis and Management of Urticaria-2016. Turkderm-Turk Arch Dermatol Venereol. 2016; 50(3): 82-98

Corresponding Author: Emek Kocat�rk G�nc�, T�rkiye

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