Transcript
Michelle Tarbox: Hello, this is Michelle Tarbox. I'm an associate professor of dermatology and dermatopathology and chair and program director at Texas Tech University Health Sciences Center in beautiful, sunny Lubbock, Texas.
I just finished speaking about chronic spontaneous urticaria at the Science of Skin Summit here in Austin, Texas, and I would love to share some pearls with you.
Both the international and national guidelines recommend antihistamines as first line therapy for chronic spontaneous urticaria. You start with the ones that are most efficacious, and those are typically going to be cetirizine, levocetirizine, or fexofenadine. Those have the best data behind them, and you can select them based off of their side effect profile.
About 10% of patients will have sedation at the lowest dose of cetirizine, and that increases to almost 40% at four times daily dosing.
With levocetirizine, the sedation shows up on the first dose if it's going to be there. So if the patient tolerates it well at the first low dose, you can generally up titrate that with safety.
If you have a patient that needs to have a non-sedating antihistamine, then fexofenadine is your best bet and it has great data behind it as well.
Loratadine and desloratadine don't have great data for chronic spontaneous urticaria, although they're lovely for managing allergic rhinitis, so they have a place in the house of medicine.
One of the most important things to understand about chronic spontaneous urticaria is it is not an exogenous allergy. This is a process that is triggered by either autoallergic or autoimmune mechanisms. I like to tell my patients with CSU the allergen is you. We can't get rid of you, so let's treat the urticaria.
Just like with psoriasis and eczema, there are patient reported outcome scales that we can track to monitor a patient's progress and ensure that we're accelerating therapy appropriately. These metrics may also be helpful in getting medications covered for your patient and recording them can be straightforward and simple. There's even an app on the phone that can help your patients do this accurately.
There's two main scales that we use. One is the Urticaria Activity Score, the UAS7, and it looks at the activity of the urticaria over the previous seven days. And if you can intuit, you would like a less active case of urticaria. So lower scores are better and zero is ideal. Good control is less than or equal to six.
The other metric is the Urticaria Control Test. This is actually a report card for us. How good of a job are we doing in controlling the patient's urticaria? And I don't know about you guys, but I like the high score. So if you do a great job controlling your patient's urticaria, you get a high UCT. So you want high control and low activity, that will tell you you're doing a great job managing your patients.
