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Consensus on the Definition of Control and Remission in Chronic Urticaria

Giménez-Arnau AM1, Jáuregui I2, Silvestre-Salvador JF3, Valero A4, Ferrer M5, Sastre J6, Ortiz de Frutos FJ7, Labrador-Horrillo M8, Bartra J9, Miquel Miquel J10 on behalf of the Urticaria Study Group

1Dermatology Department, Hospital del Mar, Institut Mar d’investigacions Mèdiques, Universitat Pompeu Fabra, Barcelona, Spain
2Allergology Service, Hospital Universitario Cruces, Baracaldo, Vizcaya, Spain
3Dermatology Department, Hospital General Universitario de Alicante, Alicante, Spain
4Allergy Department, Hospital Clínic, IDIBAPS, Barcelona, Spain
5Department of Allergy, Clínica Universidad de Navarra, Navarra, Spain
6Allergology Service, Hospital Universitario Fundación Jiménez Díaz and Instituto de Investigación Sanitaria (IIS), Madrid, Spain
7Dermatology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
8Allergology Department, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Spain
9Allergy Department, Hospital Clínic, IDIBAPS, Barcelona, Spain
10Dermatology Department, Hospital Arnau de Vilanova, Valencia, Spain

J Investig Allergol Clin Immunol 2022; Vol 32(4) : 261-269
doi: 10.18176/jiaci.0820

The terms control and remission and other key terms used in chronic urticaria (CU) such as flare-up, relapse, exacerbation, and recurrence have not been fully defined in the literature. Disease monitoring and treatment goals in clinical practice are not well established. After a qualitative appraisal of available evidence, we aimed to find a consensus definition of control and remission, clarify key terminology, provide guidance on how to monitor the disease, and establish treatment goals in clinical practice. A  modified Delphi consensus approach was used. Based on a literature review, a scientific committee provided 137 statements addressing controversial definitions and terms, available patient-reported outcomes (PROs), and recommendations on how to measure therapeutic objectives in CU. The questionnaire was evaluated by 138 expert allergists and dermatologists. A consensus was reached on 105 out of the 137 proposed items (76.6%). The experts agreed that complete control and remission of CU could be defined as the absence of signs or symptoms while on treatment and in the absence of treatment, respectively. Consensus was not reached on the definition of other key terms such as flare-up, exacerbation, and recurrence. The panel agreed that the objective of therapy in CU should be to achieve complete control. PROs that define the degree of control (complete, good, partial, or absence) were established. An algorithm for disease assessment is provided. In conclusion, this work offers consensus definitions and tools that may be useful in the management of patients with CU.

Key words: Chronic urticaria, Terminology as topic, Patient outcome assessment, Recurrence, Consensus