Publications

Background: The current EAACI/GA2LEN/EDF/WAO guideline for urticaria provide specific recommendations for the diagnostic workup and treatment of patients with chronic spontaneous urticaria (CsU). This study explored ifphysicians in Ecuador know these recommendations and implement them in their actual clinical practice for CsU.

Methods: We investigated physicians who treat CsU patients in a cross-sectional study using a standardized questionnaire. Descriptive statistics were employed, adjusted logistic regression was performed to assess the link ofguideline knowledge and use of therapy.

Results: Seven hundred forty surveys were collected and analyzed. The mean age of physicians was 42.3 (±12.5) years. Most of the participants (65.1%) were general physicians (GP), 13.7% were pediatricians, 11.0% internists, 6.8%dermatologists or allergists (D/A). Only 18.8% knew the EAACI/GA2LEN/EDF/WAO guideline. 44.5% of GPs searched forCsU etiology in contrast to 90% of D/A. Most common diagnostic test was total serum IgE (83.5%). Most common firstline symptomatic treatment was oral corticoids (46.3%), followed by second generation antihistamines (sgAHs, 36.8%).A/D prescribed more sgAHs (regular doses) (74.1 vs 28.6% of GP) (p< 0.05). Experience with omalizumab was reportedonly by 3.5%, of physicians, and higher rates among who were familiar with the guideline.

Conclusion: This study shows that the knowledge of guideline recommendations in physicians who treat urticaria patients in Ecuador is low. The diagnostic workup and treatment of CsU patients are largely not in line with guidelinerecommendations in real life practice settings. We were able to compare results between German and Ecuadorianphysicians and found that Ecuadorian physicians have lower awareness of the current guideline (33 vs 18%). Onlyone-third of physicians reported using regular doses of sgAHs as the first line treatment. Also, only 12.9% of physiciansuse sgAHs in higher doses and physicians still use fgAHs, particularly pediatricians (42.9%). Our results suggest thatdisparities in knowledge between physicians from different countries could influence the management of CsU.Knowledge of the guidelines is linked to better choices of treatments. Awareness of guidelines needs to be promotedfor better management of chronic urticaria.