The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria

Torsten Zuberbier¹, Amir Hamzah Abdul Latiff², Mohamed Abuzakouk³, Susan Aquilina⁴, Riccardo Asero⁵, Diane Baker⁶, Barbara Ballmer-Weber^{7

8}, Christine Bangert⁹, Moshe Ben-Shoshan¹⁰, Jonathan A Bernstein¹¹, Carsten Bindslev-Jensen¹², Knut Brockow¹³, Zenon Brzoza¹⁴, Herberto Jose Chong Neto¹⁵, Martin K Church^{1

16}, Paulo R Criado¹⁷, Inna V Danilycheva¹⁸, Corinna Dressler¹⁹, Luis Felipe Ensina²⁰, Luz Fonacier²¹, Matthew Gaskins¹⁹, Krisztian Gáspár²², Aslı Gelincik²³, Ana Giménez-Arnau²⁴, Kiran Godse²⁵, Margarida Gonçalo²⁶, Clive Grattan²⁷, Martine Grosber²⁸, Eckard Hamelmann²⁹, Jacques Hébert³⁰, Michihiro Hide^{31

32}, Allen Kaplan³³, Alexander Kapp³⁴, Aharon Kessel³⁵, Emek Kocatürk³⁶, Kanokvalai Kulthanan³⁷, Désirée Larenas-Linnemann³⁸, Antti Lauerma³⁹, Tabi A Leslie⁴⁰, Markus Magerl^{1

41}, Michael Makris⁴², Raisa Y Meshkova⁴³, Martin Metz^{1

41}, Daniel Micallef⁴, Charlotte G Mortz⁴⁴, Alexander Nast¹⁹, Hanneke Oude-Elberink⁴⁵, Ruby Pawankar⁴⁶, Paolo D Pigatto⁴⁷, Hector Ratti Sisa⁴⁸, María Isabel Rojo Gutiérrez⁴⁹, Sarbjit S Saini⁵⁰, Peter Schmid-Grendelmeier⁵¹, Bulent E Sekerel⁵², Frank Siebenhaar^{1

41}, Hanna Siiskonen⁵³, Angele Soria⁵⁴, Petra Staubach-Renz⁵⁵, Luca Stingeni⁵⁶, Gordon Sussman⁵⁷, Andrea Szegedi²², Simon Francis Thomsen⁵⁸, Zahava Vadasz⁵⁹, Christian Vestergaard⁶⁰, Bettina Wedi⁶¹, Zuotao Zhao⁶², Marcus Maurer^{1

41}

Affiliations

¹ Comprehensive Allergy Centre Charité, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
² Allergy & Immunology Centre, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
³ Department of Allergy and Immunology, Respiratory Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
⁴ Department of Dermatology, Mater Dei Hospital, Msida, Malta.
⁵ Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano (MI), Italy.
⁶ Baker Allergy, Asthma and Dermatology, Portland, Oregon, USA.
⁷ Clinic for Dermatology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
⁸ Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
⁹ Department of Dermatology, Medical University of Vienna, Vienna, Austria.
¹⁰ Division of Allergy, Immunology and Dermatology, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
¹¹ University of Cincinnati Physicians Immunology Research Center, Cincinnati, OH, USA.
¹² Department of Dermatology and Allergy Centre, Odense University Hospital and University of Southern Denmark, Odense, Denmark.
¹³ Department of Dermatology and Allergy Biederstein, Faculty of Medicine, Technical University Munich, Munich, Germany.
¹⁴ Department of Internal Diseases with Division of Allergology, University of Opole, Opole, Poland.
¹⁵ Division of Allergy and Immunology, Department of Pediatrics, Federal University of Paraná, Curitiba, Brazil.
¹⁶ University of Southampton, Southampton, UK.
¹⁷ Sociedade Brasileira de Dermatologia (SBD), Centro Universitário FMABC, Alergoskin (UCARE), Santo André, Brazil.
¹⁸ Department of Allergology and Immunotherapy, National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow, Russia.
¹⁹ Division of Evidence-Based Medicine, Department of Dermatology, Venereology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
²⁰ Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
²¹ New York University Long Island School of Medicine, New York, New York, USA.
²² Division of Dermatological Allergology, Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
²³ Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
²⁴ Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mèdiques, Universitat Autònoma y Universitat Pompeu Fabra, Barcelona, Spain.
²⁵ Department of Dermatology, D Y Patil University School of Medicine, Navi Mumbai, India.
²⁶ Department of Dermatology, Coimbra University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
²⁷ Guy's Hospital, St John's Institute of Dermatology, London, UK.
²⁸ Department of Dermatology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
²⁹ Department of Pediatrics, Children's Center Bethel, University Hospital OWL, University Bielefeld, Bielefeld, Germany.
³⁰ Service d'allergie, Centre Hospitalier Université Laval/Centre Hospitalier Universitaire de Québec, Québec, Quebec, Canada.
³¹ Department of Dermatology, Hiroshima University, Hiroshima, Japan.
³² Department of Dermatology, Hiroshima Citizens Hospital, Hiroshima, Japan.
³³ Department of Medicine, Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston, South Carolina, USA.
³⁴ Department of Dermatology & Allergy, Hannover Medical School (MHH), Hannover, Germany.
³⁵ Division of Allergy and Clinical Immunology, Bnai Zion Medical Center and the Bruce and Ruth Rappaport Faculty of Medicine, Technion, Haifa, Israel.
³⁶ Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey.
³⁷ Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
³⁸ Hospital Médica Sur, Mexico City, Mexico.
³⁹ Department of Dermatology, Allergology and Venereology, Inflammation Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
⁴⁰ Department of Dermatology, Royal Free Hospital, London, UK.
⁴¹ Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology, Berlin, Germany.
⁴² Allergy Unit, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, University General Hospital "Attikon", Athens, Greece.
⁴³ Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk, Russia.
⁴⁴ Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital and University of Southern Denmark, Odense, Denmark.
⁴⁵ University of Groningen, Groningen, The Netherlands.
⁴⁶ Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
⁴⁷ Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
⁴⁸ Primera Cátedra de Clínica Médica, Hospital de Clínicas de la Facultad de Ciencias Médicas-Universidad Nacional de Asunción, Asunción, Paraguay.
⁴⁹ Hospital Juárez de México, Mexico City, Mexico.
⁵⁰ Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland, USA.
⁵¹ Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.
⁵² Division of Pediatric Allergy and Asthma, Hacettepe University Faculty of Medicine, Ankara, Turkey.
⁵³ Department of Pathology, Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland.
⁵⁴ Department of Dermatology and Allergology, Tenon Hospital, APHP Sorbonne University and Cimi-Paris Inserm 1135, Paris, France.
⁵⁵ Department of Dermatology, University Medical Center Mainz, Mainz, Germany.
⁵⁶ Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy.
⁵⁷ Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto, Canada.
⁵⁸ Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
⁵⁹ Proteomic and Clinical Flow Cytometry Unit, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel.
⁶⁰ Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark.
⁶¹ Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, Germany.
⁶² Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China.

PMID: 34536239
DOI: 10.1111/all.15090

Free article

The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria

Torsten Zuberbier et al. Allergy. 2022 Mar.

Free article

. 2022 Mar;77(3):734-766.

doi: 10.1111/all.15090. Epub 2021 Oct 20.

Authors

Affiliations

¹ Comprehensive Allergy Centre Charité, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
² Allergy & Immunology Centre, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
³ Department of Allergy and Immunology, Respiratory Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
⁴ Department of Dermatology, Mater Dei Hospital, Msida, Malta.
⁵ Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano (MI), Italy.
⁶ Baker Allergy, Asthma and Dermatology, Portland, Oregon, USA.
⁷ Clinic for Dermatology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
⁸ Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
⁹ Department of Dermatology, Medical University of Vienna, Vienna, Austria.
¹⁰ Division of Allergy, Immunology and Dermatology, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
¹¹ University of Cincinnati Physicians Immunology Research Center, Cincinnati, OH, USA.
¹² Department of Dermatology and Allergy Centre, Odense University Hospital and University of Southern Denmark, Odense, Denmark.
¹³ Department of Dermatology and Allergy Biederstein, Faculty of Medicine, Technical University Munich, Munich, Germany.
¹⁴ Department of Internal Diseases with Division of Allergology, University of Opole, Opole, Poland.
¹⁵ Division of Allergy and Immunology, Department of Pediatrics, Federal University of Paraná, Curitiba, Brazil.
¹⁶ University of Southampton, Southampton, UK.
¹⁷ Sociedade Brasileira de Dermatologia (SBD), Centro Universitário FMABC, Alergoskin (UCARE), Santo André, Brazil.
¹⁸ Department of Allergology and Immunotherapy, National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow, Russia.
¹⁹ Division of Evidence-Based Medicine, Department of Dermatology, Venereology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
²⁰ Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
²¹ New York University Long Island School of Medicine, New York, New York, USA.
²² Division of Dermatological Allergology, Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
²³ Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
²⁴ Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mèdiques, Universitat Autònoma y Universitat Pompeu Fabra, Barcelona, Spain.
²⁵ Department of Dermatology, D Y Patil University School of Medicine, Navi Mumbai, India.
²⁶ Department of Dermatology, Coimbra University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
²⁷ Guy's Hospital, St John's Institute of Dermatology, London, UK.
²⁸ Department of Dermatology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
²⁹ Department of Pediatrics, Children's Center Bethel, University Hospital OWL, University Bielefeld, Bielefeld, Germany.
³⁰ Service d'allergie, Centre Hospitalier Université Laval/Centre Hospitalier Universitaire de Québec, Québec, Quebec, Canada.
³¹ Department of Dermatology, Hiroshima University, Hiroshima, Japan.
³² Department of Dermatology, Hiroshima Citizens Hospital, Hiroshima, Japan.
³³ Department of Medicine, Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston, South Carolina, USA.
³⁴ Department of Dermatology & Allergy, Hannover Medical School (MHH), Hannover, Germany.
³⁵ Division of Allergy and Clinical Immunology, Bnai Zion Medical Center and the Bruce and Ruth Rappaport Faculty of Medicine, Technion, Haifa, Israel.
³⁶ Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey.
³⁷ Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
³⁸ Hospital Médica Sur, Mexico City, Mexico.
³⁹ Department of Dermatology, Allergology and Venereology, Inflammation Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
⁴⁰ Department of Dermatology, Royal Free Hospital, London, UK.
⁴¹ Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology, Berlin, Germany.
⁴² Allergy Unit, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, University General Hospital "Attikon", Athens, Greece.
⁴³ Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk, Russia.
⁴⁴ Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital and University of Southern Denmark, Odense, Denmark.
⁴⁵ University of Groningen, Groningen, The Netherlands.
⁴⁶ Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
⁴⁷ Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
⁴⁸ Primera Cátedra de Clínica Médica, Hospital de Clínicas de la Facultad de Ciencias Médicas-Universidad Nacional de Asunción, Asunción, Paraguay.
⁴⁹ Hospital Juárez de México, Mexico City, Mexico.
⁵⁰ Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland, USA.
⁵¹ Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.
⁵² Division of Pediatric Allergy and Asthma, Hacettepe University Faculty of Medicine, Ankara, Turkey.
⁵³ Department of Pathology, Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland.
⁵⁴ Department of Dermatology and Allergology, Tenon Hospital, APHP Sorbonne University and Cimi-Paris Inserm 1135, Paris, France.
⁵⁵ Department of Dermatology, University Medical Center Mainz, Mainz, Germany.
⁵⁶ Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy.
⁵⁷ Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto, Canada.
⁵⁸ Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
⁵⁹ Proteomic and Clinical Flow Cytometry Unit, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel.
⁶⁰ Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark.
⁶¹ Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, Germany.
⁶² Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China.

PMID: 34536239
DOI: 10.1111/all.15090

Abstract

This update and revision of the international guideline for urticaria was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the Global Allergy and Asthma European Network (GA²LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), the European Dermatology Forum (EDF; EuroGuiDerm), and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology with the participation of 64 delegates of 50 national and international societies and from 31 countries. The consensus conference was held on 3 December 2020. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease that presents with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous or inducible urticaria is disabling, impairs quality of life, and affects performance at work and school. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.

Keywords: angioedema; consensus; evidence-based; hives; itch; mast cell; urticaria; wheal.

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References

REFERENCES

1. Zuberbier T, Asero R, Bindslev-Jensen C, et al. EAACI/GA(2)LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria. Allergy. 2009;64(10):1417-1426. doi:10.1111/j.1398-9995.2009.02179.x
1. Zuberbier T, Asero R, Bindslev-Jensen C, et al. EAACI/GA(2)LEN/EDF/WAO guideline: management of urticaria. Allergy. 2009;64(10):1427-1443. doi:10.1111/j.1398-9995.2009.02178.x
1. Zuberbier T, Aberer W, Asero R, et al. The EAACI/GA(2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014;69(7):868-887. doi:10.1111/all.12313
1. Zuberbier T, Aberer W, Asero R, et al. Methods report on the development of the 2013 revision and update of the EAACI/GA2 LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria. Allergy. 2014;69(7). doi:10.1111/all.12370
1. AGREE Next Steps Consortium. The AGREE II Instrument. http://www.agreetrust.org. Accessed January 12, 2015.

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The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria

Affiliations

The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria

Authors

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Research Materials