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. 2023 Dec 6:4:1290021.
doi: 10.3389/falgy.2023.1290021. eCollection 2023.

Hong Kong-Macau Severe Hives and Angioedema Referral Pathway

Philip H Li  1 , Elaine Y L Au  2 , Si-Leong Cheong  3 , Ling Chung  3 , Ka I Fan  3 , Marco H K Ho  4 , Agnes S Y Leung  5   6 , Martin M H Chung  7 , Jane C Y Wong  1 , Ricardo Coelho  3
Affiliations

Hong Kong-Macau Severe Hives and Angioedema Referral Pathway

Philip H Li et al. Front Allergy. .

Abstract

Background: Urticaria (defined as the presence of hives, angioedema, or both) can be caused by a variety of etiologies ranging from more common conditions such as chronic spontaneous urticaria (CSU) to rarer conditions such as hereditary angioedema (HAE). Specialist referral may be necessary in cases of severe urticaria or HAE, but access to specialist services remains limited in certain regions, such as the Greater Bay Area (GBA) of China. To address this, the Hong Kong-Macau Severe Hives and Angioedema Referral Pathway (SHARP) was initiated by the Hong Kong Institute of Allergy and Macau Society of Dermatology to promote multidisciplinary collaboration and regional exchange of expertise in the diagnosis and management of severe urticaria.

Methods: A nominated task force of dermatologists and immunologists who manage patients with severe urticaria formulated the consensus statements (CS) using the Delphi method. The consensus was defined a priori as an agreement of ≥80%.

Results: A total of 24 CS were formulated, including four statements on classifications and definitions, seven statements on diagnosis, and 13 statements on management and referral. The definitions for acute/chronic urticaria and severe CSU were stated. Unnecessary investigations and inappropriate medications were discouraged. The characteristics and recommended approach to suspected bradykinergic angioedema were specified. Stepwise treatment options using second-generation antihistamines, omalizumab, or cyclosporin for patients with CSU were addressed, and the importance of access to HAE-specific medications was emphasized. Furthermore, an integrated referral pathway for patients with severe hives and angioedema was constructed.

Conclusion: The SHARP provides guidance for the management and specialist referral of patients with severe hives and angioedema in Hong Kong and Macau.

Keywords: Hong Kong; Macau; angioedema; hereditary; hives; pathway; referral; urticaria.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Clinical pathway for patients with severe hives and angioedema in Hong Kong and Macau.
See this image and copyright information in PMC

References

    1. Champion RH, Roberts SO, Carpenter RG, Roger JH. Urticaria and angio-oedema. A review of 554 patients. Br J Dermatol. (1969) 81(8):588–97. 10.1111/j.1365-2133.1969.tb16041.x - DOI - PubMed
    1. Madsen F, Attermann J, Linneberg A. Epidemiology of non-hereditary angioedema. Acta Derm Venereol. (2012) 92(5):475–9. 10.2340/00015555-1389 - DOI - PubMed
    1. Zuberbier T, Abdul Latiff AH, Abuzakouk M, Aquilina S, Asero R, Baker D, et al. The international EAACI/GA(2)LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy. (2022) 77(3):734–66. 10.1111/all.15090 - DOI - PubMed
    1. Saini S, Shams M, Bernstein JA, Maurer M. Urticaria and angioedema across the ages. J Allergy Clin Immunol Pract. (2020) 8(6):1866–74. 10.1016/j.jaip.2020.03.030 - DOI - PubMed
    1. Kesh S, Bernstein JA. Isolated angioedema: a review of classification and update on management. Ann Allergy Asthma Immunol. (2022) 129(6):692–702. 10.1016/j.anai.2022.08.003 - DOI - PubMed

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