The update on urticaria involves new concepts on the pathogenesis and the treatment of severe hives that are unresponsive to conventional treatments. A newly described autoantibody IgG against IgE receptor has been identified in some severe chronic urticaria patients. Anti-inflammatory and immunomodulating agents are being used with increasing frequency by academic faculty and other physicians in severe chronic idiopathic urticaria (CIU).
Fatalities have been associated with allergen skin testing and immunotherapy. Therefore, physicians using such tests and therapy should be knowledgeable in their use and take proper precautions to decrease the risk of anaphylaxis. The American Academy of Allergy and Immunology recommends a 20-minute wait that can be extended for high risk patients following an injection, and that the physician in charge of administering immunotherapy should be familiar with and prepared to appropriately treat anaphylaxis. Future treatment with peptides rather than whole allergens may increase safety.
Practice parameters (guidelines) have been developed for many years. The first such parameter, developed by a Joint Task Force of the American Academy of Allergy and Immunology, and the American College of Allergy and Immunology, was on the diagnosis and treatment of patients with asthma. It was sent in notebook form to members of the Academy and College in 1993. An updated version will be published as a supplement to the Journal of Allergy and Clinical Immunology sometime in 1995. Although the overriding consideration in the development of these parameters is to improve the level of care for patients, and by doing so to decrease asthma morbidity and mortality, recent guidelines have also emphasized cost factors, especially those that are now being developed by managed care organizations. Practice parameters can also reduce malpractice liability, and studies have even shown a reduction in hospital admissions by instituting relatively simple measures of patient behavior. There is no doubt that practice parameters will become an important part of our everyday life.
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