Ürtikerde Yeni Tedavi Klavuzu DR. EMEL ERDAL ÇALIKOĞLU

Transkript

1 Ürtikerde Yeni Tedavi Klavuzu DR. EMEL ERDAL ÇALIKOĞLU

2 Neden Tedavi Klavuz?

3 Immunol Allergy Clin North Am Feb;34(1): Urticaria: impact on quality of life and economic cost. O'Donnell BF. Patients with urticaria suffer itch, swellings, fatigue caused by sleep disturbance and the side effects of medication, and disruption of many facets of their lives. Much progress has been made in formally evaluating the degree of quality-of-life (QoL) impairment suffered by patients with urticaria. This review focuses on QoL in chronic urticaria (>6 weeks duration) and examines QoL measures, including the chronic urticaria-quality of life questionnaire (CU- Q2oL). Patients with urticaria have difficulty identifying and coping with their emotions. The psychiatric comorbidity and the financial burden on the patient and society because of chronic urticaria, is also examined.

4 Allergy Oct;69(10):1275-9, 2014 Economic burden of inadequate management of allergic diseases in the European Union: a GA(2) LEN review. Zuberbier T, Lötvall J, Simoens S, Subramanian SV, Church MK. BACKGROUND: In the European Union (EU), between 44 and 76 million individuals of the 217 million EU employees suffer from allergic disease of the airways or the skin. Up to 90% of these persons are untreated or insufficiently treated. This has major socio-economic consequences such as absence from work (absenteeism), particularly reduced productivity at work (presenteeism). METHODS: We used published literature and online statistical information from Eurostat and Eurofound to assess the costs of allergic disease to society. RESULTS: Allergies have an impact on direct, indirect, intangible and opportunity costs. Most importantly, for the EU, avoidable indirect costs per patient insufficiently treated for allergy range between 55 and 151 billion per annum due to absenteeism and presenteeism, that is, 2405 per untreated patient per year. On the other hand, appropriate therapy for allergic diseases is available at comparatively low costs at an average of 125 per patient annually, equalling only 5% of the costs of untreated disease, allowing potential savings of up to 142 billion. CONCLUSIONS: A better care for allergies based on guideline-based treatment would allow Europe's economy substantial savings. In addition, allergies have an impact on learning and performance at school and university, leading to opportunity costs for society. This cannot be calculated moneywise but will have an impact in a modern knowledge-based society. Still allergies are trivialized in society, noting that the costs of therapy are paid by patients and healthcare services, whereas economic savings are made by employers and society. A change of this mindset is urgently needed.

5

6 Hangi Klavuz?

7 Clin Exp Allergy, 2015; 45: BSACI: British Society for Allergy and Clinical Immunology

8 Allergy International, 2012; 61:

9 AAAAI: American Academy of Allergy, Asthma & Immunology ACAAI: American College of Allergy, Asthma &Immunolgy

10 Allergy,2014;69:

11 EACCI/GA 2 LEN/EDF/WAO EACCI: European Academy of Allergy and Clinical Immunology GA 2 LEN: Global Allergy and Asthma European network EDF: European Dermatology Forum WAO: World Allergy Organisation (21 ülke, dernek)

12 GRADE: Grading of Reccomendations Assesment, Developement and Evaluation Kasım 2012, Berlin 39 ülke literatürleri

13 Hangi Yaşam Kalitesi Ölçeği? CU-Q2OL :Chronic Urticaria Quality Life questionnaire* AE-QOL :The angioedema Quality Life questionnaire

14 Kronik Ürtiker Sınıflandırılması

15

16

17 Tanı da Rutin Diagnostik Testler Akut ürtikerde rutin diagnostik testler gereksiz Kronik spontan ürtikerde sınırlı rutin diagnostik testler

18 Kronik Spontan ürtiker Tam kan, sed ve CRP HIKAYEYE BAĞLı OLARAK; İnfeksiyonlar (H. Pylori) Tiroid otoantikorları Deri testleri Psödoallerjenden fakir diet Otolog serum testi Lezyonel deri biyopsisi

19 Tedavide tam semptom kontrolü amaçlanmalı mı? Evet, amaç olabildiğince güvenli tam semptom kontrolü!

20 Gıda kısıtlaması yapılmalı mı? Sadece belli bir gıdaya spesifik IgE si olanlarda o gıdalar kısıtlanmalı Psödoallerjenden fakir diet? Genişletilmiş diagnostik programda öneriliyor!

21 2. jenerasyon antihistaminikler mi tercih edilmeli? Evet! İlk tercih 2. jenerasyon antihistaminikler Sürekli günlük kullanım *İki ayrı ajanı beraber kullanmak yerine, Dört kat doz artırımı!

22 Gebe, emziren ve çocuklar? *Aynı tedavi algoritması uygulanabilir! (zayıf kanıt, klinik konsensus)

23 Birinci Aşama: Modern ikinci jenerasyon antihistaminik 2 haftadan fazla sürerse İkinci Aşama: Dört kata kadar doz artırımı 1-4 hafta daha sürerse Üçüncü Aşama: Omalizumab, siklosporin, montelükast*,kısa süreli sistemik kortikosteroid*

24 4.Omalizumab, Siklosporin 3.Anti-lökotrien, Tranexamic asid (anjioödem varsa) 2.Doz artırımı ya da ikinci bir antihistaminik eklenmesi 1.Standart sedadif olmayan antihistaminik

25 STEP4 Omalizumab, siklosporin, antienflamatuar ajanlar, immünsüpresanlar, biolojikler STEP 3 Potent antihistaminiklerin doz artırımı (hidroksizin ve doksepin) * STEP 2 Bir veya daha fazlası; 2. Generasyon antihistaminiğin doz artırımı İkinci bir 2. jenerasyon antihistaminik eklenmesi H2 Antagonist eklenmesi Lökotrien R antagonisti eklenmesi Geceye 1. jenerasyon antihistaminik eklenmesi* STEP 1 2. jenerasyon antihistaminik ile monoterapi Tetikleyen faktörlerden kaçınma

26

27 Curr Allergy Asthma Rep. 2015;15:535. Urticaria Guidelines: Consensus and Controversies in the European and American Guidelines. Fine LM, Bernstein JA. Urticaria can present acutely and be self-limiting or become chronic and persist for weeks, months, or years. In either case, the condition may have a significant impact on the patient's quality of life. Two major consensus groups, the EAACI/WAO and the AAAAI/ACAAI Joint Task Force, have written guidelines on the diagnosis and management of urticaria. While both agree on most points regarding the definition, general evaluation, and treatment, there are some differences which exist. The guidelines, which are written to assist both primary practitioners and specialists in managing their patients with urticaria, have been developed based on scientific evidence, and when insufficient evidence is available, then recommendations are based on expert consensus opinion. The majority of the differences between the two guidelines pertain to recommendations based on expert opinion because of weak scientific evidence. Within this document, we compare the recommendations of these two groups, highlighting the key similarities and differences. Tek klavuz?

28 Volepük Esperento

29 ...Aman doktor canım gülüm doktor derdime bir çare.. Çaresiz dertlere düştüm doktor bana bir çare Kişisel tedavi planı!

30 SheldonJM, Mathews KP, Lovell RG. The vexing urticaria problem: present concepts of etiology and management. J Allergy, 1954;25: The long range management of some of the more. refractory cases of urticaria continues to present a difficult problem for even the most expert in the field. Topal IO,Kocatürk Göncü OE,Güngör S,Durmuşcan M, Sucu V, Yıldırmak S. Does replacement of vitamin D reduce the symptom scores and improve quality of life in patients with chronic urticaria? J Dermatolog Treat 2015;21:1-19.

31