Table 2.
Summary of consensus recommendations for patients with severe hives and angioedema in Hong Kong and Macau.
| Classifications and definitions |
| 1. We suggest urticaria be characterized by wheals (hives), angioedema, or both |
| 2. We recommend urticaria be classified as (i) acute (≤6 weeks) or chronic (>6 weeks) and (ii) as spontaneous (absence of specific eliciting factor) or inducible (presence of specific eliciting factor) |
| 3. We suggest “severe chronic spontaneous urticaria (CSU)” be defined by symptoms assessed by patient-reported outcome measures (PROM) equivalent to a weekly urticaria activity score (UAS7) above 27 |
| Diagnosis |
| 4. We recommend that acute urticaria does not require routine investigations, except in the cases of suspected immediate-type hypersensitivity reactions |
| 5. We recommend patients with CSU be regularly assessed with PROM such as the UAS7 |
| 6. We recommend angioedema be classified by its etiology (mast cell- or bradykinin-mediated) whenever possible |
| 7. We suggest CSU be diagnosed clinically and blood tests are not usually necessary unless other diagnoses are suspected |
| 8. We recommend against routine allergy tests and skin biopsies for patients diagnosed with CSU |
| 9. We recommend angiotensin-converting enzyme inhibitor (ACEI) associated angioedema (ACEI-AE) be excluded first in all patients with angioedema of any etiology |
| 10. We recommend C1 esterase inhibitor (C1-INH) deficiency be considered in cases of suspected bradykinergic angioedema after ACEI-AE has been excluded |
| 11. We recommend initial screening for low C4 levels in patients with suspected bradykinin-mediated angioedema |
| Management and referral |
| 12. We recommend the treatment aim of urticaria be complete symptom control and normalization of quality of life |
| 13. We recommend second-generation H1 antihistamines be taken regularly for the treatment of CSU |
| 14. We recommend second-generation H1 antihistamines up to fourfold in patients with CSU unresponsive to standard doses, before consideration of other treatments |
| 15. We suggest against different combinations of, especially first-generation, H1 antihistamines, to be used at the same time for the treatment of urticaria |
| 16. We recommend against long-term use of steroids in the treatment of urticaria |
| 17. We recommend against the use of ACEI in patients with a history of spontaneous angioedema of any etiology. |
| 18. We suggest against the use of antihistamines, steroids, or adrenaline in patients with confirmed bradykinergic angioedema |
| 19. We recommend referral to a dermatology or I&A specialist center for patients with severe CSU not responding to a fourfold dosing of second-generation H1 antihistamines |
| 20. We suggest omalizumab for the treatment of severe CSU unresponsive to a fourfold dosing of second-generation H1 antihistamines |
| 21. We suggest cyclosporin for the treatment of severe CSU unresponsive to a fourfold dosing of second-generation H1 antihistamine and omalizumab; or when omalizumab is unavailable/contraindicated. |
| 22. We recommend referral to an I&A specialist center for patients with suspected bradykinin-mediated angioedema, where ACEI-AE has been excluded |
| 23. We recommend all patients with confirmed hereditary angioedema (HAE) should have access to HAE-specific medications |
| 24. We recommend against the use of non-HAE-specific medications (such as attenuated androgens, anti-fibrinolytics, and fresh frozen plasma) for the treatment and prophylaxis of HAE |