O que há de novo na urticária crônica espontânea?
What is new in chronic spontaneous urticaria?
Solange Oliveira Rodrigues Valle; Antônio Abílio Motta; Claudia Soïdo Falcão do Amaral; Luis Felipe Chiaverini Ensina; Márcia Carvalho Mallozi; Maria das Graças de Melo Teixeira Spengler; Maria Fernanda Ferraro; Mário Cezar Pires; Maurício Martins; Nelson Guilherme Bastos Cordeiro; Alfeu Tavares França
Resumo
A urticária crônica espontânea (UCE) é a forma mais frequente das urticárias crônicas (UC) e ocasiona um grande impacto negativo na qualidade de vida dos pacientes e seus familiares. A patogênese da UC é complexa e não está totalmente esclarecida. Entretanto, houve um grande avanço na última década em relação ao mecanismo de ativação dos mastócitos, que são as células que desempenham papel central na fisiopatologia da doença. Na maioria dos casos, a história clínica completa e o exame físico são considerados suficientes para fazer o diagnóstico da UCE, a menos que a história sugira a necessidade de outros exames. Além disso, os médicos precisam estar atentos para os potenciais diagnósticos diferenciais. Uma variedade de ferramentas e questionários está disponível para auxiliar os médicos no diagnóstico e monitoramento dos pacientes com UC. O principal objetivo do tratamento é o controle dos sintomas. Os anti-histamínicos de segunda geração nas doses habituais são recomendados como tratamento de primeira linha. Entretanto, pacientes que são refratários às doses habituais podem necessitar do aumento da dose. Ainda assim, muitos apresentam sintomas de urticária. Nestes casos, recomenda-se adicionar outros medicamentos, como o montelucaste, ciclosporina e omalizumabe. Entre esses mencionados acima, o omalizumabe é o único licenciado para o tratamento da UCE. Neste artigo, revisamos as principais e atuais publicações sobre a urticária crônica espontânea.
Palavras-chave
Abstract
Chronic spontaneous urticaria (CSU) is the most common form of chronic urticaria (CU) and has major negative impact on the quality of life of patients and their families. The pathogenesis of CU is complex and not fully understood. However, there has been tremendous progress in the past decade with regard to the mechanism of activation of mast cells, which play a central role in the pathophysiology of this disease. In most cases, thorough clinical history and physical examination are considered sufficient to establish a diagnosis of CSU, unless the history suggests the need for further testing. In addition, physicians should be alert to potential differential diagnoses. A variety of tools and questionnaires are available to assist physicians in the diagnosis and monitoring of patients with CU. The main treatment objective is to control symptoms. Second generation antihistamines at standard doses are recommended as first-line treatment. However, refractory patients may require higher doses. Still, many patients will continue to experience symptoms of urticaria. In these cases, adding other medications, such as omalizumab, cyclosporine, or montelukast, is recommended. Among these, omalizumab is the only medication licensed for the treatment of CSU. In this article, we review the newest and most important publications on chronic spontaneous urticaria.
Keywords
Referências
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Submetido em:
31/10/2016
Aceito em:
24/11/2016
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