The results of a survey of Russian doctors in order to identify the compliance of the management of children with chronic urticaria with clinical recommendations
Authors: Smolkin Yu. S. , Masalskiy S. S. , Khakimova R. F. , Trusova O. V. , Larkova I. A. , Timofeeva E. V. , Meshkova R. Ya. , Migacheva N.  B. , Stezhkina E. V. , Lepeshkova T. S. , Pischalnikov A. Yu. 
Published: October 2023

Introduction. Primary observation of children with (CU) in Russia is performed by pediatricians, dermatologists, and algologists. It is unclear how clinical guidelines are used in a heterogeneous group of specialists.

Materials and methods. Online survey of pediatricians, allergists, and dermatologists (n = 304) in the Russian Federation using a questionnaire, from 5 blocks of questions related to etiology, diagnosis, and therapy. 316 physicians with a median experience of 10 [5; 20] years were included in the questionnaire.

Results. 83.3 % of respondents observed no more than 2 children with CU per month. Self-education to expand knowledge (video lectures, special literature) was indicated by 72.6 % of participants. The clinical guidelines used by physicians were documents of pediatric and allergy associations of Russia (77.3 and 55.9 %, respectively), international guides were used by 27 % of respondents.

The most frequent deviations from the recommended algorithm were the prescription of biochemical blood tests (64.9 %), ultrasound examination of organs (56.9 %), consultations of specialists without indications: gastroenterologist (48.2 %), infectious disease specialist (31.8 %), rheumatologist (27.1 %). The autologous serum test in children is not used by 87.2 % of physicians for various reasons.

During allergy testing, respondents recommend: the concentration of total IgE in serum (63.9 %), the number of eosinophils in the blood (61.2 %). The importance of determining specific IgE was indicated by no more than one third of the respondents. Skin tests during remission period were supported by 59.1 % of all physicians, who considered allergologic examination to be necessary. Diet: 18.6 % of respondents do not recommend a special diet for children; 27.7 % exclude from the diet foods to which sensitization is detected, the rest recommend an nonspecific elimination diet.

Antihistamines of 2nd generation (AG II) are the most used in clinical practice (86.5 %). Physicians named cetirizine (25.7 %) and levocetirizine (19.7 %) as the drugs of choice up to 12 years of age. The need to double the dose of AG II in the absence of response to the standard dose was supported by 59.5 % of physicians. The other physicians preferred a change of AG II molecule in the standard dose. Experience with the use of omalizumab was reported by 20 % of specialists, with 76.3 % understanding the significance and willingness to use biologic therapy. If omalizumab is ineffective, 44.1 % of physicians consider glucocorticosteroids to be the drug of choice; 38.8 % — cyclosporine A. About one third of physicians use alternative therapies not considered in the clinical guidelines.

Conclusion. A significant number of physicians do not use recommendations based on evidence-based studies in real practice. AG II are the basis of CU therapy in children in all age groups.