The global impact of the COVID-19 pandemic on the management and course of chronic urticaria
Emek Kocatürk 1, Andaç Salman 2, Ivan Cherrez-Ojeda 3, Paulo Ricardo Criado 4 5 6, Jonny Peter 7, Elif Comert-Ozer 2, Mohamed Abuzakouk 8, Rosana Câmara Agondi 9, Mona Al-Ahmad 10, Sabine Altrichter 11, Rand Arnaout 12, Luisa Karla Arruda 13, Riccardo Asero 14, Andrea Bauer 15, Moshe Ben-Shoshan 16, Jonathan A Bernstein 17, Mojca Bizjak 18, Isabelle Boccon-Gibod 19, Hanna Bonnekoh 20 21, Laurence Bouillet 19, Zenon Brzoza 22, Paula Busse 23, Regis A Campos 24 25, Emily Carne 26, Niall Conlon 27, Roberta F Criado 28, Eduardo M de Souza Lima 29, Semra Demir 30, Joachim Dissemond 31, Sibel Doğan Günaydın 32, Irina Dorofeeva 33, Luis Felipe Ensina 34, Ragıp Ertaş 35, Silvia Mariel Ferrucci 36, Ignasi Figueras-Nart 37, Daria Fomina 38 39, Sylvie M Franken 40, Atsushi Fukunaga 41, Ana M Giménez-Arnau 42, Kiran Godse 43, Margarida Gonçalo 44, Maia Gotua 45, Clive Grattan 46, Carole Guillet 47, Naoko Inomata 48, Thilo Jakob 49, Gul Karakaya 50, Alicja Kasperska-Zając 51, Constance H Katelaris 52, Mitja Košnik 18, Dorota Krasowska 53, Kanokvalai Kulthanan 54, M Sendhil Kumaran 55, Claudia Lang 47, José Ignacio Larco-Sousa 56, Elisavet Lazaridou 57, Tabi Anika Leslie 58, Undine Lippert 59, Oscar Calderón Llosa 60, Michael Makris 61, Alexander Marsland 62, Iris V Medina 63, Raisa Meshkova 64, Esther Bastos Palitot 65, Claudio A S Parisi 66, Julia Pickert 67, German D Ramon 68, Mónica Rodríguez-Gonzalez 69, Nelson Rosario 70, Michael Rudenko 71, Krzysztof Rutkowski 72, Jorge Sánchez 73, Sibylle Schliemann 74, Bulent Enis Sekerel 75, Faradiba S Serpa 76, Esther Serra-Baldrich 77, Zhiqiang Song 78, Angèle Soria 79, Maria Staevska 80, Petra Staubach 81, Anna Tagka 82, Shunsuke Takahagi 83, Simon Francis Thomsen 84, Regina Treudler 85, Zahava Vadasz 86, Solange Oliveira Rodrigues Valle 87, Martijn B A Van Doorn 88, Christian Vestergaard 89, Nicola Wagner 90, Dahu Wang 91, Liangchun Wang 92, Bettina Wedi 93, Paraskevi Xepapadaki 94, Esra Yücel 95, Anna Zalewska-Janowska 96, Zuotao Zhao 97, Torsten Zuberbier 21, Marcus Maurer 98
Affiliations
Affiliations
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey.
- Urticaria Center of Reference and Excellence (UCARE), School of Medicine, Universidad de Especialidades Espíritu Santo, Samborondón, Ecuador and RespiraLab, Research, Guayaquil, Ecuador.
- Urticaria Center of Reference and Excellence (UCARE), Faculdade de Medicina do ABC, Santo André, Brazil.
- Alergoskin Alergia e Dermatologia SS ltda, Santo André, Brazil.
- UCARE Center, São Paulo, Brazil.
- Urticaria Center of Reference and Excellence (UCARE), Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, 7925, South Africa.
- Urticaria Center of Reference and Excellence (UCARE), Cleveland Clinic Abu Dhabi, UAE.
- Urticaria Center of Reference and Excellence (UCARE), University of São Paulo, São Paulo, Brazil.
- Urticaria Center of Reference and Excellence (UCARE), Microbiology Department, Faculty of Medicine, Kuwait University, Safat, Kuwait.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Urticaria Center of Reference and Excellence (UCARE), King Faisal Specialist Hospital & Research Center, Al Faisal University, Riyadh, Saudi Arabia.
- Urticaria Center of Reference and Excellence (UCARE), Preto Medical School, University of São Paulo, São Paulo, Brazil.
- Urticaria Center of Reference and Excellence (UCARE), Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany.
- Urticaria Center of Reference and Excellence (UCARE), Division of Allergy, Immunology and Dermatology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada.
- Urticaria Center of Reference and Excellence (UCARE), University of Cincinnati College of Medicine, Division of Immunology, Rheumatology and Allergy, Cincinnati, USA.
- Urticaria Center of Reference and Excellence (UCARE), Division of Allergy, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia.
- Urticaria Center of Reference and Excellence (UCARE), Clinical Immunology/Internal Medicine Department, National Reference Center for Angioedema, Grenoble University Hospital, Grenoble, France.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Autoinflammation Reference Center Charité (ARC2), Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Urticaria Center of Reference and Excellence (UCARE), Department of Internal Medicine with Division of Allergology, Institute of Medical Sciences, University of Opole, Opole, Poland.
- Urticaria Center of Reference and Excellence (UCARE), Division of Clinical Immunology and Allergy, Icahn School at Mount Sinai, New York, NY, USA.
- Urticaria Center of Reference and Excellence (UCARE), Universidade Federal da Bahia, Salvador, Brazil.
- Serviço de Imunologia, Hospital das Clínicas Professor Edgard Santos, Salvador, Brazil.
- Urticaria Center of Reference and Excellence (UCARE), University Hospital of Wales, Cardiff, UK.
- Urticaria Center of Reference and Excellence (UCARE), Department of Immunology, St James's Hospital and Trinity College, Dublin, Ireland.
- Urticaria Center of Reference and Excellence (UCARE), Faculdade de Medicina do ABC (FMABC), Santo André, Brazil.
- Urticaria Center of Reference and Excellence, (UCARE), Faculdade de Ciências, Médicas e da Saúde de Juiz de Fora (SUPREMA), Hospital Maternidade Therezinha de Jesus, Minas Gerais, Brazil.
- Urticaria Center of Reference and Excellence (UCARE), Division of Allergy, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Venereology and Allergology, University of Essen, Essen, Germany.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology and Venereology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
- Urticaria Center of Reference and Excellence (UCARE), Department of Allergy and Immunotherapy, Institute of Immunology, FMBA of Russia, Moscow, Russia.
- Urticaria Center of Reference and Excellence (UCARE), Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Kayseri City Education and Research Hospital, Kayseri, Turkey.
- Urticaria Center of Reference and Excellence (UCARE), Ambulatorio di Dermatologia Allergologica e Professionale, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
- Urticaria Center of Reference and Excellence (UCARE), The Dermatology Department of the Hospital de Bellvitge, Universitat de Barcelona, Barcelona, Spain.
- Urticaria Center of Reference and Excellence (UCARE), Center of Allergy and Immunology, Moscow Ministry of Healthcare, Moscow, Russia.
- Department of Allergology and Clinical Immunology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Amsterdam UMC, Amsterdam, The Netherlands.
- Urticaria Center of Reference and Excellence (UCARE), Division of Dermatology, Kobe University, Graduate School of Medicine, Kobe, Japan.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Hospital del Mar, IMIM, Universitat Autònoma, Barcelona, Spain.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, D Y. Patil University School of Medicine, Mumbai, India.
- Urticaria Center of Reference and Excellence (UCARE), Centro Hospitalar Universitário Coimbra and Faculty of Medicine, University of Coimbra, Clinica de Dermatologia, Coimbra, Portugal.
- Urticaria Center of Reference and Excellence (UCARE, Center of Allergy and Immunology, Tbilsi, Georgia.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Guys & St Thomas' Hospital, London, UK.
- Urticaria Center of Reference and Excellence (UCARE), Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.
- Urticaria Center of Reference and Excellence (UCARE), Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology and Allergy, University Medical Center Giessen (UKGM, Justus-Liebig-University Giessen, Giessen, Germany.
- Urticaria Center of Reference and Excellence (UCARE), School of Medicine, Department of Chest Diseases, Adult Allergy Unit, Hacettepe University, Sihhiye Ankara, Turkey.
- Urticaria Center of Reference and Excellence (UCARE), European Center for Diagnosis and Treatment of Urticaria, Medical University of Silesia, Zabrze, Poland.
- Urticaria Center of Reference and Excellence (UCARE), Immunology & Allergy Unit, Department of Medicine, Campbelltown Hospital, Campbelltown, NSW, Australia.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
- Urticaria Center of Reference and Excellence (UCARE), Clinica San Felipe, Lima, Peru.
- Urticaria Center of Reference and Excellence (UCARE), Second department of Dermatology and Venereology, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Royal Free Hospital, London, UK.
- Urticaria Center of Reference and Excellence (UCARE, Department of Dermatology, Medical Center of University Goettingen, Venerology und Allergology, Goettingen, Germany.
- Urticaria Center of Reference and Excellence (UCARE), Department of Allergy, SANNA el Golf, San Isidro, Lima.
- Urticaria Center of Reference and Excellence (UCARE), Second Department of Dermatology and Venereology, National and Kapodistrian University of Athens, University General Hospital "Attikon", Athens, Greece.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, The Urticaria Clinic, Salford Royal Foundation Trust, University of Manchester, Manchester, UK.
- Urticaria Center of Reference and Excellence (UCARE), Allergy and Clinical Immunology Department, Centro Médico Vitae, de Julio, Argentina.
- Urticaria Center of Reference and Excellence (UCARE), Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk, Russia.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Hospital Universitário Lauro Wanderley, João Pessoa, PB, Brazil.
- Urticaria Center of Reference and Excellence (UCARE), Adults and Pediatrics Allergy Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
- Urticaria Center of Reference and Excellence (UCARE), Clinical & Experimental Allergology, Department of Dermatology and Allergology, Philipps University Marburg, Marburg, Germany.
- Urticaria Center of Reference and Excellence (UCARE), Instituto de Alergia e Inmunologia del Sur, Buenos Aires, Argentina.
- Urticaria Center of Reference and Excellence (UCARE), Department of Allergy, Hospital Español de México, Mexico City, Mexico.
- Urticaria Center of Reference and Excellence (UCARE), Federal University of Parana, Rua General Carneiro, Curitiba, Brazil.
- Urticaria Center of Reference and Excellence (UCARE), London Allergy and Immunology Centre, London, UK.
- Urticaria Center of Reference and Excellence (UCARE), Department of Allergy, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.
- Urticaria Center of Reference and Excellence (UCARE), Department of Pediatrics, Graduate Program on Allergology, University of Antioquia, Medellín, Colombia.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, University Hospital Jena, Germany.
- Urticaria Center of Reference and Excellence (UCARE), Department of Pediatric Allergy, Hacettepe University Faculty of Medicine, Ankara, Turkey.
- Urticaria Center of Reference and Excellence (UCARE), Hospital Santa Casa de Misericórdia de Vitória, Espírito Santo, Brazil.
- Urticaria Center of Reference and Excellence (UCARE), Dermatology Department, Hospital Sant Pau, Barcelona, Spain.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Southwest Hospital, Army Medical University, Chongqing, China.
- Urticaria Center of Reference and Excellence (UCARE), Service de Dermatologie et Allergologie, Hopital Tenon, APHP, Université, Paris, Sorbonne, France.
- Urticaria Center of Reference and Excellence (UCARE), Department of Allergy, Sofia Medical University, Sofia, Bulgaria.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, University Medical Center, Mainz, Germany.
- Urticaria Center of Reference and Excellence (UCARE), First Department of Dermatology and Venereology, National and Kapodistrian University of Athens, "A. Syggros" Hospital, Referral Center of Occupational Dermatological Diseases, Athens, Greece.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Venerology and Allergology and Leipzig Interdisciplinary Center of Allergology Comprehensive Allergy Center, UMC Leipzig, Leipzig, Germany.
- Urticaria Center of Reference and Excellence (UCARE), Division of Allergy and Clinical Immunology, Bnai-Zion Medical Center, Technion Faculty of Medicine, Haifa, Israel.
- Urticaria Center of Reference and Excellence (UCARE), Federal University of Rio de Janeiro, Department of Internal Medicine, Immunology Service, Rio de Janeiro, Brazil.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands.
- Urticaria Center of Reference and Excellence (UCARE), Aarhus University Hospital, Aarhus, Denmark.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology, University of Erlangen, Erlangen, Germany.
- Urticaria Center of Reference and Excellence (UCARE), Dermatovenerological Department, The Second Hospital of HeBei Medical University, Shijiazhuang, HeBei Province, China.
- Urticaria Center of Reference and Excellence (UCARE, Dermatology Department of Sun Yat-sen Memorial Hospital, Guangzhou, China.
- Urticaria Center of Reference and Excellence (UCARE, Department of Dermatology and Allergology, Hannover Medical School, Allergology Division, Hannover, Germany.
- Urticaria Center of Reference and Excellence (UCARE), Department of Allergy, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.
- Urticaria Center of Reference and Excellence (UCARE), Department of Pediatric Allergy and Immunology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
- Urticaria Center of Reference and Excellence (UCARE), Chair of Clinical Immunology and Rheumatology, Department of Psychodermatology, Medical University of Lodz, Lodz, Poland.
- Urticaria Center of Reference and Excellence (UCARE), Department of Dermatology and Venerology, Peking University First Hospital, Beijing Key Laboratory of molecular Diagnosis on Dermatoses and National Clinical Research Center for Skin and Immune Diseases, Beijing, China.
- Urticaria Center of Reference and Excellence (UCARE), Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin, Berlin, Germany.
Abstract
Introduction: The COVID-19 pandemic dramatically disrupts health care around the globe. The impact of the pandemic on chronic urticaria (CU) and its management are largely unknown.
Aim: To understand how CU patients are affected by the COVID-19 pandemic; how specialists alter CU patient management; and the course of CU in patients with COVID-19.
Materials and methods: Our cross-sectional, international, questionnaire-based, multicenter UCARE COVID-CU study assessed the impact of the pandemic on patient consultations, remote treatment, changes in medications, and clinical consequences.
Results: The COVID-19 pandemic severely impairs CU patient care, with less than 50% of the weekly numbers of patients treated as compared to before the pandemic. Reduced patient referrals and clinic hours were the major reasons. Almost half of responding UCARE physicians were involved in COVID-19 patient care, which negatively impacted on the care of urticaria patients. The rate of face-to-face consultations decreased by 62%, from 90% to less than half, whereas the rate of remote consultations increased by more than 600%, from one in 10 to more than two thirds. Cyclosporine and systemic corticosteroids, but not antihistamines or omalizumab, are used less during the pandemic. CU does not affect the course of COVID-19, but COVID-19 results in CU exacerbation in one of three patients, with higher rates in patients with severe COVID-19.
Conclusions: The COVID-19 pandemic brings major changes and challenges for CU patients and their physicians. The long-term consequences of these changes, especially the increased use of remote consultations, require careful evaluation.
Keywords: COVID-19; SARS-CoV-2; UCARE; chronic urticaria; cyclosporine; omalizumab; pandemic; treatment.
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