Abstract
BackgroundChronic spontaneous urticaria (CSU) poses problems with respect to high prevalence, reduced quality of life, lack of long term efficacy, and expense of current treatments for severe intractable symptoms. There have been many reports suggesting ‘stress’ factors may be implicated, but there are no studies that explore the efficacy of treatments including a psychological perspective. A whole person treatment approach (WPTA), which addresses psychological factors has been used, with effect, for 6 years in the Auckland City Hospital Immunology Department.FindingsIn a pilot study to demonstrate feasibility of recruitment and treatment of CSU patients in a time-limited, whole person treatment approach, within a conventional immunology department, four patients (three CSU and one idiopathic angioedema) were recruited into a brief WPTA course based in non-dualistic concepts of mind and body connectedness, and utilising psychotherapy-derived listening skills for up to 10 h long sessions, once per week. Treatment efficacy rating, using Urticaria Activity Score and the Urticaria Severity Score, and reduction of drug usage, showed patients experienced long term resolution of urticaria and cessation of hospitalisation for angioedema and came off regular antihistamine medication.ConclusionsA clinician treating chronic spontaneous urticaria in an Immunology department, using a whole person treatment paradigm, can safely explore unique meanings and emotional states, in a process acceptable to patients, resulting in a significant clinical benefit for symptoms. A much larger study comparing the outcome of WPTA versus standard treatment alone is warranted.Electronic supplementary materialThe online version of this article (doi:10.1186/s13601-015-0082-7) contains supplementary material, which is available to authorized users.
Highlights
Chronic spontaneous urticaria (CSU) poses problems with respect to high prevalence, reduced quality of life, lack of long term efficacy, and expense of current treatments for severe intractable symptoms
A much larger study comparing the outcome of whole person treatment approach (WPTA) versus standard treatment alone is warranted
International drug treatment guidelines for CSU management target histamine receptors and immune mechanisms, but CSU is frequently unresponsive to antihistamine and immunosuppressive medications [2], and the impact of CSU on quality of life is often underestimated by physicians [3]
Summary
Chronic spontaneous urticaria (CSU) poses problems with respect to high prevalence, reduced quality of life, lack of long term efficacy, and expense of current treatments for severe intractable symptoms. Chronic spontaneous urticaria (CSU) will affect 1–5 % of the population during their lifetime [1] This condition constitutes approximately 25 % of the referrals to the Department of Immunology at Auckland City Hospital. Since 2008, in our department, many CSU patients have been treated with an individualised, non-dualistic whole person treatment approach (WPTA) (see Additional file 1: Appendix 1) [9,10,11,12,13]. This small pilot study was conducted to demonstrate grounds, acceptability, feasibility, and potential usefulness of a whole person approach, and to develop guidelines for a larger formal outcome study
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