The Effectiveness of Allergy Evaluation in Patients with Chronic Spontaneous Urticaria
Monday, March 7, 2016
South Exhibit Hall H (Convention Center)
Roy A. Orden, MD, Yi-Chen Liu, Yea-Jen Hsu, PhD, MHA, Jodi B Segal, MD, MPH
Rationale: The overall impact of specialty consultation for patients with chronic spontaneous urticaria (CSU) has never been reported. The objective of this study was to assess the impact of allergist/immunologist evaluation of CSU patients on filled prescriptions of corticosteroids.

Methods: We conducted an interrupted times series analysis using prescription data from Truven Health Analytics MarketScan, a nationwide claims database, for patients with dates of service between January 1, 2010 and December 31, 2012. CSU patients were identified using a previously validated ICD-9-CM coding algorithm. Eligibility for cohort inclusion was further limited to continuously enrolled patients with incident cases of CSU and incident evaluations by an allergist. The monthly oral steroid burden in the 12 months before and after the date of allergy/immunology evaluation was compared. 

Results: 635 patients met inclusion criteria. In the twelve months preceding allergy evaluation, total oral steroid prescriptions, measured in prednisone equivalents, increased by 1,579 mg per month.  Steroid prescriptions peaked at 31,145 mg in the 30 days prior to the date of allergy evaluation. Prescriptions filled on the date of evaluation were excluded due to an artifactual alignment of refills. In the twelve months after specialty consultation, prescriptions dropped by 1,580 mg per month, representing a significant treatment effect (p=0.0003). The initiation of second-line immunomodulators, particularly cyclosporine, hydroxychloroquine and dapsone, was similarly associated with significant decreases in filled corticosteroid prescriptions. 

Conclusions: The evaluation of patients with CSU by an allergy/immunology specialist is associated with a marked decrease in corticosteroid prescriptions, possibly due to the introduction of immunomodulating agents.