Treating chronic spontaneous urticaria using a brief ‘whole person’ treatment approach: a proof-of-concept study

Clinical and Translational Allergy

Brian Broom²  Margot Solomon²  Josie Goulding²  Karen Lindsay¹ 

[1] Department of Immunology, Auckland City Hospital, Park Rd, Grafton, Auckland 1023, New Zealand;Department of Psychotherapy and Counselling, Auckland University of Technology, Akoranga Rd Campus, Auckland, New Zealand

关键词: Psychotherapy;    Whole person treatment approach;    Treatment;    Efficacy;    Chronic urticaria;   

Others  :  1234651
DOI  :  10.1186/s13601-015-0082-7

 received in 2015-05-05, accepted in 2015-10-14,  发布年份 2015

【 摘 要 】

Background

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. 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.

Findings

In 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.

Conclusions

A 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.

【 授权许可】

   
2015 Lindsay et al.

【 参考文献 】

• [1]Paul E, Greilich KD, Dominante G: Epidemiology of urticaria. Monogr Allergy 1987, 21:87-115.
• [2]Zuberbier T: A Summary of the New International EAACI/GA(2)LEN/EDF/WAO Guidelines in urticaria. World Allergy Org J. 2012, 5(Suppl 1):S1-S5. BioMed Central Full Text
• [3]Grob JJ, Gaudy-Marqueste C: Urticaria and quality of life. Clin Rev Allergy Immunol 2006, 30(1):47-51.
• [4]Song CH, Stern S, Giruparajah M, Berlin N, Sussman GL: Long-term efficacy of fixed-dose omalizumab for patients with severe chronic spontaneous urticaria. Ann Allergy Asthma Immunol 2013, 110(2):113-117.
• [5]Staubach P, Dechene M, Metz M, Magerl M, Siebenhaar F, Weller K, et al.: High prevalence of mental disorders and emotional distress in patients with chronic spontaneous urticaria. Acta Derm Venereol 2011, 91(5):557-561.
• [6]Staubach P, Eckhardt-Henn A, Dechene M, Vonend A, Metz M, Magerl M, et al.: Quality of life in patients with chronic urticaria is differentially impaired and determined by psychiatric comorbidity. Br J Dermatol. 2006, 154(2):294-298.
• [7]Metz M, Krull C, Hawro T, Saluja R, Groffik A, Stanger C, et al.: Substance P is upregulated in the serum of patients with chronic spontaneous urticaria. J Invest Dermatol. 2014, 134(11):2833-2836.
• [8]Broom BC: A reappraisal of the role of ‘mindbody’ factors in chronic urticaria. Postgrad Med J 2010, 86(1016):365-370.
• [9]Broom BC. Somatic illness and the patient’s other story. A practical integrative mind/body approach to disease for doctors and psychotherapists. London: Free Association Books; 1997.
• [10]Broom BC: Medicine and story: a novel clinical panorama arising from a unitary mind/body approach to physical illness. Adv Mind Body Med. 2000, 16:161-207.
• [11]Transforming clinical practice using a mindbody approach. A radical integration. Karnac Books Ltd, London; 2013.
• [12]Broom BC: Meaning-full disease: How personal experience and meanings initiate and maintain physical illness. Karnac Books, London; 2007.
• [13]Broom BC: Somatic metaphor: a clinical phenomenon pointing to a new model of disease, personhood, and physical reality. Adv Mind Body Med. 2002, 18:16-29.
• [14]Zuberbier T, Asero R, Bindslev-Jensen C, Canonica GW, Church MK, Gimenez-Arnau A, et al.: EAACI/GA2LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria. Allergy 2009, 64:1417-1426.
• [15]Jariwala SP, Moday H, Lourdes de Asis M, Fodeman J, Hudes G, de Vos G, et al.: The Urticaria Severity Score: a sensitive questionnaire/index for monitoring response to therapy in patients with chronic urticaria. Ann Allergy Asthma Immunol 2009, 102:475-482.
• [16]Zuberbier T, Asero R, Bindslev-Jensen C, Walter Canonica G, Church MK, Gimenez-Arnau A, et al.: EAACI/GA(2)LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria. Allergy 2009, 64(10):1417-1426.
• [17]Jariwala SP, Moday H, de Asis ML, Fodeman J, Hudes G, de Vos G, et al.: The Urticaria Severity Score: a sensitive questionnaire/index for monitoring response to therapy in patients with chronic urticaria. Ann Allergy Asthma Immunol 2009, 102(6):475-482.
• [18]Berrino AM, Voltolini S, Fiaschi D, Pellegrini S, Bignardi D, Minale P, et al.: Chronic urticaria: importance of a medical-psychological approach. Eur Ann Allergy Clin Immunol. 2006, 38(5):149-152.