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MARTEG’s formation culminates in recommendations for treatment of urticaria in primary care

Pank Jit Sin
03 Dec 2018
Dr. Adrian Yong, Dr. Amir Hamzah and the rest of the committee at the launch of the MARTEG Urticaria handbook.”

Prominent members from the Malaysian Society of Allergy and Immunology (MSAI) and Dermatological Society of Malaysia (PDM) came together to establish a coalition called the Malaysian Urticaria Expert Group (MARTEG), which is supported by A. Menarini.

The expert group was established in May 2017 with a few objectives in mind. Firstly, it sought to optimize management of urticaria, in terms of efficacy and safety, in Malaysia. Furthermore, the group aspired to promote awareness of urticaria among healthcare professionals and patients. Another aim of the group was to adapt management of urticaria to local demographics based on current international evidence-based recommendations. Finally, it wanted to identify knowledge gaps that impact the management of urticaria in the local setting.

The MARTEG convened for two meetings, first of which was to discuss treatment strategies for chronic urticaria in the primary care setting. This set the stage for the second meeting, which was to identify appropriate investigations to diagnose patients in the primary care setting. The expert group referred to, and modified, international guidelines to arrive at the handbook aptly titled ‘Management of urticaria in primary care: Recommendations of a Malaysian Urticaria Expert Group (MARTEG).’ The book was launched at the recent 43rd Annual Dermatology Conference in Kuala Lumpur, recently. 

In the book, healthcare professionals (HCPs) can expect to find an easy-to-understand and comprehensive content including topics such as diagnosis of urticaria, management of urticaria in adults and children; and case studies involving adult and paediatric patients. Dr Adrian Yong and Dr Amir Hamzah, who are both chair and co-chair of MARTEG, respectively, are also the book’s authors and co-editors. The book’s main authors are Drs Chang Choong Chor, Kent Woo, Lee Yin Yin, Leong Kin Fon, Pubalan Muniandy and Tang Jyh Jong. Numerous other experts also lent time and effort to the book.

Of particular interest is the treatment recommendations for HCPs in the primary care setting, which includes community pharmacies and GP clinics. The recommendations say that unless provided with a doctor’s prescription, community pharmacists should not dispense second-generation H1-antihistamines at doses higher than that stated in the prescribing information. Patients who complain of persisting symptoms at licensed doses should be referred to a general practitioner. If patients fail to respond to second-line treatment of second-generation H1-antihistamines at four-fold licensed doses in the GP setting, these patients should be referred to a specialist. Specialists in the treatment of adults are defined as dermatologists, allergist and immunologists.

The book also takes into account treatment recommendations for pregnant and breastfeeding mothers. The key recommendation is, although systemic treatment should ideally be avoided in pregnancy, the patient’s wellbeing should also be taken into account. Patients should be counselled on the risks and benefits of treatment on maternal and infant health. This is because the effects of elevated histamine levels on pregnancy has not been studied. Similarly, the safety of antihistamines has not been systematically studied and available evidence is weak.

HCPs interested in obtaining the handbook can get in touch with A. Menarini Singapore Pte Ltd at (03)-7985 7000/7100 or at their website https://www.menariniapac.com/contact-us#EnquiryForm-div.

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