Factors that predict the success of cyclosporine treatment for chronic urticaria.

Abstract

BACKGROUND:

Chronic urticaria (CU) is a frequent, difficult clinical problem. When first-line therapy fails, patients are often treated with alternative therapies that either have a poor side effect profile or little evidence to support effectiveness.

OBJECTIVE:

To describe our low-dose cyclosporine-treated CU population and factors predicting a positive outcome.

METHODS:

A retrospective chart review was conducted of adult CU patients treated with cyclosporine. Elements of the history, physical examination, diagnostic testing, efficacy, and side effects were extracted for statistical analysis.

RESULTS:

Chronic urticaria was defined as having urticaria more than 3 days per week for 6 consecutive weeks. Sixty-eight adults with CU who fulfilled the intake criteria and completed a course of cyclosporine were identified. After taking cyclosporine at an average dose of 1.8 ± 1.1 mg/kg, 53 (78%) patients attained complete remission defined as ≤ 1 day of hives per month. Recurrence occurred in only 7 patients; all achieved remission with resumption of cyclosporine. A history of hives (P = .01), shorter duration of urticaria (mean: 55.2 weeks vs 259.63 weeks; P = .03), and positive CU Index (P = .05) predicted a favorable response to cyclosporine. Notably, autologous serum skin testing, prior response to steroids, atopic status, or presence of antithyroid antibodies was not predictive. Male sex and a positive ANA trended toward significance (P = .1). Side effects were generally mild and seen in 35% of patients; all were reversible by dose reduction.

CONCLUSION:

Cyclosporine is an effective treatment for CU, and a history of hives, shorter duration of disease, and CU index ≥10 predict a successful response.

• Authors: Seth M Hollander, Shirley S Joo, H James Wedner
• Journal: Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (Ann Allergy Asthma Immunol) Vol. 107 Issue 6 Pg. 523-8 (Dec 2011) ISSN: 1534-4436 [Electronic] United States
• PMID: 22123382 (Publication Type: Journal Article)
• Copyright: Copyright © 2011 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Chemical References

• Immunosuppressive Agents
• Cyclosporine

Topics

• Administration, Oral
• Adult
• Chronic Disease
• Cohort Studies
• Cyclosporine (administration & dosage)
• Dose-Response Relationship, Immunologic
• Female
• Humans
• Immunosuppressive Agents (administration & dosage)
• Male
• Retrospective Studies
• Urticaria (drug therapy, immunology)