Treatment of chronic spontaneous urticaria with an inadequate response to H1-antihistamine
- 1 June 2019
- journal article
- review article
- Published by Edizioni Minerva Medica in Giornale Italiano Di Dermatologia E Venereologia
- Vol. 154 (4), 444-456
- https://doi.org/10.23736/s0392-0488.19.06274-6
Abstract
The second-generation H1-antihistamines (sgAH) are the first-line symptomatic treatment of patients with chronic spontaneous urticaria (CSU). Up to 50% of the patients will not respond to licensed doses of sgAH. According to the guidelines, the dose of sgAH may be increased up to 4 times the conventional dose. However, even at higher doses, there is a subgroup of patients refractory to the antihistamine treatment. The purpose of this article was to review the different treatment options of antihistamine-refractory CSU patients. This revision examines the available literature for therapies used in chronic urticaria, including omalizumab, ciclosporin A, oral glucocorticoids, leukotriene receptor antagonists, H2 antihistamines, doxepin, dapsone, hydroxychloroquine, phototherapy, methotrexate, mycophenolate mofetil, azathioprine, autohemotherapy, intravenous immunoglobulins and rituximab, between others. After the exhaustive review of the medical literature only few high-quality studies have been identified, mostly for omalizumab. Omalizumab is an anti-immunoglobulin E monoclonal antibody, approved for the treatment of CSU, that has radically changed the management of the patients without good response to sgAH, allowing to reach complete responses in a high percentage of patients. Although actually the therapeutic management of CSU is more effective and safer than before 2014, there is place even for new and more effective treatments. A good number of partial responders and slow responders to omalizumab and a little percentage still of non-responders to available therapies stimulate the development of new drugs that will also be discussed.Keywords
This publication has 85 references indexed in Scilit:
- The use of mycophenolate mofetil for the treatment of autoimmune and chronic idiopathic urticaria: Experience in 19 patientsJournal of the American Academy of Dermatology, 2012
- Antidepressants in chronic idiopathic urticariaAllergy and Asthma Proceedings, 2011
- Efficacy and safety of omalizumab in patients with chronic urticaria who exhibit IgE against thyroperoxidaseJournal of Allergy and Clinical Immunology, 2011
- A randomized, placebo-controlled, dose-ranging study of single-dose omalizumab in patients with H1-antihistamine–refractory chronic idiopathic urticariaJournal of Allergy and Clinical Immunology, 2011
- How to assess disease activity in patients with chronic urticaria?Allergy, 2008
- Prospective randomized non‐blinded clinical trial on the use of dapsone plus antihistamine vs. antihistamine in patients with chronic idiopathic urticariaJournal of the European Academy of Dermatology and Venereology, 2007
- Cyclosporine in chronic idiopathic urticaria: A double-blind, randomized, placebo-controlled trialJournal of the American Academy of Dermatology, 2006
- Treatment of severe chronic idiopathic urticaria with oral mycophenolate mofetil in patients not responding to antihistamines and/or corticosteroidsInternational Journal of Dermatology, 2006
- Randomized double-blind study of cyclosporin in chronic ‘idiopathic’ urticariaBritish Journal of Dermatology, 2000
- Efficacy of doxepin in the treatment of chronic idiopathic urticariaJournal of Allergy and Clinical Immunology, 1986