Successful treatment of recalcitrant chronic idiopathic urticaria with sulfasalazine.

Department of Dermatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Archives of Dermatology (Impact Factor: 4.31). 11/2006; 142(10):1337-42. DOI: 10.1001/archderm.142.10.1337
Source: PubMed

ABSTRACT Antihistamines are the standard treatment for chronic idiopathic urticaria (CIU). For patients whose urticaria is unresponsive to antihistamines, the treatment options are limited. During the previous decade, there have been several case reports demonstrating success with sulfasalazine therapy. In this article, we present a case series evaluating sulfasalazine therapy for antihistamine-unresponsive CIU.
Nineteen patients with antihistamine-unresponsive CIU were treated with sulfasalazine between 2002 and 2005. During sulfasalazine therapy, 14 patients (74%) reported significant improvement, 4 patients (21%) reported minimal improvement but were not satisfied with their symptom relief, and 1 patient (5%) reported a worsening of symptoms. Of the 13 patients who required systemic steroids to control their urticaria, all were able to reduce or discontinue steroid use during sulfasalazine therapy. Although 7 patients (37%) had adverse effects (eg, nausea, headache, mild or transient leukopenia, and transaminitis) that were thought to be caused by the use of sulfasalazine, they all kept taking the drug.
This case series demonstrates that sulfasalazine can be a successful and safe treatment option for patients with CIU who have not responded adequately to treatment with antihistamines. Sulfasalazine was steroid sparing in all subjects who were steroid dependent.

  • [Show abstract] [Hide abstract]
    ABSTRACT: To examine the available treatment choices for chronic spontaneous urticaria (CSU) and discuss a new paradigm for treating such patients. The literature regarding treatment is reviewed, including considerations of published guidelines. Attention is focused on the most recent evidence indicating particular efficacy of omalizumab. Omalizumab has been found to have considerable efficacy in phase 2 and phase 3 trials in which more than 900 patients have been studied. A response rate of 65% is seen in patients resistant to antihistamines as well as to histamine2 blockers and leukotriene antagonists, and 40% of patients are completely free of hives as long as therapy is continued. In addition, serious adverse events have not been seen. Only cyclosporine can match this response rate (excluding steroids), but the adverse effect profile (blood pressure and renal function) is substantial by comparison. Double-blind, placebo-controlled studies of other agents often listed as alternatives are lacking (ie, whether their success rate exceeds the 25%-30% placebo response is uncertain). The mechanism by which omalizumab works in CSU is not clear because the response rate is unrelated to the autoimmune profile and can occur rapidly (ie, within a few days). Omalizumab has exceptional efficacy for antihistamine-resistant CSU with an excellent adverse effect profile.
    Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 03/2014; · 2.75 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Guía mexicana para el Diagnostico y Tratamiento de la Urticaria. .
    Alergia 01/2014; 61(2):s117-s192.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Chronic urticaria is defined as episodic or daily hives lasting for at least 6 weeks and impairs quality of life. Two main subtypes include chronic idiopathic (spontaneous) urticaria and inducible (physical) urticaria, but some patients have urticarial vasculitis. "Autoimmune chronic urticaria" implies the presence of histamine releasing or mast cell activating autoantibodies to IgE or FcϵRI, the high affinity receptor on mast cells and basophils. In patients not readily controlled with labeled dosages of second generation H1 receptor antagonists (antihistamines), there is evidence for reduction of urticaria using up to 4 fold increases in labeled dosages. The biologic modifier, omalizumab, helps to reduce lesions of chronic urticaria within 1-2 weeks.
    World Allergy Organization Journal 01/2014; 7(1):31.

Full-text (2 Sources)

Available from
Jun 4, 2014