Comparison of short and long term cyclosporine A therapy in chronic idiopathic urticaria
ABSTRACT Chronic idiopathic urticaria is sometimes difficult to treat, with little response to antihistamine therapy.
In a limited number of severe chronic idiopathic urticaria patients, cyclosporine A (CsA) therapy was found to be effective. In this study, we compared the clinical efficacy and safety of short- and long-term CsA applications.
Twenty patients with severe disease, unresponsive to antihistamines and showing a positive autologous serum skin test (ASST) were randomized to 4 mg/kg per day of CsA for 4 or 12 weeks. The clinical efficacy was measured with a daily activity score of weal numbers and itch (UAS). The two groups were compared in terms of mean reduction in UAS and ASST response to pre-and post-treatment sera.
The clinical improvement was dramatic in the first month of treatment in both groups. There was no significant difference in the frequency of responses, side effects and the reduction of UAS in either group.
The preliminary results of our study suggest that CsA is clinically effective for chronic urticaria. The prolonged use of this therapy for more than 1 month provides little benefit in the clinical improvement.
Article: Urticaria and angioedema.[Show abstract] [Hide abstract]
ABSTRACT: Urticaria and angioedema are commonly encountered complaints in children. Although the diagnosis is clear, establishing an etiology, especially with respect to chronic urticaria, can be challenging. A significant proportion of chronic urticarial cases are now considered to have an autoimmune etiology. This article reviews progress in the field of urticaria and angioedema including developments in pathogenesis, description of laboratory testing, and review of medications. Urticaria and angioedema can usually be controlled by avoidance of triggers, a variety of supportive medications, and reassurance.Immunology and Allergy Clinics of North America 06/2005; 25(2):353-67, vii. DOI:10.1016/j.iac.2005.03.003 · 2.22 Impact Factor
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ABSTRACT: Chronic urticaria is heterogenous, long-persisting and has a severe impact on quality of life and daily work. Effective treatment is essential but remains a confounding problem. This review summarizes available treatment strategies for chronic urticaria and their strength of evidence. Besides treatment of identified triggering factors such as chronic persistent bacterial infections (e.g., with Helicobacter pylori, streptococci, staphylococci or yersinia), standard treatment consists of nonsedating H1-antihistamines. Most patients require increasing (off-label) dosages that should be taken daily and regularly, however, this still fails in a third of cases. Reliable alternatives in the world literature are rare and the level of evidence is low. Certain subgroups may display benefit from additional treatment with cyclosporine A, cysteinyl leukotriene receptor antagonists, chloroquine, dapsone or other alternatives. A practicable step-wise treatment approach is given to optimize and individualize the treatment of patients with chronic urticaria.Expert Review of Clinical Immunology 09/2005; 1(3):459-73. DOI:10.1586/1744666X.1.3.459 · 3.34 Impact Factor
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ABSTRACT: Treatment of severe recalcitrant chronic idiopathic urticaria (CIU) is difficult. To assess the efficacy and safety of oral cyclosporin A (CsA) in CIU. The response to CsA was evaluated in 99 CIU patients with a double-blind, randomized, three-armed study: 16-week CsA, 8-week CsA +8-week placebo, and 16-week placebo. All patients received cetirizine throughout the study period and were followed-up after 8 weeks. Fewer therapeutic failures occurred with 16-week CsA (n = 3) than with placebo (n = 11) and 8-week CsA (n = 8). After 8 and 16 weeks, symptom scores significantly improved in both CsA groups over with placebo. Two patients discontinued because of hypertension. During the study period, CsA was not administered at a constant dose; from day 28 the daily dose was 3 mg/kg, which is likely to be less effective and better tolerated than higher dosages. CsA in addition to background therapy with cetirizine may be useful in the treatment of CIU.Journal of the American Academy of Dermatology 11/2006; 55(4):705-9. DOI:10.1016/j.jaad.2006.04.078 · 5.00 Impact Factor