Intravenous Immunoglobulin as a Potential Therapy for Refractory Urticaria - A Review

Abstract

Urticaria can be a chronic and debilitating affliction and is a relatively common disorder affecting between 10- 20% of the population. Common causes include reactions to medication, food allergen, physical stimuli and venoms. Urticaria can be acute or chronic. Chronic urticaria lasts for more than 6 weeks and is commonly difficult to treat. The use of immunosuppressive agents for this disorder when antihistamines fail can result in significant morbidity. Recent advances in the pathogenesis, etiology, diagnosis and management of chronic urticaria have led to new paradigms in treatment of this disorder. Cyclosporine is often the most effective but has some unique adverse effects that may prevent it from being used in some patients. The use of intravenous immunoglobulin (IVIG) has proven effective in a variety of reports and we will review the mechanisms likely involved in the successful control of urticarial symptoms by immunomodulating therapy using IVIG. In this review, we will discuss mechanisms and pathogenesis of urticaria and the specific role of intravenous immunoglobulin (IVIG) in this disorder, especially in refractory or steroid-dependent cases.

Update on the use of immunoglobulin in human disease: A review of evidence

“…A recent review endorsed (based on level III, grade D evidence) a trial of IVIG in the treatment of refractory urticaria, when adverse events related to immunosuppressives, such as cyclosporine or corticosteroids, occur or when therapies including mycophenolate mofetil or omalizumab have failed. 301 Recently, omalizumab was approved by the FDA for the treatment of chronic idiopathic urticaria. 302…”

Guía clínica chilena de urticaria crónica espontánea

“…Pequeñas series de casos ha evidenciado que gammaglobulina en dosis de 0,4 g/kg/día por 5 días EV puede ser eficaz en pacientes con UCE; sin embargo, los autores señalan que su perfil costo-beneficio y posibles efectos adversos no la hace una terapia favorable en estos pacientes 41 .…”

Chronic spontaneous urticaria: latest developments in aetiology, diagnosis and therapy

“…The average dose of IVIG ranges from 0.15 to 2 g/kg/day for 1–3 consecutive days and repeated monthly or until remission, which could be sustained for up to 1 year [Kroiss et al 2000; Klote et al 2005; Pereira et al 2007; Hrabak and Calabria, 2010; Mitzel-Kaoukhov et al 2010]. IVIG has also been used for treatment of solar urticaria and urticarial vasculitis [Watkins et al 2012].…”