Successful Treatment of Recalcitrant Chronic Idiopathic Urticaria With Sulfasalazine

McGirt, Laura Y.; Vasagar, Kavitha; Gober, Laura; Saini, Sarbjit S.; Beck, Lisa A.

doi:10.1001/archderm.142.10.1337

Cited by 80 publications

(39 citation statements)

References 46 publications

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“…The current EAACI/GA(2)LEN/EDF/WAO guidelines recommend using omalizumab, ciclosporin, or montelukast in patients who are unresponsive to up to fourfold dosed non-sedating antihistamines [3]. Additional therapeutics that have been tried in CSU include colchicine [37], mesalazine [38], hydroxychloroquine [39], dapsone [40,41], sulfasalazine [42], corticosteroids [43], narrowband ultraviolet B phototherapy [44], doxepin [45,46], mycophenolate mofetil [47,48], methotrexate [49][50][51], plasmapheresis [52], miltefosine [53], and intravenous immunoglobulin (IVIG) [54][55][56]. The vast majority of these have been used in small case reports and case series, but not in randomized controlled trials (RCTs) [ Table 1].…”

Section: Second-line Agents For Csumentioning

confidence: 99%

Treatment of Severely Recalcitrant Chronic Spontaneous Urticaria: A Discussion of Relevant Issues

2014

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Chronic spontaneous urticaria (CSU) is a common disorder with a prevalence of 1% that is characterized by recurrent wheals, angioedema, or both. CSU is self-limited but in many patients symptoms recur for several years and can be refractory to standard therapies. In this review, we present an illustrative case of a female patient with CSU who, despite taking 15 antihistamines a day in addition to a number of second-line therapies, continued to be refractory to treatment. However, once we initiated subcutaneous treatment with omalizumab 300 mg every 4 weeks, she experienced rapid relief of her CSU symptoms. Through this case, we present a review of the relevant issues, including the efficacy of laboratory tests to identify the cause of a patient's CSU, the association between CSU and thyroid disease and its relevance to treatment options, the recommendation to increase antihistamine dose up to fourfold and possible adverse events associated with this treatment option. We also include a discussion of the use of second-line therapies as well as omalizumab in refractory CSU patients.

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Section: Second-line Agents For Csumentioning

confidence: 99%

Treatment of Severely Recalcitrant Chronic Spontaneous Urticaria: A Discussion of Relevant Issues

2014

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“…An example is a recent study of sulfasalazine that has no placebo control. 31 Dapsone, hydroxychloroquine, and colchicine are, in my view, ineffective, but more important is that the data in support of their use are based primarily on uncontrolled studies of small numbers of patients. [32][33][34] The choice of these agents might be based on their apparent efficacy for urticarial vasculitis or other neutrophil-dependent dermatologic conditions.…”

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confidence: 99%

What the first 10,000 patients with chronic urticaria have taught me: A personal journey

Kaplan¹

2009

Journal of Allergy and Clinical Immunology

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“…Its mechanism of action in chronic urticaria is unclear but is, presumably, antiinflammatory. Treatment with sulphasalazine has been effective in antihistamine-resistant COU in sporadic reports and a case series of 19 patients [68]. A corticosteroid-sparing effect was shown for sulphasalazine in patients with severe chronic urticaria.…”

Section: Sulphasalazinementioning

confidence: 97%

Urticaria: current and future treatments

Borzova

Grattan

2007

Expert Review of Dermatology

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Urticaria is a common disorder with diverse clinical presentations. Correct recognition of the different clinical patterns promotes more effective treatment. Management involves treatment of any identifiable external causes, including infection, avoidance of drug, food and physical triggers and the appropriate use of pharmacological therapies. These can be divided into first-, second-and third-line approaches. The choice of treatment will be influenced by many factors, including drug licensing, safety, pattern of disease, disease severity, pharmacoeconomic considerations and patient preference. H1 antihistamines are the mainstay of treatment of most patterns of urticaria and are effective in the majority of patients with mast cell-mediated disease. Second-generation antihistamines have a better therapeutic index and improved pharmacodynamic properties compared with older 'classic' antihistamines and should be prescribed preferentially for chronic urticaria. Patients who are unresponsive to H1 antihistamines at full dose may require short-term treatment with oral corticosteroids but their long-term use for urticaria should be avoided whenever possible on account of the risk of serious adverse effects. Antileukotrienes and alternative second-line agents, prescribed off licence, can be helpful for patients who respond poorly to antihistamines when taken in conjunction but a better evidence base is needed to guide prescribing. Third-line immunosuppressive therapies can be considered for debilitating urticaria, especially for patients with corticosteroid-dependent chronic disease, and may have some potential to modify the natural course of the illness. Possible new therapeutic approaches on the horizon include new H1 antihistamines, H4 receptor antagonists, a histidine decarboxylase inhibitor under development and biological agents that target histamine-releasing autoantibody production and function.

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Successful Treatment of Recalcitrant Chronic Idiopathic Urticaria With Sulfasalazine

Cited by 80 publications

References 46 publications

Treatment of Severely Recalcitrant Chronic Spontaneous Urticaria: A Discussion of Relevant Issues

Treatment of Severely Recalcitrant Chronic Spontaneous Urticaria: A Discussion of Relevant Issues

What the first 10,000 patients with chronic urticaria have taught me: A personal journey

Urticaria: current and future treatments

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