Treatment of Autoimmune Urticaria with Low-dose Cyclosporin A: A One-year Follow-up

Abstract

Patients with autoimmune urticaria (AIU) and positive autologous serum skin test (ASST) represent a more serious type of chronic urticaria that does not respond to treatment with antihistamines, but responds completely to systemic corticosteroids. Because of the chronic course of the disease, there is a risk of side-effects. Cyclosporin A (CsA) is an alternative treatment for patients with AIU. In order to determine the efficacy of CsA at the lowest possible dose in patients with chronic idiopathic urticaria and positive ASST, 30 patients were included in a 5-month study with a follow-up one year after the end of treatment. All patients had positive ASST before treatment and autoantibodies were present in 73%. Twenty- three patients completed the study and responded to low-dose CsA treatment. Three patients did not respond to a dose of 2.5 mg/kg CsA, and 4 patients dropped-out due to side-effects. After the first month of treatment, an improvement of 31% was noted, reaching 88% after the fifth month of treatment. The mean dose of CsA was 2.16 mg/kg for the first month and 0.55 mg/kg for the fifth month. Three to 6 months after the end of the study, the ASST was repeated and was negative in 78.3% of patients. At the one-year follow-up, 20 patients were symptom-free (87%) and 3 had relapsed (13%). CsA, even in low-doses, can be an effective and short-term treat- ment with minimum side-effects in patients with AIU.

BSACI guideline for the management of chronic urticaria and angioedema

“…Ciclosporin-Low-dose ciclosporin may also be considered in patients with severe unremitting disease uncontrolled by antihistamines [87,88]. A T cell-mediated mechanism has been proposed, but ciclosporin also None of the above second-generation antihistamines has demonstrated superiority over another in licensed doses.…”

Successful Treatment of the Different Urticaria Subtypes

“…Good evidence, but from short-term studies only [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42], exists for cyclosporine A (2.5-5 mg per kg body weight) being another off-label alternative at step 3 of the treatment algorithm. However, clinical response often does not occur before 4-6 weeks of intake, and potential side effects such as arterial hypertension, disturbances of kidney and liver function, immunosuppression, and cancer risk have to be considered.…”

Autoimmune urticaria

“…Six months after the final study end-point, ASST has been repeated and negative results were recorded in 78.3% of patients who completed the study. At one-year follow-up, 20 patients were symptomfree and 3 had relapsed [36]. Efficacy of CsA in comparison with prednisolone has been studied by Lori et al [37], and good evidence for alternative treatment in the case of contraindications for systemic steroids in severe AU has been provided.…”