Treatment of Patients with Chronic Idiopathic Urticaria

Abstract

Treatment of patients with chronic idiopathic urticaria (CIU) involves reducing symptoms with the least invasive therapy and carefully balancing risk and benefit. The mainstay of therapy is the use of antihistamines with or without the use of intermittent pulses of corticosteroids. Alternative therapies to chronic corticosteroids include leukotriene antagonists, plasma-phoresis, dapsone, stanazolol, hydroxychloroquine, methotrexate, cyclosporin, tacrolimus, and warfarin. A practical approach to CIU bases treatment and severity on the patients' previous response to therapy. Therapy goals are to reduce symptoms until spontaneous resolution occurs. Management of CIU patients can be both frustrating and rewarding.

Prospective randomized non‐blinded clinical trial on the use of dapsone plus antihistamine vs. antihistamine in patients with chronic idiopathic urticaria

“…Today, we are much more aware of the anti‐inflammatory effects of the drug than antibacterial properties 5 . It has been proposed in cases of severe chronic urticaria to avoid side‐effects of corticosteroids 4,18 …”

Successful Treatment of Recalcitrant Chronic Idiopathic Urticaria With Sulfasalazine

“…23,24 Currently, antihistamines, which generally work by alleviating the symptoms rather than enacting a cure, are the standard treatment for CIU. 25,26 With the recent advent of nonsedating or minimally sedating H 1 receptor antagonists, some patients with CIU have found relief from symptoms without the adverse effect of excessive drowsiness. Unfortunately, there are those whose urticaria does not respond to treatment with antihistamines, with some studies reporting a 5% to 12% failure rate with fexofenadine hydrochloride therapy.…”

Treatment of Chronic Urticaria

“…It is important to monitor renal and liver function during therapy. Adverse events reported seem to be less pronounced or similar to those with cyclosporine (3,130,(132)(133)(134). There is a new, once-daily formulation registered as Advagraft for European Union (135).…”