Treatment of refractory chronic urticaria with tumor necrosis factor–alfa inhibitors

Wilson, Lindsay; Eliason, Mark J.; Leiferman, Kristin M.; Hull, Christopher M.; Powell, D. L.

doi:10.1016/j.jaad.2009.10.043

Cited by 53 publications

(31 citation statements)

References 5 publications

(3 reference statements)

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“…In contrast to type 2‐targeted therapies, conflicting evidence exists regarding efficacy of TNF inhibitors or ustekinumab in eczematous diseases. While some case series are encouraging, others report lack of long‐term evidence or paradoxical eczematous reactions after therapy with TNF inhibitors …”

Section: Lessons Learned For Specific Therapymentioning

confidence: 99%

“…While some case series are encouraging, 12,60 others report lack of long-term evidence 61 or paradoxical eczematous reactions after therapy with TNF inhibitors. 62 An established therapy for diseases following the bullous pattern (pattern 2b) is rituximab that eliminates B cells by targeting CD20. 63 Furthermore, it is speculated that blocking of IL-4 might be effective in bullous diseases such as pemphigus.…”

Section: Trigger Factors and Early Eventsmentioning

confidence: 99%

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Immune response patterns in non‐communicable inflammatory skin diseases

Eyerich

2018

Acad Dermatol Venereol

127

143

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Non‐communicable inflammatory skin diseases (ncISD) such as psoriasis or atopic eczema are a major cause of global disease burden. Due to their impact and complexity, ncISD represent a major challenge of modern medicine. Dermatology textbooks describe more than 100 different ncISD based on clinical phenotype and histological architecture. In the last decades, this historical description was complemented by increasing molecular knowledge – and this knowledge is now being translated into specific therapeutics. Combining the enormous advances made in lymphocyte immunology and molecular genetics with clinical and histological phenotyping reveals six immune response patterns of the skin – type I immune cells cause the lichenoid pattern characterized by immune‐mediated cell death of keratinocytes; type II immune cells underlie the eczematous pattern with impaired epidermal barrier, infection and eosinophils as well as the bullous pattern with loss of epithelial integrity; Th17 cells and ILC3 mediate the psoriatic pattern characterized by acanthosis, high metabolic activity and neutrophils; dysbalance of regulatory T cells causes either the fibrogenic pattern with rarefication of cells and dermal thickening or the granulomatous pattern defined by formation of granulomas. With more and more specific therapeutic agents approved, classifying ncISD also according to their immune response pattern will become highly relevant. This review defines the six immune response patterns of ncISD and highlights therapeutic strategies targeting key lymphocyte mediators.

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Section: Lessons Learned For Specific Therapymentioning

confidence: 99%

Section: Trigger Factors and Early Eventsmentioning

confidence: 99%

Immune response patterns in non‐communicable inflammatory skin diseases

Eyerich

2018

Acad Dermatol Venereol

127

143

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“…Treatment of one patient with cold urticaria [11] and one patient with DPU [9] was successful. In one small series of six patients with refractory CSU and chronic urticarial vasculitis, therapy with etanercept, adalimumab, or infliximab resulted in marked rapid improvement in all patients [10]. …”

Section: Discussionmentioning

confidence: 99%

TNF-Alpha Inhibitors for Chronic Urticaria: Experience in 20 Patients

Sand

Thomsen

2013

Journal of Allergy

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Patients with severe chronic urticaria may not respond to antihistamines, and other systemic treatment options may either be ineffective or associated with unacceptable side effects. We present data on efficacy and safety of adalimumab and etanercept in 20 adult patients with chronic urticaria. Twelve (60%) patients obtained complete or almost complete resolution of urticaria after onset of therapy with either adalimumab or etanercept. Further three patients (15%) experienced partial response. Duration of treatment ranged between 2 and 39 months. Those responding completely or almost completely had a durable response with a mean of 11 months. Six patients (30%) experienced side effects and five patients had mild recurrent upper respiratory infections, whereas one patient experienced severe CNS toxicity that could be related to treatment with TNF-alpha inhibitor. Adalimumab and etanercept may be effective and relatively safe treatment options in a significant proportion of patients with chronic urticaria who do not respond sufficiently to high-dose antihistamines or in whom standard immunosuppressive drugs are ineffective or associated with unacceptable side effects.

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“…In an observational study of 20 adult patients with chronic urticaria, 16 patients with CSU, two patients with CAU, one patient with delayed pressure urticaria, and one patient with neutrophilic urticaria, TNF inhibitors were shown to result in complete or almost complete resolution of urticaria in 60% of patients, while partial response was found in another 15% of patients . In another small series, six patients affected by CSU or urticarial vasculitis unresponsive to other immunosuppressive therapies experienced a significant clinical improvement when given TNF inhibitors . Furthermore, two case reports have shown efficacy of TNF inhibitors in delayed pressure urticaria and cold contact urticaria .…”

Section: Diseasesmentioning

confidence: 95%

EAACI IG Biologicals task force paper on the use of biologic agents in allergic disorders

Boyman

Kaegi

Akdiş

et al. 2015

Allergy

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Biologic agents (also termed biologicals or biologics) are therapeutics that are synthesized by living organisms and directed against a specific determinant, for example, a cytokine or receptor. In inflammatory and autoimmune diseases, biologicals have revolutionized the treatment of several immune-mediated disorders. Biologicals have also been tested in allergic disorders. These include agents targeting IgE; T helper 2 (Th2)-type and Th2-promoting cytokines, including interleukin-4 (IL-4), IL-5, IL-9, IL-13, IL-31, and thymic stromal lymphopoietin (TSLP); pro-inflammatory cytokines, such as IL-1b, IL-12, IL-17A, IL-17F, IL-23, and tumor necrosis factor (TNF); chemokine receptor CCR4; and lymphocyte surface and adhesion molecules, including CD2, CD11a, CD20, CD25, CD52, and OX40 ligand. In this task force paper of the Interest Group on Biologicals of the European Academy of Allergy and Clinical Immunology, we review biologicals that are currently available or tested for the use in various allergic and urticarial pathologies, by providing an overview on their state of development, area of use, adverse events, and future research directions.Abbreviations ABPA, allergic bronchopulmonary aspergillosis; ACQ-5/ACQ-6/ACQ-7, 5-item/6-item/7-item

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Treatment of refractory chronic urticaria with tumor necrosis factor–alfa inhibitors

Cited by 53 publications

References 5 publications

Immune response patterns in non‐communicable inflammatory skin diseases

Immune response patterns in non‐communicable inflammatory skin diseases

TNF-Alpha Inhibitors for Chronic Urticaria: Experience in 20 Patients

EAACI IG Biologicals task force paper on the use of biologic agents in allergic disorders

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