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

Kaplan, Allen P.

doi:10.1016/j.jaci.2008.10.050

Cited by 38 publications

(33 citation statements)

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“…A second line treatment option is corticosteroid therapy which is frequently used. Therapy may require high doses which produce relevant side effects, i.e., "too much for too long" (12). CyA is either an alternative option to corticosteroids or used when steroids are unsatisfactory, i.e., nonresponse patients or those needing excessive doses for control (12).…”

Section: Discussionmentioning

confidence: 99%

Cyclosporin-A Efficacy in Chronic Idiopathic Urticaria

Leo

Nettis

Aloia

et al. 2011

Int J Immunopathol Pharmacol

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Common drugs in the therapy of chronic idiopathic urticaria (CIU) include antihistamines alone or combined with corticosteroids, but severe unresponsive patients require alternative treatments. This retrospective study aims to evaluate clinical response and safety of low-dose and long-term oral Cyclosporin-A (CyA) in unresponsive patients. One hundred and ten CIU patients, unresponsive to a previous treatment (antihistamines plus prednisone 0.2 mg/kg/day), received additional oral CyA 1–3 mg/kg/day for 6 months. The patients were subdivided into three groups (A, B, C) according to the different CyA doses. Parameters of clinical efficacy including pruritus, and size and number of wheals were evaluated at baseline, after three and six months. All adverse events were recorded. The mean total symptom severity score decreased by 63% in Group A, 76% in Group B, and 85% in Group C after 6 months. Total disappearance of the symptoms was recorded in 43 patients (39.1%): 7 (28%) of Group A; 12 (37.5%) of Group B and 24 (45%) of Group C. After a mean of 2 months from CyA suspension, 14 patients (11%) had recurrence of symptoms. Minor side effects were noted in 8 patients (7%). Our study indicates that low-dose, long-term CyA therapy is efficacious and safe in severe unresponsive CIU.

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Section: Discussionmentioning

confidence: 99%

Cyclosporin-A Efficacy in Chronic Idiopathic Urticaria

Leo

Nettis

Aloia

et al. 2011

Int J Immunopathol Pharmacol

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“…In a recent overview of his extensive experience in urticaria treatment, Allen Kaplan, a leading expert in the field of urticaria, lists a number of misconceptions among the medical community and the lay public related to urticaria management and pinpoints controversies relating to the use of AH, which need to be addressed by specifically designed clinical studies[9]. The present paper is focusing exclusively on the treatment of chronic urticaria with nsAH, as these drugs are suggested as the first line of treatment, but unresolved issues still remain because of the relative paucity of reliable evidence[8].…”

Section: Defining the Topicmentioning

confidence: 99%

“…Thus, Allen Kaplan is favoring high doses of hydroxyzine and diphenhydramine if doubling the doses of second-generation nsAH does not achieve satisfactory control of symptoms[9,15,17]. In the absence of appropriate studies to provide conclusive evidence, he backs up his assertions with compelling reasoning:…”

Section: Picking the Best Antihistamine For The Treatment Of Ciumentioning

confidence: 99%

Challenges in the Management of Chronic Urticaria

Popov¹

2011

World Allergy Organization Journal

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The term "chronic idiopathic urticaria" denotes a spectrum of conditions with different poorly understood pathogenetic mechanisms in which the release of histamine plays a role. Nonsedating second-generation H1 antihistamines are postulated to be the first line of treatment of chronic idiopathic urticaria by national and international guidelines, but as control is not always achievable with the usually recommended doses, first-generation sedating antihistamines like hydroxyzine and diphenhydramine at high daily doses (200 mg) have been proposed as an alternative before resorting to treatment with systemic corticosteroids and other potentially hazardous agents. Our long time experience and recent research give us grounds to believe that increasing the doses of nonsedating H1 antihistamines up to fourfold improves significantly the chances of successful treatment. Our data suggest that the urticaria-associated discomfort is relieved by higher than conventional doses of levoce-tirizine and desloratadine in about 75% of the patients and that sedation/somnolence does not seem to be a major deterrent. The dose increase also improves the urticaria-specific quality of life. Contrary to the belief that individual patients may benefit from one antihistamine or another, we demonstrate that the drug with better ability to suppress the histamine skin effects in experiments in healthy volunteers (levocetirizine) is also superior in improving the different aspects of control of chronic urticaria (subjective and objective symptoms, quality of life) and that increasing its dose of up to fourfold may even paradoxically reduce the sense of sedation/somnolence in parallel with the relief of urticaria discomfort.

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“…Although virtually any first-generation or second-generation antihistamine has efficacy for treatment of urticaria, few studies have compared one agent to the others, and dose-escalation studies are much in need. For the past 40 years, when firstgeneration antihistamines were all we had, I advocated use of hydroxyzine (Atarax; Pfizer, New York, NY) or diphenhydramine (Benadryl; McNeil-PPC, Fort Washington, PA) at doses up to 50 mg four times daily before assuming a patient to be refractory [1]. These agents ware relatively short-acting and were meant to be used in divided doses four times daily when necessary.…”

Section: Introductionmentioning

confidence: 99%