Aharon Kessel1, Elias Toubi. 1. Division of Clinical Immunology, Bnai Zion Medical Center, Faculty of Medicine Technion, Haifa, Israel. aharon.kessel@b-zion.org.il
Abstract
BACKGROUND: In patients suffering from severe chronic urticaria (CU) and in whom both antihistamine therapy and short courses of corticosteroids are needed, cyclosporine-A (CsA) should be considered. In such patients CsA given for 1-3 months (3mg/kg/d) was reported to induce in 2/3 of patients a full remission, lasting 3-6 months, and in 1/4 of patients a long-lasting full remission. OBJECTIVE: To investigate the beneficial effect, safety and side-effects of prolonged CsA therapy in severe CU patients, in whom only short remission was previously achieved. METHODS: Six patients (mean age 40.8 years +/- 11.9) with severe CU (disease duration 7.3 years +/- 6.2) still treated with CsA (2-3 mg/kg/d) for a period of 11.6 years +/- 4. RESULTS: Five patients are favorably maintained on CsA treatment and do not require additional therapy. One patient required the addition of 5-10 mg/d prednisone (while continuing CsA 3 mg/kg/d) reducing the severity of urticaria. Two patients complained of mild hirsutism and peripheral neuropathy and one of a very mild diarrhea. CONCLUSION: Prolonged treatment with CsA is beneficial for maintaining remission in severe cases of CU. It spares the need for corticosteroids and is accompanied with mild side effects. Further experience with more patients is needed in order to strengthen our findings.
BACKGROUND: In patients suffering from severe chronic urticaria (CU) and in whom both antihistamine therapy and short courses of corticosteroids are needed, cyclosporine-A (CsA) should be considered. In such patientsCsA given for 1-3 months (3mg/kg/d) was reported to induce in 2/3 of patients a full remission, lasting 3-6 months, and in 1/4 of patients a long-lasting full remission. OBJECTIVE: To investigate the beneficial effect, safety and side-effects of prolonged CsA therapy in severe CU patients, in whom only short remission was previously achieved. METHODS: Six patients (mean age 40.8 years +/- 11.9) with severe CU (disease duration 7.3 years +/- 6.2) still treated with CsA (2-3 mg/kg/d) for a period of 11.6 years +/- 4. RESULTS: Five patients are favorably maintained on CsA treatment and do not require additional therapy. One patient required the addition of 5-10 mg/d prednisone (while continuing CsA 3 mg/kg/d) reducing the severity of urticaria. Two patients complained of mild hirsutism and peripheral neuropathy and one of a very mild diarrhea. CONCLUSION: Prolonged treatment with CsA is beneficial for maintaining remission in severe cases of CU. It spares the need for corticosteroids and is accompanied with mild side effects. Further experience with more patients is needed in order to strengthen our findings.