Lisa Neverman1, Miles Weinberger2. 1. Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa. 2. Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa. Electronic address: miles-weinberger@uiowa.edu.
Abstract
BACKGROUND: Chronic idiopathic urticaria, daily hives that last >6 weeks, can be resistant to antihistamines, even when higher than conventional doses are used. Other pharmacologic agents have been associated with inconsistent benefit. OBJECTIVE: We examined the relationship of clinical characteristics and the presence of autoimmune antibodies to antihistamine resistance in children. We further examined the efficacy and safety of cyclosporine in children whose urticaria was resistant to antihistamine. METHODS: Patients referred to the pediatric allergy and pulmonary specialty clinic at the University of Iowa Children's Hospital and diagnosed as having chronic idiopathic urticaria were identified during the period from August 2008 to July 2013. A retrospective examination of treatment and outcome was performed. RESULTS: Forty-six patients, 26 female patients and 20 male patients, with chronic idiopathic urticaria were identified. The ages of 16 patients who were antihistamine resistant ranged from 9 to 18 years (median, 12.5 years). Those patients who were antihistamine responsive had a median age of 6 years, significantly lower than those who were antihistamine resistant (P = .0001). There was no significant association between autoimmune antibodies and antihistamine resistance. All the patients who were antihistamine resistant were treated with cyclosporine; all experienced complete resolution of urticaria at times that ranged from 2 days to 3 months (median, 7 days). Relapses responsive to repeated cyclosporine occurred in 5 of the patients after 1 week to 15 months (median, 6 months). Adverse effects were not seen in these patients. CONCLUSION: Our data were consistent with efficacy and safety of cyclosporine for chronic urticaria in children when even high doses of antihistamines are ineffective.
BACKGROUND:Chronic idiopathic urticaria, daily hives that last >6 weeks, can be resistant to antihistamines, even when higher than conventional doses are used. Other pharmacologic agents have been associated with inconsistent benefit. OBJECTIVE: We examined the relationship of clinical characteristics and the presence of autoimmune antibodies to antihistamine resistance in children. We further examined the efficacy and safety of cyclosporine in children whose urticaria was resistant to antihistamine. METHODS:Patients referred to the pediatric allergy and pulmonary specialty clinic at the University of Iowa Children's Hospital and diagnosed as having chronic idiopathic urticaria were identified during the period from August 2008 to July 2013. A retrospective examination of treatment and outcome was performed. RESULTS: Forty-six patients, 26 female patients and 20 male patients, with chronic idiopathic urticaria were identified. The ages of 16 patients who were antihistamine resistant ranged from 9 to 18 years (median, 12.5 years). Those patients who were antihistamine responsive had a median age of 6 years, significantly lower than those who were antihistamine resistant (P = .0001). There was no significant association between autoimmune antibodies and antihistamine resistance. All the patients who were antihistamine resistant were treated with cyclosporine; all experienced complete resolution of urticaria at times that ranged from 2 days to 3 months (median, 7 days). Relapses responsive to repeated cyclosporine occurred in 5 of the patients after 1 week to 15 months (median, 6 months). Adverse effects were not seen in these patients. CONCLUSION: Our data were consistent with efficacy and safety of cyclosporine for chronic urticaria in children when even high doses of antihistamines are ineffective.
Authors: Onyinye I Iweala; Christopher Copenhaver; Eveline Y Wu; Timothy P Moran Journal: Ann Allergy Asthma Immunol Date: 2017-11-20 Impact factor: 6.347
Authors: M Ferrer; J Bartra; A Giménez-Arnau; I Jauregui; M Labrador-Horrillo; J Ortiz de Frutos; J F Silvestre; J Sastre; M Velasco; A Valero Journal: Clin Exp Allergy Date: 2015-04 Impact factor: 5.018
Authors: Paulo Ricardo Criado; Roberta Facchini Jardim Criado; Celina Wakisaka Maruta; Vitor Manoel Silva dos Reis Journal: An Bras Dermatol Date: 2015 Jan-Feb Impact factor: 1.896
Authors: Mario Sánchez-Borges; Ignacio J Ansotegui; Ilaria Baiardini; Jonathan Bernstein; Giorgio Walter Canonica; Motohiro Ebisawa; R Maximiliano Gomez; Sandra González-Diaz; Bryan Martin; Mário Morais de Almeida; Jose Antonio Ortega Martell Journal: World Allergy Organ J Date: 2021-06-03 Impact factor: 4.084