This summary was compiled from the tweets posted by some of the allergists who attended the 2011 ACAAI meeting. The tweets were labeled #ACAAI. The text was edited and modified by me.Double dose 2nd generation antihistamines are the mainstay of treatment of chronic idiopathic urticaria (CIU).
Corticosteroids
Corticosteroids are widely used in CIU but not many studies as you might expect have shown efficacy. They are inexpensive.
Omalizumab (Xolair)
There are no good quality studies for the use of steroids in chronic idiopathic urticaria (CIU). In contrast to steroids, a lot of small studies have shown benefit of omalizumab in CIU. Getting it paid for by the insurance companies on the other hand may be extremely difficult.
Cyclosporin
Cyclosporin has 4 successful RCTs for CIU - a lot more than some of the other medications used in CIU. Cyclosporine (CyA) 3-5mg/kg dose is most likely to succeed. UK dermatology guidelines suggest that 75% of patients with CIU will respond to cyclosporin.
Dapsone
Dapsone is successful in CIU at the dose of 25-50 mg/day. Delayed pressure urticaria may be especially responsive to dapsone.
Patient need to have laboratory evaluation and follow-up including G6PD levels, CBC and LFT measurements. Dapsone is inexpensive.
Plaquenil
Patients on plaquenil need retinal check within the first year and every 5 years afterward. There is more risk with accumulated dose greater than 1000 gm.
Montelukast (Singulair)
Antileukotrienes are listed as drug of choice after H1 blocker in European guidelines for CIU. Montelukast is probably the the safest medication for CIU (in addition to 2nd generation antihistamines). No laboratory monitoring is needed.
This summary was compiled from some of the tweets posted by Dr. David Fischer @IgECPD4, Robert Silge, MD, @DrSilge, Danny Ramirez, MD @allergysa, and a few others. The tweets were labeled #ACAAI and they reached more than 10,000 people. I would strongly encourage you to post updates on Twitter from the CME conferences that you are planning to attend in the future. Disclaimer: The text was edited, modified, and added to by me.