Chronic urticaria (CU) is a frequent, and difficult clinical problem. When first-line therapy fails, patients are often treated with alternative therapies that either have a poor side effect profile (oral steroids) or little evidence to support effectiveness.
This retrospective chart review included 66 adult CU patients treated with cyclosporine. Chronic urticaria was defined as having urticaria more than 3 days per week for 6 consecutive weeks.
Ciclosporin (INN), cyclosporine (USAN) or cyclosporin (former BAN). Image source: Wikipedia, public domain.
After taking cyclosporine at an average dose of 1.8 mg/kg, 78% patients attained complete remission defined as ≤1 day of hives per month. Recurrence occurred in only 7 patients; all achieved remission with resumption of cyclosporine.
Factors that predicted a favorable response to cyclosporine included:
- shorter duration of urticaria (mean: 55 weeks)
- positive CU Index
Autologous serum skin testing (ASST), prior response to steroids, atopic status, or presence of antithyroid antibodies was not predictive.
Side effects were generally mild and seen in 35% of patients; all were reversible by dose reduction.
The authors concluded that cyclosporine is an effective treatment for CU, shorter duration of disease, and CU index ≥10 predict a successful response.
Chronic Urticaria Treatment (click to enlarge the image).
Factors that predict the success of cyclosporine treatment for chronic urticaria. Hollander SM, Joo SS, Wedner HJ. Ann Allergy Asthma Immunol. 2011 Dec;107(6):523-8. Epub 2011 Oct 5.