Original articleInterventionFactors that predict the success of cyclosporine treatment for chronic urticaria
Introduction
Urticaria is a common disorder, with a lifetime prevalence estimated to be 12% to 22%.1 The prevalence in the general population is approximately 1%, but this rises to greater than 10% when allergy and dermatology clinics are surveyed.1 Chronic urticaria (CU), defined as hives persisting for 6 weeks or longer, accounts for one third of these cases. In contrast to acute urticaria, CU can be quite difficult to treat. Chronic urticaria is much more prevalent in adults than children and has a nearly 4:1 female-to-male ratio.2
In most case series of CU, 80% to 90% of cases will not have an identifiable cause, leading to the moniker chronic idiopathic urticaria (CIU).3 However, studies have demonstrated an association between autoantibodies to the α-chain of the high-affinity receptor for immunoglobulin E (IgE; FcϵRIα) in 30%-50% of patients with CIU.4 This along with the coexistence of CU and antithyroid antibodies 5 has led to the concept that a large proportion of CIU patients have an autoimmune basis for their hives. This group of patients with CU had been called autoantibody-associated chronic urticaria or autoimmune urticaria.
Given the presumed autoimmune nature of many CIU patients, that over 30% of these patients fail a conservative regimen of antihistamines alone2 is not unexpected. When they do, they often are placed on short bursts of oral steroids that have many unwanted side effects. In an effort to avoid steroids, other immunomodulatory medications have been tried. One of the more common second-line treatments used is cyclosporine, but few large-scale trials have been conducted to evaluate its efficacy and safety for the treatment of CIU. We present a retrospective analysis of our CU patients treated with cyclosporine designed to evaluate its safety and efficacy as well as factors predicting its success.
Section snippets
Study Design
This retrospective chart review included all patients seen in the Washington University School of Medicine Allergy and Immunology clinics between January 1, 2000 and April 1, 2010 who had their CU treated with cyclosporine.
Patient Selection
An initial query into the WUMED database included the terms ‘urticaria,' ‘hive,' and ‘cyclosporine.' The charts that returned were extensively evaluated to make sure that the patients had the following inclusion criteria: They had to have CU as defined as typical hives that
Baseline Characteristics
Of the 285 patients identified for this study, 106 met the inclusion criteria, and 68 had completed treatment with cyclosporine for CU as detailed in Figure 1. Of those that did not meet the inclusion criteria, most did not receive cyclosporine because either the urticaria resolved spontaneously or it was controlled with other medications such as antihistamines. For those that completed treatment, 53 (78%) were female and 55 (81%) were white. The average age at first visit was 40 years, and the
Discussion
This retrospective chart review showed that a history of urticaria, a shorter duration of hives, and a positive CU Index were each associated with an improved response to cyclosporine for the treatment of urticaria. Based on a thorough literature review, we are the first to find these predictive factors.
The finding that a positive CU Index correlates with the successful treatment of CU with an immune-modulating agent such as cyclosporine was not surprising. Although no gold standard has been
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Disclosures: No funding was used for this study, nor do any authors have any financial relationships with an interest in this subject matter.