Urticaria is a distressing skin condition commonly known as hives. Chronic urticaria is the occurrence of skin wheals daily or almost daily for six weeks or more. Antihistamines are the first-line treatment, but they do not work for all cases. Corticosteriods are effective for many, but the side effects are a problem for long-term use. Dr. Christine Boubouka and coworkers at the University of Athens, Greece, reported that cyclosporin A may be better for some patients with severe urticaria.
Chronic urticaria can be caused by physical factors, drugs, foods, additives, infections, parasites, inhaled allergens, systemic autoimmune diseases, or psychological stress, Boubouka explained. However, in the majority of cases, a specific cause can not be identified. Autoimmune processes are commonly involved. Patients with a positive autologous serum skin test (ASST) are most likely to have severe disease that does not respond to antihistamines.
In Boubouka's study, 25 women and five men with urticaria were treated with cyclorsporin A. The starting dose was 1.5 to 2.5 mg/kg, and the dosage was decreased each month as symptoms improved. The improvement rates were 31 percent after one month, 46 percent after two months, 71 percent after three months, 87 percent after four months, and 88 percent after five months. The authors recommended a larger study with a randomized, controlled protocol.
Dr. Becky M. Vonakis and coauthor Dr. Sarbjit S. Saini at Johns Hopkins University School of Medicine in Baltimore, Maryland, provided a review of chronic urticaria. They reported that leukotriene receptor antagonists, sulfasalazine, mycophenolate, and dapsone have also been tried with some success. These authors estimated that up to 25 percent of the United States population experiences urticaria at some time. Many of these cases clear up in less than six weeks, but one fifth of the chronic cases persist for more than five years.
Dr. Mona Al-Ahmad of Kuwait reported that the asthma medication omalizumab (Xolair) was effective in treating three patients with urticaria that did not respond to antihistamines, leukotriene receptor antagonist, or corticosteroid treatment.