NDLI: Treatment of refractory chronic urticaria: current and future therapeutic options.

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Treatment of refractory chronic urticaria: current and future therapeutic options.

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Treatment of refractory chronic urticaria: current and future therapeutic options.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Asero, Riccardo Tedeschi, Alberto Cugno, Massimo
Description	Author Affiliation: Asero R ( Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Milan, Italy, r.asero@libero.it.)
Abstract	Chronic urticaria is a distressing disease that affects up to 1 % of the general population at a time point in life and may severely worsen the quality of life. First-line treatment has been based on antihistamines, and presently relies on the use of non-sedating, second-generation antihistamines; following the recommendations of the recent international guidelines, in patients who do not respond to antihistamines at licensed doses, the daily dosage of these drugs can be increased up to fourfold. Nonetheless, a significant proportion of patients with chronic urticaria remain poorly controlled; in these cases, alternative therapeutic approaches have to be considered. This article critically reviews all of the third- and fourth-line treatment options suggested for patients whose disease is refractory to antihistamines, including systemic corticosteroids, leukotriene receptor antagonists, several different anti-inflammatory drugs (dapsone, sulfasalazine, hydroxychloroquine), various immunosuppressive drugs (calcineurin inhibitors, methotrexate, cyclophosphamide, azathioprine, mycophenolate mofetil), intravenous immunoglobulin, and newer treatment options, such as omalizumab and other biologic drugs. In addition, the article examines possible future treatment options based on recent findings about pathogenic mechanisms, and considers the treatment of antihistamine-unresponsive urticaria in special conditions such as children and pregnancy/lactation. The evidence supporting the use of several of the discussed drugs is presently limited and thus insufficient to recommend their routine use; as a consequence, such compounds should be considered only in specific cases and in adequate settings.
File Format	HTM / HTML
ISSN	11750561
Issue Number	6
Volume Number	14
e-ISSN	11791888
Journal	American Journal of Clinical Dermatology
Language	English
Publisher	Springer
Publisher Date	2013-12-01
Publisher Place	New Zealand (Aotearoa)
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Dermatology Histamine Antagonists Therapeutic Use Quality Of Life Urticaria Drug Therapy Animals Anti-inflammatory Agents Chronic Disease Dose-response Relationship, Drug Glucocorticoids Administration & Dosage Histamine H1 Antagonists, Non-sedating Humans Immunosuppressive Agents Leukotriene Antagonists Practice Guidelines As Topic Pathology Journal Article Review
Content Type	Text
Resource Type	Article
Subject	Dermatology

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