inhibitors, shows potential for randomized controlled trials.7 Tranexamic acid (2g daily) has not been effective as stand-alone therapy but may show utility as an adjuvant for levocetirizine (10mg daily) (NCT03789422).
In summary, chronic urticaria can be a relapsing, exhausting condition for patients to manage. Omalizumab has revolutionized outcomes for many, and H2 receptor and leukotriene antagonists have been phased out from the treatment strategy. Expanded-label therapies are rapidly emerging for recalcitrant cases.
Disclosure
The authors declare no conflicts of interest.
References
1. Zuberbier T, Aberer W, Asero R, et al. The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018 Jul;73(7):1393-1414.
2. Lewis V, Finlay AY. 10 years experience of the Dermatology Life Quality Index (DLQI). J Investig Dermatol Symp Proc. 2004 Mar;9(2):169-80.
3. Weller K, Siebenhaar F, Hawro T, Altrichter S, Schoepke N, Maurer M. Clinical measures of chronic urticaria. Immunol Allergy Clin North Am. 2017 Feb;37(1):35-49.
4. Saini SS, Kaplan AP. Chronic spontaneous urticaria: the devil's itch. J Allergy Clin Immunol Pract. 2018. Jul-Aug;6(4):1097-1106. 5. Kolkhir P, Borzova E, Grattan C, Asero R, Pogorelov D, Maurer M. Autoimmune comorbidity in chronic spontaneous urticaria: A systematic review. Autoimmun Rev. 2017;16:1196–208.
6. Lee JK, Simpson RS. Dupilumab as a novel therapy for difficult to treat chronic spontaneous urticaria. J Allergy Clin Immunol Pract. 2019 May- Jun;7(5):1659-1661.e1.
7. Sand FL, Thomsen SF. Off-label use of TNF-alpha inhibitors in a dermatological university department: retrospective evaluation of 118 patients. Dermatol Ther. 2015 May-Jun;28(3):158-65.
8. Al-Shaikhly T, Rosenthal JA, Ayars AG, Petroni DH. Omalizumab for chronic urticaria in children younger than 12 years. Ann Allergy Asthma Immunol. 2019 Aug;123(2):208-210.e2.
9. Sussman G, Hébert J, Gulliver W, et al. Omalizumab re-treatment and step-up in patients with chronic spontaneous urticaria: OPTIMA trial. J Allergy Clin Immunol Pract. 2020 Jul-Aug;8(7):2372-2378.e5.
10. Kulthanan K, Chaweekulrat P, Komoltri C, et al. Cyclosporine for chronic spontaneous urticaria: a meta-analysis and systematic review. J Allergy Clin Immunol Pract. 2018;6:586–99.
11. Zimmerman AB, Berger EM, Elmariah SB, Soter NA. The use of mycophenolate mofetil for the treatment of autoimmune and chronic idiopathic urticaria: experience in 19 patients. J Am Acad Dermatol. 2012 May;66(5):767-70.
In summary, chronic urticaria can be a relapsing, exhausting condition for patients to manage. Omalizumab has revolutionized outcomes for many, and H2 receptor and leukotriene antagonists have been phased out from the treatment strategy. Expanded-label therapies are rapidly emerging for recalcitrant cases.
Disclosure
The authors declare no conflicts of interest.
References
1. Zuberbier T, Aberer W, Asero R, et al. The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018 Jul;73(7):1393-1414.
2. Lewis V, Finlay AY. 10 years experience of the Dermatology Life Quality Index (DLQI). J Investig Dermatol Symp Proc. 2004 Mar;9(2):169-80.
3. Weller K, Siebenhaar F, Hawro T, Altrichter S, Schoepke N, Maurer M. Clinical measures of chronic urticaria. Immunol Allergy Clin North Am. 2017 Feb;37(1):35-49.
4. Saini SS, Kaplan AP. Chronic spontaneous urticaria: the devil's itch. J Allergy Clin Immunol Pract. 2018. Jul-Aug;6(4):1097-1106. 5. Kolkhir P, Borzova E, Grattan C, Asero R, Pogorelov D, Maurer M. Autoimmune comorbidity in chronic spontaneous urticaria: A systematic review. Autoimmun Rev. 2017;16:1196–208.
6. Lee JK, Simpson RS. Dupilumab as a novel therapy for difficult to treat chronic spontaneous urticaria. J Allergy Clin Immunol Pract. 2019 May- Jun;7(5):1659-1661.e1.
7. Sand FL, Thomsen SF. Off-label use of TNF-alpha inhibitors in a dermatological university department: retrospective evaluation of 118 patients. Dermatol Ther. 2015 May-Jun;28(3):158-65.
8. Al-Shaikhly T, Rosenthal JA, Ayars AG, Petroni DH. Omalizumab for chronic urticaria in children younger than 12 years. Ann Allergy Asthma Immunol. 2019 Aug;123(2):208-210.e2.
9. Sussman G, Hébert J, Gulliver W, et al. Omalizumab re-treatment and step-up in patients with chronic spontaneous urticaria: OPTIMA trial. J Allergy Clin Immunol Pract. 2020 Jul-Aug;8(7):2372-2378.e5.
10. Kulthanan K, Chaweekulrat P, Komoltri C, et al. Cyclosporine for chronic spontaneous urticaria: a meta-analysis and systematic review. J Allergy Clin Immunol Pract. 2018;6:586–99.
11. Zimmerman AB, Berger EM, Elmariah SB, Soter NA. The use of mycophenolate mofetil for the treatment of autoimmune and chronic idiopathic urticaria: experience in 19 patients. J Am Acad Dermatol. 2012 May;66(5):767-70.
AUTHOR CORRESPONDENCE
Adam J. Friedman MD FAAD ajfriedman@mfa.gwu.edu
