Treatment of Chronic Urticaria With Colchicine
December 2011 | Volume 10 | Issue 12 | Original Article | 1423 | Copyright © 2011
Lana N. Pho MD, Mark J. Eliason MD, Michelle Regruto MD, Christopher M. Hull MD, Douglas L. Powell MD
Background: Chronic urticaria (CU) is a cutaneous disease that can be debilitating, difficult to treat, and sometimes life-threatening. Treatment with antihistamines is often ineffective. Immunosuppressants are second line therapy but can have significant side effects. Data is needed on effective therapies with safer profiles.
Objectives: To determine the efficacy and side-effects of colchicine in patients with CU. Methods: Patients were identified through retrospective chart reviews at the University of Utah from 2002-2007. We identified 36 patients with a diagnosis of chronic urticaria based on history, physical examination, and a skin biopsy. Length of treatment ranged from one month to 17 months.
Results: Subjective clinical responses to colchicine therapy reported as complete (n=15) or partial (n=5) were found in 56 percent of patients. The mean±SD duration of treatment was 7±6 months. Three patients (15%) who had resolution of urticaria stopped colchicine secondary to diarrhea and hematuria. Of the complete responders, nine individuals (60%) have remained symptom free and four individuals (27%) had recurrence after colchicine was stopped.
Limitations: Short-term follow-up and retrospective study design.
Conclusions: This retrospective study demonstrated that colchicine was an effective and well-tolerated treatment for patients unresponsive to antihistamines. The data supports the use of colchicine for CU patients and further controlled studies are warranted to better characterize the use of colchicine in patients with CU refractory to antihistamines.
J Drugs Dermatol. 2011;10(12):1423-1428.
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Chronic urticaria (CU) has a lifelong prevalence of 0.5-1% in the United States.1 Reports have demonstrated that the disability suffered by CU patients is similar to that of patients with coronary artery disease.2 CU is defined as urticarial wheals and pruritus for duration of at least six weeks.3 Chronic urticaria is associated with angioedema in 40 percent of cases.4 Approximately 50–80 percent chronic urticaria cases have no known etiology limiting the management approach to a focus on controlling the symptoms.5-6 Though antihistamines are used as first-line treatment, as many as 50 percent of patients do not adequately respond to antihistamines alone.2 Second-line medications for patients unresponsive to antihistamines include dapsone, methotrexate, cyclosporine, and mycophenolate mofetil, and other immunomodulatory therapies.7-9 However, these medications can be associated with serious adverse effects, such as renal dysfunction, liver function abnormalities, and pancytopenia.
Colchicine is an anti-inflammatory drug that is FDA approved for the treatment of gout, familial Mediterranean fever, Behcet´s disease, and pericarditis.10 Case reports suggest a role for colchicine in the treatment of urticarial vasculitis.11-13 Colchicine induces mitotic arrest leading to inhibition of DNA synthesis and suppresses leukocyte function.14 The mechanism of action involves suppressing cell-mediated immune responses via inhibition of immunoglobulin secretion, interleukin-1 production, histamine release, and HLA-DR expression.10,14 Colchicine has a known safety profile in children and adults. One study reported 6–13 years of colchicine use in children with familial Mediterranean fever, and colchicine treatment did not prompt early withdrawal for toxicity or effects on growth, development, and fertility of children.15-16 The common potential side effects of colchicine include diarrhea (77% of patients who take high dose and 23% of patients who take low dose colchicine), nausea, and vomiting. Other less common adverse events include neutropenia, thrombocytopenia, pancytopenia, myelosuppression, transaminitis, myoneuropathy, and renal dysfunction in individuals with a prior history of renal insufficiency.
This paper evaluates the therapeutic potential of colchicine, an alternative to immunosuppressive therapy for CU. We evaluated colchicine’s adverse effect profile and its effectiveness in achieving eradication of the symptoms of urticaria. In our study, we identified patients through retrospective chart review of our institutional experience with colchicine for the treatment of recalcitrant CU.