Shahar Eduardo, Bergman Reuven, Guttman-Yassky Emma, Pollack Shimon
Institute of Allergy, Clinical Immunology and AIDS, Rambam Medical Center, Haifa, Israel.
Int J Dermatol. 2006 Oct;45(10):1224-7. doi: 10.1111/j.1365-4632.2006.02655.x.
Urticarial patients are usually treated with oral antihistamines and 50% respond well to this treatment; however, the other 50% do not respond to antihistamines and need a more aggressive approach, such as short or prolonged courses of oral corticosteroids or cyclosporine. Potential adverse effects, however, limit this regimen.
To determine the efficacy of mycophenolate mofetil, an immunomodulatory drug, in the treatment of patients with severe chronic urticaria.
In an open-label, uncontrolled trial, nine patients with documented chronic urticaria who had been treated previously with antihistamines and/or corticosteroids with poor response were enrolled in the trial. After 2 weeks of baseline assessment, patients received 1000 mg twice daily of mycophenolate mofetil for 12 weeks. Improvement was monitored using the urticarial activity score, which is the sum of the wheal number score and itch severity score. Patients also recorded their daily need for other medications to control allergic symptoms.
There was a significant decrease in the urticarial activity score relative to the baseline assessment at the end of the study period (P < 0.001). All patients were able to stop prednisone on completion of the study. There was also a decrease in antihistamine dose, but this did not reach statistical significance. Treatment with mycophenolate mofetil was not associated with significant adverse effects.
Mycophenolate mofetil may be a valuable and safe treatment for patients with chronic urticaria who do not respond to antihistamines and/or corticosteroids, and who require aggressive treatment to control their disease symptoms. Further controlled clinical studies are needed to determine its value.
荨麻疹患者通常采用口服抗组胺药治疗，50%的患者对此治疗反应良好；然而，另外50%的患者对抗组胺药无反应，需要更积极的治疗方法，如短期或长期口服糖皮质激素或环孢素。然而，潜在的不良反应限制了这种治疗方案。
确定免疫调节药物霉酚酸酯治疗重度慢性荨麻疹患者的疗效。
在一项开放标签、非对照试验中，9例有慢性荨麻疹记录且先前使用抗组胺药和/或糖皮质激素治疗效果不佳的患者纳入试验。经过2周的基线评估后，患者接受每日2次、每次1000mg的霉酚酸酯治疗，持续12周。使用荨麻疹活动评分监测病情改善情况，该评分是风团数量评分与瘙痒严重程度评分之和。患者还记录了他们每日控制过敏症状所需的其他药物。
与研究期末的基线评估相比，荨麻疹活动评分显著降低（P<0.001）。所有患者在研究结束时均能够停用泼尼松。抗组胺药剂量也有所降低，但未达到统计学意义。霉酚酸酯治疗未出现显著不良反应。
对于对抗组胺药和/或糖皮质激素无反应且需要积极治疗以控制疾病症状的慢性荨麻疹患者，霉酚酸酯可能是一种有价值且安全的治疗方法。需要进一步的对照临床研究来确定其价值。
