Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Milan, Italy.
J Investig Allergol Clin Immunol. 2010;20(5):386-90.
The effectiveness of corticosteroids in antihistamine-resistant chronic urticaria (CU) is widely accepted although large studies on their use in this disease are lacking.
To assess the proportion of patients with antihistamine-resistant CU that respond to a course of corticosteroids.
We studied 750 adult patients with CU and prescribed a course of oral corticosteroids (starting with prednisone 25 mg/day for 3 days) to those who reported little or partial response to antihistamine treatment. The corticosteroid treatment was considered effective if it resulted in long-term control of the disease with antihistamines only. Patients showing a temporary response were offered a second course of prednisone, at the end of which temporary responders and nonresponders were offered ciclosporin therapy for 3 months.
A total of 660 patients (88%) (male/female, 194/556) responded to antihistamine treatment. In 40/86 patients (47%), prednisone induced remission of the disease and subsequent control with antihistamines at licensed doses only. Thirty-five patients responded well but relapsed when prednisone doses were tapered or shortly after withdrawal. In all responders, the effect was appreciable as early as the day after the first 25 mg dose. In 8/23 temporary responders, a second course of prednisone induced remission of the disease; the other 15 patients responded well but only temporarily.
A single short course of prednisone induced remission in nearly 50% of patients with CU, and a second course induced remission in a further 9%. Less than 15% of patients did not respond at all to this treatment.
皮质类固醇治疗抗组胺药抵抗性慢性荨麻疹（CU）的有效性已被广泛接受，尽管在该疾病中使用皮质类固醇的大型研究较少。
评估皮质类固醇治疗抗组胺药抵抗性 CU 患者的缓解比例。
我们研究了 750 例成年 CU 患者，对那些报告抗组胺治疗反应不佳或部分反应的患者给予口服皮质类固醇（起始剂量为泼尼松 25mg/天，连用 3 天）。如果皮质类固醇治疗仅用抗组胺药即可长期控制疾病，则认为治疗有效。对临时缓解的患者给予第二疗程的泼尼松，在结束时，临时缓解者和无缓解者接受环孢素治疗 3 个月。
共有 660 例患者（88%）（男/女，194/556）对抗组胺治疗有反应。在 40/86 例患者（47%）中，泼尼松诱导疾病缓解，随后仅用许可剂量的抗组胺药即可控制疾病。35 例患者缓解良好，但在泼尼松剂量减少或停药后不久复发。在所有缓解者中，早在首次 25mg 剂量后的第 1 天即可观察到明显效果。在 8/23 例临时缓解者中，第二疗程的泼尼松诱导疾病缓解；其余 15 例患者缓解良好但仅为暂时缓解。
单一短疗程的泼尼松可诱导近 50%的 CU 患者缓解，第二疗程可进一步诱导 9%的患者缓解。不到 15%的患者对此治疗完全无反应。
