Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8859, USA.
Curr Opin Allergy Clin Immunol. 2012 Aug;12(4):412-20. doi: 10.1097/ACI.0b013e32835571f6.
The purpose of the review is to review the pathophysiology, available data, and our current recommendations for calcineurin inhibitor (cyclosporine and tacrolimus) treatment in antihistamine refractory chronic idiopathic urticaria (CIU) patients.
Low-dose cyclosporine (<5 mg/kg per day) may have unique immunological modulating properties beyond mast cell and basophil stabilization in CIU. Starting CIU treatment with very low cyclosporine dosages (1 mg/kg per day) and titrating based on response and side-effects may decrease adverse events while preserving efficacy. In cyclosporine responsive patients failing cyclosporine taper, case series data support the safety and efficacy of long-term (5-10 years), very low dose (1-2 mg/kg per day) cyclosporine treatment with appropriate clinical monitoring.
For CIU patients refractory to antihistamines, low-dose cyclosporine therapy (<3 mg/kg per day) with appropriate laboratory monitoring provides an alternative with an acceptable side-effect profile. Long-term (>12 months) moderate-dose (2.5-5 mg/kg per day) cyclosporine treatment may cause longitudinal increases in serum creatinine. However, decreasing or stopping cyclosporine dosing reverses measured nephrotoxicity in the vast majority of patients, and some patients with careful monitoring can tolerate very low-dose cyclosporine (<2 mg/kg per day) for longer periods. Tacrolimus is an alternative to cyclosporine with a slightly different adverse effect profile. Minimal data are available on its use in chronic urticaria.
本文旨在综述环孢素（CSA）和他克莫司（FK506）治疗抗组胺药难治性慢性特发性荨麻疹（CIU）患者的病理生理学、现有数据和我们目前的建议。
低剂量 CSA（<5mg/kg/d）可能具有独特的免疫调节特性，除了稳定肥大细胞和嗜碱性粒细胞外，在 CIU 中还具有其他作用。CIU 治疗开始时采用非常低剂量的 CSA（1mg/kg/d），并根据反应和副作用进行滴定，可能会降低不良反应的发生率，同时保持疗效。在 CSA 治疗有效的患者中，当 CSA 减量失败时，病例系列数据支持长期（5-10 年）、非常低剂量（1-2mg/kg/d）CSA 治疗的安全性和有效性，同时进行适当的临床监测。
对于抗组胺药难治性 CIU 患者，低剂量 CSA 治疗（<3mg/kg/d）结合适当的实验室监测是一种可选择的方法，其副作用谱可接受。长期（>12 个月）中剂量（2.5-5mg/kg/d）CSA 治疗可能会导致血清肌酐的纵向增加。然而，减少或停止 CSA 剂量可使绝大多数患者的肾毒性得到逆转，在仔细监测下，一些患者可以耐受非常低剂量的 CSA（<2mg/kg/d）更长时间。他克莫司是 CSA 的替代药物，具有略微不同的不良反应谱。关于其在慢性荨麻疹中的应用，仅有很少的数据。
