Division of Allergy & Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex.
J Allergy Clin Immunol Pract. 2013 Sep-Oct;1(5):433-440.e1. doi: 10.1016/j.jaip.2013.06.003. Epub 2013 Aug 2.
Patients with chronic urticaria (CU) who are refractory to antihistamines are frequently encountered by allergy specialists. Several alternative agents have been used to treat these patients; however, the evidence to support these agents is generally limited. This review focuses on some of the more commonly used alternative agents in refractory CU, including anti-inflammatory agents (montelukast, hydroxychloroquine, dapsone, sulfasalazine, methotrexate, colchicine), immunosuppressants (cyclosporine, tacrolimus, mycophenolate), and immunomodulatory agents (omalizumab, immune globulin). The evidence to support their use, dosing, potential toxicity, monitoring, and selection of these alternative agents is reviewed. Although numerous knowledge gaps exist for alternative agents in refractory CU, a rational, patient-based approach can be used with a goal of improving control and quality of life and minimizing adverse medication effects.
过敏专家经常会遇到对抗组胺药物治疗反应不佳的慢性荨麻疹（CU）患者。有几种替代药物已被用于治疗这些患者；然而，支持这些药物的证据通常是有限的。本综述重点介绍了一些在难治性 CU 中更常用的替代药物，包括抗炎药（孟鲁司特、羟氯喹、达普司酮、柳氮磺胺吡啶、甲氨蝶呤、秋水仙碱）、免疫抑制剂（环孢素、他克莫司、霉酚酸酯）和免疫调节剂（奥马珠单抗、免疫球蛋白）。本文回顾了支持这些替代药物使用的证据、剂量、潜在毒性、监测以及这些替代药物的选择。尽管在难治性 CU 中替代药物存在许多知识空白，但可以使用基于患者的合理方法，旨在改善控制和生活质量，并最大限度地减少药物不良反应。
