Neverman Lisa, Weinberger Miles
Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa.
Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa.
J Allergy Clin Immunol Pract. 2014 Jul-Aug;2(4):434-8. doi: 10.1016/j.jaip.2014.04.011. Epub 2014 Jun 7.
Chronic idiopathic urticaria, daily hives that last >6 weeks, can be resistant to antihistamines, even when higher than conventional doses are used. Other pharmacologic agents have been associated with inconsistent benefit.
We examined the relationship of clinical characteristics and the presence of autoimmune antibodies to antihistamine resistance in children. We further examined the efficacy and safety of cyclosporine in children whose urticaria was resistant to antihistamine.
Patients referred to the pediatric allergy and pulmonary specialty clinic at the University of Iowa Children's Hospital and diagnosed as having chronic idiopathic urticaria were identified during the period from August 2008 to July 2013. A retrospective examination of treatment and outcome was performed.
Forty-six patients, 26 female patients and 20 male patients, with chronic idiopathic urticaria were identified. The ages of 16 patients who were antihistamine resistant ranged from 9 to 18 years (median, 12.5 years). Those patients who were antihistamine responsive had a median age of 6 years, significantly lower than those who were antihistamine resistant (P = .0001). There was no significant association between autoimmune antibodies and antihistamine resistance. All the patients who were antihistamine resistant were treated with cyclosporine; all experienced complete resolution of urticaria at times that ranged from 2 days to 3 months (median, 7 days). Relapses responsive to repeated cyclosporine occurred in 5 of the patients after 1 week to 15 months (median, 6 months). Adverse effects were not seen in these patients.
Our data were consistent with efficacy and safety of cyclosporine for chronic urticaria in children when even high doses of antihistamines are ineffective.
慢性特发性荨麻疹，即每日出现的风疹块持续超过6周，即便使用高于常规剂量的抗组胺药，仍可能对抗组胺药产生耐药性。其他药物的疗效则参差不齐。
我们研究了儿童慢性特发性荨麻疹的临床特征及自身免疫抗体的存在与抗组胺药耐药性之间的关系。我们还进一步研究了环孢素对荨麻疹抗组胺药耐药儿童的疗效和安全性。
对2008年8月至2013年7月期间转诊至爱荷华大学儿童医院儿科过敏与肺病专科门诊并被诊断为慢性特发性荨麻疹的患者进行了回顾性研究，分析其治疗情况及预后。
共确定46例慢性特发性荨麻疹患者，其中女性26例，男性20例。16例对抗组胺药耐药的患者年龄在9至18岁之间（中位数为12.5岁）。对抗组胺药有反应的患者年龄中位数为6岁，显著低于抗组胺药耐药患者（P = .0001）。自身免疫抗体与抗组胺药耐药性之间无显著关联。所有对抗组胺药耐药的患者均接受了环孢素治疗；所有患者的荨麻疹均在2天至3个月内（中位数为7天）完全消退。5例患者在1周后至15个月内（中位数为6个月）复发，再次使用环孢素后有效。这些患者均未出现不良反应。
我们的数据表明，当高剂量抗组胺药无效时，环孢素对儿童慢性荨麻疹具有疗效且安全。
