Maurer Marcus, Vena Gino A, Cassano Nicoletta, Zuberbier Torsten
a Department of Dermatology and Allergy, Allergy Center , Charité-Universitätsmedizin Berlin , Berlin , Germany.
b Dermatology and Venereology Private Practice , Bari and Barletta , Italy.
Expert Opin Pharmacother. 2016 Jun;17(8):1131-9. doi: 10.1517/14656566.2016.1159298. Epub 2016 Mar 16.
Chronic spontaneous urticaria (CSU) is a disabling condition that causes deterioration of quality of life.
The international EAACI/GA(2)LEN/EDF/WAO guidelines have provided a stepwise treatment algorithm for CSU management. Second-generation H1-antihistamines are the first-line treatment, and the second step is the up-dosing of the same drugs. In refractory patients, the guidelines recommend the addition of omalizumab, ciclosporin A or montelukast. Systemic corticosteroids can be used as a short course during acute exacerbations. A plethora of alternative treatments has been evaluated, although the overall level of evidence for such treatments is low. Future treatment options may include inhibitors of skin mast cells and antagonists to mast cell-activating signals that are relevant for the induction of CSU signs and symptoms.
The only licensed options included in the guidelines algorithm are standard-dosed second-generation H1-antihistamines and omalizumab. High-quality evidence has documented a rapid and strong symptomatic effect of omalizumab in CSU, although the optimal long-term regimens should be further investigated. The role of alternative drugs deserves additional studies. The potential of the existing treatments for inducing remission of CSU is unknown, and this is an important area of research, as is the evaluation of predictors of response, prognostic factors, and pathomechanisms.
慢性自发性荨麻疹（CSU）是一种使人衰弱的疾病，会导致生活质量下降。
国际EAACI/GA(2)LEN/EDF/WAO指南为CSU的管理提供了逐步治疗算法。第二代H1抗组胺药是一线治疗药物，第二步是增加同一药物的剂量。对于难治性患者，指南建议加用奥马珠单抗、环孢素A或孟鲁司特。全身性皮质类固醇可在急性加重期短期使用。已经评估了大量替代治疗方法，尽管此类治疗的总体证据水平较低。未来的治疗选择可能包括皮肤肥大细胞抑制剂和与CSU体征和症状诱导相关的肥大细胞激活信号拮抗剂。
指南算法中唯一获得许可的选择是标准剂量的第二代H1抗组胺药和奥马珠单抗。高质量证据已证明奥马珠单抗在CSU中有快速且显著的症状缓解作用，尽管最佳长期治疗方案应进一步研究。替代药物的作用值得进一步研究。现有治疗方法诱导CSU缓解的潜力尚不清楚，这是一个重要的研究领域，对反应预测因素、预后因素和发病机制的评估也是如此。
