Kocatürk Emek, Can Pelin Kuteyla, Akbas Pırıl Etikan, Copur Mehmet, Degirmentepe Ece Nur, Kızıltac Kübra, Singer Ralfi
Okmeydanı Training and Research Hospital, Department of Dermatology, Kaptanpasa Mah. Darülaceze Cad. No: 27, 34384 Okmeydanı, Şişli, Istanbul, Turkey.
J Dermatol Sci. 2017 Jul;87(1):60-69. doi: 10.1016/j.jdermsci.2017.02.283. Epub 2017 Mar 1.
The recommended treatment approach in chronic inducible urticarias (CIndU) is the same as that for chronic spontaneous urticaria (CSU). But there is a lack of controlled trials assessing efficacy of available treatment options.
We aimed to evaluate the efficacy of treatment algorithm recommended by the guidelines and comparison of treatment responses in CIndU vs CSU.
This prospective parallel group controlled study included 70 CIndU and 66 CSU patients. The same treatment algorithm recommended by the European Academy of Allergology and Clinical Immunology/Global Allergy and Asthma European Network/European Dermatology Forum/World Allergy Organization (EAACI/GALEN/EDF/WAO) was implemented to both CSU and CIndU patients. Treatment responses of the groups were evaluated with urticaria control test (UCT) and dermatology life quality questionnaire (DLQI) scores at the 0, 4, 8, 12 and 24th weeks for CIndU and 0, 4, 12 and 24 weeks for CSU.
Fourteen patients (20,9%) with CIndU and 25 (37,9%) with CSU responded to standard doses of H1-AHs which was significantly higher in the CSU group (p=0,031, p<0,05). Patients with CIndU and CSU showed statistically similar responses to 2nd line treatments (combining or updosing AHs) (p=0,979; p>0,05). Twenty-seven (40,3%) of CIndU patients and 21 (31,8%) of CSU patients were diagnosed as AH-resistant urticaria. Omalizumab was administered to 15 CSU patients and 17 CIndU patients. Response rates to omalizumab were similar in both groups. Total response rates increased from 37,9% (n:25) to 68,2% (n:45) with the 2nd line treatments in CSU group while it increased from 20,9% (n:14) to 59,7% (n:40) in CIndU group. When omalizumab was introduced to AH-refractory cases as a 3rd line treatment, total response rates evaluated at the 12th week were 76,1% (n:51) in patients with CIndU and 83,3% (n:55) in CSU. Continuing omalizumab treatment for 24 weeks increased response rates in patients who were unresponsive at week 12.
CIndU seem to be more resistant to standard doses of AHs and higher doses of AHs are required for the control of symptoms. The same guidelines for CSU may be implemented to patients with CIndU.
慢性诱导性荨麻疹（CIndU）的推荐治疗方法与慢性自发性荨麻疹（CSU）相同。但缺乏评估现有治疗方案疗效的对照试验。
我们旨在评估指南推荐的治疗方案的疗效，以及比较CIndU与CSU的治疗反应。
这项前瞻性平行组对照研究纳入了70例CIndU患者和66例CSU患者。欧洲变态反应和临床免疫学会/全球变态反应和哮喘欧洲网络/欧洲皮肤病学论坛/世界变态反应组织（EAACI/GALEN/EDF/WAO）推荐的相同治疗方案应用于CSU和CIndU患者。在第0、4、8、12和24周对CIndU患者以及第0、4、12和24周对CSU患者，采用荨麻疹控制试验（UCT）和皮肤病生活质量问卷（DLQI）评分评估两组的治疗反应。
14例（20.9%）CIndU患者和25例（37.9%）CSU患者对标准剂量的H1抗组胺药（AHs）有反应，CSU组这一比例显著更高（p = 0.031，p<0.05）。CIndU和CSU患者对二线治疗（联合或增加AHs剂量）的反应在统计学上相似（p = 0.979；p>0.05）。27例（40.3%）CIndU患者和21例（31.8%）CSU患者被诊断为对AHs耐药的荨麻疹。15例CSU患者和17例CIndU患者接受了奥马珠单抗治疗。两组对奥马珠单抗的反应率相似。CSU组二线治疗后总反应率从37.9%（n = 25）增至68.2%（n = 45），而CIndU组从20.9%（n = 14）增至59.7%（n = 40）。当奥马珠单抗作为三线治疗引入对AHs难治的病例时，第12周评估的CIndU患者总反应率为76.1%（n = 51），CSU患者为83.3%（n = 55）。对第12周无反应的患者持续使用奥马珠单抗治疗24周可提高反应率。
CIndU似乎对标准剂量的AHs更耐药，需要更高剂量的AHs来控制症状。CSU的相同指南可应用于CIndU患者。
