Holm Jesper Grønlund, Ivyanskiy Ilya, Thomsen Simon Francis
a Department of Dermatology , Bispebjerg Hospital , Copenhagen , Denmark.
b I.M. Sechenov First Moscow State Medical University , Moscow , Russia.
J Dermatolog Treat. 2018 Feb;29(1):80-97. doi: 10.1080/09546634.2017.1329505. Epub 2017 May 31.
Knowledge of effectiveness and safety of the nonbiologic, nonantihistamine treatments used for chronic urticaria is important as in some cases the principal guideline-recommended drug; omalizumab, has limited effect, side effects or is too expensive or unavailable. Herein, we systematically review the evidence for the use of the nonbiologic treatments in antihistamine-refractory chronic urticaria.
We performed a systematic review of the literature using PubMed and Webofscience and identified studies that reported use of one or more of the nonbiological, nonantihistamine treatment options for chronic urticaria. The studies were evaluated based on study design, number of patients, effect of treatment and safety.
We identified 118 studies or case series with 13 different treatments (azathioprine, chloroquine, colchicine, cyclosporine, dapsone, intravenous immunoglobulin (IVIG), methotrexate, montelukast, mycophenolate mofetil, plasmapheresis, sulfasalazine, tranexamic acid and ultraviolet light (UV) A, UVB) totaling 1682 patients. There was a paucity of controlled trials for most of the treatments reviewed albeit the strongest evidence in favor of a beneficial effect in chronic urticaria was, apart from montelukast and cyclosporine, seen for UV therapy and dapsone followed by IVIG.
The treatment options reviewed should be seen as potential alternatives in treatment-resistant chronic urticaria where guideline-based selections have failed. However, larger controlled trials are warranted to advance the level of evidence, possibly supporting some treatments' future recommendation in selected patients.
了解用于慢性荨麻疹的非生物、非抗组胺药物治疗的有效性和安全性很重要，因为在某些情况下，主要指南推荐的药物奥马珠单抗效果有限、有副作用，或者过于昂贵或无法获得。在此，我们系统回顾了非生物治疗用于抗组胺药难治性慢性荨麻疹的证据。
我们使用PubMed和Webofscience对文献进行了系统回顾，确定了报告使用一种或多种非生物、非抗组胺治疗方案治疗慢性荨麻疹的研究。根据研究设计、患者数量、治疗效果和安全性对这些研究进行评估。
我们确定了118项研究或病例系列，涉及13种不同的治疗方法（硫唑嘌呤、氯喹、秋水仙碱、环孢素、氨苯砜、静脉注射免疫球蛋白（IVIG）、甲氨蝶呤、孟鲁司特、霉酚酸酯、血浆置换、柳氮磺胺吡啶、氨甲环酸以及紫外线A、紫外线B），共计1682例患者。尽管除孟鲁司特和环孢素外，紫外线疗法和氨苯砜其次是IVIG在慢性荨麻疹中有有益效果的证据最为充分，但大多数所回顾的治疗方法的对照试验都很少。
所回顾的治疗方案应被视为基于指南的选择失败时，治疗难治性慢性荨麻疹的潜在替代方案。然而，需要进行更大规模的对照试验以提高证据水平，可能支持某些治疗方法未来在特定患者中的推荐。
