Department of Dermatology, Health Sciences University Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
Department of Allergy Immunology, Health Science University Derince Training and Research Hospital, Kocaeli, Turkey.
Int Immunopharmacol. 2022 Nov;112:109198. doi: 10.1016/j.intimp.2022.109198. Epub 2022 Sep 15.
Guidelines recommend standard doses of antihistamines as first-line, and updosing of antihistamines as second-line treatment for the management of chronic urticaria (CU). However, remission rates with different types of first- and second-line treatments and indicators of antihistamine response are largely lacking in the literature.
To examine response rates to first- and second-line treatments in CU, and to identify patient characteristics that can predict antihistamine treatment outcomes.
We retrospectively analyzed treatment outcomes of 657 CU (556 chronic spontaneous urticaria (CSU), 101 chronic inducible urticaria (CIndU)) patients who had at least 3-months of follow-up data.
A standard dose of second generation antihistamines (sgAH) was effective in 43.1 % of the patients. An additional 28.8 % of patients were in remission with second-line treatments. Among patients whose disease was in remission with a standard dose of sgAHs, 14.8 % benefited from switching from their current sgAH to another sgAH. Updosing sgAHs, combination of two different sgAHs, sgAH and first generation H-antihistamine combination, and sgAH and leukotriene receptor antagonist combination provided remission in 38.3 %, 35.8 %, 37.5 % and 25 % of patients who were given these treatments, respectively. Baseline UCT score ≤ 4, emergency referral and family history of CSU were found to be risk factors for antihistamine refractoriness in patients with CSU.
A step-wise approach to the management of CU is practical as more patients respond to treatment at each step. The presence of baseline UCT score ≤ 4, emergency referral and family history of CSU might be helpful to determine patients who require third-line treatments in advance.
指南建议标准剂量的抗组胺药作为一线治疗药物，抗组胺药加量作为慢性荨麻疹（CU）二线治疗。然而，不同类型的一线和二线治疗的缓解率以及抗组胺药反应的指标在文献中大多缺乏。
研究 CU 一线和二线治疗的反应率，并确定可预测抗组胺治疗结果的患者特征。
我们回顾性分析了 657 例至少有 3 个月随访数据的 CU（556 例慢性自发性荨麻疹（CSU），101 例慢性诱导性荨麻疹（CIndU））患者的治疗结果。
标准剂量第二代抗组胺药（sgAH）在 43.1%的患者中有效。二线治疗使另外 28.8%的患者缓解。在标准剂量 sgAHs 缓解的患者中，14.8%的患者从当前 sgAH 换用另一种 sgAH 获益。sgAH 加量、两种不同 sgAH 的联合、sgAH 和第一代 H 抗组胺药联合以及 sgAH 和白三烯受体拮抗剂联合治疗，使 38.3%、35.8%、37.5%和 25%的患者缓解。基线 UCT 评分≤4、急诊转诊和 CSU 家族史是 CSU 患者对抗组胺药物耐药的危险因素。
对 CU 进行阶梯式治疗是可行的，因为每一步都有更多的患者对治疗有反应。基线 UCT 评分≤4、急诊转诊和 CSU 家族史的存在可能有助于提前确定需要三线治疗的患者。
