Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Paul-Ehrlich-Haus, Hindenburgdamm 27, 12203, Berlin, Germany.
Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany.
Am J Clin Dermatol. 2023 May;24(3):397-404. doi: 10.1007/s40257-023-00761-z. Epub 2023 Feb 22.
In chronic spontaneous urticaria (CSU), wheals, angioedema, or both appear spontaneously for > 6 weeks. Current recommended treatment options for urticaria target mast cell mediators such as histamine, or activators, such as autoantibodies. The goal of CSU treatment is to treat the disease until it is gone as effectively and safely as possible. As no cure is available for CSU as of now, the treatment is aimed at continuously suppressing disease activity, with complete control of the disease and a normalization of quality of life. To achieve this, pharmacological treatment should be continued until no longer needed. Treatment of CSU should follow the basic principles of treating as much as needed and as little as possible taking into consideration that the activity of the disease may vary. Since CSU is a disease with spontaneous remission, it is hard to tell, in patients with complete control and no signs or symptoms, when medication is no longer needed. The current international guideline for urticaria suggests that the treatment can be stepped down once a patient is free of signs and symptoms. Other reasons for stepping down the treatment of CSU patients include safety concerns or issues, pregnancy or wanting to become pregnant, and economic factors. As of now, it is unclear over which period, with what intervals and with which dosages CSU treatment should be stepped down. Guidance on this is needed for all recommended therapies: (i) standard-dosed second-generation H1-antihistamine (sgAH), (ii) higher than standard-dosed sgAH, (iii) standard-dosed omalizumab, (iv) higher than standard-dosed omalizumab, and (v) cyclosporine. However, there is a lack of controlled trials on the step down and discontinuation of these treatments. Here, we aim to provide a summary of what is known and what needs to be investigated in further studies, based on our own experience and real-world evidence.
在慢性自发性荨麻疹（CSU）中，风团、血管性水肿或两者均自发出现>6 周。目前荨麻疹的推荐治疗方案针对肥大细胞介质，如组胺，或激活物，如自身抗体。CSU 治疗的目标是尽可能有效地和安全地治疗疾病，直到疾病消失。由于目前尚无治疗 CSU 的方法，因此治疗旨在持续抑制疾病活动，使疾病得到完全控制并使生活质量正常化。为此，应继续进行药物治疗，直到不再需要为止。CSU 的治疗应遵循尽可能多和尽可能少的治疗原则，同时考虑到疾病的活动可能会有所变化。由于 CSU 是一种具有自发性缓解的疾病，因此很难判断在完全控制疾病且无任何体征或症状的患者何时不再需要药物治疗。目前的国际荨麻疹指南建议，一旦患者无任何体征和症状，即可减少治疗。减少 CSU 患者治疗的其他原因包括安全性问题或顾虑、怀孕或想要怀孕，以及经济因素。目前，尚不清楚 CSU 治疗应在多长时间内、以何种间隔和剂量减少，也不清楚应持续多久。所有推荐的治疗方法都需要这方面的指导：（i）标准剂量第二代 H1 抗组胺药（sgAH），（ii）高于标准剂量的 sgAH，（iii）标准剂量奥马珠单抗，（iv）高于标准剂量的奥马珠单抗，和（v）环孢素。然而，这些治疗方法的减少剂量和停药的对照试验较少。在这里，我们旨在根据我们自己的经验和真实世界的证据，提供对这些治疗方法的减少剂量和停药的已知和需要进一步研究的内容的总结。
