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Chronic Spontaneous Urticaria: Pathogenesis and Treatment Considerations
1Department of Medicine, Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston, SC, USA. kaplana@musc.edu.
Allergy, Asthma & Immunology Research
|September 16, 2017
Summary
Treatment for chronic spontaneous urticaria (CSU) involves escalating doses of antihistamines. If ineffective, omalizumab is the next step, followed by cyclosporine for refractory cases, with corticosteroids reserved for severe exacerbations.
Area of Science:
- Immunology
- Dermatology
Background:
- Chronic spontaneous urticaria (CSU) management requires higher antihistamine doses than typically recommended.
- First- and second-generation antihistamines are primary treatments, with limited efficacy in some patients.
Purpose of the Study:
- To outline the stepwise treatment approach for chronic spontaneous urticaria.
- To review the efficacy and limitations of various therapeutic options for CSU.
Main Methods:
- Review of current treatment guidelines and clinical literature for CSU.
- Analysis of drug efficacy, dosage, and side effect profiles.
Main Results:
- High-dose antihistamines are the initial therapy for CSU.
- Omalizumab (300 mg/month) is effective in 70% of antihistamine-refractory cases.
- Cyclosporine is effective in 65%-70% of patients unresponsive to omalizumab, requiring monitoring for side effects.
Conclusions:
- CSU treatment follows a stepwise approach, starting with antihistamines and progressing to omalizumab and cyclosporine.
- H₂-receptor blockers and leukotriene antagonists are not recommended due to lack of efficacy.
- Corticosteroids should be used cautiously for short durations to avoid toxicity.
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