Severe urticaria cases manageable with novel treatment options

Key Points

New York - Chronic urticaria can be difficult to treat, but new and evolving therapeutic options can effectively manage symptoms.

"Accurately categorizing urticaria patients is important, as treatment approaches may vary depending on urticaria type," says Nicholas Arthur Soter, M.D., professor, department of dermatology, and medical director, Harris Skin & Cancer Center, New York University Langone Medical Center, New York. "Though the treatments of both chronic urticaria and chronic autoimmune urticaria are similar, those patients diagnosed with chronic autoimmune urticaria may require the use of immunosuppressive agents . "

In many patients, this approach can be effective in controlling the pruritus, wheals and angioedema typically seen in urticaria. Depending on symptom severity, some patients may require simultaneous administration of three to four different H1 antihistamines given up to four times normal doses in order to control symptoms.

"The goal is to obtain control and keep control for a period of time and then slowly try to taper away the medicine and see if the urticaria is still present," Dr. Soter says. "I keep my patients controlled for at least two months before reducing medication doses. However, it may take even longer to gain control of the disease, depending on the severity of symptoms in the individual patient."

Secondary options

In patients whose symptoms were not controlled with H1 antihistamines, clinicians can try leukotriene inhibitors, Dr. Soter says. Leukotriene inhibitors are used in asthma patients, and even though they are not approved for urticaria, they can be used off-label.

According to Dr. Soter, anti-inflammatory agents such as colchicine and dapsone can be considered third-line therapies, as they have shown their usefulness in chronic urticaria. Colchicine and dapsone can be associated with adverse events, however.

"Dapsone and colchicine are usually reserved for those patients with severe chronic urticaria in whom other standard treatments have failed," Dr. Soter says. "Here, it is important that the physician weigh their use and prescribe them accordingly with the symptoms at hand."