Header

UZH-Logo

Maintenance Infos

Treatment of chronic spontaneous urticaria with an inadequate response to H1-antihistamines: an expert opinion


Vestergaard, Christian; Toubi, Elias; Maurer, Marcus; Triggiani, Massimo; Ballmer-Weber, Barbara; Marsland, Alexander; Ferrer, Marta; Knulst, André; Giménez-Arnau, Ana (2017). Treatment of chronic spontaneous urticaria with an inadequate response to H1-antihistamines: an expert opinion. European Journal of Dermatology, 27(1):10-19.

Abstract

Chronic spontaneous urticaria (CSU) is characterized by the sudden, continuous or intermittent appearance of pruritic wheals (hives), angioedema, or both for six weeks or more, with no known specific trigger. The international EAACI/GA(2)LEN/EDF/WAO urticaria guideline advises standard-dose, second-generation H1-antihistamines as first-line therapy. However, H1-antihistamine treatment leads to absence of symptoms in fewer than 50% of patients. Updosing of second-generation H1-antihistamines (up to fourfold) as recommended by the EAACI/GA(2)LEN/EDF/WAO urticaria guideline as second-line therapy, can improve response, but many patients remain symptomatic. Definitions of response are often subjective and a consensus is needed regarding appropriate treatment targets. There is also an unmet need for biomarkers to assess CSU severity and activity and to predict treatment response. The EAACI/GA(2)LEN/EDF/WAO urticaria guideline recommends add-on omalizumab, ciclosporin A (CsA), or montelukast third line in patients with an inadequate response to high-dose H1-antihistamines. Omalizumab is currently the only licensed systemic biologic for use in CSU. Both omalizumab and CsA are effective third-line CSU treatments; montelukast appears to have lower efficacy in this setting. Omalizumab carries a label warning for anaphylaxis, although no cases of anaphylaxis were reported in the phase III trials of omalizumab in CSU and it is generally well tolerated in patients with CSU. Omalizumab arguably has a better safety profile than CsA.

Abstract

Chronic spontaneous urticaria (CSU) is characterized by the sudden, continuous or intermittent appearance of pruritic wheals (hives), angioedema, or both for six weeks or more, with no known specific trigger. The international EAACI/GA(2)LEN/EDF/WAO urticaria guideline advises standard-dose, second-generation H1-antihistamines as first-line therapy. However, H1-antihistamine treatment leads to absence of symptoms in fewer than 50% of patients. Updosing of second-generation H1-antihistamines (up to fourfold) as recommended by the EAACI/GA(2)LEN/EDF/WAO urticaria guideline as second-line therapy, can improve response, but many patients remain symptomatic. Definitions of response are often subjective and a consensus is needed regarding appropriate treatment targets. There is also an unmet need for biomarkers to assess CSU severity and activity and to predict treatment response. The EAACI/GA(2)LEN/EDF/WAO urticaria guideline recommends add-on omalizumab, ciclosporin A (CsA), or montelukast third line in patients with an inadequate response to high-dose H1-antihistamines. Omalizumab is currently the only licensed systemic biologic for use in CSU. Both omalizumab and CsA are effective third-line CSU treatments; montelukast appears to have lower efficacy in this setting. Omalizumab carries a label warning for anaphylaxis, although no cases of anaphylaxis were reported in the phase III trials of omalizumab in CSU and it is generally well tolerated in patients with CSU. Omalizumab arguably has a better safety profile than CsA.

Statistics

Citations

Dimensions.ai Metrics
9 citations in Web of Science®
8 citations in Scopus®
2 citations in Microsoft Academic
Google Scholar™

Altmetrics

Downloads

0 downloads since deposited on 04 Jan 2017
0 downloads since 12 months

Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Dermatology Clinic
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:1 February 2017
Deposited On:04 Jan 2017 14:28
Last Modified:19 Mar 2018 07:55
Publisher:John Libbey Eurotext
ISSN:1167-1122
OA Status:Closed
Publisher DOI:https://doi.org/10.1684/ejd.2016.2905
Related URLs:http://www.jle.com/fr/revues/ejd/e-docs/treatment_of_chronic_spontaneous_urticaria_with_an_inadequate_response_to_h1_antihistamines_an_expert_opinion_308442/article.phtml
PubMed ID:27882879

Download