Abstract
BackgroundChronic Spontaneous Urticaria (CSU) is a relatively common immune mediated disease that can be effectively treated nowadays. Nevertheless, for some patients remission cannot be achieved following current treatment recommendations, defined as resistant CSU (r-CSU). Treating r-CSU is challenging, and, currently, there are no recommended interventions. In this real-life study we describe successful therapy of 18 r-CSU patients using an "intensified protocol" of anti-IgE-antibody (omalizumab) concomitantly with an immunosuppressant. We defined the r-CSU phenotype and compared it to omalizumab-responsive CSU (Or-CSU) phenotype. MethodsClinical and serological data of 72 CSU patients (ie, 18 r-CSU and 54 age and sex matched Or-CSU) were retrospectively collected and analyzed. All patients were diagnosed with CSU for ≥6 months and treated at the Sheba Medical Center during 2013–2018. ResultsOf 289 CSU patients, 18 (6%) were diagnosed with r-CSU and treated with the "intensified protocol" including omalizumab and cyclosporine-A (16p), methotrexate (1p), and azathioprine (1p). Of which, 14/18 (78%) achieved complete remission, 2/18 (11%) partial remission, and 2/18 (11%) no remission. During follow-up no serious adverse events were documented. r-CSU patients received higher doses of antihistamine (p < 0.0001) and omalizumab (425 ± 58 mg/month vs. 283 ± 86 mg/month; p < 0.0001) compared to Or-CSU. The r-CSU phenotype was linked with concomitant autoimmunity (p = 0.0005) and a lower level of IgE prior to initiation of therapy (p = 0.027). Conclusionr-CSU may be a distinct CSU phenotype characterized by severe disease, concomitant autoimmunity, and lower baseline-IgE levels (low "autoallergy"). An "intensified protocol" with omalizumab and an immunosuppressive agent was found to be efficacious and safe for r-CSU. Further larger studies are required to verify these results.
Highlights
Chronic Spontaneous Urticaria (CSU) is an immune mediated disorder that affects up to 1% of the general population, and it is characterized by hives, pruritus, and frequent angioedema.[1]
In the current study we describe 18 resistant CSU (r-CSU) patients that were successfully treated with a combination of omalizumab and an immunosuppressive medication
Eighteen[18] of these patients were diagnosed with r-CSU, and 54 consecutive age and gender matched CSU patients that were omalizumab responsive (OrCSU) served as a control group. r-CSU was defined following failure to achieve disease remission utilizing all steps of the recommended protocols
Summary
Chronic Spontaneous Urticaria (CSU) is an immune mediated disorder that affects up to 1% of the general population, and it is characterized by hives, pruritus, and frequent angioedema.[1]. “Type I00 response that is mediated by IgE antibodies, but unlike classic allergy, these IgE antibodies are directed at auto-antigens (e.g. IL-24).[5] This mechanism was recently termed "Auto-allergy". “Type II” immune responses are autoimmune in nature and are mediated by IgG autoantibodies directed against the high-affinity receptor for IgE (FceR1) or membrane-bound IgE.[6,7]. Chronic Spontaneous Urticaria (CSU) is a relatively common immune mediated disease that can be effectively treated nowadays. For some patients remission cannot be achieved following current treatment recommendations, defined as resistant CSU (rCSU). Treating r-CSU is challenging, and, currently, there are no recommended interventions. In this real-life study we describe successful therapy of 18 r-CSU patients using an "intensified protocol" of anti-IgE-antibody (omalizumab) concomitantly with an immunosuppressant. We defined the r-CSU phenotype and compared it to omalizumab-responsive CSU (Or-CSU) phenotype
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
