P04 A Complex Case of Urticaria

Abstract

Abstract An 11 year old female, with Type 1 diabetes and no previous atopy or allergy , presented with a 6 week history of facial swelling and a generalised urticaria on the trunk and limbs. She had been seen privately by “Allergy” clinic and diagnosed with chronic spontaneous urticaria with angioedema. Blood tests for common allergens were negative, with a total IgE <20 kU/L. Treatment with Loratadine, Cetirizine 10mg, Fexofenadine 120mg QDS, Acrivastine 8mg BD, Montelukast 10mg OD and prednisolone 20mg OD had only a limited effect. Skin biopsy confirmed urticaria with no evidence of vasculitis. Immunology bloods were negative. Despite reporting compliance, she continued to experience debilitating symptoms with raised UAS scores. Desloratadine 2.5mg BD and multiple intermittent short courses of prednisolone were needed. Omalizumab was started at 300mg monthly for 6 months with partial improvement. However symptoms flared on cessation and following tertiary advice, a 2nd course of Omalizumab was commenced at 300 mg s/c monthly for 3 months & 300mg s/c fortnightly for 3 months with the addition of 100mg BD Ciclosporin and Famotidine 10mg BD. Ciclosporin was discontinued after 1 month due to side effects and substituted with Methotrexate 15mg OW. If control is not obtained, management plans include Mycophenolate Mofetil, or trialing omalizumab 450mg S/C monthly. This is a case of extremely difficult to control urticaria in a child highlighting available systemic treatment options1.