Abstract
BackgroundChronic urticaria is a common disease. Plasmapheresis is an alternative treatment that can be appropriate for patients who are resistant to treatment with 2nd generation antihistamines or for whom treatment with omalizumab is unsuitable.ObjectiveTo investigate the effect of plasmapheresis treatment in chronic urticaria.MethodsA retrospective analysis was performed based on the data of 98 patients suffering from refractory chronic urticaria who received plasmapheresis as an alternative treatment in Vilnius University’s Hospital Santaros Clinics from 2000 to 2020. The efficiency of the treatment was evaluated by clinical judgment.Results58.2% of the patients exhibited a complete or significant response; of these, 37.8% had temporary relief of symptoms and 20.4% achieved disease remission; 41.8% showed no response to the plasmapheresis. Men (34.8%) had a tendency to achieve disease remission more often than women (16%) (p < 0.05). One patient did not finish the plasmapheresis treatment due to the symptoms’ exacerbation and treatment with omalizumab was initiated.ConclusionPlasmapheresis is a safe and effective alternative treatment when traditional treatment is unavailable or does not relieve symptoms completely. Our data showed that plasmapheresis was effective in more than half of our patients.
Highlights
Chronic spontaneous urticaria (CSU) defined as the presence of wheals, angioedema, or both, which lasts for at least 6 weeks, affects patients’ quality of life due to recurrent symptoms
More evidence shows that CSU can be an autoimmune disease as up to 40% of the patients have detectable histaminereleasing immunoglobulin G (IgG) autoantibodies directed against immunoglobulin E (IgE) or the high-affinity IgE receptor on mast cells and basophils or IgE autoantibodies to common structures [2]
As around half of the CSU patients cannot be controlled on this treatment, biologic omalizumab or cyclosporine A are recommended, mainly because the efficacy of these drugs is demonstrated in randomized controlled trials
Summary
Chronic spontaneous urticaria (CSU) defined as the presence of wheals, angioedema, or both, which lasts for at least 6 weeks, affects patients’ quality of life due to recurrent symptoms. More evidence shows that CSU can be an autoimmune disease as up to 40% of the patients have detectable histaminereleasing immunoglobulin G (IgG) autoantibodies directed against immunoglobulin E (IgE) or the high-affinity IgE receptor on mast cells and basophils or IgE autoantibodies to common structures (e.g., thyroid gland) [2]. As around half of the CSU patients cannot be controlled on this treatment, biologic omalizumab (anti-IgE) or cyclosporine A are recommended, mainly because the efficacy of these drugs is demonstrated in randomized controlled trials. About 30% of the patients remain symptomatic at licensed doses of omalizumab 150 and 300 mg, even after a treatment period of over 6 months [3]. Patients treated with cyclosporine A achieve remission from 54 to 73% depending on the prescribed dose and treatment duration [4]. Various other treatments have been used and described for CSU, but are not included in the current international guidelines
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