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Cyclosporine for omalizumab-refractory chronic urticaria: a report of five cases

BACKGROUND: While both the AAAAI/ACAAI and the EAACI/GA(2)LEN/EuroGuiDerm/APAAACI guidelines recommend starting cyclosporine for patients with chronic urticaria who have had an inadequate response to omalizumab, many clinicians are hesitant to initiate cyclosporine due to paucity of clinical data. T...

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Autores principales: LaCava, Anthony F., Fadugba, Olajumoke O.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10466821/
https://www.ncbi.nlm.nih.gov/pubmed/37644553
http://dx.doi.org/10.1186/s13223-023-00820-4
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author LaCava, Anthony F.
Fadugba, Olajumoke O.
author_facet LaCava, Anthony F.
Fadugba, Olajumoke O.
author_sort LaCava, Anthony F.
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description BACKGROUND: While both the AAAAI/ACAAI and the EAACI/GA(2)LEN/EuroGuiDerm/APAAACI guidelines recommend starting cyclosporine for patients with chronic urticaria who have had an inadequate response to omalizumab, many clinicians are hesitant to initiate cyclosporine due to paucity of clinical data. The objective of this study was to report real-life clinical outcomes in adult patients with chronic urticaria who had an inadequate response to omalizumab and were switched from omalizumab to cyclosporine. Medical records of adult patients with chronic urticaria who had an inadequate response with omalizumab and were later treated with cyclosporine were reviewed retrospectively. Data pertaining to treatment method, clinical response, and adverse effects were recorded. RESULTS/PRESENTATION OF CASES: Five patients with omalizumab-refractory chronic urticaria, three of whom also had angioedema and one with an inducible urticaria, were treated with low doses of oral cyclosporine (1–3 mg/kg/d). Four of five patients in this case series had complete resolution of symptoms with oral cyclosporine, while continuing other standard therapies. Systemic side effects occurred in three patients which prompted drug discontinuation in two patients. DISCUSSION: Cyclosporine alone was effective in inducing urticaria control in adult patients with chronic urticaria who had an inadequate response to omalizumab, though the impact of cyclosporine was limited by reversible adverse effects. Adverse effects were associated with pre-existing medical conditions. As novel chronic urticaria therapies are being investigated, this experience highlights the importance of uncovering chronic urticaria subtypes which tend to respond to cyclosporine, while providing alternative treatments with better tolerability.
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spelling pubmed-104668212023-08-31 Cyclosporine for omalizumab-refractory chronic urticaria: a report of five cases LaCava, Anthony F. Fadugba, Olajumoke O. Allergy Asthma Clin Immunol Case Report BACKGROUND: While both the AAAAI/ACAAI and the EAACI/GA(2)LEN/EuroGuiDerm/APAAACI guidelines recommend starting cyclosporine for patients with chronic urticaria who have had an inadequate response to omalizumab, many clinicians are hesitant to initiate cyclosporine due to paucity of clinical data. The objective of this study was to report real-life clinical outcomes in adult patients with chronic urticaria who had an inadequate response to omalizumab and were switched from omalizumab to cyclosporine. Medical records of adult patients with chronic urticaria who had an inadequate response with omalizumab and were later treated with cyclosporine were reviewed retrospectively. Data pertaining to treatment method, clinical response, and adverse effects were recorded. RESULTS/PRESENTATION OF CASES: Five patients with omalizumab-refractory chronic urticaria, three of whom also had angioedema and one with an inducible urticaria, were treated with low doses of oral cyclosporine (1–3 mg/kg/d). Four of five patients in this case series had complete resolution of symptoms with oral cyclosporine, while continuing other standard therapies. Systemic side effects occurred in three patients which prompted drug discontinuation in two patients. DISCUSSION: Cyclosporine alone was effective in inducing urticaria control in adult patients with chronic urticaria who had an inadequate response to omalizumab, though the impact of cyclosporine was limited by reversible adverse effects. Adverse effects were associated with pre-existing medical conditions. As novel chronic urticaria therapies are being investigated, this experience highlights the importance of uncovering chronic urticaria subtypes which tend to respond to cyclosporine, while providing alternative treatments with better tolerability. BioMed Central 2023-08-29 /pmc/articles/PMC10466821/ /pubmed/37644553 http://dx.doi.org/10.1186/s13223-023-00820-4 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
LaCava, Anthony F.
Fadugba, Olajumoke O.
Cyclosporine for omalizumab-refractory chronic urticaria: a report of five cases
title Cyclosporine for omalizumab-refractory chronic urticaria: a report of five cases
title_full Cyclosporine for omalizumab-refractory chronic urticaria: a report of five cases
title_fullStr Cyclosporine for omalizumab-refractory chronic urticaria: a report of five cases
title_full_unstemmed Cyclosporine for omalizumab-refractory chronic urticaria: a report of five cases
title_short Cyclosporine for omalizumab-refractory chronic urticaria: a report of five cases
title_sort cyclosporine for omalizumab-refractory chronic urticaria: a report of five cases
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10466821/
https://www.ncbi.nlm.nih.gov/pubmed/37644553
http://dx.doi.org/10.1186/s13223-023-00820-4
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