耐药慢性自发性荨麻疹-治疗方案的病例系列叙述回顾。

IF 2.3 Q1 OTORHINOLARYNGOLOGY
Sujoy Khan, Charu Chopra, Alaistair Mitchell, Alla Nakonechna, Patrick Yong, Mohammed Yousuf Karim
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引用次数: 2

摘要

背景:慢性自发性荨麻疹(CSU)对患者来说非常虚弱,对治疗临床医生来说也是一个挑战。英国国家健康与临床卓越研究所(NICE)推荐对大剂量抗组胺药无效的患者使用omalizumab,改善了治疗选择和生活质量。然而,对于治疗对标准和抗ige治疗有耐药性的患者,仍然缺乏明确的指导方针。方法:我们讨论了9例极耐药CSU病例的治疗策略以及不同社会指南之间的异质性。结果:抗组胺耐药荨麻疹患者在对奥玛珠单抗无效时,要么继续使用奥玛珠单抗,要么开始使用免疫抑制药物(氨苯砜或环孢素)。我们使用临床评估、皮肤活检(如有)和先前发表的报告来考虑氨苯砜(主要用于嗜中性粒细胞浸润)或环孢素,剂量在2至4mg /kg/天之间。1例环孢素耐药荨麻疹患者对霉酚酸酯有反应。由于omalizumab的相对安全性和有效性,两名患者仍然长期服用omalizumab,其中包括1名潜在抗体缺乏的患者,其中omalizumab优于使用免疫抑制药物的风险。结论:这些病例研究揭示了现实世界中管理耐药CSU患者的困难,以及为替代治疗方案(如生物制剂和免疫抑制药物的协同使用)提供证据的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Resistant Chronic Spontaneous Urticaria - A Case Series Narrative Review of Treatment Options.

Resistant Chronic Spontaneous Urticaria - A Case Series Narrative Review of Treatment Options.

Resistant Chronic Spontaneous Urticaria - A Case Series Narrative Review of Treatment Options.

Resistant Chronic Spontaneous Urticaria - A Case Series Narrative Review of Treatment Options.

Background: Chronic spontaneous urticaria (CSU) can be extremely debilitating to the patient and challenging for the treating clinician. The National Institute of Health and Clinical Excellence (NICE) in the United Kingdom (UK) recommendation of omalizumab for patients who fail to respond to high-dose anti-histamines has improved treatment options and quality of life. However, there is still lack of clear guidelines for treatment of patients resistant to standard and anti-IgE therapies.

Methods: We discuss the therapeutic strategies employed among nine extremely resistant CSU cases and the heterogeneity between guidelines from different societies.

Results: Patients with anti-histamine-resistant urticaria either remained on omalizumab or started on immunosuppressive drugs (dapsone or ciclosporin) when they stopped responding to omalizumab. We used clinical assessment, skin biopsies (when available) and previous published reports to consider dapsone (for predominantly neutrophilic infiltration), or ciclosporin at doses between 2 and 4 mg/kg/day. One patient with ciclosporin-resistant urticaria responded to mycophenolate mofetil. Two patients remain on long-term omalizumab due to its relative safety and efficacy including 1 patient with underlying antibody deficiency where omalizumab was preferred over risks of using immunosuppressive medications.

Conclusions: These case studies bring to light the real-world difficulties in managing patients with resistant CSU and the need for generating the evidence base on alternative therapeutic options such as synergistic use of biologics and immunosuppressive drugs.

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来源期刊
Allergy & Rhinology
Allergy & Rhinology OTORHINOLARYNGOLOGY-
CiteScore
3.30
自引率
4.50%
发文量
11
审稿时长
15 weeks
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