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SELECTED ARTICLES FROM THE RECENT LITERATURE 2007
August 23, 2007
Update on approaches to chronic urticaria
Summary
Background - Although the causes of chronic urticaria (CU) in an individual patient are often obscure. There has been continued investigation of the pathogenesis of CU with the aim of improved therapy.
Findings - This subject was reviewed by Zuberbier and Maujrer of the Charite-Universitats Medizin in Berlin, Germany. They described guidelines promulgated by Forum of representatives of several A&I and Dermatology organizations in Europe. When inciting causes of CU cannot be determined and/or avoidance of such causes is not feasible, symptomatic therapy is indicated, starting with non-sedating antihistamines (AH). However, recent studies suggest that larger doses of such AH may be needed to control CU than customarily used in condition such as allergic rhinitis.
Reference
Acta Derm Venereol 2007;87:196-205
Editor's Comments
The guidelines noted above are pretty much in line with those proposed by experienced investigators of CU. In those cases of severe CU requiring chronic treatment with sizable doses of systemic corticosteroids for control, trials of "steroid sparing" therapy with agents such as Asacol, cyclosporin A and mycophenolate mofetil should be considered. The latter is done with the understanding and advance consent of the patient that these are potent therapeutic agents with potential for adverse effects. The effects on the CU of synthroid treatment in those with CU and thyroid auto-immunity are still debated.
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