Hydroxychloroquine is clinically effective in the treatment of antihistamine-refractory chronic spontaneous urticaria
Published: September 14, 2022
Omalizumab is the most prescribed option for treating chronic spontaneous urticaria refractory to oral antihistamines. Although abundant evidence exists to support omalizumab, only small studies or anecdotal reports have evaluated effectiveness of hydroxychloroquine and other anti-inflammatory agents in refractory chronic spontaneous urticaria patients. One study involving a small number of patients reported a significant improvement in quality of life1.
In the December issue of The Journal of Allergy and Clinical Immunology: In Practice, Khan et al. report results of a retrospective study comparing the clinical effectiveness of hydroxychloroquine with omalizumab as add-on treatments for chronic urticaria unresponsive to antihistamines. The investigators evaluated add-on treatments in 264 patients from two large clinical practices with refractory chronic spontaneous urticaria not adequately controlled for at least 6 weeks with optimal doses of second-generation antihistamines.
Omalizumab (N=134) and hydroxychloroquine (N=111) were the most frequently prescribed add-on therapies, allowing comparisons of clinical outcomes for these two agents. Complete response was defined as absent or infrequent hives and patient satisfaction with treatment. Partial response was defined as reduced hives, that required a second add-on therapy. Sustained response was complete response to an add-on therapy for at least one year.
Complete sustained responses to the first add-on treatment at 1 year was observed in 82% of patients on omalizumab and 66% receiving hydroxychloroquine. In 45 patients with incomplete responses to first add-on interventions, 65% and 62% subsequently had complete responses to omalizumab and hydroxychloroquine, respectively. Both therapies were well tolerated without adverse effects leading to discontinuation of therapy. This is the first study to assess the clinical effectiveness of hydroxychloroquine in many chronic spontaneous urticaria patients relative to omalizumab, and provides support for the efficacy and safety of hydroxychloroquine for antihistamine-refractory chronic spontaneous urticaria.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.
1. Reeves GE, et al. Impact of hydroxychloroquine therapy on chronic urticaria: chronic autoimmune urticaria study and evaluation. Intern Med J 2004;34:182-6