Treatment of Severe Chronic Urticaria: a Retrospective Single Center Analysis of Patients Treated from 2009 – 2016

Chronic urticaria is defined as daily or intermittent appearance of hives for more than 6 weeks. Patients with more severe forms of the disease have increased needs for immune modifying agents for disease control, and among these cyclosporine is the mainstay of treatment. Material and Methods: This retrospective study included patients treated for chronic urticaria from 2009 - 2016 at the Department of Dermatology of the Military Medical Academy. Results: There were 145 treated patients, of whom 20 (13.8%) were resistant to at least two lines of treatment (maximum dose of antihistamine monotherapy, combination of antihistamines, addition of dapsone and short courses of corticosteroids). The patients were treated with cyclosporine (6 males and 14 females; average age 40.05 years). Median duration of treatment was 6 months (range: 2 - 17). In 9 (45%) patients, cyclosporine treatment led to a complete response, in 3 (15%) occasional urticarial plaques developed in spite of treatment, while in 2 (10%) urticaria was resistant to cyclosporine treatment, with continuous disease activity. During the follow-up period, 20% of patients experienced adverse effects. Conclusion: In conclusion, 13.8% of patients were resistant to first-line standard treatment. In these patients, cyclosporine can be regarded as a safe and effective treatment modality, with relatively short course of treatment, but 10% of patients can be regarded as treatment resistant and around 20% experience adverse effects, pointing to the need for further treatment options, including omalizumab.