title: Impact of hydroxychloroquine therapy on chronic urticaria: chronic autoimmune urticaria study and evaluation.
abstract: BACKGROUND
  Chronic urticaria (CU) imposes profound impairment on quality of life. Up to 60% of idiopathic CU is associated with autoimmune phenomena, and may respond to immunomodulation. Hydroxychloroquine offers potential efficacy for CU and is relatively benign compared with most other therapeutic approaches.
  
  
  OBJECTIVE
  The aim of the chronic autoimmune urticaria study and evaluation was to evaluate the efficacy of hydroxychloroquine in patients with chronic idiopathic urticaria.
  
  
  METHODS
  Twenty-one patients referred to the Immunology and Allergy Unit at John Hunter Hospital, New South Wales, Australia, with idiopathic CU were randomised to receive treatment with standard urticaria therapies (corticosteroids, H2-antihistamines, H1--antihistamines, doxepin) with or without hydroxychloroquine. Markers of autoimmunity, thyroid disease and mast-cell autoreactivity (autologous serum skin-prick testing (ASPT)) were assessed. Measures of urticaria control were compared at baseline and at 12 weeks for the 18 individuals who completed the study. These included urticaria scores, medication scores and quality-of-life indices.
  
  
  RESULTS
  The hydroxychloroquine-treated group achieved significant improvements in quality of life as assessed by the global symptom severity score and the LAMY-7 (a quality of life index designed by Lamy, 7th revision) at 12 weeks (P < 0.01 and P < 0.05, respectively). No significant treatment effect on medication requirements or urticaria score was detected, although differences between treatment groups approached statistical significance for urticaria score and medication requirements (0.05 < P < 0.10). ASPT-reactivity did not correlate to hydroxychloroquine-responsiveness. Hydroxychloroquine was well tolerated.
  
  
  CONCLUSIONS
  Immunomodulation with hydroxychloroquine is safe and appears to offer some efficacy as an intervention in CU.
authors.affiliation: Department of Immunology and Infectious Diseases, John Hunter Hospital, Newcastle, New South Wales, Australia. glenn.reeves@hunter.health.nsw.gov.au
authors.forename: G E M
authors.initials: GE
authors.lastname: Reeves
authors.forename: M J
authors.initials: MJ
authors.lastname: Boyle
authors.forename: J
authors.initials: J
authors.lastname: Bonfield
authors.forename: P
authors.initials: P
authors.lastname: Dobson
authors.forename: M
authors.initials: M
authors.lastname: Loewenthal
mesh_terms: D000328:Adult; D001327:Autoimmune Diseases / Q000188:drug therapy* / Q000276:immunology; D002908:Chronic Disease; D003879:Dermatologic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use*; D008297:Male; D016896:Treatment Outcome; D014581:Urticaria / Q000150:complications / Q000188:drug therapy* / Q000276:immunology
chemical_list: D003879:Dermatologic Agents; D006886:Hydroxychloroquine