title: Successful treatment of recalcitrant chronic idiopathic urticaria with sulfasalazine.
abstract: BACKGROUND
  Antihistamines are the standard treatment for chronic idiopathic urticaria (CIU). For patients whose urticaria is unresponsive to antihistamines, the treatment options are limited. During the previous decade, there have been several case reports demonstrating success with sulfasalazine therapy. In this article, we present a case series evaluating sulfasalazine therapy for antihistamine-unresponsive CIU.
  
  
  METHODS
  Nineteen patients with antihistamine-unresponsive CIU were treated with sulfasalazine between 2002 and 2005. During sulfasalazine therapy, 14 patients (74%) reported significant improvement, 4 patients (21%) reported minimal improvement but were not satisfied with their symptom relief, and 1 patient (5%) reported a worsening of symptoms. Of the 13 patients who required systemic steroids to control their urticaria, all were able to reduce or discontinue steroid use during sulfasalazine therapy. Although 7 patients (37%) had adverse effects (eg, nausea, headache, mild or transient leukopenia, and transaminitis) that were thought to be caused by the use of sulfasalazine, they all kept taking the drug.
  
  
  CONCLUSIONS
  This case series demonstrates that sulfasalazine can be a successful and safe treatment option for patients with CIU who have not responded adequately to treatment with antihistamines. Sulfasalazine was steroid sparing in all subjects who were steroid dependent.
authors.affiliation: Department of Dermatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Laura Y
authors.initials: LY
authors.lastname: McGirt
authors.forename: Kavitha
authors.initials: K
authors.lastname: Vasagar
authors.forename: Laura M
authors.initials: LM
authors.lastname: Gober
authors.forename: Sarbjit S
authors.initials: SS
authors.lastname: Saini
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Beck
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D002908:Chronic Disease; D005260:Female; D006634:Histamine H1 Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008499:Medical Records; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012460:Sulfasalazine / Q000008:administration & dosage / Q000627:therapeutic use*; D014581:Urticaria / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D006634:Histamine H1 Antagonists; D012460:Sulfasalazine