Urticaria unresponsive to antihistaminic treatment: an open study of therapeutic options based on histopathologic features.
BACKGROUND
The non- or low-sedating H1 receptor antagonists represent the basic therapy for urticaria.


OBJECTIVE
To test an alternative approach to patients unresponsive to conventional treatment.


METHODS
A total of 22 patients with chronic urticaria unresponsive to conventional antihistamine treatment were enrolled for this study. They had uncontrolled urticaria even using multiple combinations of antihistamines on maximum doses and corticosteroids in short cycles (prednisone 20-40 mg, per os once a day, 3-7 days per month). Cutaneous biopsies of the urticaria lesions were taken. These findings were classified as: (I) a mixture of perivascular dermal inflammatory infiltrate composed of lymphocytes, monocytes and neutrophils and/or eosinophils; (II) inflammatory infiltrate composed chiefly of neutrophils; and (III) inflammatory infiltrate composed mainly of eosinophils. According to histology, the patients were submitted to one of the following therapeutic schemes: class A - antihistamine treatment plus dapsone; class B - colchicine or dapsone; class C - montelukast.


RESULTS
Four patients in class A, 08 in class B and seven in class C displayed complete control of urticaria after 12 weeks of treatment; one patient in class B and two in class C did not respond to treatment. Two years after discontinuation, 16 patients are still free of urticaria.


CONCLUSIONS
This study suggests an alternative approach for treating unresponsive chronic urticaria.
Criado
Roberta F J
RF
Department of Dermatology, Faculdade de Medicina do ABC Santo Andre, Brazil. rfjcriado@terra.com.br
Criado
Paulo Ricardo
PR
Martins
Jose Eduardo C
JE
Valente
Neusa Y S
NY
Michalany
Nilceo S
NS
Vasconcellos
Cidia
C
D000085:Acetates / Q000627:therapeutic use; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D003078:Colchicine / Q000627:therapeutic use; D003521:Cyclopropanes; D003622:Dapsone / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006634:Histamine H1 Antagonists / Q000627:therapeutic use*; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011804:Quinolines / Q000627:therapeutic use; D013440:Sulfides; D050257:Tubulin Modulators / Q000627:therapeutic use*; D014581:Urticaria / Q000188:drug therapy* / Q000473:pathology*
D000085:Acetates; D000890:Anti-Infective Agents; D003521:Cyclopropanes; D006634:Histamine H1 Antagonists; D020024:Leukotriene Antagonists; D011804:Quinolines; D013440:Sulfides; D050257:Tubulin Modulators; D003622:Dapsone; C093875:montelukast; D003078:Colchicine