title: A rare cause of a common symptom, Anakinra is effective in the urticaria of Schnitzler Syndrome: a case report.
abstract: BACKGROUND
  Schnitzler Syndrome is an uncommon, inflammatory condition that presents with a constellation of chronic unremitting urticaria, fever, bone pain, arthralgia or arthritis, and a monoclonal IgM gammopathy. There is usually neutrophilia and raised inflammatory markers. Delayed diagnosis is common and treatment often unsuccessful.
  
  
  METHODS
  We report the case of a 43-year-old caucasian man who presented with urticaria unresponsive to conventional therapy. There was considerable delay in recognition of this as Schnitzler Syndrome, and symptoms were unresponsive to conventional immunosuppressive therapy.Commencement of anakinra was associated with a rapid and sustained clinical response.
  
  
  CONCLUSIONS
  Schnitzler Syndrome is a rare disorder that mimics chronic idiopathic urticaria. This diagnosis should be considered in patients with urticaria unresponsive to antihistamines and conventional immunosuppressive therapy. Anakinra is an effective treatment although further studies are required, to determine long term therapeutic requirements and assess any potential adverse effects.
authors.affiliation: Regional Immunology Service, Royal Hospitals, The Belfast Trust, Grosvenor Road, Belfast BT12 6BN. lisa.devlin1@belfasttrust.hscni.net.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Devlin
authors.forename: Gary
authors.initials: G
authors.lastname: Wright
authors.forename: J David M
authors.initials: JD
authors.lastname: Edgar