Experience with cyclosporine in children with chronic idiopathic urticaria.
BACKGROUND
The identification of an autoimmune mechanism for many patients with chronic idiopathic urticaria (CIU) was used as a rational for a controlled clinical trial of cyclosporine for adults with CIU not responsive to usual measures. That randomized placebo controlled clinical trial demonstrated clinical efficacy, acceptable safety, and a suggestion of inducing remission in such patients.


OBJECTIVE
To report our experience with cyclosporine in pediatric patients with CIU.


METHODS
Fifty-four patients with CIU were referred to us during the period from 2000 through June of 2005. Seven of those, aged 9-16, failed therapy with high dose antihistamines even with the addition of alternate morning prednisone. Neoral brand of cyclosporine, 3 mg/kg/day divided b.i.d., was initiated in these patients. Cyclosporine serum concentrations, blood urea nitrogen (BUN), creatinine, and blood pressure were routinely monitored.


RESULTS
All had cessation of hives. This occurred after 1-4 weeks for six of the seven and 8 weeks for one. While some experienced relapses, all were eventually off of all medications and free of hives. None of the seven experienced any adverse effects.


CONCLUSIONS
Our experience in children is consistent with a previous controlled clinical trial in adults and supports the efficacy and safety of cyclosporine for CIU. However, we recommend that it be reserved for those whose CIU that is resistant to conventional measures and that patients be carefully monitored with cyclosporine serum concentrations and measures of renal function.
Doshi
Devang R
DR
Pediatric Allergy and Pulmonary Division, University of Iowa College of Medicine, Iowa City, Iowa, USA.
Weinberger
Miles M
MM
D000293:Adolescent; D002648:Child; D002908:Chronic Disease; D016572:Cyclosporine / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004351:Drug Resistance; D005260:Female; D006634:Histamine H1 Antagonists / Q000008:administration & dosage; D006801:Humans; D006919:Hydroxyzine / Q000008:administration & dosage; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D008297:Male; D011241:Prednisone / Q000008:administration & dosage; D012008:Recurrence; D019233:Retreatment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014581:Urticaria / Q000097:blood / Q000188:drug therapy* / Q000473:pathology
D006634:Histamine H1 Antagonists; D007166:Immunosuppressive Agents; D006919:Hydroxyzine; D016572:Cyclosporine; D011241:Prednisone