title: Effect of high-dose intravenous immunoglobulin treatment in therapy-resistant chronic spontaneous urticaria.
abstract: BACKGROUND
  Chronic spontaneous urticaria (CSU) lasting more than 6 weeks is one of the most disabling types of urticaria and often results in severely impaired quality of life. Patients with CSU are often unsatisfied with the standard treatment. Another treatment option recommended for patients with so-called nonresponding CSU according to the newest guidelines is intravenous immunoglobulin (IVIG).
  
  
  OBJECTIVE
  To assess the efficacy and safety of high-dose IVIG as a treatment option in patients with therapy-resistant CSU.
  
  
  METHODS
  Six patients with severe CSU unresponsive to other treatment options according to the newest guidelines for several weeks were treated with high-dose IVIG (2 g/kg every 4-6 weeks). The response to treatment was observed on the basis of clinical signs and reduction of co-medications using a special treatment score. Patients were studied during the treatment period and were followed up for an average of 16 months. Adverse events were assessed.
  
  
  RESULTS
  Patients showed an improvement in symptoms and a reduction in co-medication use just after the first cycle. Symptoms such as itching, wheals, and edema were reduced after the first or second cycle of IVIG treatment. Four of 6 patients had complete remission after 2 to 4 cycles. One patient needed a longer continuation of treatment to reach a stable state of improvement, and another patient had a slight relapse after the seventh cycle. Adverse effects, such as headache and increased blood pressure, were observed only at the beginning of treatment.
  
  
  CONCLUSIONS
  High-dose IVIG represents an important therapeutic option in patients with severe CSU.
authors.affiliation: Department of Dermatology, University Medical Center Mainz, Mainz, Germany.
authors.forename: Heidrun
authors.initials: H
authors.lastname: Mitzel-Kaoukhov
authors.forename: Petra
authors.initials: P
authors.lastname: Staubach
authors.forename: Tina
authors.initials: T
authors.lastname: Müller-Brenne
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006261:Headache / Q000276:immunology; D006801:Humans; D006973:Hypertension / Q000276:immunology; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D007155:Immunologic Factors / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014581:Urticaria / Q000188:drug therapy*
chemical_list: D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors