title: Delayed pressure urticaria - dapsone heading for first-line therapy?
abstract: BACKGROUND
  Pressure urticaria as a subform of physical urticaria is rare and treatment is often difficult. Established therapeutic regimes include antihistamines (generally exceeding approved dosages in order to achieve a therapeutic benefit) or antihistamines combined with montelukast. Complete relief of symptoms is difficult.
  
  
  METHODS
  We used dapsone as an early therapeutic alternative in the event of treatment failure and established a standardized therapeutic regime at our clinic. We surveyed 31 patients retrospectively who had received dapsone between 2003-2009.
  
  
  RESULTS
  In 74 % of patients in whom symptoms persisted despite established therapies, the results of treatment with dapsone were good or very good. Longer-term pressure urticaria and the co-existence of a chronic spontaneous urticaria were associated with a smaller benefit (p<0.05). No significant effects were found related to age, gender, duration of therapy, side-effects, or Met-Hb elevation (a tendency toward a decreased benefit was associated with middle-age, male sex, shorter duration of therapy, observed side-effects, and Met-Hb elevation).
  
  
  CONCLUSIONS
  Therapy is well tolerated and results in a good therapeutic benefit which lasts after termination of therapy. With adequate monitoring, the use of dapsone in patients with pressure urticaria has such a good risk-benefit ratio that we support early treatment initiation.
authors.affiliation: Clinic and Polyclinic for Dermatological Diseases, Münster University Hospital, Germany. sonja.grundmann@ukmuenster.de
authors.forename: Sonja Alexandra
authors.initials: SA
authors.lastname: Grundmann
authors.forename: Sabine
authors.initials: S
authors.lastname: Kiefer
authors.forename: Thomas Anton
authors.initials: TA
authors.lastname: Luger
authors.forename: Randolf
authors.initials: R
authors.lastname: Brehler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001205:Ascorbic Acid / Q000008:administration & dosage; D002908:Chronic Disease; D003622:Dapsone / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008706:Methemoglobin / Q000378:metabolism; D008875:Middle Aged; D011312:Pressure / Q000009:adverse effects*; D012189:Retrospective Studies; D014581:Urticaria / Q000097:blood / Q000188:drug therapy* / Q000209:etiology*
chemical_list: D000890:Anti-Infective Agents; D003622:Dapsone; D008706:Methemoglobin; D001205:Ascorbic Acid