title: Efficacy and safety of sulfasalazine in patients with chronic idiopathic urticaria.
abstract: BACKGROUND
  There are limited data regarding alternative treatments for antihistamine refractory chronic idiopathic urticaria (CIU). Patients with recalcitrant skin disease often cannot gain satisfactory symptom control with standard therapies and may require prolonged courses of oral corticosteroids. There is a lack of information describing the degree and duration of sulfasalazine's efficacy, the frequency and nature of adverse reactions, and the appropriate safety monitoring parameters.
  
  
  OBJECTIVE
  To present a case series detailing the efficacy and safety of sulfasalazine therapy in patients with CIU.
  
  
  METHODS
  A retrospective chart review was conducted of 39 patients with sulfasalazine-treated CIU evaluated at Johns Hopkins Asthma and Allergy Center from October 2007 to March 2012. Eight patients were excluded from the final analysis.
  
  
  RESULTS
  Twenty-six patients (83.9%) showed an improvement in symptoms within the first 3 months, with 51.6% of patients (n = 16) becoming asymptomatic within the first 6 months of starting sulfasalazine. Eleven patients (35.4%) achieved complete relief of symptoms after tapering off sulfasalazine therapy. Five of the 31 patients (16.1%) failed treatment, defined as worsening symptoms and pursuit of an alternative therapy. Six of 31 patients (19.4%) had a modified course of sulfasalazine therapy owing to abnormal hematologic parameters. Serious adverse events leading to drug discontinuation occurred in 6.5% of patients (n = 2) and included a patient with drug-induced leukopenia and one with rhabdomyolysis.
  
  
  CONCLUSIONS
  Sulfasalazine is a highly effective treatment for patients with antihistamine resistant CIU. The frequency of adverse events leading to an alteration of sulfasalazine treatment supports the need for close monitoring of these patients.
authors: Johns Hopkins Bayview Medical Center, Baltimore, Maryland.
authors: Roy Anthony
authors: RA
authors: Orden
authors: Division of Allergy and Clinical Immunology, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors: Hersha
authors: H
authors: Timble
authors: Division of Allergy and Clinical Immunology, Johns Hopkins School of Medicine, Baltimore, Maryland. Electronic address: ssaini@jhmi.edu.
authors: Sarbjit S
authors: SS
authors: Saini
mesh_terms: D000328:Adult; D000368:Aged; D018926:Anti-Allergic Agents / Q000009:adverse effects / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012460:Sulfasalazine / Q000009:adverse effects* / Q000627:therapeutic use*; D017211:Treatment Failure; D014581:Urticaria / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D018926:Anti-Allergic Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D012460:Sulfasalazine