PDF(Pubmed)
Abstract：
UNASSIGNED: Chronic spontaneous urticaria (CSU) can be extremely debilitating to the patient and challenging for the treating clinician. The National Institute of Health and Clinical Excellence (NICE) in the United Kingdom (UK) recommendation of omalizumab for patients who fail to respond to high-dose anti-histamines has improved treatment options and quality of life. However, there is still lack of clear guidelines for treatment of patients resistant to standard and anti-IgE therapies.
UNASSIGNED: We discuss the therapeutic strategies employed among nine extremely resistant CSU cases and the heterogeneity between guidelines from different societies.
UNASSIGNED: Patients with anti-histamine-resistant urticaria either remained on omalizumab or started on immunosuppressive drugs (dapsone or ciclosporin) when they stopped responding to omalizumab. We used clinical assessment, skin biopsies (when available) and previous published reports to consider dapsone (for predominantly neutrophilic infiltration), or ciclosporin at doses between 2 and 4 mg/kg/day. One patient with ciclosporin-resistant urticaria responded to mycophenolate mofetil. Two patients remain on long-term omalizumab due to its relative safety and efficacy including 1 patient with underlying antibody deficiency where omalizumab was preferred over risks of using immunosuppressive medications.
UNASSIGNED: These case studies bring to light the real-world difficulties in managing patients with resistant CSU and the need for generating the evidence base on alternative therapeutic options such as synergistic use of biologics and immunosuppressive drugs.
UNASSIGNED: We discuss the therapeutic strategies employed among nine extremely resistant CSU cases and the heterogeneity between guidelines from different societies.
UNASSIGNED: Patients with anti-histamine-resistant urticaria either remained on omalizumab or started on immunosuppressive drugs (dapsone or ciclosporin) when they stopped responding to omalizumab. We used clinical assessment, skin biopsies (when available) and previous published reports to consider dapsone (for predominantly neutrophilic infiltration), or ciclosporin at doses between 2 and 4 mg/kg/day. One patient with ciclosporin-resistant urticaria responded to mycophenolate mofetil. Two patients remain on long-term omalizumab due to its relative safety and efficacy including 1 patient with underlying antibody deficiency where omalizumab was preferred over risks of using immunosuppressive medications.
UNASSIGNED: These case studies bring to light the real-world difficulties in managing patients with resistant CSU and the need for generating the evidence base on alternative therapeutic options such as synergistic use of biologics and immunosuppressive drugs.
摘要：
未经证实：慢性自发性荨麻疹（CSU）可能会使患者极度虚弱，并且对治疗临床医生具有挑战性。英国国家健康与临床卓越研究所（NICE）建议奥马珠单抗用于对大剂量抗组胺药无反应的患者，改善了治疗选择和生活质量。然而,对于标准疗法和抗IgE疗法耐药的患者,目前仍缺乏明确的治疗指南.
UNASSIGNED：我们讨论了9例极端耐药CSU病例中采用的治疗策略以及来自不同社会的指南之间的异质性。
UNASSIGNED：抗组胺性荨麻疹患者在停止对奥马珠单抗的反应时，要么继续服用奥马珠单抗，要么开始服用免疫抑制药物（氨苯砜或环孢素）。我们使用临床评估，皮肤活检（如果可用）和以前发表的报告考虑氨苯砜（主要用于嗜中性粒细胞浸润），或环孢素，剂量为2至4mg/kg/天。一名患有环孢素抗性荨麻疹的患者对霉酚酸酯有反应。由于奥马珠单抗的相对安全性和有效性，两名患者仍在长期使用奥马珠单抗，其中包括一名潜在抗体缺乏患者，其中奥马珠单抗优先于使用免疫抑制药物的风险。
UNASSIGNED：这些案例研究揭示了治疗耐药CSU患者的现实世界中的困难，以及产生基于替代治疗选择（如协同使用生物制剂和免疫抑制药物）的证据的需要。
UNASSIGNED：我们讨论了9例极端耐药CSU病例中采用的治疗策略以及来自不同社会的指南之间的异质性。
UNASSIGNED：抗组胺性荨麻疹患者在停止对奥马珠单抗的反应时，要么继续服用奥马珠单抗，要么开始服用免疫抑制药物（氨苯砜或环孢素）。我们使用临床评估，皮肤活检（如果可用）和以前发表的报告考虑氨苯砜（主要用于嗜中性粒细胞浸润），或环孢素，剂量为2至4mg/kg/天。一名患有环孢素抗性荨麻疹的患者对霉酚酸酯有反应。由于奥马珠单抗的相对安全性和有效性，两名患者仍在长期使用奥马珠单抗，其中包括一名潜在抗体缺乏患者，其中奥马珠单抗优先于使用免疫抑制药物的风险。
UNASSIGNED：这些案例研究揭示了治疗耐药CSU患者的现实世界中的困难，以及产生基于替代治疗选择（如协同使用生物制剂和免疫抑制药物）的证据的需要。
