背景:慢性荨麻疹的定义是存在发痒的风团,有时伴有血管性水肿,持续至少6周。在儿童中,大多数病例没有诱发因素,被定义为慢性自发性荨麻疹(CSU)。CSU影响高达0.75%的儿童,对生活质量和学校表现产生负面影响。CSU在成人中使用第二代抗组胺药治疗,二线治疗剂量增加到正常剂量的四倍。Omalizumab(一种针对IgE的单克隆抗体)可能被推荐作为三线治疗。在儿童中使用了类似的协议,然而,人们对其有效性和安全性知之甚少。
目的:总结我们多中心奥马珠单抗治疗顽固性CSU患儿的经验。
方法:在以色列5个三级护理中心进行的回顾性多中心病例系列。包括的患者是被诊断患有顽固性CSU的<18岁的儿童,他们接受了奥马珠单抗治疗。在奥马珠单抗治疗/症状缓解期间对患者进行随访。患者的电子病历被用来收集数据。
结果:19名参与者(11F;8M)在6至16.9岁之间出现CSU。16(84%)对奥马珠单抗有反应,包括12岁以下的儿童,尽管2人在治疗6-12个月后无反应。另外三名患者(16%)对治疗有抵抗力,通过四线(环孢素A)或其他疗法实现缓解。
结论:患有顽固性CSU的儿童,即使是<12岁的人,对标准剂量反应良好,三线奥马珠单抗治疗的比率与成人相似.然而,一些病例可能在正在进行的治疗中变得无反应。
BACKGROUND: Chronic urticaria is defined by the presence of itchy wheals, sometimes accompanied by angioedema, lasting for at least 6 weeks. In children, most cases occur without an eliciting factor and are defined as chronic spontaneous urticaria (CSU). CSU affects up to 0.75% of children with a negative impact on quality of life and school performance. CSU is treated in adults with second-generation antihistamines, increased up to four times normal doses for second-line treatment. Omalizumab (a monoclonal antibody to IgE) may be recommended as third-line therapy. A similar protocol is used in children, yet little is known of its efficacy and safety.
OBJECTIVE: To summarize our multi-center experience in treating children with recalcitrant CSU with omalizumab.
METHODS: A retrospective multi-center case series conducted in 5 tertiary care centers in Israel. Patients included were children <18 years old diagnosed with recalcitrant CSU who were treated with omalizumab. Patients were followed up throughout the duration of omalizumab therapy/symptom remission. Patients\' electronic medical records were used to gather data.
RESULTS: Nineteen participants (11 F; 8 M) presented with CSU between ages 6 and 16.9 years. Sixteen (84%) responded to omalizumab, including children <12 years old, although two became non-responsive after 6-12 months of therapy. Another three patients (16%) were resistant to treatment, achieving remission through fourth-line (Cyclosporine A) or other therapies.
CONCLUSIONS: Children with recalcitrant CSU, even those <12 years old, respond well to standard-dose, third-line omalizumab therapy at rates similar to adults. Yet, some cases may become non-responsive with ongoing treatment.