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[Treatment of chronic urticaria resistant to H1 antihistamines].
Ann Dermatol Venereol. 2003 May; 130 Spec No 1:1S78-85.AD

Abstract

Urticaria is a syndrome. Several signalisation factors (cytokines and chemokines) are implicated in activation of mast cells receptors. Immunologic or non immunologic mechanisms elicit mediator releases and inflammatory activities inducing urticaria lesions. In chronic urticaria the removal of an hypothetical cause is not possible, and the therapeutic management is first oriented towards palliation of symptoms. H1 antagonists are the treatment of choice. Higher dosage than those recommended may be necessary. But severely affected patients are not enough improved. Triggering factors should be avoided. Addition of other mediator antagonists such as leukotriene receptor antagonists have improved some patients and need further evaluation. Several alternative pathogenic therapies have been proposed with conflicting results. Tolerance induction may be tried in a few cases of severe physical urticaria. Oral steroids are reserved if possible for systemic urticaria and in short course for severe exacerbation. Immunosuppressive agents are only appropriate for patients with refractory urticaria to classical treatment. Oral cyclosporine has been used with encouraging results. Its has a suspensive effect but relapses can be treated by H1 antagonists. Whichever the drug or association of drug individual variations in the course of the disease need periodic reevaluation. A spontaneous unexplained remission is not an exception. In this heterogeneous disease an individual approach is required, leading to reduction of symptoms with the least invasive therapy, carefully balancing risk and benefits.

Authors+Show Affiliations

Service d'Allergologie Clinique, Institut Pasteur, 28, rue du Docteur Roux, 75015 Paris.

Pub Type(s)

English Abstract
Journal Article
Review

Language

fre

PubMed ID

12843813

Citation

Guinnepain, M-T. "[Treatment of Chronic Urticaria Resistant to H1 Antihistamines]." Annales De Dermatologie Et De Venereologie, vol. 130 Spec No 1, 2003, pp. 1S78-85.
Guinnepain MT. [Treatment of chronic urticaria resistant to H1 antihistamines]. Ann Dermatol Venereol. 2003;130 Spec No 1:1S78-85.
Guinnepain, M. T. (2003). [Treatment of chronic urticaria resistant to H1 antihistamines]. Annales De Dermatologie Et De Venereologie, 130 Spec No 1, 1S78-85.
Guinnepain MT. [Treatment of Chronic Urticaria Resistant to H1 Antihistamines]. Ann Dermatol Venereol. 2003;130 Spec No 1:1S78-85. PubMed PMID: 12843813.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Treatment of chronic urticaria resistant to H1 antihistamines]. A1 - Guinnepain,M-T, PY - 2003/7/5/pubmed PY - 2003/12/3/medline PY - 2003/7/5/entrez SP - 1S78 EP - 85 JF - Annales de dermatologie et de venereologie JO - Ann Dermatol Venereol VL - 130 Spec No 1 N2 - Urticaria is a syndrome. Several signalisation factors (cytokines and chemokines) are implicated in activation of mast cells receptors. Immunologic or non immunologic mechanisms elicit mediator releases and inflammatory activities inducing urticaria lesions. In chronic urticaria the removal of an hypothetical cause is not possible, and the therapeutic management is first oriented towards palliation of symptoms. H1 antagonists are the treatment of choice. Higher dosage than those recommended may be necessary. But severely affected patients are not enough improved. Triggering factors should be avoided. Addition of other mediator antagonists such as leukotriene receptor antagonists have improved some patients and need further evaluation. Several alternative pathogenic therapies have been proposed with conflicting results. Tolerance induction may be tried in a few cases of severe physical urticaria. Oral steroids are reserved if possible for systemic urticaria and in short course for severe exacerbation. Immunosuppressive agents are only appropriate for patients with refractory urticaria to classical treatment. Oral cyclosporine has been used with encouraging results. Its has a suspensive effect but relapses can be treated by H1 antagonists. Whichever the drug or association of drug individual variations in the course of the disease need periodic reevaluation. A spontaneous unexplained remission is not an exception. In this heterogeneous disease an individual approach is required, leading to reduction of symptoms with the least invasive therapy, carefully balancing risk and benefits. SN - 0151-9638 UR - https://www.unboundmedicine.com/medline/citation/12843813/[Treatment_of_chronic_urticaria_resistant_to_H1_antihistamines]_ L2 - http://www.em-consulte.com/retrieve/pii/MDOI-AD-05-2003-130-HS1-0151-9638-101019-ART12 DB - PRIME DP - Unbound Medicine ER -