Cyclosporine for omalizumab-refractory chronic urticaria: a report of five cases
Abstract Background While both the AAAAI/ACAAI and the EAACI/GA2LEN/EuroGuiDerm/APAAACI guidelines recommend starting cyclosporine for patients with chronic urticaria who have had an inadequate response to omalizumab, many clinicians are hesitant to initiate cyclosporine due to paucity of clinical d...
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | Allergy, Asthma & Clinical Immunology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13223-023-00820-4 |
| _version_ | 1797558950922551296 |
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| author | Anthony F. LaCava Olajumoke O. Fadugba |
| author_facet | Anthony F. LaCava Olajumoke O. Fadugba |
| author_sort | Anthony F. LaCava |
| collection | DOAJ |
| description | Abstract Background While both the AAAAI/ACAAI and the EAACI/GA2LEN/EuroGuiDerm/APAAACI guidelines recommend starting cyclosporine for patients with chronic urticaria who have had an inadequate response to omalizumab, many clinicians are hesitant to initiate cyclosporine due to paucity of clinical data. The objective of this study was to report real-life clinical outcomes in adult patients with chronic urticaria who had an inadequate response to omalizumab and were switched from omalizumab to cyclosporine. Medical records of adult patients with chronic urticaria who had an inadequate response with omalizumab and were later treated with cyclosporine were reviewed retrospectively. Data pertaining to treatment method, clinical response, and adverse effects were recorded. Results/presentation of cases Five patients with omalizumab-refractory chronic urticaria, three of whom also had angioedema and one with an inducible urticaria, were treated with low doses of oral cyclosporine (1–3 mg/kg/d). Four of five patients in this case series had complete resolution of symptoms with oral cyclosporine, while continuing other standard therapies. Systemic side effects occurred in three patients which prompted drug discontinuation in two patients. Discussion Cyclosporine alone was effective in inducing urticaria control in adult patients with chronic urticaria who had an inadequate response to omalizumab, though the impact of cyclosporine was limited by reversible adverse effects. Adverse effects were associated with pre-existing medical conditions. As novel chronic urticaria therapies are being investigated, this experience highlights the importance of uncovering chronic urticaria subtypes which tend to respond to cyclosporine, while providing alternative treatments with better tolerability. |
| first_indexed | 2024-03-10T17:38:46Z |
| format | Article |
| id | doaj.art-8d60e8922dfc498289e80753a9f0a0a7 |
| institution | Directory Open Access Journal |
| issn | 1710-1492 |
| language | English |
| last_indexed | 2024-03-10T17:38:46Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Allergy, Asthma & Clinical Immunology |
| spelling | doaj.art-8d60e8922dfc498289e80753a9f0a0a72023-11-20T09:45:45ZengBMCAllergy, Asthma & Clinical Immunology1710-14922023-08-011911610.1186/s13223-023-00820-4Cyclosporine for omalizumab-refractory chronic urticaria: a report of five casesAnthony F. LaCava0Olajumoke O. Fadugba1Department of Allergy and Clinical Immunology, Cleveland ClinicDivision of Pulmonary, Allergy, & Critical Care Medicine, Section of Allergy & Immunology, Perelman School of Medicine, University of PennsylvaniaAbstract Background While both the AAAAI/ACAAI and the EAACI/GA2LEN/EuroGuiDerm/APAAACI guidelines recommend starting cyclosporine for patients with chronic urticaria who have had an inadequate response to omalizumab, many clinicians are hesitant to initiate cyclosporine due to paucity of clinical data. The objective of this study was to report real-life clinical outcomes in adult patients with chronic urticaria who had an inadequate response to omalizumab and were switched from omalizumab to cyclosporine. Medical records of adult patients with chronic urticaria who had an inadequate response with omalizumab and were later treated with cyclosporine were reviewed retrospectively. Data pertaining to treatment method, clinical response, and adverse effects were recorded. Results/presentation of cases Five patients with omalizumab-refractory chronic urticaria, three of whom also had angioedema and one with an inducible urticaria, were treated with low doses of oral cyclosporine (1–3 mg/kg/d). Four of five patients in this case series had complete resolution of symptoms with oral cyclosporine, while continuing other standard therapies. Systemic side effects occurred in three patients which prompted drug discontinuation in two patients. Discussion Cyclosporine alone was effective in inducing urticaria control in adult patients with chronic urticaria who had an inadequate response to omalizumab, though the impact of cyclosporine was limited by reversible adverse effects. Adverse effects were associated with pre-existing medical conditions. As novel chronic urticaria therapies are being investigated, this experience highlights the importance of uncovering chronic urticaria subtypes which tend to respond to cyclosporine, while providing alternative treatments with better tolerability.https://doi.org/10.1186/s13223-023-00820-4Chronic spontaneous urticariaRefractory urticariaCyclosporineOmalizumab |
| spellingShingle | Anthony F. LaCava Olajumoke O. Fadugba Cyclosporine for omalizumab-refractory chronic urticaria: a report of five cases Allergy, Asthma & Clinical Immunology Chronic spontaneous urticaria Refractory urticaria Cyclosporine Omalizumab |
| title | Cyclosporine for omalizumab-refractory chronic urticaria: a report of five cases |
| title_full | Cyclosporine for omalizumab-refractory chronic urticaria: a report of five cases |
| title_fullStr | Cyclosporine for omalizumab-refractory chronic urticaria: a report of five cases |
| title_full_unstemmed | Cyclosporine for omalizumab-refractory chronic urticaria: a report of five cases |
| title_short | Cyclosporine for omalizumab-refractory chronic urticaria: a report of five cases |
| title_sort | cyclosporine for omalizumab refractory chronic urticaria a report of five cases |
| topic | Chronic spontaneous urticaria Refractory urticaria Cyclosporine Omalizumab |
| url | https://doi.org/10.1186/s13223-023-00820-4 |
| work_keys_str_mv | AT anthonyflacava cyclosporineforomalizumabrefractorychronicurticariaareportoffivecases AT olajumokeofadugba cyclosporineforomalizumabrefractorychronicurticariaareportoffivecases |