Cyclosporin a in Patients Affected by Chronic Idiopathic Urticaria: A Therapeutic Alternative

Abstract

Chronic Idiopathic Urticaria (CIU) is a cutaneous disorder for which there is no identifiable specific etiologic agent. Some recent evidences suggest that CIU might be an autoimmune disease. We analyzed immunological features occurring in CIU and evaluated effectiveness and tolerance of Cyclosporin A (CsA) treatment in patients unresponsive to antihistaminic treatment. Twenty patients with CIU were recruited after a selective diagnostic protocol and were divided into two groups. CsA was prescribed for group 1 and Prednisone for group 2 as control, for 8 weeks. Before and after the therapy we performed on all patients immunological studies. For all patients symptoms disappeared after a few days of therapy. Before therapy all patients showed activated B cells (CD19+CD23+ cells) and among B CD19+ cells, about 20% were CD5+ (cells that synthesize natural autoantibodies). After treatment with Prednisone in group 2, a significant reduction of CD4+ lymphocytes (p = 0,01) was observed. Our findings might support the CIU autoimmune pathogenetic hypothesis. The clinical remission in the CsA-treated group confirmed the therapeutic effectiveness of this therapy in antihistaminic unresponsive CIU and, at dosage used, side effects were rare, mild and reversible. Thus, CsA might be a good therapeutic alternative in CIU patients unresponsive to conventional treatments.

Cyclosporine in chronic idiopathic urticaria: A double-blind, randomized, placebo-controlled trial

“…[1][2][3][4][5][6][7][8][9] This double-blind, randomized, between-patients, multicenter study was designed to assess the efficacy and safety of CsA and to provide information on the optimal duration of therapy in patients with CIU.…”

Successful Treatment of the Different Urticaria Subtypes

“…Good evidence, but from short-term studies only [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42], exists for cyclosporine A (2.5-5 mg per kg body weight) being another off-label alternative at step 3 of the treatment algorithm. However, clinical response often does not occur before 4-6 weeks of intake, and potential side effects such as arterial hypertension, disturbances of kidney and liver function, immunosuppression, and cancer risk have to be considered.…”

Autoimmune urticaria

“…At one-year follow-up, 20 patients were symptomfree and 3 had relapsed [36]. Efficacy of CsA in comparison with prednisolone has been studied by Lori et al [37], and good evidence for alternative treatment in the case of contraindications for systemic steroids in severe AU has been provided.…”