Solar Urticaria Successfully Treated with Intravenous Immunoglobulins

Abstract

Background: Idiopathic solar urticaria (SU) is a rare type of physical urticaria, occurring immediately after exposure to visible or ultraviolet (UV) light. Treatment is based on sun avoidance and on high doses of antihistamines, but is sometimes inefficient. Methods: We report on a 41-year-old patient with severe SU who was successfully treated with a single course of 2 g/kg of intravenous immunoglobulins (IVIG). Results: A dramatic improvement in UVA and UVB tolerance was rapidly observed, with an increase of up to 10 times the UVA minimal urticarial dose on day 3. The treatment with terfenadine was continued. Healing of photosensitivity was persistent since 100 days after the single course of IVIG, no urticarian reaction was provoked with polychromatic irradiation rising above 8.3 J/cm² or after UVA doses rising above 15 J/cm². Conclusion: Use of IVIG in severe SU can be discussed when high-dose antihistamines are inefficient and quality of life is affected.

Solar urticaria treated with intravenous immunoglobulins

“…5 Studies performed on patients with chronic urticaria 5 or delayed pressure urticaria 14 showed 20% to 50% of complete response. Sporadic cases of refractory SU successfully treated with IVIG have been previously reported, [6][7][8]15 including 3 of our patients. [6][7][8] Our report shows that of 7 patients affected with severe SU who have been treated with IVIG in France, 5 experienced a considerable improvement after 1 to 3 courses (71% complete remission rate) and remission has been maintained for more than 1 year in 60% of the responsive patients.…”

“…Three of these cases (patients 1-3) have been previously reported. [6][7][8] There were 5 female and 2 male patients with a mean age of 40 years (range 32-55 years). The mean SU duration before IVIG treatment was 5 years (range 2-10 years).…”

Solar urticaria unresponsive to intravenous immunoglobulins

“…There have only been a few reports in the literature of SU successfully treated with IVIg (1–5). Patients were aged from 27 to 55 years and their SU disease duration varied from 1 month to 5 years (1–5). The administration schedule differed from one patient to another: 2–2.5 g/kg, infused over 3–5 days and a wide range number of necessary courses (from 1 to 6), with variable time lags (from 1 to 3 months between the courses).…”

Intravenous Immunoglobulin as a Potential Therapy for Refractory Urticaria - A Review

“…IVIG has been used in solar urticaria [22,23,[49][50][51][52]. Solar urticaria is characterized by development of urticarial eruption within a few minutes of exposure to ultraviolet radiation.…”

“…IVIG was infused at the dose of 2g/Kg over 5 days and both patients achieved prolonged remission after several courses. One case of severe solar urticaria remitted completely following a single infusion of IVIG administered in the dose of 2g/Kg [50]. Correia et al and Darras et al also reported on remission of severe solar urticaria in single patients following high dose IVIG infusion [51,52].…”