Chronic Spontaneous Urticaria Learning Zone
Transcript: Management of CSU with antihistamines
Ana Maria Giménez-Arnau, MD
All transcripts are created from interview footage and directly reflect the content of the interview at the time. The content is that of the speakers and is not adjusted by Medthority.
- Hello, I am Ana Maria Giménez-Arnau, dermatologist at the Hospital Del Mar Universitat Pompeu Fabra in Barcelona, Spain. I will focus your interest today as urticariologist in the management of chronic urticaria with H1 antihistamine. Our patient is a 37 years old woman, who showed along her life more than one episode of severe itch, hive, and angioedema that long lasted month and even years, more than one episode of chronic spontaneous urticaria along her life. Between 1991 and 1997, she was treated continuously with a combination of first and second generation antihistamines. She was treated regularly according with the guidelines, but remind that in order to avoid secondary adverse events as somnolence and the anticholinergic effects, second generation are recommended over the first generation anti H1. Years after, in 2003, she developed a second episode of CSU, but at that time she explained very clear, a delayed pressure urticaria that could be demonstrated by the dermographometer. And as you know, when an inducibility care is associated with CSU, the episode tend to be longer and more active.
This moderate to severe relapse of CSU showed a baseline UAS7 of 26. The baseline total IG was 200, and the autologous skin cell test was negative. CSU was controlled with fourfold the doses of second generation anti H1 rupatadine. Nevertheless, she required short courses of deflazacort, which is an oral corticosteroid. For some episodes that delay pressure urticaria. Slowly during five years, we could decrease the doses of anti H1 and finally, she was free of disease and treatment in the 2007. This approach was according to a second step included in the last chronic urticaria guideline, a step which is based mainly on the expert opinion and the publishing territory. Well, a third episode of CSU started in the 2010 and we repeated the autologous skin serum test and at this time was positive, and also the basophil activation test with the CD 63 was positive. Then in fact, this correlated well with the urticaria activity. The character moderate to severe of this episode with a new Urticaria Activity Score 7 of 26 did not respond to the anti H1 used at high doses, and immediately we introduced cyclosporine A 300 milligrammes and the urticaria stopped, no signs and no symptoms. Then we proceed with a lower dose, 200 milligrammes per day, but suddenly without a reason, she turned to UAS 7 of 42. At that time, omalizumab was still not approved.
This is why we added to the second generation anti H1 cyclosporine before omalizumab. We decided to introduce omalizumab 300 milligrammes for compressive use and it was fantastic, extremely good. After a few shots, the UAS 7 was zero. This was at the 2012. Immediately after, in the 2014, the year when omalizumab was approved by the EMA and FDA for CSU, she became pregnant. And obviously we stopped omalizumab, but the disease relapsed, and it was impossible for the patient to continue with a pregnancy. Loratadine was completely ineffective. Then we decided to introduce omalizumab and the response was extremely good. Simultaneously it was published the first expert paper with the experience using omalizumab in pregnant woman with asthma, showing a good profile of safety. Nowadays, Mary's child, son, has six years. He's safe, and she continues with omalizumab, combined with the second generation anti H1. I would like to conclude this presentation with this two sentence. Different patterns of response to the treatment are not necessarily only related to different patients, but also to different periods of the disease in the same patient. And think on this, anti H1, H1 antihistamines are suggested to be used in any step of the chronic urticaria treatment. Take care of your patients with a good strategic plan. You will succeed to control the episodes of chronic urticaria. Thanks for your attention.
Updates in your area
of interest
of interest
Articles your peers
are looking at
are looking at
Bookmarks
saved
saved
Days to your
next event
next event
This content has been developed independently by Medthority who previously received educational funding from Novartis in order to help provide its healthcare professional members with access to the highest quality medical and scientific information, education and associated relevant content.