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J Allergy Clin Immunol Pract. 2015 May-Jun;3(3):400-7. doi: 10.1016/j.jaip.2014.12.007. Epub 2015 Feb 11.

Investigation of patient-specific characteristics associated with treatment outcomes for chronic urticaria.

Author information

1
Division of Immunology, Allergy & Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
2
Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio.
3
Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
4
Division of Immunology, Allergy & Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio. Electronic address: BERNSTJA@ucmail.uc.edu.

Abstract

BACKGROUND:

Identifying clinical characteristics of patients with chronic urticaria (CU) responsive to medication may help guide clinicians select treatment.

OBJECTIVE:

The objective of this study was to investigate patient characteristics and medication use associated with urticaria control.

METHODS:

A retrospective longitudinal chart review of adult patients with CU was conducted at a multisite allergy practice. Inclusion criteria required at least 4 CU office visits to allow for pre- and posttreatment assessment. Control corresponding to medication(s) used was assessed each visit. Univariate analysis followed by multiple logistic regression was performed.

RESULTS:

A total of 221 patients with CU were included; 140 (63%) achieved complete control. The average time to control was 1.4 ± 2.7 years, which required 1-3 classes of medications. Dermatographia odds ratio (OR) = 1.85 (95% CI 1.3-2.7) or other physical urticarias, OR = 1.51 (1-2.4) and neutrophilic infiltrates on skin biopsy were markers of poor control. Thyroid autoantibodies were associated with better control using an H1-antihistamine. Whereas 22% were controlled on a second-generation H1-receptor antagonist plus a leukotriene receptor antagonist (LTRA), an additional 33% were controlled when cyclosporine was added. Use of a first or second H1-antagonist or LTRA was associated with a 3.5-16.9 times higher odds of complete CU control in those with dermatographia. The odds of achieving control for other forms of physical urticaria was greatest when colchicine was added (aOR = 32.6 [12.7-83.2]).

CONCLUSIONS:

Patient-specific CU characteristics associated with medication-disease control may be useful for selecting treatment regimens. A subset of CU patients remains poorly controlled that indicates an unmet need for novel therapeutic agents.

KEYWORDS:

Chronic urticaria; Control; Dermatographism; Hives; Medications; Patient-specific clinical characteristics; Physical urticaria; Treatment selection

PMID:
25680926
DOI:
10.1016/j.jaip.2014.12.007
[Indexed for MEDLINE]

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