Zusammenfassung
Patienten mit chronischer spontaner Urtikaria, der häufigsten nicht akuten Verlaufsform der Nesselsucht, zeigen in der Regel einen mehrjährigen Krankheitsverlauf, eine hohe Krankheitsaktivität, eine erhebliche Beeinträchtigung der Lebensqualität und ein schlechtes Ansprechen auf Therapie. Mehr als die Hälfte der Patienten entwickelt trotz Standardtherapie mit nicht sedierenden Antihistaminika weiterhin Beschwerden. In solchen Fällen sollte das Antihistaminikum höher dosiert werden (bis zur 4-fachen Tagesdosis). Wenn auch dies nicht zu einer Kontrolle der Beschwerden führt, sollte das hoch dosierte Antihistaminikum mit einem Leukotrienantagonisten kombiniert werden und ggf. zusätzlich mit einem H2-Blocker. Bei Nichtansprechen auf diese Kombinationstherapie sollten Ciclosporin A, Dapson oder Omalizumab zum Einsatz kommen.
Abstract
Patients with chronic spontaneous urticaria, the most frequent non-acute form of urticaria, generally exhibit a clinical picture of persistent disease, a high degree of disease activity, considerable impairment of quality of life, and poor response to treatment. More than half of the patients continue to develop symptoms despite standard therapy with non-sedating antihistamines. In these cases, the antihistamine dose should be increased (up to four times the daily dose). If this approach also does not result in symptom control, the high-dose antihistamine should be combined with a leukotriene antagonist and if necessary an H2 blocker. If the patient does not respond to this combination therapy, cyclosporin A, dapsone, or omalizumab should be administered.
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Literatur
Bindslev-Jensen C, Skov PS (2009) Efficacy of omalizumab in delayed pressure urticaria: a case report. Allergy 65:138–139
Boyce JA (2006) Successful treatment of cold-induced urticaria/anaphylaxis with anti-IgE. J Allergy Clin Immunol 117:1415–1418
Cassano N, D Argento V, Filotico R, Vena GA (2005) Low-dose dapsone in chronic idiopathic urticaria: preliminary results of an open study. Acta Derm Venereol 85:254–255
Church MK, Maurer M, Simons FER et al (2010) Risk of first-generation H1-antihistamines: a GA2LEN position paper. Allergy (im Druck)
Di Gioaccino M, Di Stefano F, Cavallucci E et al (2003) Treatment of chronic idiopathic urticaria and positive autologous serum skin test with cyclosporine: clinical and immunological evaluation. Allergy Asthma Proc 24:285–290
Engin B, Ozdemir M (2008) Prospective randomized non-blinded clinical trial on the use of dapsone plus antihistamine vs. antihistamine in patients with chronic idiopathic urticaria. J Eur Acad Dermatol Venereol 22:481–486
Giménez-Arnau A, Izquierdo I, Maurer M (2009) The use of a responder analysis to identify clinically meaningful differences in chronic urticaria patients following placebo-controlled treatment with rupatadine 10 and 20 mg. J Eur Acad Dermatol Venereol 23:1088–1091
Grattan CEH, O’Donnell BF, Francis DM et al (2000) Randomized double-blind study of cyclosporin in chronic „idiopathic“ urticaria. Br J Dermatol 143:365–372
Grob JJ, Auquier P, Dreyfus I, Ortonne JP (2009) How to prescribe antihistamines for chronic idiopathic urticaria: desloratadine daily vs. PRN and quality of life. Allergy 64:605–612
Güzelbey O, Ardelean E, Magerl M et al (2008) Successful treatment of solar urticaria with anti-immunoglobulin E therapy. Allergy 63:1563–1565
Kaplan AP, Joseph K, Maykut RJ et al (2008) Treatment of chronic autoimmune urticaria with omalizumab. J Allergy Clin Immunol 122:569–573
Krause K, Ardelean E, Keßler B et al (2010) Antihistamine-resistant urticaria factitia successfully treated with anti-immunoglobulin E therapy. Allergy (im Druck)
Magerl M, Staubach P, Maurer M (2010) Effective treatment of therapy resistant chronic spontaneous urticaria with omalizumab. J Allergy Clin Immunol (im Druck)
Metz M, Bergmann P, Zuberbier T, Maurer M (2008) Successful treatment of cholinergic urticaria with anti-immunoglobulin E therapy. Allergy 63:247–249
Metz M, Maurer M, Zuberbier T, Magerl M (2009) Diagnostik und Therapie der chronischen Urtikaria. Was ändert sich mit den neuen EAACI/GA2LEN/EDF/WAO Leitlinien für die Betreuung von Patienten mit Urtikaria? Dtsch Dermatologe 1111:1–6
Młynek A, Zalewska-Janowska A, Martus P et al (2008) How to assess disease activity in patients with chronic urticaria? Allergy 63:777–780
Siebenhaar F, Degener F, Zuberbier T et al (2009) High-dose desloratadine decreases wheal volume and improves cold provocation thresholds compared with standard-dose treatment in patients with acquired cold urticaria: a randomized, placebo-controlled, crossover study. J Allergy Clin Immunol 123:672–679
Spector SL, Tan RA (2007) Effect of omalizumab on patients with chronic urticaria. Ann Allergy Asthma Immunol 99:190–193
Spector SL, Tan RA (2008) Therapeutic alternatives for chronic urticaria: additional reports on omalizumab. Ann Allergy Asthma Immunol 101:647
Staevska M, Popov TA, Kralimarkova T et al (2010) The effectiveness of levocetirizine and desloratadine in up to 4 times conventional doses in difficult-to-treat urticaria. J Allergy Clin Immunol 125:676–6826
Vena GA, Cassano N, Colombo D et al (2006) Cyclosporine in chronic idiopathic urticaria: a double-blind, randomized, placebo-controlled trial. J Am Acad Dermatol 55:705–709
Zuberbier T, Asero R, Bindslev-Jensen C et al (2009) EAACI/GA2LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria. Allergy 64:1417–1426
Zuberbier T, Asero R, Bindslev-Jensen C et al (2009) EAACI/GA2LEN/EDF/WAO guideline: management of urticaria. Allergy 64:1427–1443
Interessenkonflikt
Der korrespondierende Autor weist auf folgende Beziehungen hin: Prof. Dr. Marcus Maurer ist oder war bis vor Kurzem als Investigator, Redner und/oder Berater für die Firmen Almirall Hermal, Bayer Schering Pharma, Biofrontera, Essex Pharma, Genentech, JADO Technologies, Jerini, Merckle Recordati, Novartis, Sanofi Aventis, Schering-Plough, Leo, MSD, Merck, Shire, Symbiopharm, UCB und Uriach tätig.
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Maurer, M., Altrichter, S., Ardelean, E. et al. Therapeutische Alternativen bei Antihistamintherapie-refraktärer Urtikaria. Hautarzt 61, 765–769 (2010). https://doi.org/10.1007/s00105-010-1934-7
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DOI: https://doi.org/10.1007/s00105-010-1934-7