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Kronik Spontan Ürtikerde Siklosporin Tedavisi İle İlgili Gözlemlerimiz

Year 2016, Volume: 69 Issue: 2, 107 - 110, 20.10.2016

Abstract

Aim: Treatment of severe chronic autoimmune urticaria is difficult. In this study we aimed to investigateefficacy and safety of cyclosporine in patients with chronic urticaria.
Material and Method: Twenty patients with chronic spontaneous urticaria whom detailed physical examinationwere noted and were treated in our center between 2005 and 2013 were included in this study

Results: A total 20 patients were included in this study. Daily wheal number and number of angioedema attackshad been compared and significant reduce in both parameters were detected. Total duration of treatmentwas mean (min: 4, max: 144) 27,05 (±30,9507 SD, median 18) weeks. Daily cyclosporine dosages were(min: 0,54, max: 3,57), mean 2,2672 (±0,81441SD, median 2,1237). Mild hypertension was detected in two patientsunder treatment and had been treated with anti hypertensive agents. Dyplopia was developed in 1 patient. We observed elevated creatinine levels in 3 patients.

Conclusion: A daily mean dosage of 2,2672 mg of cyclosporine is effective in treatment of chronic urticariafor a duration of 27 weeks. All patients must be followed up closely to monitore adverse events. Recurrence was seen in a mean 9 weeks after cessation of therapy.

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References

  • 1. Maurer M, Magerl M, Metz M, et al. Revisions to the international guidelines on the diagnosis and therapy of chronic urticaria. J Dtsch Dermatol Ges 2013.
  • 2. Hide M, Francis DM, Grattan CE, et al. Autoantibodies against the high-affinity IgE receptor as a cause of histamine release in chronic urticaria. N Engl J Med 1993; 328:1599-1604.
  • 3. Grattan CE, Francis DM, Hide M et al. Detection of circulating histamine releasing autoantibodies with functional properties of anti-IgE in chronic urticaria. Clin Exp Allergy 1991; 21:695-704.
  • 4. Greaves MW: Chronic urticaria. N Engl J Med 1995; 332:1767-1772.
  • 5. Confino-Cohen R, Chodick G, Shalev V et al. Chronic urticaria and autoimmunity: associations found in a large population study. J Allergy Clin Immunol 2012; 129:1307-1313.
  • 6. Grob JJ, Lachapelle JM: Non-sedating antihistamines in the treatment of chronic idiopathic urticaria using patient-reported outcomes. Curr Med Res Opin 2008; 24:2423-2428.
  • 7. Kim S, Baek S, Shin B et al: Influence of initial treatment modality on long-term control of chronic idiopathic urticaria. PLoS One 2013; 8:e69345.
  • 8. Jauregui I, Ferrer M, Montoro J, et al. Antihistamines in the treatment of chronic urticaria. J Investig Allergol Clin Immunol 2007; 17 Suppl 2:41-52.
  • 9. Mora PM, Gonzalez Perez Mdel C, Jimenez Villarruel M, et al. (Therapeutic options in idiopathic chronic urticaria). Rev Alerg Mex 2005; 52:77-82.
  • 10. Toubi E, Grattan C, Zuberbier T: Diagnostic dilemmas in chronic urticaria. Journal of the European Academy of Dermatology and Venereology : JEADV 2015; 29 Suppl 3:12-15.
  • 11. Guevara-Gutierrez E, Bonilla-Lopez S, Hernandez-Arana S, et al. Safety and efficacy of cetirizine versus cetirizine plus ranitidine in chronic urticaria: Doubleblind randomized placebo-controlled treatment 2015;1-3.
  • 12. Marone G, Triggiani M, Cirillo R, et al. Cyclosporin A inhibits the release of histamine and peptide leukotriene C4 from human lung mast cells. Ric Clin Lab 1988; 18:53-59.
  • 13. Wershil BK, Furuta GT, Lavigne JA, et al. Dexamethasone and cyclosporin A suppress mast cell-leukocyte cytokine cascades by multiple mechanisms. Int Arch Allergy Immunol 1995; 107:323- 324.
  • 14. Kozel MM, Bossuyt PM, Mekkes JR, et al. Laboratory tests and identified diagnoses in patients with physical and chronic urticaria and angioedema: A systematic review. J Am Acad Dermatol 2003; 48:409-416.
  • 15. Leznoff A, Sussman GL: Syndrome of idiopathic chronic urticaria and angioedema with thyroid autoimmunity: a study of 90 patients. J Allergy Clin Immunol 1989; 84:66-71.
  • 16. Dreskin SC, Andrews KY: The thyroid and urticaria. Curr Opin Allergy Clin Immunol 2005; 5:408-412.
  • 17. Caffarelli C, Cuomo B, Cardinale F, et al. Aetiological factors associated with chronic urticaria in children: a systematic review. Acta Derm Venereol 2013; 93:268-272.
  • 18. Loria MP, Dambra PP, D'Oronzio L et al.Cyclosporin A in patients affected by chronic idiopathic urticaria: a therapeutic alternative. Immunopharmacol Immunotoxicol 2001; 23:205-213.
  • 19. Ilter N, Gurer MA, Akkoca MA: Shortterm oral cyclosporine for chronic idiopathic urticaria. J Eur Acad Dermatol Venereol 1999; 12:67-69.
  • 20. Di Gioacchino M, Di Stefano F, Cavallucci E, et al: Treatment of chronic idiopathic urticaria and positive autologous serum skin test with cyclosporine: clinical and immunological evaluation. Allergy Asthma Proc 2003; 24:285-290.
  • 21. Toubi E, Blant A, Kessel A, et al. Lowdose cyclosporin A in the treatment of severe chronic idiopathic urticaria. Allergy 1997; 52:312-316.
  • 22. Vena GA, Cassano N, Colombo D, et al. Cyclosporine in chronic idiopathic urticaria: a double-blind, randomized, placebo-controlled trial. J Am Acad Dermatol 2006; 55:705-709.
  • 23. Kessel A, Toubi E: Cyclosporine-A in severe chronic urticaria: the option for long-term therapy. Allergy 2010, 65:1478- 1482.
  • 24. Toubi E, Bamberger E, Kessel A: Prolonged cyclosporin-A treatment for severe chronic urticaria. Allergy 2003; 58:535-536.
  • 25. Scott, J.P. & Higenbottam, T.W. Dis- Manage-Health-Outcomes (1988) 3: 107. doi:10.1007/BF03259936

Kronik Spontan Ürtikerde Siklosporin Tedavisi İle İlgili Gözlemlerimiz

Year 2016, Volume: 69 Issue: 2, 107 - 110, 20.10.2016

Abstract

Amaç: Șiddetli seyreden kronik spontan ürtiker vakalarının tedavisi güçtür. Bu çalıșmada kronik ürtikertedavisinde siklosporinin etkinlik ve güvenilirliğini ölçmeyi hedefledik.

Materyal-Metod: 2005-2016 seneleri arasında kliniğimizde tetkik ve tedavi edilen ve ayrıntılı fizik muayenebulguları not edilen 20 kronik spontan ürtiker tanılı hasta çalıșmaya dâhil edildi.

Bulgular: Çalıșmaya toplam 20 hasta dâhil edildi. Günlük ürtika plağı sayısı ve anjioödem atağı sayısı karșılaștırıldıve her iki parametrenin de anlamlı azalma tespit edildi. Tedavinin toplam süresi 27,05 hafta (min: 4,maks:144, ±30,9507) idi. Günlük siklosporin dozları ortalama 2,2672 mg (min:0,54, maks:3,57 mg) idi. Tedavialtında iki hastada hafif hipertansiyon geliști ve antihipertansif ajanlarla etkili bir șekilde tedavi edildi. Birhastad diplopi geliști. Üç hastada kreatinin seviyelerinde yükselme tespit edildi.

Sonuç: Kronik ürtiker tedavisinde, 27 hafta süre ile günlük ortalama 2,2672 mg siklosporin kullanmanın etkiliolduğu tespit edilmiștir. Yan etki gelișimi açısından tüm hastalar takipte tutulmalıdır. Tedavi kesildikten sonra nüks ortalama 9 hafta sonra gelișmiștir.

Project Number

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References

  • 1. Maurer M, Magerl M, Metz M, et al. Revisions to the international guidelines on the diagnosis and therapy of chronic urticaria. J Dtsch Dermatol Ges 2013.
  • 2. Hide M, Francis DM, Grattan CE, et al. Autoantibodies against the high-affinity IgE receptor as a cause of histamine release in chronic urticaria. N Engl J Med 1993; 328:1599-1604.
  • 3. Grattan CE, Francis DM, Hide M et al. Detection of circulating histamine releasing autoantibodies with functional properties of anti-IgE in chronic urticaria. Clin Exp Allergy 1991; 21:695-704.
  • 4. Greaves MW: Chronic urticaria. N Engl J Med 1995; 332:1767-1772.
  • 5. Confino-Cohen R, Chodick G, Shalev V et al. Chronic urticaria and autoimmunity: associations found in a large population study. J Allergy Clin Immunol 2012; 129:1307-1313.
  • 6. Grob JJ, Lachapelle JM: Non-sedating antihistamines in the treatment of chronic idiopathic urticaria using patient-reported outcomes. Curr Med Res Opin 2008; 24:2423-2428.
  • 7. Kim S, Baek S, Shin B et al: Influence of initial treatment modality on long-term control of chronic idiopathic urticaria. PLoS One 2013; 8:e69345.
  • 8. Jauregui I, Ferrer M, Montoro J, et al. Antihistamines in the treatment of chronic urticaria. J Investig Allergol Clin Immunol 2007; 17 Suppl 2:41-52.
  • 9. Mora PM, Gonzalez Perez Mdel C, Jimenez Villarruel M, et al. (Therapeutic options in idiopathic chronic urticaria). Rev Alerg Mex 2005; 52:77-82.
  • 10. Toubi E, Grattan C, Zuberbier T: Diagnostic dilemmas in chronic urticaria. Journal of the European Academy of Dermatology and Venereology : JEADV 2015; 29 Suppl 3:12-15.
  • 11. Guevara-Gutierrez E, Bonilla-Lopez S, Hernandez-Arana S, et al. Safety and efficacy of cetirizine versus cetirizine plus ranitidine in chronic urticaria: Doubleblind randomized placebo-controlled treatment 2015;1-3.
  • 12. Marone G, Triggiani M, Cirillo R, et al. Cyclosporin A inhibits the release of histamine and peptide leukotriene C4 from human lung mast cells. Ric Clin Lab 1988; 18:53-59.
  • 13. Wershil BK, Furuta GT, Lavigne JA, et al. Dexamethasone and cyclosporin A suppress mast cell-leukocyte cytokine cascades by multiple mechanisms. Int Arch Allergy Immunol 1995; 107:323- 324.
  • 14. Kozel MM, Bossuyt PM, Mekkes JR, et al. Laboratory tests and identified diagnoses in patients with physical and chronic urticaria and angioedema: A systematic review. J Am Acad Dermatol 2003; 48:409-416.
  • 15. Leznoff A, Sussman GL: Syndrome of idiopathic chronic urticaria and angioedema with thyroid autoimmunity: a study of 90 patients. J Allergy Clin Immunol 1989; 84:66-71.
  • 16. Dreskin SC, Andrews KY: The thyroid and urticaria. Curr Opin Allergy Clin Immunol 2005; 5:408-412.
  • 17. Caffarelli C, Cuomo B, Cardinale F, et al. Aetiological factors associated with chronic urticaria in children: a systematic review. Acta Derm Venereol 2013; 93:268-272.
  • 18. Loria MP, Dambra PP, D'Oronzio L et al.Cyclosporin A in patients affected by chronic idiopathic urticaria: a therapeutic alternative. Immunopharmacol Immunotoxicol 2001; 23:205-213.
  • 19. Ilter N, Gurer MA, Akkoca MA: Shortterm oral cyclosporine for chronic idiopathic urticaria. J Eur Acad Dermatol Venereol 1999; 12:67-69.
  • 20. Di Gioacchino M, Di Stefano F, Cavallucci E, et al: Treatment of chronic idiopathic urticaria and positive autologous serum skin test with cyclosporine: clinical and immunological evaluation. Allergy Asthma Proc 2003; 24:285-290.
  • 21. Toubi E, Blant A, Kessel A, et al. Lowdose cyclosporin A in the treatment of severe chronic idiopathic urticaria. Allergy 1997; 52:312-316.
  • 22. Vena GA, Cassano N, Colombo D, et al. Cyclosporine in chronic idiopathic urticaria: a double-blind, randomized, placebo-controlled trial. J Am Acad Dermatol 2006; 55:705-709.
  • 23. Kessel A, Toubi E: Cyclosporine-A in severe chronic urticaria: the option for long-term therapy. Allergy 2010, 65:1478- 1482.
  • 24. Toubi E, Bamberger E, Kessel A: Prolonged cyclosporin-A treatment for severe chronic urticaria. Allergy 2003; 58:535-536.
  • 25. Scott, J.P. & Higenbottam, T.W. Dis- Manage-Health-Outcomes (1988) 3: 107. doi:10.1007/BF03259936
There are 25 citations in total.

Details

Primary Language English
Subjects Dermatology
Journal Section Research Article
Authors

Hilayda Karakök 0000-0003-4746-1675

Seçil Saral This is me 0000-0003-3005-3595

Ayșenur Maden This is me

Nihal Kundakçı This is me 0000-0002-2586-1136

Beyza Doğanay Erdoğan 0000-0001-8845-2287

Bengü Nisa Akay 0000-0002-4896-1666

Project Number -
Publication Date October 20, 2016
Published in Issue Year 2016 Volume: 69 Issue: 2

Cite

APA Karakök, H., Saral, S., Maden, A., … Kundakçı, N. (2016). Kronik Spontan Ürtikerde Siklosporin Tedavisi İle İlgili Gözlemlerimiz. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 69(2), 107-110.
AMA Karakök H, Saral S, Maden A, Kundakçı N, Doğanay Erdoğan B, Akay BN. Kronik Spontan Ürtikerde Siklosporin Tedavisi İle İlgili Gözlemlerimiz. Ankara Üniversitesi Tıp Fakültesi Mecmuası. October 2016;69(2):107-110.
Chicago Karakök, Hilayda, Seçil Saral, Ayșenur Maden, Nihal Kundakçı, Beyza Doğanay Erdoğan, and Bengü Nisa Akay. “Kronik Spontan Ürtikerde Siklosporin Tedavisi İle İlgili Gözlemlerimiz”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 69, no. 2 (October 2016): 107-10.
EndNote Karakök H, Saral S, Maden A, Kundakçı N, Doğanay Erdoğan B, Akay BN (October 1, 2016) Kronik Spontan Ürtikerde Siklosporin Tedavisi İle İlgili Gözlemlerimiz. Ankara Üniversitesi Tıp Fakültesi Mecmuası 69 2 107–110.
IEEE H. Karakök, S. Saral, A. Maden, N. Kundakçı, B. Doğanay Erdoğan, and B. N. Akay, “Kronik Spontan Ürtikerde Siklosporin Tedavisi İle İlgili Gözlemlerimiz”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 69, no. 2, pp. 107–110, 2016.
ISNAD Karakök, Hilayda et al. “Kronik Spontan Ürtikerde Siklosporin Tedavisi İle İlgili Gözlemlerimiz”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 69/2 (October2016), 107-110.
JAMA Karakök H, Saral S, Maden A, Kundakçı N, Doğanay Erdoğan B, Akay BN. Kronik Spontan Ürtikerde Siklosporin Tedavisi İle İlgili Gözlemlerimiz. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2016;69:107–110.
MLA Karakök, Hilayda et al. “Kronik Spontan Ürtikerde Siklosporin Tedavisi İle İlgili Gözlemlerimiz”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 69, no. 2, 2016, pp. 107-10.
Vancouver Karakök H, Saral S, Maden A, Kundakçı N, Doğanay Erdoğan B, Akay BN. Kronik Spontan Ürtikerde Siklosporin Tedavisi İle İlgili Gözlemlerimiz. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2016;69(2):107-10.