지원사업
학술연구/단체지원/교육 등 연구자 활동을 지속하도록 DBpia가 지원하고 있어요.
커뮤니티
연구자들이 자신의 연구와 전문성을 널리 알리고, 새로운 협력의 기회를 만들 수 있는 네트워킹 공간이에요.
논문 기본 정보
- 자료유형
- 학술저널
- 저자정보
- 저널정보
- 대한천식알레르기학회(구 대한알레르기학회) Allergy, Asthma & Immunology Research Allergy, Asthma & Immunology Research Vol.4 No.6
- 발행연도
- 2012.1
- 수록면
- 326 - 331 (6page)
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초록· 키워드
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Chronic spontaneous urticaria is defined as persistent symptoms of urticaria for 6 weeks or more. It is associated with autoimmunity in approximately 45 percent of patients. Therapy is often difficult however the initial approach should employ high-dose non-sedating antihistamines; 4-6 tablets/day may be necessary. It has been shown that the response to 4 tablets/day exceeds 3, and exceeds 2, which exceeds 1. However the dose that corresponds to the maximal dose of first generation antihistamines (hydroxyzine, diphenhydramine) used previously, is 6/day. Yet over half the patients are refractory to antihistamines and other agents should be tried next. Whereas current guidelines (published) often add leukotriene antagonists and/or H2 receptor antogonists next, these are of little utility. Likewise drugs effective for urticarial vasculitis (colchicine, dapsone, sulfasalazine, hydroxychloroquine) are effective in a small percentage of patients and no study suggests that the response rate of any of them exceeds the 30% placebo responses seen in most double-blind, placebo controlled studies. The drugs that are effective for antihistamine-resistant chronic spontaneous urticaria are corticosteroids, cyclosporine, and Omalizumab. Use of steroids is limited by toxicity. If used at all, a dose of no more than 10 mg/day should be employed with a weekly reduction of 1 mg. The response rates to cyclosporine and Omalizumab are each close to 75%. Cyclosporine can be used effectively if care is taken to monitor blood pressure, urine protein, blood urea nitrogen, and creatinine, every 6 weeks. Omalizumab has the best profile in terms of efficacy/toxicity and, once approved by federal agencies for use in chronic spontaneous urticaria, a dramatic change in the treatment paradigm, whether associated with autoimmunity or not, is predicted. A phase 3 trial is currently in place. Refractoriness to both Omalizumab and cyclosporine is expected to be less than 5 percent of patients. Other agents, can then be tried.
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참고문헌 (54)
참고문헌 신청
Zuberbier T / 2009 / Dermatology Section of the European Academy of Allergology and Clinical Immunology; Global Allergy and Asthma European Network; European Dermatology Forum; World Allergy Organization. EAACI/GA(2)LEN/EDF/WAO guideline: management of urticaria / Allergy 64:1427~1443
Kaplan AP / 2009 / Pathogenesis of chronic urticaria / Clin Exp Allergy 39:777~787
Grattan CE / 1986 / A serological mediator in chronic idiopathic urticaria--a clinical, immunological and histological evaluation / Br J Dermatol 114:583~590
Grattan CE / 1990 / The pathology of the autologous serum skin test response in chronic urticaria resembles IgE-mediated late-phase reactions / Int Arch Allergy Appl Immunol 93:198~204
Gruber BL / 1988 / Prevalence and functional role of anti-IgE autoantibodies in urticarial syndromes / J Invest Dermatol 90:213~217
Kaplan AP / 2009 / Pathogenesis of chronic urticaria / Clin Exp Allergy 39:777~787
Grattan CE / 1986 / A serological mediator in chronic idiopathic urticaria--a clinical, immunological and histological evaluation / Br J Dermatol 114:583~590
Grattan CE / 1990 / The pathology of the autologous serum skin test response in chronic urticaria resembles IgE-mediated late-phase reactions / Int Arch Allergy Appl Immunol 93:198~204
Gruber BL / 1988 / Prevalence and functional role of anti-IgE autoantibodies in urticarial syndromes / J Invest Dermatol 90:213~217
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