Factors that predict the success of cyclosporine treatment for chronic urticaria

Chronic urticaria (CU) is a frequent, difficult clinical problem. When first-line therapy fails, patients are often treated with alternative therapies that either have a poor side effect profile or little evidence to support effectiveness. To describe our low-dose cyclosporine-treated CU population and factors predicting a positive outcome. A retrospective chart review was conducted of adult CU patients treated with cyclosporine. Elements of the history, physical examination, diagnostic testing, efficacy, and side effects were extracted for statistical analysis. Chronic urticaria was defined as having urticaria more than 3 days per week for 6 consecutive weeks. Sixty-eight adults with CU who fulfilled the intake criteria and completed a course of cyclosporine were identified. After taking cyclosporine at an average dose of 1.8 ± 1.1 mg/kg, 53 (78%) patients attained complete remission defined as ≤1 day of hives per month. Recurrence occurred in only 7 patients; all achieved remission with resumption of cyclosporine. A history of hives (P =.01), shorter duration of urticaria (mean: 55.2 weeks vs 259.63 weeks; P =.03), and positive CU Index (P =.05) predicted a favorable response to cyclosporine. Notably, autologous serum skin testing, prior response to steroids, atopic status, or presence of antithyroid antibodies was not predictive. Male sex and a positive ANA trended toward significance (P =.1). Side effects were generally mild and seen in 35% of patients; all were reversible by dose reduction. Cyclosporine is an effective treatment for CU, and a history of hives, shorter duration of disease, and CU index <10 predict a successful response.