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KMID : 1225720200120050750
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Allergy, Asthma & Immunology Research : AAIR
2020 Volume.12 No. 5 p.750 ~ p.770
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The KAAACI/KDA Evidence-Based Practice Guidelines for Chronic Spontaneous Urticaria in Korean Adults and Children: Part 2. Management of H1-Antihistamine-Refractory Chronic Urticaria
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Choi Jeong-Hee
Lee Dong-Hun
Song Woo-Jung
Choi Mi-Ra
Kwon Jae-Woo
Kim Gun-Woo
Kim Myung-Hwa
Kim Mi-Ae
Kim Min-Hye
Kim Byung-Keun
Kim Su-Jeong
Kim Joung-Soo
Kim Jung-Eun
Kim Ju-Young
Kim Joo-Hee
Kim Hyun-Jung
Kim Hye-One
Kim Hyo-Bin
Roh Joo-Young
Park Kyung-Hee
Park Kui-Young
Park Han-Ki
Park Hyun-Sun
Bae Jung-Min
Byun Ji-Yeon
Song Dae-Jin
Ahn Young-Min
Lee Seung-Eun
Lee Young-Bok
Lee Joong-Sun
Lee Ji-Hyun
Lim Kyung-Hwan
Youn Sang-Woong
Chang Yoon-Seok
Jeon You-Hoon
Jeon Jie-Hyun
Jue Mihn-Sook
Choi Sun-Hee
Hur Gyu-Young
Lim Dae-Hyun
Ye Young-Min
Park Young-Min
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Abstract
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Quite a few patients with chronic spontaneous urticaria (CSU) are refractory to H1-antihistamines, even though the dose of H1-antihistamines is increased up to 4-fold. CSU that is not controlled with H1-antihistamines results in increased disease burden. Several immunomodulators have been used to manage these patients. The guidelines reported herein are connected to Part 1 of the KAAACI/KDA Evidence-Based Practice Guidelines for Chronic Spontaneous Urticaria in Korean Adults and Children, and aimed to provide evidence-based recommendations for the management of H1-antihistamine-refractory CSU. Part 2 focuses on the more commonly used additional treatment options for refractory CSU, including omalizumab, cyclosporine, leukotriene receptor antagonist, dapsone, methotrexate, and phototherapy. The evidence to support their efficacy, dosing, safety, and selection of these agents is systematically reviewed. To date, for patients with refractory CSU, the methodologically sound data to evaluate the use of omalizumab has been growing; however, the evidence of other immunomodulators and phototherapy is still insufficient. Therefore, an individualized stepwise approach with a goal of achieving complete symptom control and minimizing side effects can be recommended. Larger controlled studies are needed to elevate the level of evidence to select a rational therapeutic agent for patients with refractory CSU.
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KEYWORD
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Urticaria, antihistamine, treatment, guideline, evidence, leukotriene, IgE, cyclosporine
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