Impact of hydroxychloroquine therapy on chronic urticaria: chronic autoimmune urticaria study and evaluation

Authors: Reeves, G. E. M.1; Boyle, M. J.1; Bonfield, J.2; Dobson, P.1; Loewenthal, M.1

Source: Internal Medicine Journal, Volume 34, Number 4, April 2004 , pp. 182-186(5)

Publisher: Wiley-Blackwell

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Abstract:

Abstract Background: 

Chronic urticaria (CU) imposes profound impairment on quality of life. Up to 60% of idiopathic CU is associated with autoimmune phenomena, and may respond to immunomodulation. Hydroxychloroquine offers potential efficacy for CU and is relatively benign compared with most other therapeutic approaches. Objective: 

The aim of the chronic autoimmune urticaria study and evaluation was to evaluate the efficacy of hydroxychloroquine in patients with chronic idiopathic urticaria. Methods: 

Twenty-one patients referred to the Immunology and Allergy Unit at John Hunter Hospital, New South Wales, Australia, with idiopathic CU were randomised to receive treatment with standard urticaria therapies (corticosteroids, H2-antihistamines, H1-¬≠antihistamines, doxepin) with or without hydroxychloroquine. Markers of autoimmunity, thyroid disease and mast-cell autoreactivity (autologous serum skin-prick testing (ASPT)) were assessed. Measures of urticaria control were compared at baseline and at 12 weeks for the 18 individuals who completed the study. These included urticaria scores, medication scores and quality-of-life indices. Results: 

The hydroxychloroquine-treated group achieved significant improvements in quality of life as assessed by the global symptom severity score and the LAMY-7 (a quality of life index designed by Lamy, 7th revision) at 12 weeks (P < 0.01 and P < 0.05, respectively). No significant treatment effect on medication requirements or urticaria score was detected, although differences between treatment groups approached statistical significance for urticaria score and medication requirements (0.05 < P < 0.10). ASPT-reactivity did not correlate to hydroxychloroquine-responsiveness. Hydroxychloroquine was well tolerated. Conclusion: 

Immunomodulation with hydroxychloroquine is safe and appears to offer some efficacy as an intervention in CU. (Intern Med J 2004; 34: 182−186)

Keywords: chronic urticaria; hydroxychloroquine; ­autologous skin testing

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1444-0903.2004.00532.x

Affiliations: 1: Department of Immunology and Infectious Diseases and 2: Department of Nursing, John Hunter Hospital, Newcastle, New South Wales, Australia

Publication date: April 1, 2004

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