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

Jeong Hee Choi, Dong Hun Lee, Woo Jung Song, Mira Choi, Jae Woo Kwon, Gun Woo Kim, Myung Hwa Kim, Mi Ae Kim, Min Hye Kim, Byung Keun Kim, Sujeong Kim, Joung Soo Kim, Jung Eun Kim, Ju Young Kim, Joo Hee Kim, Hyun Jung Kim, Hye One Kim, Hyo Bin Kim, Joo Young Roh, Kyung Hee ParkKui Young Park, Han Ki Park, Hyunsun Park, Jung Min Bae, Ji Yeon Byun, Dae Jin Song, Young Min Ahn, Seung Eun Lee, Young Bok Lee, Joong Sun Lee, Ji Hyun Lee, Kyung Hwan Lim, Sang Woong Youn, Yoon Seok Chang, You Hoon Jeon, Jiehyun Jeon, Mihn Sook Jue, Sun Hee Choi, Gyu Young Hur, Dae Hyun Lim, Young Min Ye, Young Min Park

Research output: Contribution to journalReview articlepeer-review

8 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)750-770
Number of pages21
JournalAllergy, Asthma and Immunology Research
Volume12
Issue number5
DOIs
StatePublished - 2020

Keywords

  • Antihistamine
  • Cyclosporine
  • Evidence
  • Guideline
  • IgE
  • Leukotriene
  • Treatment
  • Urticaria

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