慢性荨麻疹:一种新的治疗方法

慢性荨麻疹的治疗基本上是对症治疗。已经使用了许多药物，但没有一种是治愈的。这包括抗组胺阻滞剂、抗白三烯、皮质类固醇、环孢素、羟氯喹、氨苯砜、柳氮磺胺、甲氨喋呤、静脉注射丙种球蛋白和奥玛珠单抗[1,2]。其他生物制剂如利妥昔单抗已被证实可成功治疗慢性自身免疫性难治性荨麻疹[3]。最近，Kocaturk E等人表明，研究性物质P拮抗剂C5^一个/ C5^一个受体抑制剂，抗IL4，抗IL5和抗IL13等可靶向治疗[4]。最近，更多的生物制剂被提议用于治疗荨麻疹，如Ligelizumab，以及靶向细胞内信号通路的分子，如脾脏酪氨酸酶激酶抑制剂和其他[5]。慢性荨麻疹的其他替代疗法包括阿达木单抗、维生素D、益生菌、组织蛋白、自体全血或血清注射[6]和光疗[7]。

这些治疗模式都不能长期缓解慢性荨麻疹。我们问自己，该如何处理慢性荨麻疹患者，唯一确定的原因是对花粉敏感，特别是当荨麻疹与其他过敏症状相关时，如过敏性鼻炎，或过敏性哮喘，或两者兼有。在我们的患者中最常见的致敏过敏原是艾草，俄罗斯蓟，苋和菊。部分患者对杂草、草和牧豆树敏感。由于我们地区一年12个月都有阳光，植物全年都在授粉。因此，我们决定从患者耐受无反应的低浓度局部变应原疫苗开始治疗。我们知道一些过敏专科医生使用更高浓度的疫苗进行维持，我们的患者无法耐受浓度超过1:500 w/v而无反应。这可能是因为花粉一直在空气中，此外，人们还发现花粉会被沙粒碾碎，这使花粉的威力更大。在我们得到所有患者的同意之前，他们都被告知这是一种新方法。在开始SCIT一年后，我们的大多数患者有显著的改善，大多数停止对症治疗。 Xing DR, et al., [8] treated 2885 patients who had chronic urticaria and dust mite allergy, with immunotherapy with good to excellent results; with efficacy of 91.1% (226/248) with 66.1% of excellent or good results. Collins found more mugwort and birch sensitization in patients with chronic urticaria compared to allergicrhinitis but no allergy vaccine was given [9]. Similar studies by other authors showed the same [10,11]. There is one case report by Kasperska-Zajak where a patient with respiratory allergy and CU his Urticaria flared up during Immunotherapy with dust mite suggesting that Immunotherapy is beneficial in sensitized chronic urticaria [12]. Mahesha, et al., found high sensitivity among patients with urticaria to dust mite suggesting that allergy may play a role in the cause of chronic urticaria [13].Our patients had overall efficacy of immunotherapy of 86% with 14% (4/29) patients showed 100% remission of their urticaria compared to patient who stayed on symptomatic treatment. Although some cases of chronic urticaria go into remission even without treatment, our patients were symptomatic all the time and they did not benefit from other forms of treatment. Furthermore, we observed the continuity of their urticaria two weeks before SCIT. Their remission after SCIT cannot be attributed to natural course of remission and relapse. We believe our study proves that chronic urticaria is amenable to treatment with allergy vaccine when pollens are the main or the only underlying cause.This novel approach has no previous similar study in the English literature. Therefore, more studies are needed to confirm our findings. Although some authors mentioned that chronic urticaria is not allergic [14].