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 Park, Kui 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
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.