- List articles in this issue
Evidence for Methotrexate as a Useful Treatment for Steroid-dependent Chronic Urticaria
Chronic urticaria is a relatively common disorder that can be severe and may impair quality of life. The management of recalcitrant chronic urticaria that is not responding to histamine antagonists includes short-term systemic corticosteroids, anti-inflammatory drugs (colchicine, dapsone and sulfasalazine) and immunomodulatory agents, such as cyclosporine, methotrexate, plasmapheresis and intravenous immunoglobulin. We report here our retrospective experience with the use of methotrexate in 8 patients (2 males and 6 females) with recalcitrant chronic urticaria who were not responding to high-dose first- and second-generation antihistamines. The mean duration of the disease prior to methotrexate treatment was 12 ± 8 months. Patients were treated for a mean duration of 4.5 months with a mean dose of 15 mg methotrexate/week. A complete response was achieved in 7 out of 8 patients (87%). Five out of the 7 patients were disease-free during a period of 1–10 months follow-up after discontinuing methotrexate and prednisone therapy. No serious adverse effects were reported. Methotrexate is an effective and safe treatment for chronic urticaria in patients who are not responsive to conventional therapy.
Lior Sagi, Michal Solomon, Sharon Baum, Anna Lyakhovitsky, Henri Trau, Aviv Barzilai
Greaves MW. Chronic idiopathic urticaria. Curr Opin Allergy Clin Immunol 2003; 3: 363–368.
Fiebiger E, Maurer D, Holub H, Reininger B, Hartmann G, Woisetschlager M, et al. Serum IgG autoantibodies directed against the alpha chain of Fc epsilon RI: a selective marker and pathogenetic factor for a distinct subset of chronic urticaria patients? J Clin Invest 1995; 96: 2606–2612.
Hide M, Francis DM, Grattan CE, Hakimi J, Kochan JP, Greaves MW. Autoantibodies against the high-affinity IgE receptor as a cause of histamine release in chronic urticaria. N Engl J Med 1993; 328: 1599–1604.
Tong LJ, Balakrishnan G, Kochan JP, Kinet JP, Kaplan AP. Assessment of autoimmunity in patients with chronic urticaria. J Allergy Clin Immunol 1997; 99: 461–465.
Zweiman B, Valenzano M, Atkins PC, Tanus T, Getsy JA. Characteristics of histamine-releasing activity in the sera of patients with chronic idiopathic urticaria. J Allergy Clin Immunol 1996; 98: 89–98.
Boehm I, Bauer R, Bieber T. Urticaria treated with dapsone. Allergy 1999; 54: 765–766.
Grattan CE, Francis DM, Slater NG, Barlow RJ, Greaves MW. Plasmapheresis for severe, unremitting, chronic urticaria. Lancet 1992; 339: 1078–1080.
Grattan CE, O’Donnell BF, Francis DM, Niimi N, Barlow RJ, Seed PT, et al. Randomized double-blind study of cyclosporin in chronic ’idiopathic’ urticaria. Br J Dermatol 2000; 143: 365–372.
Jaffer AM. Sulfasalazine in the treatment of corticosteroid-dependent chronic idiopathic urticaria. J Allergy Clin Immunol 1991; 88: 964–965.
O’Donnell BF, Barr RM, Black AK, Francis DM, Kermani F, Niimi N, et al. Intravenous immunoglobulin in autoimmune chronic urticaria. Br J Dermatol 1998; 138: 101–106.
Werni R, Schwarz T, Gschnait F. Colchicine treatment of urticarial vasculitis. Dermatologica 1986; 172: 36–40.
Zuberbier T, Asero R, Bindslev-Jensen C, Walter Canonica G, Church MK, Gimenez-Arnau AM, et al. EAACI/GA(2)LEN/EDF/WAO guideline: management of urticaria. Allergy 2009; 64: 1427–1443.
Gach JE, Sabroe RA, Greaves MW, Black AK. Methotrexate- responsive chronic idiopathic urticaria: a report of two cases. Br J Dermatol 2001; 145: 340–343.
Montero Mora P, Gonzalez Perez Mdel C, Almeida Arvizu V, Matta Campos JJ. Autoimmune urticaria. Treatment with methotrexate. Rev Alerg Mex 2004; 51: 167–172.
Perez A, Woods A, Grattan CE. Methotrexate: a useful steroid-sparing agent in recalcitrant chronic urticaria. Br J Dermatol 2010; 162: 191–194.
Weiner MJ. Methotrexate in corticosteroid-resistant urticaria. Ann Intern Med 1989; 110: 848.
Elias J, Boss E, Kaplan AP. Studies of the cellular infiltrate of chronic idiopathic urticaria: prominence of T-lymphocytes, monocytes, and mast cells. J Allergy Clin Immunol 1986; 78: 914–918.
Sabroe RA, Poon E, Orchard GE, Lane D, Francis DM, Barr RM, et al. Cutaneous inflammatory cell infiltrate in chronic idiopathic urticaria: comparison of patients with and without anti-FcepsilonRI or anti-IgE autoantibodies. J Allergy Clin Immunol 1999; 103: 484–493.
Kalb RE, Strober B, Weinstein G, Lebwohl M. Methotrexate and psoriasis: 2009 National Psoriasis Foundation Consensus Conference. J Am Acad Dermatol 2009; 60: 824–837.
Lyakhovitsky A, Barzilai A, Heyman R, Baum S, Amichai B, Solomon M, et al. Low-dose methotrexate treatment for moderate-to-severe atopic dermatitis in adults. J Eur Acad Dermatol Venereol 24: 43–49.
Comet R, Domingo C, Larrosa M, Moron A, Rue M, Amengual MJ, et al. Benefits of low weekly doses of methotrexate in steroid-dependent asthmatic patients. A double-blind, randomized, placebo-controlled study. Respir Med 2006; 100: 411–419.
Cronstein BN. Low-dose methotrexate: a mainstay in the treatment of rheumatoid arthritis. Pharmacol Rev 2005; 57: 163–172.
Cronstein BN. The antirheumatic agents sulphasalazine and methotrexate share an anti-inflammatory mechanism. Br J Rheumatol 1995; 34 Suppl 2: 30–32.
Cronstein BN, Naime D, Ostad E. The antiinflammatory mechanism of methotrexate. Increased adenosine release at inflamed sites diminishes leukocyte accumulation in an in vivo model of inflammation. J Clin Invest 1993; 92: 2675–2682.
Cutolo M, Sulli A, Pizzorni C, Seriolo B, Straub RH. Anti-inflammatory mechanisms of methotrexate in rheumatoid arthritis. Ann Rheum Dis 2001; 60: 729–735.
Morabito L, Montesinos MC, Schreibman DM, Balter L, Thompson LF, Resta R, et al. Methotrexate and sulfasalazine promote adenosine release by a mechanism that requires ecto-5’-nucleotidase-mediated conversion of adenine nucleotides. J Clin Invest 1998; 101: 295–300.
There are no related articles.
Share with your friends
There is no supplementary for this article.
Volume 91, Issue 3
View at PubMed