A Case of Autoimmune Chronic Urticaria Successfully Treated with Cyclosporine

Tanaka Toshihiko, Kitano Fumiaki, Kiriya Mamiko, Kameyoshi Yoshikazu, Ra Chisei, Hide Michihiro

doi:10.14924/dermatol.115.1011

Recently, histamine-releasing auto-antibodies that react with the high-affinity IgE receptor (FcεRI) or, less often, with IgE have been identified in chronic idiopathic urticaria. Although antihistamines remain the first line and essential treatment for chronic urticaria, immunosuppressive therapies, such as cyclosporine, are useful as an alternative treatments for cases recalcitrant to antihistamines or corticosteroids. A sixty-eight year-old woman consulted our clinic with a three-year history of daily attacks of weals with severe itch on her trunk and extremities. Her symptoms were recalcitrant against antihistamines or 10 mg/day predonisolone. She showed an immediate weal response to an autologous serum skin test, and her serum induced histamine release from basophils derived from a healthy donor. The amount of histamine release from basophils induced by her serum was enhanced by removing cell-surface IgE and abolished by preincubating the serum with soluble FcεRIα, indicating that her serum contains autoantibodies to FcεRIα. Making the diagnosis of autoimmune urticaria, oral cyclosporine 3 mg/kg was added to the preceding medications; this treatment resulted in disappearance of the itch and weal within a few days. The histamine-release activity in her serum also declined in parallel with the severity of clinical symptoms. Cyclosporine may have an inhibitory effect, not only on the degranulation of mast cells, but also on the production of serum autoantibodies with the histamine-releasing activity.

A Case of Autoimmune Chronic Urticaria Successfully Treated with Cyclosporine

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