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ALLERGIES
cause found.(4) Most authorities suggest CBC, matol. 2003;48:409–416.
ESR or CRP; often some more extensive labo- 5. Chang S, Carr W. Urticarial vasculitis. Allergy Asthma Proc
ratory work up may be suggested to include thy-
roid function tests, liver function tests and 2007;28:97-100
urinalysis. The main reason the laboratory eval- 6. Staevska M; Popov TA; Kralimarkova T et al. The effectiveness
uation is performed is not to identify the cause
but rather to ensure there is no hidden cause. In of levocetirizine and desloratadine in up to 4 times conventional
case of suspected urticarial vasculitis, skin biopsy doses in difficult-to-treat urticaria. J Allergy Clin Immunol.
is necessary.(5) 2010; 125(3):676-682
7. Gómez-Vera J Gutiérrez-Ávila SA Acosta-Gutiérrez DN, et al.
The cornerstones of treatment are the anti- Ann Allergy Asthma Immunol. 2016;117:204-206. Omalizumab
histamines which may be used at much higher in the treatment of antihistamine-resistant chronic urticaria in
doses than used for treatment of allergic rhini- adults.
tis, often four times the usual dose.(6) Combi- 8. Kaplan AP; Therapy of chronic urticaria: a simple, modern ap-
nations of two antihistamines may be more effective for many proach. Ann Allergy Asthma Immunol. 2014; 112:419-425
patients than just doubling the dose of one. 9. Saini SS, Bindslev-Jensen C, et al. Efficacy and safety of omal-
izumab in patients with chronic idiopathic/spontaneous urticaria
Short courses of oral steroids may be used in case of recalcitrant who remain symptomatic on H1 antihistamines: a randomized,
urticaria, although this is not a treatment recommended by all ex- placebo-controlled study. J Invest Dermatol. 2015;135:67e75
perts due to the adverse effects.
Dr. Chris Christodoulou completed his medical studies
One of the latest treatments of recalcitrant hives is omalizumab, at the Semmelweis University of Medicine in Budapest,
an anti IgE monoclonal antibody that targets IgE. Several studies Hungary (1990). Thereafter he did his residency in In-
that have evaluated its efficacy suggest that this is a good therapeutic ternal Medicine at Easton Hospital, PA (1992-1995),
option in patients who have failed other standard treatment modal- followed by a fellowship in allergy-immunology at the UTHSCSA, in
ities. About 65 percent of patients resistant to antihistamines re- San Antonio, TX (1995-1997). He then continued his education as a
sponded favorably to omalizumab and about 40 percent of patients subspecialty fellow in Clinical Laboratory Immunology (CLI) at All
were completely free of hives while on this drug. No major adverse Children’s Hospital, St. Petersburg, FL which was extended to a total of
effects were recorded although very rarely anaphylactic reactions 2 years (1997-1999). After completing his education he returned to his
were reported. home country Cyprus where he practiced allergy-immunology until
2015, when he returned to San Antonio and has been practicing here
References: since then.
1. Bernstein JA; Lang DM; Khan DA; et al. The diagnosis and man-
Practice: MedCare Associates, 19260 Stone Oak Parkway, Suite 105,
agement of acute and chronic urticaria: 2014 update. J Allergy San Antonio TX 78258, tel: (210) 402-3456
Clin Immunol. 2014;133:1270-1277
2. Powell RJ, Du Toit GL, Siddique N, et al.; British Society for Al-
lergy and Clinical Immunology (BSACI) guidelines for the man-
agement of chronic urticaria and angio-oedema. Clin Exp Allergy.
2007;37:631–650.
3. Grattan CE, Humphreys F; British Association of Dermatologists
Therapy Guidelines and Audit Subcommittee. Guidelines for
evaluation and management of urticaria in adults and children.
Br J Dermatol. 2007;157:1116–1123.
4. Kozel MM, Bossuyt PM, Mekkes JR, Bos JD. Laboratory tests
and identified diagnoses in patients with physical and chronic
urticaria and angioedema: a systematic review. J Am Acad Der-
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