Efficacy and safety of sulfasalazine in patients with chronic idiopathic urticaria

Roy Anthony Orden, Hersha Timble, Sarbjit S Saini

Research output: Contribution to journalArticle

Abstract

Background There are limited data regarding alternative treatments for antihistamine refractory chronic idiopathic urticaria (CIU). Patients with recalcitrant skin disease often cannot gain satisfactory symptom control with standard therapies and may require prolonged courses of oral corticosteroids. There is a lack of information describing the degree and duration of sulfasalazine's efficacy, the frequency and nature of adverse reactions, and the appropriate safety monitoring parameters. Objective To present a case series detailing the efficacy and safety of sulfasalazine therapy in patients with CIU. Methods A retrospective chart review was conducted of 39 patients with sulfasalazine-treated CIU evaluated at Johns Hopkins Asthma and Allergy Center from October 2007 to March 2012. Eight patients were excluded from the final analysis. Results Twenty-six patients (83.9%) showed an improvement in symptoms within the first 3 months, with 51.6% of patients (n = 16) becoming asymptomatic within the first 6 months of starting sulfasalazine. Eleven patients (35.4%) achieved complete relief of symptoms after tapering off sulfasalazine therapy. Five of the 31 patients (16.1%) failed treatment, defined as worsening symptoms and pursuit of an alternative therapy. Six of 31 patients (19.4%) had a modified course of sulfasalazine therapy owing to abnormal hematologic parameters. Serious adverse events leading to drug discontinuation occurred in 6.5% of patients (n = 2) and included a patient with drug-induced leukopenia and one with rhabdomyolysis. Conclusion Sulfasalazine is a highly effective treatment for patients with antihistamine resistant CIU. The frequency of adverse events leading to an alteration of sulfasalazine treatment supports the need for close monitoring of these patients.

Original languageEnglish (US)
Pages (from-to)64-70
Number of pages7
JournalAnnals of Allergy, Asthma and Immunology
Volume112
Issue number1
DOIs
StatePublished - Jan 2014

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Sulfasalazine
Urticaria
Safety
Histamine Antagonists
Therapeutics
Rhabdomyolysis
Leukopenia
Physiologic Monitoring
Complementary Therapies
Skin Diseases
Pharmaceutical Preparations
Adrenal Cortex Hormones
Hypersensitivity
Asthma

ASJC Scopus subject areas

  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine

Cite this

Efficacy and safety of sulfasalazine in patients with chronic idiopathic urticaria. / Orden, Roy Anthony; Timble, Hersha; Saini, Sarbjit S.

In: Annals of Allergy, Asthma and Immunology, Vol. 112, No. 1, 01.2014, p. 64-70.

Research output: Contribution to journalArticle

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abstract = "Background There are limited data regarding alternative treatments for antihistamine refractory chronic idiopathic urticaria (CIU). Patients with recalcitrant skin disease often cannot gain satisfactory symptom control with standard therapies and may require prolonged courses of oral corticosteroids. There is a lack of information describing the degree and duration of sulfasalazine's efficacy, the frequency and nature of adverse reactions, and the appropriate safety monitoring parameters. Objective To present a case series detailing the efficacy and safety of sulfasalazine therapy in patients with CIU. Methods A retrospective chart review was conducted of 39 patients with sulfasalazine-treated CIU evaluated at Johns Hopkins Asthma and Allergy Center from October 2007 to March 2012. Eight patients were excluded from the final analysis. Results Twenty-six patients (83.9{\%}) showed an improvement in symptoms within the first 3 months, with 51.6{\%} of patients (n = 16) becoming asymptomatic within the first 6 months of starting sulfasalazine. Eleven patients (35.4{\%}) achieved complete relief of symptoms after tapering off sulfasalazine therapy. Five of the 31 patients (16.1{\%}) failed treatment, defined as worsening symptoms and pursuit of an alternative therapy. Six of 31 patients (19.4{\%}) had a modified course of sulfasalazine therapy owing to abnormal hematologic parameters. Serious adverse events leading to drug discontinuation occurred in 6.5{\%} of patients (n = 2) and included a patient with drug-induced leukopenia and one with rhabdomyolysis. Conclusion Sulfasalazine is a highly effective treatment for patients with antihistamine resistant CIU. The frequency of adverse events leading to an alteration of sulfasalazine treatment supports the need for close monitoring of these patients.",
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