Successful treatment of recalcitrant chronic idiopathic urticaria with sulfasalazine

Background: Antihistamines are the standard treatment for chronic idiopathic urticaria (CIU). For patients whose urticaria is unresponsive to antihistamines, the treatment options are limited. During the previous decade, there have been several case reports demonstrating success with sulfasalazine therapy. In this article, we present a case series evaluating sulfasalazine therapy for antihistamine-unresponsive CIU. Observations: Nineteen patients with antihistamine-unresponsive CIU were treated with sulfasalazine between 2002 and 2005. During sulfasalazine therapy, 14 patients (74%) reported significant improvement, 4 patients (21%) reported minimal improvement but were not satisfied with their symptom relief, and 1 patient (5%) reported a worsening of symptoms. Of the 13 patients who required systemic steroids to control their urticaria, all were able to reduce or discontinue steroid use during sulfasalazine therapy. Although 7 patients (37%) had adverse effects (eg, nausea, headache, mild or transient leukopenia, and transaminitis) that were thought to be caused by the use of sulfasalazine, they all kept taking the drug. Conclusions: This case series demonstrates that sulfasalazine can be a successful and safe treatment option for patients with CIU who have not responded adequately to treatment with antihistamines. Sulfasalazine was steroid sparing in all subjects who were steroid dependent.