IADVL
Indexed with PubMed and Science Citation Index (E) 
 
Users online: 5822 
     Home | Feedback | Login 
About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe What's New Contact  
  Navigate here 
  Search
 
   Next article
   Previous article 
   Table of Contents
  
 Resource links
   Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
   Article in PDF (73 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   References

 Article Access Statistics
    Viewed7040    
    Printed119    
    Emailed4    
    PDF Downloaded186    
    Comments [Add]    
    Cited by others 7    

Recommend this journal

 
LETTER TO EDITOR
Year : 2004  |  Volume : 70  |  Issue : 6  |  Page : 377

Methotrexate in autoimmune urticaria


Consultant Dermatologist, Navi Mumbai, India

Correspondence Address:
Shree Skin Centre, 22, L Market, Sector 8, Nerul, Navi Mumbai - 400706, India
drgodse@yahoo.co.in



How to cite this article:
Godse K. Methotrexate in autoimmune urticaria. Indian J Dermatol Venereol Leprol 2004;70:377


How to cite this URL:
Godse K. Methotrexate in autoimmune urticaria. Indian J Dermatol Venereol Leprol [serial online] 2004 [cited 2019 Oct 23];70:377. Available from: http://www.ijdvl.com/text.asp?2004/70/6/377/13486


Sir,

Chronic idiopathic urticaria may be autoimmune in origin (autoimmune urticaria), caused by functional autoantibodies that activate mast cells and basophils through cross linking the high affinity IgE receptor (Fc RI ) to secrete histamine.[1] An incidence of 30% to 50% has been reported by various investigators.[1] While there are no clinical features that distinguish ordinary urticaria from autoimmune urticaria, a simple test, the autologous serum skin test, can be used to detect functional autoantibodies. Patients with autoimmune urticaria whose disease is pursuing a severe disabling and recalcitrant course have been treated with immunosuppressive therapy, including cyclosporine.[2] However, its high cost makes this drug an impractical option in India. Gach et al successfully tried methotrexate in two patients without detectable autoantibodies and in whom steroids and antihistamines were not effective.[3] However, there are no randomized controlled studies of the use of methotrexate in patients with autoimmune urticaria.[4] We report our preliminary experience of using methotrexate in four patients with autoimmune urticaria.

We tested 45 patients (age ranging from 15 to 55 years) with chronic idiopathic urticaria with the autologous serum skin test for autoantibodies. Twelve of them showed a positive result, including four (3 females and 1 male) who were recalcitrant to treatment with oral antihistamines (fexofenadine, cetirizine, hydroxyzine). After performing baseline investigations (complete blood count, random blood sugar, SGPT, and urine examination), we tried methotrexate in these patients with autoimmune urticaria in a dose of 2.5 mg orally twice a day on Saturday and Sunday of every week. Informed consent was taken before starting methotrexate. In addition, cetirizine 10 mg and folic acid 1.5 mg were given daily. All four patients showed a remarkable effect in the form of reduction in whealing and itching in one month. Investigations were repeated after one month for monitoring of side effects. Treatment with methotrexate was continued for 2 months and later only cetirizine was continued. One patient developed a relapse within two weeks of stopping methotrexate and was again started on methotrexate.

All the four patients had troublesome urticaria that was difficult to control with antihistamines alone. After a course of methotrexate the urticaria was controllable with cetirizine in three patients. In India methotrexate has the potential of being a viable option for the treatment of resistant autoimmune urticaria as it is cost effective and most dermatologists have the experience of using it for psoriasis. A larger controlled study needs to be undertaken to confirm these preliminary findings. 

  References Top

1.Grattan CE. Autoimmune urticaria. Immunol Allergy Clin North Am 2004;24:163-81.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.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;143:365-72.  Back to cited text no. 2    
3.Gach JE, Sabroe RA, Greaves MW, Black AK. Methotrexate responsive chronic idiopathic urticaria: A report of two cases. Br J Dermatol 2001;145:340-3.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Grattan CE, Sabroe RA, Greaves MW. Chronic urticaria. J Am Acad Dermatol 2002;46:645-60.  Back to cited text no. 4    

 

Top
Print this article  Email this article
Previous article Next article

    

Online since 15th March '04
Published by Wolters Kluwer - Medknow