Effective treatments for urticarial vasculitis

A meta-analysis of effective and ineffective treatments

What treatments are available for patients with the rare inflammatory disease known as urticarial vasculitis? How effective are these treatments? Researchers from Charité – Universitätsmedizin Berlin embarked on a systematic review and meta-analysis to address these questions. Recently published in the Journal of Allergy and Clinical Immunology*, the results of this meta-analysis reveal which of the available treatment options offer more promising outcomes. 

Urticarial vasculitis is a rare inflammatory disease of blood vessels which affects between 20,000 and 50,000 people in Germany every year. The disease remains difficult to treat, and none of the drugs currently used in the treatment of urticarial vasculitis have been specifically approved for this purpose. Physicians use an array of treatment options to help patients, and do so with widely varying results. With this in mind, a team of researchers led by Prof. Dr. Marcus Maurer, Head of Research at Charité's Department of Dermatology, Venereology and Allergology, set out to determine which of the options available would prove effective in treating urticarial vasculitis. To do so, the researchers carried out a meta-analysis of 250 publications, all of which reported on the treatment of patients with urticarial vasculitis. The central result of their meta-analysis is that patients with urticarial vasculitis appear to benefit from treatment with corticosteroids, biologics and immunosuppressive agents. In contrast, antihistamines and other anti-inflammatory drugs appeared to be ineffective.

Antihistamines are commonly used to treat patients with urticaria. While urticaria and urticarial vasculitis share a similar symptom complex (itching, wheals, redness and swelling of the skin), they do not represent variants of the same condition. The similarities of their dermatological manifestations mean that urticarial vasculitis is often mistaken for ordinary urticaria. 

“Our research is helping to ensure that we can improve the treatment of patients with urticarial vasculitis,” says Prof. Maurer. He adds: “Our future research projects will aim to develop criteria for improving the diagnosis of urticarial vasculitis. We are also hoping to develop methods that will enable us to objectively measure a patient’s response to treatment. These efforts will form the basis of future research to develop treatments specifically targeted at urticarial vasculitis.”

*Kolkhir P, Grakhova M, Bonnekoh H, Krause K, Maurer M. Treatment of urticarial vasculitis: A systematic review. J Allergy Clin Immunol. 2018 Sep 27. pii: S0091-6749(18)31356-3. doi: 10.1016/j.jaci.2018.09.007.

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