Immunosuppressive therapy

Back to decision-making tree Print last updated on 18/09/2020

In situations of CSU refractory to anti-H1 antihistamines

Cyclosporine is the most widely used immunosuppressant after failure of treatment with a single or double dose. The dose of cyclosporine was 4 or 5 mg/kg/day at initiation, followed by a rapid and progressive reduction in 15-day increments. The maximum study period was 6 months. Cyclosporine was prescribed in addition to conventional or double-dose anti-H1 antihistamines. Adverse effects were frequent (paraesthesia, headaches, digestive disorders, hypertrichosis, high blood pressure).

The WG considers that cyclosporine can be used in the treatment of refractory CSU in addition to anti-H1 antihistamines.

Methotrexate at a dose of 15 mg/week was not shown to be superior to placebo when taken in addition to anti-H1 antihistamines (at variable doses). It cannot be recommended.

Most experts use cyclosporine to treat CSU in adults and children from 12 years of age, in case of contraindication or failure of omalizumab, in addition to 4 doses of anti-H1 antihistamines.

No studies have been conducted on the use of other immunosuppressants in CSU, so the WG does not recommend them.

Cyclosporine and pregnancy or breastfeeding

There appears to be an increased risk of mother-to-child infections. Isolated cases of thrombocytopenia, neutropenia and neonatal lymphopenia have been reported that may warrant a complete blood count (CBC) within the first days of life in newborns.

Breastfeeding may be permitted in full-term, healthy newborns if the dose taken by the mother is low. In other circumstances, the decision must be made on a case-by-case basis.

Cyclosporine and drug interaction

Caution should be exercised when using cyclosporine with other nephrotoxic drugs.

➜ treatment with omalizumab