Estimates suggest that approximately 30% of patients with chronic urticaria (CU) are refractory to antihistamines,1 a disease characteristic that, in our experience, frequently results in the use of corticosteroids to control acute flares and maintain remission. Reluctance may exist on the part of the patient or physician to use immunomodulatory medications as steroid-sparing agents in the treatment of this frustrating condition because of adverse side effects, need for laboratory monitoring, and uncertainty of outcome. We recently conducted a retrospective chart review to determine the relative effectiveness and safety of immunomodulatory therapies used in our tertiary clinic practice to treat antihistamine-refractory CU.
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