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CC BY 4.0 · Arq Neuropsiquiatr 2024; 82(S 01): S1-S52
DOI: 10.1055/s-0044-1789320
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Chronic spontaneous urticaria during natalizumab therapy in a patient with multiple sclerosis: a case report

Authors

  • Ana Clara Rodrigues

    1   Centro de Referência em Esclerose Múltipla da Paraíba, João Pessoa PB, Brazil.

  • Bianca Oliveira

    1   Centro de Referência em Esclerose Múltipla da Paraíba, João Pessoa PB, Brazil.

  • Daniel Lima Júnior

    1   Centro de Referência em Esclerose Múltipla da Paraíba, João Pessoa PB, Brazil.

  • Davi Guerra

    1   Centro de Referência em Esclerose Múltipla da Paraíba, João Pessoa PB, Brazil.

  • Luiza Villarim

    1   Centro de Referência em Esclerose Múltipla da Paraíba, João Pessoa PB, Brazil.

  • Jeanina Dionizio

    1   Centro de Referência em Esclerose Múltipla da Paraíba, João Pessoa PB, Brazil.

  • Tania Albuquerque

    1   Centro de Referência em Esclerose Múltipla da Paraíba, João Pessoa PB, Brazil.
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    Address for correspondence: Ana Clara Rodrigues (email: clariguilherme@gmail.com).

    Abstract

    Case Presentation: A 40-year-old female patient with a confirmed diagnosis of multiple sclerosis (MS) since 2016 was initially treated with interferon β-1a 44 mg. In 2022, natalizumab was initiated as part of her therapy regimen. In July 2023, she began to experience episodes of urticarial lesions accompanied by pruritus. By November 2023, she was diagnosed with chronic urticaria following the persistence of symptoms for more than 6 weeks. Differential diagnoses, including rheumatological conditions, were thoroughly investigated. Despite the administration of high-dose H1 and H2 antagonists as first- and second-line treatments, there was no improvement. Subsequently, omalizumab was introduced as a third-line therapeutic option.

    Discussion: Chronic spontaneous urticaria (CSU) is characterized by the recurrent occurrence of pruritic wheals and/or angioedema lasting for over 6 weeks. Its etiology may involve autoantibodies or remain idiopathic, often devoid of identifiable external triggers. Previous literature has documented cases linking CSU with relapsing remitting multiple sclerosis, particularly in association with immunomodulatory agents such as interferons and alemtuzumab. Immunological dysregulation following medication administration appears to play a contributory role in this phenomenon. Standard therapeutic strategies involve the use of H1 and H2 antagonists, alongside leukotriene antagonists. In refractory cases, omalizumab, an anti-IgE monoclonal antibody, has emerged as a safe and efficacious option.

    Final Comments: Omalizumab demonstrates a favorable response rate of ~ 84% in cases of chronic urticaria. Its consideration in refractory chronic urticaria subsequent to the treatment of MS with immunomodulatory agents and monoclonal antibodies is warranted.


     

    Die Autoren geben an, dass kein Interessenkonflikt besteht.

    Publikationsverlauf

    Artikel online veröffentlicht:
    02. Oktober 2024

    © 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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