warfarin and Urticaria

The chronic idiopathic urticaria treatment is a difficult and often frustrating problem for physicians. Due to the lack of definitive medical therapeutic programs to relieve the symptoms and prevent from their recurrence, several pharmacologic approaches to the management of chronic idiopathic urticaria are proposed. The chronic urticaria pharmacologic therapy is therefore fit to abrogate effects of histamine and other mediators on cutaneous vasculature and inflammatory cells that participate in the pathogenesis of the urticaria. The most common approach is to avoid all aggravating factors and to block histamine. The mainstay therapy is the H1 antihistamines. A significant number of patients may remain unresponsive even after an increase in the dose or a change in the type of H1 antihistaminic drug. In these cases, several therapies can be associated: combinations of H1 antihistamines, nonsedating one tablet (morning) and one sedating (evening), this approach is very usual but no study has confirmed it rational; addition an H2 antagonist to the previous treatment for some patients may improve control of their symptoms; alternatively, the tricyclic antidepressant, Doxepin is usually prescribed. The results of other drugs reported in the literature is unpredictable, to include them in a strategy therapy. The results with Badrenergic agents, nifedipine, ketotifen, leukotriene antagonists and tranexamic acid are variable and don't appear better than those with H1 antagonists. The efficiency of danazol has to be confirmed by other controlled studies. Warfarin, sulfasalazine and ultraviolet radiation have been used apparently successfully, but no controlled study has been published. Only when the above treatments have failed then immunosuppresive therapies, intravenous immunoglobulin and plasmapheresis can be proposed for chronic idiopathic urticaria.

Topics: Adrenergic beta-Agonists; Androgens; Anti-Allergic Agents; Antidepressive Agents, Tricyclic; Calcium Channel Blockers; Chronic Disease; Drug Resistance; Histamine H1 Antagonists; Histamine Release; Humans; Immunosuppressive Agents; Leukotriene Antagonists; Plasmapheresis; Ultraviolet Therapy; Urticaria; Warfarin

Chronic idiopathic urticaria is a disabling condition that does not always respond to antihistamine drugs and other agents are sometimes needed to control disease activity. Warfarin has demonstrated efficacy in single unblinded case studies [1] but has been dismissed by others [2].. We investigated the effect of warfarin treatment in eight patients with chronic idiopathic urticaria unresponsive to antihistamines in an open study. Six of the eight patients responded to treatment and three had a dramatic response. These three were included in a double-blind placebo-controlled trial of warfarin therapy to confirm significant benefit from treatment.. The three warfarin responders had their stable warfarin dose encapsulated and placebo capsules were provided. A double-blind placebo-controlled crossover trial was performed on each patient. Visual analogue scores recorded disease activity.. Comparison of visual analogue scores showed a significant benefit while on warfarin with a reduction in pruritus and angio-oedema.. This is the first double-blind placebo-controlled study to show a response of chronic idiopathic urticaria to warfarin. The mechanisms of action are unclear and require further study.

Topics: Adult; Angioedema; Anticoagulants; Chronic Disease; Cross-Over Studies; Dose-Response Relationship, Drug; Double-Blind Method; Drug Resistance; Female; Histamine; Humans; Intradermal Tests; Male; Middle Aged; p-Methoxy-N-methylphenethylamine; Pain Measurement; Placebos; Urticaria; Warfarin

Chronic spontaneous urticaria is a common condition, with a lifetime prevalence of 0.5-1.0%. It has a significant effect on quality of life, comparable to having triple-vessel coronary artery disease. Warfarin and nicoumalone are synthetic derivatives of the plant toxin coumarin. We report the first case of successful response to both warfarin and nicoumalone in the same patient, thereby demonstrating a class action of synthetic coumarins in the disease. Complete response with both coumarins occurred once an INR above 2.0 was achieved, and was maintained during a 12-month follow-up. The mechanism of action of coumarins on urticaria is not known, but may be related to decrease in thrombin production or to interference of activation of other inflammatory proteins produced during the coagulation process. Side-effects of anticoagulation can be catastrophic, and coumarin treatment currently remains reserved for restricted severe recalcitrant cases only.

Topics: Acenocoumarol; Administration, Oral; Chronic Disease; Dermatologic Agents; Female; Humans; International Normalized Ratio; Treatment Outcome; Urticaria; Warfarin; Young Adult

Topics: Adult; Angioedema; Humans; Male; Middle Aged; Urticaria; Warfarin

Topics: Adult; Angioedema; Humans; Male; Urticaria; Warfarin

Topics: Adult; Angioedema; Chronic Disease; Humans; Male; Middle Aged; Patient Compliance; Urticaria; Warfarin

Topics: Animals; Dog Diseases; Dogs; Female; Urticaria; Vitamin K; Warfarin

Topics: Coumarins; Humans; Peripheral Vascular Diseases; Urticaria; Vascular Diseases; Warfarin