More therapeutic alternatives for chronic idiopathic urticaria?

From a recent review of the literature (updated November 30, 2007) it emerges that more than 3,000 patients with chronic idiopathic urticaria (CIU) have been studied for antithyroid antibodies (ATA). The prevalence of ATA in CIU seems to vary from 1% to 29% (higher in women in all the studies); in most studies, however, it is significantly higher in patients with CIU than in control patients or in the general population. Our recent figures obtained in more than 500 patients (presented at the 2007 World Allergy Congress held in Bangkok) are 33% in women and 15% in men (P < .001). Some authors report the prevalence of ATA to be significantly more elevated in patients classified as having autoimmune urticaria on the basis of the results of both the autologous serum skin test and the in vitro histamine release assay.

We observed no beneficial effect of thyroxin treatment on symptom scores of 46 hypothyroid cases. We therefore agree with the recently published British Society for Allergy and Clinical Immunology guidelines for the management of chronic urticaria and angioedema,4 which state that if there is a clear rationale for treating the hypothyroid state with thyroxin, the use of thyroxin in a euthyroid subject is controversial and not recommended. Nevertheless, we believe that this topic should have been discussed