From the Guidelines
Rituximab is not generally indicated for the treatment of urticaria, and its use should be restricted to severe, refractory cases that have failed to respond to standard therapies. When considering rituximab for urticaria, it's essential to weigh the potential benefits against the risks, including infusion reactions, increased risk of infections, and rare but serious adverse events like progressive multifocal leukoencephalopathy 1. The current evidence base for rituximab in urticaria is limited, with some studies suggesting that it may not be effective in treating chronic spontaneous urticaria, as noted in a study where no improvement was seen in a patient with severe corticosteroid-dependent chronic urticaria given rituximab 1. Key points to consider when evaluating the use of rituximab for urticaria include:
- The patient's disease severity and refractoriness to standard treatments
- The potential risks and side effects associated with rituximab
- The need for screening for hepatitis B, tuberculosis, and other infections before initiating treatment
- The importance of managing treatment with specialists experienced in immunosuppressive therapies and complex urticaria cases Given the limited evidence and potential risks, rituximab should only be considered after exhausting conventional treatment options, including high-dose antihistamines and omalizumab. In general, immunomodulating therapies like ciclosporin, tacrolimus, and mycophenolate mofetil have been more extensively studied and may be considered as alternative options for severe, refractory chronic urticaria 1.
From the Research
Rituximab Indication in Urticaria
- Rituximab is not a commonly indicated treatment for urticaria, as the primary treatments include antihistamines, omalizumab, and cyclosporine 2, 3.
- However, there is evidence to suggest that rituximab may be effective in treating refractory chronic spontaneous urticaria (CSU) 4.
- A case study reported an 8-month remission of refractory CSU following the use of rituximab, suggesting that it may be a potential therapeutic option for patients who do not respond to other treatments 4.
- The mechanism by which rituximab may alleviate CSU symptoms is through the abrogation of autoantibody production, which is necessary for the development of the disease 4.
- Other treatments, such as omalizumab, have been shown to be effective in treating CSU, with a success rate of 65-80% 3.
- Newer agents, such as Bruton tyrosine kinase inhibitors and anti-KIT monoclonal antibodies, are being developed to treat refractory CSU, but more research is needed to determine their efficacy and safety 5.