Chronic Spontaneous Urticaria: The Importance of Prompt Diagnosis and Evidence-based Management with Targeted Biologic Therapies
Podcast 2 Pre-test

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Janet is a 66-year-old woman who presents with an 8-month history of recurrent wheals all over her body and several episodes of angioedema. She has had some relief in association with several oral steroid courses, but has developed high blood sugar as a result of these treatments. She also has difficulty controlling her hypertension, and a BMI of 32. She has been treated with a second-generation H-1 antihistamine, a H-2 antihistamine, and an anti-leukotriene agent taken daily. She has experienced significant impairment in her quality of life.

Laboratory studies:

IgE = 180 IU/ml

ESR = 14 mm/hr

ANA = negative

CMP, CBC, TSH = WNL or unremarkable.

Which of the following is true based on best evidence concerning next steps in her management?

Dietary elimination of salicylates would be likely to result in improvement

Elevated IgE level is a favorable prognostic sign, indicating salutary response to omalizumab is more likely

Therapeutic trial of cyclosporine (3-5 mg/kg/day) would be favorable from a risk/benefit standpoint

Therapeutic trial of doxepin, advanced to 75-100 mg/day, would be in her best health care interest