Are You Harnessing Collaboration Between Specialties to Address Uncontrolled CSU?
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Which of the following is a characteristic of chronic spontaneous urticaria?
Absence of systemic inflammatory disease
Inability to trigger wheals through allergen testing and angioedema
Predictable pattern of exacerbation
Presence of exercise-induced anaphylaxis
Which of the following are events of special interest for the BTK class of investigational drugs and must be monitored carefully while administering them as part of a clinical trial to a patient with CSU?
Infection
Rash
Platelet dysfunction
Abdominal pain
Genelia is a 60-year-old woman who presents with a 6-month history of recurrent wheals and several episodes of facial angioedema. She has NSAID intolerance, hypertension, and a BMI of 38. Her lab values include an IgE of 120 kU/L and no evidence of anti-TPO autoantibodies. Previously, she has been treated with second-generation H-1 antihistamines and up to 450 mg of omalizumab per month. She is unable to take cyclosporine due to hypertension. She has experienced significant impairment in her quality of life. For her most recent flare up, a regimen of omalizumab and sg-H1 antihistamines plus steroids has not worked.
What is the next step in her management based on best evidence?
Administration of alternative, corticosteroid-sparing agent
Add montelukast 10 mg by mouth QHS
Administer a tapering course of oral corticosteroids
No change to current regimen
Done
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