CHRONIC SULFASALAZINE THERAPY IN THE TREATMENT OF DELAYED PRESSURE URTICARIA AND ANGIOEDEMA

Background: Delayed pressure urticaria/angioedema can be profoundly di sabling with painful and prolonged swelling of feet and hands as well as systemic symptoms of malaise and flu-like illness. Occupations requ iring prolonged standing and forceful use of hands may be seriously co mpromised by this condition. The severe forms of the disease are usual ly unresponsive to antihistamines and nonsteroidal anti-inflammatory d rugs, and patients frequently require corticosteroids for control of s ymptoms. Objective: It was the purpose of this report to evaluate the clinical utility of sulfasalazine for two patients with refractory del ayed pressure urticaria. Methods: Sulfasalazine, starting at 500 mg/da y (with weekly incremental dosing to a total of 4 g), was administered to two patients with disabling pressure urticaria and angioedema (sym ptomatic daily with normal activities) who had failed all other report ed therapeutic options except corticosteroids. Results: Patient A requ ired daily prednisone in excess of 30 mg (for more than 6 months) to c ontrol his painful angioedema sufficiently in order to continue workin g asa colorectal surgeon. Patient B also experienced daily symptoms fo r more than 1 year. Both patients tolerated sulfasalazine to a dose of 4 g/day without adverse reactions and achieved complete resolution of symptoms. Patient A continued to be well controlled 1 year after star ting but must maintain a dose of 2 g or greater per day. Patient B rep orted excellent control 6 months after starting but was subsequently l ost to follow-up. Conclusion: Sulfasalazine, in doses used for inflamm atory bowel disease, appears to be an effective alternative therapy fo r delayed pressure urticaria and angioedema in patients poorly control led by traditional treatment and may act as a corticosteroid-sparing a gent.