Successful use of mycophenolate mofetil to treat severe chronic urticaria in a patient intolerant to ciclosporin

Conflict of interest: none declared. Mycophenolate mofetil (MMF) is a pro‐drug of mycophenolic acid, which acts by inhibiting lymphocyte proliferation and antibody production. A number of reports have been published on its effectiveness in treating several dermatological conditions, including psoriasis, immunobullous diseases and connective‐tissue disorders.1 We report the use of MMF to treat chronic urticaria (CU). A 34‐year‐old white woman presented with a 3‐month history of daily symptoms of CU. Before her referral to us, she had been treated by her general practitioner with conventional high‐dose H1 and H2 receptor antagonists (cetirizine, levocetirizine and loratidine at different times; at her time of presentation and she had been on a combination of fexofenadine 180 mg twice daily and ranitidine 300 mg once daily for 6 weeks). She had a family history of hypothyroidism. We found that the patient was positive for thyroid peroxidase antibodies. She was started on ciclosporin 3 mg/kg, with a good response within 3 weeks. This was reduced and stopped after 6 months, without relapse for 3 years. On subsequent flare, ciclosporin was prescribed, but although effective, this had to be discontinued because of nephrotoxicity. The condition responded to prednisolone 25 mg/day and MMF 500 mg twice daily. The MMF was gradually increased to a dose of 1.5 g twice daily, allowing cessation of the oral prednisolone. With this dose, the patient's symptoms were well controlled for 6 months, but relapsed each time the dose was reduced below 500 mg twice daily, thus this dose was continued for a further 10 months. Fexofenadine 180 mg daily was then re‐introduced, which resulted in an improvement in symptoms that was sufficient to allow reduction and withdrawal of MMF without recurrence. She had no side‐effects or laboratory abnormalities during treatment, and no recurrence of the CU occurred during the 6‐month follow‐up after discontinuation of MMF.