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Iron supplementation for chronic urticaria.

Of 122 patients (mean age, 42.5 years) with chronic urticaria (i.e., urticaria present for at least 6 consecutive weeks) who had had a poor response to conventional treatment with antihistamines and glucocorticoids, 81 (66%) were found to have moderately low serum iron. The patients with low serum iron received iron supplements (105 mg per day, as ferrous sulfate) for 30 to 45 days. One month after the first visit, improvement was greater than 80% in the patients treated with iron, as compared with an improvement of 20% to 30% in patients with normal serum iron who did not receive iron supplementation. Two months after the first visit, all 81 patients treated with iron had normal serum iron. Sixty-four (79%) of those 81 patients had complete remission of urticaria and the remaining 17 patients (21%) had greater than 80% improvement. Among the patients who received iron therapy, those whose serum iron levels were close to the lower limit of normal after treatment had less improvement than did patients who serum iron levels were higher.

Comment: Chronic urticaria is a common and difficult-to-treat problem. The results of the present study indicate that patients with chronic urticaria frequently have low serum iron levels, and that in those patients, iron supplementation results in considerable improvement in, or complete remission of, the urticaria. While a low serum iron level by itself is not definitive evidence of iron deficiency, a therapeutic trial of iron supplementation would seem reasonable for patients with chronic urticaria who have low serum iron.

The study did not investigate whether iron supplementation would be beneficial for patients with normal serum iron levels. Iron supplementation can cause acute liver failure or other serious adverse effects in people with hemochromatosis; therefore, iron overload should be ruled out before starting patients on iron therapy. The mechanism by which iron supplementation improves chronic urticaria is not known.

Guameri F et al. Oral iron therapy and chronic idiopathic urticaria: sideropenic urticaria? Dermatol Ther. 2014;27:223-226.

by Alan R. Gaby, MD

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Title Annotation:Literature Review & Commentary
Author:Gaby, Alan R.
Publication:Townsend Letter
Date:Jul 1, 2015
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