Spontaneous chronic urticaria (UCS) is a disease that affects 1% of the general population
with a potentially severe impact on quality of life. Most patients respond favorably to
long-term antihistamine treatment, but sometimes it is necessary to give a high dose (4 times
the formal dose, Berlin consensus 2016). These high doses are often accompanied by side
effects requiring cessation of treatment. The therapeutic alternative is then omalizumab, an
expensive biotherapy. UCS is secondary to non-specific mast cell activation. It has been
shown to be associated with activation of fibrinolysis that correlates with the severity of
symptoms. Patients with UCS resistant to levocetirizine were shown to have higher D-dimer
levels than patients who responded to antihistamines. Tranexamic acid is a molecule with
antifibrinolytic propertiesSeveral cases of severe chronic urticaria responding favorably to
treatment with tranexamic acid have been reported. In our department, Investigators also
noticed the improvement of some of their patients on tranexamic acid. The combination of
these two treatments appears to be synergistic: action on histamine receptors and control of
fibrinolysis.
The investigators propose to evaluate the association of tranexamic acid and levocetirizine
for the treatment of chronic spontaneous urticaria.