We thank Taskapan and Harmanyeri for their interest in our recent article.1 We agree that in our patient, the cause of her urticaria was probably autoimmune in origin. In our article we point out that antithyroid microsomal antibodies and antiplatelet antibodies were present in her serum. In addition, when she did not respond to treatment with antihistamines and oral prednisone, we treated her for what we believed to be autoimmune urticaria with pulse methylprednisolone sodium succinate (Solu-Medrol), and then with plasmapheresis followed by cyclophosphamide, with transient but moderate improvement. It was not until she received ketotifen fumarate, a mast cell stabilizer,2 that her urticaria started to improve. As we also stated, she continued to have lesions but they were fewer in number and not as severe. The patient now has been free of urticaria for approximately 1 year and remains taking only ketotifen, which she is fearful of discontinuing. She has not experienced any sedation from the use of the medication.
Egan CA, Rallis TM. Ketotifen and Chronic Urticaria—Reply. Arch Dermatol. 1998;134(2):241. doi: