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existen cohortes y series de casos tratados con este f&#225;rmaco a dosis bajas durante periodos de tiempo m&#225;s prolongados &#63;de hasta 10 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a>&#63;&#46; Realizamos este estudio con el objetivo de conocer mejor el uso de la ciclosporina en UCE en pacientes con fracaso previo al omalizumab&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Dise&#241;amos un estudio observacional&#44; longitudinal y prospectivo de los pacientes con un diagn&#243;stico de UCE tratados con ciclosporina en nuestro centro&#44; que ya hab&#237;an fracasado al tratamiento con omalizumab&#46; Se recogieron variables epidemiol&#243;gicas&#44; cl&#237;nicas y de gravedad de la urticaria mediante la escala Urticaria Activity Score de los &#250;ltimos 7 d&#237;as &#63;UAS7d&#63;&#44; as&#237; como la dosis de ciclosporina en distintos momentos del tratamiento &#40;al inicio&#44; dosis m&#225;xima&#44; al final del tratamiento&#41;&#44; el tiempo de tratamiento y de seguimiento&#44; y los efectos adversos observados&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">De un total de 38 pacientes que hab&#237;an recibido tratamiento con omalizumab&#44; 3 &#40;7&#44;9&#37;&#41; no respondieron al f&#225;rmaco biol&#243;gico y fueron tratados con ciclosporina &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; El UAS7d al inicio del tratamiento con la ciclosporina era de 24&#44; 41 y 42&#46; Se inici&#243; ciclosporina a dosis de 3&#44;8&#44; 3&#44;15 y 3&#44;85<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#237;a&#44; respectivamente&#46; En los 3 pacientes se alcanz&#243; el control de la enfermedad &#40;UAS7d<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#41; en el primer mes de tratamiento&#44; lo que permiti&#243; disminuir la dosis de ciclosporina progresivamente sin rebrotes de la enfermedad y su suspensi&#243;n tras 5&#44; 14 y 12 meses&#44; con una dosis de ciclosporina de entre 0&#44;46 y 0&#44;68<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#237;a&#46; No hemos observado recidiva de la urticaria en ninguno de los pacientes&#44; ni efectos adversos relevantes durante el seguimiento&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Aunque cl&#225;sicamente se ha utilizado la ciclosporina en el tratamiento de la UCE&#44; no hay pautas definidas de su uso&#46; En un metaan&#225;lisis publicado en el a&#241;o 2017<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a>&#44; se analizan los distintos estudios publicados en la literatura&#44; entre ellos 2 ensayos cl&#237;nicos<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4&#44;5</span></a>&#46; Los resultados indican que la ciclosporina es eficaz para el tratamiento de la UCE&#44; pero son dif&#237;ciles de extrapolar a la vida real&#44; puesto que el paciente candidato a este tratamiento tiene una UCE no controlada con omalizumab y de larga duraci&#243;n en el tiempo&#44; dependiente de ciclos de corticoides orales frecuentemente&#46; Hemos de remontarnos a art&#237;culos publicados antes de la aprobaci&#243;n del omalizumab para poder acercarnos a unas pautas con las que poder tratar a estos pacientes a medio plazo&#44; sin los temidos efectos adversos de la ciclosporina&#46; En el art&#237;culo de Kessel y Toubi se realiza un estudio prospectivo en el que 20 pacientes con UCE no controlada con una dosis de ciclosporina a 3<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#237;a durante 3 meses reciben dosis de este f&#225;rmaco de entre 1-2<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#237;a de forma mantenida hasta el control de la enfermedad<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a>&#46; En 8 de los pacientes&#44; este f&#225;rmaco se consigue suspender tras 8-14 meses de tratamiento&#44; y los 12 restantes son tratados con ciclosporina durante un tiempo comprendido entre 60 y 120 meses&#44; sin observarse efectos adversos&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Boubouka et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> encontraron similares resultados en un estudio prospectivo&#44; en el que una cohorte de 30 pacientes con UCE recib&#237;an tratamiento con ciclosporina con unas dosis entre 1&#44;5 y 2&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#237;a ajustado a la cl&#237;nica durante un tiempo de 5 meses&#46; En el 88&#37; se los pacientes se obtuvo el control de la enfermedad con una dosis final de 0&#44;55<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#237;a&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En nuestra experiencia&#44; la ciclosporina es una opci&#243;n para el tratamiento de la UCE tras el fracaso al tratamiento con omalizumab&#46; 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                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">UAS7d inicial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dosis inicio &#40;mg&#47;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">UAS24h un mes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">UAS7d un mes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dosis final&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tiempo tratamiento &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tiempo seguimiento &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paciente 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paciente 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paciente 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "imagenFichero" => array:1 [
                0 => "xTab2684613.png"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Resultados de nuestra serie</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:8 [
            0 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Benefits and harms of omalizumab treatment in adolescent and adult patients with chronic idiopathic &#40;spontaneous&#41; urticaria&#58; A meta-analysis of &#8220;real-world&#8221; evidence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;D&#46; Tharp"
                            1 => "J&#46;A&#46; Bernstein"
                            2 => "A&#46; Kavati"
                            3 => "B&#46; Ortiz"
                            4 => "K&#46; MacDonald"
                            5 => "K&#46; Denhaerynck"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamadermatol.2018.3447"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA Dermatol"
                        "fecha" => "2019"
                        "volumen" => "155"
                        "paginaInicial" => "29"
                        "paginaFinal" => "38"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30427977"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The EAACI&#47;GA<span class="elsevierStyleSup">2</span>LEN&#47;EDF&#47;WAO guideline for the definition&#44; classification&#44; diagnosis and management of urticaria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Zuberbier"
                            1 => "W&#46; Aberer"
                            2 => "R&#46; Asero"
                            3 => "A&#46;H&#46; Abdul Latiff"
                            4 => "D&#46; Baker"
                            5 => "B&#46; Ballmer-Weber"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/all.13397"
                      "Revista" => array:4 [
                        "fecha" => "2018"
                        "volumen" => "73"
                        "paginaInicial" => "1393"
                        "paginaFinal" => "1414"
                      ]
                    ]
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                ]
              ]
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            2 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Ciclosporina UR 25<span class="elsevierStyleHsp" style=""></span>mg&#47;50<span class="elsevierStyleHsp" style=""></span>mg&#47;100<span class="elsevierStyleHsp" style=""></span>mg c&#225;psulas blandas EFG &#91;informaci&#243;n folleto&#93;&#46; Las Matas &#40;Madrid&#44; Espa&#241;a&#41;&#58; Germed Farmac&#233;utica&#44; S&#46; L&#59; 2012&#46;"
                ]
              ]
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            3 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cyclosporine in chronic idiopathic urticaria&#58; A double-blind&#44; randomized&#44; placebo-controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46;A&#46; Vena"
                            1 => "N&#46; Cassano"
                            2 => "D&#46; Colombo"
                            3 => "E&#46; Peruzzi"
                            4 => "P&#46; Pigatto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2006.04.078"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2006"
                        "volumen" => "55"
                        "paginaInicial" => "705"
                        "paginaFinal" => "709"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17010756"
                            "web" => "Medline"
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              "identificador" => "bib0065"
              "etiqueta" => "5"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Randomized double-blind study of cyclosporin in chronic &#8216;idiopathic&#8217; urticaria"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;E&#46; Grattan"
                            1 => "B&#46;F&#46; O&#8217;Donnell"
                            2 => "D&#46;M&#46; Francis"
                            3 => "N&#46; Niimi"
                            4 => "R&#46;J&#46; Barlow"
                            5 => "P&#46;T&#46; Seed"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1365-2133.2000.03664.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2000"
                        "volumen" => "143"
                        "paginaInicial" => "365"
                        "paginaFinal" => "372"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10951147"
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              "etiqueta" => "6"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cyclosporine-A in severe chronic urticaria&#58; The option for long-term therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Kessel"
                            1 => "E&#46; Toubi"
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                    0 => array:2 [
                      "doi" => "10.1111/j.1398-9995.2010.02419.x"
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                        "tituloSerie" => "Allergy"
                        "fecha" => "2010"
                        "volumen" => "65"
                        "paginaInicial" => "1478"
                        "paginaFinal" => "1482"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20626384"
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              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cyclosporine for chronic spontaneous urticaria&#58; A meta-analysis and systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Kulthanan"
                            1 => "P&#46; Chaweekulrat"
                            2 => "C&#46; Komoltri"
                            3 => "S&#46; Hunnangkul"
                            4 => "P&#46; Tuchinda"
                            5 => "L&#46; Chularojanamontri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaip.2017.07.017"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Allergy Clin Inmunol Pract&#46;"
                        "fecha" => "2017"
                        "volumen" => "6"
                        "paginaInicial" => "586"
                        "paginaFinal" => "599"
                        "itemHostRev" => array:3 [
                          "pii" => "S0923753419313699"
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              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of autoinmune uricaria with low-dose cyclosporin A&#58; A one-year follow-up"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; Boubouka"
                            1 => "C&#46; Harissi"
                            2 => "D&#46; Kouimintzis"
                            3 => "D&#46; Kalogeromitros"
                            4 => "P&#46; Stavropoulos"
                            5 => "A&#46; Katsarou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2340/00015555-0939"
                      "Revista" => array:5 [
                        "tituloSerie" => "Acta Derm Venereol&#46;"
                        "fecha" => "2011"
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CARTA CIENTÍFICO CLÍNICA
Ciclosporina: una vieja amiga en el tratamiento de la urticaria crónica espontánea
Ciclosporin: An Old Ally in the Treatment of Chronic Spontaneous Urticaria
B. Pinilla Martín
Corresponding author
belenpinillamartin@gmail.com

Autor para correspondencia.
, F. Tous Romero, F.J. Ortiz de Frutos
Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Desde la introducci&#243;n de omalizumab para el tratamiento de la urticaria cr&#243;nica espont&#225;nea &#40;UCE&#41;&#44; se ha conseguido el control de la enfermedad en un porcentaje alto de los pacientes refractarios al tratamiento con dosis altas de antihistam&#237;nicos<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a>&#46; En las &#250;ltimas gu&#237;as europeas<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a>&#44; el tratamiento con ciclosporina est&#225; indicado en los pacientes en los que ha fracasado previamente omalizumab&#46; Su uso para esta indicaci&#243;n se encuentra fuera de la ficha t&#233;cnica&#44; aunque se ha utilizado cl&#225;sicamente en el tratamiento de la UCE<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a>&#46; Los datos publicados son escasos y solo constan 2 ensayos cl&#237;nicos aleatorizados de apenas 16<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> y 8<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> semanas de tratamiento<span class="elsevierStyleSup">&#46;</span> No obstante&#44; existen cohortes y series de casos tratados con este f&#225;rmaco a dosis bajas durante periodos de tiempo m&#225;s prolongados &#63;de hasta 10 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a>&#63;&#46; Realizamos este estudio con el objetivo de conocer mejor el uso de la ciclosporina en UCE en pacientes con fracaso previo al omalizumab&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Dise&#241;amos un estudio observacional&#44; longitudinal y prospectivo de los pacientes con un diagn&#243;stico de UCE tratados con ciclosporina en nuestro centro&#44; que ya hab&#237;an fracasado al tratamiento con omalizumab&#46; Se recogieron variables epidemiol&#243;gicas&#44; cl&#237;nicas y de gravedad de la urticaria mediante la escala Urticaria Activity Score de los &#250;ltimos 7 d&#237;as &#63;UAS7d&#63;&#44; as&#237; como la dosis de ciclosporina en distintos momentos del tratamiento &#40;al inicio&#44; dosis m&#225;xima&#44; al final del tratamiento&#41;&#44; el tiempo de tratamiento y de seguimiento&#44; y los efectos adversos observados&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">De un total de 38 pacientes que hab&#237;an recibido tratamiento con omalizumab&#44; 3 &#40;7&#44;9&#37;&#41; no respondieron al f&#225;rmaco biol&#243;gico y fueron tratados con ciclosporina &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; El UAS7d al inicio del tratamiento con la ciclosporina era de 24&#44; 41 y 42&#46; Se inici&#243; ciclosporina a dosis de 3&#44;8&#44; 3&#44;15 y 3&#44;85<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#237;a&#44; respectivamente&#46; En los 3 pacientes se alcanz&#243; el control de la enfermedad &#40;UAS7d<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#41; en el primer mes de tratamiento&#44; lo que permiti&#243; disminuir la dosis de ciclosporina progresivamente sin rebrotes de la enfermedad y su suspensi&#243;n tras 5&#44; 14 y 12 meses&#44; con una dosis de ciclosporina de entre 0&#44;46 y 0&#44;68<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#237;a&#46; No hemos observado recidiva de la urticaria en ninguno de los pacientes&#44; ni efectos adversos relevantes durante el seguimiento&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Aunque cl&#225;sicamente se ha utilizado la ciclosporina en el tratamiento de la UCE&#44; no hay pautas definidas de su uso&#46; En un metaan&#225;lisis publicado en el a&#241;o 2017<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a>&#44; se analizan los distintos estudios publicados en la literatura&#44; entre ellos 2 ensayos cl&#237;nicos<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4&#44;5</span></a>&#46; Los resultados indican que la ciclosporina es eficaz para el tratamiento de la UCE&#44; pero son dif&#237;ciles de extrapolar a la vida real&#44; puesto que el paciente candidato a este tratamiento tiene una UCE no controlada con omalizumab y de larga duraci&#243;n en el tiempo&#44; dependiente de ciclos de corticoides orales frecuentemente&#46; Hemos de remontarnos a art&#237;culos publicados antes de la aprobaci&#243;n del omalizumab para poder acercarnos a unas pautas con las que poder tratar a estos pacientes a medio plazo&#44; sin los temidos efectos adversos de la ciclosporina&#46; En el art&#237;culo de Kessel y Toubi se realiza un estudio prospectivo en el que 20 pacientes con UCE no controlada con una dosis de ciclosporina a 3<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#237;a durante 3 meses reciben dosis de este f&#225;rmaco de entre 1-2<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#237;a de forma mantenida hasta el control de la enfermedad<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a>&#46; En 8 de los pacientes&#44; este f&#225;rmaco se consigue suspender tras 8-14 meses de tratamiento&#44; y los 12 restantes son tratados con ciclosporina durante un tiempo comprendido entre 60 y 120 meses&#44; sin observarse efectos adversos&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Boubouka et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> encontraron similares resultados en un estudio prospectivo&#44; en el que una cohorte de 30 pacientes con UCE recib&#237;an tratamiento con ciclosporina con unas dosis entre 1&#44;5 y 2&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#237;a ajustado a la cl&#237;nica durante un tiempo de 5 meses&#46; En el 88&#37; se los pacientes se obtuvo el control de la enfermedad con una dosis final de 0&#44;55<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#237;a&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En nuestra experiencia&#44; la ciclosporina es una opci&#243;n para el tratamiento de la UCE tras el fracaso al tratamiento con omalizumab&#46; El esquema terap&#233;utico que consideramos m&#225;s adecuado&#44; por presentar menos efectos adversos con la misma eficacia&#44; es una dosis inicial de 3-4<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#237;a hasta lograr el control de la enfermedad&#44; y su disminuci&#243;n progresiva hasta unas dosis muy bajas &#40;&#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#237;a&#41;&#46;</p></span>"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sexo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Edad al inicio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">UAS24h inicial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">UAS7d inicial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dosis inicio &#40;mg&#47;kg&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">UAS24h un mes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">UAS7d un mes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dosis final&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tiempo tratamiento &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tiempo seguimiento &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paciente 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paciente 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paciente 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Resultados de nuestra serie</p>"
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    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:8 [
            0 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "1"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Benefits and harms of omalizumab treatment in adolescent and adult patients with chronic idiopathic &#40;spontaneous&#41; urticaria&#58; A meta-analysis of &#8220;real-world&#8221; evidence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;D&#46; Tharp"
                            1 => "J&#46;A&#46; Bernstein"
                            2 => "A&#46; Kavati"
                            3 => "B&#46; Ortiz"
                            4 => "K&#46; MacDonald"
                            5 => "K&#46; Denhaerynck"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamadermatol.2018.3447"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA Dermatol"
                        "fecha" => "2019"
                        "volumen" => "155"
                        "paginaInicial" => "29"
                        "paginaFinal" => "38"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30427977"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The EAACI&#47;GA<span class="elsevierStyleSup">2</span>LEN&#47;EDF&#47;WAO guideline for the definition&#44; classification&#44; diagnosis and management of urticaria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Zuberbier"
                            1 => "W&#46; Aberer"
                            2 => "R&#46; Asero"
                            3 => "A&#46;H&#46; Abdul Latiff"
                            4 => "D&#46; Baker"
                            5 => "B&#46; Ballmer-Weber"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/all.13397"
                      "Revista" => array:4 [
                        "fecha" => "2018"
                        "volumen" => "73"
                        "paginaInicial" => "1393"
                        "paginaFinal" => "1414"
                      ]
                    ]
                  ]
                ]
              ]
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            2 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Ciclosporina UR 25<span class="elsevierStyleHsp" style=""></span>mg&#47;50<span class="elsevierStyleHsp" style=""></span>mg&#47;100<span class="elsevierStyleHsp" style=""></span>mg c&#225;psulas blandas EFG &#91;informaci&#243;n folleto&#93;&#46; Las Matas &#40;Madrid&#44; Espa&#241;a&#41;&#58; Germed Farmac&#233;utica&#44; S&#46; L&#59; 2012&#46;"
                ]
              ]
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            3 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cyclosporine in chronic idiopathic urticaria&#58; A double-blind&#44; randomized&#44; placebo-controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46;A&#46; Vena"
                            1 => "N&#46; Cassano"
                            2 => "D&#46; Colombo"
                            3 => "E&#46; Peruzzi"
                            4 => "P&#46; Pigatto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2006.04.078"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2006"
                        "volumen" => "55"
                        "paginaInicial" => "705"
                        "paginaFinal" => "709"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17010756"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
              ]
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            4 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Randomized double-blind study of cyclosporin in chronic &#8216;idiopathic&#8217; urticaria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;E&#46; Grattan"
                            1 => "B&#46;F&#46; O&#8217;Donnell"
                            2 => "D&#46;M&#46; Francis"
                            3 => "N&#46; Niimi"
                            4 => "R&#46;J&#46; Barlow"
                            5 => "P&#46;T&#46; Seed"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1365-2133.2000.03664.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2000"
                        "volumen" => "143"
                        "paginaInicial" => "365"
                        "paginaFinal" => "372"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10951147"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0070"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cyclosporine-A in severe chronic urticaria&#58; The option for long-term therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Kessel"
                            1 => "E&#46; Toubi"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1398-9995.2010.02419.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Allergy"
                        "fecha" => "2010"
                        "volumen" => "65"
                        "paginaInicial" => "1478"
                        "paginaFinal" => "1482"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20626384"
                            "web" => "Medline"
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                      ]
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              ]
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              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cyclosporine for chronic spontaneous urticaria&#58; A meta-analysis and systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Kulthanan"
                            1 => "P&#46; Chaweekulrat"
                            2 => "C&#46; Komoltri"
                            3 => "S&#46; Hunnangkul"
                            4 => "P&#46; Tuchinda"
                            5 => "L&#46; Chularojanamontri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
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Article information
ISSN: 00017310
Original language: Spanish
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