ABSTRACT
Chronic idiopathic urticaria can be extremely disabling in it's severe form and may respond poorly to antihistamines or systemic corticosteroids, so immunomodulatory treatment had been tried for those severe cases. To determine the beneficial effect and safety of methotrexate in Chronic idiopathic urticaria patients compared with loratadine. Forty patients with severe Chronic idiopathic urticaria were included in this study. Twenty of these patients received methotrexate in a dose of 12 mg once a day/week IM injection, after performing baseline investigations. The other 20 patients received loratadine 10 mg orally once daily. Both groups were treated for 8 weeks and were followed up for 8 weeks after treatment. After 8 weeks of treatment there was a significant improvement in both frequency of episodes and duration of episodes in patients treated with methotrexate. At the end of treatment and after 8 weeks follow up assessment, patients treated with methotrexate showed a significant improvement regarding frequency of episodes [P value <0.0001] and duration of episodes [P value<0.0001] compared with those treated with loratadine. It is concluded that methotrexate was not only significantly more effective than loratadine in the treatment of chronic idiopathic urticaria but also had a significantly sustained effect after discontinuation of therapy