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He achieved only partial remission with typical medications for CSU including omalizumab, cyclosporine and cetirizine. After 6\u2009years, his worsening symptoms and abnormal investigations led to a rare diagnosis of Schnitzler\u2019s syndrome and a trial of the interleukin 1 receptor antagonist, anakinra, which caused a rapid and complete resolution of his symptoms.<\/jats:p>","DOI":"10.1136\/bcr-2018-228546","type":"journal-article","created":{"date-parts":[[2019,4,29]],"date-time":"2019-04-29T09:03:33Z","timestamp":1556528613000},"page":"e228546","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Refractory urticaria and the importance of diagnosing Schnitzler\u2019s syndrome"],"prefix":"10.1136","volume":"12","author":[{"given":"Tina","family":"Nham","sequence":"first","affiliation":[{"name":"Department of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carol","family":"Saleh","sequence":"additional","affiliation":[{"name":"Department of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derek","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie L","family":"Vakaljan","sequence":"additional","affiliation":[{"name":"Department of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason A","family":"Ohayon","sequence":"additional","affiliation":[{"name":"Department of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah M","family":"Siegal","sequence":"additional","affiliation":[{"name":"Department of Medicine, McMaster University, Hamilton, Ontario, Canada"},{"name":"Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,4,29]]},"reference":[{"key":"2025082708240295000_12.4.e228546.1","doi-asserted-by":"publisher","DOI":"10.1067\/mai.2000.105706"},{"key":"2025082708240295000_12.4.e228546.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1398-9995.2010.02496.x"},{"key":"2025082708240295000_12.4.e228546.3","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.1016\/j.jaip.2016.11.037","article-title":"Chronic Idiopathic Urticaria: Systemic Complaints and Their Relationship with Disease and Immune Measures","volume":"5","author":"Doong","year":"2017","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2025082708240295000_12.4.e228546.4","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/2045-7022-4-41","article-title":"Schnitzler\u2019s syndrome: lessons from 281 cases","volume":"4","author":"de Koning","year":"2014","journal-title":"Clin Transl Allergy"},{"key":"2025082708240295000_12.4.e228546.5","unstructured":"Schnitzler L . 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