The effectiveness of levocetirizine and desloratadine in up to 4 times conventional doses in difficult-to-treat urticaria.
The effectiveness of levocetirizine and desloratadine in up to 4 times conventional doses in difficult-to-treat urticaria.
Background
H1-antihistamines are first line treatment of chronic urticaria, but many patients do not get satisfactory relief with recommended doses. European guidelines recommend increased antihistamine doses of up to 4-fold.
Objective
To provide supportive evidence for the European guidelines.
Methods
Eighty tertiary referral patients with chronic urticaria (age range, 19-67 years) were randomized for double-blind treatment with levocetirizine or desloratadine (40/40). Treatment started at the conventional daily dose of 5 mg and then increased weekly to 10 mg, 20 mg, or 20 mg of the opposite drug if relief of symptoms was incomplete. Wheal and pruritus scores, quality of life, patient discomfort, somnolence, and safety were assessed.
Results
Thirteen patients became symptom-free at 5 mg (9 levocetirizine vs 4 desloratadine), compared with 28 subjects on the higher doses of 10 mg (8/7) and 20 mg (5/1). Of the 28 patients nonresponsive to 20 mg desloratadine, 7 became symptom-free with 20 mg levocetirizine. None of the 18 levocetirizine nonresponders benefited with 20 mg desloratadine. Increasing antihistamine doses improved quality of life but did not increase somnolence. Analysis of the effect of treatment on discomfort caused by urticaria showed great individual heterogeneity of antihistamine responsiveness: 15% of patients were good responders, 10% were nonresponders, and 75% were responders to higher than conventional antihistamine doses. No serious or severe adverse effects warranting discontinuation of treatment occurred with either drug.
Conclusion
Increasing the dosage of levocetirizine and desloratadine up to 4-fold improves chronic urticaria symptoms without compromising safety in approximately three quarters of patients with difficult-to-treat chronic urticaria.
urticaria, levocetirizine, antihistamines, desloratadine, somnolence, quality of life
676-682
Staevska, Maria
715b38a7-725f-44be-89b6-a25c9ddeea51
Popov, Todor A.
5a003e62-e355-4cea-9e37-43225ec5a340
Kralimarkova, Tanya
c04d2bd7-325e-4702-89b2-bc35820efc6b
Lazarova, Cvetelina
03254f9d-237f-4f1c-8af1-38e61fdb8e98
Kraeva, Steliana
54f2b727-536b-4ef5-8798-b96350f3a1e6
Popova, Dora
0f1a2b5d-0cc3-4174-86a8-9d58353d642a
Church, Diana S.
cf09fa9a-bee0-4c1a-a66b-0759d799f378
Dimitrov, Vasil
f526fb21-22de-46ca-b959-cec227ec53bc
Church, Martin K.
dad189d5-866e-4ae1-b005-0d87f74282b8
March 2010
Staevska, Maria
715b38a7-725f-44be-89b6-a25c9ddeea51
Popov, Todor A.
5a003e62-e355-4cea-9e37-43225ec5a340
Kralimarkova, Tanya
c04d2bd7-325e-4702-89b2-bc35820efc6b
Lazarova, Cvetelina
03254f9d-237f-4f1c-8af1-38e61fdb8e98
Kraeva, Steliana
54f2b727-536b-4ef5-8798-b96350f3a1e6
Popova, Dora
0f1a2b5d-0cc3-4174-86a8-9d58353d642a
Church, Diana S.
cf09fa9a-bee0-4c1a-a66b-0759d799f378
Dimitrov, Vasil
f526fb21-22de-46ca-b959-cec227ec53bc
Church, Martin K.
dad189d5-866e-4ae1-b005-0d87f74282b8
Staevska, Maria, Popov, Todor A., Kralimarkova, Tanya, Lazarova, Cvetelina, Kraeva, Steliana, Popova, Dora, Church, Diana S., Dimitrov, Vasil and Church, Martin K.
(2010)
The effectiveness of levocetirizine and desloratadine in up to 4 times conventional doses in difficult-to-treat urticaria.
Journal of Allergy and Clinical Immunology, 125 (3), .
(doi:10.1016/j.jaci.2009.11.047).
Abstract
Background
H1-antihistamines are first line treatment of chronic urticaria, but many patients do not get satisfactory relief with recommended doses. European guidelines recommend increased antihistamine doses of up to 4-fold.
Objective
To provide supportive evidence for the European guidelines.
Methods
Eighty tertiary referral patients with chronic urticaria (age range, 19-67 years) were randomized for double-blind treatment with levocetirizine or desloratadine (40/40). Treatment started at the conventional daily dose of 5 mg and then increased weekly to 10 mg, 20 mg, or 20 mg of the opposite drug if relief of symptoms was incomplete. Wheal and pruritus scores, quality of life, patient discomfort, somnolence, and safety were assessed.
Results
Thirteen patients became symptom-free at 5 mg (9 levocetirizine vs 4 desloratadine), compared with 28 subjects on the higher doses of 10 mg (8/7) and 20 mg (5/1). Of the 28 patients nonresponsive to 20 mg desloratadine, 7 became symptom-free with 20 mg levocetirizine. None of the 18 levocetirizine nonresponders benefited with 20 mg desloratadine. Increasing antihistamine doses improved quality of life but did not increase somnolence. Analysis of the effect of treatment on discomfort caused by urticaria showed great individual heterogeneity of antihistamine responsiveness: 15% of patients were good responders, 10% were nonresponders, and 75% were responders to higher than conventional antihistamine doses. No serious or severe adverse effects warranting discontinuation of treatment occurred with either drug.
Conclusion
Increasing the dosage of levocetirizine and desloratadine up to 4-fold improves chronic urticaria symptoms without compromising safety in approximately three quarters of patients with difficult-to-treat chronic urticaria.
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More information
Published date: March 2010
Keywords:
urticaria, levocetirizine, antihistamines, desloratadine, somnolence, quality of life
Organisations:
Infection Inflammation & Immunity
Identifiers
Local EPrints ID: 79608
URI: http://eprints.soton.ac.uk/id/eprint/79608
ISSN: 0091-6749
PURE UUID: 927c0369-a457-482e-b577-51765e556e8b
Catalogue record
Date deposited: 17 Mar 2010
Last modified: 14 Mar 2024 00:32
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Contributors
Author:
Maria Staevska
Author:
Todor A. Popov
Author:
Tanya Kralimarkova
Author:
Cvetelina Lazarova
Author:
Steliana Kraeva
Author:
Dora Popova
Author:
Diana S. Church
Author:
Vasil Dimitrov
Author:
Martin K. Church
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