SELECTED ARTICLES FROM THE RECENT LITERATURE 2005
12/2/05
Antihistamine treatment of chronic urticaria
Summary
Background - H1 antihistamines (AH) are a mainstay in the symptomatic treatment of chronic idiopathic urticaria (CIU). However, are any one of the several newer AH superior in such treatment?
Findings - The literature related to this subject was reviewed by Monroe of Milwaukee, WI. He pointed out that consideration of the potential for cognitive/sedative effects leads to favor the newer, relatively non-sedating, AH over older AH such as diphenhydramine.
There have been relatively few clinical studies comparing the efficacy of individual newer AH agents. The limited data suggests no distinct superiority of one particular AH agent in CIU. However, cetirizine is less desirable because of cognitive/sedative effects of this drug seen in about 10% of patients. Safety factors are of greater consideration when patients take larger than recommended doses of these newer AH, either as prescribed or on their own.
Reference
Cutis 2005;76:118-26
Editor's Comments
This description is in general agreement with my impression that there is no clear-cut superior efficacy of any one of the newer AH (loratadine, desloratadine, fexofenadine) in CIU. I should mention that Dr. Allen Kaplan, a leading investigator of CIU, is convinced the diphenhydramine is more effective than newer AH in CIU with decreased sedative effects seen with continued long-term use. There is considerable variation in effects of different AH agents among individual CIU patients (with little benefit from all agents in some patients). I prefer fexofenadine 180 mg/day in adults because of little or no adverse side effects. When the hives interfere with sleep, I prescribe doxipen (a very potent, but sedating AH) at bedtime.
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