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SELECTED ARTICLES FROM THE RECENT LITERATURE 2006
11/3/06
Are higher antihistamine doses more effective in chronic urticaria?
Summary
Background - In some patients, chronic idiopathic urticaria (CIU) is not controlled adequately with usual doses of non-sedating antihistamines (AH). Will higher than FDA- approved doses of such AH be more effective in such cases of CIU?
Findings - Asero of the San Carlo Clinic in Milan, Italy investigated 22 adults with histories of CIU poorly controlled on cetirizine (Cet) 10 mg/day. This lack of response was confirmed during the first week of the study, consisting of treatment with Cet 10 mg/day. During the next week, the Cet treatment was increased to 10 mg t.i.d. The CIU in only one of the 22 patients improved with the higher dose Cet treatment.
Reference
Clin Exp Dermatol 2006;October 16, E pub
Editor's Comments
Although this was an open, uncontrolled study, the findings strongly suggest that significantly increasing the daily dose of Cet will generally be not more effective than the usual 10 mg/day dose in adults. One could question whether increased efficacy might result from use of Cet 10 mg t.i.d. for longer than one week. However, my research experience with Cet treatment suggests that sedative effects would occur in a sizable percentage of those treated with such higher doses. This has been pointed out by Chowdury of the FDA (New Eng J Med 2002;220-222) who also summarized previous studies showing no greater efficacy on the treatment of CIU with the use of very high doses of non-sedating AH as compared to FDA-approved doses.
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