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      Up-dosing of non-sedating antihistamines in chronic urticaria: Need for well-designed clinical trials in India

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      Publication date (Print):
      Journal: Perspectives in Clinical Research
      Publisher: Medknow Publications & Media Pvt Ltd
      Keywords: Antihistamines, up-dosing, urticaria

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          Abstract

          Urticaria is a heterogeneous group of diseases. Chronic urticaria significantly impacts quality-of-life of patients. Second generation, non-sedating antihistamines are recommended as first line treatment for chronic spontaneous urticaria. In patients with inadequate control of symptoms, increase in dosage of non-sedating antihistamines up to four fold has been recommended. This recommendation is based on low cost, good safety and good evidence of efficacy of non-sedating, second generation antihistamines. This article reviewed Indian data on up-dosing of antihistamines in chronic urticaria. There is a need for well-designed clinical trials with -up-dosing of individual antihistamines in Indian patients.

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          Most cited references9

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          EAACI/GA(2)LEN/EDF/WAO guideline: management of urticaria.

          T Zuberbier, R Asero, C. Bindslev-Jensen … (2009)
          This guideline, together with its sister guideline on the classification of urticaria (Zuberbier T, Asero R, Bindslev-Jensen C, Canonica GW, Church MK, Giménez-Arnau AM et al. EAACI/GA(2)LEN/EDF/WAO Guideline: definition, classification and diagnosis of urticaria. Allergy 2009;64: 1417-1426), is the result of a consensus reached during a panel discussion at the Third International Consensus Meeting on Urticaria, Urticaria 2008, a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA(2)LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO). As members of the panel, the authors had prepared their suggestions regarding management of urticaria before the meeting. The draft of the guideline took into account all available evidence in the literature (including Medline and Embase searches and hand searches of abstracts at international allergy congresses in 2004-2008) and was based on the existing consensus reports of the first and the second symposia in 2000 and 2004. These suggestions were then discussed in detail among the panel members and with the over 200 international specialists of the meeting to achieve a consensus using a simple voting system where appropriate. Urticaria has a profound impact on the quality of life and effective treatment is, therefore, required. The recommended first line treatment is new generation, nonsedating H(1)-antihistamines. If standard dosing is not effective, increasing the dosage up to four-fold is recommended. For patients who do not respond to a four-fold increase in dosage of nonsedating H(1)-antihistamines, it is recommended that second-line therapies should be added to the antihistamine treatment. In the choice of second-line treatment, both their costs and risk/benefit profiles are most important to consider. Corticosteroids are not recommended for long-term treatment due to their unavoidable severe adverse effects. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS).
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            Chronic urticaria.

            Mel F Greaves (1995)
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              Urticaria: evaluation and treatment.

              Paul Schaefer (2011)
              Urticaria involves intensely pruritic, raised wheals, with or without edema of the deeper cutis. It is usually a self-limited, benign reaction, but can be chronic. Rarely, it may represent serious systemic disease or a life-threatening allergic reaction. Urticaria has a lifetime prevalence of approximately 20 percent in the general population. It is caused by immunoglobulin E- and nonimmunoglobulin E-mediated mast cell and basophil release of histamine and other inflammatory mediators. Diagnosis is made clinically. Chronic urticaria is usually idiopathic and requires only a simple laboratory workup unless elements of the history or physical examination suggest specific underlying conditions. Treatment includes avoidance of triggers, although these can be identified in only 10 to 20 percent of patients with chronic urticaria. First-line pharmacotherapy for acute and chronic urticaria is nonsedating second-generation antihistamines (histamine H1 blockers), which can be titrated to larger than standard doses. First-generation antihistamines, histamine H2 blockers, leukotriene receptor antagonists, and brief corticosteroid bursts may be used as adjunctive treatment. More than one-half of patients with chronic urticaria will have resolution or improvement of symptoms within one year.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Perspect Clin Res
                Journal ID (iso-abbrev): Perspect Clin Res
                Journal ID (publisher-id): PCR
                Title: Perspectives in Clinical Research
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 2229-3485
                ISSN (Electronic): 2229-5488
                Publication date (Print): Apr-Jun 2014
                Volume: 5
                Issue: 2
                Pages: 88-90
                Affiliations
                [1] Freelance Consultant: Medical Communication and Training, Navi Mumbai, India
                Author notes
                Address for correspondence: Dr. Anant D. Patil, B-101, Balaji Bhavan CHS, Sector 44 A, Nerul, Mumbai, Maharashtra, India. E-mail: anantdpatil@ 123456gmail.com
                Article
                Publisher ID: PCR-5-88
                DOI: 10.4103/2229-3485.128029
                PMC ID: 3980551
                PubMed ID: 24741487
                SO-VID: e5d59f23-dec1-4745-b5be-3c051676b8ee
                Copyright © Copyright: © Perspectives in Clinical Research
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Research Methodology

                ScienceOpen disciplines: Medicine
                Keywords: antihistamines,up-dosing,urticaria
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: antihistamines, up-dosing, urticaria

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