Evaluation of Different Combined Regimens in the Treatment of Cholinergic Urticaria

Abstract

BackgroundCholinergic urticaria is uncommon and accounts for 10% of all young adults. To date, there is no effective therapy for cholinergic urticaria.ObjectiveTo determine the therapeutic efficacy of different drug combinations in the treatment of cholinergic urticaria.Patients and MethodsThe participants included in the study are in the age range of 16 to 29 years, with cholinergic urticaria of any duration as diagnosed by physicians. Patients were recruited from Asthma and Allergy Centers in Baghdad and Tikrit. The selected patients were divided randomly into 3 groups according to the treatment protocol. All patients completed screening before treatment.ResultsThe study indicated that cholinergic urticaria was completely controlled in 30.4% of patients (group A) receiving 4 mg of chlorpheniramine maleate, half hour before the exercise, plus chlordiazopoxide (5 mg) and clindium bromide (2.5 mg) tablets, 3 times daily. However, cure rate was higher (83.1%) in patients (group B) receiving 4 mg of chlorpheniramine maleate (histadine), 3 times daily, plus 25 mg of maprotiline HCl (ludiomil), once daily at night. Furthermore, the complete cure rate was 85.4% in patients (group C) receiving 4 mg of chlorpheniramine maleate (histadine)3 times daily, plus 200 mg of cimetidine (tagadine), 3 times daily. The frequency of relapse was higher in group A (89%) as compared with group B (68.4%) and group C (23.5%) (P <0.0001).ConclusionsCombination of H1 and H2 antagonists was more effective based on complete control of cholinergic urticaria with lower relapsing rate. However, a future placebo-controlled clinical trial taking in consideration higher H1 antagonists than we used is warranted.

Chronic inducible urticaria: A systematic review of treatment options

“…Four studies including 316 patients assessed antihistamines for the treatment of cholinergic urticaria. [35][36][37][38]41 First-generation H1-AHs versus second-generation H1-AHs versus placebo. Kobza Black et al 36 used 20 mg of hydroxyzine 3 times daily versus placebo and found that the mean "degree of improvement'' (self-assessed; scale: minimal 5 0, maximal 5 3) was 1.58 (n 5 10) for hydroxyzine and 0.74 (n 5 9) for placebo after 5 days of treatment.…”

“…First-generation H1-AHs in combination. Alsamarai et al 35 recruited a total of 251 patients and compared 3 groups: 4 mg of chlorpheniramine maleate (half hour before exercise) plus 5 mg of chlordiazepoxide plus 2.5 mg of clindium bromide 3 times daily versus 4 mg of chlorpheniramine maleate 3 times daily plus 25 mg of maprotiline HCL once daily versus 4 mg of chlorpheniramine maleate 3 times daily plus 20 mg of cimetidine 3 times daily. Pairwise comparisons of all 3 groups showed that adding maprotiline was more effective than adding chlordiazepoxide and clindium bromide (RR, 0.32; 95% CI, 0.21-0.48), as was adding cimetidine (RR, 0.28; 95% CI, 0.19-0.42) when evaluating "complete symptom control.''…”

Cholinergic urticaria: More than a simple inducible urticaria

“…Although oral antihistamines are a primary treatment for ChU, some patients do not respond successfully to antihistamine therapy . In this study, most patients showed at least partial improvement with oral antihistamines.…”

Assessment of the Mechanistic Role of Cinnarizine in Modulating Experimentally-Induced Bronchial Asthma in Rats

“…Histamine H 1 -receptors play a major role in the pathogenesis of extrinsic asthma, and blockade of this receptor is well-known to protect against asthmatic attacks [58,59,60]. Moreover, calcium channel blockade in bronchial tree was reported to decrease airway remodeling [16], while inhibition of calcium influx into mast cells decreases their ability for degranulation and histamine release [49].…”