Fexofenadine HCl is safe and effective for treatment of chronic idiopathic urticaria

Nelson, Harold S.; Reynolds, Robert F.; Mason, Jolene

doi:10.1016/s1081-1206(10)62515-x

Cited by 106 publications

(73 citation statements)

References 17 publications

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“…The question emerges whether increasing the dose of nsAH high enough would prove helpful in controlling the urticaria symptoms. Studies with fexofenadine failed to show that increasing the dose from 60 to 240 mg makes a meaningful difference[20,21]. However, a twofold increase of the standard dose of cetirizine was found effective in patients with cholinergic urticaria,[22] a threefold increase of the cetirizine dose brought about some benefit in a small proportion of patients with chronic unremitting urticaria,[23] and a fourfold increase of the recommended dose of desloratadine was proven effective in acquired cold urticaria[24].…”

Section: Picking the Best Antihistamine For The Treatment Of Ciumentioning

confidence: 99%

Challenges in the Management of Chronic Urticaria

Popov¹

2011

World Allergy Organization Journal

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The term "chronic idiopathic urticaria" denotes a spectrum of conditions with different poorly understood pathogenetic mechanisms in which the release of histamine plays a role. Nonsedating second-generation H1 antihistamines are postulated to be the first line of treatment of chronic idiopathic urticaria by national and international guidelines, but as control is not always achievable with the usually recommended doses, first-generation sedating antihistamines like hydroxyzine and diphenhydramine at high daily doses (200 mg) have been proposed as an alternative before resorting to treatment with systemic corticosteroids and other potentially hazardous agents. Our long time experience and recent research give us grounds to believe that increasing the doses of nonsedating H1 antihistamines up to fourfold improves significantly the chances of successful treatment. Our data suggest that the urticaria-associated discomfort is relieved by higher than conventional doses of levoce-tirizine and desloratadine in about 75% of the patients and that sedation/somnolence does not seem to be a major deterrent. The dose increase also improves the urticaria-specific quality of life. Contrary to the belief that individual patients may benefit from one antihistamine or another, we demonstrate that the drug with better ability to suppress the histamine skin effects in experiments in healthy volunteers (levocetirizine) is also superior in improving the different aspects of control of chronic urticaria (subjective and objective symptoms, quality of life) and that increasing its dose of up to fourfold may even paradoxically reduce the sense of sedation/somnolence in parallel with the relief of urticaria discomfort.

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Section: Picking the Best Antihistamine For The Treatment Of Ciumentioning

confidence: 99%

Challenges in the Management of Chronic Urticaria

Popov¹

2011

World Allergy Organization Journal

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“…Studies with fexofenadine failed to show that increasing the dose from 60 to 240 mg makes a meaningful difference. 20,21 However, a twofold increase of the standard dose of cetirizine was found effective in patients with cholinergic urticaria, 22 a threefold increase of the cetirizine dose brought about some benefit in a small proportion of patients with chronic unremitting urticaria, 23 and a fourfold increase of the recommended dose of desloratadine was proven effective in acquired cold urticaria. 24 Led by the plausible statement of Allen Kaplan that defining the level of refractoriness to antihistamines is the key to effective therapy, we carried out a study to check if a dose increase of the modern second-generation H 1 receptor antagonists desloratadine and levocetirizine of up to fourfold could increase the success rate of treatment of chronic urticaria and improve the health-related quality of life without compromising safety.…”

Section: Picking the Best Antihistamine For The Treatment Of Ciumentioning

confidence: 99%

Challenges in the Management of Chronic Urticaria

Popov

2011

World Allergy Organization Journal

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Abstract:The term "chronic idiopathic urticaria" denotes a spectrum of conditions with different poorly understood pathogenetic mechanisms in which the release of histamine plays a role. Nonsedating second-generation H 1 antihistamines are postulated to be the first line of treatment of chronic idiopathic urticaria by national and international guidelines, but as control is not always achievable with the usually recommended doses, first-generation sedating antihistamines like hydroxyzine and diphenhydramine at high daily doses (200 mg) have been proposed as an alternative before resorting to treatment with systemic corticosteroids and other potentially hazardous agents. Our long time experience and recent research give us grounds to believe that increasing the doses of nonsedating H 1 antihistamines up to fourfold improves significantly the chances of successful treatment. Our data suggest that the urticaria-associated discomfort is relieved by higher than conventional doses of levocetirizine and desloratadine in about 75% of the patients and that sedation/somnolence does not seem to be a major deterrent. The dose increase also improves the urticaria-specific quality of life. Contrary to the belief that individual patients may benefit from one antihistamine or another, we demonstrate that the drug with better ability to suppress the histamine skin effects in experiments in healthy volunteers (levocetirizine) is also superior in improving the different aspects of control of chronic urticaria (subjective and objective symptoms, quality of life) and that increasing its dose of up to fourfold may even paradoxically reduce the sense of sedation/ somnolence in parallel with the relief of urticaria discomfort.

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“…Estudos multicêntricos, randomizados, duplo-cegos, controlados por placebo, demonstraram que a FEX 120-180 mg/dia é capaz de melhorar de forma significativa os sintomas 49,50 e a qualidade de vida de pacientes com urticária crônica idiopática 49 . As evidências indicam que a FEX é segura e bem tolerada [44][45][46][47]50 , mesmo em doses até 11 vezes maiores do que as terapêuticas 40 .…”

Section: Fexofenadinaunclassified

New antihistamines: a critical view

Camelo-Nunes¹

2006

J Pediatr (Rio J)

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Objective: To perform a critical evaluation of the more recent H1 antihistamines and the various terms used to describe them, based on a review of evidence on their role in the treatment of allergic disorders.Sources: Original articles, reviews and consensus documents published from 1998 to 2006 and indexed in the MEDLINE and PubMed databases. Keyword: antihistamines.Summary of the findings: Second-generation antihistamines differ from first-generation ones because of their elevated specificity and affinity for peripheral H1 receptors and because of their lower penetration of the central nervous system (CNS), having fewer sedative effects as a result. Whilst second-generation antihistamines are in general better tolerated than their predecessors, some adverse effects, principally cardiotoxicity, have been observed with some of them. Over the last 20 years, new compounds with different pharmacokinetic properties have been synthesized. The majority of these exhibit antiinflammatory properties that are independent of their action on the H1 receptor. More recent improvements, generally in the form of active metabolites, led to the use of the term third-generation antihistamines. This term emerged spontaneously, with no clear definition of its meaning or clinical implications, creating great confusion among healthcare professionals. Conclusions:On the basis of the evidence on H1 antihistamines, none of them deserve the title third-generation antihistamine. As the Consensus Group on New Generation Antihistamines concluded, to merit this definition, a new class of antihistamines would have to demonstrate distinct clinical advantages over existing compounds and fulfill at least three prerequisites: they should be free from cardiotoxicity, drug interactions and effects on the CNS. J Pediatr (Rio J). 2006;82(5 Suppl):S173-80: Antihistamines, desloratadine, fexofenadine, levocetirizine, rupatadine. ResumoObjetivo: Avaliar criticamente os mais novos anti-histamínicos anti-H1 e os diferentes termos utilizados para denominá-los, com base na revisão de evidências sobre o papel dos anti-H1 no tratamento das doenças alérgicas.Fontes dos dados: Artigos originais, revisões e consensos indexados nos bancos de dados MEDLINE e PUBMED de 1998 a 2006. Palavra chave: anti-histamínicos.

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Fexofenadine HCl is safe and effective for treatment of chronic idiopathic urticaria

Cited by 106 publications

References 17 publications

Challenges in the Management of Chronic Urticaria

Challenges in the Management of Chronic Urticaria

Challenges in the Management of Chronic Urticaria

New antihistamines: a critical view

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