Prediction of the Efficacy of Antihistamines in Chronic Spontaneous Urticaria Based on Initial Suppression of the Histamine- Induced Wheal

Abstract

Background: Antihistamines are the first line of treatment for chronic spontaneous urticaria. However, there is no effective method to predict whether an antihistamine will have a beneficial clinical effect or not. Objective: To assess whether the change in histamine-induced wheal and flare measurements 24 hours after administration of antihistamine can predict the efficacy of treatment. Methods: We performed a multicenter, triple-blind, randomized study. Patients received a daily oral dose of cetirizine, fexofenadine, bilastine, desloratadine, or ebastine over 8 weeks. After 4 weeks, a higher dose of antihistamine was administered to patients who did not experience a clinical response. A histamine skin prick test was carried out at baseline and 24 hours after the first dose of antihistamine. Disease severity (Urticaria Activity Score [UAS]), response to the histamine skin prick test, and impact on the patient's quality of life (Dermatology Life Quality Index [DLQI]) were determined every 2 weeks. Results: The study population comprised 150 patients (30 per group) and 30 controls. Twenty-four hours after administration of antihistamine, inhibition of the histamine wheal by >75% was significantly associated with better UAS and DLQI scores. The safety and efficacy of the 5 antihistamines were similar. After updosing, rates of disease control (DLQI score <5) increased from 58.7% to 76.7%. Conclusions: Measurement of the histamine-induced wheal can predict which patients will have a strong clinical response to antihistamines but has limited utility for identifying nonresponders. The clinical significance of these data could be relevant in the search for new urticaria treatment regimens.

Management of chronic urticaria in children: a clinical guideline

“…A recent review of 73 studies with 9759 participants, including adolescents over 12 years of age, although none of them included specific paediatric data, concluded that anti-H1 anti-histamine drugs are beneficial in less than 50% of cases [162]. More recently, a blind randomized controlled trial, performed on mixed adult and adolescent populations, confirmed the efficacy of cetirizine (10 mg), fexofenadine (180 mg), bilastine (20 mg), desloratadine (5 mg), ebastine (20 mg) [163]. In a non-controlled prospective study in subjects with AU or CU aged 11 to 92 years, levocetirizine 5 mg daily for 2–6 weeks greatly improved or resolved symptoms in 60–80% of patients.…”

“…Second generation H1 antagonists are generally well tolerated [158, 162, 163, 165–168], except for astemizole and terfenadine whose metabolism by P450 liver cytochrome can be blocked by the concomitant administration of ketoconazole or erythromycin, causing cardiotoxic effects.…”

“…Some authors have described the benefit of a higher dosage (up to fourfold) of second generation H1-antihistamines, in order to control symptoms without compromising the safety profile of these drugs [162, 174]. This approach is recommended by European guidelines [7] based on the assessment of the risk-benefit ratio [175] The efficacy of this approach has been shown in randomized controlled studies on adolescents aged> 12 years old and adults using up to fourfold higher dosage than standard one of cetirizine, fexofenadine, bilastine, ebastine, desloratadine in CU [163, 176] and desloratadine, rupatadine and bilastine in cold-induced urticaria [177, 178]. , without significant increasing in side effects.…”

Dietary Habits in Patients with Chronic Spontaneous Urticaria: Evaluation of Food as Trigger of Symptoms Exacerbation

“…Based on a previously described cohort (URTICA project, ClinicalTrials.gov Identifier: NCT01940393 ) [ 6 ], we collected data from patients older than 12 years diagnosed with CSU, which was defined as the recurrence of hives for at least 6 weeks, in whom the diagnosis had been made by an allergist or a dermatologist. The severity of the disease and quality of life were evaluated with UAS (Urticaria Activity Score) and DLQI (Dermatology Life Quality Index), respectively.…”

C‐reactive protein (CRP) rs3093059C predicts poor mizolastine response in chronic spontaneous urticaria patients with elevated serum CRP level

“…The second‐generation non‐sedating H1 antihistamines are the first choice for the treatment of CSU . Non‐sedating H1 antihistamine drugs mizolastine, desloratadine and fexofenadine are widely used as H1‐receptor antagonist.…”