Atopic dermatitis and skin disease
The effectiveness of levocetirizine and desloratadine in up to 4 times conventional doses in difficult-to-treat urticaria

https://doi.org/10.1016/j.jaci.2009.11.047Get rights and content

Background

H1-antihistamines are first line treatment of chronic urticaria, but many patients do not get satisfactory relief with recommended doses. European guidelines recommend increased antihistamine doses of up to 4-fold.

Objective

To provide supportive evidence for the European guidelines.

Methods

Eighty tertiary referral patients with chronic urticaria (age range, 19-67 years) were randomized for double-blind treatment with levocetirizine or desloratadine (40/40). Treatment started at the conventional daily dose of 5 mg and then increased weekly to 10 mg, 20 mg, or 20 mg of the opposite drug if relief of symptoms was incomplete. Wheal and pruritus scores, quality of life, patient discomfort, somnolence, and safety were assessed.

Results

Thirteen patients became symptom-free at 5 mg (9 levocetirizine vs 4 desloratadine), compared with 28 subjects on the higher doses of 10 mg (8/7) and 20 mg (5/1). Of the 28 patients nonresponsive to 20 mg desloratadine, 7 became symptom-free with 20 mg levocetirizine. None of the 18 levocetirizine nonresponders benefited with 20 mg desloratadine. Increasing antihistamine doses improved quality of life but did not increase somnolence. Analysis of the effect of treatment on discomfort caused by urticaria showed great individual heterogeneity of antihistamine responsiveness: ∼15% of patients were good responders, ∼10% were nonresponders, and ∼75% were responders to higher than conventional antihistamine doses. No serious or severe adverse effects warranting discontinuation of treatment occurred with either drug.

Conclusion

Increasing the dosage of levocetirizine and desloratadine up to 4-fold improves chronic urticaria symptoms without compromising safety in approximately three quarters of patients with difficult-to-treat chronic urticaria.

Section snippets

Patients

The 80 patients recruited into the study (27 men and 53 women; age, 19-67 years) had been referred to the tertiary specialist centre of the Clinic of Allergy and Asthma in Sofia with difficult-to-treat chronic urticaria in that they had failed to respond to their previous prescribed treatments (Table I). All had tried standard doses of first-generation and/or second-generation H1-antihistamines, and 58 of the 80 patients, 28 on levocetirizine and 30 on desloratadine, were receiving intermittent

Results

Of the 80 patients randomized to treatment (intention-to-treat population), all 40 patients in the levocetirizine arm completed the study, whereas of the 40 subjects assigned to desloratadine, 3 (2 men and 1 woman) withdrew their informed consent (2 because the study interfered with their professional activities [travelling] while the third chose not to give an explanation about quitting the trial) during the second (2) and third (1) week of treatment. ASST was positive in 47 subjects (59%), 22

Discussion

This study provides evidence that in patients with difficult-to-treat chronic urticaria, increasing the daily dose of 2 second-generation antihistamines, levocetirizine and desloratadine, to up to 4 times their conventionally prescribed doses of 5 mg/d increases the control of urticaria symptoms without compromising patient safety. The number of chronic urticaria patients who became symptom-free more than doubled when administering the drugs in doses double or quadruple the conventional doses.

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  • Cited by (0)

    Supported by an unrestricted educational grant by UCB Pharma. UCB Pharma had no involvement in the study or the preparation of this article either practically or editorially.

    Disclosure of potential conflict of interest: M. K. Church has consulted for FAES Pharma. T. A. Popov has received honoraria from Merck & Co, Schering-Plough, and UCB Pharma and has received research support from Chiesi Pharma, Merck & Co, and UCB Pharma. V. Dimitrov has received honoraria from AstraZeneca, Chiesi Pharma, UCB Pharma and Shering Plough and has received research support from Novartis. The rest of the authors have declared that they have no conflict of interest.

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