Non sedating antihistamines urticaria treatment

Urticaria symptoms are mediated mainly by the release of histamine from mast cells, which causes vasodilatation, extravasation, and subsequent development of wheal-and-flare type skin reactions (6).

The current guidelines for management of urticaria strongly recommend non-sedating H-antihistamines (ns AH) as the first-line symptomatic treatment for CSU, based on a large body of high-quality evidence (7).

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In addition, in a study on patients with acquired cold urticaria, a preventive application of desloratadine at 4 times the standard dose was significantly more effective in reducing urticaria lesion severity compared with the standard 5 mg dose, without any increase in adverse events (18).

Other studies also point towards a better efficacy of continuously applied high-dose ns AHs in CSU (19, 20).

Increasing the ns AH to up to 4 times the standard dose is recommended by the current guidelines in all patients who cannot achieve symptom control with standard doses (7).

Desloratadine is a modern ns AH that has been shown to reduce pruritus and wheals and to improve quality of life in several studies at the standard 5 mg dose (12–17).

The aim of the study was to determine whether wheals in CSU can be actively reduced by on-demand treatment with a modern ns AH in guideline-suggested dosages.

This study simulates the treatment approach used by many patients: they wait with antihistamine treatment until wheals appear and then expect the wheals to disappear more rapidly than without treatment.Symptoms of 29 patients with chronic spontaneous urticaria were followed without treat­ment on one day and again on another day during the next 3 weeks after a single dose of either 5 mg or 20 mg desloratadine, using different objective measures.While the intervention with both doses of desloratadine was effective in terms of a reduction in hyperthermic skin area, there was no improvement in wheal area and wheal volume compared with no treatment.Most clinical trials rely on patient assessments of symptoms and quality of life over a period of outpatient treatment time.Although this is entirely appropriate, we designed the current clinical study to examine the efficacy of standard dose desloratadine (5 mg) and up-dosed desloratadine (20 mg) on existing wheals, under carefully monitored conditions, using the most technically reliable, objective measures.While these studies indicate that the treatment schedule can generally have a major impact on the outcome of treatment, the results on the efficacy of on-demand ns AHs in CSU have not yet been independently confirmed.