Efficacy and Safety of Up-dosed Second-generation Antihistamines in Uncontrolled Chronic Spontaneous Urticaria: A Review.
Chronic spontaneous urticaria
effectiveness
safety
second generation anti-histamines
up-dosing
Journal
The Journal of clinical and aesthetic dermatology
ISSN: 1941-2789
Titre abrégé: J Clin Aesthet Dermatol
Pays: United States
ID NLM: 101518173
Informations de publication
Date de publication:
Mar 2023
Mar 2023
Historique:
entrez:
23
3
2023
pubmed:
24
3
2023
medline:
24
3
2023
Statut:
ppublish
Résumé
Oral second-generation antihistamines (sgAH) constitute the first-line treatment for chronic spontaneous urticaria (CSU), a debilitating dermatological condition. However, many patients respond incompletely, and up-dosing sgAHs up to four-fold their conventional dose is recommended for disease control. Many physicians refrain from up-dosing due to a paucity of efficacy and safety data, instead adding a second antihistamine or an immunomodulator. With the aim of addressing this knowledge gap, we conducted a literature review to highlight efficacy and safety data on up-dosed sgAHs. We conducted a comprehensive search of the literature across multiple databases (PubMed, EMBASE, MEDLINE and Google scholar) using the keywords (alone and in combination) and MeSH items as well as non-MeSH terms such as "chronic spontaneous urticaria", "chronic idiopathic urticaria", AND "updosing", "second-generation anti-histamines", "cetirizine", "fexofenadine", "levocetirizine", "desloratadine", "ebastine", "bilastine", and "rupatadine". Our review suggests bilastine, fexofenadine, levocetirizine, and cetirizine are recommended for up-dosing in non-responsive patients with CSU (Grade A recommendation), while desloratadine and ebastine can be recommended (Grade B recommendation). Among those with Grade A recommendation, bilastine and levocetirizine may be up-dosed safely to four times, while fexofenadine has been studied at three times the conventional dose. None of the drugs showed any dose-dependent increase of adverse effects; however, cetirizine up-dosing may increase the risk of dose-related sedation. There were no reports of systemic complications, including cardiotoxicity, at higher than licensed doses of these drugs. Only cetirizine and rupatadine up-dosing have been documented to be effective and safe in children, while there is lack of data on geriatric patients and pregnant or lactating females.
Sections du résumé
Background
UNASSIGNED
Oral second-generation antihistamines (sgAH) constitute the first-line treatment for chronic spontaneous urticaria (CSU), a debilitating dermatological condition. However, many patients respond incompletely, and up-dosing sgAHs up to four-fold their conventional dose is recommended for disease control. Many physicians refrain from up-dosing due to a paucity of efficacy and safety data, instead adding a second antihistamine or an immunomodulator.
Objective
UNASSIGNED
With the aim of addressing this knowledge gap, we conducted a literature review to highlight efficacy and safety data on up-dosed sgAHs.
Methods
UNASSIGNED
We conducted a comprehensive search of the literature across multiple databases (PubMed, EMBASE, MEDLINE and Google scholar) using the keywords (alone and in combination) and MeSH items as well as non-MeSH terms such as "chronic spontaneous urticaria", "chronic idiopathic urticaria", AND "updosing", "second-generation anti-histamines", "cetirizine", "fexofenadine", "levocetirizine", "desloratadine", "ebastine", "bilastine", and "rupatadine".
Results
UNASSIGNED
Our review suggests bilastine, fexofenadine, levocetirizine, and cetirizine are recommended for up-dosing in non-responsive patients with CSU (Grade A recommendation), while desloratadine and ebastine can be recommended (Grade B recommendation). Among those with Grade A recommendation, bilastine and levocetirizine may be up-dosed safely to four times, while fexofenadine has been studied at three times the conventional dose. None of the drugs showed any dose-dependent increase of adverse effects; however, cetirizine up-dosing may increase the risk of dose-related sedation. There were no reports of systemic complications, including cardiotoxicity, at higher than licensed doses of these drugs. Only cetirizine and rupatadine up-dosing have been documented to be effective and safe in children, while there is lack of data on geriatric patients and pregnant or lactating females.
Types de publication
Journal Article
Review
Langues
eng
Pagination
44-50Informations de copyright
Copyright © 2023. Matrix Medical Communications. All rights reserved.
Déclaration de conflit d'intérêts
DISCLOSURES: The authors report no conflicts on interest relevant to the content of this article.
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