Non-sedating antihistamines recommended to treat urticaria

Most doctors know how complex the management of urticaria— particularly chronic urticaria—can be. New clinical guidelines will help you identify and treat your patients with this condition.

Specifically, the Consensus Statement, published recently in the Indian Journal for Dermatology, provides helpful information on pharmacotherapeutic management of urticaria.

“This Consensus Statement on Urticaria Management strongly recommends use of non-sedating [H1] antihistamines as the first line of treatment with up-dosing of the same molecule, four times, as a next step,” Dr. Kiran Godse, MD, DVD, FAAD, associate professor of dermatology at the Dr. D. Y. Patil Medical College & Hospital, Navi Mumbai, India, explained in [s2If !is_user_logged_in()]…

[/s2If][s2If is_user_logged_in()]an exclusive interview with mdCurrent-India.


“This Consensus Statement on Urticaria Management strongly recommends use of non-sedating [H1] antihistamines as the first line of treatment with up-dosing of the same molecule, four times, as a next step.”
Dr. Kiran Godse, MD, DVD, FAAD, associate professor of dermatology at the Dr. D. Y. Patil Medical College & Hospital, Navi Mumbai, India


Key Point: Treat most patients with non-sedating antihistamines. You can usually increase the dose up to four times the recommended dose to get a good response. For nonresponsive patients, additional treatment options are available, depending on cost.

Although the exact incidence of urticaria in India is not known, up to 20% of people develop the condition, which can greatly decrease a patient’s quality of life. Urticaria does not favor any particular age but is most common after adolescence. It is twice as common in women than men.

Signs and symptoms

The first sign of urticaria is itchy and swollen skin lesions that usually occur quickly. The condition is usually autoimmune-related or has an unknown cause. Various pathways and mechanisms are involved, and urticaria is classified by duration and frequency. If it occurs every day or most days for at least 6 weeks, it is considered chronic urticaria. If less than that, it is acute.

Acute urticaria is more common in children and young adults. In acute cases, urticaria is usually due to an allergy from food, nuts, seafood, food additives, drugs, viruses, or other infections. Sometimes urticaria is caused by an insect sting or a blood transfusion. Autoimmune urticaria and physical urticaria are the two largest subtypes. Physical urticaria happens when friction or rubbing of an area causes skin damage, such as a rubbing belt or tight clothing. Anti-inflammatory drugs, aspirin, local heat, and stress can worsen the condition. Once the cause of urticaria is found, removing that and other triggers will improve symptoms.

Pharmacotherapy

Providing symptomatic relief with oral non-sedating (second generation) antihistamines or topical calamine will also help patients feel better. Some of these agents include: fexofenadine, loratadine, desloratadine, cetirizine, levocetirizine, ebastine, mizolastine, olapatadine, and rupatadine. Some of these agents may cause sedation if the dose is raised too high. Safety studies indicate that loratadine dosing can be carefully raised in pregnant women if necessary, but remember that it is metabolized by the liver. Breast-feeding women can use loratadine, desloratadine, or fexofenadine in therapeutic doses, but the doses should not be escalated in these patients. Weight-based dosing should be used to treat infants and children. Use caution when treating older patients and those with liver or kidney disease.


Source: Godse KV, Zawar V, Krupashankar DS et al. Consensus Statement on the Management of Urticaria. Indian Journal for Dermatology. 2011;56(5):485-489.

Access the original journal information here:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3221204/?report=printable
Journal publishers are independent from mdCurrent-India and may require a subscription or charge a fee to download the full article.

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