A multicentric trial of loratadine and cetirizine in urticaria

Two hundred and ten patients with chronic urticaria were divided into two groups; one group was treated with Loratadine 10mg daily while the other with cetirizine 10mg daily. The total duration of treatment was four weeks. Pretreatment and post-treatment evaluations were made. It was noticed that loratadine was superior to cetirizine in terms of a rapid onset of actions, overall clinical efficacy and minimal side effects.     

盐酸左西替利嗪治疗慢性特发性荨麻疹的临床研究

目的：研究盐酸左西替利嗪治疗慢性特发性荨麻疹的疗效和安全性。方法：采用随机、双盲、对照的临床研究方法，对44例慢性特发性荨麻疹患者进行随机分组，试验组予以盐酸左西替利嗪片口服，对照组采用盐酸西替利嗪片口服，每日1次。观察治疗第7、14和28天的临床疗效和不良反应：结果：服药后第7、14和28天试验组和对照组的有效率分别为77．28％和68．18％、86．37％和77．28％、90．91％和81．82％。试验组略高于对照组，但差异并无显著性。试验中没有发生严重不良反应。结论：盐酸左西替利嗪治疗慢性特发性荨麻疹安全有效。     

Loratadine and cetirizine in the treatment of chronic urticaria

Aim This study was designed to compare loratadine and cetirizine in controlling the symptoms of chronic urticaria. Subjects One hundred and sixteen adult patients with chronic urticaria. Methods In this double-blind study the patients were randomly divided into three therapeutic groups: 38 received loratadine (10 mg), 40 cetirizine (10 mg) and 38 placebo tablets once daily for 28 days. Steroid-dependent subjects and patients with physical urticaria or with angioncurotic hereditary oedema as well as pregnant or breast-feeding women were excluded from the study. A suitable wash-out period was observed in case of previous treatments for the same disease. Itching, erythema, number of lesions and diameter of the largest one were evaluated according to a scale from 0 (absent) to 3 (severe). The minimum entry study score for itching plus number of lesions had to be at least equal to three. Control visits were scheduled after 3, 7 and 14 days of therapy. Symptoms, disease status, therapeutic response, side effects and compliance were evaluated at each visit. Diary cards were filled in by patients at home. Results Active drugs compared to placebo significantly reduced global clinical symptoms (p < 0.05). Loratadine was more rapid in developing its activity than the other two agents (p < 0.01 at day 3). Each single symptom showed the same trend. At the end of the study 24 (63%) patients treated with loratadine, 18 (45%) with cetirizine and 5 (13%) with placebo were free from symptoms. Four failures occurred with loratadine, six with cetirizine and seventeen with placebo. The tolerability profile was similar for all three groups. One patient receiving cetirizine dropped out due to severe gastric pain. Conclusions Loratadine is more active and safer than cetirizine in the treatment of chronic urticaria.     

地氯雷他定治疗慢性荨麻疹临床研究

目的评价地氯雷他定治疗慢性荨麻疹的疗效与安全性。方法采用随机开放平行对照的方法,对78例慢性荨麻疹患者随机分组,分别给予地氯雷他定5mg、西替利嗪10mg,均每日一次口服,观察治疗第14d、第28d的临床疗效及停药1w后的复发率。结果两者第14d、第28d的有效率分别为:地氯雷他定组68.89%和91.11%,西替利嗪组60.67%和84.85%,两者间无显著性差异(P>0.05)。停药1w后复发率,地氯雷他定组28.89%,西替利嗪组36.36%。两者试验过程中均无明显不良反应。结论地氯雷他定、西替利嗪治疗慢性荨麻疹疗效好,安全性高。     

The effect of cetirizine on symptoms and wealing in dermographic urticaria

The effect of cetirizine, 10 mg at night, on dermographic urticaria, was studied in 19 patients. The study design was a randomized, double-blind, crossover comparison with placebo, each treatment being given for 7 days. Patients kept a daily diary of itch and weal severity (100-mm linear analogue scale), and recorded sleep disturbance. The dermographic weal response was measured objectively with a spring-loaded stylus, and the weal threshold calculated from the force/response curve. There was a small, insignificant subjective response to placebo, but no objective response. On cetirizine, the subjective assessment of wealing was reduced from 34.3±6.7 (mean ± SEM, 0–100 scale) to 16.8±4.1 (P= 0.02), itch was reduced from 43.2±6.6 to 19.4±4.1 (P=0.001), and nights disturbed from 46.2 to 8.8% (P=0.03). There was a shift to the right in the position of the force/response curve, and the wealing threshold increased from 24.6±3.2 to 54.7±4.4 g/mm² (P=0.00001), but there was no correlation between change in itch scores and wealing threshold. Cetirizine 10 mg daily is an effective treatment in dermographic urticaria, and its usefulness will depend on the prevalence of unwanted effects.     

西替利嗪联合曲尼司特治疗慢性荨麻疹疗效观察

目的观察西替利嗪联合曲尼司特治疗慢性荨麻疹的疗效。方法将入选的80例患者按就诊时间顺序随机分为两组,治疗组48例,对照组32例。治疗组口服西替利嗪10mg,1次/d,曲尼司特0.1g3次/d;对照组仅口服西替利嗪10mg,1次/d;两组均连用4周后评价疗效,停药4周后观察复发情况。结果治疗4周后,治疗组有效率(75.00%)明显高于对照组(50.00%),差异有显著性意义(χ2=5.27,Р<0.05);对照组复发率(55.56%)明显高于治疗组(22.73%)。结论西替利嗪联合曲尼司特治疗慢性荨麻疹疗效满意,能明显降低复发率,疗效优于单用西替利嗪组。     

地氯雷他定治疗慢性荨麻疹疗效观察

目的 :观察地氯雷他定治疗慢性荨麻疹的疗效和安全性。方法 :采取随机对照临床试验 ,试验组每日口服一片地氯雷他定 (每片 5mg) ,疗程 1 4d;对照组每日口服一片西替利嗪 (每片 1 0mg) ,疗程 1 4d。结果 :共治疗 85例 ,试验组 4 3例 ,对照组 4 2例。总有效率试验组为 88 37% ,对照组为80 95 % ,两组比较差异无显著性 (P >0 0 5 )。不良反应发生率试验组为 9 30 % ,对照组为 1 9 0 5 % ,两组比较差异无显著性 (P >0 0 5 )。结论 :地氯雷他定是一种治疗慢性荨麻疹有效安全的药物。     

Clinical and immunohistological characterization of cutaneous lesions in chronic lymphocytic leukaemia

The effects of the H I receptor antagonists astemizole and chlorpheniramine on dermographism were compared in a double-blind study in sixteen patients. Both drugs resulted in a parallel and significant depression of the dermographic force-response curve and an elevation of the weal-force threshold, but the changes were greater in the patients receiving astemizole (a maximal potency shift of 74% for astemizole and 37% for chlorpheniramine). Subjective itch (10 cm line) and frequency of dermographic episodes were also reduced more by astemizole than by chlorpheniramine. The effect of astemizole was greater at 4 weeks than at 2 weeks, whereas the effect of chlorpheniramine had decreased at 4 weeks. The effect of astemizole but not chlorpheniramine was still apparent 4 weeks after treatment had been stopped. Since the degree of residual dermographism was comparable despite great differences in histamine weal inhibition a vasoactive mechanism in addition to that mediated by histamine must be involved in dermographic urticaria.     

仙特敏、甲氰咪呱和潘生丁联合治疗慢性荨麻疹疗效观察

报道仙特敏、甲氰咪呱和潘生丁联合应用治疗５７例慢性荨麻疹的疗效观察。结果：联合组显效率和总有效率分别为７９％和９１．２％，仙特敏单用组显效率和总有效率分别为５１．４％和７７．１％，两组比较有显著性差异（Ｐ＜０．００１）。本文提示这三种药联用是治疗慢性荨麻疹安全和有效的方法。     

Comparative efficacy of cetirizine and levocetirizine in chronic idiopathic urticaria

H1 receptor antagonists are the mainstay of treatment for chronic idiopathic urticaria. Newer hydroxyzine derivatives such as cetirizine and levocetirizine have been found to be equally efficacious in preclinical studies in patients with chronic idiopathic urticaria. In this study, the clinical efficacy of cetirizine and levocetirizine has been studied sequentially in individual patients. Fifty chronic idiopathic urticaria patients received 10 mg of levocetirizine daily for 6 weeks. Some 45 patients out of these showed reasonably good clinical efficacy on a visual analog scale to qualify for comparison with levocetirizine. A total of 30 patients completed the study period of 6 weeks each of cetirizine and levocetirizine sequentially. Thus, the clinical efficacy of cetirizine and levocetirizine was comparable with a marginal advantage of better antipruritic effect with levocetirizine, probably at the cost of increased sedation.     

Urticarial intolerance reaction to cetirizine

The paradoxical acute exacerbation of pre-existing chronic idiopathic urticaria accompanied by intense generalized pruritus, facial oedema, and dyspnoea in a 36-year-old-woman 3-4 h after a single oral dose of 10 mg cetirizine (Zyrtec tablets), suggested the presence of an underlying intolerance reaction. However, a type I hypersensitivity reaction also had to be excluded. Detailed allergy testing supported the view that the patient had suffered an intolerance reaction to cetirizine. This is the third known case of most probably a nonallergic generalized urticaria following the administration of cetirizine, a drug with extensive usage worldwide. However a type I sensitization to cetirizine is indeed possible, as has been demonstrated in this research with the verification of cetirizine-specific IgE antibodies in one of the control sera.     

盐酸依匹斯汀每日/隔日疗法治疗慢性荨麻疹临床观察

[摘要] 目的 观察盐酸依匹斯汀每日-隔日疗法治疗慢性荨麻疹的疗效和安全性。方法 80例患者被随机分为试验组和对照组,各40例。前者先服盐酸依匹斯汀片10mg,1次/d,连续4周,后改为10mg,隔日1次,再服4周;后者口服盐酸依匹斯汀片10mg,1次/d,连续8周。结果 试验组的有效率、不良反应发生率分别为82.05%、7.69%,对照组依次为89.47%、5.26%,两组有效率、不良反应发生率比较均无统计学意义(Ｐ均>0.05)。试验组的成本-效果比低于对照组,且服药次数明显减少。结论 盐酸依匹斯汀每日-隔日疗法治疗慢性荨麻疹疗效好、安全、经济且方便。     

Treatment of chronic urticaria with cetirizine dihydrochloride a non-sedating antihistamine

The efficacy of cetirizine dihydrochloride, a new H₁-antagonist with minimal sedative or anticholinergic side effects was evaluated in 30 patients with chronic idiopathic urticaria. In the first part of the study, cetirizine 10 mg and placebo were compared in a double-blind cross-over trial. In the second part, patients who did not respond adequately in the first part were randomized, still double-blind, to receive 10 mg cetirizine either once daily or twice daily. In the first part, treatment was discontinued by 17 patients on placebo and two patients on cetirizine because of lack of efficacy. Cetirizine dihydrochloride was found significantly to reduce occurrence of weals, erythema and pruritus compared with placebo (P <0.001). Twenty-six of the patients improved on cetirizine and two on placebo. Mild sedation was noted by two patients on cetirizine and by one on placebo.     

Histamine, but not leukotriene C4, is an essential mediator in cold urticaria wheals

In addition to histamine, leukotriene C4 (LTC4) might also play a role in mediating cold urticaria wheals. To study the significance of LTC4 vs. histamine, 6 patients with cold urticaria were challenged with the ice cube test before and after ingestion of 10 mg cetirizine (antihistamine), 10 mg montelukast (leukotriene antagonist) or a combination of both drugs. Cetirizine diminished the cold-induced wheal by 50+/- 42%. Montelukast had no significant effect, and the combination of both drugs diminished the wheal by 37+/- 33%. Furthermore, a skin microdialysis technique detected the release of histamine in the cold-induced wheal, whereas no LTC4 release was detected. In conclusion, the antihistamine is effective and histamine is released, whereas the leukotriene antagonist is not effective and LTC4 is not released in the cold urticaria wheal.     

Effect of cetirizine on cutaneous reactions to PAF, kallikrein and serum in patients with chronic urticaria

The effects of oral administration of the antihistamine cetirizine on the weal and flare caused by intradermal injection of platelet activating factor (PAF-acether), kallikrein, histamine and the patient's own serum were investigated in 10 patients with chronic urticaria. Cetirizine markedly reduced the weal and flare induced by all these agents as measured 12 min after the injections. The delayed reactions observed after injection of PAF, kallikrein and serum were also inhibited by cetirizine at 6 hours. In addition, reactions which were present 20 h after injection of the agent before administration of cetirizine were found to be inhibited at the same point in time after cetirizine treatment. These effects might explain the good inhibitory clinical effect of cetirizine on the patients' urticaria. No side-effects were noted during the treatment.     

左西替利嗪与西替利嗪治疗慢性荨麻疹多中心随机双盲对照研究

目的 研究和比较左西替利嗪和西替利嗪治疗慢性荨麻疹的疗效和安全性.方法 选择慢性荨麻疹患者为研究对象,采用多中心、随机、双盲、对照临床研究.试验组盐酸左西替利嗪片每日1次,每次5mg,对照组盐酸西替利嗪片每日1次,每次10mg,均连续服用28d.分别于用药后第7、14、28天随访,观察疗效和不良反应.结果 入选病例132例,可评价疗效和安全性病例均为130例.ITT分析左西替利嗪组治疗后第7、14、28天有效率分别为73.44%、82.81%、89.06%,西替利嗪组有效率分别为77.27%、81.82%、81.82%,两组比较差异无显著性.左西替利嗪组和西替利嗪组不良反应发生率分别为14.06%和18.18%,主要有口干、嗜睡.结论 左西替利嗪治疗慢性荨麻疹安全有效.     

Effects of loratadine and cetirizine on serum levels of neuropeptides in patients with chronic urticaria

H1‐receptor inhibiting drugs, namely loratadine and cetirizine, were frequently used in treatment of chronic urticaria. Urticarial weal and flare reactions, a neurogenic reflex due to neuropeptides, were reported to be more effectively inhibited by cetirizine than loratadine. The aim of this study was to determine and compare the effects of systemic loratadine and cetirizine treatments on serum levels of selected neuropeptides in chronic urticaria. Treatment groups of either systemic loratadine or cetirizine (10 mg/d), consisting of 16 and 22 patients, respectively, were included. Serum levels of stem cell factor (SCF), neuropeptide Y (NPY), calcitonin gene‐related peptide (CGRP), nerve growth factor (NGF), vasoactive intestinal peptide (VIP), and substance P (SP) were detected before and after one week of treatment with antihistamines. Serum NPY and VIP levels were significantly decreased when compared before and after treatment with antihistamines (P < 0.001 and P < 0.01, respectively). SCF and NGF values were also decreased after antihistamine treatment (P < 0.05). Post‐treatment levels of CGRP were significantly higher compared with pretreatment values, while no significant difference was detected between pre and post treatment levels of SP. Cetirizine was significantly more effective than loratadine on lowering serum levels of SCF among the other neuropeptides. Systemic loratadine and cetirizine treatments in patients with chronic urticaria precisely caused variations in serum levels of neuropeptides. The predominant effect of cetirizine compared to loratadine on reducing serum SCF levels might be explained with anti‐inflammatory properties of cetirizine.     

盐酸非索非那定联合雷公藤多甙治疗慢性荨麻疹的临床观察

目的观察盐酸非索非那定联合雷公藤多甙治疗慢性荨麻疹与盐酸非索非那定单独应用治疗慢性荨麻疹的临床疗效。方法 75例过敏门诊慢性荨麻疹患者,随机分为治疗组38例,对照组37例,治疗组口服盐酸非索非那定片60mg,2次/d,雷公藤多甙片10mg,3次/d,对照组单独使用盐酸非索非那定片,用法同治疗组,两组疗程均为4周,计算疗效指数,判定疗效。结果两组有效率(84.21%和62.16%)差异有统计学意义(P<0.05)。结论盐酸非索非那定联合雷公藤多甙治疗慢性荨麻疹疗效肯定,药物协同作用明显。     

In dermographic urticaria H2 receptor antagonists have a small but therapeutically irrelevant additional effect compared with H1 antagonists alone

Two studies of the additional effect of an H₂ receptor antagonist when given in combination with an H₁ antagonist were undertaken in dermographic urticaria. Using a randomized, double-blind, crossover design in 19 patients, a combination of cetirizine (10 mg at night) and ranitidine (150 mg twice daily) was compared with a combination of cetirizine (10 mg at night) and placebo. The addition of ranitidine did not produce any significant difference in linear analogue scores for weal, Itch or sleep disturbance. There was a significant depression of the frictional force/wealing response curve with an increase in wealing threshold (P<0.0001) following the addition of H₂ blockade. The wealing threshold was 54.7 ± 4.4 (mean ± SEM) g/mm² for the H₁ antagonist alone, and 73.2 ± 5.7 for the combination of H₁ and H₂ antagonists. In a second similar study involving nine different patients, comparing terfenadine (120 mg twice daily) with a combination of terfenadine and ranitidine (150 mg twice daily), the weal threshold was 59.8 ± 6.6 for the H₁ antagonist alone, and 73.0 ± 6.4 for the combination of H₁ and H₂ antagonists. Thus, in dermographic urticaria, adding an H₂ antagonist to treatment with a potent H₁ antagonist gives a small, significant reduction in wealing response, but no symptomatic benefit. We conclude that involvement of the H₂ receptor in this urticarial disease is minimal, and does not justify the use of H₂ receptor antagonists.     

盐酸非索非那定治疗126例慢性特发性荨麻疹

目的:评价盐酸非索非那定片治疗慢性特发性荨麻疹的有效性和安全性。方法:多双盲、随机、平行组对照的临床试验,以盐酸西替利嗪片为对照药。结果:共完成病例126例,试验组63例,对照组63例。试验组有效率为88.89%,对照组有效率为80.95%,两组无显著性差异(P >0.05)。试验组不良反应发生率为4.76%;对照组不良反应发生率为9.52%,两组无显著性差异(P>0.05)。结论：:盐酸非索非那定片治疗慢性特发性荨麻疹的有效性与盐酸西替利嗪片相当。