Efficacy of H, antihistamine, corticosteroids and cyclophosphamide in the treatment of chronic dermographic urticaria

H, antihistamines relieve urticaria by blocking the action of histamine on the target tissue, while demonstration of autoantibodies in the sera of a proportion of the patients having chronic idiopathic urticaria, use of immunosuppressive drugs for the treatment of these patients has acquired the greater rationality. We evaluated the role of corticosteroids and cyclophosphamide in the treatment of chronic dermographic urticaria. Twenty-five patients, 13 males and 12 females, between 18-53 years in age, having chronic dermographic urticaria were taken up for this study. The patients were divided into three groups. Group I patients (n=9) were treated with cetirizine hydrochloride 10 mg per day orally, group II patients (n=7) were treated with betamethasone 2 mg along with cyclophosphamide 50 mg along with cetirizine 10 mg per day for a total period of 4 weeks. The patients were evaluated every week to record the therapeutic response and side effects, and then followed up without treatment for a period of 6 months to look for recurrence of the urticaria, if any. Six patients in group I and all the patients in group II and group III had complete remission while the remaining patients in group I had partial relief. The side effects included drowsiness in 4 patients. All the patients in group II had weight gain, 4 patients had acne and 2 patients developed cushingoid features. Majority of the patients relapsed within 3 days after stopping the treatment. Supplementation of the treatment with oral corticosteroids or cyclophosphamide was more effective in controlling the symptoms as compared to cetirizine alone. But a four weeks supplementation was not adequate for preventing the relapses when the drugs were withdrawn.     

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.     

Evaluation of H2 receptor antagonists in chronic idiopathic urticaria

H1-antagonist (hydroxyzine hydrochloride) in dosage of 10 mg-25 mg thrice a day failed to elicit satisfactory response in 60 out of 170 patients of chronic idiopathic urticaria. Additional administration of H2-antagonist (cimetidine) in dosage of 200 mg four times a day, in patients not responding earlier to H1-antagonist alones exhibited moderate to good improvement of various parameters of urticaria in approximately 85% patients.     

Ultraviolet light therapy in chronic urticaria

Fifteen patients with chronic urticaria were treated with ultraviolet light B (UVB) for 1-3 months during the spring 1984 and a follow-up study was performed in November 1984-January 1985. Patients with cold urticaria, cholinergic urticaria and dermographism became clearly better or got rid of their symptoms more often than those with "non-specific" chronic urticaria. The good results achieved during the phototherapy held during the summer but in the autumn urticaria became worse in one third of the cases. The result suggests that UV-therapy might be worth trying in many patients with chronic urticaria.     

Bilastine: a new H1‐antihistamine with an optimal profile for updosing in urticaria

This review set out to examine published papers detailing the efficacy of bilastine in skin models and urticaria to assess whether it meets the optimal profile for updosing in urticaria, that is, strong clinical efficacy and freedom from unwanted side effects, particularly sedation. Bilastine is a highly effective H₁‐antihistamine even when used at the basic dose of 20 mg daily. Its facilitated uptake after oral dosage gives it a rapid onset and long duration of action. In both wheal and flare studies and in urticaria updosing fourfold showed increased effectiveness. With respect to somnolence, bilastine is a substrate for P‐glycoprotein, a membrane pump which prevents it crossing the blood–brain barrier. Consequently, bilastine is a practically ‘non‐sedating’ H₁‐antihistamine. In conclusion, the excellent profile of bilastine in both efficacy and safety make it the ideal H₁‐antihistamine for updosing the daily dose fourfold in difficult‐to‐treat urticaria as recommended by the EAACI/GA²LEN/EDF/WAO guideline for the management of urticaria.     

Review of H1 antihistamines in the treatment of chronic idiopathic urticaria

Chronic idiopathic urticaria (CIU) can have a profound effect on patient quality of life (QOL). Ideally, any therapy used to treat CIU should be effective across a wide range of doses without causing unwanted side effects; a wide therapeutic window allows the physician to tailor treatment to the individual. Oral H1 antihistamines are the mainstay of therapy for CIU, but agents within this class diverge in their individual therapeutic indices. The literature was reviewed to compare the currently available oral H1 antihistamines regarding their efficacy and safety at a wide range of doses. If sedation and cognitive impairment are considered relevant to treatment selection due to their effect on QOL and safety, then newer-generation agents should be selected over older-generation antihistamines. There are few well-controlled clinical studies in which newer-generation agents have been directly compared. Moreover, there are no evidence-based data demonstrating statistical superiority of one newer-generation agent over another in the treatment of CIU. However, of the newer agents, those that are labelled nonsedating at recommended doses (fexofenadine, loratadine, and desloratadine) should be selected over cetirizine. In cases where the physician judges that a higher-than-recommended dose should be prescribed, or when the patient is likely to take a higher dose, the relative safety profile of these agents demands detailed consideration.     

Prospective randomized non-blinded clinical trial on the use of dapsone plus antihistamine vs. antihistamine in patients with chronic idiopathic urticaria

Background Treatment of chronic idiopathic urticaria (CIU) is difficult. Objective The purpose of this study was to evaluate the efficacy and safety of dapsone in CIU. Methods The response to dapsone was evaluated in 65 CIU patients with a randomized, two armed study: 3‐month dapsone + desloratadin and 3‐month desloratadin. All were followed for up to 3 months and 3 months after; all took desloratadine 10 mg daily throughout the study. The primary measure of efficacy was a daily urticaria activity score (UAS) of weal numbers and itch (maximum score, 42 per week). Results Sixty‐five patients completed the randomized 3‐month trial medication. Mean reduction in UAS from baseline at 3 months was 7 [95% confidence interval (95% CI), 6.92–7.08] for active group and 5.77 (95% CI, 5.47–6.08) for control subjects (P < 0.001). The reduction in visual analogue score (VAS) at 3 months for active group (mean, 2.58; 95% CI, 2.33–2.83) and control subjects (mean, 2.55; 95% CI, 2.38–2.73) was also significant (P < 0.001). The reduction of UAS and VAS at 3 months compared between active group and control subjects showed no significant difference. Mean reduction in UAS from the end of the study at 3 months after was 1.16 and –4.8 for active and control subjects, respectively. These results were compared with each other, and it was statistically significant (P ≤ 0.05). Limitations No placebo was used. The study was not blinded. Lack of blinding may have led to bias. The follow‐up period was short. Conclusion This study shows that dapsone leads to a persistent decrease in VAS and UAS and is associated with complete remission in some patients.     

Thl-Th2失衡与慢性荨麻疹

Th1-Th2亚群失衡在慢性荨麻疹发生及发展中的作用正日益引起人们的重视。研究表明,慢性荨麻疹是由于相应变应原的刺激引起Th2为主的免疫应答,从而产生临床症状。该文阐述了Th1-Th2的分化途径、与慢性荨麻疹的关系及相应治疗方法。     

Effects of relaxation therapy and hypnotizability in chronic urticaria

The therapeutic results of hypnosis with relaxation therapy were evaluated in 15 patients with chronic urticaria of 7.8 years' average duration. Compared with baseline and control session values, the hypnosis session provided relief of pruritus as measured by three self-report parameters. There was no change in the number of hives. All subjects were given a standard test for hypnotizability. Assuming that the results were not biased by their preceding relaxation sessions, we determined that six subjects were hypnotizable and nine were nonhypnotizable. Subjects in both groups improved symptomatically, but hypnotizable subjects had fewer hives and became more symptomatic during the control (testing and history taking) session. Hypnotizable subjects also more frequently related stress as a causative factor. At a follow-up examination five to 14 months after the completion of the experimental sessions, six patients were free of hives and an additional seven reported improvement.     

Effectiveness of combination treatment with H1-(Tavegyl) and H2-antagonists (Altramet) in chronic/chronically-recurrent urticaria

Histamine H1 receptor antagonists are a mainstay in the management of chronic/chronic recurrent urticaria (c./c.r.U.). Since experimental studies have confirmed the presence of cutaneous H2 receptors partially conflicting results have been reported on the use of H2 antagonists in c./c.r.U. 20 patients with c./c.r.U. of idiopathic type were treated with cimetidine plus clemastine or placebo plus clemastine in a double-blind crossover study. Before this treatment traditional H1 antagonists alone failed to show any satisfying therapeutic effect. The results reveal that combined therapy is statistically more effective than corresponding H1 antagonists alone (P = 0.001). The addition of cimetidine is proposed in patients with c./c.r.U. if conventional therapy has been tried and proven ineffective.     

Cetirizine: a new H1 antagonist with antieosinophilic activity in chronic urticaria.

Although the action of H1 antagonists in the early phase of IgE-mediated, allergic skin reactions is well established, the effect of these antihistamines on the ensuing late-phase reaction has only recently been investigated. The eosinophilic late-phase reaction, sometimes associated with the tissue damage that occurs in chronic idiopathic urticaria, is important in allergic responses. Cetirizine is a new H1 antagonist with potent inhibitory action against the infiltration of eosinophils into involved tissue, thereby affecting the late-phase reaction. No other antihistamine has yet been reported to possess this antieosinophilic property. The mechanisms by which cetirizine acts against eosinophils, although not thoroughly understood, seem to involve direct action against these cells.     

Acquired cold urticaria: H1 and H2 antagonists versus cold induced histamine release

Three patients with idiopathic cold urticaria were treated with either or both cyproheptadine (Histamine H₁ receptor antagonist) and cimetidine (Histamine H₂ receptor antagonist). Cold induced histamine release (CIHR) was significantly higher in the patients (71.0 ± 23.8 pm/ml) than in normal volunteers (4.5 ± 1.0 pm/ml). Improvement of clinical manifestations with reduced CIHR was obtained by combination therapy using cyproheptadine and cimetidine but no favorable response was noted with either drug alone. The combined therapy with both drugs completely suppressed pruritis and edema but failed to suppress the erythematous reaction. Single cyproheptadine therapy was rather favored by the patients despite positive CIHR with the therapy. Histamine release from patients' leukocytes under three different conditions (37°C, 4°C→37°C, 4°C) was not significantly different.     

Thyroid autoimmunity in chronic idiopathic urticaria: implications for therapy

The association between thyroid autoimmunity and chronic idiopathic urticaria has long been recognized, although prevalence rates differ in the studies reported to date (from 12 to 29%). There is, therefore, a strong indication to screen patients affected by chronic urticaria of unknown origin for thyroid antibodies (antithyroperoxidase and antithyroglobulin) and, when positive, for serum thyrotropin to assess thyroid functional status. Less clear is the implication of thyroid autoimmunity for therapy, as most patients with urticaria who have associated thyroid autoimmunity are euthyroid. There is no doubt that cases with clinical or subclinical thyroid dysfunction should undergo treatment with either levothyroxine or antithyroid drugs for hypo- or hyper-function, respectively. Although the best remission rates for symptoms of urticaria have so far been obtained with levothyroxine in patients who are euthyroid, monitoring of thyroid function through serum thyrotropin determination is highly recommended because of the risk of hyperthyroidism, especially in the elderly.     

Therapy of urticaria with H1 and H2 antihistaminics. Results of clinical and experimental studies

The antipruritic effect of modern H1- and H2-receptor blockers in chronic urticaria, that had been clinically proved, was experimentally studied by means of the histamine weal test. The H2-antihistamine preparation ranidine alone did not clearly reduce weals or erythemas induced by histamine when compared with a placebo. As expected, both parameters were markedly reduced by the H1-antihistamine preparation terfenadine. After combined administration of both drugs, the effect of the H1-blocker proved to be significantly increased. We discuss the possible mode of action and the consequences for anti-allergic therapy.     

慢性荨麻疹患者血浆凝血酶原片段F1+2水平的研究

目的: 分析慢性荨麻疹与血浆F1+2之间的关系.方法: 用酶联免疫吸附双抗夹心法(ELISA),检测34例自体血浆皮肤试验(APST)阳性的慢性荨麻疹患者,治疗前后血浆凝血酶原片段F1+2水平.结果: 慢性荨麻疹经治疗后血浆凝血酶原片段F1+2水平明显降低(P<0.001),治疗前较正常对照组高(P<0.001),治疗后与正常对照组的水平差异无显著性(P>0.05).结论: 慢性荨麻疹血浆F1+2水平升高,提示其可能在慢性荨麻疹发病中具有重要意义.