Abstract | Background: 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: With the aim of addressing this knowledge gap, we conducted a literature review to highlight efficacy and safety data on up-dosed sgAHs. Methods: 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: 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.
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Authors | Indrashis Podder, Arunima Dhabal, Sankha Subhra Chakraborty |
Journal | The Journal of clinical and aesthetic dermatology
(J Clin Aesthet Dermatol)
Vol. 16
Issue 3
Pg. 44-50
(Mar 2023)
ISSN: 1941-2789 [Print] United States |
PMID | 36950042
(Publication Type: Journal Article, Review)
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