Antihistamines in urticaria

Abstract

Urticaria is one of the most common and, in its chronic course, excruciating dermato-allergic diseases. Apart from the dermatological diagnosis, the identification and evaluation of causal triggering factors is of utmost importance. Here a 'three-step guideline' (according to Ring and Przybilla) has gained acceptance, ranging a general basic examination via an intensive investigation until oral provocation tests for food allergy and oral provocation tests for idiosyncrasy (OPTI) against food additives. Apart from true IgE-mediated allergies, pseudo-allergic reactions against food additives as well as food contents represent a major problem in chronic urticaria. Recently gastric mucosal colonization with Helicobacter pylori as the trigger of chronic urticaria has received attention. New pathophysiological concepts describe autoantibodies that are directed either against IgE or against the high-affinity IgE-receptor on the surface of mast cells and basophil leucocytes. In the intradermal test with autologous serum positive wheal and flare reactions can be observed (Greaves' test). In many patients with chronic urticaria considerable psychosomatic involvement is also observed. Histamine is one of the major mediators of most forms of urticaria although in some cases, especially physical urticaria, other mediators seem to play a role. Therefore antihistamines, and mainly H1 antihistamines, are the mainstay of antiurticaria therapy. Some studies have shown a benefit of combined H1- and H2-antagonist treatment in special forms of urticaria namely urticaria factitia. Similarly pretreatment with combined H1 and H2 antagonists has been proven to reduce effectively the frequency of pseudo-allergic reaction to some histamine-releasing drugs used in radiology or surgery. More than 50 years after the first introduction of an antihistamine into allergy therapy, antihistamines still represent modern and exciting agents contributing to the continuous improvement of antiallergic therapy. Antihistamine therapy can be performed with either the classical or second generation antihistamines. Classical antihistamines are connected with considerable side-effects especially sedation and anticholinergic effects. New non-sedating antihistamines have been developed that do not cross the blood-brain barrier. The efficacy of mizolastine, a new non-sedating H1 antagonist, has been evaluated in several placebo-controlled and comparative clinical trials. Overall, mizolastine 10 mg/day was found to be significantly more effective than placebo and as effective as other second generation antihistamine drugs in the management of patients with chronic urticaria, with a rapid and sustained action.

Assessment of Lupin Allergenicity in the Cholera Toxin Model: Induction of IgE Response Depends on the Intrinsic Properties of the Conglutins and Matrix Effects

“…Nevertheless, our study indicates that the various proteins studied here still exhibit individual characteristics, which are beyond the concentration present in the fed samples. Accordingly, CT may be regarded as a tool to experimentally introduce the appropriate conditions in the gut at the time of allergen administration, for inducing an allergic response, in line with the less well-established conditions in atopic individuals leading to a food allergy [34]. Thus, this study justifies the CT food allergy model in assessment of the allergenicity of potential food allergens as well as the impact of the food matrix [32].…”

Management of cutaneous drug reactions

“…In the case of mild type 1 reactions, such as urticaria and pruritus, antihistamines may be beneficial to suppress the symptoms while continuing the treatment [41]. When treating through mild type 1 reactions, it is imperative to avoid lapses in treatment because restarting treatment may invoke anaphylaxis.…”

Effect of combined histamine H1 and H3 receptor blockade on cutaneous microvascular permeability elicited by compound 48/80

“…Urticaria is one of the most common allergic dermatological conditions in the US (Ring et al, 1999). The prevalence of all types of urticaria in the US range up to 35% of the population.…”