Challenges in the Management of Chronic Urticaria

Abstract

The term "chronic idiopathic urticaria" denotes a spectrum of conditions with different poorly understood pathogenetic mechanisms in which the release of histamine plays a role. Nonsedating second-generation H1 antihistamines are postulated to be the first line of treatment of chronic idiopathic urticaria by national and international guidelines, but as control is not always achievable with the usually recommended doses, first-generation sedating antihistamines like hydroxyzine and diphenhydramine at high daily doses (200 mg) have been proposed as an alternative before resorting to treatment with systemic corticosteroids and other potentially hazardous agents. Our long time experience and recent research give us grounds to believe that increasing the doses of nonsedating H1 antihistamines up to fourfold improves significantly the chances of successful treatment. Our data suggest that the urticaria-associated discomfort is relieved by higher than conventional doses of levoce-tirizine and desloratadine in about 75% of the patients and that sedation/somnolence does not seem to be a major deterrent. The dose increase also improves the urticaria-specific quality of life. Contrary to the belief that individual patients may benefit from one antihistamine or another, we demonstrate that the drug with better ability to suppress the histamine skin effects in experiments in healthy volunteers (levocetirizine) is also superior in improving the different aspects of control of chronic urticaria (subjective and objective symptoms, quality of life) and that increasing its dose of up to fourfold may even paradoxically reduce the sense of sedation/somnolence in parallel with the relief of urticaria discomfort.

Hydroxyzine-induced priapism

“…Medications with alpha-adrenergic antagonistic properties, including trazodone and other antipsychotics, have been noted to carry an increased risk of inducing ischemic priapism [3,4]. While hydroxyzine is primarily an antihistaminergic agent, it has been noted to have alpha-adrenergic antagonistic properties due to a lack of receptor selectivity [5]. This lack of selectivity may be exacerbated at higher doses.…”

CASO 5-2014: Urticaria Crónica Idiopática o Urticaria espontánea y Omalizumab. Revisión del tema a propósito de un caso

“…El 35-50% de los pacientes tienen un mecanismo autoinmune, con autoanticuerpos frente a la cadena α del receptor de alta afinidad de IgE o contra la propia IgE (1,12) . Pacientes con UCI exhiben en promedio niveles de IgE total más altos en comparación con los controles sanos (13,14) .…”

Targeted Therapy for Chronıc Spontaneous Urtıcarıa: Ratıonale and Recent Progress

“…In the pre-omalizumab period, antihistamines (AHs) were the only US Food and Drug Administration (FDA)approved drug class for the treatment of CSU. The major challenge during that period was the treatment of patients not responding to AHs [5]. A meta-analysis showed that the rates of response to AHs at standard doses and updosing of AHs were 38.6% and 63.2%, respectively [6].…”