The Efficacy of a Two-Fold Increase of H1-Antihistamine in the Treatment of Chronic Urticaria - the Vietnamese Experience

Authors

  • Huyen Tran Thi National Hospital of Dermatology and Venereology, Hanoi, Vietnam; Hanoi Medical University, Hanoi, Vietnam
  • Lan Pham Thi National Hospital of Dermatology and Venereology, Hanoi, Vietnam; Hanoi Medical University, Hanoi, Vietnam
  • Thuong Nguyen Van National Hospital of Dermatology and Venereology, Hanoi, Vietnam; Hanoi Medical University, Hanoi, Vietnam
  • Phuong Pham Thi Minh National Hospital of Dermatology and Venereology, Hanoi, Vietnam
  • Hao Nguyen Trong HCMC Hospital of Dermato-Venereology, Ho Chi Minh City, Vietnam
  • Tro Chau Van Department of Dermatology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
  • Sau Nguyen Huu National Hospital of Dermatology and Venereology, Hanoi, Vietnam; Hanoi Medical University, Hanoi, Vietnam
  • Trang Trinh Minh National Hospital of Dermatology and Venereology, Hanoi, Vietnam
  • Nghi Dinh Huu National Hospital of Dermatology and Venereology, Hanoi, Vietnam; Hanoi Medical University, Hanoi, Vietnam
  • Tam Hoang Van National Hospital of Dermatology and Venereology, Hanoi, Vietnam; Hanoi Medical University, Hanoi, Vietnam
  • Van Tran Cam National Hospital of Dermatology and Venereology, Hanoi, Vietnam
  • My Le Huyen National Hospital of Dermatology and Venereology, Hanoi, Vietnam
  • Khang Tran Hau National Hospital of Dermatology and Venereology, Hanoi, Vietnam; Hanoi Medical University, Hanoi, Vietnam
  • Thuy Nguyen Thanh National Hospital of Dermatology and Venereology, Hanoi, Vietnam
  • Phuong Hoang Thi National Hospital of Dermatology and Venereology, Hanoi, Vietnam
  • Linh Nguyen Thuy National Hospital of Dermatology and Venereology, Hanoi, Vietnam
  • Marco Gandolfi Unit of Dermatology, University of Parma, Parma, Italy
  • Francesca Satolli Unit of Dermatology, University of Parma, Parma, Italy
  • Claudio Feliciani Unit of Dermatology, University of Parma, Parma, Italy
  • Michael Tirant University of Rome G. Marconi, Rome, Italy; Psoriasis Eczema Clinic, Melbourne, Australia
  • Aleksandra Vojvodic Department of Dermatology and Venereology, Military Medical Academy of Belgrade, Belgrade, Serbia
  • Torello Lotti University of Rome G. Marconi, Rome, Italy

DOI:

https://doi.org/10.3889/oamjms.2019.069

Keywords:

Chronic urticaria, Chronic idiopathic urticaria, Antihistamine, Fexofenadine, Levocetirizine

Abstract

BACKGROUND: Chronic urticaria, a mast cell-driven condition, is common, debilitating and hard to treat. H1-antihistamines are the first line treatment of chronic urticaria, but often patients do not get satisfactory relief with the recommended dose. European guidelines recommend increased antihistamine doses up to four-fold.

AIM: We conducted this study to evaluate the efficacy of increased H1-antihistamine doses up to two-fold in Vietnamese chronic urticaria patients.

METHODS: One hundred and two patients with chronic urticaria were recruited for treatment with levocetirizine (n = 52) or fexofenadine (n = 50). Treatment started at the conventional daily dose of 5 mg levocetirizine or 180 mg fexofenadine for 2 weeks and then increased to 10 mg levocetirizine or 360 mg fexofenadine for 2 weeks if patients did not have an improvement in symptoms. At week 0, week 2 and week 4 wheal, pruritus, size of the wheal, total symptom scores, and associated side-effects were assessed.

RESULTS: With the conventional dose, the total symptom scores after week 2 decreased significantly in both groups compared to baseline figures, i.e. 7.4 vs 2.3 for levocetirizine group and 8.0 vs 2.6 for fexofenadine group (p < 0.05). However, there were still 26 patients in each group who did not have improvements. Of these 26 patients, after having a two-fold increase of the conventional dose, 11.5% and 38.5% became symptom-free at week 4 in levocetirizine group and fexofenadine group, respectively. At week 4 in both groups, the total symptom scores had significantly decreased when compared with those at week 2 (2.8 ± 1.5 versus 4.7 ± 1.6 in levocetirizine group; 2.1 ± 1.9 versus 5.1 ± 1.4 in fexofenadine group). In both groups, there was no difference in the rate of negative side effects between the conventional dose and the double dose.

CONCLUSION: This study showed that increasing the dosages of levocetirizine and fexofenadine by two-fold improved chronic urticaria symptoms without increasing the rate of negative side effects.

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Published

2019-01-28

How to Cite

1.
Tran Thi H, Thi LP, Nguyen Van T, Thi Minh PP, Nguyen Trong H, Chau Van T, Nguyen Huu S, Trinh Minh T, Dinh Huu N, Hoang Van T, Cam VT, Le Huyen M, Tran Hau K, Thanh TN, Thi PH, Thuy LN, Gandolfi M, Satolli F, Feliciani C, Tirant M, Vojvodic A, Lotti T. The Efficacy of a Two-Fold Increase of H1-Antihistamine in the Treatment of Chronic Urticaria - the Vietnamese Experience. Open Access Maced J Med Sci [Internet]. 2019 Jan. 28 [cited 2021 Jun. 25];7(2):259-63. Available from: https://oamjms.eu/index.php/mjms/article/view

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