PMID- 28289538
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200929
IS  - 2045-7022 (Print)
IS  - 2045-7022 (Electronic)
IS  - 2045-7022 (Linking)
VI  - 7
DP  - 2017
TI  - Effectiveness and safety of antihistamines up to fourfold or higher in treatment 
      of chronic spontaneous urticaria.
PG  - 4
LID - 10.1186/s13601-017-0141-3 [doi]
LID - 4
AB  - BACKGROUND: Treatment with second-generation antihistamines is recommended in 
      patients with chronic spontaneous urticaria (CSU). Some patients remain 
      unresponsive even after up-dosing up to fourfold. Many third line treatment 
      options have limited availability and/or give rise to significant side effects. 
      We investigated effectiveness and safety of antihistamine treatment with dosages 
      up to fourfold and higher. METHODS: This retrospective analysis of patients' 
      records was performed in adult CSU patients suffering wheals and/or angioedema 
      (AE). Demographic, clinical, and therapeutic data was extracted from their 
      medical records. We recorded the type, maximum prescribed dosage, effectiveness, 
      and reported side effects of antihistamine treatment. RESULTS: Of 200 screened 
      patients, 178 were included. Treatment was commenced with a once daily dose of 
      antihistamines. Persisting symptoms meant that up-dosing up to fourfold occurred 
      in 138 (78%) of patients, yielding sufficient response in 41 (23%). Up-dosing 
      antihistamines was necessary in 110 (80%) patient with weals alone or weals with 
      angioedema and 28 (64%) with AE only (p = 0.039). Of the remaining 97 patients 
      with insufficient response, 59 were treated with dosages higher than fourfold 
      (median dosage 8, range 5-12). This was sufficient in 29 patients (49%). Side 
      effects were reported in 36 patients (20%), whereof 30 (17%) experienced 
      somnolence. Side effects after up-dosing higher than fourfold were reported in 
      six out of 59 patients (10%). CONCLUSION: Up-dosing antihistamines higher than 
      fourfold dosage seems a feasible therapeutic option with regards to effectiveness 
      and safety. The need for third line therapies could be decreased by 49%, with a 
      very limited increase of reported side effects.
FAU - van den Elzen, Mignon T
AU  - van den Elzen MT
AUID- ORCID: 0000-0002-8796-2231
AD  - Department of Dermatology and Allergology, University Medical Center Utrecht 
      (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands. ISNI: 
      0000000090126352. GRID: grid.7692.a
FAU - van Os-Medendorp, Harmieke
AU  - van Os-Medendorp H
AD  - Department of Dermatology and Allergology, University Medical Center Utrecht 
      (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands. ISNI: 
      0000000090126352. GRID: grid.7692.a
FAU - van den Brink, Imke
AU  - van den Brink I
AD  - Department of Dermatology and Allergology, University Medical Center Utrecht 
      (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands. ISNI: 
      0000000090126352. GRID: grid.7692.a
FAU - van den Hurk, Karin
AU  - van den Hurk K
AD  - Department of Dermatology and Allergology, University Medical Center Utrecht 
      (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands. ISNI: 
      0000000090126352. GRID: grid.7692.a
FAU - Kouznetsova, Ouliana I
AU  - Kouznetsova OI
AD  - Department of Dermatology and Allergology, University Medical Center Utrecht 
      (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands. ISNI: 
      0000000090126352. GRID: grid.7692.a
FAU - Lokin, Alexander S H J
AU  - Lokin ASHJ
AD  - Department of Dermatology and Allergology, University Medical Center Utrecht 
      (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands. ISNI: 
      0000000090126352. GRID: grid.7692.a
FAU - Laheij-de Boer, Anna-Marijke
AU  - Laheij-de Boer AM
AD  - Department of Dermatology and Allergology, University Medical Center Utrecht 
      (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands. ISNI: 
      0000000090126352. GRID: grid.7692.a
FAU - Rockmann, Heike
AU  - Rockmann H
AD  - Department of Dermatology and Allergology, University Medical Center Utrecht 
      (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands. ISNI: 
      0000000090126352. GRID: grid.7692.a
FAU - Bruijnzeel-Koomen, Carla A F M
AU  - Bruijnzeel-Koomen CAFM
AD  - Department of Dermatology and Allergology, University Medical Center Utrecht 
      (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands. ISNI: 
      0000000090126352. GRID: grid.7692.a
FAU - Knulst, Andre C
AU  - Knulst AC
AD  - Department of Dermatology and Allergology, University Medical Center Utrecht 
      (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands. ISNI: 
      0000000090126352. GRID: grid.7692.a
LA  - eng
PT  - Journal Article
DEP - 20170214
PL  - England
TA  - Clin Transl Allergy
JT  - Clinical and translational allergy
JID - 101576043
PMC - PMC5309999
OTO - NOTNLM
OT  - Angioedema
OT  - Antihistamines
OT  - Refractory
OT  - Therapy
OT  - Urticaria
EDAT- 2017/03/16 06:00
MHDA- 2017/03/16 06:01
PMCR- 2017/02/14
CRDT- 2017/03/15 06:00
PHST- 2016/11/07 00:00 [received]
PHST- 2017/02/03 00:00 [accepted]
PHST- 2017/03/15 06:00 [entrez]
PHST- 2017/03/16 06:00 [pubmed]
PHST- 2017/03/16 06:01 [medline]
PHST- 2017/02/14 00:00 [pmc-release]
AID - 141 [pii]
AID - 10.1186/s13601-017-0141-3 [doi]
PST - epublish
SO  - Clin Transl Allergy. 2017 Feb 14;7:4. doi: 10.1186/s13601-017-0141-3. eCollection 
      2017.