title: Differential effects of new-generation H1-receptor antagonists in pruritic dermatoses.
abstract: In search of an improved treatment of pruritic dermatoses, we have studied azelastine, a novel H1-receptor antagonist, during a 2-week treatment period, using a double-blind, placebo-controlled design. The potent H1-antagonist cetirizine was used for comparison. Symptoms were recorded daily by the patients on a diary card, using a 4-point scale. The same parameters and adverse events were evaluated at weekly intervals, and global improvement was evaluated at the end of treatment. In all 230 evaluable patients with moderate to severe itching, azelastine caused an overall significant improvement in comparison to placebo (P = 0.02), with significance also for pruritus (P = 0.01 after 1 week and P = 0.02 after 2 weeks). Both drugs reduced itching more effectively in urticaria than in atopic eczema. Azelastine was superior to cetirizine in reducing pruritus, whereas cetirizine caused a more marked reduction of whealing. Both drugs rarely caused fatigue and dry mouth, but taste perversion occurred only in azelastine-treated patients (9.7%) and headaches only with cetirizine (10.4%). Therefore, the two H1-blockers exert differential effects on pruritus verses whealing and a distinctive adverse events pattern. The data also underline the low efficacy of antihistamines in atopic eczema, compared to urticaria.
authors.affiliation: Department of Dermatology, Virchow Klinikum, Humboldt University, Berlin, Germany.
authors.forename: B M
authors.initials: BM
authors.lastname: Henz
authors.forename: P
authors.initials: P
authors.lastname: Metzenauer
authors.forename: E
authors.initials: E
authors.lastname: O'Keefe
authors.forename: T
authors.initials: T
authors.lastname: Zuberbier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017332:Cetirizine / Q000009:adverse effects / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006634:Histamine H1 Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010793:Phthalazines / Q000009:adverse effects / Q000627:therapeutic use*; D011537:Pruritus / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D006634:Histamine H1 Antagonists; D010793:Phthalazines; D017332:Cetirizine; C020976:azelastine