Rupatadine and its effects on symptom control, stimulation time, and temperature thresholds in patients with acquired cold urticaria.
BACKGROUND
Patients with acquired cold urticaria (ACU) show itchy wheals during cold exposure. This disturbing condition involves histamine and platelet-activating factor in its pathogenesis. Rupatadine is a dual antagonist of both histamine and platelet-activating factor.


OBJECTIVE
To assess rupatadine efficacy in preventing reactions to cold challenge in patients with ACU.


METHODS
A crossover, randomized, double-blind, placebo-controlled study in which 21 patients with ACU received rupatadine, 20 mg/d, or placebo for 1 week each is presented. The main outcome was the critical stimulation time threshold (CSTT) determined by ice cube challenge. Secondary outcomes included CSTT and the critical temperature threshold assessed by a cold provocation device (TempTest 3.0), as well as scores for wheal reactions, pruritus, burning sensations, and subjective complaints after cold challenge.


RESULTS
After rupatadine treatment, 11 (52%) of 21 patients exhibited a complete response (ie, no urticaria lesions after ice cube provocation). A significant improvement in CSTT compared with placebo was observed after ice cube and TempTest 3.0 challenge (P = .03 and P = .004, respectively). A significant reduction of critical temperature threshold (P < .001) and reduced scores for cold provocation-induced wheal reactions (P = .01), pruritus (P = .005), burning sensation (P = .03), and subjective complaints (P = .03) after rupatadine treatment were also found. Mild fatigue (n = 4), somnolence (n = 1), and moderate headache (n = 1) were reported during active treatment.


CONCLUSIONS
Rupatadine, 20 mg/d, shows high efficacy and is well tolerated in the treatment of ACU symptoms.
Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité-Universittätsmedizin, Berlin, Germany.
Martin
M
Metz
Elisabeth
E
Scholz
Marta
M
Ferrán
Iñaki
I
Izquierdo
Ana
A
Giménez-Arnau
Marcus
M
Maurer
D000328:Adult; D003080:Cold Temperature; D003533:Cyproheptadine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D004311:Double-Blind Method; D004781:Environmental Exposure; D005260:Female; D006633:Histamine Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010972:Platelet Activating Factor / Q000037:antagonists & inhibitors; D011537:Pruritus; D016896:Treatment Outcome; D014581:Urticaria / Q000188:drug therapy* / Q000503:physiopathology
D006633:Histamine Antagonists; D010972:Platelet Activating Factor; C103639:rupatadine; D003533:Cyproheptadine