title: H1-antihistamine up-dosing in chronic spontaneous urticaria: patients' perspective of effectiveness and side effects--a retrospective survey study.
abstract: BACKGROUND
  The guidelines recommend that first line treatment of chronic spontaneous urticaria should be second generation non-sedating H(1)-antihistamines with a positive recommendation against the use of old sedating first generation antihistamines. If standard dosing is not effective, increasing the dosage up to four-fold is recommended. The objective of this study was to obtain the chronic spontaneous urticaria-patient perspective on the effectiveness and unwanted effects of H(1)-antihistamines in standard and higher doses.
  
  
  RESULTS
  This was a questionnaire based survey, initially completed by 368 individuals. 319 (248 female, 71 male, median age 42 years) had a physician-confirmed diagnosis of chronic spontaneous urticaria and were included in the results. Participants believed standard doses (manufacturers recommended dose) of second generation antihistamines to be significantly (P<0.005) more effective than first generation drugs. Furthermore, they believed that second generation drugs caused significantly (P<0.001) fewer unwanted effects and caused significantly (P<0.001) less sedation than first generation antihistamines. Three-quarters of the patients stated that they had up-dosed with antihistamines with 40%, 42% and 54% reporting significant added benefit from taking 2, 3 or 4 tablets daily respectively. The number of reports of unwanted effects and sedation following up-dosing were not significantly different from those reported for standard doses.
  
  
  CONCLUSIONS
  This survey supports the urticaria guidelines recommendations that the first line treatment for chronic spontaneous urticaria should be second generation rather than first generation H(1)-antihistamines and that, if standard dosing is not effective, the dosage should be increased up to four-fold.
authors: Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors: Karsten
authors: K
authors: Weller
authors: Claudia
authors: C
authors: Ziege
authors: Petra
authors: P
authors: Staubach
authors: Knut
authors: K
authors: Brockow
authors: Frank
authors: F
authors: Siebenhaar
authors: Karoline
authors: K
authors: Krause
authors: Sabine
authors: S
authors: Altrichter
authors: Martin K
authors: MK
authors: Church
authors: Marcus
authors: M
authors: Maurer
mesh_terms: D000328:Adult; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D005260:Female; D006306:Health Surveys; D006634:Histamine H1 Antagonists / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014581:Urticaria / Q000188:drug therapy*
chemical_list: D006634:Histamine H1 Antagonists