title: Levocetirizine and rupatadine in chronic idiopathic urticaria.
abstract: BACKGROUND
  Chronic idiopathic urticaria (CIU) is a common dermatological condition. Its pathogenesis involves mainly histamine and also other mediators, including platelet-activating factor (PAF) and tumor necrosis factor-α (TNF-α). In the absence of an exact etiology, H1 -antihistaminics are the mainstay of treatment. Levocetirizine is widely prescribed for CIU. Rupatadine, a newer antihistaminic, has PAF receptor antagonist activity and has shown anti-TNF-α activity in vitro. These additional anti-inflammatory effects may improve its efficacy.
  
  
  OBJECTIVE
  This study was conducted to compare the efficacy and safety of rupatadine and levocetirizine, respectively, in CIU patients.
  
  
  METHODS
  A prospective, open, comparative, randomized study was conducted in 100 patients, of whom 50 were treated with levocetirizine and 50 were treated with rupatadine. Efficacy parameters used were urticarial activity score (UAS) and Dermatology Life Quality Index (DLQI) values. Safety was evaluated by monitoring for adverse drug reactions and by using the critical flicker fusion threshold (CFFT) test and a visual analog scale (VAS) at baseline, and at 2, 4, and 6 weeks.
  
  
  RESULTS
  The mean UAS decreased to 0.10 in the levocetirizine group and to 0.38 in the rupatadine group. Patients in the levocetirizine group showed a more significant (P < 0.001) improvement, although symptoms improved in both groups. Significant reductions in mean DLQI scores were observed in both groups, but the decrease was statistically significant in the levocetirizine group (P < 0.05). Somnolence was the most common side effect in both groups. Patients in the levocetirizine group showed more psychomotor impairment based on the CFFT test. Findings on the VAS showed sedative effects in both groups (P < 0.05).
  
  
  CONCLUSIONS
  Levocetirizine was found to be more efficacious than rupatadine in CIU patients, but both drugs caused mild sedation.
authors.affiliation: Department of Pharmacology, Christian Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Madhulika
authors.initials: M
authors.lastname: Johnson
authors.affiliation: Department of Pharmacology, Christian Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Gagandeep
authors.initials: G
authors.lastname: Kwatra
authors.affiliation: Department of Pharmacology, Christian Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Dinesh K
authors.initials: DK
authors.lastname: Badyal
authors.affiliation: Department of Dermatology, Christian Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Emy A
authors.initials: EA
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017332:Cetirizine / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002908:Chronic Disease; D003533:Cyproheptadine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006634:Histamine H1 Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D039563:Histamine H1 Antagonists, Non-Sedating / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010972:Platelet Activating Factor / Q000037:antagonists & inhibitors; D011788:Quality of Life; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014581:Urticaria / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D006634:Histamine H1 Antagonists; D039563:Histamine H1 Antagonists, Non-Sedating; D010972:Platelet Activating Factor; D014409:Tumor Necrosis Factor-alpha; C103639:rupatadine; D003533:Cyproheptadine; C472067:levocetirizine; D017332:Cetirizine