title: Treatment of solar urticaria using antihistamine and leukotriene receptor antagonist combinations tailored to disease severity.
abstract: BACKGROUND
  Solar urticarial (SU) is characterized by erythema, whealing, and/or pruritus occurring minutes after sun exposure. Treatment is difficult and often unsatisfactory.
  
  
  OBJECTIVE
  To determine the action spectra and minimal urticaria dose (MUD) and to tailor a treatment regimen graded according to disease severity in a series of patients with SU.
  
  
  METHODS
  Eleven patients (seven females, four males, age range: 5-60 years) with a clinical history suggestive of SU, verified by photo-provocation tests to ultraviolet A (UVA), visible light, and/or UVB, were treated with various combinations of antihistamines and leukotriene receptor antagonist.
  
  
  RESULTS
  All patients were sensitive to visible light (median MUD 50 J/cm(2)). Three patients were sensitive to UVA (median MUD 3.75 J/cm(2)), and one patient was sensitive to UVB (MUD of 0.03 J/cm(2)). Two patients experienced a spontaneous remission without treatment. One patient declined treatment. The remaining eight patients were managed by a combination of antihistamines (desloratidine, fexofenadine, cetirizine HCl) and a leukotriene receptor antagonist (montelukast). Seven of the 8 patients experienced a sustained remission of symptoms and signs following treatment.
  
  
  CONCLUSIONS
  Photoprovocation for SU with determination of action spectra and MUD enables specifically tailored treatment regimens consisting of combinations of antihistamines and leukotriene receptor antagonist.
authors.affiliation: Photodermatosis clinic and Laser unit, Department of Dermatology, Rabin Medical Center, Petah-Tikva, Israel.|Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Assi
authors.initials: A
authors.lastname: Levi
authors.affiliation: Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Claes D
authors.initials: CD
authors.lastname: Enk
mesh_terms: D000085:Acetates / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D017332:Cetirizine / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003521:Cyclopropanes; D004359:Drug Therapy, Combination; D005260:Female; D039563:Histamine H1 Antagonists, Non-Sedating / Q000627:therapeutic use*; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D017336:Loratadine / Q000031:analogs & derivatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010787:Photosensitivity Disorders / Q000188:drug therapy* / Q000209:etiology; D011804:Quinolines / Q000627:therapeutic use*; D012074:Remission Induction; D012075:Remission, Spontaneous; D012720:Severity of Illness Index; D013440:Sulfides; D013472:Sunlight / Q000009:adverse effects*; D016593:Terfenadine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014466:Ultraviolet Rays / Q000009:adverse effects; D014581:Urticaria / Q000188:drug therapy* / Q000209:etiology; D055815:Young Adult
chemical_list: D000085:Acetates; D003521:Cyclopropanes; D039563:Histamine H1 Antagonists, Non-Sedating; D020024:Leukotriene Antagonists; D011804:Quinolines; D013440:Sulfides; D017336:Loratadine; D016593:Terfenadine; C093230:fexofenadine; C121345:desloratadine; C093875:montelukast; D017332:Cetirizine
keywords: antihistamines; leukotriene receptor antagonist; photoprovocation; solar urticaria