title: H1-Antihistamine Premedication in NSAID-Associated Urticaria.
abstract: Therapeutic options for pain management are restricted in patients with nonsteroidal anti-inflammatory drug (NSAID)-induced or NSAID-exacerbated urticaria because strong cyclooxygenase (COX)-I inhibiting NSAID cannot be used. Alternative NSAID such as weak COX-I inhibitors or selective COX-II inhibitors are sometimes not sufficiently effective or have potentially troublesome adverse effects.
  
  
  
  To date, prophylactic premedication with H1-antihistamines is rarely practiced in patients concurrently suffering from recurrent pain and NSAID-associated urticaria. Our data analysis aims to clarify whether prophylactic premedication before the intake of NSAID is effective, safe, and practicable.
  
  
  
  Data of 21 patients with NSAID-induced or NSAID-exacerbated urticaria who underwent single dose NSAID provocation 30 minutes after premedication with 5 mg desloratadine were retrospectively evaluated.
  
  
  
  After H1-antihistamine premedication, 17 patients tolerated 16 single dose provocation tests with strong COX-I inhibitors and 2 tests with weak COX-I inhibitors. Despite H1-antihistamine premedication, 2 patients developed acute urticaria after intake of 400 mg ibuprofen. Another 2 patients with acute urticaria after intake of 800 mg ibuprofen tolerated 400 mg ibuprofen and 1000 mg paracetamol, respectively.
  
  
  
  In the majority of patients with NSAID-induced or NSAID-exacerbated urticaria concurrently suffering from intermittent pain, a premedication regimen with 5 mg desloratadine 30 minutes before intake of a strong COX-I inhibitor seems to be effective, safe, and practicable.
authors.affiliation: Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany. Electronic address: trautmann_a@ukw.de.
authors.forename: Axel
authors.initials: A
authors.lastname: Trautmann
authors.affiliation: Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany.
authors.forename: Diana
authors.initials: D
authors.lastname: Anders
authors.affiliation: Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany.
authors.forename: Johanna
authors.initials: J
authors.lastname: Stoevesandt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D005260:Female; D006634:Histamine H1 Antagonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011292:Premedication; D016037:Single-Blind Method; D014581:Urticaria / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D006634:Histamine H1 Antagonists
keywords: Nonallergic drug hypersensitivity; Nonsteroidal anti-inflammatory drug hypersensitivity; Nonsteroidal anti-inflammatory drug-exacerbated urticaria; Nonsteroidal anti-inflammatory drug-induced urticaria; Provocation test