title: An open-label prospective clinical study to assess the efficacy of increasing levocetirizine dose up to four times in chronic spontaneous urticaria not controlled with standard dose.
abstract: OBJECTIVE
  The EAACI/GA2LEN/EDF/WAO recommendation of increasing antihistamines' dose up to four times in urticaria not adequately controlled with the standard dose is largely based on expert opinion. The objective of this study is to test the current urticaria guidelines of up-dosing antihistamines as second-line treatment.
  
  
  METHODS
  This was an open-label study conducted prospectively on 113 patients with chronic spontaneous urticaria. All patients were treated with sequentially increasing doses of levocetrizine (5 mg, 10 mg, 15 mg and 20 mg/day) every week till the patients became completely asymptomatic or dose of 20 mg/day reached. Urticaria Activity Score (UAS)-7, urticaria-related quality-of-life (CU-Q2oL) and patients' global assessment were used to assess treatment response.
  
  
  RESULTS
  Twenty-one (18.58%) patients became asymptomatic with levocetirizine 5 mg/day, while 50 required higher doses of levocetirizine for complete control: 29/92 (31.52%), 6/63 (9.52%) and 15/57 (26.31%) with 10 mg, 15 mg and 20 mg/day, respectively. The percentage of patients experiencing >75% improvement increased with increasing doses of levocetirizine: 26.54%, 53.98%, 60.17% and 69.91% with 5 mg, 10 mg, 15 mg and 20 mg/day, respectively. Sequential up-dosing of levocetirizine produced a progressive improvement in both urticaria control (UAS-7) and quality-of-life (CU-Q2oL) without significantly increasing somnolence.
  
  
  CONCLUSIONS
  Our results support the current recommendations of increasing antihistamines up to four times the standard dose in patients who fail the first-line treatment.
authors: a Department of Dermatology and Venereology , All India Institute of Medical Sciences , New Delhi , India.
authors: Vinod Kumar
authors: VK
authors: Sharma
authors: a Department of Dermatology and Venereology , All India Institute of Medical Sciences , New Delhi , India.
authors: Vishal
authors: V
authors: Gupta
authors: b Department of Biostatistics , All India Institute of Medical Sciences , New Delhi , India.
authors: Mona
authors: M
authors: Pathak
authors: a Department of Dermatology and Venereology , All India Institute of Medical Sciences , New Delhi , India.
authors: M
authors: M
authors: Ramam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017332:Cetirizine / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D006970:Disorders of Excessive Somnolence / Q000209:etiology; D004305:Dose-Response Relationship, Drug; D005260:Female; D039563:Histamine H1 Antagonists, Non-Sedating / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014581:Urticaria / Q000188:drug therapy* / Q000473:pathology; D055815:Young Adult
chemical_list: D039563:Histamine H1 Antagonists, Non-Sedating; C472067:levocetirizine; D017332:Cetirizine
keywords: Chronic urticaria; levocetirizine; up-dosing