title: Effectiveness and safety of antihistamines up to fourfold or higher in treatment of chronic spontaneous urticaria.
abstract: BACKGROUND
  Treatment with second-generation antihistamines is recommended in patients with chronic spontaneous urticaria (CSU). Some patients remain unresponsive even after up-dosing up to fourfold. Many third line treatment options have limited availability and/or give rise to significant side effects. We investigated effectiveness and safety of antihistamine treatment with dosages up to fourfold and higher.
  
  
  METHODS
  This retrospective analysis of patients' records was performed in adult CSU patients suffering wheals and/or angioedema (AE). Demographic, clinical, and therapeutic data was extracted from their medical records. We recorded the type, maximum prescribed dosage, effectiveness, and reported side effects of antihistamine treatment.
  
  
  RESULTS
  Of 200 screened patients, 178 were included. Treatment was commenced with a once daily dose of antihistamines. Persisting symptoms meant that up-dosing up to fourfold occurred in 138 (78%) of patients, yielding sufficient response in 41 (23%). Up-dosing antihistamines was necessary in 110 (80%) patient with weals alone or weals with angioedema and 28 (64%) with AE only (p = 0.039). Of the remaining 97 patients with insufficient response, 59 were treated with dosages higher than fourfold (median dosage 8, range 5-12). This was sufficient in 29 patients (49%). Side effects were reported in 36 patients (20%), whereof 30 (17%) experienced somnolence. Side effects after up-dosing higher than fourfold were reported in six out of 59 patients (10%).
  
  
  CONCLUSIONS
  Up-dosing antihistamines higher than fourfold dosage seems a feasible therapeutic option with regards to effectiveness and safety. The need for third line therapies could be decreased by 49%, with a very limited increase of reported side effects.
authors.affiliation: Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands.
authors.forename: Mignon T
authors.identifier: 0000-0002-8796-2231
authors.initials: MT
authors.lastname: van den Elzen
authors.affiliation: Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands.
authors.forename: Harmieke
authors.initials: H
authors.lastname: van Os-Medendorp
authors.affiliation: Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands.
authors.forename: Imke
authors.initials: I
authors.lastname: van den Brink
authors.affiliation: Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands.
authors.forename: Karin
authors.initials: K
authors.lastname: van den Hurk
authors.affiliation: Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands.
authors.forename: Ouliana I
authors.initials: OI
authors.lastname: Kouznetsova
authors.affiliation: Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands.
authors.forename: Alexander S H J
authors.initials: ASHJ
authors.lastname: Lokin
authors.affiliation: Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands.
authors.forename: Anna-Marijke
authors.initials: AM
authors.lastname: Laheij-de Boer
authors.affiliation: Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands.
authors.forename: Heike
authors.initials: H
authors.lastname: Röckmann
authors.affiliation: Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands.
authors.forename: Carla A F M
authors.initials: CAFM
authors.lastname: Bruijnzeel-Koomen
authors.affiliation: Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands.
authors.forename: André C
authors.initials: AC
authors.lastname: Knulst
keywords: Angioedema; Antihistamines; Refractory; Therapy; Urticaria