Updosing of Nonsedating Anti-histamines in Recalcitrant Chronic Urticaria

The Efficacy and Safety of High Dose (10 mg) of Desloratadine (Dazit® 10) in the Treatment of Chronic Spontaneous Urticaria in India: A Phase III, Multicentric, Open-Label, Single-Arm Study

BACKGROUND

Chronic spontaneous urticaria (CSU) is a debilitating affliction that affects diverse quality of life (QoL) parameters such as sleep, self-esteem, and daily activities. Second-generation antihistamines, such as desloratadine, are more effective and safer in managing CSU. Desloratadine is a nonsedating, potent, and highly selective H1 receptor antagonist. At its daily dose of 5 mg, almost half of CSU patients do not show symptomatic improvement. European Academy of Allergy and Clinical Immunology (EAACI)/Global Allergy and Asthma European Network (GA2LEN)/European Dermatology Forum (EDF) (EuroGuiDerm)/Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI) guidelines recommend increasing the dosage to up to four times in such nonresponsive patients. However, there is insufficient clinical evidence in Indian settings.

METHOD

We evaluated the efficacy and safety of 10 mg desloratadine (OD) in 256 nonresponsive patients with moderate to severe CSU. The primary outcome was the change in Urticaria Activity Score (UAS7) from baseline to four weeks. Additionally, change in Chronic Urticaria Quality of Life (CU-Q2oL) scores during the course of treatment was also evaluated.

RESULT

The mean UAS7 scores showed a significant reduction from 31.9 ± 4.8 at baseline to 18.2 ± 8.1 at the end of the study (p < 0.0001). The use of a higher dose of desloratadine also decreased the CU-Q2oL scores significantly from 59.8 ± 14.7 at baseline to 35.4 ± 10 at four weeks (p < 0.0001). The incidence of adverse events (AEs) possibly linked to the drug was low (1.6%), and no serious adverse events were reported.

CONCLUSION

Results indicated improvements in the disease severity as well as its positive impact on participants' QoL. This study confirms the efficacy and safety of daily use of a twofold dose of desloratadine in nonresponsive moderate to severe CSU patients.

Diagnosis and Management of Urticaria in Indian Settings: Skin Allergy Research Society's Guideline-2022

Urticaria is a common skin disorder. Chronic urticaria, i.e., the presence of symptoms for more than six weeks, is associated with a significant adverse impact on sleep, performance, quality of life, and financial status of the patients. Although several treatment options are available, the condition can be challenging to treat for many clinicians. Several updates have been published on the subject of urticaria and its management since the publication of an updated consensus statement in 2018 by Indian experts. The objective of this consensus statement is to summarize the updates and provide concise information, including classification, diagnosis, and management of urticaria. Understanding and elimination of the underlying eliciting trigger are essential in all possible cases. The goal of pharmacological treatment is to provide symptomatic relief. Second-generation nonsedating H1 antihistamine continue to be recommended as the first-line treatment, the dose of which can be increased up to four times in patients not responding satisfactorily, in the second step. The role of omalizumab, cyclosporine, H2 antihistamines, and other options is also discussed.

Do pharmacists counsel customers about the effects of sedating antihistamines on driving skills? A survey of community pharmacies in Saudi Arabia

Objective

To investigate the level of counselling regarding the effects of sedating antihistamines on driving skills provided by private community pharmacies in Madinah, Saudi Arabia.

Methods

This study randomly selected private community pharmacies. Mystery shoppers following a similar scenario individually visited these pharmacies. These clients asked for a commonly used brand of sedating antihistamine and noted the counselling offered by the pharmacist. If spontaneous counselling was not offered, necessary information regarding the medication’s use was requested. Finally, the content of counselling was documented.

Results

Of the 100 pharmacies selected, 12 were excluded for various reasons and 88 pharmacies were included in the study. Only 23 pharmacies offered spontaneous counselling. Although 73.9% of pharmacists (65 of 88), spontaneously or upon request, mentioned sedation as a side-effect, only one pharmacist warned the client against driving after taking the medication, and three other pharmacists warned against dealing with hazardous machinery. Other side-effects were almost ignored.

Conclusion

A life-threatening insufficiency in the quality of counselling at Saudi Arabian private community pharmacies exists. Traffic accidents, secondary to the side-effects of sedating antihistamines, may be avoided if proper counselling is offered. Saudi Arabian authorities should take appropriate actions to ensure optimal practice in community pharmacies.