Wan Kong-Sang
Department of Pediatric, Taipei City Hospital, Renai Branch, Taipei City 106, Taiwan.
J Dermatolog Treat. 2009;20(4):194-7. doi: 10.1080/09546630802607495.
Chronic idiopathic urticaria (CIU) is often difficult to treat. Although histamine-releasing activity is detectable for up to 50% of CIU patients, antihistamine therapy provides only a limited response.
This study aimed to assess the clinical efficacy of combined leukotriene receptor antagonist (LRA) and H1 antihistamine, H1 and H2 antihistamine, and two H1 antihistamines as a synergistic therapeutic regimen for treating CIU compared with a matched placebo modality.
A total of 120 newly diagnosed adult patients were evaluated. Patients were single blinded and randomly assigned to one of four medication groups that received the following regimens for 4 weeks: Group A, combination of sedating H1 antihistamine and non-sedating H1 antihistamine; Group B, combination of H1 antihistamine and H2 antihistamine; Group C, combination of H1 antihistamine and LRA; and Group D, matched placebo medication. The primary measure of treatment efficacy was the daily urticaria activity score (UAS) of 'wheal and itch'. A positive therapeutic response was defined as a reduction to < 25% of baseline weekly UAS, while a relapse was a return to > 75% of baseline weekly UAS.
In all, 107 patients completed the trial medication. At the end of 4 weeks, the UAS score as a response to treatment was 23.3% for Group A, 63.3% for Group B, 53.3% for Group C, and no real change for the placebo treatment group.
The combination of LRA and H1 receptor antagonist is promising for CIU treatment and is reasonably well tolerated by patients. The combination of H1- and H2-receptor antagonists provided the greatest treatment efficacy by the measures used in this small study.
慢性特发性荨麻疹（CIU）通常难以治疗。尽管高达50%的CIU患者可检测到组胺释放活性，但抗组胺治疗的效果有限。
本研究旨在评估白三烯受体拮抗剂（LRA）与H1抗组胺药联合、H1和H2抗组胺药联合以及两种H1抗组胺药联合作为协同治疗方案治疗CIU的临床疗效，并与匹配的安慰剂模式进行比较。
共评估了120例新诊断的成年患者。患者为单盲，随机分配到四个药物治疗组之一，接受以下治疗方案4周：A组，镇静性H1抗组胺药与非镇静性H1抗组胺药联合；B组，H1抗组胺药与H2抗组胺药联合；C组，H1抗组胺药与LRA联合；D组，匹配的安慰剂药物。治疗效果的主要衡量指标是“风团和瘙痒”的每日荨麻疹活动评分（UAS）。阳性治疗反应定义为每周UAS降至基线的<25%，而复发定义为每周UAS回升至基线的>75%。
共有107例患者完成了试验用药。4周结束时，A组作为治疗反应的UAS评分为23.3%，B组为63.3%，C组为53.3%，安慰剂治疗组无实际变化。
LRA与H1受体拮抗剂联合治疗CIU前景良好，患者耐受性较好。在这项小型研究中所采用的衡量标准下，H1和H2受体拮抗剂联合提供了最大的治疗效果。
