Foundation for the Development of Medical and Biological Sciences (FUNDEMEB), Cartagena, Colombia.
Institute for Immunological Research, Universidad de Cartagena, Cartagena, Colombia.
J Investig Allergol Clin Immunol. 2016;26(3):177-84. doi: 10.18176/jiaci.0039.
Antihistamines are the first line of treatment for chronic spontaneous urticaria. However, there is no effective method to predict whether an antihistamine will have a beneficial clinical effect or not.
To assess whether the change in histamine-induced wheal and flare measurements 24 hours after administration of antihistamine can predict the efficacy of treatment.
We performed a multicenter, triple-blind, randomized study. Patients received a daily oral dose of cetirizine, fexofenadine, bilastine, desloratadine, or ebastine over 8 weeks. After 4 weeks, a higher dose of antihistamine was administered to patients who did not experience a clinical response. A histamine skin prick test was carried out at baseline and 24 hours after the first dose of antihistamine. Disease severity (Urticaria Activity Score [UAS]), response to the histamine skin prick test, and impact on the patient's quality of life (Dermatology Life Quality Index [DLQI]) were determined every 2 weeks.
The study population comprised 150 patients (30 per group) and 30 controls. Twenty-four hours after administration of antihistamine, inhibition of the histamine wheal by >75% was significantly associated with better UAS and DLQI scores. The safety and efficacy of the 5 antihistamines were similar. After updosing, rates of disease control (DLQI score <5) increased from 58.7% to 76.7%.
Measurement of the histamine-induced wheal can predict which patients will have a strong clinical response to antihistamines but has limited utility for identifying nonresponders. The clinical significance of these data could be relevant in the search for new urticaria treatment regimens.
抗组胺药是治疗慢性自发性荨麻疹的一线药物。然而，目前尚没有有效的方法来预测抗组胺药是否具有临床疗效。
评估抗组胺药治疗 24 小时后组胺诱导的风团和红晕测量值的变化是否可以预测治疗效果。
我们进行了一项多中心、三盲、随机研究。患者接受西替利嗪、非索非那定、比拉斯汀、地氯雷他定或依巴斯汀的每日口服剂量治疗，持续 8 周。4 周后，对未出现临床反应的患者给予更高剂量的抗组胺药。在基线和抗组胺药首次给药后 24 小时进行组胺皮肤点刺试验。每 2 周评估疾病严重程度（荨麻疹活动评分[UAS]）、组胺皮肤点刺试验的反应以及对患者生活质量的影响（皮肤病生活质量指数[DLQI]）。
研究人群包括 150 名患者（每组 30 名）和 30 名对照者。抗组胺药给药 24 小时后，组胺风团抑制率>75%与 UAS 和 DLQI 评分的改善显著相关。5 种抗组胺药的安全性和疗效相似。在加量后，疾病控制率（DLQI 评分<5）从 58.7%增加到 76.7%。
组胺诱导的风团测量值可以预测哪些患者对抗组胺药有强烈的临床反应，但对识别无反应者的作用有限。这些数据的临床意义可能与寻找新的荨麻疹治疗方案有关。
