van den Elzen Mignon T, van Os-Medendorp Harmieke, van den Brink Imke, van den Hurk Karin, Kouznetsova Ouliana I, Lokin Alexander S H J, Laheij-de Boer Anna-Marijke, Röckmann Heike, Bruijnzeel-Koomen Carla A F M, Knulst André C
Department of Dermatology and Allergology, University Medical Center Utrecht (G02.124), PO Box 85.500, 3508 GA Utrecht, The Netherlands.
Clin Transl Allergy. 2017 Feb 14;7:4. doi: 10.1186/s13601-017-0141-3. eCollection 2017.
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.
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.
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%).
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.
慢性自发性荨麻疹（CSU）患者推荐使用第二代抗组胺药治疗。一些患者即使将剂量增加至四倍仍无反应。许多三线治疗方案可用性有限和/或会产生严重副作用。我们研究了高达四倍及更高剂量抗组胺药治疗的有效性和安全性。
对出现风团和/或血管性水肿（AE）的成年CSU患者的病历进行回顾性分析。从他们的病历中提取人口统计学、临床和治疗数据。我们记录了抗组胺药治疗的类型、最大处方剂量、有效性和报告的副作用。
在200例筛查患者中，178例被纳入。抗组胺药治疗开始时为每日一次剂量。持续存在的症状意味着138例（78%）患者的剂量增加至四倍，41例（23%）患者有足够反应。仅出现风团或伴有血管性水肿的风团患者中有110例（80%）需要增加抗组胺药剂量，仅患有血管性水肿的患者中有28例（64%）需要增加剂量（p = 0.039）。在其余97例反应不足的患者中，59例接受了高于四倍的剂量治疗（中位剂量8，范围5 - 12）。其中29例（49%）患者治疗有效。36例（20%）患者报告有副作用，其中30例（17%）出现嗜睡。59例接受高于四倍剂量治疗的患者中有6例（10%）报告有副作用。
将抗组胺药剂量增加至四倍以上似乎是一种在有效性和安全性方面可行的治疗选择。三线治疗的需求可减少49%，报告的副作用增加非常有限。
