Efficacy of leukotriene receptor antagonist with an anti-H1 receptor antagonist for treatment of chronic idiopathic urticaria

J Dermatolog Treat. 2009;20(4):194-7. doi: 10.1080/09546630802607495.

Abstract

Background: 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.

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acetates / administration & dosage
  • Adolescent
  • Adult
  • Cetirizine / administration & dosage
  • Chronic Disease
  • Cyclopropanes
  • Drug Therapy, Combination
  • Famotidine / administration & dosage
  • Female
  • Histamine H1 Antagonists / administration & dosage*
  • Histamine H2 Antagonists / administration & dosage
  • Humans
  • Hydroxyzine / administration & dosage
  • Leukotriene Antagonists / administration & dosage*
  • Male
  • Middle Aged
  • Quinolines / administration & dosage
  • Single-Blind Method
  • Sulfides
  • Urticaria / drug therapy*
  • Young Adult

Substances

  • Acetates
  • Cyclopropanes
  • Histamine H1 Antagonists
  • Histamine H2 Antagonists
  • Leukotriene Antagonists
  • Quinolines
  • Sulfides
  • Hydroxyzine
  • Famotidine
  • montelukast
  • Cetirizine