H1-Antihistamine Premedication in NSAID-Associated Urticaria

J Allergy Clin Immunol Pract. 2016 Nov-Dec;4(6):1205-1212. doi: 10.1016/j.jaip.2016.05.018. Epub 2016 Jun 30.


Background: Therapeutic options for pain management are restricted in patients with nonsteroidal anti-inflammatory drug (NSAID)-induced or NSAID-exacerbated urticaria because strong cyclooxygenase (COX)-I inhibiting NSAID cannot be used. Alternative NSAID such as weak COX-I inhibitors or selective COX-II inhibitors are sometimes not sufficiently effective or have potentially troublesome adverse effects.

Objective: To date, prophylactic premedication with H1-antihistamines is rarely practiced in patients concurrently suffering from recurrent pain and NSAID-associated urticaria. Our data analysis aims to clarify whether prophylactic premedication before the intake of NSAID is effective, safe, and practicable.

Methods: Data of 21 patients with NSAID-induced or NSAID-exacerbated urticaria who underwent single dose NSAID provocation 30 minutes after premedication with 5 mg desloratadine were retrospectively evaluated.

Results: After H1-antihistamine premedication, 17 patients tolerated 16 single dose provocation tests with strong COX-I inhibitors and 2 tests with weak COX-I inhibitors. Despite H1-antihistamine premedication, 2 patients developed acute urticaria after intake of 400 mg ibuprofen. Another 2 patients with acute urticaria after intake of 800 mg ibuprofen tolerated 400 mg ibuprofen and 1000 mg paracetamol, respectively.

Conclusions and clinical relevance: In the majority of patients with NSAID-induced or NSAID-exacerbated urticaria concurrently suffering from intermittent pain, a premedication regimen with 5 mg desloratadine 30 minutes before intake of a strong COX-I inhibitor seems to be effective, safe, and practicable.

Keywords: Nonallergic drug hypersensitivity; Nonsteroidal anti-inflammatory drug hypersensitivity; Nonsteroidal anti-inflammatory drug-exacerbated urticaria; Nonsteroidal anti-inflammatory drug-induced urticaria; Provocation test.

Publication types

  • Clinical Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Analgesics / adverse effects
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Female
  • Histamine H1 Antagonists / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Premedication*
  • Single-Blind Method
  • Urticaria / chemically induced*
  • Urticaria / diagnosis
  • Urticaria / prevention & control*
  • Young Adult


  • Analgesics
  • Anti-Inflammatory Agents, Non-Steroidal
  • Histamine H1 Antagonists