levocetirizine and Chronic-Disease

There have recently been guidelines developed for the diagnosis and treatment of rhinitis and urticaria. For both conditions, second-generation antihistamines remain as the first-line therapy.. The article presents the current pharmacology, chemical properties, pharmacokinetics and metabolism of levocetirizine. The article also reviews the clinical efficacy of levocetirizine for seasonal allergic and perennial rhinitis, as well as chronic urticaria. The article is formed through the review of all the published literature in English retrieved from the PubMed/MEDLINE database between 1966 and March 2011 using the search terms: levocetirizine, allergic rhinitis, chronic urticaria and antihistamine. Furthermore, the article also reviews data provided by the manufacturer in addition to reports from governmental agencies.. Levocetirizine has several pharmacokinetic properties that are desirable for an antihistamine providing a combination of both potency and safety. Its clinical advantages are derived from its rapid and extensive absorption, limited distribution and its very low degree of metabolism. Furthermore, levocetirizine scores very highly in terms of clinical efficacy as well as in patient/physician satisfaction studies. Given the lack of large multi-center studies that compare the treatment options for urticaria, clinicians must rely on potency studies when choosing treatment and levocetirizine does score very highly. However, other potent skin antihistamines, such as desloratadine or fexofenadine, should be preferred for patients who have a strict contraindication to the sedative effects of the drug.

Topics: Cetirizine; Chronic Disease; Drug Evaluation; Histamine H1 Antagonists, Non-Sedating; Humans; Randomized Controlled Trials as Topic; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Urticaria

Only recently available on the US market, levocetirizine has emerged as an effective new option in the treatment of chronic idiopathic urticaria (CIU). Levocetirizine is the active isomer of cetirizine and demonstrates twice the affinity for the H1 receptor compared with the parent compound. In the treatment of CIU, levocetirizine has consistently demonstrated high response rates, fast onset, and a favorable side effect profile.

Topics: Cetirizine; Chronic Disease; Cost-Benefit Analysis; Histamine H1 Antagonists, Non-Sedating; Humans; Urticaria

Chronic spontaneous urticaria (CSU) is a debilitating condition, adversely affecting the patient's quality of life. Bilastine is a recently introduced, non-sedative H1-antihistamine for its treatment. We wanted to compare the effectiveness, safety, and tolerability of bilastine 20 mg vs levocetirizine 5 mg in moderate-to-severe CSU. We conducted a double-blind, randomized controlled trial with two groups: bilastine 20 mg (n = 31) and levocetirizine 5 mg (n = 27), once daily for 42 days. We included patients (18-65 years), with moderate-to-severe CSU. UAS7, VAS, and DLQI were used to assess severity of urticaria, global urticaria-induced discomfort and quality of life, respectively. DLQI was assessed at baseline (D0) and end-of-treatment (D42), while UAS7 and VAS were noted at baseline and all follow-up visits. Assessment of UAS7 alteration was our primary objective, while changes in DLQI and VAS were the secondary outcomes. Safety was assessed by recording drug-related adverse events, biochemical investigations, and electrocardiogram, along with tolerability and compliance. Both drugs significantly improved UAS7, DLQI, and VAS at end-of-treatment (D42) compared with baseline (intra-group). At the end-of-treatment, all parameters showed greater improvement with bilastine, but only UAS7 reduction was significant (bilastine > levocetirizine, P = .03). In both the groups, UAS7 and VAS improved significantly D14 onwards, and was maintained throughout the study. Sedation was significantly less with bilastine (P = .04), while neither drug showed any serious adverse-effect. Tolerability of both drugs was similar. Therefore, bilastine was found to be a more effective and less-sedative novel therapy for CSU compared to levocetirizine, with similar effect on quality of life.

Topics: Benzimidazoles; Cetirizine; Chronic Disease; Chronic Urticaria; Double-Blind Method; Histamine H1 Antagonists, Non-Sedating; Humans; Piperidines; Quality of Life; Treatment Outcome; Urticaria

This was an open-label study conducted prospectively on 113 patients with chronic spontaneous urticaria. All patients were treated with sequentially increasing doses of levocetrizine (5 mg, 10 mg, 15 mg and 20 mg/day) every week till the patients became completely asymptomatic or dose of 20 mg/day reached. Urticaria Activity Score (UAS)-7, urticaria-related quality-of-life (CU-Q2oL) and patients' global assessment were used to assess treatment response.. Twenty-one (18.58%) patients became asymptomatic with levocetirizine 5 mg/day, while 50 required higher doses of levocetirizine for complete control: 29/92 (31.52%), 6/63 (9.52%) and 15/57 (26.31%) with 10 mg, 15 mg and 20 mg/day, respectively. The percentage of patients experiencing >75% improvement increased with increasing doses of levocetirizine: 26.54%, 53.98%, 60.17% and 69.91% with 5 mg, 10 mg, 15 mg and 20 mg/day, respectively. Sequential up-dosing of levocetirizine produced a progressive improvement in both urticaria control (UAS-7) and quality-of-life (CU-Q2oL) without significantly increasing somnolence.. Our results support the current recommendations of increasing antihistamines up to four times the standard dose in patients who fail the first-line treatment.

Topics: Adolescent; Adult; Aged; Cetirizine; Chronic Disease; Disorders of Excessive Somnolence; Dose-Response Relationship, Drug; Female; Histamine H1 Antagonists, Non-Sedating; Humans; Male; Middle Aged; Prospective Studies; Quality of Life; Severity of Illness Index; Treatment Outcome; Urticaria; Young Adult

Chronic idiopathic urticaria (CIU) is a common dermatological condition. Its pathogenesis involves mainly histamine and also other mediators, including platelet-activating factor (PAF) and tumor necrosis factor-α (TNF-α). In the absence of an exact etiology, H1 -antihistaminics are the mainstay of treatment. Levocetirizine is widely prescribed for CIU. Rupatadine, a newer antihistaminic, has PAF receptor antagonist activity and has shown anti-TNF-α activity in vitro. These additional anti-inflammatory effects may improve its efficacy.. This study was conducted to compare the efficacy and safety of rupatadine and levocetirizine, respectively, in CIU patients.. A prospective, open, comparative, randomized study was conducted in 100 patients, of whom 50 were treated with levocetirizine and 50 were treated with rupatadine. Efficacy parameters used were urticarial activity score (UAS) and Dermatology Life Quality Index (DLQI) values. Safety was evaluated by monitoring for adverse drug reactions and by using the critical flicker fusion threshold (CFFT) test and a visual analog scale (VAS) at baseline, and at 2, 4, and 6 weeks.. The mean UAS decreased to 0.10 in the levocetirizine group and to 0.38 in the rupatadine group. Patients in the levocetirizine group showed a more significant (P < 0.001) improvement, although symptoms improved in both groups. Significant reductions in mean DLQI scores were observed in both groups, but the decrease was statistically significant in the levocetirizine group (P < 0.05). Somnolence was the most common side effect in both groups. Patients in the levocetirizine group showed more psychomotor impairment based on the CFFT test. Findings on the VAS showed sedative effects in both groups (P < 0.05).. Levocetirizine was found to be more efficacious than rupatadine in CIU patients, but both drugs caused mild sedation.

Topics: Adolescent; Adult; Aged; Cetirizine; Child; Chronic Disease; Cyproheptadine; Female; Histamine H1 Antagonists; Histamine H1 Antagonists, Non-Sedating; Humans; Male; Middle Aged; Platelet Activating Factor; Quality of Life; Severity of Illness Index; Tumor Necrosis Factor-alpha; Urticaria; Young Adult

Many physicians believe that the most effective way to treat chronic urticaria is to take a nonsedating second-generation H1 -antihistamine in the morning and a sedating first-generation H1 -antihistamine, usually hydroxyzine, at night to enhance sleep. But is this belief well founded?. To test this belief by comparing the effectiveness and prevalence of unwanted sedative effects when treating patients with chronic spontaneous urticaria (CSU) with levocetirizine 15 mg daily plus hydroxyzine 50 mg at night (levocetirizine plus hydroxyzine) vs. levocetirizine 20 mg daily (levocetirizine monotherapy).. In this randomized, double-blind, cross-over study, 24 patients with difficult-to-treat CSU took levocetirizine plus hydroxyzine or levocetirizine monotherapy for periods of 5 days each. At the end of each treatment period, assessments were made of quality of life (Chronic Urticaria Quality of Life Questionnaire, CU-Q2 oL), severity of urticaria symptoms (Urticaria Activity Score, UAS), sleep disturbance during the night and daytime somnolence.. Both treatments significantly decreased UAS, night-time sleep disturbances and CU-Q2 oL scores (P < 0·001) without significant differences between the two. Compared with baseline, daytime somnolence was significantly reduced by levocetirizine monotherapy (P = 0·006) but not by levocetirizine plus hydroxyzine (P = 0·218). Direct comparison of the two treatment modalities in terms of daytime somnolence favoured levocetirizine monotherapy (P = 0·026).. The widespread belief that sleep is aided by the addition of a sedating first-generation H1 -antihistamine, usually hydroxyzine, at night is not supported. These results are in line with the urticaria guidelines, which state that first-line treatment for urticaria should be new-generation, nonsedating H1 -antihistamines only.

Topics: Adult; Aged; Cetirizine; Chronic Disease; Cross-Over Studies; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Histamine H1 Antagonists; Histamine H1 Antagonists, Non-Sedating; Humans; Hydroxyzine; Male; Middle Aged; Patient Selection; Quality of Life; Sleep Wake Disorders; Treatment Outcome; Urticaria; Young Adult

Chronic urticaria (CU) is characterized by frequent appearance of wheals for ≥ 6 weeks. This study was undertaken to compare effectiveness and safety of olopatadine, a newer antihistamine with additional anti-inflammatory properties, in treating CU in comparison to the established second-generation antihistamine levocetirizine.. A single center, assessor-blind, randomized (1:1), active-controlled, parallel group, Phase IV trial (CTRI/2011/08/001965) was conducted with 120 adult CU patients of either sex. Subjects received either olopatadine (5 mg b.i.d.) or levocetirizine (5 mg/day) for 9 weeks, continuously for first 4 weeks and then on demand basis for last 5 weeks. Primary outcome measures were urticaria activity score (UAS) and urticaria total severity score (TSS). Routine hematological and biochemical tests and treatment-emergent adverse events were monitored for safety.. Data from 54 subjects on olopatadine and 51 on levocetirizine were analyzed for effectiveness. UAS and TSS values declined significantly with both drugs over the treatment period but the reduction was greater with olopatadine. Adverse event profiles were comparable with sedation being the commonest complaint.. Olopatadine is a safe and more effective alternative to levocetirizine in the treatment of CU.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Anti-Allergic Agents; Cetirizine; Chronic Disease; Dibenzoxepins; Double-Blind Method; Female; Histamine H1 Antagonists; Histamine H1 Antagonists, Non-Sedating; Humans; Male; Middle Aged; Olopatadine Hydrochloride; Single-Blind Method; Urticaria; Young Adult

Chronic Idiopathic Urticaria is difficult to treat due to its persistent debilitating symptoms. New generation anti-histaminics are first line treatment for this condition. The aim of this study is to compare efficacy and safety of rupatadine and levocetirizine in chronic idiopathic urticaria.. A randomized, single blinded, single-centred, parallel group outdoor based clinical study was conducted in 70 patients of CIU to compare the two drugs. After initial clinical assessment and baseline investigations, rupatadine was prescribed to 35 patients and levocetirizine to another 35 patients for 4 weeks. At follow-up, the patients were re-evaluated and then compared using different statistical tools. Main outcome measures were DC eosinophil, Absolute Eosinophil Count (AEC), serum IgE, Total Symptom Score, Aerius Quality of Life Questionnaire score, and Global efficacy score.. Rupatadine significantly improved patients' clinical condition including symptom score from baseline to day 28. In rupatadine group, there was 27.9 percent decrease (P=0.027) in DC eosinophil, 35.6 percent decrease (P=0.036) in AEC, 15.3 percent decrease (P=0.024) in serum IgE, 28.2 percent decrease (P=0.02) in Total Symptom Scoring, and 27.3 percent decrease (P=0.006) in Aerius Quality of Life Questionnaire score. Global efficacy score of rupatadine was found to be significantly greater (P=0.009) than levocetirizine. The overall incidence of adverse drug reactions was also found to be less in rupatadine group.. Rupatadine is a better choice in CIU in comparison to levocetirizine due to better efficacy and safety profile.

Topics: Adolescent; Adult; Cetirizine; Child; Chronic Disease; Cyproheptadine; Female; Follow-Up Studies; Histamine Antagonists; Humans; Male; Middle Aged; Single-Blind Method; Treatment Outcome; Urticaria; Young Adult

Bilastine is a novel nonsedative H(1)-receptor antagonist, which may be used for the symptomatic treatment of chronic idiopathic urticaria (CU). The aim of this study was to compare the clinical efficacy and safety of bilastine 20 mg vs levocetirizine 5 mg and placebo in CU patients with moderate-to-severe symptoms.. Overall 525 male and female subjects aged 18-70 years were randomized to receive bilastine 20 mg, levocetirizine 5 mg or placebo, once daily for 28 days, in double-blind manner, in 46 centres across Europe and Argentina. Patients rated symptoms of pruritus, number of wheals, and maximum size of wheals (on predefined scales) as reflective (over past 12 h) symptoms twice daily, for assessment of change from baseline in the total symptoms scores (TSS) over 28 days as the primary efficacy measure. Changes in reflective and instantaneous symptoms scores, Dermatology Life Quality Index (DLQI), and CU-associated discomfort and sleep disturbance were assessed as secondary outcomes. Safety was assessed according to adverse events, laboratory tests and electrocardiograms.. Bilastine reduced patients' mean reflective and instantaneous TSS from baseline to a significantly greater degree than placebo (P < 0.001); from day 2 onwards of treatment. The DLQI, general discomfort, and sleep disruption were also improved significantly in bilastine-treated patients as compared with placebo-treated patients (P < 0.001 for all parameters). Comparison with levocetirizine indicated both treatments to be equally efficacious as well as equally safe and well tolerated as compared with placebo.. Bilastine 20 mg is a novel effective and safe treatment option for the management of CU.

Topics: Adolescent; Adult; Aged; Area Under Curve; Benzimidazoles; Cetirizine; Chronic Disease; Double-Blind Method; Female; Histamine H1 Antagonists, Non-Sedating; Humans; Male; Middle Aged; Piperidines; Quality of Life; Urticaria; Young Adult

H(1)-antihistamines are first line treatment of chronic urticaria, but many patients do not get satisfactory relief with recommended doses. European guidelines recommend increased antihistamine doses of up to 4-fold.. To provide supportive evidence for the European guidelines.. Eighty tertiary referral patients with chronic urticaria (age range, 19-67 years) were randomized for double-blind treatment with levocetirizine or desloratadine (40/40). Treatment started at the conventional daily dose of 5 mg and then increased weekly to 10 mg, 20 mg, or 20 mg of the opposite drug if relief of symptoms was incomplete. Wheal and pruritus scores, quality of life, patient discomfort, somnolence, and safety were assessed.. Thirteen patients became symptom-free at 5 mg (9 levocetirizine vs 4 desloratadine), compared with 28 subjects on the higher doses of 10 mg (8/7) and 20 mg (5/1). Of the 28 patients nonresponsive to 20 mg desloratadine, 7 became symptom-free with 20 mg levocetirizine. None of the 18 levocetirizine nonresponders benefited with 20 mg desloratadine. Increasing antihistamine doses improved quality of life but did not increase somnolence. Analysis of the effect of treatment on discomfort caused by urticaria showed great individual heterogeneity of antihistamine responsiveness: approximately 15% of patients were good responders, approximately 10% were nonresponders, and approximately 75% were responders to higher than conventional antihistamine doses. No serious or severe adverse effects warranting discontinuation of treatment occurred with either drug.. Increasing the dosage of levocetirizine and desloratadine up to 4-fold improves chronic urticaria symptoms without compromising safety in approximately three quarters of patients with difficult-to-treat chronic urticaria.

Topics: Adult; Aged; Cetirizine; Chronic Disease; Dose-Response Relationship, Drug; Double-Blind Method; Female; Histamine H1 Antagonists, Non-Sedating; Humans; Loratadine; Male; Middle Aged; Quality of Life; Urticaria; Young Adult

Topics: Cetirizine; Chronic Disease; Double-Blind Method; Female; Histamine H1 Antagonists, Non-Sedating; Humans; Loratadine; Male; Pilot Projects; Sleep Stages; Urticaria

Nonsedating H(1)-antihistamines are recommended for the treatment of urticaria by the recent EAACI/GA(2)LEN/EDF guidelines. The aim of this study was to compare the efficacy, after 4 weeks of treatment, with levocetirizine 5 mg and desloratadine 5 mg, both once daily in the morning, in symptomatic chronic idiopathic urticaria (CIU) patients.. This multi-center, randomized, double-blind study involved 886 patients (438 on levocetirizine and 448 on desloratadine). The primary objective was to compare their efficacy on the mean pruritus severity score after 1 week of treatment. Mean pruritus severity score over 4 weeks and pruritus duration score, number and size of wheals, mean CIU composite score (sum of the scores for pruritus severity and numbers of wheals), quality of life, and the patient's and investigator's global satisfaction with treatment, were secondary efficacy measures.. Levocetirizine led to a significantly greater decrease in pruritus severity than desloratadine over the first treatment week; mean pruritus severity scores of 1.02 and 1.18 for levocetirizine and desloratadine, respectively (P < 0.001). The result was similar for the entire 4-week treatment period (P = 0.004). In addition, levocetirizine decreased pruritus duration and the mean CIU composite scores to a significantly greater extent than desloratadine during the first week (P = 0.002 and 0.005, respectively) and over the entire study (P = 0.009 and P < 0.05, respectively). Similarly, levocetirizine increased the patients' global satisfaction after one and 4 weeks (P = 0.012 and 0.021, respectively), compared with desloratadine. Safety and tolerability were similar in both groups.. Levocetirizine 5 mg was significantly more efficacious than desloratadine 5 mg in the treatment of CIU symptoms.

Topics: Cetirizine; Chronic Disease; Double-Blind Method; Female; Histamine H1 Antagonists, Non-Sedating; Humans; Loratadine; Male; Pruritus; Quality of Life; Severity of Illness Index; Urticaria

To study the clinical effects of integrative Chinese and Western medicine in treating chronic urticaria and its impact on peripheral blood content of interleukin-10 (IL-10) and IL-8.. Patients were assigned to the treatment group and the control group according to their sequence of visiting. They were treated orally with levocetirizine hydrochloride 5 mg once a day, but additional Kangqian Decoction (a self-formulated Chinese herbal preparation consisted of thorowax root 15 g, divaricate saposhnikovia root 9 g, licorice root 15 g, moutan bark 15 g, red sage root 15 g, milkvetch root 30 g, and schisandra fruit 12 g, etc. ) was given to the treatment group one dose per day, for 2 weeks as one therapeutic course. The efficacy was evaluated after two courses of medication, and patients' IL-10 and IL-8 levels in the peripheral blood were determined before and after treatment.. The total effective rate in the treatment group and control group was 93.75% and 56.66% respectively with significance difference between them (P <0.01). After treatment, the level of serum IL-10 was significantly lower while that of IL-8 was significantly higher in the treatment group (2.96 +/- 1.66, 50.17 +/- 32.35) than that in the control group (4.77 +/- 2.99, 29.44 +/- 17.62) respectively (P < 0.01).. Chronic urticaria was related to the immune unbalance of body. Integrative medicine could adjust immune function to display a quick, potent anti-inflammatory and anti-anaphylactic actions in treating chronic urticaria with less adverse reaction and low recurrent rate.

Topics: Adolescent; Adult; Cetirizine; Chronic Disease; Drug Therapy, Combination; Drugs, Chinese Herbal; Female; Humans; Integrative Medicine; Interleukin-10; Interleukin-8; Medicine, Chinese Traditional; Middle Aged; Urticaria; Young Adult

Persistent allergic rhinitis often impairs quality of life.. We assessed the extent to which treating persistent allergic rhinitis with montelukast, desloratadine, and levocetirizine alone or in combination improved quality of life.. A 32-week randomized, double-blind, placebo-controlled, crossover study was performed in 2 arms: 20 patients received montelukast 10 mg/d and/or desloratadine 5 mg/d or placebo; 20 patients received montelukast 10 mg/d and/or levocetirizine 5 mg/d or placebo. The treatment periods were separated by 2-week washout periods. Quality of life was assessed on the day before starting treatment and on the last day of each treatment period using the Rhinoconjunctivitis Quality of Life Questionnaire. Sleep problems were also assessed.. In the desloratadine plus montelukast arm, the mean (SEM) quality of life score before treatment was 3.1 (0.41). After placebo, this score was 2.16 (0.43), after desloratadine it was 1.79 (0.38), after montelukast it was 1.48 (0.37), and after montelukast plus desloratadine it was 1.59 (0.37). In the montelukast plus levocetirizine arm, the mean quality of life score before treatment was 2.58 (0.49). After placebo it was 1.78 (0.46), after levocetirizine it was 1.38 (0.42), after montelukast it was 1.36 (0.37), and after montelukast plus levocetirizine it was 1.26 (0.39).. Placebo, montelukast, desloratadine and levocetirizine significantly improved quality of life. Combining montelukast with either levocetirizine or desloratadine gave additional benefits in comparison to each agent alone and could be considered for patients whose quality of life is impaired by persistent allergic rhinitis.

Topics: Acetates; Adolescent; Adult; Aged; Cetirizine; Chronic Disease; Cross-Over Studies; Cyclopropanes; Double-Blind Method; Drug Interactions; Female; Histamine H1 Antagonists, Non-Sedating; Humans; Leukotriene Antagonists; Loratadine; Male; Middle Aged; Quality of Life; Quinolines; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Sulfides; Treatment Outcome

Data regarding narrowband ultraviolet B (NB-UVB) phototherapy in patients with chronic urticaria is limited. The aim of this open, controlled study was to determine whether NB-UVB is effective in treating urticaria in combination with antihistamin. A total of 81 patients with chronic urticaria were recruited, 48 of whom were randomized into the NB-UVB plus antihistamine group. The control group (n = 33) received only antihistamine. Patients were assessed using the urticaria activity score and a visual analogue score (VAS). The 2 groups were evaluated at the same time-points: at treatment sessions 10 and 20 and at follow-up 3 months post-treatment. The reduction in urticaria activity score and VAS was statistically significant (p < 0.05 for both groups). When comparing the groups, the mean urticaria activity score was significantly lower in the NB-UVB group at session 10 (22.6 vs. 27.3) and session 20 (17.4 vs. 20.7). Statistically significant differences were also noted in VAS between the 2 groups (p < 0.01) at 3 months post-treatment. We conclude that NB-UVB may be an effective complementary treatment for patients with chronic urticaria.

Topics: Adult; Cetirizine; Chronic Disease; Combined Modality Therapy; Female; Histamine H1 Antagonists, Non-Sedating; Humans; Male; Prospective Studies; Radiation Dosage; Severity of Illness Index; Treatment Outcome; Ultraviolet Therapy; Urticaria

H1 receptor antagonists are the mainstay of treatment for chronic idiopathic urticaria. Newer hydroxyzine derivatives such as cetirizine and levocetirizine have been found to be equally efficacious in preclinical studies in patients with chronic idiopathic urticaria. In this study, the clinical efficacy of cetirizine and levocetirizine has been studied sequentially in individual patients. Fifty chronic idiopathic urticaria patients received 10 mg of levocetirizine daily for 6 weeks. Some 45 patients out of these showed reasonably good clinical efficacy on a visual analog scale to qualify for comparison with levocetirizine. A total of 30 patients completed the study period of 6 weeks each of cetirizine and levocetirizine sequentially. Thus, the clinical efficacy of cetirizine and levocetirizine was comparable with a marginal advantage of better antipruritic effect with levocetirizine, probably at the cost of increased sedation.

Topics: Adolescent; Adult; Aged; Cetirizine; Chronic Disease; Female; Histamine H1 Antagonists, Non-Sedating; Humans; Male; Middle Aged; Piperazines; Treatment Outcome; Urticaria

Chronic urticaria is a common skin condition. It is frequently a disabling disease because of the persistence of clinical symptoms, the unpredictable course and its negative influence on the quality of life.. To determine whether levocetirizine is efficacious in the treatment of chronic idiopathic urticaria.. A randomized, double-blind, placebo-controlled study was conducted in 106 patients with a diagnosis of chronic idiopathic urticaria. A 1-week single blind placebo run-in period (baseline) was followed by a 6-week double blind active treatment period. The patients were randomized to receive one of the following treatments once daily: (a) oral levocetirizine 5 mg, or (b) oral placebo. The study ended after another 1-week single blind placebo washout period.. The evaluable population consisted of 100 patients. Levocetirizine administered once daily is effective and well tolerated in the treatment of the symptoms of chronic idiopathic urticaria and in improving the patient's quality of life. Levocetirizine was superior to placebo in reducing the mean total symptoms score as well as individual symptoms, the number of daily episodes and the number of weals, the overall severity of symptoms and the quality of life. The significant beneficial effects of levocetirizine lasted only during the active trial, while at follow-up there was a significant worsening of all the variables evaluated in this study, after the end of the active trial (week 7).. A global assessment indicates that levocetirizine 5 mg once daily is an effective agent in patients with chronic idiopathic urticaria, as its action provides a rapid and satisfactory control of the symptoms and measures of subjective disease, although this is limited to the duration of treatment.

Topics: Adult; Aged; Cetirizine; Chronic Disease; Double-Blind Method; Drug Administration Schedule; Female; Histamine H1 Antagonists, Non-Sedating; Humans; Male; Middle Aged; Piperazines; Pruritus; Quality of Life; Severity of Illness Index; Treatment Outcome; Urticaria

Chronic idiopathic urticaria (CIU) is defined by the almost daily presence of urticaria for at least 6 weeks without an identifiable cause. Symptoms include short-lived wheals, itching, and erythema. CIU impedes significantly a patient's quality of life (QoL). Levocetirizine is an antihistamine from the latest generation approved for CIU.. To investigate the efficacy of levocetirizine, 5 mg, and placebo for the symptoms and signs of CIU, as well as for the QoL and productivity.. The primary criteria of evaluation were the pruritus severity scores over 1 week of treatment and over 4 weeks. The QoL was assessed via the Dermatology Life Quality Index (DLQI).. Baseline pruritus severity scores were comparable in the two treatment groups (2.06+/-0.58). After 1 week, levocetirizine was superior to placebo and demonstrated a considerable efficacy (difference=0.78, P<0.001). This efficacy was maintained over the entire study period (4 weeks, P<0.001). The number and size of wheals were considerably reduced compared with placebo over 1 week and over the total treatment period (P

Topics: Adult; Cetirizine; Chronic Disease; Double-Blind Method; Efficiency; Female; Germany; Histamine H1 Antagonists, Non-Sedating; Humans; Male; Piperazines; Quality of Life; Severity of Illness Index; Sick Leave; Switzerland; Urticaria

Antihistamines are the cornerstone of treatment for many allergic diseases, such as allergic rhinitis and chronic urticaria. Since the discovery of their beneficial effects in the 1940s, scientists have found molecules with greater selectivity to block specific histamine receptors without some of the detrimental side effects that are seen if antihistamines cross the blood-brain barrier. Levocetirizine is the active enantiomer of cetirizine and a selective H(1)-histamine blocker. It exhibits many favourable characteristics of an ideal antihistamine, both pharmacodynamically and pharmacokinetically, including high bioavailability, rapid onset of action, limited distribution and low degree of metabolism. Furthermore, clinical trials indicate that it is safe and effective for the treatment of allergic rhinitis and chronic urticaria with a minimal amount of untoward effects.

Topics: Allergy and Immunology; Cetirizine; Chronic Disease; Clinical Trials, Phase III as Topic; Double-Blind Method; Histamine H1 Antagonists, Non-Sedating; Humans; Multicenter Studies as Topic; Piperazines; Randomized Controlled Trials as Topic; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Stereoisomerism; Urticaria

Topics: Benzimidazoles; Cetirizine; Chronic Disease; Chronic Urticaria; Humans; India; Piperidines; Urticaria

According to current guidelines, non-sedative H1-antihistamines (nsAH) are the first-line therapy of chronic spontaneous urticaria (CSU). But even up-dosed antihistamines (to four times the standard dose) produce symptom resolution in less than 50% of patients. Biomarkers that can predict the response to nsAH are still unknown. We carried out a prospective study and used discriminant analysis to evaluate the combination of D-dimer, fibrinogen, C-reactive protein and ESR values for predicting the outcome of treatment with levocetirizine in 84 CSU patients. We found that elevation of these parameters is associated with more active disease, low quality of life and lack of response to standard doses of levocetirizine. Thus, evaluation of these markers may be considered useful before starting treatment with nsAH. The mechanisms behind the increase in these parameters in CSU patients need to be elucidated in further studies.

Topics: Adolescent; Adult; Aged; Biomarkers; Blood Sedimentation; C-Reactive Protein; Cetirizine; Chronic Disease; Female; Fibrin Fibrinogen Degradation Products; Fibrinogen; Histamine H1 Antagonists, Non-Sedating; Humans; Immunoglobulin E; Inflammation Mediators; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Quality of Life; Severity of Illness Index; Time Factors; Treatment Outcome; Urticaria; Young Adult

Allergic rhinitis (AR) and chronic idiopathic urticaria (CIU) are highly burdensome diseases, which are increasing in prevalence, especially in the paediatric population. Despite the availability of a large number of medications for treatment of AR and CIU, their use in children has primarily been based on data obtained from a limited number of clinical trials in children and/or testing in adults. The H(1)-antihistamines have traditionally been used as first-line treatment for the relief of both AR and CIU symptoms in children. The first-generation H(1)-antihistamines are associated with marked adverse effects such as sedation, sleepiness/drowsiness as well as difficulties in learning and cognitive processing; thus, they are recommended for limited or discontinued use in children with AR or CIU. In contrast, second-generation H(1)-antihistamines are more adapted for the use in children with AR and CIU due to better safety profiles. However, only a limited number of trials with these agents have been conducted and generally, data from well-designed trials in children are lacking. Levocetirizine is one of the most extensively investigated H(1)-antihistamines for its pharmacologic properties, safety, efficacy as well as overall global satisfaction in children aged 2-12 years. Levocetirizine is the only H(1)-antihistamine launched in the 21st century shown to lack clinically relevant adverse effects on physical and psychomotor development or routine laboratory tests over a long-term period of 18 months in 1- to 3-year-old children predisposed to development of allergic disease. Available data suggest that levocetirizine is a suitable treatment option for AR and CIU in children aged 6 months to 12 years.

Topics: Adult; Anti-Allergic Agents; Attitude of Health Personnel; Cetirizine; Child; Child, Preschool; Chronic Disease; Histamine H1 Antagonists, Non-Sedating; Humans; Infant; Parents; Physicians; Randomized Controlled Trials as Topic; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Treatment Outcome; Urticaria

Chronic idiopathic urticaria (CIU) is not uncommon, yet there is little information about the clinical features of CIU patients in Taiwan. The purpose of this study was to investigate the clinical features of CIU in Taiwan.. Patients with CIU were collected consecutively from the Urticaria Special Clinic in a medical center in northern Taiwan from December 2005 to May 2006. Clinical features and laboratory findings were studied. We also evaluated the therapeutic response of CIU patients with second-generation H1 receptor antagonist monotherapy for 6 weeks.. A total of 62 CIU patients were investigated. The female to male ratio was 2.1:1 with a mean age of 31.8 years. The mean duration of the disease was 25.7 months (1.5-180 months). The most common aggravating factor was weather (79.7%), especially hot weather (50.8%). Fifty percent of the patients had atopy, and 37.3% of patients had positive autologous serum skin test. Besides, 61.3% of patients had at least one serum specific IgE antibody to the 18 common allergens examined. Finally, 60.7% of patients responded well to second-generation H1 receptor antagonist. Non-responders tended to have atopy (p = 0.0471), especially allergic rhinitis (p = 0.0107).. This study provided an overview of CIU patients in a medical center in northern Taiwan. We found that atopy did not influence the severity or durtation of CIU. Nevertheless, atopy was associated with a poor therapeutic response of second-generation antihistamine. A survey of personal atopy history, especially allergic rhinitis, is important for management of CIU patients in Taiwan.

Topics: Adolescent; Adult; Cetirizine; Chronic Disease; Female; Histamine H1 Antagonists; Humans; Loratadine; Male; Middle Aged; Taiwan; Treatment Outcome; Urticaria; Young Adult

Topics: Cetirizine; Chronic Disease; Clinical Trials as Topic; Histamine H1 Antagonists, Non-Sedating; Humans; Piperazines; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Urticaria

Some antihistamines are capable of reducing levels of adhesion molecules in wealing tissues of patients with chronic urticaria (CU).. To determine if 6 weeks of therapy with levocetirizine 5 mg once daily would also induce any decrease in serum levels of intercellular adhesion molecule-1, vascular cell adhesion molecule-1, endothelial leucocyte adhesion molecule-1 (ELAM-1) or P-selectin in subjects with CU and chronic autoimmune urticaria.. Thirty-six patients with CU (18 with positive and 18 with negative autologous serum skin test) were studied, together with 10 control healthy subjects. All patients received levocetirizine 5 mg daily. Serum soluble cellular adhesion molecule (CAM) levels were determined by immunoenzymatic assay before and after the end of the study period. Disease activity was recorded according to the EAACI/GA(2)LEN/EDF scoring system.. After levocetirizine therapy CAM levels decreased in patients with CU, significantly in the cases of ELAM-1 and P-selectin. Patients' clinical scores improved during regular antihistamine therapy.. Levocetirizine 5 mg daily demonstrated a broad anti-inflammatory effect in patients with CU. The significant decrease in serum levels of ELAM-1 and P-selectin might reflect the inhibitory activity on neutrophil rolling and extravasation towards inflamed skin.

Topics: Adolescent; Adult; Aged; Cetirizine; Chronic Disease; E-Selectin; Enzyme-Linked Immunosorbent Assay; Female; Histamine H1 Antagonists, Non-Sedating; Humans; Intercellular Adhesion Molecule-1; Male; Middle Aged; P-Selectin; Piperazines; Urticaria; Vascular Cell Adhesion Molecule-1

Chronic idiopathic urticaria is a distressing condition that severely affects patients' quality of life. The overall costs associated with this disease, both for the healthcare payer and society, are unknown. The objective of this study was to evaluate the cost effectiveness of levocetirizine, a first-line treatment for urticaria.. Data were collected from two placebo-controlled trials and from official French databases. The effectiveness of the treatment was assessed by the mean number of pruritus-free days experienced by the patient within a 30-day period (PFD30). Direct cost parameters were medications used, medical procedures and hospitalisations for urticaria or treatment of adverse events. Productivity cost parameters were the workdays lost, defined as absenteeism and/or presenteeism, resulting from urticaria. The costing was performed using a French societal perspective. Costs were reported in euro (2002 values) and were standardised to a 30-day month. Whenever possible, incremental cost-effectiveness ratios (ICERs) were derived from these data.. The pooled sample contained 294 patients. Compared with placebo, patients in the levocetirizine group experienced an additional mean 6.5 (95% CI 3.8, 9.3) pruritus-free days per month (p < 0.001). Considering only direct medical costs, the incremental cost of treatment with levocetirizine was totally offset by the reduction in other medical costs (i.e. reduced cost of additional medications, medical procedures and hospitalisations). From the perspective of society, treatment with levocetirizine was cost saving, with a net gain of Euro 91.93 per patient per month.. Treating chronic idiopathic urticaria with levocetirizine is a dominant strategy for society since it is more effective (in terms of pruritus-free days gained) and less costly than placebo.

Topics: Adult; Anti-Allergic Agents; Cetirizine; Chronic Disease; Cost-Benefit Analysis; Female; Health Care Costs; Humans; Male; Piperazines; Randomized Controlled Trials as Topic; Urticaria