Clinical Control of CSU with Antihistamines Allows for Tolerance of NSAID-Exacerbated Cutaneous Disease

Abstract

Many patients with chronic spontaneous urticaria (CSU) experience exacerbations after the administration of nonsteroidal anti-inflammatory drugs (NSAIDs), with clinical implications for the selection of therapeutic options for pain management. Case reports suggest that antihistamines could prevent these reactions. To determine whether antihistamines can prevent NSAID-exacerbated reactions in patients with CSU. Data on 121 patients with CSU and a history of NSAID exacerbations were evaluated. Two types of challenge with NSAIDs were performed using the NSAIDs reported in the medical record (a diagnostic challenge test without the use of antihistamines and a challenge test using antihistamines). The order in which the tests were performed in each patient was dependent on the treating physician. Patients with a positive first diagnostic challenge underwent a second challenge using H1-antihistamines (anti-H1), patients with a negative first challenge using anti-H1 underwent a second diagnostic challenge without the use of anti-H1, and patients with a negative first diagnostic challenge or a positive first challenge using anti-H1 did not undergo a second challenge. In some patients, additional challenges were performed with an alternative NSAID before performing the diagnostic challenge test or the challenge test using anti-H1. In the diagnostic challenge test, 96 patients tested positive. Seventy-two (75%) of these patients tolerated the NSAIDs involved in the reaction when they used antihistamines. NSAID restrictions create many inconveniences for patients with CSU. Clinical control of CSU with the use of antihistamines can prevent further exacerbations due to NSAID intake in many patients to help them avoid unnecessary restrictions.