Do sedating H 1-antihistamines still have a role to play in the management of chronic idiopathic urticaria?

Abstract

Summary At present, the mainstay therapy for chronic idiopathic urticaria remains second generation (“non sedating”) antihistamines. Efficacy, however, is not always sufficient to allow monotherapy, and therefore first generation (sedating) antihistamines are often used either alone or in combination with second generation antihistamines. The rationale for such therapy is, however, poorly investigated in clinically controlled trials. The only parameter favoring use of first generation antihistamines is their relatively low price, whereas their actions on other receptors (e.g. the muscarinic receptors) together with their sedative potential are major disadvantages in comparison with second generation antihistamines, where specific H1-blockade can be achieved and sedation can be avoided. In selected cases, the dose of second generation antihistamines may be increased in order to increase efficacy and in some cases the accompaning sedation is also used for therapy.