RESUMO
BACKGROUND AND OBJECTIVES: According to current guidelines, oral antihistamines are the first-line treatment for chronic spontaneous urticaria (CSU). Up-dosing antihistamines to 4-fold the licensed dose is recommended if control is not achieved. Such indications are based mainly on expert opinion. Objectives: To critically review and analyze clinical evidence on the efficacy and safety of higher-than-licensed dosage of second-generation oral antihistamines in the treatment of CSU. MATERIAL AND METHODS: A systematic literature review was performed following a sensitive search strategy. All articles published in PubMed, EMBASE, and the Cochrane Library between 1961 and October 2018 were examined. Publications with CSU patients prescribed secondgeneration antihistamines in monotherapy compared with placebo, licensed dosages, and/or higher dosages were included. Articles were evaluated by peer reviewers. Quality was evaluated using the Jadad and Oxford scores. RESULTS: We identified 337 articles, of which 14 were included in the final evaluation (fexofenadine, 6; cetirizine, 2; levocetirizine and desloratadine, 1; levocetirizine, 1; rupatadine, 2; ebastine, 1; and bilastine, 1). Only 5 studies were placebo-controlled. The number of patients included ranged from 20 to 439. The observation lapse was ≤16 weeks. High fexofenadine doses produced a significant dosedependent response and controlled urticaria in most patients. Cetirizine, levocetirizine, rupatadine, and bilastine were more effective in up-dosing. The most frequent adverse events were headache and drowsiness. CONCLUSION: The low quality and heterogeneity of the articles reviewed made it impossible to reach robust conclusions and reveal the need for large-scale randomized clinical trials.
Assuntos
Antialérgicos/uso terapêutico , Urticária Crônica/tratamento farmacológico , Antagonistas não Sedativos dos Receptores H1 da Histamina/uso terapêutico , Administração Oral , Animais , Ensaios Clínicos como Assunto , Cálculos da Dosagem de Medicamento , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , Resultado do TratamentoRESUMO
Background: According to current guidelines, oral antihistamines are the first-line treatment for chronic spontaneous urticaria (CSU). Up-dosing antihistamines to 4-fold the licensed dose is recommended if control is not achieved. Such indications are based mainly on expert opinion. Objectives: To critically review and analyze clinical evidence on the efficacy and safety of higher-than-licensed dosage of second-generation oral antihistamines in the treatment of CSU. Material and Methods: A systematic literature review was performed following a sensitive search strategy. All articles published in PubMed, EMBASE, and the Cochrane Library between 1961 and October 2018 were examined. Publications with CSU patients prescribed secondgeneration antihistamines in monotherapy compared with placebo, licensed dosages, and/or higher dosages were included. Articles were evaluated by peer reviewers. Quality was evaluated using the Jadad and Oxford scores. Results: We identified 337 articles, of which 14 were included in the final evaluation (fexofenadine, 6; cetirizine, 2; levocetirizine and desloratadine, 1; levocetirizine, 1; rupatadine, 2; ebastine, 1; and bilastine, 1). Only 5 studies were placebo-controlled. The number of patients included ranged from 20 to 439. The observation lapse was ≤16 weeks. High fexofenadine doses produced a significant dosedependent response and controlled urticaria in most patients. Cetirizine, levocetirizine, rupatadine, and bilastine were more effective in up-dosing. The most frequent adverse events were headache and drowsiness. Conclusion: The low quality and heterogeneity of the articles reviewed made it impossible to reach robust conclusions and reveal the need for large-scale randomized clinical trials (AU)
Assuntos
Humanos , Antialérgicos/administração & dosagem , Urticária/tratamento farmacológico , Antagonistas não Sedativos dos Receptores H1 da Histamina/administração & dosagem , Administração Oral , Doença Crônica , Ensaios Clínicos como Assunto , Cálculos da Dosagem de Medicamento , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Resultado do TratamentoAssuntos
Acetaminofen/efeitos adversos , Analgésicos não Narcóticos/efeitos adversos , Toxidermias/etiologia , Hipersensibilidade a Drogas/imunologia , Fenilefrina/efeitos adversos , Simpatomiméticos/efeitos adversos , Acetaminofen/administração & dosagem , Acetaminofen/química , Adulto , Analgésicos não Narcóticos/administração & dosagem , Testes de Provocação Brônquica , Resfriado Comum/tratamento farmacológico , Resfriado Comum/imunologia , Resfriado Comum/fisiopatologia , Reações Cruzadas , Hipersensibilidade a Drogas/fisiopatologia , Feminino , Cefaleia/prevenção & controle , Humanos , Testes do Emplastro , Fenilefrina/administração & dosagem , Fenilefrina/química , Simpatomiméticos/administração & dosagemAssuntos
Obstrução das Vias Respiratórias/induzido quimicamente , Angioedema/induzido quimicamente , Fibrinolíticos/efeitos adversos , Insuficiência Respiratória/induzido quimicamente , Terapia Trombolítica/efeitos adversos , Ativador de Plasminogênio Tecidual/efeitos adversos , Idoso , Obstrução das Vias Respiratórias/tratamento farmacológico , Angioedema/tratamento farmacológico , Antialérgicos/uso terapêutico , Fibrinolíticos/administração & dosagem , Humanos , Masculino , Infarto do Miocárdio/complicações , Infarto do Miocárdio/tratamento farmacológico , Insuficiência Respiratória/tratamento farmacológico , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/administração & dosagem , Resultado do TratamentoRESUMO
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