Antipruritic efficacy of a high-dosage antihistamine therapy. Results of a retrospectively analysed case series

Schulz S, Metz M, Siepmann D, Luger TA, Maurer M, Ständer S

Abstract

BACKGROUND AND OBJECTIVES: The causal treatment of chronic pruritus is not always possible or effective necessitating symptomatic antipruritic therapy. Antihistamines are the only drugs approved for the treatment of chronic pruritus, but they are rarely effective at standard doses. The aim of this investigation was to describe the efficacy and safety of high-dosage antihistamine treatment in patients with chronic pruritus of different origin. PATIENTS: A total of 67 patients with chronic pruritus caused by different skin diseases or chronic pruritus of unknown origin were treated with levocetirizine 10 mg/fexofenadine 360 mg or levocetirizine 10 mg/fexofenadine 360 mg/azelastine 4 mg or desloratadine 20 mg per day. RESULTS: A therapeutic response was achieved in 43.8% of patients with a combination of two antihistamines, 68.4% of patients with three antihistamines and 76.9% of patients with high dosage desloratadine. The average reduction in pruritus was 57.5% (two antihistamines), 67.4% (three antihistamines) and 89% (desloratadine). Adverse drug effects were observed rarely. CONCLUSIONS: The results of this case series suggest a high antipruritic effect in chronic pruritus by administration of high-dosage, non-sedating antihistamines. These results have to be confirmed in controlled trials. The combination was not more effective than the high dosage monotherapy. The latter one might be preferable due to unknown interactions and addition of side-effects in the combination therapy.