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CORRESPONDENCE COLUMN
Year : 2007  |  Volume : 52  |  Issue : 4  |  Page : 212-213
Comparative efficacy of fexofenadine and levocetirizine in chronic idiopathic urticaria


Terna Hospital, Sector 10, Vashi, Navi Mumbai - 400 703, India

Correspondence Address:
K V Godse
Terna Hospital, Sector 10, Vashi, Navi Mumbai - 400 703
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.37733

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How to cite this article:
Godse K V, Jain A, Pharande P. Comparative efficacy of fexofenadine and levocetirizine in chronic idiopathic urticaria. Indian J Dermatol 2007;52:212-3

How to cite this URL:
Godse K V, Jain A, Pharande P. Comparative efficacy of fexofenadine and levocetirizine in chronic idiopathic urticaria. Indian J Dermatol [serial online] 2007 [cited 2019 Sep 22];52:212-3. Available from: http://www.e-ijd.org/text.asp?2007/52/4/212/37733


Chronic idiopathic urticaria (CIU) is defined by the almost daily presence of urticaria for at least six weeks without an identifiable cause. Symptoms include short-lived wheals, itching and erythema. There is limited data available comparing the effects of fexofenadine with other antihistamines in chronic idiopathic urticaria from India. The aim of this study was to investigate the efficacy and side-effects of fexofenadine and levocetirizine in patients with CIU.

Forty patients in the age group of 14 to 70 years with CIU were randomized to receive fexofenadine HCl 180 mg once daily, levocetirizine 5 mg once daily in the morning [Table - 1]. Physical urticaria patients, pregnant women and lactating mothers were not included. All the patients were investigated thoroughly to rule out any septic focus or any obvious cause of urticaria and their complete blood count, urine and sugar were analyzed before starting the treatment. A general and systemic examination was conducted and their consent was obtained at the initial visit. All patients were divided into two groups. All medications including antihistaminics were withdrawn for one day prior to study. Treatment was given either up to the relief of symptoms or up to one month. All patients were followed up for response to treatment. All patients were reviewed at 0, two and four weeks with urticaria activity score. Two patients from the levocetirizine group did not follow up. They were replaced with two new patients in the same age group.

The Urticaria Activity Score consisted of the sum of the wheal number score and the itch severity score. [1] The wheal numbers are graded from 0 to 3 as follows: 0 - less than 10 small wheals (diameter, <3 cm); 1-10 to 50 small wheals or less than 10 large wheals (diameter, >3 cm); 2 - greater than 50 small wheals or 10 to 50 large wheals; and 3 - almost the whole body is covered. The severity of the itching is graded from 0 to 3 (0, none; 1, mild; 2, moderate; and 3, severe).

Mean urticaria activity score of urticaria in patients treated with fexofenadine was 4.35 and the mean score of urticaria in patients treated with levocetirizine was 3.40 at baseline. At the end of two weeks mean scores had a significant change in both the groups but in the fexofenadine treatment group, decrease was 65.5% which was more as compared to 48.8% in the levocetirizine treatment group, but the difference was not significant.

At the end of the fourth week the decrease in urticaria activity scores was 80.5% in the fexofenadine treatment group and 61.8% in the levocetirizine treatment group; the decrease in urticaria activity scores was significantly more in the fexofenadine treatment group as compared to the levocetirizine treatment group [Table - 2]. No patient could stop treatment before four weeks of treatment.

Headache was reported in one patient of the fexofenadine group and drowsiness was present in two patients in the levocetirizine group.

Fexofenadine hydrochloride is a nonsedating long-acting antihistamine with highly selective peripheral H1 receptor antogonist activity and a 180 mg once daily dose showed optimum effects in chronic urticaria. [2] Levocetirizine has pharmacodynamically and pharmacokinetically favorable characteristics, including high bioavailability, rapid onset of action, limited distribution and a low degree of metabolism. [3] Clinical trials indicate that it is safe and effective for the treatment of allergic rhinitis and chronic urticaria with a minimal number of untoward effects. Furthermore, several recent studies have demonstrated that in addition to its being a potent antihistamine, levocetirizine has several anti-inflammatory effects that are observed at clinically relevant concentrations that may enhance its therapeutic benefit.

A randomized, double-blind, placebo-controlled, parallel, multicenter study has shown Levocetirizine, 5 mg once daily, is an effective treatment for CIU, characterized not only by a rapid and sustained response, but also by an important improvement in Quality of life. [4] Similarly fexofenadine HCl is well tolerated and is statistically superior to placebo in reducing signs and symptoms of CIU and in ameliorating interference with sleep and daily activities due to urticaria. [5]

Our study found fexofenadine superior to levocetirizine at the end of the fourth week in treatment of chronic idiopathic urticaria. There are no studies comparing fexofenadine and levocetirizine in Pubmed search. Large studies are required to confirm these findings.


   Acknowledgement Top


Authors wishes to thank Sanofi Aventis and Systopic Laboratories for supply of medicines free of charge.

 
   References Top

1.Erbagci Z. The leukotriene receptor antagonist montelukast in the treatment of chronic idiopathic urticaria: A single-blind, placebo-controlled, crossover clinical study. J Allergy Clin Immunol 2002;110:484-8.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Paul E, Berth Jones J, Ortonne JP. Fexofenadine hydrochloride in the treatment of chronic idiopathic urticaria: A placebo controlled parallel group, close ranging study. J Dermatol Treatment 1998;9:143-9.  Back to cited text no. 2    
3.Walsh GM. Levocetirizine: An update. Curr Med Chem 2006;13:2711-5.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Kapp A, Pichler WJ. Levocetirizine is an effective treatment in patients suffering from chronic idiopathic urticaria: A randomized, double-blind, placebo-controlled, parallel, multicenter study. Int J Dermatol 2006;45:469-74.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Finn AF Jr, Kaplan AP, Fretwell R, Qu R, Long J. A double-blind, placebo-controlled trial of fexofenadine HCl in the treatment of chronic idiopathic urticaria. J Allergy Clin Immunol 1999;104:1071-8.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]



 
 
    Tables

  [Table - 1], [Table - 2]

This article has been cited by
1 Chronic urticaria and treatment options
Godse, K.V.
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[Pubmed]



 

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