Russian Journal of AllergyRussian Journal of Allergy1810-88302686-682XFarmarus Print Media157410.36691/RJA1574MiscellaneousThe use of Cetirizine and Levocetirizine in patients with chronic urticaria and other allergic dermatoses: issues of dosage increasing and long-term use. Resolution of the Advisory BoardKruglovaLarisa S.<p>MD, Dr. Sci. (Med.), Professor</p>kruglovals@mail.ruhttps://orcid.org/0000-0002-5044-5265LvovAndrey N.<p>MD, Dr. Sci. (Med.), Professor</p>alvov@mail.ruhttps://orcid.org/0000-0002-3875-4030AraviyskayaElena R.<p>MD, Dr. Sci. (Med.), Professor</p>arelenar@mail.ruhttps://orcid.org/0000-0002-6378-8582BakulevAndrey L.<p>MD, Dr. Sci. (Med.), Professor</p>al_ba05@mail.ruhttps://orcid.org/0000-0002-1450-4942GadzhigoroevaAida G.<p>MD, Dr. Sci. (Med.), Professor</p>aida2010@mail.ruhttps://orcid.org/0000-0003-0489-0576GalimovaElena S.<p>MD, Dr. Sci. (Med.), Professor</p>lenagalimova@mail.ruhttps://orcid.org/0000-0002-3788-2284DanilychevаInna V.<p>MD, Cand. Sci. (Med.)</p>ivdanilycheva@mail.ruhttps://orcid.org/0000-0002-8279-2173ElisyutinaOlga G.<p>MD, Dr. Sci. (Med.), Leading Researcher</p>el-olga@yandex.ruhttps://orcid.org/0000-0002-4609-2591ZiganshinOleg R.<p>MD, Dr. Sci. (Med.), Professor</p>ziganshin_oleg@mail.ruhttps://orcid.org/0000-0002-5857-0319IlinaNatalia I.<p>MD, Dr. Sci. (Med.), Professor</p>instimmun@yandex.ruhttps://orcid.org/0000-0002-3556-969XKokhanMuza M.<p>MD, Dr. Sci (Med.), Professor</p>mkokhan@yandex.ruhttps://orcid.org/0000-0001-6353-6644MatushevskayaElena V.<p>MD, Dr. Sci. (Med.), Professor</p>matushevskaya@mail.ruhttps://orcid.org/0000-0003-4583-0617MigachevaNatalia B.<p>MD, Dr. Sci. (Med.), Professor</p>nbmigacheva@gmail.comhttps://orcid.org/0000-0003-0941-9871MurashkinNikolay N.<p>MD, Dr. Sci. (Med.), Professor</p>m_nn2001@mail.ruhttps://orcid.org/0000-0003-2252-8570NemchaninovaOlga B.<p>MD, Dr. Sci. (Med.), Professor</p>obnemchaninova@mail.ruhttps://orcid.org/0000-0002-5961-6980NenashevaNatalia M.<p>MD, Dr. Sci. (Med.), Professor</p>1444031@gmail.comhttps://orcid.org/0000-0002-3162-2510OlisovaOlga Yu.<p>MD, Dr. Sci. (Med.), Professor</p>olisovaolga@mail.ruhttps://orcid.org/0000-0003-2482-1754PavlinovaElena B.<p>MD, Dr. Sci. (Med.), Professor</p>123elena@mail.ruhttps://orcid.org/0000-0002-6444-1871PrituloOlga A.<p>MD, Dr. Sci. (Med.), Professor</p>55550256@mail.ruhttps://orcid.org/0000-0001-6515-1924RepetskayaMarina N.<p>MD, Dr. Sci. (Med.), Professor</p>proffrep@yandex.ruhttps://orcid.org/0000-0002-2001-4296SamtsovAlexey V.<p>MD, Dr. Sci. (Med.), Professor</p>avsamtsov@mail.ruSidorenkoOlga A.<p>MD, Dr. Sci. (Med.), Professor</p>ola_ps@mail.ruhttps://orcid.org/0000-0002-7387-2497SnarskayaElena S.<p>MD, Dr. Sci. (Med.), Professor</p>snarskaya-dok@mail.ruhttps://orcid.org/0000-0002-7968-7663SokolovskiyEvgeny V.<p>MD, Dr. Sci. (Med.), Professor</p>s40@mail.ruhttps://orcid.org/0000-0001-7610-6061TamrazovaOlga B.<p>MD, Dr. Sci. (Med.), Professor</p>anait_tamrazova@mail.ruhttps://orcid.org/0000-0003-3261-6718TataurshchikovaNatalia S.<p>MD, Dr. Sci. (Med.), Professor</p>natalytataur@yandex.ruhttps://orcid.org/0000-0002-3486-8188FedenkoElena S.<p>MD, Dr. Sci. (Med.), Professor</p>efedks@gmail.comhttps://orcid.org/0000-0003-3358-5087FedotovaNatalia V.<p>MD, Cand. Sci. (Med.)</p>nfedotova23@mail.ruhttps://orcid.org/0000-0003-0631-7212ShartanovaNatalia V.<p>MD, Dr. Sci. (Med.)</p>nshartanova@yandex.ruhttps://orcid.org/0000-0002-1197-9002YusupovaLuiza A.<p>MD, Dr. Sci. (Med.), Professor</p>yuluizadoc@hotmail.comhttps://orcid.org/0000-0001-8937-2158Central State Medical Academy of Department of Presidential AffairsLomonosov Moscow State UniversityAcademician I.P. Pavlov First St. Petersburg State Medical UniversityGalaktika Beauty InstituteMoscow Scientific and Practical Center of Dermatovenereology and CosmetologyInstitute of Beautiful HairBashkir State Medical UniversityNational Research Center — Institute of Immunology Federal Medical-Biological Agency of RussiaSouth-Ural State Medical UniversityChelyabinsk Regional Clinical Skin and Venereological DispensaryMoscow State University of Medicine and Dentistry named after A.I. EvdokimovThe Russian National Research Medical University named after N.I. PirogovUral Research Institute of Dermatovenereology and ImmunopathologyAcademy of Postgraduate Education under the Federal state budgetary institution «Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency»Samara State Medical UniversitySamara Regional Clinical Hospital named after V.D. SeredavinNational Medical Research Center for Children’s HealthNovosibirsk State Medical UniversityRussian Medical Academy of Continuous Professional EducationFirst Sechenov Moscow State Medical University (Sechenov University)Omsk State Medical UniversityMedical Academy named after S.I. Georgievsky of V.I. Vernadsky Crimean Federal UniversityPerm State Medical UniversityMilitary medical academy of S.M. KirovRostov State Medical UniversityPeoples’ Friendship University of RussiaScientific Research Institute ― Ochapovsky Regional Clinic HospitalKazan State Medical Academy under the Russian Medical Academy of Continuous Professional Education081020221933884030909202212092022Copyright © 2022, Pharmarus Print Media2022<p>This article reflects the main issues discussed at the Advisory Board with the participation of leading dermatovenereologists, allergists, and immunologists. The Advisory Board has become a platform for discussing the accumulated clinical and organizational problems in the field of managing patients with chronic urticaria and other allergic dermatoses. The Advisory Board also discussed the possibility of long-term use of cetirizine and levocetirizine and the use of their high doses in clinical practice. The subject of discussion was the question of the algorithm for escalation and subsequent de-escalation of the dose of non-sedating H<sub>1</sub> antihistamines. An algorithm for escalation and de-escalation of doses of antihistamines was created based on the discussion, which can be recommended for use in clinical practice.</p>
<p>This article was simultaneously published in several journals with permission from authors and publishers. The parallel publication is available here: The use of cetirizine and levocetirizine in patients with chronic urticaria and other allergic dermatoses: Issues of dosage increasing and long-term use from the resolution of the Advisory Board. <em>Effective Pharmacotherapy</em>. 2022;18(25):614. DOI: https://doi.org/10.33978/2307-3586-2022-18-25-6-14. This article published with permission from authors and copyright holder.</p>non-sedating H1-antihistaminesurticariaallergic dermatosescetirizinelevocetirizinelong-term usedose escalationdose de-escalationнеседативные Н1-антигистаминные препаратыкрапивницааллергодерматозыцетиризинлевоцетиризиндлительное применениеэскалация дозыдеэскалация дозы[Holgate ST, Canonica GW, Simons FE. Consensus Group on New-Generation Antihistamines (CONGA): present status and recommendations. Clin Exp Allergy. 2003;33:1305–1324. doi: 10.1046/j.1365-2222.2003.01769.x][Levina YuG, Namazova-Baranova LS, Alekseeva AA, et al. Clinical and pharmacological features of the use of cetirizine in the treatment of allergic diseases in children. Pediatric Pharmacol. 2014;11(3):20–26. (In Russ).][Tataurshchikova NS, Sepiashvili RI. Rational use of antihistamines in clinical practice. Educational and methodical manual. Moscow: MEDpress-inform; 2013. P. 36. (In Russ).][Nettis E, Foti C, Ambrifi M, et al. Urticaria: recommendations from the Italian Society of Allergology, Asthma and Clinical Immunology and the Italian Society of Allergological, Occupational and Environmental Dermatology. Clin Mol Allergy. 2020;18:8. doi: 10.1186/s12948-020-00123-8][Caffarelli C, Paravati F, El Hachem M, et al. Management of chronic urticaria in children: a clinical guideline. Ital J Pediatr. 2019;45:101. doi: 10.1186/s13052-019-0695-x][Ansotegui IJ, Bernstein JA, Canonica GW, et al. Insights into urticaria in pediatric and adult populations and its management with fexofenadine hydrochloride. Allergy Asthma Clin Immunol. 2022;18:41. doi: 10.1186/s13223-022-00677-z][Church MK, Maurer M, Simons FE, et al.; Global Allergy and Asthma European Network. Risk of first-generation H(1)-antihistamines: a GA(2)LEN position paper. Allergy. 2010;65(4):459−466. doi: 10.1111/j.1398-9995.2009.02325.x][Ashenager MS, Grgela T, Aragane Y, Kawada A. Inhibition of cytokine-induced expression of T-cell cytokines by antihistamines. Inv Allergol Clin Immunol. 2007;17(1):20–26.][Zuberbier T, Aberer W, Asero R, et al. The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018;73(7):1393−1414. doi: 10.1111/all.13397][Urticaria. Clinical recommendations. Russian Society of Allergologists and Clinical Immunologists, Russian Society of Dermatovenerologists and Cosmetologists, Union of Pediatricians of Russia; 2019. 60 p. (In Russ).][Atopic dermatitis. Clinical recommendations. Russian Society of Dermatovenerologists and Cosmetologists, Russian Association of Allergologists and Clinical Immunologists, Union of Pediatricians of Russia; 2020. 81 p. (In Russ).][Jáuregui I, Ferrer M, Montoro J, et al. Antihistamines in the treatment of chronic urticaria. J Investig Allergol Clin Immunol. 2007;17(Suppl. 2):41−52.][Filatova TA, Revyakina VA, Kondyurina EG, Zelenskaya VV. Cetirizine (Parlazine) in the treatment of atopic dermatitis in children. Current Pediatrics. 2005;4(2):109−112. (In Russ).][Ningombam A, Handa S, Srivastava N, et al. Addition of oral fexofenadine to topical therapy leads to a significantly greater reduction in the serum interleukin-31 levels in mild to moderate paediatric atopic dermatitis. Clin Exp Dermatol. 2022;47(4):724−729. doi: 10.1111/ced.15032][Gillard M, Christophe B, Wels B, et al. H1 antagonists: receptor affinity versus selectivity. Inflamm Res. 2003;52(Suppl. 1):S49−50. doi: 10.1007/s000110300050][Gushchin IS. Multifunctional antiallergic capabilities of the H1-receptor antagonist levocetirizine. Russian Journal of Allergy. 2014;(2):11−24. (In Russ).][Corsico AG, Leonardi S, Licari A, et al. Focus on the cetirizine use in clinical practice: a reappraisal 30 years later. Multidiscip Respir Med. 2019;14:40. doi: 10.1186/s40248-019-0203-6][Gushchin IS. Antihistamines. Moscow: Aventis Pharma; 2000. 54 p. (In Russ).][Guevara-Gutierrez E, Bonilla-Lopez S, Hernández-Arana S, Tlacuilo-Parra A. Safety and efficacy of cetirizine versus cetirizine plus ranitidine in chronic urticaria: double-blind randomized placebo-controlled study. J Dermatolog Treat. 2015;26(6):548−550. doi: 10.3109/09546634.2015.1025031][Handa S, Dogra S, Kumar B. Comparative efficacy of cetirizine and fexofenadine in the treatment of chronic idiopathic urticaria. J Dermatolog Treat. 2004;15(1):55−57. doi: 10.1080/09546630310013450][Fadel R, Ramboer I, Chatterjee N, et al. Cetirizine inhibits bradykinin-induced cutaneous wheal and flare in atopic and healthy subjects. Allergy. 2000;55(9):888−891. doi: 10.1034/j.1398-9995.2000.00322.x][Gushchin IS. Cetirizine ― etalon H1-antihistamine. Drugs and Technologies. 2009;(5):60−70. (In Russ).][Fadel R, David B, Herpin-Richard N, et al. In vivo effects of cetirizine on cutaneous reactivity and eosinophil migration induced by platelet-activating-factor (PAF-acether) in man. J Allergy Clin Immunol. 1990;86:314−320.][Purohit A, Duvernelle C, Melac M, et al. Twenty-four hours of activity of cetirizine and fexofenadine in the skin. Ann Allergy Asthma Immunol. 2001;86(4):387−392. doi: 10.1016/S1081-1206(10)62483-0][Purohit A, Melac M, Pauli G, Frossard N. Comparative activity of cetirizine and desloratadine on histamine-induced wheal-and-flare responses during 24 hours. Ann Allergy Asthma Immunol. 2004;92(6):635−640. doi: 10.1016/S1081-1206(10)61429-9][Sanchez J, Zakzuk J, Cardona R. Prediction of the efficacy of antihistamines in chronic spontaneous Urticaria based on initial suppression of the histamine- induced wheal. J Investig Allergol Clin Immunol. 2016;26:177–184. doi: 10.18176/jiaci.0039][Kruglova LS, Tataurshchikova NS, Tipaeva EV. Issues of long-term use of antihistamines. Pharmateca. 2021;28(14):87−93. (In Russ). doi: 10.18565/pharmateca.2021.14.87-93][Grant JA, Riethuisen JM, Moulaert B, DeVos C. A double-blind, randomized, single-dose, crossover comparison of levocetirizine with ebastine, fexofenadine, loratadine, mizolastine, and placebo: suppression of histamine-induced wheal-and-flare response during 24 hours in healthy male subjects. Ann Allergy Asthma Immunol. 2002;88(2):190−197. doi: 10.1016/S1081-1206(10)61995-3][Church DS, Church MK. Pharmacology of antihistamines. World Allergy Organ J. 2011;4(3 Suppl.): S22−27. doi: 10.1097/WOX.0b013e3181f385d9][Kawauchi H, Yanai K, Wang DY, et al. Antihistamines for allergic rhinitis treatment from the viewpoint of nonsedative properties. Int J Mol Sci. 2019;20:213. doi: 10.3390/ijms20010213][Potter PC, Kapp A, Maurer M, et al. Comparison of the efficacy of levocetirizine 5 mg and desloratadine 5 mg in chronic idiopathic urticaria patients. Allergy. 2009;64:596−604. doi: 10.1111/j.1398-9995.2008.01893.x][Dr. Reddy’s Laboratories [Internet]. Instructions for the medical use of the drug Allergen. LP-004008-011216. (In Russ). Available from: https://allerway.ru/instruction/allerway/. Accessed: 15.07.2022.][Dr. Reddy’s Laboratories [Internet]. Instructions for the medical use of the drug Allergen Express. LP-006153. (In Russ). Available from: https://allerway.ru/instruction/allerway-express/. Accessed: 15.07.2022.][Kareva EN. The choice of an antihistamine drug: a pharmacologist’s view. Russ Med J. 2016;(3):811–816. (In Russ).][Dr. Reddy’s Laboratories [Internet]. Instructions for the medical use of the drug Cetrin. Р N013283/01. (In Russ). Available from: https://cetrine.ru/instrukciya. Accessed: 15.07.2022.][Elisyutina OG, Fedenko ES. Experience of using cetirizine in atopic dermatitis. Russian Journal of Allergy. 2007;(5):59−62. (In Russ).][State Register of Medicines. (In Russ). Available from: https://grls.rosminzdrav.ru/Default.aspx. Accessed: 15.07.2022.][Nenasheva NM, Shartanova NV, Ovchinnikov AYu, et al. Seasonal allergic rhinitis and its control with antihistamines in outpatient practice. Russian Journal of Allergy. 2020;17(2):44−52. (In Russ). doi: 10.36691/RJA1370][Bachert C, Bousquet J, Canonica GW, et al.; XPERT Study Group. Levocetirizine improves quality of life and reduces costs in long-term management of persistent allergic rhinitis. J Allergy Clin Immunol. 2004;114(4):838–844. doi: 10.1016/j.jaci.2004.05.070][Simons FE; Early Prevention of Asthma in Atopic Children (EPAAC) Study Group. Safety of levocetirizine treatment in young atopic children: an 18-month study. Pediatr Allergy Immunol. 2007;18(6):535–542. doi: 10.1111/j.1399-3038.2007.00558.x][Diepgen TL; Early Treatment of the Atopic Child Study Group. Long-term treatment with cetirizine of infants with atopic dermatitis: a multi-country, double-blind, randomized, placebo-controlled trial (the ETAC trial) over 18 months. Pediatr Allergy Immunol. 2002;13(4):278–286. doi: 10.1034/j.1399-3038.2002.01047.x][Hussein Z, Pitsiu M, Majid O, et al.; ETAC Study Group. Retrospective population pharmacokinetics of levocetirizine in atopic children receiving cetirizine: the ETAC study. Br J Clin Pharmacol. 2005;59(1):28–37. doi: 10.1111/j.1365-2125.2005.02242.x][Zuberbier T, Bindslev-Jensen C, Canonica W, et al. EAACI/ GA2LEN/EDF guideline: management of urticaria. Allergy. 2006;61:321–331. doi: 10.1111/j.1398-9995.2005.00962.x][Okubo Y, Shigoka Y, Yamazaki M, Tsuboi R. Double dose of cetirizine hydrochloride is effective for patients with urticaria resistant: a prospective, randomized, non-blinded, comparative clinical study and assessment of quality of life. J Dermatolog Treat. 2013;24(2):153−160. doi: 10.3109/09546634.2011.608783][Zuberbier T, Aberer W, Burtin B, et al. Efficacy of cetirizine in cholinergic urticaria. Acta Derm Venereol. 1995;75(2):147−149. doi: 10.2340/0001555575147149][Castells M, Metcalfe DD, Escribano L. Diagnosis and treatment of cutaneous mastocytosis in children: practical recommendations. Am J Clin Dermatol. 2011;12(4):259−270. doi: 10.2165/11588890-000000000-00000][Ständer S, Pereira MP, Berger T, et al. IFSI-guideline on chronic prurigo including prurigo nodularis. ITCH. 2020;5(4):42. doi: 10.1097/itx.0000000000000042][Prurigo. Clinical recommendations. Russian Society of Dermatovenerologists and Cosmetologists. (In Russ). Available from: https://diseases.medelement.com/disease/пруриго-рекомендации-рф/15250. Accessed: 15.07.2022.][Staevska M, Popov TA, Kralimarkova T, et al. The effectiveness of levocetirizine and desloratadine in up to 4 times conventional doses in difficult-to-treat urticaria. Am Acad Allergy Asthma Immunol. 2010;125(3):676−682. doi: 10.1016/j.jaci.2009.11.047][Sharma VK, Gupta V, Pathak M, Ramam M. An open-label prospective clinical study to assess the efficacy of increasing levocetirizine dose up to four times in chronic spontaneous urticaria not controlled with standard dose. J Dermatolog Treat. 2017;28(6):539−543. doi: 10.1080/09546634.2016.1246705][Godse KV. Updosing of antihistamines to improve control of chronic urticaria. Indian J Dermatol Venereol Leprol. 2010;76(1):61−62. doi: 10.4103/0378-6323.58684][Huang X, Li Z, Sun R. High-dose levocetirizine for the treatment of refractory chronic spontaneous urticaria and the effect on the serum inositol triphosphate level. J Int Med Res. 2019;47(9):4374−4379. doi: 10.1177/0300060519857768][Hulhoven R, Rosillon D, Letiexhe M, et al. Levocetirizine does not prolong the QT/QTc interval in healthy subjects: results from a thorough QT study. Eur J Clin Pharmacol. 2007;63:1011–1017. doi: 10.1007/s00228-007-0366-5]