Evaluation of Efficacy and Safety of High Dose Second Generation Non-sedating Antihistamines Levocetrizine and Fexofenadine in Chronic Urticaria- A Prospective, Parallel, Randomized, Single Blind, Comparative Study

Objectives: The first line drugs, recommended for chronic urticaria are nonsedating antihistamines. There are few studies with up dosing of different antihistamines. All are single armed and non‐randomized studies. The present study was to evaluate the efficacy and safety of high doses of second generation antihistamines levocetrizine and fexofenadine in chronic urticaria. Methods: In this prospective, parallel, randomized, single blind, comparative study, patients with moderate to severe pruritus and urticaria were included. Twenty four patients were randomized either to Fexofenadine 180 mg or Levocetrizine 5 mg groups. Patients were monitored weekly up to 4weeks.The dose of Fexofenadine was doubled to 360 mg and Levocetrizine to 10 mg at the end of 1 week in non‐responders. The dose of Fexofenadine was increased to 540 mg and Levocetrizine to 20 mg at the end of 2 weeks in non‐responders. These doses were continued till the end of study (4 weeks). Patients who completed 2 week treatment with highest dose were included in the analysis. All patients were evaluated for symptoms (degree of pruritus, number and size of wheals and number of urticarial episodes per week) visual analog scale for sedation and critical flicker fusion threshold (CFFT) for coordination before and after study. Results: The change in mean total symptoms score was highly significant in Fexofenadine group than Levocetrizine group. There was a highly significant decrease in CFFT in Fexofenadine group. Conclusions: Fexofenadine is superior to Levocetrizine in reducing mean symptoms score and sedation and improving coordination in patients with chronic urticaria.