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Introduction to dermatological treatment
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
Non-sedative antihistamines are the most useful drugs in urticaria and angio-oedema. Cetirizine, levocetirizine, fexofenadine, loratadine, desloratadine, mizolastine and rupatadine are the ones most commonly used. They are not useful in eczema as histamine is not the cause of itch in this condition. High doses (off-licence but NICE approved) are often required in urticaria and 4 times the standard hay fever doses are accepted practice, e.g. cetirizine 20 mg b.i.d.
R
Published in Caroline Ashley, Aileen Dunleavy, John Cunningham, The Renal Drug Handbook, 2018
Caroline Ashley, Aileen Dunleavy, John Cunningham
Mainly metabolised by the cytochrome P450 (CYP 3A4) enzyme pathway. The amounts of unaltered active substance found in urine and faeces were insignificant. This means that rupatadine is almost completely metabolised.
Rapid, persistent, and simultaneous remission of urticaria and severe atopic dermatitis after treatment with omalizumab
Published in Journal of Dermatological Treatment, 2018
Ester Del Duca, Maria Esposito, Stefania Lechiancole, Alessandro Giunta, Luca Bianchi
A 32-year-old woman arrived at our clinic for urticaria not controlled by high dose of antihistamines. She suffered from widespread hives that have been presented for 6 months resistant to cetirizine 20 mg BID for 2 months and oral betamethasone 4 mg daily in decalage for 6 weeks. After 6 weeks, the therapy was reinforced adding rupatadine 10 mg once a day for 1 month without improvement. She reported also AD since the age of 10 treated with topical triamcinolone acetonide cream and emollients without any benefits. At the dermatological evaluation, we assessed the presence of widespread xerosis, flexural eczema, skin fissures involving perioral area and hands, hyperlinear palms and erythematous, lichenification of the neck area. Moreover, we identified a widespread erythema of trunk and limbs characterized by edematous, well-defined bordered wheals.
Mast cell activation: beyond histamine and tryptase
Published in Expert Review of Clinical Immunology, 2023
Theoharis C. Theoharides, Adam I. Perlman, Assma Twahir, Duraisamy Kempuraj
Minimizing exposure to potential triggers (e.g. allergens, foods, heat, stress) is clearly important. If there allergy to food antigens [302,303] or histamine intolerance is present [304], supplementation with the main histamine metabolizing enzyme, diamine oxidase (DAO) [305] shortly before meals could be beneficial especially if its activity is low or there is the presence of gene polymorphisms. The initial treatment approach is the use of second-generation, H-1 antihistamines up to 4 times the recommended doses as tolerated [306–310]. Unique among these, is the histamine-1 receptor antagonist rupatadine, which was specifically developed to have potent anti-PAF activity [311]. Rupatadine is not available in the US although it has been available in Europe for over 20 years and in Canada since about 2000 (Canadian online pharmacies will send it with a US prescription). Rupatadine at 40 mg/day is well tolerated and inhibits histamine- and PAF-induced flares and ex vivo platelet aggregation in normal male subjects [312]. When compared to other second second-generation H-1 antihistamines in chronic urticaria, 20 mg/day of rupatadine showed the greatest efficacy in the treatment of CSU (71.6%) as compared to 20 mg/day of desloratadine (50%), and 20 mg/day of levocetirizine (21.7%) Notably, rupatadine also inhibited histamine and TNF release from human mast cells in response to PAF [256], and the release of histamine and IL-6 from human mast cells was stimulated by different triggers [313]. Rupatadine, unlike desloratadine and levocetirizine, also inhibited the PAF-induced release of histamine from human mast cells [314].
Recurrent oedema of the uvula in a patient with chronic spontaneous urticaria successfully treated with omalizumab
Published in Journal of Dermatological Treatment, 2018
Rupatadine 10 mg twice a day for 20 days was prescribed and the clinic diary for UAS determination was given to the patient. At control visit, UAS was 4 and UAS7 was 20. Chronic spontaneous urticaria with uvula angioedema was diagnosed, and, due to unsatisfactory control and intolerable symptoms of urticaria, omalizumab 300 mg every 4 weeks was added to rupatadine 10 mg/day. After the first injection of omalizumab, urticaria regression was observed, with UAS = 0 and UAS7 = 0. After 6 months of treatment with omalizumab and antihistamines, no urticaria recurrence was reported and no new episodes of angioedema had occurred. Antihistamine and omalizumab treatments were discontinued.