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Updosing antihistamines in chronic spontaneous urticaria

In recent years, it has become customary in the treatment of chronic spontaneous urticaria (CSU) to prescribe second-generation antihistamines in dosages higher than the authorised dosage. The efficacy of this off-label updosing has only been shown in patients responding insufficiently to the usual dosages. The available evidence is, however, of low quality, and there are also  disadvantages to this updosing. Is it definitely advisable to increase the dosage of antihistamines in patients with CSU who respond insufficiently to the usual dosage?

  • Off-label updosing of antihistamines results in a limited improvement of chronic spontaneous urticaria in case of insufficient response to the authorised dosage. Updosing for other indications has not been investigated.
  • Updosing should only be considered for patients responding insufficiently to the authorised dosage.
  • In view of the lack of evidence about adverse effects after updosing, caution should be exercised, especially regarding vulnerable patient groups and patients who have to participate in traffic.

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  • Sander van den Bogert, dr, pharmacist