CETIRIZINE
Place in Therapy
Place in Therapy
Cetirizine is a second-generation antihistamine that is considered first-line along with other second-generation antihistamines for the treatment of mild urticaria. The majority of evidence supporting the use of cetirizine in mild urticaria comes from the extrapolation of data in studies investigating chronic idiopathic urticaria. There are a few studies however studying its’ use in acute urticaria including urticaria related to mosquito bites. These studies agree that cetirizine is effective as a first-line agent for mild urticaria. A systematic review that analyzed these studies concluded that there are not enough well-designed clinical trials comparing the efficacy between second-generation antihistamines. The majority of evidence compares cetirizine to placebo and therefore second-generation H1-receptor antagonists are considered first-line as a group.
Cetirizine is considered first line because it has been shown to have a long duration of action, fewer side effects and less cognitive impairment than first-generation antihistamines. Some studies did show that it had some more sedation than other second-generation antihistamines but was still better tolerated than first-generation antihistamines. Clinical practice guidelines referenced studies that showed that increasing the dose of cetirizine up to 4 times the original dose is an effective second-line option if urticaria persists for 2 weeks. Cetirizine is first-line in pediatrics as well as it has been well studied and has long-term safety data behind it. There are only small sample size studies evaluating the safety of cetirizine in pregnancy however none have reported birth defects. Based on this weak evidence it is considered safe however it is preferred that systemic therapy is avoided.
References
1. Reunala T, Lappalainen P, Brummer-Korvenkontio H, Coulie P, Palosuo T. Cutaneous reactivity to mosquito bites: effect of cetirizine and development of anti-mosquito antibodies. Clin Exp Allergy. 1991;21(5):617-622.
2. Lee EE, Maibach HI. Treatment of urticaria: an evidence-based evaluation of antihistamines. Am J Clin Dermatol. 2001;2(1):27-32.
3. Zuberbier T, Aberer W, Asero R, et al. The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of the urticarial: the 2013 revision and update. Allergy. 2014;69(7):868-87.
Cetirizine is a second-generation antihistamine that is considered first-line along with other second-generation antihistamines for the treatment of mild urticaria. The majority of evidence supporting the use of cetirizine in mild urticaria comes from the extrapolation of data in studies investigating chronic idiopathic urticaria. There are a few studies however studying its’ use in acute urticaria including urticaria related to mosquito bites. These studies agree that cetirizine is effective as a first-line agent for mild urticaria. A systematic review that analyzed these studies concluded that there are not enough well-designed clinical trials comparing the efficacy between second-generation antihistamines. The majority of evidence compares cetirizine to placebo and therefore second-generation H1-receptor antagonists are considered first-line as a group.
Cetirizine is considered first line because it has been shown to have a long duration of action, fewer side effects and less cognitive impairment than first-generation antihistamines. Some studies did show that it had some more sedation than other second-generation antihistamines but was still better tolerated than first-generation antihistamines. Clinical practice guidelines referenced studies that showed that increasing the dose of cetirizine up to 4 times the original dose is an effective second-line option if urticaria persists for 2 weeks. Cetirizine is first-line in pediatrics as well as it has been well studied and has long-term safety data behind it. There are only small sample size studies evaluating the safety of cetirizine in pregnancy however none have reported birth defects. Based on this weak evidence it is considered safe however it is preferred that systemic therapy is avoided.
References
1. Reunala T, Lappalainen P, Brummer-Korvenkontio H, Coulie P, Palosuo T. Cutaneous reactivity to mosquito bites: effect of cetirizine and development of anti-mosquito antibodies. Clin Exp Allergy. 1991;21(5):617-622.
2. Lee EE, Maibach HI. Treatment of urticaria: an evidence-based evaluation of antihistamines. Am J Clin Dermatol. 2001;2(1):27-32.
3. Zuberbier T, Aberer W, Asero R, et al. The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of the urticarial: the 2013 revision and update. Allergy. 2014;69(7):868-87.