LORATADINE
Place in Therapy
Place in Therapy
Loratadine, along with other second generation H1-antihistamines, are recommended as first line therapy for the treatment of acute and chronic urticaria in adult and pediatric patient populations by both American and International urticaria guidelines1-3. Symptom control with antihistamines is achieved in 91% of patients, regardless of urticaria subtype1. While clinical relief of both itching and inflammation is equivalent in both first-generation and second-generation H1-antihistamines, second-generation antihistamines, including fexofenadine, cetirizine, loratadine or their active metabolites, are recommended as the preferred agents due to their lack of sedation and other CNS effects1-4.
There is no preferred second-generation antihistamine recommended for the treatment of urticaria in healthy adults as no studies have directly compared these agents2,3. Cetirizine, levocetirizine, fexofenadine, loratadine and desloratadine have all been studied in pediatric patients and determined to be safe and effective, with loratadine, desloratadine and cetirizine approved in patients as young as 2 years of age2,5. Finally, while it is often recommended that systemic treatment is avoided in pregnancy, loratadine and cetirizine remain the only second-generation antihistamines safely studied in pregnancy and lactation, and are therefore considered first line agents in both pregnant and breastfeeding women1,2.
References:
1. Frigas E, Park MA. Acute Urticaria and Angioedema: Diagnostic and Treatment Considerations. Am J Clin Dermatol. 2009; 10(4): 239-250.
2. Zuberbier T et al. The EAACI/GA2LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014; 69: 868-887.
3. Joint Task Force on Practice Parameters. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol. 2014; 133(5): 1270-1277.
4. Patient Self-Care. 2nd Edition. Canadian Pharmacists Association 2010. Chapter 72 – Insect Bites and Stings. Nancy Kleinman. Pages 691-700.
5. Jensen B, Regier L, Downey S, Karlson P, Taylor J. OTC (Over-The-Counter) Products: Allergy-systemic. RxFiles. 2013. Accessed July 12, 2014. Available at: http://www.rxfiles.ca/rxfiles/uploads/documents/members/CHT-OTCs.pdf
Loratadine, along with other second generation H1-antihistamines, are recommended as first line therapy for the treatment of acute and chronic urticaria in adult and pediatric patient populations by both American and International urticaria guidelines1-3. Symptom control with antihistamines is achieved in 91% of patients, regardless of urticaria subtype1. While clinical relief of both itching and inflammation is equivalent in both first-generation and second-generation H1-antihistamines, second-generation antihistamines, including fexofenadine, cetirizine, loratadine or their active metabolites, are recommended as the preferred agents due to their lack of sedation and other CNS effects1-4.
There is no preferred second-generation antihistamine recommended for the treatment of urticaria in healthy adults as no studies have directly compared these agents2,3. Cetirizine, levocetirizine, fexofenadine, loratadine and desloratadine have all been studied in pediatric patients and determined to be safe and effective, with loratadine, desloratadine and cetirizine approved in patients as young as 2 years of age2,5. Finally, while it is often recommended that systemic treatment is avoided in pregnancy, loratadine and cetirizine remain the only second-generation antihistamines safely studied in pregnancy and lactation, and are therefore considered first line agents in both pregnant and breastfeeding women1,2.
References:
1. Frigas E, Park MA. Acute Urticaria and Angioedema: Diagnostic and Treatment Considerations. Am J Clin Dermatol. 2009; 10(4): 239-250.
2. Zuberbier T et al. The EAACI/GA2LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014; 69: 868-887.
3. Joint Task Force on Practice Parameters. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol. 2014; 133(5): 1270-1277.
4. Patient Self-Care. 2nd Edition. Canadian Pharmacists Association 2010. Chapter 72 – Insect Bites and Stings. Nancy Kleinman. Pages 691-700.
5. Jensen B, Regier L, Downey S, Karlson P, Taylor J. OTC (Over-The-Counter) Products: Allergy-systemic. RxFiles. 2013. Accessed July 12, 2014. Available at: http://www.rxfiles.ca/rxfiles/uploads/documents/members/CHT-OTCs.pdf