Cochrane for Clinicians: Second-Generation h1-Antihistamines for Chronic Spontaneous Urticaria

Cetirizine (Zyrtec) in a dosage of 10 mg daily is effective at completely suppressing symptoms of chronic spontaneous urticaria (number needed to treat [NNT] = 4).1 (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.) Practice Pointers Chronic spontaneous urticaria affects up to 1% of the general population.2 The economic burden of chronic spontaneous urticaria in the United States is estimated to be $2.5 billion to $5 billion annually.3 Second-generation H1-antihistamines are recommended as the mainstay of treatment for chronic spontaneous urticaria.4 The authors of this study sought to determine if second-generation H1-antihistamines are effective for the relief of chronic spontaneous urticaria and whether one agent is superior to others. Practice parameters that were endorsed by the American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology recommend that physicians perform a thorough history and physical examination in patients with chronic urticaria to determine if an underlying cause exists. In patients without a secondary cause, a stepwise approach to management with trigger avoidance and second-generation H1-antihistamines is the mainstay of therapy.4 For those not responding to standard doses of second-generation H1-antihistamines, higher doses may be tried.4 European guidelines also recommend second-generation H1-antihistamines as first-line therapy.5 The practice recommendations in this activity are available at http://summaries.cochrane.org/CD006137.