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Year : 2000  |  Volume : 66  |  Issue : 2  |  Page : 106-107

Loratadine and cetirizine in urticaria

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PMID: 20877046

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How to cite this article:
. Loratadine and cetirizine in urticaria. Indian J Dermatol Venereol Leprol 2000;66:106-7

How to cite this URL:
. Loratadine and cetirizine in urticaria. Indian J Dermatol Venereol Leprol [serial online] 2000 [cited 2020 Jun 6];66:106-7. Available from: http://www.ijdvl.com/text.asp?2000/66/2/106/4888

To the Editor

We appreciate the comments made by Dr. Sanath Aithal [1] with reference to our article [2] -"A multicentric trial of Loratacdine and Cetirizine in Urticaria".We thank him for the same and have the following clarifications to offer on the observations made by Dr. Aithal.

1. Patients selected were those with chronic idiopathic urticaria (urticaria of at least six weeks duration with detectable cause).

2. (a) The effects of loratadine and cetirizine on the duration of lesions was indeed documented during the trial according to score outlined in [Table 1] of our article. [2] Due to lack of space, this parameter was not discussed in detail. The mean scores for the duration of lesions decreased in both groups over the study period and at the second, third, fourth and fifth visits, the loratadine group had significantly lower scores (p < 0.05) than the cetirizine group.

Visit 2 (day 4) 0.9 vs 1.3 (p < 0.05) Visit 3 (day 8) 0.6 vs 1.0 (p < 0.05) Visit 4 (day 10) 0.3 vs 0.08 (p < 0.05)

Visit 5 (day 28) 0.2.vs 0.7 (p < 0.05)

The above has also been highlighted in [Figure 3] of our article. [2]

(b) Therapeutic response was also evaluated by pa­tients and documented (patient's global evaluation). Throughout the treatment period, percentage of patients with either definite improvement or complete disappearance of signs and symptoms was more in the loratadine group than in the cetirizine one.

Visit 2 (day 4) 71% vs 43% Visit 3 (day 8) 82% vs 62% Visit 4 (day 10) 92% vs 74% Visit 5 (day 28) 93% vs 75%

(c) The trial was designed for a total duration of 4 weeks in each patient. Patients were not evaluated after the 5th visit (28 days). Our protocol was based on studies done earlier where there has been no follow-up after the trial duration period. [3],[4] Most trials in urticaria do not evaluate patients for relapse, unless specifically designed for that purpose.

3. Though assessment of cognitive and psychomo­tor performance is an important parameter of anti­histamine evaluation, it was not the aim of our study, which was done primarily to compare the clinical efficacy and tolerability of the two antihistamines, These parameters have not usually been a part of an efficacy/ tolerability evaluation. Tolerability is based on side effects reported voluntarily during the trial process. The reference quoted by Dr. Aithall is based on review of the pharmacological evaluation of antihistamines, and is not an evaluation of these parameters in a clinical study in patients of urticaria.

The literature available however documents loratadine to be safe on the above parameters and superior to cetirizine. "No differences were found between placebo and loratadine on measures of cognition, pyschomotor perfomance, mood or sedation, [6] and "after single recommended doses cetirizine is sedative and impairing (actual driving, psychomotor test performance and EEG), whereas loratadine is not. [7]

4. When stating that little data is available compar­ing loratadine and cetirzine in urticaria, it was meant in the context of literature availability based on patient evaluation in chronic urticaria, particularly in Indian patients.

The five references quoted by Dr. Aithal as comparative studies are all based on data generated from healthy volunteers or review articles on various aspects related to the pharmacology of antihistamines in general and are not based on patients of chronic urticaria.

  References Top

1.Aithal S. Loratadine in urticaria. Indian J Dermatol Venereol Leprol 1999;65: 107-108.  Back to cited text no. 1    
2.Jayakar T, Pandhi R K, Oberoi C, et al. A multicentric trial of loratadine and cetirizine in urticaria.Indian 3 Dermatol Venereol Leprol 1998;64:12-15.  Back to cited text no. 2    
3.Monroe MD. Relative efficacy and safety of loratadine, hydroxyzine and placebo in chronic idiopathic urticaria and atopic dermatitis. Clinical Therapeutics 1992;14:17-21.  Back to cited text no. 3    
4.Guerra L, Vincenzi C, et al. Loratadine and cetrizine in the treatment of chronic urticaria. 3 Europ Acad Dermatol Venereal 1994;3 :148-152.  Back to cited text no. 4    
5.Simons FER, Simons K]. The pharmacology and use of H1­receptor-antagonist drugs. N Engl J Med 1994;330: 166-1790.  Back to cited text no. 5    
6.Kay GG, Berman B. Initial and steady- state effects of diphenhydramine and loratadine on sedation, congnition, mood, and psychomotor performance. Arch Intern Med 1997;157: 2350­2356.  Back to cited text no. 6    
7.Rameakers JG, Uiterwijik MMC, et al. Effects of loratadine and cetrizine on actual driving and psychometric test performance, and EEG during driving. Eur J Clin pharmacol 1992;42:363-369.  Back to cited text no. 7    


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