The treatment outcomes and dose de-escalation of
desloratadine up-dosing in chronic spontaneous urticaria
, Suteeraporn Chaowattanapanit,
Division of Dermatology, Department of
Medicine, Faculty of Medicine, Srinagarind
Hospital Medical School, Khon Kaen
University, Khon Kaen, Thailand
Division of Dermatology
Department of Medicine
Faculty of Medicine
Srinagarind Hospital Medical School
Khon Kaen University
Khon Kaen 40002
Funding source: None.
Conﬂicts of interest: None.
Background An increase in dosages up to fourfold of second generation antihistamines is
recommended for recalcitrant chronic spontaneous urticaria (CSU). No regimen guidelines
about dose de-escalation, however, are mentioned once the disease is controlled.
Objective To demonstrate the treatment outcomes and dose reduction in desloratadine
assessed using the urticarial activity score over 7 consecutive days.
Methods Medical records of all patients with CSU treated with desloratadine were
collected retrospectively during a period from January 2010 to December 2013.
Results Sixty-seven (94.4%) patients had remission of the disease with variable doses of
desloratadine. The patients who had CSU concomitant with antithyroid antibodies or high
erythrocyte sedimentation rates had a greater tendency not to respond to the standard
dose. Once the disease was completely controlled, 67 patients ﬁnished the treatment, but
63 (94%) patients had recurrent symptoms. Sixty-three patients took the same dose that
induced the response for a further 4 weeks before stopping or reducing the dose, 41/63
(65.1%), however developed urticaria again. Forty-one patients took the same dose for a
further 8 weeks; only 2/41 (4.9%) patients developed the rash again. The mean follow-up
period after the disease was controlled was 7.5 months.
Conclusion Most patients need higher than the standard doses to obtain remission. Once
the disease is completely controlled, however, maintenance of the same dosage for at
least 8 weeks before dose reduction is suggested in order to avoid recurrence of the
Chronic urticaria (CU) may seem as a non-life-threatening dis-
ease, but in reality, it is severe and often debilitating especially
due to the itch. It may lead to the loss of both the social life and
work of the patients. Chronic spontaneous urticaria (CSU) is
characterized by the spontaneous appearance of widespread
edematous, pruritic wheals surrounded by a red ﬂare that lasts
≥6 weeks and can recur.
CSU is a challenge in regard to
treatment. Current international guidelines propose that second-
generation non-sedating antihistamines constitute the ﬁrst line
of treatment for urticaria, whether acute or chronic. The Euro-
pean Academy of Allergology and Clinical Immunology/Global
Allergy and Asthma European Network/European Dermatology
Forum/World Allergy Organization (EAACI/GA
guidelines state that before considering an alternative treatment,
a trial of second-generation antihistamines at doses up to four
times indicated is warranted for patients who do not respond to
standard doses when the potential beneﬁts outweigh any risks.
In addition, increased antihistamine doses improve patient
quality of life without increasing somnolence. Once this disease
is completely controlled, however, the optimal method for reduc-
ing the dose of antihistamine has not been determined.
Desloratadine is a non-sedating, second-generation H1-anti-
histamine. Overall, the quality of evidence is high for deslo-
ratadine being safe and effective in CU, leading to strong
recommendations for its use.
The purpose of this study is to
present retrospective data obtained from patients who were
treated for CSU with desloratadine, especially those who were
treated with dosages above the standard dose range. The
follow-up responses were monitored after the disease was
All medical records of outpatients of Srinagarind Hospital
Medical School who were aged 18 years or over and were
diagnosed as CSU patients during a period of 4 years from
January 2010 to December 2013 were retrospectively reviewed.
ª 2018 The International Society of Dermatology International Journal of Dermatology 2018, 57, 423–427