Publications

In case of failure with first-line treatment using second-generation nonsedative anti-H1 antihistamines, the joint EAACI (European Academy of Allergy and Clinicallmmunology) and GA2′ lEN (Global Allergy and Asthma European Network) guidelines, subsequentlyaccepted by the EDF (European Dermatology Forum), propose to increase the dosage of these antihistaminesup to fourfold rather than  associating medications or using first-generation antihistamines that have sedative and anticholinergic effects. These recommendations are expert recommendations, but due to the lack of contralled studies further investigations in this field are necessary. Cold urticaria seems to be an interesting study model to verify the value of increasing doses of antihistamines because provocation tests are available and there is a classic resistance to the dosages currently in use. A randomized double-blind, crossover, placebo-controlled trial has shown that the total control of symptoms was reached more frequently with doses of second-generation anti-H1 antihistamines four times greater than the normal dose. The assessment criteria evaluated the temperature threshold of cold urticaria as well as the volume of induced wheals.