Does Cetirizine Provide More Benefits Than Diphenhydramine for Acute Urticaria?

Patients in the cetirizine group experienced significantly less sedation at 1 hour, 2 hours, and at discharge.
Patients in the cetirizine group experienced significantly less sedation at 1 hour, 2 hours, and at discharge.

This article is part of MPR's coverage of the ACAAI 2018 meeting, taking place in Seattle, Washington. Our staff will report on medical research related to allergy, asthma, and more conducted by experts in the field. Check back regularly for more news from ACCAI 2018.


SEATTLE — Intravenous (IV) cetirizine was shown to be an effective alternative to IV diphenhydramine for treating acute urticaria, with multiple benefits, including less adverse events and less symptom recurrence, according to research presented at the 2018 Annual Scientific Meeting of the American College of Allergy, Asthma, and Immunology (ACAAI), held November 15th through the 19th in Seattle

The only currently available H1-antihistamine injection is diphenhydramine, a first-generation antihistamine that is short in duration and causes sedation, anticholinergic effects, and drug interactions. In this phase 3 clinical trial, researchers compared diphenhydramine injection with a newly developed cetirizine injection for the treatment of the most common allergic reaction symptom: acute urticaria.

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Trial participants (N=262) were randomly assigned to an IV diphenhydramine group or to an IV cetirizine group, with a primary efficacy end point of change from baseline in 2-hour pruritus score. Secondary end points were time spent in the treatment center and the need to return to the treatment center within 48 hours. Patient sedation scores were determined at 1 hour, 2 hours, and at discharge.

The change from baseline in 2-hour pruritus score was shown to be statistically noninferior from IV cetirizine to IV diphenhydramine, in favor of IV cetirizine. The participants treated with diphenhydramine spent an average of 2.07 hours in the treatment center compared with 1.71 hours spent by participants treated with cetirizine (per protocol P=.0024), and 14% of the participants treated with diphenhydramine returned to the treatment center within 48 hours compared with 5.5% of the group treated with cetirizine (P=.0232). Furthermore, the cetirizine group experienced significantly less sedation at 1 hour, 2 hours, and at discharge compared with the diphenhydramine group (P=.0034, .0292, and .0443, respectively).

The investigators concluded that "IV cetirizine is an effective alternative to IV diphenhydramine in the treatment of acute urticaria with benefits of less sedation, less AE, earlier discharge, less symptom recurrence, and [fewer] return[s] to treatment center.”

Disclosures: Several researchers received speaking or consulting fees, were employed by, or conducted contracted research for JDP Therapeutics Inc.

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Reference

Berger W, Blaiss M, Stiell I, et al. Intravenous (IV) cetirizine shows greater overall benefit to IV diphenhydramine for acute urticaria. Presented at: 2018 Annual Scientific Meeting of the American College of Allergy, Asthma, and Immunology (ACAAI); November 15-19, 2018; Seattle, WA. Abstract P162.