According to Humphreys and Hunter up to 40% of patients with CU may not achieve good control with antihistaminic therapy [].They reported that out of 390 CU patients who were treated with antihistamines 44% responded well, 29% became asymptomatic, and 15% showed partial improvement.

It must be noticed, however, that it is difficult to find clinical investigations that strictly follow the criteria recommended by the guidelines on the management of urticaria, and therefore studies included in this review were those in which higher doses of NSAHs were used regardless of the clinical response to conventional doses.

AHs included in this review are desloratadine, levocetirizine, fexofenadine, and the recently introduced NSAHs rupatadine and bilastine.

You may have taken antihistamines in the past and found it hard to concentrate or stay awake.

For many people, sedating antihistamines, also called old, classic, or first-generation antihistamines, cause sleepiness, grogginess, and slow reaction time.

Six articles included patients with CSU/CIU and other 2 studied patients with acquired cold urticaria.

Four investigations chose mean pruritus scores as the main outcome, and the other 4 utilized the percentage of symptom-free patients as the main parameter of efficacy.

In a recent paper from Japan it was observed that the improvement rates (defined as a urticaria symptom score UAS ≤ 3) in 117 CU patients who received standard doses of AHs were 36.6% at 12 months, 51.2% at 24 months, and 66.1% at 60 months, while the remission rates were 11.5%, 13.9%, and 27.7%, respectively [].

The present article is a review of the literature on the treatment of CU with increased doses of NSAHs in order to investigate if there are differences in efficacy between the various second generation AHs that have been studied in controlled protocols.

The best responses were obtained with fexofenadine, rupatadine, and bilastine.