High-dose desloratadine (4-times the standard dose) is effective and safe in cold urticaria

CNN: Woman is allergic to cold

Increased dosing of nonsedating antihistamines is recommended by the current European guidelines for acquired cold urticaria (ACU) who do not respond satisfactorily to the standard dose.

The authors compared the effects of 5 and 20 mg of desloratadine and placebo on cold-induced urticarial reactions in patients with ACU in a prospective, randomized, double-blind, 3-way crossover trial of 30 patients.

Desloratadine (trade names NeoClarityn, Claramax, Clarinex and Aerius) is an active metabolite of loratadine. Image source: Wikipedia, public domain.

At the end of each treatment, patients underwent cold provocation with the TempTest 2.0/2.1 system, and urticarial reactions were assessed.

Desloratadine at 20 mg/d significantly reduced cold-induced wheal volume versus desloratadine at 5 mg/d.

High-dose desloratadine (20 mg) was well tolerated, with no increased rate of somnolence.

The authors concluded that desloratadine at standard (5 mg) and high doses (20 mg) significantly improved objective signs of ACU provoked by cold exposure.

Desloratadine at 4 times the standard dose was better than 5 mg of desloratadine without an increase in AEs. Therefore, the increased desloratadine dosing might benefit patients with urticaria who do not respond to standard doses.

High-dose desloratadine decreases wheal volume and improves cold provocation thresholds compared with standard-dose treatment in patients with acquired cold urticaria: A randomized, placebo-controlled, crossover study. Siebenhaar F, Degener F, Zuberbier T, Martus P, Maurer M. J Allergy Clin Immunol. 2009 Feb 5.
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