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Paradoxical exacerbation of chronic urticaria by H1-antihistamines and montelukast.
Eur Ann Allergy Clin Immunol. 2009 Dec; 41(6):187-9.EA

Abstract

Histamine is the main mediator of urticaria and H1-receptor antagonists represent the treatment of choice in all patients with chronic urticaria. Leukotriene receptor antagonists as montelukast have also been used in patients with chronic urticaria unresponsive to H1-antihistamines alone. We report a patient with chronic urticaria whose disease was paradoxically exacerbated by H1-antihistamines and montelukast, and controlled by immunosuppressive drugs as ciclosporin and azathioprine. Urticaria exacerbations were caused by different molecules including either piperidine (fexofenadine, desloratadine, ebastine, rupatadine) or piperazine (hydroxyzine, cetirizine) derivatives as well as by montelukast suggesting that an IgE-mediated mechanism was not involved. A possible explanation of the observed urticaria exacerbation is that H1-antihistamines and montelukast may shift the H1 histamine receptor and the leukotriene receptor to the active conformation instead of the inactive state. The beneficial effects of ciclosporin and azathioprine confirm that immunosuppressive drugs have an important role in the treatment of refractory chronic urticaria and back the hypothesis that an autoimmune/autoreactive mechanism often underlies the disease.

Authors+Show Affiliations

Unità Operativa di Allergologia e Immunologia Clinica, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milano, Italy.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

20128233

Citation

Tedeschi, A. "Paradoxical Exacerbation of Chronic Urticaria By H1-antihistamines and Montelukast." European Annals of Allergy and Clinical Immunology, vol. 41, no. 6, 2009, pp. 187-9.
Tedeschi A. Paradoxical exacerbation of chronic urticaria by H1-antihistamines and montelukast. Eur Ann Allergy Clin Immunol. 2009;41(6):187-9.
Tedeschi, A. (2009). Paradoxical exacerbation of chronic urticaria by H1-antihistamines and montelukast. European Annals of Allergy and Clinical Immunology, 41(6), 187-9.
Tedeschi A. Paradoxical Exacerbation of Chronic Urticaria By H1-antihistamines and Montelukast. Eur Ann Allergy Clin Immunol. 2009;41(6):187-9. PubMed PMID: 20128233.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Paradoxical exacerbation of chronic urticaria by H1-antihistamines and montelukast. A1 - Tedeschi,A, PY - 2010/2/5/entrez PY - 2010/2/5/pubmed PY - 2010/3/3/medline SP - 187 EP - 9 JF - European annals of allergy and clinical immunology JO - Eur Ann Allergy Clin Immunol VL - 41 IS - 6 N2 - Histamine is the main mediator of urticaria and H1-receptor antagonists represent the treatment of choice in all patients with chronic urticaria. Leukotriene receptor antagonists as montelukast have also been used in patients with chronic urticaria unresponsive to H1-antihistamines alone. We report a patient with chronic urticaria whose disease was paradoxically exacerbated by H1-antihistamines and montelukast, and controlled by immunosuppressive drugs as ciclosporin and azathioprine. Urticaria exacerbations were caused by different molecules including either piperidine (fexofenadine, desloratadine, ebastine, rupatadine) or piperazine (hydroxyzine, cetirizine) derivatives as well as by montelukast suggesting that an IgE-mediated mechanism was not involved. A possible explanation of the observed urticaria exacerbation is that H1-antihistamines and montelukast may shift the H1 histamine receptor and the leukotriene receptor to the active conformation instead of the inactive state. The beneficial effects of ciclosporin and azathioprine confirm that immunosuppressive drugs have an important role in the treatment of refractory chronic urticaria and back the hypothesis that an autoimmune/autoreactive mechanism often underlies the disease. SN - 1764-1489 UR - https://www.unboundmedicine.com/medline/citation/20128233/Paradoxical_exacerbation_of_chronic_urticaria_by_H1_antihistamines_and_montelukast_ L2 - https://medlineplus.gov/hives.html DB - PRIME DP - Unbound Medicine ER -