PubMed · 6152833
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G R Hervey. Motion illness.. https://pubmed.ncbi.nlm.nih.gov/6152833/
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This article reviews the effect of H1 antihistamines on the pruritus of urticaria, from articles in which their therapeutic effect on chronic idiopathic and physical urticaria is assessed. In limited studies available pruritus improved concomitantly with wealing by an average of two thirds, though the response in individual patients was variable. In some physical urticarias the pruritus and wealing showed disproportionate improvement compared to erythema. The minimally sedating H1 antihistamines were as effective or more effective than classical H1 antihistamines. The dose of antihistamines that totally abolished a histamine weal only partly reduced urticarial weals (therefore by inference also of the associated pruritus). Additional therapy aimed at pruritogenic mediators other than histamine would be expected to improve urticarial pruritus.
Treatment of chronic urticaria presents a challenge to both practitioner and patient. Traditional H1 antagonists with good efficacy but substantial side effects are being supplanted in many cases by nonsedating H1 antagonists such as terfenadine and astemizole. Antidepressant medications and combinations of H1 and H2 antagonists offer improved results for selected patients. Further development and investigation of mast cell stabilizers and inhibitors of urticaria mediators other than histamine hold promise. A better understanding of the underlying pathogenesis remains the greatest hope of formulating rational and effective therapy.
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