Evaluation of Different Combined Regimens in the Treatment of Cholinergic Urticaria

BACKGROUND: Cholinergic urticaria is uncommon and accounts for 10% of all young adults. To date, there is no effective therapy for cholinergic urticaria. OBJECTIVE: To determine the therapeutic efficacy of different drug combinations in the treatment of cholinergic urticaria. PATIENTS AND METHODS: The participants included in the study are in the age range of 16 to 29 years, with cholinergic urticaria of any duration as diagnosed by physicians. Patients were recruited from Asthma and Allergy Centers in Baghdad and Tikrit. The selected patients were divided randomly into 3 groups according to the treatment protocol. All patients completed screening before treatment. RESULTS: The study indicated that cholinergic urticaria was completely controlled in 30.4% of patients (group A) receiving 4 mg of chlorpheniramine maleate, half hour before the exercise, plus chlordiazopoxide (5 mg) and clindium bromide (2.5 mg) tablets, 3 times daily. However, cure rate was higher (83.1%) in patients (group B) receiving 4 mg of chlorpheniramine maleate (histadine), 3 times daily, plus 25 mg of maprotiline HCl (ludiomil), once daily at night. Furthermore, the complete cure rate was 85.4% in patients (group C) receiving 4 mg of chlorpheniramine maleate (histadine)3 times daily, plus 200 mg of cimetidine (tagadine), 3 times daily. The frequency of relapse was higher in group A (89%) as compared with group B (68.4%) and group C (23.5%) (P <0.0001). CONCLUSIONS: Combination of H1 and H2 antagonists was more effective based on complete control of cholinergic urticaria with lower relapsing rate. However, a future placebo-controlled clinical trial taking in consideration higher H1 antagonists than we used is warranted.