Chronic urticaria: clinical aspects and focus on a new antihistamine, levocetirizine

Chronic urticaria (CU) involves release of histamine from mast cells and/or basophils, which in turn promotes the classic inflammatory cascade. The resultant symptoms can severely impact sufferers' quality of life and in severe cases prevent them from leading a normal existence, with consequent burdens on family and society. Rapid initiation of effective reliable therapy is important in combating CU, together with avoidance of triggers or exacerbating factors, if known. While newer immunologically-based therapies are beginning to be developed, antihistamines remain a cornerstone of effective therapy. Treatment should be tailored to individual patient circumstances, but in principle the choice of antihistamine component should be governed by the availability of evidence of rapid and prolonged efficacy specifically in CU and evidence of good tolerability and safety. Increasingly, evidence of beneficial effects on patient quality of life is also required for rational selection of an antihistamine from amongst those available. Levocetirizine is a new single-isomer antihistamine with a proven efficacy on chronic urticaria as documented in two recent clinical studies, which have included effectiveness and quality of life assessments.