Clinical advantages of dual activity in urticaria

Urticaria is a common disorder that adversely affects quality of life; work -related and recreational activities are restricted, while rest, sleep, and emotions are seriously disturbed in a significant proportion of patients. The pathogenic mechanisms vary, but cutaneous mast-cell activation with rel ease of histamine and other vasoactive or proinflammatory mediators is thou ght to be the final common pathway for lesion induction in most cases. A su bsequent, but incompletely understood, late-phase allergic reaction seems t o prolong the inflammatory process, particularly in certain chronic forms o f the disorder. Although histamine is considered an important mediator of u rticaria, additional substances, including the cysteinyl leukotrienes (LTs) , are putative mediators of the immediate urticarial responses and the infl ammatory events that follow in some types of urticaria. A second-generation antihistamine, mizolastine, which exhibits dual activity with selective H- 1-receptor antagonism and, as shown in animal studies, anti-5-lipoxygenase activity, represents an advance in the treatment of urticaria. It has rapid , potent and sustained action. At the recommended 10-mg dose, mizolastine s uppresses the histamine-induced wheal reaction as early as 1 h after oral a dministration. Compared to placebo, mizolastine significantly reduces overa ll patient discomfort and pruritus in patients with chronic idiopathic urti caria. Double-blind, placebo-controlled studies have also shown mizolastine to be at least as effective as other second-generation antihistamines. Fur thermore, with long-term use of mizolastine over 1 year, a reduction in pru ritus and the number of urticarial episodes was maintained with no evidence of tachyphylaxis or tolerance. Mizolastine has also been shown to be an ef fective treatment for cold-induced urticaria, causing significant delay in the whealing response to the ice-cube test and also reducing the wheal diam eter.