Profile of H1-antihistamine prescriptions for chronic spontaneous urticaria in pregnant patients, children and elderly patients among Spanish allergists
T. Caballero1; I. Sanchez-Matas2; A. Rosado3; M. Rodriguez-Rodriguez4; N. Prior5; A. Moreno-Ancillo6; I. Losantos Garcia7; PA. Galindo-Bonilla8; R. Cabañas9; JM. Beitia10; ML. Baeza11; E. Gonzalez-Mancebo12
1La Paz University Hospital, IdiPAZ, CIBERER U754, Madrid, Spain; 2Complejo Hospitalario Universitario de Toledo, Toledo, Spain; 3Hospital Universitario Fundación Alcorcón, Madrid, Spain; 4Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Alcalá de Henares, Spain; 5Hospital Universitario Severo Ochoa, Madrid, Spain; 6Hospital General Nuestra Señora del Prado, Talavera de la Reina, Spain; 7Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain; 8Hospital General Universitario de Ciudad Real, Ciudad Real, Spain; 9La Paz University Hospital, IdiPAZ, CIBERER U754, PIELenRed, Madrid, Spain; 10ARAyDAL, Hospital Universitario de Guadalajara, Guadalajara, Spain; 11Hospital General Universitario Gregorio Marañón, CIBERER U761, IIS-GM, Madrid, Spain; 12ARADyAL, Hospital Universitario de Fuenlabrada, Madrid, Spain
Background

Urticaria is a frequent consultation cause in allergy departments. Second generation H1 antihistamines (2GH1AHs) at licensed doses are the first line therapy for chronic spontaneous urticaria (CSU). Aim: To study the prescribing habits of H1-antihistamines (H1AHs) for CSU treatment in pregnant patients, children, and elderly patients among Spanish allergists.

Method

An online survey was developed to analyse the prescribing habits of H1AHs for CSU. Specific questions on H1AH use in pregnant patients, children and elderly patients were included. It was disseminated through the Spanish Society of Allergy and Clinical Immunology among its members during April/May 2021, 128 responses were received. A descriptive statistical analysis was performed.

Results

Eighty-two percent allergists reported using different H1AHs for CSU treatment during pregnancy compared with non-pregnant CSU adult patients. The main reasons were prior experience and different evidence level for its safe use in pregnancy. They mainly used 2GH1AHs, being cetirizine (79%) and loratadine (65%) the most used. However, 27% reported the use of a sedative-first-generation-H1AH (1GH1AH) (dexchlorpheniramine).

Regarding children, 46% used different H1AHs from those used in adults. The most frequent reason for using different H1AHs was drug non-approval in minors. The most used H1AHs were cetirizine (87%) and desloratadine (87%), followed by loratadine (61%) and ebastine (54%). A 42% used a sedative 1GH1AH (oral dexchlorpheniramine) in children.

Only 22% reported using different H1AHs in the elderly in comparison with CSU patients under 65 y.o., mainly because of comorbidities and concern about possible drug interactions. Sedative 1GH1AHs (e.g. oral dexchlorpheniramine) were rarely used in this age group.

Conclusion

The pattern of H1AH prescriptions for CSU was highly modified in pregnant patients, but only half of prescribers used different H1AH in children and most used the same H1AH in the elderly. 2GH1AHs were mainly used in the three populations (pregnant patients, children, elderly patients), but sedative 1GH1AHs went on being used in pregnant patients and children despite guideline recommendations. However, sedative 1GH1AHs were rarely used in elderly patients.