From the Guidelines
For chronic urticaria, the recommended dose of levocetirizine is up to 4-fold higher than the standard dose, if needed, to achieve complete disease control, as per the latest guidelines 1.
Key Considerations
- The standard dose of levocetirizine is 5 mg once daily, taken in the evening, which is appropriate for adults and children 12 years and older.
- For patients who do not respond to the standard dose, a higher dose (up to 4-fold higher) may be used, as recommended by the latest international urticaria guideline 1.
- The dose may need to be reduced for elderly patients with decreased kidney function, and children under 12 years old require lower doses.
- Levocetirizine works by blocking histamine receptors, reducing itching, hives, and other symptoms of chronic urticaria.
- Patients should take levocetirizine with or without food, but taking it with food may help reduce stomach upset.
- The full therapeutic effect may take a few days to develop, so patients should continue taking it even if symptoms don't improve immediately.
- Common side effects include drowsiness, dry mouth, and fatigue, which may diminish over time with continued use.
Treatment Approach
- The treatment approach should be based on an "as much as needed and as little as possible" principle, with step-up and step-down strategies to achieve complete disease control 1.
- Patients should be assessed regularly using the UCT score to determine the level of disease control and adjust the treatment accordingly.
- Step-down protocols should be implemented with prudence and patience, considering individual patient needs and reducing the treatment burden to assess patients for spontaneous remission.
From the Research
Dose of Levocetirizine for Chronic Urticaria
- The dose of Levocetirizine for chronic urticaria is 5 mg once daily, as indicated in a randomized, double-blind, placebo-controlled study 2.
- This study found that Levocetirizine 5 mg once daily is effective and well tolerated in the treatment of symptoms of chronic idiopathic urticaria and in improving the patient's quality of life.
- The significant beneficial effects of Levocetirizine lasted only during the active trial, while at follow-up there was a significant worsening of all the variables evaluated in this study, after the end of the active trial (week 7) 2.
Treatment of Chronic Urticaria
- The mainstay of treatment for chronic urticaria is avoidance of triggers, if identified, and first-line pharmacotherapy is second-generation H1 antihistamines, which can be titrated to greater than standard doses 3.
- In refractory chronic urticaria, patients can be referred to subspecialists for additional treatments, such as omalizumab or cyclosporine 3.
- A personalized endotype-based approach is emerging based on the identification of autoantibodies and other drivers of urticaria pathogenesis, with promising options for targeted treatment of chronic urticaria 4.