Many Koreans are still taking first-generation antihistamines or steroids to treat chronic idiopathic urticaria (CIU), also known as hives, which stops them from getting better quickly, a local expert said Thursday.
The number of people with CIU has been on a steady incline with the condition affecting 2.26 percent of the Korean population from 2010 to 2014. CIU is characterized by itchy welts also known as urticarial caused by an allergic reaction that persists for more than six weeks.
|Professor Ye Young-min from Ajou University Medical Center’s Department of Allergy and Clinical Immunology presents on chronic idiopathic urticarial in Korea, during a media event hosted by Novartis Korea Wednesday.|
“People are still using first-generation antihistamines, especially steroids, so people aren’t getting better,” said Professor Ye Young-min from Ajou University Medical Center’s Department of Allergy and Clinical Immunology, at a news conference held by Novartis Korea Wednesday.
Steroids are the standard go-to treatment for the itching associated with hives but have shown to provide no notable relief to emergency patients than a placebo, according to a study published in the Annals of Emergency Medicine.
First generation antihistamines also carry many multiple side effects, including drowsiness. These drugs include Benadryl (diphenhydramine), Clistin (carbinoxamine), Tavist (clemastine), Chlor-Trimeton (chlorpheniramine), and Dimetane (brompheniramine).
The Korean Academy of Asthma, Allergy and Clinical Immunology put forth a guideline in 2015 that advises against the use of first-generation antihistamines and steroids. It instead recommends the use of two types of second-generation antihistamines for two weeks. These drugs include Allegra (fexofenadine), Claritin (loratadine), and Zyrtec (cetirizine), among others.
Physicians can use four types of second-generation antihistamines if there is no improvement.
If CIU symptoms continue, they can use a leukotriene receptor antagonist and a first-generation antihistamine combination or immunosuppressant therapies such as Xolair (omalizumab) and Cyclosporine. Doctors can use steroids finally for a short period if there is no improvement then, the guideline reads.
Despite the guidelines that advise against the use of first-generation antihistamines and steroids, many patients are still using them, Ye said.
Data from the insurance claims for CIU treatment from 2006 to 2014 showed about 30 percent took antihistamines (H1RA) and 70 percent took an antihistamine with corticosteroid. The data does not include how many people used over-the-counter drugs for treatment since they’re not reimbursed or prescribed by a physician.
“Data shows more people than we initially thought are taking steroids. For chronic hives, around 50 percent are still using first-generation antihistamines, calling for more education on treatment,” Ye said. “It seems that patients in Korea take a lot of first-generation antihistamines because they can get them easily over the counter at pharmacies.”
“This is why patients do not get better and more than 30 percent of patients need treatment for more than three years,” she added. “Even though this is not a live-or-die condition, it does drop the quality of life for many patients and persists for a long period.”
Professor Ye also pointed out difficulties patients face with treatment fees for specific therapies. Novartis’ Xolair is the only biologic therapy approved by the Ministry of Food and Drug Safety to treat CSU as add-on therapy, but remains out of reach for many patients due to its high price and lack of government reimbursement, she noted.
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