Clinical effectiveness and safety of cetirizine versus rupatadine in chronic spontaneous urticaria: a randomized, double‐blind, 6‐week trial

Background Urticaria is a distressing condition associated with diverse clinical presentations. Chronic spontaneous urticaria ( CsU ) is characterized by wheals and angioedema. Its treatment requires an algorithmic approach to identify the optimum medication. Objectives Cetirizine is commonly used in the treatment of urticaria. Rupatadine is a selective non‐sedating H 1 ‐antihistamine approved for the treatment of CsU . This trial was conducted to ascertain whether the properties of rupatadine offer advantages over cetirizine. Methods Seventy patients with CsU were enrolled. Parameters assessed included: (i) mean number of wheals ( MNW ); (ii) pruritus; (iii) mean total symptom score ( MTSS ); (iv) size of wheal; (v) interference of wheals with sleep; and (vi) sedation. Patients with CsU were divided randomly into two groups. Routine investigations were performed at baseline and at the end of the study. Results Evaluations of MTSS , MNW , and pruritus revealed statistically significant differences at week 3 compared with baseline in the cetirizine group. However, greater reductions in these parameters were obtained with rupatadine. In patients receiving rupatadine, reductions in the MNW , size of wheals, and intensity of erythema were also significant at six weeks ( P  < 0.001) and were significantly greater than those in the cetirizine group ( P  < 0.05). Conclusions Improvements in MTSS , MNW , size of wheals, intensity of erythema, and differential eosinophil count imply that rupatadine is a particularly attractive therapeutic modality compared with cetirizine for the treatment of CsU .