Evaluation of different therapies in indian patients with chronic urticaria: A systematic review of randomized controlled trials in the last decade

The objective of this study was to perform a systematic review of randomized controlled trials (RCTs) related to chronic urticaria in Indian patients evaluating different treatment options published in the last decade. A systematic literature search of PubMed/Medline was performed using keywords “Study(ti) OR trial(ti) AND urticaria(ti) AND “2009”(Date-Publication): “2020”(Date-Publication). All the selected articles were screened for author information and study design. Only RCTs from India were considered for the final analysis. Out of 205 articles retrieved, 11 RCTs were selected for the systematic review. Six RCTs evaluated the effects of antihistamines (loratadine, levocetirizine, rupatadine, and olopatadine) in Indian patients with chronic urticaria. The results show that these agents are effective and well tolerated in the treatment of chronic urticaria. Other therapies evaluated through RCTs included levocetirizine plus montelukast, add-on methotrexate, azathioprine, cyclosporine, narrowband ultraviolet B, psoralen plus ultraviolet A, and vitamin D. Levocetirizine 5 mg plus montelukast 10 mg combination was found to be as effective as levocetirizine 10 mg in patients not responding to levocetirizine 5 mg/day. A small trial did not prove the benefit of methotrexate add-on therapy with antihistamine. Azathioprine trials show that it can be a useful option in resource-limited settings. Second-generation antihistamines represent the most commonly investigated therapies through RCTs in India, and they represent a valuable option in the management of chronic urticaria.