To compare the added effectiveness of ketotifen along with traditional H1 anti histamines for the symptomatic improvement of chronic idiopathic urticaria

Abstract

Objective To compare the added effectiveness of ketotifen along with traditional H1 anti histamines for the symptomatic improvement of chronic idiopathic urticaria.  Methods  The study was conducted in the outpatient department of Dermatology at Punjab Rangers Teaching Hospital over a period of 3 months starting from April 2021 till end of June 2021.  A total of 32 patients with chronic idiopathic urticaria between the age of 15 to 50 years were enrolled. Children below the age of 15 years and patients who were known diabetics and hypertensives were excluded from this study. Patients were divided in two equal groups A &B, with each given a different regime. Group A was given Ebastine (10mg) in morning and Hydroxyzine (10mg) at night, whereas Group B was given Ebastine (10mg) in morning, Ketotifen (1mg) and Hydroxyzine (10mg) at night. Two scales were constructed to assess the severity of the disease, one was severity of pruritis and other was frequency of urticarial episodes. The first variable, which was severity of pruritis was graded into mild, moderate and severe. Mild pruritis requiring only occasional use of antihistamines, moderate requiring these 2-3 times a week and severe disease where antihistamines were taken more than thrice a week   Frequency of the urticarial episodes was similarly graded as mild, moderate and severe with mild disease comprising of episodes of urticaria less than 2 days per week, moderate disease with attacks between 3-4 days per week and severe disease as urticarial attacks for more than 4 days in a week. Patients were followed after a period of 4 weeks and the response of the treatment was also measured on the same variables, meanwhile results were interpreted to find which drug regime was more efficient to control recurrent episodes of urticaria.   Results  Response in the severity of pruritis was graded as mild (less than 30% improvement), moderate (between 30%-60% improvement) and good response (more than 70% improvement). Similarly the response in frequency of episodes was also graded into percent improvement of less than 10% (no significant response), 20%-30% (mild), 30%-60% (moderate) and more than 70% (good). Both the groups showed considerable improvement to a variable extent.  Out of 16 patients of group A, 12 (75%)  showed some symptomatic improvement while 4 (25%) reported no improvement at all, whereas among the 16 patients of group B, 14 (87.5%) showed significant improvement while, 2 (12.5%) had no improvement at all. Considering pruritis first, out of 12 patients who responded to the treatment, in group A, only 5 (41.6%) showed good response, 6 (50%) showed moderate and 1 (8.3%) had mild response. Concerning the frequency of urticarial episodes, out of 12 patients of group A, 5 (41.6%) showed good recovery and the remaining 7 (58.33%) showed moderate recovery. Among the 14 patients of group B who responded to the treatment, 8 (57.14%) showed good response in pruritis, 4 (28.5%) showed moderate response and 2 (14.2%) had mild response. Regarding the frequency, out of 14 patients of group B, 8 (57.14%) good recovery, 6 (42.85%) showed moderate recovery. Thus overall, group B (ketotifen group) showed a better response to treatment decreasing the intensity of pruritis and reducing the frequency of episodes to a significant extent as compared to Group A who were taking Ebastine and hydroxyzine alone.  Conclusion Based on the results of the current study, we conclude that Ketotifen, if started as first line therapy, has a better efficacy in reducing the severity of the disease, as compared to traditional H1-antihistamines alone.