Skip to main content
SpringerLink
Log in

Evaluation of Treatment Satisfaction in Children with Allergic Disease Treated with an Antihistamine

An International, Non-Interventional, Retrospective Study

  • Original Research Article
  • Published:
Clinical Drug Investigation Aims and scope Submit manuscript

Abstract

Background and Objectives: Histamine H1-receptor antagonists (antihistamines) have been shown to be efficacious and safe in children and are recommended as first-line treatment for the symptoms of allergic rhinitis and urticaria. No published study to date has directly compared satisfaction with the different antihistamines in children in a real-life clinical setting. This study aimed to investigate parent and physician satisfaction with the efficacy and tolerability of oral antihistamine treatment in children and to compare satisfaction between levocetirizine and the other antihistamines used by children in this cohort.

Methods: This was an international Observational Survey in Children with Allergic Rhinitis (OSCAR). Children aged 2–12 years, with a history of an allergic condition leading to a consultation, were enrolled from 424 primary-care/ specialist allergy clinics across Bulgaria, India, Portugal, Romania, Russia, South Korea and Spain. At the consultation, parents and physicians of eligible children completed questionnaires evaluating their satisfaction with specific antihistamines currently employed for management of the child’s allergic condition, as well as their intention for future use of that treatment. Parents’ satisfaction scores for efficacy, tolerability and global satisfaction with the antihistamine used were primary study outcomes, while physicians’ satisfaction scores for the same measures were secondary outcomes. Other secondary outcomes were parents’ rating of the impact of the antihistamine treatment on their child’s sleep and school performance, and parents’ and physicians’ willingness to use/recommend the same antihistamine in the future.

Results: A total of 4581 patients were enrolled; 3048 (66.5%) had allergic rhinitis (55.9% persistent allergic rhinitis and 44.1% intermittent allergic rhinitis), and 663 (14.5%) had urticaria as primary conditions. Additionally, 2465 patients (53.8%) suffered from other allergic diseases, including allergic asthma (33.3%), atopic dermatitis (17.6%), food allergy (5.3%), other allergies (5.0%) and drug hypersensitivity (2.0%). Parents’ and physicians’ satisfaction scores were closely concordant and demonstrated significantly greater global satisfaction for the second-generation antihistamines than for the first-generation antihistamines. Levocetirizine (n = 2339) and fexofenadine (n = 42) generally scored highest for efficacy, tolerability and global satisfaction, as well as for impact on the child’s ability to function at school, quality of school activities and quality of sleep. Furthermore, >97% of parents and physicians indicated their desire to continue or recommend the use of levocetirizine in the future. Somnolence, the most commonly reported adverse event in this survey, was observed predominantly in patients treated with first-generation antihistamines. Among second-generation antihistamines, reports of somnolence were most frequent in the cetirizine group.

Conclusion: Second-generation antihistamines have a better risk:benefit ratio than first-generation antihistamines, indicating that the latter should be avoided or their use limited in children whenever possible. Levocetirizine and fexofenadine were perceived by parents and physicians to produce significantly higher treatment satisfaction than the majority of the other antihistamines with respect to overall efficacy and tolerability, and impact on the child’s sleep and school activities. The newer antihistamine levocetirizine seems to be a preferred and appropriate future treatment choice for children with allergic diseases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Table I
Table II
Table III
Fig 2
Table IV
Table V
Fig. 3
Fig. 4
Table VI
Table VII
Fig. 5
Table VIII
Table IX
Table X
Table XI
Table XII
Table XIII

Similar content being viewed by others

References

  1. Eigenmann PA, Antonella Muraro M, Sampson HA, et al. iPAC: an initiative to fight the burden of allergies in children. Pediatr Allergy Immunol 2008; 19Suppl. 19: 1–3

    Article  Google Scholar 

  2. Hamelmann E, Herz U, Holt P, et al. New visions for basic research and primary prevention of pediatric allergy: an iPAC summary and future trends. Pediatr Allergy Immunol 2008; 19Suppl. 19: 4–16

    Article  Google Scholar 

  3. Halken S, Lau S, Valovirta E. New visions in specific immunotherapy in children: an iPAC summary and future trends. Pediatr Allergy Immunol 2008; 19Suppl. 19: 60–70

    Article  Google Scholar 

  4. Eigenmann PA, Beyer K, Burks AW, et al. New visions for food allergy: an iPAC summary and future trends. Pediatr Allergy Immunol 2008; 19Suppl. 19: 26–39

    Article  Google Scholar 

  5. Rancé F, Boguniewicz M, Lau S. New visions for atopic eczema: an iPAC summary and future trends. Pediatr Allergy Immunol 2008; 19Suppl. 19: 17–25

    Article  Google Scholar 

  6. Baiardini I, Braido F, Tarantini F, et al. ARIA-suggested drugs for allergic rhinitis: what impact on quality of life? A GA2LEN review. Allergy 2008; 63(6): 660–9

    Article  CAS  Google Scholar 

  7. Baiardini I, Braido F, Brandi S, et al. The impact of GINA suggested drugs for the treatment of asthma on health-related quality of life: a GA2LEN review. Allergy 2008; 63(8): 1015–30

    Article  CAS  Google Scholar 

  8. Passalacqua G, Canonica GW, Baiardini I. Rhinitis, rhinosinusitis and quality of life in children. Pediatr Allergy Immunol 2007; 18Suppl. 18: 40–5

    Article  Google Scholar 

  9. Bousquet J, Reid J, van Weel C, et al. Allergic rhinitis management pocket reference 2008. Allergy 2008; 63(8): 990–6

    Article  CAS  Google Scholar 

  10. van Weel C, Bateman ED, Bousquet J, et al. Asthma management pocket reference 2008. Allergy 2008; 63(8): 997–1004

    Article  Google Scholar 

  11. Zuberbier T, Bindslev-Jensen C, Canonica W, et al. EAACI/ GA2LEN/EDF guideline: management of urticaria. Allergy 2006; 61(3): 321–31

    Article  CAS  Google Scholar 

  12. De Vos C, Mitchev K, Pinelli M-E, et al. Non-interventional study comparing treatment satisfaction in patients treated with antihistamines. Clin Drug Invest 2008; 28: 221–30

    Article  Google Scholar 

  13. Holgate ST, Canonica GW, Simons FE, et al. Consensus group on new-generation antihistamines (CONGA): present status and recommendations. Clin Exp Allergy 2003; 33: 1305–24

    Article  CAS  Google Scholar 

  14. Molimard M, Diquet B, Strolin Beneditti M. Comparison of pharmacokinetics and metabolism of desloratadine, fexofenadine, levocetirizine and mizolastine in humans. Fund Clin Pharmacol 2004; 18: 399–411

    Article  CAS  Google Scholar 

  15. Tillement J-P, Albengres E, Barré L, et al. The apparent volumes of distribution of H1-receptor antagonists. Dermatol Ther 2000; 13: 337–43

    Article  Google Scholar 

  16. Simons FE, Early Prevention of Asthma in Atopic Children (EPAAC) Study Group. H1-antihistamine treatment in young atopic children: effect on urticaria. Ann Allergy Asthma Immunol 2007; 99: 261–6

    Article  CAS  Google Scholar 

  17. Simons FE, Early Prevention of Asthma in Atopic Children (EPAAC) Study Group. Safety of levocetirizine treatment in young atopic children: an 18-month study. Pediatr Allergy Immunol 2007b; 18(6): 535–42

    Article  Google Scholar 

  18. Asarnoj A, Ostblom E, Kull I, et al. Sensitization to inhalant allergens between 4 and 8 years of age is a dynamic process: results from the BAMSE birth cohort. Clin Exp Allergy 2008; 38(9): 1507–13

    Article  CAS  Google Scholar 

  19. Linneberg A. The allergic march in early childhood and beyond. Clin Exp Allergy 2008; 38(9): 1419–21

    Article  CAS  Google Scholar 

  20. de Blic J, Wahn U, Billard E, et al. Levocetirizine in children: evidenced efficacy and safety in a six-week, randomised seasonal allergic rhinitis trial. Pediatr Allergy Immunol 2005; 16: 267–75

    Article  Google Scholar 

  21. Potter PC. Efficacy and safety of levocetirizine on symptoms and health-related quality of life of children with perennial allergic rhinitis: a double blind placebo controlled randomized clinical trial. Ann Allergy Asthma Immunol 2005; 95: 175–80

    Article  CAS  Google Scholar 

  22. Bloom M, Staudinger H, Herron J. Safety of desloratadine syrup in children. Curr Med Res Opin 2004; 20(12): 1959–65

    Article  CAS  Google Scholar 

  23. Milgrom H, Kittner B, Lanier R, et al. Safety and tolerability of fexofenadine for the treatment of allergic rhinitis in children 2 to 5 years old. Ann Allergy Asthma Immunol 2007; 99(4): 358–63

    Article  CAS  Google Scholar 

  24. Wahn U, Meltzer EO, Finn Jr AF, et al. Fexofenadine is efficacious and safe in children (aged 6–11 years) with seasonal allergic rhinitis. J Allergy Clin Immunol 2003; 111(4): 763–9

    Article  CAS  Google Scholar 

  25. Beno SM, Nadel FM, Alessandrini EA. A survey of emergency department management of acute urticaria in children. Pediatr Emerg Care 2007; 23(12): 862–8

    Article  Google Scholar 

  26. Liu H, Zheng Q, Farley JM. Antimuscarinic actions of antihistamines on the heart. J Biomed Sci 2006; 13(3): 395–401

    Article  CAS  Google Scholar 

  27. Ferrer M, Jáuregui I, Bartra J, et al. Chronic urticaria: do urticaria nonexperts implement treatment guidelines? A survey of adherence to published guidelines by nonexperts. Br J Dermatol 2009; 160(4): 823–7

    Article  CAS  Google Scholar 

  28. Deacock SJ. An approach to the patient with urticaria. Clin Exp Immunol 2008; 153(2): 151–61

    Article  CAS  Google Scholar 

  29. Patel T, Ishiuji Y, Yosipovitch G. Nocturnal itch: why do we itch at night? Acta Derm Venereol 2007; 87(4): 295–8

    Article  CAS  Google Scholar 

  30. Boyle J, Eriksson M, Stanley N, et al. Allergy medication in Japanese volunteers: treatment effect of single doses on nocturnal sleep architecture and next day residual effects. Curr Med Res Opin 2006; 22(7): 1343–51

    Article  Google Scholar 

  31. Singer AJ, Thode Jr HC. Determination of the minimal clinically significant difference on a patient visual analog satisfaction scale. Acad Emerg Med 1998; 5(10): 1007–11

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This study was sponsored by UCB Farchim SA, Bulle, Switzerland. The statistical analysis was performed by the Biometrics Department, Global Medical Affairs, UCB SA, Brussels, Belgium. The authors would like to thank Jagdish Devalia, PhD, JD Medical and Scientific Communications Ltd, Southall, UK, for his medical writing assistance in preparing the manuscript and collating the comments of authors and other contributors. Marta Ferrer has acted as a consultant to UCB SA. Margarita Guizova has received honoraria from UCB SA. The other authors have no conflicts of interest that are directly relevant to the content of this study.

Author information

Authors and Affiliations

  1. Department of Allergy, Clinica Universidad de Navarra Medical School, Pamplona, Spain

    Marta Ferrer

  2. Immuno-Allergy Department, CUF-Descobertas Hospital, Lisbon, Portugal

    Mário Morais-Almeida

  3. Paediatric Department, University Hospital ‘St Anna’, Sofia, Bulgaria

    Margarita Guizova

  4. Department of Clinical Immunology, Allergology and Laboratory Diagnostics, Kuban State Medical University, Krasnodar, Russia

    Roman Khanferyan

  5. Vice Dean for International Programs and Medical Education, Universidad de Navarra Medical School, 31080, Pamplona, Spain

    Marta Ferrer

  6. Head of the Department of Allergy, Universidad de Navarra, 31080, Pamplona, Spain

    Marta Ferrer

Authors
  1. Marta Ferrer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mário Morais-Almeida
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Margarita Guizova
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roman Khanferyan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marta Ferrer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ferrer, M., Morais-Almeida, M., Guizova, M. et al. Evaluation of Treatment Satisfaction in Children with Allergic Disease Treated with an Antihistamine. Clin. Drug Investig. 30, 15–34 (2010). https://doi.org/10.2165/11530910-000000000-00000

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/11530910-000000000-00000

Keywords

Search

Navigation