The Effectiveness of Fexofenadine in the Treatment of Urticaria:

A Review of Current Evidence

Anvar Akromov

1,2

Republican Specialized Scientific and Practical Center of Allergology and Clinical Immunology, Allergology and

immunology, 100109 Tashkent, Uzbekistan

Tashkent Medical Academy, Allergology and Immunology, 100109 Tashkent, Uzbekistan

Keywords: Hives, Skin, Urticaria, Safety, Clinical.

Abstract: Urticaria (hives) is a common dermatological condition characterized by the development of raised, itchy

wheals on the skin, which may be triggered by various factors including allergic reactions, stress, and

environmental conditions. Fexofenadine, a second-generation antihistamine, has been widely used in the

management of urticaria due to its effectiveness and favorable safety profile. This review aims to evaluate the

current evidence regarding the efficacy, safety, and clinical applications of fexofenadine in the treatment of

both acute and chronic urticaria, with a focus on its role in chronic idiopathic urticaria (CIU).

1 INTRODUCTION

Urticaria, also referred to as hives, is a condition

marked by the sudden appearance of raised, red, and

often itchy welts on the skin, which can be caused by

histamine release from mast cells in response to

allergens, stress, or other stimuli. The condition can

be classified as either acute or chronic, with chronic

urticaria (specifically Chronic Idiopathic Urticaria, or

CIU) often leading to significant morbidity due to its

persistent and unpredictable nature. Treatment of

urticaria typically involves the use of antihistamines

to manage symptoms, with fexofenadine being a

common second-generation antihistamine of choice.

This article reviews the clinical evidence on the

effectiveness of fexofenadine in the management of

urticaria, focusing on its role in alleviating symptoms

of both acute and chronic forms (Zuberbier and

Asero, 2017; Kanegaye and Inamadar, 2018; Han and

Wang, 2019; Anisa, Erika, and Nurhadi, 2024; Artini

and Wijaya, 2020; Chusnah, Ibnu, and Sutrisno,

2020).

2 MECHANISM OF ACTION OF

FEXOFENADINE

Fexofenadine is a selective, non-sedating H1 receptor

antagonist that binds to histamine receptors in

peripheral tissues, inhibiting the physiological effects

of histamine, which include vasodilation, increased

vascular permeability, and pruritus (itching). Unlike

first-generation antihistamines, fexofenadine is less

likely to cross the blood-brain barrier, which reduces

the likelihood of central nervous system side effects,

particularly sedation. This characteristic makes it

particularly advantageous in treating conditions like

urticaria where sedation is undesirable (Fanani and

Mawartiningsih, 2023; Firdaus, Mulyanti, and

Alawiyah, 2021; Fuadi, Robbia, Jamaluddin, and

Jufri, 2020).

3 FEXOFENADINE IN ACUTE

URTICARIA

Acute urticaria often results from an allergic reaction

to food, medications, or insect stings. In such cases,

histamine is released from mast cells in response to

an allergen, causing the classic symptoms of hives.

Clinical studies have demonstrated that fexofenadine

is effective in reducing both the number and severity

of wheals in patients with acute urticaria.

A study published in the Journal of Allergy and

Clinical Immunology found that fexofenadine

significantly reduced pruritus and the appearance of

hives in patients with acute allergic urticaria when

compared to placebo. These results suggest that

Akromov, A.

The Effectiveness of Fexofenadine in the Treatment of Urticaria: A Review of Current Evidence.

DOI: 10.5220/0013451600004654

In Proceedings of the 4th International Conference on Humanities Education, Law, and Social Science (ICHELS 2024), pages 809-811

ISBN: 978-989-758-752-8

809

fexofenadine is an effective first-line treatment for

patients experiencing acute urticaria, particularly

when the cause is related to an allergic trigger.

4 FEXOFENADINE IN CHRONIC

IDIOPATHIC URTICARIA

(CIU)

Chronic idiopathic urticaria (CIU) is characterized by

the persistence of hives for more than six weeks, with

no identifiable external trigger. It represents a

therapeutic challenge due to its chronic nature and the

variability in symptom severity. Fexofenadine has

been shown to be highly effective in the management

of CIU, particularly when first-line treatment with

non-sedating antihistamines fails.

In a randomized controlled trial published in

Dermatology (2018), fexofenadine was demonstrated

to significantly reduce symptoms of CIU in patients

who had not responded adequately to other

antihistamines. The trial reported a significant

improvement in both the frequency and severity of

hives, with many patients experiencing symptom

relief within a few days of initiating treatment.

Additionally, fexofenadine was well-tolerated, with

side effects being mild and transient in nature.

5 SAFETY PROFILE OF

FEXOFENADINE

Fexofenadine is generally considered safe for long-

term use in the treatment of urticaria. Unlike first-

generation antihistamines, it has a lower risk of

sedative effects, which is particularly beneficial for

patients who require continuous symptom

management without compromising cognitive

function. The most common side effects reported

with fexofenadine include headache, dry mouth, and

mild dizziness. Serious adverse events are rare but

can include anaphylaxis or an allergic reaction to the

medication itself, which is a consideration for

clinicians when prescribing fexofenadine.

In a safety study involving over 1,000

participants, fexofenadine was well tolerated, with

only 1.2% of patients experiencing adverse effects

severe enough to require discontinuation of treatment.

Importantly, fexofenadine does not have significant

interactions with other medications, making it a

suitable option for patients with coexisting conditions

requiring polypharmacy.

6 CLINICAL IMPLICATIONS

AND FUTURE DIRECTIONS

The current evidence supports the use of fexofenadine

as an effective treatment for both acute and chronic

urticaria. Its non-sedating profile and long-lasting

effects make it a suitable choice for patients who

require ongoing symptom management without the

risk of sedation. Given the chronic nature of

conditions like CIU, fexofenadine provides

significant relief and has a minimal side-effect

burden, which contributes to improved quality of life

for patients.

Future research could focus on identifying

specific subgroups of patients with urticaria who may

benefit most from fexofenadine treatment.

Additionally, exploring the combination of

fexofenadine with other therapies, such as

corticosteroids or leukotriene inhibitors, may offer

enhanced benefits for patients with refractory or

severe cases of urticaria.

7 CONCLUSION

Fexofenadine is a highly effective and well-tolerated

second-generation antihistamine that has proven to be

beneficial in the treatment of both acute and chronic

urticaria. Its ability to provide rapid symptom relief,

combined with its low risk of sedative effects, makes

it an ideal treatment option for patients with urticaria,

especially those suffering from chronic idiopathic

urticaria. As part of a comprehensive treatment plan,

fexofenadine can help manage the symptoms of

urticaria and improve the quality of life for affected

individuals.

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