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This may be one of the reasons why, in routine daily practice, many patients tend to perform on-demand, rather than continuous, daily, preventive treatment of their symptoms with H-antihistamines.In allergic rhinitis, several studies point towards a better efficacy of modern non-sedating antihistamines if given continuously (8–10).The only study in CSU examining both treatment approaches was published by Grob and colleagues (11), who showed that daily treatment with desloratadine resulted in significantly better quality of life compared with on-demand therapy.While these studies indicate that the treatment schedule can generally have a major impact on the outcome of treatment, the results on the efficacy of on-demand ns AHs in CSU have not yet been independently confirmed.

Outpatients, age range 18–75 years, were eligible for the study if: () they had a history of beneficial effect from antihistamine treatment.Desloratadine is a modern ns AH that has been shown to reduce pruritus and wheals and to improve quality of life in several studies at the standard 5 mg dose (12–17).In addition, in a study on patients with acquired cold urticaria, a preventive application of desloratadine at 4 times the standard dose was significantly more effective in reducing urticaria lesion severity compared with the standard 5 mg dose, without any increase in adverse events (18).In addition, it has not been studied whether on-demand ns AHs in higher than standard doses might have a beneficial effect compared with standard doses.Increasing the ns AH to up to 4 times the standard dose is recommended by the current guidelines in all patients who cannot achieve symptom control with standard doses (7).

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Accordingly, the minimum and maximum value of the 7-day cumulative score is 0 and 42, respectively (Table I).

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