***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Non-sedating H1-antihistamines are the recommended first-line treatment for chronic spontaneous urticaria . While efficacy studies usually apply continuous daily treatment regimens , many patients take their medication on dem and . In this r and omized , double-blind trial we tested whether on-dem and H1-antihistamine desloratadine in st and ard and higher doses is able to improve the resolution of existing wheals . Symptoms of 29 patients with chronic spontaneous urticaria were followed without treatment on one day and again on another day during the next 3 weeks after a single dose of either 5 mg or 20 mg desloratadine , using different objective measures . While the intervention with both doses of desloratadine was effective in terms of a reduction in hyperthermic skin area , there was no improvement in wheal area and wheal volume compared with no treatment . Wheal numbers were reduced after treatment with 20 mg , but not 5 mg , desloratadine . In conclusion , the beneficial effects of non-sedating H1-anti-histamines given on dem and appear to be low . Thus , a preventive treatment strategy should be preferred in chronic spontaneous urticaria Chronic urticaria represents a cutaneous reaction pattern that may last for slightly more than six weeks to more than five years . Treatment of patients with chronic urticaria  can be a problem for both physician and patient because of the significant side effects that may be caused by first-generation H1 antihistamines or long-term corticosteroid therapy . Newer antihistamines represent a major advance for the treatment of patients with chronic urticaria . Of this group , cetirizine appears to offer some distinct pharmacokinetic and pharmacodynamic advantages . An open-label multicenter trial of 217 patients with chronic idiopathic urticaria demonstrated that cetirizine was effective , rapid in onset , and well tolerated . Thus , cetirizine was shown to be an attractive alternative treatment for patients with chronic idiopathic urticaria BACKGROUND Patients with acquired cold urticaria ( ACU ) show itchy wheals during cold exposure . This disturbing condition involves histamine and platelet-activating factor in its pathogenesis . Rupatadine is a dual antagonist of both histamine and platelet-activating factor . OBJECTIVE To assess rupatadine efficacy in preventing reactions to cold challenge in patients with ACU . METHODS A crossover , r and omized , double-blind , placebo-controlled study in which 21 patients with ACU received rupatadine , 20 mg/d , or placebo for 1 week each is presented . The main outcome was the critical stimulation time threshold ( CSTT ) determined by ice cube challenge . Secondary outcomes included CSTT and the critical temperature threshold assessed by a cold provocation device ( TempTest 3.0 ) , as well as scores for wheal reactions , pruritus , burning sensations , and subjective complaints after cold challenge . RESULTS After rupatadine treatment , 11 ( 52 % ) of 21 patients exhibited a complete response ( ie , no urticaria lesions after ice cube provocation ) . A significant improvement in CSTT compared with placebo was observed after ice cube and TempTest 3.0 challenge ( P = .03 and P = .004 , respectively ) . A significant reduction of critical temperature threshold ( P < .001 ) and reduced scores for cold provocation-induced wheal reactions ( P = .01 ) , pruritus ( P = .005 ) , burning sensation ( P = .03 ) , and subjective complaints ( P = .03 ) after rupatadine treatment were also found . Mild fatigue ( n = 4 ) , somnolence ( n = 1 ) , and moderate headache ( n = 1 ) were reported during active treatment . CONCLUSION Rupatadine , 20 mg/d , shows high efficacy and is well tolerated in the treatment of ACU symptoms The Confidence Profile Method is a Bayesian method for adjusting and combining pieces of evidence to estimate parameters , such as the effect of  health technologies on  health outcomes . The information in each piece of evidence is captured in a likelihood function that gives the likelihood of the observed results of the evidence as a function of possible values of the parameter . A posterior distribution is calculated from Bayes formula as the product of the likelihood function and a prior distribution . Multiple pieces of evidence are incorporated by successive applications of Bayes ' formula . Pieces of evidence are adjusted for biases to internal or external validity by modeling the biases and deriving " adjusted " likelihood functions that incorporate the models . Likelihood functions have been derived for one- , two- and multi-arm prospect i ve studies ; 2 x 2 , 2 x n and matched case-control studies , and cross-sectional studies . Biases that can be incorporated in likelihood functions include crossover in controlled trials , error in measurement outcomes , patient selection biases , differences in technologies , and differences in length of follow-up . Effect measures include differences of rates , ratios of rates , and odds ratios . The elements of the method are illustrated with an analysis of the effect of a thrombolytic agent  on the difference in probability of 1-year survival after a heart attack BACKGROUND H(1)-antihistamines are first line treatment of chronic urticaria , but many patients do not get satisfactory relief with recommended doses . European guidelines recommend increased antihistamine doses of up to 4-fold . OBJECTIVE To provide supportive evidence for the European guidelines . METHODS Eighty tertiary referral patients with chronic urticaria ( age range , 19 - 67 years ) were r and omized for double-blind treatment with levocetirizine or desloratadine ( 40/40 ) . Treatment started at the conventional daily dose of 5 mg and then increased weekly to 10 mg , 20 mg , or 20 mg of the opposite drug if relief of symptoms was incomplete . Wheal and pruritus scores , quality of life , patient discomfort , somnolence , and safety were assessed . RESULTS Thirteen patients became symptom-free at 5 mg ( 9 levocetirizine vs 4 desloratadine ) , compared with 28 subjects on the higher doses of 10 mg ( 8/7 ) and 20 mg ( 5/1 ) . Of the 28 patients nonresponsive to 20 mg desloratadine , 7 became symptom-free with 20 mg levocetirizine . None of the 18 levocetirizine nonresponders benefited with 20 mg desloratadine . Increasing antihistamine doses improved quality of life but did not increase somnolence . Analysis of the effect of treatment on discomfort caused by urticaria showed great individual heterogeneity of antihistamine responsiveness : approximately 15 % of patients were good responders , approximately 10 % were nonresponders , and approximately 75 % were responders to higher than conventional antihistamine doses . No serious or severe adverse effects warranting discontinuation of treatment occurred with either drug . CONCLUSION Increasing the dosage of levocetirizine and desloratadine up to 4-fold improves chronic urticaria symptoms without compromising safety in approximately three quarters of patients with difficult-to-treat chronic urticaria BACKGROUND According to the EAACI/GA(2)LEN/EDF guidelines for urticaria management , modern non-sedating H1-antihistamines are the first-line symptomatic treatment for chronic urticaria . Two previous r and omized clinical trials demonstrated rupatadine efficacy and safety in chronic urticaria treatment . However , a responder analysis to identify clinical ly meaningful differences in patients with chronic urticaria has not yet been performed . METHODS This analysis includes the pooled data from two r and omized , double-blind , placebo-controlled , multicentre studies in which chronic urticaria patients were treated with rupatadine at different doses . Responder rates were defined as the percentage of patients after 4 weeks of treatment who exhibited a reduction of symptoms by at least 50 % or 75 % as compared to baseline . The variables analysed were as follows : Mean Pruritus Score ( MPS ) , Mean Number of Wheals ( MNW ) , and Mean Urticaria Activity Score ( UAS ) . RESULTS A total of 538 patients were included . This responder analysis , using different response levels , shows that the efficacy of rupatadine 10 mg and 20 mg is significantly better as compared to placebo in the treatment of chronic urticaria patients . Notably , treatment with rupatadine 20 mg daily result ed in a higher percentage of patients with response of 75 % symptom reduction or better than rupatadine 10 mg . CONCLUSION Our results support the use of higher than st and ard doses of non sedating antihistamines in chronic urticaria . We strongly recommend performing and reporting responder analyses for established and new drugs used by patients with chronic urticaria This r and omised , double-blind , placebo-controlled , parallel-group , international , dose-ranging study investigated the effect of treatment with rupatadine 5 , 10 and 20 mg once daily for 4 weeks on symptoms and interference with daily activities and sleep in 12 - 65 years-old patients with moderate-to-severe chronic idiopathic urticaria ( CIU ) .  Rupatadine 10 and 20 mg significantly reduced pruritus severity by 62.05 % and 71.87 % respectively , from baseline , over a period of 4 weeks compared to reduction with placebo by 46.59 % ( p < 0.05 ) . Linear trends were noted for reductions in mean number of wheals and interference with daily activities and sleep with rupatadine 10 and 20 mg over the 4-week treatment period . The two most frequently reported AEs were somnolence ( 2.90 % for placebo , 4.29 % for 5 mg- , 5.41 % for 10 mg- and 21.43 % for 20 mg-rupatadine-treated group ) and headache ( 4.35 % for placebo , 2.86 % for 5 mg- , 4.05 % for 10 mg- and 4.29 % for 20 mg-rupatadine-treated group ) . These findings suggest that rupatadine 10 and 20 mg is a fast-acting , efficacious and safe treatment for the management of patients with moderate-to-severe CIU . Rupatadine decreased pruritus severity , in a dose- and time-dependent manner BACKGROUND Increased dosing of nonsedating antihistamines is recommended by the current European Academy of Allergology and Clinical Immunology/Global Allergy and Asthma European Network/European Dermatology Forum guidelines on patients with acquired cold urticaria ( ACU ) who do not respond satisfactorily to the st and ard dose . Prospect i ve data supporting this recommendation are scant . OBJECTIVE We sought to assess the effects of 5 and 20 mg of desloratadine and placebo on cold-induced urticarial reactions in patients with ACU . METHODS In this prospect i ve , r and omized , double-blind , 3-way crossover trial , patients with ACU ( n = 30 ) received placebo , 5 mg of desloratadine , and 20 mg of desloratadine every day each for 7 days separated by 14-day washout periods . At the end of each treatment , patients underwent cold provocation with the TempTest 2.0/2.1 system , and urticarial reactions were assessed by using digital 3-dimensional time-lapse photography and thermography ; the critical temperature threshold ( CTT ) and critical stimulation time threshold ( CSTT ) were measured . Adverse events ( AEs ) reported during the study were assessed . RESULTS Compared with placebo , 7 days of desloratadine at 5 and 20 mg/d significantly reduced the volume of cold-induced wheals and areas of hyperthermic skin and improved CTT and CSTT results .  Desloratadine at 20 mg/d significantly reduced cold-induced wheal volume and CTT and CSTT values versus desloratadine at 5 mg/d . Desloratadine was well tolerated , with no increased rate of somnolence or other AEs with 20 mg of desloratadine . CONCLUSIONS Desloratadine at st and ard and high doses significantly improved objective signs of ACU provoked by cold exposure . Desloratadine at 4 times the st and ard dose significantly reduced ACU lesion severity versus 5 mg of desloratadine without an increase in AEs . This study supports current guidelines that increased desloratadine dosing might benefit patients with urticaria who do not respond to st and ard doses BACKGROUND Fexofenadine is a nonsedating antihistamine approved for treatment of seasonal allergic rhinitis . OBJECTIVE This dose-finding study assessed the safety and efficacy of fexofenadine in chronic idiopathic urticaria . METHODS The 4-week , double-blind , r and omized , placebo-controlled study included patients diagnosed with chronic urticaria who had moderate to severe pruritus . Patients received twice daily oral doses of placebo or fexofenadine HCl ( 20 , 60 , 120 , or 240 mg ) at 7 AM and 7 PM . Patients recorded scores for pruritus severity and number of wheals ( over the previous 12 hours ) in a daily diary . Efficacy variables included mean daily changes from baseline in pruritus severity , number 
    Output:
    
We did not find significant differences in response rates or number of weals in those patients who received a st and ard dosage vs. a high dosage .
We found a significant improvement only in the pruritus variable of the Urticaria Activity Score scale .
We found that updosing antihistamines significantly improved control of pruritus but not weal number .