Antihistamínicos en el tratamiento de la urticaria en México

Désirée Larenas-Linnemann, Mario Sánchez-Borges, Blanca Estela Del Río-Navarro, María de Lourdes Alonzo-Romero Pareyón, César Alfonso Maldonado-García, Enrique Mendoza-López, José Antonio Ortega-Martell, Juan José Luis Sienra-Monge, Miguel Alejandro Medina-Ávalos, María Isabel Rojo-Gutiérrez, Angélica María Beirana-Palencia, Jorge Bernardo Vargas-Correa, Carlos Báez-Loyola, Ruth Ivonne Mireya Ramírez-Segura, María Graciela Guzmán-Perea

Resumen


Existen cuatro tipos de receptores histaminérgicos. Los síntomas de alergia, especialmente rinoconjuntivitis alérgica y urticaria, son principalmente causados por activación del receptor H1; por ende, los antihistamínicos H1 orales (anti-H1) forman parte integral del tratamiento de estas enfermedades. Los antihistamínicos son agonistas inversos, porque estabilizan la forma inactiva del receptor. Los antihistamínicos H1 de primera generación producen efectos adversos por varios mecanismos: sedación (fijación a receptores H1 cerebrales), boca seca, retención urinaria, aumento de peso (baja selectividad: estimulación de los receptores de serotonina, muscarina y alfa-adrenérgicos) e interacciones medicamentosas (con sustrato de citocromo P450-3A4). Los antihistamínicos H1 de segunda generación son generalmente más seguros. Las nuevas guías de tratamiento de la rinitis alérgica y urticaria recomiendan como manejo de primera intención a los antihistamínicos H1 de segunda generación. En urticaria se recomienda hasta cuadruplicar su dosis en caso necesario. El aumento de la eficacia en el control de la urticaria con cuádruple dosis, sin que se afecte la seguridad, se ha documentado para bilastina, desloratadina y levocetirizina (rupatadina). Respecto de ebastina y fexofenadina, hasta ahora, sólo se comprobó la seguridad de cuádruple dosis. Una rigurosa excepción son astemizol y terfenadina, que a concentraciones séricas elevadas pueden causar taquicardia ventricular. No se recomiendan los antihistamínicos H1 de primera generación y aumentar su dosis no es seguro.

Palabras clave


antihistamínicos de primera generación; antihistamínicos de segunda generación; urticaria; rinitis alérgica; sedación; citocromo P450

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Referencias


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DOI: http://dx.doi.org/10.29262/ram.v62i3.103

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