ANTIHISTAMINES
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Nowadays we find a great deal of medications for treating pruritus, 
one saying it is better than the other, one tab/day, less sedation, 
etc. But is this really thruth? I don't have much experience but I 
find older antihistaminic drugs more effective in general, but the 
mayority show no good effect in treatment of severe or moderate 
pruritus. Even combinations of 2 H1 or H1+H2 are not so good. I wold 
like to know your experiences in treating mod/sev pruritus and your 
comments to my subjective and inexperienced observations.

Ennio Barron Nunez
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Besides antihistamines, we are using other drugs and modalities. Narcotic
antagonists/PUVA/UVB.  My personal favorites are cetirizine, hydroxyzine,
and doxepin for histamine induced itch. What is the experience with
Ketotifen, which as far as I know is not available here? I had thought that
might work in mastocytosis itch and to prevent the occurance of
neurofibromas at the sites of trauma in neurofibromatosis. I have never had
any success with H2 blockers-but apparently Eugene Monroe in Milwaukee has.
 
Diane Thaler
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If pruritus really was caused by histamine release only, also the 
newer H1 blockers had a chance. But unfortunately, it isn't. So the 
major effect against itching is because of the sedative effect of the 
older ones, I think. My personal favorite for severe pruritus is 
alimemazin (brand name Repeltin forte, by Pierre Fabre)  25 mg  tid,
but this dosage is hardly tolerable nor approved for out-patients. If 
this doesn't do, nothing will do. For milder forms I give 
dimetindenmaleat (Fenistil, Zyma) 4 times 20 drops. Maybe these drugs 
are also available outside Europe... Due to the limited value of 
these things, I think it always is essantial to look for the cause of 
pruritus that might be treated in another way. In AD, the best idea 
is an adequate external therapy, most of the times. Cetirizine and 
loratidine I only use in allergic rhinitis or totally mild forms of 
hives or if the patient insists on driving or has to work with other 
dangerous machines.

Hans J. Kammler
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