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Second-generation H1-antagonists are the mainstay of treatment in patients with urticaria. These drugs appear to have comparable efficacy to each other in relieving symptoms of urticaria such as erythema, wheals and itching. However, response may vary between individuals so if one drug is ineffective it is worth trying another.The slow onset of action of astemizole makes it unsuitable for rapid relief of symptoms. Acrivastine is inconvenient for long-term prophylaxis because of its short duration of action.All of the second-generation H1-antagonists have a lower sedative potential than the older H1-antagonists. Of the newer agents, cetirizine appears to have the highest risk of drowsiness.