1
|
Ansotegui IJ, Bousquet J, Canonica GW, Demoly P, Gómez RM, Meltzer EO, Murrieta-Aguttes M, Naclerio RM, Rosario Filho N, Scadding GK. Why fexofenadine is considered as a truly non-sedating antihistamine with no brain penetration: a systematic review. Curr Med Res Opin 2024:1-13. [PMID: 39028636 DOI: 10.1080/03007995.2024.2378172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/27/2024] [Accepted: 07/05/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVE Fexofenadine is a second-generation inverse agonist of H1-receptor of histamine which is highly selective with proven efficacy in relieving symptoms associated with allergic conditions. It has an additional benefit of not penetrating the blood-brain barrier and therefore do not induce sedation and not impair the cognitive function/psychomotor performance. This review aimed at providing evidence based on available controlled studies to reinforce the non-sedative property of fexofenadine for treating patients with allergic rhinitis and urticaria. METHODS We performed an electronic literature search using keywords such as fexofenadine, drowsiness, somnolence, sedation, fatigue, cognitive, impairment, psychomotor, driving performances, sleep, rapid eye movement, alertness, clinical study, in vitro study, in vivo study, and pharmacodynamics in the Embase search engine. The review included randomized controlled trials, review articles, systematic reviews, and meta-analyses, together with post-marketing analysis conducted in healthy subjects and patients with allergy and were focused on comparing the antihistaminic potential or safety of fexofenadine with other antihistamines or placebo. RESULTS Positron emission tomography (PET) and proportional impairment ratio (PIR) data along with other objective tests from various studies confirmed the non-sedative property of fexofenadine. Results of brain H1-receptor occupancy (H1RO) obtained from PET showed no H1RO by fexofenadine, the receptor which is known to cause sedation of H1 antihistamines. Most studies calculating PIR value as 0 showed fexofenadine to be a non-impairing oral antihistamine regardless of dose. Clinical trials in adults and children showed fexofenadine to be well tolerated without sedative effect or impairment of cognitive/psychomotor function even at higher than recommended doses. CONCLUSION Published literature based on various parameters and clinical trials conducted for evaluating the effect of fexofenadine on sedation and central nervous system shows fexofenadine is both clinically effective and non-sedating.
Collapse
Affiliation(s)
- Ignacio J Ansotegui
- Department of Allergy & Immunology, Hospital Quirónsalud Bizkaia, Bilbao, Spain
| | - Jean Bousquet
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Freie Universität Berlin, Berlin, Germany
- Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Giorgio Walter Canonica
- Personalized Medicine Asthma & Allergy Clinic, Humanitas University & Research Hospital, Milano, Italy
| | - Pascal Demoly
- Department of Pulmonology, Division of Allergy, University Hospital of Montpellier, Montpellier, France
- IDESP, University of Montpellier - INSERM, Montpellier, France
| | - Rene Maximiliano Gómez
- Faculty of Health Sciences, Catholic University of Salta, Salta, Argentina
- Ayre Foundation/Alas Medical Institute, Salta, Argentina
| | - Eli O Meltzer
- Department of Pediatrics, Division of Allergy and Immunology, University of California San Diego, La Jolla, CA, USA
| | | | - Robert M Naclerio
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | | | - Glenis K Scadding
- RNENT Hospital, London, UK
- Department of Immunity & Infection, University College London, London, UK
| |
Collapse
|
2
|
Canonica GW, Kuna P, Maurer M, Mösges R, Novak Z, Papadopoulos N, Rodriguez del Rio P. Bilastine for the treatment of allergic rhinoconjunctivitis and urticaria: results from an international Delphi study. Drugs Context 2024; 13:2024-2-3. [PMID: 38742145 PMCID: PMC11090268 DOI: 10.7573/dic.2024-2-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/12/2024] [Indexed: 05/16/2024] Open
Abstract
Background Second-generation oral H1-antihistamines, including bilastine, represent the emerging treatments of allergic rhinitis (including rhinoconjunctivitis) and chronic urticaria in both adults and children. This study analyses available evidence supporting the use of bilastine amongst second-generation antihistamines for the symptomatic treatment of allergic rhinitis and urticaria in adults and children. Methods Consensus amongst experts from 17 countries on the ideal treatment of rhinitis and urticaria, and the specific role of bilastine was measured by means of a modified Delphi process. A total of 12 statements were voted on by the experts using a five-point Likert scale (1 = strongly disagree; 2 = disagree; 3 = undecided; 4 = agree; 5 = strongly agree). The definition of consensus was set at a minimum of 80% concordance for 4+5 scores (agree or strongly agree). Results All proposed statements reached consensus, with a concordance of ≥98% for five statements and ≥96% for seven. Conclusions The wide consensus obtained for the proposed statements suggests a prominent role for bilastine in the management of allergic rhinitis and urticaria.
Collapse
Affiliation(s)
- Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Personalized Medicine Asthma & Allergy IRCCS Humanitas Research Hospital, Milan, Italy
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - Marcus Maurer
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Freie Universität Berlin, Berlin, Germany
- Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Ralph Mösges
- IMSB, Medical Faculty, University at Cologne, Cologne, Germany
- ClinCompetence Cologne GmbH, Cologne, Germany
| | - Zoltan Novak
- Pediatric Department, University of Szeged, Szeged, Hungary
| | | | | | | |
Collapse
|
3
|
Xiang YK, Fok JS, Podder I, Yücel MB, Özkoca D, Thomsen SF, Kocatürk E. An update on the use of antihistamines in managing chronic urticaria. Expert Opin Pharmacother 2024; 25:551-569. [PMID: 38654448 DOI: 10.1080/14656566.2024.2345731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/17/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Urticaria, a mast cell-mediated skin disease, manifests as acute or chronic, with the latter divided into spontaneous and inducible types and requires individualized management, including identifying triggers and comorbidities. Antihistamines, particularly the second generation group, form the mainstay of primary treatment plans consisting of dosage adjustments and/or in combination with other treatment modalities depending on underlying disease control. AREAS COVERED A literature search was conducted using 'antihistamines,' 'urticaria,' 'pharmacogenomics,' 'genomics,' 'biomarkers' and 'treatment response' as key words. In this review, we focus on the comprehensive understanding and application of antihistamines in managing adult and adolescent patients with chronic urticaria. EXPERT OPINION Using antihistamines to treat urticaria is set to change significantly, focusing more on personalized medicine and identifying key biomarkers to enhance treatment response prediction. These changes aim to make treatments more specific and cost-effective by avoiding unnecessary tests. Applying new approaches in everyday clinical care faces challenges like proving the biomarkers' reliability, updating current guidelines, and incorporating individualized treatments into standard procedures. Efforts should now concentrate on finding easy-to-use biomarkers, improving access to pharmacogenomics, understanding why some patients are resistant to treatment, and creating more specific treatment options based on patient needs.
Collapse
Affiliation(s)
- Yi-Kui Xiang
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Allergology, Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Jie Shen Fok
- Department of Respiratory Medicine and General Medicine, Box Hill Hospital, Melbourne, Australia
- Monash Lung, Sleep and Allergy/Immunology, Monash Medical Centre, Melbourne, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Indrashis Podder
- Department of Dermatology, College of Medicine and Sagore Dutta Hospital, Kolkata, India
| | - Muhammed Burak Yücel
- Urticaria Center of Reference and Excellence, Department of Dermatology, Kayseri City Education and Research Hospital, University of Health Sciences, Kayseri, Turkey
| | - Defne Özkoca
- Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey
| | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital, Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Emek Kocatürk
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Allergology, Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
- Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey
| |
Collapse
|
4
|
Wang D, Guo Q, Wu Z, Li M, He B, Du Y, Zhang K, Tao Y. Molecular mechanism of antihistamines recognition and regulation of the histamine H 1 receptor. Nat Commun 2024; 15:84. [PMID: 38167898 PMCID: PMC10762250 DOI: 10.1038/s41467-023-44477-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
Histamine receptors are a group of G protein-coupled receptors (GPCRs) that play important roles in various physiological and pathophysiological conditions. Antihistamines that target the histamine H1 receptor (H1R) have been widely used to relieve the symptoms of allergy and inflammation. Here, to uncover the details of the regulation of H1R by the known second-generation antihistamines, thereby providing clues for the rational design of newer antihistamines, we determine the cryo-EM structure of H1R in the apo form and bound to different antihistamines. In addition to the deep hydrophobic cavity, we identify a secondary ligand-binding site in H1R, which potentially may support the introduction of new derivative groups to generate newer antihistamines. Furthermore, these structures show that antihistamines exert inverse regulation by utilizing a shared phenyl group that inserts into the deep cavity and block the movement of the toggle switch residue W4286.48. Together, these results enrich our understanding of GPCR modulation and facilitate the structure-based design of novel antihistamines.
Collapse
Affiliation(s)
- Dandan Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of USTC, MOE Key Laboratory for Membraneless Organelles and Cellular Dynamics, Hefei National Center for Cross-disciplinary Sciences, Biomedical Sciences and Health Laboratory of Anhui Province, Center for Advanced Interdisciplinary Science and Biomedicine of IHM, Division of Life Sciences and Medicine, University of Science and Technology of China, 230027, Hefei, P. R. China
| | - Qiong Guo
- Department of Laboratory Medicine, The First Affiliated Hospital of USTC, MOE Key Laboratory for Membraneless Organelles and Cellular Dynamics, Hefei National Center for Cross-disciplinary Sciences, Biomedical Sciences and Health Laboratory of Anhui Province, Center for Advanced Interdisciplinary Science and Biomedicine of IHM, Division of Life Sciences and Medicine, University of Science and Technology of China, 230027, Hefei, P. R. China
| | - Zhangsong Wu
- Kobilka Institute of Innovative Drug Discovery, School of Medicine, The Chinese University of Hong Kong, 518172, Shenzhen, Guangdong, China
| | - Ming Li
- Department of Laboratory Medicine, The First Affiliated Hospital of USTC, MOE Key Laboratory for Membraneless Organelles and Cellular Dynamics, Hefei National Center for Cross-disciplinary Sciences, Biomedical Sciences and Health Laboratory of Anhui Province, Center for Advanced Interdisciplinary Science and Biomedicine of IHM, Division of Life Sciences and Medicine, University of Science and Technology of China, 230027, Hefei, P. R. China
| | - Binbin He
- Department of Laboratory Medicine, The First Affiliated Hospital of USTC, MOE Key Laboratory for Membraneless Organelles and Cellular Dynamics, Hefei National Center for Cross-disciplinary Sciences, Biomedical Sciences and Health Laboratory of Anhui Province, Center for Advanced Interdisciplinary Science and Biomedicine of IHM, Division of Life Sciences and Medicine, University of Science and Technology of China, 230027, Hefei, P. R. China
| | - Yang Du
- Kobilka Institute of Innovative Drug Discovery, School of Medicine, The Chinese University of Hong Kong, 518172, Shenzhen, Guangdong, China
| | - Kaiming Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital of USTC, MOE Key Laboratory for Membraneless Organelles and Cellular Dynamics, Hefei National Center for Cross-disciplinary Sciences, Biomedical Sciences and Health Laboratory of Anhui Province, Center for Advanced Interdisciplinary Science and Biomedicine of IHM, Division of Life Sciences and Medicine, University of Science and Technology of China, 230027, Hefei, P. R. China.
| | - Yuyong Tao
- Department of Laboratory Medicine, The First Affiliated Hospital of USTC, MOE Key Laboratory for Membraneless Organelles and Cellular Dynamics, Hefei National Center for Cross-disciplinary Sciences, Biomedical Sciences and Health Laboratory of Anhui Province, Center for Advanced Interdisciplinary Science and Biomedicine of IHM, Division of Life Sciences and Medicine, University of Science and Technology of China, 230027, Hefei, P. R. China.
| |
Collapse
|
5
|
Li L, Liu R, Peng C, Chen X, Li J. Pharmacogenomics for the efficacy and side effects of antihistamines. Exp Dermatol 2022; 31:993-1004. [PMID: 35538735 DOI: 10.1111/exd.14602] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/01/2022] [Accepted: 05/09/2022] [Indexed: 11/27/2022]
Abstract
Antihistamines, especially H1 antihistamines, are widely used in the treatment of allergic diseases such as urticaria and allergic rhinitis, mainly for reversing elevated histamine and anti-allergic effects. Antihistamines are generally safe, but some patients experience adverse reactions, such as cardiotoxicity, central inhibition, and anticholinergic effects. There are also individual differences in antihistamine efficacy in clinical practice. The concept of individualized medicine has been deeply rooted in people's minds since it was put forward. Pharmacogenomics is the study of the role of inheritance in individual variations in drug response. In recent decades, pharmacogenomics has been developing rapidly, which provides new ideas for individualized medicine. Polymorphisms in the genes encoding metabolic enzymes, transporters, and target receptors have been shown to affect the efficacy of antihistamines. In addition, recent evidence suggests that gene polymorphisms influence urticaria susceptibility and antihistamine therapy. Here, we summarize current reports in this area, aiming to contribute to future research in antihistamines and clinical guidance for antihistamines use in individualized medicine.
Collapse
Affiliation(s)
- Liqiao Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Runqiu Liu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Cong Peng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jie Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| |
Collapse
|
6
|
Mann C, Wegner J, Weeß HG, Staubach P. Pathobiology of Second-Generation Antihistamines Related to Sleep in Urticaria Patients. BIOLOGY 2022; 11:biology11030433. [PMID: 35336805 PMCID: PMC8945773 DOI: 10.3390/biology11030433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022]
Abstract
Background: Standard treatment options for urticaria are second-generation antihistamines; however, their effect on sleep is uncertain. This study measures the influence of different antihistamines on the biologic sleep pattern of urticaria patients and the relevance of sleep in urticaria patients. Methods: Ten patients with chronic spontaneous urticaria (CSU) and uncontrolled symptoms under a single dose of second-generation antihistamines were included. Two nights were monitored: the first night after 5 days on single dosage and the second night after 5 days on fourfold dosage. Patient-rated questionnaires were used and sleep was monitored using polygraphy. Results: The patients’ rated daytime sleepiness decreased (p = 0.0319), as did their insomnia severity (p = 0.0349). The urticaria control (UCT) improved (p = 0.0007), as did the quality of life (p < 0.0001). There was no significant change of nightly pruritus (p = 0.1173), but there was an improvement of daytime pruritus (p = 0.0120). A significant increase in rapid eye movement (REM) sleep was seen (p = 0.0002) (from a mean of 3.9% to 14.3%). The deep sleep state (N3) also improved (8.7% to 12.3%) (p = 0.1172). Conclusion: This study has demonstrated an improvement of the sleep pattern in CSU patients under up-dosed second-generation antihistamines, without increased daytime sleepiness, alongside an improvement of urticaria symptoms and quality of life.
Collapse
Affiliation(s)
- Caroline Mann
- Department of Dermatology, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (J.W.); (P.S.)
- Correspondence:
| | - Joanna Wegner
- Department of Dermatology, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (J.W.); (P.S.)
| | - Hans-Günter Weeß
- Division of Sleep Medicine, Center for Psychiatry, Psychosomatic and Psychotherapy, Pfalzklinikum Klingenmünster, 76889 Klingenmünster, Germany;
| | - Petra Staubach
- Department of Dermatology, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (J.W.); (P.S.)
| |
Collapse
|
7
|
Goyal T, Kohli S, Tayal R. Antihistamines in children: A dermatological perspective. INDIAN JOURNAL OF PAEDIATRIC DERMATOLOGY 2022. [DOI: 10.4103/ijpd.ijpd_124_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
8
|
Yanai K, Yoshikawa T, Church MK. Efficacy and Safety of Non-brain Penetrating H 1-Antihistamines for the Treatment of Allergic Diseases. Curr Top Behav Neurosci 2021; 59:193-214. [PMID: 34622396 DOI: 10.1007/7854_2021_265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
H1 receptor antagonists, known as H1-antihistamines (AHs), inactivate the histamine H1-receptor thereby preventing histamine causing the primary symptoms of allergic diseases, such as atopic dermatitis, pollinosis, food allergies, and urticaria. AHs, which are classified into first-generation (fgAHs) and second-generation (sgAHs) antihistamines, are the first line of treatment for allergic diseases. Although fgAHs are effective, they cause adverse reactions such as potent sedating effects, including drowsiness, lassitude, and cognitive impairment; anticholinergic effects, including thirst and tachycardia. Consequently, the use of fgAHs is not recommended for allergic diseases. Today, sgAHs, which are minimally sedating and, therefore, may be used at more effective doses, are the first-line treatment for alleviating the symptoms of allergic diseases. Pharmacologically, the use of sedating fgAHs is limited to antiemetics, anti-motion sickness drugs, and antivertigo drugs. The use of histamine H1-receptor occupancy (H1RO) based on positron emission tomography (PET) has been developed for the evaluation of brain penetrability. Based on the results of the H1RO-PET studies, non-brain-penetrating AHs (nbpAHs) have recently been reclassified among sgAHs. The nbpAHs are rapidly acting and exhibit minimal adverse reactions and, thus, are considered first-line drugs for allergic diseases. In this review, we will introduce recent topics on the pharmacodynamics and pharmacokinetics of AHs and make recommendations for the use of nbpAHs as first-line treatment options for allergic diseases.
Collapse
Affiliation(s)
- Kazuhiko Yanai
- Department of Pharmacology, Tohoku University School of Medicine, Sendai, Japan. .,Cyclotron and Radioisotope Center (CYRIC), Tohoku University, Sendai, Japan.
| | - Takeo Yoshikawa
- Department of Pharmacology, Tohoku University School of Medicine, Sendai, Japan
| | - Martin K Church
- Department of Dermatology and Allergy, Charitè-Universitätsmedizin, Berlin, Germany
| |
Collapse
|
9
|
Falkenstein M, Elek M, Stark H. Chemical Probes for Histamine Receptor Subtypes. Curr Top Behav Neurosci 2021; 59:29-76. [PMID: 34595743 DOI: 10.1007/7854_2021_254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Ligands with different properties and different selectivity are highly needed for in vitro and in vivo studies on the (patho)physiological influence of the chemical mediator histamine and its receptor subtypes. A selection of well-described ligands for the different receptor subtypes and different studies is shown with a particular focus on affinity and selectivity. In addition, compounds with radioactive or fluorescence elements will be presented with their beneficial use for other species or different investigations.
Collapse
Affiliation(s)
- Markus Falkenstein
- Institute of Pharmaceutical and Medicinal Chemistry, Heinrich Heine University Düsseldorf, Duesseldorf, Germany
| | - Milica Elek
- Institute of Pharmaceutical and Medicinal Chemistry, Heinrich Heine University Düsseldorf, Duesseldorf, Germany
| | - Holger Stark
- Institute of Pharmaceutical and Medicinal Chemistry, Heinrich Heine University Düsseldorf, Duesseldorf, Germany.
| |
Collapse
|
10
|
Molecular Determinants of the Kinetic Binding Properties of Antihistamines at the Histamine H 1 Receptors. Int J Mol Sci 2021; 22:ijms22052400. [PMID: 33673686 PMCID: PMC7957501 DOI: 10.3390/ijms22052400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/17/2021] [Accepted: 02/25/2021] [Indexed: 12/12/2022] Open
Abstract
The binding affinity of ligands for their receptors is determined by their kinetic and thermodynamic binding properties. Kinetic analyses of the rate constants of association and dissociation (kon and koff, respectively) of antihistamines have suggested that second-generation antihistamines have a long duration of action owing to the long residence time (1/koff) at the H1 receptors. In this study, we examined the relationship between the kinetic and thermodynamic binding properties of antihistamines, followed by an evaluation of the structural determinants responsible for their kinetic binding properties using quantitative structure-activity relationship (QSAR) analyses. We found that whereas the binding enthalpy and entropy might contribute to the increase and decrease, respectively, in the koff values, there was no significant relationship with the kon values. QSAR analyses indicated that kon and koff values could be determined by the descriptors FASA_H (water-accessible surface area of all hydrophobic atoms divided by total water-accessible surface area) and vsurf_CW2 (a 3D molecular field descriptor weighted by capacity factor 2, the ratio of the hydrophilic surface to the total molecular surface), respectively. These findings provide further insight into the mechanisms by which the kinetic binding properties of antihistamines are regulated by their thermodynamic binding forces and physicochemical properties.
Collapse
|
11
|
Differential Regulation of Bilastine Affinity for Human Histamine H 1 Receptors by Lys 179 and Lys 191 via Its Binding Enthalpy and Entropy. Int J Mol Sci 2021; 22:ijms22041655. [PMID: 33562121 PMCID: PMC7915449 DOI: 10.3390/ijms22041655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 11/17/2022] Open
Abstract
Bilastine, a zwitterionic second-generation antihistamine containing a carboxyl group, has higher selectivity for H1 receptors than first-generation antihistamines. Ligand-receptor docking simulations have suggested that the electrostatic interaction between the carboxyl group of second-generation antihistamines and the amino group of Lys179ECL2 and Lys1915.39 of human H1 receptors might contribute to increased affinity of these antihistamines to H1 receptors. In this study, we evaluated the roles of Lys179ECL2 and Lys1915.39 in regulating the electrostatic and hydrophobic binding of bilastine to H1 receptors by thermodynamic analyses. The binding enthalpy and entropy of bilastine were estimated from the van ’t Hoff equation using the dissociation constants. These constants were obtained from the displacement curves against the binding of [3H] mepyramine to membrane preparations of Chinese hamster ovary cells expressing wild-type human H1 receptors and their Lys179ECL2 or Lys1915.39 mutants to alanine at various temperatures. We found that the binding of bilastine to wild-type H1 receptors occurred by enthalpy-dependent binding forces and, more dominantly, entropy-dependent binding forces. The mutation of Lys179ECL2 and Lys1915.39 to alanine reduced the affinity of bilastine to H1 receptors by reducing enthalpy- and entropy-dependent binding forces, respectively. These results suggest that Lys179ECL2 and Lys1915.39 differentially contribute to the increased binding affinity to bilastine via electrostatic and hydrophobic binding forces.
Collapse
|
12
|
Teixeira JG, Oliveira J. Voltammetric Study of the Antihistamine Drug Bilastine: Anodic Characterization and Quantification Using a Reusable MWCNTs Modified Screen Printed Carbon Electrode. ELECTROANAL 2020. [DOI: 10.1002/elan.202060494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Jorge Ginja Teixeira
- Chemistry Department of Science and Technology School Évora University CLAV Rua Romão Ramalho 59 7000-671 Évora Portugal
- HERCULES Laboratory Évora University Palácio do Vimioso Largo Marquês de Marialva 8 7000–809 Évora Portugal
| | - João Oliveira
- Chemistry Department of Science and Technology School Évora University CLAV Rua Romão Ramalho 59 7000-671 Évora Portugal
| |
Collapse
|
13
|
Kobayashi C, Tanaka A, Yasuda T, Hishinuma S. Roles of Lys191 and Lys179 in regulating thermodynamic binding forces of ligands to determine their binding affinity for human histamine H 1 receptors. Biochem Pharmacol 2020; 180:114185. [PMID: 32738199 DOI: 10.1016/j.bcp.2020.114185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 12/23/2022]
Abstract
Docking simulations based on the crystal structure of human histamine H1 receptors have predicted crucial roles of Lys1915.39 and Lys179ECL2, which exist at the entrance of the ligand-binding pocket, in increasing the H1-receptor selectivity for carboxylated second-generation antihistamines via electrostatic interaction. In this study, we evaluated the roles of Lys1915.39 and Lys179ECL2 in regulating the thermodynamic binding forces of non-carboxylated and carboxylated antihistamines that determine their binding affinity for human H1 receptors. The binding enthalpy and entropy of the 3 sets of non-carboxylated and corresponding carboxylated antihistamines (doxepin and olopatadine, desloratadine and loratadine, and terfenadine and fexofenadine, respectively) were estimated using the van't Hoff equation with the dissociation constants obtained from the displacement curves of the non-carboxylated and carboxylated antihistamines against the binding of [3H]mepyramine to the membrane preparations of Chinese hamster ovary cells expressing human H1 receptors at various temperatures, ranging from 4 °C to 37 °C. We found that the affinity for carboxylated antihistamines was lower than that for the corresponding non-carboxylated compounds due to lower enthalpy-dependent electrostatic binding forces and/or entropy-dependent hydrophobic binding forces. Mutations of Lys1915.39 and/or Lys179ECL2 to alanine mostly increased the binding affinity for antihistamines due to a variety of changes in both enthalpy- and entropy-dependent binding forces. These results suggest that Lys1915.39 and Lys179ECL2 may not contribute to selectively increasing the binding affinity for carboxylated antihistamines via electrostatic interaction, but that they can negatively modulate the binding affinity for non-carboxylated and carboxylated antihistamines non-selectively by affecting their electrostatic as well as hydrophobic binding forces.
Collapse
Affiliation(s)
- Chihiro Kobayashi
- Department of Pharmacodynamics, Meiji Pharmaceutical University, 2-522-1 Kiyose, Tokyo 204-8588, Japan
| | - Airi Tanaka
- Department of Pharmacodynamics, Meiji Pharmaceutical University, 2-522-1 Kiyose, Tokyo 204-8588, Japan
| | - Tomomi Yasuda
- Department of Pharmacodynamics, Meiji Pharmaceutical University, 2-522-1 Kiyose, Tokyo 204-8588, Japan
| | - Shigeru Hishinuma
- Department of Pharmacodynamics, Meiji Pharmaceutical University, 2-522-1 Kiyose, Tokyo 204-8588, Japan.
| |
Collapse
|
14
|
Koshiyama S, Tanimura K, Ito K, Funayama S, Hira D, Komase Y, Sato S. Gastroesophageal reflux-like symptoms are associated with hyposalivation and oropharyngeal problems in patients with asthma. Respir Investig 2020; 59:114-119. [PMID: 32665193 DOI: 10.1016/j.resinv.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/17/2020] [Accepted: 06/04/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous studies have suggested a significant relationship between hyposalivation and inhalation therapy-induced oropharyngeal problems. However, salivary secretion tests are not widely performed in daily clinical practice. In fact, xerostomia, the complaint of dry mouth, may not indicate hyposalivation. Therefore, we determined the clinical factors associated with hyposalivation in patients with asthma. METHODS This study is a post-hoc analysis of our previous studies. Adult patients with asthma on maintenance inhalation therapy were enrolled. The participants completed questionnaires on oropharyngeal symptoms and underwent a salivary secretion test. Symptom severity was evaluated using a numerical rating scale (NRS), and salivary secretion was measured using the modified cotton roll method. Using logistic regression analysis, we identified the clinical factors associated with hyposalivation. RESULTS In total, 531 patients completed the questionnaire (43.8 ± 16.9 years and male/female = 171/360), and 234 patients successfully performed a salivary secretion test, of which 126 (53.8%) were diagnosed with hyposalivation (<0.25 g/min). The patients with hyposalivation were significantly older (p < 0.0001) and had severe xerostomia and/or gastroesophageal reflux-like symptoms (GERLS) (p < 0.0001). Many of these patients had also used inhaled long-acting beta agonists (p = 0.012) and high-dose inhaled corticosteroids (p = 0.024). Multivariate analysis revealed that advanced age (odds ratio [OR] 1.05, p < 0.0001), severe xerostomia (OR 1.02, p = 0.0006) and severe GERLS (OR 1.02, p = 0.001) were independently and significantly associated with hyposalivation. CONCLUSIONS Age, xerostomia, and GERLS were significantly related to hyposalivation in patients with asthma. To identify oropharyngeal problems in these patients, a careful assessment of the suspected symptoms of gastroesophageal reflux may be useful.
Collapse
Affiliation(s)
- Setsuko Koshiyama
- Kyoto Pharmaceutical Association, 563 Bairin-cho, Higashioji Gojo Agaru, Higashiyama-ku, Kyoto, 605-0863, Japan; NPO Association of Inhalation Therapist, 1197-1 Yasashi-cho, Asahi-Ku, Yokohama, Kanagawa, 241-0811, Japan.
| | - Kazuya Tanimura
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan; NPO Association of Inhalation Therapist, 1197-1 Yasashi-cho, Asahi-Ku, Yokohama, Kanagawa, 241-0811, Japan.
| | - Kayoko Ito
- Oral Rehabilitation, Niigata University Medical and Dental Hospital, 754 Asahimachi-dori Ichibancho, Chuo-ku, Niigata, 951-8520, Japan.
| | - Saori Funayama
- Oral Rehabilitation, Niigata University Medical and Dental Hospital, 754 Asahimachi-dori Ichibancho, Chuo-ku, Niigata, 951-8520, Japan.
| | - Daiki Hira
- College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1 Noji-higashi, Kusatsu, Shiga, 525-8577, Japan; NPO Association of Inhalation Therapist, 1197-1 Yasashi-cho, Asahi-Ku, Yokohama, Kanagawa, 241-0811, Japan.
| | - Yuko Komase
- Department of Respiratory Internal Medicine, St. Marianna University School of Medicine, Yokohama-City Seibu Hospital, 1197-1 Yasashi-cho, Asahi-Ku, Yokohama, Kanagawa, 241-0811, Japan; NPO Association of Inhalation Therapist, 1197-1 Yasashi-cho, Asahi-Ku, Yokohama, Kanagawa, 241-0811, Japan.
| | - Susumu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan; NPO Association of Inhalation Therapist, 1197-1 Yasashi-cho, Asahi-Ku, Yokohama, Kanagawa, 241-0811, Japan.
| |
Collapse
|
15
|
Cataldi M, Maurer M, Taglialatela M, Church MK. Cardiac safety of second‐generation H
1
‐antihistamines when updosed in chronic spontaneous urticaria. Clin Exp Allergy 2019; 49:1615-1623. [DOI: 10.1111/cea.13500] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/16/2019] [Accepted: 09/02/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Mauro Cataldi
- Section of Pharmacology Department of Neuroscience School of Medicine University of Naples Federico II Naples Italy
| | - Marcus Maurer
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité–Universitätsmedizin Berlin Berlin Germany
| | - Maurizio Taglialatela
- Section of Pharmacology Department of Neuroscience School of Medicine University of Naples Federico II Naples Italy
| | - Martin K. Church
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité–Universitätsmedizin Berlin Berlin Germany
| |
Collapse
|
16
|
Nakamura T, Hiraoka K, Harada R, Matsuzawa T, Ishikawa Y, Funaki Y, Yoshikawa T, Tashiro M, Yanai K, Okamura N. Brain histamine H 1 receptor occupancy after oral administration of desloratadine and loratadine. Pharmacol Res Perspect 2019; 7:e00499. [PMID: 31338198 PMCID: PMC6624455 DOI: 10.1002/prp2.499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/30/2019] [Accepted: 06/10/2019] [Indexed: 01/27/2023] Open
Abstract
Some histamine H1 receptor (H1R) antagonists induce adverse sedative reactions caused by blockade of histamine transmission in the brain. Desloratadine is a second-generation antihistamine for treatment of allergic disorders. Its binding to brain H1Rs, which is the basis of sedative property of antihistamines, has not been examined previously in the human brain by positron emission tomography (PET). We examined brain H1R binding potential ratio (BPR), H1R occupancy (H1RO), and subjective sleepiness after oral desloratadine administration in comparison to loratadine. Eight healthy male volunteers underwent PET imaging with [11C]-doxepin, a PET tracer for H1Rs, after a single oral administration of desloratadine (5 mg), loratadine (10 mg), or placebo in a double-blind crossover study. BPR and H1RO in the cerebral cortex were calculated, and plasma concentrations of loratadine and desloratadine were measured. Subjective sleepiness was quantified by the Line Analogue Rating Scale (LARS) and the Stanford Sleepiness Scale (SSS). BPR was significantly lower after loratadine administration than after placebo (0.504 ± 0.074 vs 0.584 ± 0.059 [mean ± SD], P < 0.05), but BPR after desloratadine administration was not significantly different from BPR after placebo (0.546 ± 0.084 vs 0.584 ± 0.059, P = 0.250). The plasma concentration of loratadine was negatively correlated with BPR in subjects receiving loratadine, but that of desloratadine was not correlated with BPR. Brain H1ROs after desloratadine and loratadine administration were 6.47 ± 10.5% and 13.8 ± 7.00%, respectively (P = 0.103). Subjective sleepiness did not significantly differ among subjects receiving the two antihistamines and placebo. At therapeutic doses, desloratadine did not bind significantly to brain H1Rs and did not induce any significant sedation.
Collapse
Affiliation(s)
- Tadaho Nakamura
- Division of Pharmacology, Faculty of MedicineTohoku Medical and Pharmaceutical UniversitySendaiJapan
- Department of PharmacologyTohoku University Graduate School of MedicineSendaiJapan
| | - Kotaro Hiraoka
- Cyclotron and Radioisotope CenterTohoku UniversitySendaiJapan
| | - Ryuichi Harada
- Department of PharmacologyTohoku University Graduate School of MedicineSendaiJapan
| | - Takuro Matsuzawa
- Department of PharmacologyTohoku University Graduate School of MedicineSendaiJapan
| | - Yoichi Ishikawa
- Cyclotron and Radioisotope CenterTohoku UniversitySendaiJapan
| | | | - Takeo Yoshikawa
- Department of PharmacologyTohoku University Graduate School of MedicineSendaiJapan
| | - Manabu Tashiro
- Cyclotron and Radioisotope CenterTohoku UniversitySendaiJapan
| | - Kazuhiko Yanai
- Department of PharmacologyTohoku University Graduate School of MedicineSendaiJapan
| | - Nobuyuki Okamura
- Division of Pharmacology, Faculty of MedicineTohoku Medical and Pharmaceutical UniversitySendaiJapan
- Department of PharmacologyTohoku University Graduate School of MedicineSendaiJapan
| |
Collapse
|
17
|
Chen IS, Liu C, Tateyama M, Karbat I, Uesugi M, Reuveny E, Kubo Y. Non-sedating antihistamines block G-protein-gated inwardly rectifying K + channels. Br J Pharmacol 2019; 176:3161-3179. [PMID: 31116876 DOI: 10.1111/bph.14717] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/19/2019] [Accepted: 05/02/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND PURPOSE A second-generation antihistamine, terfenadine, is known to induce arrhythmia by blocking hERG channels. In this study, we have shown that terfenadine also inhibits the activity of G-protein-gated inwardly rectifying K+ (GIRK) channels, which regulate the excitability of neurons and cardiomyocytes. To clarify the underlying mechanism(s), we examined the effects of several antihistamines on GIRK channels and identified the structural determinant for the inhibition. EXPERIMENTAL APPROACH Electrophysiological recordings were made in Xenopus oocytes and rat atrial myocytes to analyse the effects of antihistamines on various GIRK subunits (Kir 3.x). Mutagenesis analyses identified the residues critical for inhibition by terfenadine and the regulation of ion selectivity. The potential docking site of terfenadine was analysed by molecular docking. KEY RESULTS GIRK channels containing Kir 3.1 subunits heterologously expressed in oocytes and native GIRK channels in atrial myocytes were inhibited by terfenadine and other non-sedating antihistamines. In Kir 3.1 subunits, mutation of Phe137, located in the centre of the pore helix, to the corresponding Ser in Kir 3.2 subunits reduced the inhibition by terfenadine. Introduction of an amino acid with a large side chain in Kir 3.2 subunits at Ser148 increased the inhibition. When this residue was mutated to a non-polar amino acid, the channel became permeable to Na+ . Phosphoinositide-mediated activity was also decreased by terfenadine. CONCLUSION AND IMPLICATIONS The Phe137 residue in Kir 3.1 subunits is critical for inhibition by terfenadine. This study provides novel insights into the regulation of GIRK channels by the pore helix and information for drug design.
Collapse
Affiliation(s)
- I-Shan Chen
- Division of Biophysics and Neurobiology, Department of Molecular and Cellular Physiology, National Institute for Physiological Sciences, National Institutes of Natural Sciences, Okazaki, Japan.,Department of Physiological Sciences, School of Life Science, SOKENDAI (The Graduate University for Advanced Studies), Hayama, Japan
| | - Chang Liu
- Division of Biophysics and Neurobiology, Department of Molecular and Cellular Physiology, National Institute for Physiological Sciences, National Institutes of Natural Sciences, Okazaki, Japan.,Department of Physiological Sciences, School of Life Science, SOKENDAI (The Graduate University for Advanced Studies), Hayama, Japan
| | - Michihiro Tateyama
- Division of Biophysics and Neurobiology, Department of Molecular and Cellular Physiology, National Institute for Physiological Sciences, National Institutes of Natural Sciences, Okazaki, Japan.,Department of Physiological Sciences, School of Life Science, SOKENDAI (The Graduate University for Advanced Studies), Hayama, Japan
| | - Izhar Karbat
- Department of Biomolecular Sciences, Weizmann Institute of Science, Rehovot, Israel
| | - Motonari Uesugi
- Institute for Integrated Cell-Material Sciences (WPI-iCeMS), Kyoto University, Uji, Japan.,Institute for Chemical Research, Kyoto University, Uji, Japan
| | - Eitan Reuveny
- Department of Biomolecular Sciences, Weizmann Institute of Science, Rehovot, Israel
| | - Yoshihiro Kubo
- Division of Biophysics and Neurobiology, Department of Molecular and Cellular Physiology, National Institute for Physiological Sciences, National Institutes of Natural Sciences, Okazaki, Japan.,Department of Physiological Sciences, School of Life Science, SOKENDAI (The Graduate University for Advanced Studies), Hayama, Japan
| |
Collapse
|
18
|
Zeerak S, Godse K, Kumar S. Awareness of Family Physicians Towards Antihistamines. Indian J Dermatol 2019; 64:112-114. [PMID: 30983606 PMCID: PMC6440187 DOI: 10.4103/ijd.ijd_325_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Antihistamines are one of the commonly prescribed groups of drugs for allergic disorders and pruritus. They are broadly grouped into two generations, the second-generation ones being more effective and with less side effects. The family physicians frequently use antihistamines as patients contact them initially for their problem. It will be interesting to know the mode of selection of antihistamines by them. MATERIALS AND METHODS The study was carried out on a sample of 100 family physicians. Primary data were collected from them after taking informed consent. A pre-validated questionnaire regarding knowledge, awareness, and prescribing schedule of antihistamines was filled up. The data were then analyzed with suitable statistical tests. RESULTS Almost 73% of physicians prescribed second-generation antihistamines, while 27% prescribed the first-generation ones. Only 15% of them were aware about the ARIA and GA2LEN guidelines and their recommendations for prescribing second-generation antihistamines over the older first-generation antihistamines, while 85% had not heard about them previously. A minimum 7% of practitioners revealed that they updosed the same drug four times in the treatment of urticaria, while 93% did not do it. CONCLUSION Even though a sizeable percentage of family physicians prescribed second-generation antihistamines, most of them were not aware of their dosing guidelines.
Collapse
Affiliation(s)
- Sumaya Zeerak
- From the Department of Dermatology, Sub-District Hospital, Pampore, Srinagar, Jammu and Kashmir, India
| | - Kiran Godse
- Department of Dermatology, Dr. D.Y. Patil School of Medicine, Mumbai, Maharashtra, India
| | - Sujit Kumar
- Department of Dermatology, Dr. D.Y. Patil School of Medicine, Mumbai, Maharashtra, India
| |
Collapse
|
19
|
Matterne U, Böhmer MM, Weisshaar E, Jupiter A, Carter B, Apfelbacher CJ. Oral H1 antihistamines as 'add-on' therapy to topical treatment for eczema. Cochrane Database Syst Rev 2019; 1:CD012167. [PMID: 30666626 PMCID: PMC6360926 DOI: 10.1002/14651858.cd012167.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The symptoms of eczema can lead to sleeplessness and fatigue and may have a substantial impact on quality of life. Use of oral H1 antihistamines (H1 AH) as adjuvant therapy alongside topical agents is based on the idea that combining the anti-inflammatory effects of topical treatments with the blocking action of histamine on its receptors in the skin by H1 AH (to reduce the principal symptom of itch) might magnify or intensify the effect of treatment. Also, it would be unethical to compare oral H1 AH alone versus no treatment, as topical treatment is the standard management for this condition. OBJECTIVES To assess the effects of oral H1 antihistamines as 'add-on' therapy to topical treatment in adults and children with eczema. SEARCH METHODS We searched the following databases up to May 2018: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and the GREAT database (Global Resource of EczemA Trials; from inception). We searched five trials registers and checked the reference lists of included and excluded studies for further references to relevant randomised controlled trials (RCTs). We also searched the abstracts of four conference proceedings held between 2000 and 2018. SELECTION CRITERIA We sought RCTs assessing oral H1 AH as 'add-on' therapy to topical treatment for people with eczema compared with topical treatment plus placebo or no additional treatment as add-on therapy. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. Primary outcome measures were 'Mean change in patient-assessed symptoms of eczema' and 'Proportion of participants reporting adverse effects and serious adverse events'. Secondary outcomes were 'Mean change in physician-assessed clinical signs', 'Mean change in quality of life', and 'Number of eczema flares'. MAIN RESULTS We included 25 studies (3285 randomised participants). Seventeen studies included 1344 adults, and eight studies included 1941 children. Most studies failed to report eczema severity at baseline, but they were conducted in secondary care settings, so it is likely that they recruited patients with more severe cases of eczema. Trial duration was between three days and 18 months. Researchers studied 13 different H1 AH treatments. We could not undertake pooling because of the high level of diversity across studies in terms of duration and dose of intervention, concomitant topical therapy, and outcome assessment. Risk of bias was generally unclear, but five studies had high risk of bias in one domain (attrition, selection, or reporting bias). Only one study measured quality of life, but these results were insufficient for statistical analysis.Although this review assessed 17 comparisons, we summarise here the results of three key comparisons in this review.Cetirizine versus placeboOne study compared cetirizine 0.5 mg/kg/d against placebo over 18 months in 795 children. Study authors did not report patient-assessed symptoms of eczema separately for pruritus. Cetirizine is probably associated with fewer adverse events (mainly mild) (risk ratio (RR) 0.68, 95% confidence interval (CI) 0.46 to 1.01) and the need for slightly less additional H1 AH use as an indication of eczema flare rate (P = 0.035; no further numerical data given). Physician-assessed clinical signs (SCORing Atopic Dermatitis index (SCORAD)) were reduced in both groups, but the difference between groups was reported as non-significant (no P value given). Evidence for this comparison was of moderate quality.One study assessed cetirizine 10 mg/d against placebo over four weeks in 84 adults. Results show no evidence of differences between groups in patient-assessed symptoms of eczema (pruritus measured as part of SCORAD; no numerical data given), numbers of adverse events (RR 1.11, 95% CI 0.50 to 2.45; mainly sedation, other skin-related problems, respiratory symptoms, or headache), or physician-assessed changes in clinical signs, amount of local rescue therapy required, or number of applications as an indicator of eczema flares (no numerical data reported). Evidence for this comparison was of low quality.Fexofenadine versus placeboCompared with placebo, fexofenadine 120 mg/d taken in adults over one week (one study) probably leads to a small reduction in patient-assessed symptoms of pruritus on a scale of 0 to 8 (mean difference (MD) -0.25, 95% CI -0.43 to -0.07; n = 400) and a greater reduction in the ratio of physician-assessed pruritus area to whole body surface area (P = 0.007; no further numerical data given); however, these reductions may not be clinically meaningful. Results suggest probably little or no difference in adverse events (mostly somnolence and headache) (RR 1.05, 95% CI 0.74 to 1.50; n = 411) nor in the amount of 0.1% hydrocortisone butyrate used (co-intervention in both groups) as an indicator of eczema flare, but no numerical data were given. Evidence for this comparison was of moderate quality.Loratadine versus placeboA study of 28 adults compared loratadine 10 mg/d taken over 4 weeks versus placebo. Researchers found no evidence of differences between groups in patient-assessed pruritus, measured by a 100-point visual analogue scale (MD -2.30, 95% CI -20.27 to 15.67); reduction in physician-assessed clinical signs (SCORAD) (MD -4.10, 95% CI -13.22 to 5.02); or adverse events. Study authors reported only one side effect (folliculitis with placebo) (RR 0.25, 95% CI 0.01 to 5.76). Evidence for this comparison was of low quality. Number of eczema flares was not measured for this comparison. AUTHORS' CONCLUSIONS Based on the main comparisons, we did not find consistent evidence that H1 AH treatments are effective as 'add-on' therapy for eczema when compared to placebo; evidence for this comparison was of low and moderate quality. However, fexofenadine probably leads to a small improvement in patient-assessed pruritus, with probably no significant difference in the amount of treatment used to prevent eczema flares. Cetirizine was no better than placebo in terms of physician-assessed clinical signs nor patient-assessed symptoms, and we found no evidence that loratadine was more beneficial than placebo, although all interventions seem safe.The quality of evidence was limited because of poor study design and imprecise results. Future researchers should clearly define the condition (course and severity) and clearly report their methods, especially participant selection and randomisation; baseline characteristics; and outcomes (based on the Harmonising Outcome Measures in Eczema initiative).
Collapse
Affiliation(s)
- Uwe Matterne
- University of RegensburgMedical Sociology, Institute of Epidemiology and Preventive MedicineRegensburgGermany
| | - Merle Margarete Böhmer
- University of RegensburgMedical Sociology, Institute of Epidemiology and Preventive MedicineRegensburgGermany
| | - Elke Weisshaar
- Heidelberg University HospitalDepartment of Clinical Social MedicineThibautstrasse 3HeidelbergGermany69115
| | - Aldrin Jupiter
- Heidelberg University HospitalDepartment of Clinical Social MedicineThibautstrasse 3HeidelbergGermany69115
| | - Ben Carter
- King's College London; Institute of Psychiatry, Psychology & NeuroscienceBiostatistics and Health InformaticsDenmark HillLondonUK
| | - Christian J Apfelbacher
- University of RegensburgMedical Sociology, Institute of Epidemiology and Preventive MedicineRegensburgGermany
| | | |
Collapse
|
20
|
Antihistamines for Allergic Rhinitis Treatment from the Viewpoint of Nonsedative Properties. Int J Mol Sci 2019; 20:ijms20010213. [PMID: 30626077 PMCID: PMC6337346 DOI: 10.3390/ijms20010213] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 12/26/2018] [Accepted: 12/29/2018] [Indexed: 12/21/2022] Open
Abstract
Antihistamines targeting the histamine H1 receptor play an important role in improving and maintaining the quality of life of patients with allergic rhinitis. For more effective and safer use of second-generation drugs, which are recommended by various guidelines, a classification based on their detailed characteristics is necessary. Antihistamines for first-line therapy should not have central depressant/sedative activities. Sedative properties (drowsiness and impaired performance) are associated with the inhibition of central histamine neurons. Brain H1 receptor occupancy (H1RO) is a useful index shown to be correlated with indices based on clinical findings. Antihistamines are classified into non-sedating (<20%), less-sedating (20–50%), and sedating (≥50%) groups based on H1RO. Among the non-sedating group, fexofenadine and bilastine are classified into “non-brain-penetrating antihistamines” based on the H1RO. These two drugs have many common chemical properties. However, bilastine has more potent binding affinity to the H1 receptor, and its action tends to last longer. In well-controlled studies using objective indices, bilastine does not affect psychomotor or driving performance even at twice the usual dose (20 mg). Upon selecting antihistamines for allergic rhinitis, various situations should be taken into our consideration. This review summarizes that the non-brain-penetrating antihistamines should be chosen for the first-line therapy of mild allergic rhinitis.
Collapse
|
21
|
Gasheva OY, Tsoy Nizamutdinova I, Hargrove L, Gobbell C, Troyanova-Wood M, Alpini SF, Pal S, Du C, Hitt AR, Yakovlev VV, Newell-Rogers MK, Zawieja DC, Meininger CJ, Alpini GD, Francis H, Gashev AA. Prolonged intake of desloratadine: mesenteric lymphatic vessel dysfunction and development of obesity/metabolic syndrome. Am J Physiol Gastrointest Liver Physiol 2019; 316:G217-G227. [PMID: 30475062 PMCID: PMC6383386 DOI: 10.1152/ajpgi.00321.2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This study aimed to establish mechanistic links between the prolonged intake of desloratadine, a common H1 receptor blocker (i.e., antihistamine), and development of obesity and metabolic syndrome. Male Sprague-Dawley rats were treated for 16 wk with desloratadine. We analyzed the dynamics of body weight gain, tissue fat accumulation/density, contractility of isolated mesenteric lymphatic vessels, and levels of blood lipids, glucose, and insulin, together with parameters of liver function. Prolonged intake of desloratadine induced development of an obesity-like phenotype and signs of metabolic syndrome. These alterations in the body included excessive weight gain, increased density of abdominal subcutaneous fat and intracapsular brown fat, high blood triglycerides with an indication of their rerouting toward portal blood, high HDL, high fasting blood glucose with normal fasting and nonfasting insulin levels (insulin resistance), high liver/body weight ratio, and liver steatosis (fatty liver). These changes were associated with dysfunction of mesenteric lymphatic vessels, specifically high lymphatic tone and resistance to flow together with diminished tonic and abolished phasic responses to increases in flow, (i.e., greatly diminished adaptive reserves to respond to postprandial increases in lymph flow). The role of nitric oxide in this flow-dependent adaptation was abolished, with remnants of these responses controlled by lymphatic vessel-derived histamine. Our current data, considered together with reports in the literature, support the notion that millions of the United States population are highly likely affected by underevaluated, lymphatic-related side effects of antihistamines and may develop obesity and metabolic syndrome due to the prolonged intake of this medication. NEW & NOTEWORTHY Prolonged intake of desloratadine induced development of obesity and metabolic syndrome associated with dysfunction of mesenteric lymphatic vessels, high lymphatic tone, and resistance to flow together with greatly diminished adaptive reserves to respond to postprandial increases in lymph flow. Data support the notion that millions of the USA population are highly likely affected by underevaluated, lymphatic-related side effects of antihistamines and may develop obesity and metabolic syndrome due to the prolonged intake of this medication.
Collapse
Affiliation(s)
- Olga Y. Gasheva
- 1Department of Medical Physiology, College of Medicine, Texas A&M University Health Science Center, Temple, Texas
| | - Irina Tsoy Nizamutdinova
- 1Department of Medical Physiology, College of Medicine, Texas A&M University Health Science Center, Temple, Texas
| | - Laura Hargrove
- 2Central Texas Veterans Health Care System, Temple, Texas
| | - Cassidy Gobbell
- 3Department of Biomedical Engineering, Texas A&M University, College Station, Texas
| | - Maria Troyanova-Wood
- 3Department of Biomedical Engineering, Texas A&M University, College Station, Texas
| | | | - Sarit Pal
- 1Department of Medical Physiology, College of Medicine, Texas A&M University Health Science Center, Temple, Texas
| | - Christina Du
- 4Department of Comparative Medicine, Baylor Scott & White Health, Temple, Texas
| | - Angie R. Hitt
- 4Department of Comparative Medicine, Baylor Scott & White Health, Temple, Texas
| | - Vlad V. Yakovlev
- 3Department of Biomedical Engineering, Texas A&M University, College Station, Texas
| | - M. Karen Newell-Rogers
- 1Department of Medical Physiology, College of Medicine, Texas A&M University Health Science Center, Temple, Texas
| | - David C. Zawieja
- 1Department of Medical Physiology, College of Medicine, Texas A&M University Health Science Center, Temple, Texas
| | - Cynthia J. Meininger
- 1Department of Medical Physiology, College of Medicine, Texas A&M University Health Science Center, Temple, Texas
| | - Gianfranco D. Alpini
- 1Department of Medical Physiology, College of Medicine, Texas A&M University Health Science Center, Temple, Texas,2Central Texas Veterans Health Care System, Temple, Texas
| | - Heather Francis
- 1Department of Medical Physiology, College of Medicine, Texas A&M University Health Science Center, Temple, Texas,2Central Texas Veterans Health Care System, Temple, Texas
| | - Anatoliy A. Gashev
- 1Department of Medical Physiology, College of Medicine, Texas A&M University Health Science Center, Temple, Texas
| |
Collapse
|
22
|
Hishinuma S, Tamura Y, Kobayashi C, Akatsu C, Shoji M. Differential Regulation of Thermodynamic Binding Forces of Levocetirizine and ( S)-Cetirizine by Lys191 in Human Histamine H₁ Receptors. Int J Mol Sci 2018; 19:ijms19124067. [PMID: 30558340 PMCID: PMC6321019 DOI: 10.3390/ijms19124067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 01/24/2023] Open
Abstract
Cetirizine is a zwitterionic second-generation antihistamine containing R- and S-enantiomers, levocetirizine, and (S)-cetirizine. Levocetirizine is known to have a higher affinity for the histamine H₁ receptors than (S)-cetirizine; ligand-receptor docking simulations have suggested the importance of the formation of a salt bridge (electrostatic interaction) between the carboxylic group of levocetirizine and the Lys191 residue at the fifth transmembrane domain of human histamine H₁ receptors. In this study, we evaluated the roles of Lys191 in the regulation of the thermodynamic binding forces of levocetirizine in comparison with (S)-cetirizine. The binding enthalpy and entropy of these compounds were estimated from the van 't Hoff equation, by using the dissociation constants obtained from their displacement curves against the binding of [³H]mepyramine to the membrane preparations of Chinese hamster ovary cells expressing wild-type human H₁ receptors and their Lys191 mutants to alanine at various temperatures. We found that the higher binding affinity of wild-type H₁ receptors for levocetirizine than (S)-cetirizine was achieved by stronger forces of entropy-dependent hydrophobic binding of levocetirizine. The mutation of Lys191 to alanine reduced the affinities for levocetirizine and (S)-cetirizine, through a reduction in the entropy-dependent hydrophobic binding forces of levocetirizine and the enthalpy-dependent electrostatic binding forces of (S)-cetirizine. These results suggested that Lys191 differentially regulates the binding enthalpy and entropy of these enantiomers, and that Lys191 negatively regulates the enthalpy-dependent electrostatic binding forces of levocetirizine, contrary to the predictions derived from the ligand-receptor docking simulations.
Collapse
Affiliation(s)
- Shigeru Hishinuma
- Department of Pharmacodynamics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan.
| | - Yuri Tamura
- Department of Pharmacodynamics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan.
| | - Chihiro Kobayashi
- Department of Pharmacodynamics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan.
| | - Chizuru Akatsu
- Department of Pharmacodynamics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan.
| | - Masaru Shoji
- Department of Pharmacodynamics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan.
| |
Collapse
|
23
|
Kikuchi A, Nasir FBM, Inami A, Mohsen A, Watanuki S, Miyake M, Takeda K, Koike D, Ito T, Sasakawa J, Matsuda R, Hiraoka K, Maurer M, Yanai K, Watabe H, Tashiro M. Effects of levocetirizine and diphenhydramine on regional glucose metabolic changes and hemodynamic responses in the human prefrontal cortex during cognitive tasks. Hum Psychopharmacol 2018. [PMID: 29532516 PMCID: PMC5900896 DOI: 10.1002/hup.2655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Antihistamines often have sedative side effects. This was the first study to measure regional cerebral glucose (energy) consumption and hemodynamic responses in young adults during cognitive tests after antihistamine administration. METHODS In this double-blind, placebo-controlled, three-way crossover study, 18 healthy young Japanese men received single doses of levocetirizine 5 mg and diphenhydramine 50 mg at intervals of at least six days. Subjective feeling, task performances, and brain activity were evaluated during three cognitive tests (word fluency, two-back, and Stroop). Regional cerebral glucose consumption changes were measured using positron emission tomography with [18 F]fluorodeoxyglucose. Regional hemodynamic responses were measured using near-infrared spectroscopy. RESULTS Energy consumption in prefrontal regions was significantly increased after antihistamine administration, especially diphenhydramine, whereas prefrontal hemodynamic responses, evaluated with oxygenated hemoglobin levels, were significantly lower with diphenhydramine treatment. Stroop test accuracy was significantly impaired by diphenhydramine, but not by levocetirizine. There was no significant difference in subjective sleepiness. CONCLUSIONS Physiological "coupling" between metabolism and perfusion in the healthy human brain may not be maintained under pharmacological influence due to antihistamines. This uncoupling may be caused by a combination of increased energy demands in the prefrontal regions and suppression of vascular permeability in brain capillaries after antihistamine treatment. Further research is needed to validate this hypothesis.
Collapse
Affiliation(s)
- Asuka Kikuchi
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope CenterTohoku UniversitySendaiJapan
| | | | - Akie Inami
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope CenterTohoku UniversitySendaiJapan
| | - Attayeb Mohsen
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope CenterTohoku UniversitySendaiJapan,Department of PharmacologyTohoku University Graduate School of MedicineSendaiJapan,Bioinformatics ProjectNational Institutes of Biomedical Innovation, Health, and NutritionOsakaJapan
| | - Shoichi Watanuki
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope CenterTohoku UniversitySendaiJapan
| | - Masayasu Miyake
- Division of Radiation Safety, Cyclotron and Radioisotope CenterTohoku UniversitySendaiJapan
| | - Kazuko Takeda
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope CenterTohoku UniversitySendaiJapan
| | - Daigo Koike
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope CenterTohoku UniversitySendaiJapan
| | - Takayasu Ito
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope CenterTohoku UniversitySendaiJapan
| | - Junpei Sasakawa
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope CenterTohoku UniversitySendaiJapan
| | - Rin Matsuda
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope CenterTohoku UniversitySendaiJapan
| | - Kotaro Hiraoka
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope CenterTohoku UniversitySendaiJapan
| | - Marcus Maurer
- Department of Dermatology and AllergyCharité—Universitätsmedizin BerlinBerlinGermany
| | - Kazuhiko Yanai
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope CenterTohoku UniversitySendaiJapan,Department of PharmacologyTohoku University Graduate School of MedicineSendaiJapan
| | - Hiroshi Watabe
- Division of Radiation Safety, Cyclotron and Radioisotope CenterTohoku UniversitySendaiJapan
| | - Manabu Tashiro
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope CenterTohoku UniversitySendaiJapan
| |
Collapse
|
24
|
Sakano E, Sarinho ESC, Cruz AA, Pastorino AC, Tamashiro E, Kuschnir F, Castro FFM, Romano FR, Wandalsen GF, Chong-Neto HJ, Mello JFD, Silva LR, Rizzo MC, Miyake MAM, Rosário Filho NA, Rubini NDPM, Mion O, Camargos PA, Roithmann R, Godinho RN, Pignatari SSN, Sih T, Anselmo-Lima WT, Solé D. IV Brazilian Consensus on Rhinitis - an update on allergic rhinitis. Braz J Otorhinolaryngol 2017; 84:S1808-8694(17)30187-8. [PMID: 29254864 PMCID: PMC9442845 DOI: 10.1016/j.bjorl.2017.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/16/2017] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The guidelines on allergic rhinitis aim to update knowledge about the disease and care for affected patients. The initiative called "Allergic Rhinitis and its Impact on Asthma", initially published in 2001 and updated in 2008 and 2010, has been very successful in disseminating information and evidence, as well as providing a classification of severity and proposing a systemized treatment protocol. In order to include the participation of other medical professionals in the treatment of allergic rhinitis, it is important to develop algorithms that accurately indicate what should and can be done regionally. OBJECTIVE To update the III Brazilian Consensus on Rhinitis - 2012, with the creation of an algorithm for allergic rhinitis management. METHODS We invited 24 experts nominated by the Brazilian Association of Allergy and Immunology, Brazilian Association of Otorhinolaryngology and Head and Neck Surgery and Brazilian Society of Pediatrics to update the 2012 document. RESULTS The update of the last Brazilian Consensus on Rhinitis incorporated and adapted the relevant information published in all "Allergic Rhinitis and its Impact on Asthma" Initiative documents to the Brazilian scenario, bringing new concepts such as local allergic rhinitis, new drugs and treatment evaluation methods. CONCLUSION A flowchart for allergic rhinitis treatment has been proposed.
Collapse
Affiliation(s)
- Eulalia Sakano
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Oftalmologia e Otorrinolaringologia, Campinas, SP, Brazil; Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil.
| | - Emanuel S C Sarinho
- Universidade Federal de Pernambuco (UFPE), Faculdade de Medicina, Departamento de Pediatria, Recife, PE, Brazil; Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Alvaro A Cruz
- Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Departamento de Pediatria - Instituto da Criança, Salvador, BA, Brazil; Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil
| | - Antonio C Pastorino
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Department of Pediatrics - Instituto da Criança, São Paulo, SP, Brazil
| | - Edwin Tamashiro
- Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Fábio Kuschnir
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade do Estado do Rio de Janeiro (UERJ), Faculdade de Medicina, Departamento de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Fábio F M Castro
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Medicina - Divisão de Imunologia Clínica e Alergia, São Paulo, SP, Brazil
| | - Fabrizio R Romano
- Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Gustavo F Wandalsen
- Universidade Federal de Pernambuco (UFPE), Faculdade de Medicina, Departamento de Pediatria, Recife, PE, Brazil; Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Herberto J Chong-Neto
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal do Paraná (UFPR), Departamento de Pediatria, Curitiba, PR, Brazil
| | - João F de Mello
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Luciana R Silva
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Departamento de Pediatria, Salvador, BA, Brazil
| | - Maria Cândida Rizzo
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Cidade de São Paulo (UNICID), Faculdade de Medicina, São Paulo, SP, Brazil
| | - Mônica A M Miyake
- Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil; Hospital Sirio-Libanês, Núcleo de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Nelson A Rosário Filho
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal do Paraná (UFPR), Departamento de Pediatria, Curitiba, PR, Brazil
| | - Norma de Paula M Rubini
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Departamento de Medicina, Divisão de Alergia e Imunologia, Rio de Janeiro, RJ, Brazil
| | - Olavo Mion
- Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Paulo A Camargos
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal de Minas Gerais (UFMG), Departamento de Pediatria, Divisão de Pneumologia, Belo Horizonte, MG, Brazil
| | - Renato Roithmann
- Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil; Universidade Luterana do Brasil (ULBRA), Departamento de Otorrinolaringologia, Canoas, RS, Brazil
| | - Ricardo N Godinho
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Pontifícia Universidade Católica de Minas Gerais (PUC-MG), Instituto de Ciências Biológicas e da Saúde, Belo Horizonte, MG, Brazil
| | - Shirley Shizue N Pignatari
- Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil; Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Tania Sih
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, São Paulo, SP, Brazil
| | - Wilma T Anselmo-Lima
- Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Dirceu Solé
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Pediatria - Divisão de Alergia, Imunologia Clínica e Reumatologia, São Paulo, SP, Brazil
| |
Collapse
|
25
|
Yanai K, Yoshikawa T, Yanai A, Nakamura T, Iida T, Leurs R, Tashiro M. The clinical pharmacology of non-sedating antihistamines. Pharmacol Ther 2017; 178:148-156. [PMID: 28457804 DOI: 10.1016/j.pharmthera.2017.04.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We previously reported on brain H1 receptor occupancy measurements of antihistamines in human brain using [11C]doxepin and positron emission tomography (PET). We proposed the use of brain H1 receptor occupancy to classify antihistamines objectively into three categories of sedating, less-sedating, and non-sedating antihistamines according to their sedative effects. Non-sedating antihistamines are recommended for the treatment of allergies such as pollinosis and atopic dermatitis because of their low penetration into the central nervous system. Physicians and pharmacists are responsible for fully educating patients about the risks of sedating antihistamines from pharmacological points of view. If a sedating antihistamine must be prescribed, its sedative effects should be thoroughly considered before choosing the drug. Non-sedating antihistamines should be preferentially used whenever possible as most antihistamines are equally efficacious, while adverse effects of sedating antihistamines can be serious. This review summarizes the pharmacological properties of clinically useful non-sedating antihistamines from the perspective of histamine function in the CNS.
Collapse
Affiliation(s)
- Kazuhiko Yanai
- Department of Pharmacology, Tohoku University School of Medicine, Sendai 980-8575, Japan; Cyclotron and Radioisotope Center, Tohoku University, Sendai 980-8578, Japan
| | - Takeo Yoshikawa
- Department of Pharmacology, Tohoku University School of Medicine, Sendai 980-8575, Japan.
| | - Ai Yanai
- Department of Pharmacology, Tohoku University School of Medicine, Sendai 980-8575, Japan
| | - Tadaho Nakamura
- Department of Pharmacology, Tohoku Medical and Pharmaceutical University, Sendai 981-8558, Japan
| | - Tomomitsu Iida
- Department of Pharmacology, Tohoku University School of Medicine, Sendai 980-8575, Japan
| | - Rob Leurs
- Amsterdam Institute of Molecules, Medicines and Systems, Department of Medicinal Chemistry, Vrije Universiteit Amsterdam, The Netherlands
| | - Manabu Tashiro
- Cyclotron and Radioisotope Center, Tohoku University, Sendai 980-8578, Japan
| |
Collapse
|
26
|
Hishinuma S, Kosaka K, Akatsu C, Uesawa Y, Fukui H, Shoji M. Asp73-dependent and -independent regulation of the affinity of ligands for human histamine H 1 receptors by Na . Biochem Pharmacol 2016; 128:46-54. [PMID: 28040476 DOI: 10.1016/j.bcp.2016.12.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 12/27/2016] [Indexed: 11/16/2022]
Abstract
The affinity of ligands for G-protein-coupled receptors (GPCRs) is allosterically regulated by Na+ via a highly conserved aspartate residue (Asp2.50) in the second transmembrane domain of GPCRs. In the present study, we examined the Na+-mediated regulation of the affinity of ligands for Gq/11-protein-coupled human histamine H1 receptors in Chinese hamster ovary cells. The affinities of 3 agonists and 20 antihistamines were evaluated by their displacement curves against the binding of [3H]-mepyramine to membrane preparations in the presence or absence of 100mM NaCl. The affinities of most drugs including histamine, an agonist, and d-chlorpheniramine, a first-generation antihistamine, were reduced by NaCl, with the extent of NaCl-mediated changes varying widely between drugs. In contrast, the affinities of some second-generation antihistamines such as fexofenadine were increased by NaCl. These changes were retained in intact cells. The mutation of Asp2.50 (Asp73) to asparagine abrogated NaCl-induced reductions in affinities for histamine and d-chlorpheniramine, but not NaCl-induced increases in the affinity for fexofenadine. Quantitative structure-activity relationship (QSAR) analyses showed that these Na+-mediated changes were explained and predicted by a combination of the molecular energies and implicit solvation energies of the compounds. These results suggest that Na+ diversely regulates the affinity of ligands for H1 receptors from the extracellular sites of receptors via Asp73-dependent and -independent mechanisms in a manner that depends on the physicochemical properties of ligands. These results may contribute to a deeper understanding of the fundamental mechanisms by which the affinity of ligands for their receptors is allosterically regulated by Na+.
Collapse
Affiliation(s)
- Shigeru Hishinuma
- Department of Pharmacodynamics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan.
| | - Kiyoe Kosaka
- Department of Pharmacodynamics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Chizuru Akatsu
- Department of Pharmacodynamics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Yoshihiro Uesawa
- Department of Clinical Pharmaceutics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Hiroyuki Fukui
- Department of Molecular Studies for Incurable Diseases, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
| | - Masaru Shoji
- Department of Pharmacodynamics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| |
Collapse
|
27
|
|
28
|
Wandalsen GF, Miranda C, Ensina LF, Sano F, Amazonas RB, Silva JMD, Solé D. Association between desloratadine and prednisolone in the treatment of children with acute symptoms of allergic rhinitis: a double-blind, randomized and controlled clinical trial. Braz J Otorhinolaryngol 2016; 83:633-639. [PMID: 27670203 PMCID: PMC9449020 DOI: 10.1016/j.bjorl.2016.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/06/2016] [Accepted: 08/14/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction A combination of antihistamines and oral corticosteroids is often used to treat acute symptoms of allergic rhinitis. Objective To evaluate safety and efficacy of desloratadine plus prednisolone in the treatment of acute symptoms of children (2–12 years) with allergic rhinitis, and to compare it to dexchlorpheniramine plus betamethasone. Methods Children with moderate/severe persistent allergic rhinitis and symptomatic (nasal symptoms score [0–12] ≥ 6) were allocated in a double-blind, randomized fashion to receive dexchlorpheniramine plus betamethasone (n = 105; three daily doses) or desloratadine plus prednisolone (n = 105; single dose followed by two of placebo) for 7 days. At the beginning and end of the evaluation, the following were obtained: nasal symptoms score, extra nasal symptoms score, peak nasal inspiratory flow, blood biochemistry, and electrocardiogram. Ninety-six children of the dexchlorpheniramine plus betamethasone group and 98 of the desloratadine plus prednisolone group completed the protocol. Results The two groups were similar regarding initial and final nasal symptoms scores, extra nasal symptoms scores and peak nasal inspiratory flow. A drop of 76.4% and 79.1% for nasal symptoms score, 86.0% and 79.2% for extra nasal symptoms score, as well as an increase of 25.2% and 24.3% for peak nasal inspiratory flow occurred for those treated with desloratadine plus prednisolone and dexchlorpheniramine plus betamethasone, respectively. There were no significant changes in blood chemistry. Sinus tachycardia was the most frequent electrocardiogram change, but with no clinical significance. Drowsiness was reported significantly more often among those of dexchlorpheniramine plus betamethasone group (17.14% × 8.57%, respectively). Conclusion The desloratadine plus prednisolone combination was able to effectively control acute symptoms of rhinitis in children, improving symptoms and nasal function. Compared to the dexchlorpheniramine plus betamethasone combination, it showed similar clinical action, but with a lower incidence of adverse events and higher dosing convenience.
Collapse
Affiliation(s)
- Gustavo F Wandalsen
- Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina, (EPM) Departamento de Pediatria, São Paulo, SP, Brazil
| | - Carolina Miranda
- Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina, (EPM) Departamento de Ginecologia, São Paulo, SP, Brazil; Fundação de Apoio à Escola Paulista de Medicina (FAP), São Paulo, SP, Brazil
| | - Luis Felipe Ensina
- Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina, (EPM) Departamento de Pediatria, São Paulo, SP, Brazil; Universidade de Santo Amaro (Unisa), Clínica Médica, São Paulo, SP, Brazil
| | - Flavio Sano
- Hospital Nipo-Brasileiro, Pediatria, São Paulo, SP, Brazil
| | - Roberto Bleul Amazonas
- Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil; Fundação Getúlio Vargas, MBA em Marketing, Rio de Janeiro, RJ, Brazil; Grupo NC Farma, São Paulo, SP, Brazil
| | | | - Dirceu Solé
- Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina, (EPM) Departamento de Pediatria, São Paulo, SP, Brazil.
| |
Collapse
|
29
|
Hishinuma S, Nozawa H, Akatsu C, Shoji M. C-terminal of human histamine H 1 receptors regulates their agonist-induced clathrin-mediated internalization and G-protein signaling. J Neurochem 2016; 139:552-565. [PMID: 27566099 DOI: 10.1111/jnc.13834] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 08/02/2016] [Accepted: 08/25/2016] [Indexed: 02/06/2023]
Abstract
It has been suggested that the agonist-induced internalization of G-protein-coupled receptors from the cell surface into intracellular compartments regulates cellular responsiveness. We previously reported that Gq/11 -protein-coupled human histamine H1 receptors internalized via clathrin-dependent mechanisms upon stimulation with histamine. However, the molecular determinants of H1 receptors responsible for agonist-induced internalization remain unclear. In this study, we evaluated the roles of the intracellular C-terminal of human histamine H1 receptors tagged with hemagglutinin (HA) at the N-terminal in histamine-induced internalization in Chinese hamster ovary cells. The histamine-induced internalization was evaluated by the receptor binding assay with [3 H]mepyramine and confocal immunofluorescence microscopy with an anti-HA antibody. We found that histamine-induced internalization was inhibited under hypertonic conditions or by pitstop, a clathrin terminal domain inhibitor, but not by filipin or nystatin, disruptors of the caveolar structure and function. The histamine-induced internalization was also inhibited by truncation of a single amino acid, Ser487, located at the end of the intracellular C-terminal of H1 receptors, but not by its mutation to alanine. In contrast, the receptor-G-protein coupling, which was evaluated by histamine-induced accumulation of [3 H]inositol phosphates, was potentiated by truncation of Ser487, but was lost by its mutation to alanine. These results suggest that the intracellular C-terminal of human H1 receptors, which only comprises 17 amino acids (Cys471-Ser487), plays crucial roles in both clathrin-dependent internalization of H1 receptors and G-protein signaling, in which truncation of Ser487 and its mutation to alanine are revealed to result in biased signaling toward activation of G-proteins and clathrin-mediated internalization, respectively.
Collapse
Affiliation(s)
- Shigeru Hishinuma
- Department of Pharmacodynamics, Meiji Pharmaceutical University, Tokyo, Japan
| | - Hiroki Nozawa
- Department of Pharmacodynamics, Meiji Pharmaceutical University, Tokyo, Japan
| | - Chizuru Akatsu
- Department of Pharmacodynamics, Meiji Pharmaceutical University, Tokyo, Japan
| | - Masaru Shoji
- Department of Pharmacodynamics, Meiji Pharmaceutical University, Tokyo, Japan
| |
Collapse
|
30
|
Cima F, Franchi N. Histamine Stimulates Ciliary Beat Frequency via the H2 Receptor in the ProtochordateBotryllus schlosseri. JOURNAL OF EXPERIMENTAL ZOOLOGY PART B-MOLECULAR AND DEVELOPMENTAL EVOLUTION 2016; 326:176-92. [DOI: 10.1002/jez.b.22675] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/04/2016] [Accepted: 04/11/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Francesca Cima
- Department of Biology; University of Padova; Padova Italy
| | - Nicola Franchi
- Department of Biology; University of Padova; Padova Italy
| |
Collapse
|
31
|
Abstract
By 2050, the US aging population will nearly double. It will be increasingly important for health care providers to diagnose and manage rhinitis. Nasal symptoms of rhinorrhea, congestion, sneezing, nasal/ocular pruritus, and postnasal drainage affect up to 32% of older adults, and can impact quality of life. Several underlying factors associated with aging may contribute to the pathogenesis of rhinitis in older adults. Although treatment options for rhinitis exist, special considerations need to be made because comorbidities, limited income, memory loss, and side effects of medications are common in older adults and may impact outcomes.
Collapse
Affiliation(s)
- Alan P Baptist
- Division of Allergy and Clinical Immunology, University of Michigan, 24 Frank Lloyd Wright Drive, Suite H-2100, Ann Arbor, MI 48106, USA.
| | - Sharmilee Nyenhuis
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, 840 S. Wood Street MC 719, Chicago, IL 60612, USA
| |
Collapse
|
32
|
Inami A, Matsuda R, Grobosch T, Komamura H, Takeda K, Yamada Y, Miyake M, Hiraoka K, Maurer M, Yanai K, Tashiro M. A simulated car-driving study on the effects of acute administration of levocetirizine, fexofenadine, and diphenhydramine in healthy Japanese volunteers. Hum Psychopharmacol 2016; 31:167-77. [PMID: 26999510 DOI: 10.1002/hup.2524] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 01/18/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Antihistamines are often used for treating allergic rhinitis. However, many older antihistamines cause sedative side effects. The sedative effects of antihistamines on car-driving have been investigated. This has not been investigated for levocetirizine, a new-generation antihistamine, in Asian populations, and so we evaluated its sedative effects in healthy Japanese subjects. METHODS In this double-blind, placebo-controlled, four-way crossover study, healthy volunteers received single doses of levocetirizine 5 mg, fexofenadine 60 mg, diphenhydramine 50 mg, and placebo at intervals of at least 6 days. Simple brake reaction time and choice brake reaction time task (CBRT), a lateral tracking (LT) task, and a multiple task, a mixture of CBRT and LT task, were used to compare driving performance between the four drugs. Subjective sedation was also assessed. RESULTS The simple brake reaction time and CBRT, and the CBRT component of the multiple task, did not show any significant differences between the drugs. In contrast, the LT, both as a single parameter and as a component of the multiple task, showed significant differences between diphenhydramine and the newer-generation antihistamines in a manner that corresponds with subjective sedation. CONCLUSIONS Levocetirizine and fexofenadine did not impair psychomotor performance in subjects performing simulated car-driving tasks, while diphenhydramine did impair psychomotor performance in the subjects. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Akie Inami
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan
| | - Rin Matsuda
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan
| | - Thomas Grobosch
- Department of Dermatology and Allergy, Allergie-Centrum-Charité/ECARF, Charité - Universitätsmedizin, Berlin, Germany
| | - Hiroshi Komamura
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan
| | - Kazuko Takeda
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan
| | - Yusuke Yamada
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan
| | - Masayasu Miyake
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan
| | - Kotaro Hiraoka
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan
| | - Marcus Maurer
- Department of Dermatology and Allergy, Allergie-Centrum-Charité/ECARF, Charité - Universitätsmedizin, Berlin, Germany
| | - Kazuhiko Yanai
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan.,Department of Pharmacology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Manabu Tashiro
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan
| |
Collapse
|
33
|
Histamine H1 Receptor Occupancy in the Human Brain Measured by Positron Emission Tomography. HISTAMINE RECEPTORS 2016. [DOI: 10.1007/978-3-319-40308-3_13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
34
|
Jáuregui I, Ramaekers JG, Yanai K, Farré M, Redondo E, Valiente R, Labeaga L. Bilastine: a new antihistamine with an optimal benefit-to-risk ratio for safety during driving. Expert Opin Drug Saf 2015; 15:89-98. [PMID: 26571227 DOI: 10.1517/14740338.2016.1112786] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Rational selection of a second-generation H1-antihistamine requires efficacy and safety considerations, particularly regarding central nervous system (CNS) effects (cognitive and psychomotor function), potential for driving impairment, minimal sedative effects and a lack of interactions. This review evaluates the key safety features of the non-sedating antihistamine, bilastine, during driving and in preventing road traffic accidents. AREAS COVERED Among the second-generation H1-antihistamines, sedative effects which can affect cognitive and psychomotor performance, and possibly driving ability, may not be similar. Bilastine is absorbed rapidly, undergoes no hepatic metabolism or cytochrome P450 interaction (minimal drug-drug interaction potential), and is a substrate for P-glycoprotein (limiting CNS entry). Positron emission tomography showed that, compared with other second-generation H1-antihistamines, bilastine has the lowest cerebral histamine H1-receptor occupancy. Bilastine 20 mg once daily (therapeutic dose) is non-sedating, does not enhance the effects of alcohol or CNS sedatives, does not impair driving performance and has at least similar efficacy as other second-generation H1-antihistamines in the treatment of allergic rhinoconjunctivitis and urticaria. EXPERT OPINION Current evidence shows that bilastine has an optimal benefit-to-risk ratio, meeting all conditions for contributing to safety in drivers who need antihistamines, and hence for being considered as an antihistamine of choice for drivers.
Collapse
Affiliation(s)
- Ignacio Jáuregui
- a Allergy Department , Basurto University Hospital , Bilbao 48013 , Spain
| | - Johannes G Ramaekers
- b Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience , Maastricht University , Maastricht , The Netherlands
| | - Kazuhiko Yanai
- c Department of Pharmacology , Tohoku University Graduate School of Medicine , Sendai , Japan
| | - Magí Farré
- d Clinical Pharmacology Unit , Hospital Universitari Germans Trias i Pujol-IGTP, Hospital del Mar Medical Research Institute-IMIM, and Universidad Autónoma de Barcelona-UAB , Barcelona , Spain
| | - Esther Redondo
- e Coordinadora del Grupo de Trabajo de Actividades Preventivas de SEMERGEN , International Health Center , Madrid , Spain
| | - Román Valiente
- f Medical and Clinical Department , FAES FARMA S. A. , Leioa , Spain
| | - Luis Labeaga
- f Medical and Clinical Department , FAES FARMA S. A. , Leioa , Spain
| |
Collapse
|
35
|
Hu Y, Sieck DE, Hsu WH. Why are second-generation H1-antihistamines minimally sedating? Eur J Pharmacol 2015; 765:100-6. [PMID: 26291661 DOI: 10.1016/j.ejphar.2015.08.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 11/29/2022]
Abstract
H1-antihistamines are widely used in treating allergic disorders, e.g., conjunctivitis, urticaria, dermatitis and asthma. The first-generation H1-antihistamines have a much greater sedative effect than the second-generation H1-antihistamines. Researchers could not offer a satisfactory explanations until late 1990s when studies showed that second-generation H1-antihistamines were substrates of P-glycoprotein. P-glycoprotein, expressed in the blood-brain barrier, acts as an efflux pump to decrease the concentration of H1-antihistamines in the brain, which minimizes drug effects on the central nervous system and results in less sedation. P-glycoprotein is found in the apical side of the epithelium. It consists of transmembrane domains that bind substrates/drugs and nucleotide-binding domains that bind and hydrolyze ATP to generate energy for the drug efflux. This review mainly discusses interactions between P-glycoprotein and commonly used second-generation H1-antihistamines. In addition, it describes other possible determining factors of minimal sedating properties of second-generation H1-antihistamines.
Collapse
Affiliation(s)
- Yawen Hu
- Department of Biomedical Science, Iowa State University, Ames, IA, USA
| | - Deidra E Sieck
- Department of Biomedical Science, Iowa State University, Ames, IA, USA
| | - Walter H Hsu
- Department of Biomedical Science, Iowa State University, Ames, IA, USA.
| |
Collapse
|
36
|
Farré M, Pérez-Mañá C, Papaseit E, Menoyo E, Pérez M, Martin S, Bullich S, Rojas S, Herance JR, Trampal C, Labeaga L, Valiente R. Bilastine vs. hydroxyzine: occupation of brain histamine H1 -receptors evaluated by positron emission tomography in healthy volunteers. Br J Clin Pharmacol 2015; 78:970-80. [PMID: 24833043 PMCID: PMC4243871 DOI: 10.1111/bcp.12421] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 05/08/2014] [Indexed: 12/16/2022] Open
Abstract
AIM A close correlation exists between positron emission tomography (PET)-determined histamine H1 -receptor occupancy (H1 RO) and the incidence of sedation. Antihistamines with H1 RO <20% are classified as non-sedating. The objective was to compare the H1 RO of bilastine, a second generation antihistamine, with that of hydroxyzine. METHODS This randomized, double-blind, crossover study used PET imaging with [(11) C]-doxepin to evaluate H1 RO in 12 healthy males (mean age 26.2 years), after single oral administration of bilastine (20 mg), hydroxyzine (25 mg) or placebo. Binding potentials and H1 ROs were calculated in five cerebral cortex regions of interest: frontal, occipital, parietal, temporal, insula. Plasma bilastine concentrations, subjective sedation (visual analogue scale), objective psychomotor performance (digital symbol substitution test), physiological variables and safety (adverse events, AEs), were also evaluated. RESULTS The mean binding potential of all five regions of interest (total binding potential) was significantly greater with bilastine than hydroxyzine (mean value 0.26 vs. 0.13, P < 0.01; mean difference and 95% CI -0.130 [-0.155, 0.105]). There was no significant difference between bilastine and placebo. Overall H1 RO by bilastine was significantly lower than that by hydroxyzine (mean value -3.92% vs. 53.95%, P < 0.01; mean difference and 95% CI 57.870% [42.664%, 73.075%]). There was no significant linear relationship between individual bilastine plasma concentrations and total binding potential values. No significant between-treatment differences were observed for sedation and psychomotor performance. Twenty-six non-serious AEs were reported. Sleepiness or sedation was not reported with bilastine but appeared in some subjects with hydroxyzine. CONCLUSIONS A single oral dose of bilastine 20 mg had minimal H1 RO, was not associated with subjective sedation or objective impairment of psychomotor performance and was devoid of treatment-related sedative AEs, thus satisfying relevant subjective, objective and PET criteria as a non-sedating antihistamine.
Collapse
Affiliation(s)
- Magí Farré
- Human Pharmacology and Neuroscience Research Unit, Hospital del Mar Medical Research Institute-IMIM, and Universidad Autónoma de Barcelona-UAB, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Fitzsimons R, van der Poel LA, Thornhill W, du Toit G, Shah N, Brough HA. Antihistamine use in children. Arch Dis Child Educ Pract Ed 2015; 100:122-31. [PMID: 25147323 DOI: 10.1136/archdischild-2013-304446] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 07/28/2014] [Indexed: 12/12/2022]
Abstract
This review provides an overview of the use of antihistamines in children. We discuss types of histamine receptors and their mechanism of action, absorption, onset and duration of action of first-generation and second-generation H(1)-antihistamines, as well as elimination of H(1)-antihistamines which has important implications for dosing in children. The rationale for the use of H(1)-antihistamines is explored for the relief of histamine-mediated symptoms in a variety of allergic conditions including: non-anaphylactic allergic reactions, atopic eczema (AE), allergic rhinitis (AR) and conjunctivitis, chronic spontaneous urticaria (CSU) and whether they have a role in the management of intermittent and chronic cough, anaphylaxis, food protein-induced gastrointestinal allergy and asthma prevention. Second-generation H(1)-antihistamines are preferable to first-generation H(1)-antihistamines in the management of non-anaphylactic allergic reactions, AR, AE and CSU due to: their better safety profile, including minimal cognitive and antimuscarinic side effects and a longer duration of action. We offer some guidance as to the choices of H(1)-antihistamines available currently and their use in specific clinical settings. H(1)-antihistamine class, availability, licensing, age and dosing administration, recommended indications in allergic conditions and modalities of delivery for the 12 more commonly used H(1)-antihistamines in children are also tabulated.
Collapse
Affiliation(s)
- Roisin Fitzsimons
- Children's Allergy Service, Guy's and St. Thomas' NHS Foundation Trust, London, UK Department of Asthma, Allergy and Respiratory Science, King's College London, London, UK
| | | | - William Thornhill
- Evelina Children's Pharmacy, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - George du Toit
- Children's Allergy Service, Guy's and St. Thomas' NHS Foundation Trust, London, UK Department of Asthma, Allergy and Respiratory Science, King's College London, London, UK
| | - Neil Shah
- Department of Gastroenterology, Great Ormond Street Hospital, London, UK TARGID, Catholic University of Leuven, Leuven, The Netherlands
| | - Helen A Brough
- Children's Allergy Service, Guy's and St. Thomas' NHS Foundation Trust, London, UK Department of Asthma, Allergy and Respiratory Science, King's College London, London, UK
| |
Collapse
|
38
|
Do JA, Kim JY, Choi JY, Lee JH, Kim HJ, Noh E, Cho SH, Yoon CY, Kim WS. Development of a LC.MS/MS method for simultaneous analysis of 20 antihistamines in dietary supplements. ANALYTICAL SCIENCE AND TECHNOLOGY 2015. [DOI: 10.5806/ast.2015.28.2.86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
39
|
Central nervous system effects of the second-generation antihistamines marketed in Japan--review of inter-drug differences using the proportional impairment ratio (PIR)-. PLoS One 2014; 9:e114336. [PMID: 25501360 PMCID: PMC4264760 DOI: 10.1371/journal.pone.0114336] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 11/08/2014] [Indexed: 11/19/2022] Open
Abstract
Background Second-generation antihistamines (AHs) have, in general, fewer sedative effects than the first-generation. However, important inter-drug differences remain in the degree of cognitive and/or psychomotor impairment. The extent to which a particular compound causes disruption can be conveniently compared, to all other AHs, using the Proportional Impairment Ratio (PIR). Although the PIR can differentiate the relative impairment caused by individual drugs, there is no indication of the reliability of the ratios obtained. Objective To calculate the PIRs –together with 95% confidence intervals (CIs), as an index of reliability– and compare AHs currently, or soon to be, available in Japan, with respect to their intrinsic capacity to cause impairment. Methods Results from studies of cetirizine, desloratadine, ebastine, fexofenadine, levocetirizine, loratadine, mequitazine, and olopatadine were included in the PIR calculations. All data utilised came from crossover studies in healthy volunteers which were randomised and placebo and positive-internal controlled. Existing databases from studies reporting the sedative effects of AHs on objective (speed, accuracy, memory) and subjective (feeling) psychometrics were augmented, via results from suitable studies published after the previous reviews. The null value for a PIR was one. Results A total of 45 studies were finally included for this review. Of the AHs assessed, fexofenadine, ebastine, and levocetirizine showed a PIR for objective tests of 0. However, only fexofenadine (PIR = 0.49) had an upper limit of the 95% CI of less than 1. Fexofenadine, levocetirizine, desloratadine, olopatadine, loratadine, and mequitazine all had a PIR for subjective ratings of 0, but the upper limits of the 95% CIs were all in excess of 1, although fexofenadine (PIR = 2.57) was the lowest. Conclusions The results show that there are differences between second-generation AHs in the extent of sedation produced. However, subjective ratings indicate that patients may not necessarily be aware of this.
Collapse
|
40
|
Hiraoka K, Tashiro M, Grobosch T, Maurer M, Oda K, Toyohara J, Ishii K, Ishiwata K, Yanai K. Brain histamine H1 receptor occupancy measured by PET after oral administration of levocetirizine, a non-sedating antihistamine. Expert Opin Drug Saf 2014; 14:199-206. [PMID: 25466429 DOI: 10.1517/14740338.2015.989831] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Histamine H1 receptor (H1R) antagonists often have sedative side effects, which are caused by the blockade of the neural transmission of the histaminergic neurons. We examined the brain H1R occupancy (H1RO) and the subjective sleepiness of levocetirizine, a new second-generation antihistamine, comparing fexofenadine, another non-sedating antihistamine, as a negative active control. METHODS Eight healthy volunteers underwent positron emission tomography (PET) imaging with [(11)C]doxepin, a PET tracer that specifically binds to H1Rs, after a single oral administration of levocetirizine (5 mg), fexofenadine (60 mg) or placebo in a double-blind crossover study. Binding potential ratios and H1ROs in the cerebral cortices regions were calculated using placebo. Subjective sleepiness was assessed with the Line Analogue Rating Scale and the Stanford Sleepiness Scale. RESULTS There was no significant difference between the mean brain H1RO after levocetirizine administration (8.1%; 95% CI: -9.8 to 26.0%) and fexofenadine administration (-8.0%; 95% CI: -26.7 to 10.6%). Similarly, subjective sleepiness was not significantly different between the two antihistamines and placebo. Neither subjective sleepiness nor plasma concentrations was significantly correlated with the brain H1RO of the two antihistamines. CONCLUSION At therapeutic dose, levocetirizine does not bind significantly to the brain H1Rs and does not induce significant sedation.
Collapse
Affiliation(s)
- Kotaro Hiraoka
- Tohoku University, Cyclotron and Radioisotope Center, Division of Cyclotron Nuclear Medicine , 6-3, Aoba, Aramaki, Aoba-ku, Sendai, 980-8578 , Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
Background Chronic spontaneous urticaria (CSU) is characterised by the development of crops of red, itchy, raised weals or hives with no identifiable external cause.Objectives To assess the effects of H1-antihistamines for CSU.Search methods We searched the following databases up to June 2014: Cochrane Skin Group Specialised Register, CENTRAL (2014, Issue 5), MEDLINE(from 1946), EMBASE (from 1974) and PsycINFO (from 1806). We searched five trials registers and checked articles for references to relevant randomised controlled trials.Selection criteria We included randomised controlled trials of H1-antihistamines for CSU. Interventions included single therapy or a combination of H1-antihistamines compared with no treatment (placebo) or another active pharmacological compound at any dose.Data collection and analysis We used standard methodological procedures as expected by The Cochrane Collaboration.Our primary outcome measures were proportion of participants with complete suppression of urticaria: 'good or excellent' response,50% or greater improvement in quality of life measures, and adverse events.We present risk ratios (RR) with 95% confidence intervals(CIs). Main results We identified 73 studies (9759 participants); 34 studies provided data for 23 comparisons. The duration of the intervention was up to two weeks (short-term) or longer than two weeks and up to three months (intermediate-term).Cetirizine 10mg once daily in the short term and in the intermediate term led to complete suppression of urticaria by more participants than was seen with placebo (RR 2.72, 95% CI 1.51 to 4.91). For this same outcome, comparison of desloratadine versus placebo in the intermediate term (5 mg) (RR 37.00, 95% CI 2.31 to 593.70) and in the short term (20 mg) (RR 15.97, 95% CI 1.04 to 245.04)favoured desloratadine, but no differences were seen between 5 mg and 10 mg for short-term treatment.Levocetirizine 20 mg per day (short-term) was more effective for complete suppression of urticaria compared with placebo (RR 20.87,95% CI 1.37 to 317.60), and at 5 mg was effective in the intermediate term (RR 52.88, 95% CI 3.31 to 843.81) but not in the shortterm, nor was 10 mg effective in the short term.Rupatadine at 10 mg and 20 mg in the intermediate term achieved a 'good or excellent response' compared with placebo (RR 1.35,95% CI 1.03 to 1.77).Loratadine (10 mg) versus placebo (RR 1.86, 95% CI 0.91 to 3.79) and loratadine (10 mg) versus cetirizine (10 mg) (RR 1.05, 95%CI 0.76 to 1.43) over short-term and intermediate-term treatment showed no significant difference for 'good or excellent response' or for complete suppression of urticaria, respectively.Loratadine (10 mg) versus desloratadine (5 mg) (intermediate-term) showed no statistically significant difference for complete suppression of urticaria (RR 0.91, 95% CI 0.78 to 1.06) or for 'good or excellent response' (RR 1.04, 95% CI 0.64 to 1.71). For loratadine(10 mg) versus mizolastine (10 mg) (intermediate-term), no statistically significant difference was seen for complete suppression of urticaria (RR 0.86, 95% CI 0.64 to 1.16) or for 'good or excellent response' (RR 0.88, 95% CI 0.55 to 1.42).Loratadine (10mg) versus emedastine (2mg) (intermediate-term) showed no statistically significant difference for complete suppression(RR 1.04, 95% CI 0.78 to 1.39) or for 'good or excellent response' (RR 1.09, 95% CI 0.96 to 1.24); the quality of the evidence was moderate for this comparison.No difference in short-term treatment was noted between loratadine (10mg) and hydroxyzine (25mg) in terms of complete suppression(RR 1.00, 95% CI 0.32 to 3.10).When desloratadine (5 to 20 mg) was compared with levocetirizine (5 to 20 mg), levocetirizine appeared to be the more effective (P value < 0.02).In a comparison of fexofenadine versus cetirizine, more participants in the cetirizine group showed complete suppression of urticaria(P value < 0.001).Adverse events leading to withdrawals were not significantly different in the following comparisons: cetirizine versus placebo at 10 mg and 20 mg (RR 3.00, 95% CI 0.68 to 13.22); desloratadine 5 mg versus placebo (RR 1.46, 95% CI 0.42 to 5.10); loratadine 10 mg versus mizolastine 10 mg (RR 0.38, 95% CI 0.04 to 3.60); loratadine 10mg versus emedastine 2mg (RR 1.09, 95%CI 0.07 to 17.14);cetirizine 10 mg versus hydroxyzine 25 mg (RR 0.78, 95% CI 0.25 to 2.45); and hydroxyzine 25 mg versus placebo (RR 3.64, 95%CI 0.77 to 17.23), all intermediate term.No difference was seen between loratadine 10 mg versus mizolastine 10 mg in the proportion of participants with at least 50%improvement in quality of life (RR 3.21, 95% CI 0.32 to 32.33).Authors' conclusions Although the results of our review indicate that at standard doses of treatment, several antihistamines are effective when compared with placebo, all results were gathered from a few studies or, in some cases, from single-study estimates. The quality of the evidence was affected by the small number of studies in each comparison and the small sample size for many of the outcomes, prompting us to downgrade the quality of evidence for imprecision (unless stated for each comparison, the quality of the evidence was low).No single H1-antihistamine stands out as most effective. Cetirizine at 10 mg once daily in the short term and in the intermediate term was found to be effective in completely suppressing urticaria. Evidence is limited for desloratadine given at 5 mg once daily in the intermediate term and at 20 mg in the short term. Levocetirizine at 5 mg in the intermediate but not short term was effective for complete suppression. Levocetirizine 20 mg was effective in the short term, but 10 mg was not. No difference in rates of withdrawal due to adverse events was noted between active and placebo groups. Evidence for improvement in quality of life was insufficient.
Collapse
Affiliation(s)
- Maulina Sharma
- Department of Dermatology, Derby Hospitals NHS Foundation Trust, London Road Community Hospital, London Road, Derby, DE1 2QY, UK.
| | | | | | | |
Collapse
|
42
|
Potter PC. Effectiveness and safety of new-generation antihistamines in allergenic rhinitis and urticaria. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2005.10873256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
43
|
Differential thermodynamic driving force of first- and second-generation antihistamines to determine their binding affinity for human H1 receptors. Biochem Pharmacol 2014; 91:231-41. [PMID: 25065879 DOI: 10.1016/j.bcp.2014.07.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 07/17/2014] [Accepted: 07/17/2014] [Indexed: 01/03/2023]
Abstract
Differential binding sites for first- and second-generation antihistamines were indicated on the basis of the crystal structure of human histamine H1 receptors. In this study, we evaluated differences between the thermodynamic driving forces of first- and second-generation antihistamines for human H1 receptors and their structural determinants. The binding enthalpy and entropy of 20 antihistamines were estimated with the van't Hoff equation using their dissociation constants obtained from their displacement curves against the binding of [(3)H]mepyramine to membrane preparations of Chinese hamster ovary cells expressing human H1 receptors at various temperatures from 4°C to 37°C. Structural determinants of antihistamines for their thermodynamic binding properties were assessed by quantitative structure-activity relationship (QSAR) analyses. We found that entropy-dependent binding was more evident in second- than first-generation antihistamines, resulting in enthalpy-entropy compensation between the binding forces of first- and second-generation antihistamines. QSAR analyses indicated that enthalpy-entropy compensation was determined by the sum of degrees, maximal electrostatic potentials, water-accessible surface area and hydrogen binding acceptor count of antihistamines to regulate their affinity for receptors. In conclusion, it was revealed that entropy-dependent hydrophobic interaction was more important in the binding of second-generation antihistamines, even though the hydrophilicity of second-generation antihistamines is generally increased. Furthermore, their structural determinants responsible for enthalpy-entropy compensation were explored by QSAR analyses. These findings may contribute to understanding the fundamental mechanisms of how the affinity of ligands for their receptors is regulated.
Collapse
|
44
|
Uesawa Y, Hishinuma S, Shoji M. Molecular Determinants Responsible for Sedative and Non-sedative Properties of Histamine H1–Receptor Antagonists. J Pharmacol Sci 2014; 124:160-8. [DOI: 10.1254/jphs.13169fp] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
45
|
García-Martín E, Canto G, Agúndez JAG. Metabolic considerations of drugs in the treatment of allergic diseases. Expert Opin Drug Metab Toxicol 2013; 9:1437-52. [PMID: 23902458 DOI: 10.1517/17425255.2013.823400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The clinical management of allergic diseases involves a number of drugs, most of which are extensively metabolized. This review aims to analyze the metabolism and the clinical implications of altered metabolism for these drugs. AREAS COVERED The authors present an overview of current knowledge of the metabolism of: antihistamine drugs, glucocorticoids, inhaled β-2 bronchodilators, anticholinergics and other drugs used in allergic diseases, such as cromoglycate, omalizumab, montelukast and epinephrine. Polymorphic drug metabolism is relevant for chlorpheniramine, loratadine and montelukast. Inhibition of drug metabolism is relevant for loratadine, methylprednisolone, fluticasone, mometasone, triamcinolone or prednisolone. Polymorphic pre-systemic metabolism may be relevant to budesonide, fluticasone, beclomethasone, mometasone or salmeterol. The authors also discuss the current information on gene variations according to the 1,000 genomes catalog and other databases. Finally, the authors review the clinical implications of these variations with a particular regard to drugs used in the management of allergic diseases. EXPERT OPINION Most drugs used in allergic diseases are extensively metabolized. Drug interaction or adverse reactions related to altered metabolism are relevant issues that should be considered in the management of allergic diseases. However, much additional research is required before defining pharmacogenomic biomarkers for the management of drugs used in allergic diseases.
Collapse
Affiliation(s)
- Elena García-Martín
- University of Extremadura, Department of Biochemistry & Molecular Biology , Avda. de la Universidad s/n, E-10071, Cáceres , Spain +34927257000 ext 89676 ;
| | | | | |
Collapse
|
46
|
Abstract
The medical treatment of allergic rhino-conjunctivitis involves different classes of drugs administered locally or by general route. They belong to three main classes, antihistamines, steroids and mast cell stabilizers. Since it is a relatively benign and also highly common disease, treatment options are limited by possible, even mild, side effects and by cost efficacy restriction. In the more severe forms of the condition, treatment efficacy remains unsatisfactory.
Collapse
Affiliation(s)
- R Harf
- Service de pneumologie A, pavillon médical, centre hospitalier Lyon sud, hospices civils de Lyon, 69310 Pierre-Bénite, France.
| |
Collapse
|
47
|
Nettis E, Delle Donne P, Di Leo E, Calogiuri GF, Ferrannini A, Vacca A. Rupatadine for the treatment of urticaria. Expert Opin Pharmacother 2013; 14:1807-13. [PMID: 23806068 DOI: 10.1517/14656566.2013.813481] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Rupatadine fumarate is a second-generation antihistamine provided with a potent, long-lasting and balanced in vivo dual platelet-activating factor (PAF) and histamine antagonist activity and it uniquely combines both activities at a high level of potency. Rupatadine has a rapid onset of action and a long-lasting effect, so a once-daily dosing is permitted, moreover is well tolerated by young adults and the elders. Rupatadine does not present the side effects of first-generation H1-antihistamines, such as somnolence, fatigue, headache, impaired memory and learning, sedation, increased appetite, dry mouth, dry eyes, visual disturbances, constipation, urinary retention and erectile dysfunction. AREAS COVERED This study evaluates the effectiveness and safety of rupatadine in chronic urticaria (CU) and acquired cold urticaria (ACU), through a systematic review of the literature. EXPERT OPINION Patients affected by urticaria are often discouraged because frequently their disease does not recognize a cause and it is unresponsive to treatments. Patients can control their symptoms assuming second-generation H1-antihistamines, such as rupatadine. Several randomized, double-blind, placebo-controlled trials testify effectiveness and safety of rupatadine in CU and ACU. However, further clinical trials to evaluate the efficacy of rupatadine in different urticaria subtypes and to test the safety of doses higher than 20 mg are encouraged.
Collapse
Affiliation(s)
- Eustachio Nettis
- University of Bari Medical School, Section of Allergology and Clinical Immunology, Department of Internal Medicine and Infectious Diseases, Bari, Italy.
| | | | | | | | | | | |
Collapse
|
48
|
Abstract
H1-antihistamines, the mainstay of treatment for urticaria, were developed from anticholinergic drugs more than 70 years ago. They act as inverse agonists rather than antagonists of histamine H1-receptors which are members of the G-protein family. The older first generation H1-antihistamines penetrate readily into the brain to cause sedation, drowsiness, fatigue and impaired concentration and memory causing detrimental effects on learning and examination performance in children and on impairment of the ability of adults to work and drive. Their use should be discouraged. The newer second-generation H1-antihistamines are safer, cause less sedation and are more efficacious. Three drugs widely used for symptomatic relief in urticaria, desloratadine, levocetirizine and fexofenadine are highlighted in this review. Of these levocetirizine and fexofenadine are the most potent in humans in vivo. However, levocetirizine may cause somnolence in susceptible individuals, whereas fexofenadine has a relatively short duration of action and may be required to be given twice daily for all round daily protection. Although desloratadine is less potent, it has the advantages of rarely causing somnolence and having a long duration of action.
Collapse
Affiliation(s)
- Martin K Church
- Allergie-Centrum-Charité/ECARF, Charité-Universitätsmedizin Berlin, Germany
| | | |
Collapse
|
49
|
Jáuregui I, Ferrer M, Bartra J, del Cuvillo A, Dávila I, Montoro J, Mullol J, Sastre J, Valero A. Bilastine for the treatment of urticaria. Expert Opin Pharmacother 2013; 14:1537-44. [DOI: 10.1517/14656566.2013.800044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
50
|
Mizuguchi H, Ono S, Hattori M, Sasaki Y, Fukui H. Usefulness of HeLa cells to evaluate inverse agonistic activity of antihistamines. Int Immunopharmacol 2013; 15:539-43. [PMID: 23453703 DOI: 10.1016/j.intimp.2013.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 02/06/2013] [Accepted: 02/07/2013] [Indexed: 11/25/2022]
Abstract
Antihistamines are thought to antagonize histamine and prevent it from binding to the histamine H1 receptor (H1R). However, recent studies indicate that antihistamines are classified into two groups, i.e., inverse agonists and neutral antagonists on the basis of their ability to down-regulate the constitutive activity of H1R. As H1R is an allergy-sensitive gene whose expression influences the severity of allergic symptoms, inverse agonists should more potently alleviate allergic symptoms than neutral antagonists by inhibiting H1R constitutive activity. Therefore, it is important to assess inverse agonistic activity of antihistamines. Here we report a novel assay method using HeLa cells expressing H1R endogenously for evaluation of inverse agonistic activity of antihistamines. Pretreatment with inverse agonists down-regulated H1R gene expression below to its basal level. On the other hand, basal H1R mRNA expression was unchanged by neutral antagonist pretreatment. Both inverse agonists and neutral antagonists suppressed histamine-induced H1R mRNA elevation. Classification of antihistamines on the basis of their suppressive activity of basal H1R gene expression was consistent with that of inositol phosphate accumulation in H1R-overexpressed cells. Our data suggest that the assay method using HeLa cells is more convenient and useful than the existing methods and may contribute to develop new antihistamines with inverse agonistic activity.
Collapse
Affiliation(s)
- Hiroyuki Mizuguchi
- Department of Molecular Pharmacology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima 770-8505, Japan
| | | | | | | | | |
Collapse
|