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Pentewar GS, Parab SR. Pharmacoeconomic Assessment of Antiallergic Drugs by Comparing Serum Immunoglobulin E Level as a Diagnostic and Monitoring Indicator of Allergic Rhinitis in Rural Population of India. Indian J Otolaryngol Head Neck Surg 2023; 75:928-933. [PMID: 37206771 PMCID: PMC10188763 DOI: 10.1007/s12070-023-03488-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/12/2023] [Indexed: 01/30/2023] Open
Abstract
Allergic rhinitis (AR) is a chronic inflammatory disease induced by IgE mediated reaction and identified clinically by presence of nasal discharge, sneezing, itching and nasal congestion. Aim of this study was to determine Serum IgE level which is an important indicator of AR. To analyse the diagnostic significance of serum IgE level and their pharmacoeconomic status in the management of AR with commonly used antihistaminic. Estimation of serum IgE can serve as a simple and reliable investigative tool in the diagnostic and management of AR. Fifty two adult patient with history of allergic rhinitis were randomly divided into four study groups and administered either Cetirizine, Levocetirizine, Loratidine or Fexofenadine respectively for one week. Blood samples were analysed to determine serum IgE level and the results were subjected to statistical analysis. The mean value and standard deviation were obtained and tabulated using paired t test. A total 52 patient were divided into four group, 13 in each group of age between 18 and 65 years (mean age 33.73 ± 10.23 years); 48.08% females and 51.92% male were randomized. Mean compliance with treatment was 100% for all study groups. The mean serum IgE level was significantly reduced in Levocetirizine as compared to Cetirizine, Loratidine and Fexofenadine groups. Levocetirizine controls the symptoms of AR better as compared to Cetirizine, Loratidine and Fexofenadine and is a better choice due to its cost effectiveness, tolerability and safety profile.
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Mohana Karthikeyan S, Nikisha GN. Efficacy and Safety of Diethylcarbamazine in Treatment of Allergic Rhinitis: A Double Blind Randomised Controlled Trial. Indian J Otolaryngol Head Neck Surg 2022; 74:1169-1177. [PMID: 36452711 PMCID: PMC9702384 DOI: 10.1007/s12070-020-02249-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/24/2020] [Indexed: 10/23/2022] Open
Abstract
There are many evidences showing diethylcarbamazine as a potential drug for the treatment of allergic rhinitis. This study evaluated the effectiveness of diethylcarbamazine in the treatment of allergic rhinitis and compared it with montelukast and levocetirizine. This parallel double-blind randomized clinical trial was done in allergic rhinitis patients. Seven hundred and twelve participants who met the inclusion criteria and provided informed written consent were randomized and divided into 2 equal groups. Diethylcarbamazine 300 mg/day orally in divided doses was given to group A, and montelukast 10 mg and levocetirizine 5 mg/day orally at night for 21 days was given to group B. Primary outcomes were the change in symptoms, absolute eosinophil count, serum total IgE, phadiatop and response in skin prick from baseline to 21 days and 3 months after treatment. Secondary outcome was to compare it with montelukast and levocetirizine. The mean (SD) age of the patients was 33 (10.6) years, with 374 (52.5%) males and 338 (47.5%) females. There was statistically significant improvement in all the parameters in both groups. Improvement was better with diethylcarbamazine compared to montelukast and levocetirizine and the effects were sustained for 3 months in diethylcarbamazine group. The findings suggest that diethylcarbamazine is effective in the treatment of allergic rhinitis. It gives better control and is cost-effective than montelukast and levocetirizine. Trial Registration: https://www.ctri.nic.in Identifier: CTRI/2020/03/024145 registered on 20-03-2020.
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Affiliation(s)
- S. Mohana Karthikeyan
- Department of ENT and Head and Neck Surgery, Karpaga Vinayaka Institute of Medical Sciences and Research Center, Chinna Kolambakkam, Madurantagam, Tamil Nadu 603308 India
| | - G. N. Nikisha
- Department of ENT and Head and Neck Surgery, Karpaga Vinayaka Institute of Medical Sciences and Research Center, Chinna Kolambakkam, Madurantagam, Tamil Nadu 603308 India
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3
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Mueller SM, Navarini AA, Goldust M, Brandt O, Griffiths CEM, Kleyn CE. Levocetirizine for the treatment of itch in psoriasis patients: An open‐label pilot study in a real‐world setting. Dermatol Ther 2019; 33:e13166. [DOI: 10.1111/dth.13166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/10/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Simon M. Mueller
- Department of DermatologyUniversity Hospital Basel Basel Switzerland
- Department of Dermatology & AllergyUniversity Hospital of Basel Basel Switzerland
| | | | - Mohamad Goldust
- Department of DermatologyUniversity Hospital Basel Basel Switzerland
- Department of DermatologyUniversity of Rome Guglielmo Marconi Rome Italy
- Department of DermatologyUniversity Medical Center Mainz Mainz Germany
| | - Oliver Brandt
- Department of DermatologyUniversity Hospital Basel Basel Switzerland
| | | | - Christine E. Kleyn
- Dermatology Centre, The Manchester Academic Health Science CentreThe University of Manchester Manchester UK
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Yonekura S, Okamoto Y, Sakurai D, Iinuma T, Sakurai T, Yoneda R, Kurita J, Hanazawa T, Kawasaki Y. Efficacy of Desloratadine and Levocetirizine in Patients with Cedar Pollen-Induced Allergic Rhinitis: A Randomized, Double-Blind Study. Int Arch Allergy Immunol 2019; 180:274-283. [PMID: 31618733 DOI: 10.1159/000503065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/02/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND No comparative study of antihistamines that differ in structural system has been conducted in allergic rhinitis. OBJECTIVE This was a randomized, double-blind, crossover comparative study to verify the efficacy of antihistamines that differ in structural system. METHODS A total of 50 patients with moderate or more severe Japanese cedar pollen-induced allergic rhinitis were randomized to receive either placebo, desloratadine 5 mg (a tricyclic), or levocetirizine 5 mg (a piperazine). One dose of the study drug was orally administered at 9 pm on the day before a pollen exposure test, which was performed for 3 h (9 a.m. to 12 p.m.) to assess symptoms in an environmental challenge chamber (ECC). Nasal and ocular symptoms were compared at an airborne pollen level of 8,000 grains/m3. The primary endpoint was mean total nasal symptom score (TNSS) from 120 to 180 min in the ECC. Subjects with a difference of ≥1 in TNSS between 2 drugs were extracted to the relevant drug-responsive group. RESULTS The difference in TNSS from placebo was -2.42 (p < 0.0001) with levocetirizine and -1.66 (p < 0.01) with desloratadine, showing that both drugs were significantly more effective than placebo in controlling symptoms, but with no statistically significant difference between the 2 drugs. There were 12 subjects in the desloratadine-responsive group and 24 subjects in the levocetirizine-responsive group, with no contributor to response was detected. CONCLUSION Levocetirizine tended to control nasal symptoms more effectively than desloratadine. However, the response to each antihistamine varied among individuals and the predictors to the response are unknown. CLINICAL TRIAL REGISTRATION NUMBER UMIN ID: UMIN000029653.
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Affiliation(s)
- Syuji Yonekura
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshitaka Okamoto
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan, .,Chiba Rosai Hospital, Chiba, Japan,
| | - Daiju Sakurai
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomohisa Iinuma
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Toshioki Sakurai
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.,Chiba Cancer Center, Chiba, Japan
| | - Riyo Yoneda
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Junya Kurita
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Toyoyuki Hanazawa
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
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5
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Structural and clinical impact of anti-allergy agents: An overview. Bioorg Chem 2019; 94:103351. [PMID: 31668464 DOI: 10.1016/j.bioorg.2019.103351] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/04/2019] [Accepted: 10/08/2019] [Indexed: 02/06/2023]
Abstract
Allergic disorders are markedly rising in industrialized countries. The identification of compounds that trigger the immunoglobulin E (IgE)-dependent allergic reaction remain the means to improve the quality of life by limiting patient's exposure to critical allergens. Information concerning the treatment and onset of allergic disorders including atopic dermatitis, allergic rhinitis, and bronchial asthma has been provided by the research over the past decade. Recent studies also indicated that allergic inflammation is associated closely with their exacerbation and progression and indeed is the basic pathophysiology of allergic diseases. As a result of immunological and molecular biological studies our understanding of the mechanism of allergic inflammation with regard to therapeutic agents has improved. While much effort has been paid to developing a new anti-allergic agent, the allergic disease has yet to be completely conquered. The more extensive research will allow the development of new therapeutics to combat allergic diseases. Currently, with respect to mechanism of action anti-allergy drugs are classified into five types including histamine H1 antagonists, leukotriene antagonists, Th2 cytokine inhibitors, thromboxane A2 inhibitors and mediator-release inhibitors. The use of two or more anti-allergy agents together is not acknowledged at present, but this will be the subject of research in the future because with different mechanisms of action anti-allergy agents used at the same time will theoretically increase their effects. This review article focuses on anti-allergy agents highlighting their applications, clinical trials and recent advancement on drugs.
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Amin M, Desai M, Trinkaus K, Brown A, Wang-Gillam A, Tan B, Picus J, Sorscher S, Highkin M, Lears K, Lockhart AC. Phase II trial of levocetirizine with capecitabine and bevacizumab to overcome the resistance of antiangiogenic therapies in refractory metastatic colorectal cancer. J Gastrointest Oncol 2019; 10:412-420. [PMID: 31183190 DOI: 10.21037/jgo.2019.02.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Despite the clinical success of vascular endothelial growth factor (VEGF) blockade in metastatic colorectal cancers (mCRC), resistance to anti-angiogenic drugs invariably develops. IL-8 and other cytokines have been implicated in development of resistance to anti-angiogenic therapy. Levocetirizine is a second generation H1 antihistamine with anti-inflammatory and IL-8 suppression properties. We conducted a phase II trial combining levocetirizine with capecitabine and bevacizumab to potentially overcome anti-angiogenic therapy resistance in patients with refractory mCRC. Methods This was a single-center open-label prospective trial in refractory mCRC patients. Treatment consisted of oral capecitabine 850 mg/m2 twice daily administered as 7 days on and 7 days off, intravenous (IV) bevacizumab 5 mg/kg every 14 days and oral levocetirizine 5 mg daily. The primary end point was progression free survival (PFS) and secondary endpoints included objective response rate (ORR) and tolerability. An exploratory endpoint included correlation of PFS with cytokine levels. A sample size of 36 evaluable patients could identify a median PFS of 3.4 months at a 0.05 significance level. To examine cytokine changes related to levocetirizine treatment, patients were randomized to Arm A where levocetirizine was started 7 days after starting chemotherapy and to Arm B where levocetirizine was started 7 days prior to chemotherapy. Cytokine levels were measured at baseline and with each cycle of chemotherapy (up to three cycles). Results Forty-seven patients were enrolled in the trial to have 36 evaluable patients. Arm A enrolled 23 patients and Arm B enrolled 24 patients. Fifty percent of patients had progressive disease and 62% of patients had stable disease in each arm as best response. There was no demonstrable difference in PFS between the two arms (log-rank test P=0.83). Median time to progression was 3.4 months in Arm A and 3.5 months in Arm B. Conclusions Median PFS in the trial was comparable to and appeared to be better than other regimens used in the refractory setting (e.g., median PFS of 1.9 months for regorafenib). Cytokine measurement with IL-8 levels did not show any correlation with progression free survival but patients with stable disease showed overall lower levels of IL-8 as compared to patients with progressive disease in the cytokine analysis.
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Affiliation(s)
- Manik Amin
- Division of Medical Oncology, Siteman Cancer Center, Washington University in Saint Louis, St. Louis, MO, USA
| | - Monica Desai
- Division of Medical Oncology, Siteman Cancer Center, Washington University in Saint Louis, St. Louis, MO, USA
| | - Kathryn Trinkaus
- Biostatistics Shared Resource, Siteman Cancer Center, Washington University in Saint Louis, St. Louis, MO, USA
| | - Amberly Brown
- Division of Medical Oncology, Siteman Cancer Center, Washington University in Saint Louis, St. Louis, MO, USA
| | - Andrea Wang-Gillam
- Division of Medical Oncology, Siteman Cancer Center, Washington University in Saint Louis, St. Louis, MO, USA
| | - Benjamin Tan
- Division of Medical Oncology, Siteman Cancer Center, Washington University in Saint Louis, St. Louis, MO, USA
| | - Joel Picus
- Division of Medical Oncology, Siteman Cancer Center, Washington University in Saint Louis, St. Louis, MO, USA
| | - Steven Sorscher
- Division of Hematology/Oncology, Wake Forest University, Winston-Salem, NC, USA
| | - Maureen Highkin
- Division of Medical Oncology, Siteman Cancer Center, Washington University in Saint Louis, St. Louis, MO, USA
| | - Kim Lears
- Division of Medical Oncology, Siteman Cancer Center, Washington University in Saint Louis, St. Louis, MO, USA
| | - Albert C Lockhart
- Division of Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
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7
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Antihistamine Therapy: Levocetirizine in the Practice of a Family Doctor. Fam Med 2019. [DOI: 10.30841/2307-5112.2.2019.174631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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8
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Scadding GK, Kariyawasam HH, Scadding G, Mirakian R, Buckley RJ, Dixon T, Durham SR, Farooque S, Jones N, Leech S, Nasser SM, Powell R, Roberts G, Rotiroti G, Simpson A, Smith H, Clark AT. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy 2019; 47:856-889. [PMID: 30239057 DOI: 10.1111/cea.12953] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/01/2017] [Accepted: 05/04/2017] [Indexed: 12/12/2022]
Abstract
This is an updated guideline for the diagnosis and management of allergic and non-allergic rhinitis, first published in 2007. It was produced by the Standards of Care Committee of the British Society of Allergy and Clinical Immunology, using accredited methods. Allergic rhinitis is common and affects 10-15% of children and 26% of adults in the UK, it affects quality of life, school and work attendance, and is a risk factor for development of asthma. Allergic rhinitis is diagnosed by history and examination, supported by specific allergy tests. Topical nasal corticosteroids are the treatment of choice for moderate to severe disease. Combination therapy with intranasal corticosteroid plus intranasal antihistamine is more effective than either alone and provides second line treatment for those with rhinitis poorly controlled on monotherapy. Immunotherapy is highly effective when the specific allergen is the responsible driver for the symptoms. Treatment of rhinitis is associated with benefits for asthma. Non-allergic rhinitis also is a risk factor for the development of asthma and may be eosinophilic and steroid-responsive or neurogenic and non- inflammatory. Non-allergic rhinitis may be a presenting complaint for systemic disorders such as granulomatous or eosinophilic polyangiitis, and sarcoidoisis. Infective rhinitis can be caused by viruses, and less commonly by bacteria, fungi and protozoa.
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Affiliation(s)
- G K Scadding
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - H H Kariyawasam
- The Royal National Throat Nose and Ear Hospital, London, UK.,UCLH NHS Foundation Trust, London, UK
| | - G Scadding
- Department of Upper Respiratory Medicine, Imperial College NHLI, London, UK
| | - R Mirakian
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - R J Buckley
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
| | - T Dixon
- Royal Liverpool and Broad green University Hospital NHS Trust, Liverpool, UK
| | - S R Durham
- Department of Upper Respiratory Medicine, Imperial College NHLI, London, UK
| | - S Farooque
- Chest and Allergy Department, St Mary's Hospital, Imperial College NHS Trust, London, UK
| | - N Jones
- The Park Hospital, Nottingham, UK
| | - S Leech
- Department of Child Health, King's College Hospital, London, UK
| | - S M Nasser
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - R Powell
- Department of Clinical Immunology and Allergy, Nottingham University, Nottingham UK
| | - G Roberts
- Department of Child Health, University of Southampton Hospital, Southampton, UK
| | - G Rotiroti
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - A Simpson
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, UK
| | - H Smith
- Division of Primary Care and Public Health, University of Sussex, Brighton, UK
| | - A T Clark
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
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The effect of levocetirizine and montelukast on clinical symptoms, serum level and skin expression of COX-1 and COX-2 enzymes in patients suffering from chronic autoimmune urticaria - a pilot study. Postepy Dermatol Alergol 2018; 37:73-80. [PMID: 32467688 PMCID: PMC7247068 DOI: 10.5114/ada.2018.79731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 10/08/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction Chronic autoimmune urticaria (CAU) lasts over 6 weeks and is characterized by circulating IgE autoantibodies or IgG against IgE or IgE receptor. Aim To assess the clinical, laboratory and histological effects of 4-week levocetirizine and montelukast therapy in patients suffering from CAU. Material and methods Of 296 tested patients with chronic urticaria 40 had a positive ASST test. Only 17 (16 female/1 male; medium age: 44 years) fulfilled all study inclusion/exclusion criteria. The study was designed as an open, randomized trial with two arms: levocetirizine or montelukast treatment for 4 weeks following a 2-week wash-out period. All participants completed urticaria activity score (UAS) and visual analogue scale (VAS) questionnaires before and after both therapies. Blood samples and skin bioptats were obtained before and after treatment to evaluate COX-1 and COX-2 serum concentrations and skin expression. Results Clinical response to therapy measured with the UAS and VAS was better in the levocetirizine group. Both drugs caused a significant decrease in COX-1 and COX-2 serum level. COX-1 and COX-2 expression in epidermal and dermal inflammatory infiltration did not change significantly in either study group, but a significant decrease of COX-1 expression was observed when the groups were combined for analysis, and the decrease in COX-2 expression in the epidermis was of borderline significance. Conclusions The effectiveness of levocetirizine and montelukast in treating CAU may be partly related to the reduction of COX-1 and COX-2 serum level and tissue expression, but further studies on a larger group of patients are needed to support this observation.
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Heffler E, Landi M, Caruso C, Fichera S, Gani F, Guida G, Liuzzo MT, Pistorio MP, Pizzimenti S, Riccio AM, Seccia V, Ferrando M, Malvezzi L, Passalacqua G, Gelardi M. Nasal cytology: Methodology with application to clinical practice and research. Clin Exp Allergy 2018; 48:1092-1106. [PMID: 29904978 DOI: 10.1111/cea.13207] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Nasal cytology is an easy, cheap, non-invasive and point-of-care method to assess nasal inflammation and disease-specific cellular features. By means of nasal cytology, it is possible to distinguish between different inflammatory patterns that are typically associated with specific diseases (ie, allergic and non-allergic rhinitis). Its use is particularly relevant when other clinical information, such as signs, symptoms, time-course and allergic sensitizations, is not enough to recognize which of the different rhinitis phenotypes is involved; for example, it is only by means of nasal cytology that it is possible to distinguish, among the non-allergic rhinitis, those characterized by eosinophilic (NARES), mast cellular (NARMA), mixed eosinophilic-mast cellular (NARESMA) or neutrophilic (NARNE) inflammation. Despite its clinical usefulness, cheapness, non-invasiveness and easiness, nasal cytology is still underused and this is at least partially due to the fact that, as far as now, there is not a consensus or an official recommendation on its methodological issues. We here review the scientific literature about nasal cytology, giving recommendations on how to perform and interpret nasal cytology.
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Affiliation(s)
- E Heffler
- Department of Biomedical Sciences, Humanitas University, Milano, Italy.,Personalized Medicine, Asthma and Allergy Unit, Humanitas Clinical and Research Center, Humanitas University, Milano, Italy
| | - M Landi
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy.,Paediatric National Healthcare System, Torino, Italy
| | - C Caruso
- Allergy Unit, Fondazione Policlinico Gemelli, Presidio Columbus, Rome, Italy
| | - S Fichera
- Respiratory Medicine and Allergy, University of Catania, Catania, Italy
| | - F Gani
- Respiratory Allergy, A.O.U. San Luigi, Orbassano, Torino, Italy
| | - G Guida
- Allergy and Lung Physiology, AO Santa Croce e Carle, Cuneo, Italy
| | - M T Liuzzo
- Respiratory Medicine and Allergy, University of Catania, Catania, Italy
| | - M P Pistorio
- Respiratory Medicine and Allergy, University of Catania, Catania, Italy
| | - S Pizzimenti
- Respiratory Medicine Unit, National Health System, ASL Città di Torino, Torino, Italy
| | - A M Riccio
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy
| | - V Seccia
- 1st Otorhinolaryngology Unit, Department of Medical and Surgical Pathology, Pisa University Hospital, Pisa, Italy
| | - M Ferrando
- Department of Biomedical Sciences, Humanitas University, Milano, Italy.,Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy
| | - L Malvezzi
- Department of Otolaryngology, Humanitas Clinical and Research Center, Milano, Italy
| | - G Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genova, Italy
| | - M Gelardi
- Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
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Seresirikachorn K, Chitsuthipakorn W, Kanjanawasee D, Khattiyawittayakun L, Snidvongs K. Effects of H1 antihistamine addition to intranasal corticosteroid for allergic rhinitis: a systematic review and meta-analysis. Int Forum Allergy Rhinol 2018; 8:1083-1092. [PMID: 29917324 DOI: 10.1002/alr.22166] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND A combination of H1 antihistamine (AH) with intranasal corticosteroid (INCS) is commonly prescribed to patients with allergic rhinitis (AR) who have an inadequate response to monotherapy. In this systematic review we aimed to determine the effects of AH combined with INCS (AH-INCS) for treating AR. METHODS Literature searches were performed using Medline and Embase. Randomized, controlled trials that studied the effects of AH-INCS vs INCS monotherapy for treating patients with AR were included. The primary outcomes were total nasal symptom scores, total ocular symptom scores, and disease-specific quality of life. The secondary outcomes were objective tests for nasal patency and adverse events. RESULTS Sixteen studies (4026 patients) met the inclusion criteria. Compared with INCS, AH-INCS decreased total nasal symptom scores (standardized mean difference [SMD], -0.13; 95% confidence interval [CI], -0.19 to -0.06; p < 0.001; 10 trials, 3348 patients) and total ocular symptom scores (SMD, -0.12, 95% CI, -0.20 to -0.04; p = 0.003; 6 trials, 2378 patients). Subgroup analysis indicated no benefit with the oral AH-INCS combination but did show benefit with intranasal AH-INCS (SMD, -0.18; 95% CI, -0.27 to -0.09; p < 0.001). There were no significant differences with regard to disease-specific quality of life (SMD, -0.07; 95% CI, -0.16 to 0.02; p = 0.12; 6 trials, 1981 patients), nasal inspiratory flow (MD, -0.03 L/min; 95% CI, -0.57 to 0.50; p = 0.91; 1 trial, 54 patients), or adverse events. CONCLUSION Intranasal AH-INCS has benefit over INCS on nasal and ocular symptom improvement for treating AR. Oral AH-INCS is not recommended.
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Affiliation(s)
- Kachorn Seresirikachorn
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Dichapong Kanjanawasee
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Likhit Khattiyawittayakun
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Otolaryngology, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Kornkiat Snidvongs
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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12
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Antihistamines for treating rhinosinusitis: systematic review and meta-analysis of randomised controlled studies. The Journal of Laryngology & Otology 2017; 132:105-110. [DOI: 10.1017/s002221511700192x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Without the release of histamines, patients with rhinosinusitis may not benefit from antihistamines. Additionally, anticholinergic effects may do more harm than good. This study aimed to investigate the effectiveness of antihistamines in treating rhinosinusitis.Methods:An electronic search was performed. Randomised controlled trials comparing antihistamines with either placebo or other treatments for patients with rhinosinusitis were selected.Results:Two studies (184 patients) met the inclusion criteria. Loratadine decreased nasal obstruction in allergic rhinitis patients with acute rhinosinusitis (mean difference = −0.58; confidence interval = −0.85 to −0.31,p< 0.01), but had no benefit on total symptom score (mean difference = −1.25; confidence interval = −2.77 to 0.27,p= 0.11), or rhinorrhoea symptoms (mean difference = −0.06; confidence interval = −0.37 to 0.25,p= 0.71).Conclusion:There is limited evidence to support the use of antihistamines in treating rhinosinusitis. The number of included studies in this systematic review is limited. Antihistamines may relieve nasal obstruction in allergic rhinitis patients with acute rhinosinusitis.
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Sedative Effects of Levocetirizine: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. Drugs 2017; 77:175-186. [DOI: 10.1007/s40265-016-0682-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bocşan CI, Bujor AI, Miron N, Vesa ŞC, Deleanu D, Buzoianu AD. In Vivo Anti-Inflammatory Effect of H1 Antihistamines in Allergic Rhinitis: A Randomized Clinical Trial. Balkan Med J 2015; 32:352-8. [PMID: 26740893 DOI: 10.5152/balkanmedj.2015.15884] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 02/26/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Allergic rhinitis is characterized by a chronic inflammation of nasal mucosa and represents a risk factor for asthma occurrence. H1 antihistamines reduce the symptoms of rhinitis, but some compounds may have anti-inflammatory properties. AIMS We evaluated the plasma level of some cytokines in patients with persistent allergic rhinitis (PAR) and their evolution after a 4-week treatment with H1 anti-histamines, as well as the risk of asthma after 1.5 years. STUDY DESIGN Randomized clinical trial. METHODS Eighty-five patients with PAR and 30 healthy volunteers were included in the study. The patients with PAR were randomly divided into 2 groups: 41 patients treated with 5 mg/day desloratadine and 44 patients under 5 mg/day levocetirizine for 4 weeks. The clinical and biological evaluations were performed before and after treatment and included rhinitis symptoms and total symptoms score, type of sensitization, and plasmatic levels of total IgE, IL-1β, IL-6, IL-8 and TNF-α. RESULTS IL-8 and TNF-α were significantly increased in patients with PAR compared to healthy volunteers (5.85 vs 3.12, p<0.001 and 2.32 vs 1.06, p<0.001, respectively). Both H1 antihistamines reduce all symptoms of allergic rhinitis, including nasal congestion and the plasmatic level of IL-1β, IL-6, IL-8 and TNF-α, after 4 weeks of treatment. The reduction of cytokine levels was not influenced by patients' age, sex, duration or severity of rhinitis, or type of sensitization. Levocetirizine has a superior effect compared to desloratadine in reducing the rhinitis symptoms and cytokines' level. Twenty eight (32.9%) of the patients presented asthma symptoms after 1.5 years. The occurrence of asthma was influenced by house dust sensitization (OR-14.6; CI 95% 1.8-116.3; p=0.01), but baseline values of cytokines were not predictive factors for its appearance. CONCLUSION Levocetirizine and desloratadine as a prolonged therapy reduce plasmatic levels of some pro-inflammatory cytokines in patients with PAR. Levocetirizine has a better effect on decreasing the symptoms and plasmatic levels of IL-1β and IL-8. (ClinicalTrials. gov Identifier: NCT02507635). FOUNDING POSDRU and University of Medicine and Pharmacy, Iuliu Haţieganu, Cluj Napoca.
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Affiliation(s)
- Corina I Bocşan
- Department of Clinical Pharmacology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Adriana I Bujor
- Department of Allergology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Nicolae Miron
- Department of Allergology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Ştefan C Vesa
- Department of Clinical Pharmacology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Diana Deleanu
- Department of Allergology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Anca D Buzoianu
- Department of Allergology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
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Hashiguchi K, Kanzaki S, Wakabayashi KI, Tanaka N, Kawashima K, Suematsu K, Tokunaga S, Ogawa K, Okubo K. Efficacy of fluticasone furoate nasal spray and levocetirizine in patients with Japanese cedar pollinosis subjected to an artificial exposure chamber. J Drug Assess 2013; 2:94-105. [PMID: 27536443 PMCID: PMC4937659 DOI: 10.3109/21556660.2013.829070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2013] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study investigated the clinical efficacy of a combination therapy of levocetirizine (LCTZ) and fluticasone furoate nasal spray (FFNS), compared with LCTZ monotherapy, for the suppression of seasonal allergic rhinitis (SAR) symptoms induced in an artificial exposure chamber. METHODS This study was a single-center, placebo-controlled, randomized, 3-way cross-over comparative study performed in 42 Japanese cedar pollinosis patients. These subjects received (1) LCTZ plus FFNS (combination group), (2) LCTZ plus FFNS placebo (monotherapy group), or (3) LCTZ placebo plus FFNS placebo (placebo group) once on the night prior to exposure, with a 1-week washout period between exposures. Nasal (sneezing, rhinorrhea, nasal congestion, and itchy nose) and ocular (eye itching and tearing) symptoms were recorded every 15 min, and the number of sneezes, nose blowing events, and the amount of nasal secretions were measured during exposure. The primary end-point was the cumulative incidence of SAR symptoms during exposure and the 'ime to occurrence of symptoms'. The secondary end-points were the total nasal symptom score, the ocular symptom score, the amount of nasal discharge, and the number of sneezes and nose blowing events. RESULTS At all the measurement points, the lowest cumulative incidences for the nasal symptoms were observed in the combination group, followed by the monotherapy and placebo groups. All the subjects in the placebo group developed nasal symptoms within 2 h after pollen exposure, while three and eight subjects in the monotherapy and combination groups, respectively, did not develop any nasal symptoms during exposure. In addition, combination therapy delayed the onset of symptoms. CONCLUSIONS The results demonstrated that combination therapy with FFNS and LCTZ significantly suppressed the induced SAR symptoms and delayed the onset of symptoms compared with LCTZ monotherapy and placebo. Although the conditions of the allergen challenge study using an exposure chamber are different from those in real life, combination therapy with FF and LCTZ was confirmed to be an effective treatment for SAR.
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Affiliation(s)
| | - Sho Kanzaki
- Department of Otorhinolaryngology, Keio University School of Medicine, TokyoJapan
| | | | | | | | | | - Shoji Tokunaga
- Medical Information Center, Kyushu University Hospital, FukuokaJapan
| | - Kaoru Ogawa
- Department of Otorhinolaryngology, Keio University School of Medicine, TokyoJapan
| | - Kimihiro Okubo
- Department of Otolaryngology, Nippon Medical School, TokyoJapan
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Sil A, Tripathi SK, Chaudhuri A, Das NK, Hazra A, Bagchi C, Islam CN. Olopatadine versus levocetirizine in chronic urticaria: an observer-blind, randomized, controlled trial of effectiveness and safety. J DERMATOL TREAT 2013; 24:466-72. [DOI: 10.3109/09546634.2012.750414] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Klimek L, Wrede H, Schott BC, Hansen I. Patients' perception of the value of levocetirizine in allergic diseases : a multicentre observational study in Germany. Clin Drug Investig 2012; 25:609-14. [PMID: 17532705 DOI: 10.2165/00044011-200525090-00006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- L Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
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Bautista AP, Eisenlohr CP, Lanz MJ. Nasal nitric oxide and nasal eosinophils decrease with levocetirizine in subjects with perennial allergic rhinitis. Am J Rhinol Allergy 2012; 25:383-7. [PMID: 22185740 DOI: 10.2500/ajra.2011.25.3668] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Allergic rhinitis is commonly treated with antihistamines. Monitoring improvement of airway inflammation noninvasively using nasal nitric oxide (nNO) would be clinically useful. To determine the anti-inflammatory effect of oral levocetirizine dihydrochloride (LC), we measured nNO and nasal eosinophils (nEos) in perennial allergic rhinitis (PAR) subjects. METHODS A randomized double-blind placebo-controlled crossover design was used. Inclusion criteria consisted of subjects having a PAR history, exam and diary scores consistent with active symptoms, and positive skin testing. Subjects taking allergy medications 1 month before the study were not enrolled. After consenting, 31 subjects (24 female subjects; mean age, 29 years) were randomized to either oral LC (5 mg) or matching placebo for 2 weeks. After 2 week washout, subjects started the other 2-week treatment. At each visit, nNO was measured by aspiration at each nare using a nasal kit from NIOX (Aerocrine, Sweden) in parts per billion; nEos was collected from nasal smears and measured by microscopy using the scoring system (0-4+) and symptoms were self-reported using the allergic Rhinitis Quality of Life Questionnaire (RQLQ). Daily allergy symptom scores (total symptom score [TSS] 4) were collected at each visit. RESULTS During LC, mean baseline nNO was 807 ± 317 parts per billion (ppb; left) and 831 ± 332 ppb (right) and decreased significantly to 688 ± 266 ppb and 702 ± 286 ppb, respectively (p < 0.05). No significance was found during placebo treatment (778 ± 270 ppb, 808 ± 299 ppb to 802 ± 271 ppb, 813 ± 273 ppb). The mean nNO change was also significant compared with placebo (-125 ppb versus +14 ppb; p < 0.05). There was a significant decrease in nEos with LC compared with placebo (3.1-2.5 versus 2.9-2.6; p < 0.05). RQLQ scores were significantly improved with LC only. In TSS-4 scoring, a trend toward improvement during LC and significant worsening during placebo was found. Baseline nNO predicted changes in nasal eosinophils (nEos) and RQLQ. CONCLUSION We showed that oral LC therapy decreased objective markers of rhinitis inflammation, nNO and nEos, in patients with PAR. Improvement in symptom scoring was also found with LC treatment.
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Affiliation(s)
- Angela P Bautista
- Department of Allergy, Asthma, and Rhinosinusitis, AAADRS Clinical Research Center, Coral Gables, Florida 33134, USA
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Subcutaneous immunotherapy and pharmacotherapy in seasonal allergic rhinitis: A comparison based on meta-analyses. J Allergy Clin Immunol 2011; 128:791-799.e6. [DOI: 10.1016/j.jaci.2011.03.049] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2010] [Revised: 03/22/2011] [Accepted: 03/31/2011] [Indexed: 11/19/2022]
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Dumitru AF, Shamji M, Wagenmann M, Hindersin S, Scheckenbach K, Greve J, Klenzner T, Hess L, Nebel S, Zimmermann C, Zahner C, Schmidt-Weber CB, Chaker AM. Petasol butenoate complex (Ze 339) relieves allergic rhinitis–induced nasal obstruction more effectively than desloratadine. J Allergy Clin Immunol 2011; 127:1515-21.e6. [DOI: 10.1016/j.jaci.2011.02.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 02/03/2011] [Accepted: 02/10/2011] [Indexed: 01/06/2023]
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Bachert C. Levocetirizine: a modern H1-antihistamine for the treatment of allergic rhinitis. Expert Rev Clin Immunol 2010; 1:495-510. [PMID: 20477594 DOI: 10.1586/1744666x.1.4.495] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Levocetirizine is the latest of the H(1)-antihistamines indicated for adults and children (as young as 2 years old) suffering from allergic rhinitis and chronic idiopathic urticaria. Currently, it is the only therapy registered for treatment of persistent allergic rhinitis, as defined by the Allergic Rhinitis & its Impact on Asthma guidelines. Pharmacologic studies have shown levocetirizine to have a more favorable pharmacokinetic/pharmacodynamic profile than other commonly employed H(1)-antihistamines. This reflects its superiority in controlling the symptoms of seasonal, perennial and persistent allergic rhinitis in well-controlled trials. Clinical trials and postmarketing surveillance have indicated that levocetirizine is safe and well tolerated, and leads to clinically significant improvements in the quality of life of patients. It is also reported to reduce comorbidities as well as overall treatment costs when administered continuously over the longterm.
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Affiliation(s)
- Claus Bachert
- Department of Oto-Rhino-Laryngology, Univerisity Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
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22
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Singh-Franco D, Ghin HL, Robles GI, Borja-Hart N, Perez A. Levocetirizine for the treatment of allergic rhinitis and chronic idiopathic urticaria in adults and children. Clin Ther 2009; 31:1664-87. [PMID: 19808127 DOI: 10.1016/j.clinthera.2009.08.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND Levocetirizine (LCZ) is a second-generation antihistamine that was approved in January 2008 for the relief of symptoms of seasonal allergic rhinitis (SAR), perennial allergic rhinitis (PAR), and chronic idiopathic urticaria (CIU) in adults and children aged > or = 6 years. OBJECTIVES This article reviews the available literature on the pharmacokinetics and pharmacodynamics, clinical efficacy and tolerability, and effect on quality of life (QoL) of LCZ. METHODS A search of the English-language literature was performed using the following databases: MEDLINE (1966-February 2009), International Pharmaceutical Abstracts (19 70-February 2009), Database of Abstracts of Reviews of Effectiveness, Cochrane Database of Systematic Reviews, EMBASE Drugs & Pharmacology (1991-February 2009), Blackwell Synergy, CINAHL Plus with Full Text, EBSCOhost, ScienceDirect, and Wiley Interscience. The search terms were levocetirizine, allergic rhinitis, chronic idiopathic urticaria, antihistamine, pharmacokinetics, quality of life, drug interactions, case reports, and cost. Publications describing studies of > or = 2 weeks' duration that concerned the efficacy, tolerability, pharmacoeconomics, and/or QoL effects of LCZ were included in the review. RESULTS In 4 studies in adult patients with moderate to severe PAR, LCZ 5 mg/d was associated with significant improvements in symptom scores for sneezing, rhinorrhea, and ocular/nasal pruritus at 4 to 6 weeks compared with placebo (P < or = 0.05). In 3 studies, nasal congestion scores were significantly improved within 4 to 6 weeks compared with placebo (P < 0.001). LCZ 5 mg/d was associated with improvements compared with placebo in scores for the ability to do housework, complete work activities, and engage in outdoor activities at 6 months (P < or = 0.011). In a 6-week study in children with moderate to severe SAR, LCZ 5 mg/d was associated with significant improvements compared with placebo in sneezing, rhin-orrhea, and itchy nose (P < 0.004); significant improvements in symptoms from baseline were also seen in a 4-week study in adults with SAR (P < 0.001). One study in patients with SAR reported no significant difference between LCZ and fluticasone compared with fluticasone monotherapy in terms of improvement in QoL, nasal airflow obstruction, sneezing, or pruritus. In a 6-week study in patients with moderate to severe CIU, LCZ 5 mg/d was significantly more effective than placebo in reducing overall CIU symptoms (P < 0.05). In two 4-week studies, one comparing LCZ 5 mg/d with placebo and the other comparing it with desloratadine (DSL), LCZ was significantly more effective than either comparator in terms of improvement in scores for pruritus severity (P < or = 0.001 vs placebo; P < 0.004 vs DSL) and duration (P < or = 0.001 vs placebo; P = 0.009 vs DSL). LCZ was significantly more effective than placebo (but not DSL) in reducing the number and size of wheals (both, P = 0.001). In a 12-week, open-label, crossover study, patients reported significantly longer symptom relief with cetirizine than LCZ (P < 0.005). The most commonly reported adverse events in two 6-month studies in adults with PAR treated with LCZ 5 mg/d included headache (23.8%), pharyngitis (19.4%), influenza (14.6%), fatigue (8.3%), and somnolence (8.3%). There is serious concern about the possibility of febrile seizures in infants treated with LCZ. Three pharmacoeconomic studies of LCZ 5 mg/d were identified, one comparing it with placebo in patients with PAR, one comparing it with placebo in patients with CIU, and another comparing it with second-generation antihistamines and montelukast in patients with PAR. Because of design limitations and differences in comparators in these studies, it was not possible to determine the cost-effectiveness of LCZ in the treatment of PAR or CIU. CONCLUSIONS In the studies reviewed, LCZ 5 mg/d was effective in reducing symptoms of PAR, SAR, and CIU and improving QoL, with an acceptable tolerabili-ty profile. There is a need for studies of longer durations, head-to-head comparisons against other anti-histamines, drug-interaction studies, safety studies in infants, and cost-effectiveness analyses.
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Affiliation(s)
- Devada Singh-Franco
- Health Professions Division, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida 33328, USA.
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Walsh GM. The anti-inflammatory effects of levocetirizine--are they clinically relevant or just an interesting additional effect? Allergy Asthma Clin Immunol 2009; 5:14. [PMID: 20066054 PMCID: PMC2804563 DOI: 10.1186/1710-1492-5-14] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 12/17/2009] [Indexed: 12/11/2022] Open
Abstract
Levocetirizine, the R-enantiomer of cetirizine dihydrochloride has pharmacodynamically and pharmacokinetically favourable characteristics, including rapid onset of action, high bioavailability, high affinity for and occupancy of the H1-receptor, limited distribution, minimal hepatic metabolism together with minimal untoward effects. Several well conducted randomised clinical trials have demonstrated the effectiveness of levocetirizine for the treatment of allergic rhinitis and chronic idiopathic urticaria in adults and children. In addition to the treatment for the immediate short-term manifestations of allergic disease, there appears to be a growing trend for the use of levocetirizine as long-term therapy. In addition to its being a potent antihistamine, levocetirizine has several documented anti-inflammatory effects that are observed at clinically relevant concentrations that may enhance its therapeutic benefit. This review will consider the potential or otherwise of the reported anti-inflammatory effects of levocetirizine to enhance its effectiveness in the treatment of allergic disease.
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Affiliation(s)
- Garry M Walsh
- School of Medicine, University of Aberdeen, Aberdeen, UK.
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Horak F, Zieglmayer P, Zieglmayer R, Lemell P. The effects of bilastine compared with cetirizine, fexofenadine, and placebo on allergen-induced nasal and ocular symptoms in patients exposed to aeroallergen in the Vienna Challenge Chamber. Inflamm Res 2009; 59:391-8. [DOI: 10.1007/s00011-009-0117-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 10/03/2009] [Indexed: 11/29/2022] Open
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Scordamaglia F, Compalati E, Baiardini I, Scordamaglia A, Canonica GW. Levocetirizine in the treatment of allergic diseases. Expert Opin Pharmacother 2009; 10:2367-77. [PMID: 19663743 DOI: 10.1517/14656560903193086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Levocetirizine, the R-enantiomer of cetirizine dihydrochloride, is a new molecule with a potent and selective antihistamine activity. OBJECTIVE To investigate the evidence that levocetirizine is an effective therapy for allergic disease. METHODS Evaluation of published articles in English, or having an English abstract. RESULTS Clinical trials indicate that levocetirizine is safe and effective for the treatment of allergic rhinitis and chronic idiopathic urticaria. The compound shows a rapid onset of action, high bioavailability and affinity for the H1 receptor. Moreover, this molecule demonstrates many anti-inflammatory effects that enhance the clinical therapeutic benefit not only in short-term but also in long-term treatments, as reported in recent trials utilizing levocetirizine for several months. CONCLUSION Levocetirizine confirms its safe effective activity for treatment of allergic disease in both adults and children.
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Affiliation(s)
- Francesca Scordamaglia
- Genoa University, Department of Internal Medicine, Allergy and Respiratory Diseases, Genoa, Italy
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Mahmoud F, Arifhodzic N, Haines D, Novotney L. Levocetirizine modulates lymphocyte activation in patients with allergic rhinitis. J Pharmacol Sci 2009; 108:149-56. [PMID: 18946193 DOI: 10.1254/jphs.08037fp] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Levocetirizine, a second generation non-sedating antihistamine that blocks the H(1) histamine receptor, may exhibit immunoregulatory properties that augment its primary pharmacological mechanism. To investigate this possibility, 13 Kuwaiti seasonal allergic rhinitis (SAR) patients were treated with levocetirizine for four weeks in comparison with a 7-member placebo-treated control group, followed by clinical evaluation and flow cytometric analysis of peripheral venous blood for inflammatory cell and lymphocyte subpopulation profiles. Relative to the controls, levocetirizine-treated patients exhibited an expected reduction in early phase allergic symptoms, including sneezing (P<0.001), nasal itching (P<0.01), nasal congestion, and running nose (P<0.001); reduced percentages of eosinophils (P<0.05); and three subpopulations of activated T lymphocytes: CD4+CD29+, CD4+CD212+, and CD4+CD54+ (P<0.05). Levocetirizine treatment also correlated with a significant increase in the percentage of CD4+CD25+ T cells (P<0.001). The ability of levocetirizine to reduce percentage representation of cell phenotypes known to contribute to inflammatory tissue damage (eosinophils, CD4+CD29+, CD4+CD212+, and CD4+CD54+) and expand percentages of CD4+CD25+, which may include protective immunoregulatory (Treg) cells, indicates that the drug has pharmacological potential beyond the immediate effects of H(1) histamine-receptor inhibition. Although the present data does not define a therapeutic mechanism, the results reported here establish important trends that may be used to guide future mechanistic examination of immunoregulatory capacity of H(1) inhibitors.
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Affiliation(s)
- Fadia Mahmoud
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kuwait University, Kuwait.
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Levocetirizine inhibits rhinovirus-induced ICAM-1 and cytokine expression and viral replication in airway epithelial cells. Antiviral Res 2008; 81:226-33. [PMID: 19110001 DOI: 10.1016/j.antiviral.2008.12.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 11/27/2008] [Accepted: 12/01/2008] [Indexed: 11/22/2022]
Abstract
Levocetirizine inhibits the production of intercellular adhesion molecule (ICAM)-1 and secretion of interleukin (IL)-6 and IL-8, which may have beneficial effects on the pathophysiologic changes related to human rhinovirus (HRV) infection. We investigated the effects of levocetirizine on rhinovirus infection in primary human nasal epithelial cells (HNEC) and A549 cells. Cells were treated with different concentrations of levocetirizine, ranging from 0.5, 5 or 50nM, either starting at the time of infection and continuing thereafter, or beginning 24h before infection and continuing thereafter. Levocetirizine treatment inhibited the HRV-induced increase in ICAM-1 mRNA and protein levels, as well as the HRV-induced expression of IL-6 and IL-8 mRNA and protein levels. Viral titer, as measured by culture in MRC-5 cells, was reduced by levocetirizine. Levocetirizine treatment also reduced the increased nuclear factor-kappa B (NF-kappaB) expression seen with HRV infection. Levocetirizine inhibited the expression of Toll-like receptor (TLR)3 mRNA and protein levels. These findings indicate that, in HNEC and A549 cells, levocetirizine inhibits HRV replication and HRV-induced upregulation of ICAM-1, IL-6, and IL-8, TLR3 expression and NF-kappaB activation. The results of this study suggest that levocetirizine may have a possible clinical application in the treatment of airway inflammation caused by HRV infection.
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Nettis E, Calogiuri GF, Di Leo E, Cardinale F, Macchia L, Ferrannini A, Vacca A. Once daily levocetirizine for the treatment of allergic rhinitis and chronic idiopathic urticaria. J Asthma Allergy 2008; 2:17-23. [PMID: 21437140 PMCID: PMC3048603 DOI: 10.2147/jaa.s3022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Levocetirizine is the pharmacologically active enantiomer of cetirizine. It is a potent histamine H-1 receptor antagonist with anti-inflammatory and antiallergic properties. The review analyses the levocetirizine's properties in terms of safety and efficacy both in allergic rhinitis and urticarioid syndromes.
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Affiliation(s)
- E Nettis
- Section of Allergology and Clinical Immunology, Department of Internal Medicine and Infectious Diseases
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de Benedictis FM, de Benedictis D, Canonica GW. New oral H1 antihistamines in children: facts and unmeet needs. Allergy 2008; 63:1395-404. [PMID: 18782118 DOI: 10.1111/j.1398-9995.2008.01771.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Second-generation antihistamines differ from first-generation ones because of their elevated specificity and affinity for peripheral H1-receptors and because of their lower penetration to the central nervous system, having fewer sedative effects as a result. Over the last few years, new compounds with different pharmacokinetic properties have been synthesized. More recent improvements of the molecules, generally in the form of active metabolites, led to the synthesis of new-generation antihistamines. METHODS Recommendations on the minimum criteria that would have to be met for compounds to be classified as new-generation antihistamines have been recently established by a consensus statement. In the past, the pharmacokinetics and pharmacodynamics of H1 antihistamines have not been optimally investigated in the pediatric population, especially in infants and young children. RESULTS The pharmacology of second-generation H1 antihistamines has been investigated relatively deeper than old antihistamines in children. In the pediatric population, clinical studies with new-generation antihistamines are still limited in number and, with rare exceptions, of brief duration. Comparative trials on the efficacy and safety between different compounds are also lacking. CONCLUSIONS Properly designed, long-term trials with new-generation H1 antihistamines need to be performed in single age groups, in order to better define the effects of these drugs in all pediatric population.
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Arayne MS, Sultana N, Nawaz M. Simultaneous quantification of cefpirome and cetirizine or levocetirizine in pharmaceutical formulations and human plasma by RP-HPLC. JOURNAL OF ANALYTICAL CHEMISTRY 2008. [DOI: 10.1134/s1061934808090153] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bukstein DA, Lapine TJ. Allergic rhinitis in family practice: the role of levocetirizine in clinical care. Postgrad Med 2008; 120:101-10. [PMID: 18654075 DOI: 10.3810/pgm.2008.07.1797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Allergic rhinitis is one of the most common presentations of allergic disorders in the United States, affecting more than 20% of the population. Chronic rhinitis affects patients' quality of life and exacerbates comorbid conditions. Its widespread burden affects society by substantially decreasing worker and scholastic productivity. Allergic rhinitis is typically managed with pharmacotherapy to alleviate symptoms and control comorbid conditions, yet many of these agents carry their own burden due to bothersome and sometimes severe side effects that can compromise patient safety. A new generation of non- or less-sedating antihistamines has recently emerged. These agents offer the promise of enhanced efficacy and tolerability. Of these agents, levocetirizine is the latest antihistamine introduced in the United States. It appears to be safe and effective for the treatment of allergic rhinitis. In addition to covering the above topics, this article reviews the value of levocetirizine for the treatment of allergic rhinitis based on its pharmacologic and pharmacokinetic profile, its efficacy compared with placebo and other new-generation antihistamines, and its safety and tolerability.
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Affiliation(s)
- Donald A Bukstein
- University of Wisconsin-Madison, School of Medicine and Public Health, Health Sciences Learning Center, Madison, WI 53705, USA.
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Dubuske LM, Seal B, Brown MC. Pharmacoeconomics of levocetirizine in allergic rhinitis and chronic idiopathic urticaria: considerations for the USA. Expert Rev Pharmacoecon Outcomes Res 2008; 8:233-41. [PMID: 20528375 DOI: 10.1586/14737167.8.3.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Levocetirizine, a recent, second-generation oral antihistamine, was approved by the US FDA in May 2007 to treat symptoms of allergic rhinitis and chronic idiopathic urticaria. OBJECTIVE To review the economic literature for levocetirizine. METHODS Two reviewers conducted a systematic review of the literature to identify abstracts that met the inclusion criteria. Abstracts that were considered acceptable were retrieved with full text for further assessment. RESULTS A total of 82 potential studies were identified. After reviewing abstracts, 11 articles were preselected for potential inclusion. Of the 11 full-text articles, three articles met the inclusion criteria. CONCLUSION The pharmacoeconomic literature for levocetirizine was limited. The findings were consistent across the literature, suggesting levocetirizine improved outcomes, leading to incremental cost savings and cost-effectiveness. Since many of the available levocetirizine data come from European studies, differences in practice patterns and medical resources should be considered when extrapolating data to a US clinical setting.
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Affiliation(s)
- Lawrence M Dubuske
- Consultant in Allergy, Brigham and Women's Hospital; Clinical Instructor in Medicine, Harvard Medical School, Boston, MA, USA.
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Walsh GM. A review of the role of levocetirizine as an effective therapy for allergic disease. Expert Opin Pharmacother 2008; 9:859-67. [PMID: 18345961 DOI: 10.1517/14656566.9.5.859] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Levocetirizine is the R-enantiomer of cetirizine dihydrochloride with pharmacodynamically and pharmacokinetically favourable characteristics. OBJECTIVE To review the evidence that levocetirizine is an effective therapy for allergic disease. METHODOLOGY Relevant articles in English or with English abstracts were identified from systematic PubMed searches. RESULTS Levocetirizine has high bioavailability, high affinity for and occupancy of the H1 receptor, rapid onset of action, limited distribution and minimal hepatic metabolism. Clinical trials indicate that it is safe and effective for the treatment of allergic rhinitis and chronic idiopathic urticaria in adults and children with a minimal number of untoward effects. It is also becoming clearer that, in addition to its being a potent antihistamine, levocetirizine has several anti-inflammatory effects that are observed at clinically relevant concentrations that may enhance its therapeutic benefit. Furthermore, there appears to be a growing trend for the use of levocetirizine as long-term therapy in addition to it being used as a treatment for the immediate short-term manifestations of allergic disease. CONCLUSION Levocetirizine is an effective and safe treatment for use in adults and children with allergic disease.
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Affiliation(s)
- Garry M Walsh
- University of Aberdeen, School of Medicine, Institute of Medical Sciences, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK.
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Scadding GK, Durham SR, Mirakian R, Jones NS, Leech SC, Farooque S, Ryan D, Walker SM, Clark AT, Dixon TA, Jolles SRA, Siddique N, Cullinan P, Howarth PH, Nasser SM. BSACI guidelines for the management of allergic and non-allergic rhinitis. Clin Exp Allergy 2008; 38:19-42. [PMID: 18081563 PMCID: PMC7162111 DOI: 10.1111/j.1365-2222.2007.02888.x] [Citation(s) in RCA: 245] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This guidance for the management of patients with allergic and non-allergic rhinitis has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is for use by both adult physicians and paediatricians practicing in allergy. The recommendations are evidence graded. During the development of these guidelines, all BSACI members were included in the consultation process using a web-based system. Their comments and suggestions were carefully considered by the SOCC. Where evidence was lacking, consensus was reached by the experts on the committee. Included in this guideline are clinical classification of rhinitis, aetiology, diagnosis, investigations and management including subcutaneous and sublingual immunotherapy. There are also special sections for children, co-morbid associations and pregnancy. Finally, we have made recommendations for potential areas of future research.
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Affiliation(s)
- G. K. Scadding
- The Royal National Throat Nose & Ear Hospital, Gray's Inn Road, London, UK
| | - S. R. Durham
- Department of Upper Respiratory Medicine, Imperial College NHLI, Guy Scadding Building, Royal Brompton Campus, London, UK
| | - R. Mirakian
- Cambridge University NHS Foundation Trust, Allergy Clinic, Cambridge, UK
| | - N. S. Jones
- Department of Otorhinolaryngology‐Head & Neck Surgery, Queens Medical Centre, Nottingham, UK
| | - S. C. Leech
- Department of Child Health, Kings College Hospital, Denmark Hill, London, UK
| | - S. Farooque
- Department of Asthma, Allergy & Respiratory Medicine, Guy's Hospital, London, UK
| | - D. Ryan
- Department of General Practice and Primary Care, University of Aberdeen, Aberdeen, UK
| | - S. M. Walker
- Education For Health, The Athenaeum, Warwick, UK
| | - A. T. Clark
- Cambridge University NHS Foundation Trust, Allergy Clinic, Cambridge, UK
| | - T. A. Dixon
- Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK
| | - S. R. A. Jolles
- Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff, UK
| | - N. Siddique
- Department of respiratory medicine, Southampton General Hospital, Southampton, UK
| | - P. Cullinan
- Department of Occupational and Environmental Medicine, Imperial College, London, UK and
| | | | - S. M. Nasser
- Cambridge University NHS Foundation Trust, Allergy Clinic, Cambridge, UK
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Canonica GW, Tarantini F, Compalati E, Penagos M. Efficacy of desloratadine in the treatment of allergic rhinitis: a meta-analysis of randomized, double-blind, controlled trials. Allergy 2007; 62:359-66. [PMID: 17362245 DOI: 10.1111/j.1398-9995.2006.01277.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The objective of the study is to assess the efficacy of the nonsedating antihistamine, desloratadine, in the treatment of allergic rhinitis (AR). A search of MEDLINE, EMBASE, LILACS, and CINAHL databases was undertaken from January, 1966 to May, 2006. Double-blind, randomized, controlled studies of desloratadine in the treatment of AR in adult patients were carried out. The measured outcomes included the total symptoms score, the total nasal symptoms score, nasal airflow, and inflammatory markers (nasal eosinophils, nasal interleukin-4). The analysis included the calculation of standardized mean difference (SMD). A total of 57 studies were analyzed, and 13 randomized, double-blind, controlled trials were included in the meta-analysis. The trials included 3108 subjects who had completed studies involving desloratadine. There was significant heterogeneity among the study results, because of differing study methodologies. Desloratadine was associated with significant reductions in total symptoms scores (SMD -1.63; 95% CI -2.75 to -0.51; P = 0.004) and total nasal symptoms score (SMD -0.66; 95% CI -0.91 to -0.42; P < 0.001), when compared with placebo. Analysis of objective data on nasal blockage demonstrated a significant improvement in nasal airflow with desloratadine, when compared with placebo (SMD 0.32; 95% CI 0.10 to 0.55; P = 0.005). A benefit favoring desloratadine over placebo in terms of nasal eosinophil levels was also noted in the analysis. This meta-analysis confirms the reduction of AR symptoms and improvement in nasal airflow seen in individual studies of desloratadine. Objective improvements in nasal airflow, total symptoms, and total nasal symptoms seen with desloratadine are supported by Ia evidence.
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Affiliation(s)
- G W Canonica
- Allergy and Respiratory Diseases Clinic, Department of Internal Medicine, University of Genoa, Genoa, Italy
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36
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Seven B, Yoruk O, Varoglu E, Sutbeyaz Y. Evaluation of the effect of levocetirizine on nasal mucociliary clearance in allergic rhinitis patients by rhinoscintigraphy. Nucl Med Commun 2007; 28:85-7. [PMID: 17198347 DOI: 10.1097/mnm.0b013e328013eb3f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the effect of levocetirizine on nasal mucociliary clearance in allergic rhinitis patients using rhinoscintigraphy. METHODS Twenty patients with allergic rhinitis (12 males and eight females, mean age 37.7 +/- 10.5 years) were evaluated. All the patients received levocetirizine (5 mg x day(-1)) for 4 weeks, and the speed of nasal mucociliary clearance was assessed before and after treatment. Twenty healthy controls (11 males and nine females, mean age 39.4 +/- 7.8 years) were also evaluated. RESULTS The clearance values obtained for the treated group before and after treatment were significantly lower than those of the control group (P = 0.0001), but there was no significant difference in clearance speeds before and after treatment in the patient group (P = 0.444). CONCLUSION The study demonstrated that levocetirizine did not affect the speed of nasal mucociliary clearance in allergic rhinitis patients, and that nasal mucociliary clearance can easily be evaluated by rhinoscintigraphy.
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Affiliation(s)
- Bedri Seven
- Department of Nuclear Medicine, School of Medicine, Ataturk University, 25240 Erzurum, Turkey.
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Abstract
Allergic disease is an increasing problem worldwide. Allergic rhinitis, an inflammatory response to an allergen, affects an estimated 20-40 million people in the US, while chronic idiopathic urticaria is a dermatoallergic condition that affects 0.1-3% of people in the US and Europe. The primary goals of treatment for allergic rhinitis are to reduce symptoms, which include sneezing, rhinorrhoea and nasal congestion, improve quality of life and prevent the sequelae associated with this disease, while the goal for chronic idiopathic urticaria is the rapid and prolonged control of symptoms. Quantitatively, histamine is the most abundant mediator present during an allergic episode - thus, antihistamines (historically called histamine H(1) receptor antagonists, now called H(1) receptor inverse agonists) are a first-line defense against allergic rhinitis and chronic idiopathic urticaria. Although first-generation antihistamines can cause sedation and cognitive impairment, second-generation antihistamines are relatively non-sedating and free of such adverse events owing to their comparative inability to penetrate the blood-brain barrier. Desloratadine is one such second-generation antihistamine and is indicated for the treatment of allergic diseases, including allergic rhinitis and chronic idiopathic urticaria. It has proven efficacy against the symptoms associated with seasonal and perennial allergic rhinitis, including nasal congestion, and chronic idiopathic urticaria. As a result, it has been shown to improve patients' quality of life. The safety and efficacy profiles of desloratadine are well established, and published postmarketing analyses have assessed >54 000 patients. Although earlier second-generation antihistamines have been associated with cardiovascular adverse effects, desloratadine has been shown to be safe and well tolerated at nine times the recommended dose. In addition, it has been shown to not interact with concomitantly administered drugs and food. Overall, current data indicate that desloratadine is a safe and effective treatment for allergic diseases.
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MESH Headings
- Histamine H1 Antagonists, Non-Sedating/adverse effects
- Histamine H1 Antagonists, Non-Sedating/therapeutic use
- Humans
- Loratadine/adverse effects
- Loratadine/analogs & derivatives
- Loratadine/therapeutic use
- Product Surveillance, Postmarketing
- Randomized Controlled Trials as Topic
- Rhinitis, Allergic, Perennial/drug therapy
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Seasonal/drug therapy
- Rhinitis, Allergic, Seasonal/immunology
- Urticaria/drug therapy
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Affiliation(s)
- William E Berger
- Department of Pediatrics, Division of Allergy and Immunology, University of California, Irvine, California, USA.
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38
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Canonica GW, Tarantini F, Compalati E, Penagos M. Efficacy of desloratadine in the treatment of allergic rhinitis: a meta-analysis of randomized, double-blind, controlled trials. Allergy 2007. [DOI: 10.1111/j.1398-9995.2007.01277.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hair PI, Scott LJ. Levocetirizine: a review of its use in the management of allergic rhinitis and skin allergies. Drugs 2006; 66:973-96. [PMID: 16740020 DOI: 10.2165/00003495-200666070-00017] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Levocetirizine (Xyzal) is a selective, potent, oral histamine H(1) receptor antagonist of the latest generation that is licensed for the symptomatic treatment of allergic rhinitis (including persistent allergic rhinitis [PER]) and chronic idiopathic urticaria (CIU). Large, well designed trials indicate that levocetirizine is effective and generally well tolerated in the treatment of allergic rhinitis and CIU. Its pharmacological profile offers many positive aspects: a rapid onset and long duration of antihistaminic effect; rapid absorption and high bioavailability; a low potential for drug interactions; a low volume of distribution; and a lack of effect on cognition, psychomotor function and the cardiovascular system. Allergen challenge chamber studies suggest that levocetirizine has better efficacy than desloratadine, loratadine or fexofenadine. Well controlled, long-term studies with other later-generation H(1) receptor antagonists are required to fully define its clinical profile relative to other agents in this class. Overall, levocetirizine is a valuable addition to the oral H(1) receptor antagonists available for the treatment of allergic rhinitis and as first-line therapy in patients with CIU.
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Affiliation(s)
- Philip I Hair
- Adis International Limited, 51 Centorian Drive, Mairangi Bay, Auckland 1311, New Zealand.
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Patou J, De Smedt H, van Cauwenberge P, Bachert C. Pathophysiology of nasal obstruction and meta-analysis of early and late effects of levocetirizine. Clin Exp Allergy 2006; 36:972-81. [PMID: 16911353 DOI: 10.1111/j.1365-2222.2006.02544.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Nasal obstruction, also referred to as congestion, blockage or stuffiness, is a crucial symptom in allergic rhinitis (AR) and may affect sleep as well as quality of life. Early- and late-phase-allergic reactions both contribute to nasal obstruction, although it primarily represents a major symptom in the chronic allergic reaction. A complex network of inflammatory and neurogenic phenomena relates to chronic nasal obstruction, including the subepithelial accumulation of inflammatory cells, particularly mast cells and eosinophils, and the release of neuropeptides. Nasal obstruction is a difficult-to-treat symptom. Vasoconstrictors (decongestants) and intranasal corticosteroids, due to their anti-inflammatory properties, have mainly been used for relieving the nasal passages from the congested mucosa. However, there is accumulating evidence recently that the latest-generation potent antihistamines have decongestant properties in AR. This paper aims to review the pathophysiologic background of nasal obstruction and the evidence for an antihistamine, levocetirizine, in relieving nasal congestion. A meta-analysis on the early and late effects of levocetirizine on nasal obstruction under artificial and natural allergen exposure conditions is presented, demonstrating convincingly that levocetirizine shows a consistent effect on nasal obstruction as early as over the first 2 h and sustained over 6 weeks.
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Affiliation(s)
- J Patou
- Department of Otorhinolaryngology, Upper Airways Research Laboratory, Ghent University Hospital, Ghent, Belgium
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42
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Schenkel EJ. Combining desloratadine and pseudoephedrine in the treatment of seasonal allergic rhinitis. Expert Rev Clin Immunol 2006; 2:519-31. [PMID: 20477610 DOI: 10.1586/1744666x.2.4.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Nonsedating antihistamines are a first-line therapy in the management of allergic rhinitis. They relieve the majority of the histamine-mediated symptoms of the condition, including rhinorrhea, sneezing, and pruritus. The nonsedating antihistamine desloratadine is effective in alleviating the symptoms of both seasonal and perennial allergic rhinitis. It may also have some decongestant properties, and thus help to alleviate nasal congestion. Administering desloratadine in combination with the decongestant pseudoephedrine may offer allergic rhinitis patients with moderate-to-severe nasal congestion the benefits of desloratadine's effectiveness for alleviating histamine-mediated symptoms plus pseudoephedrine's relief from nasal congestion. This drug profile reviews a combination therapy containing desloratadine and pseudoephedrine, approved in the USA for the relief of the symptoms of seasonal allergic rhinitis, including nasal congestion.
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Affiliation(s)
- Eric J Schenkel
- Valley Clinical Research Center, 3729 Easton-Nazareth Highway, Suite 202, Easton, PA 18045, USA.
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43
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Tworek D, Bocheńska-Marciniak M, Kupczyk M, Górski P, Kuna P. The effect of 4 weeks treatment with desloratadine (5mg daily) on levels of interleukin (IL)-4, IL-10, IL-18 and TGF beta in patients suffering from seasonal allergic rhinitis. Pulm Pharmacol Ther 2006; 20:244-9. [PMID: 16530440 DOI: 10.1016/j.pupt.2006.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2005] [Revised: 11/22/2005] [Accepted: 01/20/2006] [Indexed: 11/15/2022]
Abstract
Anti-inflammatory effect of desloratadine (DL), including, but not limited to depression of production of IL-4, IL-6 and IL-8, has been shown in several in vitro experiments but only a few in vivo studies refer to this findings. The purpose of our study was to evaluate the influence of DL on levels of IL-4, IL-10, IL-18 and TGF-beta in sera of patients with seasonal allergic rhinitis (SAR). Sixty-nine subjects suffering from SAR with hypersensitivity to grass pollen were included into the evaluation of clinical efficacy of DL (5mg once daily). None of them was taking any H(1) receptor antagonist during the pollen season before inclusion into the study. Samples of peripheral blood were taken before and after 4 weeks of treatment. Levels of cytokines were determined using the ELISA method. The mean level of IL-4 was 0.212+/-0.07pg/ml before and 0.221+/-0.1pg/ml after the treatment (p=0.52); IL-10 5.13+/-3.14 and 4.71+/-0.88 (p=0.69); IL-18 54.45+/-26.09 and 44.80+/-22.42 (p=0.48); TGF beta 949.17+/-401.5 and 955.7+/-391.2 (p=0.97)pg/ml before and after the treatment, respectively. Unless in vitro DL demonstrates not only anti-allergic but also anti-inflammatory activities data from this in vivo study in a group of patients suffering from SAR do not support previous pre-clinical findings.
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Affiliation(s)
- Damian Tworek
- Division of Pneumonology and Allergy, Medical University of Lodz, 22 Kopcińskiego Str., 90-153 Lodz, Poland
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Abstract
BACKGROUND Chronic idiopathic urticaria is a distressing condition that severely affects patients' quality of life. The overall costs associated with this disease, both for the healthcare payer and society, are unknown. The objective of this study was to evaluate the cost effectiveness of levocetirizine, a first-line treatment for urticaria. METHODS Data were collected from two placebo-controlled trials and from official French databases. The effectiveness of the treatment was assessed by the mean number of pruritus-free days experienced by the patient within a 30-day period (PFD30). Direct cost parameters were medications used, medical procedures and hospitalisations for urticaria or treatment of adverse events. Productivity cost parameters were the workdays lost, defined as absenteeism and/or presenteeism, resulting from urticaria. The costing was performed using a French societal perspective. Costs were reported in euro (2002 values) and were standardised to a 30-day month. Whenever possible, incremental cost-effectiveness ratios (ICERs) were derived from these data. RESULTS The pooled sample contained 294 patients. Compared with placebo, patients in the levocetirizine group experienced an additional mean 6.5 (95% CI 3.8, 9.3) pruritus-free days per month (p < 0.001). Considering only direct medical costs, the incremental cost of treatment with levocetirizine was totally offset by the reduction in other medical costs (i.e. reduced cost of additional medications, medical procedures and hospitalisations). From the perspective of society, treatment with levocetirizine was cost saving, with a net gain of Euro 91.93 per patient per month. CONCLUSION Treating chronic idiopathic urticaria with levocetirizine is a dominant strategy for society since it is more effective (in terms of pruritus-free days gained) and less costly than placebo.
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Affiliation(s)
- Alexander Kapp
- Department of Dermatology and Allergology, Hannover Medical University, Hannover, Germany.
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Passalacqua G, Canonica GW. A Review of the Evidence from Comparative Studies of Levocetirizine and Desloratadine for the Symptoms of Allergic Rhinitis. Clin Ther 2005; 27:979-92. [PMID: 16154477 DOI: 10.1016/j.clinthera.2005.07.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2005] [Indexed: 02/02/2023]
Abstract
BACKGROUND Levocetirizine and desloratadine are newer antihistamines indicated for the treatment of allergic rhinitis and chronic idiopathic urticaria. OBJECTIVE This article discusses the pharmacokinetics and pharmacodynamics of levocetirizine and desloratadine and reviews studies that have directly compared the effects of these 2 drugs in allergic rhinitis and urticaria. METHODS Relevant articles were identified through a search of MEDLINE from 1999 through 2004 using the main search terms levocetirizine and desloratadine. RESULTS Levocetirizine is absorbed rapidly and reaches a steady-state plasma concentration more quickly than does desloratadine. It is also metabolized to a lesser extent than desloratadine, has a lower V(d), and has higher specificity for histamine(1) receptors. Eight well-controlled trials were identified that directly compared the effects of levocetirizine and desloratadine in the skin and nose of healthy individuals and patients with allergic rhinitis. Drug activity was measured in terms of wheal, flare, and itch reactions; nasal symptoms or symptom scores; increases in concentrations of inflammatory markers; or facial thermography. In most of these trials, levocetirizine had a faster onset and greater consistency of effect than desloratadine. The differences in the pharmacokinetic and pharmacodynamic profiles of the 2 drugs may partially explain these clinical findings. CONCLUSIONS Levocetirizine may be preferred to desloratadine as a treatment option for allergic rhinitis because of its faster onset of action and greater consistency of effect. Although comparative studies in chronic idiopathic urticaria are not available, data from histamine-induced wheal and flare studies in healthy volunteers suggest that levocetirizine may be more effective in preventing itching than desloratadine.
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Affiliation(s)
- Giovanni Passalacqua
- Allergy and Respiratory Diseases, Department of Internal Medicine, University of Genoa, Italy.
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48
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Ciprandi G, Cirillo I, Vizzaccaro A, Civardi E, Barberi S, Allen M, Marseglia GL. Desloratadine and levocetirizine improve nasal symptoms, airflow, and allergic inflammation in patients with perennial allergic rhinitis: a pilot study. Int Immunopharmacol 2005; 5:1800-8. [PMID: 16275616 DOI: 10.1016/j.intimp.2005.05.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2004] [Revised: 12/15/2004] [Accepted: 05/26/2005] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nasal obstruction is the main symptom in patients with perennial allergic rhinitis. Some new antihistamines have been demonstrated to be capable of improving this symptom. OBJECTIVE The aim of this pilot study was to evaluate nasal symptoms, nasal airflow, eosinophils, and IL-4 in patients with perennial allergic rhinitis, before and after treatment with two new antihistamines: desloratadine and levocetirizine. METHODS Thirty patients with perennial allergic rhinitis were evaluated, 26 males and 4 females (mean age 26+/-7.1 years). All of them received either desloratadine (5 mg/daily) or levocetirizine (5 mg/daily) or placebo for 4 weeks. The study was double-blind, parallel-group, placebo-controlled, and randomized. Total symptom score (including: rhinorrhea, nasal itching, sneezing, and nasal obstruction) was assessed before and after treatment. Rhinomanometry and decongestion test, nasal lavage, and nasal scraping were performed in all subjects before and after treatment. Eosinophils were counted by conventional staining; IL-4 was measured by immunoassay of fluids recovered from nasal lavage. RESULTS Desloratadine and levocetirizine treatment induced significant symptom relief and significant reduction of IL-4. Both antihistamines significantly affected all parameters in comparison with placebo. CONCLUSIONS This pilot study demonstrates the effectiveness of antihistaminic treatment in: i) relieving nasal symptoms, including obstruction, ii) improving nasal airflow, iii) exerting decongestant activity, iv) reducing eosinophil infiltration, and v) diminishing IL-4 levels.
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Affiliation(s)
- Giorgio Ciprandi
- Allergologia-U.O. ORL, Dipartimento Regionale Testa-Collo, Padiglione Specialità (piano terzo), Ospedale San Martino, Largo R. Benzi 10, 16132, Genoa, Italy.
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49
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Abstract
Nasal congestion is a common and troublesome symptom of allergic rhinitis. Because it impairs the natural human drive for nasal breathing, it -- in addition -- leads to lower self-esteem and to impaired quality of life. It is a symptom that is difficult to treat. Traditionally, intranasal steroids, because of their potent anti-inflammatory properties, and vasoconstrictors have been utilized for relieving the nasal passages from the inflamed and congested mucosal tissues. Recent studies with the last-generation antihistamines have demonstrated the decongestant properties of these antihistamines in both the more acute seasonal allergic rhinitis and the more chronic and lasting perennial allergic rhinitis. This study aims to review the efficacy of the potent antihistamine, levocetirizine, in relieving nasal congestion as reported in various studies and settings. Comparisons with placebo and with other antihistamines have been presented in order to help general medical practitioners differentiate between the properties of the various available antihistamines.
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Affiliation(s)
- L Klimek
- Centre for Rhinology and Allergology, Mannheim University, Wiesbaden, Germany.
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