Evidence of desloratadine syrup efficacy and tolerability in children with pollen-induced allergic rhinitis

A comparative study of loratadine syrup and cyproheptadine HCL solution for treating perennial allergic rhinitis in Taiwanese children aged 2-12 years

We assessed the efficacy of loratadine syrup compared with cyproheptadine HCl solution for treating children aged from 2 to 12 years with perennial allergic rhinitis (PAR) in Taiwan. Sixty children with mite-induced PAR were enrolled and randomly placed into two treatment groups: loratadine syrup or cyproheptadine HCl solution. Treatment efficacy and symptom changes from baseline to post-treatment were evaluated by total symptom scores and visual analogue scales (VAS) during a 2-week period. There were no differences in age, gender, height, or weight between the two groups. After 2 weeks of treatment, there was a significantly greater reduction in symptom scores in the loratadine group than in the cyproheptadine group (p<0.001). Clinical and subjective VAS showed significant differences in percentage changes from baseline between the loratadine and cyproheptadine groups at all time points (all p<0.001, in favor of loratadine). Clinical VAS change at week 1: 95.1 vs 11.3; subjective VAS change at week 1: 88.6 vs 13.6; clinical VAS change at week 2: 125.5 vs 18.3; subjective VAS change at week 2: 101.4 vs 7.1. Thus, loratadine was superior to cyproheptadine for alleviating both nasal and non-nasal symptoms of perennial allergic rhinitis in Taiwanese children aged 2-12 years.

Parental attitudes toward new dosage forms of desloratadine in an online survey: results from four European countries

BACKGROUND

Allergic disease affects an estimated 50% of children worldwide and causes considerable impairment in academic performance and daily activities. Pediatric formulations for allergy treatment are often highly sugared or contain ingredients to improve palatability, appearance, and patient acceptance/adherence. These excipients, however, are associated with dental caries, gastrointestinal intolerance, and dermatologic reactions.

OBJECTIVE

To assess the appeal of new sugar-free/dye-free syrup and orodispersible formulations of the second-generation antihistamine desloratadine to parents of children with allergy in four European countries.

DESIGN

In an online survey of households with children aged < or =12 years with allergies in France, Italy, the Netherlands, and Spain, respondents were asked to consider one of two desloratadine product concepts: a sugar-free, dye-free oral solution or an orodispersible tablet.

PARTICIPANTS

Eligible households had to have at least one child aged < or =12 years with symptomatic seasonal, pet, or indoor allergies or hives for > or =1 week/year. Respondents had to be the decision makers regarding their child's allergy medication and to be likely to treat symptoms with prescription medication some of the time.

RESULTS

There were 627 eligible households. Most (88%) parents in Spain were likely to ask their physician about and to consider trying sugar-free, dye-free desloratadine syrup, followed by 76% of those in France, 68% in Italy, and 56% in the Netherlands. About three-quarters of parents in France, Spain, and Italy and more than half of those in the Netherlands were likely to ask their physician about and to consider trying the orodispersible formulation.

LIMITATIONS

There is no control group for comparisons between the study's online responses and those that would have resulted from another survey methodology. Further, response biases do exist across countries based on cultural norms.

CONCLUSION

Survey respondents were generally receptive to the new sugar-free, dye-free syrup and orodispersible tablet formulations of the second-generation antihistamine desloratadine. At least half of parents surveyed indicated their willingness to try the new products.

Update on prescription and over-the-counter histamine inverse agonists in rhinitis therapy

Allergic rhinitis (AR) is associated with histamine-mediated physiologic events. The currently used histamine antagonists are all inverse agonists that bind and inactivate histamine H1 receptors. Second-generation antihistamines are much more H1-receptor selective with less central nervous system penetration than first-generation agents. Antihistamines typically are more effective in seasonal than perennial AR and do not demonstrate significant relief of nasal congestion. The recent availability of some second-generation antihistamines as over-the-counter products clearly places them as the preferred first-line treatment for mild to moderate AR based on safety when compared with first-generation over-the-counter antihistamines. The remaining prescription-only second-generation antihistamines, fexofenadine, desloratadine, and levocetirizine, all have unique attributes. Antihistamines in oral, intranasal, or intraocular formulations will likely remain among the mainstays of allergy therapeutics.

Pharmacokinetics of desloratadine in children between 2 and 11 years of age

AIMS

The aim of the studies was to characterize the pharmacokinetics of desloratadine in healthy children and to determine the appropriate dose for paediatric patients 2-11 years old.

METHODS

Two open-label, single-dose studies were carried out in healthy children between 2-5 (n = 18) and 6-11 years old (n = 18). On day 1, subjects received a single oral dose of desloratadine syrup (1.25 mg for 2-5 year olds or 2.5 mg for 6-11 year olds). Subjects were followed for an additional 4 days during which vital signs were measured daily and blood samples were collected periodically.

RESULTS

Plasma desloratadine C(max) occurred at a median of 2.0 h after dosing in both age groups. Median values for the younger (2-5 years old) and older (6-11 years old) groups were 2.28 and 2.05 ng ml(-1), respectively. Arithmetic (and harmonic) mean t(1/2) (h) values for each group, respectively, were 16.4 (13.9) and 19.4 (15.8). Exposure to desloratadine was similar in both the younger and older age groups, with a median AUC(last) of 38.8 and 38.2 ng ml(-1) h, respectively. These data were similar to values in adults, who received 5 mg doses of desloratadine. No adverse events or clinically significant abnormal laboratory values were noted in either group.

CONCLUSIONS

Single doses of desloratadine syrup (1.25 and 2.5 mg) were well tolerated in children 2-5 and 6-11 years old. Desloratadine exposure in children appears to be similar to that observed in adults, in whom efficacy has been established.

Desloratadine dose selection in children aged 6 months to 2 years: comparison of population pharmacokinetics between children and adults

AIMS

The aim of this study was to identify the dose of desloratadine in children aged > or =6 months- < or =2 years that would yield a single-dose target exposure (AUC) comparable with that in adults taking 5 mg desloratadine as syrup.

METHODS

In a phase 1, single-dose, open-label, pharmacokinetic study in 58 children aged > or =6 months- <1 year and > or =1 year- < or =2 years were randomly assigned to desloratadine syrup 0.625 mg (1.25 ml) and 1.25 mg (2.5 ml), respectively. Because the volume of blood that could be collected from individual subjects was limited, a population pharmacokinetic approach was used to estimate the pharmacokinetics of desloratadine. Safety was assessed based on results of screening and postdose physical examinations, laboratory safety tests, vital signs, and adverse events.

RESULTS

The apparent clearance (CL/F) of desloratadine, population estimate (%CV), in children aged > or =6 months- <1 year was 27.8 l h(-1) (35) and corresponding values in children > or =1 year- < or =2 years was 35.5 l h(-1) (51), compared with 137 l h(-1) (58) for adults. The CL/F ratios (children to adults) indicated that doses of 1 mg for > or =6 months- <1 year and 1.25 mg for > or =1 year- < or =2 years would result in similar systemic exposure to that observed in adults receiving the recommended 5 mg dose. Desloratadine was well tolerated with no safety issues.

CONCLUSIONS

Doses of 1.0 and 1.25 mg in children aged > or =6 months- < or =2 years should result in an exposure to desloratadine similar to that of adults receiving doses of 5 mg.

Review of desloratadine for the treatment of allergic rhinitis, chronic idiopathic urticaria and allergic inflammatory disorders

Desloratadine is a once-daily, non-sedating, non-impairing, selective histamine H1-receptor antagonist. It relieves the symptoms of seasonal allergic rhinitis (including nasal obstruction and congestion, and morning symptoms), perennial allergic rhinitis and chronic idiopathic urticaria by blocking multiple critical steps in the systemic allergic cascade and downregulating key allergy-induced inflammatory mediators. It also relieves asthma symptoms and decreases rescue medication use in patients with seasonal allergic rhinitis and comorbid asthma. Numerous clinical studies have demonstrated that desloratadine is safe, well tolerated and free of serious cardiac effects. Pharmacokinetic studies have demonstrated a low propensity for drug-drug or drug-food interactions. This review outlines the mechanism of action, efficacy and safety of desloratadine for the treatment of allergic inflammatory disorders.

Treatment for allergic rhinitis and chronic idiopathic urticaria: focus on oral antihistamines

OBJECTIVE

To review the efficacy and safety of first- and newer-generation antihistamines for the management of allergic rhinitis and chronic idiopathic urticaria (CIU), with a focus on management in the pharmacy.

DATA SOURCES

A literature review was performed using MEDLINE (1966-October 2005), with no time or language restrictions. Key words or phrases used were histamine, antihistamine(s), first- and second-generation, allergic rhinitis, chronic idiopathic urticaria, quality of life, impairment, sedation, cost-effectiveness, astemizole, cetirizine, desloratadine, diphenhydramine, fexofenadine, loratadine, hydroxyzine, ketotifen, and mizolastine. Additional references were found in the bibliographies of the articles cited.

STUDY SELECTION AND DATA EXTRACTION

Clinical trials and other experimental studies of the use of antihistamines for the management of allergic rhinitis and CIU were selected. Review papers and guidelines were also included.

DATA SYNTHESIS

First-generation antihistamines are effective at ameliorating the symptoms of allergic rhinitis and CIU; however, they are associated with adverse effects due to a lack of selectivity for the histamine H(1)-receptor and an ability to bind to cerebral H(1)-receptors. Newer-generation agents, in general, possess high H(1)-receptor selectivity and a low tendency to cross the blood-brain barrier, while maintaining efficacy. In general, safety at elevated doses has been demonstrated for the newer antihistamines, although higher rates of sedation and impairment have been reported with increasing doses for some agents.

CONCLUSIONS

Pharmacists can play an important role in the management of allergic rhinitis and CIU by considering the relative advantages of newer-generation agents when reviewing treatment options.