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Solé D, Kuschnir FC, Pastorino AC, Constantino CF, Galvão C, Chong E Silva DC, Baptistella E, Goudouris ES, Sakano E, Ejzenbaum F, Matsumoto FY, Mizoguchi FM, Aarestrup FM, Wandalsen GF, Chong Neto HJ, Brito de Oliveira JV, Lubianca Neto JF, Rizzo MCV, Silva Chavarria MLF, Urrutia-Pereira M, Filho NAR, de Paula Motta Rubini N, Mion O, Piltcher OB, Ramos RT, Francesco RD, Roithmann R, Anselmo-Lima WT, Romano FR, de Mello Júnior JF. V Brazilian Consensus on Rhinitis - 2024. Braz J Otorhinolaryngol 2024; 91:101500. [PMID: 39388827 PMCID: PMC11497470 DOI: 10.1016/j.bjorl.2024.101500] [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: 08/14/2024] [Accepted: 08/17/2024] [Indexed: 10/12/2024] Open
Abstract
Since we published the "IV Brazilian Consensus on Rhinitis", in2017, several advances have been achieved and have enabled a further understanding of the different aspects of "Rhinitis". This new guideline, developed jointly by ASBAI, SBP and SBORL, represents a relevant milestone in the updated and integrated management of the different forms of the disease, and it aims to unify evidence-based approaches to improve the diagnosis and treatment of this common and often underestimated condition. The document covers a wide range of topics, including clear definitions of the different phenotypes and endotypes of rhinitis, risk factors, updated diagnostic criteria, and recommended methods for clinical and laboratory investigation. We stress the importance of detailed clinical history and objective assessment, as well as tools for control and assessing severity tools an accurate diagnostic approach to the disease. Regarding treatment, it emphasizes the treatment customization, considering the severity of symptoms, the presence of comorbidities and the impact on the patient's quality of life. We discuss different drug treatment, in addition to non-pharmacological measures, such as environmental control and specific immunotherapy; and the possible role of immunobiological agents. Furthermore, the consensus addresses issues related to patient education, prevention and management of special situations, such as rhinitis in children, in pregnant women and in the elderly. In short, the "V Brazilian Consensus on Rhinitis" represents a comprehensive and updated guide for healthcare professionals involved in the diagnosis and management of rhinitis, aiming to improve patients' quality of life through an integrated and evidence-based approach.
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Affiliation(s)
- Dirceu Solé
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil; Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Fábio Chigres Kuschnir
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Antônio Carlos Pastorino
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade de São Paulo, São Paulo, SP, Brazil
| | - Clóvis F Constantino
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade de Santo Amaro, São Paulo, SP, Brazil
| | - Clóvis Galvão
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade de São Paulo, São Paulo, SP, Brazil
| | - Débora Carla Chong E Silva
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal do Paraná́, Curitiba, PR, Brazil
| | - Eduardo Baptistella
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil
| | - Ekaterini Simões Goudouris
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Eulália Sakano
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil; Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Fábio Ejzenbaum
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Fausto Yoshio Matsumoto
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil; Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Flavio Massao Mizoguchi
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil
| | - Fernando Monteiro Aarestrup
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Gustavo F Wandalsen
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil; Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Herberto José Chong Neto
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal do Paraná́, Curitiba, PR, Brazil
| | | | - José Faibes Lubianca Neto
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Fundação Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | | | | | - Marilyn Urrutia-Pereira
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal do Pampa, Uruguaiana, RS, Brazil
| | - Nelson Augusto Rosário Filho
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal do Paraná́, Curitiba, PR, Brazil
| | - Norma de Paula Motta Rubini
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Olavo Mion
- Universidade de São Paulo, São Paulo, SP, Brazil; Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil
| | - Otávio Bejzman Piltcher
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil; Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazi
| | - Regina Terse Ramos
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Renata Di Francesco
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade de São Paulo, São Paulo, SP, Brazil
| | - Renato Roithmann
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil; Universidade Luterana do Brasil, Canos, RS, Brazil
| | - Wilma Terezinha Anselmo-Lima
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil; Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Fabrizio Ricci Romano
- Universidade de São Paulo, São Paulo, SP, Brazil; Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil
| | - João Ferreira de Mello Júnior
- Universidade de São Paulo, São Paulo, SP, Brazil; Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil.
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Yu F, Liu X, Ou H, Li X, Liu R, Lv X, Xiao S, Hu M, Liang T, Chen T, Wei X, Zhang Z, Liu S, Liu H, Zhu Y, Liu G, Tu T, Li P, Zhang H, Pan T, Ma X. The histamine receptor H1 acts as an alternative receptor for SARS-CoV-2. mBio 2024; 15:e0108824. [PMID: 38953634 PMCID: PMC11324024 DOI: 10.1128/mbio.01088-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/29/2024] [Indexed: 07/04/2024] Open
Abstract
Numerous host factors, in addition to human angiotensin-converting enzyme 2 (hACE2), have been identified as coreceptors of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), demonstrating broad viral tropism and diversified druggable potential. We and others have found that antihistamine drugs, particularly histamine receptor H1 (HRH1) antagonists, potently inhibit SARS-CoV-2 infection. In this study, we provided compelling evidence that HRH1 acts as an alternative receptor for SARS-CoV-2 by directly binding to the viral spike protein. HRH1 also synergistically enhanced hACE2-dependent viral entry by interacting with hACE2. Antihistamine drugs effectively prevent viral infection by competitively binding to HRH1, thereby disrupting the interaction between the spike protein and its receptor. Multiple inhibition assays revealed that antihistamine drugs broadly inhibited the infection of various SARS-CoV-2 mutants with an average IC50 of 2.4 µM. The prophylactic function of these drugs was further confirmed by authentic SARS-CoV-2 infection assays and humanized mouse challenge experiments, demonstrating the therapeutic potential of antihistamine drugs for combating coronavirus disease 19.IMPORTANCEIn addition to human angiotensin-converting enzyme 2, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can utilize alternative cofactors to facilitate viral entry. In this study, we discovered that histamine receptor H1 (HRH1) not only functions as an independent receptor for SARS-CoV-2 but also synergistically enhances ACE2-dependent viral entry by directly interacting with ACE2. Further studies have demonstrated that HRH1 facilitates the entry of SARS-CoV-2 by directly binding to the N-terminal domain of the spike protein. Conversely, antihistamine drugs, primarily HRH1 antagonists, can competitively bind to HRH1 and thereby prevent viral entry. These findings revealed that the administration of repurposable antihistamine drugs could be a therapeutic intervention to combat coronavirus disease 19.
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Affiliation(s)
- Fei Yu
- Medical Research
Institute, Guangdong Provincial People’s Hospital (Guangdong
Academy of Medical Sciences), Southern Medical
University, Guangzhou,
Guangdong, China
| | - Xiaoqing Liu
- Guangzhou National
Laboratory, Guangzhou International
Bio-Island, Guangzhou,
Guangdong, China
- Institute of Human
Virology, Zhongshan School of Medicine, Sun Yat-sen
University, Guangzhou,
Guangdong, China
| | - Hailan Ou
- Medical Research
Institute, Guangdong Provincial People’s Hospital (Guangdong
Academy of Medical Sciences), Southern Medical
University, Guangzhou,
Guangdong, China
| | - Xinyu Li
- Shenzhen Key
Laboratory of Systems Medicine for Inflammatory Diseases, Shenzhen
Campus of Sun Yat-sen University,
Shenzhen, Guangdong,
China
| | - Ruxin Liu
- Shenzhen Key
Laboratory of Systems Medicine for Inflammatory Diseases, Shenzhen
Campus of Sun Yat-sen University,
Shenzhen, Guangdong,
China
| | - Xi Lv
- Medical Research
Institute, Guangdong Provincial People’s Hospital (Guangdong
Academy of Medical Sciences), Southern Medical
University, Guangzhou,
Guangdong, China
- School of Medicine,
South China University of Technology,
Guangzhou, Guangdong,
China
| | - Shiqi Xiao
- Guangzhou National
Laboratory, Guangzhou International
Bio-Island, Guangzhou,
Guangdong, China
| | - Meilin Hu
- Guangzhou National
Laboratory, Guangzhou International
Bio-Island, Guangzhou,
Guangdong, China
- Department of Breast
Surgery, The Second Affiliated Hospital of Guangzhou Medical
University, Guangzhou,
Guangdong, China
| | - Taizhen Liang
- Guangzhou National
Laboratory, Guangzhou International
Bio-Island, Guangzhou,
Guangdong, China
- State Key Laboratory
of Respiratory Disease, National Clinical Research Center for
Respiratory Disease, Guangzhou Institute of Respiratory Health, the
First Affiliated Hospital of Guangzhou Medical
University, Guangzhou,
Guangdong, China
| | - Tao Chen
- Guangzhou National
Laboratory, Guangzhou International
Bio-Island, Guangzhou,
Guangdong, China
- State Key Laboratory
of Respiratory Disease, National Clinical Research Center for
Respiratory Disease, Guangzhou Institute of Respiratory Health, the
First Affiliated Hospital of Guangzhou Medical
University, Guangzhou,
Guangdong, China
| | - Xuepeng Wei
- Guangzhou National
Laboratory, Guangzhou International
Bio-Island, Guangzhou,
Guangdong, China
| | - Zhenglai Zhang
- Guangzhou National
Laboratory, Guangzhou International
Bio-Island, Guangzhou,
Guangdong, China
| | - Sen Liu
- Guangzhou National
Laboratory, Guangzhou International
Bio-Island, Guangzhou,
Guangdong, China
- School of Biology and
Biological Engineering, South China University of
Technology, Guangzhou,
Guangdong, China
| | - Han Liu
- Guangzhou National
Laboratory, Guangzhou International
Bio-Island, Guangzhou,
Guangdong, China
| | - Yiqiang Zhu
- Guangzhou National
Laboratory, Guangzhou International
Bio-Island, Guangzhou,
Guangdong, China
| | - Guangyan Liu
- Department of Pathogen
Biology, Shenyang Medical College,
Shenyang, Liaoning,
China
| | - Tianyong Tu
- Guangzhou National
Laboratory, Guangzhou International
Bio-Island, Guangzhou,
Guangdong, China
| | - Peiwen Li
- Guangzhou National
Laboratory, Guangzhou International
Bio-Island, Guangzhou,
Guangdong, China
| | - Hui Zhang
- Institute of Human
Virology, Zhongshan School of Medicine, Sun Yat-sen
University, Guangzhou,
Guangdong, China
| | - Ting Pan
- Shenzhen Key
Laboratory of Systems Medicine for Inflammatory Diseases, Shenzhen
Campus of Sun Yat-sen University,
Shenzhen, Guangdong,
China
| | - Xiancai Ma
- Medical Research
Institute, Guangdong Provincial People’s Hospital (Guangdong
Academy of Medical Sciences), Southern Medical
University, Guangzhou,
Guangdong, China
- Guangzhou National
Laboratory, Guangzhou International
Bio-Island, Guangzhou,
Guangdong, China
- State Key Laboratory
of Respiratory Disease, National Clinical Research Center for
Respiratory Disease, Guangzhou Institute of Respiratory Health, the
First Affiliated Hospital of Guangzhou Medical
University, Guangzhou,
Guangdong, China
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Almalki MA, Alanazi TYA, Mahgoub SM, Abo El-Ela FI, Mohamed MA. Greens appraisal of validated stability indicating RP-HPLC method and forced degradation study for quantification of Ebastine in wastewater and dosage form. ANNALES PHARMACEUTIQUES FRANÇAISES 2024; 82:420-432. [PMID: 37739216 DOI: 10.1016/j.pharma.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVES Allergic rhinitis and chronic idiopathic urticaria are common conditions triggered by environmental irritants, stress, and certain foods. The FDA has recently announced that the efficacy and safety of Ebastine (EBS) have been thoroughly evaluated and confirmed. This study considered using various tools to assess their greenness. We used AGREEprep, analytical eco-scale (ESA), and analytical method volume intensity (AMVI) to evaluate the greenness of the validated stability-indicating method and a forced degradation study. This allowed for easy determination and quantitation of EBS in wastewater and dosage form. METHODS The method was established on Symmetry RP-C18 (150mm×4.6mm,5μm) using mobile phase, which can be prepared by mixing buffer solution of pH 3 with acetonitrile in a ratio of (37.5: 62.5, v/v) in addition to dissolving 0.72 gm of sodium lauryl sulfate in the final solution. The separation process was executed at a flow rate of 1.5mL/min and 5μL injection volume with UV detection at 254nm. Linearity was conducted for EBS in the 5-50μg/mL range. Different validation parameters were investigated, including accuracy, precision, robustness, and specificity. RESULTS The limits of both detection and quantification were 0.84μg/mL and 2.57μg/mL for EBS. The recovery percentages of EBS were found to be 101.01% and 101.02% for wastewater and pharmaceutical formulations, respectively. CONCLUSION According to International Council for Harmonisation (ICH) guidelines, a forced degradation study of EBS was evaluated, including acid, base hydrolysis, and oxidative hydrolysis using hydrogen peroxide and photolytic and thermal degradation. The highest degradation was achieved by acid hydrolysis. The safety and efficacy of EBS were evaluated via a safety comparative profile study.
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Affiliation(s)
- Manal A Almalki
- Chemistry Department, College of Science, Taibah University, Al-Madinah Al Munawarah, Al-Madina 30002, Saudi Arabia
| | - Tahani Y A Alanazi
- Chemistry Department, Faculty of Science, University of Ha'il, P.O. Box 2440, Ha'il 81451, Saudi Arabia
| | - Samar M Mahgoub
- Materials Science and Nanotechnology Department, Faculty of Postgraduate Studies for Advanced Sciences, Beni-Suef University, Beni-Suef, Egypt
| | - Fatma I Abo El-Ela
- Department of Pharmacology, Faculty of Veterinary Medicine, Beni-Suef University, Beni-Suef, Egypt
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Chiniard T, Dib É, Guénot F, du Baret de Limé M, Manen O, Monin J. Flight safety risk assessment of self-medication among fighter pilots: a cross-sectional study. Int J Clin Pharm 2023; 45:1415-1423. [PMID: 37430120 DOI: 10.1007/s11096-023-01611-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/27/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Fighter pilots are a specific population in which any adverse drug reaction can unpredictably interact with aeronautical constraints and thus compromise flight safety. This issue has not been evaluated in risk assessments. AIM To provide a semi-quantitative assessment of the risk to flight safety of self-medication in fighter pilots. METHOD A cross-sectional survey that aimed at identifying the determinants of self-medication in fighter pilots was conducted. All medications consumed within 8 h preceding a flight were listed. A modified Failure Mode and Effects Analysis was performed, and any adverse drug reaction reported in the French marketing authorization document of a drug was considered a failure mode. The frequency of occurrence and severity were evaluated using specific scales to assign each to three risk criticality categories: acceptable, tolerable, and unacceptable. RESULTS Between March and November 2020, the responses of 170 fighter pilots were analyzed, for an overall return rate of approximately 34%. Among them, 78 reported 140 self-medication events within 8 h preceding a flight. Thirty-nine drug trade names (48 different international nonproprietary names) were listed, from which 694 potential adverse drug reactions were identified. The risk criticality was considered unacceptable, tolerable and acceptable for 37, 325 and 332 adverse drug reactions, respectively. Thus, the risk criticality was considered unacceptable, tolerable and acceptable for 17, 17, and 5 drugs, respectively. CONCLUSION This analysis suggests that the overall risk to flight safety of the current practice of self-medication in fighter pilots may be considered at least tolerable, or even unacceptable.
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Affiliation(s)
- Thomas Chiniard
- Department of Anesthesiology and Intensive Care, Bégin Military Hospital, Saint-Mandé, France.
- French Military Medical Service Academy, École du Val-de-Grâce, Paris, France.
| | - Élise Dib
- 6th Medical Unit, 1st Medical Center, Vincennes, France
| | - François Guénot
- Medical Service, Nuclear Missile Submarines Squadron, Brest Naval Base, Brest, France
| | | | - Olivier Manen
- Medicine Department, Aeromedical Center, Percy Military Hospital, Clamart, France
- French Military Medical Service Academy, École du Val-de-Grâce, Paris, France
| | - Jonathan Monin
- Medicine Department, Aeromedical Center, Percy Military Hospital, Clamart, France
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Delli Colli L, Al Ali A, Gabrielli S, Delli Colli M, Mule P, Lawson B, Clarke AE, Morris J, Gravel J, Lim R, Chan ES, Goldman RD, O'Keefe A, Gerdts J, Chu DK, Upton J, Hochstadter E, Bretholz A, McCusker C, Zhang X, Benor S, Simons E, Abrams EM, Protudjer JLP, Ben-Shoshan M. Managing anaphylaxis: Epinephrine, antihistamines, and corticosteroids: More than 10 years of Cross-Canada Anaphylaxis REgistry data. Ann Allergy Asthma Immunol 2023; 131:752-758.e1. [PMID: 37689113 DOI: 10.1016/j.anai.2023.08.606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/04/2023] [Accepted: 08/22/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Epinephrine is the first-line treatment for anaphylaxis but is often replaced with antihistamines or corticosteroids. Delayed epinephrine administration is a risk factor for fatal anaphylaxis. Convincing data on the role of antihistamines and corticosteroids in anaphylaxis management are sparse. OBJECTIVE To establish the impact of prehospital treatment with epinephrine, antihistamines, and/or corticosteroids on anaphylaxis management. METHODS Patients presenting with anaphylaxis were recruited prospectively and retrospectively in 10 Canadian and 1 Israeli emergency departments (EDs) between April 2011 and August 2022, as part of the Cross-Canada Anaphylaxis REgistry. Data on anaphylaxis cases were collected using a standardized form. Primary outcomes were uncontrolled reactions (>2 doses of epinephrine in ED), no prehospital epinephrine use, use of intravenous fluids in ED, and hospital admission. Multivariate regression was used to identify factors associated with primary outcomes. RESULTS Among 5364 reactions recorded, median age was 8.8 years (IQR, 3.78-16.9); 54.9% of the patients were males, and 52.5% had a known food allergy. In the prehospital setting, 37.9% received epinephrine; 44.3% received antihistamines, and 3.15% received corticosteroids. Uncontrolled reactions happened in 250 reactions. Patients treated with prehospital epinephrine were less likely to have uncontrolled reactions (adjusted odds ratio [aOR], 0.955 [95% CI, 0.943-0.967]), receive intravenous fluids in ED (aOR, 0.976 [95% CI, 0.959-0.992]), and to be admitted after the reaction (aOR, 0.964 [95% CI, 0.949-0.980]). Patients treated with prehospital antihistamines were less likely to have uncontrolled reactions (aOR, 0.978 [95% CI, 0.967-0.989]) and to be admitted after the reaction (aOR, 0.963 [95% CI, 0.949-0.977]). Patients who received prehospital corticosteroids were more likely to require intravenous fluids in ED (aOR, 1.059 [95% CI, 1.013-1.107]) and be admitted (aOR, 1.232 [95% CI, 1.181-1.286]). CONCLUSION Our findings in this predominantly pediatric population support the early use of epinephrine and suggest a beneficial effect of antihistamines. Corticosteroid use in anaphylaxis should be revisited.
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Affiliation(s)
- Luca Delli Colli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Adnan Al Ali
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sofianne Gabrielli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marina Delli Colli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Pasquale Mule
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Benjamin Lawson
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ann E Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Judy Morris
- Department of Emergency Medicine, Sacré-Coeur Hospital, Montreal, Quebec, Canada
| | - Jocelyn Gravel
- Department of Pediatric Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Université de Montréal, Quebec, Canada
| | - Rod Lim
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at London Health Science Centre, London, Ontario, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ran D Goldman
- Division of Clinical Pharmacology and Emergency Medicine, Department of Pediatrics, BC Children's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew O'Keefe
- Faculty of Medicine, Department of Pediatrics, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Jennifer Gerdts
- Executive Director, Food Allergy Canada, Toronto, Ontario, Canada
| | - Derek K Chu
- Division of Clinical Immunology & Allergy, Department of Medicine, and Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Julia Upton
- Division of Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Elana Hochstadter
- Department of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Adam Bretholz
- Department of Pediatric Emergency Medicine, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Christine McCusker
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Xun Zhang
- Center for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Shira Benor
- Allergy and Clinical Immunology Unit, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Elinor Simons
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, University of Manitoba, and Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, University of Manitoba, and Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, University of Manitoba and Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada; Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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D'Amato G, Murrieta-Aguttes M, D'Amato M, Ansotegui IJ. Pollen respiratory allergy: Is it really seasonal? World Allergy Organ J 2023; 16:100799. [PMID: 37520612 PMCID: PMC10384659 DOI: 10.1016/j.waojou.2023.100799] [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] [Received: 04/27/2023] [Revised: 06/16/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Allergic rhinitis (AR) is a highly prevalent respiratory condition that carries a heavy burden and can have a significant impact on patient quality of life. AR is caused by seasonal or perennial exposure to outdoor pollens and molds as well as indoor allergic triggers. In this review article, we discuss the factors associated with the development of AR throughout the year and the fact that patients with AR need continuous treatment rather than seasonal treatment. Conventionally, AR has been mainly categorized into seasonal AR and perennial AR, but these classes do not seem to be well-adapted. Climate changes, temperature changes, and high carbon dioxide (CO2) concentration affect the growth of plants and increase the length of pollen seasons and pollen allergenicity. Air pollution aggravates allergic sensitization symptoms in AR sensitized individuals. Due to increased air pollution and indefinite pollen seasons AR symptoms are present throughout the year. Patients with AR often need continuous treatment, which should be considered while making the strategy for treating allergic rhinitis sufferers. Management of AR involves avoiding the allergen, medications for symptomatic relief, anti-inflammatory therapies, and allergy immunotherapy. Although the first-generation H1-antihistamines reduce AR symptoms, they cause sedation and impair cognitive functions; thus, second-generation antihistamines (ie, levocetirizine, loratadine, bilastine, fexofenadine) are preferred. The efficacy and safety of fexofenadine for the treatment of seasonal allergic rhinitis (SAR) symptoms have been demonstrated by numerous clinical studies, irrespective of the season and underlying allergen. In this review, we discuss the allergic rhinitis classification, the role of climate change, air pollution, and factors contributing to year-round symptoms in patients with AR and the need for continuous pharmacological treatment for management.
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Affiliation(s)
- Gennaro D'Amato
- Division of Respiratory and Allergic Diseases, Department of Chest Diseases, High Specialty A. Cardarelli Hospital, University of Naples Federico II, Napoli, Italy
| | | | - Maria D'Amato
- First Division of Pneumology, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’ Medical School Naples, Napoli, Italy
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Trincianti C, Tosca MA, Ciprandi G. Updates in the diagnosis and practical management of allergic rhinitis. Expert Rev Clin Pharmacol 2023; 16:669-676. [PMID: 37314373 DOI: 10.1080/17512433.2023.2225770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/12/2023] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Allergic rhinitis (AR) is a widespread disease that can be associated with other conditions, including conjunctivitis, rhinosinusitis, asthma, food allergy, and atopic dermatitis. Diagnosis is based on the history and documentation of sensitization, such as the production of allergen-specific IgE, preferably using molecular diagnostics. Treatments are based on patient education, non-pharmacological and pharmacological remedies, allergen-specific immunotherapy (AIT), and surgery. Symptomatic treatments mainly concern intranasal/oral antihistamines and/or nasal corticosteroids. AREAS COVERED This review discusses current and emerging management strategies for AR, covering pharmacological and non-pharmacological remedies, AIT, and biologics in selected cases with associated severe asthma. However, AIT presently remains the unique causal treatment for AR. EXPERT OPINION The management of allergic rhinitis could include new strategies. In this regard, particular interest should be considered in the fixed association between intranasal antihistamines and corticosteroids, probiotics and other natural substances, and new formulations (tablets) of AIT.
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Abstract
Allergic rhinitis is a common disorder that regularly occurs in children and adolescents. The disease is associated with other allergic diseases, such as asthma, and it carries a heavy burden, with effects on sleep, school performance, and quality of life. Classic symptoms include sneezing, rhinorrhea, nasal obstruction, and nasal itching. When the eyes are involved, the term allergic rhinoconjunctivitis is used. Triggers may include airborne pollens, molds, dust mites, and animals. Skin or blood allergy testing can be a useful diagnostic modality that may guide therapy. Immunotherapy can prevent the development of further allergic sensitizations as well as subsequent asthma.
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Affiliation(s)
- Charles Frank Schuler Iv
- Division of Allergy and Clinical Immunology, University of Michigan, Domino's Farms, 24 Frank Lloyd Wright Drive, PO Box 442, Suite H-2100, Ann Arbor, MI 48105, USA.
| | - Jenny Maribel Montejo
- Division of Allergy and Clinical Immunology, University of Michigan, Domino's Farms, 24 Frank Lloyd Wright Drive, PO Box 442, Suite H-2100, Ann Arbor, MI 48105, USA
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Andersson NW, Andersen JT. Pros and Cons in Using Population-Based Registers for Assessing the Fetal Safety of Drugs-Reply. JAMA Pediatr 2021; 175:427-428. [PMID: 33464312 DOI: 10.1001/jamapediatrics.2020.5323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Jon Trærup Andersen
- Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen NV, Denmark
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Jeong S, Jang J, Cho H, Lee Y. Simultaneous measurement of epinastine and its metabolite, 9,13b‐dehydroepinastine, in human plasma by a newly developed ultra‐performance liquid chromatography–tandem mass spectrometry and its application to pharmacokinetic studies. Biomed Chromatogr 2020; 34:e4848. [DOI: 10.1002/bmc.4848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/31/2020] [Accepted: 04/12/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Seung‐Hyun Jeong
- College of Pharmacy, Chonnam National University Gwangju Republic of Korea
| | - Ji‐Hun Jang
- College of Pharmacy, Chonnam National University Gwangju Republic of Korea
| | - Hea‐Young Cho
- College of Pharmacy, CHA University Seongnam‐si Gyeonggi‐Do Republic of Korea
| | - Yong‐Bok Lee
- College of Pharmacy, Chonnam National University Gwangju Republic of Korea
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Meeuwis SH, van Middendorp H, Pacheco-Lopez G, Ninaber MK, Lavrijsen APM, van der Wee N, Veldhuijzen DS, Evers AWM. Antipruritic Placebo Effects by Conditioning H1-antihistamine. Psychosom Med 2020; 81:841-850. [PMID: 31490841 PMCID: PMC6844655 DOI: 10.1097/psy.0000000000000743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/15/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Allergic rhinitis symptoms can be reduced by behaviorally conditioning antihistamine. It is unclear whether these findings extend to histamine-induced itch or work when participants are informed about the conditioning procedure (open-label conditioning). The current study aims to investigate the efficacy of (open-label) antipruritic behavioral conditioning for histamine-induced itch. METHODS Healthy participants (n = 92; 84% female) were randomized to I) an open-label conditioned, II) closed-label conditioned, III) conditioned-not-evoked control, or IV) nonconditioned control group. A two-phase conditioning paradigm was used. During acquisition, a conditioned stimulus (CS; distinctively tasting beverage) was repeatedly paired with the H1-antihistamine levocetirizine (groups I-III). During evocation, the CS was paired with placebo (I, II), or instead of the CS, water was paired with placebo (III). The nonconditioned control group (IV) received CS with placebo in both phases. Itch after histamine iontophoresis and physiological data (i.e., spirometry, heart rate, skin conductance) were assessed. Combined conditioned and combined control groups were first compared, and analyses were repeated for separate groups. RESULTS Marginally lower itch was reported in the combined conditioned compared with the control groups (F(1,88) = 2.10, p = .076, ηpartial = 0.02); no differences between separate groups were found. No effects on physiological data were found, except for heart rate, which reduced significantly and consistently for control groups, and less consistently for conditioned groups (group by time interaction: F(7,80) = 2.35, p = .031, ηpartial = 0.17). CONCLUSION Limited support was found for the efficacy of antipruritic behavioral conditioning, regardless of whether participants were informed about the conditioning procedure. The application of open-label conditioning in patient populations should be further researched. TRIAL REGISTRATION www.trialregister.nl; ID NTR5544.
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Affiliation(s)
- Stefanie H Meeuwis
- From the Health, Medical and Neuropsychology Unit, Institute Psychology, Faculty of Social and Behavioural Sciences, (Meeuwis, van Middendorp, Pacheco-Lopez, Veldhuijzen, Evers), Leiden University; Leiden Institute for Brain and Cognition (Meeuwis, van Middendorp, Veldhuijzen, Evers), Leiden University Medical Center, Leiden, The Netherlands; Health Sciences Department, Campus Lerma (Pacheco-Lopez), Metropolitan Autonomous University, Lerma, Edo Mex, Mexico; and Departments of Pulmonology (Ninaber), Dermatology (Lavrijsen), and of Psychiatry (van der Wee, Evers), Leiden University Medical Center, Leiden, The Netherlands
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Applying Biopharmaceutical Classification System criteria to predict the potential effect of Cremophor ® RH 40 on fexofenadine bioavailability at higher doses. Ther Deliv 2020; 11:447-464. [PMID: 32715985 DOI: 10.4155/tde-2020-0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aim: To study the impact of various permeability enhancers on fexofenadine bioavailability. Furthermore, to predict the potential effect of Cremophor® RH 40 on fexofenadine pharmacokinetics at higher doses using Biopharmaceutical Classification System criteria. Experimental methods: The effect of the dose increase (60-360 mg) on the dissolution and permeability behavior of fexofenadine-Cremophor RH 40 formulations was studied in humans. The Biopharmaceutical Classification System criteria of the drug was determined. Results & conclusion: Cremophor RH 40 improved the dissolution and bioavailability of fexofenadine. The pharmacokinetics increased linearly with the dose increase. Absorption number (An) was significantly increased after addition of Cremophor RH 40 in comparison to an unprocessed drug. Similar An values were observed throughout the same dose range. The dose number (D0) values were <1 whereas, all the dissolution number (Dn) values were >1 at the same dose level.
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Paczkowska M, Mizera M, Tężyk A, Zalewski P, Dzitko J, Cielecka-Piontek J. Hydrophilic interaction chromatography (HILIC) for the determination of cetirizine dihydrochloride. ARAB J CHEM 2019. [DOI: 10.1016/j.arabjc.2016.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
Allergic rhinitis is a common disorder that regularly occurs in children and adolescents. The disease is associated with other allergic diseases, such as asthma, and it carries a heavy burden, with effects on sleep, school performance, and quality of life. Classic symptoms include sneezing, rhinorrhea, nasal obstruction, and nasal itching. When the eyes are involved, the term allergic rhinoconjunctivitis is used. Triggers may include airborne pollens, molds, dust mites, and animals. Skin or blood allergy testing can be a useful diagnostic modality that may guide therapy. Immunotherapy can prevent the development of further allergic sensitizations as well as subsequent asthma.
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Affiliation(s)
- Charles Frank Schuler Iv
- Division of Allergy and Clinical Immunology, University of Michigan, Domino's Farms, 24 Frank Lloyd Wright Drive, PO Box 442, Suite H-2100, Ann Arbor, MI 48105, USA.
| | - Jenny Maribel Montejo
- Division of Allergy and Clinical Immunology, University of Michigan, Domino's Farms, 24 Frank Lloyd Wright Drive, PO Box 442, Suite H-2100, Ann Arbor, MI 48105, USA
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Gumieniczek A, Berecka-Rycerz A, Pietraś R, Kozak I, Lejwoda K, Kozyra P. Comparative Study of Chemical Stability of Two H 1 Antihistaminic Drugs, Terfenadine and Its In Vivo Metabolite Fexofenadine, Using LC-UV Methods. JOURNAL OF ANALYTICAL METHODS IN CHEMISTRY 2019; 2019:5790404. [PMID: 31061743 PMCID: PMC6466962 DOI: 10.1155/2019/5790404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 03/10/2019] [Indexed: 06/09/2023]
Abstract
A comparative study of chemical stability of terfenadine (TER) and its in vivo metabolite fexofenadine (FEX) was performed. Both TER and FEX were subjected to high temperature at different pH and UV/VIS light at different pH and then quantitatively analyzed using new validated LC-UV methods. These methods were used to monitor the degradation processes and to determine the kinetics of degradation for both the compounds. As far as the effects of temperature and pH were concerned, FEX occurred more sensitive to degradation than TER. As far as the effects of UV/VIS light and pH were concerned, the both drugs were similarly sensitive to high doses of light. Using all stress conditions, the processes of degradation of TER and FEX followed the first-order kinetics. The results obtained for these two antihistaminic drugs could be helpful in developing their new derivatives with higher activity and stability at the same time.
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Affiliation(s)
- Anna Gumieniczek
- Department of Medicinal Chemistry, Medical University of Lublin, Jaczewskiego 4, 20-090 Lublin, Poland
| | - Anna Berecka-Rycerz
- Department of Medicinal Chemistry, Medical University of Lublin, Jaczewskiego 4, 20-090 Lublin, Poland
| | - Rafał Pietraś
- Department of Medicinal Chemistry, Medical University of Lublin, Jaczewskiego 4, 20-090 Lublin, Poland
| | - Izabela Kozak
- Department of Medicinal Chemistry, Medical University of Lublin, Jaczewskiego 4, 20-090 Lublin, Poland
| | - Karolina Lejwoda
- Department of Medicinal Chemistry, Medical University of Lublin, Jaczewskiego 4, 20-090 Lublin, Poland
| | - Paweł Kozyra
- Department of Medicinal Chemistry, Medical University of Lublin, Jaczewskiego 4, 20-090 Lublin, Poland
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Abdulah R, Insani WN, Destiani DP, Rohmaniasari N, Mohenathas ND, Barliana MI. Polypharmacy leads to increased prevalence of potentially inappropriate medication in the Indonesian geriatric population visiting primary care facilities. Ther Clin Risk Manag 2018; 14:1591-1597. [PMID: 30233194 PMCID: PMC6129028 DOI: 10.2147/tcrm.s170475] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background The geriatric population is particularly vulnerable to being prescribed potentially inappropriate medication (PIM); however, the prevalence of this occurrence remains poorly investigated in Indonesia. Thus in this research, we focused on investigating the prevalence and predictors of PIM among the Indonesian geriatric population in a primary health care setting. Methods A retrospective observational study was conducted in 25 primary health care facilities in Karawang District, Indonesia. The medical prescriptions of patients aged ≥60 years during January–December 2014 were documented, and the PIM was assessed based on Beers and McLeod criteria. The influence of age, sex, number of diseases, and polypharmacy toward PIM was assessed using a logistic regression model. A P-value of <0.05 defined statistical significance. Results A total of 3,819 subjects were included in the study. PIM was highly prevalent (52.2%) among the Indonesian elderly. Chlorpheniramine, mefenamic acid, ibuprofen, and nifedipine were the most commonly prescribed PIM. Polypharmacy (odds ratio: 1.2 [0.6, 2.1]) was the only factor associated with the use of PIM, while sex, age, and multiple diseases did not show significant association. Conclusion PIM is a concern in the Indonesian geriatric population. Health care professionals are encouraged to review the medications of their geriatric patients using updated safety guidelines to prevent risks associated with PIM.
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Affiliation(s)
- Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia,
| | - Widya N Insani
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia,
| | - Dika P Destiani
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia,
| | - Nurul Rohmaniasari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia,
| | - Nithya D Mohenathas
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia,
| | - Melisa I Barliana
- Department of Biological Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
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Combining MucilAir™ and Vitrocell ® Powder Chamber for the In Vitro Evaluation of Nasal Ointments in the Context of Aerosolized Pollen. Pharmaceutics 2018; 10:pharmaceutics10020056. [PMID: 29747472 PMCID: PMC6027377 DOI: 10.3390/pharmaceutics10020056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 04/27/2018] [Accepted: 04/27/2018] [Indexed: 12/24/2022] Open
Abstract
Hay fever is notoriously triggered when nasal mucosa is exposed to allergenic pollen. One possibility to overcome this pollen exposure may be the application of an ointment with physical protective effects. In this context, we have investigated Bepanthen® Eye and Nose Ointment and the ointment basis petrolatum as reference while using contemporary in vitro techniques. Pollen from false ragweed (Iva xanthiifolia) was used as an allergy-causing model deposited as aerosol using the Vitrocell® Powder Chamber (VPC) on Transwell® inserts, while being coated with either Bepanthen® Eye and Nose Ointment and petrolatum. No pollen penetration into ointments was observed upon confocal scanning laser microscopy during an incubation period of 2 h at 37 °C. The cellular response was further investigated by integrating the MucilAir™ cell system in the VPC and by applying pollen to Bepanthen® Eye and Nose Ointment covered cell cultures. For comparison, MucilAir™ were stimulated by lipopolysaccharides (LPS). No increased cytokine release of IL-6, TNF-α, or IL-8 was found after 4 h of pollen exposure, which demonstrates the safety of such ointments. Since nasal ointments act as a physical barrier against pollen, such preparations might support the prevention and management of hay fever.
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Effects of inclusion of cetirizine hydrochloride in β-cyclodextrin. J INCL PHENOM MACRO 2018; 91:149-159. [PMID: 30100814 PMCID: PMC6061035 DOI: 10.1007/s10847-018-0808-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 04/27/2018] [Indexed: 10/24/2022]
Abstract
Following the preparation of inclusion complex of cetirizine (CTZ) and β-cyclodextrin (β-CD), the compound was investigated to assess the possibility of modifying the physicochemical properties (solubility, release, stability, permeability) of CTZ after complexation that are vital for subsequent formulation studies involving the said complex. Changes in FT-IR/Raman spectra, DSC thermograms and XRD diffractograms confirmed the formation of a CTZ-β-CD system. Hydrophilic interaction chromatography with a DAD detector was employed to determine alterations of the CTZ concentration during studies following complexation. An analysis of a phase-solubility diagram of cCTZ = fcβ-CD indicated a linear rise in the solubility of CTZ as the concentration of β-CD increased. The inclusion of CTZ in a system with β-CD significantly reduced the instability of CTZ in the presence of oxidizing factors. It was also found that regardless of the pH of the acceptor fluids used in the release studies an increase was observed in the concentration of CTZ in CD system compared to its free form. The ability to permeate artificial biological membranes manifested by CTZ after complexation was enhanced as well. In summary, CD has significant potential to mask the bitter taste of CTZ and to counter the instability induced by oxidizing factors.
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Dykewicz MS, Wallace DV, Baroody F, Bernstein J, Craig T, Finegold I, Huang F, Larenas-Linnemann D, Meltzer E, Steven G, Bernstein DI, Blessing-Moore J, Dinakar C, Greenhawt M, Horner CC, Khan DA, Lang D, Oppenheimer J, Portnoy JM, Randolph CR, Rank MA, Dykewicz MS, Wallace DV. Treatment of seasonal allergic rhinitis: An evidence-based focused 2017 guideline update. Ann Allergy Asthma Immunol 2017; 119:489-511.e41. [PMID: 29103802 DOI: 10.1016/j.anai.2017.08.012] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/15/2017] [Indexed: 12/11/2022]
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Faustino-Rocha AI, Ferreira R, Gama A, Oliveira PA, Ginja M. Antihistamines as promising drugs in cancer therapy. Life Sci 2017; 172:27-41. [DOI: 10.1016/j.lfs.2016.12.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/11/2016] [Accepted: 12/13/2016] [Indexed: 12/28/2022]
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Sun Y, Zhao H, Ye Y, Nie W, Bai W, Liu J, Li S, Wang F, Han M, He L. Efficacy and safety of using a warming needle for persistent allergic rhinitis: study protocol for a randomized controlled trial. Trials 2016; 17:305. [PMID: 27363578 PMCID: PMC4929718 DOI: 10.1186/s13063-016-1432-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/08/2016] [Indexed: 11/26/2022] Open
Abstract
Background Many previous studies have shown the potential therapeutic effect of acupuncture for allergic rhinitis. Most of these studies, however, were limited by the short duration of observations and lack of sham acupuncture as the control group. Our preliminary experiments showed that the use of a warm needling achieved a much more persistent effect in the treatment of allergic rhinitis (AR) compared with simple acupuncture therapy. Hence, we have designed a multicenter, randomized controlled trial (RCT) in which the first-line medication loratadine will be used as the control group, and the effect of warm needling therapy will be evaluated through long-term observation. Methods/design The trial is designed as a multicenter, parallel-group, randomized, single-blinded (outcome assessors), non-inferiority trial. A total of 98 patients with persistent AR will be randomly assigned into two groups. Patients in the treatment group will be treated with warm needling at GV14 and acupuncture at EX-HN3, ST2, LI20, EX-HN8, GV23, LU7, LU5 and LI4 three times a week, for a total of 4 weeks. Patients in the control group will be treated with oral loratadine 10 mg/day for 4 weeks. The primary outcome will be the change in the Total Nasal Symptom Score (TNSS) from baseline to that at 6 months after treatment during the follow-up period. The secondary outcomes will include the Total Non-nasal Symptom Score and the Rhinoconjunctivitis Quality of Life Questionnaire, changes in the TNSS from baseline to that at 2 and 4 weeks during treatment, and 3 months after treatment during the follow-up period. Outcomes will be measured at 2 and 4 weeks, and 3 and 6 months after treatment. Any side effects of treatment will be observed and recorded. Discussion We expect that the study results will provide evidence to determine the effects of warm needling compared with loratadine. Our final goal of the study is to evaluate the difference in the short-term and long-term effects between the two therapeutic methods, especially the long-term effect of warm needling. Trial registration ClinicalTrials.gov NCT02339714. Registered on 14 January 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1432-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yuxiu Sun
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.,Hubei University of Chinese Medicine, Wuhan, 430061, China
| | - Hong Zhao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, 100700, China.
| | - Yongming Ye
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Wenbin Nie
- Mentougou Hospital of TCM, Beijing, 102300, China
| | - Wenjing Bai
- China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Jia Liu
- China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Sinuo Li
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Fang Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Mingjuan Han
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Liyun He
- China Academy of Chinese Medical Sciences, Beijing, 100700, China
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Comert S, Karakaya G, Kalyoncu AF. Wraparound eyeglasses improve symptoms and quality of life in patients with seasonal allergic rhinoconjunctivitis. Int Forum Allergy Rhinol 2016; 6:722-30. [DOI: 10.1002/alr.21737] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/04/2015] [Accepted: 12/31/2015] [Indexed: 01/05/2023]
Affiliation(s)
- Sule Comert
- Department of Chest Diseases, Division of Allergy and Clinical Immunology; School of Medicine, Hacettepe University; Ankara Turkey
| | - Gul Karakaya
- Department of Chest Diseases, Division of Allergy and Clinical Immunology; School of Medicine, Hacettepe University; Ankara Turkey
| | - Ali Fuat Kalyoncu
- Department of Chest Diseases, Division of Allergy and Clinical Immunology; School of Medicine, Hacettepe University; Ankara Turkey
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El-Kommos ME, El-Gizawy SM, Atia NN, Hosny NM. Determination of Some Non-sedating Antihistamines via Their Native Fluorescence and Derivation of Some Quantitative Fluorescence Intensity - Structure Relationships. J Fluoresc 2015; 25:1695-709. [DOI: 10.1007/s10895-015-1656-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/09/2015] [Indexed: 10/23/2022]
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Lappin G. Approaches to intravenous clinical pharmacokinetics: Recent developments with isotopic microtracers. J Clin Pharmacol 2015; 56:11-23. [DOI: 10.1002/jcph.569] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/08/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Graham Lappin
- Visiting Professor of Pharmacology, School of Pharmacy; University of Lincoln; Lincoln UK
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Ranchon F, Vial T, Rioufol C, Hénin E, Falandry C, Freyer G, Trillet-Lenoir V, Le Tourneau C, You B. Concomitant drugs with low risks of drug-drug interactions for use in oncology clinical trials. Crit Rev Oncol Hematol 2015; 94:189-200. [PMID: 25638703 DOI: 10.1016/j.critrevonc.2014.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 12/10/2014] [Accepted: 12/23/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Drug-drug interactions (DDIs) may occur with investigational drugs and affect patient safety, trial outcomes, and drug development. A list of preferred drugs with minimal risks of DDIs for treatment of symptoms or comorbidities frequently encountered by cancer patients would be helpful. METHODS We reviewed the literature to assess DDIs reported for the main drugs available for treatment of symptoms/comorbidities frequently encountered by cancer patients. Reviews and relevant original articles cited were retrieved and analyzed, and the following data were collected and double-checked: pharmacological properties; effects, if any, of drugs on CYP enzymes, membrane transporters, and QT interval; and involvement in significant DDIs. RESULTS A list of preferred drugs with minimal risks of DDIs was compiled. CONCLUSION Acknowledging for heterogeneity in data sources, prevention of unexpected DDIs during clinical trials may be improved by using this list of preferred drugs for the management of study patient's symptoms.
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Affiliation(s)
- Florence Ranchon
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Lyon, France; EMR UCBL/HCL 3738, Faculté de médecine Lyon-Sud, Université Claude Bernard Lyon 1, Lyon, France
| | - Thierry Vial
- Centre régional de Pharmacovigilance, Lyon, France
| | - Catherine Rioufol
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Lyon, France; EMR UCBL/HCL 3738, Faculté de médecine Lyon-Sud, Université Claude Bernard Lyon 1, Lyon, France
| | - Emilie Hénin
- EMR UCBL/HCL 3738, Faculté de médecine Lyon-Sud, Université Claude Bernard Lyon 1, Lyon, France
| | - Claire Falandry
- EMR UCBL/HCL 3738, Faculté de médecine Lyon-Sud, Université Claude Bernard Lyon 1, Lyon, France; Oncologie Médicale, Centre d'Investigation des Thérapeutiques en Oncologie et Hématologie de Lyon (CITOHL), Groupement Hospitalier Sud, Institut de Cancérologie des Hospices, Civils de Lyon (IC-HCL), Lyon, France
| | - Gilles Freyer
- EMR UCBL/HCL 3738, Faculté de médecine Lyon-Sud, Université Claude Bernard Lyon 1, Lyon, France; Oncologie Médicale, Centre d'Investigation des Thérapeutiques en Oncologie et Hématologie de Lyon (CITOHL), Groupement Hospitalier Sud, Institut de Cancérologie des Hospices, Civils de Lyon (IC-HCL), Lyon, France
| | - Véronique Trillet-Lenoir
- EMR UCBL/HCL 3738, Faculté de médecine Lyon-Sud, Université Claude Bernard Lyon 1, Lyon, France; Oncologie Médicale, Centre d'Investigation des Thérapeutiques en Oncologie et Hématologie de Lyon (CITOHL), Groupement Hospitalier Sud, Institut de Cancérologie des Hospices, Civils de Lyon (IC-HCL), Lyon, France
| | - Christophe Le Tourneau
- Département d'Oncologie Médicale, Unité d'Investigation Clinique, INSERM U900, Institut Curie, Paris, France
| | - Benoit You
- EMR UCBL/HCL 3738, Faculté de médecine Lyon-Sud, Université Claude Bernard Lyon 1, Lyon, France; Oncologie Médicale, Centre d'Investigation des Thérapeutiques en Oncologie et Hématologie de Lyon (CITOHL), Groupement Hospitalier Sud, Institut de Cancérologie des Hospices, Civils de Lyon (IC-HCL), Lyon, France.
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Mahdy AM, Webster NR. Histamine and antihistamines. ANAESTHESIA AND INTENSIVE CARE MEDICINE 2014. [DOI: 10.1016/j.mpaic.2014.02.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Etwel F, Djokanovic N, Moretti ME, Boskovic R, Martinovic J, Koren G. The fetal safety of cetirizine: An observational cohort study and meta-analysis. J OBSTET GYNAECOL 2014; 34:392-9. [DOI: 10.3109/01443615.2014.896887] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Molinari G, Colombo G, Celenza C. Respiratory allergies: a general overview of remedies, delivery systems, and the need to progress. ISRN ALLERGY 2014; 2014:326980. [PMID: 25006500 PMCID: PMC3972928 DOI: 10.1155/2014/326980] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 12/24/2013] [Indexed: 01/10/2023]
Abstract
The spread of respiratory allergies is increasing in parallel with the alarm of the scientific community. Evidently, our knowledge of the onset mechanisms of these diseases and, as a consequence, of the available remedies is inadequate. This review provides a brief, general description of current therapeutic resources and the state of research with regard to both drugs and medical devices in order to highlight their limits and the urgent need for progress. Increasing the amount of basic biochemical research will improve our knowledge of such onset mechanisms and the potential efficacy of therapeutic preparations.
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Affiliation(s)
- Giuliano Molinari
- Biochemistry Consulting Service, Giuliano Molinari, 20017 Rho, Milan, Italy
| | - Giselda Colombo
- Allergy and Immunology Unit, San Raffaele Hospital, 20132 Milan, Italy
| | - Cinzia Celenza
- Quality Assurance Service, Sandoz S.P.A., 21040 Origgio, Varese, Italy
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Ali I, Al-Othman ZA, Al-Warthan A, Alam SD, Farooqi JA. Enantiomeric Separation and Simulation Studies of Pheniramine, Oxybutynin, Cetirizine, and Brinzolamide Chiral Drugs on Amylose-Based Columns. Chirality 2014; 26:136-43. [DOI: 10.1002/chir.22276] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/19/2013] [Accepted: 10/24/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Imran Ali
- Department of Chemistry; Jamia Millia Islamia, (Central University) New Delhi; India
- Department of Chemistry, College of Science; King Saud University; Riyadh Kingdom of Saudi Arabia
| | - Zeid A. Al-Othman
- Department of Chemistry, College of Science; King Saud University; Riyadh Kingdom of Saudi Arabia
| | - Abdulrahman Al-Warthan
- Department of Chemistry, College of Science; King Saud University; Riyadh Kingdom of Saudi Arabia
| | - Syed Dilshad Alam
- Department of Chemistry; Jamia Millia Islamia, (Central University) New Delhi; India
| | - Javed A. Farooqi
- Department of Chemistry, School of Sciences; Indira Gandhi National Open University; New Delhi India
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Wildermuth K, Zabel S, Rosychuk RAW. The efficacy of cetirizine hydrochloride on the pruritus of cats with atopic dermatitis: a randomized, double-blind, placebo-controlled, crossover study. Vet Dermatol 2013; 24:576-81, e137-8. [DOI: 10.1111/vde.12067] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Kerstin Wildermuth
- Department of Clinical Sciences; Colorado State University College of Veterinary Medicine and Biomedical Sciences; 300 West Drake Fort Collins CO 80523 USA
- Tierdermatologie Dr. Wildermuth; Borsigstraße 7a 65205 Wiesbaden Germany
| | - Sonja Zabel
- Department of Small Animal Medicine and Surgery; University of Georgia College of Veterinary Medicine; 501 DW Brooks Drive Athens GA 30602 USA
| | - Rod A. W. Rosychuk
- Department of Clinical Sciences; Colorado State University College of Veterinary Medicine and Biomedical Sciences; 300 West Drake Fort Collins CO 80523 USA
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Cingi C, Toros SZ, Ince I, Ertugay CK, Gurbuz MK, Cakli H, Erdogmus N, Karasulu E, Kaya E. Does desloratadine alter the serum levels of montelukast when administered in a fixed-dose combination? Laryngoscope 2013; 123:2610-4. [DOI: 10.1002/lary.24134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 03/11/2013] [Accepted: 03/11/2013] [Indexed: 01/08/2023]
Affiliation(s)
- Cemal Cingi
- Medical Faculty, Department of Otorhinolaryngology; Osmangazi University; Eskisehir Turkey
| | - Sema Zer Toros
- Department of Otorhinolaryngology/Head and Neck Surgery; Haydarpasa Numune Research and Education Hospital; Istanbul Turkey
| | - Iskender Ince
- Center for Drug Research and Development and Pharmacokinetic Applications; Ege University; Izmir Turkey
| | | | - M. Kezban Gurbuz
- Medical Faculty, Department of Otorhinolaryngology; Osmangazi University; Eskisehir Turkey
| | - Hamdi Cakli
- Medical Faculty, Department of Otorhinolaryngology; Osmangazi University; Eskisehir Turkey
| | - Nagehan Erdogmus
- Medical Faculty, Department of Otorhinolaryngology; Osmangazi University; Eskisehir Turkey
| | - Ercument Karasulu
- Medical Faculty, Department of Otorhinolaryngology; Osmangazi University; Eskisehir Turkey
- Center for Drug Research and Development and Pharmacokinetic Applications; Ege University; Izmir Turkey
| | - Ercan Kaya
- Medical Faculty, Department of Otorhinolaryngology; Osmangazi University; Eskisehir Turkey
- Center for Drug Research and Development and Pharmacokinetic Applications; Ege University; Izmir Turkey
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Zhang L, Cheng L, Hong J. The clinical use of cetirizine in the treatment of allergic rhinitis. Pharmacology 2013; 92:14-25. [PMID: 23867423 DOI: 10.1159/000351843] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 03/15/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cetirizine is among the first second-generation H1 antihistamines (SGAHs) developed to provide selective H1 receptor inhibition without central nervous system depression. OBJECTIVE The aim of this review is to summarize the amount of data collected over 25 years of clinical use of cetirizine and compare this with data available for other SGAHs in the management of patients with allergic rhinitis (AR). METHODS A comprehensive literature search for publications relating to cetirizine was performed using the Pubmed database, and relevant papers published in English were selected for detailed review. RESULTS Compared with the majority of other SGAHs, cetirizine was generally shown to have a more favourable pharmacological profile, to be well tolerated, be at least equally or more efficacious in attenuating/inhibiting nasal and ocular symptoms and to improve the quality of life in AR patients. The majority of clinical trials investigating the effect of SGAHs in AR patients further indicated that cetirizine was often employed as the main comparator active drug. CONCLUSION Based on the evidence that cetirizine is a commonly employed active comparator drug in AR, it is tempting to suggest that cetirizine may be a suitable benchmark in the development of novel pharmacotherapies for AR.
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Affiliation(s)
- Luo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Jones BL, Kearns G, Neville KA, Sherwin CMT, Spigarelli MMG, Leeder JS. Variability of histamine pharmacodynamic response in children with allergic rhinitis. J Clin Pharmacol 2013; 53:731-7. [PMID: 23681823 DOI: 10.1002/jcph.93] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 04/09/2013] [Indexed: 11/05/2022]
Abstract
Histamine iontophoresis with laser Doppler monitoring (HILD) is a robust and dynamic surrogate for histamine microvasculature response. We characterized histamine pharmacodynamics in children using HILD. HILD was performed in 54 children with allergic rhinitis. A non-compartmental analysis and non-linear mixed-effects model with a linked effect PK/PD model was used to provide estimates for area under the effect curve (AUEC), maximal response over baseline (EffmaxNT), and time of EffmaxNT (Tmax). Data were placed in sub-groups by visualization of time vs. response relationships. ANOVA and regression analyses were used for sub-group comparisons. Three histamine response phenotypes were identified. One group demonstrated a hyper-responsive phenotype (higher Tmax, EffmaxNt and AUEC, P < .01). AUEC and EffmaxNT were more strongly associated in this group (r(2) = 0.86) than the entire cohort (r(2) = 0.64). These data demonstrate a hyper-responsive histamine phenotype via HILD. This finding is important to future pharmacologic studies of antihistamines.
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Affiliation(s)
- Bridgette L Jones
- Department of Paediatrics, University of Missouri, Kansas City, MO 64108, USA.
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Hoyte FCL, Katial RK. Antihistamine therapy in allergic rhinitis. Immunol Allergy Clin North Am 2011; 31:509-43. [PMID: 21737041 DOI: 10.1016/j.iac.2011.05.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Antihistamines have long been a mainstay in the therapy for allergic rhinitis. Many different oral antihistamines are available for use, and they are classified as first generation or second generation based on their pharmacologic properties and side-effect profiles. The recent introduction of intranasal antihistamines has further expanded the role of antihistamines in the treatment of allergic rhinitis. Certain patient populations, such as children and pregnant or lactating women, require special consideration regarding antihistamine choice and dosing as part of rhinitis therapy.
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Affiliation(s)
- Flavia C L Hoyte
- Division of Allergy, Asthma, and Immunology, National Jewish Health, 1400 Jackson Street, Room K624, Denver, CO 80206, USA
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Gundogdu E, Alvarez IG, Karasulu E. Improvement of effect of water-in-oil microemulsion as an oral delivery system for fexofenadine: in vitro and in vivo studies. Int J Nanomedicine 2011; 6:1631-40. [PMID: 21904453 PMCID: PMC3160949 DOI: 10.2147/ijn.s22673] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Fexofenadine (FEX) has high solubility and low permeability (BCS, Class III). In this work, novel FEX loaded water in oil microemulsion (w/o) was designed to improve bioavailability and compared with Fexofen(®) syrup in in vitro and in vivo studies. In addition, pharmacokinetic parameters in permeability studies were estimated by using WinNonLin software program. w/o microemulsion system was optimized using a pseudoternary phase diagram, composed of span 80/lutrol F 68 (9.5:0.5 w/w), oleic acide, isopropyl alcohol and water as surfactant mixture; oil and cosurfactant was developed for oral drug delivery. w/o microemulsion systems were characterized by phase behavior, particle size, viscosity and solubilization capacity. In vitro studies were studied using Caco-2 cell monolayer. Pharmacokinetic parameters of w/o microemulsion were investigated in rabbits and compared to Fexofen(®) syrup. Fexofen(®) syrup and microemulsion were administered by oral gavage at 6 mg/kg of the same concentration. The experimental results indicated that microemulsion (HLB = 5.53) formed nanometer sized droplets (33.29 ± 1.76) and had good physical stability. This microemulsion increased the oral bioavailability of FEX which was highly water-soluble but fairly impermeable. The relative bioavailability of FEX microemulsion was about 376.76% compared with commercial syrup in rabbits. In vitro experiments were further employed for the enhanced effect of the microemulsion for FEX. These results suggest that novel w/o microemulsion plays an important role in enhancing oral bioavailability of low permeability drugs.
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Affiliation(s)
- E Gundogdu
- Faculty of Pharmacy, Department of Biopharmaceutics and Pharmacokinetics, Ege University, Izmir, Turkey.
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Mahdy AM, Webster NR. Histamine and antihistamines. ANAESTHESIA AND INTENSIVE CARE MEDICINE 2011. [DOI: 10.1016/j.mpaic.2011.04.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kang MJ, Song WH, Shim BH, Oh SY, Lee HY, Chung EY, Sohn Y, Lee J. Pharmacologically active metabolites of currently marketed drugs: potential resources for new drug discovery and development. YAKUGAKU ZASSHI 2010; 130:1325-37. [PMID: 20930485 DOI: 10.1248/yakushi.130.1325] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Biotransformation is the major clearance mechanism of therapeutic agents from the body. Biotransformation is known not only to facilitate the elimination of drugs by changing the molecular structure to more hydrophilic, but also lead to pharmacological inactivation of therapeutic compounds. However, in some cases, the biotransformation of drugs can lead to the generation of pharmacologically active metabolites, responsible for the pharmacological actions. This review provides an update of the kinds of pharmacologically active metabolites and some of their individual pharmacological and pharmacokinetic aspects, and describes their importance as resources for drug discovery and development.
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Affiliation(s)
- Myung Joo Kang
- Division of Pharmaceutical Sciences, College of Pharmacy, Chung-Ang University, Seoul, South Korea
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Jones BL, Kearns GL. Histamine: New Thoughts About a Familiar Mediator. Clin Pharmacol Ther 2010; 89:189-97. [DOI: 10.1038/clpt.2010.256] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Berlin M, Boyce CW, de Lera Ruiz M. Histamine H3 Receptor as a Drug Discovery Target. J Med Chem 2010; 54:26-53. [DOI: 10.1021/jm100064d] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Michael Berlin
- Chemical Research, Merck Research Laboratories, 2015 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Christopher W. Boyce
- Chemical Research, Merck Research Laboratories, 2015 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
| | - Manuel de Lera Ruiz
- Chemical Research, Merck Research Laboratories, 2015 Galloping Hill Road, Kenilworth, New Jersey 07033, United States
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Mutlib A, Espina R, Vishwanathan K, Babalola K, Chen Z, Dehnhardt C, Venkatesan A, Mansour T, Chaudhary I, Talaat R, Scatina J. Application of Quantitative NMR in Pharmacological Evaluation of Biologically Generated Metabolites: Implications in Drug Discovery. Drug Metab Dispos 2010; 39:106-16. [DOI: 10.1124/dmd.110.032490] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Chronic urticaria is heterogenous, long-persisting and has a severe impact on quality of life and daily work. Effective treatment is essential but remains a confounding problem. This review summarizes available treatment strategies for chronic urticaria and their strength of evidence. Besides treatment of identified triggering factors such as chronic persistent bacterial infections (e.g., with Helicobacter pylori, streptococci, staphylococci or yersinia), standard treatment consists of nonsedating H1-antihistamines. Most patients require increasing (off-label) dosages that should be taken daily and regularly, however, this still fails in a third of cases. Reliable alternatives in the world literature are rare and the level of evidence is low. Certain subgroups may display benefit from additional treatment with cyclosporine A, cysteinyl leukotriene receptor antagonists, chloroquine, dapsone or other alternatives. A practicable step-wise treatment approach is given to optimize and individualize the treatment of patients with chronic urticaria.
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Affiliation(s)
- Bettina Wedi
- Department of Dermatology and Allergology, Hannover Medical University, Ricklinger Str. 5, D-30449 Hannover, Germany.
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Chen Z, Venkatesan AM, Dos Santos O, Delos Santos E, Dehnhardt CM, Ayral-Kaloustian S, Ashcroft J, McDonald LA, Mansour TS. Stereoselective synthesis of an active metabolite of the potent PI3 kinase inhibitor PKI-179. J Org Chem 2010; 75:1643-51. [PMID: 20112997 DOI: 10.1021/jo9026269] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The synthesis and stereochemical determination of 1-(4-(4-((1R,5R,6R)-6-hydroxy-3-oxa-8-azabicyclo[3.2.1]octan-8-yl)-6-morpholino-1,3,5-triazin-2-yl)phenyl)-3-(pyridin-4-yl)urea (2), an active metabolite of the potent PI3 kinase inhibitor PKI-179 (1), is described. Stereospecific hydroboration of the double bond of 2,5-dihydro-1H-pyrrole 8 gave the 2,3-trans alcohol 9 exclusively. The configuration of the 3-hydroxyl group in 9 was inverted by an oxidation and stereoselective reduction sequence to give the corresponding 2,3-cis isomer 23. Both exo (21) and endo (27) isomers of the metabolite 2 were prepared via a practical synthetic route from 9 and 23, respectively, and the stereochemistry of 2 was determined to be endo. The endo isomer (27) was separated into two enantiomers 28 and 29 by chiral HPLC. Compound 2 was found to be enantiomerically pure and identical to the enantiomer 28. The absolute stereochemistry of the enantiomer 28 was determined by Mosher's method, thus establishing the stereochemistry of the active metabolite 2.
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Affiliation(s)
- Zecheng Chen
- Chemical Sciences, Wyeth Research, 401 North Middletown Road, Pearl River, New York 10956, USA.
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Lappin G, Shishikura Y, Jochemsen R, Weaver RJ, Gesson C, Houston B, Oosterhuis B, Bjerrum OJ, Rowland M, Garner C. Pharmacokinetics of fexofenadine: Evaluation of a microdose and assessment of absolute oral bioavailability. Eur J Pharm Sci 2010; 40:125-31. [DOI: 10.1016/j.ejps.2010.03.009] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 02/27/2010] [Accepted: 03/12/2010] [Indexed: 12/01/2022]
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Smith SM, Gums JG. Fexofenadine: biochemical, pharmacokinetic and pharmacodynamic properties and its unique role in allergic disorders. Expert Opin Drug Metab Toxicol 2010; 5:813-22. [PMID: 19545214 DOI: 10.1517/17425250903044967] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Fexofenadine is one of several second-generation H(1)-antihistamines approved for the treatment of various allergic disorders; however, it shows numerous unique properties that make it an optimal choice for many patients. OBJECTIVE To review the pharmacology, efficacy and safety of fexofenadine and the attributes differentiating it from other H(1)-antihistamines. METHODS We performed a literature search in PubMed/MEDLINE (1966 - March 2009) using the keywords fexofenadine, antihistamine, allergic rhinitis and chronic urticaria. We also reviewed data provided by the manufacturer in addition to reports from various governmental agencies. RESULTS/CONCLUSIONS Fexofenadine is devoid of sedative and anticholinergic effects and may offer equivalent or greater efficacy in treating allergic disorders compared with other currently available second-generation H(1)-antihistamines. In addition, fexofenadine may offer cost savings over other selected H(1)-antihistamines owing to its recent availability in generic form in the US.
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Affiliation(s)
- Steven M Smith
- University of Florida, Colleges of Pharmacy and Medicine, Departments of Pharmacotherapy & Translational Research and Community Health & Family Medicine, Gainesville, FL 32610-0486, USA.
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Bachert C. A review of the efficacy of desloratadine, fexofenadine, and levocetirizine in the treatment of nasal congestion in patients with allergic rhinitis. Clin Ther 2009; 31:921-44. [PMID: 19539095 DOI: 10.1016/j.clinthera.2009.05.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2009] [Indexed: 12/18/2022]
Abstract
BACKGROUND Nasal congestion is the most troublesome symptom of allergic rhinitis (AR). First-generation and older second-generation antihistamines, while effective against nasal itching, sneezing, and rhinorrhea, have limited efficacy in relieving nasal congestion. OBJECTIVE This review included nasal challenge studies and clinical trials that reported the effects on nasal congestion of the newer second-generation antihistamines desloratadine, fexofenadine, and levocetirizine. METHODS MEDLINE and EMBASE were searched for nasal challenge studies and clinical trials published in English between January 1, 1991, and January 31, 2009, using the following terms, alone or in combination: antihistamines, second-generation antihistamines, allergic rhinitis, intermittent allergic rhinitis, perennial allergic rhinitis, persistent allergic rhinitis, seasonal allergic rhinitis, nasal challenge, nasal blockage, and nasal congestion. Studies that were not active or placebo controlled, that did not evaluate change in nasal congestion scores, or that focused on treatments other than desloratadine, fexofenadine, and levocetirizine for nasal congestion associated with AR were excluded. RESULTS Twenty-six clinical trials met the criteria for inclusion in the review. In 11 placebo-controlled trials that included objective assessment of nasal congestion, desloratadine, fexofenadine, and levocetirizine were associated with reductions in the severity of nasal congestion through maintenance of nasal airflow. The mean AUC for nasal airflow over 6 hours was significantly greater with desloratadine compared with placebo in 3 studies (P < 0.05); placebo-controlled trials of fexofenadine and levocetirizine had similar results. In 25 placebo- and active-controlled trials that reported subject-rated symptom scores, the 3 newer antihistamines were efficacious in the treatment of nasal congestion associated with AR. In 10 trials that reported objective and/or subjective measures, desloratadine was associated with significant improvements in nasal congestion compared with placebo (P < or = 0.05), beginning as early as the first 2 hours after allergen challenge. Fexofenadine was associated with significantly lower nasal congestion scores compared with placebo in 4 studies (P <- 0.05); nasal congestion scores were significantly reduced with levocetirizine in 3 placebo-controlled trials (P < or = 0.005). CONCLUSIONS In the studies reviewed, desloratadine, fexofenadine, and levocetirizine were effective in relieving the nasal congestion associated with AR compared with placebo. This effect began as early as day 2 and was consistent and progressive throughout treatment. Desloratadine, fexofenadine, and levocetirizine are appropriate options for the treatment of nasal congestion in patients with AR.
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Affiliation(s)
- Claus Bachert
- Department of Otorhinolaryngology, University Hospital Ghent, Ghent, Belgium.
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Magerl M, Schmolke J, Metz M, Zuberbier T, Siebenhaar F, Maurer M. Prevention of signs and symptoms of dermographic urticaria by single-dose ebastine 20 mg. Clin Exp Dermatol 2009; 34:e137-40. [DOI: 10.1111/j.1365-2230.2008.03097.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bachert C, Kuna P, Sanquer F, Ivan P, Dimitrov V, Gorina MM, van de Heyning P, Loureiro A. Comparison of the efficacy and safety of bilastine 20 mg vs desloratadine 5 mg in seasonal allergic rhinitis patients. Allergy 2009; 64:158-65. [PMID: 19132976 DOI: 10.1111/j.1398-9995.2008.01813.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Bilastine is a novel, nonsedating H(1)-antihistamine developed for symptomatic treatment of Allergic Rhinitis and Chronic Idiopathic Urticaria. The objective of this study was to compare the efficacy and safety of bilastine 20 mg vs placebo and desloratadine 5 mg in subjects with seasonal allergic rhinitis (SAR). METHODS This randomized, double blind, placebo-controlled, parallel-group multicentre study evaluated the effect of 2 weeks' treatment with bilastine 20 mg, desloratadine 5 mg or matched placebo once daily, in 12-70 years old symptomatic SAR patients. All subjects assessed the severity of nasal (obstruction, rhinorrhoea, itching, and sneezing) and nonnasal (ocular itching, tearing, ocular redness, itching of ears and/or palate) symptoms on a predetermined scale to provide a total symptom score (TSS), composed of nasal and nonnasal symptom scores (NSS and NNSS, respectively). The primary efficacy measure was the area under the curve (AUC) for the TSS over the entire treatment period. RESULTS Bilastine 20 mg significantly reduced the AUC of TSS to a greater degree from baseline compared to placebo (98.4 with bilastine vs 118.4 with placebo; P < 0.001), but not compared to desloratadine 5 mg (100.5). Bilastine 20 mg was not different from desloratadine 5 mg but significantly more effective than placebo in improving the NSS, NNSS, and rhinitis-associated discomfort scores (P < 0.05), and rhinoconjunctivitis quality of life questionnaire total (P < 0.005) and four out of seven individual domain (P < 0.05) scores. The incidence of treatment emergent adverse events was similar for bilastine (20.6%), desloratadine (19.8%), and placebo (18.8%). CONCLUSION Bilastine 20 mg once daily was efficacious, safe and not different from desloratadine 5 mg once daily in the treatment of SAR symptoms.
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Affiliation(s)
- C Bachert
- Department of Oto-Rhino-Laryngology, Ghent University Hospital, Ghent, Belgium
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Simon FER, Simons KJ. H1 antihistamines: current status and future directions. World Allergy Organ J 2008; 1:145-55. [PMID: 23282578 PMCID: PMC3650962 DOI: 10.1186/1939-4551-1-9-145] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Accepted: 07/16/2008] [Indexed: 02/07/2023] Open
Abstract
In this review, we compare and contrast the clinical pharmacology, efficacy, and safety of first-generation H1 antihistamines and second-generation H1 antihistamines. First-generation H1 antihistamines cross the blood-brain barrier, and in usual doses, they potentially cause sedation and impair cognitive function and psychomotor performance. These medications, some of which have been in use for more than 6 decades, have never been optimally investigated. Second-generation H1 antihistamines such as cetirizine, desloratadine, fexofenadine, levocetirizine, and loratadine cross the blood-brain barrier to a significantly smaller extent than their predecessors. The clinical pharmacology, efficacy, and safety of these medications have been extensively studied. They are therefore the H1 antihistamines of choice in the treatment of allergic rhinitis, allergic conjunctivitis, and urticaria. In the future, clinically advantageous H1 antihistamines developed with the aid of molecular techniques might be available.
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Affiliation(s)
- F Estelle R Simon
- Department of Pediatrics and Child Health, Winnipeg, Manitoba, Canada
- Department of Immunology, Winnipeg, Manitoba, Canada
- Department of Canadian Institutes of Health Research National Training Program in Allergy and Asthma, Winnipeg, Manitoba, Canada
- Department of Faculty of Medicine, Winnipeg, Manitoba, Canada
| | - Keith J Simons
- Department of Pediatrics and Child Health, Winnipeg, Manitoba, Canada
- Department of Faculty of Medicine, Winnipeg, Manitoba, Canada
- Department of Faculty of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
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