Antihistamines Increase Body Mass Index Percentiles and Z-Scores in Hispanic Children

In Vitro and In Vivo Characterization of the Transdermal Gel Formulation of Desloratadine for Prevention of Obesity and Metabolic Syndrome

Chronic use of antihistamines can induce abnormalities in lipid absorption with potential excessive accumulation of lipids in the mesentery that can lead to the development of obesity and a metabolic syndrome. The focus of the present work was to develop a transdermal gel formulation of desloratadine (DES) to prevent/reduce obesity and metabolic syndromes. Nine formulations were prepared to contain hydroxypropyl methylcellulose (2-3%), DES (2.5-5.0%), and Transcutol^® (15-20%). The formulations were evaluated for cohesive and adhesive properties, viscosity, drug diffusion through synthetic and pig ear skin, and pharmacokinetics in New Zealand white rabbits. Drug permeation was faster through the skin compared to synthetic membranes. The drug had good permeation, as indicated by very short lag time (0.08-0.47 h) and high flux (59.3-230.7 μg/cm².h). The maximum plasma concentration (C_max) and area under the curve (AUC) of transdermal gel formulations were 2.4 and 3.2 fold that of the Clarinex tablet formulation. In conclusion, as indicated by the higher bioavailability, transdermal gel formulation of DES may decrease the dose of the drug, compared to commercial formulation. It has the potential to reduce or eliminate metabolic syndromes associated with oral antihistamine therapy.

Advances in Research on Nutrition and Childhood Obesity

Obesity is a complex, multifactorial problem affecting children and adolescents around the world [...].

Treating Obesity in Children and Adolescents with Special Healthcare Needs

PURPOSE OF REVIEW

This paper aims to summarize the literature regarding treatment of obesity in children with special healthcare needs and provide examples of implementation based on the available scientific evidence and the clinical experience of the authors.

RECENT FINDINGS

Due to the complexity of providing treatment for children with obesity and special healthcare needs, multidisciplinary teams are recommended to adapt care to meet the children's unique needs and ensure coordination of care across settings/caregivers. Medication management is often required to assist with the side effects of psychotropic medications. Children with special healthcare needs (SHCN) such as intellectual and developmental disabilities (IDD) should be considered for metabolic and bariatric surgery as they have similar outcomes to children without SHCN. Children with special healthcare needs can be successful in weight management treatment when they have access to comprehensive care including dietary, behavioral, pharmacological, and surgical interventions. Each child requires a tailored approach to ensure their special healthcare needs are addressed within the treatment plan.

Non-alcoholic fatty liver disease (NAFLD) and mental illness: Mechanisms linking mood, metabolism and medicines

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the world and one of the leading indications for liver transplantation. It is one of the many manifestations of insulin resistance and metabolic syndrome as well as an independent risk factor for cardiovascular disease. There is growing evidence linking the incidence of NAFLD with psychiatric illnesses such as schizophrenia, bipolar disorder and depression mechanistically via genetic, metabolic, inflammatory and environmental factors including smoking and psychiatric medications. Indeed, patients prescribed antipsychotic medications, regardless of diagnosis, have higher incidence of NAFLD than population norms. The mechanistic pharmacology of antipsychotic-associated NAFLD is beginning to emerge. In this review, we aim to discuss the pathophysiology of NAFLD including its risk factors, insulin resistance and systemic inflammation as well as its intersection with psychiatric illnesses.

Efficacy and Safety of Non-brain Penetrating H1-Antihistamines for the Treatment of Allergic Diseases

H₁ receptor antagonists, known as H₁-antihistamines (AHs), inactivate the histamine H₁-receptor thereby preventing histamine causing the primary symptoms of allergic diseases, such as atopic dermatitis, pollinosis, food allergies, and urticaria. AHs, which are classified into first-generation (fgAHs) and second-generation (sgAHs) antihistamines, are the first line of treatment for allergic diseases. Although fgAHs are effective, they cause adverse reactions such as potent sedating effects, including drowsiness, lassitude, and cognitive impairment; anticholinergic effects, including thirst and tachycardia. Consequently, the use of fgAHs is not recommended for allergic diseases. Today, sgAHs, which are minimally sedating and, therefore, may be used at more effective doses, are the first-line treatment for alleviating the symptoms of allergic diseases. Pharmacologically, the use of sedating fgAHs is limited to antiemetics, anti-motion sickness drugs, and antivertigo drugs. The use of histamine H₁-receptor occupancy (H₁RO) based on positron emission tomography (PET) has been developed for the evaluation of brain penetrability. Based on the results of the H₁RO-PET studies, non-brain-penetrating AHs (nbpAHs) have recently been reclassified among sgAHs. The nbpAHs are rapidly acting and exhibit minimal adverse reactions and, thus, are considered first-line drugs for allergic diseases. In this review, we will introduce recent topics on the pharmacodynamics and pharmacokinetics of AHs and make recommendations for the use of nbpAHs as first-line treatment options for allergic diseases.