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Staubach P, Bilo B, Fluhr JW, Krause K, Kulthanan K, Salman A, Katelaris C, Bernstein JA, Maurer M, Mann C. UCOMB-real life data: treatment strategies for chronic urticaria patients with comorbidities. J DERMATOL TREAT 2024; 35:2329784. [PMID: 38508226 DOI: 10.1080/09546634.2024.2329784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND There is a lack of real-life safety data on treatment options for chronic urticaria in the presence of comedication and comorbidities. METHODS We present a single-center UCARE pilot study of 212 outpatients with chronic urticaria. Patients were divided into three groups according to different CU therapies according to international guidelines. RESULTS Of 212 patients, 108 (mean age 48.9 years, 71.3% female) had 59 comorbidities, including cardiovascular, autoimmune and malignant diseases. Patients were followed for a mean of 24.6 months (SD ± 21.3). Urticaria therapies were divided into three groups: A: 105 (97.2%) with omalizumab and 2nd generation antihistamines), B: 16 patients (14.8%): dual therapy with antihistamines and cyclosporine in 10 (9.3%), montelukast in five (4. 6%), dapsone in four (3.7%), hydroxychloroquine in one patient (0.9%), C: 12 (11.1%) patients received a third drug for 4.9 months (SD ± 3.2) and one quadruple therapy (2.1 months). 10 out of 12 (83.3%) patients received montelukast, two (16.7%) cyclosporine, two (16.7%) dapsone and one (8.3%) hydroxychloroquine as a third drug for chronic urticaria. CONCLUSIONS Combining treatment modalities for chronic urticaria and comorbidities are available and feasible with a good safety profile.
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Affiliation(s)
- Petra Staubach
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Benedikt Bilo
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Joachim W Fluhr
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology IFA, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Fraunhofer Insitute for Translational Medicine and Pharmacology, ITMP Berlin, Immunology and Allergology IA, Berlin, Germany
| | - Karoline Krause
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology IFA, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Fraunhofer Insitute for Translational Medicine and Pharmacology, ITMP Berlin, Immunology and Allergology IA, Berlin, Germany
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Andac Salman
- Department of Dermatology, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Connie Katelaris
- Department of Medicine, Campbelltown Hospital and Western Sydney University Sydney, Campbelltown, Australia
| | - Jonathan A Bernstein
- Division of Rheumatology, Allergy and Immunology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology IFA, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Fraunhofer Insitute for Translational Medicine and Pharmacology, ITMP Berlin, Immunology and Allergology IA, Berlin, Germany
| | - Caroline Mann
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Chen S, Cao W, Xiao X, Wang L, Wan R, Zou Z, Yang Q, Li Y. A systematic review and meta-analysis of efficacy and safety of compound glycyrrhizin combined with second-generation non-sedated antihistamine for the treatment of chronic urticaria. J DERMATOL TREAT 2024; 35:2299597. [PMID: 38166511 DOI: 10.1080/09546634.2023.2299597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/20/2023] [Indexed: 01/04/2024]
Abstract
BACKGROUND Chronic urticaria (CU) is a prevalent dermatologic disease that negatively affects life, current therapies remain suboptimal. Hence, there is an urgent need to identify effective and safe treatment. OBJECTIVE Assess the efficacy and safety of compound glycyrrhizin (CG) combined with second-generation nonsedated antihistamine for the treatment of CU. METHODS Nine databases were queried to screen RCTs related. Two reviewers independently assessed the risk of bias using Cochrane Collaboration. Primary objective was the total efficiency rate, while secondary was rate of recurrence, adverse events, and cure. Statistical analyses using Review Manager 5.4 and Stata17. RESULTS Twenty-four RCTs were identified. Significant differences were noted in rate of total efficiency (n = 2649, RR = 1.36, 95%CI:1.30-1.43, p < 0.00001), cure (n = 2649, RR = 1.54, 95%CI:1.42-1.66, p < 0.00001) and recurrence (n = 446, RR = 0.34, 95%CI:0.20-0.58, p < 0.00001) between the combination of CG with second-generation non-sedated antihistamine and antihistamine monotherapy. Contrastingly, adverse events rate (n = 2317, RR = 0.76, 95% CI:0.59-0.97, p = 0.03) was comparable between the two groups. Our results indicated that CG combined with second-generation non-sedated antihistamine could significantly mitigate the symptoms in CU compared with antihistamine monotherapy. No serious adverse events were reported. CONCLUSIONS CG combined with second-generation nonsedated antihistamine is effective for CU. Nevertheless, higher-quality studies are warranted to validate our results.
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Affiliation(s)
- Sijue Chen
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wei Cao
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xianjun Xiao
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lu Wang
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Renhong Wan
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zihao Zou
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qian Yang
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ying Li
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Chu Z, Cen L, Xu Q, Lin G, Mo J, Shao L, Zhao Y, Li J, Ye W, Fang T, Ren W, Zhu Q, He G, Xu Y. Discovery of the novel and potent histamine H1 receptor antagonists for treatment of allergic diseases. Eur J Med Chem 2024; 268:116197. [PMID: 38368709 DOI: 10.1016/j.ejmech.2024.116197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/27/2024] [Accepted: 01/28/2024] [Indexed: 02/20/2024]
Abstract
Desloratadine, a second-generation histamine H1 receptor antagonist, has established itself as a first-line drug for the treatment of allergic diseases. Despite its effectiveness, desloratadine exhibits an antagonistic effect on muscarinic M3 receptor, which can cause side effects such as dry mouth and urinary retention, ultimately limiting its clinical application. Herein, we describe the discovery of compound Ⅲ-4, a novel H1 receptor antagonist with significant H1 receptor antagonistic activity (IC50 = 24.12 nM) and enhanced selectivity towards peripheral H1 receptor. In particular, Ⅲ-4 exhibits reduced M3 receptor inhibitory potency (IC50 > 10,000 nM) and acceptable hERG inhibitory activity (17.6 ± 2.1 μM) compare with desloratadine. Additionally, Ⅲ-4 exhibits favorable pharmacokinetic properties, as well as in vivo efficacy and safety profiles. All of these reveal that Ⅲ-4 has potential to emerge as a novel H1 receptor antagonist for the treatment of allergic diseases. More importantly, the compound Ⅲ-4 (HY-078020) has recently been granted clinical approval.
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Affiliation(s)
- Zhaoxing Chu
- Jiangsu Key Laboratory of Drug Design and Optimization, Department of Medicinal Chemistry, China Pharmaceutical University, Nanjing, 210009, China; Hefei Institute of Pharmaceutical Industry Co., Ltd., Hefei, 230088, China
| | - Lifang Cen
- Jiangsu Key Laboratory of Drug Design and Optimization, Department of Medicinal Chemistry, China Pharmaceutical University, Nanjing, 210009, China
| | - Qinlong Xu
- Hefei Institute of Pharmaceutical Industry Co., Ltd., Hefei, 230088, China
| | - Gaofeng Lin
- Hefei Institute of Pharmaceutical Industry Co., Ltd., Hefei, 230088, China
| | - Jiajia Mo
- Hefei Institute of Pharmaceutical Industry Co., Ltd., Hefei, 230088, China
| | - Li Shao
- Hefei Institute of Pharmaceutical Industry Co., Ltd., Hefei, 230088, China
| | - Yan Zhao
- Hefei Institute of Pharmaceutical Industry Co., Ltd., Hefei, 230088, China
| | - Jiaming Li
- College of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230012, China
| | - Wenfeng Ye
- Hefei Institute of Pharmaceutical Industry Co., Ltd., Hefei, 230088, China
| | - Tao Fang
- Hefei Institute of Pharmaceutical Industry Co., Ltd., Hefei, 230088, China
| | - Weijie Ren
- Jiangsu Key Laboratory of Drug Design and Optimization, Department of Medicinal Chemistry, China Pharmaceutical University, Nanjing, 210009, China
| | - Qihua Zhu
- Jiangsu Key Laboratory of Drug Design and Optimization, Department of Medicinal Chemistry, China Pharmaceutical University, Nanjing, 210009, China.
| | - Guangwei He
- Hefei Institute of Pharmaceutical Industry Co., Ltd., Hefei, 230088, China.
| | - Yungen Xu
- Jiangsu Key Laboratory of Drug Design and Optimization, Department of Medicinal Chemistry, China Pharmaceutical University, Nanjing, 210009, China.
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Bernstein JA, Bernstein JS, Makol R, Ward S. Allergic Rhinitis: A Review. JAMA 2024; 331:866-877. [PMID: 38470381 DOI: 10.1001/jama.2024.0530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Importance Allergic rhinitis affects an estimated 15% of the US population (approximately 50 million individuals) and is associated with the presence of asthma, eczema, chronic or recurrent sinusitis, cough, and both tension and migraine headaches. Observations Allergic rhinitis occurs when disruption of the epithelial barrier allows allergens to penetrate the mucosal epithelium of nasal passages, inducing a T-helper type 2 inflammatory response and production of allergen-specific IgE. Allergic rhinitis typically presents with symptoms of nasal congestion, rhinorrhea, postnasal drainage, sneezing, and itching of the eyes, nose, and throat. In an international study, the most common symptoms of allergic rhinitis were rhinorrhea (90.38%) and nasal congestion (94.23%). Patients with nonallergic rhinitis present primarily with nasal congestion and postnasal drainage frequently associated with sinus pressure, ear plugging, muffled sounds and pain, and eustachian tube dysfunction that is less responsive to nasal corticosteroids. Patients with seasonal allergic rhinitis typically have physical examination findings of edematous and pale turbinates. Patients with perennial allergic rhinitis typically have erythematous and inflamed turbinates with serous secretions that appear similar to other forms of chronic rhinitis at physical examination. Patients with nonallergic rhinitis have negative test results for specific IgE aeroallergens. Intermittent allergic rhinitis is defined as symptoms occurring less than 4 consecutive days/week or less than 4 consecutive weeks/year. Persistent allergic rhinitis is defined as symptoms occurring more often than 4 consecutive days/week and for more than 4 consecutive weeks/year. Patients with allergic rhinitis should avoid inciting allergens. In addition, first-line treatment for mild intermittent or mild persistent allergic rhinitis may include a second-generation H1 antihistamine (eg, cetirizine, fexofenadine, desloratadine, loratadine) or an intranasal antihistamine (eg, azelastine, olopatadine), whereas patients with persistent moderate to severe allergic rhinitis should be treated initially with an intranasal corticosteroid (eg, fluticasone, triamcinolone, budesonide, mometasone) either alone or in combination with an intranasal antihistamine. In contrast, first-line therapy for patients with nonallergic rhinitis consists of an intranasal antihistamine as monotherapy or in combination with an intranasal corticosteroid. Conclusions and Relevance Allergic rhinitis is associated with symptoms of nasal congestion, sneezing, and itching of the eyes, nose, and throat. Patients with allergic rhinitis should be instructed to avoid inciting allergens. Therapies include second-generation H1 antihistamines (eg, cetirizine, fexofenadine, desloratadine, loratadine), intranasal antihistamines (eg, azelastine, olopatadine), and intranasal corticosteroids (eg, fluticasone, triamcinolone, budesonide, mometasone) and should be selected based on the severity and frequency of symptoms and patient preference.
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Affiliation(s)
- Jonathan A Bernstein
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Joshua S Bernstein
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Richika Makol
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stephanie Ward
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Altunisik N. Comment on 'Dramatic improvement with colchicine in antihistamine- and omalizumab-resistant chronic spontaneous urticaria'. Clin Exp Dermatol 2024; 49:289. [PMID: 37967318 DOI: 10.1093/ced/llad395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 11/07/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Nihal Altunisik
- Department of Dermatology, Inonu University, Malatya, Turkey
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Jain V, Giménez-Arnau A, Hayama K, Reich A, Carr W, Tillinghast J, Dahale S, Lheritier K, Walsh P, Zharkov A, Hugot S, Haemmerle S. Remibrutinib demonstrates favorable safety profile and sustained efficacy in chronic spontaneous urticaria over 52 weeks. J Allergy Clin Immunol 2024; 153:479-486.e4. [PMID: 37866460 DOI: 10.1016/j.jaci.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/22/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Remibrutinib (LOU064), an oral, highly selective Bruton tyrosine kinase inhibitor, offers fast disease control in patients with chronic spontaneous urticaria (CSU) who remain symptomatic despite treatment with second-generation H1 antihistamines. It is currently in phase 3 development for CSU. OBJECTIVE We sought to evaluate long-term safety and efficacy of remibrutinib in patients with CSU inadequately controlled with H1 antihistamines. METHODS In this phase 2b extension study, patients who completed the core study and had a weekly Urticaria Activity Score (UAS7) ≥16 at the beginning of the extension study received remibrutinib 100 mg twice daily for 52 weeks. The primary objective was to assess long-term safety and tolerability. Key efficacy end points included change from baseline in UAS7 and proportion of patients with complete response to treatment (UAS7 = 0) and well-controlled disease (UAS7 ≤6) at week 4 and over 52 weeks. RESULTS Overall, 84.3% (194/230) of patients entered the treatment period and received ≥1 doses of remibrutinib. The overall safety profile of remibrutinib was comparable between the extension and core studies. Most treatment-emergent adverse events were mild to moderate and considered unrelated to remibrutinib by investigators. The 3 most common treatment-emergent adverse events by system organ class were infections (30.9%), skin and subcutaneous tissue (26.8%), and gastrointestinal disorders (16.5%). At week 4 and 52, mean ± SD change from baseline in UAS7 was -17.6 ± 13.40 and -21.8 ± 10.70; UAS7 = 0 (as observed) was achieved in 28.2% and 55.8% and UAS7 ≤6 (as observed) was achieved in 52.7% and 68.0% of patients, respectively. CONCLUSIONS Remibrutinib demonstrated a consistent favorable safety profile with fast and sustained efficacy for up to 52 weeks in patients with CSU.
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Affiliation(s)
- Vipul Jain
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Ana Giménez-Arnau
- Department of Dermatology, Hospital del Mar Medical Research Institute, Universitat Pompeu Fabra, Barcelona, Spain
| | - Koremasa Hayama
- Department of Dermatology, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów, Poland
| | - Warner Carr
- Allergy and Asthma Associates of Southern California, and Southern California Research, Mission Viejo
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Maurer M, Ensina LF, Gimenez-Arnau AM, Sussman G, Hide M, Saini S, Grattan C, Fomina D, Rigopoulos D, Berard F, Canonica GW, Rockmann H, Irani C, Szepietowski JC, Leflein J, Bernstein JA, Peter JG, Kulthanan K, Godse K, Ardusso L, Ukhanova O, Staubach P, Sinclair R, Gogate S, Thomsen SF, Tanus T, Ye YM, Burciu A, Barve A, Modi D, Scosyrev E, Hua E, Letzelter K, Varanasi V, Patekar M, Severin T. Efficacy and safety of ligelizumab in adults and adolescents with chronic spontaneous urticaria: results of two phase 3 randomised controlled trials. Lancet 2024; 403:147-159. [PMID: 38008109 DOI: 10.1016/s0140-6736(23)01684-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/08/2023] [Accepted: 08/09/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Many patients with chronic spontaneous urticaria (CSU) do not achieve complete control of their symptoms with current available treatments. In a dose-finding phase 2b study, ligelizumab improved urticaria symptoms in patients with H1-antihistamine (H1-AH) refractory CSU. Here, we report the efficacy and safety outcomes from two ligelizumab phase 3 studies. METHODS PEARL-1 and PEARL-2 were identically designed randomised, double-blind, active-controlled and placebo-controlled parallel-group studies. Patients aged 12 years or older with moderate-to-severe H1-AH refractory CSU were recruited from 347 sites in 46 countries and randomly allocated in a 3:3:3:1 ratio via Interactive Response Technology to 72 mg ligelizumab, 120 mg ligelizumab, 300 mg omalizumab, or placebo, dosed every 4 weeks, for 52 weeks. Patients allocated to placebo received 120 mg ligelizumab from week 24. The primary endpoint was change-from-baseline (CFB) in weekly Urticaria Activity Score (UAS7) at week 12, and was analysed in all eligible adult patients according to the treatment assigned at random allocation. Safety was assessed throughout the study in all patients who received at least one dose of the study drug. The studies were registered with ClinicalTrials.gov, NCT03580369 (PEARL-1) and NCT03580356 (PEARL-2). Both trials are now complete. FINDINGS Between Oct 17, 2018, and Oct 26, 2021, 2057 adult patients were randomly allocated across both studies (72 mg ligelizumab n=614; 120 mg ligelizumab n=616; 300 mg omalizumab n=618, and placebo n=209). A total of 1480 (72%) of 2057 were female, and 577 (28%) of 2057 were male. Mean UAS7 at baseline across study groups ranged from 29·37 to 31·10. At week 12, estimated treatment differences in mean CFB-UAS7 were as follows: for 72 mg ligelizumab versus placebo, -8·0 (95% CI -10·6 to -5·4; PEARL-1), -10·0 (-12·6 to -7·4; PEARL-2); 72 mg ligelizumab versus omalizumab 0·7 (-1·2 to 2·5; PEARL-1), 0·4 (-1·4 to 2·2; PEARL-2); 120 mg ligelizumab versus placebo -8·0 (-10·5 to -5·4; PEARL-1), -11·1 (-13·7 to -8·5; PEARL-2); 120 mg ligelizumab versus omalizumab 0·7 (-1·1 to 2·5; PEARL-1), -0·7 (-2·5 to 1·1; PEARL-2). Both doses of ligelizumab were superior to placebo (p<0·0001), but not to omalizumab, in both studies. No new safety signals were identified for ligelizumab or omalizumab. INTERPRETATION In the phase 3 PEARL studies, ligelizumab demonstrated superior efficacy versus placebo but not versus omalizumab. The safety profile of ligelizumab was consistent with previous studies. FUNDING Novartis Pharma.
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Affiliation(s)
- Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology, Charité-Universitätsmedizin Berlin, Germany; Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany.
| | - Luis Felipe Ensina
- Federal University of São Paulo, São Paulo, Brazil; CPAlpha Clinical Research Center, Barueri, Brazil
| | - Ana Maria Gimenez-Arnau
- Department of Dermatology, Hospital del Mar-IMIM, Universitat Pompeu Fabra, Barcelona, Spain
| | - Gordon Sussman
- Division of Allergy and Clinical Immunology, University of Toronto, Canada
| | - Michihiro Hide
- Department of Dermatology, Hiroshima University, Hiroshima, Japan; Department of Dermatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Sarbjit Saini
- Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland, MD, USA
| | - Clive Grattan
- St John's Institute of Dermatology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Daria Fomina
- Center of Allergy and Immunology, Clinical State Hospital 52, Moscow Ministry of Healthcare, Moscow, Russia; Department of Clinical Allergology and Immunology, I M Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Frederic Berard
- Département d'Allergologie et Immunologie Clinique, CHU Lyon-Sud, Pierre Bénite Cedex, France
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy; Department of Biomedical Science, Humanitas University-Pieve Emanuele, Milan, Italy
| | - Heike Rockmann
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Carla Irani
- Internal Medicine and Clinical Immunology, Saint Joseph University, Beirut, Lebanon
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Jeffrey Leflein
- Allergy and Immunology Associates of Ann Arbor, PC Ann Arbor, Michigan, MI, USA
| | - Jonathan A Bernstein
- University of Cincinnati College of Medicine Division of Rheumatology, Allergy, and Immunology and Bernstein Clinical Research Center, Cincinnati, OH, USA
| | - Jonny G Peter
- Division of Allergology and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kiran Godse
- Department of Dermatology, D Y Patil School of Medicine, Navi Mumbai, Maharashtra, India
| | - Ledit Ardusso
- Department of Pulmonology, Allergy and Immunology, School of Medicine, National University of Rosario, Rosario, Santa Fe, Argentina
| | - Olga Ukhanova
- Scientific Medical Center of General Therapy and Pharmacology, Stavropol, Russia
| | - Petra Staubach
- Department of Dermatology, University Medical Center, Mainz, Germany
| | - Rodney Sinclair
- Department of Dermatology, St Vincent's Hospital, The Skin and Cancer Foundation of Victoria and The University of Melbourne, Victoria, VIC, Australia
| | - Shaila Gogate
- Colorado Allergy and Asthma Centers, Denver, Colorado, CO, USA
| | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Biomedical Sciences, Copenhagen, Denmark
| | - Tonny Tanus
- Kern Allergy Medical Clinic, Bakersfield, CA, USA
| | - Young Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | | | - Avantika Barve
- Novartis Pharmaceuticals, East Hanover, New Jersey, NJ, USA
| | - Darshna Modi
- Novartis Pharmaceuticals, East Hanover, New Jersey, NJ, USA
| | - Emil Scosyrev
- Novartis Pharmaceuticals, East Hanover, New Jersey, NJ, USA
| | - Eva Hua
- China Novartis Institutes for Biomedical Research, Shanghai, China
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Herrero-Vanrell R, Jáuregui Presa I, Leceta Bilbao A, Montero-Iruzubieta J. Fundamental Aspects and Relevance of Components in Antihistamine Eye Drops. J Investig Allergol Clin Immunol 2023; 33:431-438. [PMID: 38095492 DOI: 10.18176/jiaci.0963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Ocular allergy covers a series of immune-allergic inflammatory diseases of the ocular surface, with different degrees of involvement and severity. These pathologies are caused by a variety of IgE- and non-IgE-mediated immune mechanisms and may involve all parts of the external eye, including the conjunctiva, cornea, eyelids, tear film, and commensal flora. The most frequent is allergic conjunctivitis, a condition with different clinical forms that are classified according to the degree of involvement and the presence or absence of proliferative changes in the palpebral conjunctiva, associated atopic dermatitis, and mechanical stimuli by foreign bodies, including contact lenses. Treatment guidelines for allergic conjunctivitis propose a stepwise approach that includes medications for both ophthalmic and oral administration depending on symptom severity, allergic comorbidities, and degree of control. In the case of antihistamines, eye drops are the most prescribed ophthalmic formulations. To avoid disrupting the delicate balance of the ocular surface, topical ophthalmic medications must be well tolerated. The primary aim of this article is to review the physicochemical characteristics and other features of excipients (preservative agents, buffers, pH adjusters, viscosity enhancers, wetting agents or cosolvents, antioxidants, tonicity adjusters, and osmo-protectants) and active compounds (ocular antihistamines) that must be considered when developing formulations for ophthalmic administration of antihistamines. We also provide a brief overview of antihistamine eye drops that could be of interest to professionals treating ocular allergy and encourage the use of preservative-free formulations when possible.
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Affiliation(s)
- R Herrero-Vanrell
- Innovation, Therapy and Pharmaceutical Development in Ophthalmology (InnOftal) Research Group, UCM 920415
- Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, Complutense University, Madrid, Spain
- San Carlos Clinical Hospital Health Research Institute (IdISSC), Madrid, Spain
- Instituto Universitario de Farmacia Industrial, Faculty of Pharmacy (UCM), Madrid, Spain
| | - I Jáuregui Presa
- Servicio de Alergia, Hospital Universitario Cruces, Barakaldo, Spain
- Biocruces Bizkaia Health Research Institute, Immunopathology Group, Barakaldo, Spain
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Zare H, Nabavizdeh SH, Jaladat AM, Zarshenas MM, Moghtaderi M, Basirat A, Nasri N. The Added-on of Ziziphus jujube Syrup in the Treatment of Chronic Spontaneous Urticaria Resistant to Standard-Dose of Secondary-generation H 1 Antihistamine: A Double-Blind Randomized Clinical Trial. Iran J Med Sci 2023; 48:582-590. [PMID: 38094286 PMCID: PMC10715122 DOI: 10.30476/ijms.2023.95531.2690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 11/01/2022] [Accepted: 12/03/2022] [Indexed: 12/18/2023]
Abstract
Background Although antihistamines are the first-line treatment for chronic spontaneous urticaria (CSU), 50% of patients don't respond to standard doses. In this study, the effectiveness of Ziziphus jujube fruit syrup in combination with antihistamines was assessed in patients with CSU. Methods This double-blind randomized clinical trial was conducted in Shiraz between December 2019 and December 2020. 64 patients with CSU who had experienced hives for at least six weeks and did not respond to the usual treatments were enrolled in the study. They were randomly assigned to intervention and control groups using permuted block random allocation. For four weeks, the intervention group received 7.5 mL Ziziphus jujube syrup twice a day, while the control group received 7.5 mL simple jujube syrup twice a day. Both groups received cetirizine 10 mg every night. Urticaria activity score (UAS) and CU-Q2oL questionnaires were used to assess urticaria state and sleep quality before and after each week for four consecutive weeks. Data were analyzed using SPSS software version 18, and P<0.05 was considered statistically significant. Results Before the intervention, there was no statistically significant difference between the two groups' mean of UAS (P=0.490) and sleep quality (P=0.423). During the follow-up, UAS in the intervention group was significantly lower (P=0.001). Moreover, this difference was significant on the day 28 (P=0.046). During the follow-up, the quality of sleep in both groups improved significantly, and this improvement was more significant in the intervention group. Conclusion Ziziphus jujube syrup could be an effective adjuvant treatment for CSU.Trial Registration Number: IRCT20190304042916N1.
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Affiliation(s)
- Hamid Zare
- Department of Persian Medicine; School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Health System Research, Vice Chancellor of Treatment, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Hesamedin Nabavizdeh
- Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Mohamad Jaladat
- Traditional Medicine and History of Medicine Research Center, Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohamad Mehdi Zarshenas
- Medicinal Plants Processing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Phytopharmaceuticals (Traditional Pharmacy), School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
- Traditional Medicine and Hydrotherapy Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mozhgan Moghtaderi
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Atefeh Basirat
- Health System Research, Vice Chancellor of Treatment, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nahid Nasri
- Health System Research, Vice Chancellor of Treatment, Shiraz University of Medical Sciences, Shiraz, Iran
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Kim MJ, Kulkarni V, Goode MA, Sivesind TE. Exploring the interactions of antihistamine with retinoic acid receptor beta (RARB) by molecular dynamics simulations and genome-wide meta-analysis. J Mol Graph Model 2023; 124:108539. [PMID: 37331258 PMCID: PMC10529808 DOI: 10.1016/j.jmgm.2023.108539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023]
Abstract
Kaposi sarcoma (KS) is one of the most common AIDS-related malignant neoplasms, which can leave lesions on the skin among HIV patients. These lesions can be treated with 9-cis-retinoic acid (9-cis-RA), an endogenous ligand of retinoic acid receptors that has been FDA-approved for treatment of KS. However, topical application of 9-cis-RA can induce several unpleasant side effects, like headache, hyperlipidemia, and nausea. Hence, alternative therapeutics with less side effects are desirable. There are case reports associating over-the-counter antihistamine usage with regression of KS. Antihistamines competitively bind to H1 receptor and block the action of histamine, best known for being released in response to allergens. Furthermore, there are already dozens of antihistamines that are FDA-approved with less side effects than 9-cis-RA. This led our team to conduct a series of in-silico assays to determine whether antihistamines can activate retinoic acid receptors. First, we utilized high-throughput virtual screening and molecular dynamics simulations to model high-affinity interactions between antihistamines and retinoic acid receptor beta (RARβ). We then performed systems genetics analysis to identify a genetic association between H1 receptor itself and molecular pathways involved in KS. Together, these findings advocate for exploration of antihistamines against KS, starting with our two promising hit compounds, bepotastine and hydroxyzine, for experimental validation study in the future.
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Affiliation(s)
- Minjae J Kim
- University of Tennessee Health Sciences Center School of Medicine, Memphis, TN, USA.
| | | | - Micah A Goode
- University of Tennessee Health Sciences Center School of Medicine, Memphis, TN, USA.
| | - Torunn E Sivesind
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Kulumbegov B, Chikovani T, Gotua M, Kikodze N, Magen E. Interleukin-33, endothelin-1, and inflammatory parameters in chronic spontaneous urticaria. Allergy Asthma Proc 2023; 44:429-435. [PMID: 37919851 DOI: 10.2500/aap.2023.44.230051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Background: Endothelin-1 (ET-1) and interleukin-33 (IL-33) can modulate the activation of mast cells and basophils in the pathophysiology of allergic diseases, interplaying with other mediators of "low-grade inflammation." Objective: To compare ET-1, IL-33, the neutrophil-lymphocyte ratio (NLR), eosinophil-lymphocyte ratio (ELR), platelet-lymphocyte ratio (PLR), eosinophil-basophil ratio (EBR), systemic immune inflammation index (SII), and system inflammation response index (SIRI) in patients with chronic spontaneous urticaria (CSU) and are antihistamine sensitive (AHS), antihistamine resistant (AHR), omalizumab sensitive (OmS), and omalizumab resistant (OmR). Methods: A prospective observational study enrolled 68 consecutive patients with CSU diagnosed and managed according to the dermatology section of the European Academy of Allergology and Clinical Immunology (EAACI), the European Union funded network of excellence, the Global Allergy and Asthma European Network (GA2LEN), the European Dermatology Forum (EDF), and the World Allergy Organization guidelines. Patients with a urticaria control test score of >12 are considered treatment sensitive, and ≤ 12 are considered resistant. The control group consisted of 20 sex-matched subjects without urticarial diseases. Total immunoglobulin E (IgE), antinuclear antibodies (ANA), thyroid stimulating hormone, antithyroid peroxidase, mean platelet volume (MPV), NLR, ELR, PLR, EBR, SII, SIRI, ET-1, and IL-33 were measured at the study entry and compared between the study groups. Results: Thirty AHS group, 38 AHR group, and 20 control group patients were included. The AHS, AHR, and control groups did not differ in demographic parameters, but the CSU groups were characterized by higher indicators of inflammation. In comparison with the AHS group, the AHR group was characterized by higher levels of IL-33 (p = 0.007), ET-1 (p = 0.032), C-reactive protein (p = 0.016), MPV (p = 0.002), and higher rates of positive ANA (p = 0.019). Of the 38 patients from the AHR group, 30 (79%) were included in the OmS group and 8 (21%) were included in the OmR group. The OmR group was characterized by higher levels of C-reactive protein (p = 0.022), EBR (p < 0.001), higher rates of ANA (p = 0.004), and lower levels of ET-1 (p = 0.025) than the OmS group. Conclusion: Our study did not confirm NRL, PRL, SII, and SIRI, PLR as the biomarkers of treatment response to antihistamines and/or omalizumab in CSU. Higher blood levels of IL-33 and ET-1 characterize AHR CSU.
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Affiliation(s)
| | - Tinatin Chikovani
- Immunology Department, Tbilisi State Medical University, Tbilisi, Georgia, and
| | - Maia Gotua
- From the Center of Allergy and Immunology, Tbilisi, Georgia
| | - Nino Kikodze
- Immunology Department, Tbilisi State Medical University, Tbilisi, Georgia, and
| | - Eli Magen
- Assuta Ashdod University Medical Center, Ben Gurion University of the Negev, Ashdod, Israel
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12
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Bei W, Qian J, Zilu Q, Kai C, Ruili J, Feng H, Liuqing C. Comparing four immunosuppressive agents for chronic spontaneous urticaria-A network meta-analysis. Int Immunopharmacol 2023; 123:110577. [PMID: 37567010 DOI: 10.1016/j.intimp.2023.110577] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Immunosuppression is an integral part of treating chronic spontaneous urticaria (CSU), but there is no literature to evaluate the efficacy of multiple immunosuppressive agents. OBJECTIVE The comparison of the efficacy, safety, and incidence of adverse effects of four immunosuppressive medicines (tripterygium glycosides, methotrexate, cyclosporine A, and azathioprine) in combination with antihistamines in treating CSU provides a clinical reference and evidence-based medicine for treating CSU. METHODS PUBMED, The Cochrane Library, EMBASE, WANFANG, CNKI, CBM, and clinical trial registration platform were searched to collect relevant randomized controlled trials (RCT) and cohort studies of four immunosuppressive medicines combined with antihistamines for treating CSU. The primary outcomes were the efficacy of weekly urticaria activity score 7 (UAS7) and adverse effects. RESULTS This study pooled data from seven randomized clinical trials with 410 participants. The standardized mean differences for change in UAS7 were 0.10 (95% confidence interval (CI), 0.01 to 0.68) for cyclosporine A plus antihistamine; 0.03 (95% CI, 0.00 to 0.23) for azathioprine plus antihistamine; 0.52 (95% CI, 0.32 to 0.85) for tripterygium glycosides plus antihistamine; and 1.54 (95% CI, 0.64 to 3.67) for methotrexate plus antihistamine. There were no significant differences in side effects between these medicines in the limited number of trials and clinical samples. CONCLUSION Our results indicate that cyclosporine A combined with antihistamine resulted in greater improvements regarding the UAS7 in CSU patients and that tripterygium glycosides are also effective in treating CSU.
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Affiliation(s)
- Wang Bei
- Clinical College of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430000, China; Department of Dermatology, Wuhan No. 1 Hospital, Hospital of Traditional Chinese and Western Medicine Affiliated to Hubei University of Chinese Medicine, Wuhan Hospital of Traditional Chinese and Western Medicine Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430000, China; Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, Hubei 430000, China
| | - Jiang Qian
- Department of Dermatology, Wuhan No. 1 Hospital, Hospital of Traditional Chinese and Western Medicine Affiliated to Hubei University of Chinese Medicine, Wuhan Hospital of Traditional Chinese and Western Medicine Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430000, China; Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, Hubei 430000, China
| | - Qu Zilu
- Department of Dermatology, Wuhan No. 1 Hospital, Hospital of Traditional Chinese and Western Medicine Affiliated to Hubei University of Chinese Medicine, Wuhan Hospital of Traditional Chinese and Western Medicine Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430000, China; Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, Hubei 430000, China
| | - Chen Kai
- Department of Dermatology, Wuhan No. 1 Hospital, Hospital of Traditional Chinese and Western Medicine Affiliated to Hubei University of Chinese Medicine, Wuhan Hospital of Traditional Chinese and Western Medicine Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430000, China; Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, Hubei 430000, China
| | - Jiang Ruili
- Department of Dermatology, Wuhan No. 1 Hospital, Hospital of Traditional Chinese and Western Medicine Affiliated to Hubei University of Chinese Medicine, Wuhan Hospital of Traditional Chinese and Western Medicine Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430000, China; Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, Hubei 430000, China
| | - Hu Feng
- Department of Dermatology, Wuhan No. 1 Hospital, Hospital of Traditional Chinese and Western Medicine Affiliated to Hubei University of Chinese Medicine, Wuhan Hospital of Traditional Chinese and Western Medicine Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430000, China; Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, Hubei 430000, China.
| | - Chen Liuqing
- Clinical College of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430000, China; Department of Dermatology, Wuhan No. 1 Hospital, Hospital of Traditional Chinese and Western Medicine Affiliated to Hubei University of Chinese Medicine, Wuhan Hospital of Traditional Chinese and Western Medicine Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430000, China; Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, Hubei 430000, China.
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Zhang M, Ao T, Cheng L. Highlights of the treatment of allergic rhinitis according to Chinese guidelines. Curr Opin Allergy Clin Immunol 2023; 23:334-340. [PMID: 37357787 DOI: 10.1097/aci.0000000000000921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
PURPOSE OF REVIEW This review aimed to introduce the pharmacotherapy of allergic rhinitis according to the 2022 updated Chinese guidelines. RECENT FINDINGS Despite recent advances in basic and clinical research worldwide, pharmacotherapy remains a mainstream in allergic rhinitis treatment. Usually, the first-line drugs, involving intranasal corticosteroids, second-generation oral and intranasal H1-antihistamines, or leukotriene receptor antagonists, can achieve acceptable outcomes in the treatment of allergic rhinitis. The second-line drugs, such as oral corticosteroids, intranasal decongestants and intranasal anticholinergics, can assist in controlling severe symptoms, like nasal congestion/blockage and watery rhinorrhea. For those with moderate-to-severe allergic rhinitis, evidence-based stepwise strategies are suitable, in which the types and dosages of drugs are de-escalated or upgraded according to their therapeutic efficacy. Meanwhile, omalizumab, a novel biological agent, has burgeoned to satisfy the need of patients. SUMMARY This review highlights the staples in Chinese guidelines about the pharmacotherapy for allergic rhinitis to better understand the guidelines and promote the clinical practice.
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Affiliation(s)
- Min Zhang
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital
| | - Tian Ao
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital
| | - Lei Cheng
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital
- International Centre for Allergy Research, Nanjing Medical University, Nanjing, China
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Zuberbier T, Peter J, Staubach P, Chularojanamontri L, Kulthanan K. Potential Therapeutic Approaches for Chronic Urticaria: Beyond H1-Antihistamines and Biologics. J Allergy Clin Immunol Pract 2023; 11:2265-2273. [PMID: 37356753 DOI: 10.1016/j.jaip.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/31/2023] [Accepted: 06/14/2023] [Indexed: 06/27/2023]
Abstract
Chronic urticaria is a disease that can significantly impact a patient's quality of life and ability to function. There are effective treatment options, such as nonsedating antihistamines or biologics, but some patients do not respond to these therapies, or the therapies are not available or affordable to all patients. This review aims to summarize potential treatment strategies for patients (1) who do not respond to antihistamines and (2) cannot readily access or do not respond to biologics. The review emphasizes the importance of sound clinical practice, including correct diagnosis of chronic urticaria phenotypes, treatment of associated comorbidities, and consideration of add-on pharmacological and nonpharmacological approaches. Although some treatments may lack high-quality evidence, they may still be justifiable in certain cases, provided that there is shared decision-making, regular reassessment, and early recognition of adverse events.
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Affiliation(s)
- Torsten Zuberbier
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany.
| | - Jonny Peter
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Petra Staubach
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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15
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Hong D, Weng J, Ye M, Liu Y. Efficacy of different oral H 1 antihistamine treatments on allergic rhinitis: a systematic review and network meta-analysis of randomized controlled trials. Braz J Otorhinolaryngol 2023; 89:101272. [PMID: 37271114 PMCID: PMC10250918 DOI: 10.1016/j.bjorl.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/02/2022] [Accepted: 03/25/2023] [Indexed: 06/06/2023] Open
Abstract
INTRODUCTION Oral H1 antihistamines are the first-line treatment for patients with allergic rhinitis, while it is uncertain which kind and dosage of the antihistamines are more effective in improving symptoms of patients. OBJECTIVE To evaluate the efficacy of different oral H1 antihistamine treatments on patients with allergic rhinitis by performing a network meta-analysis. METHODS The search was executed in PubMed, Embase, OVID, the Cochrane Library and ClinicalTrials.gov for relevant studies. The network meta-analysis was performed by using Stata 16.0, and the outcome measures of the analysis were symptom score reductions of patients. Relative risks with 95% Confidence Intervals were used in the network meta-analysis to compare the clinical effect of treatments involved, and Surface Under the Cumulative Ranking Curves (SUCRAs) were also calculated to rank the treatments' efficacy. RESULTS 18 eligible randomized controlled studies, involving a total of 9419 participants, were included in this meta-analysis. All the antihistamine treatments outperformed placebo in total symptom score reduction and each individual symptom score reduction. According to the results of SUCRA, rupatadine 20 mg and rupatadine 10 mg were ranked relatively high in reductions of total symptom score (SUCRA: 99.7%, 76.3%), nasal congestion score (SUCRA: 96.4%, 76.4%), rhinorrhea score (SUCRA: 96.6%, 74.6%) and ocular symptom score (SUCRA: 97.2%, 88.8%); rupatadine 20 mg and levocetirizine 5 mg were ranked relatively high in reductions of nasal itching score (SUCRA: 84.8%, 83.4%) and sneezing score (SUCRA: 87.3%, 95.4%); loratadine 10 mg was ranked the lowest in each symptom score reduction besides placebo. CONCLUSION This study suggests that rupatadine is the most effective in alleviating symptoms of patients with allergic rhinitis among different oral H1 antihistamine treatments involved, and rupatadine 20 mg performs better than rupatadine 10 mg. While loratadine 10 mg has inferior efficacy for patients to the other antihistamine treatments.
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Affiliation(s)
- Dongdong Hong
- Shenzhen Traditional Chinese Medicine Hospital, Department of Otorhinolaryngology, People's Republic of China, Shenzhen, China
| | - Juanling Weng
- Shenzhen Traditional Chinese Medicine Hospital, Department of Otorhinolaryngology, People's Republic of China, Shenzhen, China
| | - Meiting Ye
- Shenzhen Traditional Chinese Medicine Hospital, Department of Otorhinolaryngology, People's Republic of China, Shenzhen, China
| | - Yuanxian Liu
- Shenzhen Traditional Chinese Medicine Hospital, Department of Otorhinolaryngology, People's Republic of China, Shenzhen, China.
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16
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Abstract
Urticaria and angioedema are caused by immunoglobulin E- and non-immunoglobulin E-mediated release of histamine and other inflammatory mediators from mast cells and basophils. Diagnosis is made clinically, and anaphylaxis must be ruled out if urticaria or angioedema is present. A limited nonspecific laboratory workup should be considered unless elements of the history or physical examination suggest specific underlying conditions. The mainstay of treatment is avoidance of triggers when and if triggers are identified. The first-line pharmacotherapy is second-generation H1 antihistamines, which can be titrated to greater than standard doses.
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Affiliation(s)
- Kate Szymanski
- Department of Family Medicine, College of Medicine and Life Sciences at the University of Toledo Medical Center, 3333 Glendale Avenue, Toledo, OH 43614-2598, USA.
| | - Paul Schaefer
- Department of Family Medicine, College of Medicine and Life Sciences at the University of Toledo Medical Center, 3333 Glendale Avenue, Toledo, OH 43614-2598, USA
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Kocatürk E, Al-Ahmad M, Krause K, Gimenez-Arnau AM, Thomsen SF, Conlon N, Marsland A, Savk E, Criado RF, Danilycheva I, Fomina D, Godse K, Khoshkhui M, Gelincik A, Degirmentepe EN, Demir S, Ensina LF, Kasperska-Zajac A, Rudenko M, Valle S, Medina I, Bauer A, Zhao Z, Staubach P, Bouillet L, Küçük ÖS, Baygül A, Maurer M. Treatment patterns and outcomes in patients with chronic urticaria during pregnancy: Results of PREG-CU, a UCARE study. J Eur Acad Dermatol Venereol 2023; 37:356-364. [PMID: 36066999 DOI: 10.1111/jdv.18574] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/17/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although chronic urticaria (CU) is a common and primarily affects females, there is little data on how pregnancy interacts with the disease. OBJECTIVE To analyse the treatment use by CU patients before, during and after pregnancy as well as outcomes of pregnancy. METHODS PREG-CU is an international, multicentre study of the Urticaria Centers of Reference and Excellence network. Data were collected via a 47-item-questionnaire completed by CU patients who became pregnant during their disease course. RESULTS Questionnaires from 288 CU patients from 13 countries were analysed. During pregnancy, most patients (60%) used urticaria medication including standard-dose second generation H1-antihistamines (35.1%), first generation H1-antihistamines (7.6%), high-dose second-generation H1-antihistamines (5.6%) and omalizumab (5.6%). The preterm birth rate was 10.2%; rates were similar between patients who did and did not receive treatment during pregnancy (11.6% vs. 8.7%, respectively). Emergency referrals for CU and twin birth were risk factors for preterm birth. The caesarean delivery rate was 51.3%. More than 90% of new-borns were healthy at birth. There was no link between any patient or disease characteristics or treatments and medical problems at birth. CONCLUSION Most CU patients used treatment during pregnancy especially second-generation antihistamines which seem to be safe during pregnancy regardless of the trimester. The rates of preterm births and medical problems of new-borns in CU patients were similar to population norms and not linked to treatment used during pregnancy. Emergency referrals for CU increased the risk of preterm birth and emphasize the importance of sufficient treatment to keep urticaria under control during pregnancy.
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Affiliation(s)
- Emek Kocatürk
- Department of Dermatology, Urticaria Center of Reference, and Excellence (UCARE), Koç University School of Medicine, Istanbul, Turkey
- Institute of Allergology, Urticaria Center of Reference and Excellence (UCARE), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Berlin, Germany
| | - Mona Al-Ahmad
- Microbiology Department, Faculty of Medicine, Urticaria Center of Reference, and Excellence (UCARE), Kuwait University, Safat, Kuwait
| | - Karoline Krause
- Institute of Allergology, Urticaria Center of Reference and Excellence (UCARE), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Berlin, Germany
| | - Ana M Gimenez-Arnau
- Department of Dermatology, Urticaria Center of Reference, and Excellence (UCARE), Hospital del Mar, IMIM, Universitat Pompeu Fabra, Barcelona, Spain
| | - Simon Francis Thomsen
- Department of Dermatology, Urticaria Center of Reference, and Excellence (UCARE), Bispebjerg Hospital, Copenhagen, Denmark
| | - Niall Conlon
- Department of Immunology, Urticaria Center of Reference and Excellence (UCARE), St. James's Hospital, Dublin and Trinity College, Dublin, Ireland
| | - Alexander Marsland
- Department of Dermatology, Urticaria Center of Reference, and Excellence (UCARE), The Urticaria Clinic, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
| | - Ekin Savk
- Aydın Adnan Menderes University, Aydın, Turkey
| | - Roberta F Criado
- Department of Dermatology, Urticaria Center of Reference and Excellence (UCARE), Faculdade de Medicina do ABC (FMABC), Santo André, Brazil
| | | | - Daria Fomina
- First Moscow State Medical University, Moscow, Russia
- Urticaria Center of Reference and Excellence (UCARE), Moscow Center of Allergy and Immunology, Clinical Hospital 52, Ministry of Moscow Healthcare, Moscow, Russia
| | - Kiran Godse
- Dr. D.Y. Patil Medical College & Hospital, Mumbai, India
| | - Maryam Khoshkhui
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Aslı Gelincik
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Semra Demir
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Alicja Kasperska-Zajac
- European Center for Diagnosis and Treatment of Urticaria (GA2LEN UCARE Network), Medical University of Silesia in Katowice, Katowice, Poland
| | | | - Solange Valle
- Federal University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Iris Medina
- The Centro Médico Vitae, Buenos Aires, Argentina
| | - Andrea Bauer
- Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Zuotao Zhao
- Department of Dermatology and Venerology, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses and National Clinical Research Center for Skin and Immune Diseases, Peking University First Hospital, Beijing, China
| | - Petra Staubach
- Department of Dermatology, University Medical Center, Mainz, Germany
| | | | - Özlem Su Küçük
- Department of Dermatology and Venerology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Arzu Baygül
- Department of Biostatistics, Koç University School of Medicine, Istanbul, Turkey
| | - Marcus Maurer
- Institute of Allergology, Urticaria Center of Reference and Excellence (UCARE), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Berlin, Germany
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18
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Wang J, Lu C, Liu X, Zhang G, Zhang J, Gao M, Liu D, Zhang X, Liu Y. Histamine H1 receptor antagonist attenuates catecholamine surge and organ injury after severe burns. Front Endocrinol (Lausanne) 2023; 14:1068925. [PMID: 36843581 PMCID: PMC9946968 DOI: 10.3389/fendo.2023.1068925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Severe burns induce a catecholamine surge, causing severe damage to the organism and raising the possibility of multisystem organ failure. Few strategies are generally acceptable to reduce catecholamine surge and organ injury post-burn. We have previously shown that histamine can amplify the catecholamine surge. In addition, promethazine, a first-generation histamine H1 receptor antagonist, alleviates catecholamine surge and organ injury after severe burns in rats. However, evidence is lacking on whether promethazine benefits patients after severe burns. Currently, sedation and analgesia (such as midazolam and fentanyl) are commonly required for patients after severe burns. It remains unclear if patients after severe burns derive clinical benefit from histamine H1 receptor antagonists combined with sedation and analgesia. This study investigates the therapeutic effect of promethazine on patients after severe burns. Moreover, we test the therapeutic effect of cetirizine, a second-generation histamine H1 receptor antagonist, combined with sedation and analgesia in rats after severe burns. We find that promethazine-pethidine treatment shows a tendency for a lower level of total bilirubin than midazolam-fentanyl in patients 7-day after severe burn. Our study confirms that cetirizine combined with midazolam and fentanyl reduces catecholamine surge and liver and lung damage after severe burns in rats; the effects are better than midazolam and fentanyl treatment. In summary, for the first time, we suggest that histamine H1 receptor antagonist has the potential clinical value of reducing liver injury in patients after severe burns. In addition, we reveal that cetirizine combined with midazolam and fentanyl may be an ideal strategy for treating severe burns.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yan Liu
- *Correspondence: Yan Liu, ; Xiong Zhang,
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19
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Hanibuchi M, Mitsuhashi A, Saijo A, Kajimoto T, Sato S, Kitagawa T, Nishioka Y. A case of atopic cough with aphonia showed a prominent response to a histamine H 1 receptor antagonist. J Med Invest 2023; 70:281-284. [PMID: 37164735 DOI: 10.2152/jmi.70.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
A 33-year-old woman admitted to our hospital for further examination of severe non-productive cough lasting for about two months. Her symptom did not ameliorate by treatments including long acting β2 agonists. She had a medical history of drug allergy to non-steroidal anti-inflammatory drugs. At the initial visit, she could not speak at all and communicated with us in writing. Chest auscultation revealed no wheezes, rhonchi and other crackles. Laboratory findings showed a mild eosinophilia with normal total and specific serum immunoglobulin E. The results of an electrocardiogram, a chest X-ray and a chest CT were unremarkable. A fractional exhaled nitric oxide value was within normal limit. Based on these observations, a diagnosis of atopic cough (AC) was suspected, and we started treatment with a histamine H1 receptor antagonist (H1-RA). She had become able to speak again in association with complete disappearance of cough by eight-weeks after treatment initiation, and her symptoms did not recur even after cessation of treatment. By the confirmation of remarkable clinical improvement in response to a H1-RA, a diagnosis of AC was made. To the best of our knowledge, this is the first report of an AC patient who presented severe cough with aphonia. J. Med. Invest. 70 : 281-284, February, 2023.
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Affiliation(s)
- Masaki Hanibuchi
- Department of Respiratory Medicine, Shikoku Central Hospital of the Mutual aid Association of Public School teachers, Shikoku-Chuo, Japan
- Department of Community Medicine for Respirology, Hematology and Metabolism, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Atsushi Mitsuhashi
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Atsuro Saijo
- Department of Respiratory Medicine, Shikoku Central Hospital of the Mutual aid Association of Public School teachers, Shikoku-Chuo, Japan
| | - Tatsuya Kajimoto
- Department of Respiratory Medicine, Shikoku Central Hospital of the Mutual aid Association of Public School teachers, Shikoku-Chuo, Japan
| | - Seidai Sato
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Tetsuya Kitagawa
- Department of Cardiovascular Surgery, Shikoku Central Hospital of the Mutual aid Association of Public School teachers, Shikoku-Chuo, Japan
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
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20
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Ayse Ornek S, Orcen C, Church MK, Kocaturk E. An evaluation of remission rates with first and second line treatments and indicators of antihistamine refractoriness in chronic urticaria. Int Immunopharmacol 2022; 112:109198. [PMID: 36115277 DOI: 10.1016/j.intimp.2022.109198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Guidelines recommend standard doses of antihistamines as first-line, and updosing of antihistamines as second-line treatment for the management of chronic urticaria (CU). However, remission rates with different types of first- and second-line treatments and indicators of antihistamine response are largely lacking in the literature. OBJECTIVES To examine response rates to first- and second-line treatments in CU, and to identify patient characteristics that can predict antihistamine treatment outcomes. METHODS We retrospectively analyzed treatment outcomes of 657 CU (556 chronic spontaneous urticaria (CSU), 101 chronic inducible urticaria (CIndU)) patients who had at least 3-months of follow-up data. RESULTS A standard dose of second generation antihistamines (sgAH) was effective in 43.1 % of the patients. An additional 28.8 % of patients were in remission with second-line treatments. Among patients whose disease was in remission with a standard dose of sgAHs, 14.8 % benefited from switching from their current sgAH to another sgAH. Updosing sgAHs, combination of two different sgAHs, sgAH and first generation H1-antihistamine combination, and sgAH and leukotriene receptor antagonist combination provided remission in 38.3 %, 35.8 %, 37.5 % and 25 % of patients who were given these treatments, respectively. Baseline UCT score ≤ 4, emergency referral and family history of CSU were found to be risk factors for antihistamine refractoriness in patients with CSU. CONCLUSIONS A step-wise approach to the management of CU is practical as more patients respond to treatment at each step. The presence of baseline UCT score ≤ 4, emergency referral and family history of CSU might be helpful to determine patients who require third-line treatments in advance.
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Affiliation(s)
- Sinem Ayse Ornek
- Department of Dermatology, Health Sciences University Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Cihan Orcen
- Department of Allergy Immunology, Health Science University Derince Training and Research Hospital, Kocaeli, Turkey
| | - Martin K Church
- Institute for Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Emek Kocaturk
- Institute for Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Dermatology, Koc University School of Medicine, Istanbul, Turkey; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
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21
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Gao S, Liu K, Ku W, Wang D, Wake H, Qiao H, Teshigawara K, Nishibori M. Histamine induced high mobility group box-1 release from vascular endothelial cells through H1 receptor. Front Immunol 2022; 13:930683. [PMID: 36275732 PMCID: PMC9583674 DOI: 10.3389/fimmu.2022.930683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/22/2022] [Indexed: 11/19/2022] Open
Abstract
Background Systemic allergic reaction is characterized by vasodilation and vascular leakage, which causes a rapid, precipitous and sustained decrease in arterial blood pressure with a concomitant decrease of cardiac output. Histamine is a major mediator released by mast cells in allergic inflammation and response. It causes a cascade of inflammation and strongly increases vascular permeability within minutes through its four G-protein-coupled receptors (GPCRs) on endothelial cells. High mobility group box-1 (HMGB1), a nonhistone chromatin-binding nuclear protein, can be actively secreted into the extracellular space by endothelial cells. HMGB1 has been reported to exert pro-inflammatory effects on endothelial cells and to increase vascular endothelial permeability. However, the relationship between histamine and HMGB1-mediated signaling in vascular endothelial cells and the role of HMGB1 in anaphylactic-induced hypotension have never been studied. Methods and results EA.hy 926 cells were treated with different concentrations of histamine for the indicated periods. The results showed that histamine induced HMGB1 translocation and release from the endothelial cells in a concentration- and time-dependent manner. These effects of histamine were concentration-dependently inhibited by d-chlorpheniramine, a specific H1 receptor antagonist, but not by H2 or H3/4 receptor antagonists. Moreover, an H1-specific agonist, 2-pyridylethylamine, mimicked the effects of histamine, whereas an H2-receptor agonist, 4-methylhistamine, did not. Adrenaline and noradrenaline, which are commonly used in the clinical treatment of anaphylactic shock, also inhibited the histamine-induced HMGB1 translocation in endothelial cells. We therefore established a rat model of allergic shock by i.v. injection of compound 48/80, a potent histamine-releasing agent. The plasma HMGB1 levels in compound 48/80-injected rats were higher than those in controls. Moreover, the treatment with anti-HMGB1 antibody successfully facilitated the recovery from compound 48/80-induced hypotension. Conclusion Histamine induces HMGB1 release from vascular endothelial cells solely through H1 receptor stimulation. Anti-HMGB1 therapy may provide a novel treatment for life-threatening systemic anaphylaxis.
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Affiliation(s)
- Shangze Gao
- Department of Pharmacology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, China
- Tsinghua-Peking Center for Life Sciences, Tsinghua University, Beijing, China
| | - Keyue Liu
- Department of Pharmacology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Wenhan Ku
- Department of Pharmacology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Dengli Wang
- Department of Pharmacology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hidenori Wake
- Department of Pharmacology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Handong Qiao
- Department of Pharmacology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kiyoshi Teshigawara
- Department of Pharmacology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masahiro Nishibori
- Department of Translational Research and Drug Development, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- *Correspondence: Masahiro Nishibori,
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22
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Chu DK, Freitag T, Marrin A, Walker TD, Avilla E, Freitag A, Spill P, Foster GA, Thabane L, Jordana M, Waserman S. Peanut Oral Immunotherapy With or Without H 1 and H 2 Antihistamine Premedication for Peanut Allergy (PISCES): A Placebo-Controlled Randomized Clinical Trial. J Allergy Clin Immunol Pract 2022; 10:2386-2394. [PMID: 35643280 DOI: 10.1016/j.jaip.2022.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 05/15/2023]
Abstract
BACKGROUND Current forms of peanut oral immunotherapy (OIT) are associated with side effects, and there is a lack of evidence addressing how to mitigate them. OBJECTIVE To determine whether premedication with desloratadine and ranitidine results in fewer side effects during peanut OIT/desensitization. METHODS A total of 43 patients with peanut allergy (mean age, 7.6 ± 2.1 years, 37% females, 63% males, baseline eliciting dose, 33 ± 26 mg) were randomized to OIT with or without concomitant H1 and H2 antihistamine blockade, or double-placebo. Patients, study staff/investigators, and statisticians were blinded. The primary outcomes were the frequency and severity of OIT-induced adverse events. The secondary outcomes were quality of life and eliciting doses to blinded food challenge. RESULTS Adverse reactions occurred more in the OIT groups compared with the double-placebo group (OIT with antihistamines vs double-placebo hazard ratio, 3.75 [95% CI, 2.79-4.72]; OIT with placebo antihistamines vs double-placebo, hazard ratio, 4.62 [95% CI, 3.61-5.62]). Patients given antihistamines cotreatment with OIT had a similar risk of adverse events compared with those who did not use antihistamines with OIT (hazard ratio, 1.23 [95% CI, 0.49-1.97]). OIT with and without antihistamines accelerated the incidence rate of adverse events compared with double-placebo (4.8 and 6.4 events per patient vs 3.5 per patient, incidence rate ratio, 2.49 [95% CI, 1.36-4.56] and 2.04 [95% CI, 1.01-4.15], respectively). Antihistamines pretreatment modestly reduced the frequency of moderate to severe adverse reactions among OIT-treated groups (1.9 per patient vs 4.2 per patient, incidence rate ratio, 0.46 [95% CI, 0.24-0.89]), primarily urticaria (0.6 vs 2.1 per patient) followed by abdominal pain (2.6 vs 4.2 per patient), but increased neuropsychiatric adverse events (primarily tiredness and sedation, 2.3 vs 0.7 per patient). Eliciting doses after treatment were similar in all groups. Quality of life improved similarly regardless of treatment with peanut OIT or placebo OIT. CONCLUSIONS Peanut OIT with antihistamines modestly reduce the skin and gastrointestinal components of the high incidence of adverse reactions during OIT, and there are no clear differences in improvement in quality of life whether treated with OIT, OIT with antihistamines, or placebo OIT despite OIT being effective in inducing desensitization. Safer food allergy treatment approaches that importantly improve quality of life need to be proved in future robust randomized trials.
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Affiliation(s)
- Derek K Chu
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada; The Research Institute of St Joe's Hamilton, Hamilton, ON, Canada.
| | - Tosha Freitag
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Andrea Marrin
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Tina D Walker
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ernie Avilla
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Andeas Freitag
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Paul Spill
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Gary A Foster
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada; The Research Institute of St Joe's Hamilton, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada; The Research Institute of St Joe's Hamilton, Hamilton, ON, Canada
| | - Manel Jordana
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Susan Waserman
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
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23
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Gimenez-Arnau A, Bartra J, Ferrer M, Jauregui I, Borbujo J, Figueras I, Muñoz-Bellido FJ, Pedraz J, Serra-Baldrich E, Tejedor-Alonso MA, Velasco M, Terradas P, Labrador M. A Specialized Therapeutic Approach to Chronic Urticaria Refractory to H1-Antihistamines Improves Disease Burden: The Spanish AWARE Experience. J Investig Allergol Clin Immunol 2022; 32:191-199. [PMID: 33349612 DOI: 10.18176/jiaci.0661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE During its first year, the AWARE study assessed disease activity, patient quality of life (QOL), and treatment patterns in chronic urticaria (CU) refractory to H1-antihistamines (H1-AH) in clinical practice. METHODS We performed an observational, prospective (24 months), international, multicenter study. The inclusion criteria were age ≥18 years and H1-AH-refractory CU (>2 months). At each visit, patients completed questionnaires to assess disease burden (Urticaria Control Test [UCT]), disease activity (7 day-Urticaria Activity Score [UAS7]), and QOL (Dermatology Life Quality index [DLQI], Chronic Urticaria Quality of Life Questionnaire [CU-Q2oL], and Angioedema Quality of Life Questionnaire [AE-QoL]). We present data for Spain. RESULTS The study population comprised 270 evaluable patients (73.3% female, mean [SD] age, 48.9 [14.7] years). At baseline, 89.3% were prescribed a CU treatment. After 1 year, first- and second-line treatments became less frequent and third-line treatments became more frequent. At baseline, 47.0% of patients experienced angioedema; at 1 year, this percentage had fallen to 11.8%. The mean (SD) AE-QoL score decreased from 45.2 (28.7) to 24.0 (25.8). The mean (SD) UCT score decreased from 7.0 (4.5) to 12.1 (4.1). According to UAS7, 38.2% of patients reported absence of wheals and itch in the previous 7 days at 1 year compared with 8.3% at baseline. The mean (SD) DLQI score decreased from 8.0 (7.4) to 2.8 (4.6). At the 1-year visit, the percentage of patients reporting a high or very high impact on QOL fell from 29.9% to 9.6%. CONCLUSION H1-AH-refractory CU in Spain is characterized by absence of control of symptoms and a considerable impact on QOL. Continuous follow-up of CU patients and third-line therapies reduce disease burden and improve patients' QOL.
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Affiliation(s)
| | - J Bartra
- Allergy Section, Pulmonology Department, Hospital Clínic, IDIBAPS, ARADyAL, Universitat de Barcelona, Barcelona, Spain
| | - M Ferrer
- Clínica Universidad de Navarra, ARADyAL, Pamplona, Spain
| | - I Jauregui
- Hospital Universitario Cruces, Vizcaya, Spain
| | - J Borbujo
- Hospital de Fuenlabrada, Madrid, Spain
| | - I Figueras
- Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - J Pedraz
- Hospital Quirón, Pozuelo de Alarcón, Madrid, Spain
| | | | | | - M Velasco
- Hospital Arnau de Vilanova, Valencia, Spain
| | | | - M Labrador
- Hospital Vall d'Hebron, ARADyAL, Barcelona, Spain
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24
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Altrichter S, Staubach P, Pasha M, Singh B, Chang AT, Bernstein JA, Rasmussen HS, Siebenhaar F, Maurer M. An open-label, proof-of-concept study of lirentelimab for antihistamine-resistant chronic spontaneous and inducible urticaria. J Allergy Clin Immunol 2022; 149:1683-1690.e7. [PMID: 34954198 DOI: 10.1016/j.jaci.2021.12.772] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/11/2021] [Accepted: 12/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic urticaria (CU) is a debilitating mast cell-driven disease, often refractory to standard therapy (ie, antihistamines). Lirentelimab, an anti-sialic acid-binding immunoglobulin-like lectin 8 mAb, selectively inhibits mast cells and depletes eosinophils. OBJECTIVE We sought to determine safety and efficacy of lirentelimab in patients with CU. METHODS This phase 2a study enrolled patients with CU refractory to up to 4-fold H1-antihistamine doses. Patients received 6 monthly intravenous doses of lirentelimab (0.3, 1, and up to 3 mg/kg). Primary efficacy end point was change in Urticaria Control Test score at week 22. Urticaria Activity Score weekly average (UAS7) was assessed in patients with chronic spontaneous urticaria (CSU), and Cholinergic UAS7 was used for patients with cholinergic urticaria (CholU). RESULTS A total of 45 patients were enrolled in 4 cohorts (n = 13 omalizumab-naive CSU, n = 11 omalizumab-refractory CSU, n = 11 CholU, n = 10 symptomatic dermographism). Urticaria Control Test scores increased with lirentelimab across cohorts, with mean changes at week 22 of 11.1 ± 4.1, 4.8 ± 7.0, 6.5 ± 6.2, and 3.4 ± 4.1 and complete response rates (Urticaria Control Test score ≥ 12) of 92%, 36%, 82%, and 40%, respectively. In omalizumab-naive and omalizumab-refractory patients with CSU, disease activity decreased at week 22 (mean UAS7 change, -73% and -47%, respectively), with UAS7 response rates (≥50% reduction) of 77% and 45%, respectively. In patients with symptomatic dermographism, 50% (5 of 10) and 40% (4 of 10) had complete itch and hive resolution by FricTest, respectively, and 100% (7 of 7) evaluable patients with CholU had negative responses to Pulse-Controlled Ergometry exercise test. Most common adverse events included infusion-related reactions (43%; all mild/moderate and transient), nasopharyngitis (21%), and headache (19%). No treatment-related serious adverse events occurred. CONCLUSIONS Lirentelimab demonstrated activity across 3 forms of antihistamine-refractory CU.
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Affiliation(s)
- Sabine Altrichter
- Dermatologial Allergology, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany; Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Hospital Mainz, Mainz, Germany
| | | | | | | | | | | | - Frank Siebenhaar
- Dermatologial Allergology, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany; Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Marcus Maurer
- Dermatologial Allergology, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany; Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany.
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25
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Ovchinnikov AY, Miroshnichenko NA, Nikolaeva YO. [Modern H1 antihistamines in the treatment of patients with allergic rhinitis and comorbid acute respiratory infections]. Vestn Otorinolaringol 2022; 87:30-39. [PMID: 35818943 DOI: 10.17116/otorino20228703130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
UNLABELLED Patients with allergic rhinitis (AR) have a predisposition to frequent acute respiratory viral infections (ARVI). Inflammation of the mucous membrane of the nasal cavity and paranasal sinuses in such patients is more pronounced against the background of a combination of allergic and infectious inflammation. OBJECTIVE To evaluate the effect of therapy using modern antihistamines on the condition and severity of symptoms in adult patients with exacerbation of AR caused by plant pollen (seasonal) (SAR) and the development of ARVI. MATERIAL AND METHODS An observational study was conducted at the Department of Otorhinolaryngology of the Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of the Russian Federation from April to August 2021. Included are patients of both sexes aged 18 to 65 years with a previously (at least 1 year ago) verified diagnosis of mild and moderate acute SAR in the acute stage, who sought medical help for ARVI. All patients were prescribed therapy with the inclusion of a drug belonging to the pharmacological group of antihistamines of the 2nd generation (a course of 14 days). In addition, patients received symptomatic ARVI therapy according to indications, including nasal decongestants (as needed), antipyretic and antitussive drugs. RESULTS Based on the data obtained, it was possible to prove that the use of modern antihistamines in patients comorbid with AR and ARVI has a pronounced therapeutic effect. Theoritin provides a therapeutic effect at an early stage in relation to nasal and non-nasal symptoms of SAR/ARVI, and also quickly improves the quality of life of patients, which makes its use promising for the treatment of ARVI against the background of AR. The drug has an antihistamine activity comparable to cetirizine and surpasses it in its ability to suppress an allergic inflammatory reaction, for example on the skin, as well as in the duration of preservation of the antihistamine effect. CONCLUSION The presented results indicate the effectiveness of theoritin and cetirizine in the treatment of patients with seasonal exacerbation of allergic rhinitis, comorbid for acute respiratory viral infections.
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Affiliation(s)
- A Yu Ovchinnikov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - N A Miroshnichenko
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Yu O Nikolaeva
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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26
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Yaşar AU, Cinemre B. Doxylamine Addiction: A Case Report. Turk Psikiyatri Derg 2022; 33:211-213. [PMID: 36148572 DOI: 10.5080/u26340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Doxylamine succinate, one of the antihistamines available without a prescription for patients suffering from insomnia, is also an antihistamine with the potential for abuse. Although there are case reports about the addictive potential of antihistamines, there are not many studies on doxylamine succinate addiction in the literature. To our knowledge, there have been no case reports on doxylamine succinate addiction in Turkey. This case report presents a patient (43, M), who started using over-the-counter doxylamine succinate at 25 mg/day due to insomnia, gradually increased to 125 mg/day for the last 3 years continuing his doxylamine succinate intake for 5 years uninterrupted, as well as his treatment process. In addition, possible causes and consequences of doxylamine succinate and the potential for abuse of antihistaminic drugs are discussed through the case. Keywords: Antihistamines, drug dependence, doxylamine.
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27
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Porwal A, Yadav YC, Pathak K, Yadav R. An Update on Assessment, Therapeutic Management, and Patents on Insomnia. Biomed Res Int 2021; 2021:6068952. [PMID: 34708126 PMCID: PMC8545506 DOI: 10.1155/2021/6068952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/15/2021] [Accepted: 10/04/2021] [Indexed: 11/18/2022]
Abstract
Insomnia is an ordinary situation related to noticeable disability in function and quality of life, mental and actual sickness, and mishappenings. It represents more than 5.5 million appointments to family doctors every year. Nonetheless, the ratio of insomniacs who are treated keeps on being low, demonstrating the requirement for proceeding with advancement and dispersal of effective treatments. Accordingly, it becomes significant to provide a compelling treatment for clinical practice. It indicates a need for the determination of various critical viewpoints for the evaluation of insomnia along with various accessible alternatives for treatment. These alternatives incorporate both nonpharmacological therapy, specifically cognitive behavioural therapy for insomnia, and a number of pharmacological treatments like orexin antagonists, "z-drugs," benzodiazepines, selective histamine H1 antagonists, nonselective antihistamines, melatonin receptor agonists, antipsychotics, antidepressants, and anticonvulsants. Besides in individuals whose insomnia is due to restless leg syndrome, depression/mood disorder, or/and circadian disturbance, there is insignificant proof favouring the effectiveness of different prescriptions for the treatment of insomnia though they are widely used. Other pharmacological agents producing sedation should be prescribed with care for insomnia therapy because of greater risk of next-day sleepiness along with known adverse effects and toxicities. This review is also aimed at providing an update on various patents on dosage forms containing drugs for insomnia therapy.
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Affiliation(s)
- Amit Porwal
- Faculty of Pharmacy, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, 206130 Uttar Pradesh, India
| | - Yogesh Chand Yadav
- Faculty of Pharmacy, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, 206130 Uttar Pradesh, India
| | - Kamla Pathak
- Faculty of Pharmacy, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, 206130 Uttar Pradesh, India
| | - Ramakant Yadav
- Faculty of Medical Sciences, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, 206130 Uttar Pradesh, India
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Cook JS, Angles A, Morley E. Urticaria and edema in a 2-year-old boy. J Fam Pract 2021; 70:353-355. [PMID: 34818169 DOI: 10.12788/jfp.0264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The absence of blisters, the presence of mild systemic symptoms, and the patient's age guided the diagnosis.
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Affiliation(s)
- Jeffrey S Cook
- North Colorado Family Medicine Residency Program, Greeley (Dr. Cook); Delta Health Family Medicine, CO (Dr. Angles); Family Physicians of Greeley, CO (Dr. Morley)
| | - Amber Angles
- North Colorado Family Medicine Residency Program, Greeley (Dr. Cook); Delta Health Family Medicine, CO (Dr. Angles); Family Physicians of Greeley, CO (Dr. Morley)
| | - Erin Morley
- North Colorado Family Medicine Residency Program, Greeley (Dr. Cook); Delta Health Family Medicine, CO (Dr. Angles); Family Physicians of Greeley, CO (Dr. Morley)
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Plescia F, Salvago P, Dispenza F, Messina G, Cannizzaro E, Martines F. Efficacy and Pharmacological Appropriateness of Cinnarizine and Dimenhydrinate in the Treatment of Vertigo and Related Symptoms. Int J Environ Res Public Health 2021; 18:4787. [PMID: 33946152 PMCID: PMC8125582 DOI: 10.3390/ijerph18094787] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 02/02/2023]
Abstract
Vertigo is not itself a disease, but rather a symptom of various syndromes and disorders that jeopardize balance function, which is essential for daily activities. It is an abnormal sensation of motion that usually occurs in the absence of motion, or when a motion is sensed inaccurately. Due to the complexity of the etiopathogenesis of vertigo, many pharmacological treatments have been tested for efficacy on vertigo. Among these drugs, cinnarizine, usually given together with dimenhydrinate, appears to be the first-line pharmacotherapy for the management of vertigo and inner ear disorders. Based on these considerations, the present non-interventional study aimed to investigate the clinical efficacy and tolerability of a fixed combination of cinnarizine (20 mg) and dimenhydrinate (40 mg) in patients suffering from vertigo-related symptoms. To this end, we enrolled 120 adults-70 males, and 50 females-with an average age of 64 years. Before beginning pharmacological treatment, all patients were screened for the intensity of vertigo, dizziness, and concomitant symptoms through the Visual Scale of Dizziness Disorders and Dizziness Handicap Inventory scales. At the end of the anamnestic evaluation, patients received the fixed-dose combination of cinnarizine (20 mg) plus dimenhydrinate (40 mg) 3 times daily, for 60 days. The results of this study provide further insight regarding the efficacy of the fixed combination when used to reduce symptoms of vestibular vertigo of central and/or peripheral origin, after both the 15- and 60-day therapies. Independent of the type of vertigo, the fixed combination was able to reduce dizziness- and vertigo-associated symptoms in more than 75% of all patients treated, starting from 15 days of therapy, and improving 60 days after starting the therapy. Interestingly, we also found differences between male and female patients in the framework of the pharmacological effects of therapy. This study provides further details concerning the therapeutic efficacy of the fixed combination of cinnarizine and dimenhydrinate, and also focuses attention on the possibility that these drugs could act in a gender-specific manner, paving the way for further research.
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Affiliation(s)
- Fulvio Plescia
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities “Giuseppe D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy; (F.P.); (E.C.)
| | - Pietro Salvago
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata (BiND), Sezione di Audiologia, Università Degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy;
| | - Francesco Dispenza
- UOC Otorinolaringoiatria, A.O.U.P. “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy;
| | - Giuseppe Messina
- Department of Psychological, Pedagogical and Human Movement Sciences, University of Palermo, Via Giovanni Pascoli 6, Palermo 90144, Italy;
- PosturaLab Center, 90127 Palermo, Italy
| | - Emanuele Cannizzaro
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities “Giuseppe D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy; (F.P.); (E.C.)
| | - Francesco Martines
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata (BiND), Sezione di Audiologia, Università Degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy;
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Azenha Rama T, Álvarez-Twose I. Delving Into COVID-19 Vaccination-Induced Anaphylaxis: Are mRNA Vaccines Safe in Mast Cell Disorders? J Investig Allergol Clin Immunol 2021; 31:193-195. [PMID: 33574015 DOI: 10.18176/jiaci.0680] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Affiliation(s)
- T Azenha Rama
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, Porto, Portugal
- Serviço de Imunologia, Faculdade de Medicina da Universidade do Porto, Portugal
| | - I Álvarez-Twose
- Instituto de Estudios de Mastocitosis de Castilla La Mancha, Hospital Virgen del Valle, Toledo, Spain
- Spanish Network on Mastocytosis (REMA), Spain
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Arga M, Cavkaytar Ö, Emeksiz HC. A randomized controlled trial of adding intravenous corticosteroids to H1 antihistamines in patients with acute urticaria. Am J Emerg Med 2020; 45:592-593. [PMID: 33358900 DOI: 10.1016/j.ajem.2020.12.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/12/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Mustafa Arga
- Istanbul Medeniyet University, Faculty of Medicine, Department of Pediatric Allergy and Immunology, Istanbul, Turkey.
| | - Özlem Cavkaytar
- Istanbul Medeniyet University, Faculty of Medicine, Department of Pediatric Allergy and Immunology, Istanbul, Turkey
| | - Hamdi Cihan Emeksiz
- Istanbul Medeniyet University, Faculty of Medicine, Department of Pediatric Endocrinology, Istanbul, Turkey
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Abstract
INTRODUCTION Henoch-Schönlein purpura (HSP) is an extremely rare condition in patients with pulmonary tuberculosis, with only a few reported cases. Compared to patients with typical clinical symptoms, it is difficult to make a definitive diagnosis when HSP presents as an initial manifestation in pulmonary tuberculosis patients. Herein, a case of pulmonary tuberculosis that showed HSP at first was reported, and the related literatures were reviewed. PATIENT CONCERNS A 24-year-old man presented with palpable purpura on the extremities, accompanied by abdominal pain, bloody stools, and knee pain. DIAGNOSES The patient was diagnosed with pulmonary tuberculosis based on the results of interferon gamma release assays, purified protein derivative test, and computed tomography. INTERVENTIONS The patient was treated with vitamin C and chlorpheniramine for 2 weeks, and the above-mentioned symptoms were relieved. However, 3 weeks later, the purpura recurred with high-grade fever and chest pain during the inspiratory phase. The patient was then treated with anti-tuberculosis drugs, and the purpura as well as the high fever disappeared. OUTCOMES The patient recovered well and remained free of symptoms during the follow-up examination. CONCLUSION Pulmonary tuberculosis presenting with HSP as an initial manifestation is not common. Therefore, it is difficult to clinically diagnose and treat this disease. When an adult patient shows HSP, it is important to consider the possibility of tuberculosis to avoid misdiagnosis and delayed treatment.
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Affiliation(s)
- Jie Li
- Department of Hematology, Hebei General Hospital
| | - Xiao-Zi Wang
- Department of Pathology, Hebei Medical University, Shijiazhuang, China
| | | | - Jie Yang
- Department of Hematology, Hebei General Hospital
| | | | - Li-Ying Xue
- Department of Pathology, Hebei Medical University, Shijiazhuang, China
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Li Q, Liu KY, Liu Q, Wang G, Jiang W, Meng Q, Yi Y, Yang Y, Wang R, Zhu S, Li C, Wu L, Zhao D, Yan L, Zhang L, Kim JS, Zu X, Kozielski AJ, Qian W, Chang JC, Patnaik A, Chen K, Cao Q. Antihistamine Drug Ebastine Inhibits Cancer Growth by Targeting Polycomb Group Protein EZH2. Mol Cancer Ther 2020; 19:2023-2033. [PMID: 32855270 PMCID: PMC7541747 DOI: 10.1158/1535-7163.mct-20-0250] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/21/2020] [Accepted: 08/05/2020] [Indexed: 12/17/2022]
Abstract
Enhancer of zester homolog 2 (EZH2), a histone lysine methyltransferase and the catalytic component of polycomb repressive complex 2, has been extensively investigated as a chromatin regulator and a transcriptional suppressor by methylating H3 at lysine 27 (H3K27). EZH2 is upregulated or mutated in most cancers, and its expression levels are negatively associated with clinical outcomes. However, the current developed small-molecule inhibitors targeting EZH2 enzymatic activities could not inhibit the growth and progression of solid tumors. Here, we discovered an antihistamine drug, ebastine, as a novel EZH2 inhibitor by targeting EZH2 transcription and subsequently downregulating EZH2 protein level and H3K27 trimethylation in multiple cancer cell lines at concentrations below 10 μmol/L. The inhibition of EZH2 by ebastine further impaired the progression, migration, and invasiveness of these cancer cells. Overexpression of Ezh2 wild-type and its mutant, H689A (lacking methyltransferase activity), rescued the neoplastic properties of these cancer cells after ebastine treatment, suggesting that EZH2 targeted by ebastine is independent of its enzymatic function. Next-generation RNA-sequencing analysis also revealed that C4-2 cells treated with 8 μmol/L ebastine showed a gene profiling pattern similar to EZH2-knockdown C4-2 cells, which was distinctively different from cells treated with GSK126, an EZH2 enzyme inhibitor. In addition, ebastine treatment effectively reduced tumor growth and progression, and enhanced progression-free survival in triple-negative breast cancer and drug-resistant castration-resistant prostate cancer patient-derived xenograft mice. Our data demonstrated that ebastine is a novel, safe, and potent anticancer agent for patients with advanced cancer by targeting the oncoprotein EZH2.
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Affiliation(s)
- Qiaqia Li
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Center for Inflammation and Epigenetics, Houston Methodist Research Institute, Houston, Texas
| | - Kilia Y Liu
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Qipeng Liu
- Center for Inflammation and Epigenetics, Houston Methodist Research Institute, Houston, Texas
| | - Guangyu Wang
- Center for Bioinformatics and Computational Biology, Houston Methodist Research Institute, Houston, Texas
- Center for Cardiovascular Regeneration, Houston Methodist Research Institute, Houston, Texas
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, Cornell University, New York, New York
| | - Weihua Jiang
- Center for Inflammation and Epigenetics, Houston Methodist Research Institute, Houston, Texas
| | - Qingshu Meng
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Center for Inflammation and Epigenetics, Houston Methodist Research Institute, Houston, Texas
| | - Yang Yi
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Center for Inflammation and Epigenetics, Houston Methodist Research Institute, Houston, Texas
| | - Yongyong Yang
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Rui Wang
- Center for Inflammation and Epigenetics, Houston Methodist Research Institute, Houston, Texas
| | - Sen Zhu
- Center for Inflammation and Epigenetics, Houston Methodist Research Institute, Houston, Texas
- Center for Cardiovascular Regeneration, Houston Methodist Research Institute, Houston, Texas
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, Cornell University, New York, New York
| | - Chao Li
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Center for Inflammation and Epigenetics, Houston Methodist Research Institute, Houston, Texas
| | - Longxiang Wu
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dongyu Zhao
- Center for Bioinformatics and Computational Biology, Houston Methodist Research Institute, Houston, Texas
- Center for Cardiovascular Regeneration, Houston Methodist Research Institute, Houston, Texas
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, Cornell University, New York, New York
| | - Lin Yan
- Center for Inflammation and Epigenetics, Houston Methodist Research Institute, Houston, Texas
| | - Lili Zhang
- Center for Cardiovascular Regeneration, Houston Methodist Research Institute, Houston, Texas
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, Cornell University, New York, New York
| | - Jung-Sun Kim
- Center for Inflammation and Epigenetics, Houston Methodist Research Institute, Houston, Texas
| | - Xiongbing Zu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | | | - Wei Qian
- Houston Methodist Cancer Center, Houston, Texas
| | | | - Akash Patnaik
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Kaifu Chen
- Center for Bioinformatics and Computational Biology, Houston Methodist Research Institute, Houston, Texas.
- Center for Cardiovascular Regeneration, Houston Methodist Research Institute, Houston, Texas
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, Cornell University, New York, New York
| | - Qi Cao
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
- Center for Inflammation and Epigenetics, Houston Methodist Research Institute, Houston, Texas
- Houston Methodist Cancer Center, Houston, Texas
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Wedi B. [Are cationic amphiphilic H1 antihistamines useful as adjuvant treatment of malignant melanoma?]. Hautarzt 2020; 71:653-655. [PMID: 32671497 DOI: 10.1007/s00105-020-04652-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Bettina Wedi
- Klinik für Dermatologie, Allergologie und Venerologie, Comprehensive Allergy Center (CAC), Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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Abstract
INTRODUCTION Recently CDK4/6 inhibitors have been introduced for the treatment of hormone positive breast cancer resistant to endocrine therapy. Among their side effects, alopecia is often reported being associated to patients' distress and depressive symptoms. CASE REPORT We report the case of a 70-year-old woman affected by breast cancer in treatment with Palbociclib, who developed alopecia.Management and Outcome: We prescribed a topical solution with cetirizine. Global photography, trichoscopy and trichogram were assessed. All evaluations demonstrated alopecia improvement. DISCUSSION Currently, no treatment options for CDK 4/6 inhibitors induced alopecia have been proposed. Herein, we report the use of topical cetirizine.
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Affiliation(s)
- Gemma Caro
- Department of Ematology, Oncology and Dermatology, "Sapienza" University of Rome, Rome, Italy
| | - Maria C Fortuna
- Department of Ematology, Oncology and Dermatology, "Sapienza" University of Rome, Rome, Italy
| | - Francesca Magri
- Department of Ematology, Oncology and Dermatology, "Sapienza" University of Rome, Rome, Italy
| | - Alessandro Federico
- Department of Ematology, Oncology and Dermatology, "Sapienza" University of Rome, Rome, Italy
| | - Marta Carlesimo
- Department of Ematology, Oncology and Dermatology, "Sapienza" University of Rome, Rome, Italy
| | - Alfredo Rossi
- Department of Ematology, Oncology and Dermatology, "Sapienza" University of Rome, Rome, Italy
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Abstract
Objective: Bilastine is a potent and highly selective H1-antihistamine approved for the treatment of allergic rhinoconjunctivitis and urticaria. This article summarizes available data on the use of bilastine in the treatment of allergic disorders in different age groups, including younger and older adults, and school-age children and adolescents.Methods: A PubMed literature search ("bilastine") was conducted on 25 February 2019. Additional literature known to the authors and identified from the reference lists of cited publications was included.Results: Bilastine is administered orally at a dose of 20 mg once daily in adults and adolescents aged ≥12 years and 10 mg once daily in children aged 6 to <12 years. Clinical trials have demonstrated its efficacy at improving nasal and ocular symptoms in patients with allergic rhinitis, and wheals and itching in patients with urticaria. It has a rapid onset of action and long duration of action. Bilastine does not undergo significant metabolism and does not interact with the CYP450 system, which limits its potential for drug-drug interactions. No dosage adjustments are required in patients with renal or hepatic impairment, or in the elderly. Bilastine is generally well tolerated, even when administered at above-standard doses. It does not exhibit anticholinergic effects or cardiotoxic effects, shows no central nervous system penetration and has minimal sedative properties. It has been shown to improve health-related quality of life.Conclusions: Bilastine is a suitable option for the treatment of patients with allergic rhinoconjunctivitis or urticaria across age groups from school-age children to elderly patients.
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Affiliation(s)
- Martin K Church
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marysia Tiongco-Recto
- Department of Paediatrics, Section of Allergy and Immunology, University of the Philippines-Philippine General Hospital, Manila, The Philippines
| | - Erminia Ridolo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Zoltán Novák
- Paediatric Department, University of Szeged, Szeged, Hungary
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Reid AT, Bubak ME. An Urticarial Primer. S D Med 2019; 72:556-560. [PMID: 32130800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This primer focuses on the diagnosis and treatment of urticaria. All forms have in common the release of histamine with resultant pruritis. Causes include allergies, medications, infections, cold, heat, and pressure with many being defined as idiopathic. Most diagnoses require only a history and physical examination. Treatments normally include non-sedating antihistamines and avoidances but may require systemic steroids, H2 or leukotriene blockers, immunosuppressants, or anti-IgE therapy. While some forms are short lived, many are recurrent for years. Relief from the pruritis should be expected.
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Affiliation(s)
- Alexander T Reid
- Department of Family Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Mark E Bubak
- Dakota Asthma and Allergy, Sioux Falls, South Dakota
- Departments of Internal Medicine and Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
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Abstract
Urticaria, also known as hives, may affect up to 20% of the population at some time. Urticaria is described as pruritic erythematous, raised, circumscribed lesions with central pallor that blanch with pressure. Urticaria is closely associated with angioedema in 40% of individuals; approximately 10% of patients experience angioedema without urticaria. Urticarial lesions often are generalized, with multiple lesions in no specific distribution; angioedema tends to be localized and commonly affects the face (periorbital and perioral regions) or tongue. Urticaria is subdivided into acute and chronic urticaria based on the duration of symptoms. Acute urticaria lasts < 6 weeks, and an identifiable cause, such as food products, medications (aspirin, nonsteroidal anti-inflammatory drugs, antibiotics), or insect stings, may be discovered. Urticaria that lasts for >6 weeks is designated as chronic urticaria, and an etiology is seldom identified and thus considered spontaneous. Chronic urticaria may have an autoimmune basis. There is a well-documented association between autoimmune hypothyroidism (Hashimoto disease) and urticaria and angioedema, with a higher incidence of antithyroid (antithyroglobulin and antiperoxidase) antibodies in these patients, who are usually euthyroid. Furthermore, results of studies revealed a circulating immunoglobulin G (IgG) antibody directed against the high affinity IgE receptor alpha subunit IgE receptor (FcεRI) or IgE in 40-60% of patients with chronic urticaria. A stepwise approach to the treatment of urticarial is recommended with second-generation H1 antihistamines being the first line of therapy.
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Contreras‐Ruiz J, Peternel S, Jiménez Gutiérrez C, Culav‐Koscak I, Reveiz L, Silbermann‐Reynoso MDL. Interventions for pityriasis rosea. Cochrane Database Syst Rev 2019; 2019:CD005068. [PMID: 31684696 PMCID: PMC6819167 DOI: 10.1002/14651858.cd005068.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pityriasis rosea is a scaly, itchy rash that mainly affects young adults and lasts for 2 to 12 weeks. The effects of many available treatments are uncertain. This is an update of a Cochrane Review first published in 2007. OBJECTIVES To assess the effects of interventions for the management of pityriasis rosea in any individual diagnosed by a medical practitioner. SEARCH METHODS We updated our searches of the following databases to October 2018: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We searched five trials registers. We also checked the reference lists of included and excluded studies, contacted trial authors, scanned the abstracts from major dermatology conference proceedings, and searched the CAB Abstracts database. We searched PubMed for adverse effects to November 2018. SELECTION CRITERIA Randomised controlled trials of interventions in pityriasis rosea. Treatment could be given in a single therapy or in combination. Eligible comparators were no treatment, placebo, vehicle only, another active compound, or placebo radiation treatment. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by the Cochrane. Our key outcomes were good or excellent rash improvement within two weeks, rated separately by the participant and medical practitioner; serious adverse events; resolution of itch within two weeks (participant-rated); reduction in itch score within two weeks (participant-rated); and minor participant-reported adverse events not requiring withdrawal of the treatment. MAIN RESULTS We included 14 trials (761 participants). In general, risk of selection bias was unclear or low, but risk of performance bias and reporting bias was high for 21% of the studies. Participant age ranged from 2 to 60 years, and sex ratio was similar. Disease severity was measured by various severity indices, which the included studies did not categorise. Six studies were conducted in India, three in Iran, two in the Philippines, and one each in Pakistan, the USA, and China. The included studies were conducted in dermatology departments and a paediatric clinic. Study duration ranged from 5 to 26 months. Three studies were funded by drug manufacturers; most studies did not report their funding source. The included studies assessed macrolide antibiotics, an antiviral agent, phototherapy, steroids and antihistamine, and Chinese medicine. None of the studies measured participant-rated good or excellent rash improvement. All reported outcomes were assessed within two weeks of treatment, except for adverse effects, which were measured throughout treatment. There is probably no difference between oral clarithromycin and placebo in itch resolution (risk ratio (RR) 0.84, 95% confidence interval (CI) 0.47 to 1.52; 1 study, 28 participants) or rash improvement (medical practitioner-rated) (RR 1.13, 95% CI 0.89 to 1.44; 1 study, 60 participants). For this comparison, there were no serious adverse events (1 study, 60 participants); minor adverse events and reduction in itch score were not measured; and all evidence was of moderate quality. When compared with placebo, erythromycin may lead to increased rash improvement (medical practitioner-rated) (RR 4.02, 95% CI 0.28 to 56.61; 2 studies, 86 participants, low-quality evidence); however, the 95% CI indicates that the result may also be compatible with a benefit of placebo, and there may be little or no difference between treatments. Itch resolution was not measured, but one study measured reduction in itch score, which is probably larger with erythromycin (MD 3.95, 95% CI 3.37 to 4.53; 34 participants, moderate-quality evidence). In the same single, small trial, none of the participants had a serious adverse event, and there was no clear difference between groups in minor adverse events, which included gastrointestinal upset (RR 2.00, CI 0.20 to 20.04; moderate-quality evidence). Two trials compared oral azithromycin to placebo or vitamins. There is probably no difference between groups in itch resolution (RR 0.83, 95% CI 0.28 to 2.48) or reduction in itch score (MD 0.04, 95% CI -0.35 to 0.43) (both outcomes based on one study; 70 participants, moderate-quality evidence). Low-quality evidence from two studies indicates there may be no difference between groups in rash improvement (medical practitioner-rated) (RR 1.02, 95% CI 0.52 to 2.00; 119 participants). In these same two studies, no serious adverse events were reported, and there was no clear difference between groups in minor adverse events, specifically mild abdominal pain (RR 5.82, 95% CI 0.72 to 47.10; moderate-quality evidence). Acyclovir was compared to placebo, vitamins, or no treatment in three trials (all moderate-quality evidence). Based on one trial (21 participants), itch resolution is probably higher with placebo than with acyclovir (RR 0.34, 95% CI 0.12 to 0.94); reduction in itch score was not measured. However, there is probably a significant difference between groups in rash improvement (medical practitioner-rated) in favour of acyclovir versus all comparators (RR 2.45, 95% CI 1.33 to 4.53; 3 studies, 141 participants). Based on the same three studies, there were no serious adverse events in either group, and there was probably no difference between groups in minor adverse events (only one participant in the placebo group experienced abdominal pain and diarrhoea). One trial compared acyclovir added to standard care (calamine lotion and oral cetirizine) versus standard care alone (24 participants). The addition of acyclovir may lead to increased itch resolution (RR 4.50, 95% CI 1.22 to 16.62) and reduction in itch score (MD 1.26, 95% CI 0.74 to 1.78) compared to standard care alone. Rash improvement (medical practitioner-rated) was not measured. The trial reported no serious adverse events in either group, and there may be no difference between groups in minor adverse events, such as headache (RR 7.00, 95% CI 0.40 to 122.44) (all results based on low-quality evidence). AUTHORS' CONCLUSIONS When compared with placebo or no treatment, oral acyclovir probably leads to increased good or excellent, medical practitioner-rated rash improvement. However, evidence for the effect of acyclovir on itch was inconclusive. We found low- to moderate-quality evidence that erythromycin probably reduces itch more than placebo. Small study sizes, heterogeneity, and bias in blinding and selective reporting limited our conclusions. Further research is needed to investigate different dose regimens of acyclovir and the effect of antivirals on pityriasis rosea.
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Affiliation(s)
- Jose Contreras‐Ruiz
- Hospital General Dr. Manuel Gea GonzálezDepartment of DermatologyPuente de Piedra 150‐T1‐C111. Col. Toriello GuerraMexico CityMexico14050
| | - Sandra Peternel
- Clinical Hospital Center RijekaDepartment of DermatovenereologyKresimirova 42RijekaCroatia51000
- University of Rijeka, Faculty of MedicineRijekaCroatia51000
| | - Carlos Jiménez Gutiérrez
- Universidad Tecnologica de México‐Laureate International UniversitiesAdscrito Unidad de Investigación TraslacionalKinchil 234‐3Col. Heroes de Padierna. Delegación TlalpanMéxico.DFDFMexico14200
| | - Ivana Culav‐Koscak
- General hospital "Dr. Ivo Pedisic"Department of Dermatology and VenereologyJ.J. Strossmayera 59SisakCroatia44000
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Gremida A, Mir F, McCarthy D. A Granular Approach to a Patient with Diarrhea and Flushing. Dig Dis Sci 2019; 64:1792-1797. [PMID: 31111279 DOI: 10.1007/s10620-019-05673-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Anas Gremida
- Division of Gastroenterology and Hepatology, MSC 10-5550, 1 University of New Mexico, Albuquerque, NM, USA.
| | - Fazia Mir
- Division of Gastroenterology and Hepatology, Presbyterian Hospital, Albuquerque, NM, USA
| | - Denis McCarthy
- Division of Gastroenterology and Hepatology, MSC 10-5550, 1 University of New Mexico, Albuquerque, NM, USA
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Verta R, Grange C, Gurrieri M, Borga S, Nardini P, Argenziano M, Ghè C, Cavalli R, Benetti E, Miglio G, Bussolati B, Pini A, Rosa AC. Effect of Bilastine on Diabetic Nephropathy in DBA2/J Mice. Int J Mol Sci 2019; 20:ijms20102554. [PMID: 31137660 PMCID: PMC6566437 DOI: 10.3390/ijms20102554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 01/08/2023] Open
Abstract
Diabetic nephropathy is an unmet therapeutic need, and the search for new therapeutic strategies is warranted. Previous data point to histamine H1 receptor as a possible target for glomerular dysfunction associated with long term hyperglycaemia. Therefore, this study investigated the effects of the H1 receptor antagonist bilastine on renal morphology and function in a murine model of streptozotocin-induced diabetes. Diabetes was induced in DBA2/J male mice and, from diabetes onset (glycaemia ≥200 mg/dL), mice received bilastine (1–30 mg/kg/day) by oral gavage for 14 consecutive weeks. At the end of the experimental protocol, diabetic mice showed polyuria (+195.5%), increase in Albumin-to-Creatine Ratio (ACR, +284.7%), and a significant drop in creatinine clearance (p < 0.05). Bilastine prevented ACR increase and restored creatinine clearance in a dose-dependent manner, suggesting a positive effect on glomerular filtration. The ultrastructural analysis showed a preserved junctional integrity. Preservation of the basal nephrin, P-cadherin, and synaptopodin expression could explain this effect. In conclusion, the H1 receptor could contribute to the glomerular damage occurring in diabetic nephropathy. Bilastine preserved the glomerular junctional integrity, leading to the hypothesis of anti-H1 antihistamines as a possible add-on therapy for diabetic nephropathy.
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Affiliation(s)
- Roberta Verta
- Department of Scienza e Tecnologia del Farmaco, University of Turin, Via P. Giuria 9, 10125 Turin, Italy.
| | - Cristina Grange
- Department of Scienze Mediche, University of Turin, C.So Dogliotti 14, 10126 Turin, Italy.
| | - Maura Gurrieri
- Department of Scienza e Tecnologia del Farmaco, University of Turin, Via P. Giuria 9, 10125 Turin, Italy.
| | - Sara Borga
- Department of Scienza e Tecnologia del Farmaco, University of Turin, Via P. Giuria 9, 10125 Turin, Italy.
| | - Patrizia Nardini
- Department of Clinical and Experimental Medicine, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy.
| | - Monica Argenziano
- Department of Scienza e Tecnologia del Farmaco, University of Turin, Via P. Giuria 9, 10125 Turin, Italy.
| | - Corrado Ghè
- Department of Scienza e Tecnologia del Farmaco, University of Turin, Via P. Giuria 9, 10125 Turin, Italy.
| | - Roberta Cavalli
- Department of Scienza e Tecnologia del Farmaco, University of Turin, Via P. Giuria 9, 10125 Turin, Italy.
| | - Elisa Benetti
- Department of Scienza e Tecnologia del Farmaco, University of Turin, Via P. Giuria 9, 10125 Turin, Italy.
| | - Gianluca Miglio
- Department of Scienza e Tecnologia del Farmaco, University of Turin, Via P. Giuria 9, 10125 Turin, Italy.
| | - Benedetta Bussolati
- Department of Biotechnology and Health Sciences, Molecular Biotechnology Center University of Turin, Via Nizza 52, 10125 Turin, Italy.
| | - Alessandro Pini
- Department of Clinical and Experimental Medicine, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy.
| | - Arianna Carolina Rosa
- Department of Scienza e Tecnologia del Farmaco, University of Turin, Via P. Giuria 9, 10125 Turin, Italy.
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Yamauchi K, Ogasawara M. The Role of Histamine in the Pathophysiology of Asthma and the Clinical Efficacy of Antihistamines in Asthma Therapy. Int J Mol Sci 2019; 20:ijms20071733. [PMID: 30965592 PMCID: PMC6480561 DOI: 10.3390/ijms20071733] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/30/2019] [Accepted: 04/01/2019] [Indexed: 12/12/2022] Open
Abstract
Mast cells play a critical role in the pathogenesis of allergic asthma. Histamine is a central mediator released from mast cells through allergic reactions. Histamine plays a role in airway obstruction via smooth muscle contraction, bronchial secretion, and airway mucosal edema. However, previous clinical trials of H1 receptor antagonists (H1RAs) as a treatment for asthma were not successful. In recent years, type 2 innate immunity has been demonstrated to be involved in allergic airway inflammation. Allergic asthma is defined by IgE antibody-mediated mast cell degranulation, while group 2 innate lymphoid cells (ILC2) induce eosinophilic inflammation in nonallergic asthma without allergen-specific IgE. Anti-IgE therapy has demonstrated prominent efficacy in the treatment of severe allergic asthmatics sensitized with specific perennial allergens. Furthermore, recent trials of specific cytokine antagonists indicated that these antagonists were effective in only some subtypes of asthma. Accordingly, H1RAs may show significant clinical efficacy for some subtypes of allergic asthma in which histamine is deeply associated with the pathophysiology.
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Affiliation(s)
- Kohei Yamauchi
- Division of Respirology, Department of Internal Medicine, Takizawa Central Hospital, Takizawa 020-0664, Japan.
| | - Masahito Ogasawara
- Division of Bioregulatory Pharmacology, Department of Pharmacology, Iwate Medical University, Morioka 028-3694, Japan.
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Costa C, Rosmaninho I, Guilherme A, Ferreira J, Antunes J, Pina A, Prates S, Marques JG, Azevedo F, Cunha AP, Brito C, Massa A, Sousa JT, Velho GC, Raposo I, Pinto GM, Sousa V, Martins AR. Chronic Urticaria in the Real-Life Clinical Practice Setting in Portugal: Baseline Results from the Non-Interventional Multicentre AWARE Study. ACTA MEDICA PORT 2019; 32:133-140. [PMID: 30896394 DOI: 10.20344/amp.9496] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 09/17/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION There is a paucity of information regarding chronic urticaria patients' care in a real-world setting. The objective of this study was to report and evaluate the baseline characteristics of Portuguese chronic urticaria patients refractory to H1-antihistamines included in the AWARE study. MATERIAL AND METHODS This is a non-interventional cohort study. Adult patients with a diagnosis of chronic urticaria with symptoms for at least two months, refractory to H1-antihistamines, consulting one of the 10 participating urticaria centers throughout Portugal have been included in the study. Baseline sociodemographic data, medical history, clinical parameters, medication, weekly urticaria activity score, and dermatology quality of life index have been collected. RESULTS Seventy six patients were included, of which 76.3% were women. The majority of patients had a diagnosis of chronic spontaneous urticaria (88.2%) and 39.5% had angioedema. Around 91.0% of patients were medicated with non-sedative H1-antihistamines and 35.4% with a third line therapy. Median dermatology quality of life index was 5.0 and median weekly urticaria activity score was 13.0. DISCUSSION The baseline results suggest that patients with chronic urticaria refractory to H1-antihistamines are being under-treated in the real-world setting. CONCLUSION The AWARE study demonstrates the real impact of chronic urticaria on Portuguese patients refractory to H1-antihistamines treatment, and 30% report a very large or extremely large deleterious effect on their quality of life. The follow-up of these patients will allow evaluating strategies aimed at optimizing disease control.
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Affiliation(s)
- Célia Costa
- Serviço de Imunoalergologia. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa
| | - Isabel Rosmaninho
- Serviço de Imunoalergologia. Centro Hospitalar de Vila Nova de Gaia/Espinho. Vila Nova de Gaia. Portugal
| | - Arminda Guilherme
- Serviço de Imunoalergologia. Centro Hospitalar de Vila Nova de Gaia/Espinho. Vila Nova de Gaia. Portugal
| | - José Ferreira
- Serviço de Imunoalergologia. Centro Hospitalar de Vila Nova de Gaia/Espinho. Vila Nova de Gaia. Portugal
| | - Joana Antunes
- Serviço de Dermatologia. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal
| | - Ana Pina
- Serviço de Dermatologia. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal
| | - Sara Prates
- Serviço de Imunoalergologia. Hospital Dona Estefânia. Centro Hospitalar Lisboa Central. Lisboa. Portugal
| | - João Gaspar Marques
- Serviço de Imunoalergologia. Hospital Dona Estefânia. Centro Hospitalar Lisboa Central. Lisboa. Portugal
| | - Filomena Azevedo
- Serviço de Dermatologia. Centro Hospitalar de São João. Porto. Portugal
| | - Ana Paula Cunha
- Serviço de Dermatologia. Centro Hospitalar de São João. Porto. Portugal
| | - Celeste Brito
- Serviço de Dermatologia. Hospital de Braga. Braga. Portugal
| | - António Massa
- Serviço de Dermatologia. Centro Hospitalar de Vila Nova de Gaia. Vila Nova de Gaia. Portugal
| | - João Teles Sousa
- Serviço de Dermatologia. Hospital Egas Moniz. Centro Hospitalar Lisboa Ocidental. Lisboa. Portugal
| | | | - Inês Raposo
- Serviço de Dermatologia. Centro Hospitalar do Porto. Porto. Portugal
| | - Gabriela Marques Pinto
- Serviço de Dermatologia. Hospital dos Capuchos. Centro Hospitalar Lisboa Central. Lisboa. Portugal
| | - Virgínia Sousa
- Serviço de Dermatologia. Hospital dos Capuchos. Centro Hospitalar Lisboa Central. Lisboa. Portugal
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Saberi A, Pourshafie SH, Kazemnejad-Leili E, Nemati S, Sutohian S, Sayad-Fathi S. Ondansetron or promethazine: Which one is better for the treatment of acute peripheral vertigo? Am J Otolaryngol 2019; 40:10-15. [PMID: 30268346 DOI: 10.1016/j.amjoto.2018.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/12/2018] [Accepted: 09/14/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Vertigo is a common annoying complaint needing emergent treatment. There are various treatment options for this condition with different outcomes and side effects. OBJECTIVES Assessment and comparison of the effectiveness of Ondansetron and Promethazine in the treatment of acute peripheral vertigo. MATERIALS AND METHODS This clinical trial was conducted in an academic hospital in the north of Iran in 2017. A total of 170 eligible patients were randomly allocated to groups A: received intramuscular (IM) promethazine; and B: received intravenous (IV) Ondansetron, using quadripartite blocks. The severity of vertigo, nausea, blood pressure, heart rate, side-effects, need for re-administration, and the time to become asymptomatic were assessed before the injections, 30 min after and 2 h after the injections. RESULTS Excellent improvement in vertigo occurred in both groups (P < 0.001), with a more significant reduction in the promethazine-treated group (P < 0.001). Nausea was reduced more significantly in the ondansetron-treated group (P < 0.05). There were more side-effects seen in the promethazine-treated when compared to the group with ondansetron treatment (P < 0.001). No significant differences were seen in the blood pressures between groups (P > 0.05). Heart rates were reduced in both groups but the changes were insignificant (P > 0.05). The ondansetron-treated group showed a greater need for re-administration of the medication (50.6% vs. 27.1%). The relief score was significantly higher in the ondansetron-treated group compared with the group received promethazine (P < 0.001). The time to become asymptomatic showed no statistically significant difference between groups (p = 0.28). CONCLUSION Our results indicated that while promethazine cures peripheral vertigo more efficiently, ondansetron is more beneficial for the improvement of nausea and vomiting.
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Affiliation(s)
- Alia Saberi
- Neuroscience Research Center, Neurology Department, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Seyed Hashem Pourshafie
- Road Trauma Research Center, Emergency Department, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnejad-Leili
- Rhino-sinus, Ear and Skull Base Diseases Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran; Neuroscience Research Center, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Shadman Nemati
- Rhino-sinus, Ear and Skull Base Diseases Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran; Neuroscience Research Center, Guilan University of Medical Sciences, Rasht, Iran.
| | - Sara Sutohian
- Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Sara Sayad-Fathi
- Neuroscience Research Center, Department of Anatomical Sciences, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
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Sharawat IK, Suthar R. Drug Induced Acute Dystonic Reaction. Indian Pediatr 2018; 55:1003. [PMID: 30587655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
| | - Renu Suthar
- Pediatric Neurology Unit, Department of Pediatrics, PGIMER, Chandigarh, India.
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Martin P, Tamblyn R, Benedetti A, Ahmed S, Tannenbaum C. Effect of a Pharmacist-Led Educational Intervention on Inappropriate Medication Prescriptions in Older Adults: The D-PRESCRIBE Randomized Clinical Trial. JAMA 2018; 320:1889-1898. [PMID: 30422193 PMCID: PMC6248132 DOI: 10.1001/jama.2018.16131] [Citation(s) in RCA: 209] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
IMPORTANCE High rates of inappropriate prescribing persist among older adults in many outpatient settings, increasing the risk of adverse drug events and drug-related hospitalizations. OBJECTIVE To compare the effectiveness of a consumer-targeted, pharmacist-led educational intervention vs usual care on discontinuation of inappropriate medication among community-dwelling older adults. DESIGN, SETTING, AND PARTICIPANTS A cluster randomized trial (D-PRESCRIBE [Developing Pharmacist-Led Research to Educate and Sensitize Community Residents to the Inappropriate Prescriptions Burden in the Elderly]) that recruited community pharmacies in Quebec, Canada, from February 2014 to September 2017, with follow-up until February 2018, and randomly allocated them to intervention or control groups. Patients included were adults aged 65 years and older who were prescribed 1 of 4 Beers Criteria medications (sedative-hypnotics, first-generation antihistamines, glyburide, or nonsteroidal anti-inflammatory drugs), recruited from 69 community pharmacies. Patients were screened and enrolled before randomization. INTERVENTIONS Pharmacists in the intervention group were encouraged to send patients an educational deprescribing brochure in parallel to sending their physicians an evidence-based pharmaceutical opinion to recommend deprescribing. The pharmacists in the control group provided usual care. Randomization occurred at the pharmacy level, with 34 pharmacies randomized to the intervention group (248 patients) and 35 to the control group (241 patients). Patients, physicians, pharmacists, and evaluators were blinded to outcome assessment. MAIN OUTCOMES AND MEASURES Discontinuation of prescriptions for inappropriate medication at 6 months, ascertained by pharmacy medication renewal profiles. RESULTS Among 489 patients (mean age, 75 years; 66% women), 437 (89%) completed the trial (219 [88%] in the intervention group vs 218 [91%] in the control group). At 6 months, 106 of 248 patients (43%) in the intervention group no longer filled prescriptions for inappropriate medication compared with 29 of 241 (12%) in the control group (risk difference, 31% [95% CI, 23% to 38%]). In the intervention vs control group, discontinuation of inappropriate medication occurred among 63 of 146 sedative-hypnotic drug users (43.2%) vs 14 of 155 (9.0%), respectively (risk difference, 34% [95% CI, 25% to 43%]); 19 of 62 glyburide users (30.6%) vs 8 of 58 (13.8%), respectively (risk difference, 17% [95% CI, 2% to 31%]); and 19 of 33 nonsteroidal anti-inflammatory drug users (57.6%) vs 5 of 23 (21.7%), respectively (risk difference, 35% [95% CI, 10% to 55%]) (P for interaction = .09). Analysis of the antihistamine drug class was not possible because of the small sample size (n = 12). No adverse events requiring hospitalization were reported, although 29 of 77 patients (38%) who attempted to taper sedative-hypnotics reported withdrawal symptoms. CONCLUSIONS AND RELEVANCE Among older adults in Quebec, a pharmacist-led educational intervention compared with usual care resulted in greater discontinuation of prescriptions for inappropriate medication after 6 months. The generalizability of these findings to other settings requires further research. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02053194.
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Affiliation(s)
| | - Robyn Tamblyn
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Andrea Benedetti
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, McGill University, Montreal, Quebec, Canada
- Department of Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sara Ahmed
- Faculty of Medicine, School of Physical & Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Cara Tannenbaum
- Faculty of Pharmacy, Université de Montréal, Quebec, Canada
- Faculty of Medicine, Université de Montréal, Quebec, Canada
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Yuan W, Hou S, Jia H, Qiu Z, Liu T, Chen X, Li H, Sun Y, Liang L, Sui X, Zhao X, Zhao Z. Ketotifen fumarate attenuates feline gingivitis related with gingival microenvironment modulation. Int Immunopharmacol 2018; 65:159-173. [PMID: 30316074 DOI: 10.1016/j.intimp.2018.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/02/2018] [Accepted: 10/04/2018] [Indexed: 11/17/2022]
Abstract
Gingivitis is evidenced by inflammation of the free gingiva, and still reversible. If left untreated, it may then progress to periodontitis. In the present study, the therapeutical effect of ketotifen fumarate on gingivitis was explored. Domestic cats with varying degrees of gingivitis naturally were enrolled in this study. Subgroups of animals were treated twice daily for one week with or without ketotifen fumarate (5 mg/kg). Effects of ketotifen fumarate were measured on gingival index, cells accumulation, mediators release, receptor-ligand interaction, oxidative stress, MAPK and NF-κB pathways, epithelial barrier and apoptosis. Ketotifen fumarate attenuated the initiation and progression of gingivitis, inhibited the infiltrations of mast cells, B lymphocytes, T lymphocytes, macrophages, neutrophils and eosinophils as well as the release of IgE, β-hexosaminidase, tryptase, chymase, TNF-α, IL-4, and IL-13, influenced endothelial cells, fibroblasts and epithelial cells proliferation and apoptosis, and induced Th2 cells polarization, where ketotifen fumarate also might affect their interactions. Ketotifen fumarate reduced the oxidative stress, and inhibited NF-κB and p38 MAPK related with mast cells and macrophages accumulation. Ketotifen fumarate improved the aberrant expression of ZO-1 and inhibits the following apoptosis. On the other hand, these cells and mediators augmented functional attributes of them involving SCF/c-Kit, α4β7/VCAM-1 and IL-8/IL-8RB interactions, thus creating a positive feedback loop to perpetuate gingivitis, where an inflammation microenvironment was modeled. Our results showed a previously unexplored therapeutic potential of ketotifen fumarate for gingivitis and further suggest that, in addition to biofilms, targeting inflammation microenvironment could be new strategy for the treatment of gingivitis/periodontitis.
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Affiliation(s)
- Weifeng Yuan
- Beijing Institute of Animal Husbandry and Veterinary Medicine, Chinese Academy of Agricultural Sciences, Beijing 100193, People's Republic of China
| | - Shaohua Hou
- Beijing Institute of Animal Husbandry and Veterinary Medicine, Chinese Academy of Agricultural Sciences, Beijing 100193, People's Republic of China
| | - Hong Jia
- Beijing Institute of Animal Husbandry and Veterinary Medicine, Chinese Academy of Agricultural Sciences, Beijing 100193, People's Republic of China
| | - Zhizhao Qiu
- Meilianzhonghe Animal Hospital, Beijing 100077, People's Republic of China
| | - Tao Liu
- College of Animal Husbandry and Veterinary Medicine, Xinyang Agriculture and Forestry University, Xinyang 464001, People's Republic of China
| | - Xinsheng Chen
- Animal Hospital, Shanghai Wild Animal Park, Shanghai 200120, People's Republic of China
| | - Hongjun Li
- Luoyang Animal Husbandry Station, Luoyang 471002, People's Republic of China
| | - Yanchen Sun
- Yichongtang Animal Hospital, Zhengzhou 450016, People's Republic of China
| | - Lin Liang
- Beijing Institute of Animal Husbandry and Veterinary Medicine, Chinese Academy of Agricultural Sciences, Beijing 100193, People's Republic of China
| | - Xiukun Sui
- Beijing Institute of Animal Husbandry and Veterinary Medicine, Chinese Academy of Agricultural Sciences, Beijing 100193, People's Republic of China
| | - Xinghui Zhao
- Beijing Institute of Animal Husbandry and Veterinary Medicine, Chinese Academy of Agricultural Sciences, Beijing 100193, People's Republic of China.
| | - Zhanzhong Zhao
- Beijing Institute of Animal Husbandry and Veterinary Medicine, Chinese Academy of Agricultural Sciences, Beijing 100193, People's Republic of China.
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Wang Y, Fang J, Song P, Bao Y, Song W, Liu J, Lang C, Jorgenson K, Jung M, Shen D, Li S, Sun R, Ding X, Yang J, Meng X, Wang N, Yan Z, Yan Y, Kong Q, Dong Y, Cui F, Tu Y, Cui B, Kong J. The Dysfunction of the Cerebellum and Its Cerebellum-Reward-Sensorimotor Loops in Chronic Spontaneous Urticaria. Cerebellum 2018; 17:507-516. [PMID: 29574551 PMCID: PMC6126981 DOI: 10.1007/s12311-018-0933-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Chronic spontaneous urticaria (CSU) is a common itchy skin disease. Despite its prevalence, the neuropathology of CSU is uncertain. In this study, we explored resting state functional connectivity (rs-FC) changes in CSU, as well as how the symptom changes following intervention can modulate rs-FC. Forty patients and 40 healthy controls (HCs) were recruited. Following an intervention, 32 patients participated in a second scan approximately 6 weeks after the first scan. Compared with healthy controls, CSU subjects exhibited higher regional homogeneity (ReHo) values in the cerebellum, which were positively associated with urticaria activity scores over 7 days (UAS7) at baseline. After an intervention accompanied with clinical improvement, we found that ReHo values decreased at the cerebellum and increased at the bilateral primary somatosensory cortex (SI)/primary motor cortex (MI)/supplementary motor area (SMA). Using the cerebellum as a seed, CSU subjects exhibited increased rs-FC with reward regions when compared with HCs and exhibited decreased rs-FC at the right orbitofrontal cortex and right sensorimotor region following the intervention. The improvement rate values were positively associated with reduced rs-FC values in the two regions. Using the cluster of SI/MI/SMA as a seed, CSU patients exhibited decreased rs-FC with the left putamen, caudate, accumbens, and thalamus following the intervention. These results demonstrate the altered cerebellar activity and cerebellum-reward-sensorimotor loops in CSU.
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Affiliation(s)
- Yuming Wang
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Jiliang Fang
- Department of Radiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Ping Song
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Yan Bao
- Department of Radiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Wenwen Song
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Jiao Liu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 350122, China
| | - Courtney Lang
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Kristen Jorgenson
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Minyoung Jung
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Dong Shen
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Shasha Li
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Ruirui Sun
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Xu Ding
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Jiao Yang
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Xiao Meng
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Ning Wang
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Zhifang Yan
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Yuhe Yan
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Qian Kong
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Ying Dong
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Fangyuan Cui
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Yiheng Tu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Bingnan Cui
- Department of Dermatology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA.
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49
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Kennedy L, Hargrove L, Demieville J, Karstens A, Jones H, DeMorrow S, Meng F, Invernizzi P, Bernuzzi F, Alpini G, Smith S, Akers A, Meadows V, Francis H. Blocking H1/H2 histamine receptors inhibits damage/fibrosis in Mdr2 -/- mice and human cholangiocarcinoma tumorigenesis. Hepatology 2018; 68:1042-1056. [PMID: 29601088 PMCID: PMC6165706 DOI: 10.1002/hep.29898] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 02/28/2018] [Accepted: 03/12/2018] [Indexed: 12/12/2022]
Abstract
Primary sclerosing cholangitis (PSC) patients are at risk of developing cholangiocarcinoma (CCA). We have shown that (1) histamine increases biliary hyperplasia through H1/H2 histamine receptors (HRs) and (2) histamine levels increase and mast cells (MCs) infiltrate during PSC and CCA. We examined the effects of chronic treatment with H1/H2HR antagonists on PSC and CCA. Wild-type and multidrug-resistant knockout (Mdr2-/- ) mice were treated by osmotic minipumps with saline, mepyramine, or ranitidine (10 mg/kg body weight/day) or a combination of mepyramine/ranitidine for 4 weeks. Liver damage was assessed by hematoxylin and eosin. We evaluated (1) H1/H2HR expression, (2) MC presence, (3) L-histidine decarboxylase/histamine axis, (4) cholangiocyte proliferation/bile duct mass, and (5) fibrosis/hepatic stellate cell activation. Nu/nu mice were implanted with Mz-ChA-1 cells into the hind flanks and treated with saline, mepyramine, or ranitidine. Tumor growth was measured, and (1) H1/H2HR expression, (2) proliferation, (3) MC activation, (4) angiogenesis, and (5) epithelial-mesenchymal transition (EMT) were evaluated. In vitro, human hepatic stellate cells were evaluated for H1HR and H2HR expression. Cultured cholangiocytes and CCA lines were treated with saline, mepyramine, or ranitidine (25 μM) before evaluating proliferation, angiogenesis, EMT, and potential signaling mechanisms. H1/H2HR and MC presence increased in human PSC and CCA. In H1/H2HR antagonist (alone or in combination)-treated Mdr2-/- mice, liver and biliary damage and fibrosis decreased compared to saline treatment. H1/H2HR antagonists decreased tumor growth, serum histamine, angiogenesis, and EMT. In vitro, H1/H2HR blockers reduced biliary proliferation, and CCA cells had decreased proliferation, angiogenesis, EMT, and migration. Conclusion: Inhibition of H1/H2HR reverses PSC-associated damage and decreases CCA growth, angiogenesis, and EMT; because PSC patients are at risk of developing CCA, using HR blockers may be therapeutic for these diseases. (Hepatology 2018).
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Affiliation(s)
- Lindsey Kennedy
- Research, Central Texas Veterans Health Care System, Temple, Texas, USA
- Medicine, Texas A&M Health Science Center, Temple, Texas, USA
| | - Laura Hargrove
- Medicine, Texas A&M Health Science Center, Temple, Texas, USA
| | | | - Allen Karstens
- Scott & White Digestive Disease Research Center, Baylor Scott & White Health, Temple, Texas, USA
| | - Hannah Jones
- Scott & White Digestive Disease Research Center, Baylor Scott & White Health, Temple, Texas, USA
| | - Sharon DeMorrow
- Research, Central Texas Veterans Health Care System, Temple, Texas, USA
- Medicine, Texas A&M Health Science Center, Temple, Texas, USA
| | - Fanyin Meng
- Research, Central Texas Veterans Health Care System, Temple, Texas, USA
- Scott & White Digestive Disease Research Center, Baylor Scott & White Health, Temple, Texas, USA
- Medicine, Texas A&M Health Science Center, Temple, Texas, USA
| | - Pietro Invernizzi
- Program for Autoimmune Liver Diseases, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Francesca Bernuzzi
- Program for Autoimmune Liver Diseases, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Gianfranco Alpini
- Research, Central Texas Veterans Health Care System, Temple, Texas, USA
- Scott & White Digestive Disease Research Center, Baylor Scott & White Health, Temple, Texas, USA
- Medicine, Texas A&M Health Science Center, Temple, Texas, USA
| | - Steven Smith
- Scott & White Digestive Disease Research Center, Baylor Scott & White Health, Temple, Texas, USA
| | - Austin Akers
- Scott & White Digestive Disease Research Center, Baylor Scott & White Health, Temple, Texas, USA
| | - Victoria Meadows
- Research, Central Texas Veterans Health Care System, Temple, Texas, USA
| | - Heather Francis
- Research, Central Texas Veterans Health Care System, Temple, Texas, USA
- Scott & White Digestive Disease Research Center, Baylor Scott & White Health, Temple, Texas, USA
- Medicine, Texas A&M Health Science Center, Temple, Texas, USA
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50
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Gupta A, Arora P, Malhotra P, Sardana K. Pheniramine maleate: an apparently safe drug causing bullous fixed drug eruption. Dermatol Online J 2018; 24:13030/qt1vc6p92x. [PMID: 30142724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 06/08/2023] Open
Abstract
Fixed drug eruption is a delayed type hypersensitivity reaction to a drug seen most frequently with antibiotics such as tetracyclines, sulfonamides, and NSAIDs such as naproxen and ibuprofen. Although H1-antihistamines rarely elicit cutaneous adverse effects, there have been a few reports in the literature implicating them in causing fixed drug eruption, particularly the piperazine derivatives (hydroxyzine, cetirizine, levocetirizine), and loratadine. However, cutaneous drug reactions with the alkylamine derivatives like pheniramine maleate are extremely uncommon and fixed drug eruptions have not been reported with any of the alkylamine antihistamines to date. We herein report a case of multifocal bullous fixed drug eruption following ingestion of pheniramine maleate.
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Affiliation(s)
- Aastha Gupta
- Department of Dermatology, Dr Ram Manohar Lohia Hospital, New Delhi.
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