Consenso para el manejo práctico de la urticaria en atención primaria

Introduction: urticaria has a high impact on the quality of life of patients with this condition. While there are multiple evidence-based guidelines, these tend to be aimed at providing management recommendations for specialists rather than primary care physicians, who are usually the first to care for patients with urticaria. Objective: to develop a consensus document aimed at presenting evidence-based recommendations to help general practitioners, family doctors, pediatricians, internists and emergency physicians provide timely care for patients with urticaria, facilitating its diagnosis and timely care, and thus avoiding delays for the patients. Methods: international urticaria guidelines with recommendations based on the GRADE system were used as the source of information. Delegates of the interested scientific societies were convened, and, through structured meetings, treatment barriers and possible solutions for the application of the recommendations in primary care were identified. Results: the main barriers for primary care physicians in applying the guidelines were identified: confusion in the diagnosis, proper timing of treatment, first-line medications, and management of special situations. Possible consensus solutions were proposed for each identified barrier. Conclusion: this consensus document contains recommendations for the management and treatment of acute and chronic urticaria which help primary care physicians provide timely and effective treatment for patients with this disease. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2722).

Efficacy of different oral H1 antihistamine treatments on allergic rhinitis: a systematic review and network meta-analysis of randomized controlled trials

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.

Comparative Study of Bilastine and Fexofenadine in Control of Intermittent Allergic Rhinitis

Background: Allergic rhinitis (AR) impacts 10-30% of the world affecting the quality of life of many. Hence, the requirement of a treatment targeted at delivering maximum symptom control and has minimum to no side effects. Objectives: Comparison of efficacy of Bilastine and Fexofenadine in patients suffering from intermittent allergic rhinitis with the help of Total Nasal Symptom Scoring(TNSS) and assessment of side effects- sedation and cardiac toxicity. Methodology: 60 subjects diagnosed with intermittent allergic rhinitis (IAR) were recruited and divided into groups of 30 each. One group was started on Bilastine 20mg OD and the other on Fexofenadine 120mg OD. TNSS was calculated based on symptom severity at presentation, on 10th day and 30th of antihistamine therapy. AEC values and ECG changes were compared for both groups at day 0, day 30. Measurement of sedation was done at day 10, day 30. Intergroup comparison and intragroup assessment of TNSS and its variables, sedative effects and ECG changes at day 0 and day 30 were done using Un-paired and Paired T-test. Results: Patients showed reduction in symptoms of AR with both drugs. TNSS and Rhinorrhoea showed significant improvement in Fexofenadine group as compared to Bilastine. AEC values showed significant reduction in both groups. Statistically significant ECG changes were seen after 30 days of Fexofenadine therapy but were clinically insignificant. No sedative effects were noted with both drugs. Conclusion: Both Bilastine and Fexofenadine were found to be effective in reducing symptoms in patients with IAR. Fexofenadine was more effective than Bilastine in overall symptom control and specifically in controlling rhinorrhoea after one month of therapy. Both the drugs had no sedative effects or cardiac toxicity.

Comparative CNS activities of chlorpheniramine maleate, ebastine, and fexofenadine in Swiss albino mice

Background: Not all second-generation antihistamines were devoid of the central nervous system (CNS) effects such as cognitive and psychomotor impairment. Although these drugs penetrate blood–brain barrier (BBB) to lesser extent, many of them have been found to produce dose-related impairment of CNS functions with interdrug differences present among them. Aim and Objective: This study is aimed to analyze and compare the effects of different antihistamines (first and second generation) on the CNS using Swiss albino mice. Materials and Methods: Twenty-four Swiss albino mice of either sex weighing around 25 - 30 g were randomly divided into six groups with six in each group. Antihistamines such as chlorpheniramine maleate (CPM), ebastine, and fexofenadine were administered to respective groups through oral route. Their effects on CNS were evaluated using rotarod and actophotometer. The data were analyzed using statistical methods. Results: CPM produced significant reduction (P < 0.05) in motor coordination and spontaneous locomotor activity. Ebastine does not have any effect on motor coordination but significant reduction (P < 0.05) in spontaneous locomotor activity. Fexofenadine does not have any effect on motor coordination and spontaneous locomotor activity. Conclusion: We conclude that CPM has significant CNS depressant actions, ebastine has minimal CNS depressant actions, and fexofenadine does not have CNS depressant actions.

Application of capillary zone electrophoresis to determine second-generation H1 antihistaminic drugs, loratadine and rupatadine

Abstract The second generation of H1 antihistamines from the piperidine group are often used for treating allergic diseases due to their action on histaminic receptors, the primary mediator of allergy. Moreover, the antihistamines have anti-inflammatory action, mediated through platelet-activating factor blocking activity. A simple and rapid capillary zone electrophoresis method was developed and validated for the determination of loratadine (LOR) and rupatadine (RUP) in tablets. The analyses were carried out using a fused silica capillary of 50.2 cm (40 cm effective length), 75 µm i.d. The background electrolyte was composed of boric acid 35 mmol/L, pH 2.5. Voltage of 20 kV, hydrodynamic injection of 3447.3 Pa for 3s, temperature at 25 ºC, and UV detection at 205 nm were applied. Electrophoretic separation was achieved at 1.8 and 2.8 min for RUP and LOR, respectively. The method was linear for both drugs in a range of 50.0 to 400.0 µg/mL (r>0.99). The limits of detection and quantification were 46.37 and 140.52 µg/mL, for LOR and 29.60 and 89.69 µg/mL for RUP respectively. The precision was less than 5.0 % for both drugs. The average recovery was approximately 100 %. The proposed novel method can significantly contribute to the rapid detection of counterfeit products and in quality control of drug products containing antihistamines

Evaluation of 0.1% Olopatadine Hydrochloride versus 0.5% Ketorolac Tromethamine Solution in the Management of Allergic Conjunctivitis

Introduction: The term “allergic conjunctivitis” refers to a group of hypersensitivity disorders of eye. This is a commonocular condition which presents with itching, redness, tearing, swelling, burning, fullness in the eye, leading to rubbing ofthe eye, and blurred vision. Histamine, prostaglandins, and mast cell degranulation are important mediators responsiblefor the signs and symptoms of seasonal and perennial allergic conjunctivitis. Olopatadine is a novel drug with dual actionof mast cell stabilizer with blocking of histamine H1 receptors. Ketorolac tromethamine 0.5% ophthalmic solution is a verypotent nonsteroidal anti-inflammatory drug (NSAID) that inhibits the enzyme cyclooxygenase and decreases the synthesisof prostaglandins.Objectives: The objectives of the study were to compare the clinical efficacy and therapeutic effects of 0.1% olopatadinehydrochloride to that of 0.5% ketorolac tromethamine ophthalmic solution with different pharmacological mechanisms in themanagement of seasonal allergic conjunctivitis.Materials and Methods: This was a comparative study that was conducted on patients with allergic conjunctivitis attendingophthalmology outpatient department in a tertiary health-care center during the study period of 1 year. A total of 100 patientswere chosen by purposive sampling method and randomized into two groups. Group A patients were treated with olopatadineand Group B patients were treated with ketorolac and the drugs were instilled twice daily. Patients were evaluated for clinicalsigns and symptoms at baseline and at 30 min, 2 days, 7 days, and 14 days of application of eye drops.Results: The mean age in our study was 27.81 years and had male predominance. There was a significant reduction in thefrequency of all ocular signs and symptoms of hyperemia and itching following initiation of medication. The percentage of nonresponders was comparable between both the groups. Three patients showed increase in hyperemia signs at 30 min postapplication of ketorolac. Adverse reaction was observed in three patients in the ketorolac group.Conclusion: The topical dual-action drug-olopatadine and NSAID-ketorolac both have an attenuating and equivocal effect onthe clinical signs and symptoms of allergic conjunctivitis.

Cupping therapy for patients with chronic urticaria: A systematic review and meta-analysis / 中西医结合学报

BACKGROUND@#Chronic urticaria (CU) is a common skin disease, which has a negative effect on quality of life. Current treatments do not fully control the symptoms of urticaria for many CU patients, thus effective and safe treatments for CU are still needed.@*OBJECTIVE@#This review aims to evaluate the effectiveness and safety of cupping therapy in patients with CU.@*SEARCH STRATEGY@#The search strategy looked for the presence of related keywords, such as "chronic urticaria" and "cupping therapy," in the title and abstract of research articles indexed in major databases. Randomized controlled trials (RCTs) were selected after querying nine electronic databases from their inception to May 2019 with the above search terms.@*INCLUSION CRITERIA@#RCTs were included if they recruited patients with CU who were intervened with dry or wet cupping. Publications could be written in Chinese or English.@*DATA EXTRACTION AND ANALYSIS@#Data were extracted, and the studies were assessed for the quality of their methodological design and risk of bias. Meta-analyses of the RCT data were conducted to assess the total effective rate of the treatment as the primary outcome. Skin disease quality of life index score, recurrence rate, and adverse events were assessed as secondary outcomes. Subgroup analyses were conducted based on different interventions.@*RESULTS@#Thirteen comparisons from 12 RCTs involving 842 participants were included. There were no significant differences between wet cupping and medications in total effective rate (n = 372; risk ratio [RR] = 1.10, 95% confidence interval [CI] 0.97 to 1.25; P = 0.14) or recurrence rate (n = 240; RR = 0.56, 95% CI 0.23 to 1.36; P = 0.20). Cupping therapy, in combination with antihistamine treatment was more efficacious than antihistamines alone, with a greater total effective rate (n = 342; RR = 1.18, 95% CI 1.01 to 1.39; P = 0.03) and lower recurrence rate (n = 342; RR = 0.52, 95% CI 0.32 to 0.84; P = 0.007). Cupping therapy combined with acupuncture was more effective than acupuncture alone (n = 156; RR = 1.25, 95% CI 1.07 to 1.46; P = 0.006). No serious adverse events were reported.@*CONCLUSION@#Wet cupping may be as effective as treatment with antihistamines. When cupping therapy is used as an adjuvant therapy to antihistamines or acupuncture, it may enhance the efficacy. Results drawn from these studies should be interpreted with caution and applied with care to clinical practice, because of the poor quality among the studies that were reviewed.@*SYSTEMATIC REVIEW REGISTRATION@#PROSPERO, CRD42019137451.

Meta-analysis of Effectiveness and Safety of Classical Prescription versus Antihistamines in the Treatment of Eczema / 中国药房

OBJECTIVE：To systematically evaluate the effectiveness and safety of classical prescription versus antihistamines in the treatment of eczema. METHODS ：Retrieved from CBM and CNKI ，randomized controlled trials （RCTs）about classical prescription（trial group ）versus antihistamines （control group ）in the treatment of eczema were collected. The qualities of included literatures were evaluated by modified Jadad scale after literature screening and data extraction ，and Meta-analysis was performed by using Rev Man 5.3 software. RESULTS ：Totally 19 RCTs involving 1 829 patients were included. Meta-analysis showed that total response rate of patients with Shire Yunfu type [OR ＝5.67，95％CI（3.44，9.33），P＜0.000 01]，Pixu Shiyun type [OR ＝4.23， 95％ CI（1.89，9.46），P＝0.000 4]，Xuexu Fengzao type [OR ＝3.57，95％ CI（2.36，5.41），P＜0.000 01] in trial group were significantly higher than that of control group. There were no statistical differences in the incidence of ADR between patients with Shire Yunfu type [OR ＝0.72，95％CI（0.21，2.41），P＝0.59]，Pixu Shiyun type [OR ＝0.31，95％CI（0.01，13.57），P＝0.54]，Xuexu Fengzao type [OR＝1.08，95％ CI（0.18，6.59），P＝0.93] in trial group and control group. After treatment ，the levels of TNF-α [SMD＝－1.67，95％CI（－2.04，－1.31），P＜0.000 01]，IL-6 [SMD＝－1.53，95％CI（－1.88，－1.17），P＜0.000 01] and IL-8 [SMD＝－1.75，95％CI（－2.28，－1.21），P＜0.000 01] in patients with Shire Yunfu type in trial group were significantly lower than control group. There was no statistical significance in CD 4+ levels [SMD ＝1.51，95％CI（－0.37，3.38），P＝0.12] between Shire Yunfu type patients in trial group and control group. CONCLUSIONS ：Therapeutic efficacy of classical prescription in treatment of eczema is better than antihistamines，with similar safety . Modified Longdan xiegan decoction can significantly reduce the levels of inflammatory cytokines in patients with Shire Yunfu type.

Pediatric mastocytosis: report of 23 cases in 5 years / Mastocitosis cutánea en niños: reporte de 23 casos en 5 años

RESUMEN Introducción: Las mastocitosis son un conjunto de trastornos clínicos, producidos todos ellos por una proliferación de mastocitos y su acumulación en varios órganos, entre los cuales el más común es la piel. Objetivo: Presentar la experiencia de pacientes con mastocitosis oriundos de Neuquén atendidos en el consultorio de Dermatología pediátrica en un período de 5 años. Detallar formas clínicas, presentación, topografía de las lesiones y evolución. Diseño: Se realizó un estudio descriptivo, retrospectivo de corte transversal, en el período comprendido entre abril de 2013 y marzo de 2018. Materiales y Método: Se revisaron las Historias clínicas digitales de pacientes con diagnóstico de mastocitosis cutánea que concurrieron al consultorio de dermatología infantil en la ciudad de Neuquén. Resultados: Se reunieron 23 casos de mastocitosis cutánea; de ellos el 60,87% corresponden a mastocitosis maculopapular y el 39,13%, a mastocitomas. No hubo diferencias significativas en cuanto al sexo. La mayoría de ellos presentó lesiones localizadas en tronco y miembros. El 95% tuvo signo de Darier positivo. Conclusiones: En nuestra muestra la presentación clínica más frecuente fue la mastocitosis maculopapular y la edad de inicio fue antes del año de vida en la totalidad de los pacientes. Las lesiones se distribuyeron en tronco y miembros en la mayoría de los casos. Los pacientes con mastocitomas solitarios permanecieron estables; en los casos de mastocitosis maculopapular se utilizaron antihistamínicos, con buena evolución.

ABSTRACT Introduction: Mastocytosis is a heterogeneous group of disorders, characterized by a proliferation of mast cells and its accumulation in several organs, being the skin the most frequently affected one. Design: A descriptive, retrospective cross-sectional study, was conducted in the period from April 2013 to March 2018 in Neuquen city. Materials and Method: Electronic medical records of patients diagnosed with cutaneous mastocytosis who attended to the pediatric dermatology clinic in Neuquen city were reviewed. Results: We present 23 cases of cutaneous mastocytosis, of which 60,87% were maculopapular and 39,13% mastocytomas. There were no significant differences in terms of sexes. Most of them presented localized lesions in trunk and limbs. 95% had positive Darier´s sign. Conclusions: In our sample, the most frequent clinical presentation was maculopapular mastocytosis, and the age of onset was during the first year of life in all patients. The majority of lesions were distributed over the trunk and limbs. Patients with mastocytoma remained stable; maculopapular patients recieved antihistamines, with good evolution.

Omalizumabe no tratamento da urticária crônica espontânea: análise de custo-efetividade e impacto orçamentário / Omalizumab in the treatment of chronic spontaneous urticaria: cost-effectiveness analysis and budgetary impact

Objetivos: Determinar a relação custo-efetividade da adição do omalizumabe (Oma) no tratamento da urticária crônica espontânea (UCE) refratária aos tratamentos convencionais, bem como o impacto orçamentário no contexto da saúde suplementar (SS) no Brasil. Métodos: Na análise econômica, utilizou-se o modelo de Markov baseado no Urticaria Activity Score for 7 days (UAS7), considerando- se os desfechos clínicos: anos de vida salvos com doença controlada (UAS7 = 0 ou UAS7 ≤ 6), e anos de vida ajustados à qualidade (QALY). Três razões de custo-efetividade incremental (RCEI) foram calculadas. O impacto orçamentário foi calculado com base em dados da SS, população elegível e o horizonte de 5 anos. Resultados: As RCEI calculadas para o desfecho anos de vida salvos com doença controlada nos horizontes de 3 e 5 anos foram R$ 108.935,42 e R$ 166.977,29, respectivamente. O impacto orçamentário, do primeiro ao quinto ano, da incorporação do Oma à SS para o tratamento de pacientes com UCE refratária variou entre R$ 65 milhões e R$ 157 milhões, que equivaleria a R$ 1,38/assistido no primeiro ano incorporação. Sendo assim, ao analisar os custos adicionais por desfecho adicional salvo, nota-se que a RCEI também se mostrou menor que três vezes o PIB per capita no Brasil, podendo-se dizer que o tratamento com Oma é custo-efetivo em comparação ao tratamento atual também neste desfecho. Conclusão: A análise econômica demonstrou que o tratamento com Oma da UCE refratária ao tratamento com antihistamínicos H1 em doses elevadas é custo-efetivo no cenário nacional, e a sua incorporação na SS é viável.

Objectives: To determine the cost-effectiveness of adding omalizumab (Oma) to the treatment of chronic spontaneous urticaria (CSU) refractory to conventional treatments, as well as its budgetary impact in the context of private health insurance (PHI) in Brazil. Methods: In the economic analysis, the Markov model based on the Urticaria Activity Score over 7 days (UAS7) was used considering the following clinical outcomes: life years saved with controlled disease (UAS7 = 0 or UAS7 ≤ 6) and quality-adjusted life years (QALYs). Three incremental cost-effectiveness ratios (ICERs) were calculated. The budgetary impact was calculated using PHI data, eligible population, and 5-year horizon. Results: The estimated ICERs for life years saved with controlled disease in 3- and 5-year horizons were R$ 108,935.42 and R$ 166,977.29, respectively. The budgetary impact from the first to the fifth year of the incorporation of Oma into PHI for the treatment of patients with refractory CSU ranged from R$ 65 million to R$ 157 million, equivalent to R$ 1.38/assisted patient in the first year of incorporation. When additional costs were analyzed per additional outcome saved, ICER was shown to be less than three times the GDP per capita in Brazil. Thus, Oma is cost-effective compared to the current treatment in this outcome as well. Conclusion: The economic analysis demonstrated that treatment with Oma of CSU refractory to the treatment with H1 antihistamines in high doses is cost-effective in the Brazilian setting and its incorporation into the PHI system is feasible.

Clinical application of H_1 antihistamines in children with allergic rhinitis / 中国实用儿科杂志

The incidence of allergic rhinitis in children increases year by year,and H_1 antihistamines play a role in the control of allergic diseases by blocking the binding of histamine and H_1 receptor. The second-generation H_1 antihistamines have more stable binding,better specificity,lower central inhibitory effect and longer action time,and can effectively improve the symptoms of the nose and eyes,which is the firstline drug for the treatment of allergic rhinitis in children. At present,there aren't objective testing methods to evaluate the effectiveness and safety of antihistamines. Therefore,the dosage for children should be adjusted according to body weight,appropriate dosage forms should be selected,age limit should be paid attention to,dosage varieties should be individualized as far as possible,and reasonable course of treatment should be applied.

Relationship of Concomitant Medications on Infusion Related Reactions to Infliximab： A Case-Control Study Using Individual Case Safety Reports Database / 薬剤疫学

Objective：Infliximab is a chimeric monoclonal antibody against tumor necrosis factor (TNF) -α that is indicated in the treatment of chronic inflammatory diseases. Infliximab is administered by intravenous infusion and may be associated with infusion related reactions (IRRs). Recent study showed that the use of concomitant antihistamines associated with an increased incidence IRR, using an observational registry database in Canada. The aim of this study was to determine whether the use of concomitant antihistamines associated with an increase in the proportional reporting ratio (PRR) of IRR, using individual case safety reports (ICSRs) with infliximab as one of the suspected drugs, not only from Canada, but also from the United States of America (US), the United Kingdom (UK), and Japan.Design：Case-control studyMethods：We used VigiBase, the WHO's global safety report database, in this study. One-to-one propensity-matching analysis was performed in each country using IBM SPSS version 24 to evaluate outcomes. The primary endpoint was the assessment of concomitant medications associated with IRR in the cases treated with infliximab.Results：There were 35,729, 19,095, 4,618, and 1,565 ICSRs in which some adverse events were reported with infliximab as one of the suspected drugs in Canada, the US, the UK, and Japan, respectively, after the exclusion of ICSRs with unknown patient age or unknown patient sex. IRRs were reported in 2,293, 1,427, 303, and 69 ICSRs, respectively. The use of concomitant antihistamines was significantly associated with an increased PRR of IRR in Canada (p<0.001). The uses of concomitant antihistamines were also significantly associated with an increased PRR of IRR in the US (p<0.001), the UK (p<0.001), and Japan (p＝0.007).Conclusion：The uses of concomitant antihistamines were associated with an increased PRR of IRR with infliximab in the case-control study using ICSRs from Canada, the US, the UK, and Japan.

Relationship of Concomitant Medications on Infusion Related Reactions to Infliximab： A Case-Control Study Using Individual Case Safety Reports Database / 薬剤疫学

Objective ： Infliximab is a chimeric monoclonal antibody against tumor necrosis factor (TNF) -α that is indicated in the treatment of chronic inflammatory diseases. Infliximab is administered by intravenous infusion and may be associated with infusion related reactions (IRRs). Recent study showed that the use of concomitant antihistamines associated with an increased incidence IRR, using an observational registry database in Canada. The aim of this study was to determine whether the use of concomitant antihistamines associated with an increase in the proportional reporting ratio (PRR) of IRR, using individual case safety reports (ICSRs) with infliximab as one of the suspected drugs, not only from Canada, but also from the United States of America (US), the United Kingdom (UK), and Japan.Design ： Case-control studyMethods ： We used VigiBase, the WHO's global safety report database, in this study. One-to-one propensity-matching analysis was performed in each country using IBM SPSS version 24 to evaluate outcomes. The primary endpoint was the assessment of concomitant medications associated with IRR in the cases treated with infliximab.Results ： There were 35,729, 19,095, 4,618, and 1,565 ICSRs in which some adverse events were reported with infliximab as one of the suspected drugs in Canada, the US, the UK, and Japan, respectively, after the exclusion of ICSRs with unknown patient age or unknown patient sex. IRRs were reported in 2,293, 1,427, 303, and 69 ICSRs, respectively. The use of concomitant antihistamines was significantly associated with an increased PRR of IRR in Canada (p<0.001). The uses of concomitant antihistamines were also significantly associated with an increased PRR of IRR in the US (p<0.001), the UK (p<0.001), and Japan (p＝0.007).Conclusion ： The uses of concomitant antihistamines were associated with an increased PRR of IRR with infliximab in the case-control study using ICSRs from Canada, the US, the UK, and Japan.

Evaluation Of Efficacy And Safety Of High Dose Second Generation Non – Sedating Antihistamines Levocetirizine And Fexofenadine In Chronic Urticaria – A Prospective, Parallel, Randomized, Single Blind, Comparative Study.

There are few studies with up dosing of different 2 generation antihistamines. This study evaluates efficacy and safety of high doses of Levocetirizine and Fexofenadine in chronic urticaria. This study includes 24 patients with chronic urticaria. Initially Fexofenadine 180 mg or Levocetirizine 5 mg was started. Doses of study drugs were doubled at the end of 1 week and tripled at the end of 2 weeks in non-responders and th continued up to 4 week. Patients completed 2 week treatment with highest doses were included in the analysis. All patients were evaluated for symptoms, VAS for sedation and critical flicker fusion threshold (CFFT) for coordination before and after study. Reduction in mean total symptoms score and CFFT were highly significant in Fexofenadine group. Conclusion: Fexofenadine is superior to Levocetrizine in high doses in reducing mean symptoms score and sedation and no impairment in coordination in patients with chronic urticaria.

Meta-analysis of Efficacy and Safety of Yupingfeng Powder Combined with Second-generation Antihistamines Versus Second-generation Antihistamines for Chronic Urticaria / 中国药房

OBJECTIVE:To evaluate the efficacy and safety of Yupingfeng powder combined with second- generation antihistamines versus second-generation antihistamines for chronic urticaria(CU)systematically,and to provide evidence-based reference for clinical treatment for CU. METHODS:Retrieved from PubMed,Embase,The Cochrane Library,CJFD,VIP and CBM,RCT about therapeutic efficacy(total response rate,cure rate,recurrence rate)and safety(the incidence of ADR)of Yupingfeng combined with second-generation antihistamines(trial group)versus second-generation antihistamines(control group) in the treatment of CU were collected. The data extraction was performed for included clinical studies,and Meta-analysis was performed by using Rev Man 5.3 statistical software after quality evaluation with Cochrane Handbook 5.1.0 evaluation criteria. RESULTS:A total of 34 RCTs were enrolled,involved 3 405 patients in total. Results of Meta-analysis showed that the total response rate [OR=4.02,95%CI(3.03,5.34),P<0.001],cure rate [OR=2.25,95%CI(1.95,2.60),P<0.001] and recurrence rate [OR=0.33,95%CI(0.26,0.42),P<0.001] of trial group were significantly better than those of control group,with statistical significance. There was no statistical significance in the incidence of ADR between 2 groups [OR=0.98,95%CI(0.71,1.37),P=0.92]. CONCLUSIONS:For CU therapy,Yupingfeng powder combined with second-generation antihistamines is better than second-generation antihistamines alone in improving total response rate and cure rate,reducing recurrence rate,both have similar safety.

Efficacy of single dose antihistamine vs. single dose valerian-hops in subjective sleep measures among war refugees: a comparison trial

Abstract Background Many sedatives and anxiolytics are used in single dose or chronically to aid sleep. Clinically important sedatives include valerian-hops and antihistamines as they are used over the counter and are highly accessible and safe agents. Objectives To evaluate and compare a single dose of chlorpheniramine versus valerian-hops combination in modulating subjective sleep measures in insomniac war refugees. Methods Insomnia among refugees was screened using the Insomnia Severity Index (ISI). Insomniac subjects were randomized to received a single dose valerian-hops (320/80 mg) (n = 65), or chlorpheneramine (4 mg) (n = 50) or placebo (n = 76) two hours prior sleeping. Participants were instructed to complete Leeds Sleep Evaluation Questionnaire (LSEQ), visual analogue scales of anxiety and sedation. Also sleep latency, total hours slept and self-rated improvement were obtained. Results Almost 75% of screened refugees had insomnia. Chlorpheneramine reduced sleep latency and anxiety significantly, however it resulted in poor sleep quality. Valerian-hops group showed marked anxiolysis one hour after dosing, a sleep quality similar to placebo and better than chlorpheneramine, and better alertness compared to placebo. Participants satisfaction was higher with chlorpheneramine and there was no difference in the total hours slept. Discussion Valerian-hops combination may provide better sleep quality than antihistamines.

Position statement of the Brazilian Academy of Rhinology on the use of antihistamines, antileukotrienes, and oral corticosteroids in the treatment of inflammatory sinonasal diseases / Posicionamento da Academia Brasileira de Rinologia sobre o uso de anti-histamínicos, antileucotrienos e corticosteroides orais no tratamento de doenças inflamatórias nasossinusais

Abstract Introduction: Inflammatory conditions of the nose and paranasal sinuses are very prevalent in the general population, resulting in marked loss of quality of life in affected patients, as well as significant work, leisure, and social activity losses. These patients require specific and specialized treatment. A wide range of oral medications are available. Objective: The present document is aimed to clarify, for professionals treating patients with inflammatory sinonasal diseases, both specialists and general practitioners, specific oral therapies in noninfectious nasal inflammatory conditions. Methods: The methodology used to create this article included the search for the key words: oral corticosteroids, antihistamines, antileukotrienes, rhinitis, rhinosinusitis in the MEDLINE and EMBASE databases in the last 5 years. Since no relevant article was found for the text on the subject of interest in the last 5 years, the search was extended for another 5 years, and so on, according to the authors’ needs. Results: Relevant literature was found regarding the use of antihistamines, antileukotrienes and oral corticosteroids in these conditions. The Brazilian Academy of Rhinology emphasizes, after extensive discussion by the collegiate, key points in the treatment with these drugs. Conclusion: There is support in the literature for the use of these drugs; however, final considerations about the role of each of them have been made.

Resumo Introdução: As afecções inflamatórias do nariz e dos seios paranasais são muito prevalentes na população geral, causam acentuada perda de qualidade de vida dos pacientes afetados, geram perdas significativas das atividades de trabalho, lazer e sociais. Esses pacientes necessitam de tratamento específico e especializado e uma ampla gama de medicações orais está disponível. Objetivo: O presente documento tem por objetivo esclarecer àqueles que tratam das doenças nasossinusais inflamatórias, tanto especialistas quanto generalistas, sobre as terapêuticas orais nas afecções inflamatórias nasais não infecciosas. Método: A metodologia usada para elaboração deste artigo incluiu a busca das palavras chave: corticosteroides orais, anti-histamínicos, antileucotrienos, rinite, rinossinusite nos bancos de dados Medline e Embase nos últimos 5 anos. Como não foi achado artigo relevante para o texto sobre o assunto de interesse nos últimos 5 anos, a busca foi estendida por mais 5 anos, e assim por diante, de acordo com a necessidade dos autores. Resultados: Literatura relevante foi encontrada com relação ao uso dos anti-histamínicos, antileucotrienos e corticosteroides orais nessas afecções. A Academia Brasileira de Rinologia ressalta, após amplo debate do colegiado, pontos-chave no tratamento com esses medicamentos. Conclusão: Há respaldo na literatura para o uso desses medicamentos, entretanto considerações finais acerca do papel de cada deles foram feitas.

Clinical observation of leukotriene receptor antagonist combined with antihistamine in the treatment of allergic / 中国生化药物杂志

Objective To study the clinical therapeutic effect of the combined antihistamine for the treatment of allergic pharyngitis.Methods In January 2015 to December 2016 during the hospital outpatient service received by irritating cough,50 patients with pharyngeal itching for the main symptoms as the object of study,summary and analysis on the clinical symptoms of all patients,in the conventional treatment on the basis of leukotriene receptor antagonist combined antihistamines treatment,close observation after 1 week,2 weeks after treatment in patients with symptoms improved after treatment.Results The clinical main characteristic of allergic pharyngitis is the irritating dry cough,and the first pharynx is a cough.After a week of treatment,the symptoms of the patient were significantly improved,and after two weeks of treatment,the symptoms of the patient continued to be improved and the results were significant.Conclusion In clinical patients with cough,is one of the most important causes of allergic pharyngitis,if the patient is not adopted in treatment of anti-allergic drugs,can lead to therapeutic effect,but the joint antihistamines leukotriene receptor antagonist treatment,can effectively eliminate the symptoms of allergic pharyngitis,obvious effect,effectively improve the patient's quality of life.

Chronic Spontaneous Urticaria: Pathogenesis and Treatment Considerations

The treatment of chronic spontaneous urticaria begins with antihistamines; however, the dose required typically exceeds that recommended for allergic rhinitis. Second-generation, relatively non-sedating H1-receptor blockers are typically employed up to 4 times a day. First-generation antihistamines, such as hydroxyzine or diphenhydramine (Atarax or Benadryl), were employed similarly in the past. Should high-dose antihistamines fail to control symptoms (at least 50%), omalizumab at 300 mg/month is the next step. This is effective in 70% of antihistamine-refractory patients. H₂-receptor blockers and leukotriene antagonists are no longer recommended; they add little and the literature does not support significant efficacy. For those patients who are unresponsive to both antihistamines and omalizumab, cyclosporine is recommended next. This is similarly effective in 65%–70% of patients; however, care is needed regarding possible side-effects on blood pressure and renal function. Corticosteroids should not be employed chronically due to cumulative toxicity that is dose and time dependent. Brief courses of steroid e.g., 3–10 days can be employed for severe exacerbations, but should be an infrequent occurrence. Finally, other agents, such as dapsone or sulfasalazine, can be tried for those patients unresponsive to antihistamines, omalizumab, and cyclosporine.

Recomendaciones para el diagnóstico, clasificación y el manejo de la urticaria / Recommendations for the diagnosis, classification and management of urticaria

La urticaria es la aparición súbita de habones en la piel con o sin angioedema, es una enfermedad con un curso benigno, pero con un impacto negativo en la calidad de vida de quien la padece; se trata de una entidad relativamente común, desencadenada por varios gatillos, muchas veces reconocibles con una buena historia clínica, sin embargo, en la mayoría de los casos estos son desconocidos, como en la urticaria crónica. Su fisiopatología está mediada por una respuesta inmune y su tratamiento es sintomático con antihistamínicos, aunque en ocasiones se debe recurrir a inmunomoduladores.

Urticaria is a sudden onset of hives with or without angioedema, it is a disease with a benign course but with a negative impact on the quality of life of patients. It is a relatively common entity, triggered by various stimuli, often recognizable with a good clinical history, however in most cases these are unknown like in chronic urticaria. Its pathophysiology is usually mediated by an immune response and treatment is symptomatic with antihistamines, however some patients have to be immune regulated.