Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 19 de 19
Alerg. inmunol. clin ; 39(3-4): 33-34, 2020.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1150718


Hasta el momento, no hay un antihistamínico con efecto terapéutico absoluto y al mismo tiempo con altísimo perfil de seguridad. No obstante, se dispone hoy de medicación antialérgica relativamente moderna en términos de respuesta y escasa posibilidad de efectos indeseables, y de costo accesible.

Int. arch. otorhinolaryngol. (Impr.) ; 23(3): 325-330, July-Sept. 2019. tab
Article in English | LILACS | ID: biblio-1040031


Abstract Introduction Oral antihistamines and intranasal corticosteroids have been shown to be effective and safe for the treatment of allergic rhinitis; however, the evidence suggests a level of superiority of corticosteroids, so they should be preferred over the former. Objective To know the prescription profile of two second generation antihistamines (cetirizine and levocetirizine) and two nasal corticosteroids (mometasone and furoateciclesonide) in a cohort of patients with allergic rhinitis, and to compare the clinical outcomes obtained. Methods A cohort study was carried including patients with allergic rhinitis treated with cetirizine, levocetirizine, mometasone furoate or ciclesonide. The improvement was evaluated with the total nasal symptoms score (TNSS). This scale yields results between 0 and 12. Zero indicates absence of symptoms. Results A total of 314 patients completed 12 weeks of follow-up. Seventy-five percent were treated with antihistamines, 20% with corticosteroids, and 5% with a combination of the above. The TNSS median for corticosteroid was 2.5 points; for antihistamines, its was 5 points, and for combination, it was 4 points. We found differences between corticosteroids and antihistamines. Conclusion The prescription percentage of second generation oral antihistamines is higher than that of intranasal corticosteroids. However, patients with allergic rhinitis treated with the second option obtained better control of symptoms.

Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Adrenal Cortex Hormones/therapeutic use , Rhinitis, Allergic/drug therapy , Histamine Antagonists/therapeutic use , Drug Prescriptions , Administration, Intranasal , Cohort Studies , Treatment Outcome , Cetirizine/therapeutic use , Adrenal Cortex Hormones/administration & dosage , Colombia , Mometasone Furoate/therapeutic use
An. bras. dermatol ; 94(2,supl.1): 56-66, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1011090


Abstract: Background: Urticarias are frequent diseases, with 15% to 20% of the population presenting at least one acute episode in their lifetime. Urticaria are classified in acute ( ≤ 6 weeks) or chronic (> 6 weeks). They may be induced or spontaneous. Objectives: To verify the diagnostic and therapeutic recommendations in chronic spontaneous urticaria (CSU), according to the experience of Brazilian experts, regarding the available guidelines (international and US). Methods: A questionnaire was sent to Brazilian experts, with questions concerning diagnostic and therapeutic recommendations for CSU in adults. Results: Sixteen Brazilian experts answered the questionnaire related to diagnosis and therapy of CSU in adults and data were analyzed. Final text was written, considering the available guidelines (International and US), adapted to the medical practices in Brazil. Diagnostic work up in CSU is rarely necessary. Biopsy of skin lesion and histopathology may be indicated to rule out other diseases, such as, urticarial vasculitis. Other laboratory tests, such as complete blood count, CRP, ESR and thyroid screening. Treatment of CSU includes second-generation anti-histamines (sgAH) at licensed doses, sgAH two, three to fourfold doses (non-licensed) and omalizumab. Other drugs, such as, cyclosporine, immunomodulatory drugs and immunosuppressants may be indicated (non-licensed and with limited scientific evidence). Conclusions: Most of the Brazilian experts in this study partially agreed with the diagnostic and therapeutic recommendations of the International and US guidelines. They agreed with the use of sgAH at licensed doses. Increase in the dose to fourfold of sgAH may be suggested with restrictions, due to its non-licensed dose. Sedating anti-histamines, as suggested by the US guideline, are indicated by some of the Brazilian experts, due to its availability. Adaptations are mandatory in the treatment of CSU, due to scarce or lack of other therapeutic resources in the public health system in Brazil, such as omalizumab or cyclosporine.

Humans , Adult , Urticaria/diagnosis , Urticaria/drug therapy , Consensus , Societies, Medical , Urticaria/prevention & control , Severity of Illness Index , Brazil , Chronic Disease , Anti-Allergic Agents/therapeutic use , Cyclosporins/therapeutic use , Histamine H1 Antagonists, Non-Sedating/therapeutic use , Dermatology , Omalizumab/therapeutic use , Immunosuppressive Agents/therapeutic use
Article in English | WPRIM | ID: wpr-741363


Although rare, antihistamines can cause adverse effects, including drug-induced eruptions or anaphylaxis. A 4-year-old child visited the pediatric department of a hospital for skin eruptions after administration of antihistamines, (e.g., ucerax [hydroxyzine] or leptizine [levocetirizine]), for cholinergic rashes; he did not have pruritus. Skin prick, intradermal, and drug provocation tests were performed to determine the relationship between the antihistamines and eruptions. Levocetirizine induced wheals in the skin prick test and a rash in the oral drug provocation test. In contrast, ketotifen induced no reaction in the skin prick test but showed a positive reaction in the oral provocation test. Our case report highlights that children can experience the same types of adverse reactions as seen in adults, and cross-reactivity between various antihistamines can occur.

Adult , Anaphylaxis , Child , Child, Preschool , Drug Eruptions , Exanthema , Histamine Antagonists , Humans , Ketotifen , Pruritus , Skin , Urticaria
An. bras. dermatol ; 93(5): 686-695, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-949961


Abstract: Background: There is a lack of evidence to support acyclovir administration in pityriasis rosea. Objective: To determine the efficacy of acyclovir in patients with typical pityriasis rosea. Methods: A systematic review and meta-analysis of experimental studies was performed in MEDLINE, SCOPUS, EMBASE and others, from January 1990 to October 2016 on acyclovir for pityriasis rosea. Random effect model was used to find the pooled Risk Ratio. Outcomes, evaluated between weeks 1 to 8, were regression of lesions, cessation of lesions, decrease of symptoms and duration of disease. Comparisons were acyclovir vs. placebo; acyclovir vs. symptomatic treatment; acyclovir vs. antibiotic; acyclovir vs. observation and combined therapy (acyclovir plus symptomatic treatment) vs. symptomatic treatment alone. Results: Seven papers were analyzed with 324 participants, of which 159 received acyclovir and 165 were controls. Acyclovir was superior to placebo for complete regression of lesions at week 1 (Risk Ratio 5.72, CI95% 2.36-13.88). However, combined therapy was not superior to symptomatic treatment at week 4 (Risk Ratio 1.46, CI95% 0.93-2.29). Individual studies showed the superiority of acyclovir for the control of symptoms and pruritus. Study limitations: We faced differences designs of trials and inconsistency between reports. Conclusion: Symptomatic treatment is a reasonable option for pityriasis rosea, and the addition of acyclovir is justified for the control of symptoms and pruritus.

Humans , Male , Female , Child , Adult , Antiviral Agents/therapeutic use , Acyclovir/therapeutic use , Pityriasis Rosea/drug therapy , Antiviral Agents/administration & dosage , Placebos , Acyclovir/administration & dosage , Follow-Up Studies , Administration, Topical , Treatment Outcome
An. bras. dermatol ; 93(2): 233-237, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-887191


Abstract: Background: Several dermatoses are mediated by histamine, such as urticaria, angioedema, and papular urticaria. There are no Brazilian studies comparing the potency of antihistamines. Objectives: To evaluate the tolerability and efficacy of the main commercial brand and generic H1 antihistamines, regarding the suppression of the wheal and flare to the histamine test. Methods: A quasi-experimental, open study with 10 healthy adults submitted to the histamine test on the ventral aspect of the forearms. After 20 minutes, wheal and flares were measured. The tests were performed after two hours of intake of dexchlorpheniramine, hydroxyzine, levocetirizine, fexofenadine, cetirizine, loratadine, ebastine, desloratadine, epinastine and rupatadine, as well as generics of loratadine, cetirizine and fexofenadine. Results: All antihistamines presented a reduction in the wheal compared to the control (p <0.02), as well as in the flare, except for rupatadine (p = 0.70). In the internal comparison, cetirizine, fexofenadine, epinastine, levocetirizine, dexchlorpheniramine and hydroxyzine were the most potent, with no difference between them (p > 0.1). As for halo, cetirizine, epinastine, hydroxyzine and fexofenadine were the most potent, with no difference between them (p > 0.1). The most common adverse effect was drowsiness, which was more prevalent among first-generation drugs (p < 0.01). Generic loratadine, fexofenadine and cetirizine halos were higher than their controls (p <0.03).. Study limitations: A single-center study evaluating only aspects related to histamine. Conclusions: Brazilian commercial antihistamines presented different profiles of inhibition of wheal and flares in the histamine test, as well as adverse effects. Generic loratadine, fexofenadine and cetirizine presented larger flares than brand drugs.

Humans , Male , Female , Adult , Middle Aged , Young Adult , Skin/drug effects , Vasodilation/drug effects , Capillary Permeability/drug effects , Histamine , Anti-Allergic Agents/pharmacology , Histamine H1 Antagonists/pharmacology , Reference Values , Skin/immunology , Time Factors , Brazil , Skin Tests/methods , Reproducibility of Results , Drug Hypersensitivity , Non-Randomized Controlled Trials as Topic
Acta otorrinolaringol. cir. cabeza cuello ; 46(4): 294-300, 2018. graf, tab
Article in Spanish | LILACS, COLNAL | ID: biblio-999308


Introducción: La azelastina es un antihistamínico tópico nasal, exento de los molestos efectos sistémicos, la cual asociada con fluticasona, ha mostrado excelentes resultados en el control de la rinitis alérgica. Objetivo: Evaluar los resultados del tratamiento del spray nasal de azelastina y fluticasona. Diseño: Observacional descriptivo prospectivo. Materiales y métodos: Se evaluaron 76 pacientes de ambos sexos, con edades entre los 12 y 59 años, con diagnóstico de rinitis alérgica en el que se midieron los síntomas: obstrucción, prurito, estornudos y rinorrea. La severidad de los síntomas fue valorada por el propio paciente de 0 a 10 pretratamiento, a la semana, dos, tres y cuatro semanas de iniciado el tratamiento, el cual fue igual para todos los pacientes, con control ambiental y la atomización de 2 puff en cada fosa nasal del spray de azelastina y fluticasona. Se hizo seguimiento de los síntomas nasales y la aparición de efectos colaterales. Resultados: Se observó una diferencia estadísticamente significativa entre el puntaje obtenido previo al tratamiento y en la evaluación posterior desde la primera semana de uso y hasta el momento del seguimiento final a la cuarta semana (p<0,0001 Friedman F). Conclusiones: El spray nasal de azelastina y fluticasona, es muy útil en el control de los síntomas de rinitis alérgica, mostrando además un adecuado perfil de seguridad.

Introduction: Azelastine, is a topical nasal antihistamine free of systemic effects, the quality associated with fluticasone, has been excellent in the control of allergic rhinitis. Objective: To evaluate the results of the treatment of the nasal spray of azelastine and fluticasone. Design: Prospective and descriptive study. Methods: 76 patients of both sexes, aged between 12 and 59 years, with a diagnosis of allergic rhinitis in which the symptoms were measured: obstruction, pruritus, sneezing and rhinorrhea. The severity of each symptom was assessed by the patient from 0 to 10 before and after a week, two, three and four weeks, which was the same for all patients, with environmental control and the atomization of 2 puffs in each nostril of the azelastine and fluticasone spray. A follow-up of nasal symptoms and the appearance of side effects. Results: A statistically significant difference was observed between the score obtained before the treatment and in the subsequent evaluation from the first week until the time of the final follow-up at the fourth week (p <0.0001 Friedman F). Conclusion: The nasal spray of azelastine and fluticasone is very useful in the control of the symptoms of allergic rhinitis.

Humans , Rhinitis, Allergic, Perennial , Fluticasone , Glucocorticoids , Histamine Antagonists
Gut and Liver ; : 781-788, 2017.
Article in English | WPRIM | ID: wpr-82310


BACKGROUND/AIMS: Although proton pump inhibitors (PPIs) have been widely used for the prevention and treatment of stress gastric ulcers in hospital settings, there are concerns that PPIs increase the risk of Clostridium difficile infection (CDI). However, little is known about the risk of CDI following PPI and histamine-2 receptor antagonist (H2RA) use. We evaluated the comparative hospital-acquired CDI occurrence risk associated with the concurrent use of PPIs versus H2RAs. METHODS: A systematic search of PubMed, MEDLINE/Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Google Scholar through August 19, 2016, identified 12 studies that reported the hospital-acquired CDI occurrence following H2RA and PPI use for the prevention and treatment of stress gastric ulcers. Random-effects pooled odds ratios and 95% confidence intervals were estimated. Heterogeneity was measured using I², and a meta-regression analysis was conducted. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the overall quality of the evidence. RESULTS: A total of 74,132 patients from 12 observational studies were analyzed. Compared to H2RAs, PPIs increased the risk of CDI by 38.6% (pooled odds ratio, 1.386; 95% confidence interval, 1.152 to 1.668; p=0.001; I²=42.81%). Subgroup analyses of the purpose of study medication use, study site, and study design confirmed the consistency of a greater CDI risk with PPIs than with H2RAs. The overall quality of evidence was rated as low. CONCLUSIONS: The use of PPIs for both the prevention and treatment of stress ulcers was associated with a 38.6% increased risk of hospital-acquired CDI occurrence compared to H2RA use.

Clostridioides difficile , Clostridium , Histamine Antagonists , Humans , Nursing , Odds Ratio , Population Characteristics , Proton Pump Inhibitors , Proton Pumps , Protons , Stomach Ulcer , Ulcer
Asia Pacific Allergy ; (4): 253-256, 2016.
Article in English | WPRIM | ID: wpr-750076


Second-generation antihistamines are widely prescribed for the control of symptoms of allergic inflammation such as itchy hives, coryza, and itchy eyes. In rare circumstances, these drugs might provoke allergic inflammation. Hypersensitivity to bepotastine besilate, a second-generation antihistamine has never been reported. A 17-year-old schoolgirl, whose paroxysmal itchy hives had been controlled with bepotastine, experienced aggravation of the hives. An oral provocation test confirmed her hypersensitivity to bepotastine and cross-reactivity to levocetirizine. She showed no reaction to chlorpheniramine, ketotifen, or olopatadine among the 13 antihistamines tested. While searching for an antihistamine to control her itchy hives, we found that she also exhibited cross-reactivity to various antihistamines with different chemical structures from that of bepotastine, which is not predicted according to the chemical classification of antihistamines. We report a case of hypersensitivity to bepotastine besilate in a patient with chronic spontaneous urticaria.

Adolescent , Chlorpheniramine , Classification , Drug Hypersensitivity , Histamine Antagonists , Humans , Hypersensitivity , Inflammation , Ketotifen , Olopatadine Hydrochloride , Urticaria
Asia Pacific Allergy ; (4): 16-28, 2016.
Article in English | WPRIM | ID: wpr-750052


BACKGROUND: There is limited literature in the management of chronic urticaria in children. Treatment algorithms are generally extrapolated from adult studies. OBJECTIVE: Utility of a weight and age-based algorithm for antihistamines in management of chronic spontaneous urticaria (CSU) in childhood. To document associated factors that predict for step of control of CSU and time taken to attain control of symptoms in children. METHODS: A workgroup comprising of allergists, nurses, and pharmacists convened to develop a stepwise treatment algorithm in management of children with CSU. Sequential patients presenting to the paediatric allergy service with CSU were included in this observational, prospective study. RESULTS: Ninety-eight patients were recruited from September 2012 to September 2013. Majority were male, Chinese with median age 4 years 7 months. A third of patients with CSU had a family history of acute urticaria. Ten point two percent had previously resolved CSU, 25.5% had associated angioedema, and 53.1% had a history of atopy. A total of 96.9% of patients achieved control of symptoms, of which 91.8% achieved control with cetirizine. Fifty percent of all the patients were controlled on step 2 or higher. Forty-seven point eight percent of those on step 2 or higher were between 2 to 6 years of age compared to 32.6% and 19.6% who were 6 years and older and lesser than 2 years of age respectively. Eighty percent of those with previously resolved CSU required an increase to step 2 and above to achieve chronic urticaria control. CONCLUSION: We propose a weight- and age-based titration algorithm for different antihistamines for CSU in children using a stepwise approach to achieve control. This algorithm may improve the management and safety profile for paediatric CSU patients and allow for review in a more systematic manner for physicians dealing with CSU in children.

Adult , Angioedema , Asian Continental Ancestry Group , Cetirizine , Child , Histamine Antagonists , Humans , Hypersensitivity , Male , Pharmacists , Prospective Studies , Urticaria
Asia Pacific Allergy ; (4): 56-66, 2016.
Article in English | WPRIM | ID: wpr-750047


The prevalence of allergic diseases is increasing globally, most particularly in middle- to low-income countries. This article examines the burden of allergic rhinitis and chronic urticaria in the Asia-Pacific region, unmet clinical needs, and the potential role of bilastine in the management of these conditions. An International Advisory Group meeting was convened in association with the Asian Pacific Society of Respirology Annual Congress in November 2014, followed by a literature review, and consensus-based outcomes from the meeting and literature review are described. Regional estimates of the prevalence of allergic rhinitis range from 10% to 50%, while little is known regarding the burden of urticaria in the Asia-Pacific region. A survey of allergy patients in the region identified fast, complete, and long-lasting symptom relief as the medication attributes most important to patients. International treatment guidelines for allergic rhinitis and urticaria advocate the first-line use of second-generation, no-sedating H1-antihistamines, such as bilastine, over their first-generation counterparts and a range of these agents are available to Asia-Pacific patients. The newer agents possess many of the properties of an "ideal" antihistamine (once daily administration, rapid and complete symptom relief, limited potential for drug-drug interactions, minimal side effects). The burgeoning prevalence of allergic diseases in the Asia-Pacific region and the uncontrolled symptoms that these patients experience demand a new antihistamine that offers the highest number of positive features according to the international guidelines.

Asia , Asian Continental Ancestry Group , Consensus , Group Processes , Histamine Antagonists , Humans , Hypersensitivity , Prevalence , Rhinitis, Allergic , Urticaria
Rev. bras. med. fam. comunidade ; 9(31): 159-168, abr./jun. 2014. ilus
Article in Portuguese | LILACS | ID: biblio-879387


Dermatite atópica (DA) é uma inflamação crônica e pruriginosa da pele, que acomete crianças nos primeiros anos de vida. Sua etiologia permanece pouco elucidada, mas sabe-se que ocorre uma disfunção da barreira cutânea que facilita a penetração de alérgenos/irritantes na epiderme, provocando reação inflamatória com predomínio de resposta Th2 em relação a Th1. O diagnóstico é clínico, podendo associar-se com a presença de história familiar e pregressa de atopias, como rinite e asma. A DA manifesta-se por meio de lesões eczematosas, pruriginosas, com presença de eritema, pápulas, vesículas e escamas. Os principais diagnósticos diferenciais são dermatite seborreica, dermatite de contato, psoríase e escabiose. O tratamento baseia-se na educação do paciente e de seus familiares, somado ao controle do prurido com anti-histamínicos e da inflamação com corticoides e inibidores da calcineurina. Devido à alta prevalência e impacto da DA na qualidade de vida de crianças, corrobora-se a importância do diagnóstico precoce e de uma abordagem individualizada.

Atopic dermatitis (AD) is a chronic and inflammatory disease that affects the skin of children in their early stages of life. Its aetiology remains little understood, but it is known that there is a dysfunction of the skin barrier, which facilitates the penetration of allergens/irritants into the epidermis, causing an inflammatory response with a predominance of Th2 response relative to Th1. The diagnosis is clinical and may be associated with previous and family medical history of atopies such as rhinitis and asthma. AD manifests itself through eczematous, pruritic injuries with the presence of erythema, papules, vesicles, and scales. The main differential diagnoses of AD are seborrheic dermatitis, contact dermatitis, psoriasis and scabies. The treatment is based on the education of patients and their families, plus the control of pruritus with antihistamines and of inflammation with corticosteroids or calcineurin inhibitors. Given the high prevalence and impact of AD on the quality of life of paediatric patients, early diagnosis and an individualized approach are paramount.

La dermatitis atópica (DA) es una enfermedad crónica e inflamatorio en la piel, que afecta a los niños en los primeros años de vida. Su etiología sigue siendo poco dilucidado, pero se sabe que existe una disfunción de la barrera de la piel que facilita la penetración de alérgeno/irritante sobre la piel, causando una reacción inflamatoria con predominante respuesta Th2 hacia Th1. El diagnóstico es clínico y puede estar asociado con la presencia de la historia familiar y la historia anterior de enfermedades atópicas, tales como la rinitis y el asma. La DA se manifiesta a través de lesiones eczematosas y pruriginosas, la presencia de eritema, pápulas, vesículas y escamas. Los principales diagnósticos diferenciales son dermatitis seborreica, dermatitis de contacto, la psoriasis y la sarna. El tratamiento se basa en la educación de los pacientes y sus familias, además del control del prurito con antihistamínicos y la inflamación con corticoides y los inhibidores de la calcineurina. Dada la alta prevalencia y el impacto de la DA en la calidad de vida de los pacientes pediátricos, corroborase la importancia del diagnóstico precoz y un enfoque individualizado.

Clinical Diagnosis , Child , Dermatitis, Atopic , Drug Therapy , Histamine Antagonists
Asia Pacific Allergy ; (4): 142-148, 2014.
Article in English | WPRIM | ID: wpr-749995


BACKGROUND: Allergic rhinitis and rhinosinusitis, common and debilitating conditions, should be managed in accordance with guideline recommendations. Guideline adherence shows regional differences. As of now, there is little data from Asia and none from Malaysia on the current treatment practices and unmet needs in the management of these conditions. OBJECTIVE: The objective of this study was to assess the current practice in the management of allergic rhinitis and rhinosinusitis by conducting a survey among ear, nose and throat (ENT) specialists, pharmacists, and general practitioners (GPs) in Malaysia. METHODS: We conducted a survey study among ENT specialists, pharmacists, and GPs in Malaysia, who answered a multiple choice questionnaire focused on the current practice in the management of allergic rhinitis and rhinosinusitis in their respective field. More than 200 ENT specialists, 100 pharmacists, and 200 GPs participated in the survey. RESULTS: Antihistamines were the most preferred choice for the treatment of mild allergic rhinitis by ENT specialists (45%), pharmacists (78%), and GPs (51%), with the most preferable duration of 3 months with antihistamines. Satisfaction with the recommendations in the current Allergic Rhinitis and its Impact on Asthma (ARIA) guideline was high; 66%, 58%, and 89% of the ENT specialists, pharmacists, GPs, respectively, reported that the current ARIA guidelines are sufficient for their clinical/pharmacy practice. CONCLUSION: The current practices in the management of allergic rhinitis in Malaysia are largely in line with the ARIA guidelines. The majority of physicians and pharmacists are satisfied with the recommendations in the ARIA guidelines.

Asia , Asthma , Ear , General Practitioners , Guideline Adherence , Histamine Antagonists , Humans , Malaysia , Nose , Pharmacists , Pharynx , Professional Practice , Rhinitis, Allergic , Sleep Stages , Specialization , Steroids , Surveys and Questionnaires
Article in Korean | WPRIM | ID: wpr-126200


Antihistamines (histamine receptor antagonists) are widely prescribed medicines in the treatment of allergic disorders, especially the symptoms of hypersensitivity reactions, mainly blocking the activity of vasoactive amines to their receptors. Drug adverse reactions such as sleepiness and dry mouth are frequently encountered. However, drug hypersensitivity provoking itchy hives by antihistamines were rarely reported. A 41-year-old female patient visited allergy clinic for generalized itchy hives from time to time, which had been aggravated 3 months before. Whenever she was exposed to antihistamines for treatment, she felt her hives got immediately full-blown. As a screening, she was tested with various antihistamines on her skin, then skin test-negative antihistamines were orally administered. Finally we failed to choose a safe antihistamine for the treatment of her symptoms. We report a case of drug hypersensitivity to various antihistamines with cross-reactions in a patient with chronic urticaria.

Adult , Amines , Cross Reactions , Drug Hypersensitivity , Female , Histamine Antagonists , Humans , Hypersensitivity , Mass Screening , Mouth , Skin , Urticaria
Biomédica (Bogotá) ; 33(4): 503-512, Dec. 2013. ilus, tab
Article in Spanish | LILACS | ID: lil-700468


Introducción. Aproximadamente el 50 % de los casos de urticaria crónica no mejoran adecuadamente con las dosis convencionales de antihistamínicos, por lo cual se han planteado múltiples opciones terapéuticas, entre las cuales el omalizumab es una herramienta novedosa que ahora cuenta con evidencia de alta calidad que soporta su uso en los casos difíciles, que mejora rápidamente el índice sintomático y el uso de medicamentos, y cuenta con un buen perfil de seguridad. Objetivo. Presentar tres casos de mujeres adultas con urticaria crónica espontánea de más de ocho años de evolución, que no mejoraron con el tratamiento con altas dosis de antihistamínicos, asociados a antileucotrienos e inmunomoduladores y en quienes se combinaban varios mecanismos fisiopatológicos: urticaria crónica espontánea con componente de autoinmunidad, componente de presión y urticaria vasculítica. Materiales y métodos. Se reportan los casos con sus respectivas evaluaciones clínicas y de laboratorio, los medicamentos usados y la respuesta después del inicio de omalizumab y se hace una revisión de la literatura científica sobre uso de este medicamento en la urticaria crónica. Resultados. En los tres casos presentados se obtuvo una mejoría completa de los síntomas tras el inicio del omalizumab. Conclusión. El omalizumab es una opción terapéutica exitosa en casos de urticaria crónica de difícil control con vasculitis asociada, cuando se han agotado las opciones propuestas por las guías internacionales.

Introduction: Approximately 50% of chronic urticaria cases do not respond adequately to conventional doses of antihistamines, so a number of other therapeutic options have been suggested. Among these, omalizumab is an innovative tool, which now has high-quality evidence that supports its use in difficult cases, rapidly improving the symptom index and the use of medications with a good safety profile. Objective: To report three cases of adult women with spontaneous chronic urticaria with an evolution of more than eight years, which did not improve with high doses of antihistamines and leukotriene receptor blockers, associated with immunomodulatory therapy in which several etiologic mechanisms were combined: chronic spontaneous urticaria with autoimmune and pressure components, and vasculitis. Materials and methods: We report the cases with their clinical and laboratory evaluations, used medication, the response after the start of omalizumab and we performed a review of the literature on the use of this drug in chronic urticaria. Results: In all the presented cases, we obtained complete improvement of symptoms after starting omalizumab. Conclusion: Omalizumab is a successful treatment option in cases of difficult to control chronic urticaria with associated vasculitis in which the options proposed by international guidelines have been exhausted.

Adult , Female , Humans , Middle Aged , Anti-Allergic Agents/therapeutic use , Antibodies, Anti-Idiotypic/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Urticaria/complications , Urticaria/drug therapy , Vasculitis/complications , Chronic Disease
J. bras. nefrol ; 34(2): 148-152, abr.-jun. 2012. ilus, graf, tab
Article in English | LILACS | ID: lil-643715


INTRODUCTION: Uremic pruritus is common among dialysis patients. Effective treatments are not readily available. Early evidence with antihistamines and gabapentin indicate variable effects. OBJECTIVE: To compare the efficacy and side effects of gabapentin and desloratadine in patients with dialysis pruritus. METHODS: Prospective, open-label, cross-over clinical trial in 22 patients on chronic hemodialysis with sustained pruritus over a period of at least 60 days. After a one-week run-in period, we assigned patients to three weeks of either gabapentin 300 mg thrice weekly or desloratadine 5 mg thrice weekly. After a one-week washout period, each patient crossed-over to the alternate regimen for three more weeks. The primary endpoint of the study was the change in the visual analogue pruritus score (VAS). RESULTS: Nineteen subjects completed the two treatment blocks and were available for analysis. VAS scores decreased with both treatments (5.95 to 4.6 with gabapentin, p = 0.07; 5.89 to 3.4 with desloratadine, p = 0.004), but only desloratadine reached statistical significance. There were no differences when comparing the final pruritus score with gabapentin and desloratadine (4.6 versus 3.4, p = 0.16) Excessive sedation was common with gabapentin. Desloratadine was well tolerated. CONCLUSION: Desloratadine provides significant relief of uremic pruritus compared with no therapy. gabapentin has marginal efficacy. Desloratadine is better tolerated than gabapentin.

INTRODUÇÃO: Prurido urêmico é comum entre pacientes em diálise. Tratamentos eficazes não estão disponíveis até o momento. Provas recentes com anti-histamínicos e gabapentina indicam vários efeitos. OBJETIVO: Comparar a eficiência e os efeitos colaterais da gabapentina e da desloratadina em pacientes com prurido na diálise. MÉTODOS: Estudo prospectivo, aberto e comparativo com 22 pacientes em hemodiálise crônica com prurido constante durante um período de pelo menos 60 dias. Após uma semana, submetemos os pacientes a três semanas de gabapentina 300 mg, três vezes por semana, ou desloratadina 5 mg três vezes por semana. Após um período de eliminação de uma semana, os pacientes trocaram de regime por mais três semanas. O objetivo primário do estudo foi a mudança na escala visual analógica (EVA) de prurido. RESULTADOS: Dezenove indivíduos completaram os dois tratamentos e foram submetidos à análise. Os escores da EVA caíram com ambos os tratamentos (5,95 para 4,6 com gabapentina, p = 0,07; 5,89 para 3,4 com desloratadina, p = 0,004), mas somente a desloratadina teve significância estatística. Nenhuma diferença foi observada ao comparar o escore final do prurido com gabapentina e desloratadina (4,6 versus 3,4, p = 0,16). Excesso de sedação foi comum com gabapentina. A desloratadina teve alto nível de tolerância. CONCLUSÃO: A desloratadina dá alívio significante do prurido urêmico quando comparada a nenhum tratamento. A gabapentina tem eficiência marginal. A desloratadina tem maior nível de tolerância em relação à gabapentina.

Humans , Middle Aged , Amines/therapeutic use , Cyclohexanecarboxylic Acids/therapeutic use , Histamine H1 Antagonists, Non-Sedating/therapeutic use , Loratadine/analogs & derivatives , Pruritus/drug therapy , Renal Dialysis , gamma-Aminobutyric Acid/therapeutic use , Amines/adverse effects , Cross-Over Studies , Cyclohexanecarboxylic Acids/adverse effects , Histamine H1 Antagonists, Non-Sedating/adverse effects , Loratadine/adverse effects , Loratadine/therapeutic use , Prospective Studies , Pruritus/etiology , Renal Dialysis/adverse effects , Uremia/complications , Uremia/therapy , gamma-Aminobutyric Acid/adverse effects
Med. U.P.B ; 29(1): 56-61, ene.-jun. 2010.
Article in Spanish | LILACS, COLNAL | ID: lil-589347


Objetivo: identificar el número de reacciones adversas medicamentosas en pacientes hospitalizados mediante la búsqueda activa de la prescripción de antihistamínicos, biperideno y vitamina K. Metodología: estudio descriptivo entre julio de 2008 y junio de 2009, a través de la búsqueda, en historias clínicas, de la Clínica Universitaria Bolivariana, n=143. Se estimó la frecuencia de reacciones adversas medicamentosas probables o posiblesy el reporte espontáneo médico.Resultados: se evaluaron 892 casos de pacientes hospitalizados con prescripción de antihistamínicos, biperideno y vitamina K; 143 casos fueron incluidos por su asociación con el tratamiento de reacciones adversas medicamentosas probables o posibles. Hubo una frecuencia de casos sin reporte espontáneo médico de 72.7% (n=104), se presentó un tiempo con unamedia de 8.1 días, una mediana de 4 días RIQ (1-11) y un rango en días de (0-37). Conclusión: se observó una baja frecuencia de reacciones adversas medicamentosas con reporte espontáneo médico y ocho días en promedio para el mismo. Por lo tanto, es necesario crear una cultura del reporte espontáneo y oportuno que ayude amejorar la seguridad de los medicamentos administrados.

Objective: the purpose of the present study was to identify the number of adverse drug reactions in hospitalized patients, through active search for prescription of antihistamines, biperiden and vitamin K. Methods: we conducted an observational, descriptive study from July 2008-June 2009, by the search in medical records in the Clinica Universitaria Bolivariana, n=143. We estimated the frequency of probable or possible adverse drug reactions andspontaneous medical report. Results: we assessed 892 inpatient cases with antihistamines, biperiden or vitamin K prescription; 143 cases were includedin the study for their relationship with treatment of possible or probable adverse drug reactions. We found a frequency of cases with no spontaneous medical report in 72.7% (n=104), the time for presentation of the latter was with a mean of 8.1 days, a median of 4 days, IQR (1-11) and a range in days of 0-37. Conclusion: we observed a low frequency of adverse drug reactions with spontaneous medical report and an average of eight days for notification when it was reported. Therefore, it is necessary to promote spontaneous and timely reporting that can help improve the safety in administered drugs.

Humans , Drug-Related Side Effects and Adverse Reactions , Safety , Therapeutics , Pharmaceutical Preparations , Prescriptions , Histamine Antagonists
Article in Chinese | WPRIM | ID: wpr-406525


Objective To investigate the efficiency of intracerebroventricular injection of histamine receptor antagonists on mechanical pain threshold of neuropathic pain in rats. Methods The neuropathic pain rat model was established by partially ligation of the sciatic nerve in 30 rats. Two weeks later, histamine receptor 1 antagonist pyrilamine 1.5 μg or 15 μg was injected intracerebroventricularly in group P1 or P2, histamine receptor 2 antagonist ranitidine 10 μg or 100 μg in group R1 or R2, and normal saline in group C as the control. The pain threshold was measured. Results Compaered with group C,the pain threshold was signifigantly increased in group R1 and R2, especially in group R2 (P<0.05). Conclusion Histamine H2 receptor antagonist can increase pain threshold in rats with neuropathic pain.

An. bras. dermatol ; 82(3): 253-256, maio-jun. 2007. ilus
Article in Portuguese | LILACS-Express | LILACS | ID: lil-458930


Os anti-histamínicos são drogas muito usadas na prática do dermatologista, sendo a primeira escolha no tratamento da urticária crônica. Os efeitos colaterais mais comuns são os relacionados ao sistema nervoso central. A ginecomastia é decorrente de várias causas, entre elas a indução por drogas. Apresenta-se caso de ginecomastia induzida por anti-histamínico H1,em paciente em tratamento de urticária crônica. A investigação laboratorial e radiológica descartou outras causas para a ginecomastia, que involuiu com a retirada da medicação. Objetiva-se discutir os efeitos colaterais dos anti-histamínicos e apresentar caso de ginecomastia induzida por drogas.

Antihistaminic drugs are very commonly used in dermatological practice, and are the first-line therapy to chronic urticaria. The commonest side effects are related to the central nervous system. Gynecomastia, in turn, may be due to a myriad of disorders, including the use of medication. The case of H1 antihistaminic-induced gynecomastia in a patient undergoing chronic urticaria treatment is reported. Radiological and laboratorial investigations discarded other possible causes for the gynecomastia, which disappeared after removal of the medication. Antihistaminic-related side effects, including gynecomastia, are discussed.