Pityriasis rubra pilaris post-infection due COVID-19: case report / Pitiriasis rubra pilaris post-infección por COVID-19: reporte de un caso

Abstract Case description: 32-month-old boy, IgG positive for SARS-CoV-2, presented to the emergency department with dermatologic lesions. Clinical findings: Four days before admission, he presented skin eruptions with redness and pruritus on hands and feet. Generalized papular erythema was evidenced, upper extremities with diffuse erythematosquamous plaques, palmoplantar keratoderma, so he was evaluated by a dermatologist who diagnosed pityriasis rubra pilaris. Treatment and outcome: rehydrating cream, cetirizine 0.5 mg/kg/day every two days, and prednisolone 2 mg/kg/day in the morning. He was discharged after 14 days, the patient presented clinical improvement, but the erythematous lesion persisted on the trunk and extremities. In the evaluation, after three months, the patient did not show the described lesions, evidencing an improvement and clinical resolution of the dermatological problems. Clinical relevance: We report a patient with pityriasis rubra piloris associated with a post-infection by SARS-CoV-2 that had not been described before.

Resumen Descripción del caso: Niño 32 meses de vida, con IgG positivo para SARS-CoV-2, acude al servicio de emergencia por presentar lesiones dermatológicas. Hallazgos clínicos: Cuatro días antes del ingreso presentó erupciones en la piel, con enrojecimiento y prurito en manos y pies. Se evidenció eritema papular generalizado, extremidades superiores con placas eritematoescamosas difusas, queratodermia palmo-plantar por lo que es evaluado por dermatólogo quien diagnostica pitiriasis rubra pilaris. Tratamiento y resultado: Crema rehidratantes, cetirizina 0.5 mg/kg/día cada 2 días y prednisolona 2 mg/kg/día por la mañana. Fue dado de alta a los 14 días, el paciente presenta mejora clínica, pero aún persiste la lesión eritematosa en tronco y extremidades. En la evaluación a los tres meses el paciente no mostró las lesiones descritas, evidenciando una mejoría y resolución clínica de los problemas dermatológicos. Relevancia clínica: Se reporta un paciente con afectación por pitiriasis rubra piloris asociado a una post-infección por SARS-CoV-2 que no se había descrito antes.

Gingivoestomatitis herpética severa en paciente con cardiopatía congénita; reporte de caso clínico / Gengivoestomatite herpética grave em paciente com cardiopatia congênita; relato de caso clínico / Severe herpetic gingivostomatitis in a patient with congenital heart disease; clinical case report

La gingivoestomatitis herpética corres-ponde a la manifestación primaria de la infección por virus herpes simple tipo I que se presenta con mayor frecuencia en lactantes mayores y preescolares. Objeti-vo: describir abordaje y manejo de gingi-vo estomatitis herpética en una paciente con cardiopatía congénita y cuadro de desnutrición severa. El caso se refiere a paciente femenina de 16 meses de edad a quien le fue realizado anamnesis, exa-men clínicoe interconsultas con servicios de pediatría, patología, medicina bucal, infectología. El diagnóstico incluyó co-municación intraventricular, desnutrición severa y gingivoestomatitis herpética. Se realizó tratamiento paliativo para el dolor, terapia antiviral (aciclovir en suspensión 1cc cada 6 horas por 7 días) y tratamiento tópico (sucralfato en suspensión 1g/5ml mezclado en partes iguales con cetirizina en suspensión. 5 mg / 5 ml, 3 veces al día directamente sobre las lesiones) durante 14 días logrando reducción de la sintoma-tologia. Conclusiones: el correcto manejo multidisciplinario permitió lograr dismi-nución en tamaño y número de las lesio-nes en cavidad oral, orientación dietética y canalización apropiada.

A gengivoestomatite herpética correspon-de à manifestação primária da infecção pelo vírus herpes simplex tipo I, que ocorre com mais frequência em bebês e em idade pré-escolar. Objetivo: descrever a aborda-gem e o tratamento da estomatite herpética gengival em um paciente com cardiopatia congênita e desnutrição grave. O caso re-fere-se a uma paciente de 16 meses de ida-de, submetida a anamnese, exame clínico e interconsultas com serviços de pediatria, patologia, medicina bucal, infectologia. O diagnóstico incluiu comunicação intraven-tricular, desnutrição grave e gengivosto-matite herpética. Foram realizados trata-mento paliativo para dor, terapia antiviral (suspensão de aciclovir 1cc a cada 6 horas por 7 dias) e tratamento tópico (suspensão de sucralfato 1g / 5ml misturado em partes iguais com suspensão de cetirizina 5mg / 5ml, 3 vezes ao dia diretamente. lesões) por 14 dias, alcançando redução dos sintomas. Conclusões: o correto manejo multidisci-plinar permitiu diminuir o tamanho e o número de lesões na cavidade oral, orien-tação alimentar e canalização adequada.

Herpetic gingivostomatitis is the pri-mary manifestation of herpes simplex virus type I infection, common in older infants and preschoolers. Objective: to describe the approach and management of herpetic stomatitis in a patient with congenital heart disease and severe mal-nutrition. The case refers to a 16-mon-th-old female patient who underwent an anamnesis, clinical examination, and inter-consultations with pediatric, pa-thological, oral medicine services, and Diagnosis included intraventricular communication, severe malnutrition, and herpetic gingivostomatitis. Palliati-ve treatment for pain, antiviral therapy (acyclovir suspension 1cc every 6 hours for 7 days) and topical treatment (sucral-fate suspension 1g / 5ml mixed in equal parts with cetirizine suspension 5mg / 5ml, 3 times a day directly, were perfor-med. about injuries) for 14 days. Conclu-sions: multidisciplinary, management, allowed to obtain, clinical diagnosis and establish a treatment plan with positive outcome,decreasing oral cavity dietary guidance and appropriate channeling.

Urticária crônica espontânea de difícil tratamento: existiria um lugar para usar dapsona na falta de omalizumabe? / Spontaneous chronic urticaria of difficult treatment: is there a place to use dapsone in the lack of omalizumab?

Muitos estudos sugerem que a urticária crônica espontânea (UCE) seja uma doença autoimune. A primeira linha de tratamento consiste no uso de anti-histamínicos H1 de segunda geração, que podem ser empregados em até quatro vezes a dose recomendada. A Dapsona ­ diaminodifenil sulfona (DDS) ­ é um quimioterápico com propriedades antimicrobianas e anti-inflamatórias. Em dermatologia, a DDS é usada em doenças nas quais predominam neutrófilos. O omalizumabe é um anticorpo monoclonal, que se liga às moléculas de IgE na circulação e impede que estas IgEs se liguem aos seus receptores. Omalizumabe é recomendado como terceira linha de tratamento de pacientes com UCE, refratários a anti-histamínicos em doses quadriplicadas, na dose de 300 mg a cada quatro semanas. Paciente do sexo feminino, com 41 anos, com UCE sem períodos de remissão por mais de um ano, tratada sem sucesso, com diferentes anti-histamínicos. Existia uma extensa investigação laboratorial. Foi-lhe administrada Cetirizina (anti-histamínico H1 de segunda geração), em elevada dose (40 mg/dia) associada a antileucotrieno (10 mg/dia) por um período de duas semanas. No final do período, a UCE manteve-se completamente inalterada. Foi realizada biopsias das urticas com diagnóstico histopatológico "Dermatite neutrofílica com infiltrado intersticial neutrofílico, sem vasculite ativa e sem eosinófilos". Na falta de omalizumabe, a paciente continuou o tratamento com Cetirizina (40 mg/dia), agora associado a 100 mg/dia de DDS. Atualmente, após 16 semanas de observação, seu quadro mantém-se estável, com urticas ausentes, afora alguns surtos leves, intermitentes. Poder-se-ia usar a DDS na UCE refratária a anti-histamínicos? Alguns estudos bem conduzidos oferecem essa oportunidade.

Many studies suggest that chronic spontaneous urticaria (CSU) is an autoimmune disease. The first line of treatment consists of the use of second-generation H1 antihistamines, which can be used at up to four times the recommended dose. dapsone ­ diaminodiphenyl sulfone (DDS) ­ is a chemotherapeutic agent with antimicrobial and anti-inflammatory properties. In dermatology, DDS is used to treat diseases in which neutrophils predominate. Omalizumab is a monoclonal antibody that binds to IgE molecules in the circulation and prevents these IgEs from binding to their receptors. Omalizumab is recommended as a third-line treatment for patients with CSU refractory to antihistamines in quadruplicate doses, at a dose of 300 mg every four weeks. A 41 year-old female patient with CSU without remission periods for more than one year was unsuccessfully treated with different antihistamines. An extensive laboratory investigation was conducted. She was given a high dose (40 mg/day) of cetirizine (second-generation H1 antihistamine) associated with antileukotriene (10 mg/ day) for a period of two weeks. At the end of the period, CSU remained completely unchanged. Wheal biopsies were performed, with histopathological diagnosis: neutrophilic dermatitis with neutrophilic interstitial infiltrate, without active vasculitis and without eosinophils. In the absence of omalizumab, the patient continued treatment with cetirizine (40 mg/day), now associated with 100 mg/day of DDS. Currently, after 16 weeks of observation, her condition remains stable and the wheals disappeared, apart from some mild, intermittent outbreaks. Could DDS be used in the CSU refractory to antihistamines? Some well-conducted studies offer this opportunity.

Perfil dos portadores de urticária crônica do hospital universitário de Salvador-BA / Profile of patients with chronic urticaria at the University Hospital of Salvador-BA

Introdução: A urticária crônica é caracterizada pela presença de placas eritematosas cutâneas com prurido por mais de 6 semanas, com ou sem angioedema. Estudos indicam que essa afecção afeta cerca de 1% da população mundial, sendo que a maior parte desses casos de causas idiopáticas. A qualidade de vida em pacientes com urticária pode ser gravemente prejudicada. Os objetivos desse estudo são caracterizar o perfil epidemiológico da urticária crônica dentro de um serviço especializado público no estado da Bahia, bem como avaliar a influência dessa disfunção na qualidade de vida desses pacientes. Métodos: Trata-se de um estudo descritivo observacional a partir de informações extraídas dos prontuários de 135 pacientes atendidos no serviço de Alergia e Imunologia do Ambulatório Magalhães Neto, pertencente ao Complexo do Hospital Universitário Edgard Santos da Universidade Federal da Bahia. Resultados: Indivíduos do sexo feminino representam 80,0% do número total de participantes desse estudo; 71 indivíduos (52,6%) têm mais de 45 anos de idade; foi verificada a presença de angioedema associado à urticária em 52,0% dos participantes. O tempo médio do início dos sintomas associados à doença foi de 7,3 anos, e o tempo médio de diagnóstico da doença foi de 4,4 anos. Com relação à presença de comorbidades, a mais prevalente foi a rinite alérgica (27,0%). O fármaco mais utilizado no tratamento desses participantes foi a Cetirizina, que foi prescrita em 36,0% dos casos. Para 31% a urticária crônica espontânea afeta muito a sua qualidade de vida. Conclusões: O perfil dos participantes desse estudo se assemelha ao de outros em estudos realizados no mundo. A urticária crônica impacta predominantemente de forma moderada a qualidade de vida, e mais fortemente as dimensões sono/estado mental e alimentação.

Introduction: Chronic urticaria is characterized by the presence of erythematous skin plaques with pruritus for more than 6 weeks, with or without angioedema. Studies indicate that this condition affects about 1% of the world population, with idiopathic causes accounting for most cases. Quality of life in patients with urticaria can be severely impaired. The objectives of this study were to characterize the epidemiological profile of chronic urticaria within a specialized public service in the state of Bahia and to evaluate the influence of this disorder on the quality of life of these patients. Methods: This was an observational descriptive study based on information extracted from the medical records of 135 patients seen at the Department of Allergy and Immunology of the Magalhaes Neto Outpatient Clinic, which belongs to the Edgard Santos University Hospital Complex of the Federal University of Bahia. Results: Women accounted for 80.0% of the sample; 71 individuals (52.6%) were over 45 years of age. Presence of angioedema was associated with urticaria in 52.0% of participants. The mean time to the onset of disease-associated symptoms was 7.3 years, and the mean time to disease diagnosis was 4.4 years. Regarding the presence of comorbidities, allergic rhinitis was the most prevalent disorder (27.0%). Cetirizine was the most commonly used drug for treatment, being prescribed in 36.0% of cases. Chronic spontaneous urticaria was reported to greatly affect quality of life by 31% of participants. Conclusions: The profile of the participants in this study resembles that of participants in studies conducted worldwide. Overall, chronic urticaria has a moderate impact on quality of life and a stronger impact on the dimensions of sleep / mental state and diet.

Prescription Profile and Clinical Outcomes in Patients with Allergic Rhinitis Treated with Oral Antihistamines or Nasal Corticosteroids

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.

A stepwise approach in the management of chronic spontaneous urticaria in children

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.

A case of levocetirizine-induced liver injury

Levocetirizine is a second-generation nonsedative antihistaminic agent that has been demonstrated to be safe and effective for treating allergic disease. There was only one case report of levocetirizine-induced liver toxicity, but a liver biopsy was not performed. In this article, we present the first case of levocetirizine-induced liver injury with histologic findings. A 48-year-old man was hospitalized with jaundice and generalized pruritus that had developed after 2 months of therapy with levocetirizine for prurigo nodularis. Laboratory findings revealed acute hepatitis with cholestasis. A liver biopsy demonstrated portal inflammation and hepatitis with apoptotic hepatocytes. The patient fully recovered 3 weeks after withdrawing levocetirizine. Although levocetirizine is safe and effective, physicians should be aware of its potential hepatotoxicity.

Effects of Early Cell Damage from Repetitive Intermittent Fever Exposure in Alopecia Progression and Evaluation of New Candidate Drugs: Ibuprofen, Menthol, and Cetirizine

BACKGROUND: Alopecia areata (AA) is a very disturbing and expensive disorder in which the exact etiology is not known and it is yet to be treated completely well. Most alopecia patients exhibit some inflammation in the hair follicles regardless of the causes. The clinical symptoms of alopecia present very diversely while the prime symptom is local intermittent fever which are related to inflamed cells. METHODS: This study aimed to evaluate how repetitive intermittent fever can damage the normal human dermal fibroblast (NHDF) cells and investigated the cytotoxic and proliferative effects after application of new candidate drugs (ibuprofen, menthol, cetirizine) for alopecia in comparison to minoxidil. RESULTS: This study demonstrated that ibuprofen, menthol, or/and cetirizine can prevent or slow down the damage of NHDF cells from intermittent fever in early alopecia. Aggressive preventative intervention with those drugs before complete destruction of hair follicle by excessive repetitive fever, is a very important step for alopecia therapy and these drugs are recommended as candidate drugs for alopecia in the future. CONCLUSION: Aggressive preventative intervention with drugs before complete destruction of hair follicles (NHDF cells) by excessive repetitive fever is a very important step for alopecia therapy or progression.

Effects of cetirizine in dogs with chronic atopic dermatitis: a randomized, double blind, placebo-controlled trial

This study was conducted to evaluate the effects of cetirizine in dogs with atopic dermatitis (AD) while fulfilling Favrot's diagnostic clinical criteria. Dogs received either 3 mg/kg cetirizine (n = 27), or a placebo (n = 23) orally once daily for 14 days in a randomized, double blind, placebo-controlled study, without concomitant medication. The effects were evaluated using a pruritus visual analog scale at the start (day 0) and at day 14. After 14 days, cetirizine clearly had no effect on the pruritus in dogs with chronic AD, and there was no significant difference between groups. These findings indicated that cetirizine (and likely H1 histamine receptor antagonists in general) should not be recommended for the control of pruritus in dogs with long term allergies.

Bubbly orange baby: A rare case of diffuse cutaneous mastocytosis, bullous type

Mastocytosis is an uncommon, sporadic, heterogenous illness resulting from hyperplasia of mast cells. Diffuse cutaneous mastocytosis is the rarest subtype of mastocytosis affecting children, with bullous mastocytosis being its least common variety. Systemic manifestations like nausea, vomiting, bone pain, diarrhea, and central nervous system abnormalities are less common in children than adults. We report a four-month old male who presented with a two-month history of generalized yellowish to tan macules, papules and plaques with peau d'orange texture, with some blisters and erosions on the back, abdomen and scalp. Darier's sign was positive. Baseline laboratory workup were negative for systemic involvement. CD117 and Giemsa staining were positive for mast cells. Based on the clinical findings and histopathologic results, a diagnosis of bullous mastocytosis was made. Treatment included ketotifen drops, mupirocin cream and cetirizine drops, which resulted in flattening of most lesions and resolution of blisters and erosions.

Clinical effects of gabapentin on the treatment of pruritus of scar resulting from deep partial-thickness burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the clinical effects of gabapentin on the treatment of pruritus of scar resulting from deep partial-thickness burn.</p><p><b>METHODS</b>A total of fifty-eight patients suffering from pruritus of scar after deep partial-thickness burn were hospitalized from January 2013 to January 2014. Patients were divided into placebo group (n =18, treated with oral vitamin C in the dose of 100 mg for 4 weeks, twice per day) , cetirizine group (n = 20, treated with oral cetirizine in the dose of 10 mg for 4 weeks, twice per day) , and gabapentin group (n = 20, treated with oral gabapentin in the dose of 300 mg for 4 weeks, twice per day) . Before treatment and on post treatment day (PTD) 3 and 28, the Visual Analog Scale (VAS) was used to assess the itching degree, and the mean scores were recorded. The remission rates of pruritus on PTD 3 and 28 were calculated. The adverse effects were observed during treatment. Data were processed with analysis of variance, q test, and chi-square test.</p><p><b>RESULTS</b>Compared with that before treatment, the itching degree of patients with light, moderate, and severe itching in placebo group was not relieved after treatment; the itching degree of patients with moderate or severe itching in cetirizine group was alleviated after treatment, but not in patients with light itching; itching degree of all patients in gabapentin group was significantly relieved after treatment. There were no obvious differences in VAS scores among the 3 groups before treatment (F = 2.78, P > 0.05). On PTD 3 and 28, the VAS scores of patients in both gabapentin group [(2.3 ± 0.8) and (0.6 ± 0.3) points] and cetirizine group [(4.2 ± 1.7) and (2.8 ± 1.2) points] were lower than those in placebo group [(5.7 ± 2.0) and (5.7 ± 1.9) points, with q values from 6.70 to 7.75, P values below 0.05]. The VAS scores of patients in gabapentin group on PTD 3 and 28 were lower than those in cetirizine group (with q values respectively 6.30 and 6.90, P values below 0.05). The remission rates of pruritus of patients in gabapentin group on PTD 3 and 28 were respectively (66 ± 20)% and (91 ± 17)%, and they were higher than those in cetirizine group [(33 ± 8)% and (56 ± 14)%, with q values respectively 4.70 and 3.82, P values below 0.05]. The remission rate of pruritus of patients in placebo group on PTD 3 and 28 was 0, which was lower than that of the other 2 groups each (with q values from 3.94 to 6.76, P values below 0.05). During the course of treatment, 5 patients in gabapentin group suffered from adverse effects including mild-to-moderate drowsiness and dizziness, but they disappeared one week later. No adverse effects were observed in patients of the other two groups.</p><p><b>CONCLUSIONS</b>For patients with deep partial-thickness burn, gabapentin can effectively alleviate scar itching after wound healing with safety.</p>

Therapeutic Plasmapheresis Enabling Radioactive Iodine Treatment in a Patient with Thyrotoxicosis

Therapeutic plasma exchange (TPE) is one possible treatment for patients resistant to conventional antithyroid drugs or requiring urgent attention for thyrotoxicosis. We report a 35-yr-old man with thyrotoxicosis, ultimately attributed to Graves' disease in whom antithyroid drug used initially was soon discontinued, due to abnormal liver function, and replaced by Lugol's solution. Three weeks later, an escape phenomenon (to Lugol's solution) was apparent, so we performed TPE to control the thyrotoxicosis. Two courses of TPE by a centrifugal type machine resulted in diminished levels of thyroid hormone levels, which then rebounded after another two courses of membrane filtration type TPE. However, the patient could be treated with radioactive iodine therapy without any complications at present.

Crecimiento bacteriano de Streptococcus mutans frente a la cetirizina y prednisona con y sin sacarosa: estudio in vitro / Bacterial growth of Streptococcus mutans exposed to cetirizine and prednisone with and without sucrose: in vitro study

Objetivos: Comparar el crecimiento de Streptococus mutans antes y después de la aplicación de cetirizina y prednisona con y sin sacarosa a las 6, 12, 24 y 36 horas. Métodos: Diseño experimental, para ello se utilizó una muestra de 84 tubos de ensayo, 6 tubos por cada una de las medicinas o controles utilizados. Las variables que se consideraron fueron medicinas pediátricas con edulcorantes divididas en dos grupos: cetirizinas y prednisonas. En el grupo de las cetirizinas se consideraron las cetirizinas comerciales Hisaler®, Lergium® y Rigotax®, así como los preparados de cetirizina con xilitol, sacarosa y aspartame. En el grupo de las prednisonas se consideraron las prednisonas comerciales: Cortiprex® y Nisona® así como los preparados de prednisona con sacarosa y otros edulcorantes. La técnica que se empleó fue la de turbimetría la cual nos da el indicador absorvancia. Resultados: los resultados fueron leídos a las 6, 12, 24 y 36 horas. Conclusiones: Las medicinas comerciales que presentaron menor crecimiento de Streptococcus mutans fueron Rigotax® y Nisona®. Los preparados que presentaron menor crecimiento de Streptoccoccus mutans fueron cetirizina con aspartame y prednisona con edulcorante. Las medicinas comerciales presentaron diferencias estadísticamente significativas con sus respectivos preparados, produciéndose menor crecimiento de Streptococcus mutans en las medicinas comerciales.

Objetives: To compare the growth of Streptococcus mutans, before and after the application of cetirizine and prednisone with and without sucrose at 6, 12, 24 and 36 hours. Methods: The type of study was experimental. To carry it on, a sample of 84 test tubes was used, 6 tubes for each of the medications or controls. The variables considered were pediatric medication with sweeteners, divided in two groups: cetirizines and prednisones. In the cetirizines groups, those over the counter were: Hisaler®, Lergium® and Rigotax®; those that in their formulas included cetirizine with xylitol, sucrose, and aspartame. In the prednisone groups, which are over the counter, the following were found: Cortiprex® and Nisona®, as well as those that in their formulas included prednisone with saccarose and other sweeteners. The method used was turbimetry with the spectrophotometer, to meassure: absorbency. Results: The results were read at 6, 12, 24 and 36 hours. Conclusions: The commercial medications that showed less growth of the Streptococcus mutans, were Rigotax® and Nisona®. The preparation that showed less growth of the Streptococcus mutans were cetirizine with aspartame and prednisone with sorbitol. Over the counter medications showed significant statistical differences with their respective preparation, producing less growth of the Streptococcus mutans in over the counter medications.

Clinical characteristics and combined use of medicine analysis of 2 991 hospitalized patients with psoriasis based on real world database / 中国中药杂志

To analyze the clinical characteristics and combined use of chemical and traditional Chinese medicine (TCM) medicine of hospitalized patients with psoriasis base on real world database, 2 991 cases of hospitalized patients with psoriasis in hospital information system (HIS) database from 16 hospitals in China were analyzed for general hospitalization information, combined diseases and combined use of drugs et al. The results showed that half of inpatients aged 18-45 years old. The most common syndrome of TCM was intrinsic blood heat. More than 1/3 inpatients' hospitalization time was 18-25 days, and the average expense of hospitalization was 6 989. 20 RMB. The top five combined diseases were hypertension, non-alcoholic fatty liver disease, diabetes, upper respiratory tract infection and lipoprotein disorders. Medicine information analysis showed 599 chemical medicines and 341 TCMs were used and combined use of drugs was common in clinical practice. Licorice extract medicine was the most common combined TCM with western medicine; in the next two places were compound Qingdai capsule and tripterygium glycosides. The most common combined use of chemical medicines were Vitamin C, calcium gluconate, ketotifen, cetirizine, retinoic acid and external use glucocorticoid. Anti-inflammatory and liver protection, clearing heat and toxic materials, activating blood and dissolving stasis were the most common combined TCM medicine with western medicine, while the most common combined chemical medicine with TCM were anti-allergic, anti-infection, glucocorticoid and retinoic acid. In conclusion, half of hospitalized patients of psoriasis were young adults. The main type of combined diseases was metabolic disorders and upper respiratory infections. Combined use of chemical medicine and TCM was common in clinical practice. Licorice extract medicine was the most common combined TCM with western medicine.

Determination of enantiomeric impurity in levocetirizine tablets by capillary electrophoresis / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To determine enantiomeric impurity in levocetirizine tablets by using capillary electrophoresis.</p><p><b>METHODS</b>The effects of pH and the concentrations of sulfated-Β-cyclodextrin (S-Β-CD) and buffer salt on chiral resolution were examined with S-Β-CD as chiral selector.</p><p><b>RESULTS</b>A good enantioseparation of cetirizine was achieved with 30 mmol/L NaH2PO4 buffer solution (pH 7.0) containing 20 g/L of S-Β-CD.</p><p><b>CONCLUSION</b>The method developed in the study is sensitive and reliable for determination of enantiomeric impurity in levocetirizine tablets.</p>

The Modulatory Role of Spinally Located Histamine Receptors in the Regulation of the Blood Glucose Level in D-Glucose-Fed Mice

The possible roles of spinal histamine receptors in the regulation of the blood glucose level were studied in ICR mice. Mice were intrathecally (i.t.) treated with histamine 1 (H1) receptor agonist (2-pyridylethylamine) or antagonist (cetirizine), histamine 2 (H2) receptor agonist (dimaprit) or antagonist (ranitidine), histamine 3 (H3) receptor agonist (alpha-methylhistamine) or antagonist (carcinine) and histamine 4 (H4) receptor agonist (VUF 8430) or antagonist (JNJ 7777120), and the blood glucose level was measured at 30, 60 and 120 min after i.t. administration. The i.t. injection with alpha-methylhistamine, but not carcinine slightly caused an elevation of the blood glucose level. In addition, histamine H1, H2, and H4 receptor agonists and antagonists did not affect the blood glucose level. In D-glucose-fed model, i.t. pretreatment with cetirizine enhanced the blood glucose level, whereas 2-pyridylethylamine did not affect. The i.t. pretreatment with dimaprit, but not ranitidine, enhanced the blood glucose level in D-glucose-fed model. In addition, alpha-methylhistamine, but not carcinine, slightly but significantly enhanced the blood glucose level D-glucose-fed model. Finally, i.t. pretreatment with JNJ 7777120, but not VUF 8430, slightly but significantly increased the blood glucose level. Although histamine receptors themselves located at the spinal cord do not exert any effect on the regulation of the blood glucose level, our results suggest that the activation of spinal histamine H2 receptors and the blockade of spinal histamine H1 or H3 receptors may play modulatory roles for up-regulation and down-regulation, respectively, of the blood glucose level in D-glucose fed model.

Validating a stability indicating HPLC method for kinetic study of cetirizine degradation in acidic and oxidative conditions

A stability indicating High-Performance Liquid Chromatography [HPLC] method was validated and used to study the degradation of cetirizine dihydrochloride in acidic and oxidative conditions. The separation was carried out on a Symmetry C18 column and a mixture of 50 mM KH[2]PO[4] and acetonitrile [60:40 v/v, pH = 3.5] was used as the mobile phase. The method was linear over the range of 1-20 micro g/mL of cetirizine dihydrochloride [r[2] > 0.999] and the within-day and between-day precision values were less than 1.5%. The results showed that cetirizine dihydrochloride was unstable in 2 M HCl and 0.5% H[2]O[2]. The kinetics of the acidic degradation showed a pseudo-first-order reaction in the temperature range of 70-90[degree sign]C. In addition, the kinetics of hydrogen peroxide mediated degradation was pseudo-first-order in the temperature range of 50-80[degree sign]C

HPTLC-densitometric determination of cetirizine and montelukast analysis in combined tablet dosage forms

A simple, accurate and rapid high performance thin layer chromatography [HPTLC]-densitometric method was developed for separation and determination of cetirizine [CET] as a long acting antihistamine and montelukast [MON] as an antileukotriene in pharmaceutical dosage forms. The compounds were separated on silica gel 60 F[254] HPTLC plates using a mixture of ethyl acetate: methanol: ammonia solution [25%] [14: 3: 2 v/v/v] as mobile phase. The plates were developed vertically up to a distance of 80 mm. Compact spots of both cetirizine [R[f] = 0.30 +/- 0.01] and montelukast [R[f] = 0.52 +/- 0.02] were obtained. UV detection was performed at 230 nm. Quantitative analysis was performed by absorbance densitometry using peak area. The method was validated in terms of linearity, precision, accuracy, limit of detection [LOD], and limit of quantification [LOQ]. The calibration curves were linear in the range of 40-2000 ng spot[-1] for cetirizine and 120-1000 ng spot[-1] for montelukast. For MON, recovery varied in range of 99.20-100.88% with RSD ranging from 1.02 to 1.90% and for CET, recovery varied in range of 98.13-100.05% with RSD ranging from 1.57 to 1.85%. The LODs were found to be 3.94 and 2.08 ng spot[-1] for CET and MON, respectively. It was observed that the proposed HPTLC method could be used for efficient analysis and monitoring of the CET and MON in combined tablet dosage forms, more convenient with better precision and accuracy than HPLC method

Comparision of efficacy of levocetirizine with montelukast and levocetirizine alone in persistent allergic rhinitis

To compare the efficacy of levocetirizine with montelukast and levocetirizine alone in patients with persistent allergic rhinitis in our setup. Patients with symptoms of AR attending ENT clinic were registered and divided into two groups based on drug given. Patients with odd numbers were included in group A receiving levocetirizine 5mg with montelukast 10mg once daily while patients with even numbers were included in group B receiving only levocetirizine 5mg once daily. Data was collected at visit 1 prior to medication, visit 2 one week after medication and visit 3 two weeks after medication. Medication history review, nasal symptom assessment and anterior rhinoscopy were done at each visit. Patients were evaluated for rhinorrhea, sneezing, nasal itching and nasal obstruction on a scale. Total symptom complex score [TSCS] was calculated by adding scores of all four variables under study using proforma. Lower the score more effective will be the drug. One hundred twenty four patients were included in study; 63 were male and 61 were female. TSCS was 9 -10 in 73.3% patients at visit 1 in levocetirizine + montelukast group that improved to 4-5 in 28.3% and 3- 4 in 65% patients at visit 2 and 3 respectively. Patients receiving levocetirizine alone had TSCS of 9 to 10 in 52.9% at visit 1 with an improvement to 3-4 in 9.4% and 49.1% at visit 2 and visit 3 respectively. Levocetirizine with montelukast is superior to levocetirizine alone in controlling overall symptoms of AR.

A case of levocetirizine-induced fixed drug eruption and cross-reaction with piperazine derivatives

Fixed drug eruption is an uncommon adverse drug reaction caused by delayed cell-mediated hypersensitivity. Levocetirizine is an active (R)-enatiomer of cetirizine and there have been a few reports of fixed drug eruption related to these antihistamines. We experienced a case of levocetirizine-induced fixed drug eruption and cross-reaction with other piperazine derivatives confirmed by patch test. A 73-year-old female patient presented with recurrent generalized itching, cutaneous bullae formation, rash and multiple pigmentation at fixed sites after taking drugs for common cold. She took bepotastine besilate (Talion®) and levocetirizine (Xyzal®) as antihistamine. She took acetaminophen, pseudoephedrine 60 mg / triprolidine 2.5 mg (Actifed®), dihydrocodeinebitartrate 5 mg / di-methylephedrine hydrochloride 17.5 mg / chlorpheniramine maleate 1.5 mg / guaifenesin 50 mg (Codening®) and aluminium hydroxide 200 mg / magnesium carbonate 120 mg (Antad®) at the same time. Patch test was done with suspected drugs and the result was positive with levocetirizine. We additionally performed patch test for other antihistamines such as cetirizine, hydroxyzine, fexofenadine and loratadine. Piperazine derivatives (cetirizine and hydroxyzine) were positive, but piperidine derivatives (fexofenadine and loratadine) were negative to patch test. There was no adverse drug reaction when she was challenged with fexofenadine. We report a case of levocetirizine-induced fixed drug eruption confirmed by patch test. Cross-reactions were only observed in the piperazine derivatives and piperidine antihistamine was tolerant to the patient.