Antihistamine effects on actual driving performance in a standard test: a summary of Dutch experience, 1989-94

The review summarizes the major results of eight double-blind, placebo-controlled, volunteer studies undertaken by three independent institutions for showing the effects on actual driving performance of "sedating" and "nonsedating" antihistamines (respectively, triprolidine, diphenhydramine, clemastine and terfenadine, loratadine, cetirizine, acrivastine, mizolastine, and ebastine). A common, standardized test was used that measures driving impairment from vehicular "weaving" (i.e., standard deviation of lateral position (SDLP)). Logical relationships were found between impairment and dose, time after dosing, and repeated doses over 4–5 days. The newer drugs were generally less impairing, but differences existed among their effects, and none was unimpairing at doses 1–2 × the currently recommended levels. One or possibly two of the newer drugs possessed both performance-enhancing and -impairing properties, depending on dose, suggesting two mechanisms of action.     

Differential modulation of mediator release from human basophils and mast cells by mizolastine

BACKGROUND: Basophils and mast cells play a major role in the pathogenesis of allergic disorders by releasing several proinflammatory mediators. Some histamine H1 receptor antagonists exert anti-inflammatory activities by modulating mediator release from basophils and mast cells. OBJECTIVE: To study the in vitro effects of mizolastine, an H1 receptor antagonist, on the release of eicosanoids, histamine and IL-4 from human basophils and lung mast cells. METHODS AND RESULTS: Mizolastine (10(-7)-10(-5) M) concentration-dependently inhibited the release of cysteinyl leukotriene C4 from anti-IgE-stimulated basophils (IC(50): 3.85+/-0.28 microM) and mast cells (IC(50): 3.92+/-0.41 microM). The same concentrations of mizolastine did not affect anti-IgE-induced prostaglandin D2 release from lung mast cells. In contrast, mizolastine enhanced up to 80% IgE-mediated histamine release (EC(50): 4.63+/-0.14 microM) from basophils, but not from mast cells and it significantly potentiated IL-4 release from basophils induced by anti-IgE. Mizolastine did not affect histamine release from basophils induced by formyl peptide, whereas it inhibited cysteinyl leukotriene C4 release (IC(50): 1.86+/-0.24 microM). Blockade of cytosolic phospholipase A2 and arachidonic acid mobilization by pyrrolidine-1 did not alter the effect of mizolastine on histamine release from basophils, thereby excluding accumulation of arachidonic acid metabolic intermediates as the cause of this effect. Mizolastine did not influence anti-IgE-induced activation of extracellular signal-regulated kinase-1 and -2 (ERK-1 and -2) in human basophils. CONCLUSIONS: Mizolastine efficiently inhibits LTC4 synthesis in human basophils and mast cells presumably by interfering with 5-lipoxygenase. In contrast, it enhances histamine and IL-4 release only from anti-IgE-stimulated basophils. Therefore, mizolastine differentially regulates the production of mediators from basophils and mast cells in a cell- and stimulus-specific fashion.     

咪唑斯汀治疗慢性荨麻疹临床疗效评价及对血清IL-4水平的影响

目的：评价咪唑斯汀治疗慢性荨麻疹的疗效，探讨IL-4在慢性荨麻疹发病中的作用。方法：对32例慢性荨麻疹患用咪唑斯汀治疗，评价疗效，记录不良反应。同时用ELISA法检测慢性荨麻疹患治疗前后及正常人血清IL-4的水平。结果：治疗1、2wk后总有效率分别为62．5％、84．4％(P＜0．01)，不良反应3例。治疗前血清IL-4水平较正常人明显升高(P＜0．01)；治疗后IL-4水平下降(P＜0．01)，与正常人比较差异不甚明显(P＞0．05)。结论：咪唑斯汀是一种有效、安全的治疗慢性荨麻疹的药物，能降低慢性荨麻疹患血清IL-4的水平。     

RP-HPLC测定人血浆中咪唑斯汀浓度

 目的测定人血浆中咪唑斯汀的浓度方法采用反相高效液相色谱法,色谱柱为日本HiQ silC₁₈ V(4.6 mm×150 mm,5μm),检测波长为285nm,流动相为0.025 mol·L^-1磷酸二氢钾缓冲液-乙腈-甲醇(75:25:5)(pH=2.58).流速0.5 mL·mm^-1。结果回归方程Y=0.002 8X+0.0013(r=0.999 4),其线性范围为20.8～554.7 ng·mL^-1,最低检测浓度为13.87 ng·mL^-1(S/N>3),提取回收率在77.93%～88.84%之间(RSD为2.49%-7.45%),日内和日间RSD分别为4.58%～8.25%和2.08%～7.65% 结论该法操做简便、快速、准确、重现性好,适用于咪唑斯汀的药动学研究。     

Mizolastine in the treatment of seasonal allergic rhinoconjunctivitis: a European clinical experience with 5408 patients managed in daily practice (PANEOS SAR Study)

BACKGROUND: Mizolastine, a potent H1 antihistamine with additional antiallergic properties, is marketed for the treatment of allergic rhinoconjunctivitis and urticaria. The objective was to investigate the safety and effectiveness of mizolastine under conditions of daily practice in patients with seasonal allergic rhinoconjunctivitis (SAR). METHODS: In an open multicenter study, mizolastine 10 mg daily was administered for 14 days during the pollen season. Nasal and ocular symptoms, time to onset of symptom relief, and effect of the drug on diurnal alertness were evaluated. Safety was evaluated on the basis of self-reported adverse events (AE). RESULTS: A total of 5408 patients (36+/-14 years of age, females=57%) with a history of SAR for 8+/-9 years were treated for a mean of 17.1+/-5.0 days. SAR symptoms improved in 93% and decreased by at least 50% in 86% of patients; 78% reported improvement after the first drug intake and 51% from the first hour. Sixty-nine percent considered mizolastine more effective than other antihistamines taken previously. The incidence of AE was low (3.8%). CONCLUSION: The high responder rate, the rapid onset of action, and the low incidence of AE observed in this large multicenter study confirm the previously reported beneficial efficacy and safety of mizolastine in the management of SAR.     

Mizolastine therapy also has an effect on nasal blockade in perennial allergic rhinoconjunctivitis

Background Mizolastine is a new, nonsedating antihistamine with additional anti-inflammatory properties, providing relief in allergic rhinitis and urticaria. The aim of this study was to determine the efficacy and safety of 10 mg o.d. mizolastine given to patients with perennial allergic rhinoconjunctivitis.
Methods This double-blind, placebo-controlled study involved 257 patients suffering from the disease for more than 10 years. They were allocated, after a 1-week placebo run-in, to receive mizolastine (n = 133) or placebo (n = 124) for 4 weeks.
Results Mizolastine-treated patients showed significantly greater alleviation of nasal symptoms, with a mean decrease of 36% compared with pretreatment score, compared to a mean decrease of 10% in placebo patients (P<0.001). Nasal blockade responded favorably to mizolastine compared to placebo and was associated with a significant reduction in rhinoscopy findings (P=0.030). Likewise, the mean ocular symptom score decreased 40% in mizolastine-treated patients compared to 7% in the placebo group (P<0.003). The safety profile of mizolastine was satisfactory and similar to that of placebo.
Conclusions In patients suffering from perennial allergic rhinoconjunctivitis, mizolastine is a safe and potent treatment. Mizolastine's pronounced effect on nasal blockade could possibly be linked to its anti-inflammatory properties.     

咪唑斯汀对健康人心脏复极化影响的随机、双盲、安慰剂对照研究

目的：研究治疗剂量咪唑斯汀对健康志愿者心室复极化的影响。方法：采用随机、双盲、安慰剂对照，给予40名健康志愿者随机服用咪唑斯汀或安慰剂3d，以12导联心电图记录服药前及服药后1、2、13、24h心电图变化。结果：用药前、后健康志愿者所有心电图指标均在正常范围，咪唑斯汀与安慰剂组心电图指标(心率、P—R间期、QRS波、Q—T间期)相比差异无显著性。结论：短期应用治疗剂量咪唑斯汀对健康志愿者心室复极化无影响。     

Inhibition of mediator and cytokine release from dispersed nasal polyp cells by mizolastine

BACKGROUND: Mizolastine is a potent and selective H1-receptor antagonist with antiallergic properties; in in-vitro animal models, mizolastine was shown to inhibit 5-lipoxygenase activity and to decrease the release of leukotrienes (LT) and tumor necrosis factor-alpha (TNF-alpha). This study investigated the effects of three concentrations of mizolastine (0.1, 1.0, 10 microM) on the release of LT (LTB4 and LTC4/D4) and prostaglandin D2 (PGD2) after stimulation by anti-IgE, and on the spontaneous release of cytokines (TNF-alpha and granulocyte/macrophage-colony-stimulating factor [GM-CSF]), from dispersed cells obtained from surgically resected nasal polyps of patients with nasal polyposis. METHODS: Cells from nasal polyps were obtained using enzymatic dispersion. For experiments involving the measurement of LT and PGD2, the cells were preincubated with mizolastine or its dissolution vehicle for 20 min prior to challenge with 10 microg/ml epsilon-chain specific anti-IgE for 45 min at 37 degrees C; for the cytokine release, cells were incubated with mizolastine or its dissolution vehicle for 24 h. LT and PGD2 were measured by enzyme immunoassay (EIA) and cytokines by enzyme-linked immunosorbent assay (ELISA) using commercially available kits. RESULTS: Mizolastine inhibited significantly and in a dose-dependent manner the release of LTB4 and TNF-alpha at all concentrations, LTC4/D4 at 10 microM, and GM-CSF from 1 microM; no effect was observed on the release of PGD2. CONCLUSION: Mizolastine inhibits the release of LT, TNF-alpha and GM-CSF in this in vitro model, which mimics closely the inflammatory cells of allergic rhinitis.     

咪唑斯汀联合粉尘螨注射液对慢性荨麻疹患者血清CC型趋化因子水平的影响

目的：研究粉尘螨特异性免疫治疗对慢性荨麻疹患者CC型趋化因子表达水平的影响，探讨特异性免疫治疗的作用机制。方法：将64例粉尘螨过敏的慢性荨麻疹患者随机分为两组，分别采用粉尘螨注射液联合咪唑斯汀治疗或单用咪唑斯汀治疗。应用双抗体夹心酶联免疫吸附试验（ELISA）检测治疗前、后以及正常对照血清中调节激活正常T细胞表达和分泌的细胞因子（RANTES）及单核细胞趋化蛋白-1（MCP-1）的水平。结果：两组慢性荨麻疹患者治疗前血清RANTES和MCP-1的水平均显著高于各自治疗后第16周末（P分别〈0．001和0．05）及正常对照（P均〈0．001）；联合治疗组在治疗后第16周末的RANTES和MCP-1水平以及每周咪唑斯汀用量的评分均显著低于单用咪唑斯汀组（P〈0．01）。结论：RANTES和MCP-1在慢性荨麻疹的发病中起重要作用，特异性免疫治疗对慢性荨麻疹的治疗效果可能与其使RANTES和MCP-1下调的作用有关。