Combined H1 and H2 antihistamine therapy in chronic urticaria

Chronic urticaria is a frustrating problem for the patient and the physician. The cause is usually undetermined, and the therapy is directed toward controlling symptoms. Recent evidence that human skin blood vessels possess H2 receptors, as well as the commonly recognized H1 receptors, suggests a possible reason for the frequent failure of H1 antihistamines in controlling this disorder. Eighteen patients with refractory chronic idiopathic urticaria participated in a double-blind, cross-over study to evaluate the efficacy of combined H1 (hydroxyzine hydrochloride) and H2 (cimetidine) antihistamines vs H1 antihistamines alone. This study indicates that combined H1 and H2 antihistamine therapy is statistically more effective than H1 antihistamines alone in controlling the symptoms of chronic urticaria.     

Review of H1 antihistamines in the treatment of chronic idiopathic urticaria

Chronic idiopathic urticaria (CIU) can have a profound effect on patient quality of life (QOL). Ideally, any therapy used to treat CIU should be effective across a wide range of doses without causing unwanted side effects; a wide therapeutic window allows the physician to tailor treatment to the individual. Oral H1 antihistamines are the mainstay of therapy for CIU, but agents within this class diverge in their individual therapeutic indices. The literature was reviewed to compare the currently available oral H1 antihistamines regarding their efficacy and safety at a wide range of doses. If sedation and cognitive impairment are considered relevant to treatment selection due to their effect on QOL and safety, then newer-generation agents should be selected over older-generation antihistamines. There are few well-controlled clinical studies in which newer-generation agents have been directly compared. Moreover, there are no evidence-based data demonstrating statistical superiority of one newer-generation agent over another in the treatment of CIU. However, of the newer agents, those that are labelled nonsedating at recommended doses (fexofenadine, loratadine, and desloratadine) should be selected over cetirizine. In cases where the physician judges that a higher-than-recommended dose should be prescribed, or when the patient is likely to take a higher dose, the relative safety profile of these agents demands detailed consideration.     

法莫替丁与H_1受体拮抗剂联合治疗慢性荨麻疹临床观察

３０例单用Ｈ１受体拮抗剂治疗疗效差的慢性荨麻疹患者,联合应用法莫替丁治疗４周。结果显示临床痊愈率和显效率分别为８３．３％和１０％,表明法莫替丁与Ｈ１受体拮抗剂联合用于这类单用Ｈ１受体拮抗剂不能奏效的慢性荨麻疹患者是一种有效的治疗方法。     

Evaluation of H2 receptor antagonists in chronic idiopathic urticaria

H1-antagonist (hydroxyzine hydrochloride) in dosage of 10 mg-25 mg thrice a day failed to elicit satisfactory response in 60 out of 170 patients of chronic idiopathic urticaria. Additional administration of H2-antagonist (cimetidine) in dosage of 200 mg four times a day, in patients not responding earlier to H1-antagonist alones exhibited moderate to good improvement of various parameters of urticaria in approximately 85% patients.     

不同剂量氮(艹卓)斯汀及联合西咪替丁治疗慢性荨麻疹疗效观察

目的:对比不同剂量氮(艹卓)斯汀及联合西咪替丁治疗慢性荨麻疹的疗效及不良反应.方法:采用随机人组开放观察同样疗程不同剂量氮(艹卓)斯汀(A、B两组)及联合西咪替丁(B c组)治疗慢性荨麻疹的疗效及不良反应.A组患者采用氮(艹卓)斯汀4mg/d治疗:B组患者采用氮(艹卓)斯汀2 mg/d治疗;B C组患者采用氮(艹卓)斯汀2 mg/d联合西咪替丁400 mg/d治疗.3组胄者均在28 d时观察疗效及不良反应.结果:A组显效27例(81.8%),良效4例(12.1%),微效2例(6.1%);B组显效21例(61.8%),良效6例(17.6%).微效7例(2.06%);B C组显效26例(78.8%),良效3例(9.1%),微效4例(12.1%).A组出现口干1例,困倦2例;B组出现口干3例,头昏、困倦1例;B C组出现困倦3例,口干1例.均不影响疗效.结论:A组及B C组患者的疗效相似,且高于B组,差异有统计学意义(P<0.05).     

不同剂量氮斯汀及联合西咪替丁治疗慢性荨麻疹疗效观察

目的:对比不同剂量氮斯汀及联合西咪替丁治疗慢性荨麻疹的疗效及不良反应。方法:采用随机入组开放观察同样疗程不同剂量氮斯汀(A、B两组)及联合西咪替丁(B C组)治疗慢性荨麻疹的疗效及不良反应。A组患者采用氮斯汀4mg/d治疗;B组患者采用氮斯汀2mg/d治疗;B C组患者采用氮斯汀2mg/d联合西咪替丁400mg/d治疗。3组患者均在28d时观察疗效及不良反应。结果:A组显效27例(81.8%),良效4例(12.1%),微效2例(6.1%);B组显效21例(61.8%),良效6例(17.6%),微效7例(2.06%);B C组显效26例(78.8%),良效3例(9.1%),微效4例(12.1%)。A组出现口干1例,困倦2例;B组出现口干3例,头昏、困倦1例;B C组出现困倦3例,口干1例。均不影响疗效。结论:A组及B C组患者的疗效相似,且高于B组,差异有统计学意义(P<0.05)。     

Cetirizine: a new H1 antagonist with antieosinophilic activity in chronic urticaria.

Although the action of H1 antagonists in the early phase of IgE-mediated, allergic skin reactions is well established, the effect of these antihistamines on the ensuing late-phase reaction has only recently been investigated. The eosinophilic late-phase reaction, sometimes associated with the tissue damage that occurs in chronic idiopathic urticaria, is important in allergic responses. Cetirizine is a new H1 antagonist with potent inhibitory action against the infiltration of eosinophils into involved tissue, thereby affecting the late-phase reaction. No other antihistamine has yet been reported to possess this antieosinophilic property. The mechanisms by which cetirizine acts against eosinophils, although not thoroughly understood, seem to involve direct action against these cells.     

Thl-Th2失衡与慢性荨麻疹

Th1-Th2亚群失衡在慢性荨麻疹发生及发展中的作用正日益引起人们的重视。研究表明,慢性荨麻疹是由于相应变应原的刺激引起Th2为主的免疫应答,从而产生临床症状。该文阐述了Th1-Th2的分化途径、与慢性荨麻疹的关系及相应治疗方法。     

复方甘草酸苷片联合氯雷他定治疗儿童慢性荨麻疹的疗效观察

目的：探讨复方甘草酸苷片联合氯雷他定治疗儿童慢性荨麻疹的疗效及安全性。方法：将80例慢性荨麻疹患儿分为两组,治疗组40例口服复方甘草酸苷片75mg,3次/d,氯雷他定5mg,1次/d,对照组40例口服氯雷他定5mg,1次/d。两组疗程均为4周,治疗后第14,30天评价疗效。结果：治疗结束时症状/体征总评分,治疗组优于对照组（P〈0.01）;治疗组总有效率82.5%,明显优于对照组的57.5%（χ^2=5.952,P〈0.05）;且无明显副作用。结论：复方甘草酸苷片联合氯雷他定治疗儿童慢性特发性荨麻疹疗效满意,安全性好。     

Effectiveness of as‐needed antihistamines in chronic spontaneous urticaria patients under omalizumab treatment

The question how second‐generation antihistamines (sgAHs) should be used when chronic spontaneous urticaria (CSU) is under control with omalizumab is still unanswered. This study aimed to investigate the effectiveness of as‐needed sgAHs in patients with well‐controlled urticaria under omalizumab treatment. Patients from four different urticaria centers who were treated with omalizumab 300 mg/4 weeks for at least 3 months, had well‐controlled urticaria (Urticaria Control Test: 16 > UCT≥12) and were using sgAHs only if needed, were included in this study. In order to assess effectiveness of sgAHs, change in the itch, hives, and total itch‐hives scores before and after sgAHs were evaluated using modified urticaria activity score‐twice daily. Fifty‐three patients [38 female (71.7%)] with mean age 41.1 ± 11.4 years were included in this study. Median sgAH intake per patient throughout the 4 week‐intervals was 3 (2–5) tablets. sgAH intake decreased itch, hives and total itch‐hives scores 45.7% ± 52.9, 42.4% ± 39.1, and 50.2% ± 51.1, respectively (P < .001 for all). This decrease was similar in both isolated‐urticaria and urticaria‐and‐angioedema phenotypes. Baseline IgE levels were positively correlated with the decrease of three symptom scores (r = 0.31, P = .05; r = 0.375, P = .017; r = 0.31, P = .05, respectively) that showed in patients with higher baseline total IgE levels, as needed sgAH intake decreased the symptom scores less. Our study showed that sgAHs may still be an effective option for the treatment of the intermittent symptoms in patients with well‐controlled urticaria under omalizumab treatment. Baseline total IgE levels may be used as a potential biomarker for sgAH effectiveness in these patients.     

Therapy of urticaria with H1 and H2 antihistaminics. Results of clinical and experimental studies

The antipruritic effect of modern H1- and H2-receptor blockers in chronic urticaria, that had been clinically proved, was experimentally studied by means of the histamine weal test. The H2-antihistamine preparation ranidine alone did not clearly reduce weals or erythemas induced by histamine when compared with a placebo. As expected, both parameters were markedly reduced by the H1-antihistamine preparation terfenadine. After combined administration of both drugs, the effect of the H1-blocker proved to be significantly increased. We discuss the possible mode of action and the consequences for anti-allergic therapy.     

慢性特发性荨麻疹患者嗜碱粒细胞转录激活蛋白-1的相关研究

目的 探讨转录激活蛋白1（AP-1）在慢性特发性荨麻疹（CIU）发病中的作用。方法 采用嗜碱粒细胞免疫磁珠分离技术,提取CIU患者和正常人对照者外周血嗜碱粒细胞,进一步分离嗜碱粒细胞核蛋白。分别通过TransAM AP-1 Family试剂盒和Western印迹法,研究CIU患者和正常人对照者外周血嗜碱粒细胞AP-1家族因子DNA结合活性的改变及P-c-jun蛋白的表达情况。结果 CIU组与正常人对照组相比,嗜碱粒细胞AP-1家族因子DNA结合活性存在一定的差异。CIU组P-c-jun、c-fos、Fos-B、Jun-B、Jun-D因子DNA结合活性高于正常人对照组,其中P-c-jun、Jun-D差异有统计学意义（P ＜ 0.05）。Fra-1因子DNA结合活性检测中,CIU组低于正常人对照组,但差异无统计学意义（P ＞ 0.05）。Western印迹法发现, CIU组P-c-jun（Ser73）蛋白表达较之正常人对照组升高（P ＜ 0.05）,而P-c-jun（Ser63）蛋白表达两组之间差异无统计学意义。结论 CIU患者嗜碱粒细胞AP-1家族部分因子DNA结合活性的改变及P-c-jun（Ser73）蛋白表达升高可能为CIU发病环节之一。