Efficacy of beclomethasone nasal solution, flunisolide, and cromolyn in relieving symptoms of ragweed allergy

Although three effective topical treatments for allergic rhinitis are available, little information to assist the clinician in choosing among them has been reported. Therefore, we conducted a randomized clinical trial to compare beclomethasone nasal solution, flunisolide, and cromolyn with placebo in 120 patients with hay fever during the ragweed season of 1984. We found that all three agents were superior to placebo (P less than 0.001) and that the glucocorticoids were more effective than cromolyn (P less than 0.001). Surprisingly, we also found that these intranasal treatments considerably reduced the symptoms of seasonal asthma. Further study of this therapeutic advantage is needed.     

Causality Assessment of Olfactory and Gustatory Dysfunction Associated with Intranasal Fluticasone Propionate: Application of the Bradford Hill Criteria

Causality assessment is crucial to post-marketing pharmacovigilance and helps optimize safe and appropriate use of medicines by patients in the real world. Self-reported olfactory and gustatory dysfunction are common in the general population as well as in patients with allergic rhinitis and nasal polyposis. Intranasal corticosteroids, including intranasal fluticasone propionate (INFP), are amongst the most effective drugs indicated in the treatment of allergic rhinitis and nasal polyposis. While intranasal corticosteroids are associated with olfactory and gustatory dysfunction and are currently labeled for these adverse events, causality assessment has not been performed to date. Although there is no single widely accepted method to assess causality in pharmacovigilance, the Bradford Hill criteria offer a robust and comprehensive approach because nine distinct aspects of an observed potential drug–event association are assessed. In this literature-based narrative review, Hill’s criteria were applied to determine causal inference between INFP and olfactory and gustatory dysfunction.     

Indications for allergen immunotherapy during pregnancy

Allergen immunotherapy has been proven to be an efficacious and valuable tool in the treatment of the allergic patient with perennial rhinitis who is intolerant of medications or has moderate to severe asthma. It may also be useful for the allergic pregnant patient to reduce the severity of asthma or rhinitis, and possibly to prevent the complications of severe asthma. It may reduce the use of other medications that are undesirable during pregnancy. Allergen immunotherapy has been shown to be safe for both the mother and fetus during pregnancy. It does not need to be stopped during pregnancy, but the maintenance dose should be modified. Immunotherapy plays an important role in the treatment of severe allergic disease by virtue of its capacity to reduce airway hyperresponsiveness and late-phase airway responses that lead to inflammation and chronic symptoms.     

支气管哮喘合并过敏性鼻炎的中西医结合治疗

目的研究中西医结合治疗支气管哮喘合并过敏性鼻炎的临床效果。方法随机抽取2010年1月至2011年6月间收治支气管哮喘合并过敏性鼻炎的患者100例,并随机将其分为治疗组和对照组,每组50例。对照组采用生黄芪15 g,党参12 g,白术、当归、熟地黄、茯苓各10 g,法半夏、陈皮、紫苏子各6 g,柴胡、防风、荆芥、羌活、射干、杏仁、紫菀、款冬花各5 g,麻黄4 g,白芥子、甘草各3 g,将此剂熬制后服用。治疗组是对照组的基础上采用硫酸沙丁胺醇雾化溶液雾化吸入治疗方式进行治疗。并将两组患者的过敏性鼻炎体征评分及肺功能的变化进行统计分析。结果治疗组患者通过治疗后,患者过敏性鼻炎体征评分无显著性差异(P>0.05)。治疗组患者的肺功能改善情况显著优于对照组的改善(P<0.05)。结论中西医结合联合治疗支气管哮喘合并过敏性鼻炎能够充分地改善患者的鼻炎症状,改善肺功能,促进患者的康复。     

鼻内镜手术治疗结构异常性慢性鼻炎

目的探讨有结构异常的慢性鼻炎的手术治疗方法并评价其效果。方法对67例分别有鼻中隔偏曲、下鼻甲代偿性肥大、钩突和筛泡肥大、中鼻甲肥大和内移的慢性鼻炎患者，在鼻内镜下应用电动切割器进行微创手术治疗，随访半年以上。结果痊愈39例(58．21％)，显效21例(31．34％)，有效4例(5．97％)，无效3例(4．48％)；总有效率为95．52％，无1例并发症出现。结论有结构异常的慢性鼻炎患者有必要尽早行鼻内镜下微创手术治疗，伴变应性鼻炎者，效果不肯定。     

药物和聚焦超声治疗变应性鼻炎的随机对照研究

目的探讨药物和聚焦超声治疗中-重度持续性变应性鼻炎(allergic rhinitis,AR)的临床疗效及安全性。方法100例中-重度持续性AR根据随机分配方案(完全随机设计),按1∶1比例随机分配到药物组和聚焦超声组,每组各50例。药物组予鼻用皮质类固醇布地奈德鼻喷剂,以及抗组胺药氯雷他定,治疗4周;聚焦超声组使用CZB型超声波鼻炎治疗仪进行治疗。治疗结束后随访6个月进行疗效和安全性评估。结果药物组显效率24%,有效率36%,无效率40%,总有效率为60%;聚焦超声组显效率38%,有效率50%,无效率12%,总有效率为88%。两组总有效率差异有统计学意义(P<0.05)。术后患者均未出现并发症。结论鼻内镜下采用聚焦超声治疗中-重度持续性AR具有操作简单、创伤小等优点,安全性高,近期效果优于药物组。     

Pharmacotherapy of asthma and allergic rhinitis

It has become easier to treat and control the symptoms of asthma, while the treatment of allergies remains directed toward the prevention and blockade of histamine-induced symptoms. This article details treatment options, including beta-2 selective sympathomimetic agonists, methods of delivery, theophylline, cromolyn, corticosteroids, antihistamines, decongestants, and intranasal steroids.     

Azatadine maleate/pseudoephedrine sulfate repetabs versus placebo in the treatment of severe seasonal allergic rhinitis

The symptoms of seasonal allergic rhinitis can be alleviated by the use of an antihistamine and a decongestant. The efficacy and safety of the combination of azatadine maleate and pseudoephedrine sulfate were examined in this double-blind study comparing active drug to placebo. While 74% of the patients administered the combination drug showed marked improvement in the signs and symptoms of seasonal allergic rhinitis, only 29% of patients receiving placebo demonstrated improvement. Adverse reactions were mild and transient.     

Desloratadine: a nonsedating antihistamine

OBJECTIVE: To review information on desloratadine, a nonsedating antihistamine. DATA SOURCES: An English-language MEDLINE search was conducted (1966-July 2002). References of identified articles were subsequently reviewed for additional data. Schering Corporation provided unpublished information. STUDY SELECTION/DATA EXTRACTION: Articles and abstracts pertaining to desloratadine were considered for inclusion, with emphasis on randomized, placebo-controlled, double-blind trials. DATA SYNTHESIS: Desloratadine is approved for the treatment of symptoms associated with seasonal allergic rhinitis (SAR), perennial allergic rhinitis (PAR), and chronic idiopathic urticaria (CIU) in patients aged > or =12 years. In placebo-controlled trials, desloratadine demonstrated superior efficacy as a once-daily treatment of SAR, PAR, and CIU. Data suggest that desloratadine has antiinflammatory and decongestant activity. CONCLUSIONS: Desloratadine appears to be a "me-too" agent, with no major differences compared with other second-generation antihistamines.     

Effectiveness of specific immunotherapy in the treatment of allergic rhinitis: an analysis of randomized, prospective, single- or double-blind, placebo-controlled studies

BACKGROUND: The effectiveness of specific immunotherapy (SIT) in the treatment of allergic rhinitis has been supported by empirical evidence and clinical experience. OBJECTIVE: This report is an analysis of multiple studies involving patients with documented allergic rhinitis. METHODS: All studies of the effectiveness of SIT in the treatment of allergic rhinitis published in English between the years 1966 and 1996 were identified through a MEDLINE search. All prospective, single- or double-blind, placebo-controlled studies were included in the analysis. One author (R.N.R.) extracted data from the studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model for a variety of clinical measures in studies that permitted the extraction of numbers of patients with positive and negative outcomes. RESULTS: Data were extracted from 16 studies of the clinical effectiveness of SIT in the treatment of allergic rhinitis, involving 759 patients (546 adults, 53 children, 160 all ages). In 15 (94%) of the studies, investigators concluded that SIT was effective. In the remaining study (the only one conducted in children), investigators concluded that SIT was not effective. Symptoms of allergic rhinitis were more likely to improve in patients receiving SIT than in the comparison patients (OR 1.81, 95% CI 1.48 to 2.23). Symptom-medication scores were significantly lower in patients receiving SIT than in the comparison patients in all studies using such measures (P < 0.05). CONCLUSION: Results of this analysis support the conclusion that SIT is effective in the treatment of allergic rhinitis.     

Allergic rhinitis. A useful guide to diagnosis and treatment

Patients presenting with typical signs and symptoms of allergic rhinitis may respond to avoidance of allergens and to medications for symptomatic relief. Treatment may include antihistamines, decongestants, cromolyn sodium, and/or topical nasal steroids. Patients whose symptoms are refractory to these therapeutic measures should be referred to an allergist for further evaluation and consideration for possible allergen immunotherapy.     

Experience in clinical use of primalan (mequitazine) in allergology

AIM: To study efficacy of primalan (mequitasine) in the treatment of allergic rhinoconjunctivitis and chronic recurrent urticaria. MATERIAL AND METHODS: The study included 140 patients. Of them, 60 patients had allergic rhinitis, 80 patients had chronic recurrent urticaria. All the patients received primalan (mequitasin) in a dose 10 mg/day (5 mg twice daily or a single dose 10 mg). The disease symptoms and side effects of primalan were assessed for 28 days of the treatment. RESULTS: Primalan (mequitasin) proved to be highly effective against allergic rhinitis (good and very good response--76%, satisfactory--20%) and chronic recurrent urticaria (the response in 90% patients). Good primalan tolerance was reported. Side effects were moderate and did not require the drug withdrawal (sleepiness in 6.6%, dryness of the mucosa in 5%). CONCLUSION: Primalan (mequitasin) can be recommended for wide application in therapy of allergic rhinitis and chronic recurrent urticaria.     

孟鲁司特联合补肾温肺方治疗支气管哮喘合并变应性鼻炎的临床分析

[摘要]目的 观察孟鲁司特联合补肾温肺方对支气管哮喘合并变应性鼻炎的疗效，并探讨其发病机制。方法 将本科40例患者随机分为对照组和观察组，对照组服用孟鲁司特，观察组在此基础上加服中药方剂补肾温肺方。结果 观察组治疗后支气管哮喘和变应性鼻炎的有效率分别为90.0%、85.0%，明显优于对照组的60.0%和55.0%（P<0.05）；IgE、FEV、PEF、哮喘症状、鼻炎症状和生活质量等指标明显得到改善，且均优于对照组（P<0.05）。结论 支气管哮喘患者往往合并变应性鼻炎，应及早发现，采用孟鲁司特联合补肾温肺方进行综合治疗，可取得较好疗效。     

Delayed genomic and acute nongenomic action of glucocorticosteroids in seasonal allergic rhinitis

BACKGROUND: Glucocorticosteroids are effective in the treatment of allergic rhinitis, a disease characterized by a variety of symptoms, e.g. rhinorrhea and itching. The time course of symptomatic relief for allergic rhinitis by steroids has not been examined in detail to date, although the onset of steroid action is one of the main discriminations between genomic and nongenomic actions of steroids. We therefore investigated the time course of subjective and objective measures of nasal affection after steroid administration in patients with allergic rhinitis following specific allergen challenge. METHODS: Six female and 18 male volunteers (median age 26 years) with a history of allergic rhinitis but currently free of symptoms were included in this randomized, placebo-controlled, double-blind, three-period crossover study. A single dose of either betamethasone (60 mg), methylprednisolone (400 mg) or placebo was given intravenously, 5 min after intranasal allergen provocation. After 10, 20, 60, 150 and 240 min, nasal itching and nasal obstruction were assessed using a standardized visual analogue scale. In addition, nasal airflow was measured by anterior rhinomanometry. RESULTS: Nasal itching was markedly reduced following either of the two steroids within 10 min after administration of study drug. Itching was depressed by 38% following betamethasone (P<0.05) and by 18% following methylprednisolone (P=0.07) compared with placebo. Nasal airflow and nasal obstruction were not significantly altered by steroids during the first 2 h of the study. However, after 150 min, nasal airflow was 21% rsp. 19% higher after methylprednisolone and betamethasone (P<0.05) compared with placebo. After 240 min, nasal airflow was increased by 20% following betamethasone (P<0.05) and by 19% following methylprednisolone. Nasal obstruction was also beneficially affected by both steroids 150 and 240 min after administration compared with placebo (P<0.05 for both time points following betamethasone). CONCLUSION: This study for the first time shows rapid in vivo effects of external glucocorticosteroids in humans. Itching, a pathophysiologically complex sensation, is favourably influenced by steroids within 10 min, therefore presumably via nongenomic mechanisms. Though no detailed mechanisms can be derived from this study, steroid interaction with receptors in the central nervous system may play an important role in mediating this effect.     

Observations with tinset tablet in allergic respiratory tract diseases

The effect of Tinset tablet (30 mg oxatomide) has been examined in 68 patients suffering from allergic diseases of the upper respiratory tract or from allergic diseases accidentally accompanying different pulmonary diseases. In general the daily doses were 2 x 1 tab., occasionally 2 x 2 tab., a number of 12-16-year old patients received only 1 tab. daily. On the basis of the clinical symptoms, spirometric examinations, and global evaluation it has been concluded that the drug may be used most successfully in seasonal rhinitis, allergodermatosis, and allergic conjunctivitis cases and in extrinsic allergic asthma of children. The therapeutic effectiveness of the drug is insignificant in perennial rhinitis and adult extrinsic astham cases. The somnolence-inducing effect of the drug is notable (it developed in 50% of the patients). In 23 of the 68 patients weight-gain, in 3 cases each gastric complaint or dryness of mouth developed.     

A comparison of the efficacy and tolerability of olopatadine hydrochloride 0.1% ophthalmic solution and cromolyn sodium 2% ophthalmic solution in seasonal allergic conjunctivitis

BACKGROUND: Treatments for allergic conjunctivitis have various mechanisms of action. Cromolyn sodium stabilizes conjunctival mast cells by preventing calcium influx across the cell membrane, whereas olopatadine hydrochloride is both an antihistamine and a mast cell stabilizer. OBJECTIVE: This study compared the efficacy and tolerability of olopatadine and cromolyn in controlling the ocular signs and symptoms of seasonal allergic conjunctivitis. METHODS: This was a multicenter, randomized, double-masked, parallel-group trial. One group instilled olopatadine 0.1% ophthalmic solution and placebo BID, and the other instilled cromolyn 2% ophthalmic solution QID, both for 6 weeks. The formulation of cromolyn used in this study is currently available only in Europe and Australia. RESULTS: The intent-to-treat efficacy and safety analyses included 185 patients, 91 in the olopatadine group and 94 in the cromolyn group. At 30 minutes after the first instillation, respective decreases of approximately 30% and approximately 20% were reported in self-rated ocular itching and redness with both treatments; by 4 hours, itching had decreased by approximately 38% in both groups. Differences between treatments were not statistically significant. At 4 hours, redness had decreased by approximately 38% and approximately 26% in the respective treatment groups. By day 42, both treatments had produced significant reductions from baseline in ocular signs and symptoms; however, the reductions in itching and redness were significantly greater with olopatadine compared with cromolyn (both variables, P < 0.05). The difference in physicians' impression of overall improvement on days 30 and 42 significantly favored olopatadine over cromolyn (both days, P < 0.05). Most patients (62.2%) had reacted positively to grass pollen at baseline. The regression slopes correlating itching and redness with pollen count were 5 times lower for olopatadine compared with cromolyn (P = 0.002 and P = 0.016, respectively), indicating that olopatadine's efficacy increased as the pollen count increased. CONCLUSIONS: Six weeks' instillation of olopatadine 0.19% ophthalmic solution BID had a significantly greater effect on the ocular signs and symptoms of allergic conjunctivitis compared with 6 weeks' instillation of cromolyn 2% ophthalmic solution QID. Both treatments were well tolerated by patients in all age groups; however, olopatadine appeared to have better local tolerability in children aged <11 years.     

Prophylactic treatment of seasonal allergic rhinitis.

The prophylactic effectiveness of the new, second-generation antihistamines cetirizine and terfenadine was evaluated in a double-blind, multicenter study of 487 patients with seasonal allergic rhinitis. The patients were randomly assigned to eight weeks of treatment with 10 mg of cetirizine given either in the morning or evening, or 60 mg of terfenadine twice daily. Success rates in the three treatment groups, as assessed by physicians, were 61%, 58%, and 56%, respectively. On a scale of 0 (no symptoms) to 100 (most severe symptoms), symptoms in the three regimens were rated by patients as 31, 34, and 41, respectively. A significantly greater alleviation of eye watering and irritation was noted in the morning cetirizine group than in the terfenadine group. No serious side effects were experienced. It is concluded that 10 mg of cetirizine once daily is as effective as 60 mg of terfenadine twice daily in the prophylactic treatment of seasonal allergic rhinitis.     

聚焦超声治疗变应性鼻炎的临床观察

目的:观察临床聚焦超声治疗变应性鼻炎的疗效。方法:运用CZB型超声波治疗仪,对60例变应性鼻炎患者进行治疗。按照2004年制定的"变应性鼻炎的治疗原则和推荐方案",用记分法分别评定其疗效。结果:随访12个月进行疗效评价,其中显效率35.0%(21/60),有效率46.7%(28/60),无效率18.3%(11/60),总有效率为81.7%(49/60)。结论:采用聚焦超声治疗变应性鼻炎,具有操作简单、创伤小、安全性高、可重复等优点,近期效果显著。     

Ketamine as an analgesic: parenteral, oral, rectal, subcutaneous, transdermal and intranasal administration

Ketamine is a parenteral anesthetic agent that provides analgesic activity at sub-anesthetic doses. It is an N-methyl-D-aspartate (NMDA) receptor antagonist with opioid receptor activity. Controlled studies and case reports on ketamine demonstrate efficacy in neuropathic and nociceptive pain. Because ketamine is a phencyclidine analogue, it has some of the psychological adverse effects found with that hallucinogen, especially in adults. Therefore, ketamine is not routinely used as an anesthetic in adult patients. It is a frequently used veterinary anesthetic, and is used more frequently in children than in adults. The psychotomimetic effects have prompted the DEA to classify ketamine as a Schedule III Controlled Substance. A review of the literature documents the analgesic use of ketamine by anesthesiologists and pain specialists in patients who have been refractory to standard analgesic medication regimens. Most reports demonstrate no or mild psychotomimetic effects when ketamine is dosed at sub-anesthetic doses. Patients who respond to ketamine tend to demonstrate dramatic pain relief that obviates the desire to stop treatment due to psychotomimetic effects (including hallucinations and extracorporeal experiences). Ketamine is approved by the FDA for intravenous and intramuscular administration. Use of this drug by the oral, intranasal, transdermal, rectal, and subcutaneous routes has been reported with analgesic efficacy in treating nociceptive and neuropathic pain. Ketamine also has been reported to produce opioid dose sparing and good patient acceptance. A transdermal formulation is currently under patent review in Brazil and an intranasal formulation is currently undergoing phase I/II clinical trials.