Showing papers in "Annals of allergy in 1987"

Studies of prevalence of Japanese cedar pollinosis among the residents in a densely cultivated area.

Abstract: Prevalence studies of Japanese cedar pollinosis in densely planted areas were performed using pollen counts, patient studies, and population surveys with questionnaires. The incidence of pollinosis was increased and appeared to be related to dispersed pollen, which resulted in high immunologic responses. Onset of symptoms was influenced by hereditary factors as well as pollution from automobile exhausts.

IgG subclasses--a review.

Abstract: Recognition that IgG consists actually of four subclasses has opened up a vast amount of knowledge regarding the biology of each subclass. Of particular interest has been the recognition that various antibodies are restricted to some subclasses. The possible role of IgG4 in immunization, desensitization, and allergy is being determined. IgG subclass deficiencies are being increasingly recognized, especially in association with infection. These patients can now be effectively treated.

Receptor effects of cetirizine.

Abstract: First-generation H1-antagonist antihistamines such as hydroxyzine have a significant ability to cross the blood-brain barrier and cause sedation, which limits their usefulness in the treatment of allergic disorders. Cetirizine, a carboxylated metabolite of hydroxyzine, possesses the parent compound's antihistaminic activity but does not cause sedation. This lack of CNS effects may be due to cetirizine's greater selectivity or potency at H1 receptors in the brain, compared with its effects at the receptors involved in sedation, or it may result from the agent's relative exclusion from the CNS compartment. We compared cetirizine's activity at central H1 sites with the activity of hydroxyzine and terfenadine. We also compared the abilities of cetirizine and three other antihistamines to cross the blood-brain barrier. We found the drugs' potency at H1 receptors in the CNS to be similar to their activities in other tissues. However, their selectivity varied widely. Cetirizine, in fact, failed to bind at any of the receptors investigated except H1 sites, even at concentrations as high as 10 micron. Both hydroxyzine and D-chlorpheniramine crossed the blood-brain barrier in significant amounts. Terfenadine did so to a much lesser extent, and cetirizine passed into the CNS only half as readily as terfenadine. We suggest that cetirizine's reduced incidence of sedative side effects may stem partly from its selectivity for H1 receptors over sites involved in sedation, and partly from its relative exclusion from the CNS.

Food allergens: structure and immunologic properties.

Abstract: Few of the food allergens have been purified and characterized. Complex mixtures of allergens seem to exist in some commonly allergenic foods. Much further research will be necessary to develop any detailed understanding of the chemistry of food allergens.

Mediators of human mast cells and human mast cell subsets.

Abstract: Although a great deal has been learned about the mediators produced by mast cells, the ultimate biologic function(s) of mast cell remains a mystery. Histamine, LTC4, PAF, and possibly tryptase (C3a generation) all enhance vasopermeability. Mediators with anticoagulant activities such as heparin and tryptase (fibrinogenolysis) and antithrombotic activity, PGD2, would appear to facilitate dispersion in tissues of the plasma ultrafiltrate brought there by the subgroup of mediators that enhance vasopermeability. In contrast, PAF causes platelet aggregation and chymase may cause arteriolar vasoconstriction (decreasing the volume of plasma reaching venules) by generation of angiotensin II. Assessment of any differential production of mediators by different types of mast cells will be of obvious importance in sorting out the physiologic responses to mast cell activation as well as the pathophysiology of allergic reactions.

Treatment of acute attacks of bronchial asthma. A comparative study of epinephrine (subcutaneous) and fenoterol (inhalation).

Abstract: Two decades ago it was shown that the major immunoglobulin (Ig) present in human secretions is a dimeric IgA covalently bound to an epithelial glycoprotein of about 80 kD, now called the secretory component (SC). Pentameric IgM is likewise actively enriched in most exocrine fluids and is associated with SC, although not in a covalently stabilized complex. Three findings explain the selective translocation of polymeric Ig (pIg) into exocrine fluids: (1) preferential local production; (2) J-chain-expressing capacity of pIg-producing immunocytes; and (3) SC-mediated epithelial transport. Human hepatocytes lack SC and the human liver, therefore, cannot act as an efficient "IgA pump". This is in contrast to the rat liver which shows a remarkable capacity for transport of dimeric IgA from blood into the bile. The J chain of pIg and the epithelial SC represent the "lock and key" in the glandular transport of secretory IgA (SIgA) and SIgM. It has recently been shown that SC is synthesized as a transmembrane protein of about 95 kD and constitutes the actual pIg surface receptor. Complexing between ligand and receptor in the plasma membrane is followed by endocytosis. The completed SIgA and SIgM molecules are then translocated in cytoplasmic vesicles through the epithelial cell to the gland lumen along with an excess of free SC. The main function of SIgA is to exert immune exclusion; that is, by intimate cooperation with innate nonspecific defense factors it decreases penetration of soluble antigens and inhibits epithelial colonization of bacteria and viruses. Especially in selective IgA deficiency, SIgM may exert a similar protective function since its synthesis is markedly increased in the intestinal mucosa. Leakage of IgG into exocrine fluids is enhanced by mucosal irritation. Although IgG should not be considered as a SIg, it may contribute to immune exclusion. This is seen especially in the respiratory tract where IgG is less easily subjected to proteolytic degradation than in the intestinal juice. In contrast, by activating complement, IgG antibodies may at the same time be phlogistic and accelerate mucosal penetration of antigens. IgG may thus contribute to persistent immunopathology in mucosal disease. The same is true for IgE antibodies which may be carried into mucous membranes and secretions by mast cells and cause their degranulation with local histamine release. Traces of IgD may likewise be found in the secretions but without obvious biologic significance. Regulation of secretory immunity takes place both in organized lymphoepithelial structures, such as the Peyer's patches, and adjacent to the glands in the lamina propria.(ABSTRACT TRUNCATED AT 400 WORDS)

The metabolism and pharmacokinetics of 14C-cetirizine in humans

Abstract: This study investigated the metabolism and pharmacokinetics of cetirizine, a new H1-receptor antagonist. Single oral doses of 14C-cetirizine dihydrochloride (10 mg) in aqueous solution were administered to six healthy male volunteers. The drug was rapidly absorbed: The peak mean concentration of radioactivity (359 ng-equivalents/mL) and of unchanged drug (341 ng/mL) were achieved within one hour. Mean concentrations of cetirizine declined biexponentially and had a mean elimination half-life of 7.4 hours. The drug was excreted quite rapidly, with 60% of the dose recovered in the 24-hour urine. An additional 10% was excreted in urine over the next four days. Approximately 10% of the dose was excreted in feces over the five-day study period. The dose was excreted mainly as the unchanged drug. Examination of the radioactive compounds present in the plasma, and excreted in the urine and feces indicate that there is little metabolism of cetirizine. One minor metabolite, formed by oxidative O-dealkylation of the cetirizine side chain, was detected in plasma and feces.

Safety and efficacy of loratadine (Sch-29851): a new non-sedating antihistamine in seasonal allergic rhinitis.

Abstract: Loratadine, a new antihistamine in the non-sedating class, was evaluated for efficacy and safety in treatment of allergic rhinitis in a multicentered study. Loratadine was found to be both safe and efficacious. When administered to patients with seasonal allergic rhinitis, a single daily oral dose of 10 mg is comparable in efficacy to clemastine, 1 mg, given twice daily. The incidence of sedation with loratadine is comparable to placebo and significantly lower than with clemastine. The incidence of anticholinergic side effects with loratadine is low and in this study was comparable to placebo and clemastine.

Measurement of intestinal permeability to mannitol and lactulose as a means of diagnosing food allergy and evaluating therapeutic effectiveness of disodium cromoglycate.

Abstract: Gastrointestinal permeability was evaluated in 90 fasting healthy subjects and 60 patients with food allergy by oral administration to both groups of 5 g of mannitol, a marker of absorption of small molecules, and 5 g of lactulose, a marker of abnormal absorption of large molecules, and subsequent measurement of urinary excretion of mannitol and lactulose In healthy subjects, mean 5-hour urinary excretion of mannitol was 1411% and of lactulose 026% In the fasting state, the 60 patients with food allergy exhibited a mean urinary recovery of mannitol of 1322%, not significantly different from that in healthy subjects Mean recovery of lactulose in the patients with food allergy was 055%, significantly greater than in the healthy patients After ingestion of food allergens by the patients, mean mannitol recovery fell to 1157% and mean recovery of lactulose rose to 104%, both values being significantly different from those obtained in the fasting patients On challenging the patients after they had taken sodium cromoglycate, mean mannitol and lactulose recoveries (1353% and 062%, respectively) were not significantly different from those in fasting patients but were significantly different from those obtained on challenging patients unprotected by sodium cromoglycate Evaluation of intestinal permeability in this way provides an objective means of diagnosing food allergy and assessing the effectiveness of anti-allergic agents such as sodium cromoglycate

The "Asthma Self-Efficacy Scale".

Abstract: According to Bandura, a person's expectations that a favorable outcome will follow a particular behavior are not sufficient to promote the occurrence of the behavior; the person must also believe that he or she will be effective at performing the behavior. The latter is referred to as self-efficacy. It has become a major focus in assessing patient performance of skills required to manage their illness. The present paper describes the development, testing, and applicability of an instrument for assessing self-efficacy in asthmatic patients. It notes that the Asthma Self-Efficacy Scale is not only a reliable paper-and-pencil instrument, but that it has a wide potential applicability throughout health care settings in measuring self-efficacy in asthmatic patients. The Asthma Self-Efficacy Scale is included.

Adverse reactions to aspirin and nonsteroidal anti-inflammatory drugs.

Abstract: Nonsteroidal anti-inflammatory drugs (NSAID) are among the most frequent causes of adverse drug reactions. The clinical symptoms often resemble allergy and consist of anaphylactic shock, bronchospasm, urticaria, angioedema, and various skin eruptions. Patients with asthma or urticaria are particularly prone to these reactions. In about 10% of adult asthmatics, aspirin and several other NSAID precipitate open asthmatic attacks, most likely through inhibition of cyclooxygenase. This distinct clinical syndrome has a characteristic sequence of symptoms and clinical course. In 20% to 40% of patients with active urticaria, aspirin increases wheals and swelling. Pyrazolones might provoke two different types of clinical reactions, acting as allergens or interfering pharmacologically with cyclooxygenation of arachidonic acid. Other mechanisms might operate in some of the remaining adverse reactions to NSAID. Emerging clinical syndromes help to guide the clinicians through the maze of symptoms and often provide a unique insight into the mechanism of basic disease.

Hypersensitivity reaction to pine nuts (pinon nuts--pignolia).

Abstract: This report describes two patients with allergic reactions due to the ingestion of pine nuts. Skin testing to the aqueous allergen revealed immediate positive prick test reactions suggesting an IgE-mediated response. No reported cases have been found previously in a review of the medical literature.

Airway hyperresponsiveness: therapeutic implications.

Abstract: In summary, this article has reviewed the importance of airway inflammation in the pathogenesis of asthma. Inflammatory triggering factors (allergen, low molecular weight sensitizing chemicals, viral URTI) are more important in the pathogenesis of asthma than the bronchospastic triggering factors. Likewise, anti-inflammatory treatment strategies (environmental control, sodium cromoglycate, steroids) are more important in the long-term control of asthma than are the purely bronchodilator strategies.

The diagnosis of perennial rhinitis due to house dust mite (Dermatophagoides pteronyssinus) demonstrated by nasal provocation tests.

Abstract: The disposition of cetirizine, a new H1-receptor antagonist, was evaluated in 30 healthy adults of various ages and in 15 adults with various degrees of renal insufficiency. The purpose of the evaluation was to determine whether dosage schedules of cetirizine will require modification in the elderly or patients with renal insufficiency. We found that the elimination half-life of cetirizine was prolonged in patients with mild and moderate renal insufficiency, compared with age-matched individuals with normal renal function (19.0 +/- 3.3 and 20.9 +/- 4.4 hours, vs 7.4 +/- 3.0 hours, respectively). However, the mean apparent steady-state volume of distribution did not differ significantly between these subject groups (range 0.41 to 0.47 L/kg). Total body clearance and renal clearance of the drug were both significantly lower in the patients with renal insufficiency. In elderly subjects, the elimination half-life of cetirizine was significantly prolonged compared with younger adults, and apparent total body clearance was significantly reduced. Again, there was no significant difference in the volume of distribution between the groups. Linear regression showed good correlations between the disposition characteristics of cetirizine and age as well as creatinine clearance. However, we found no relationship between age and the ratio of apparent total body clearance of cetirizine to creatinine clearance. Thus the disposition of cetirizine is independent of age but dependent on renal function. The relationship between apparent total body clearance of cetirizine and creatinine clearance was significant only in patients with creatinine clearances greater than 40 mL/min. Progressive decrements in creatinine clearance were not associated with similar changes in the pharmacokinetic parameters of cetirizine.

Cetirizine effects on objective measures of daytime sleepiness and performance

Abstract: Sixty healthy men and women with no sleep complaints, 21 to 45 years of age (mean age 28), were randomly assigned to one of five parallel groups that received one of the following: cetirizine 5 mg (n = 13), 10 mg (n = 13), or 20 mg (n = 11); hydroxyzine 25 mg (n = 12); or placebo (n = 11). After one adaptation night in the lab, the subjects' sleep patterns were recorded from 2300 to 0730 hours. Subjects were in bed during this period. When they awoke at 0730, a test agent was administered according to double-blind technique. Multiple Sleep Latency Tests (MSLT: 20-minute opportunities to fall asleep in bed while EEG and eye movements are recorded) were given at two-hour intervals throughout the day, and a 30-minute vigilance performance test was given at 1000 and 1600 hours. Subjects receiving cetirizine in doses of 5 to 20 mg did not differ from placebo controls in any objective or subjective measure of daytime alertness. Subjects receiving hydroxyzine were significantly more sedated and showed slower reaction times than the placebo control group for at least four hours after treatment. Self-rated feelings of sleepiness, impairment, and fatigue did not differ significantly between groups. This suggests that hydroxyzine subjects may not have been aware of their sleepiness and slower reaction times.

Chronic asthma and rhinitis due to Candida albicans, epidermophyton, and trichophyton.

Abstract: Asthma and rhinitis due to Candida albicans is well known. Trichophyton and Epidermophyton are not usually considered as causal agents for these diseases. During the years 1982 and 1983 all of the cases of chronic asthma or rhinitis exhibiting a positive immediate skin response (greater than or equal to 10 mm) to one of these three antigens were selected for this study (60 asthma and 75 rhinitis). They all went through nasal and bronchial provocation tests with the specific antigen. Late reactions were also registered. A RAST was performed in some of the patients reacting to Candida albicans. Following inhalation challenge with antigens, an immediate response was obtained in 91 cases (asthma 30, rhinitis 51). A dual response was observed in 17 cases of asthma and in 13 cases of rhinitis. A RAST-Candida albicans was done in 64 cases. Results were positive in 52 patients. In 46 cases there was a correlation between the RAST and the provocation tests. Hyposensitization treatment was given to 92 patients. After 2 years of treatment, a good to excellent response could be observed in almost 60% of the treated cases. A rough estimation of the incidence of immediate bronchial and nasal hypersensitivity among patients with chronic asthma and rhinitis to the three yeasts gives the approximate figure of 8% to 10%.

Antihistamines, drowsiness, and psychomotor impairment: central nervous system effect of cetirizine.

Abstract: Altered central nervous system function as indicated by drowsiness and impaired psychomotor performance is often a consequence of the use of traditional antihistamines. Demonstration that newer agents lack these CNS effects requires quantitative and objective measurements that are sensitive enough to assess the psychomotor capabilities required for such activities as driving an automobile. These capabilities include extended attention span, vigilance, visual tracking, rapid information processing, and reaction time. We have used several psychomotor function tests to conduct two investigations assessing the CNS effects of cetirizine. In the first study, 12 healthy, atopic subjects received single oral doses of hydroxyzine 25 mg, cetirizine 10 mg and 20 mg, and placebo in a double-blind, four-way crossover study. Skin-wheal response to intradermal histamine, psychomotor effects, and serum concentrations of each drug were measured for 36 hours after each dose. The CNS effects were measured using critical flash-fusion frequency tests and Stroop word testing. Perceived feelings of drowsiness were measured using a visual analogue scale (VAS). In the second study, 15 healthy subjects received single oral doses of diphenhydramine 50 mg, cetirizine 5 mg, 10 mg, and 20 mg, and placebo in a double-blind, five-way crossover study. Skin-wheal response to intradermal histamine, psychomotor effects, and serum concentrations of each drug were measured for 24 hours after each dose. The CNS effects were measured using digit-symbol substitution testing. "Trails-B" maze tracking, and an analyzer of driving performance that assessed reaction time and vigilance.(ABSTRACT TRUNCATED AT 250 WORDS) Language: en

House dust mites in Caracas, Venezuela

Abstract: An investigation of bedding dust fauna was carried out in Caracas, Venezuela. Mites were recovered from all samples. The average mite density of 15.6 mites/mg dust was among the highest reported worldwide. Pyroglyphid mites were the most frequent and abundant, and Dermatophagoides pteronyssinus was the largest contributor to the total mite counts. It was also found that the storage mite Blomia tropicalis occurred in 96% of the samples examined and contributed an average of 15% of the total mites. The genera Tyrophagus and Tarsonemus were infrequent but occasionally large contributors to the bedding dust fauna. In our area, therefore, sensitivity to those abundant nonpyroglyphid mites should be routinely investigated in house dust-sensitive patients.

Study of mediators of anaphylaxis in nasal wash fluids after aspirin and sodium metabisulfite nasal provocation in intolerant rhinitic patients

Abstract: Nasal histamine (H), leukotriene C4 (I-LTC4) and SRS-A activity were studied in seven aspirin-(ASA)-intolerant patients (AIR) with rhinitis and in five ASA-tolerant control patients with chronic rhinitis after nasal provocation (NP) with a lysine acetylsalicylate solution. The same parameters were also studied after metabisulfite (MBS) NP in four sulfite-intolerant patients with rhinitis and in six control patients with chronic rhinitis. In six ASA-intolerant subjects and in four controls, we studied the PGD2 levels in nasal washes after ASA NP 0.2 mL of lysine acetylsalicylate solution (10 mg/mL) was sprayed intranasally in ASA-intolerant patients and controls and a 25-mg/mL MBS solution in sulfite intolerant patients and controls. Nasal wash fluids were obtained using 5 mL of 0.15 M saline before and 7 1/2, 15, 30, and 60 minutes after nasal provocation. The nasal provocation with ASA induced itching and sneezing in four out of seven intolerant subjects. In this subgroup histamine values in nasal wash fluids were significantly higher versus the remaining ASA-intolerant patients at 30 and 60 minutes (P less than .05 and P less than .01, respectively) and versus controls at 60 minutes (P less than .01). We found significantly higher I-LTC4 (P less than .01) and SRS-A levels in nasal washes collected from ASA-intolerant subjects versus controls at 60 minutes after nasal provocation. There was no significant increase in the mean PGD2 values in either the ASA-intolerant or control groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative study of the peripheral and central effects of terfenadine and cetirizine 2 HCl.

Abstract: The histamine cutaneous reactivity of healthy volunteers was measured after a single oral intake of placebo, terfenadine 60 mg and 180 mg, and cetirizine 2 HCl 10 mg. Central side effects were evaluated by Visual Analog Scales for drowsiness and movement coordination. The anti-H1 cutaneous effect of cetirizine 2 HCl proved to be significantly more rapid, more pronounced, and longer lasting than that of terfenadine 60 mg. Cetirizine and terfenadine 180 mg were equipotent. The Visual Analog Scales for central nervous system effects did not show any difference between cetirizine, terfenadine, and placebo.

IgE-mediated food allergy.

Abstract: The behaviour of some immunologic parameters was studied in order to explain the presence or the lack of symptomatology in subjects with IgE specific to foods. In particular, we compared the levels of serum and salivary IgA and IgE antibody specific to apple in 33 patients allergic to birch and with anti-apple IgE, of whom 24 had oral allergy syndrome after eating apple and nine were apple tolerants. We found no differences in the IgE-related parameters such as levels of anti-apple IgE antibody in serum and secretions, mean size of apple skin prick test, and number of patients with a positive histamine release from peripheral basophils stimulated by apple. Similarly, we detected no statistically significant differences in serum and salivary total IgG and total anti-apple IgA antibody of the two groups. We could, however, observe a significantly higher anti-apple salivary IgA/anti-apple serum IgE and anti-apple salivary IgA/anti-apple serum IgA ratios and a significant correlation between the same parameters in tolerant patients when compared with the intolerants. These results seem to suggest that the presence of appropriate levels of secretory anti-apple IgA associated to anti-apple IgE might be one of the factors playing a key role in the prevention of clinical symptoms in atopic subjects.

Pathophysiology of intestinal uptake and absorption of antigens in food allergy.

Abstract: An important adaptation of the gastrointestinal tract to the extrauterine environment is its development of a mucosal barrier against the penetration of proteins and protein fragments. To combat the potential danger of invasion across the mucosal barrier, the infant must develop within the lumen and on the luminal mucosal surface an elaborate system of defense mechanisms that act to control and maintain the epithelium as an impermeable barrier to the uptake of macromolecular antigens. These defenses include a unique local immunologic system adapted to function in the complicated milieu of the intestine as well as other nonimmunologic processes such as a gastric barrier, intestinal surface secretions, peristaltic movement, etc, all of which help to provide maximum protection for the intestinal surface. Unfortunately, during the immediate postpartum period, especially for premature and "small-for-date" infants, this elaborate local defense system is incompletely developed. As a result of the delay in the maturation of the mucosal barrier, newborn infants are particularly vulnerable to pathologic penetration by harmful intraluminal substances. The consequences of altered defense are susceptibility to infection and the potential for hypersensitivity reactions and the formation of immune complexes. With these reactions comes the potential for developing life-threatening diseases such as necrotizing enterocolitis, sepsis, and hepatitis. Fortunately, nature has provided a means for passively protecting the "vulnerable" newborn against the dangers of a deficient intestinal defense system: human milk. It is now increasingly apparent that human milk contains not only antibodies and viable leukocytes, but many other substances that can interfere with bacterial colonization and prevent antigen penetration.

Humoral immunity in bronchiectasis.

Abstract: The study of the natural history of food allergy is hindered by the lack of a reliable method of diagnosing food allergy except through oral challenge. This need raises a conflict between the need to document continued sensitivity and the effects of these repeated challenges not only on the natural history but also on the immediate induction of symptoms especially in the highly sensitive patient. Despite this difficulty, a number of investigators have provided data on a total of 177 infants and children who were subjected to repeated challenges. In only a few reports were these repeated challenges carried out in rigorous double-blind protocol. When the challenges were repeated, the results did not differ from the group as a whole. These studies agree that the prognosis in food allergy is excellent, with 60% to 73% of infants losing their food sensitivity in the first year and 26% to 53% of older children eventually remitting. The specific food causing symptoms (egg, milk, soy, etc) affected the prognosis but the intensity of IgE-mediated sensitization as indicated by skin testing or RAST did not. The data regarding the loss of immunologic tests as symptoms subsided differed from study to study. This may be due to the age at which patients were first studied varied widely or because the compliance with dietary restrictions in the various studies varied. Finally, a large majority of children developed respiratory symptoms to inhalant allergens at the same time their food-related symptoms disappeared.

Inhibition of histamine and allergen skin wheal by cetirizine in four animal species.

Abstract: Histamine-induced skin reactions were studied in four animal species. Cetirizine displayed very potent oral antihistaminic activity in this model. In rats, the dose that reduced the reaction by 50% in comparison to controls was 4.2 mumol/kg and between 0.1 and 0.4 mumol/kg for the other species (mice, guinea pigs, and dogs). Cetirizine also inhibited the immediate hypersensitivity reaction induced by Ascaris extract in dogs. By the oral route, cetirizine had a more potent and longer acting activity than mepyramine, clemastine, terfenadine, astemizole, and hydroxyzine.

The comparative pharmacokinetics of H1-receptor antagonists.

Abstract: H1-receptor antagonists appear to be absorbed rapidly after oral administration, with peak serum concentrations being reached one to three hours after a dose For most of these drugs, the absolute bioavailability is unknown because no intravenous formulations are available for comparative purposes The serum elimination half-life values of these agents are variable: a few hours for terfenadine and triprolidine; about 9 hours for cetirizine, azatadine, and loratadine; from 20 to 25 hours for hydroxyzine, chlorpheniramine, and brompheniramine; and from 5 to 14 days for astemizole Few pharmacokinetic studies of H1-receptor antagonists in children have been reported However, it is known that chlorpheniramine, hydroxyzine, cetirizine, and terfenadine have shorter elimination half-life values in children than in adults Regardless of the age of patients, for most of the H1-receptor antagonists the apparent volumes of distribution and total body clearances appear to be large (34 to 185 L/kg and 44 to 321 mL/min/kg, respectively) Cetirizine is an exception, with values of 08 L/kg and 05 mL/min/kg Urinary excretion of unchanged antihistamine is higher after cetirizine (60% of dose) than any other H1 blocker For H1-receptor antagonists with long half-life values, steady state may not be reached for several days (chlorpheniramine and brompheniramine) or several weeks (astemizole), and significant accumulation of drug occurs if the dosing interval is more frequent than every half-life There is no evidence for the introduction of metabolism of H1-receptor antagonists, even after months of treatment

Corticosteroid complications in respiratory disease.

Abstract: Complications observed in 51 patients receiving corticosteroids for greater than 1 year for asthma and other chronic pulmonary diseases were compared retrospectively with 31 control patients who had never been on corticosteroids. The prevalence of Cushingoid features (P less than .005), ocular complications (cataracts and glaucoma, P less than .025), and skeletal complications (compression fractures of vertebrae, aseptic necrosis of the femoral head, and osteopenia, P less than .005) in the study group was significantly higher than in the control group, as was the prevalence of total complications (P less than .005). Multiple regression analysis demonstrated that serious ocular and skeletal complications were directly proportional to the total lifetime dosage of corticosteroids. The high toxicity of steroid therapy should give further impetus to the formulation of ways to reduce or avoid steroid complications.

Systemic anaphylaxis due to an oxidation product of p-phenylenediamine in a hair dye.

Abstract: An anaphylactic reaction to a hair dye is reported. Skin testing with the dye and its individual components demonstrated a wheal and flare response to an oxidation product of p-phenylenediamine. This product is N'N'-bis-(4-aminophenyl)-2,5-diamino-1,4-quinonediimine. Passive transfer of this sensitivity by the patient's serum to a normal control implicated an IgE-mediated reaction.

Non-IgE antibody mediated mechanisms in food allergy.

Abstract: Food sensitivity or intolerance is not necessarily based on the Type I allergic reaction. Non-IgE antibody reactions, complement-dependent reactions, enzyme deficiencies such as lactase and non-immunologic histamine release (such as with some sea foods) have been described. Even the detection of specific antibodies on their own does not necessarily indicate that a given symptom is due to that antibody. Food allergy nevertheless exists. It is important that those observers fortunate enough to see many cases document their observations carefully and eventually publish them for the education of their less fortunate colleagues. Is food allergy more common in infants and young children? What happens as they grow older? How often is atopic eczema due to food allergy? Why are some foods more likely to be implicated than others? Does a negative RAST result eliminate the diagnosis or a positive one confirm it? Until the answers to these and other questions are known, the mainstay of diagnosis will be the history, and that of treatment will be the elimination diet.

Clinical profile of astemizole. A survey of 50 double-blind trials.

Abstract: From clinical-pharmacologic and clinical data involving over 2,800 patients, astemizole appears to be a very effective and well-tolerated antihistamine. It is superior to placebo and commonly used antihistamines for the relief of rhinitis, particularly rhinorrhea and sneezing. It has a pronounced effect on ocular itching and lacrimation in conjunctivitis and on pruritus and wheals in urticaria. This superiority is due to a very specific, almost complete and sustained histamine H1-blockade. The clinical data confirm the experimental data in relation to its lack of sedative effects.

Effect of an antihistamine/decongestant on nasal and eustachian tube function following intranasal pollen challenge.

Abstract: Ten adult subjects with documented ragweed allergic rhinitis underwent progressive intranasal allergen challenge following pretreatment with either an antihistamine/decongestant or placebo in a double-blind crossover fashion Objective measurements of nasal and Eustachian tube (ET) function were made following each challenge dose using posterior rhinomanometry and sonotubometry The percent decrease in nasal airway function, expressed as a change in conductance, was significantly less in the drug pretreatment tests when compared with placebo pretreatment Eustachian tube function was also significantly improved by antihistamine/decongestant pretreatment as 13 of the 20 ET were obstructed at a higher antigen dose following drug pretreatment when compared with placebo These results demonstrate a role for antihistamine/decongestant preparations in the treatment of allergic rhinitis as well as for potential allergen-induced ET dysfunction