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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Triamcinolone acetonide aerosol (TAA), a topical corticosteroid, now available for intranasal use, has been shown to be highly effective in the treatment of both seasonal and perennial allergic rhinitis (PAR) in adults. To evaluate the efficacy and safety of TAA in children, 210 patients (ages 4 to 12 years) with PAR were randomly assigned to one of three treatment groups (placebo, TAA 82.5 micrograms/day, or TAA 165 micrograms/day). Medication was given tid over 12 weeks in a double-blind fashion. Response to medication was evaluated using symptom scoring, physician evaluation, and, in 44 patients, nasal airflow determinations by anterior rhinomanometry. The higher dose of TAA (165 micrograms/day) significantly improved rhinitis symptoms relative to placebo: the total nasal symptom score and most individual symptom scores (eg, nasal stuffiness, itch, sneezing) were significantly better, duration of rhinitis symptoms (hours per day) was significantly reduced, and nasal airflow in a subset of patients showed significant improvement. The lower dose of TAA (82.5 micrograms/day) was superior to placebo by the same parameters as the higher dose, but this improvement was not as consistently significant as the higher dose. There were no clinically significant adverse events; nasal irritation and epistaxis were rare with a similar incidence among treatment groups. In conclusion, TAA at 165 micrograms/day was effective in controlling the symptoms of PAR and in improving nasal airflow in pediatric patients; the lower dose (82.5 micrograms/day) was marginally effective. Both doses were safe and well-tolerated in the children studied.
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PMID:Clinical evaluation of triamcinolone acetonide nasal aerosol in children with perennial allergic rhinitis. 195 2

For the symptomatic treatment of allergic rhinitis the following groups of drugs are available: decongestants (sympathicomimetics), stabilizers of the mast cell membrane (DNCG, nedocromil), corticosteroids (aerosols), antihistamines, ketotifen, anticholinergics. The world wide use (and abuse) of decongestants (sympathicomimetics) is limited by the so-called rhinopathia medicamentosa, when the necessary treatment exceeds 3 or 4 weeks. The antiallergic preparations like sodiumcromoglycat and nedocromil prevent sneezing, rhinorrhea and eye irritations. Their reported effect is "stabilisation" of the mast cell membrane. They have practical no side effects, but the patients compliance is limited by the short, prophylactic effect, necessitating frequent topical applications up to 6 times daily. As the overall symptom scores are only reduced between 30% to 50%, they are not suited for severe cases of allergic rhinitis. Nedocromil should have a significantly better efficiency than DNCG. The development of efficient topical glucocorticosteroid aerosols was a great progress in the treatment of allergic rhinitis. With daily doses of 100 micrograms to 800 micrograms they are very effective against hypersecretion, sneezing, itching and also blocking of the nose. Because of the so-called "first pass" effect after resorption through the nasal mucosa they have minimal general side effects, especially on the balance of the endocrine system. Their rate local side effects on the nasal respiratory mucosa include local irritations, crusting, dryness and seldom nose bleeding.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The symptomatic therapy of allergic rhinitis]. 196 61

This double-blind, multicentre study was designed to compare the efficacy and tolerability of terfenadine 120 mg with cetirizine 10 mg, each taken once daily, in the treatment of seasonal allergic rhinitis. Two hundred and eighty-five patients were recruited to the study by nine general practice centres in the south of England during the 1989 hay-fever season. Symptom severity was assessed daily by the patient and before and after the one-week treatment period by the investigator. At the second clinic visit both patient and investigator assessed the overall response to treatment. The two treatment groups were well matched for all demographic variables and baseline symptom scores. Improvement in all seven symptoms (nasal congestion, sneezing, rhinorrhoea, itching nose, itching eyes, watery eyes and red eyes) and overall response to treatment were similar in both treatment groups. Adverse events were mainly of mild to moderate severity and were reported by 14 patients on terfenadine and 21 patients treated with cetirizine (p = 0.317). This study confirmed terfenadine's role as the treatment of choice in hayfever. A single 120 mg dose in the morning effectively reduced symptoms by 43 to 70 per cent of baseline values, with an acceptably low incidence of side effects. Cetirizine at a single dose of 10 mg displayed equal efficacy in controlling hayfever symptoms but, in common with other studies, had a significantly greater incidence of drowsiness (p = 0.046).
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PMID:Multicentre, double-blind comparison of terfenadine and cetirizine in patients with seasonal allergic rhinitis. 197 16

Studies using nasal provocation followed by nasal lavage have demonstrated that histamine plays an important role in the mediation of allergic rhinitis but not of rhinovirus infection. The response to antigen challenge is often biphasic. During the early response, increases in histamine levels appear to be associated with activation of mast cells. In a subset of persons who exhibit an additional late response, however, the rise in histamine is concomitant with an increase in the number of basophils. Further evidence of the role of histamine in allergic rhinitis has emerged from nasal provocation experiments involving pretreatment with a variety of drugs known to antagonize or affect release of histamine. Nasal provocation with histamine causes sneezing, itching, rhinorrhea, and nasal congestion. Most H1 antihistamines have been found to inhibit sneezing and to lessen the increase in vascular permeability, but they do not affect histamine release. The H1 antihistamine terfenadine, however, inhibits histamine release during the early response; effects on late response remain unknown. Prednisone decreases histamine levels during the late, but not the early, response. One-week pretreatment with topical steroids, on the other hand, affects both the early and the late response.
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PMID:The role of histamine in allergic rhinitis. 197 83

Nasal itching, sneezing, and rhinorrhea are troublesome symptoms in patients with perennial allergic rhinitis. Most first-generation H1-receptor agonists achieve a 50% reduction in these symptoms, but their benefits are frequently offset by annoying anticholinergic and sedative side effects. Cetirizine is a major metabolite of hydroxyzine that has little anticholinergic activity and causes significantly less sedation. In addition, it can be given once a day. In placebo-controlled comparisons with terfendadine, both active drugs were comparably effective and significantly better than placebo in relieving sneezing, rhinorrhea, and nasal itching. In a multicenter, double-blind comparison with placebo, both cetirizine, 10 and 20 mg given once daily, were similarly effective and superior to placebo in reducing the overall symptoms of rhinitis. In another multicenter, double-blind study, cetirizine was comparable with diphenhydramine and significantly superior to placebo in reducing total symptom severity, sneezing, rhinorrhea, and ocular itching. The safety of cetirizine was demonstrated in all studies. Cetirizine tended to be less sedating than diphenhydramine.
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PMID:Perennial allergic rhinitis: clinical efficacy of a new antihistamine. 197 94

A randomized, double-blind, placebo-controlled, parallel group study was conducted in 11 centers to evaluate the safety and efficacy of a once-a-day regimen of 110 micrograms, 220 micrograms; and 440 micrograms of triamcinolone acetonide intranasal aerosol versus placebo in relieving the symptoms of rhinitis in 305 adult and older pediatric patients with perennial allergic rhinitis. Nasal stuffiness, nasal discharge, sneezing, nasal itching and the nasal index (the sum of the mean scores of the first three symptoms) averaged over the first 6 weeks and second 6 weeks of the study were significantly reduced in patients who received the 220 micrograms/day and the 440 micrograms/day dosages. The 110 micrograms/day group had a reduction in these nasal symptoms, but only the sneezing and nasal index were significantly (P less than .05) better than placebo. During the last 6 weeks of the study, patients were allowed to take oral back-up medication for their nasal symptoms; all three groups receiving triamcinolone nasal aerosol took less back-up medication than did the placebo group. There were no significant adverse effects or laboratory abnormalities noted during this study. Intranasal triamcinolone acetonide 220 micrograms and 440 micrograms, used once-a-day for 12 weeks is clinically and statistically superior to placebo for the treatment of perennial allergic rhinitis.
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PMID:Once daily triamcinolone acetonide nasal spray is effective for the treatment of perennial allergic rhinitis. 201 34

Allergic rhinitis is a classic example of a type I immunological reaction. After allergic provocation tests a biphasic reaction is seen in the respiratory tract that is more pronounced in the lower than in the upper respiratory tract due to the physiological changes during the nasal cycle. The early phase of the immediate reaction starts some minutes after allergen provocation. After 5-10 h the nasal symptoms (discharge, blockage, sneezing and itching of the nose) reappear, a phenomenon which is called the "late-phase response" (LPR). The LPR is of great clinical importance in the pathophysiology of perennial allergic rhinitis and phenomena such as nasal priming and nasal hyper-reactivity. The most important effector cell of the early phase of the immediate reaction is the mast cell, whereas basophils, eosinophils and neutrophil granulocytes seem to be more important for the LPR. There is also evidence for morphological and functional heterogeneity of mast cells in man. The role of the chemotactically immigrated eosinophils in allergic reactions has not been clear until now: the eosinophil-derived mediators may enhance or inhibit the allergic reaction. Also the eosinophils show different morphological and functional states (so-called hypo- and hyperdense eosinophils). The symptoms of allergic rhinitis (sneezing, discharge, blockage, itching of the nose) are caused by different mediators, of which the most important is histamine. Other mediators or modulators of the allergic reactions are leucotrienes, prostaglandins, PAF, serotonin, and the kallikrein-kinine and complement systems. In recent years many regulatory peptides have been detected in the human nasal mucosa.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Current pathophysiologic aspects of allergic rhinitis. I]. 226 46

Therapeutic approaches to seasonal allergic rhinitis are reviewed in this paper. Pharmacotherapeutic approaches include nonsedative antihistamines, anti-allergic drugs, vasoconstrictors, anticholinergic agents and topical corticosteroids. The choice of treatment depends upon its relative efficacy and safety. Although effective, immunotherapy has been seriously questioned in recent years owing to the occurrence of possibly serious side-effects. Antihistamines are safe and effective for treatment of histamine-mediated symptoms of itching, sneezing and rhinorrhoea. The newer compounds do not cause sedation. For nasal symptoms, topical anti-allergic drugs are not as effective as other treatments. Topical vasoconstrictors are often used, though they cause side-effects when the treatment is prolonged. Anticholinergic drugs are safe and effective for rhinorrhea. Corticosteroids are highly effective for most symptoms, but their administration by oral or parenteral routes cannot be recommended because of side-effects. Topical corticosteroids inactivated by hepatic first pass metabolism are favoured as they are highly effective and safe. Their mechanism of action is not completely understood, but they act through both an anti-inflammatory effect and an anti-allergic activity decreasing mediator release. These drugs are the most effective in the treatment of nasal obstruction because of their anti-inflammatory effect. They are usually administered in response to symptoms, but in the future, it is likely that they will be used prophylactically before the pollen season in order to decrease the priming effect.
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PMID:Pathophysiology and treatment of seasonal allergic rhinitis. 228 90

The atopic conditions, atopic dermatitis, asthma, and allergic rhinitis, may arise as a result of infiltrating bone marrow-derived cells into skin or respiratory mucosae. Release of inflammatory factors from these cells could account for cutaneous vascular instability and pruritus in atopic dermatitis. Erythema and itch have been induced by experimental stress interviews and by blind food challenges. In the latter, increased plasma histamine was detected and correlated with cutaneous reactions. Basophils from patients with atopic dermatitis have increased histamine release after exposure to immunologic or nonimmunologic lectin stimuli. This increased releasability may relate to inadequate cyclic AMP regulation of cell function. We have found that leukocytes of patients with atopic dermatitis have elevated phosphodiesterase activity and consequently reduced intracellular cyclic AMP. Exposure of the cells to a phosphodiesterase inhibitor caused considerable reduction in histamine release. Similarly, exposure of atopic B lymphocytes to a phosphodiesterase inhibitor greatly reduced the high spontaneous IgE synthesis in mononuclear leukocyte cultures. Elevated leukocyte phosphodiesterase activity may also serve as a marker for the atopic diathesis. We have found elevated enzyme activity in umbilical cord blood from newborns with atopic parents, suggesting that this defect may relate to a genetically determined defect. These studies have provided insight into basic abnormalities associated with atopic dermatitis and the atopic diathesis. Defects of regulatory mechanisms in immune and inflammatory cells may help explain the seemingly disparate disorders of physiologic, pharmacologic, and immunologic systems in atopy.
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PMID:Immunopharmacology of the atopic diseases. 240 83

A long-term follow-up study (24 years minimum) was made of 955 individuals aged 24-44 years, who had atopic dermatitis (AD) in childhood. The material was divided into two groups; patients who in 1952-56 had been hospitalized on at least one occasion at the Department of Dermatology, Karolinska Hospital, Stockholm (Group 1), and patients who in 1955-56 had been out-patients in the same department (Group 2). At the time of investigation 62% and 40% of the patients in Groups 1 and 2 respectively had ongoing dermatitis, the majority with mild skin lesions. The frequency of healing of AD and severity of persistent or recurring dermatitis were influenced by several factors. In order of relative importance, disregarding sampling errors, persistent dry/itchy skin in adult life, widespread dermatitis in childhood, associated allergic rhinitis, family history of AD, associated bronchial asthma, early age at onset, and female sex were associated with low frequency of healing and increased severity of persistent or recurring dermatitis.
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PMID:Prognostic factors in atopic dermatitis. 241 Oct 75


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