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

Atopic dermatitis (AD) is a familial inflammatory skin disorder, which is characterized by extreme pruritus, the typical morphology and distribution, the chronic or chronically relapsing course, and the personal or family case history of atopy (asthma, allergic rhinitis, atopic dermatitis); moreover, we find a variety of additional features, which are either less specific or relatively rare. Although this disease has been well-known since the beginning of the century, we have not clearly understood its pathogenesis so far. This article reviews the reported deviations of the immune system and the alterations of the mediators of inflammation as well as the abnormalities of cyclic nucleotide regulation. These findings are correlated to the clinical symptoms. The following topics have been dealt with in detail: association with HLA-antigens, elevation of serum IgE and generation of IgE immune complexes, numerical and functional deficiencies of T-suppressor cells, involvement of granulocytes, alterations of mediators of inflammation, and particularly, observations on the cAMP-phosphodiesterase. These extremely complex findings, which are based on the interaction between disregulation of the autonomous nervous system and alterations of the immune system, may provide a better understanding of the pathogenesis of atopic dermatitis.
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PMID:[Pathogenesis of atopic dermatitis]. 243 53

Nasal challenges with pollen grains represent one of the techniques of provocation. However, the clinical criteria of positivity are not clearly established. Nasal challenges with increasing numbers of orchard-grass pollen grains were performed in 60 patients allergic to grass pollens and 20 normal subjects. Before any challenge, the nose was washed three times with saline and then lactose, and 50, 150, 450, 1350, and 4050 orchard-grass pollen grains were insufflated into the nostrils until a symptom score of 5 was reached. This score was mainly based on major symptoms of allergic rhinitis, for example, rhinorrhea, nasal obstruction, sneezes, and to a lesser extent, on minor symptoms, such as pruritus, conjunctivitis, and pharyngitis. Nasal secretions were obtained after each challenge by lavage. Histamine was titrated by a radioimmunoassay with a monoclonal antibody against acylated histamine. Prostaglandin D2 (PGD2) was assayed with an enzyme immunoassay with a polyclonal antibody against PGD2 methoxamine. None of the normal subjects had a symptom score greater than 2; 55/60 patients had a positive challenge. The release of PGD2 was significantly (p less than 0.001, Kruskal-Wallis test) correlated with a symptom score of 5; 74.5% of patients had a significant release of PGD2 in nasal secretions. In contrast, although 58.2% of patients had a release of histamine in nasal secretions when the challenge was positive, the correlation with symptom scores was not significant. PGD2 in nasal secretions increased 3.7-fold after a positive nasal challenge.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Correlation between symptoms and the threshold for release of mediators in nasal secretions during nasal challenge with grass-pollen grains. 246 5

Allergic rhinitis is characterised by symptoms of sneezing, itching of the nose with watery secretions, and nasal obstruction. We have previously shown that patients can have the diagnosis of allergic rhinitis confirmed by nasal provocation tests and assessment of nasal inspiratory peak flow (NIPF) after specific allergen or hyperosmolar challenge. We now show that histamine is released into the nasal lavage fluid in response to such challenges. Saline lavage alone results in detectable histamine levels in the order of 5 ng/ml, but in the presence of allergen (HDM) there is a significant increase in histamine release in atopics but not in control subjects. With hyperosmolar challenge, atopics showed a biphasic response in that histamine release was increased with 1.8% and 3.6% saline but returned to baseline with 5.4% and 7.2% saline, then showing a further increase with 9.0% saline. This raises the possibility of two populations of responsive mast cells. Hyperosmolar challenge leads to symptoms of nasal itch and sneezing as well as histamine release in atopics but not in controls. This suggests that hyperosmolar challenge can be used as a simple diagnostic test for allergic rhinitis and may provide a model for nasal hyper-reactivity.
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PMID:Nasal histamine release following hyperosmolar and allergen challenge. 247 Feb 66

The efficacy and tolerability of Naaga (the magnesium salt of N-acetyl-aspartyl-glutamate) and of sodium cromoglycate after intranasal application were tested and compared in 100 patients suffering from chronic allergic rhinitis. The study was conducted according to a randomized, double-blind design in four centers. The intensity and frequency of typical allergic symptoms such as nasal obstruction, sneezing, runny and itching nose, conjunctivitis, ocular itching and tear flow were recorded on a 4-point scale (absent, light, moderate and severe). The intensity of nasal and ocular symptoms was found to be marked for patients in two centers. For the patients in the other two centers the drugs' efficacy was difficult to assess because symptoms were not marked (rated either as absent or light) at the beginning of the study. Thus the assessment of efficacy was based on 60 patients (centers 1 and 2), while the assessment of tolerability was based on the whole patient sample (n = 100). There was no statistically significant difference between the two compounds in terms of efficacy. A total of five patients in each of both groups complained of moderate untoward effects (all patients from the same center).
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PMID:[NAAGA versus disodium cromoglycate in perennial allergic rhinopathy: results of a multicenter study]. 250 Jun 92

A total of 317 patients received loratadine, 10 mg once daily, terfenadine 60 mg twice daily, or placebo in a 14-day, double-blind, randomized study in seasonal allergic rhinitis. Four nasal and four nonnasal symptoms were evaluated. At the end point evaluation, mean total scores of combined nasal and nonnasal symptoms decreased from baseline (improved) 46%, 44%, and 35%, respectively, for loratadine, terfenadine, and placebo. The difference between loratadine and placebo treatment was significant (p = 0.03). Loratadine was particularly effective compared with placebo in relieving nasal discharge, sneezing, and itching/burning eyes. Therapeutic response to treatment was good or excellent in 66 (64%) of 103 loratadine-treated patients, 58 (56%) of 104 terfenadine-treated patients, and 48 (47%) of 102 placebo-treated patients. Adverse experiences reported during the study were usually mild or moderate and were not significantly different among the three treatment groups. Sedation (somnolence) was reported by 10 loratadine-treated patients, seven terfenadine-treated patients, and eight placebo-treated patients. Loratadine, 10 mg once daily, was comparable to terfenadine, 60 mg twice daily, and significantly superior to placebo in the symptomatic relief of seasonal allergic rhinitis.
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PMID:Efficacy and safety of loratadine (10 mg once daily), terfenadine (60 mg twice daily), and placebo in the treatment of seasonal allergic rhinitis. 257 17

The efficacy of terfenadine in combination with phenylpropanolamine was assessed by comparison with terfenadine alone in a double-blind, parallel group study of 66 patients with nasal birch pollen allergy. The patients were allocated randomly into two groups; 34 patients received terfenadine (60 mg) twice daily and 32 patients a combination tablet containing terfenadine (60 mg) and phenylpropanolamine (50 mg) twice daily for 17 days during the birch pollen season. Nasal symptoms (sneezing, discharge, itching and blockage) were relieved significantly by both drugs, but control of symptoms was more rapid and better with the terfenadine-phenylpropanolamine combination. Rhinoscopic evaluation of nasal secretion and mucosal swelling showed no differences between the treatment groups. Compared with pre-season values, nasal peak expiratory flow (PEF)-values worsened significantly during the season in the terfenadine, but not in the terfenadine-phenylpropanolamine, group. The general condition of the patients was significantly better in the terfenadine-phenylpropanolamine group. There were no marked side-effects in either group. At the end of the trial some of the patients in both treatment groups still had symptoms; this is apparently due to the long-lasting and severe pollen season. It is concluded that terfenadine combined with phenylpropanolamine gives better control of seasonal allergic rhinitis than terfenadine alone.
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PMID:Terfenadine with or without phenylpropanolamine in the treatment of seasonal allergic rhinitis. 257 26

The object of the above study was to evaluate the tolerability and possible therapeutic use of MgNAAGA (Mg salt of N-acetyl-aspartyl-glutamic acid) in patients with allergic rhinitis. Out of 22 subjects with respiratory allergy, 12 were treated for 15 days with MgNAAGA and 10 with DSCG for the same length of time. During this period, patients kept a diary in which they recorded the following symptoms: rhinorrhea, itching, sneezing and nasal obstruction. The trial drug was found to be well tolerated and not to give rise to relevant side effects. The therapeutic efficacy was similar to that of DSCG.
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PMID:[Evaluation of the efficacy of the magnesium salt of N-acetyl-aspartyl-glutamic acid in the treatment of acute rhinitis]. 257 79

The clinical manifestations of allergic rhinitis are the result of an immune-mediated process after exposure of a sensitized individual to airborne allergens. The primary symptomatology includes nasal congestion, rhinorrhea, nasal and conjunctival pruritus, and sneezing. Principles of management include allergen avoidance, palliative therapy, immunotherapy, and pharmacotherapy. Oral decongestants stimulate alpha-adrenergic receptors in the nasal cavity, resulting in vasoconstriction and decreased edema. Oral antihistamines block histamine1 (H1) receptors, and may relieve rhinorrhea, sneezing, and nasal and conjunctival pruritus. Topical decongestants have a local effect on adrenergic receptors in the nasal mucosa, resulting in rapid, marked vasoconstriction. Intranasal corticosteroids inhibit mediator release from mast cells and basophils, and reduce edema of the nasal mucosa. Dexamethasone sodium phosphate, beclomethasone dipropionate, and flunisolide are currently available for intranasal administration. Cromolyn sodium inhibits allergen-induced degranulation and mediator release from sensitized cells, and is useful primarily as a prophylactic agent. Several agents, including the corticosteroids budesonide and flucortin butylester, the mast cell-stabilizing agent nedocromil sodium, the anticholinergic agent ipratropium bromide, and the H1 receptor antagonist levocabastine are being investigated for intranasal use in the management of allergic rhinitis.
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PMID:Management of allergic rhinitis: focus on intranasal agents. 257 39

The pathophysiology, clinical manifestations and diagnosis, and pharmacotherapy of allergic rhinitis are reviewed. Allergic rhinitis is an immunologically mediated disease initiated by an antigen-antibody reaction in sensitized persons. Clinical manifestations include nasal obstruction, rhinorrhea, itching of the nose and eyes, coughing, and sneezing and may be perennial or seasonal. Diagnosis is confirmed by challenging the patient with suspected allergens in skin-prick tests. Avoidance of offending allergens is the cornerstone of therapy. Antihistamines and decongestants provides only minimal relief when used alone and are more effective when combined with other agents. Two newer antihistamines, astemizole and terfenadine, lack the sedative and anticholinergic properties of older antihistamines. Intranasal corticosteroids are particularly effective in relieving symptoms; beclomethasone diproprionate and flunisolide do so without producing systemic adverse effects. Cromolyn sodium is effective in relieving nasal symptoms and is the prototype of a new noncorticosteroidal class of compounds termed antiallergy drugs. Drugs under investigation for the treatment of allergic rhinitis include histamine H2-receptor antagonists, nonsteroidal anti-inflammatory agents, anticholinergic agents, and beta-adrenergic receptor agonists. Immunotherapy is a helpful adjunctive treatment. Treatment with drugs may be necessary for those patients with allergic rhinitis who find it difficult or impossible to avoid the offending allergen. The severity of symptoms and the adverse effects of agents should be considered when individual therapeutic plans are being established.
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PMID:Pharmacotherapy of allergic rhinitis. 266 11

In order to explore the dynamics of the cellular response of the airway mucosa to allergen exposure, controlled daily allergen challenges were performed for 7 days during the pollen-free winter months in nine patients with strictly seasonal allergic rhinitis caused by birch pollen allergen. Symptoms obtained after the challenge were related to morphologic changes within and on the surface of the nasal mucosa. Cell samples were obtained daily prior to challenge from the nasal mucosa using mucosal imprints on plastic strips, brush samplings from the nasal mucosa, and nasal lavage. For light microscopy, the cellular material obtained by brushing and nasal lavage were cytocentrifuged onto object slides. Histamine was measured in the cell pellets that were obtained using the lavage and brush procedures as well as in the lavage supernatant fluid. Four symptoms (sneezes, itching, secretion, and blockage) were recorded and expressed individually as well as in the form of a composite symptom score. Nasal blockage was measured using a nasal peak flow meter. The patients displayed an increase in nasal symptoms after the allergen challenge, which was further increased between Days 2 to 7 (p less than 0.05). The light microscopic evaluation of the lavage revealed an immediate increase in eosinophils from 2.3 to 13.1% and was maintained on the same level throughout the period of challenges. A similar increase was noted in the brush specimens, and a strong correlation was obtained between these two methods of sampling.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Nasal mucosal response to repeated challenges with pollen allergen. 278 44


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