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 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Noninfectious rhinitis and the clinical pharmacology of drugs used in its treatment, including specific treatment recommendations, are reviewed. Characterized by hyperreactivity of the nasal mucosa to a variety of stimuli, noninfectious rhinitis can be classified either as seasonal or perennial allergic rhinitis (when antigens can be identified) or as vasomotor or nonallergic rhinitis (when antigens are not identifiable). However, noninfectious rhinitis is probably better viewed as a continuum between these extremes rather than as definitive categories. Treatment measures include removal of offending agents when possible, and injection of allergenic extracts to decrease sensitivity to inhalant allergens. Among the pharmacologic alternatives, the classical H1 antihistamines competitively inhibit the action of mast-cell histamine at its receptor sites and thus decrease sneezing, nasal pruritus, rhinorrhea, and conjunctivitis. Orally bioavailable alpha-adrenergic agents such as pseudoephedrine and phenylpropanolamine decrease nasal congestion that responds poorly to antihistamines. Topical vasoconstrictors are contraindicated in chronic rhinitis because of the complications of rebound congestion. Systemic corticosteroids are effective but rarely appropriate for chronic rhinitis. Potent topical corticosteroids such as intranasal beclomethasone dipropionate are useful for severe nasal congestion. Cromolyn sodium, an inhibitor of histamine release from mast cells, appears to have some efficacy in suppressing symptoms of allergic rhinitis and conjunctivitis when used topically. Anticholinergics have occasionally been recommended to reduce rhinorrhea, but little data on their efficacy are available.
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PMID:Medical management of noninfectious rhinitis. 611 Dec 17

Ninety patients participated in a randomised, double blind, placebo controlled comparison of terfenadine with astemizole in the treatment of hay fever. They entered the trial as a cohort before the grass pollen season and recorded daily their symptoms of itching eyes, sneezing, running nose, and blocked nose on visual analogue scales in diary cards. Over the eight weeks of the trial astemizole was significantly better than either terfenadine or placebo in alleviating itching eyes, sneezing, and running nose (p less than 0.0001) but no better than placebo for the treatment of blocked nose. The placebo was significantly better than terfenadine for the treatment of running nose and blocked nose (p less than 0.002). Neither of these H1 antihistamine drugs was associated with sedative adverse effects despite significantly inhibiting histamine induced skin weal responses. These results suggest that astemizole is a satisfactory non-sedative H1 antihistamine for maintenance treatment of hay fever. Terfenadine is ineffective by comparison.
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PMID:Comparative trial of two non-sedative H1 antihistamines, terfenadine and astemizole, for hay fever. 614 5

Major improvements in the quality of recent pharmacologic studies of rhinitis are evident. In many of the studies, the criteria for patient selection are being more carefully described and patients with allergic rhinitis, nonallergic rhinitis with eosinophilia, and vasomotor rhinitis are no longer grouped together. In most studies, efficacy is still being ascertained by subjective symptom scores, although in some of the challenge studies, investigators are making noble attempts to quantitate symptoms objectively, eg, amount of secretions, sneezing, and even itching of the nares. Although nasal congestion is only one symptom of chronic rhinitis, the various methods of measuring nasal resistance by rhinometry are increasingly well described and standardized. General concepts that are emerging from the vast literature on pharmacologic treatment of rhinitis are as follows: 1) The much-maligned H1 receptor antagonists may actually be more useful than previously thought, once further information about how to use them optimally is available. Interesting new antihistamines are being developed. Further investigations of allied drugs such as the tricyclic antidepressants (doxepin) are definitely in order. 2) alpha-adrenergic agonists definitely have short-term usefulness but side effects from this class of drugs have, if anything, been underestimated. Exploration of the use of beta-adrenergic agonists and anti-cholinergics in the treatment of chronic rhinitis has begun. 3) Disodium cromoglycate is not universally effective in chronic rhinitis, perhaps in part because compliance with a prophylactic drug requiring insufflation four or six times daily may not be high. The degree of response and the percentage of patients having an excellent response to the drug is lower than for the new corticosteroids. 4) Topical corticosteroids administered intranasally are clearly the most effective medications for treatment of chronic rhinitis. Further study of the benefit versus the long-term risk of these drugs is mandatory, but their remarkable efficacy and safety in the treatment of chronic rhinitis is undisputed. Some comparisons between the four major groups of drugs are now being made, and further attempts to define the relative roles and the interactions of drugs used in the pharmacologic treatment of rhinitis are definitely needed.
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PMID:Pharmacologic treatment of rhinitis. 614 9

A single capsule of sustained release pseudoephedrine (SUDAFED S.A., Burroughs Wellcome Co.) was shown by objective and subjective measurements to be superior to placebo in relieving nasal congestion associated with allergic rhinitis. The drug had no discernible effect on (1) the degree of wetness perceived in the mouth or nose, (2) a complex of symptoms which included sneezing, coughing, sniffing, swallowing, itching of eyes and nose or (3) number of nose blows. The study was marked by an absence of serious adverse reactions.
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PMID:A study of sustained action pseudoephedrine in allergic rhinitis. 617 54

In a double-blind study, a timed-release tablet containing carbinoxamine maleate 8 mg and pseudoephedrine hydrochloride 120 mg was compared with placebo for the treatment of signs and symptoms of nasal allergy. Ninety-four adults with rhinitis caused by grass or ragweed allergy were paired according to severity of symptoms and nasal congestion, then assigned randomly to drug or placebo. After baseline measurements were taken, three doses of drug or placebo were given at 12-hour intervals. The active drug was significantly better than placebo in relieving the following symptoms: nasal congestion, nose blowing, sneezing, nasal pruritus, rhinorrhea, ophthalmic pruritus, and sniffles. Improvement over baseline in mean total nasal air flow also was greater in subjects given active drug. The incidence of nonspecific symptoms, including possible drug side effects, was similar between groups. We conclude that the timed-release tablet is safe and effective therapy for the treatment of signs and symptoms of nasal allergy.
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PMID:Efficacy of a timed-release antihistamine/decongestant tablet for symptoms of nasal allergy. 669 89

More than 1200 patients who received pindolol for the treatment of hypertension, angina pectoris, and various arrhythmias in studies conducted in the United States were included in the New Drug Application submitted to the FDA. Nearly 1000 of these patients received pindolol as monotherapy. The side effects reported were generally transient and of mild or moderate severity. The most frequently reported side effects seen after pindolol administration, compared to those seen after placebo, were in decreasing order of incidence: headache, dizziness, insomnia, muscle pain, fatigue, weakness, nervousness, joint pain, edema, nausea, and muscle cramps. Other side effects that occurred more frequently with pindolol than with placebo but at a rather low incidence induced weight gain, bizarre dreams, visual disturbances, lethargy, and diarrhea. Nasal congestion, throat discomfort, nocturia, impotence, pruritus, anxiety, hypotension, bradycardia, and heart failure occurred only rarely. Of the 323 patients who received pindolol alone for the treatment of mild to moderate hypertension, only 20 (6.2%) were withdrawn from the study because of side effects. Overall, 3.4% of the patients treated with pindolol were withdrawn because of side effects, most of which involved the central nervous system, that is, insomnia, anxiety, dizziness, and headache. However, a few patients manifested some edema and weight gain while receiving pindolol alone. Review of the side effects data did not reveal a tendency for the incidence of side effects to be dose related. One placebo-controlled, double-blind study designed to evaluate the fixed dosages of 15, 30, and 60 mg in the treatment of mild to moderate hypertension suggested that only the incidences of insomnia and nervousness increased with increasing doses. However, these side effects were generally transient and of mild or moderate severity. The evidence indicates that pindolol has an acceptable safety profile and that any side effects that appear are generally well tolerated and disappear with continued treatment.
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PMID:Adverse reactions to pindolol administration. 704 82

The study investigated the effect of the oral H1-blocker terfenadine on allergen challenge in subjects with nasal allergy in comparison with the topical steroid, budesonide. A randomized, placebo-controlled, double-blind, crossover study with 3 experimental days was performed outside the pollen season. Seventeen nonsmokers with hay fever (symptoms, positive skin prick test, and RAST against timothy) were treated for 14 days before each experimental day, where the response to nasal challenge with four different concentrations of timothy was measured every 15 min for 6 h. The nasal cavity dimensions were measured by acoustic rhinometry and the olfactory function as the threshold for the sense of smell of butanol. Nasal symptoms were determined by questionnaires. Both terfenadine and budesonide dry powder had an effect on the hay fever symptoms during nasal pollen challenge. Terfenadine was more efficient than budesonide against histamine-mediated symptoms such as sneezing and itching. Budesonide increased nasal airway dimensions better than terfenadine (P < 0.01). A marked effect of budesonide was seen 1-2 h after challenge, suggesting an effect on "early late phase" reaction in the nose. In 7/17 subjects, a significant (P < 0.05) improvement of olfactory function after budesonide treatment was seen. In conclusion, topical steroid (budesonide) is superior to antihistamine (terfenadine) in treatment of nasal congestion in hay fever, especially for the postchallenge reaction, and may, in some cases, relieve the decreased sense of smell during pollen challenge.
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PMID:Effect of terfenadine and budesonide on nasal symptoms, olfaction, and nasal airway patency following allergen challenge. 750 5

A daily dose of either terfenadine 120 mg or cetirizine 10 mg was compared in two parallel groups of patients suffering from hay fever. According to a double-blind, double-dummy, randomized design, 28 patients were treated with one of the two drugs once daily in the morning for 2 weeks during the 1990 grass pollen season. The severity of nasal congestion, rhinorrhea, sneezing, nasopharyngeal itching and itchy, watery, red eyes was evaluated by the investigator after a 1-week run-in period and at the end of the treatment. The patients made a daily record of the severity of symptoms on a diary card. In addition, drug-related central nervous system (CNS) effects were assessed at baseline and at the end of the treatment by neuropsychological tests aimed at investigating selective and sustained attention, visuomotor abilities and anxiety, and by quantitative, bit-mapped EEG. Both terfenadine and cetirizine produced a significant improvement in symptoms at endpoint without any significant difference between the two drugs. Drowsiness was referred by one patient in each treatment group. No significant impairment of psychomotor performance occurred with either drug. Quantitative EEG showed a significant power increase in the relative (%) delta band in both groups of treated patients. Although the difference was not statistically significant, a tendency towards greater involvement of the CNS was observed with the use of cetirizine. In conclusion, the results of this study confirm that terfenadine and cetirizine are equally effective in the management of hay fever. Some differentiated untoward EEG changes were also observed in relation to the drugs used, without any variation in neuropsychological performance.
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PMID:Comparative study of terfenadine and cetirizine in hay fever: assessment of efficacy and central nervous system effects. 755 Dec 4

The efficacy of a multiple oral dose treatment with mebhydroline (Omeril coated tablets, 100 mg t.i.d.) was examined in 3 studies which were performed in a randomized, double-blind and placebo-controlled 2-way cross-over design. A second target was to investigate the suitability of different pharmacodynamic models for testing the efficacy of antihistamines. Study A involved a nasal provocation with a specific allergen in 11 symptom-free patients suffering from seasonal allergic rhinitis. In study B, a nasal provocation with histamine was investigated in 11 healthy volunteers. Study C involved a cutaneous provocation with a specific allergen in 12 symptom-free patients suffering from seasonal allergic rhinitis/atopy. The mebhydroline treatment's superiority over placebo was shown statistically at the 95% confidence level for the symptoms itchy nose in study A and for nasal congestion in study B. In study C, allergen-induced weals (planimetric measurement) and itching (visual analog scale) were significantly changed by mebhydroline. A qualitative evaluation revealed a reaction intensity that differed between the 2 treatments to a clinically relevant degree, however, without reaching significance. On the basis of the data it is expected that the clinical efficacy of mebhydroline may be further substantiated in confirmatory clinical trials which should include placebo and positive controls. The test methods used differed in their suitability for measuring the pharmacodynamic effects of antihistamines. Overall, the most clear-cut results were seen in hay fever patients using a specific allergen for provocation. The planimetric assessment of weal response should be preferred as a cutaneous model. Both AR and AARM have their clinical relevance. Based on highly significant results of a subgroup analysis there are indications in favor to AR, but momentary there is no definite conclusion in favor of or against either of the 2 methods.
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PMID:Three explorative studies on the efficacy of the antihistamine mebhydroline (Omeril). 758 91

Apart from adrenergic and cholinergic neurones, peptidergic neurones are involved in the autonomic control of nasal mucosa. Their transmitter substances are peptides, so-called "neuropeptides". It is assumed that they are released from peptidergic neurones in the nasal mucosa after irritation of receptors by unspecific stimuli, and are responsible for the symptoms of hyperreactive rhinopathy. Repeated topical application of Capsaicin (8-methyl-N-vanillyl-6-nonenamide) leads to a selective degeneration of peptidergic neurones and desensitisation of its receptors in the nasal mucosa. 123 patients who were suffering from hyperreactive rhinopathy were treated in a prospective study by repeated topical applications of capsaicin solutions in increasing concentrations. A symptom score demonstrated an improvement of the predominating symptoms (nasal congestion, hypersecretion, sneezing) by 62% to 72%. A reduction of unpleasant side effects following application (epiphora, itching, sneezing, mucosal oedema) indicating a desensitising effect could be documented by a symptom score and by active anterior rhinomanometry. Immunohistochemical investigations of nasal mucosa biopsies revealed no reduction of peptidergic neurones within the nasal mucosa, so that a blockage of receptors seems to be responsible for the positive effects. The treatment of hyperreactive rhinopathy with capsaicin or related substances seems to be a promising new way in the treatment of hyperreactive rhinopathy. Further investigations have to prove the site of effect and mechanism of activity of the substance, such as the best modality of application.
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PMID:[Treatment of nonspecific hyper-reflectory rhinopathy (vasomotor rhinitis) with capsaicin]. 760 68


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