UMLS:C0033774 - FACTA Search

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Query: UMLS:C0033774 (pruritus)
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Intranasal corticosteroids are accepted as safe and effective first-line therapy for allergic rhinitis. Several intranasal corticosteroids are available: beclomethasone dipropionate, budesonide, flunisolide, fluticasone propionate, mometasone furoate, and triamcinolone acetonide. All are efficacious in treating seasonal allergic rhinitis and as prophylaxis for perennial allergic rhinitis. In general, they relieve nasal congestion and itching, rhinorrhea, and sneezing that occur in the early and late phases of allergic response, with studies showing almost complete prevention of late-phase symptoms. The rationale for topical intranasal corticosteroids in the treatment of allergic rhinitis is that adequate drug concentrations can be achieved at receptor sites in the nasal mucosa. This leads to symptom control and reduces the risk of systemic adverse effects. Adverse reactions usually are limited to the nasal mucosa, such as dryness, burning and stinging, and sneezing, together with headache and epistaxis in 5-10% of patients regardless of formulation or compound. Differences among agents are limited to potency, patient preference, dosing regimens, and delivery, device and vehicle.
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PMID:Intranasal corticosteroids for allergic rhinitis. 1243 72

Allergic rhinitis, a common and often debilitating disease marked by rhinorrhea, nasal congestion, nasal itching, and sneezing, is on the increase worldwide. Treatment involves allergen avoidance, pharmacotherapy, and, in selected cases, immunotherapy. This overview describes the characteristics, pathogenesis, and diagnosis of allergic rhinitis. The major contributing allergens of seasonal and perennial allergic rhinitis are identified. Pharmacotherapy is described within the context of treatment guidelines developed by the major asthma and allergy professional organizations. Oral H1 antihistamines are first-line therapy for mild-to-moderate allergic rhinitis. The newer, nonsedating agents are recommended over first-generation antihistamines. Some of the newer oral antihistamines, such as cetirizine, desloratadine, and fexofenadine, have been shown to relieve the symptom of nasal congestion. Intranasal steroids are first-line therapy for patients with more severe symptoms.
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PMID:Treatment of allergic rhinitis. 1251 78

A new competitive histamine H(1)-receptor antagonist with superior binding affinity at this receptor as compared with other common antihistamines, desloratadine is the active metabolite of loratadine, the most extensively used agent of this class. Under development for the treatment of allergic rhinitis and urticaria and currently awaiting regulatory approval in the United States, desloratadine was recently approved and became commercially available in Europe for the treatment of allergic disease. Desloratadine is at least 50-fold more potent in vitro and appears to be 10-fold more potent in vivo than loratadine. The new antihistamine is metabolized to 3-hydroxydesloratadine, which retains biological activity. Absorption of orally administered desloratadine is dose proportional, and desloratadine achieves steady-state concentrations after approximately 5 doses with once-daily administration. This is consistent with mean half-life values of 24-27 h and a 24-h dosing interval. The absorption of desloratadine is not affected by food and there are no clinically relevant drug-drug interactions. In randomized, double-blind, placebo-controlled clinical trials, a single 5 mg dose of desloratadine conferred significant relief of seasonal allergic rhinitis (SAR) symptoms - including the complaint of nasal congestion - within hours of the first dose, and these effects were sustained both for the entire 24-h dosing interval and up to 2-4 weeks with once-daily treatment (5 mg/day). In addition, patients with seasonal exacerbations of mild to moderate asthma derived similar clinical benefits from desloratadine, with significant, first-dose relief of both SAR-related complaints such as nasal congestion as well as asthma symptoms. In addition, beta(2) agonist requirements for symptom management were significantly reduced from baseline in these asthma patients when treated with the 5 mg/day desloratadine regimen as compared with placebo. Also experiencing marked relief of symptoms upon treatment with desloratadine were patients with chronic idiopathic urticaria, who exhibited significant first-dose relief of pruritus and sustained reductions in this symptom, numbers of lesions (and size of largest hive) and sleep disturbances, with a marked improvement in their ability to carry out activities of daily living. The clinical benefits of desloratadine in the above clinical settings were accompanied by general improvements in quality of life. Desloratadine does not cross the blood-brain barrier, as demonstrated by both human studies using cognitive indices as well as work in animal models. Desloratadine is well tolerated, and no significant drug-related (or food-related) adverse effects were noted when the agent was administered together with cytochrome P450 inhibitors (e.g., ketoconazole, erythromycin). Administration of desloratadine has not been shown to cause any significant changes in cardiac activity at therapeutic doses, even at 9-fold higher doses, or in the presence of P450 inhibitors. Nor does administration of desloratadine lead to sedation, even in the presence of alcohol. (c) 2001 Prous Science. All rights reserved.
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PMID:Desloratadine: A preclinical and clinical overview. 1276 22

Perennial allergic rhinitis is an inflammatory disorder characterized by symptoms of nasal congestion, rhinorrhea, sneezing, and itching. The prevalence of allergic rhinitis is quite common and affects 20% or more of various populations. Some patients with allergic rhinitis are symptomatic only during the pollen season, while many others are allergic to multiple allergens including indoor allergens such as house dust mites, animal dander, cockroaches, and fungi, which lead to perennial symptoms. Immunoglobulin (Ig)-E is the proximate cause of perennial allergic rhinitis. Circulating IgE antibodies bind to the high affinity IgE receptor on mast cells and basophils. IgE antibodies, bound to the receptors crosslinked by allergen, initiate the secretion of inflammatory mediators including histamine, leukotrienes, and cytokines. These mediators can induce both acute and chronic changes that result in symptoms of allergy. Many therapies are approved for the treatment of allergic rhinitis including intranasal corticosteroids, antihistamines with or without decongestants, and nasal cromolyn sodium (sodium cromoglicate). Allergen avoidance is the mainstay of therapy for many patients but is not always practical. For those patients who have not responded to appropriate medications, allergen specific immunotherapy may also be effective.A number of studies with omalizumab have shown that it is effective in the treatment of seasonal allergic rhinitis induced by pollen such as ragweed and birch pollen. Omalizumab is a molecularly cloned humanized monoclonal antibody inhibiting human IgE. It binds specifically to the region of the IgE molecule that binds to the IgE receptor on the mast cell or basophils. Because omalizumab cannot bind IgE molecules that are already bound to the surface receptors on mast cells and basophils, it does not stimulate secretion of mediators from these cells. Omalizumab does not appear to stimulate an immune response against itself. It rapidly reduces free serum IgE levels by over 95% when administered at therapeutic doses and also results in the reduction of IgE receptors on mast cells and basophils. The combined effects of reduction of both free IgE in serum and the receptor density on the mast cells or basophils results in decreased allergen-stimulated mediator release. Preliminary studies in the treatment of perennial allergic rhinitis supports omalizumab's efficacy and safety. The compound has been well tolerated. Aside from urticarial reactions, adverse effects appear to be minimal. Omalizumab is the first of several new immune-based specifically targeted molecules that may prove to be extremely valuable in the treatment of perennial allergic rhinitis, as it is often unresponsive to traditional therapies.
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PMID:Etiopathogenesis and management of perennial allergic rhinitis: a state-of-the-art review. 1517 93

Sanfujiu is a method of applying herbal drug paste onto acupoints Fengmen and Feishu during the 3 hottest summer days, to treat patients with allergies using traditional Chinese medicine. The objectives of this study were to describe the immediate reactions (adverse effects and perceived efficacy) to the Sanfujiu treatment, and examine the variations in the prevalence of the reactions to and perceived efficacy of Sanfujiu among different sub-groups, based on patient age and diagnosis. The study subjects included 119 patients who completed Sanfujiu treatment at a regional hospital in Taipei. One week after treatment, trained interviewers conducted telephone interviews with the patients. More than 80% of the patients reported having reactive symptoms after using the Sanfujiu treatment. Younger subjects (< or = 16 years of age) were more likely to have reactive symptoms. Patients with rhinitis were more likely to have runny noses and nasal congestion after the treatment. Patients with allergic eczema were more likely to have skin itching all over the body. Overall, 44.6% of patients perceived the treatment as being effective, while 52.1% of patients did not notice any effects, either good or bad, from the treatment. The perceived efficacy of Sanfujiu treatment was not related to patient age, sex, or diagnosis. This study demonstrated that Sanfujiu treatment was moderately effective, as perceived by the patients, in treating their allergic symptoms immediately after the treatment. Symptoms reactive to the treatment were common but are usually mild. This information is essential for patient consultation, and serves as a reference for clinicians.
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PMID:The treatment of allergies using Sanfujiu: A method of applying Chinese herbal medicine paste to acupoints on three peak summer days. 1567 1

The aim of this study was to examine the effects of aqueous triamcinolone acetonide (TAA AQ) and fluticasone propionate (FP) nasal sprays on seasonal allergic rhinitis (SAR) symptoms and health-related quality of life (HRQL) in patients stratified into cohorts based on symptom severity. In a multicenter, investigator-blinded, parallel-group study, 295 patients with a > or =2-year history of SAR received once-daily TAA AQ, 220 microg, or FP, 200 microg, for 3 weeks. Median baseline total nasal symptom score (TNSS; sum of nasal congestion, rhinorrhea, sneezing, and nasal itching scores) for all patients was 8.14 (range, 0-12). Patients were stratified by baseline TNSS into a moderate (<814) or severe (> or =8.14) cohort. Changes from baseline TNSS, individual symptom scores, and HRQL were assessed. Sixty-nine TAA AQ and 76 FP patients were included in the moderate stratum (baseline mean TNSS = 6.14 and 6.22, respectively), and 79 (TAA AQ) and 71 (FP) patients were included in the severe stratum (TNSS = 10.03 and 9.47, respectively). At the study end, patients showed significant (p < 0.0001 all comparisons) and comparable improvements in TNSS in both the moderate (TAA AQ, -2.40 [95% confidence interval [CI, -2.92, -1.87], 39% improvement; FP, -2.22 [95% CI, -2.72, -1.73], 36% improvement) and the severe (TAA AQ, -3.85 [95% CI, -4.36, -3.33], 38% improvement; FP, -3.84 [95% CI, -4.43, -3.24], 41% improvement) strata. TAA AQ and FP significantly and comparably improved HRQL in both strata versus baseline. Once-daily TAA AQ and FP nasal sprays in patients with moderate or severe SAR provided significant and comparable symptom relief and improvements in HRQL.
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PMID:Triamcinolone acetonide and fluticasone propionate nasal sprays provide comparable relief of seasonal allergic rhinitis symptoms regardless of disease severity. 1570 53

Studies evaluating newer antihistamines in children are few. Levocetirizine is a potent and highly selective H1-antihistamine with a proven efficacy in adults. Primary objective was to assess the efficacy of levocetirizine 5 mg once-daily in reducing seasonal allergic rhinitis (SAR) symptoms, as measured by Total Four Symptom Score (T4SS = sum of sneezing, rhinorrhea, nasal and ocular pruritus), over the first 2 wk of treatment. Efficacy over 4 and 6 wk of treatment, effect on nasal congestion and on health-related quality of life as measured by PRQLQ (Paediatric Rhinoconjunctivitis Quality of Life Questionnaire) were among the major secondary objectives. A double-blind, randomized, placebo-controlled study including 177 children with a documented SAR (to grass and/or weed) for at least a year and having a mean baseline T4SS > or = 6 (out of 12). Children evaluated daily the severity of T4SS and nasal congestion on a scale from 0 (absent) to 3 (severe). PRQLQ responses were assessed on a scale from 0 (not bothered) to 6 (extremely bothered) and analysed descriptively. Global evaluation of disease evolution judged by investigators, parents and children was made on a scale from 1 (marked worsening) to 7 (marked improvement). For the primary objective, levocetirizine was statistically highly superior to placebo with a difference in adjusted means of 1.29 (95% CI: 0.66-1.92) in favour of levocetirizine (p < 0.001). The effect of levocetirizine was almost twice that of placebo (94.1% relative improvement over placebo). Nasal congestion was improved with levocetirizine reaching maximum difference to placebo of 0.31 (p < 0.05), a relative improvement over placebo of 77.5%. PRQLQ scores at week 2 improved with levocetirizine more than with placebo (0.85 vs. 0.51, respectively) remaining larger after 4 and 6 wk of treatment. In the study, 84.3%, 80.9%, 80.9% of children had their disease evolution rated as slightly-to-markedly improved by, respectively, the investigators, the parents and children themselves. Incidence of treatment-emergent adverse events was similar in both groups (33.7% with levocetirizine; 30.7% with placebo). No child in the levocetirizine group discontinued treatment because of adverse events. The 6-wk duration of this study was longer than the usual 2-4-wk duration for similar studies and shows that levocetirizine controls SAR symptoms in children over the entire pollen season.
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PMID:Levocetirizine in children: evidenced efficacy and safety in a 6-week randomized seasonal allergic rhinitis trial. 1585 59

Aim of the study was to evaluate the clinical efficacy of sublingual-oral immunotherapy in allergic rhinitis induced by various allergens and to demonstrate its effects using objective methods such as skin prick tests and specific IgE analysis. The first 100 patients diagnosed with allergic rhinitis and treated with sublingual-oral immunotherapy took part in the study and were followed for 2 years. Baseline findings were statistically compared with data obtained at the end of the study period. All symptoms including nasal discharge, sneezing, nasal congestion, and itching, as well as all clinical findings, including lower turbinate colour, turbinate congestion, and nasal discharge, observed by the physician, were significantly decreased after sublingual-oral treatment for two years (p < 0.001). A significant reduction in skin test reactivity was found when the initial and the final tests were compared. The difference between before and after treatment levels of specific IgE levels for D. pteronyssinus, D. farinea, and grasses were significant (p < 0.001), but were not significant for cereals (p=679 ns). As far as concerns the correlation between the recovery of clinical findings and age, as well as the correlation between the recovery of clinical findings and sex, neither of these were statistically significant (age: r = -0.076, p = 0.453, sex: r = -0.004, p = 0.97). The efficacy of the treatment, determined by means of symptom evaluations, was higher than expected in our study. A certain effect of this recovery might be due to the placebo effect, but it is supported by the improvement in skin tests and specific IgE levels.
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PMID:Efficacy of long-term sublingual-oral immunotherapy in allergic rhinitis. 1648 78

Allergic rhinitis is a common medical condition characterized by nasal, throat, and ocular itching; rhinorrhea; sneezing; nasal congestion; and, less frequently, cough. The treatment of allergic rhinitis should control these symptoms without adversely affecting daily activities or cognitive performance and should prevent sequelae such as asthma exacerbation or sinusitis. This review describes a stepwise approach to treatment of allergic rhinitis derived from a synthesis of clinical trial results, patient preferences, and real-world tolerability data. Key clinical considerations include frequency and intensity of symptoms, patient age, comorbidities, compliance with treatment regimens (influenced by formulation, route and frequency of administration), and effects on quality of life. Oral second-generation antihistamines, versus first-generation agents and inhaled corticosteroids, should be considered first-line treatment because they provide rapid relief of most allergic rhinitis symptoms without safety and tolerability issues. Additional therapeutic agents can then be added or substituted based on individual symptom response.
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PMID:Allergic rhinitis: treatment based on patient profiles. 1649 Apr 66

Several clinical studies have confirmed the effectiveness of montelukast 10mg orally in adults with both asthma and allergic rhinitis. The objective of this phase IV study was to investigate the efficacy and safety of montelukast 10mg in adults with both asthma and allergic rhinitis in a real-life setting. Data from 5855 patients (mean age: 42.8+/-15.4 years) were collected and analyzed following treatment for 4-6 weeks. Efficacy was analyzed by comparing baseline values of: general, day- and night-time improvement in asthma symptoms, need for rescue medication or inhaled corticosteroids (ICSs), general and specific improvement in allergic rhinitis symptoms, reduction in rhinitis medication use, and general and specific quality of life (QoL) improvement with values collected at the end of the observation period of 4-6 weeks. Following treatment with 10mg montelukast 86.5% (n=4547) of patients reported a strong or marked improvement in day-time asthma symptoms and 88.5% (n=4367) reported improvement in night-time symptoms. A similarly high proportion of patients had a strong or marked improvement in all symptoms of allergic rhinitis (i.e. sneezing/itching (84%), rhinorrhea (81.7%), nasal congestion (79.3%), watery eyes (78.4%) and red or burning eyes (77.7%). The use of asthma and rhinitis medication was also reduced. 92.3% (n=5685) of all patients intended to continue montelukast therapy. Overall QoL was "very good" or "good" in 85.2% of patients (n=4991) and a "strong" or "marked" improvement in each of the four domains of sleep, work, everyday life and physical activity. Montelukast was well tolerated. Adverse drug reactions occurred in 14 out of 6158 patients. None of the adverse events was serious. Accordingly, montelukast 10mg is a safe and effective treatment for patients with both asthma and allergic rhinitis.
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PMID:Efficacy and safety of montelukast in adults with asthma and allergic rhinitis. 1662 55

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