Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We have previously reported that elevated osmolality of nasal secretions is linked to the rhinitic reaction to cold and dry air (CDA) that results in inflammatory mediator release and that nasal challenge with hyperosmolal solutions can induce histamine release in randomly selected individuals. These findings led to a comparison of the effect of nasal challenge with hypertonic fluid in 11 subjects who demonstrated a nasal response to CDA compared to 10 subjects without CDA sensitivity. All volunteers were challenged with isosmolal (300 mosmol/kg H2O) and hyperosmolal (800 mosmol/kg H2O) mannitol solutions. Their response was evaluated by symptom scores and quantification of histamine in nasal lavages. CDA responders differed significantly from non-responders in terms of both the total amount and the concentration of histamine in the lavage following hyperosmolal challenge (p less than 0.04 and p less than 0.02, respectively). In addition, CDA responders reported a higher change from baseline for nasal congestion, pruritus, and lacrimation following hyperosmolal challenge, but the scores for rhinorrhea, the volume of the returned nasal lavage fluid following hyperosmolal challenge, and the capacity to reduce the osmolality of the administered hyperosmolal fluid did not differ. Allergic status was not a factor in hyperosmolal reactivity. To investigate possible differences in nonspecific nasal mucosal sensitivity that could account for these findings, all subjects underwent provocation with five increasing doses of histamine, from 0.01 to 1 mg. No significant difference between CDA responders and nonresponders in symptomatology or in the induction of vascular permeability, as assessed by TAME-esterase activity in nasal fluids, could be demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Studies on the relationships between sensitivity to cold, dry air, hyperosmolal solutions, and histamine in the adult nose. 211 49

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

Fifty-two cases of perennial rhinitis were studied, leading to the diagnosis of seven cases of nonallergic rhinitis with eosinophilia syndrome (NARES) a frequency of 13.5%. Symptoms of nasal hyperreactivity involving sneezing, rhinorrhea, nasal obstruction and pruritus were more severe than in other types of rhinitis. The frequency of hyposmia was very specific to NARES. Nasal endoscopy and sinus CT revealed an evolution towards nasal polyposis in four patients. The nasal challenge to house dust mites showed the absence of any increase in local eosinophilia. Bronchial hyperreactivity to carbachol occurred in one case. There was no case of intolerance to aspirin. There was particular adrenergic hyperreactivity among the seven patients, evidenced by study of the reactivity of the cardiovascular alpha and beta receptors. The authors emphasize the features that are shared by NARES and by the triad, which suggest that NARES is the early phase of the triad. They advance the pathogenic hypothesis of an autonomic nervous system dysregulation with a predominating adrenergic hyperreactivity. Inflammatory effects of local release of neurotransmitters induce a switch from a neurogenic to a self-sustaining inflammation. Tissue eosinophilia is regulated by chemical attractants and activating substances of various origins and plays a major part in the chronic inflammatory state.
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PMID:Nonallergic rhinitis with eosinophilia syndrome a precursor of the triad: nasal polyposis, intrinsic asthma, and intolerance to aspirin. 234 37

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

Forty-six of 152 consecutive adult rhinitis patients had perennial nonallergic rhinitis (PNR). Eighty-five percent of those with PNR presented with nasal congestion, whereas 15% presented with rhinorrhea. Their mean age was 40.5 years (range = 21-77), and 74% were female. Patients with perennial nonallergic rhinitis in this series were characterized by ocular pruritus or burning, 28%; frontal headache, 22%; symptoms consistent with asthma, 33%; an unremarkable nasal mucosa, 96%; the absence of nasal polyps, 100%; nasal eosinophilia (greater than or equal to 5%), 10%; nasal neutrophilia (greater than or equal to 25%), 22%; numerous nasal bacteria, 12%; sinusitis, 6%; and a geometric mean IgE of 26.4 U/mL. This experience suggests that PNR is a common problem in a general allergy practice. Nasal obstruction, usually more difficult to treat than rhinorrhea, is the dominant symptom. Unexpected findings were frequent conjunctivitis and nasal neutrophilia.
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PMID:Perennial nonallergic rhinitis: a retrospective review. 248 Jul 28

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

1. Applications of capsaicin, nicotine and methacholine were made locally onto the nasal mucosa in human controls and patients suffering from hyperreactive nasal disorders. Perception of sensation was registered as a sympton score and secretion quantified. The sensory reaction (irritation - pain) to capsaicin was similar in the three groups studied, i.e. controls, a group of patients with the diagnosis of vasomotor rhinitis and a group of patients with increased nasal secretion as the main symptom of the hyperreactive disorder. Nicotine induced only a mild itching sensation in the three groups. However, capsaicin and nicotine challenge caused a significantly larger secretory response in the last group than in the unselected vasomotor rhinitis group and in the control group. 2. Pretreatment with muscarinic receptor antagonists almost completely abolished the secretory response to both capsaicin and nicotine, and blocked methacholine-induced secretion. Furthermore, pretreatment with a combination of local anaesthetic and vasoconstrictor agent abolished the capsaicin-induced irritation, as well as the capsaicin- and nicotine-induced secretion on both the ipsilateral and the contralateral side. Therefore, no clearcut contribution seems to be exerted by locally released peptides from sensory neurones as direct trigger substances for the secretory response to capsaicin. 3. In conclusion, the nasal secretory response, in man, to both capsaicin and nicotine, seems to be mediated via cholinergic parasympathetic reflexes. In patients with hyperreactive non-allergic disorders of the nasal mucosa with rhinorrhea as the main complaint, the enhanced secretion may be due to a hyperreactive efferent cholinergic mechanism rather than hypersensitive irritant receptors on capsaicin- and nicotine-sensitive sensory neurones. Challenge with irritant agents seems a useful test for the evaluation of both afferent and efferent reflexogenic responses in hyperreactive disorders of the nasal mucosa.
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PMID:Capsaicin and nicotine-sensitive afferent neurones and nasal secretion in healthy human volunteers and in patients with vasomotor rhinitis. 272 Feb 99

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.
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PMID:Clinical profile of astemizole. A survey of 50 double-blind trials. 288 7


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