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

The steroids in vernal keratoconjunctivitis (VKC) are not always effective and may result in glaucoma. Cromolyn sodium inhibits degranulation from mast cells, thus preventing release of prostaglandins and the mediators of inflammation when used topically. Aspirin, which blocks the production of inflammation-producing prostaglandins in mast cells released in VKC, especially prostaglandin D2, was used orally in 11 patients with intractable VKC of mixed type with limbal predominance. The chi 2 test of combined therapy showed a significant improvement in itching, lacrimation, and limbal edema (P less than .005) and improved photophobia, palpebral lesions, and corneal staining (P less than .02) at six weeks.
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PMID:Evaluation of combined systemic aspirin and cromolyn sodium in intractable vernal catarrh. 212 Oct 83

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

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

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

Twelve patients with seasonal allergic conjunctivitis caused by either birch or timothy grass pollen were challenged out of season in both eyes, with the relevant allergen. Itching, redness, swelling, and tearing were assessed on a 0-3 scale. When a positive reaction, i.e., at least 4 points, had occurred in both eyes, one drop of 2% sodium cromoglycate was administered to one eye and one drop of placebo to the other eye in each patient, in a double-blind, randomized fashion. Symptoms were then assessed after 2, 10, 30, and 60 min. Sodium cromoglycate was statistically better than placebo in reducing the symptoms at 2, 10, and 30 min after the treatment had been administered, showing that topical application of 2% sodium cromoglycate can quickly relieve ongoing symptoms of allergic inflammation in the eye.
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PMID:Topical sodium cromoglycate (Opticrom) relieves ongoing symptoms of allergic conjunctivitis within 2 minutes. 765 43

Seasonal allergic conjunctivitis is rarely associated with permanent vision impairment; however, it is a relatively common condition that may compromise the quality of life. It may, in extreme cases, impair daily activities, including work. Numerous treatment options have become available for the relief of acute symptoms. Avoidance should always be the first line in therapy but, in most cases, is not practical, especially with pollen allergies. The use of saline eyedrops is simple and nontoxic, and it is effective in up to 30% to 35% of cases. It can and should be added to all other remedies to reduce adverse effects and cost by decreasing the need for other therapeutic options. Antihistamines and decongestants are useful treatment choices for the majority of cases. Ketorolac tromethamine may be helpful in relieving pruritus, but it offers little advantage over topical antihistamines. Corticosteroids may be used for severe cases for a limited time. If topical corticosteroids are being considered, an ophthalmologist should be consulted. Cromolyn sodium and lodoxamide ophthalmic solution may be helpful in the prophylaxis of symptoms during the allergy season, but these agents require frequent dosing. Olopatadine hydrochloride is a mast cell stabilizer and antihistamine that can be dosed twice a day. Immunotherapy is effective and should be offered to those who are intolerant or have allergic conjunctivitis refractory to medications.
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PMID:Seasonal allergic conjunctivitis: overview and treatment update. 1047 15

Seasonal allergic conjunctivitis is rarely associated with permanent vision impairment; however, it is a relatively common condition that may compromise the quality of life of patients with this diagnosis. In extreme cases daily activities, including work, may be compromised. Numerous treatment options have become available for the relief of acute symptoms. Corticosteroids may be used for severe cases for a limited time. If topical corticosteroids are being considered, an ophthalmologist should be consulted. Decongestants and antihistamines are useful treatment options for the majority of cases. Antihistamines, either topical or oral, should be the first-line therapy. Ketorolac may be helpful in relieving pruritus but offers little advantage over topical antihistamines. Sodium cromoglycate and lodoxamide may be helpful in the prophylaxis of symptoms during the allergy season but require frequent dosing. Immunotherapy is effective and should be offered to those who are intolerant or refractory to medications. Obviously, avoidance should always be the first choice in therapy but in most cases is not practical, especially with pollen allergies. The use of saline eyedrops is simple, nontoxic and is effective in up to 30-35% of cases. It can and should be added to all other remedies to reduce adverse effects and cost by decreasing the need for other therapeutic options.
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PMID:Seasonal allergic conjunctivitis. 1509 55

Uremic pruritus occurs in up to 50% of patients undergoing chronic hemodialysis. The pathogenesis of this disabling condition is unknown but likely involves multiple pathways involving the peripheral and central nervous system as well as local chemical and inflammatory mediators. Therapy has involved modification of the dialysis procedure, topical medications such as emollients, physical treatments such as ultraviolet light, and several oral medications such as antihistamines, activated charcoal, and gabapentin. Unfortunately, most of these therapies have not been subjected to rigorous clinical trials and clinical success has been variable. Two patients with disabling uremic pruritus refractory to multiple interventions are reported, who showed significant improvement in pruritus severity as assessed by a visual analog scale when they were treated with the mast cell stabilizer cromolyn sodium. Cessation of cromolyn resulted in return of pruritus, which improved with rechallenge with the medication. Cromolyn sodium may offer an alternative therapy for patients with refractory uremic pruritus, and should be subjected to a randomized placebo-controlled trial.
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PMID:Cromolyn sodium: a potential therapy for uremic pruritus? 1662 73

Tuberculosis is a common disease in India. However, tuberculosis primarily affecting the conjuctiva is a rare entity. We report a 14-year-old girl who presented with unilateral eye discharge, watering, redness and itching for two weeks. Giant papillae were present on the upper tarsal conjunctiva. A provisional diagnosis of allergic conjunctivitis was made. Topical therapy with 1% Prednisolone acetate and 2% Sodium cromoglycate was commenced. The patient returned six months later with no improvement in the symptoms. The tarsal conjunctiva had a polypoidal, velvety appearance with giant papillae. A fibrinous membrane was seen over the tarsal conjunctiva and a preauricular node was found. Excision biopsy and histopathologic examination revealed necrotizing granulomatous inflammation suggestive of tuberculosis. Systemic examination and investigations were normal. She was started on anti-tuberculous therapy. In two months she showed complete resolution of symptoms and marked reduction in papillae and conjunctival thickening. Symptoms and signs of unilateral conjunctivitis may masquerade as primary conjunctival tuberculosis. In an endemic country like India, laterality, chronicity and non-resolution of symptoms with steroids are indications for pursuing a biopsy earlier than later. In our patient, the histopathology clinched the diagnosis of conjunctival tuberculosis resulting in a faster and complete resolution of the disease condition.
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PMID:Primary conjunctival tuberculosis in a 14 year old girl. 2143 54


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