Our library of drug research abstracts drawn from the medical literature is updated on a regular schedule, and you can be assured that new astelin research articles will be listed here shortly after becoming available to us.
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[Efficacy evaluation of polysaccharide nucleic acid-fraction of BCG on vasomotor rhinitis]
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2008 Mar; 22(5): 201-3
Chen J, Kong W, Zhou Y, Xiang J, Shu H, Shi Q, Tan H
OBJECTIVE: To investigate the efficacy and safety of polysaccharide nucleic acid-fraction (BCG-PSN) in the treatment of vasomotor rhinitis. METHOD: Sixty patients were randomly divided into BCG-PSN group (n = 30) and control group (n = 30). The patients in BCG-PSN group were administered with BCG-PSN 1.0 mg twice a week for two months, and intranasal azelastine was used if needed. The patients in control group were administered with intranasal azelastine solely twice a day, which could be decreased with the symptom relief. Follow-up was 6 months. Symptom and medication scores were recorded. Side effects were registered. RESULT: The symptom and medication scores of BCG-PSN group were significantly lower than that of control group (P < 0.01) after BCG-PSN treatment. There was no significant difference in symptom score between the two groups at 6 months after BCG-PSN treatment (P > 0.05), while the medication score of BCG-PSN group was still much lower than that of control group (P < 0.01). No serious adverse events were reported in BCG-PSN group except for local pain on the injection place in one patient. CONCLUSION: BCG-PSN is effective and safe in the treatment of vasomotor rhinitis.
J Pharmacol Sci. 2008 May; 107(1): 66-79
Hishinuma S, Sato Y, Kobayashi Y, Komazaki H, Saito M
We evaluated changes in the binding properties of sedative and non-sedative histamine H1-receptor antagonists induced by internalization of H1 receptors in intact human U373 MG astrocytoma cells. Internalization of H1 receptors was induced without their degradation by treatment with 0.1 mM histamine for 30 min at 37 degrees C, and then the intact cell binding assay was performed at 4 degrees C. The binding properties of [3H]mepyramine, a cell-penetrating radioligand for H1 receptors, were not changed by histamine pretreatment. Displacement curves for sedative H1-receptor antagonists (diphenhydramine, chlorpheniramine, promethazine, ketotifen, azelastine and oxatomide) against [3H]mepyramine binding were not changed by histamine pretreatment. In contrast, the displacement curves for non-sedative H1-receptor antagonists (mequitazine, bepotastine, olopatadine, epinastine, carebastine, desloratadine and fexofenadine) were changed by histamine pretreatment: two types of changes, i.e. a rightward shift in the monophasic curve or an increase in the proportion of the low affinity component of the biphasic curve, were prevented under hypertonic conditions, in which clathrin-mediated receptor internalization is known to be inhibited. Thus, internalization-mediated changes in the binding properties of H1-receptor antagonists were well correlated with their sedative and non-sedative behaviors, which might confirm their permeability through the biomembrane and possibly the blood brain barrier.
Nasal ocular reflexes and eye symptoms in patients with allergic rhinitis.
Ann Allergy Asthma Immunol. 2008 Mar; 100(3): 194-9
Baroody FM, Foster KA, Markaryan A, deTineo M, Naclerio RM
BACKGROUND: Allergic patients often complain of eye symptoms during the allergy season. A possible mechanism for these eye symptoms is a nasal ocular reflex. OBJECTIVE: To demonstrate eye symptoms after nasal allergen challenge. METHODS: In a double-blind, placebo-controlled, crossover, clinical trial, 20 patients with seasonal allergic rhinitis were challenged in 1 nostril with antigen, and the response was monitored in both nostrils and in both eyes. Symptoms were recorded. Filter paper disks (intranasally) and Schirmer strips (intraocularly) were used for collecting secretions, which were subsequently eluted for the measurement of histamine and albumin levels. Patients were treated once topically at the site of challenge with azelastine or placebo. RESULTS: After placebo treatment, ipsilateral nasal challenge caused nasal symptoms and an increase in secretion weights; both were blocked by treatment with azelastine. Histamine and albumin levels increased only at the site of nasal challenge. Azelastine pretreatment inhibited the increase in albumin but not histamine levels. Symptoms of itchy and watery eyes increased significantly compared with symptoms with sham challenge after nasal allergen and were blocked by azelastine use. Ocular secretion weights increased bilaterally after placebo use and were not inhibited by azelastine use. CONCLUSIONS: Nasal allergen challenge releases histamine at the site of the challenge, which probably initiates a nasonasal and a nasal ocular reflex. This reflex is reduced by an H1-receptor antagonist applied at the site of the challenge. The eye symptoms associated with allergic rhinitis probably arise, in part, from a naso-ocular reflex.
Seasonal allergic rhinitis: limited effectiveness of treatments.
Prescrire Int. 2008 Feb; 17(93): 28-32
(1) Seasonal allergic rhinitis, otherwise known as hayfever, is a harmless condition, although it can cause major discomfort and interfere with activities of daily living. We conducted a review of the literature, based on our in-house methodology, to determine the risk-benefits of treatments used in this setting. (2) Placebo-controlled trials show that sodium cromoglicate relieves symptoms, especially if it is used before symptoms appear. Adverse effects are rare with sodium cromoglicate nasal solutions and eye drops. (3) Nasal steroids have well-documented efficacy. Beclometasone is the best choice. Adverse effects include epistaxis, nasal irritation and, occasionally, systemic disorders. (4) Oral antihistamines are less effective than nasal steroids. They also provoke adverse effects, especially drowsiness. Nasal azelastine seems to have a similar efficacy as oral antihistamines. (5) The adverse effects of systemic steroids must not be overlooked, especially with long-term use. Oral administration is an alternative for severe symptoms that do not respond to other treatments, although this is rarely the case. Long-acting intramuscular steroids carry an increased risk of adverse effects. (6) Despite evaluation in several randomised controlled trials, there is no firm evidence that homeopathic preparations have any specific efficacy in allergic rhinitis. (7) Vasoconstrictors, ipratropium and montelukast, have negative risk-benefit balances in hay fever. (8) When a single allergen is responsible (grasses, ragweed, birch), clinical trials suggest that specific desensitisation can provide a modest improvement. However, this treatment carries a risk of local adverse effects, as well as a risk of rare but severe anaphylactic reactions, especially in patients who also have unstable severe asthma. (9) Sublingual desensitisation seems to be even less effective than subcutaneous desensitisation in adults. Follow-up is too short to know whether there is a risk of severe anaphylactic reactions. The results of paediatric studies are even less convincing. (10) In practice, when drug therapy is needed to relieve symptoms of seasonal allergic rhinitis, sodium cromoglicate is the first-line treatment. If a nasal steroid solution is chosen, it should be used for the shortest possible period.
Exp Eye Res. 2008 May; 86(5): 791-7
Sanchis-Merino ME, Montero JA, Ruiz-Moreno JM, Rodriguez AE, Pastor S
In order to compare the relative efficacy of topical antihistamines with balanced saline solution (BSS) and benzalkonium chloride (BC) in the early phase of allergic conjunctivitis in an animal model of ocular anaphylaxis, 96 male guinea pigs were sensitized with intraperitoneal egg albumin (EA) and aluminum hydroxide. Seventy-six animals were used for determination of Evans blue (EB) extravasation and 20 for clinical evaluation of the allergic response (redness, edema, discharge and itch-scratch response). Eighteen days after sensitization the animals were topically challenged by conjunctival instillation of EA and treated 15min before and 15min after challenge with commercially available drugs (ketotifen, ketotifen single dose units [SDU], olopatadine, azelastine, spaglumic acid and emedastine) and controls (BSS and BC). The animals used for EB quantification were anesthetized and received an intravenous injection of EB simultaneously to the topical challenge. The ocular extravasation of the colorant was determined by 620nm absorbance spectrophotometry. The animals used for clinical evaluation were observed for clinical signs of the allergic reaction. EB ocular extravasation was significantly lower in the eyes treated by spaglumic acid and emedastine. The clinical scoring was consistent with EB extravasation, though the difference was not statistically significant. Spaglumic acid and emedastine seem to be the most useful drugs to reduce EB extravasation and allergic signs in an animal model of early phase allergic conjunctivitis.
Elucidating the mechanism underlying the ocular symptoms associated with allergic rhinitis.
Allergy Asthma Proc. 2008 Jan-Feb; 29(1): 24-8
Naclerio RM, Pinto J, deTineo M, Baroody FM
Ocular symptoms occur in approximately 40% of patients with allergic rhinitis. The purpose of this study was to determine whether nasal challenge with antigen induces a nasal-ocular reflex. We performed a double-blind crossover trial in 20 subjects. A nasal challenge with antigen was performed in one nostril, and the response was assessed in both nostrils and both eyes. Subjects were treated before challenge with either placebo or azelastine, an H(1)-antihistamine. Nasal challenge with antigen led to a nasonasal reflex and a nasal-ocular reflex as manifested by an increase in symptoms and secretion weights. Treatment with azelastine reduced both reflexes. A nasal-ocular reflex follows nasal challenge with antigen and probably contributes to the ocular symptoms associated with allergic rhinitis.
Ann Allergy Asthma Immunol. 2008 Jan; 100(1): 74-81
Ratner PH, Hampel F, Van Bavel J, Amar NJ, Daftary P, Wheeler W, Sacks H
BACKGROUND: To our knowledge, there are no published studies that evaluated the efficacy of azelastine hydrochloride nasal spray in combination with an intranasal corticosteroid, although anecdotal reports of the use of these agents in combination are common. OBJECTIVE: To determine if greater efficacy could be achieved with the intranasal antihistamine azelastine and the intranasal corticosteroid fluticasone propionate used concurrently compared with the efficacy of each agent alone. METHODS: This randomized, 2-week, multicenter, double-blind trial was conducted during the Texas mountain cedar season. After a 5-day placebo lead-in period, 151 patients with moderate to severe nasal symptoms were randomized to treatment with the following: (1) azelastine nasal spray, 2 sprays per nostril twice daily; (2) fluticasone nasal spray, 2 sprays per nostril once daily; or (3) azelastine nasal spray, 2 sprays per nostril twice daily, plus fluticasone nasal spray, 2 sprays per nostril once daily. The primary efficacy variable was the change from baseline in the total nasal symptom score (TNSS), consisting of sneezing, itchy nose, runny nose, and nasal congestion. RESULTS: All 3 groups had statistically significant (P < .001) improvements from their baseline TNSS after 2 weeks of treatment. The TNSS improved 27.1% with fluticasone nasal spray, 24.8% with azelastine nasal spray, and 37.9% with the 2 agents in combination (P < .05 vs either agent alone). All 3 treatments were well tolerated. CONCLUSIONS: The significant improvement in the TNSS with combination therapy relative to the individual agents alone is in contrast to previously published studies that found no advantage with an oral antihistamine and an intranasal corticosteroid in combination. Azelastine nasal spray and fluticasone nasal spray in combination may provide a substantial therapeutic benefit for patients with seasonal allergic rhinitis compared with therapy with either agent alone.
A novel and effective approach to treating rhinitis with nasal antihistamines.
Ann Allergy Asthma Immunol. 2007 Nov; 99(5): 383-90; quiz 391-2, 418
Kaliner MA
OBJECTIVES: To review existing treatments for rhinitis and summarize data available on the use of a nasal antihistamine (azelastine) in treating allergic and nonallergic vasomotor rhinitis. Data Sources: Relevant articles and references published between 1995 and 2007 regarding the treatment of allergic and vasomotor rhinitis were identified from PubMed, review articles, meta-analyses, and practice guidelines. Study Selection: All key relevant articles were reviewed and the most relevant selected for inclusion in this review. RESULTS: The efficacy and safety of azelastine nasal spray in treating allergic rhinitis and vasomotor rhinitis have been determined in a number of U.S. multicenter, randomized, double-blind, placebo-controlled trials. In all trials, azelastine was associated with a rapid onset of action and a sustained improvement over time in rhinitis, congestion, and other symptoms. In patients with allergic rhinitis, the combination of azelastine and nasal corticosteroids increased treatment efficacy by more than 40% compared with either product alone. CONCLUSIONS: Intranasal antihistamine therapy represents an effective mode of drug delivery in patients with allergic and nonallergic vasomotor rhinitis and is an important option for rhinitis therapy, particularly if rapid symptom relief is required or if congestion is a major symptom. Use of azelastine plus nasal corticosteroids is effective in both allergic rhinitis and vasomotor rhinitis, suggesting that this combination represents an effective treatment strategy for all patients with either allergic or nonallergic vasomotor rhinitis.
Effects of ototopical antihistamine on otitis media in an allergic rat.
Laryngoscope. 2008 Feb; 118(2): 283-7
Cutler JL, Labadie RF
OBJECTIVES/HYPOTHESIS: A reliable model of allergy has been created in the Brown Norway rat. In this model, allergen presentation to the middle ear causes functional disruption of the eustachian tube, predisposing to the development of otitis media with effusion. The purpose of this study was to study the effects of ototopical antihistamine on lipopolysaccharide (LPS)-induced otitis media in the allergic rat model. STUDY DESIGN: Prospective animal-based research study. METHODS: Fifteen (n = 15) rats were made allergic via sensitization to ovalbumin (OVA) by subcutaneous injection and randomized into three groups: saline (SAL) + LPS, olopatadine (OLO) + LPS, and azelastine (AZE) + LPS. Allergic rats were transtympanically injected with OVA 24 hours prior to challenge, creating a subclinical inflammatory response in which there is no visible middle ear effusion. Thirty-five microliters of test substance (SAL + LPS, OLO + LPS, or AZE + LPS) were injected into the middle ear at 0, 2, and 4 hours. Effusion was collected at 2, 4, and 6 hours. Statistical analysis was performed on effusion volume and albumin concentration. RESULTS: Significant increase in effusion volume with respect to time was noted for the SAL + LPS group, whereas the AZE + LPS group demonstrated a decrease. Intergroup comparison revealed a significant decrease in effusion volume at hour 6, with both AZE and OLO less than LPS alone. A significant decrease in albumin concentration over time was noted in the AZE group. Intergroup comparison revealed a significant difference inalbumin concentration at hour 6, with OLO significantly lower than LPS. CONCLUSIONS: Ototopical antihistamines are effective in reducing effusion volume and albumin concentration in LPS-induced otitis media in an allergic rat model. This finding supports the hypothesis that ototopic antihistamines may prove effective in treating patients with allergy-induced eustachian tube dysfunction.
Efficacy and safety of azelastine nasal spray at a dose of 1 spray per nostril twice daily.
Ann Allergy Asthma Immunol. 2007 Sep; 99(3): 267-72
Lumry W, Prenner B, Corren J, Wheeler W
BACKGROUND: Azelastine hydrochloride nasal spray is available worldwide for the treatment of seasonal allergic rhinitis (SAR) and perennial allergic rhinitis. One spray per nostril twice daily is the most commonly recommended dose. OBJECTIVE: To determine the efficacy and safety of azelastine nasal spray, 1 spray per nostril twice daily, in patients with SAR. METHODS: In 2 studies conducted in the United States we assessed 554 patients with moderate-to-severe SAR who were still symptomatic after a 1-week placebo lead-in period. Patients were randomized to 2 weeks of double-blind treatment with azelastine nasal spray, 1 spray per nostril twice daily, or placebo nasal spray. The primary efficacy variable was change from baseline in total nasal symptom score, consisting of sneezing, itchy nose, runny nose, and nasal congestion. RESULTS: Mean differences in total nasal symptom score between the azelastine and placebo groups were significant in both studies: 2.69 vs 1.31 (P = .01) in study 1 and 3.68 vs 2.50 (P = .02) in study 2. Bitter taste was reported by 8.3% of patients treated with 1 spray per nostril twice daily compared with the labeled incidence of 19.7% with 2 sprays per nostril twice daily. Somnolence was reported by 1 patient (0.4%) using the 1-spray regimen compared with the labeled incidence of 11.5% using the 2-spray regimen. CONCLUSIONS: Azelastine nasal spray at a dose of 1 spray per nostril twice daily is effective and has improved tolerability compared with 2 sprays per nostril twice daily in patients with SAR.