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Autohemotherapy is a commonly used treatment for recalcitrant chronic urticaria in some countries. Herein we report our experience using autologous serum therapy in eight patients with recalcitrant chronic spontaneous urticaria. Autologous serum therapy was initiated weekly for nine weeks followed by every fortnightly. Urticaria Activity Score (UAS) 7, Dermatology Life Quality Index (DLQI), and reduction of antihistamine usage were used to assess the treatment response. Eight patients (age range: 25-76 years old; four females and four males) had one to ten years of duration of recalcitrant chronic spontaneous urticaria. All failed to respond to high doses of second-generation antihistamines and five to immune-modulating agents. Three did not respond to omalizumab. At week nine, the reduction of UAS7 ranged from 76.2 to 100. There was more than an 80 improvement in DLQI in all patients. The number of wheals seemed to be reduced first followed by pruritus. Three patients had stopped antihistamines by week eight of treatment. No adverse events were reported in all eight patients. Autologous serum therapy may serve as an alternative treatment for recalcitrant chronic spontaneous urticaria. Apart from the practicality, which requires frequent clinic visits, venipuncture, and centrifugation, it is cheap and effective with minimal adverse events. Keywords: Atopic dermatitis, autologous serum therapy, omalizumab, recalcitrant chronic spontaneous urticarial, Author(s): Ingrid Ting Pao Lin (corresponding author) [1]; Nurul Izyan Ghazali [2]; Yan Teo [1]; Siaw Ling Lai [1]; Mohammed Faizal Bakhtiar [3]; Min Moon Tang [1] Introduction Chronic spontaneous [...]

Backgrounds: A large proportion of patients with chronic spontaneous urticaria (CSU) are resistant to a standard dose of antihistamine. Acknowledged biomarkers for identifying these patients have not been determined. The neutrophil/lymphocyte ratio (NLR) has been considered as an important indicator of inflammation in chronic diseases. Aims: To explore whether NLR could serve as a biomarker for predicting the response to H1-antihistamine in patients with CSU. Methods: This hospital-based, retrospective study included 109 patients with CSU diagnosed from 2017 to 2020 in our clinic and divided them into two groups by their responses to the 2-week antihistamine therapy of standard-dose: 69 with H1-antihistamine-refractory and 40 with non-H1-antihistamine-refractory CSU. The laboratory test results were collected from the hospital information system and integrated with SPSS software. Results: Patients refractory to H1-antihistamine had significantly higher median NLR (P = 0.039), age (3 P = 0.021), complement C3 (P = 0.026), presence of elevated WBC (P = 0.026) and elevated monocytes (MONO) (P = 0.045) and significantly lower IgM (P = 0.022). The binary logistic regression model revealed that NLR was significantly associated with H1-antihistamine-refractory of CSU (odds ratio (OR) 1.717, 95 confidence interval (CI) 1.065-2.766, P = 0.026), which was consistent with that after adjusted for potential confounding factors including age, complement C3, presence of elevated WBC and MONO, and IgM (OR 1.681, 95 CI 1.019-2.773, P = 0.042). Conclusion: Our results showed a strong and significant association between higher NLR and H1-antihistamine resistance in CSU, suggesting that NLR may be a potential biomarker for predicting the response to H1-antihistamine therapy in patients with CSU. Keywords: Biomarker, CSU, H1-antihistamine, refractory, neutrophil/lymphocyte ratio, Author(s): Xiaonan Qiu [1]; Qiao Ran [1]; Juanjuan Pan [1]; Guozhen Tan (corresponding author) [1] Introduction Chronic urticaria, one of the most frequent skin disorders, is characterized by the presence [...]

Background Methods Results Conclusion Intranasal antihistamines (INAH), corticosteroids (INCS), and their fixed combinations (INAH+INCS) are one of the cornerstones of the treatment of allergic rhinitis (AR). We performed a systematic review and network‐meta‐analysis comparing the efficacy and safety of INAH, INCS, and INAH+INCS in patients with AR.We searched four electronic bibliographic databases and three clinical trial databases for randomised controlled trials assessing the use of INAH, INCS, and INAH+INCS in adults with seasonal or perennial AR. We performed a network meta‐analysis on the Total Nasal Symptom Score, Total Ocular Symptom Score, Rhinoconjunctivitis Quality‐of‐Life Questionnaire, development of adverse events, and withdrawals due to adverse events. Certainty of evidence was assessed using GRADE‐NMA.We included 167 primary studies, most of which assessed patients with seasonal AR. Among individual medications, azelastine‐fluticasone, and fluticasone furoate were the most frequently highest‐ranked interventions for efficacy outcomes, being regularly associated with clinically meaningful larger improvements when compared to other active treatments. Considering drug classes, INAH+INCS were the highest‐ranked interventions for all outcomes in which they were assessed, followed in most cases by INCS. In 105 out of 184 comparisons in seasonal AR, and 28 out of 97 comparisons in perennial AR, certainty of evidence was considered “high” or “moderate”.Intranasal medications for AR display clinically relevant differences in their efficacy, but all show a good safety profile. To our knowledge, this is the first network meta‐analysis comparing INAH, INCS, and INAH+INCS in AR, providing relevant evidence for guideline developers and practising physicians on the most efficacious treatments. [ABSTRACT FROM AUTHOR]

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Delayed pressure urticaria (DPU) is a subset of chronic inducible urticaria. It is characterized by the formation of wheals anytime between 30 minutes and 24 hours after stimulus exposure of localized pressure application. In this case report, we discuss a military flight crew member with no significant past medical history who developed DPU following rapid decompression in an altitude chamber. The chamber training included an uneventful ascent to 45,000 feet, higher than he had been previously, and a rapid decompression. About 16 hours later, he developed pruritic swelling of his hands and feet, along with diffuse deep nodular swelling, erythematous plaques, and erythematous nodules. His DPU was refractory to monotherapy treatment with antihistamines, and he continued to develop lesions in weight-bearing areas. Control of symptoms was achieved through combination treatment of a second-generation antihistamine, a leukotriene receptor antagonist, and an immunosuppressant (cyclosporine). His waiver to return to flight status was denied while on cyclosporine. He was transitioned to a monoclonal antibody that binds free immunoglobin E (omalizumab) with resolution of symptoms and was cleared to return to active duty. [ABSTRACT FROM AUTHOR]

This article reports the findings of an online survey designed to collect information about substance use (licit, illicit, or pharmaceutical) and mental health (depression or anxiety) among social workers. Among the 489 participants, Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) screenings indicated symptoms of depression and anxiety at a higher prevalence than those of the general Canadian population. There were relatively few correlations between mental health scores and substance use. PHQ-9 total score significantly predicted past-year antidepressant use and past-year sleeping medication use. GAD-7 total score significantly predicted past-year benzodiazepine use and past-year melatonin use. Effects of substances (e.g. cannabis, alcohol, benzodiazepines, cocaine, ecstasy) were predominantly beneficial or nonproblematic (e.g. enjoyment/pleasure; socializing enhanced; concentration/focus improved). Subjective experiences of social workers should be sought to understand potential relationships between mental health scores and enhancement effects of substance use. Substances are being used, at least in part, for their performance-enhancing effects to meet the expectations of day-to-day life. Interventions can shift toward root causes, with institutions held more accountable for supporting social workers and promoting "workplace care." [ABSTRACT FROM AUTHOR]

Gastrointestinal (GI) disorders range from intermittent heartburn to life-threatening GI hemorrhage. One of the most common GI disorders is gastroesophageal reflux disease (GERD), which affects an estimated 19% of adults in North America. This article discusses the advantages and disadvantages of acidsuppressive therapy for patients with GERD as well as relevant nursing considerations. [ABSTRACT FROM AUTHOR]

There are only a few clinical trials which address the treatment of acute urticaria (AU). Especially, the added value of systemic corticosteroids to antihistamines is unclear in treatment of severe AU. To review the existing evidence‐based approaches for AU treatment. A systematic electronic search was done in PubMed and Web of Science to retrieve all studies on the treatment of patients with AU. A descriptive synthesis was conducted based on the PRISMA statement. Quality assessment was independently performed by both reviewers ('Cochrane risk‐of‐bias tool' for RCTs). Ten randomized controlled trials (RCTs) (n = 857 participants) were included. Four studies assessed corticosteroid effectiveness added to antihistamines and six studies compared the efficacy of H1 and/ or H2‐antihistamines. The addition of corticosteroid (prednisone) to an antihistamine (levo)cetirizine did not improve symptoms of AU compared to antihistamine alone in two out of three RCTs. The combination of diphenhydramine (50 mg, IV) and ranitidine (50 mg, IV) or cimetidine (300 mg, IV) was most efficient for relief of urticaria in two out of five studies. Most frequent adverse effects were sedation and drowsiness. Recent guidelines on urticaria treatment mainly focus on chronic urticaria rather than on AU. Moreover, only few, small RCTs provide evidence for the management of AU. Thus, the state‐of‐the‐art management of this frequent condition remains unclear. The addition of corticosteroids to an antihistamine as treatment for AU needs to be further investigated. Well‐designed, high‐quality interventional trials are needed to establish evidence‐based treatment guidelines for AU. [ABSTRACT FROM AUTHOR]

AbstractThe common cold is the most frequent upper respiratory viral infection. Although benign, it represents a high socioeconomic burden. Many over-the-counter drugs are available to manage the symptoms of this condition, with antihistamines and vasoconstrictors being the most widely used. This review aimed to compare the potential mechanisms underlying the efficacy and safety of chlorphenamine and pseudoephedrine, the most commonly used agents in these two classes of drugs, and provide a useful perspective to impact appropriate decisions when considering these options for symptomatic common cold treatment. To conduct a comprehensive analysis, we systematically reviewed the use of pseudoephedrine and chlorphenamine using various databases, including MEDLINE, Google Scholar, Scopus, and Embase. We also perused the bibliographies of relevant articles and the EudraVigilance database. The findings suggest that pseudoephedrine may offer specific benefits in rapidly alleviating nasal congestion in the short term. Chlorphenamine appears to exhibit a higher degree of efficacy in alleviating rhinorrhea and other specific cold symptoms compared to pseudoephedrine. Pharmacovigilance data and case report reviews showed that pseudoephedrine may induce a higher incidence of less common but potentially life-threatening adverse effects compared to chlorphenamine. We concluded that antihistamine drugs exhibit a more favorable benefit/risk profile than vasoconstrictors for treating symptomatic common colds. [ABSTRACT FROM AUTHOR]

Acid-suppressant drugs (ASDs) have revolutionized the treatment of acid-related disorders such as gastroesophageal reflux and gastrointestinal ulceration in both human and veterinary species. However, continued advancement in this field is dependent on a shared understanding of both human and veterinary research as well as an appreciation for species similarities and differences. In this Currents in One Health article, we will compare the efficacy of and indications for ASDs in humans and small animals, noting species differences and knowledge gaps when applicable. We will also highlight areas where further research is needed, specifically emphasizing the need for more feline research and a better understanding of which diseases may benefit from gastroprotection. Finally, given the rising overuse of ASDs in both human and veterinary medicine, we will explore the known adverse effects of these drugs in dogs and cats. This article is focused on our current understanding of these drugs in veterinary medicine and their clinical implications. The companion Currents in One Health article by Gould et al, AJVR, October 2024, will explore the future of ASD research and use by evaluating these drugs’ pH-independent effects in humans and rodent models. [ABSTRACT FROM AUTHOR]

Irritable bowel syndrome is characterized by the association of abdominal pain and bowel habits disorders. It is part of the disorders of brain gut interactions. The importance of the placebo effect is well known for this group of diseases, and according to certain authors, placebo should be considered as a treatment in its own right for irritable bowel syndrome. Drug treatment of irritable bowel syndrome pain is one therapeutic option among others, including dietary modifications, psycho-emotional behavioral therapies, and electrical stimulation. Literature data suggest that a number of dietary supplements, herbal medicines and probiotics can improve abdominal pain. Antispasmodics have moderate but demonstrated effectiveness, including peppermint oil, phloroglucinol and mebeverine. Central neuromodulators (anti-epileptics used for neuropathic pain and antidepressants) are part of the therapeutic arsenal used for intractable abdominal pain in irritable bowel syndrome: here again, the level of evidence is quite low, and the side effects frequent. Other pharmacological agents that have shown greater efficacy than placebo for the treatment of irritable bowel syndrome pain include antagonists of histamine 1 receptors, and guanylate cyclase-C agonist secretagogues. In total, many molecules are available to treat the pain of irritable bowel syndrome. However, for the most part they have limited effectiveness, and some have side effects which should prompt careful prescription. [ABSTRACT FROM AUTHOR]

Background/Objectives: Autism spectrum disorder (ASD) is a neurodevelopmental condition marked by social interaction difficulties, repetitive behaviors, and immune dysregulation with elevated pro-inflammatory markers. Autophagic deficiency also contributes to social behavior deficits in ASD. Histamine H3 receptor (H3R) antagonism is a potential treatment strategy for brain disorders with features overlapping ASD, such as schizophrenia and Alzheimer's disease. Methods: This study investigated the effects of sub-chronic systemic treatment with the H3R antagonist E159 on social deficits, repetitive behaviors, neuroinflammation, and autophagic disruption in male BTBR mice. Results: E159 (2.5, 5, and 10 mg/kg, i.p.) improved stereotypic repetitive behavior by reducing self-grooming time and enhancing spontaneous alternation in addition to attenuating social deficits. It also decreased pro-inflammatory cytokines in the cerebellum and hippocampus of treated BTBR mice. In BTBR mice, reduced expression of autophagy-related proteins LC3A/B and Beclin 1 was observed, which was elevated following treatment with E159, attenuating the disruption in autophagy. The co-administration with the H3R agonist MHA (10 mg/kg, i.p.) reversed these effects, highlighting the role of histaminergic neurotransmission in observed behavioral improvements. Conclusions: These preliminary findings suggest the therapeutic potential of H3R antagonists in targeting neuroinflammation and autophagic disruption to improve ASD-like behaviors. [ABSTRACT FROM AUTHOR]

Background: Antihistamines has always remained the mainstay drug treatment for Allergic Rhinitis (AR). Bilastine is a novel, non-sedative antihistamine with a super-selective H1 receptor antagonist property. Both bilastine and fexofenadine are second generation antihistamine drugs commonly used to manage AR and Chronic Urticaria (CU). Autologous Skin Serum Test (ASST) is a practical test for histamine release in CU. These tests have been studied in AR patients with limited data studies. Methods: 114 patients diagnosed with perennial AR were recruited and divided into two groups of 57 each. One group was started Bilastine 20 mg once a day and other group, fexofenadine 180 mg once a day. Total Nasal Symptom Score (TNSS) was calculated at presentation and two weeks of antihistamine therapy. ASST was hypothesized to be the test for AR and performed at the time of presentation and at two weeks follow-up. Intergroup and Intragroup assessment of TNSS, ASST and its variables were done using unpaired and paired t test respectively. Results: Patients showed reduction in symptoms of AR with both antihistamines. A significant improvement of sneezing and rhinorrhoea was seen in Fexofenadine group as compared to Bilastine group. TNSS showed statistically significant improvement in both the groups. ASST had statistically significant reduction in both the groups. Conclusions: Both Bilastine and fexofenadine were found to be effective in reduction of symptoms of allergic rhinitis. Bilastine was found to be more effective in overall as well as sneezing and rhinorrhoea noted two weeks after therapy. [ABSTRACT FROM AUTHOR]

Allergic rhinitis (AR), commonly called hay fever, is primarily caused by the release of histamine after exposure to an allergen. This article reviews over-thecounter nasal spray options for the prevention and treatment of AR, including mechanisms of action, risks and benefits, and patient education. [ABSTRACT FROM AUTHOR]

Copyright of Immunology Quarterly / Immunológiai Szemle is the property of Medicina Konyvkiado Zrt. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article discusses the creation of the World Wide Approved Drug (WWAD) database, which aims to provide comprehensive information on medicines approved for therapeutic use worldwide. The database collects data from National Medicine Registers (NMRs) and official documentation from medicines regulatory authorities (MRAs) of different countries. The article emphasizes the need for a unified resource that aggregates information on worldwide approved medicines and highlights the challenges in accessing and processing this data. The World Wide Approved Drugs (WWAD) database is a comprehensive resource that provides information on low molecular weight pharmaceutical substances from 71 countries and regions. It includes data on drug names, chemical structures, therapeutic indications, molecular targets, and biological activities. The database can be used for various purposes, including searching for information on approved drugs, drug repositioning, data enrichment, and assessing the novelty of investigated compounds. The WWAD database is freely available for academic use through the Way2Drug platform. This document contains a list of references and citations from various scientific articles and databases related to topics such as computational chemistry, drug discovery, drug repurposing, and regulatory approval of drugs. The references cover a range of subjects including the use of artificial intelligence and machine learning in drug discovery, the development of databases for drug repurposing, and the analysis of drug approvals by regulatory agencies. The document provides a comprehensive list of sources that library patrons can use to further their research on these topics. [Extracted from the article]

Introduction: Chronic spontaneous urticaria (CSU) is characterized by urticaria persisting for more than 6 weeks. Antihistamines, notably sgAH (second generation antihistamines) are the first line of treatment for CSU. Areas covered: This consensus aimed to review the existing research on receptor occupancy of antihistamines, including levocetirizine, and translate its implications in the treatment of CSU. The consensus deliberations were under the banner of the Antihistamine Receptor Occupancy Group (AROG) from India, an expert panel of 12 dermatologists with a mix of institutional and practitioner backgrounds. This group analyzed the existing translational research on the receptor occupancy of levocetirizine to establish the clinical efficacy and safety of levocetirizine in the treatment of CSU using the grading of recommendations assessment, development, and evaluation (GRADE) method vis-a-vis the varied SGAH. Expert opinion: SGAH constitute the first step in the therapeutic ladder for managing CSU. Levocetirizine has high bioavailability, high affinity and occupancy of the H1 receptor, rapid onset of action, limited distribution and minimal hepatic metabolism. It exhibits significant anti-inflammatory effects at clinically relevant concentrations. The marked receptor occupancy translates to enhanced efficacy as compared to similarly dosed SGAH with the lower cost making it an appropriate drug for chronic use. Receptor occupancy should be the basis of intra-class head-to-head trials in CSU. [ABSTRACT FROM AUTHOR]

Introduction: Decongestants are commonly used drugs in clinical practice, and they can relieve nasal congestion caused by factors like influenza, rhinitis, and acute upper respiratory tract infection. Areas covered: In this article, we review the research outcomes about decongestants, which aim to provide beneficial information that can guide the clinical application of decongestants for clinicians. Expert opinion: Although the use of nasal decongestants is increasingly limited, caution rather than prohibition is now advocated. Scientific and accurate use of nasal decongestants can achieve satisfactory clinical effectiveness on nasal congestion, and it is not easy to produce adverse reactions. Patients with severe nasal congestion may use nasal decongestants solely or in combination with nasal corticosteroids or nasal antihistamines to exert a synergistic effect. The concentration, dose, frequency, and time of nasal decongestants determine whether drug-induced rhinitis will occur. Additionally, we recommend patients not to buy nasal sprays with unknown ingredients on the internet or in pharmacy, so as to avoid the risk of rhinitis medicamentosa. For patients with rhinitis medicamentosa, the use of nasal decongestants should be stopped immediately. However, more evidence is still needed to standardize the clinical use of nasal decongestants. [ABSTRACT FROM AUTHOR]

Background: For treating patients with refractory chronic spontaneous urticaria (CSU) resistant to standard doses of 2nd generation H1-antihistamines (H1AH) the International and Japanese guidelines recommend increasing H1AH dose. The latter also recommends switching to a different H1AH. This study explored if the efficacy of the standard dose of bilastine 20 mg is non-inferior to that of double-dose of H1AH in patients with refractory CSU. Methods: This phase IV, multicenter, open-label, randomized, parallel-group trial evaluated the efficacy and safety of switching treatment to bilastine compared to treatment with a 2-fold dose of H1AH in patients with CSU refractory to standard dose H1AH. The primary endpoint was the mean total symptom score (TSS) at Day 5-7 after the start of administration. Results: Treatment efficacy and safety were evaluated in 128 patients (bilastine, n=64; 2-fold dose of H1AH, n=64). The mean TSS at Day 5-7 after the start of administration was smaller than the non-inferiority margin of 0.8, demonstrating non-inferiority of the bilastine switching group to the double-dose H1AH group (0.17 (95% CI -0.32, 0.67)). No difference in Japanese version of Epworth Sleepiness Scale (JESS), DLQI, and urticaria activity score over 7 consecutive days (UAS7) was observed between the two groups. There were no serious adverse events in either group. H1AH-related adverse events occurred in 5 subjects (8 cases) and 2 subjects (3 cases) in the double-dose H1AH and bilastine groups, respectively. Conclusions: Switching treatment to bilastine demonstrated non-inferiority to a double-dose of H1AH in terms of efficacy in patients with CSU refractory to standard dose H1AH with a favorable safety profile. Clinical trial registration: https://jrct.niph.go.jp/latest-detail/jRCTs051180105, identifier jRCTs051180105. [ABSTRACT FROM AUTHOR]

Effective suppression of gastric acid secretion promotes healing of erosive esophagitis. Treatment guidelines recommend proton pump inhibitors (PPIs) and histamine H2–receptor antagonists (H2RAs). Emerging evidence also supports potassium‐competitive acid blockers (P‐CABs). The aim was to construct a mathematical model to examine the relationship between pH holding time ratios (HTRs) and erosive esophagitis healing rates with H2RAs, PPIs and P‐CABs. By literature search, we identified studies of H2RAs, PPIs or P‐CABs that reported mean pH >4 HTRs at steady state (days 5–8) and erosive esophagitis healing rates after 4 and/or 8 weeks. We aggregated treatments by drug class and developed a non‐linear, mixed‐effects model to explore the relationship between pH >4 HTRs and healing rates. The pH dataset included 82 studies (4297 participants; 201 dosage arms); healing rate data came from 103 studies (43,417 patients; 196 treatment arms). P‐CABs achieved the longest periods with intragastric pH >4, and the highest healing rates after 4 and 8 weeks. The predicted probabilities of achieving ≥90% healing rates at 8 weeks were 74.1% for P‐CABs, 17.3% for PPIs and 0% for H2RAs. P‐CABs provide the longest duration with intragastric pH >4 and, accordingly, the highest healing rates of erosive esophagitis. [ABSTRACT FROM AUTHOR]

This report explored cases of scabies balanitis involving the glans penis in five men. All the patients complained of genital itching with an associated rash on the penis. Examination revealed an erythematous papular rash on the glans penis in three of the men, while two of them had an erythematous, firm, nodular rash on the glans penis. Scabies balanitis was diagnosed in all cases. The treatment included topical benzyl benzoate (25%) and antihistamines. The lesions resolved after a single application of benzyl benzoate in all cases, except for one patient who had repeated applications of benzyl benzoate (25%) before symptom resolution. The main predisposing factors were unprotected heterosexual intercourse and poor hygiene practices. [ABSTRACT FROM AUTHOR]

We aimed to determine the in vitro and in vivo synergistic antiallergic effect of guaijaverin and epigallocatechin gallate (EGCG) complex (GEC), and the antiallergic rhinitis (AR) properties of guaijaverin-rich Psidium guajava and EGCG-rich Camellia sinensis (ILS-F-2301). GEC showed synergistic inhibition of β-hexosaminidase by 4.20% and interleukin (IL)-4, -5, and -13 by 4.08%, 0.67%, and 4.71%, respectively, while increasing interferon (IFN)–γ by 12.43%, compared with EGCG only. In addition, 50 μg/mL of ILS-F-2301 inhibited β-hexosaminidase release, and inhibited IL-4, -5, and -13 by 61.54%, 58.79%, and 59.25%, respectively, while increasing IFN–γ (showing 133.14% activation). Moreover, 50 μg/mL of ILS-F-2301 suppressed p-STAT6 and GATA3, while p-STAT1 and T-bet increased, and 0.039 μg/mL of guaijaverin or 5.275 μg/mL of EGCG modulated T helper (Th)1- and Th2-related proteins. These data suggested that guaijaverin and EGCG in ILS-F-2301 was the main active compound involved in Th1/Th2 modulation. In the AR mouse model, the administration of ILS–F–2301 inhibited ovalbumin (OVA)-specific IgE, histamine in serum; it also inhibited IL-4 and -5 by 28.23% and 47.15%, respectively, while increasing IFN–γ (showing 37.11% activation), compared with OVA/Alu-treated mice. Taken together, our findings suggest that ILS–F–2301 is a functional food for alleviating anti-AR. [ABSTRACT FROM AUTHOR]

Background: Medication utilization has been increasing in the U.S. year‐over‐year for several decades. As older adults take more medications, there is a higher risk of them being exposed to drug–drug or drug‐disease interactions. The American Geriatrics Society in 2019 updated their Beers Criteria for Potentially Inappropriate Medication (PIM) Use in Older Adults. The objective of this study was to assess the prevalence of utilization of medications included in the 2019 Beers Criteria. Methods: An analysis was conducted using the Medicare Part D Provider Utilization and Payment Data Public Use File for calendar‐year 2020. Medications identified in the 2019 Beers Criteria were applied to the analysis. Two categories of medications were assessed: (1) "Avoid" and (2) "Use With Caution." Results: In 2020, 56 million prescriptions were dispensed to Medicare patients 65 years and older that are recommended to be avoided without exception (4.7% of all prescriptions) totaling $957 million in medication costs. The most utilized medication classes in this category were benzodiazepines (25,949,994 prescriptions), "Z‐drugs" (6,204,909 prescriptions), long‐acting sulfonylureas (5,306,577 prescriptions), 1st‐generation antihistamines (5,049,289 prescriptions), and tricyclic antidepressants (4,190,062 prescriptions). Additionally, 135 million prescriptions were dispensed to Medicare beneficiaries 65 years and older for medications which the Beers Criteria states to use caution (11.3% of all prescriptions) exceeding $2.85 billion in medication costs. The most utilized medications for this category were diuretics (74,599,126 prescriptions), selective serotonin reuptake inhibitors (30,033,121 prescriptions), serotonin and norepinephrine reuptake inhibitors (11,858,968 prescriptions), tramadol (11,450,878 prescriptions), and mirtazapine (5,737,304 prescriptions). Conclusion: Even with the existence of the AGS Beers Criteria for PIM Use in Older Adults and its continued updated versions, 16% of medications dispensed to Medicare Part D were potentially inappropriate. Future studies are needed to assess if this has led to worsened outcomes among older adults who utilized these PIM. [ABSTRACT FROM AUTHOR]

Certain guidelines recommend a second‐generation H1‐antihistamine (AH) as first‐line treatment for patients with chronic urticaria (CU). However, some patients show insufficient response to a standard dose of this therapy and might benefit from adding leukotriene receptor antagonists (LTA). Therefore, we aimed to perform a systematic review and meta‐analysis comparing LTA plus antihistamines with antihistamines alone. We performed a systematic review and meta‐analysis, searching PubMed, EMBASE, and Cochrane Central for randomized clinical trial (RCT) data comparing LTA plus AH treatment to AH alone in patients with CU. Statistical analysis was performed using R Studio 4.3.2. Heterogeneity was assessed with I2 statistics. Three studies comprising 234 patients with urticaria were included. The mean age was 37.23 years in the leukotriene antagonist + antihistamines (LTA + AH) group and 39.14 years in the antihistamines (AH) group. Follow‐up ranged from 2 to 18 months between studies. There was no statistically significant difference between groups in terms of TSS level (SMD: −74.82; 95% CI: −222.66 to 73.02; P = 0.32; I2 = 98%), neither in terms of pruritus (MD: −0.07; 95% CI: −0.42 to 0.28; P = 0.70; I2 = 74%). After sensitivity analysis, with the systematic exclusion of each study from the grouped estimates, the result for TSS level did not change. These findings suggest that leukotriene receptor antagonists with antihistamines do not have better outcomes than antihistamines alone regarding TSS and pruritus in patients with CU. [ABSTRACT FROM AUTHOR]

PURPOSE: Premedication, including a histamine-1 receptor (H1) antagonist, is recommended to all patients treated with paclitaxel chemotherapy to reduce the incidence of hypersensitivity reactions (HSRs). However, the scientific basis for this premedication is not robust, which provides opportunities for optimization. Substitution of intravenously administered first-generation H1 antagonist for orally administered second-generation H1 antagonist could reduce side effects, and improve efficiency and sustainability. This study investigates the efficacy and safety of substituting intravenous clemastine for oral cetirizine as prophylaxis for paclitaxel-induced HSRs. METHODS: This single-center, prospective, noninferiority study compares a historic cohort receiving a premedication regimen with intravenous clemastine to a prospective cohort receiving oral cetirizine. Primary end point of the study is HSR grade ≥3. The difference in incidence was calculated together with the 90% CI. We determined that the two-sided 90% CI of HSR grade ≥3 incidence in the oral cetirizine cohort should not be more than 4% higher (ie, the noninferiority margin) compared with the intravenous clemastine cohort. RESULTS: Two hundred and twelve patients were included in the oral cetirizine cohort (June 2022 and May 2023) and 183 in the intravenous clemastine cohort. HSR grade ≥3 incidence was 1.6% (n = 3) in the intravenous clemastine cohort and 0.5% (n = 1) in the oral cetirizine cohort, resulting in a difference of –1.2% (90% CI, –3.4 to 1.1). CONCLUSION: Premedication containing oral cetirizine is as safe as premedication containing intravenous clemastine in preventing paclitaxel-induced HSR grade ≥3. These findings could contribute to optimization of care for patients and improve efficiency and sustainability. Oral cetirizine is a nonsedative, easy, and effective alternative for IV antihistamines before paclitaxel. [ABSTRACT FROM AUTHOR]

Background: Chronic urticaria (CU) is a prevalent dermatologic disease that negatively affects life, current therapies remain suboptimal. Hence, there is an urgent need to identify effective and safe treatment. Objective: Assess the efficacy and safety of compound glycyrrhizin (CG) combined with second-generation nonsedated antihistamine for the treatment of CU. Methods: Nine databases were queried to screen RCTs related. Two reviewers independently assessed the risk of bias using Cochrane Collaboration. Primary objective was the total efficiency rate, while secondary was rate of recurrence, adverse events, and cure. Statistical analyses using Review Manager 5.4 and Stata17. Results: Twenty-four RCTs were identified. Significant differences were noted in rate of total efficiency (n=2649, RR = 1.36, 95%CI:1.30–1.43, p<0.00001), cure (n=2649, RR = 1.54, 95%CI:1.42–1.66, p<0.00001) and recurrence (n=446, RR = 0.34, 95%CI:0.20–0.58, p<0.00001) between the combination of CG with second-generation non-sedated antihistamine and antihistamine monotherapy. Contrastingly, adverse events rate (n=2317, RR = 0.76, 95% CI:0.59–0.97, p=0.03) was comparable between the two groups. Our results indicated that CG combined with second-generation non-sedated antihistamine could significantly mitigate the symptoms in CU compared with antihistamine monotherapy. No serious adverse events were reported. Conclusions: CG combined with second-generation nonsedated antihistamine is effective for CU. Nevertheless, higher-quality studies are warranted to validate our results. [ABSTRACT FROM AUTHOR]

Pongsakorn Tantilipikorn,1 Virat Kirtsreesakul,2 Chaweewan Bunnag,3 Mukda Vangveeravong,4 Sanguansak Thanaviratananich,5 Supinda Chusakul6 1Center of Research Excellence in Allergy & Immunology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand; 2Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand; 3Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 4Queen Sirikit National Institute of Child Health, Bangkok, Thailand; 5Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khonkaen, Thailand; 6Department of Otolaryngology, Chulalongkorn University, Bangkok, ThailandCorrespondence: Virat Kirtsreesakul, Division of Allergy and Rhinology, Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand, Tel/Fax +6674 429-620, Email kvirat2002@hotmail.comAbstract: The incidence of allergic rhinitis (AR) in Asia and the world is steadily rising. Patients experience incomplete symptom relief despite existing treatment options, which warrants the need for new therapeutic regimes. Azelastine hydrochloride/fluticasone propionate (MP-AzeFlu), a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate has been indicated in the treatment of AR. The current review discusses the effects of MP-AzeFlu versus conventional therapies in achieving superior clinical improvement with a very rapid onset of action (5 minutes). The superiority of MP-AzeFlu in offering complete symptom control with sustained relief in patients with AR compared to the existing therapeutic options is also discussed. MP-AzeFlu has been shown to improve the quality of life for patients with AR, thereby enhancing patient adherence to therapy and establishing its preference for the treatment of AR. Currently, the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines recommend the use of a combination of intranasal corticosteroids and intranasal antihistamines as first-line treatment in patients with persistent AR with visual analog scores ≥ 5 or when prior treatment with single agents has been ineffective. Widely published data on the efficacy and safety of its prolonged use in adults and children have validated that effective treatment of AR can be achieved with MP-AzeFlu.Keywords: fixed-dose combination, intranasal, MP-AzeFlu, corticosteroids, antihistamines

Background: Comprehensive long-term follow-up data regarding chronic spontaneous urticaria (CSU) among general populations, especially from the Indian subcontinent is scanty. Aim and Objectives: The aim of the study were to analyze the clinico-epidemiological profile, comorbidities of CSU patients, and factors affecting patient response to various doses of levocetirizine. Materials and Methods: In this retrospective cohort study, complete history regarding demographic profile, clinical examination, investigations, treatment given, and follow-up details of all CSU patients attending urticaria clinic between 2010 and 2019 were analyzed. These were considered variables to determine the factors playing a role in response to various doses of levocetirizine. Results: Totally, 1104 files of CSU were analyzed. The male-to-female ratio was 1:1.5 with a mean age of 33.03 ± 14.33 years. Thyroid dysfunction and atopy were seen in 142 (12.8%) and 184 (16.7%) patients, respectively. Vitamin D deficiency and high serum immunoglobulin E (IgE) levels were seen in 461 (41.7%) and 340 (30.7%) patients, respectively. Immunosuppressives were required at some point in 196 (17.7%) patients. Patients with higher levels of serum IgE and D-dimer (P < 0.05) were found to require frequent updosing of levocetirizine, while age, sex, duration of illness, presence of angioedema, co-morbidities, identifiable precipitating factors, presence of diurnal variation, family history, and vitamin D deficiency were found to not have an effect on levocetirizine dosing. Conclusion: Ours is a large single-center study exemplifying the biomarkers including baseline serum IgE and D-dimer levels, which could identify a CSU patient who could warrant a higher dose of antihistamine/antihistamine refractory urticaria.

Background: While bidirectional endoscopy is recognized as the standard approach for investigating iron deficiency anemia (IDA) in men older than 45 and postmenopausal women, evidence supporting the application of this approach in younger men and premenopausal women is scarce in the absence of symptoms. Our primary aim is to identify the diagnostic yield of bidirectional endoscopy in men younger than 45 and premenopausal women, and describe the clinical characteristics of those with significant endoscopic and pathology-proven findings. Methods: We performed a retrospective chart review including patients younger than age 45 with IDA who underwent esophagogastroduodenoscopy (EGD) and/or colonoscopy at the Brooklyn VA Hospital between 2009 and 2023. Demographic, clinical, and endoscopic patient data was all collected, stratified, analyzed, and interpreted. Results: In 143 patients younger than age 45 with IDA, 28.6% were found to have positive upper gastrointestinal (GI) findings, of which 70.3% were pathology-proven H. pylori cases. 57.9% of patients reported upper GI symptoms, while 42.9% of patients were asymptomatic. In total, 18.2% of symptomatic patients were found to have clinically significant findings on EGD as compared with 42.9% of asymptomatic patients. Additionally, 9.1% of symptomatic patients were found to have biopsy proven H. pylori-associated gastritis or duodenitis as compared with 33.9% of asymptomatic patients. Of the patients who underwent colonoscopy, 8.3% were found to have lower GI lesions. Conclusions: We found the diagnostic yield of EGD to be significantly higher than that of colonoscopy in younger IDA patients. Our findings suggest current guidelines are clinically relevant to the young patient cohort. Our study also found asymptomatic IDA patients below age 45 to have a significantly higher diagnostic yield of EGD as compared to symptomatic IDA patients within the same age cohort. The differences in diagnostic yields may be a result of symptomatic patients being more likely to have been prescribed proton pump inhibitors or histamine receptor antagonists prior to endoscopy. [ABSTRACT FROM AUTHOR]

Objective: Rapid drug desensitization (RDD) is a safe and effective method of inducing temporary tolerance and gradually increasing the dose over a few hours to a few days, thereby preventing severe hypersensitivity reactions. Despite the limited number of pediatric desensitization studies in the literature, it is important to explore this area further to provide better treatment options for patients. This study will determine the safety and efficacy of desensitization and present management strategies for breakthrough reactions in pediatric patients with immediate hypersensitivity reactions (HSR). Materials and Methods: This retrospective study enrolled 14 pediatric patients with drug HSRs who underwent drug desensitization between January 2020 and January 2024. The desensitization protocols used were developed by Castells and consisted of a 12-step protocol with 3 parenteral preparations with increasing concentrations. The standard protocol included premedication with antihistamine (pheniramine) and methylprednisolone (1 mg/kg) 30 minutes before the infusion. Results: The study involved 14 patients. A total of 64 desensitizations were carried out for 16 different drugs. Only 13% resulted in mild to severe reactions. Overall, almost 92% of all desensitizations were successful. Additionally, it is important to highlight that all breakthrough reactions (BRs) occurred with monoclonal antibodies. Mild BRs during RDD were associated with more severe reactions during the next RDDs. No BRs were seen during RDD in patients with mild initial reactions. Conclusion: It is important to note that desensitization is not an extreme method, and that pediatric age is not a contraindication. Desensitization is a safe and successful method for children, with a positive impact on survival and overall prognosis. [ABSTRACT FROM AUTHOR]

Acute generalized exanthematous pustulosis (AGEP) is a sudden-onset, severe and rare adverse skin reaction characterized by nonfollicular sterile pustules tending to intertriginous localization. Lesions develop on erythematous and edematous skin. It is often triggered by drugs. This article presents a case diagnosed with AGEP due to etodolac. To the best of our knowledge, this is the second case of AGEP due to etodolac in the literature. A 47-year-old female patient presented with diffuse erythema on the extremities, a purple purpuric rash on the extensor face of both legs, and millimetric pustules on an erythematous base on the inner surface of the left arm. She stated that the reaction developed after taking 3 medications, including etodolac tablets, and gargling the throat with povidone-iodine. The patient was diagnosed with AGEP and her EuroSCAR AGEP Validation Score was calculated as 9 suggesting a definitive diagnosis of AGEP. All of the suspected drugs were discontinued. Methylprednisolone 16 mg/day, a local corticosteroid, and an oral antihistamine were started. Her symptoms resolved and laboratory abnormalities returned to normal within 2 weeks. Patch tests were performed 3 months after the reaction with the suspected drugs. The patch testing showed that only 10% etodolac at 48-, 72- and 96-hour readings were positive (++). The patient was diagnosed with AGEP due to etodolac. AGEP is often secondary reaction to drugs. The most frequent causative drugs are diltiazem, aminopenicillins, pristinamycin, terbinafine, sulphonamides, quinolones, and hydroxychloroquine. AGEP secondary to NSAIDs is very rare. Only one previous case of AGEP due to etodolac was reported in 2011. [ABSTRACT FROM AUTHOR]

Anaphylaxis typically occurs due to immunological mechanisms involving IgE, IgG, or complement-mediated responses, but nonimmunological mechanisms can also contribute to the development of anaphylaxis by triggering mast cell and basophil degranulation. In cases where alternative treatment options are unavailable, or when the use of a specific drug is essential, a desensitization protocol should be considered. In this context, we present a successful oral desensitization protocol in a pediatric patient who experienced anaphylaxis after taking acetazolamide orally. [ABSTRACT FROM AUTHOR]

Objectives: Perennial allergic rhinitis (PAR) is common in Japan. Second-generation antihistamines (SGAs) are commonly used for its treatment; however, it remains unclear which SGA is the most cost-effective. Additionally, the pharmacoeconomics of Japanese Kampo shoseiryuto (which was traditionally prescribed to treat PAR in Japan) remains poorly understood. In this study, we aimed to investigate the effectiveness of various SGAs and shoseiryuto for the treatment of PAR in Japanese outpatients, from the healthcare payer's perspective. Methods: The most cost- and clinically effective SGAs were determined from a list of 6 SGAs (bepotastine, 10 mg; cetirizine, 10 mg; ebastine, 10 mg; epinastine, 20 mg; loratadine, 10 mg; and olopatadine, 5 mg) together with shoseiryuto, using the overall improvement rate through a model-based analysis. The time horizon was 28 days. Costs were determined based on the Medical Fee Index in 2020. Deterministic and probabilistic sensitivity analyses were conducted to address the uncertainty of the base-case results. Results: Overall, bepotastine (10 mg) and ebastine (10 mg) were cost-effective. Shoseiryuto was less cost-effective than ebastine (10 mg) (dominated). Ebastine (10 mg) was the most cost-effective option based on deterministic and probabilistic sensitivity analyses. Conclusions: Ebastine (10 mg) was the most cost-effective treatment strategy for PAR among the agents evaluated in this study. This insight could aid in establishing an appropriate formulary for treating PAR in hospitals and communities. [ABSTRACT FROM AUTHOR]

Fexofenadine is a second-generation inverse agonist of H1-receptor of histamine which is highly selective with proven efficacy in relieving symptoms associated with allergic conditions. It has an additional benefit of not penetrating the blood–brain barrier and therefore do not induce sedation and not impair the cognitive function/psychomotor performance. This review aimed at providing evidence based on available controlled studies to reinforce the non-sedative property of fexofenadine for treating patients with allergic rhinitis and urticaria. We performed an electronic literature search using keywords such as fexofenadine, drowsiness, somnolence, sedation, fatigue, cognitive, impairment, psychomotor, driving performances, sleep, rapid eye movement, alertness, clinical study, in vitro study, in vivo study, and pharmacodynamics in the Embase search engine. The review included randomized controlled trials, review articles, systematic reviews, and meta-analyses, together with post-marketing analysis conducted in healthy subjects and patients with allergy and were focused on comparing the antihistaminic potential or safety of fexofenadine with other antihistamines or placebo. Positron emission tomography (PET) and proportional impairment ratio (PIR) data along with other objective tests from various studies confirmed the non-sedative property of fexofenadine. Results of brain H1-receptor occupancy (H1RO) obtained from PET showed no H1RO by fexofenadine, the receptor which is known to cause sedation of H1 antihistamines. Most studies calculating PIR value as 0 showed fexofenadine to be a non-impairing oral antihistamine regardless of dose. Clinical trials in adults and children showed fexofenadine to be well tolerated without sedative effect or impairment of cognitive/psychomotor function even at higher than recommended doses. Published literature based on various parameters and clinical trials conducted for evaluating the effect of fexofenadine on sedation and central nervous system shows fexofenadine is both clinically effective and non-sedating. [ABSTRACT FROM AUTHOR]

In a double‐blind, randomized controlled trial, we investigated the effectiveness of adding antiplatelet drugs to up‐dosing antihistamines for the treatment of chronic spontaneous urticaria (CSU) in patients with elevated D‐dimer levels who had an inadequate response to conventional antihistamine doses. Twenty patients with Urticaria Activity Score over 7 days (UAS7) ≥16 and D‐dimer >500 ng/mL were randomized to receive either antiplatelet therapy (cilostazol 150 mg/day + dipyridamole 50 mg/day) with antihistamine (desloratadine 20 mg/day) or antihistamine alone for 4 weeks. The antiplatelet group demonstrated a greater decrease in UAS7 compared to the control group (28.10 to 8.90 vs. 22.90 to 16.40, p < 0.001 vs. p = 0.054). Both groups experienced improved quality of life (DLQI), but the improvement was greater in the antiplatelet group (p = 0.046). D‐dimer levels decreased only in the antiplatelet group (1133.67 ng/mL to 581.89 ng/mL, p = 0.013) with no significant change observed in the control group. This suggests that combining dipyridamole and cilostazol with up‐dosing antihistamines may be more effective for CSU patients with high D‐dimer levels compared to up‐dosing antihistamines alone. This could be due to a reduction in platelet activation, as evidenced by the decrease in D‐dimer levels observed in the antiplatelet group. [ABSTRACT FROM AUTHOR]

Summary: Several professional societies have provided recommendations for prescribing medications for insomnia. None has provided an integrative analysis that concurrently quantifies safety and efficacy (e.g., risk–benefit ratios). This represents an important gap for informing clinician decision‐making. Accordingly, the aim of the present review is to provide such an analysis for five classes of sleep‐promoting medications. Adverse event data values were extracted from the most recent FDA‐approved package inserts and converted to an integer before being placebo‐adjusted and standardized as a rate per 1000 (AEr). Efficacy data, pre‐to‐post self‐reported data for active and placebo conditions were acquired from pivotal trials identified in "white papers" and systematic reviews/meta‐analyses. Weighted effect sizes were calculated for subjective sleep latency, wake time after sleep onset and total sleep time, and then were averaged by medication class for each sleep continuity variable. Overall efficacy was represented by a single variable, SWT (sleep latency + wake time after sleep onset + total sleep time). Risk–benefit was represented using a simple ratio value. For safety, it was found that melatonin receptor agonists had the lowest adverse event rate (AEr = 43.1), and non‐benzodiazepine benzodiazepine receptor agonists had the highest rate (AEr = 255.0). For efficacy, it was found that the pre‐to‐post placebo adjusted effect sizes were largest for benzodiazepines (effect size = 1.94) and smallest for melatonin receptor agonists (effect size = 0.109). For risk–benefit, histamine antagonist had the most favourable profile (risk–benefit = 69.5), while melatonin receptor agonist had the least favourable profile (risk–benefit = 395.7). Overall, the combined metric for risk–benefit suggests that treatment with a histamine antagonist is optimal and potentially represents the best first‐line therapy for the medical management of insomnia. [ABSTRACT FROM AUTHOR]

Background: Famotidine is a competitive histamine H-receptor antagonist that reduces the formation of stomach acid and is used to treat gastrointestinal disorders associated with acid reflux, gastroesophageal reflux disease, duodenal ulcer, gastric ulcer, and pathological hypersecretory disorders. This study is designed to investigate the possible neuroprotective effects of the ranolazine scopolamine-induced Alzheimer's disease-like feature in a mouse model. Methods: Mice were divided equally into five groups (ten mice per group), including control group and induction group. The mice in the induction group were administered scopolamine 1 mg/kg i.p., once daily for 7 days, to induce features similar to Alzheimer's disease. The mice in the remaining three treatment groups were given tested medications prophylactically for 14 days. After that the induction was carried out with scopolamine 1 mg/kg i.p., once daily, while the tested medication dosages were continued for an additional 7 days. These treatment groups included: the donepezil group (5 mg/kg/day), the famotidine group (40 mg/kg/day) and the combined group with donepezil (5 mg/kg/day) and famotidine (40 mg/kg/day); all were administrated i.p., once daily. Behavioral parameters were assessed, among others with the Y-maze test and novel object recognition test, and the inflammatory cytokines and oxidative stress parameters were assessed as well. Results: Famotidine exhibits significant improvements in behavior and memory, level of oxidative stress parameter, and inflammatory cytokines. Conclusions: Famotidine and its combination at prescribed doses in the current study improved learning and memory impairments in mice model of Alzheimer's disease probably via their antioxidant and anti-inflammatory properties confirmed by a significant increase in antioxidant mediator and a significant decrease in oxidative stress marker and inflammatory cytokines. [ABSTRACT FROM AUTHOR]

Clobenpropit is a histamine H3 receptor antagonist and has developed as a potential therapeutic drug due to its ability to inhibit CXCR4, a chemokine receptor involved in autoimmune diseases and cancer pathogenesis. The CXCL12/CXCR4 axis involves several biological phenomena, including cell proliferation, migration, angiogenesis, inflammation, and metastasis. Accordingly, inhibiting CXCR4 can have promising clinical outcomes in patients with malignancy or autoimmune disorders. Based on available knowledge, Clobenpropit can effectively regulate the release of monocytederived inflammatory cytokine in autoimmune diseases such as juvenile idiopathic arthritis (JIA), presenting a potential targeted target with possible advantages over current therapeutic approaches. This review summarizes the intricate interplay between Clobenpropit and CXCR4 and the molecular mechanisms underlying their interactions, comprehensively analyzing their impact on immune regulation. Furthermore, we discuss preclinical and clinical investigations highlighting the probable efficacy of Clobenpropit for managing autoimmune diseases and cancer. Through this study, we aim to clarify the immunomodulatory role of Clobenpropit and its advantages and disadvantages as a novel therapeutic opportunity. [ABSTRACT FROM AUTHOR]

Background: Granulocyte-colony stimulating factors (G-CSFs) are administered to many pediatric patients undergoing myelosuppressive cancer treatment to prevent febrile neutropenia. The most common side effect of G-CSF administration is bone pain, which can be debilitating and result in treatment delays and complications. The use of loratadine to safely and effectively manage G-CSF-induced bone pain in this population is examined. Methods: A literature review was performed using PubMed to locate relevant articles. Search terms included histamine antagonists, loratadine, granulocyte-colony stimulating factor, G-CSF bone pain, pegfilgrastim, and cancer-related bone pain. Ultimately, 18 peer-reviewed articles are included in this narrative review. Results: Current treatment options to manage bone pain are largely reliant on acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids, but are not always feasible or effective. More recently, loratadine has been studied for its use in treating G-CSF-induced bone pain. As a second-generation antihistamine, loratadine is non-sedating and has shown to be beneficial in treating bone pain with minimal side effects. Conclusions: There appears to be benefit in the use of loratadine to treat bone pain with minimal risk. Although loratadine has been used extensively to treat bone pain caused by G-CSF in the adult population, more research is needed specifically in the pediatric setting. Evidence also suggests that loratadine may prove beneficial in treating other types of cancer-related bone pain as well, but more research is needed before making evidence-based practice recommendations. [ABSTRACT FROM AUTHOR]

Introduction: Procarbazine is an oral chemotherapeutic agent used in the treatment of brain malignancies and is associated with hypersensitivity reactions. In case of grade 4 reactions, rechallenge should be avoided, and the agent should be replaced, unless the treatment is curative, in which case the application of a desensitization protocol should be considered. We present a successful case of desensitization in procarbazine anaphylaxis. Case report: A 53-year-old male patient was diagnosed with recurrent anaplastic oligodendroglioblastoma. The patient received three cycles of procarbazine, lomustine, and vincristine chemotherapy for malignancy recurrence. In the fourth cycle, on the 12th day of procarbazine treatment, the patient developed anaphylaxis. Procarbazine was given together with premedication as part of the 12-step desensitization process, and the fourth cycle was successfully completed. Management and outcome: Procarbazine hypersensitivity reactions are observed less frequently than reactions to other chemotherapeutics. We presented a case of procarbazine-associated severe anaphylaxis that was able to continue procarbazine chemotherapy with successful desensitization. This case is important in terms of confirming the procarbazine desensitization protocol. Discussion: In literature there is only one protocol developed was successfully applied in one patient with procarbazine anaphylaxis. In the current case, we took this protocol into consideration in the management of our patient. Following the use of this protocol, the patient was able to continue procarbazine chemotherapy successfully. Procarbazine anaphylaxis is rare, and more cases are needed to be reported to confirm the desensitization protocol and when to continue procarbazine treatment. [ABSTRACT FROM AUTHOR]

Background: Comprehensive long‑term follow‑up data regarding chronic spontaneous urticaria (CSU) among general populations, especially from the Indian subcontinent is scanty. Aim and Objectives: The aim of the study were to analyze the clinico‑epidemiological profile, comorbidities of CSU patients, and factors affecting patient response to various doses of levocetirizine. Materials and Methods: In this retrospective cohort study, complete history regarding demographic profile, clinical examination, investigations, treatment given, and follow‑up details of all CSU patients attending urticaria clinic between 2010 and 2019 were analyzed. These were considered variables to determine the factors playing a role in response to various doses of levocetirizine. Results: Totally, 1104 files of CSU were analyzed. The male‑to‑female ratio was 1:1.5 with a mean age of 33.03 ± 14.33 years. Thyroid dysfunction and atopy were seen in 142 (12.8%) and 184 (16.7%) patients, respectively. Vitamin D deficiency and high serum immunoglobulin E (IgE) levels were seen in 461 (41.7%) and 340 (30.7%) patients, respectively. Immunosuppressives were required at some point in 196 (17.7%) patients. Patients with higher levels of serum IgE and D‑dimer (P < 0.05) were found to require frequent updosing of levocetirizine, while age, sex, duration of illness, presence of angioedema, co‑morbidities, identifiable precipitating factors, presence of diurnal variation, family history, and vitamin D deficiency were found to not have an effect on levocetirizine dosing. Conclusion: Ours is a large single‑center study exemplifying the biomarkers including baseline serum IgE and D‑dimer levels, which could identify a CSU patient who could warrant a higher dose of antihistamine/antihistamine refractory urticaria. [ABSTRACT FROM AUTHOR]

Background: Numerous studies highlight the critical role that neural histamine plays in feeding behavior, which is controlled by central histamine H3 and H1 receptors. This is the fundamental motivation for the increased interest in creating histamine H3 receptor antagonists as anti-obesity medications. On the other hand, multiple other neurotransmitter systems have been identified as pharmacotherapeutic targets for obesity, including sigma-2 receptor systems. Interestingly, in our previous studies in the rat excessive eating model, we demonstrated a significant reduction in the development of obesity using dual histamine H3/sigma-2 receptor ligands. Moreover, we showed that compound KSK-94 (structural analog of Abbott's A-331440) reduced the number of calories consumed, and thus acted as an anorectic compound. Therefore, in this study, we extended the previous research and studied the influence of KSK-94 on adipose tissue collected from animals from our previous experiment. Methods: Visceral adipose tissue was collected from four groups of rats (standard diet + vehicle, palatable diet + vehicle, palatable diet + KSK-94, and palatable diet + bupropion/naltrexone) and subjected to biochemical, histopathological, and immunohistochemical studies. Results: The obtained results clearly indicate that compound KSK-94 prevented the hypertrophy and inflammation of visceral adipose tissue, normalized the levels of leptin, resistin and saved the total reduction capacity of adipose tissue, being more effective than bupropion/naltrexon in these aspects. Moreover, KSK-94 may induce browning of visceral white adipose tissue. Conclusion: Our study suggests that dual compounds with a receptor profile like KSK-94, i.e., targeting histamine H3 receptor and, to a lesser extent, sigma-2 receptor, could be attractive therapeutic options for patients at risk of developing obesity or with obesity and some metabolic disorders. However, more studies are required to determine its safety profile and the exact mechanism of action of KSK-94. [ABSTRACT FROM AUTHOR]

Background: Cynara scolymus has bioactive constituents and has been used for therapeutic actions. The present study was undertaken to investigate the mechanisms underlying pain-relieving effects of the hydroethanolic extract of C. scolymus (HECS). Methods: The antinociceptive activity of HECS was assessed through formalin and acetic acid-induced writhing tests at doses of 50, 100 and 200 mg/kg intraperitoneally. Additionally, naloxone (non-selective opioid receptors antagonist, 2 mg/kg), atropine (non-selective muscarinic receptors antagonist, 1 mg/kg), chlorpheniramine (histamine H1-receptor antagonist, 20 mg/kg), cimetidine (histamine H2-receptor antagonist, 12.5 mg/kg), flumazenil (GABAA/BDZ receptor antagonist, 5 mg/kg) and cyproheptadine (serotonin receptor antagonist, 4 mg/kg) were used to determine the systems implicated in HECS-induced analgesia. Impact of HECS on locomotor activity was executed by open-field test. Determination of total phenolic content (TPC) and total flavonoid content (TFC) was done. Evaluation of antioxidant activity was conducted employing 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging assay. Results: HECS (50, 100 and 200 mg/kg) significantly indicated dose dependent antinociceptive activity against pain-related behavior induced by formalin and acetic acid (P < 0.001). Pretreatment with naloxone, atropine and flumazenil significantly reversed HECS-induced analgesia. Antinociceptive effect of HECS remained unaffected by chlorpheniramine, cimetidine and cyproheptadine. Locomotor activity was not affected by HECS. TPC and TFC of HECS were 59.49 ± 5.57 mgGAE/g dry extract and 93.39 ± 17.16 mgRE/g dry extract, respectively. DPPH free radical scavenging activity (IC50) of HECS was 161.32 ± 0.03 µg/mL. Conclusions: HECS possesses antinociceptive activity which is mediated via opioidergic, cholinergic and GABAergic pathways. [ABSTRACT FROM AUTHOR]

Purpose/Aim of the study: There is still no evidence of which drug has the greatest therapeutic potential for post-traumatic arthrofibrosis. The aim of this study is to systematically review the literature for quality evidence and perform a meta-analysis about the pharmacological therapies of post-traumatic arthrofibrosis in preclinical models. Materials and Methods: A comprehensive and systematic search strategy was performed in three databases (MEDLINE, EMBASE and Web of Science) retrieving studies on the effectiveness of pharmacological therapies in the management of post-traumatic arthrofibrosis using preclinical models in terms of biomechanical outcomes. Risk of bias assessment was performed using the SYRCLE's risk of bias tool. A meta-analysis using a random-effects model was conducted if a minimum of three studies reported homogeneous outcomes for drugs with the same action mechanism. Results: Forty-six studies were included in the systematic review and evaluated for risk of bias. Drugs from 6 different action mechanisms of 21 studies were included in the meta-analysis. Overall, the methodological quality of the studies was poor. Statistically significant overall effect in favor of reducing contracture was present for anti-histamines (Chi2 p = 0.75, I2 = 0%; SMD (Standardized Mean Difference) = –1.30, 95%CI: −1.64 to −0.95, p < 0.00001) and NSAIDs (Chi2 p = 0.01, I2 = 63%; SMD= −0.93, 95%CI: −1.58 to −0.28, p = 0.005). Conclusions: Anti-histamines, particularly ketotifen, have the strongest evidence of efficacy for prevention of post-traumatic arthrofibrosis. Some studies suggest a potential role for NSAIDs, particularly celecoxib, although heterogeneity among the included studies is significant. [ABSTRACT FROM AUTHOR]

Purpose of Review: The aim of this review, is to present an updated revision of topical management of SAC and PAC, based on the available scientific evidence and focused on the impact of ophthalmic solution formulations on eye surface. Recent Findings: Physicians treating ocular allergy should be aware of tear film and tear film disruption in SAC and PAC, and how eye drop composition and additives affect the physiology of the allergic eye. Summary: Seasonal and perennial allergic conjunctivitis (SAC and PAC) are the most frequent causes of ocular allergy (OA), and both conditions are underdiagnosed and undertreated. SAC and PAC are immunoglobulin E (IgE)-mediated hypersensitivity reactions. The additional tear film disruption caused by the release of inflammatory mediators increases and exacerbates the impact of signs and symptoms and may trigger damage of the ocular surface. Comorbidities are frequent, and dry eye disease in particular must be considered. Clinical guidelines for the management of SAC and PAC recommend topical therapy with antihistamines, mast cells stabilizers or dualaction agents as first-line treatment, but care should be taken, as many medications contain other compounds that may contribute to ocular surface damage. [ABSTRACT FROM AUTHOR]

Background/Aim: Postnasal drip may be related to several diseases, but not all patients are clearly diagnosed. Patients with chronic, idiopathic postnasal drip symptoms are easily overlooked, and their clinical features are yet to be identified. This study aimed to analyze the clinical features and response to first generation antihistamine-decongestant therapy in patients with chronic idiopathic postnasal drip, suggesting it as a distinct entity. Patients and Methods: A retrospective cohort study involving 157 chronic idiopathic postnasal drip patients was conducted, analyzing demographics, symptoms, and treatment response to first-generation antihistamines and nasal decongestants. Results: Mean age of patients was 55.4±17.0 years old. Median duration of symptom was 36 months (range=12-66 months) and severity in the visual analogue scale was 7 (range=5-8). Throat discomfort was the most frequently associated symptom (73.7%). Cough was recorded in 30.3% of patients. Viscosity of postnasal drip was associated with rhinorrhea and throat discomfort. Of the patients, 71.6% responded positively to 1st generation antihistamine-decongestant medication. However, 25.9% of patients presented symptom re-occurrence. Patients with nasal stiffness or persistent symptoms presented a higher reoccurrence rate compared to others. Conclusion: This study outlines the clinical features of patients with chronic idiopathic postnasal drip and suggests it as a distinctive entity., This proposal aims to enhance diagnostic precision and promote further research in the field. [ABSTRACT FROM AUTHOR]

Proton pump inhibitor (PPI) use may be associated with renal dysfunction. Renal dysfunction in PPI users requires evaluation of development and progression risks simultaneously, using estimated glomerular filtration rate (eGFR) slope, which indicates changes in eGFR per year. To the best of our knowledge, no studies have evaluated eGFR slope in PPI users. This study investigated the association between PPI use and renal dysfunction using eGFR slope. A single-center cohort study was conducted using the health records data at Hamamatsu University Hospital in Japan. Participants were defined as first users of acid-suppressing drugs (PPIs or Histamine H2 receptor antagonists (H2RAs)) from 2010 to 2021 and continuously prescribed for ≥ 90 days. The H2RA group was used for the propensity-score matching (PSM) to the PPI group to minimize the effects of confounders. The eGFR slope was estimated using a linear mixed effects model. Participants were stratified by baseline eGFR and age, respectively, as subgroup analyses. A total of 4,649 acid-suppressing drug users met the inclusion criteria, including 950 taking H2RAs and 3,699 PPIs. After PSM, 911 patients were assigned to each group. The eGFR slopes of the PPI and H2RA users were -4.75 (95% CI: -6.29, -3.20) and -3.40 (-4.38, -2.42), respectively. The difference between the groups was not significant. Significant declines in eGFR were observed with PPIs with baseline eGFR ≥ 90 and age < 65. PPI use for ≥ 90 days may hasten eGFR decline compared to H2RA use, especially in patients with eGFR ≥ 90 or age < 65. [ABSTRACT FROM AUTHOR]