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[Oral second generation antihistamines in allergic rhinitis].

Abstract

BACKGROUND

Histamine is a key mediator of the allergic immediate reaction. Antihistamines belong to the most frequently used treatment modalities in allergic rhinitis.

METHODS

The National Libraray of Medicine was searched for current data of the effects of histamine and antihistamines in allergic rhinitis.

RESULTS

Histamine acts on 4 different histamine receptors. Activation of H1-receptors on nasal trigeminal nerve fibers transmits nasal itch and sneezing. Nasal hypersecretion is mainly mediated by an trigeminal-parasympathetic reflex. Activation of H1-receptors results in contraction of nasal endothelial cells with consecutive plasma extravasation and edema formation. Histamine also activates H2-receptors on smooth muscle cells surrounding nasal capacitance vessels. They transmit muscle relaxation, increased blood content and an enlarged volume of nasal mucosa. Via peripheral H3-receptors, histamine modulates neurogenic inflammation and via H4-receptors functions of immune cells. Oral second generation antihistamines inhibit histamine dependent activation of nasal H1-receptors. They mainly reduce nasal itch, sneezing, and hypersecretion. In addition, allergy related activity impairment is reduced resulting in improved physical and mental performance. Second generation antihistamines reduce proinflammatory effects mediated by H1-receptors, however, drug concentrations necessary for mast cell stabilization as observed in vitro are not reached in vivo. Oral second generation antihistamines are readily absorbed and reduce allergy symptoms for approximately 24 hours, allowing convenient once daily medication. Modern antihistamines are generally safe; tachyphylaxis, tolerance or rebound has not been observed.

CONCLUSION

Due to their minimal adverse effects and efficient symptom reduction oral second generation antihistamines are particularly useful for the treatment of less severe intermittent forms of nasal allergy.

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  • Publisher Full Text
  • Authors+Show Affiliations

    Univ.-HNO-Klinik Ulm.

    Source

    Laryngo- rhino- otologie 84:1 2005 Jan pg 30-41

    MeSH

    Administration, Oral
    Adult
    Anti-Allergic Agents
    Cetirizine
    Child
    Conjunctivitis, Allergic
    Controlled Clinical Trials as Topic
    Female
    Histamine
    Histamine H1 Antagonists
    Histamine H1 Antagonists, Non-Sedating
    Humans
    Hypersensitivity, Immediate
    Loratadine
    Male
    Nasal Mucosa
    Pregnancy
    Receptors, Histamine
    Receptors, Histamine H1
    Receptors, Histamine H2
    Rhinitis, Allergic, Seasonal
    Time Factors

    Pub Type(s)

    Comparative Study
    English Abstract
    Journal Article
    Review

    Language

    ger

    PubMed ID

    15647976

    Citation

    Riechelmann, H. "[Oral Second Generation Antihistamines in Allergic Rhinitis]." Laryngo- Rhino- Otologie, vol. 84, no. 1, 2005, pp. 30-41.
    Riechelmann H. [Oral second generation antihistamines in allergic rhinitis]. Laryngorhinootologie. 2005;84(1):30-41.
    Riechelmann, H. (2005). [Oral second generation antihistamines in allergic rhinitis]. Laryngo- Rhino- Otologie, 84(1), pp. 30-41.
    Riechelmann H. [Oral Second Generation Antihistamines in Allergic Rhinitis]. Laryngorhinootologie. 2005;84(1):30-41. PubMed PMID: 15647976.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - [Oral second generation antihistamines in allergic rhinitis]. A1 - Riechelmann,H, PY - 2005/1/14/pubmed PY - 2005/3/30/medline PY - 2005/1/14/entrez SP - 30 EP - 41 JF - Laryngo- rhino- otologie JO - Laryngorhinootologie VL - 84 IS - 1 N2 - BACKGROUND: Histamine is a key mediator of the allergic immediate reaction. Antihistamines belong to the most frequently used treatment modalities in allergic rhinitis. METHODS: The National Libraray of Medicine was searched for current data of the effects of histamine and antihistamines in allergic rhinitis. RESULTS: Histamine acts on 4 different histamine receptors. Activation of H1-receptors on nasal trigeminal nerve fibers transmits nasal itch and sneezing. Nasal hypersecretion is mainly mediated by an trigeminal-parasympathetic reflex. Activation of H1-receptors results in contraction of nasal endothelial cells with consecutive plasma extravasation and edema formation. Histamine also activates H2-receptors on smooth muscle cells surrounding nasal capacitance vessels. They transmit muscle relaxation, increased blood content and an enlarged volume of nasal mucosa. Via peripheral H3-receptors, histamine modulates neurogenic inflammation and via H4-receptors functions of immune cells. Oral second generation antihistamines inhibit histamine dependent activation of nasal H1-receptors. They mainly reduce nasal itch, sneezing, and hypersecretion. In addition, allergy related activity impairment is reduced resulting in improved physical and mental performance. Second generation antihistamines reduce proinflammatory effects mediated by H1-receptors, however, drug concentrations necessary for mast cell stabilization as observed in vitro are not reached in vivo. Oral second generation antihistamines are readily absorbed and reduce allergy symptoms for approximately 24 hours, allowing convenient once daily medication. Modern antihistamines are generally safe; tachyphylaxis, tolerance or rebound has not been observed. CONCLUSION: Due to their minimal adverse effects and efficient symptom reduction oral second generation antihistamines are particularly useful for the treatment of less severe intermittent forms of nasal allergy. SN - 0935-8943 UR - https://www.unboundmedicine.com/medline/citation/15647976/[Oral_second_generation_antihistamines_in_allergic_rhinitis]_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2004-826000 DB - PRIME DP - Unbound Medicine ER -