A review of the efficacy of desloratadine, fexofenadine, and levocetirizine in the treatment of nasal congestion in patients with allergic rhinitis

Bachert, Claus

doi:10.1016/j.clinthera.2009.05.017

Cited by 62 publications

(45 citation statements)

References 75 publications

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“…H1 antihistamines are widely recommended in all types of allergic rhinitis, regardless of symptom severity or persistence (1). They control all of the symptoms, but to a lesser extent nasal congestion (1,16). New generation agents, such as levocetirizine and desloratadine, possess anti-inflammatory properties, reducing allergic inflammation (16,17).…”

mentioning

confidence: 99%

In Vivo Anti-Inflammatory Effect of H1 Antihistamines in Allergic Rhinitis: A Randomized Clinical Trial

et al. 2015

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Background: Allergic rhinitis is characterized by a chronic inflammation of nasal mucosa and represents a risk factor for asthma occurrence. H1 antihistamines reduce the symptoms of rhinitis, but some compounds may have anti-inflammatory properties. Aims: We evaluated the plasma level of some cytokines in patients with persistent allergic rhinitis (PAR) and their evolution after a 4-week treatment with H1 antihistamines, as well as the risk of asthma after 1.5 years. Study Design: Randomized clinical trial. Methods: Eighty-five patients with PAR and 30 healthy volunteers were included in the study. The patients with PAR were randomly divided into 2 groups: 41 patients treated with 5 mg/day desloratadine and 44 patients under 5 mg/day levocetirizine for 4 weeks. The clinical and biological evaluations were performed before and after treatment and included rhinitis symptoms and total symptoms score, type of sensitization, and plasmatic levels of total IgE, IL-1β, IL-6, IL-8 and TNF-α. Results: IL-8 and TNF-α were significantly increased in patients with PAR compared to healthy volunteers (5.85 vs 3.12, p<0.001 and 2.32 vs 1.06, p<0.001, respectively). Both H1 antihistamines reduce all symptoms of allergic rhinitis, including nasal congestion and the plasmatic level of IL-1β, IL-6, IL-8 and TNF-α, after 4 weeks of treatment. The reduction of cytokine levels was not influenced by patients' age, sex, duration or severity of rhinitis, or type of sensitization. Levocetirizine has a superior effect compared to desloratadine in reducing the rhinitis symptoms and cytokines' level. Twenty eight (32.9%) of the patients presented asthma symptoms after 1.5 years. The occurrence of asthma was influenced by house dust sensitization (OR-14.6; CI 95% 1.8-116.3; p=0.01), but baseline values of cytokines were not predictive factors for its appearance. Conclusion: Levocetirizine and desloratadine as a prolonged therapy reduce plasmatic levels of some proinflammatory cytokines in patients with PAR. Levocetirizine has a better effect on decreasing the symptoms and plasmatic levels of IL-1β and IL-8. (ClinicalTrials. gov Identifier: NCT02507635) Founding: POSDRU and University of Medicine and Pharmacy, Iuliu Haţieganu, Cluj Napoca.

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confidence: 99%

In Vivo Anti-Inflammatory Effect of H1 Antihistamines in Allergic Rhinitis: A Randomized Clinical Trial

et al. 2015

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“…The anti-allergic effect [21] was seen on the next day of 1 st dose of treatment, but significance was found on the 2 nd day for ebastine and its combination with montelukast groups, and 3 rd day for montelukast and effect continued as long as treatment continued. During 4 th week, treatment was stopped with continuing the scoring of symptoms in all 3 groups.…”

Section: Discussionmentioning

confidence: 95%

“…In contrast, other contradictory studies have shown that the combination of different antihistamines with montelukast had controlled not only subjective symptom scores [18,19] but also produced significant objective proof of anti-allergic actions, more than individual antihistamines, in AR. [21] and [8][9][10][11] However, ebastine was not studied in any of those supporting and non-supporting studies.…”

Section: Discussionmentioning

confidence: 99%

Randomized prospective double-blind comparative clinical study of ebastine and its combined preparation of montelukast in persistent allergic rhinitis

Rajashekar¹,

Shobha²

2017

Natl J Physiol Pharm Pharmacol

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Background: Antiallergic drugs are widely prescribed in allergic rhinitis (AR). Antihistamines and antileukotrienes are effective only in providing symptomatic relief of allergic symptoms, often used as fixed dose combinations (FDC) of both. Controversial reports regarding their efficacy in AR, when used alone or in their combined preparations, prompted the present study. Aims and Objectives: The aim of this study was to compare the anti-allergic effect of ebastine, montelukast, and their FDC on the subjective nasal and extranasal symptoms in mild-to-moderate persistent AR (PAR) patients. Materials and Methods: Mild-to-moderate PAR patients divided into three groups to receive drugs ebastine, montelukast, and their combined preparation for 3 weeks. Their efficacy was measured by total five nasal symptoms scoring system, AM, and PM symptom scores. The treatment was withdrawn in the last week, to assess the persisting anti-allergic action of treatment drugs. Results: When compared to baseline values, all the treatment groups showed a significant decrease in the total mean score of allergic symptoms. Ebastine and its combination with montelukast significantly decreased both AM and PM mean scores, but montelukast did only for PM mean score. Among three compared groups, ebastine and its combined preparation with montelukast were found significant in reducing total and AM symptoms. Conclusion: All 3 groups showed anti-allergic effects in a variable manner. Montelukast controlled daytime symptoms better. Ebastine and its combination with montelukast controlled allergic symptoms to a similar extent.

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“…Although receptor occupancy for these drugs appears to correlate with pharmacodynamic activity in skin wheal and flare studies and with efficacy in allergen challenge chamber studies,[33,34] are the differences relevant in clinical practice? Studies in allergic rhinitis suggest that the above 3 drugs are of similar effectiveness[35,36]. However, in chronic urticaria in which local histamine concentrations are high, the differences do seem to be important.…”

Section: Second-generation H1-antihistaminesmentioning

confidence: 99%

“…The anti-inflammatory effects of H 1 -antihistamines, which is a class effect mediated through the H 1 -receptor, are summarized in Ref[14]. The clinical implications of this lie in the ability of H 1 -antihistamines to reduce nasal congestion and hyper-reactivity,[36] which result from the sensitization of sensory neurones in the nose by allergic inflammation[46]. However, as nasal congestion is more slowly relieved than other nasal symptoms,[47] continuous rather than on demand therapy with antihistamines is required for its treatment[48].…”

Section: Second-generation H1-antihistaminesmentioning

confidence: 99%

Pharmacology of Antihistamines

Church¹,

Church²

2011

World Allergy Organization Journal

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This article reviews the molecular biology of the interaction of histamine with its H1-receptor and describes the concept that H1-antihistamines are not receptor antagonists but are inverse agonists i.e. they produce the opposite effect on the receptor to histamine. It then discourages the use of first-generation H1-antihistamines in clinical practice today for two main reasons. First, they are less effective than second generation H1-antihistamines. Second, they have unwanted side effects, particularly central nervous system and anti-cholinergic effects, and have the potential for causing severe toxic reactions which are not shared by second-generation H1-antihistamines. There are many efficacious and safe second-generation H1-antihistamines on the market for the treatment of allergic disease. Of the three drugs highlighted in this review, levocetirizine and fexofenadine are the most efficacious in humans in vivo. However, levocetirizine may cause somnolence in susceptible individuals while fexofenadine has a relatively short duration of action requiring twice daily administration for full all round daily protection. While desloratadine is less efficacious, it has the advantages of rarely causing somnolence and having a long duration of action. Lastly, all H1-antihistamines have anti-inflammatory effects but it requires regular daily dosing rather than dosing 'on-demand' for this effect to be clinically demonstrable.

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A review of the efficacy of desloratadine, fexofenadine, and levocetirizine in the treatment of nasal congestion in patients with allergic rhinitis

Cited by 62 publications

References 75 publications

In Vivo Anti-Inflammatory Effect of H1 Antihistamines in Allergic Rhinitis: A Randomized Clinical Trial

In Vivo Anti-Inflammatory Effect of H1 Antihistamines in Allergic Rhinitis: A Randomized Clinical Trial

Randomized prospective double-blind comparative clinical study of ebastine and its combined preparation of montelukast in persistent allergic rhinitis

Pharmacology of Antihistamines

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