Carter D. Brooks

Spectrum of Seasonal Allergic Rhinitis Symptom Relief with Topical Corticoid and Oral Antihistamine Given Singly or in Combination

Sixty ragweed-sensitive volunteers participated in a 2-week study that compared symptom profiles during treatment with antihistamine (loratadine, LOR) alone, topical corticoid (beclomethasone, BEC) alone, or the two drugs combined. For 5 days commencing shortly after the beginning of the ragweed bloom, patients took no treatment while we collected baseline data. They were then randomized to one of the three treatments, receiving that treatment for the balance of the 2-week study term. Twice each day they recorded the severity of congestion, eye symptoms, running and blowing, itching, and sneezing. At the end of the study they provided an estimate of overall symptom relief, which favored combined treatment (vs LOR P = 0.001, vs BEC P = 0.042). To gain an estimate of disease severity and treatment effectiveness over time, and to smooth out day-to-day variation, we divided symptom diary reports into three segments (days 2–4, 5–7, and 8–10) for analysis. Combined treatment controlled symptoms better than antihistamine alone in nearly all study segments. Corticoid alone or combined with antihistamine provided similar control of congestion, running and blowing, and eye complaints. Combination therapy controlled itching and sneezing better, especially through the study segments 1 and 2. Patient preference for combined treatment seems to relate to control of itching and sneezing and rapid onset of effect.

Effect of H2 blockade in the challenged allergic nose

Abstract To examine whether H 2 blockade might prevent development of allergen-induced nasal congestion, we subjected 18 volunteers with allergic rhinitis to nasal allergen challenge after pretreatment with cimetidine or with placebo. Response after cimetidine was more severe than that which followed placebo. H 2 blockade has a subtle adverse effect on nasal allergic response.

Profile of ragweed hay fever symptom control with terfenadine started before or after symptoms are established

Forty‐two ragweed hay fever patients participated in a study which examined the profile of symptom relief provided by terfenadine, and the relative adequacy of symptom control with the drug given from the beginning of the season compared with treatment started after symptoms were well established. Compared with placebo, terfenadine effectively relieved sneeze, itch and eye symptoms. It had no effect on running, blowing and drainage. Subjectively perceived congestion benefited marginally. When the drug was begun after symptoms were well established, sneezing responded quickly and maximally. Eye discomfort lessened but not to the level experienced by those dosed from the beginning of the season. The pattern in other symptom categories was less clear. Overall, terfenadine improved all rhinitis symptoms except those related to hypersecretion. Some symptoms appeared to respond better when drug dosing commenced at the beginning of the season.

Hay fever treatment with combined antihistamine and cyclooxygenase-inhibiting drugs

Twenty-eight ragweed-allergic patients with hay fever participated in a clinical trial that examined the pattern of symptom relief resulting from addition of a cyclooxygenase-inhibiting drug to standard antihistamine therapy. In the first week antihistamine use by the subjects was standardized, and subjects were oriented to use of the hay fever symptom diary. They were then allocated, according to symptom severity, to two treatment groups. One group received 120 mg of terfenadine and 300 mg of flurbiprofen (a cyclooxygenase-inhibiting drug) per day. Members of the other group received terfenadine and a placebo that looked like flurbiprofen. This treatment lasted 1 week. Subjects recorded severity of congestion, drainage, running, nose blowing, itching, and sneezing four times each day. The flurbiprofen-treated patients experienced less severe symptoms, demonstrating maximum benefit 3 to 5 days into the drug trial with some loss of effect thereafter. Secretion-related symptoms appeared to benefit most. Combined blockade of histamine and cyclooxygenase products appears to offer improved symptom control in ragweed hay fever.

Effect of ibuprofen or aspirin on probenecid-induced uricosuria.

We dosed eight normal volunteers with single doses of probenecid alone and with aspirin or ibuprofen. Urinary urate clearance was increased by probenecid. This increase was partially inhibited by aspirin but not by ibuprofen.

Effect of Systemic Corticoid and Antihistamine Alone or in Combination on Elements of the Response to a Two Dose Nasal Allergen Challenge

This study examined the effects of low dose systemic corticoid (methylprednisolone, MP), standard dose antihistamine (terfenadine, TF) or the combination on response to out-of-season acute allergen challenge. We feel that a single dose challenge delivered to the nose may represent real disease imperfectly and in this study used two doses given 1 hour apart, hoping to approximate better the circumstances of natural allergen stimulation. The study used clinical endpoints only: measured nasal airway resistance (NAR), sneeze count, and weight of blown nasal secretions. Subjects showed similar NAR, sneezing, and secretion response to both challenges. With placebo treatment, NAR rose after the first allergen provocation and returned to baseline about 30 minutes later. Antihistamine pretreatment appeared to delay but did not prevent this rise; low dose corticoid partially inhibited it, and the combination totally ablated the response. All active treatments suppressed sneezing and secretion better than placebo. Combination corticoid/antihistamine treatment showed no greater effect on sneeze/secretion than did antihistamine alone; this differs from our findings in separate studies comparing analogous drug combinations in naturally-acquired ragweed hayfever.

Eicosanoid Products in Nasal Rinses Obtained After Acute and Chronic Allergen Stimulation

To explore biochemical relationships between naturally occurring allergic rhinitis and a nasal provocation model, we measured PGD2 and LTC4 content of nasal rinses obtained before and after nasal allergen challenge, in and out of the allergy season. Both PGD2 and LTC4 contents rose after challenge. The rise in season was substantially greater than that seen out of season, and the amounts of eicosanoids present after acute challenge out of season were greater than those recovered when the patients were symptomatic in season. Eicosanoid response is quantitatively different with chronic environmental exposure and with acute laboratory provocation.