Asthma antihistamine therapy

Omalizumab, a recombinant humanized monoclonal antibody that inhibits the binding of human IgE to its high-affinity receptor FceRI by selectively binding the immunoglobulin in solution, has been used as a successful treatment of intractable allergic asthma. The efficacy of the monoclonal antibody treatment was therefore investigated in patients with chronic autoimmune urticaria who remained symptomatic on antihistamine therapy. Of the 12 patients treated, seven showed complete resolution of the urticaria, four responded with a decrease in the urticaria activity score but the urticaria persisted, and one patient showed no improvement. 

DeBuske L. New concepts in pharmacodynamics of antihistamine therapies for allergic disease risk/benefit assessment. IRINE Optimal Paradigms for Allergy and Asthma Managed Care Quality of Life, Outcomes and Risk/Beneflts Assessments, Short Hills, NJ, April 10, 1999. 

Patients who may benefit from allergen immunotherapy include those who do not tolerate traditional drug therapy (e.g., nosebleeds with intranasal steroids or sedation with antihistamines), suffer from severe symptoms, have comorbid conditions (e.g., asthma or sinusitis), fail drug therapy, or prefer not to take long-term medication. 

Simons FE Is antihistamine (Hj-recep-tor antagonist) therapy useful in clinical asthma Clin Exp Allergy 1999 29 (suppl3) 98-104. 

Although the antihistamines are not useful as primary agents in the treatment of asthma, a number of studies have shown that the second-generation compounds are effective as adjunctive therapies in asthmatic patients with concomitant rhinitis, urticaria, or dermatitis. Cetirizine has been used to prevent the progression from atopic dermatitis to asthma in young children. 

Zitt MJ. The role of nonsedating antihistamines in asthma therapy. Allergy Asthma Proc. 2003 24 239-252. 

Second-generation antihistamines have proved to be important therapeutic tools in the treatment of atopic disease, including both seasonal and perennial allergic rhinitis, urticaria, and atopic dermatitis (20). Several studies have shown that the use of second-generation antihistamines as adjunctive therapy can benefit patients whose allergic asthma co-exists with allergic rhinitis (21). 

Walsh GM. Second-generation antihistamines in asthma therapy is there a protective effect Am J Respir Med 2002 l(l) 27-34. 

Nedocromil, a well-tolerated drug (2 inhalations 4 times a day at regular intervals to provide 14 mg/day), is indicated for maintenance therapy in the management of patients with mild to moderate bronchial asthma. Nedocromil has no intrinsic bronchodilating, glucocorticoid, or antihistaminic properties. Therefore, it should not be used in stams asth-maticus (see also Figure 94). 

As with CB, anticholinergic agents are also rational bronchodilators for use in asthma. Their use would be expected to contribute additional bronchodilation to that provided by methylxanthines and sympathomimetic amines since the mechanism of action is directed at the effects of the non-specific stimuli. The concomitant use of all three types could also permit a more precise assessment of the non-reversible component of the patient s airways obstruction. Since many antihistamines have anticholinergic activity, it is possible that patients who take such therapy for other reasons may already have some benefit of this kind of bronchodilation. 

Dmgs that help control asthma and act as good maintenance therapy generally reduced the allergen-induced responses, including the late asthmatic response, while agents with minimal effect on these last, such as calcium channel blockers and antihistamines, were not found useful for this purpose (111,112). 

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