First do no harm: Managing antihistamine impairment in patients with allergic rhinitis
First do no harm: Managing antihistamine impairment in patients with allergic rhinitis
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DOI：
10.1067/mai.2003.1550
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发表时间：
2003-05-01
影响因子：
14.2
通讯作者：
Wong, DE
中科院分区：
文献类型：
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作者：
Casale, TB;Blaiss, MS;Wong, DE
抗组胺药物是几十年来一直用于治疗变应性鼻炎的有效药物；然而，它们可能以不适当的方式使用或选择，并可能是药物相关发病率的来源。我们的目标是介绍相关的背景信息和关于抗组胺药物在变应性鼻炎治疗中的使用的专家共识声明。2002年7月，过敏、临床免疫学、药理学和损伤评估方面的14位专家应邀参加了一次圆桌会议，介绍当前的概念，并就抗组胺药物治疗变应性鼻炎的临床管理制定共识声明。许多用于治疗过敏性鼻炎的抗组胺药物，以及疾病本身，可能会产生镇静、损害和降低生活质量。变应性鼻炎更适合使用相对无害的第二代抗组胺药物(如碘雷他定、地洛他定、西替利津和非索非那定)来治疗，因为较老的药物(如苯海拉明、扑尔敏和溴苯那明)会产生镇静和损害，并恶化睡眠结构。尽管围绕第二代抗组胺药物的不同程度的疗效存在一些争论，但众所周知，一些药物可能会产生不同程度的嗜睡或损害，特别是在高于推荐剂量的情况下。第二代抗组胺药物在安全性方面的差异小于第一代和第二代之间的差异。作为一种不镇静、不损害(即使高于推荐剂量)的第二代抗组胺药，所有患者都首选第二代抗组胺药，特别是那些有较高不良反应风险的患者。我们建议初级保健和专科医生、护士从业者、医生助理、药剂师和所有其他参与诊断和治疗过敏性鼻炎的健康专业人员遵循这份共识文件，并与推荐抗组胺治疗的患者分享这一信息。此外，还应对抗组胺药物的效果进行进一步的流行病学研究。
Antihistamines are effective medications that have been used for decades in the management of allergic rhinitis; however, they may be administered or selected in an inappropriate fashion and may be the source of drug-related morbidity. Our objective is to present relevant background information and an expert consensus statement on the use of antihistamines in treatment of allergic rhinitis. In July 2002, 14 experts in allergy, clinical immunology, pharmacology, and impairment assessment were invited to participate in a roundtable conference to present current concepts and develop a consensus statement on the clinical management of allergic rhinitis with antihistamines. Many of the antihistamines used to treat allergic rhinitis, as well as the disease itself, may produce sedation, impairment, and reduced quality of life. Allergic rhinitis is more appropriately managed with the relatively nonimpairing second-generation antihistamines (eg, Ioratadine, desloratadine, cetirizine, and fexofenadine), because older agents (eg, diphenhydramine, chlorpheniramine, and brompheniramine) produce sedation and impairment and worsen sleep architecture. Although there is some debate surrounding the varying degrees of efficacy of second-generation antihistamines, it is known that some agents may produce varying levels of drowsiness or impairment, especially at higher than recommended doses. The differences with regard to safety among the second-generation antihistamines are smaller than are the differences between the first and second generations. A nonsedating, nonimpairing (even at higher than recommended doses), second-generation antihistamine is preferred for all patients, particularly those with a higher risk for the development of adverse effects. We recommend that primary care and specialist physicians, nurse practitioners, physician assistants, pharmacists, and all other health professionals involved in the diagnosis and treatment of allergic rhinitis follow this consensus document and share this information with patients for whom antihistamine therapy is recommended. In addition, further epidemiologic studies on the effects of antihistamines should be performed.