Antipruritic Research Articles

Executive summary: American Academy of Dermatology guidelines of care for the management of atopic dermatitis in adults with topical therapies

These guidelines update the 2014 recommendations for management of atopic dermatitis in adults with topical therapies. A multidisciplinary workgroup employed best practices for guideline development, including a systematic review of the evidence and application of the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of the evidence and formulating and grading recommendations. The evidence on atopic dermatitis treatment supported strong recommendations for the use of nonprescription moisturizers, topical calcineurin inhibitors, topical corticosteroids, and topical PDE-4 and JAK inhibitors. Conditional recommendations are made for the use of bathing and wet wrap therapy and against the use of topical antimicrobials, antiseptics, and antihistamines.

Contact Dermatitis Follow-up Care in a Comorbid, Elderly Woman Using Patient-assisted Teledermatology Consultation in Covid-19 Era

Teledermatology is a boon in the current situation considering the ongoing COVID-19 pandemic. The use of teledermatology with the available technology for follow-up care in a comorbid, geriatric and COVID-19 situation is reported. An elderly female with comorbidities presented to us with acute history of itchy red lesions over the face and scalp after application of hair dye. She was diagnosed with a case of contact dermatitis and was treated with topical corticosteroids and antihistamines after routine investigations. Considering her status of being elderly, comorbidities and no caretakers, we offered patient-assisted teledermatology consultation (PATC) through mobile messenger app for her follow-up. We were able to assess the serial images sent by the patient on days 3, 5, and 7 and observed improvement. Mobile messenger apps are convenient for the patients and reduce 75% of follow-up visits. It achieves both patient and physician satisfaction. We suggest PATC for follow-up, especially in the elderly with comorbidities. It minimizes multiple follow-up visits, save time, and cost.

Clinical Efficacy of Sublingual Specific Immunotherapy in Children with Allergic Rhinitis and its Impact on their Inflammatory Factors and Immune Function

The main objective of this study is to analyze the effects of sublingual specific immunotherapy and conventional drug therapy on inflammatory factors and immune function in children with allergic rhinitis. The research subjects were divided into three groups, group A received sublingual administration of dust mite drops, group B received routine treatment such as passive intervention with topical hormones, antihistamines and nasal irrigation and group C received sublingual administration of dust mite drops and on the basis of drop therapy, conventional treatments such as topical and systemic use of corticosteroids, antihistamines and anti-leukotriene’s are combined. Comparison was done among the three different sets of indicators. After treatment, the allergic rhinitis symptom score, visual analog scale score and inflammatory factor index levels in the three groups were calculated. The score was lower in group A than in group B and lower in group C than in group A. Adverse reactions were lowest in group A and highest in group C. After treatment, the levels of whole blood cluster of differentiation 4+, cluster of differentiation 4+/cluster of differentiation 8+ cells and serum immunoglobulin E were lower in group C than group A, and lower in group B than group A. The cluster of differentiation 8+ index was highest in group C and lowest in group B. Sublingual specific immunotherapy is effective and safe for children with allergic rhinitis.

AN UNUSUAL CASE OF CHRONIC COUGH IN A PEDIATRIC PATIENT

<h3>Introduction</h3> Common causes of chronic cough in children are postinfectious, asthma, rhinosinusitis, and gastroesophageal reflux. Sensory neuropathic cough (SNC) is a rare cause of chronic cough in children. Its diagnosis is by exclusion; therefore, treatment is often delayed. We present a difficult pediatric case of sensory neuropathic cough. <h3>Case Description</h3> A 12-year-old female with well-controlled asthma developed a new-onset dry to wet cough after a viral infection that persisted for 6 weeks. Symptoms occurred both day and night. No wheezing was reported. She was hoarse but was able to speak in full sentences between coughing. There were no apparent triggers. Initial treatment with daily inhaled corticosteroid, long and short-acting beta-2-agonists, oral leukotriene receptor antagonist, and short courses of systemic steroids failed to relieve her symptoms. The addition of oral histamine-1-and-2-receptor antagonists, intranasal topical steroids and antihistamines, and antibiotics for potential sinus infection was also unsuccessful. Impulse oscillometer and computed tomography of the chest showed no abnormalities. Laryngoscopy was negative for vocal cord dysfunction, pooling of secretions, masses, polyps, or laryngeal swelling. She was seen by a neurologist 8 weeks after the cough began where she was diagnosed with sensory neuropathic cough and started on amitriptyline, resolving her cough. <h3>Discussion</h3> Our case illustrates the challenges of diagnosing sensory neuropathic cough as there are no standardized diagnostic criteria. Peripheral and central neurological sensitization are potential pathophysiologic explanations. Neuromodulating agents such as amitriptyline and gabapentin can potentially provide relief to some. Our patient had resolution of symptoms after use of amitriptyline.

Study of Different Local Treatments of Post COVID-19 Smell Dysfunction.

This study was designed to differentiate between the impact of the topical nasal spray of corticosteroids, antihistamines, a combination of them, and normal 0.2% saline in treating patients with post-coronavirus disease 2019 (COVID-19) smell dysfunction. Patients with hyposmia or anosmia (n = 240), who recently recovered from COVID-19, were enrolled in this trial and were randomly assigned to four parallel groups. Group I (G1) received a combination of topical corticosteroid and antihistamine nasal spray (n = 60). Group II (G2) received topical corticosteroid nasal spray (n = 60). Group III (G3) received antihistamine nasal spray (n = 60). Group IV (G4) received 0.2% normal nasal saline nasal spray (n = 60). The treatments were used in all groups for 3 weeks. The sense of smell was assessed using the butanol threshold and discrimination tests. The smell tests were evaluated weekly for 3 weeks. The mean age of the patients was 51.9 ± 7.1 years; moreover, 83.8% and 16.2% were male and female, respectively. The results of the smell tests in the first week significantly improved with those in the third week (P< 0.001). The greatest degree of improvement was found in the first group, followed by the second, third, and fourth groups. The results suggest the ability of combination therapy of corticosteroid and antihistamine nasal spray to manage post-COVID-19 hyposmia or anosmia; however, this combination therapy was not superior to corticosteroid nasal spray. Trial registration ID: UMIN000043537.

Fabrication of nanostructured lipid carriers ocugel for enhancing Loratadine used in treatment of COVID-19 related symptoms: statistical optimization, in-vitro, ex-vivo, and in-vivo studies evaluation

Loratadine (LORA), is a topical antihistamine utilized in the treatment of ocular symptoms of COVID-19. The study aimed to develop a Loratadine Nanostructured Lipid Carriers Ocugel (LORA-NLCs Ocugel), enhance its solubility, trans-corneal penetrability, and bioavailability. full-factorial design was established with 24 trials to investigate the impact of several variables upon NLCs properties. LORA-NLCs were fabricated by using hot melt emulsification combined with high-speed stirring and ultrasonication methods. All obtained formulae were assessed in terms of percent of entrapment efficiency (EE%), size of the particle (PS), zeta potential (ZP), as well as in-vitro release. Via using Design Expert® software the optimum formula was selected, characterized using FTIR, Raman spectroscopy, and stability studies. Gel-based of optimized LORA-NLCs was prepared using 4% HPMC k100m which was further evaluated in terms of physicochemical properties, Ex-vivo, and In-vivo studies. The optimized LORA-NLCs, comprising Compritol 888 ATO®, Labrasol®, and Span® 60 showed EE% of 95.78 ± 0.67%, PS of 156.11 ± 0.54 nm, ZP of −40.10 ± 0.55 Mv, and Qh6% of 99.67 ± 1.09%, respectively. Additionally, it illustrated a spherical morphology and compatibility of LORA with other excipients. Consequently, gel-based on optimized LORA-NLCs showed pH (7.11 ± 0.52), drug content (98.62%± 1.31%), viscosity 2736 cp, and Q12% (90.49 ± 1.32%). LORA-NLCs and LORA-NLCs Ocugel exhibited higher ex-vivo trans-corneal penetrability compared with the aqueous drug dispersion. Confocal laser scanning showed valuable penetration of fluoro-labeled optimized formula and LORA-NLCs Ocugel through corneal. The optimized formula was subjected to an ocular irritation test (Draize Test) that showed the absence of any signs of inflammation in rabbits, and histological analysis showed no effect or damage to rabbit eyeballs. Cmax and the AUC0–24 were higher in LORA-NLCs Ocugel compared with pure Lora dispersion-loaded gel The research findings confirmed that NLCs could enhance solubility, trans-corneal penetrability, and the bioavailability of LORA.

Effect of Topical H1-antihistamine on the level of Transforming growth factor beta (TGF-β) and Collagen of Acute wound in animal model

Imbalance of collagen synthesis and degradation causes formation of abnormal scarring leading to hypertrophic scar or keloid. Previous studies have shown that applying antihistamines could reduce the level of dermal collagen. However, no data whether topical antihistamine could be used as preventative therapy for abnormal scar formation. The aim of this study was to assess whether the application of topical antihistamine in acute wounds could affect the level of transforming growth factor beta (TGF-β), a regulator of wound healing process, and collagen in wound healing phase in order to suppress the keloid formation. A randomized post-test only control group design study was conducted. Twenty-four acute wounds on Rattus novergicus rats were randomized divided into control and treatment groups. The animals of treatment group received daily topical antihistamine consisting 1% diphenhydramine hydrochloride and 0.1% zinc acetate. The full-thickness skin tissue from each rat were taken on day 5 and 21 and were subjected to ELISA test to measure the levels of TGF-β and collagen. Our data found that in the treatment group, the level of collagen decreased significantly over time (1623.61ng/mL on day 5 to 755.15ng/mL on day 21, p=0.001). Similarly, the level of TGF- also decreased although was not statistically significant (p=0.766). In contrast, the levels of TGF-β level and collagen in the control group increased significantly from day 5 to day 21, p=0.003 and p=0.001, respectively. The level of TGF- in treatment group was significantly higher compared to the control group p=0.001 on day 21 while the level of collagen had no different between treatment and control group (p=0.124). In conclusion, our data suggest that topical antihistamine reduced the levels of TGF-β and collagen at the end of the proliferation phase or the beginning of the remodeling phase. Further study is warrant to elucidate the effect of antihistamine on other would healing markers or parameters.

Real-world treatment patterns for atopic dermatitis in South Korea

The phenotypes of atopic dermatitis (AD) are diverse, and ethnic differences have been suggested. To date, few studies have explored large-scale national data on the treatment patterns of AD in Asians. Therefore, we aimed to examine real-world treatment patterns for AD, including the probability of discontinuation of AD treatment and restart after discontinuation. A retrospective observational study was conducted using the nationwide healthcare database in South Korea between January 1, 2016 to July 31, 2020. We identified 944,559 pediatric patients and 1,066,453 adults with AD. Topical corticosteroids and antihistamines were the most commonly prescribed medications in all age groups. The frequency of topical corticosteroid prescription decreased as the age increased. Although immunosuppressive drugs were not widely used in both children and adults, cyclosporine was the most frequently prescribed immunosuppressant, particularly among those aged 12 years or more (1–2%). Pediatric patients were more likely to discontinue treatment than adult patients. Treatment restart for moderate-to-severe AD was earlier than that for overall AD. In conclusion, significant differences were observed in the treatment patterns of AD between pediatric and adult patients. These findings will improve our understanding of the latest treatment patterns for AD, which may contribute to decision-making in clinical practice.

Erythema multiforme in children.

Children who present with rashes with "target" lesions are frequently diagnosed with erythema multiforme (EM). This is a self-limiting condition in most children; how should primary care providers differentiate between this and urticaria or Stevens-Johnson syndrome, and what is the recommended course of treatment? While EM is common in children, urticaria is also very common and tends to be more "waxing and waning" compared with EM's fixed lesions. Stevens-Johnson syndrome and toxic epidermal necrolysis are more severe and distinct conditions; they have much more substantial mucous membrane involvement and contain widespread erythematous or purpuric macules with blisters. Since EM is a self-limiting condition, treatment of EM in children is generally supportive, and rarely do children need hospital admission for rehydration. In more severe cases involving mucous membranes or substantial pain, some patients will benefit from topical steroids or antihistamines. When children present with signs of herpes infection, antiviral treatment (acyclovir) may be of benefit. Systemic steroids should be reserved for the most challenging cases.

Treatment Patterns of Atopic Dermatitis Medication in 0-10-Year-Olds: A Nationwide Prescription-Based Study.

IntroductionThe literature on treatment patterns for paediatric atopic dermatitis (AD) is scarce and is rarely based on real-world data. Using national registers, we sought to establish up-to-date, population-based prevalence estimates, predictors of risk and disease burden and a comprehensive overview of treatment patterns and course for paediatric patients with AD.MethodsDispensed prescriptions for the entire Norwegian child population aged 0–10 years from 2014 to 2020 were analysed.ResultsThere were 176,458 paediatric patients with AD. Of these, 99.2% received topical corticosteroids, 5.1% received topical calcineurin inhibitors, 37.1% received potent topical corticosteroids and 2.1% received systemic corticosteroids. Of the 59,335 live births in Norway (2014), 14,385 [24.8%; 95% confidence interval (CI) 24.5–25.1] paediatric patients were treated for AD before the age of 6 years, and of these, only 934 (6.5%; 95% CI 6.1–6.9) received medication annually for 5 years or more. Compared with girls, 17.9% (95% CI 6.5–27.9) more boys were treated for at least 5 years, receiving 6.4% (95% CI 1.2–11.3) more potent topical corticosteroids and 12.4% (95% CI 6.5–18.0) more were treated for skin infections. Compared with patients with late-onset treatment, 18.9% (95% CI 7.5–29.0) more paediatric patients with early-onset treatment were still receiving treatment at 5 years of age, 15.7% (95% CI 7.1–23.4) more paediatric patients received potent topical corticosteroids and 44.4% (95% CI 36.5–51.2) more paediatric patients were treated for skin infections.ConclusionMost paediatric patients were treated for a mild disease for a limited period. Although the prevalence of AD is higher at a younger age, these paediatric patients were the least likely to receive potent topical corticosteroids. Male sex and early-onset AD are associated with and are potential predictors of long-term treatment and treatment of potent topical corticosteroids, antihistamines and skin infections, which may have clinical utility for personalised prognosis, healthcare planning and future AD prevention trials.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-022-00754-6.

Contact Allergens in Over-the-Counter Topical Antihistamine and Mast Cell Stabilizer Ophthalmic Agents.

Contact Allergens in Over-the-Counter Topical Antihistamine and Mast Cell Stabilizer Ophthalmic Agents.

Persistent subcutaneous nodules and Aluminium sensitization: Literature review and Case series report

The development of persistent subcutaneous nodules at vaccination or hyposensitization injection site is a rare and under-reported event. These lesions have been attributed to the aluminium salts used as adjuvants. Patch testing on patients with the aforementioned clinical manifestations have yielded high sensitization rates to aluminium. It is believed this delayed hypersensitivity is the apparent cause of these reactive lesions in the dermis and subcutaneous tissue. In addition, aluminium hypersensitivity may cause contact dermatitis and gingivitis since it can be found in toothpaste and deodorants. We describe a series of 4 patients who developed SN at the injection site of vaccines and/or hyposensitization therapy, who underwent ultrasonography and patch testing for diagnostic confirmation. Patient management usually consists of potent topical steroids, antihistaminics, emollients and aluminium-containing products avoidance.

Sensitization to trometamol in patients with delayed local reactions after administration of the Moderna mRNA-1273 vaccine against SARS-CoV-2

Sensitization to trometamol in patients with delayed local reactions after administration of the Moderna mRNA-1273 vaccine against SARS-CoV-2

Vulvar inflammatory disorders: A review

Vulvar inflammatory disorders (VID) are a miscellaneous group of non-infectious conditions of the vulvar area, which can be broadly classified based on etiology and pathology. Here, we discuss a few pertinent VID including vulvar dermatitis, psoriasis, lichen planus, and lichen sclerosus. This review will focus only on common VID, and a few rare conditions with characteristic features such as Crohn’s disease, plasma cell vulvitis, acantholytic disorder of genitocrural area, desquamative vulvitis, and atrophic vulvovaginitis. A thorough history taking and relevant investigations including dermoscopy and biopsy are relevant to proper diagnosis and management of VID. Early management of VID is essential since these conditions are prone to interfere with psychosexual functioning of the patient. Potent topical steroids are the first line management in most cases, followed by topical calcineurin inhibitors, emollients, and antihistamines. Vulvar area is resistant to steroid induced atrophy; hence, use of potent topical steroids does not pose a problem. Oral steroids or steroid sparing agents are used in resistant cases.

Relationship between allergic rhinitis and allergic conjunctivitis (allergic rhinoconjunctivitis) - review.

Allergic rhinitis and allergic conjunctivitis are so frequently associated that the need to coin a new name to describe the simultaneous manifestations generated the term allergic rhinoconjunctivitis. The significant impact of rhinoconjunctivitis on the quality of life and the wellbeing of the patients is the reason why the medical community shows a great interest to this disease. Another aspect is the financial burden that is not negligible. The anatomical connection between the organs involved facilitates the propagation of the disease. The allergic pathophysiological mechanisms implicated in allergic rhinitis and conjunctivitis also share common features. The diagnosis of rhinoconjunctivitis is based on the concordance between the symptoms, the clinical examination, and the diagnostic tests that should reveal the existence of an allergen specific IgE in vivo or in vitro. Whilst the nasal smear for eosinophils is considered a reliable diagnostic test for allergic rhinitis, the occurrence of eosinophils in the conjunctive is not a trustworthy indicator of allergy. The therapy of allergic rhinoconjunctivitis is based on patient education, pharmacotherapy, and allergen-specific immunotherapy. The local treatment for the allergic rhinitis is primarily based on topical corticosteroids that also manage the ocular symptoms. The first line of treatment of the ocular manifestations is represented by topical antihistamines and mast-cell stabilizers or double action drugs.

Clinical Guidelines for the Use of Antipruritic Drugs in the Control of the Most Frequent Pruritic Skin Diseases in Dogs.

Pruritus is a common clinical sign in many skin disorders and is currently the main complaint in canine dermatology. Pruritic skin diseases can affect the quality of life of dogs and their owners. Several families of antipruritic drugs are available to help control pruritus in dogs. The aim of this review is to help practitioners select the most appropriate symptomatic treatment in the most frequent situations of dermatological pruritus in dogs. The molecules reviewed here are systemic and topical glucocorticoids, antihistamines, ciclosporin, oclacitinib and lokivetmab. A level of evidence (1, 2 or 3) has been established according to a detailed algorithm for each individual study in the literature published between 1990 and March 2021. The guidelines result from evidence grading using the strength of recommendation taxonomy (SoRT) and clinical recommendations using a thorough methodology.

Allergic rhinitis in children: a comprehensive approach to treatment

Prevalence of allergic rhinitis among chronic upper respiratory diseases in pediatrics is one of highest. Beside anti-inflammatory drugs (topical steroids, antileukotrienes, antihistamines), reliever therapies are important too in treatment of allergic rhinitis. Decongestant prescription in children should lasts no more than 7–10 days; combination of alpha1-adrenomimetic with topical antihistamines is one of possible ways to improve the efficacy, for example, the combination of dimetindene maleate with phenylephrine as nasal drops. We present the results of retrospective evaluation of 625 patients aged from 0 to 17 years with allergic rhinitis, diagnosed not less than 12 month ago. Among examined group, mild allergic rhinitis prevalence was 56.9%, moderate 37.2% and severe 5.9%. During the year all patients experienced 1754 exacerbations (on average, 2.79 ± 1.13 exacerbations per patient). Contact with allergen (35.3%) and respiratory infections (28.8%) were more prevalent reasons of exacerbation; non-specific trigger provocation (pungent smells, air humidity or temperature change etc.) (19.8%) and unknown reason (16.4%) of allerhttps://doi.org/10.21518/2079-701X-2022-16-1-184-189 gic rhinitis exacerbation were less prevalent. When treated with combined nasal drops of dimetindene maleate and phenylephrine median [Q25; Q75] duration of exacerbation was a bit shorter 7.94 [6.25; 17.15] days, than using other decongestants, but difference was statistically insignificant. Combined nasal drops were maximal clinically efficient among patients under 12 years old with exacerbations, caused by allergens contacts. We did not register any adverse events caused by decongestant treatment, during our study. Patients with allergic rhinitis should be provided with written action plan for the disease exacerbation. Using as reliever therapy combined nasal drops (dimetindene maleate and phenylephrine) registered for patients from 1 year old, decrease number of medicines and reduce allergic rhinitis exacerbations duration.

Sulfasalazine induced atypical drug reaction with eosinophilia and systemic symptoms syndrome: a case report

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a type IV b hypersensitivity reaction characterized by cutaneous manifestations, fever, lymphadenopathy, hematologic abnormalities, and multiple organ manifestations. We report a case of sulfasalazine induced DRESS syndrome who was admitted with a complaint of morbilliform rash all over the body, a fever of 100oF, and severe abdominal pain. Initially the patient did not mention about intake of sulfasalazine while taking the drug history as he could not remember the past medication. The laboratory investigations revealed elevated eosinophils, WBC, and liver function tests. The patient was treated with antibiotics assuming tropical infection, but the patient’s condition was not improving. Later while taking proper drug history from a patient representative over the telephone revealed that the patient was in 4th week of tablet sulfasalazine 500 mg treatment for polyarthritis. Further, the J-SCAR scale was used to diagnose it as Sulfasalazine induced atypical DRESS syndrome. The patient was treated with topical and intravenous corticosteroids and antihistamine; the patient exhibited surprising symptomatic improvement. The patient was given a tapering dose of oral corticosteroid tablet prednisolone 20 mg for three weeks and topical corticosteroid mometasone lotion for two weeks upon discharge.

Mesenchymal stem cell therapy for alleviating ocular surface inflammation in allergic conjunctivitis

Allergic eye diseases have become a major concern worldwide, especially in the paediatric population. Vernal keratoconjunctivitis, a seasonal, chronic, bilateral inflammation of the ocular surface, represents one of the most common forms of ocular allergy in subtropical climates which may lead to corneal scarring and blindness if not properly treated. Late diagnosis of the disease and potential side effects of the currently used topical steroids, antihistamines, and mast cell stabilizers necessitates the development of early diagnostic tools and alternate immunosuppressive therapies. Mesenchymal stem cells have shown promising therapeutic potentials due to their tissue repair, anti-allergic, and immunomodulatory properties. However, their role in allergic conjunctivitis/vernal keratoconjunctivitis is poorly explored. Here, it is hypothesized that mesenchymal stem cells or their secreted products alleviate inflammation and promote repair of the damaged ocular surface in allergic conjunctivitis patients. It is presumed that they do so through multiple anti-allergic mechanisms and maintain long-term immunosuppression with significantly reduced or negligible side effects. These cells or their secreted products (extracellular vesicles, growth factors, conditioned medium, inflammatory mediators, and other biomolecules) can be used as topical immunosuppressive medications for effectively treating ocular surface inflammation in allergic conjunctivitis.

Allergic Rhinitis: A Critical Modern Review

Allergic rhinitis addresses a hyperactivity of the resistant framework in any case harmless particles making a fiery reaction where none is required. Allergic Rhinitis is clinically represented by a mixture of two or additional nasal symptoms: running, blocking, itching and sneezing. Allergic rhinitis is regularly partitioned by age, seriousness, and duration of symptoms. Investigation represents how epidemiologic evaluations on the commonness of hypersensitive or allergic rhinitis shift considerably with whether both clinical appraisal and testing were utilized to make the determination. The treatment of allergic rhinitis should combine allergen avoidance, pharmacotherapy and allergen immunotherapy. Treatments of allergic rhinitis include intranasal corticosteroids, oral and topical antihistamines, decongestants, intranasal cromolyn, intranasal anticholinergics. First-generation and Second-generation oral antihistamines and intranasal corticosteroids are the most effective modality for treating allergic rhinitis. Immunotherapy is an efficient immune-modulating treatment that ought to be counseled if pharmacologic medical care for allergic rhinitis isn't effective or not tolerated. This article provides an overview of the prevalence, pathophysiology, diagnosis, and appropriate management of the allergic rhinitis.