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

Year 2015, Volume: 32 Issue: 4, 352 - 358, 01.10.2015

Corina İ. Bocşan Ştefan C. Vesa Adriana İ. Bujor Nicolae Miron Diana Deleanu Anca D. Buzoianu

Abstract

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 pro-inflammatory 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.

Keywords

Cytokines, histamine H1 antagonists, allergic rhinitis

References

• . Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al; World Health Organization; GA(2)LEN; AllerGen. Allergic rhinitis and its impact on asthma. Allergy 2008;63(Suppl 86):8-160. [CrossRef]
• 2. Bauchau V, Durham SR. Prevalence and rate of diagnosis of allergic rhinitis in Europe. Eur Respir J 2004;24:758-64. [CrossRef]
• 3. Leynaert B, Neukirch C, Kony S, Guénégou A, Bousquet J, Aubier M, et al. Association between asthma and rhinitis according to atopic sensitization in a population-based study. J Allergy Clin Immunol 2004;113:86-93. [CrossRef]
• 4. Min YG. The pathophysiology, diagnosis and treatment of allergic rhinitis. Allergy Asthma Immunol Res 2010;2:65-76. [CrossRef]
• 5. Okayama Y, Kawakami T. Development, migration, and survival of mast cells. Immunol Res 2006;34:97-115. [CrossRef]
• 6. Prussin C, Metcalfe DD. IgE, mast cells, basophils, and eosinophils. J Allergy Clin Immunol 2003;111(Suppl 2):S486-94. [CrossRef]
• 7. Amin K. The role of mast cells in allergic inflammation. Respir Med 2012;106:9-14. [CrossRef]
• 8. Bradding P, Roberts JA, Britten KM, Montefort S, Djukanovic R, Mueller R, et al. Interleukin-4, -5, and -6 and tumor necrosis factor-alpha in normal and asthmatic airways: evidence for the human mast cell as a source of these cytokines. Am J Respir Cell Mol Biol 1994;10:471-80. [CrossRef]
• 9. Bradding P. The role of the mast cell in asthma: a reassessment. Curr Opin Allergy Clin Immunol 2003;3:45-50. [CrossRef]
• 10. Lee NA, Gelfand EW, Lee JJ. Pulmonary T cells and eosinophils: conspirators or independent triggers of allergic respiratory pathology? J Allergy Clin Immunol 2001;107:945-57. [CrossRef]
• 11. Wagenmann M, Schumacher L, Bachert C. The time course of the bilateral release of cytokines and mediators after unilateral nasal allergen challenge. Allergy 2005;60:1132-8. [CrossRef]
• 12. Ohkubo K, Ikeda M, Pawankar R, Gotoh M, Yagi T, Okuda M. Mechanisms of IL-6, IL-8, and GM-CSF release in nasal secretions of allergic patients after nasal challenge. Rhinology 1998;36:156-61.