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Современные аспекты лечения аллергического ринита
Современные аспекты лечения аллергического ринита
Карпищенко С.А., Колесникова О.М. Современные аспекты лечения аллергического ринита. Consilium Medicum. 2019; 21 (3): 70–74. DOI: 10.26442/20751753.2019.3.190271
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Аннотация
Аллергический ринит (АР) – широко распространенное заболевание, его встречаемость наблюдается от 17 до 40% населения разных стран. АР негативно влияет на качество жизни пациентов и часто ассоциируется с астмой. Современная стратегия лечения АР основана на 3 принципах: устранения контакта с аллергеном, фармакотерапии и иммунотерапии. Антигистаминные препараты II поколения как представители фармакотерапии применяются на всех ступенях лечения АР из-за своей высокой терапевтической эффективности и оказывают не только противоаллергическое, но и противовоспалительное действие. В статье сделан сравнительный обзор эффективности антигистаминных препаратов II поколения между собой и в сравнении с антилейкотриеновыми препаратами. Несмотря на наличие эффективных лекарств для лечения АР, существует доля пациентов, на которых терапия не оказывает должного действия. В настоящее время идут поиски новых препаратов и/или способов доставки «старых» лекарств, которые бы обеспечили улучшение клинического течения АР. На первый взгляд, интраназальное введение препаратов сочетает в себе хороший профиль безопасности с эффективностью. Однако в контексте «точной медицины» после определения молекулярной мишени один препарат может оказывать влияние на большее число заболеваний или симптомов одного заболевания. С этой точки зрения предпочтительнее использовать один системный препарат для купирования многообразий аллергической реакции.
Ключевые слова: аллергический ринит, антигистаминные препараты, эбастин, стандарты.
Ключевые слова: аллергический ринит, антигистаминные препараты, эбастин, стандарты.
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Allergic rhinitis is a worldwide disease, which occurred from 17% to 40% of the population in different countries. Allergic rhinitis affects negative on the quality of patient’s life and is often associated with asthma. Modern strategy for the treatment of allergic rhinitis based on three principles: the elimination of contact with the allergic agent, pharmacotherapy and immunotherapy. The second generation of the antihistamines drugs, as a representative of pharmacotherapy, are used at all stages of the allergic rhinitis treatment due to their high therapeutic efficacy and have not only anti-allergic, but also anti-inflammatory effect. In this article provides a comparative review of the effectiveness of second-generation antihistamines drugs among themselves and in comparison with antileukotriene medications. Although the availability of effective drugs for allergic rhinitis treatment, there is some kind of patients who had no effect from drugs. At the recent time, there are some searches for a new drugs and / or delivery methods for “known” drugs that would improve allergic rhinitis treatment. At first sight, intranasal using of drugs combines a good safety with high efficiency. However, after determining the molecular goal, one drug can affect a greater number of diseases or symptoms. From this point of view, it is preferable to use one systemic drug for stopping the variations of an allergic reaction.
Key words: allergic rhinitis, antihistamines, ebastine, standards.
Key words: allergic rhinitis, antihistamines, ebastine, standards.
Полный текст
Список литературы
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2. http: //www.whogis.com/gho/ru/
3. Compalati E, Ridolo E, Passalacqua G et al. The link between allergic rhinitis and asthma: the united airways disease. Expert Rev Clin Immunol 2010; 6 (3): 413–23.
4. Baiardini I, Braido F, Tarantini F et al. ARIA-suggested drugs for allergic rhinitis: what impact on quality of life? A GA2LEN review. Allergy 2008; 63 (6): 660–9.
5. Antonov V.B., Medvedeva T.V., Sobolev A.V. Mikogennye allergii. Allergologiia. 1998; 2: 23–6 (in Russian).
6. Karpishchenko S.A., Riabova M.A., Lavrova O.V. et al. K voprosu o differentsial'noi diagnostike vospalitel'noi patologii verkhnikh dykhatel'nykh putei u beremennykh. Folia Otorhinolaryngologiae et Pathologiae Respiratoriae. 2017; 23 (2): 20–2 (in Russian).
7. Canonica G, Triggiani M, Senna G. Clin Mol Allergy 2015; 13: 25. DOI: 10.1186/s12948-015-0029-5
8. Belan E.B., Sadchikova T.L. Allergicheskii rinit: sovremennye podkhody k diagnostike i lecheniiu. Lekarstvennyi vestn. 2017; 3 (67). T. 11: 3–11 (in Russian).
9. Bousquet J, Dahl R, Khaltaev N. GARD (Global alliance against chronic respiratory diseases). Rev Maladies Respiratoires 2006; 23 (4): 73–5. DOI: 10.1111/j.1398-9995.2008.01640.x
10. Pawankar R. Allergic diseases and asthma: A global public health concern and a call to action. World Allergy Organization J 2014; 7 (1): 12. DOI: 10.1186/1939-4551-7-12
11. Thomas SHL. Antihistamine poisoning. Medicine 2012; 40: 109–10.
12. Tran NP, Vickery J, Blaiss MS. Management of Rhinitis: Allergic and Non-Allergic. Allergy, Asthma Immunol Res 2011; 3 (3): 148. DOI: 10.4168/aair.2011.3.3.148
13. Grant JA, Danielson L, Rihoux JP, DeVos C. A double-blind single dose, crossover comparison of cetirizine, ebastine, epinestine, fexofenadine, terfenadine and loratadine versus placebo: suppression of histamineinduced wheal and flare response for 24 h in healthy male subjects. Allergy 1999; 54: 700–7.
14. Gispert J, Antonijoan R, Barbanoj M et al. Efficacy of ebastine, cetirizine, and loratadine in histamine cutaneous challenge. Ann Allergy Asthma Immunol 2002; 89: 259–64.
15. Moss AJ, Chaikin P, Garcia JD et al. A review of the cardiac systemic side-effects of antihistamines: ebastine. Clin Exp Allergy 1999; 29 (Suppl. 3): 200–5.
16. Gillen MS, Miller B, Chaikin P, Morganroth J. Effects of supratherapeutic doses of ebastine and terfenadine on the QT interval. Br J Clin Pharmacol 2001; 52: 201–4.
17. Pecoraro L, Paiola G, Pietrobelli A. Ebastine overdose in a child. Clin Case Rep 2017; 5 (4): 403–5. DOI: 10.1002/ccr3.845
18. Heffler E, Brussino L, Giacco S. New drugs in early-stage clinical trials for allergic rhinitis Expert Opin Investig Drugs 2019; 28 (3): 267–73. DOI: 10.1080/13543784.2019.1571581
19. Hamed A, Preston D, Eschenbacher W. Nasal IgE Production in Allergic Rhinitis: Impact of Rhinovirus Infection Clin Exp Allergy. 2019. DOI: 10.1111/cea.13372
20. Seidman MD, Gurgel RK, Lin SY et al. Guideline Otolaryngology Development Group, Clinical practice guideline: allergic rhinitis, Otolaryngol. Head Neck Surg 2015; 152: S1–43.
21. Wei C. The efficacy and safety of H1-antihistamine versus Montelukast for allergic rhinitis: A systematic review and meta-analysis. Biomed Pharmacother 2016; 83: 989–97.
2. http: //www.whogis.com/gho/ru/
3. Compalati E, Ridolo E, Passalacqua G et al. The link between allergic rhinitis and asthma: the united airways disease. Expert Rev Clin Immunol 2010; 6 (3): 413–23.
4. Baiardini I, Braido F, Tarantini F et al. ARIA-suggested drugs for allergic rhinitis: what impact on quality of life? A GA2LEN review. Allergy 2008; 63 (6): 660–9.
5. Антонов В.Б., Медведева Т.В., Соболев А.В. Микогенные аллергии. Аллергология. 1998; 2: 23–6.
[Antonov V.B., Medvedeva T.V., Sobolev A.V. Mikogennye allergii. Allergologiia. 1998; 2: 23–6 (in Russian).]
6. Карпищенко С.А., Рябова М.А., Лаврова О.В. и др. К вопросу о дифференциальной диагностике воспалительной патологии верхних дыхательных путей у беременных. Folia Otorhinolaryngologiae et Pathologiae Respiratoriae. 2017; 23 (2): 20–2.
[Karpishchenko S.A., Riabova M.A., Lavrova O.V. et al. K voprosu o differentsial'noi diagnostike vospalitel'noi patologii verkhnikh dykhatel'nykh putei u beremennykh. Folia Otorhinolaryngologiae et Pathologiae Respiratoriae. 2017; 23 (2): 20–2 (in Russian).]
7. Canonica G, Triggiani M, Senna G. Clin Mol Allergy 2015; 13: 25. DOI: 10.1186/s12948-015-0029-5
8. Белан Э.Б., Садчикова Т.Л. Аллергический ринит: современные подходы к диагностике и лечению. Лекарственный вестн. 2017; 3 (67). Т. 11: 3–11.
[Belan E.B., Sadchikova T.L. Allergicheskii rinit: sovremennye podkhody k diagnostike i lecheniiu. Lekarstvennyi vestn. 2017; 3 (67). T. 11: 3–11 (in Russian).]
9. Bousquet J, Dahl R, Khaltaev N. GARD (Global alliance against chronic respiratory diseases). Rev Maladies Respiratoires 2006; 23 (4): 73–5. DOI: 10.1111/j.1398-9995.2008.01640.x
10. Pawankar R. Allergic diseases and asthma: A global public health concern and a call to action. World Allergy Organization J 2014; 7 (1): 12. DOI: 10.1186/1939-4551-7-12
11. Thomas SHL. Antihistamine poisoning. Medicine 2012; 40: 109–10.
12. Tran NP, Vickery J, Blaiss MS. Management of Rhinitis: Allergic and Non-Allergic. Allergy, Asthma Immunol Res 2011; 3 (3): 148. DOI: 10.4168/aair.2011.3.3.148
13. Grant JA, Danielson L, Rihoux JP, DeVos C. A double-blind single dose, crossover comparison of cetirizine, ebastine, epinestine, fexofenadine, terfenadine and loratadine versus placebo: suppression of histamineinduced wheal and flare response for 24 h in healthy male subjects. Allergy 1999; 54: 700–7.
14. Gispert J, Antonijoan R, Barbanoj M et al. Efficacy of ebastine, cetirizine, and loratadine in histamine cutaneous challenge. Ann Allergy Asthma Immunol 2002; 89: 259–64.
15. Moss AJ, Chaikin P, Garcia JD et al. A review of the cardiac systemic side-effects of antihistamines: ebastine. Clin Exp Allergy 1999; 29 (Suppl. 3): 200–5.
16. Gillen MS, Miller B, Chaikin P, Morganroth J. Effects of supratherapeutic doses of ebastine and terfenadine on the QT interval. Br J Clin Pharmacol 2001; 52: 201–4.
17. Pecoraro L, Paiola G, Pietrobelli A. Ebastine overdose in a child. Clin Case Rep 2017; 5 (4): 403–5. DOI: 10.1002/ccr3.845
18. Heffler E, Brussino L, Giacco S. New drugs in early-stage clinical trials for allergic rhinitis Expert Opin Investig Drugs 2019; 28 (3): 267–73. DOI: 10.1080/13543784.2019.1571581
19. Hamed A, Preston D, Eschenbacher W. Nasal IgE Production in Allergic Rhinitis: Impact of Rhinovirus Infection Clin Exp Allergy. 2019. DOI: 10.1111/cea.13372
20. Seidman MD, Gurgel RK, Lin SY et al. Guideline Otolaryngology Development Group, Clinical practice guideline: allergic rhinitis, Otolaryngol. Head Neck Surg 2015; 152: S1–43.
21. Wei C. The efficacy and safety of H1-antihistamine versus Montelukast for allergic rhinitis: A systematic review and meta-analysis. Biomed Pharmacother 2016; 83: 989–97.
________________________________________________
2. http: //www.whogis.com/gho/ru/
3. Compalati E, Ridolo E, Passalacqua G et al. The link between allergic rhinitis and asthma: the united airways disease. Expert Rev Clin Immunol 2010; 6 (3): 413–23.
4. Baiardini I, Braido F, Tarantini F et al. ARIA-suggested drugs for allergic rhinitis: what impact on quality of life? A GA2LEN review. Allergy 2008; 63 (6): 660–9.
5. Antonov V.B., Medvedeva T.V., Sobolev A.V. Mikogennye allergii. Allergologiia. 1998; 2: 23–6 (in Russian).
6. Karpishchenko S.A., Riabova M.A., Lavrova O.V. et al. K voprosu o differentsial'noi diagnostike vospalitel'noi patologii verkhnikh dykhatel'nykh putei u beremennykh. Folia Otorhinolaryngologiae et Pathologiae Respiratoriae. 2017; 23 (2): 20–2 (in Russian).
7. Canonica G, Triggiani M, Senna G. Clin Mol Allergy 2015; 13: 25. DOI: 10.1186/s12948-015-0029-5
8. Belan E.B., Sadchikova T.L. Allergicheskii rinit: sovremennye podkhody k diagnostike i lecheniiu. Lekarstvennyi vestn. 2017; 3 (67). T. 11: 3–11 (in Russian).
9. Bousquet J, Dahl R, Khaltaev N. GARD (Global alliance against chronic respiratory diseases). Rev Maladies Respiratoires 2006; 23 (4): 73–5. DOI: 10.1111/j.1398-9995.2008.01640.x
10. Pawankar R. Allergic diseases and asthma: A global public health concern and a call to action. World Allergy Organization J 2014; 7 (1): 12. DOI: 10.1186/1939-4551-7-12
11. Thomas SHL. Antihistamine poisoning. Medicine 2012; 40: 109–10.
12. Tran NP, Vickery J, Blaiss MS. Management of Rhinitis: Allergic and Non-Allergic. Allergy, Asthma Immunol Res 2011; 3 (3): 148. DOI: 10.4168/aair.2011.3.3.148
13. Grant JA, Danielson L, Rihoux JP, DeVos C. A double-blind single dose, crossover comparison of cetirizine, ebastine, epinestine, fexofenadine, terfenadine and loratadine versus placebo: suppression of histamineinduced wheal and flare response for 24 h in healthy male subjects. Allergy 1999; 54: 700–7.
14. Gispert J, Antonijoan R, Barbanoj M et al. Efficacy of ebastine, cetirizine, and loratadine in histamine cutaneous challenge. Ann Allergy Asthma Immunol 2002; 89: 259–64.
15. Moss AJ, Chaikin P, Garcia JD et al. A review of the cardiac systemic side-effects of antihistamines: ebastine. Clin Exp Allergy 1999; 29 (Suppl. 3): 200–5.
16. Gillen MS, Miller B, Chaikin P, Morganroth J. Effects of supratherapeutic doses of ebastine and terfenadine on the QT interval. Br J Clin Pharmacol 2001; 52: 201–4.
17. Pecoraro L, Paiola G, Pietrobelli A. Ebastine overdose in a child. Clin Case Rep 2017; 5 (4): 403–5. DOI: 10.1002/ccr3.845
18. Heffler E, Brussino L, Giacco S. New drugs in early-stage clinical trials for allergic rhinitis Expert Opin Investig Drugs 2019; 28 (3): 267–73. DOI: 10.1080/13543784.2019.1571581
19. Hamed A, Preston D, Eschenbacher W. Nasal IgE Production in Allergic Rhinitis: Impact of Rhinovirus Infection Clin Exp Allergy. 2019. DOI: 10.1111/cea.13372
20. Seidman MD, Gurgel RK, Lin SY et al. Guideline Otolaryngology Development Group, Clinical practice guideline: allergic rhinitis, Otolaryngol. Head Neck Surg 2015; 152: S1–43.
21. Wei C. The efficacy and safety of H1-antihistamine versus Montelukast for allergic rhinitis: A systematic review and meta-analysis. Biomed Pharmacother 2016; 83: 989–97.
Авторы
С.А.Карпищенко*, О.М.Колесникова
ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П.Павлова» Минздрава России, Санкт-Петербург, Россия
*karpischenkos@mail.ru
ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П.Павлова» Минздрава России, Санкт-Петербург, Россия
*karpischenkos@mail.ru
________________________________________________
Sergei A. Karpishchenko*, Olga M. Kolesnikova
Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
*karpischenkos@mail.ru
Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
*karpischenkos@mail.ru
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