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Zyrtec (Cetirizine)
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Zyrtec

Zyrtec is a strong-active remedy which is taken in treatment and termination of bothersome outdoor and indoor allergy and its symptoms such as sneeze, itching, stuffy, runny nose and red, itchy, watery eyes. Zyrtec also makes great progress in treatment of chronic hives. Zyrtec is safety both for adults and children.

Other names for this medication:

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Also known as:  Cetirizine.

Description

Zyrtec is developed by medical scientists to combat troublesome symptoms of outdoor and indoor allergy. Target of Zyrtec is to control, ward off, terminate and treat outdoor and indoor allergy. Zyrtec operates by making the level of natural chemical histamine lower to ward off outdoor (seasonal) and indoor allergy symptoms. Zyrtec is "non- sedating"antihistamine.

Zyrtec is also known as Cetirizine, Reactine, Alercet, Alergex, Alerid, Certex-24, Cetrine, Cetzine, Cezin, Histazine, Riztec, Ryzen, Triz, Virlix, Xero-sed, Zirtin, Zyrzine.

Dosage

Zyrtec can be taken in tablets (5 mg, 10 mg), syrup (1ml), chewable tablets (5 mg, 10 mg). You should take it by mouth.

It would be better to take Zyrtec every day at the same time.

It is better to take Zyrtec once a day (with or without meals).

Zyrtec of 10 mg works for 24 hours.

Zyrtec can be given to children of 2 years and infants of 6 months. Elderly people who are over 60 years should use Zyrtec lowest dose.

If you want to achieve most effective results do not stop taking Zyrtec suddenly.

Overdose

If you overdose Zyrtec and you don't feel good you should visit your doctor or health care provider immediately. Symptoms of Zyrtec overdosage: extreme sleepiness, confused mental state, weakness.

Storage

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F) away from moisture and heat. Throw away any unused medicine after the expiration date. Keep out of the reach of children.

Side effects

The most common side effects associated with Zyrtec are:

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Side effect occurrence does not only depend on medication you are taking, but also on your overall health and other factors.

Contraindications

Do not take Zyrtec if you are allergic to Zyrtec components.

Try to be careful with Zyrtec if you're pregnant or you plan to have a baby, or you are a nursing mother. Zyrtec can harm your baby.

Try to be careful with Zyrtec usage in case of having kidney or liver disease.

Try to be careful with Zyrtec usage in case of taking cough, cold or allergy medication, depression medication (paroxetine as Paxil, nortriptyline as Pamelor, amitriptyline as Elavil; sertraline as Zoloft, fluoxetine as Prozac, doxepin as Sinequan), medicines for anxiety or sleep (triazolam as Halcion, chlordiazepoxide as Librium, alprazolam as Xanax, diazepam as Valium, temazepam as Restoril).

Try to avoid machine driving.

Zyrtec can be given to children of 2 years and infants of 6 months. Elderly people who are over 60 years should use Zyrtec lowest dose.

If you want to achieve most effective results without any side effects it is better to avoid alcohol.

Do not stop taking Zyrtec suddenly.

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The aim of this study was to compare the effect of antileukotriene (anti-LT), antihistamine, and a combination of anti-LT and antihistamine on the symptoms and nasal resistance in allergic rhinitis patients.

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Substantial evidence implicates mast cells and their main constituent histamine in the pathogenesis of visceral hypersensitivity. We explored the specific contribution of histamine H4 (H4R) and H1 (H1R) receptors to visceral hypersensitivity in a postinflammatory rat model.

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From 2001 to 2011, the FDA approved 9 single-enantiomer products: dexlansoprazole, levoleucovorin, levocetirizine, armodafinil, arformoterol, eszopiclone, escitalopram, dexmethylphenidate, and esomeprazole. Of those 9 drugs, 3 had at least 1 pre-approval randomized trial that included the racemic precursor as a direct comparator, but there was no evidence of superiority of the single enantiomer over the racemic at comparable doses. Between 2001 and 2011, US Medicaid programs spent approximately $6.3 billion on these 9 single-enantiomer drugs.

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The antigen-induced expression of eotaxin by endothelial cells and the adherence and subsequent migration of eosinophils from the microvasculature to the tissues are rapid events partially under the control of histamine released from degranulating mast cells.

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Brain histamine is involved in a wide range of physiological functions such as regulation of the sleep-wake cycle, arousal, cognition, and memory mainly through interactions with histamine H1 receptors (H1Rs). Neurons producing histamine, histaminergic neurons, are exclusively located in the posterior hypothalamus and transmit histamine to almost all regions of the brain. Histamine H1 antagonists, or antihistamines, often prescribed for treatment of allergic disorders, sometimes induce sleepiness and cognitive deficits. It is understood that the mechanism of such CNS side effects is that antihistamine blocks H1Rs in the brain. The purpose of the present study was to compare the CNS side effects of different antihistamines. Subjective sleepiness was measured using the Stanford Sleepiness Scale (SSS) and psychomotor performance was examined by a tachistoscope testing system in healthy, young, Japanese volunteers (16 males, 20-28 yrs.) before and after oral administration of antihistamines such as fexofenadine (FEX) and cetirizine (CET). Additionally, H1R occupancy by antihistamines was examined by PET with 11C-doxepin in 8 volunteers. The results of SSS and psychomotor tests demonstrated that FEX tended to be less sedative than CET though the difference was not statistically significant. PET measurements revealed that no H1Rs in the cerebral cortex were occupied by FEX while about 30% of H1Rs were occupied by CET. In summary, it was confirmed that histamine and H1Rs are involved in maintaining arousal and cognition in humans, and that the severity of clinical symptoms is correlated to the amount of antihistamine that penetrated into the brain.

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Second-generation histamine H(1) receptor antagonists are recognized as being highly effective treatments for allergic-based disease and are among the most frequently prescribed drugs in the world. The newer antihistamines represent a heterogeneous group of compounds with markedly different chemical structures, a spectrum of antihistaminic properties, adverse effects, half-life, tissue distribution, metabolism and varying degrees of anti-inflammatory effects. Histamine is an important mast cell- and basophil-derived mediator that has been implicated in the pathogenesis of asthma, resulting in smooth muscle contraction, mucus hypersecretion, and increased vascular permeability leading to mucosal edema. Antihistamines should never be used as monotherapy for asthma but there is evidence that these drugs give a measure of protection in histamine-induced bronchoconstriction. Furthermore, several studies have demonstrated that the use of second-generation antihistamines, as adjunct therapy, may benefit those patients whose allergic asthma co-exists with allergic rhinitis. Indeed, many patients present with both allergic rhinitis and asthma. The link between the upper and lower respiratory airways is now well established and there is increasing evidence that allergic rhinitis is a risk factor for the development of asthma. More recently, a number of novel antihistamines have been developed which are either metabolites of active drugs or enantiomers and there is emerging evidence that at least one of these drugs, desloratadine, may give significant symptomatic benefit in some types of asthma. It is of interest to note that cetirizine provides a primary pharmacological intervention strategy to prevent the development of asthma in specifically-sensitized high risk groups of infants. Moreover, the documented anti-inflammatory activities of antihistamines may provide a novel mechanism of action for the therapeutic control of virus-induced asthma exacerbations by inhibiting the expression of intercellular adhesion molecule-1 (ICAM-1) by airway epithelial cells. Finally, several well-conducted studies suggest that combination therapy with antihistamines and antileukotrienes may be as effective as corticosteroid use in patients with allergic asthma and seasonal allergic rhinitis.

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Cetirizine but not prednisolone inhibited the early-phase response (37%, P = 0.004). In contrast prednisolone, but not cetirizine, significantly inhibited the size of the late-phase reaction at 24 h (70%, P = 0.021). This was associated with significant decreases in total (MBP+) and activated (EG2+) eosinophils (P = 0.019 and 0.014, respectively), as compared with placebo. There were also clear but non-significant reductions in interleukin-3, interleukin-4, interleukin-5 and granulocyte/macrophage-colony stimulating factor mRNA+ cells.

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In chronic intractable diarrhea, colonic or duodenal biopsy specimens may appear unremarkable on routine hematoxylin-eosin staining, but increased mast cells may be demonstrated by immunohistochemistry for mast cell tryptase, with the novel term mastocytic enterocolitis describing this condition. Similar increases in mast cells are not apparent in control populations or in patients with other specific diseases that cause chronic diarrhea. The cause of the increased mast cells remains to be elucidated.

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Sixty-one cases of chronic urticaria were randomly divided into an observation group (n = 31) and a control group (n = 30). They were treated respectively with Bo's abdominal acupuncture and cetirizine. Their therapeutic effects were compared.

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Histamine receptors mediate nociceptive pathways, especially in the central nervous system. Some studies have demonstrated the analgesic effects of histamine receptor antagonists in the peripheral nervous system. It is not clear whether the local analgesic effect is class-specific or drug-specific.

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The pharmacologic activity and potency of the two enantiomers of cetirizine in the management of allergic skin conditions were investigated by studying the effect of treatment with 5.0 mg cetirizine; 2.5 mg levocetirizine, the (R)-enantiomer; and 2.5 mg ucb 28557, the (S)-enantiomer, on histamine-induced wheal and flare response in 18 healthy volunteers. Each treatment was administered as a single oral dose in randomized, double-blind, and crossover manner, and the efficacy of treatment was assessed over a period of 32 h, as per cent inhibition of the histamine-induced wheal and flare areas before treatment. Blood and urine samples were collected in a time-dependent manner and analyzed for the total amounts of each study drug, to elucidate their pharmacokinetic profiles.

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This study was a 12-week, double-blind, randomized, placebo-controlled trial. Sixty children with AR aged 6-13 years with nasal total symptoms score (NTSS) ≥5 who fulfilled the inclusion criteria were enrolled. Patients were randomized into two groups with 28 participants receiving levocetirizine plus placebo and 32 participants receiving regular levocetirizine plus LP (HF.A00232) for the first 8 weeks, with a shift to levocetirizine as rescue treatment during the following 4 weeks. Parameters evaluated, including nasal, throat, and eye TSS (NTSS, TTSS, and ETSS, respectively), TSS and levocetirizine use, were recorded daily. Physical examinations and Pediatric Rhinoconjunctivitis Quality of Life Questionnaires (PRQLQs) were administered at each visit. In addition, blood samples were obtained for evaluation of cytokines including interleukin-4, interferon-γ, interleukin-10, and transforming growth factor-β at baseline, Week 8, and Week 12.

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The suppressive activity of LCT on OPN functions on nasal epithelial cells may be responsible for the attenuating effect of the agent on allergic diseases.

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Our results suggest a protective effect of cetirizine against high-fat diet-induced beta-cell dysfunction, but not against autoimmune beta-cell destruction.

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Chronic urticaria is a problem for both physician and patient. In an effort to avoid the risks associated with corticosteroid treatment, many first-generation H1-receptor antagonists have been tried and found to induce undesirable levels of sedation when given in amounts sufficient to control urticaria. Cetirizine, a pharmacologically active oxidized metabolite of hydroxyzine, was developed to provide selective H1-receptor inhibition without depression of the central nervous system. In a 4-week, multicenter, double-blind, placebo-controlled safety and efficacy study, cetirizine, in a once-a-day dose (5 to 20 mg), was equivalent in efficacy to hydroxyzine in divided doses (25 to 75 mg/day). The incidence of somnolence in the cetirizine group was not significantly different from that of the placebo group. However, in the hydroxyzine group, the incidence of somnolence was significantly higher than that in the placebo group (p = 0.001). The results of this study demonstrate that cetirizine has a greater safety margin over the older parent drug hydroxyzine.

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To determine the effectiveness of 2 second-generation antihistamines in modulating motion sickness induced by Coriolis vestibular cross-coupling stimulation.

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Cetirizine does not prevent the incidence or affect the severity of nevirapine-associated rash.

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A previous study showed the inhibitory effects of loratadine on histamine-induced wheal, flare and itch in human skin to be very variable between individuals. It was hypothesised that this variability may have been due to differences in the rates of metabolism of loratadine to its active form, desloratadine. This double blind, crossover study examined the effects of desloratadine in 12 healthy volunteers. Levocetirizine was used as a comparator.

max daily dose zyrtec

The histamine-induced wheal and flare response was used to compare quantitatively the antihistaminic potency of levocetirizine and desloratadine.

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A group of ten normal volunteers were studied, each subject visiting the laboratory on three occasions with intervals of at least 2 weeks between visits.

pediatric zyrtec dosing

We describe the case of a 30-year-old woman who reported several episodes of anaphylaxis with angioedema and relapsing urticaria. Some events were related to nonsteroidal anti-inflammatory drug intake and one episode followed alcohol ingestion, but in most cases no triggers could be identified. Specific immunoglobulin E determination was negative for food and drug allergens, C3 and C4 were in the normal range, C1 inhibitor was slightly reduced and serum tryptase was undetectable. In vivo autologous serum skin test and in vitro basophil histamine release assay were positive indicating the presence of circulating histamine-releasing factors. When oral tolerance tests were performed, only doxycycline was tolerated whereas levofloxacin, clarithromycin, nimesulide and tramadol caused mild urticaria. Premedication with cetirizine allowed the patient to tolerate levofloxacin, clarithromycin and nimesulide. The demonstration of circulating histamine-releasing factors in a patient with idiopathic anaphylaxis and multiple drug allergy syndrome provides a new mechanistic insight and might open the way to new therapeutic approaches.

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P-glycoprotein (P-gp) is a drug efflux pump expressed, amongst others, on the luminal surface of the cerebral endothelial cells forming the blood-brain barrier. Studies in rodents have demonstrated that antihistamines that are substrates of the P-gp transporter display no or minor central nervous system (CNS) effects as compared to antihistamines that are not P-gp transporter substrates.

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We investigated the suitability of cetirizine HCl (cetirizine) for the initial treatment of chronic urticaria. A secondary aim was to identify the optimal alternative treatments when switching from this drug to other drugs in patients who are dissatisfied with cetirizine. We started cetirizine at a once-daily dose of 10 mg for 2 weeks and then, depending on the course of symptoms in individual patients, it was either continued, titrated to a higher dose, or switched to other drugs (antihistamines including H2 blockers) for a further 2 weeks. Degrees of patient satisfaction and ratings by physicians were analyzed, as were adverse events. At 2 weeks after the start of treatment, among 74 patients included in the final evaluation 55 (74.3%) expressed satisfaction with cetirizine therapy. Those not satisfied included five (6.7%) who felt drowsy after taking the drug and 14 (18.9%) in whom the drug had not demonstrated adequate efficacy. After optimizing the treatment on a per-patient basis, including switching from cetirizine to other drugs, the percentage satisfied with treatment at 4 weeks was 83.7% (62/74). In the group of patients who were satisfied with the therapy at 2 weeks, attending physicians confirmed that wheals and scratches were significantly alleviated at 2 and 4 weeks, respectively. Adverse effects were mild and uncommon. Cetirizine as an initial treatment for chronic urticaria appears effective and safe. For patients in whom cetirizine fails to satisfactorily alleviate symptoms as well as those who complain of drowsiness, switching to other antihistamine drugs may be an effective strategy.

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zyrtec d buy online 2015-01-25

Our results suggest that early intervention with levocetirizine soon after onset of symptoms may attenuate these symptoms buy zyrtec as effectively as prophylactic treatment before pollen dispersal. These results are important from the perspective of patient convenience and reduction of medical costs.

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Chronic urticaria represents a cutaneous reaction pattern that may last for slightly more than six weeks to more than five years. Treatment of patients with chronic urticaria can be a problem for both physician and patient because of the significant side effects that may be caused by first-generation H1 antihistamines or long-term corticosteroid therapy. Newer antihistamines represent a major advance for the treatment of patients with chronic urticaria. Of this group, cetirizine buy zyrtec appears to offer some distinct pharmacokinetic and pharmacodynamic advantages. An open-label multicenter trial of 217 patients with chronic idiopathic urticaria demonstrated that cetirizine was effective, rapid in onset, and well tolerated. Thus, cetirizine was shown to be an attractive alternative treatment for patients with chronic idiopathic urticaria.

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Itch is the major symptom of atopic dermatitis (AD). Acupuncture has been shown to exhibit Moduretic 40 Mg a significant effect on experimental itch in AD. Our study evaluated acupuncture and antihistamine itch therapy (cetirizine) on type I hypersensitivity itch and skin reaction in AD using a patient and examiner-blinded, randomized, placebo-controlled, crossover trial.

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To describe two patients, a father and daughter with the characteristics of this disease and review the features that differentiate it from other cold Sinequan 10 Mg Side Effects -induced syndromes.

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Delusions of parasitosis are a rare psychiatric disorder in which the patient has a fixed, false belief of being infested with parasites. The disorder is classified as primary if no cause is identified or secondary if associated with general organic conditions, psychiatric illnesses, and drugs (substance induced). Several medications have been reported in association with delusions of parasitosis, including anti-parkinsonian medications, ciprofloxacin, cetirizine, doxepin, and others. Delusions of parasitosis have not been previously reported to be associated with gabapentin use. We present the case of a patient who developed delusions of Voltaren 75 Mg Injection Dosage parasitosis after been initiated on gabapentin treatment for neuropathic pain and complete disappearance of symptoms after the medication was discontinued.

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We investigated the suitability Nolvadex Pct Cycle Dosage of cetirizine HCl (cetirizine) for the initial treatment of chronic urticaria. A secondary aim was to identify the optimal alternative treatments when switching from this drug to other drugs in patients who are dissatisfied with cetirizine. We started cetirizine at a once-daily dose of 10 mg for 2 weeks and then, depending on the course of symptoms in individual patients, it was either continued, titrated to a higher dose, or switched to other drugs (antihistamines including H2 blockers) for a further 2 weeks. Degrees of patient satisfaction and ratings by physicians were analyzed, as were adverse events. At 2 weeks after the start of treatment, among 74 patients included in the final evaluation 55 (74.3%) expressed satisfaction with cetirizine therapy. Those not satisfied included five (6.7%) who felt drowsy after taking the drug and 14 (18.9%) in whom the drug had not demonstrated adequate efficacy. After optimizing the treatment on a per-patient basis, including switching from cetirizine to other drugs, the percentage satisfied with treatment at 4 weeks was 83.7% (62/74). In the group of patients who were satisfied with the therapy at 2 weeks, attending physicians confirmed that wheals and scratches were significantly alleviated at 2 and 4 weeks, respectively. Adverse effects were mild and uncommon. Cetirizine as an initial treatment for chronic urticaria appears effective and safe. For patients in whom cetirizine fails to satisfactorily alleviate symptoms as well as those who complain of drowsiness, switching to other antihistamine drugs may be an effective strategy.

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Azelastine nasal spray and cetirizine significantly improved the TNSS and individual symptoms compared with baseline (P < .001). The TNSS improved by a mean of 4.6 (23.9%) with azelastine nasal spray compared with 3.9 (19.6%) with Cymbalta And Adhd Medicine cetirizine. Significant differences favoring azelastine nasal spray were seen for the individual symptoms of sneezing and nasal congestion. Improvements in the RQLQ overall (P = .002) and individual domain (P < or = .02) scores were greater with azelastine nasal spray. Both treatments were well tolerated.

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The CIRANO study suggests that levocetirizine Ventolin Inhaler Online Cheap is effective on PER symptoms, including a transient improvement in loss of smell, and that this improvement concurs more with reduction of nasal inflammation than of nasal patency.

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This double-blind cross-over study compared the potential of bilastine, cetirizine, and fexofenadine to relieve the symptoms of Paracetamol Overdose Definition allergic rhinitis.

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We compared the consistency and efficacy of the two antihistamines, cetirizine (10 mg) and ebastine Strattera Too High Dose (20 mg) on histamine skin reactivity 4 h after treatment.

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Leukotrienes are potent lipid mediators involved in acute and chronic inflammatory processes and allergic inflammation. Cetirizine is an H1-receptor antagonist used in the treatment of allergic symptoms. We analyzed the effect of cetirizine on the formation of leukotriene B4 (LTB4) after stimulation of human peripheral blood neutrophils. The Allegra Off Brand inflammatory mediators were analyzed after cellular activation with different stimuli: the Ca ionophore A23187, which bypasses membranous signal transduction elements; the bacterial peptide formyl-methionine-leucyl-phenylalanine (fMLP), which activates cells by binding to a GTP-protein (G-protein)-coupled receptor, and with sodium fluoride (NaF), which directly activates G-proteins. After cellular preincubation with cetirizine, the amounts of LTB4 generated from neutrophil granulocytes decreased significantly when the cells were subsequently stimulated with either fMLP or NaF, in contrast to stimulations with the Ca ionophore. The data provide evidence that cetirizine exerts anti-inflammatory effects apart from H1 antagonism.

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Our results suggest a protective effect Cytoxan Online of cetirizine against high-fat diet-induced beta-cell dysfunction, but not against autoimmune beta-cell destruction.

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The efficacy of prophylactic treatment before the start of pollen dispersal for prevention of aggravation of symptoms is unclear. The aim of the present study was to examine the efficacy Cefixime 500 Mg Price of prophylactic treatment with an antihistamine for seasonal allergic rhinitis (SAR) using an environmental challenge chamber (ECC).

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Antihistamines are very popular cold treatments. 9640 prescriptions (4069 men and 5391 women) were analysed during the January -March 2006 period. The informations of polish doctors opinions were gathered from questionnaires. The patients studied suffered from respiratory infections (common cold - 32%, laryngitis - 21%, sinusitis - 19%, bronchitis - 18%, tonsillitis - 10%). In 1621 (16.8%) persons antibiotics were applied. Among them the most common amoxycilline (41%), macrolides (26,4%) and cephalosporines (22.8%) were prescribed. The coexistence of repiratory infection with allergic disease was confirmed in 6181 (65%) patients. The combination of antihistamine - cetirizine (Alermed, Lekam, Poland) with other medications were applied in every patient treatment. Anti-inflammatory properties in 36%, allergy in anamnesis in 14% and allergic symptoms in 28% were pointed out by polish doctors as the main reasons for prescriptions of cetirizine. Only 7% of doctors admitted in survey that they always prescribed antihistmines for respiratory infections. Duration of illness was shorter than seven days in most patients. In polish doctors opinions cetirizine may be applied in respiratory infections, because of its effects in alleviating clinical symptoms and in shortening of illness duration. Especially this treatment is indicated when coexistence of respiratory infection with allergic disease is confirmed. Additionally cetirizine is safe and good tolerated drug. However, further controlled studies are necessary to confirm these data.

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Acute skin inflammation occurs following topical aminolevulinic acid-photodynamic therapy (ALA-PDT), but its nature and mediation are ill defined. As we observed an urticarial response, a potential role for histamine was explored. In 13 healthy volunteers, we assessed the time course and dose-response of the acute cutaneous response(s) to ALA-PDT, the impact of H(1) antihistamine blockade, and measured dermal histamine release. An ALA dose series was iontophoresed into ventral forearm skin and exposed to red light. All participants exhibited an immediate urticarial response, both wheal and flare correlating with log ALA dose. Subsequently, a dose-related erythema developed at treatment sites by 3 hours and persisted at 24 hours. H(1) blockade with oral cetirizine doubled the median minimal urticating dose of ALA and reduced the slope of dose-response for wheal and flare, whereas at the highest ALA dose, mean wheal and flare areas reduced by 68 and 60%, respectively. In contrast, cetirizine did not influence the 24 hour minimal phototoxic dose or erythema dose-response. Histamine release after ALA-PDT mirrored the urticarial response, levels peaking within 30 minutes and returning to baseline by 24 hours. Thus, two discrete acute inflammatory responses to topical ALA-PDT occur in human skin; histamine mediates the immediate response, but does not appear involved in the delayed phototoxicity.

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Leukotriene receptor antagonists are recommended for the treatment of asthma, and have proved anecdotally successful even in atopic dermatitis. Standard treatments of atopic dermatitis are often unsatisfactory. Accordingly, we compared montelukast, 10 mg/day, with a combined regimen (orally administered cetirizine and clarythromycin, topical corticosteroids and hydrating preparations) for treatment of moderate-to-severe atopic dermatitis of adults. The trial was designed as a randomized single-blind study. SCORAD, eosinophilic cationic protein (ECP), eosinophilic protein X (EPX) serum levels were assessed at baseline and after 6 weeks in 32 adult patients with atopic dermatitis (16 treated with montelukast; 16 treated with the combined regimen). Similar improvements, evaluated in term of SCORAD reductions, were detected in both groups (Mann-Whitney, p < 0.05), while ECP and EPX levels significantly reduced within each group (Welch's approximate t, p < 0.05). We conclude that montelukast is as effective as the comparison combined regimen to treat atopic dermatitis of adults.

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Thirty patients with severe unremitting disease, responding poorly to antihistamines and showing a positive autologous serum skin test (ASST) as a marker of HRA, were randomized to 4 mg kg-1 daily of cyclosporin (Sandimmun, n = 20) or placebo (n = 10) for 4 weeks. Non-responders were offered open-label cyclosporin for 4 weeks. All were followed for up to 20 weeks or until clinical relapse; all took cetirizine 20 mg daily throughout the study. The primary measure of efficacy was a daily urticaria activity score (UAS) of weal numbers and itch (maximum score 42 per week). A positive response was defined as a reduction to < 25% of baseline weekly UAS and relapse as a return to > 75%. The effect of cyclosporin on serum HRA was assessed by in vitro basophil histamine release assays and ASSTs before and after treatment.

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Combined antihistamine and antileukotriene treatment started 6 weeks before the pollen season is effective in preventing AR symptoms and reduces allergic inflammation in nasal mucosa during natural allergen exposure.

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To compare the clinical efficacy of levocetirizine with that of levocetirizine plus Lactobacillus johnsonii EM1 (Lj EM1) for treating perennial allergic rhinitis (PAR) in children.

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To describe the clinical features and evolution of four pediatric patients and to discuss the main differential diagnoses.

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H4R and H1R antagonists dose-dependently reduce and even normalise postinflammatory visceral hypersensitivity via different underlying mechanisms but with a synergistic effect. Both receptor subtypes represent promising targets for the treatment of postinflammatory visceral hypersensitivity.

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During placebo treatment, wheal-and-flare responses were significantly greater to antigen at 20 minutes (p < 0.01) and induration at 6 hours (p < 0.01) at antigen challenge sites than at buffer diluent sites. During cetirizine treatment, these wheal-and-flare responses to antigen were inhibited significantly (p < 0.01) but gross LPRs were not affected. During placebo treatment, significantly more cells per high-power field were found in antigen sites than in buffer sites of neutrophils at 20 minutes (p < 0.01) and 24 hours; than in eosinophils at 20 minutes, 6 hours, and 24 hours (p < 0.01 for each); than in EG2+ cells at 20 minutes (p = 0.004), 6 hours (p = 0.001), and 24 hours (p = 0.02); and at T lymphocyte sites at 24 hours (p = 0.001). Extracellular deposition of lactoferrin and ECP was significantly greater at antigen sites than at buffer sites at 6 and 24 hours. Cetirizine treatment had no significant effect on these responses.

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Intercellular adhesion molecules (ICAMs), in particular ICAM-1, appear to play a crucial role in the recruitment and migration of inflammatory cells to the site of an allergic reaction. Glucocorticoids and allergen-specific immunotherapy have been shown to exert effects on selected components of this system, both in vitro and in vivo, but further research is required to better understand the effects of these therapies. Nasal and conjunctival challenge models (including natural and experimental allergen exposure) represent useful and safe tools for studying the activity of antiallergy drugs in vivo. These tests allow the investigation of a wide variety of parameters including inflammatory infiltrate, ICAM-1 expression, and changes in the concentration of soluble inflammatory mediators. With these tools, anti-inflammatory activity related to the modulation of epithelial cell adhesion molecules has been demonstrated in vivo for several H(1)-receptor antagonists (azelastine, cetirizine, loratadine, levocabastine, oxatomide, and terfenadine). Fexofenadine is a nonsedating, long-acting antihistamine with highly selective H(1)-receptor antagonist activity and a particularly favorable safety profile. In addition, fexofenadine has proven anti-inflammatory activity and has been shown to inhibit a number of mediators at clinically relevant concentrations, including in vitro inhibition of ICAM-1 expression on conjunctival and nasal epithelial cells.

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The aim of this review is to summarize the amount of data collected over 25 years of clinical use of cetirizine and compare this with data available for other SGAHs in the management of patients with allergic rhinitis (AR).

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A stereoselective high performance liquid chromatography method has been developed for the chiral separation of the enantiomers of six antihistamines, doxylamine, carbinoxamine, dioxopromethazine, oxomemazine, cetirizine and hydroxyzine. The effects of mobile phase additive, column temperature and flow rate on the retention time and resolution were studied. Enantiomeric separation of cetirizine, doxylamine and hydroxyzine were achieved on cellulose tris-(3,5-dichlorophenylcarbamate) immobilized on silica gel chiral stationary phase known as Chiralpak IC (RS = 3.74, RS = 1.85 and RS = 1.74, respectively).

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To investigate the efficacy of levocetirizine, 5 mg, and placebo for the symptoms and signs of CIU, as well as for the QoL and productivity.

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A nasal antigen challenge model of allergic individuals was used to evaluate whether antihistamines could inhibit human mast cell and basophil mediator release in vivo. In placebo-controlled trials, topically applied azatadine base, a tricyclic antihistamine with in vitro antirelease action, effectively reduced symptoms and mediator levels in nasal lavage fluids after antigen challenge, suggesting mast cell inhibition. Both terfenadine and cetirizine, systemically administered antihistamines, were clinically effective in reducing sneezing and changes in vascular permeability. Only terfenadine significantly reduced histamine in antigen-induced nasal secretions. However, cetirizine did reduce the level of leukotriene C4 in these fluids. These results indicate that some antihistamines may be capable of suppressing mediator release from nasal mast cells. The significance of this property in those compounds' overall clinical effect is unclear because of their other concomitant activities.

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Statistically significant inhibition of skin reaction (over 90%) and blood flow (over 80%) in relation to the start values in cetirizine group as well as between the groups which received cetirizine or placebo (p<0,001), remained at the same level all the time during the examination.

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The recently introduced H1 receptor antagonists ebastine, fexofenadine and mizolastine, and the relatively new H1 antagonists acrivastine, astemizole, azelastine, cetirizine, levocabastine and loratadine, are diverse in terms of chemical structure and clinical pharmacology, although they have similar efficacy in the treatment of patients with allergic disorders. Acrivastine is characterised by a short terminal elimination half-life (t1/2 beta) [1.7 hours] and an 8-hour duration of action. Astemizole and its metabolites, in contrast, have relatively long terminal t1/2 beta values; astemizole has a duration of action of at least 24 hours and is characterised by a long-lasting residual action after a short course of treatment. Azelastine, which has a half-life of approximately 22 hours, is primarily administered intranasally although an oral dosage formulation is used in some countries. Cetirizine is eliminated largely unchanged in the urine, has a terminal t1/2 beta of approximately 7 hours and a duration of action of at least 24 hours. Ebastine is extensively and rapidly metabolised to its active metabolite; carebastine, has a half-life of approximately 15 hours and duration of action of at least 24 hours. Fexofenadine, eliminated largely unchanged in the faeces and urine, has a terminal t1/2 beta of approximately 14 hours and duration of action of 24 hours, making it suitable for once or twice daily administration. Levocabastine has a terminal t1/2 beta of 35 to 40 hours regardless of the route of administration, but is only available as a topical application administered intranasally or ophthalmically in patients with allergic rhinoconjunctivitis. Loratadine is rapidly metabolised to an active metabolite descarboethoxyloratadine and has a 24-hour duration of action. Mizolastine has a terminal t1/2 beta of approximately 13 hours and duration of action of at least 24 hours. Most orally administered new H1 receptor antagonists are well absorbed and appear to be extensively distributed into body tissues; many are highly protein-bound. Most of the new H1 antagonists do not accumulate in tissues during repeated administration and have a residual action of less than 3 days after a short course has been completed. Tachyphylaxis, or loss of peripheral H1 receptor blocking activity during regular daily use, has not been found for any new H1 antagonist. Understanding the pharmacokinetics and pharmacodynamics of these new H1 antagonists provides the objective basis for selection of an appropriate dose and dosage interval and the rationale for modification in the dosage regimen that may be needed in special populations, including elderly patients, and those with hepatic dysfunction or renal dysfunction. The studies cited in this review provide the scientific foundation for using the new H1 antagonists with optimal effectiveness and safety.

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Noxious digital nerve stimulation leads to transient suppression of the electromyographic activity in isometrically contracted hand muscles, known as the "cutaneous silent period" (CSP). To date, neurotransmitters potentially involved in mediating this electromyographic (EMG) suppression remain unknown. Anecdotal observation lead to the hypothesis that antihistaminic medication may counteract nociceptive EMG suppression, as CSPs in one male subject who was accustomed to CSP recordings were temporarily lost following ingestion of an antihistaminic drug for acute rhinitis. A second otherwise healthy male subject, who was on long-term cetirizine for allergic rhinitis, presented without clearly defined CSPs when volunteering for normal values.

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D-dimer levels were elevated in 14/68 (20.6%) patients (range 306-7,317 ng/ml; normal values <278 ng/ml) and were associated with a more severe disease. Twelve of 14 patients with elevated D-dimer levels did not respond to antihistamine treatment (p = 0.0001). On the whole, 14 patients reported a poor or absent response to cetirizine 10 mg daily and only 1 of these responded satisfactorily to cetirizine 30 mg daily. Eight patients with elevated D-dimer and whose disease was not satisfactorily controlled by prednisone received nadroparin and tranexamic acid. A marked improvement of symptoms was observed in 5/8 cases.

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A third generation of antihistamines is emerging for the treatment of allergic rhinitis and chronic urticaria. First generation antihistamines are among the most widely used drugs in the world, and provide symptomatic relief from allergies and the common cold to millions of patients, mainly in OTC combination preparations. Their full potential is limited by the sedation caused by their effects on histamine receptors in the brain. Second generation antihistamines (terfenadine, astemizole, loratadine and cetirizine), which block peripheral H1 receptors without penetrating the blood-brain barrier, were developed and introduced from 1981 onwards to provide comparable therapeutic benefit without the CNS side-effects. Although largely successful in this goal, terfenadine and astemizole were found to cause potentially serious arrhythmias when plasma concentrations became elevated subsequent to impaired metabolism. It was established that the cardiac toxicity was mainly due to the parent drugs. As active metabolites could account for most of the clinical benefit, the goal for the third generation of antihistamines became to develop therapeutically active metabolites that were devoid of cardiac toxicity. The first of these drugs, fexofenadine (the active metabolite of terfenadine), was approved in July 1996, after an unusually rapid development programme. Its introduction set a new standard of safety that led the FDA to request the withdrawal of terfenadine in 1997 on the grounds that a safer version of an equivalent drug was now available. Norastemizole and descarboethoxy loratadine, the metabolites of astemizole and loratadine, respectively, are also in clinical development. These offer comparable or superior clinical benefits.

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The pattern of patients' response was similar in SAR and PAR. Both levocetirizine and loratadine were superior to placebo in alleviating SAR and PAR symptoms at all time intervals evaluated during the two study days. Levocetirizine decreased the mean MSC score intervals in SAR subjects, with the most marked difference observed on day 2 (p = 0.002). In PAR patients, although with borderline significance (p = 0.08), levocetirizine decreased the mean CSS more than loratadine. Levocetirizine appeared to have a faster onset of action than loratadine in SAR (45 min versus 1 h 15 min) and PAR (1 h versus 1 h 30 min). However, these apparent differences were not tested for statistical significance. Both medications were well tolerated and no treatment-related adverse events were reported. This level of antihistamine efficacy was maintained regardless of whether the subjects' rhinitis was seasonal or perennial.

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Daily treatment for 6 weeks with cetirizine 10 mg (93 patients) was compared with placebo treatment (93 patients) in a randomized, double-blind parallel study of patients with allergic rhinitis and asthma. This multicenter study was started just before onset of the fall pollen season. Rhinitis and asthma symptoms were assessed twice daily; spirometry was performed weekly.