地氯雷他定和孟鲁司特对过敏源诱导的迟发性气道反应
2010/01/07
关键词： 抗组胺药； 白三烯抑制剂；哮喘；嗜酸性粒细胞；炎症；痰
研究表明地氯雷他定和孟鲁司特能够协同抑制过敏源诱导的早期反应，而且孟鲁司特还能抑制过敏源诱导的晚期哮喘反应。但至今未见地氯雷他定对迟发性哮喘反应的报道。
为了回答这一问题，Davis等对10过敏性哮喘患者进行了多中心、随机、双盲、交叉研究。患者分别在吸入致敏源前2小时分别接受安慰剂、地氯雷他定5mg、孟鲁司特10mg和联合治疗（地氯雷他定5mg、孟鲁司特10mg）。在致敏源吸入前、后24小时进行乙酰甲胆碱激发，并检测呼出NO水平并进行痰炎症细胞计数。
研究发现，各种药物治疗均能明显减轻患者的迟发性哮喘反应，联合治疗的效果优于地氯雷他定或孟鲁司特单一治疗，而两单一治疗的作用相当。激发试验显示，孟鲁司特和联合治疗能降低气道高反应性，而地氯雷他定不能。另外，仅孟鲁司特能降低呼出NO水平，地氯雷他定或联合治疗无此作用。三种治疗方案均能减少痰嗜酸性粒细胞数量，但地氯雷他定的作用发生在用药后7小时，而孟鲁司特治疗则需要24小时。
根据研究结果，作者认为，在接触致敏源2小时前应用地氯雷他定或孟鲁司特单药治疗或联合治疗能明显减轻迟发性哮喘反应和嗜酸性粒细胞聚集。
（韩伟 青岛市市立医院东院呼吸科 266071 摘译）
（Eur Respir J 2009; 33:1302-1308）
Single-dose desloratadine and montelukast and allergen-induced late airway responses
B. E. Davis1,2, C. Illamperuma2, G. M. Gauvreau3, R. M. Watson3, P. M. O’Byrne3, F. Deschesnes4, L. P. Boulet4 and D. W. Cockcroft1,2
Keywords: Antihistamine, antileukotriene, asthma, eosinophil, inflammation, sputum
Montelukast and desloratadine synergistically inhibit the allergen-induced early asthmatic response. Montelukast also suppresses the allergen-induced late asthmatic response, but there are no reports on the effect of desloratadine or the combination on the allergen-induced late asthmatic response.
Atopic asthmatics (n = 10) completed a multicentric randomised double-blind crossover study comparing single-dose placebo, 5 mg desloratadine, 10 mg montelukast and the combination administered 2 h prior to allergen inhalation challenge. Methacholine challenges were performed 24 h before and after allergen challenge. Exhaled nitric oxide measurements and sputum inflammatory cell counts were also carried out.
All active treatments significantly decreased the late asthmatic response area under the curve. Combination therapy provided the greatest inhibition compared to desloratadine and montelukast. Montelukast was nonsignificantly better than desloratadine but not as effective as the combination. There was a trend towards a decrease in airway responsiveness following montelukast and combination. Montelukast, but not desloratadine or the combination, decreased exhaled NO levels 24 h after allergen. The allergen-induced increase in sputum eosinophil numbers was significantly suppressed at 7 h with desloratadine and combination therapy, and at 24 h with montelukast and combination therapy.
Single-dose co-administration of desloratadine and montelukast 2 h prior to allergen inhalation clinically abolished the late asthmatic response and eosinophil recruitment.
Eur Respir J 2009; 33:1302-1308
研究表明地氯雷他定和孟鲁司特能够协同抑制过敏源诱导的早期反应，而且孟鲁司特还能抑制过敏源诱导的晚期哮喘反应。但至今未见地氯雷他定对迟发性哮喘反应的报道。
为了回答这一问题，Davis等对10过敏性哮喘患者进行了多中心、随机、双盲、交叉研究。患者分别在吸入致敏源前2小时分别接受安慰剂、地氯雷他定5mg、孟鲁司特10mg和联合治疗（地氯雷他定5mg、孟鲁司特10mg）。在致敏源吸入前、后24小时进行乙酰甲胆碱激发，并检测呼出NO水平并进行痰炎症细胞计数。
研究发现，各种药物治疗均能明显减轻患者的迟发性哮喘反应，联合治疗的效果优于地氯雷他定或孟鲁司特单一治疗，而两单一治疗的作用相当。激发试验显示，孟鲁司特和联合治疗能降低气道高反应性，而地氯雷他定不能。另外，仅孟鲁司特能降低呼出NO水平，地氯雷他定或联合治疗无此作用。三种治疗方案均能减少痰嗜酸性粒细胞数量，但地氯雷他定的作用发生在用药后7小时，而孟鲁司特治疗则需要24小时。
根据研究结果，作者认为，在接触致敏源2小时前应用地氯雷他定或孟鲁司特单药治疗或联合治疗能明显减轻迟发性哮喘反应和嗜酸性粒细胞聚集。
（韩伟 青岛市市立医院东院呼吸科 266071 摘译）
（Eur Respir J 2009; 33:1302-1308）
Single-dose desloratadine and montelukast and allergen-induced late airway responses
B. E. Davis1,2, C. Illamperuma2, G. M. Gauvreau3, R. M. Watson3, P. M. O’Byrne3, F. Deschesnes4, L. P. Boulet4 and D. W. Cockcroft1,2
Keywords: Antihistamine, antileukotriene, asthma, eosinophil, inflammation, sputum
Montelukast and desloratadine synergistically inhibit the allergen-induced early asthmatic response. Montelukast also suppresses the allergen-induced late asthmatic response, but there are no reports on the effect of desloratadine or the combination on the allergen-induced late asthmatic response.
Atopic asthmatics (n = 10) completed a multicentric randomised double-blind crossover study comparing single-dose placebo, 5 mg desloratadine, 10 mg montelukast and the combination administered 2 h prior to allergen inhalation challenge. Methacholine challenges were performed 24 h before and after allergen challenge. Exhaled nitric oxide measurements and sputum inflammatory cell counts were also carried out.
All active treatments significantly decreased the late asthmatic response area under the curve. Combination therapy provided the greatest inhibition compared to desloratadine and montelukast. Montelukast was nonsignificantly better than desloratadine but not as effective as the combination. There was a trend towards a decrease in airway responsiveness following montelukast and combination. Montelukast, but not desloratadine or the combination, decreased exhaled NO levels 24 h after allergen. The allergen-induced increase in sputum eosinophil numbers was significantly suppressed at 7 h with desloratadine and combination therapy, and at 24 h with montelukast and combination therapy.
Single-dose co-administration of desloratadine and montelukast 2 h prior to allergen inhalation clinically abolished the late asthmatic response and eosinophil recruitment.
Eur Respir J 2009; 33:1302-1308
