Safety considerations in the management of allergic diseases: Focus on antihistamines

Current Medical Research and Opinion

Volumn 28, Issue 4, 2012, Pages 623-642

  Yanai, K ^a   Rogala, B ^b   Chugh, K ^c   Paraskakis, E ^d   Pampura, A N ^e   Boev, R ^f  

^a TOHOKU UNIVERSITY SCHOOL OF MEDICINE   (Japan)

^b MEDICAL UNIVERSITY OF SILESIA   (Poland)

^c SIR GANGA RAM HOSPITAL   (India)

^d DEMOCRITUS UNIVERSITY OF THRACE   (Greece)

^e PIROGOV RUSSIAN NATIONAL RESEARCH MEDICAL UNIVERSITY   (Russian Federation)

^f UCB Farchim SA   (Switzerland)

Author keywords

Antihistamine; H1 receptor occupancy peripheral and brain; Immunotherapy; Intranasal steroid; Leukotriene receptor antagonist

Indexed keywords

ACRIVASTINE; ALPHA ADRENERGIC RECEPTOR BLOCKING AGENT; ANTIHISTAMINIC AGENT; ASTEMIZOLE; AZELASTINE; CETIRIZINE; CHLORPHENIRAMINE; CORTICOSTEROID; DESLORATADINE; DEXCHLORPHENIRAMINE; DIPHENHYDRAMINE; EBASTINE; EPINASTINE; FEXOFENADINE; HISTAMINE; HISTAMINE H1 RECEPTOR ANTAGONIST; HYDROXYZINE; KETOTIFEN; LEUKOTRIENE RECEPTOR BLOCKING AGENT; LEVOCETIRIZINE; LORATADINE; MIZOLASTINE; MONTELUKAST; MUSCARINIC RECEPTOR BLOCKING AGENT; OLOPATADINE; PROMETHAZINE; RUPATADINE; SEROTONIN ANTAGONIST; UNINDEXED DRUG; ZOLMITRIPTAN;

AGGRESSION; AGITATION; ALLERGIC RHINITIS; ALLERGY; ATTENTION DISTURBANCE; BLOOD BRAIN BARRIER; CLINICAL PROTOCOL; COGNITIVE DEFECT; CONFUSION; CONSTIPATION; DEPRESSION; DIPLOPIA; DIZZINESS; DROWSINESS; DRUG CHOICE; DRUG EFFECT; DRUG EFFICACY; DRUG MECHANISM; DRUG PENETRATION; DRUG POTENCY; DRUG SAFETY; DRUG SELECTIVITY; DRUG TOLERABILITY; FATIGUE; HEADACHE; HUMAN; IMMUNOTHERAPY; INCREASED APPETITE; INSOMNIA; LEARNING DISORDER; MEMORY DISORDER; MYDRIASIS; PATIENT COMPLIANCE; PHOTOPHOBIA; PSYCHOMOTOR DISORDER; QT PROLONGATION; RECEPTOR BLOCKING; RECEPTOR OCCUPANCY; RECEPTOR UPREGULATION; REVIEW; SEIZURE; SIDE EFFECT; SLEEP WAKING CYCLE; SOMNOLENCE; SYSTEMATIC REVIEW; TACHYCARDIA; TORSADE DES POINTES; URINE RETENTION; URTICARIA; VISUAL DISORDER; WEAKNESS; WEIGHT GAIN; XEROSTOMIA;

ADMINISTRATION, ORAL; ADRENAL CORTEX HORMONES; DRUG TOXICITY; HISTAMINE H1 ANTAGONISTS; HUMANS; HYPERSENSITIVITY; LEUKOTRIENE ANTAGONISTS; SAFETY;

EID: 84859701446     PISSN: 03007995     EISSN: 14734877     Source Type: Journal    
DOI: 10.1185/03007995.2012.672405     Document Type: Review

References (114)

1. Pawankar R, Canonica GW, Holgate ST, et al. eds. WAO White Book on Allergy. Milwaukee, WI: World Allergy Organization, 2011
2. Bousquet J, Khaltaev N, Cruz AA, et al. Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008;63(Suppl 86):8-160 (Pubitemid 351357811)
3. Asha'ari ZA, Yusof S, Ismail R, et al. Clinical features of allergic rhinitis and skin prick test analysis based on the ARIA classification: a preliminary study in Malaysia. Ann Acad Med Singapore 2010;39:619-24
4. Samolinski B, Sybilski AJ, Raciborski F, et al. Prevalence of rhinitis in Polish population according to the ECAP (Epidemiology of Allergic Disorders in Poland) study. Otolaryngol Pol 2009;63:324-30
5. Klossek JM, Annesi-Maesano I, Pribil C, et al. [INSTANT: national survey of allergic rhinitis in a French adult population based-sample]. Presse Med 2009;38:1220-29
6. Maurer M, Zuberbier T. Undertreatment of rhinitis symptoms in Europe: findings from a cross-sectional questionnaire survey. Allergy 2007;62:1057-63 (Pubitemid 47220961)
7. Nolte H, Nepper-Christensen S, Backer V. Unawareness and undertreatment of asthma and allergic rhinitis in a general population. Respir Med 2006;100:354-62 (Pubitemid 43078990)
8. Sih T, Mion O. Allergic rhinitis in the child and associated comorbidities. Pediatr Allergy Immunol 2010;21(1 Pt 2):e107-13
9. Laekeman G, Simoens S, Buffels J, et al. Continuous versus on-demand pharmacotherapy of allergic rhinitis: evidence and practice. Respir Med 2010;104:615-25
10. Brozek JL, Bousquet J, Baena-Cagnani CE, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol 2010;126:466-76
11. Angier E, Willington J, Scadding G, et al. British Society for Allergy & Clinical Immunology (BSACI) Standards of Care Committee. Management of allergic and non-allergic rhinitis: a primary care summary of the BSACI guideline. Prim Care Respir J 2010;19:217-22
12. Price D, Bond C, Bouchard J, et al. International Primary Care Respiratory Group (IPCRG) Guidelines: management of allergic rhinitis. Prim Care Respir J 2006;15:58-70 (Pubitemid 43155767)
13. Zuberbier T, Asero R, Bindslev-Jensen C, et al. EAACI/GA(2)LEN/EDF/WAO guideline: management of urticaria. Allergy 2009;64:1427-43
14. Canonica GW, Blaiss M. Antihistaminic, anti-inflammatory, and antiallergic properties of the nonsedating second-generation antihistamine desloratadine: a review of the evidence. WAO Journal 2011;4:47-53
15. Baroody FM, Naclerio RM. Antiallergic effects of H1-receptor antagonists. Allergy 2000;55:17-27
16. Church MK, Maurer M, Simons FE, et al. Risk of first-generation H(1)-antihistamines: a GA(2)LEN position paper. Allergy 2010;65:459-66
17. Tashiro M, Mochizuki H, Iwabuchi K, et al. Roles of histamine in regulation of arousal and cognition: functional neuroimaging of histamine H1 receptors in human brain. Life Sci 2002;72:409-14 (Pubitemid 35452554)
18. Gillman S, Gillard M, Strolin Benedetti M. The concept of receptor occupancy to predict clinical efficacy: a comparison of second generation H1 antihistamines. Allergy Asthma Proc 2009;30:366-76
19. Yanai K, Zhang D, Tashiro M, et al. Positron emission tomography evaluation of sedative properties of antihistamines. Expert Opin Drug Saf 2011;10:613-22
20. Yanai K, Tashiro M. The physiological and pathophysiological roles of neuronal histamine: an insight from human positron emission tomography studies. Pharmacol Ther 2007;113:1-15 (Pubitemid 44969926)
21. Frossard N, Strolin-Benedetti M, Purohit A, et al. Inhibition of allergen-induced wheal and flare reactions by levocetirizine and desloratadine. Br J Clin Pharmacol 2008;65:172-29
22. Kubo N, Senda M, Ohsumi Y, et al. Brain histamine H1 receptor occupancy of loratadine measured by positron emission topography: comparison of H1 receptor occupancy and proportional impairment ratio. Hum Psychopharmacol 2011;26:133-39
23. McDonald K, Trick L, Boyle J. Sedation and antihistamines: an update. Review of inter-drug differences using proportional impairment ratios. Hum Psychopharmacol 2008;23:555-70
24. Shamsi Z, Hindmarch I. Sedation and antihistamines: a review of inter-drug differences using proportional impairment ratios. Hum Psychopharmacol 2000;15(S1):S3-30
25. Wall A, Ka° gedal M, Bergström M, et al. Distribution of zolmitriptan into the CNS in healthy volunteers: a positron emission tomography study. Drugs R D. 2005;6:139-47 (Pubitemid 40994251)
26. Fox AW. Comparative tolerability of oral 5-HT1B/1D agonists. Headache 2000;40:521-27 (Pubitemid 30497410)
27. Patient information leaflet for Patanasenasal spray. Available at: http://ecatalog.alcon.com/PI/Patanase-us-en.pdf (accessed January 9th, 2012)
28. Patient information leaflet for Astelin-nasal spray. Available at: http://www.astelin.com/pdf/astelin-pi.pdf (accessed January 9th, 2012)
29. Wen MM. Olfactory targeting through intranasal delivery of biopharmaceutical drugs to the brain-current development. Discov Med 2011;11:497-503
30. Leary AC, Dowling M, Cussen K, et al. Pharmacokinetics and pharmacodynamics of intranasal insulin spray (Nasulin) administered to healthy male volunteers: influence of the nasal cycle. J Diabetes Sci Technol 2008;2:1054-60
31. Costantino HR, Illum L, Brandt G, et al. Intranasal delivery: physicochemical and therapeutic aspects. Int J Pharm 2007;337:1-24 (Pubitemid 46756063)
32. Wermeling DP, Record KA, Kelly TH, et al. Pharmacokinetics and pharmacodynamics of a new intranasal midazolam formulation in healthy volunteers. Anesth Analg 2006;103:344-49 (Pubitemid 44140633)
33. Dhuria SV, Hanson LR, Frey 2nd WH. Intranasal delivery to the central nervous system: mechanisms and experimental considerations. J Pharm Sci 2010;99:1654-73
34. Morrison EE, Costanzo RM. Morphology of the human olfactory epithelium. J Comp Neurol 1990;297:1-13 (Pubitemid 20217192)
35. Ding X, Dahl AR. Olfactory mucosa: composition, enzymatic localization, and metabolism. In: Doty RL, ed. Handbook of Olfaction and Gustation, 2nd edn, Ch 3. New York: Marcel Dekker, 2003:33-52
36. Zhang D, Shibuya K, Tashiro M, et al. Potential central sedative effect of antihistamine eye-drops: histamine H1 occupancy measured by positron emission tomography. J Pharmacol Sci 2011;115(Suppl 1):221P
37. Salminen L. Review: systemic absorption of topically applied ocular drugs in humans. J Ocul Pharmacol 1990;6:243-49 (Pubitemid 20362803)
38. Chen C, Hanson E, Watson JW, et al. P-glycoprotein limits the brain penetration of nonsedating but not sedating H1-antagonists. Drug Metab Dispos 2003;31:312-18 (Pubitemid 36249686)
39. Zhao R, Kalvass JC, Yanni SB, et al. Fexofenadine brain exposure and the influence of blood-brain barrier P-glycoprotein after fexofenadine and terfenadine administration. Drug Metab Dispos 2009;37:529-35
40. Mimura N, Nagata Y, Kuwabara T, et al. P-glycoprotein limits the brain penetration of olopatadine hydrochloride, H1-receptor antagonist. Drug Metab Pharmacokinet 2008;23:106-14
41. Molimard M, Diquet B, Benedetti MS. Comparison of pharmacokinetics and metabolism of desloratadine, fexofenadine, levocetirizine and mizolastine in humans. Fundam Clin Pharmacol 2004;18:399-411 (Pubitemid 39215352)
42. Tamai I, Kido Y, Yamashita J, et al. Blood-brain barrier transport of H1-antagonist ebastine and its metabolite carebastine. J Drug Target 2000;8:383-93 (Pubitemid 32366706)
43. Broccatelli F, Carosati E, Neri A, et al. A novel approach for predicting Pglycoprotein (ABCB1) inhibition using molecular interaction fields. J Med Chem 2011;54:1740-51
44. Li C, Kim M, Choi JS. Effects of prednisolone on the pharmacokinetics of loratadine after oral and intravenous administration of loratadine in rats. Arch Pharm Res 2010;33:1395-400
45. Li C, Kim CS, Yang JY, et al. Effects of roxithromycin on the pharmacokinetics of loratadine after oral and intravenous administration of loratadine in rats. Eur J Drug Metab Pharmacokinet 2008;33:231-36
46. Katta A, Dhananjeyan M, Bykowski C, et al. Verapamil, but not probenecid, co-administration can convert desloratadine to a sedating antihistamine in mice. Drug Metab Lett 2007;1:7-11
47. Yasui-Furukori N, Uno T, Sugawara K, et al. Different effects of three transporting inhibitors, verapamil, cimetidine, and probenecid, on fexofenadine pharmacokinetics. Clin Pharmacol Ther 2005;77:17-23 (Pubitemid 40075385)
48. Sakugawa T, Miura M, Hokama N, et al. Enantioselective disposition of fexofenadine with the P-glycoprotein inhibitor verapamil. Br J Clin Pharmacol 2009;67:535-40
49. Shen S, He Y, Zeng S. Stereoselective regulation of MDR1 expression in Caco-2 cells by cetirizine enantiomers. Chirality 2007;19:485-90 (Pubitemid 46897964)
50. Kavanagh JJ, Grant GD, Anoopkumar-Dukie S. Low dosage promethazine and loratadine negatively affect neuromotor function. Clin Neurophysiol 2011 Aug 29 [Epub ahead of print]
51. Liu H, Farley JM. Effects of first and second generation antihistamines on muscarinic induced mucus gland cell ion transport. BMC Pharmacology 2005;5:8 doi:10.1186/1471-2210-5-8 (Pubitemid 41460678)
52. Rico S, Antonijoan R, Barbanoj M. Ebastine in the light of CONGA recommendations for the development of third-generation antihistamines. J Asthma Allergy 2009;31:73-92
53. Gillard M, Christophe B, Wels B, et al. H1 antagonists: receptor affinity versus selectivity. Inflamm Res 2003;52(Suppl 1):S49-50 (Pubitemid 36470055)
54. Danjou P, Molinier P, Berlin I, et al. Assessment of the anticholinergic effect of the new antihistamine mizolastine in healthy subjects. Br J Clin Pharmacol 1992;34:328-31
55. Radulovic S, Calderon MA, Wilson D, et al. Sublingual immunotherapy for allergic rhinitis. Cochrane Database Syst Rev 2010;12:CD002893
56. Passalacqua G, Durham SR; Global Allergy and Asthma European Network. Allergic rhinitis and its impact on asthma update: allergen immunotherapy. J Allergy Clin Immunol 2007;119:881-91 (Pubitemid 46527840)
57. Bernstein DI, Epstein T. Systemic reactions to subcutaneous allergen immunotherapy. Immunol Allergy Clin North Am 2011;31:241-49
58. Tankersley MS. How should allergists deal with local reactions to allergen immunotherapy? Curr Allergy Asthma Rep 2011;11:115-21
59. Incorvaia C, Masieri S, Scurati S, et al. The current role of sublingual immunotherapy in the treatment of allergic rhinitis in adults and children. J Asthma Allergy 2011;4:13-17
60. Undesirable effects according to the SPC of Grazax-oral lyophilisate. Available at: http://www.medicines.org.uk/EMC/medicine/19565/SPC/GRAZAX +75%2c000 +SQ-T +oral +lyophilisate/#UNDESIRABLE-EFFECTS (accessed January 9th, 2012)
61. Já uregui I, Mullol J, Bartra J, et al. H1 antihistamines: psychomotor performance and driving. J Investig Allergol Clin Immunol 2006; 16(Suppl 1):37-44
62. Hansen GR. Loratadine in the high performance aerospace environment. Aviat Space Environ Med 1999;70:919-24 (Pubitemid 29533427)
63. Vuurman EF, Rikken GH, Muntjewerff ND, et al. Effects of desloratadine, diphenhydramine, and placebo on driving performance and psychomotor performance measurements. Eur J Clin Pharmacol 2004;60:307-13 (Pubitemid 39062317)
64. Brookhuis KA, De Vries G, De Waard D. Acute and subchronic effects of the H1-histamine receptor antagonist ebastine in 10, 20 and 30 mg dose, and triprolidine 10 mg on car driving performance. Br J Clin Pharmacol 1993;36:67-70 (Pubitemid 23205316)
65. Verster JC, de Weert AM, Bijtjes SI, et al. Driving ability after acute and subchronic administration of levocetirizine and diphenhydramine: a randomized, double-blind, placebo-controlled trial. Psychopharmacology (Berl) 2003;169: 84-90 (Pubitemid 37088618)
66. Vuurman E, Theunissen E, van Oers A, et al. Lack of effects between rupatadine 10 mg and placebo on actual driving performance of healthy volunteers. Hum Psychopharmacol 2007;22:289-97 (Pubitemid 47180390)
67. Ramaekers JG, Uiterwijk MM, O'Hanlon JF. Effects of loratadine and cetirizine on actual driving and psychometric test performance, and EEG during driving. Eur J Clin Pharmacol 1992;42:363-69
68. Ridout F, Shamsi Z, Meadows R, et al. A single-center, randomized, double-blind, placebo-controlled, crossover investigation of the effects of fexofenadine hydrochloride 180 mg alone and with alcohol, with hydroxyzine hydrochloride 50 mg as a positive internal control, on aspects of cognitive and psychomotor function related to driving a car. Clin Ther 2003;25: 1518-38 (Pubitemid 36677292)
69. Vermeeren A, Ramaekers JG, O'Hanlon JF. Effects of emedastine and cetirizine, alone and with alcohol, on actual driving of males and females. J Psychopharmacol 2002;16:57-64 (Pubitemid 34273074)
70. Verster JC, Volkerts ER. Antihistamines and driving ability: evidence from onthe-road driving studies during normal traffic. Ann Allergy Asthma Immunol 2004;92:294-304 (Pubitemid 38380785)
71. Verster JC, Mets MAJ. Psychoactive Medication and Traffic Safety. Int J Environ Res Public Health 2009;6:1041-54
72. Sen A, Akin A, Craft KJ, et al. First-generation H1 antihistamines found in pilot fatalities of civil aviation accidents, 1990-2005. Aviat Space Environ Med 2007;78:514-22 (Pubitemid 46717245)
73. Bower EA, Moore JL, Moss M, et al. The effects of single-dose fexofenadine, diphenhydramine, and placebo on cognitive performance in flight personnel. Aviat Space Environ Med 2003;74:145-52 (Pubitemid 36159994)
74. Product related information for commonly used corticosteroid nasal preparations in the UK. Available at: http://www.medicines.org.uk/EMC/ searchresults.aspx?termnasal&searchtypeQuickSearch (accessed January 9th, 2012)
75. Product related information for commonly used corticosteroid nasal preparations in the USA. Available at: http://google2.fda.gov/search?qside +effects +corticosteroid +nasal&clientFDAgov&siteFDAgov& lr&proxystylesheetFDAgov&outputxml-no-dtd&getfields* (accessed January 9th, 2012)
76. Lombardi C, Gargioni S, Melchiorre A, et al. Safety of sublingual immunotherapy with monomeric allergoid in adults: multicenter post-marketing surveillance study. Allergy 2001;56:989-92 (Pubitemid 32835605)
77. Dahl R, Kapp A, Colombo G, et al. Efficacy and safety of sublingual immunotherapy with grass allergen tablets for seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol 2006;118:434-40 (Pubitemid 44160721)
78. Scadding G. Optimal management of nasal congestion caused by allergic rhinitis in children: safety and efficacy of medical treatments. Paediatr Drugs 2008;10:151-62 (Pubitemid 351629671)
79. Del Cuvillo A, Sastre J, Montoro J, et al. Use of antihistamines in pediatrics. J Investig Allergol Clin Immunol 2007;17(Suppl 2):28-40 (Pubitemid 351252753)
80. Isbister GK, Prior F, Kilham HA. Restricting cough and cold medicines in children. J Paediatr Child Health 2012;48:91-98
81. Merenstein D, Diener-West M, Halbower AC, et al. The trial of infant response to diphenhydramine: the TIRED study-a randomized, controlled, patient-oriented trial. Arch Pediatr Adolesc Med 2006;160:707-12
82. Simons FE. Prospective, long-term safety evaluation of the H1-receptor antagonist cetirizine in very young children with atopic dermatitis. ETAC Study Group. Early Treatment of the Atopic Child. J Allergy Clin Immunol 1999;104(2 Pt 1):433-40 (Pubitemid 29420443)
83. Stevenson J, Cornah D, Evrard P, et al. Long-term evaluation of the impact of the h1-receptor antagonist cetirizine on the behavioral, cognitive, and psychomotor development of very young children with atopic dermatitis. Pediatr Res 2002;52:251-57 (Pubitemid 34827246)
84. Simons FE; Early Prevention of Asthma in Atopic Children (EPAAC) Study Group. Safety of levocetirizine treatment in young atopic children: an 18-month study. Pediatr Allergy Immunol 2007;18:535-42 (Pubitemid 47206747)
85. Grimfeld A, Holgate ST, Canonica GW, et al. Prophylactic management of children at risk for recurrent upper respiratory infections: the Preventia I Study. Clin Exp Allergy 2004;34:1665-72 (Pubitemid 39551517)
86. Bloom M, Staudinger H, Herron J. Safety of desloratadine syrup in children. Curr Med Res Opin 2004;20:1959-65 (Pubitemid 40179635)
87. Boner AL, Miglioranzi P, Richelli C, et al. Efficacy and safety of loratadine suspension in the treatment of children with allergic rhinitis. Allergy 1989;44:437-41 (Pubitemid 19211460)
88. Milgrom H, Kittner B, Lanier R, et al. Safety and tolerability of fexofenadine for the treatment of allergic rhinitis in children 2 to 5 years old. Ann Allergy Asthma Immunol 2007;99:358-63 (Pubitemid 47606139)
89. Lichtenstein SJ, Pasquine TA, Edwards MR, et al. Safety and tolerability of olopatadine 0.2% in children and adolescents. J Ocul Pharmacol Ther 2007;23:366-71 (Pubitemid 350195061)
90. Ratner PH, Meltzer EO, Teper A. Mometasone furoate nasal spray is safe and effective for 1-year treatment of children with perennial allergic rhinitis. Int J Pediatr Otorhinolaryngol 2009;73:651-57
91. Má spero JF, Rosenblut A, Finn Jr A, et al. Safety and efficacy of fluticasone furoate in pediatric patients with perennial allergic rhinitis. Otolaryngol Head Neck Surg 2008;138:30-37 (Pubitemid 350299657)
92. Schenkel EJ, Skoner DP, Bronsky EA, et al. Absence of growth retardation in children with perennial allergic rhinitis after one year of treatment with mometasone furoate aqueous nasal spray. Pediatrics 2000;105:E22
93. Welch MJ, Bronsky EA, Grossman J, et al. Clinical evaluation of triamcinolone acetonide nasal aerosol in children with perennial allergic rhinitis. Ann Allergy 1991;67:493-98
94. Knorr B, Franchi LM, Bisgaard H, et al. Montelukast, a leukotriene receptor antagonist, for the treatment of persistent asthma in children aged 2 to 5 years. Pediatrics 2001;108:E48
95. Sienra-Monge JJ, Gazca-Aguilar A, Del Rio-Navarro B. Double-blind comparison of cetirizine and loratadine in children ages 2 to 6 years with perennial allergic rhinitis. Am J Ther 1999;6:149-55 (Pubitemid 29230538)
96. Saint-Martin F, Dumur JP, Pé rez I, et al. A randomized, double-blind, parallel-group study, comparing the efficacy and safety of rupatadine (20 and 10 mg), a new PAF and H1 receptor-specific histamine antagonist, to loratadine 10 mg in the treatment of seasonal allergic rhinitis. J Investig Allergol Clin Immunol 2004;14:34-40 (Pubitemid 38506429)
97. Staevska M, Popov TA, Kralimarkova T, et al. The effectiveness of levocetirizine and desloratadine in up to 4 times conventional doses in difficult-totreat urticaria. J Allergy Clin Immunol 2010;125:676-82
98. Pires A, Fortuna A, Alves G, et al. Intranasal drug delivery: how, why and what for? J Pharm Pharm Sci 2009;12:288-311
99. Garlapati RR, Lee HP, Chong FH, et al. Indicators for the correct usage of intranasal medications: a computational fluid dynamics study. Laryngoscope 2009;119:1975-82
100. Garlapati RR, Lee HP, Chong FH, et al. Indicators for the correct usage of intranasal medications: a computational fluid dynamics study. Laryngoscope 2009;119:1975-82
101. Bachert C, El-Akkad T. Patient preferences and sensory comparisons of three intranasal corticosteroids for the treatment of allergic rhinitis. Ann Allergy Asthma Immunol 2002;89:292-97 (Pubitemid 36188029)
102. Benninger MS, Hadley JA, Osguthorpe JD, et al. Techniques of intranasal steroid use. Otolaryngol Head Neck Surg 2004;130:5-24 (Pubitemid 38113911)
103. Shaikh WA, Shaikh SW. Allergies in India: a study on medication compliance. J Indian Med Assoc 2009;107:462-63
104. Senna G, Ridolo E, Calderon M, et al. Evidence of adherence to allergenspecific immunotherapy. Curr Opin Allergy Clin Immunol 2009;9:544-48
105. Scurati S, Frati F, Passalacqua G, et al. Adherence issues related to sublingual immunotherapy as perceived by allergists. Patient Prefer Adherence 2010;4:141-45
106. Spangler DL, Brunton S. Efficacy and central nervous system impairment of newer-generation prescription antihistamines in seasonal allergic rhinitis. South Med J 2006;99:593-99 (Pubitemid 43999921)
107. Kraft W, Blum RA, Frick GS, et al. Pharmacokinetics (PK) of multiple oral doses of desloratadine (DCL) and fexofenadine (FEX) in a population of healthy adults identified phenotypically as desloratadine slow metabolizers (DSMS). Clin Pharmacol Ther 2005;77:P45
108. Weber-Schoendorfer C, Schaefer C. The safety of cetirizine during pregnancy. A prospective observational cohort study. Reprod Toxicol 2008;26:19-23
109. Kä llé n B. Use of antihistamine drugs in early pregnancy and delivery outcome. J Matern Fetal Neonatal Med 2002;11:146-52
110. Boothby LA, Doering PL. FDA labelling system for drugs in pregnancy. Ann Pharmacother 2001;35:1485-89 (Pubitemid 33042087)
111. So M, Bozzo P, Inoue M, et al. Safety of antihistamines during pregnancy and lactation. Can Fam Physician 2010;56:427-29
112. Mann RD, Pearce GL, Dunn N, et al. Sedation with "non-sedating" antihistamines: four prescription-event monitoring studies in general practice. BMJ 2000;320:1184-86
113. Layton D, Wilton L, Boshier A, et al. Comparison of the risk of drowsiness and sedation between levocetirizine and desloratadine: a prescription-event monitoring study in England. Drug Saf 2006; 29:897-909 (Pubitemid 44511590)
114. Layton D, Wilton L, Shakir SA. Examining the tolerability of the non-sedating antihistamine desloratadine: a prescription-event monitoring study in England. Drug Saf 2009;32:169-79