Lin R Y, Curry A, Pesola G R, Knight R J, Lee H S, Bakalchuk L, Tenenbaum C, Westfal R E
Department of Emergency Medicine, Saint Vincents Hospital & Medical Center of New York and New York Medical College, New York, NY 10011, USA.
Ann Emerg Med. 2000 Nov;36(5):462-8. doi: 10.1067/mem.2000.109445.
Although the addition of H(2) blockers to H(1) antagonists has been promoted for use in anaphylaxis, there have been no large studies establishing the advantage of this approach in treating acute allergic syndromes. In this study we tested the hypothesis that combined H(1) and H(2) blockage results in improved outcomes in patients treated for acute allergic syndromes compared with treatment with H(1) blockade alone.
In a randomized, double-blind, placebo-controlled trial, 91 adult patients with acute allergic syndromes were treated with either 50 mg of diphenhydramine and saline solution (control group) or with 50 mg of diphenhydramine and 50 mg of ranitidine (active group). These patients were treated with parenteral administration. Patients were recruited from an emergency department at an urban academic medical center. The primary endpoints were resolution of urticaria, angioedema, or erythema at 2 hours after protocol treatment. Areas of cutaneous involvement, heart rates, blood pressures, respiratory findings, and symptom scores were also assessed at baseline, 1 hour, and 2 hours.
There were significantly more patients without urticaria at 2 hours among the patients in the active group compared with those in the control group. Both groups had similar proportions of urticaria at baseline. Logistic regression models to predict resolution of urticaria, which accounted for baseline urticarial involvement, showed odds ratios in favor of the active group treatment. Similar findings were observed when the absence of both urticaria and angioedema was considered as the dependent variable. There was not a significant difference between the 2 groups with regard to the absence of erythema or angioedema (irrespective of the presence of urticaria) at 2 hours. Blood pressure and symptoms did not show differences between the 2 groups over time. Lower heart rates were observed 1 hour after treatment in the active treatment group (mean reduction 10 beats/min) compared with those found in the placebo group (mean reduction 6 beats/min).
These data show that adding H(2) blockers to H(1) antagonists results in additional improvement of certain cutaneous outcomes for patients presenting with acute allergic syndromes. These findings favor the recommendation for using combined H(1) and H(2) antihistamines in acute allergic syndromes.
尽管有人提倡在治疗过敏反应时将H₂受体阻滞剂与H₁拮抗剂联合使用，但尚无大型研究证实这种方法在治疗急性过敏综合征方面的优势。在本研究中，我们检验了这样一个假设：与单独使用H₁受体阻滞剂治疗相比，联合使用H₁和H₂受体阻滞剂可使急性过敏综合征患者获得更好的治疗效果。
在一项随机、双盲、安慰剂对照试验中，91例急性过敏综合征成年患者被随机分为两组，一组接受50mg苯海拉明和生理盐水治疗（对照组），另一组接受50mg苯海拉明和50mg雷尼替丁治疗（治疗组）。这些患者均接受胃肠外给药治疗。患者均来自一所城市学术医疗中心的急诊科。主要终点为治疗方案实施2小时后荨麻疹、血管性水肿或红斑消退情况。同时在基线、1小时和2小时评估皮肤受累面积、心率、血压、呼吸情况及症状评分。
与对照组相比，治疗组在2小时时无荨麻疹的患者明显更多。两组在基线时荨麻疹比例相似。在考虑基线荨麻疹受累情况的逻辑回归模型中，预测荨麻疹消退的比值比有利于治疗组。当将无荨麻疹和血管性水肿作为因变量时，也观察到了类似结果。两组在2小时时无红斑或血管性水肿（无论有无荨麻疹）方面无显著差异。两组血压和症状随时间未显示出差异。与安慰剂组（平均降低6次/分钟）相比，治疗组在治疗1小时后心率降低更明显（平均降低10次/分钟）。
这些数据表明，在H₁拮抗剂基础上加用H₂受体阻滞剂可使急性过敏综合征患者的某些皮肤症状得到进一步改善。这些结果支持在急性过敏综合征中联合使用H₁和H₂抗组胺药的建议。
