Simons F E, Johnston L, Gu X, Simons K J
Health Sciences Clinical Research Centre, Faculty of Medicine, University of Manitoba, Winnipeg, Canada.
Ann Allergy Asthma Immunol. 2001 Jan;86(1):44-50. doi: 10.1016/S1081-1206(10)62354-X.
The relative contribution of histamine and the cysteinyl leukotrienes to the early and late cutaneous allergic responses (ECAR and LCAR) can be studied using antagonists of these mediators.
To determine the relative suppression of the ECARs and LCARs using standard doses of an H1-receptor antagonist, a cysteinyl leukotriene1-receptor antagonist, and the two antagonists administered concurrently.
We carried out a prospective, randomized, double-blind, placebo-controlled, four-way crossover study in 12 highly allergic participants. Intradermal tests with standardized allergen, and with histamine phosphate, LTD4, and saline controls were performed on 5 different test days as follows: pretreatment baseline and at steady state immediately after the seventh and last dose of a 1-week course of treatment with once-daily fexofenadine, 120 mg; montelukast, 10 mg; fexofenadine and montelukast administered concurrently; or placebo. On each test day, the skin test results were read at intervals from 0.25 to 24 hours after the intradermal injections were performed.
After allergen injection, compared with baseline, all treatment regimens significantly decreased the ECAR and LCAR. After allergen injection, compared with placebo, fexofenadine significantly decreased the ECAR and the LCAR from 0.25 to 2 hours and at 8 hours. Montelukast did not significantly decrease the ECAR or LCAR. Fexofenadine and montelukast administered concurrently were not more effective than fexofenadine alone at any time. In the control skin tests, compared with placebo, fexofenadine, but not montelukast, significantly decreased the histamine-induced response, and montelukast, but not fexofenadine, significantly decreased the LTD4-induced response.
Fexofenadine and montelukast administered concurrently were not significantly more effective than fexofenadine alone in decreasing the ECAR and LCAR. Montelukast does not need to be discontinued before allergen skin testing. Further studies of the effect of concurrent treatment with higher doses of a histamine antagonist and a leukotriene modifier on the allergic response in the skin are needed.
可使用组胺和半胱氨酰白三烯的拮抗剂来研究它们对皮肤过敏早期和晚期反应（ECAR和LCAR）的相对贡献。
使用标准剂量的H1受体拮抗剂、半胱氨酰白三烯1受体拮抗剂以及同时使用这两种拮抗剂，来确定对ECAR和LCAR的相对抑制作用。
我们对12名高度过敏的参与者进行了一项前瞻性、随机、双盲、安慰剂对照的四向交叉研究。在5个不同的测试日进行皮内试验，使用标准化变应原、磷酸组胺、LTD4以及生理盐水对照，具体如下：预处理基线以及在每天服用120毫克非索非那定、10毫克孟鲁司特进行为期1周的治疗，在第七剂和最后一剂后立即达到稳态时；同时服用非索非那定和孟鲁司特；或服用安慰剂。在每个测试日，皮内注射后每隔0.25至24小时读取皮肤试验结果。
注射变应原后，与基线相比，所有治疗方案均显著降低了ECAR和LCAR。注射变应原后，与安慰剂相比，非索非那定在0.25至2小时以及8小时时显著降低了ECAR和LCAR。孟鲁司特未显著降低ECAR或LCAR。同时服用非索非那定和孟鲁司特在任何时候都不比单独使用非索非那定更有效。在对照皮肤试验中，与安慰剂相比，非索非那定显著降低了组胺诱导的反应，但孟鲁司特未降低；孟鲁司特显著降低了LTD4诱导的反应，但非索非那定未降低。
同时服用非索非那定和孟鲁司特在降低ECAR和LCAR方面并不比单独使用非索非那定显著更有效。在进行变应原皮肤试验前无需停用孟鲁司特。需要进一步研究更高剂量的组胺拮抗剂和白三烯调节剂联合治疗对皮肤过敏反应的影响。
