Imaizumi Akiko, Kawakami Tamihiro, Murakami Fumiko, Soma Yoshinao, Mizoguchi Masako
Department of Dermatology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
J Dermatol Sci. 2003 Oct;33(1):23-9. doi: 10.1016/s0923-1811(03)00132-4.
Atopic dermatitis (AD) is a common chronic inflammatory and allergic skin disease that almost always begins in childhood and follows a course of remittance and flare-up. AD is characterized by intense pruritus and itchiness that can be triggered by an interplay of genetic, immunologic and environmental factors. Of the mediators, histamine is one of the most potent inducers of pruritus. Serum tryptase, which is also a mediator, may be used to examine allergic disease as well. The development of minimal sedation H1 antihistamines (second-generation antihistamines) has revolutionized treatment of allergic diseases.
The present study examines the efficacy of second-generation antihistamines in relieving pruritus due to AD. In addition, the relationship between AD pruritus and antihistamine therapy was analyzed by measuring the blood histamine and tryptase levels.
Thirty-two AD patients were recruited and underwent second-generation antihistamine therapy for 2 weeks. Seventeen received combined topical corticosteroid treatment (Group 1) and the other 15 did not receive steroid treatment (Group 2). The Severity Index and Pruritus Score were assessed as an AD clinical activity index and compared with baseline data.
Both the Severity Index and Pruritus Score improved significantly in Group 1 (P<0.001, P<0.05). Group 2 demonstrated a significant improvement in Pruritus Score (P<0.05), but not in the Severity Index. Plasma histamine levels were significantly higher in AD at baseline compared with healthy controls.
Following antihistamine therapy, these levels decreased significantly in both AD groups (P<0.05). There was a significant correlation between baseline blood histamine and typtase levels. However, this correlation was not evident following treatment. This may reflect insufficient detection capabilities of the measuring assay. The present results suggest that second-generation antihistamine therapy provides an effective clinical treatment for AD, with a notable improvement in pruritus. Furthermore, antihistamine therapy reduced plasma histamine levels in AD patients. These findings further suggest that high blood histamine and tryptase levels in AD patients contribute to the pathogenesis of this disorder, including the onset of pruritus.
特应性皮炎（AD）是一种常见的慢性炎症性过敏性皮肤病，几乎总是始于儿童期，呈缓解与发作交替的病程。AD的特征是剧烈瘙痒，可由遗传、免疫和环境因素相互作用引发。在这些介质中，组胺是最有效的瘙痒诱导剂之一。血清类胰蛋白酶也是一种介质，也可用于检查过敏性疾病。最小镇静作用的H1抗组胺药（第二代抗组胺药）的出现彻底改变了过敏性疾病的治疗方法。
本研究探讨第二代抗组胺药缓解AD所致瘙痒的疗效。此外，通过测量血液中组胺和类胰蛋白酶水平，分析AD瘙痒与抗组胺治疗之间的关系。
招募32例AD患者，接受第二代抗组胺药治疗2周。17例接受局部糖皮质激素联合治疗（第1组），另外15例未接受激素治疗（第2组）。评估严重程度指数和瘙痒评分作为AD临床活动指标，并与基线数据进行比较。
第1组的严重程度指数和瘙痒评分均有显著改善（P<0.001，P<0.05）。第2组的瘙痒评分有显著改善（P<0.05），但严重程度指数无改善。与健康对照相比，AD患者基线时血浆组胺水平显著更高。
抗组胺治疗后，两个AD组的这些水平均显著降低（P<0.05）。基线血液组胺和类胰蛋白酶水平之间存在显著相关性。然而，治疗后这种相关性不明显。这可能反映了测量方法的检测能力不足。目前的结果表明，第二代抗组胺药治疗为AD提供了有效的临床治疗，瘙痒有显著改善。此外，抗组胺治疗降低了AD患者的血浆组胺水平。这些发现进一步表明，AD患者血液中高组胺和类胰蛋白酶水平促成了该疾病的发病机制，包括瘙痒的发作。
