Runge J W, Martinez J C, Caravati E M, Williamson S G, Hartsell S C
Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina.
Ann Emerg Med. 1992 Mar;21(3):237-42. doi: 10.1016/s0196-0644(05)80881-9.
We compared the efficacies of cimetidine (an H2-receptor antagonist) and diphenhydramine (an H1-receptor antagonist) alone and in combination for alleviation of symptoms of acute allergic reactions. STUDY DESIGN AND INTERVENTIONS: In this prospective, randomized, double-blind study, patients and examiners assessed the severity of symptoms and signs of acute allergic reactions using a visual-analog scale before treatment and 30 minutes after treatment with 300 mg IV cimetidine and placebo, 50 mg IV diphenhydramine and placebo, or diphenhydramine plus cimetidine.
Thirty-nine patients with acute allergic reactions presenting to two emergency departments of teaching hospitals.
Of the 35 patients with pruritus, all 12 receiving diphenhydramine placebo had clinically significant relief compared with six of ten (60%) receiving cimetidine plus placebo (P = .03). Twelve of 13 (92%) receiving diphenhydramine plus cimetidine had relief, which was not a significant difference from the single drugs. Comparison of mean differences in pretreatment and post-treatment symptom scores (relief scores) among groups of patients with pruritus detected significantly more relief in the group receiving diphenhydramine plus placebo (80.3 +/- 7.4) than in those receiving cimetidine plus placebo (48.8 +/- 13.4) (P = .022). Of the 33 patients with urticaria, five of 11 (46%) receiving diphenhydramine plus placebo had clinically significant relief compared with eight of ten (80%) receiving cimetidine plus placebo (P = .18). Eleven of 12 patients (92%) receiving diphenhydramine plus cimetidine had relief, which is a significant difference from those receiving diphenhydramine plus placebo (P = .027). Comparison of mean relief scores in patients with urticaria detected significantly more relief in the group receiving diphenhydramine plus cimetidine (55.3 +/- 6.5) than in the group receiving diphenhydramine plus placebo (30.7 +/- 6.1) (P = .006).
For treatment of pruritus from acute allergic reactions, diphenhydramine is more effective than cimetidine, and the combination offers no additional benefit. For treatment of acute urticaria, the combination of cimetidine and diphenhydramine is more effective than diphenhydramine alone.
我们比较了西咪替丁（一种H2受体拮抗剂）和苯海拉明（一种H1受体拮抗剂）单独使用及联合使用时缓解急性过敏反应症状的疗效。研究设计与干预措施：在这项前瞻性、随机、双盲研究中，患者和检查者在治疗前以及用300毫克静脉注射西咪替丁和安慰剂、50毫克静脉注射苯海拉明和安慰剂，或苯海拉明加西咪替丁治疗30分钟后，使用视觉模拟量表评估急性过敏反应的症状和体征严重程度。
39名出现急性过敏反应的患者前往两家教学医院的急诊科就诊。
在35名瘙痒患者中，所有12名接受苯海拉明安慰剂治疗的患者临床症状均得到显著缓解，而10名接受西咪替丁加安慰剂治疗的患者中有6名（60%）症状缓解（P = 0.03）。13名接受苯海拉明加西咪替丁治疗的患者中有12名（92%）症状缓解，与单一药物治疗相比无显著差异。对瘙痒患者组治疗前和治疗后症状评分（缓解评分）的平均差异进行比较，发现接受苯海拉明加安慰剂治疗的组（80.3±7.4）比接受西咪替丁加安慰剂治疗的组（48.8±13.4）症状缓解更显著（P = 0.022）。在33名荨麻疹患者中，11名接受苯海拉明加安慰剂治疗的患者中有5名（46%）临床症状得到显著缓解，而10名接受西咪替丁加安慰剂治疗的患者中有8名（80%）症状缓解（P = 0.18）。12名接受苯海拉明加西咪替丁治疗的患者中有11名（92%）症状缓解，与接受苯海拉明加安慰剂治疗的患者相比有显著差异（P = 0.027）。对荨麻疹患者的平均缓解评分进行比较，发现接受苯海拉明加西咪替丁治疗的组（55.3±6.5）比接受苯海拉明加安慰剂治疗的组（30.7±6.1）症状缓解更显著（P = 0.006）。
对于治疗急性过敏反应引起的瘙痒，苯海拉明比西咪替丁更有效，联合使用并无额外益处。对于治疗急性荨麻疹，西咪替丁和苯海拉明联合使用比单独使用苯海拉明更有效。
