抗组胺药 H1 累积剂量对过敏性鼻炎患者痴呆风险的影响。

Cumulative Dose Effects of H1 Antihistamine Use on the Risk of Dementia in Patients With Allergic Rhinitis.

机构信息

Department of Internal Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.

Department of Health Services Administration, China Medical University, Taichung, Taiwan.

出版信息

J Allergy Clin Immunol Pract. 2024 Aug;12(8):2155-2165. doi: 10.1016/j.jaip.2024.05.027. Epub 2024 Jun 25.

DOI:10.1016/j.jaip.2024.05.027

PMID:38935035

Abstract

BACKGROUND

H1 antihistamines (AHs), categorized as first-generation antihistamines (FGAs) or second-generation antihistamines (SGAs), possess anticholinergic properties linked to heightened dementia risk.

OBJECTIVES

To explore dementia risk in patients with allergic rhinitis using AHs.

METHODS

Taiwanese patients with new-onset allergic rhinitis (2011-2017) constituted the study population (677,971 with FGAs or SGAs, 36,081 without AHs). AH use was measured in cumulative defined daily dose (cDDD). Patients were grouped by cDDD (nonuser, <60 cDDD, 60-120 cDDD, and >120 cDDD). A Cox proportional hazard model assessed the AH-dementia association. Sensitivity analysis explored AH effects on dementia risk across subgroups and associations between specific AHs and dementia types.

RESULTS

FGAs in patients with allergic rhinitis were associated with elevated dementia risk. At less than 60 cDDD, adjusted hazard ratio (aHR) was 1.13 (95% CI, 1.09-1.17); at 60 to 120 cDDD, aHR was 1.29 (95% CI, 1.21-1.38); and at more than 120 cDDD, aHR was 1.51 (95% CI, 1.42-1.62). SGAs also raised dementia risk. At less than 60 cDDD, aHR was 1.11 (95% CI, 1.05-1.17); at 60 to 120 cDDD, aHR was 1.19 (95% CI, 1.12-1.26); and at more than 120 cDDD, aHR was 1.26 (95% CI, 1.19-1.33).

CONCLUSIONS

Patients with allergic rhinitis on FGAs or SGAs face an escalating dementia risk with increasing cumulative dosage. Moreover, FGAs exhibit a higher dementia risk compared with SGAs. Nevertheless, extensive clinical trials are imperative for confirming the association between FGA use, SGA use, and dementia risk.

摘要

背景

H1 抗组胺药（AHs）分为第一代抗组胺药（FGAs）和第二代抗组胺药（SGAs），具有与痴呆风险增加相关的抗胆碱能特性。

目的

探讨过敏性鼻炎患者使用 AHs 与痴呆风险的关系。

方法

本研究纳入了 2011 年至 2017 年新诊断为过敏性鼻炎的台湾患者（使用 FGAs 或 SGAs 的患者 677971 例，未使用 AHs 的患者 36081 例）。采用累积定义日剂量（cDDD）衡量 AH 使用情况。根据 cDDD 将患者分为非使用者、<60 cDDD、60-120 cDDD 和>120 cDDD 组。采用 Cox 比例风险模型评估 AH 与痴呆的相关性。敏感性分析探索了 AH 对不同亚组痴呆风险的影响，以及特定 AH 与痴呆类型之间的关联。

结果

FGAs 在过敏性鼻炎患者中与痴呆风险升高相关。在<60 cDDD 时，调整后的危险比（aHR）为 1.13（95%CI，1.09-1.17）；在 60-120 cDDD 时，aHR 为 1.29（95%CI，1.21-1.38）；在>120 cDDD 时，aHR 为 1.51（95%CI，1.42-1.62）。SGAs 也增加了痴呆风险。在<60 cDDD 时，aHR 为 1.11（95%CI，1.05-1.17）；在 60-120 cDDD 时，aHR 为 1.19（95%CI，1.12-1.26）；在>120 cDDD 时，aHR 为 1.26（95%CI，1.19-1.33）。