Busse W W
Division of Allergy and Clinical Immunology, University of Wisconsin Medical School, Madison.
Ann Allergy. 1994 Apr;72(4):371-5.
Both first-generation and second-generation antihistamines effectively reduce symptoms of sneezing, rhinorrhea, and nasal pruritus in individuals with allergic disease. These agents act as competitive inhibitors of histamine (a principal mediator of the allergic response) at various target-organ sites. Although the classic, first-generation antihistamines are unable to halt the allergic reaction once it has begun, emerging evidence has suggested that newer, second-generation agents may interfere with the release of inflammatory mediators from mast cells or may inhibit eosinophil chemotaxis. These effects may confer additional clinical benefit. Also, the second-generation agents produce fewer adverse reactions, including a marked reduction in sedation. Contrary to previous recommendations, recent findings have suggested that antihistamines may not necessarily be contraindicated in patients who have both asthma and allergic rhinitis. A greater understanding of the mechanisms of action and clinical effects of both older-generation and newer-generation antihistamines should help define optimal therapeutic strategies in the future.
第一代和第二代抗组胺药均可有效减轻过敏性疾病患者的打喷嚏、流涕和鼻痒症状。这些药物在不同靶器官部位作为组胺（过敏反应的主要介质）的竞争性抑制剂发挥作用。虽然经典的第一代抗组胺药一旦过敏反应开始就无法阻止其发生，但新出现的证据表明，更新的第二代药物可能会干扰肥大细胞释放炎症介质，或可能抑制嗜酸性粒细胞趋化作用。这些作用可能带来额外的临床益处。此外，第二代药物产生的不良反应较少，包括镇静作用明显减轻。与之前的建议相反，最近的研究结果表明，抗组胺药在患有哮喘和过敏性鼻炎的患者中不一定是禁忌的。对第一代和新一代抗组胺药的作用机制和临床效果有更深入的了解，应有助于在未来确定最佳治疗策略。
