Brockow K, Kiehn M, Riethmüller C, Vieluf D, Berger J, Ring J
Department of Dermatology and Allergy Biederstein, Technical University Munich, München, Germany.
J Allergy Clin Immunol. 1997 Oct;100(4):458-63. doi: 10.1016/s0091-6749(97)70135-0.
Some clinical studies suggest that a combination of an H1- and H2-antagonist may be effective in the prophylaxis of allergic reactions.
The efficacy of pretreatment with an H1/H2-antagonist combination, H1-antagonist alone, or placebo in the prophylaxis of local and systemic adverse reactions to specific immunotherapy with Hymenoptera venom was compared.
In a prospective, randomized, double-blind, placebo-controlled study, 121 patients with Hymenoptera venom allergy were treated with rush immunotherapy and pretreatment with one of the following: 120 mg of terfenadine plus 300 mg of ranitidine, 120 mg of terfenadine alone, or placebo. The incidence of unwanted systemic adverse and local reactions was recorded for up to 50 weeks.
In seven patients (6%), six in the placebo group and one in the terfenadine group, systemic side effects required cessation of therapy (p = 0.005). Subjective symptoms occurred in four patients (10%) in the terfenadine plus ranitidine group and in three patients (7%) in the terfenadine group. Regarding local reactions, significantly fewer patients treated with a combination of terfenadine and ranitidine and with terfenadine alone as compared with placebo had severe local symptoms of erythema (29%, 29%, and 49%), edema (24%, 18%, and 41%), and pruritus (13%, 11%, and 31%) at week 1 (p < 0.05). This therapeutic benefit was limited to the first 4 weeks of treatment. Treatment with a combination of terfenadine and ranitidine was not superior to treatment with terfenadine alone.
Pretreatment with H1-antihistamines with or without H2-antihistamines significantly reduced local and systemic adverse reactions to immunotherapy with Hymenoptera venom and may therefore be helpful in the management of immunotherapy.
一些临床研究表明，H1拮抗剂和H2拮抗剂联合使用可能对预防过敏反应有效。
比较H1/H2拮抗剂联合用药、单独使用H1拮抗剂或安慰剂预处理对预防膜翅目毒液特异性免疫治疗的局部和全身不良反应的疗效。
在一项前瞻性、随机、双盲、安慰剂对照研究中，121例膜翅目毒液过敏患者接受了快速免疫治疗，并采用以下方法之一进行预处理：120毫克特非那定加300毫克雷尼替丁、单独使用120毫克特非那定或安慰剂。记录长达50周的不良全身不良反应和局部反应的发生率。
7例患者（6%）出现全身副作用，其中安慰剂组6例，特非那定组1例，需要停止治疗（p = 0.005）。特非那定加雷尼替丁组有4例患者（10%）出现主观症状，特非那定组有3例患者（7%）出现主观症状。关于局部反应，与安慰剂相比，在第1周时，接受特非那定和雷尼替丁联合治疗以及单独使用特非那定治疗的患者出现严重局部红斑症状（29%、29%和49%）、水肿（24%、18%和41%）和瘙痒（13%、11%和31%）的患者明显较少（p < 0.05）。这种治疗益处仅限于治疗的前4周。特非那定和雷尼替丁联合治疗并不优于单独使用特非那定治疗。
使用或不使用H2抗组胺药的H1抗组胺药预处理可显著降低膜翅目毒液免疫治疗的局部和全身不良反应，因此可能有助于免疫治疗的管理。
