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Wang W, Chen H, Gao N, Yu S, Liao J, Wang S, Gao Z, Liu Z. Effect of acupuncture at the sphenopalatine ganglion for the treatment of moderate to severe seasonal allergic rhinitis: Study protocol for a three-armed randomized controlled trial. Front Med (Lausanne) 2022; 9:904864. [PMID: 36148447 PMCID: PMC9485873 DOI: 10.3389/fmed.2022.904864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/29/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Seasonal allergic rhinitis (SAR) is a major health problem with a relatively high worldwide prevalence that severely limits the quality of life for sufferers. Acupuncture is widely used for SAR treatment in China; however, the evidence on the efficacy of acupuncture at the sphenopalatine ganglion (SPG) for SAR is inconclusive. Therefore, this study aims to investigate the efficacy and safety of acupuncture at the SPG acupoint for the treatment of SAR. Methods and analysis A total of 120 participants with SAR will be recruited and randomly assigned to the acupuncture group, placebo acupuncture (PA) group, or rescue medication (RM) group with a 1:1:1 allocation ratio. Participants in the acupuncture group and PA group will receive 8 sessions of acupuncture stimulus at the SPG plus RM or 8 sessions of shallow needling at the SPG acupoint plus RM for 4 weeks with a 4-week follow-up in the first year and a 1-week follow-up in the second year. Participants in the RM group will only receive RM throughout the study. The primary outcome is the change from baseline in the average daily combined symptoms and medication score (CSMS) over weeks 1–4. All analysis will be based on an intention-to-treat principle. All statistical tests will be two-sided and a p-value < 0.05 will be considered to be statistically significant.
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Affiliation(s)
- Weiming Wang
- Department of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences Guang’anmen Hospital, Beijing, China
| | - Hui Chen
- Department of Traditional Chinese Medicine, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, China
| | - Ning Gao
- Department of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences Guang’anmen Hospital, Beijing, China
| | - Shudan Yu
- Department of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences Guang’anmen Hospital, Beijing, China
| | - Jiahua Liao
- Department of Traditional Chinese Medicine, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, China
| | - Shijie Wang
- Department of Otolaryngology, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, China
| | - Ziqi Gao
- Department of Otolaryngology, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences Guang’anmen Hospital, Beijing, China
- *Correspondence: Zhishun Liu,
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Sun R, Tang X, Yao H, Hong S, Yang Y, Kou W, Wei P. Establishment of a new animal model of allergic rhinitis with biphasic sneezing by intranasal sensitization with Staphylococcal enterotoxin B. Exp Ther Med 2015; 10:407-412. [PMID: 26622329 DOI: 10.3892/etm.2015.2506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 02/16/2015] [Indexed: 11/06/2022] Open
Abstract
Allergic rhinitis (AR) is a global health problem. The effectiveness of currently available medications is limited and therefore investigation for more effective drugs is essential. The aim of the present study was to establish a model of AR in guinea pigs that can be utilized for the further investigation of new drugs. Guinea pigs were intranasally sensitized with 1 µg Staphylococcal enterotoxin B (SEB) dissolved in 40 µl saline once daily for 14 days. One week after the last sensitization, the same treatment was applied intranasally once every four days for a total of 30 times. In the treatment group, terfenadine was administered orally 70 min before the 4th, 14th and 24th challenge. Sneezing and nasal scratching were evaluated following each of the 30 challenges. The quantity of antigen-specific antibodies in the serum was measured. Between the 19th and 30th challenges, the guinea pigs in the model group produced significant biphasic elevations in sneezing number, with peaks 10 min-2 h and 4-8 h after the SEB challenges. In addition, the guinea pigs produced significantly more sneezing in the first peak during the 19th to 30th challenges than during the first to 18th challenges (P<0.01). Terfenadine significantly inhibited the early- and late-phase sneezing at all challenge times. The serum levels of SEB-specific immunoglobulin (Ig) E and IgG1 were higher in the model group in comparison with those in the control group (P<0.01). This experiment demonstrated that SEB can induce typical AR with biphasic sneezing in guinea pigs. Histamine may play an important role in the early- and the late-phase sneezing in the model of AR. This model can be potentially used for the investigation of new drugs.
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Affiliation(s)
- Rong Sun
- Department of Physical Examination, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Xinye Tang
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, Pediatric Research Institute of Chongqing Medical University, National Key Disciplinary Areas of Pediatrics, Ministry of Education, Chongqing, P.R. China
| | - Hongbing Yao
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, Pediatric Research Institute of Chongqing Medical University, National Key Disciplinary Areas of Pediatrics, Ministry of Education, Chongqing, P.R. China
| | - Suling Hong
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Yang Yang
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, Pediatric Research Institute of Chongqing Medical University, National Key Disciplinary Areas of Pediatrics, Ministry of Education, Chongqing, P.R. China
| | - Wei Kou
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, Pediatric Research Institute of Chongqing Medical University, National Key Disciplinary Areas of Pediatrics, Ministry of Education, Chongqing, P.R. China
| | - Ping Wei
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, Pediatric Research Institute of Chongqing Medical University, National Key Disciplinary Areas of Pediatrics, Ministry of Education, Chongqing, P.R. China
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Hsu WH, Ho TJ, Huang CY, Ho HC, Liu YL, Liu HJ, Lai NS, Lin JG. Chinese Medicine Acupoint Herbal Patching for Allergic Rhinitis: A Randomized Controlled Clinical Trial. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2012; 38:661-73. [PMID: 20626052 DOI: 10.1142/s0192415x10008135] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study is pursue the effect of herbal point-patch treatment on allergic rhinitis patients by investigation of the changes of serum total IgE (T-IgE) and eosinophile cationic protein (ECP) levels and through assessment of the results of SF-36 and rhinitis severity questionnaires. A prospective, randomized, single-blind, parallel, controlled study was used. Forty- three eligible participants were selected from outpatients of the Dept. of Ear, Nose, and Throat and Chinese medicine clinic, and 33 eligible participants completed the treatment satisfactorily. Participants used a Chinese herbal point-patch or a placebo patch once a week, for three hours at a time, after being randomly assigned to a control or an experimental group. Each treatment course was three weeks in duration, and each participant underwent two courses of treatment. Before and after each course, participants evaluated the effectiveness of the treatment by completing a questionnaire, and blood samples were collected for T-IgE and ECP analysis. The data revealed that the acupoint herbal patch is a valuable treatment for allergic rhinitis, especially in the symptoms of sneezing, running and itchy nose. The results of the SF-36 indicate a distinct improvement in GH (general health) and VT (vitality) in patients treated with acupoint herbal patches. This study supports the belief that the acupoint herbal patch is an effective treatment for allergic rhinitis and can significantly improve general health, social life and vitality in quality of life.
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Affiliation(s)
- Wei-Hung Hsu
- Department of Traditional Chinese Medicine, Potz Hospital, Executive Yuan, Taiwan
| | - Tsung-Jung Ho
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taiwan
- Department of Chinese Medicine, China Medical University, Beigang Hospital, Taiwan
- EOME, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Chih-Yang Huang
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taiwan
- Graduate Institute of Basic Medical Science, China Medical University, Taiwan
- Department of Health and Nutrition Biotechnology, Asia University, Taiwan
| | - Hsu-Chueh Ho
- Department of Health and Nutrition Biotechnology, Asia University, Taiwan
- Department of Ear, Nose and Throat, Dalin Tzuchi General Hospital, Taiwan
| | - Yi-Ling Liu
- Department of Ear, Nose and Throat, Dalin Tzuchi General Hospital, Taiwan
- National Taiwan University Hospital, Taiwan
| | - Hsu-Jan Liu
- Graduate Institute of Acupuncture Science, China Medical University, Taiwan
| | - Ning-Sheng Lai
- Division of Allergy–Immunology-Rheumatology, Dalin Tzuchi General Hospital, Taiwan
| | - Jaung-Geng Lin
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taiwan
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Abstract
Histamine is a key mediator in the development of allergy symptoms, and oral H(1)-antihistamines are among the most widely used treatments for symptomatic relief in conditions such as allergic rhinitis and chronic urticaria. Ebastine is a second-generation antihistamine which has been shown to be an effective treatment for both seasonal and perennial allergic rhinitis. In controlled clinical trials in adult and adolescent patients with allergic rhinitis, ebastine 10 mg once-daily improved symptoms to a significantly greater extent than placebo and to a similar extent as loratadine 10 mg and cetirizine 10 mg (both once-daily), while ebastine 20 mg proved to be more effective than these two comparator antihistamines. In addition, ebastine was significantly more effective than placebo at relieving the symptoms of chronic idiopathic urticaria. Ebastine provides efficacy throughout the 24-h dosing interval with once-daily administration and clinical benefit is seen from the first day of treatment. Small studies have found beneficial effects for ebastine in patients with other disorders, including cold urticaria, dermographic urticaria, atopic asthma, mosquito bites and (in combination with pseudoephedrine) the common cold. In addition to the regular ebastine tablet, a fast-dissolving tablet (FDT) formulation, which disintegrates in the mouth without the aid of a drink, is also available. It has been shown to be bioequivalent to the regular tablet, and to be significantly more effective than desloratadine at reducing histamine-induced cutaneous wheals. A number of patient surveys demonstrated that the majority of individuals who tried the fast-dissolving formulation reported it to be convenient for use, fast-acting and preferred it to their previous antihistamine medication. Perhaps most importantly, a large proportion of patients indicated that they would prefer to use this new formulation in the future. Ebastine has a rapid onset of action and it can be administered once-daily, with or without food. Dose modifications are not needed in elderly patients, or in those with renal or mild to moderate hepatic impairment. Ebastine is generally well-tolerated, and clinical studies showed that at usual therapeutic doses of 10 and 20 mg once-daily, it had no clinically relevant adverse effects on cognitive function and psychomotor performance or on cardiovascular function. In conclusion, ebastine is an effective and generally well-tolerated treatment for allergic rhinitis and chronic idiopathic urticaria. In addition to the regular tablet formulation, ebastine is available as a FDT, providing a treatment option that is particularly convenient for patients.
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Affiliation(s)
- J Sastre
- Fundación Jiménez Díaz, Allergy Service, CIBERES-Inst Salud Carlos III, Madrid, Spain
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Mullol J, Bousquet J, Bachert C, Canonica WG, Gimenez-Arnau A, Kowalski ML, Martí-Guadaño E, Maurer M, Picado C, Scadding G, Van Cauwenberge P. Rupatadine in allergic rhinitis and chronic urticaria. Allergy 2008; 63 Suppl 87:5-28. [PMID: 18339040 DOI: 10.1111/j.1398-9995.2008.01640.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Histamine is the primary mediator involved the pathophysiology of allergic rhinitis and chronic urticaria, and this explains the prominent role that histamine H(1)-receptor antagonists have in the treatment of these disorders. However, histamine is clearly not the only mediator involved in the inflammatory cascade. There is an emerging view that drugs which can inhibit a broader range of inflammatory processes may prove to be more effective in providing symptomatic relief in both allergic rhinitis and chronic urticaria. This is an important consideration of the Allergic Rhinitis and its Impact on Asthma (ARIA) initiative which provides a scientific basis for defining what are the desirable properties of an 'ideal' antihistamine. In this review of rupatadine, a newer dual inhibitor of histamine H(1)- and PAF-receptors, we evaluate the evidence for a mechanism of action which includes anti-inflammatory effects in addition to a powerful inhibition of H(1)- and PAF-receptors. We assess this in relation to the clinical efficacy (particularly the speed of onset of action) and safety of rupatadine, and importantly its longer term utility in everyday life. In clinical trials, rupatadine has been shown to be an effective and well-tolerated treatment for allergic rhinitis and chronic idiopathic urticaria (CIU). It has a fast onset of action, producing rapid symptomatic relief, and it also has an extended duration of clinical activity which allows once-daily administration. In comparative clinical trials rupatadine was shown to be at least as effective as drugs such as loratadine, cetirizine, desloratadine and ebastine in reducing allergic symptoms in adult/adolescent patients with seasonal, perennial or persistent allergic rhinitis. Importantly, rupatadine demonstrated no adverse cardiovascular effects in preclinical or extensive clinical testing, nor negative significant effects on cognition or psychomotor performance (including a practical driving study). It improved the overall well-being of patients with allergic rhinitis or CIU based on findings from quality of life questionnaires and patient global rating scores in clinical trials. Thus, rupatadine is a recently introduced dual inhibitor of histamine H(1)- and PAF-receptors, which has been shown to be an effective and generally well-tolerated treatment for allergic rhinitis and chronic urticaria. It possesses a broader profile of anti-inflammatory properties inhibiting both inflammatory cells and a range of mediators involved in the early- and late-phase inflammatory response, but the clinical relevance of these effects remain to be clarified.
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Affiliation(s)
- J Mullol
- Unitat de Rinologia, Servei d'ORL, Hospital Clinic, IDIBAPS, Barcelona, Spain
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Xue CC, Li CG, Hügel HM, Story DF. Does acupuncture or Chinese herbal medicine have a role in the treatment of allergic rhinitis? Curr Opin Allergy Clin Immunol 2006; 6:175-9. [PMID: 16670510 DOI: 10.1097/01.all.0000225156.29780.36] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Complementary medicines, including acupuncture and Chinese herbal medicine, are being used increasingly for the management of allergies such as allergic rhinitis. Until relatively recently, however, evidence for the efficacy and safety of these therapies in allergic conditions has been lacking. RECENT FINDINGS A limited number of well conducted studies, all with small sample sizes, have demonstrated the promising therapeutic potential of acupuncture and Chinese herbal medicine for allergic rhinitis. The possible additional benefit of combining the two therapies, however, is yet to be confirmed. There are concerns about the appropriateness of the sham/placebo controls that have been used in acupuncture studies and also about the safety evaluation of individual herbs and herbal formulations. In addition to well established symptom scores and specific quality of life questionnaires, the concurrent use of conventional anti-allergy medications has been utilized as an outcome measure in a number of trials that have evaluated the effectiveness of acupuncture and Chinese herbal medicine for allergic rhinitis. SUMMARY Tentatively, it appears that acupuncture and Chinese herbal medicine can be effective treatments for allergic rhinitis. Confirmatory evidence, however, is needed from large and, ideally, multi-centre trials.
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Affiliation(s)
- Charlie C Xue
- The RMIT Chinese Medicine Research Group, School of Health Sciences, RMIT University, Bundoora, Victoria, Australia.
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LaForce CF, Corren J, Wheeler WJ, Berger WE. Efficacy of azelastine nasal spray in seasonal allergic rhinitis patients who remain symptomatic after treatment with fexofenadine. Ann Allergy Asthma Immunol 2004; 93:154-9. [PMID: 15328675 DOI: 10.1016/s1081-1206(10)61468-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Currently available oral second-generation antihistamines do not provide adequate symptom relief for many allergy patients. OBJECTIVE To determine the ability of azelastine nasal spray to improve rhinitis symptoms in patients with seasonal allergic rhinitis who remained symptomatic after treatment with fexofenadine. METHODS This was a multicenter, randomized, double-blind, placebo-controlled, 2-week study in patients with moderate-to-severe seasonal allergic rhinitis. The study began with a 1-week, open-label lead-in period, during which patients received fexofenadine, 60 mg twice daily. Patients who improved less than 25% to 33% with fexofenadine were randomized to treatment with (1) azelastine nasal spray, 2 sprays per nostril twice daily; (2) azelastine nasal spray, 2 sprays per nostril twice daily, plus fexofenadine, 60 mg twice daily; or (3) placebo (saline) nasal spray and placebo capsules twice daily. The primary efficacy variable was the change from baseline to day 14 in the total nasal symptom score (TNSS), consisting of runny nose, sneezing, itchy nose, and nasal congestion symptom scores. RESULTS A total of 334 patients who remained symptomatic after treatment with fexofenadine were included in the efficacy analysis. After 2 weeks of treatment, azelastine nasal spray (P = .007) and azelastine nasal spray plus fexofenadine (P = .003) significantly improved the TNSS compared with placebo. Azelastine nasal spray monotherapy was as effective as the combination of azelastine nasal spray plus fexofenadine as measured by the TNSS and individual symptoms of the TNSS. CONCLUSIONS Azelastine nasal spray is effective monotherapy for patients who remain symptomatic after treatment with fexofenadine and should be considered in the initial management of patients with seasonal allergic rhinitis.
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Affiliation(s)
- Craig F LaForce
- Carolina Allergy and Asthma Consultants, Raleigh, North Carolina 27607, USA.
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Gelfand EW, Appajosyula S, Meeves S. Anti-inflammatory activity of H1-receptor antagonists: review of recent experimental research. Curr Med Res Opin 2004; 20:73-81. [PMID: 14741075 DOI: 10.1185/030079903125002586] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To compare the anti-inflammatory effects of fexofenadine with other H(1)-receptor antagonists in vitro. DATA SOURCES Published literature. STUDY SELECTION Recent experimental studies on anti-inflammatory effects of H(1)-receptor antagonists. Databases searched: Medline, Medscape. PERIOD COVERED 1990-2003. Search terms: second-, third-generation antihistamines; sedating, nonsedating antihistamines; in vitro anti-inflammatory activity; cetirizine; ebastine; loratadine; fexofenadine; desloratadine. RESULTS Second- and third-generation H(1)-receptor antagonists may demonstrate significant in vitro anti-inflammatory activity at concentrations considered to be clinically relevant. In some instances, higher (supraclinical) concentrations are required to achieve comparable effects. CONCLUSIONS Experimental research suggests that second- and third-generation H(1)-receptor antagonists may achieve anti-inflammatory effects in a clinical context. Further studies are required to support this conclusion.
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Affiliation(s)
- Erwin W Gelfand
- Division of Cell Biology, Department of Pediatrics, National Jewish Medical and Research Center, 1400 Jackson Street, Denver, CO 80206, USA.
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Morita K, Koga T, Moroi Y, Urabe K, Furue M. Rapid effects of olopatadine hydrochloride on the histamine-induced skin responses. J Dermatol 2002; 29:709-12. [PMID: 12484432 DOI: 10.1111/j.1346-8138.2002.tb00207.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Olopatadine hydrochloride is one of the second-generation nonsedating antihistamines that are used for treating allergic disorders such as urticaria, rhinitis, and atopic dermatitis. We examined the inhibitory effects of this drug on the flare and wheal responses induced by histamine iontophoresis at 30, 60, and 90 min after oral administration in a double-blind, cross-over, and placebo-controlled study. Olopatadine hydrochloride significantly inhibited the histamine-induced flare and wheal responses as early as 60 min after oral administration when compared with placebo. Significant inihibitory effects of olopatadine hydrochloride on the itch responses were seen at 90 min after administration. Thus, olopatadine hydrochloride exhibited a very rapid and potent antihistamine effect on the histamine-induced skin responses.
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Affiliation(s)
- Keisuke Morita
- Department of Dermatology, Graduate School of Medical Sciences, Fukuoka, Japan
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