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This randomized, double-blind, placebo-controlled crossover study compared inhibition by one 5 mg dose of levocetirizine with two 60 mg doses of fexofenadine separated by 12 h of histamine-induced wheal and flare responses in 9 Caucasian and 9 Japanese healthy male volunteers. Levocetirizine was more inhibitory than fexofenadine on wheal, flare and pruritus (p < 0.005). Variability, evaluated from the standard deviation of inhibition, ranged from 14% to 23.2% for levocetirizine and 65.4% to 112.4% for fexofenadine. Levocetirizine had a faster onset of action (30-90 min versus 2 h), shorter time to maximum effect (3-4 versus 3-6 h) and longer duration of action (at least 24 h versus ~12 h) than fexofenadine. The plasma levels of levocetirizine rose more quickly, reached higher levels, were more consistent and decreased slower than those of fexofenadine. There were no clinically significant ethnic differences in responsiveness to the drugs.

Background: Japanese cedar pollinosis, a common disease with morbidity of approximately 20% in the Japanese population, is characterized by subjectively irritating symptoms during an annual 3-month period., Objective: To investigate the effectiveness of cetirizine hydrochloride, loratadine, and fexofenadine hydrochloride in reducing pollinosis symptoms induced while walking in a park during the pollen season., Methods: A randomized, double-masked, placebo-controlled trial was conducted in 113 individuals with Japanese cedar pollinosis during 2 days in March 2003 in Osaka Expo Park, Osaka, Japan. Participants (aged 20-57 years) were divided into 4 groups according to treatment assignment: cetirizine hydrochloride, 10 mg/d; fexofenadine hydrochloride, 120 mg/d; loratadine, 10 mg/d; and placebo (lactose), twice daily. Symptoms were recorded hourly during the study. Furthermore, all the patients completed the Japanese version of the Rhinoconjunctivitis Quality of Life Questionnaire before and after the trial., Results: Self-evaluated symptom scores in all 3 active treatment groups showed significant improvements compared with the placebo group. Furthermore, the cetirizine group showed significant improvement in the domains of frequency of nose blowing and nasal obstruction compared with placebo. In addition, improvement in Japanese Rhinoconjunctivitis Quality of Life Questionnaire scores was higher in the cetirizine group than in the loratadine and placebo groups., Conclusion: Cetirizine seems to be more effective than fexofenadine and loratadine at reducing subjective symptoms in this study population.

Background: Although currently in its infancy, quality of life (QOL) research in Japan is rapidly expanding and is expected to become a standard outcome measure in clinical trials. In Japan, QOL has not previously been assessed in patients with allergic rhinitis (AR); we report the first clinical study applying the recently validated Japanese translations of the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and Work Productivity and Activity Impairment-Allergy Specific (WPAI-AS) Questionnaire to assess the effects of the oral antihistamine, fexofenadine, on QOL and work productivity due to cedar pollinosis., Patients and Methods: A randomized, double-blind, placebo-controlled, single-site study was conducted during the peak cedar pollinosis season in Japan. After a 7-day run-in period, subjects were randomized to receive fexofenadine HCl 60 mg twice daily (bid) or placebo for 2 weeks., Results: Overall, 206 Japanese subjects with AR were included in the intention-to- treat population (fexofenadine, n = 104, and placebo, n = 102). Fexofenadine statistically significantly improved overall QOL compared with placebo (p = 0.005) and improvements were reported in the RQLQ domains: activities (p = 0.047), practical problems (p = 0.003), nasal symptoms (p = 0.003) and eye symptoms (p

The development of newer, more potent, nonsedating H1-receptor antagonists has led to a reappraisal of the potential of this class of drugs in the treatment of asthma. Studies conducted in Japan have examined the pharmacologic profile and clinical efficacy of one of these newer agents, terfenadine. In vitro, terfenadine inhibited the release of histamine from rat peritoneal mast cells and guinea pig lung tissue and conjunctiva in response to such stimuli as compound 48/80, concanavalin A, substance P, A-23187, and the partial peptide of eosinophil major basic protein. Ketotifen had similar, though less potent, antiallergic activity in these models. Mechanisms that appear to be involved in the mediation of this inhibitory effect include the prevention of intracellular calcium ion release and calcium uptake, the inhibition of protein kinase C translocation, and the activation of adenylate cyclase and the resulting accumulation of cyclic AMP (cAMP). A multicenter, double-blind, controlled clinical trial compared the efficacy of ketotifen, 2 mg bid, with that of terfenadine, given at doses of 120 or 240 mg bid (two or four times the US recommended dose, respectively) in the treatment of mild to moderate atopic and mixed-type asthma in adults. Physician assessment of overall improvement and patient evaluation of response were somewhat better with terfenadine, particularly the 120-mg bid dose. As in other comparative studies of these two drugs, terfenadine produced less drowsiness than ketotifen.