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Cetirizine is an antihistamine commonly used to treat allergic rhinitis and other allergic conditions. Cetirizine is often prescribed to breastfeeding mothers although there is limited information on infant exposure via breast milk. The aim of this study was to develop a popPK model based on data from a lactation study to predict cetirizine breast milk concentrations and estimate the relative infant dose (RID) in a breastfed infant. A popPK model was developed in NONMEM on data from a human lactation study including 35 women using cetirizine or levocetirizine while breastfeeding. Serial samples of breast milk were collected (n = 205) and the cetirizine concentrations quantified using a validated LC–MS/MS method. A one‐compartment model of cetirizine in breast milk was developed and employed to calculate the relative infant dose (RID). Covariates related to the maternal characteristics and breastfeeding patterns were evaluated in the model; only milk sampling pumping duration was found to be a significant covariate, with an increasing pumping duration leading to an increased apparent milk volume of distribution (Vm). The mean RID was 1.99% with the highest RID being 3.36% at Cmax. PopPK modelling could be used to estimate infant exposure to cetirizine via breast milk. The low predicted exposure in infants supports that cetirizine is compatible with breastfeeding. [ABSTRACT FROM AUTHOR]

There are only a few clinical trials which address the treatment of acute urticaria (AU). Especially, the added value of systemic corticosteroids to antihistamines is unclear in treatment of severe AU. To review the existing evidence‐based approaches for AU treatment. A systematic electronic search was done in PubMed and Web of Science to retrieve all studies on the treatment of patients with AU. A descriptive synthesis was conducted based on the PRISMA statement. Quality assessment was independently performed by both reviewers ('Cochrane risk‐of‐bias tool' for RCTs). Ten randomized controlled trials (RCTs) (n = 857 participants) were included. Four studies assessed corticosteroid effectiveness added to antihistamines and six studies compared the efficacy of H1 and/ or H2‐antihistamines. The addition of corticosteroid (prednisone) to an antihistamine (levo)cetirizine did not improve symptoms of AU compared to antihistamine alone in two out of three RCTs. The combination of diphenhydramine (50 mg, IV) and ranitidine (50 mg, IV) or cimetidine (300 mg, IV) was most efficient for relief of urticaria in two out of five studies. Most frequent adverse effects were sedation and drowsiness. Recent guidelines on urticaria treatment mainly focus on chronic urticaria rather than on AU. Moreover, only few, small RCTs provide evidence for the management of AU. Thus, the state‐of‐the‐art management of this frequent condition remains unclear. The addition of corticosteroids to an antihistamine as treatment for AU needs to be further investigated. Well‐designed, high‐quality interventional trials are needed to establish evidence‐based treatment guidelines for AU. [ABSTRACT FROM AUTHOR]

Background & Objective: HSG was performed to determine tubal patency of nulliparous and primiparous patients without contraception who underwent a pregnancy program. The contrast used can cause allergies, although the incidence of post-HSG allergy is rare. The clinicians need to be aware of this to remain vigilant. Case Presentation: The Presented case is report of a patient P1A0 who had an allergy after HSG. Hysterosalpingography was performed as the patient wanted another pregnancy, after a long wait without contraception, while the first child was 12 years old. A P1A0 woman with a 12-year-old first child wanted a second pregnancy, who was diagnosed bronchial asthma without regularly taking asthma medications. The patient received analgesic drugs and underwent an HSG examination on the 10th day of menstruation. Thirty minutes later, she complained of itching that started on the face and spread to the whole body, including the arms and legs. The whole body then appeared to be bumped. An hour later, an asthma attack occurred in the form of short breaths. HSG examination was a routine examination carried out in patients undergoing a pregnancy program. Incidence of allergies after HSG is a rare thing. Thus, this case report needs to be submitted to consider that allergic events such as those in this case report can occur. Conclusion: Allergic reactions after HSG are rare. HSG examination is performed on patients with bronchial asthma, and drug allergy (antalgin) must be noted carefully. The two allergy risk factors can trigger an allergic reaction to the contrast used during HSG examination. [ABSTRACT FROM AUTHOR]

JC polyomavirus (JCPyV) infects the majority of the population and initially establishes a persistent but asymptomatic infection of the kidneys. In healthy individuals, the infection remains controlled by the host immune system, but for individuals experiencing prolonged immunosuppression, the infection can reactivate and spread to the brain, where it causes progressive multifocal leukoencephalopathy (PML), which is a fatal neurodegenerative disease. Currently, there are no approved therapies to treat PML, and affected individuals suffer rapid motor weakness and cognitive deterioration. To identify novel therapeutic treatments for JCPyV infection, receptor agonists/antagonists identified in a previously published drug screen were evaluated for their antiviral properties. Seven drugs were selected and validated using infectivity assays, and the mechanism of inhibition was further explored for G protein coupled receptor (GPCR)-associated inhibitors due to the role of the GPCR 5-hydroxytryptamine 2 receptors (5-HT2Rs) in JCPyV entry. The inhibitors cetirizine and paroxetine both reduced infection early in the JCPyV infectious cycle. Paroxetine specifically reduced viral internalization through altering the receptor density of 5-HT2CR, inhibiting β-arrestin recruitment to the receptor, and reducing MAPK signaling through ERK. These findings highlight the potential of receptor signaling and viral entry mechanisms as possible targets for antiviral drug development. Further, this research suggests that FDA-approved receptor agonists/antagonists currently used to treat other medical conditions could be repurposed into antivirals for the possible treatment of JCPyV infection and the fatal disease PML. [ABSTRACT FROM AUTHOR]

Clinical Practice Guidelines (CPGs) are statements informed by a systematic review of research/evidence and provide recommendations for clinical practice to improve healthcare quality and patient outcomes. The National Association of School Nurses (NASN) released School Nursing Evidence-Based Clinical Practice Guideline: Students with Allergies and Risk for Anaphylaxis, in 2023, to provide evidence-based recommendations specific to school nursing practice and support the role of the school nurse in providing high-quality care for school-age children with allergies and risk for anaphylaxis. This article will provide an overview of the CPG and Implementation Toolkit. The implementation toolkit is designed to provide school nurses with tools and resources to implement the recommendations into practice. These tools and resources include school policies; nursing assessments and intake; planning, training, implementing, and evaluating care; and data collection. Examples are discussed, including how to customize the toolkit resources to your current practice needs. [ABSTRACT FROM AUTHOR]

PURPOSE: Premedication, including a histamine-1 receptor (H1) antagonist, is recommended to all patients treated with paclitaxel chemotherapy to reduce the incidence of hypersensitivity reactions (HSRs). However, the scientific basis for this premedication is not robust, which provides opportunities for optimization. Substitution of intravenously administered first-generation H1 antagonist for orally administered second-generation H1 antagonist could reduce side effects, and improve efficiency and sustainability. This study investigates the efficacy and safety of substituting intravenous clemastine for oral cetirizine as prophylaxis for paclitaxel-induced HSRs. METHODS: This single-center, prospective, noninferiority study compares a historic cohort receiving a premedication regimen with intravenous clemastine to a prospective cohort receiving oral cetirizine. Primary end point of the study is HSR grade ≥3. The difference in incidence was calculated together with the 90% CI. We determined that the two-sided 90% CI of HSR grade ≥3 incidence in the oral cetirizine cohort should not be more than 4% higher (ie, the noninferiority margin) compared with the intravenous clemastine cohort. RESULTS: Two hundred and twelve patients were included in the oral cetirizine cohort (June 2022 and May 2023) and 183 in the intravenous clemastine cohort. HSR grade ≥3 incidence was 1.6% (n = 3) in the intravenous clemastine cohort and 0.5% (n = 1) in the oral cetirizine cohort, resulting in a difference of –1.2% (90% CI, –3.4 to 1.1). CONCLUSION: Premedication containing oral cetirizine is as safe as premedication containing intravenous clemastine in preventing paclitaxel-induced HSR grade ≥3. These findings could contribute to optimization of care for patients and improve efficiency and sustainability. Oral cetirizine is a nonsedative, easy, and effective alternative for IV antihistamines before paclitaxel. [ABSTRACT FROM AUTHOR]

Both postmortem toxicological and medical-forensic examinations are very important in the case of analyzing various types of chemical substances. Hydroxyzine (HZ) is a first-generation antihistamine drug with a sedative effect that disrupts cognitive function and affects the ability to drive motor vehicles. Enzymatic oxidation of the hydroxy-methyl group to the carboxyl group leads to the formation of its main metabolite—cetirizine (CZ). CZ is the active substance of antiallergic drugs. Because it does not cross the BBB (blood–brain barrier) easily, it is less likely to cause drowsiness or affect memory and impair cognitive function. Therefore, in criminal studies, it is often important what medication had been taken by a person involved, e.g., in a car accident, HZ or CZ. The analysis of both antihistamine drugs is challenging, as usually very low concentrations of the compound of interest need to be determined. Thus, an ultra-sensitive UHPLC–QqQ-MS/MS method was developed for simultaneous determination of HZ and CZ in biological fluid samples. The lower limit of quantification (LOQ) for HZ and CZ was calculated as 0.345 and 0.3696 ng/mL, respectively. Together with a reduced sample volume to 200 μL, it makes the developed method suitable for a sensitive multidrug forensic toxicological analysis. Samples were extracted with simple and fast liquid–liquid extraction (ethyl acetate, pH 9). The present method for the determination of HZ and CZ in human blood proved to be simple, fast, selective, and sensitive. The quantification by LC–MS/MS was successfully applied to the samples coming from 28 authentic biological fluids (blood, urine, vitreous humor, bile and stomach content), both antemortem and postmortem. The performed studies confirm that the developed method is characterized by a high extraction efficiency. Its accuracy, reproducibility, simplicity, and selectivity suggest its application in clinical, toxicological, and forensic laboratories. [ABSTRACT FROM AUTHOR]

Objective(s): Ulcerative colitis is a chronic inflammatory bowel disease (IBD) that causes inflammation and ulcers in the rectum and the innermost layer of the large intestine. Our study aimed to elucidate the ameliorative effect of cetirizine (CTZ) and loratadine (LOR) against acetic acid-induced ulcerative colitis in rats via assessment of the PI3K/p-Akt/Nrf2 signaling pathway and proinflammatory cytokine release.Materials and Methods: Thirty-two rats were allocated into four groups (n=8). Group (I) was considered normal control. Acetic acid (AA) was injected intrarectally in groups (2-4). Group (2) was kept untreated. Group (3) was administered CTZ (20 mg/kg/day) for 7 days. Group (4) was administered LOR (10 mg/kg/day) for 7 days.Results: AA showed severe macroscopic colonic lesions associated with increased ulcer number, area, and severity with significantly elevated PI3K, p-Akt, Nrf2, TNF-α, and IL-6 in colorectal tissue as compared to the normal control group. All the aforementioned indicators were greatly improved by CTZ and LOR therapy.Conclusion: This is the first study to elucidate the ameliorative effect of CTZ and LOR against AA-induced UC in rats. CTZ and LOR treatment mitigates UC via amelioration of the PI3K/p-Akt/Nrf2 pathway and proinflammatory cytokine release.

AbstractSimple and highly sensitive voltammetric methods were developed using a poly(bromocresol purple) modified glassy carbon electrode to quantify cetirizine. Poly(bromocresol purple) film was synthesized on the surface of a glassy carbon electrode by cyclic voltammetry for 50 potential cycles in 0.1 M phosphate buffer at pH 6.0 containing 5.0 × 10−4 M of the monomer. Quantification of cetirizine exhibiting irreversible properties using the optimized conditions with a linear dependence between cetirizine concentration and peak currents from 0.2 to 100 µM for differential pulse voltammetry (DPV) and 0.1 to 100 µM for square wave voltammetry (SWV). Detection limits were 21.8 and 15.1 nM for DPV and SWV, respectively. Relative standard deviation (RSD) values below 0.98% indicated good precision. Recovery values from 100.12% to 100.90% with relative standard deviations below 1.14% for DPV and SWV in pharmaceutical formulations and urine samples demonstrated the high accuracy of the developed methods. The prepared modified electrode exhibited good fabrication reproducibility and suitable long-term stability. Finally, no interferences were observed in cetirizine determination in the presence of co-existing substances in the biological samples. [ABSTRACT FROM AUTHOR]

Objectives: Perennial allergic rhinitis (PAR) is common in Japan. Second-generation antihistamines (SGAs) are commonly used for its treatment; however, it remains unclear which SGA is the most cost-effective. Additionally, the pharmacoeconomics of Japanese Kampo shoseiryuto (which was traditionally prescribed to treat PAR in Japan) remains poorly understood. In this study, we aimed to investigate the effectiveness of various SGAs and shoseiryuto for the treatment of PAR in Japanese outpatients, from the healthcare payer's perspective. Methods: The most cost- and clinically effective SGAs were determined from a list of 6 SGAs (bepotastine, 10 mg; cetirizine, 10 mg; ebastine, 10 mg; epinastine, 20 mg; loratadine, 10 mg; and olopatadine, 5 mg) together with shoseiryuto, using the overall improvement rate through a model-based analysis. The time horizon was 28 days. Costs were determined based on the Medical Fee Index in 2020. Deterministic and probabilistic sensitivity analyses were conducted to address the uncertainty of the base-case results. Results: Overall, bepotastine (10 mg) and ebastine (10 mg) were cost-effective. Shoseiryuto was less cost-effective than ebastine (10 mg) (dominated). Ebastine (10 mg) was the most cost-effective option based on deterministic and probabilistic sensitivity analyses. Conclusions: Ebastine (10 mg) was the most cost-effective treatment strategy for PAR among the agents evaluated in this study. This insight could aid in establishing an appropriate formulary for treating PAR in hospitals and communities. [ABSTRACT FROM AUTHOR]

Seasonal allergies have a negative impact on patients' quality of life. Nurses must be aware of the different treatment options and lifestyle modifications to help patients manage their symptoms. This article discusses the benefits and risks of over-the-counter medications for seasonal allergies and other implications for nurses. [ABSTRACT FROM AUTHOR]

Background: Cetirizine is a second-generation antihistamine with anti-allergy and anti-itching properties. The topical formulation of this medicine is used in androgenic alopecia treatment. Due to the hydrophilic nature of cetirizine, its skin absorption is negligible, so to increase its absorption, various enhancers were examined to see which can be used in the design of a topical formulation. Methods: First, the skin was exposed to enhancers, including eucalyptus, menthol, Tween 80, propylene glycol, and oleic acid, for 1 or 2 hours. Then, the permeability parameters of the cetirizine solution and the structural changes of the skin after exposure to enhancers were analyzed by differential scanning calorimetry (DSC) and Fourier-transform infrared spectroscopy (FTIR) techniques. Results: The obtained results show that all used enhancers increased the permeability of the drug cetirizine compared to water. Various mechanisms, such as liquefaction of lipids, destruction of lipid structure, and irreversible denaturation of intracellular keratin, are involved in the increase in drug penetration caused by eucalyptus, mint, Tween 80, propylene glycol, and oleic acid. Conclusions: The results showed that among the studied absorption enhancers, eucalyptus and Tween 80 had the strongest, and propylene glycol had the weakest absorption enhancement effect after 2- and 1-hour pre-contact, respectively. [ABSTRACT FROM AUTHOR]

Objective(s): Ulcerative colitis is a chronic inflammatory bowel disease (IBD) that causes inflammation and ulcers in the rectum and the innermost layer of the large intestine. Our study aimed to elucidate the ameliorative effect of cetirizine (CTZ) and loratadine (LOR) against acetic acid-induced ulcerative colitis in rats via assessment of the PI3K/p-Akt/Nrf2 signaling pathway and proinflammatory cytokine release. Materials and Methods: Thirty-two rats were allocated into four groups (n=8). Group (I) was considered normal control. Acetic acid (AA) was injected intrarectally in groups (2-4). Group (2) was kept untreated. Group (3) was administered CTZ (20 mg/kg/day) for 7 days. Group (4) was administered LOR (10 mg/kg/day) for 7 days. Results: AA showed severe macroscopic colonic lesions associated with increased ulcer number, area, and severity with significantly elevated PI3K, p-Akt, Nrf2, TNF-a, and IL-6 in colorectal tissue as compared to the normal control group. All the aforementioned indicators were greatly improved by CTZ and LOR therapy. Conclusion: This is the first study to elucidate the ameliorative effect of CTZ and LOR against AAinduced UC in rats. CTZ and LOR treatment mitigates UC via amelioration of the PI3K/p-Akt/Nrf2 pathway and proinflammatory cytokine release. [ABSTRACT FROM AUTHOR]

Androgenetic alopecia (AGA) presents a significant challenge in clinical practice due to its prevalence and impact on patients’ quality of life. With a diverse array of available treatment options, selecting the most appropriate therapy demands careful consideration of factors such as efficacy, safety, practicality, and cost. This review aims to evaluate the efficacy and safety profiles of various topical treatments for AGA, investigating their potential advantages in limiting systemic side effects compared to oral medications. This article explores the pharmacology, mechanisms of action, clinical efficacy, and adverse events associated with topical medications like minoxidil, finasteride, ketoconazole shampoo, clascoterone, latanoprost, spironolactone, flutamide, cetirizine, pyrilutamide, and GT20029. [ABSTRACT FROM AUTHOR]

To gain a comprehensive overview of the landscape of clinical trials for the H1-receptor antagonists (H1R antagonists) cetirizine, levocetirizine, loratadine, desloratadine, and fexofenadine and their potential use cases in drug repurposing (the use of well-known drugs outside the scope of the original medical indication), we analyzed trials from clincialtrials.gov using novel custom-coded software, which itself is also a key emphasis of this paper. To automate data acquisition from clincialtrials.gov via its API, data processing, and storage, we created custom software by leveraging a variety of open-source tools. Data were stored in a relational database and annotated facilitating a specially adapted web application. Through the data analysis, we identified use cases for repurposing and reviewed backgrounds and results in the scientific literature. Even though we found very few trials with published results for repurpose indications, extended literature research revealed some prominent use cases: Cetirizine seems promising in mitigating infusion-associated reactions and is also more effective than placebo in the treatment of androgenetic alopecia. Loratadine may be beneficial in the prophylaxis of G-CSF-related bone pain. In COVID-19, H1R antagonists may be helpful, but placebo-controlled scientific evidence is needed. For asthma, the effect of H1R antagonists only seems to be secondary by alleviating allergy symptoms. Our novel method to find potential use cases for repurposing of H1R antagonists allows for high automation, reduces human error, and was successful in revealing potential areas of interest. The software could be used for similar research questions and analyses in the future. [ABSTRACT FROM AUTHOR]

Background: Ocrelizumab is an effective medication for multiple sclerosis. However, infusion-related reactions (IRRs) are a concern for patients and may lead to discontinuation of ocrelizumab. To minimize IRRs, pre-medications are administered. However, from our experience, these medications, especially diphenhydramine, can cause marked drowsiness. The primary objective of this study was to evaluate whether cetirizine is non-inferior to diphenhydramine in limiting the proportion and severity of reactions from ocrelizumab infusions. Methods: Twenty participants were serially randomized in a 1:1 ratio to receive 10 mg of cetirizine or 25 mg of diphenhydramine orally prior to their first three ocrelizumab infusions. Results: The rate of IRRs in this study was similar across both treatment groups with no increase in the risk of severity, and no grade 3 IRRs. Further, patients receiving cetirizine experienced a reduction in fatigue. While there was not a significant difference in global satisfaction, this score increased over time in the cetirizine arm while it remained unchanged in the diphenhydramine arm. Conclusions: Overall, our results suggest that cetirizine does not increase the risk of infusion-related reactions compared to diphenhydramine. [ABSTRACT FROM AUTHOR]

Aims: Cetirizine is frequently administered at an increased dosage in clinical practice and recommended by several guidelines. Nonetheless, the pharmacokinetic (PK) profile and real-world safety data remain insufficient in the Chinese pediatric population. The objective of the current study is to develop a population pharmacokinetic (PPK) model for cetirizine in Chinese pediatric patients and to investigate the rationale behind its off-label usage. Methods: A prospective cohort study was conducted, enrolling children who had been diagnosed with allergic diseases and prescribed cetirizine. The outcomes were safety and pharmacokinetic (PK) parameters. Cetirizine concentrations were measured using a pre-established analytical method. Subsequently, a PK model was developed, followed by model evaluation and simulation. The developed PK model was employed to investigate the drug exposure differences across various age groups and to simulate scenarios of potential overdose. Results: Sixty-three children were enrolled, and 24 of them received a cetirizine dose exceeding the recommended dosage. A PPK model, based on published literature, served as the basis of our analysis, with adjustment made to estimate certain parameters. The final model evaluation and validation indicated accurate predictive performance and robust parameter estimation. Simulations conducted for the label-dose among age 1-12 indicated median maximum concentration at steady state (Cmax, ss) of 7 year old children could be the highest. The model was also used to predict the off-label dose scenarios and overdose patient to support the clinical decision. There were no adverse drug reactions in either group. Conclusion: This study provides evidence-based and model-based exploration for optimizing cetirizine usage in Chinese pediatric patients. The cetirizine PPK model showed accurate predictive performance and could be utilized to simulate individual patient exposure in real-world clinical scenarios. [ABSTRACT FROM AUTHOR]

Although cases of late-onset localized rash after bee sting and localized cold urticaria after insect sting have been rarely reported, lateonset localized urticaria or recall urticaria after a wasp sting has not previously been reported as far as we are aware. A 24-year-old male patient was stung once in the neck by a wasp in October 2018. After 15 minutes, the patient developed dizziness, fainting, flushing and dyspnea that resolved in a few hours with the treatment administered in the emergency room. One week after this event, a wasp stung his right arm and he fainted within 5-10 minutes. The patient vomited and recovered in a few hours with the treatment provided in the emergency room. Approximately one month after the last wasp sting, skin lesions that were localized only to the right forearm and consistent with urticaria developed. There were no skin lesions in other parts of the body. While this complaint of the patient was under control with cetirizine 10 mg/day, it recurred every day if he did not use an antihistamine. This situation was not related to any trigger (cold, heat, drug use, etc.). The Vespula spp. (10 mcg/mL) skin prick test was positive and the wasp-specific IgE level was found to be 56.2 IU/mL (class5). Vespula spp. subcutaneous immunotherapy was started and the patient has been on maintenance therapy for two years. No side effects related to immunotherapy have been observed so far. However, localized urticaria on the right forearm still persists in the absence of antihistamine use. A very rare case of late onset chronic localized urticaria after a wasp sting is presented. Past history of wasp or bee stings should be questioned in cases of localized urticaria. [ABSTRACT FROM AUTHOR]

JC polyomavirus (JCPyV) infects the majority of the population and initially establishes a persistent but asymptomatic infection of the kidneys. In healthy individuals, the infection remains controlled by the host immune system, but for individuals experiencing prolonged immunosuppression, the infection can reactivate and spread to the brain, where it causes progressive multifocal leukoencephalopathy (PML), which is a fatal neurodegenerative disease. Currently, there are no approved therapies to treat PML, and affected individuals suffer rapid motor weakness and cognitive deterioration. To identify novel therapeutic treatments for JCPyV infection, receptor agonists/antagonists identified in a previously published drug screen were evaluated for their antiviral properties. Seven drugs were selected and validated using infectivity assays, and the mechanism of inhibition was further explored for G protein coupled receptor (GPCR)-associated inhibitors due to the role of the GPCR 5-hydroxytryptamine 2 receptors (5-HT2Rs) in JCPyV entry. The inhibitors cetirizine and paroxetine both reduced infection early in the JCPyV infectious cycle. Paroxetine specifically reduced viral internalization through altering the receptor density of 5-HT2CR, inhibiting β-arrestin recruitment to the receptor, and reducing MAPK signaling through ERK. These findings highlight the potential of receptor signaling and viral entry mechanisms as possible targets for antiviral drug development. Further, this research suggests that FDA-approved receptor agonists/antagonists currently used to treat other medical conditions could be repurposed into antivirals for the possible treatment of JCPyV infection and the fatal disease PML.

DRESS related to first-line antituberculosis drugs (ATD) is a challenging diagnosis. With a long-lasting combined treatment of 4-concomitantly administrated drugs, identification of the culprit drug remains difficult and may expose patients to treatment interruption and affect their outcome. A 42-year-old female, treated with isoniazid, rifampicin, pyrazinamide and ethambutol for multifocal tuberculosis, developed, 40 days later, hyperthermia, facial edema, cervical lymphadenopathy and generalized exanthema. Biological test results revealed eosinophilia, atypical lymphocytes, and liver injury. DRESS was suspected, and ATD were withdrawn. As patch tests for the 4 ATD showed negative results, we decided to reintroduce pyrazinamide, ethambutol and rifampicin separately with a 3-day interval. Pyrazinamide and rifampicin were tolerated. However, after receiving ethambutol, she developed fever and generalized rash, with no biological abnormalities. Since ethambutol was claimed to be the culprit drug, isoniazid was added, and 10 hours later, the patient developed fever, facial edema, generalized rash, eosinophilia and liver injury. This clinical and biological pattern resolved 2 weeks later. This report suggests a hypersensitivity relapse to ethambutol after isoniazid-induced DRESS. [ABSTRACT FROM AUTHOR]

We aimed to determine the efficacy of the various available oral, topical, and procedural treatment options for hair loss in individuals with androgenic alopecia. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the National Library of Medicine was performed. Overall, 141 unique studies met our inclusion criteria. We demonstrate that many over the counter (e.g. topical minoxidil, supplements, low-level light treatment), prescription (e.g. oral minoxidil, finasteride, dutasteride), and procedural (e.g. platelet-rich plasma, fractionated lasers, hair transplantation) treatments successfully promote hair growth, highlighting the superiority of a multifaceted and individualized approach to management. [ABSTRACT FROM AUTHOR]

Data on drug transfer into human breast milk are sparse. This study aimed to quantify concentrations of cetirizine and levocetirizine in breast milk and to estimate drug exposure to infants. Breastfeeding women at least 8 weeks postpartum and using cetirizine or its pure (R)‐enantiomer levocetirizine were eligible to participate. Breast milk samples were collected at six predefined times during a dose interval (0, 2, 4, 8, 12 and 24 h after drug intake) at steady state. Infant drug exposure was estimated by calculating the absolute infant dose (AID) and the weight‐adjusted relative infant dose (RID). In total, 32 women were eligible for final inclusion, 31 women using cetirizine and one woman using levocetirizine. Means of the individual maximum and average cetirizine milk concentrations were 41.0 and 16.8 μg/L, respectively. Maximum concentrations occurred on average 2.4 h after intake, and the mean half‐life in milk was 7.0 h. Estimated AID and RID for cetirizine in a day were 2.5 μg/kg and 1.9%, respectively. The corresponding values for levocetirizine were 1.1 μg/kg and 1.9%. No severe adverse events were reported. Our findings demonstrate that the transfer of cetirizine and levocetirizine into breast milk is low and compatible with breastfeeding. [ABSTRACT FROM AUTHOR]

A 2-year-old boy with suspected lactose intolerance developed an extensive, itchy rash after using a nasal spray containing dexpanthenol. He was initially treated for a viral upper airway infection with ibuprofen, xylometazoline, and cetirizine. A switch to a drug containing dexpanthenol led to the appearance of the rash and subsequent sleep deprivation. No other possible cause of allergy was found. The withdrawal of all drugs but cetirizine led to full recovery. Dexpanthenol, an alcohol analog of vitamin B5, is present in many drugs for its positive impact on tissue repair. Although generally considered safe, it may rarely cause an allergic reaction, hence we underscore the importance of considering dexpanthenol oversensitivity in patients with unexplained widespread rashes, particularly in pediatric cases. [ABSTRACT FROM AUTHOR]

Cereals are the main source of energy, protein, B vitamins and minerals for the world population. Due to its ease of harvest and its resistance, wheat is the most cultivated and consumed cereal worldwide. Allergic reactions to wheat are rare, their prevalence in pediatric patients varies from 0.5-1.0%, being more frequent in areas such as Japan and northern Europe and in adults, although less frequent, they have also been described. The prognosis of allergy to wheat in childhood is favourable, but there are more severe cases that remain allergic until adolescence or adulthood; in these cases, oral tolerance induction (OTI) can be considered as a therapeutic alternative to the avoidance diet. We presented a case of 32-year-old patient with the onset of wheat allergy in adulthood with severe anaphylaxis. To date, there is no report of OTI with wheat in allergic adult patient, similar to the one described in this report. [ABSTRACT FROM AUTHOR]

Background: Although antihistamines are the first-line treatment for chronic spontaneous urticaria (CSU), 50% of patients don't respond to standard doses. In this study, the effectiveness of Ziziphus jujube fruit syrup in combination with antihistamines was assessed in patients with CSU. Methods: This double-blind randomized clinical trial was conducted in Shiraz between December 2019 and December 2020. 64 patients with CSU who had experienced hives for at least six weeks and did not respond to the usual treatments were enrolled in the study. They were randomly assigned to intervention and control groups using permuted block random allocation. For four weeks, the intervention group received 7.5 mL Ziziphus jujube syrup twice a day, while the control group received 7.5 mL simple jujube syrup twice a day. Both groups received cetirizine 10 mg every night. Urticaria activity score (UAS) and CU-Q2oL questionnaires were used to assess urticaria state and sleep quality before and after each week for four consecutive weeks. Data were analyzed using SPSS software version 18, and P<0.05 was considered statistically significant. Results: Before the intervention, there was no statistically significant difference between the two groups' mean of UAS (P=0.490) and sleep quality (P=0.423). During the follow-up, UAS in the intervention group was significantly lower (P=0.001). Moreover, this difference was significant on the day 28 (P=0.046). During the follow-up, the quality of sleep in both groups improved significantly, and this improvement was more significant in the intervention group. Conclusion: Ziziphus jujube syrup could be an effective adjuvant treatment for CSU. [ABSTRACT FROM AUTHOR]

Osteoarthritis is characterized by progressive articular cartilage degradation, subchondral bone changes, and synovial inflammation, and affects various joints, causing pain and disability. Current osteoarthritis therapies, primarily focused on pain management, face limitations due to limited effectiveness and high risks of adverse effects. Safer and more effective treatments are urgently needed. Considering that the endocannabinoid 2-arachidonoyl glycerol is involved in pain processing, increasing its concentration through monoacylglycerol lipase (MAGL) inhibition reduces pain in various animal models. Furthermore, drug repurposing approaches leverage established drug safety profiles, presenting a cost-effective route to accelerate clinical application. To this end, cetirizine and levetiracetam were examined for their MAGL inhibitory effects. In vitro studies revealed that cetirizine and levetiracetam inhibited MAGL with IC50 values of 9.3931 µM and 3.0095 µM, respectively. In vivo experiments demonstrated that cetirizine, and to a lesser extent levetiracetam, reduced mechanical and thermal nociception in complete Freund adjuvant (CFA)-induced osteoarthritis in rats. Cetirizine exhibited a notable anti-inflammatory effect, reducing CFA-induced inflammation, as well as the inflammatory infiltrate and granuloma formation in the affected paw. These findings suggest that cetirizine may serve as a promising starting point for the development of novel compounds for osteoarthritis treatment, addressing both pain and inflammation. [ABSTRACT FROM AUTHOR]

Purpose: Bilastine is a novel second-generation antihistaminic. Very few studies in Indian population have compared the safety and efficacy of bilastine with other second-generation antihistaminic like cetirizine. Hence, the present study was planned. Materials and Methods: This was a randomized, open-label comparative parallel group study conducted on 70 patients of chronic spontaneous urticaria (CSU). Patients either received cetirizine 10 mg or bilastine 20 mg once daily for 6 weeks. The primary endpoint was to find out the difference in the mean total symptom score (MTSS) at baseline and 6 weeks. The secondary endpoint was to find out changes in the scale of the number of wheals, change in pruritus scale, scale for size of wheal, change for interference of wheals with sleep, change in visual analog scale (VAS) for sedation, change in scale for intensity of erythema, and change in Scale for Extent of Skin Area Involvement (SESI). Results: Bilastine and cetirizine offer a significant reduction in MTSS, mean number of wheals, and mean pruritus scale at baseline to 1, 3, and 6 weeks. The mean difference in MTSS was significantly more in bilastine. Cetirizine showed a significant increase in VAS score for sedation as compared to bilastine. Both the drugs were well tolerated and safe. Adverse events like headache, gastric irritation, dryness of mouth, and sedation were more reported in cetirizine group. Conclusion: Bilastine was more efficacious than cetirizine in patients of CSU and the efficacy was seen earlier at 1 week, which was not seen in the cetirizine group. [ABSTRACT FROM AUTHOR]

Female pattern hair loss (FPHL) is the most prevalent form of hair loss in women. It was aimed to evaluate the therapeutic effects of topical cetirizine 1%, versus topical minoxidil 2% in patients with FPHL. Through a triple-blind randomized clinical trial, 60 women with FPHL were randomly divided into two groups of treatment with topical cetirizine 1% or topical minoxidil 2%. The endpoint was changing in hair loss severity as well as terminal hair density and diameter, according to trichoscopic evaluation. Intention-to-treat analysis was also performed for those who accomplished 3 months of treatment. Both groups showed improvement in hair diameter and density after 6 months; however, the outcome was significant only in the minoxidil group. According to per-protocol analysis, minoxidil was significantly superior to cetirizine in hair density, but not in hair diameter. According to the hair loss severity scales, FPHL was significantly improved in both the cetirizine and minoxidil groups after 6 months of therapy. The dropout rate due to adverse effects was 10.0% and 6.6% in the cetirizine and minoxidil groups, respectively. Although inferior to topical minoxidil, topical cetirizine can provide favorable therapeutic effects for FPHL, specifically when patient incompatibility with Minoxidil is observed. The study is registered in the Iranian Registry of Clinical Trials (IRCT) with the registration code IRCT20200521047536N1. [ABSTRACT FROM AUTHOR]