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Biomedical subjects

E W Monroe

Publications and source records attributed to E W Monroe.

At least 19 recordsLinked to original sources
PubMed1993

Nonsedating H1 antihistamines in chronic urticaria.

Histamine type 1 (H1) receptor antagonists are the principal therapy for chronic urticaria. Their usefulness, however, is sometimes compromised by undesirable central nervous system (CNS) side effects such as daytime sedation and anticholinergic side effects such as dry mouth. Second-generation, nonsedating antihistamines (terfenadine, astemizole, loratadine, and cetirizine hydrochloride) are just as effective as the potent first-generation antihistamines such as hydroxyzine. Yet they do not cause the CNS and anticholinergic side effects seen with the older agents. Cardiovascular side effects, which have been recently reported with terfenadine and astemizole, are dose related and rare, generally occurring in patients who overdose or who take concomitant medications that increase serum antihistamine levels. The second-generation antihistamines also offer twice daily and once daily dosage schedules, which are more convenient than the two- to four-times daily schedules of the older agents. They should therefore be considered first-line agents for the treatment of chronic urticaria. This article is a review of the role of the nonsedating antihistamines in the treatment of chronic urticaria.

Central Nervous System↗
PubMed1992

Relative efficacy and safety of loratadine, hydroxyzine, and placebo in chronic idiopathic urticaria.

The efficacy and safety of a new non-sedating antihistamine, loratadine (Clarityn, CAS 79794-75-5) 10 mg q.d., was compared to the classical antihistamine, hydroxyzine 25 mg t.i.d. and placebo in a 4-week (optional 12 week) randomized, double-blind, multi-center study in 203 patients with chronic idiopathic urticaria. Efficacy evaluations included weekly physician and patient assessments of pruritus, overall disease condition, and therapeutic response to treatment. Loratadine and hydroxyzine were significantly more effective than placebo and clinically comparable to each other as measured by all efficacy evaluations at each visit. Loratadine was safe and well tolerated with sedation and dry mouth similar to placebo and significantly less than hydroxyzine.

Adolescent↗
PubMed1990

The role of antihistamines in the treatment of chronic urticaria.

For many years, H1 antihistamines have been the primary management option for urticaria. However, undesirable side effects, particularly daytime sedation, have limited the usefulness of these classic antihistamines. A new class of peripherally acting, nonsedating antihistamines (e.g., terfenadine, astemizole, loratadine, and cetirizine) has proved to have clinical efficacy comparable with the classic antihistamines. In comparative trials between the various nonsedating agents, no significant difference in efficacy has been noted. All these agents have good safety profiles, although astemizole use has been correlated with increased appetite and weight gain in some patients, and cetirizine has caused slightly increased sedative effects compared with placebo. Although H1/H2 antihistamine combinations have been proposed as possible treatments for urticaria, studies have produced mixed results.

Chronic Disease↗
PubMed1988

Chronic urticaria: review of nonsedating H1 antihistamines in treatment.

Antihistamines are the drugs of choice in the symptomatic relief of chronic urticaria; however, the usefulness of classic antihistamines has been limited by side effects, especially daytime sedation. In the 1980s a new class of antihistamines has been developed that maintains effectiveness and produces less sedation. This review analyzes each of the new nonsedating antihistamines and evaluates its clinical efficacy, safety, and convenience in the treatment of chronic urticaria.

Chronic Disease↗
PubMed1985

Treatment of urticaria.

In conclusion, although the treatment of urticaria, especially chronic urticaria, is often unsatisfactory, considerable progress has been made in this area over the past few years. As we learn more about the pathogenic mechanisms and mediators involved in the production of urticarial lesions, we will be better able to develop more effective treatment modalities. Currently, several medications exist to block the effects of already released histamine on the target organ receptor sites on the cutaneous blood vessels, to prevent the release of histamine from the mast cells, and to interfere with the release or production of other potential mediators of urticaria. Various combinations of these different therapeutic approaches will probably prove most helpful in treating different clinical patterns of urticaria.

Acute Disease↗
PubMed1981

Urticarial vasculitis: an updated review.

Urticaria and vasculitis are two different reaction patterns in the skin. Both are caused by a wide variety of substances involving different pathogenic mechanisms. Recently isolated cases of "urticarial vasculitis" have been reported. These cases involve patients who present with a clinical picture of urticaria which, by skin biopsy, shows necrotizing vasculitis. The probable underlying pathogenic mechanism in this condition is one of immune complex deposition. This review will analyze the clinical, laboratory, and immunopathologic features of these patients and then will develop an overall concept of what constitutes "urticarial vasculitis."

Adolescent↗
PubMed1981

Vasculitis in chronic urticaria: an immunopathologic study.

Forty-five patients with chronic urticaria were studied to determine: (1) the histologic incidence of leukocytoclastic vasculitis and (2) the clinical, laboratory and immunopathologic parameters that characterized this patient group. By histopathologic examination a spectrum of changes were noted as 9 patients showed leukocytoclastic vasculitis, 15 a dense perivascular infiltrate of lymphocytes and eosinophils, and 21 only a sparse lymphocytic perivascular infiltrate. Both the vasculitis and the dense infiltrate groups had an increased incidence of circulating immune complexes, as detected by Clq binding and monoclonal rheumatoid factor inhibition radioassays. Direct immunofluorescence showed blood vessel deposition of immunoglobulins, complement, and/or fibrin in 33% of the vasculitis group, 13% of the dense infiltrate group, and 9% of the sparse infiltrate group. These studies suggest that a meaningful number of patients with chronic urticaria have histologic and immunopathologic findings of vasculitis.

Adolescent↗
PubMed1981

Combined H1 and H2 antihistamine therapy in chronic urticaria.

Chronic urticaria is a frustrating problem for the patient and the physician. The cause is usually undetermined, and the therapy is directed toward controlling symptoms. Recent evidence that human skin blood vessels possess H2 receptors, as well as the commonly recognized H1 receptors, suggests a possible reason for the frequent failure of H1 antihistamines in controlling this disorder. Eighteen patients with refractory chronic idiopathic urticaria participated in a double-blind, cross-over study to evaluate the efficacy of combined H1 (hydroxyzine hydrochloride) and H2 (cimetidine) antihistamines vs H1 antihistamines alone. This study indicates that combined H1 and H2 antihistamine therapy is statistically more effective than H1 antihistamines alone in controlling the symptoms of chronic urticaria.

Adult↗
PubMed1977

Urticaria. An updated review.

Urticaria can result from many different stimuli, and numerous factors, both immunologic and nonimmunologic, are involved in its pathogenesis. Most commonly considered of immunologic mechanisms is the type I hypersensitivity state mediated by IgE. Another immunologic mechanism involves the activation of the complement cascade, which produces anaphylatoxins that can release histamine. Immunologic, nonimmunologic, genetic, and modulating factors converge on mast cells and basophils to release mediators capable of producing urticarial lesions. In addition to the clinical and laboratory diagnosis and treatment regimens, we review such mediators as histamine, kinins, serotonin, slow-reacting substance of anaphylaxis, prostaglandins, acetylcholine, fibrin degradation products, and anaphylatoxins that increase vascular permeability and can thereby produce wheals. Special consideration is given to histamine and the factors that regulate is secretory release from mast cells and basophils, including the modulating role of intracellular levels of cyclic adenosine monophosphate.

Bites and Stings↗
PubMed1977

Lupus band test.

The lupus band test (LBT) is a direct immunofluorescent technique for demonstrating a band of localized immunoglobulins at the dermal-epidermal junction in the skin of patients with lupus erythematosus (LE). Studies have shown immunoglobulins and complement at the dermal-epidermal junction in systemic (involved and uninvolved skin) and in discoid (involved skin only) LE. It is essential that the appropriate skin site be selected for biopsy; ie, involved or uninvolved skin, light-exposed or light-protected skin. The proper location of the biopsy site is determined by whether the LBT is intended for diagnostic or prognostic purposes. From a diagnostic standpoint, the LBT is a very sensitive and specific test for LE. In addition, this procedure has considerable value as a prognostic test for a patient with an established diagnosis of LE.

Biopsy↗
PubMed1976

Vitiligo associated with regional enteritis.

Although the cause of vitiligo is unknown, there is considerable evidence to indicate that autoimmunity plays a role. Much of this evidence is based on the increased associated occurrence of vitiligo in a number of diseases also believed to be autoimmune in origin. I have observed a case of almost simultaneous onset of vitiligo and regional enteritis. A search of the literature revealed no specific case report associating these two disorders. The association of these two disorders in the same person may be more than fortuitous, since both diseases may be autoimmune in origin.

Adult↗