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Biomedical subjects

F Estelle R Simons

Publications and source records attributed to F Estelle R Simons.

At least 37 records · Page 2Linked to original sources
PubMed2005

Lack of worldwide availability of epinephrine autoinjectors for outpatients at risk of anaphylaxis.

BACKGROUND: Anaphylaxis is increasing globally and often occurs in the community rather than in a health care setting. Epinephrine, the initial treatment of choice for anaphylaxis, is listed by the World Health Organization as an essential medication; however, the extent of its availability for outpatients is unknown. OBJECTIVE: To determine the availability of epinephrine for use in the first-aid, out-of-hospital treatment of anaphylaxis in different countries. METHODS: We used an investigator-designed, validated survey instrument that was self-administered by members of the World Allergy Organization House of Delegates for 2003 to 2005. Responses were tabulated by country. RESULTS: Completed surveys were received from all 75 representatives of all 39 countries (100% response rate). At the time of the survey, epinephrine autoinjectors that contained a 0.25- or 0.3-mg dose appropriate for use in adults were available in 56.4% (95% confidence interval [CI], 40.8%-72%) of these countries. Widespread availability in Europe and availability in countries such as the United States, Canada, and Australia contrasted with limited availability in Asia, South America, and Africa. Autoinjectors that contained a 0.15-mg dose appropriate for use in some children were available in 43.6% (95% CI, 28%-59.2%) of the 39 countries. Autoinjectors that contained a dose appropriate for use in infants were not available in any country. Costs ranged from 30 US dollars to 110 US dollars. In 27.3% (95% CI, 8.7%-45.9%) of the countries, no financial assistance from government or private insurance was available to defray the cost. CONCLUSION: This study raises concerns about lack of availability and affordability of epinephrine autoinjectors worldwide for individuals of all ages, especially for the pediatric population.

Adrenergic beta-Agonists↗
PubMed2005

Hydroxyzine- and cetirizine-loaded liposomes: effect of duration of thin film hydration, freeze-thawing, and changing buffer pH on encapsulation and stability.

PURPOSE: To assess the effect of the duration of film hydration, freeze-thawing, and changing buffer pH on the extent of entrapment of hydroxyzine and cetirizine, H1-antihistamines with different polarity, into liposomes, and the stability of these liposomes. METHODS: Multilamellar vesicles (MLV) were prepared by thin-lipid film hydration using L-alpha-phosphatidylcholine (PC) and buffer containing 80 mg hydroxyzine at pH 7. For MLV containing hydroxyzine, the liposomes were subjected to 1) hydration for 1 h, 24 h, or 48 h for the control batch, batch B, or batch D respectively; and 2) hydration for 1 h, 24 h, or 48 h with freeze-thawing for 5-cycles for batch A, batch C, or batch E, respectively. These formulations were stored at 10 +/- 2 degrees C and 37 +/- 0.1 degrees C. Small unilamellar vesicles (SUV) and MLV were prepared using L-alpha-phosphatidylcholine (PC), and buffer at pH 5.0, 5.5, 6.0, 6.5, and 7.0, containing 80 mg hydroxyzine or 82 mg cetirizine by the ethanol injection and thin-lipid film hydration methods, respectively. These formulations were stored at 10 +/- 2 degrees C. Liposomes were evaluated immediately after preparation and after storage by determining percent entrapment of hydroxyzine (PETH) or of cetirizine (PEC) and by observing changes in the physical appearance (PA). Particle size (PSA) of the liposomes freshly prepared at pH=6.5 was measured from transmission electron micrographs (TEM). RESULTS: Increasing thin-film hydration time or repeated freeze-thawing did not affect the initial PETH or long-term stability of control, A, B, C, D, and E batches of MLV containing hydroxyzine stored at 10 +/- 2 degrees C. At 37 +/- 0.1 degrees C, PETH of all MLV batches decreased considerably after 1 month. This was more evident in batches B, C, and E exposed to freeze-thawing. The PETH of SUV increased markedly from 53.0% to 84.0% when the pH of the buffer was increased from 5.0 to 5.5. As pH increased from 6.0 to 7.0, PETH continued to increase from 84% to 94%. The initial PETH of MLV increased slightly from 82.0% to 94.0% as the buffer pH values increased from 5.0 to 7.0. There was no effect of pH on initial PEC, and stability of SUV or initial PEC of MLV, which ranged from 92% to 94%, as buffer pH values increased from 5.0 to 6.5. After storage at 10 +/- 2 degrees C PEC in MLV decreased from 94% to 74%. CONCLUSIONS: The freeze-thawing processes had some effect on the stability of liposomes stored at temperatures higher than ambient temperature, 37 +/- 0.1 degrees C. The effect of changing the buffer pH from 5.5 to 7.0, and from 5.0 to 6.5 on initial PETH and PEC, respectively, was minimal. After 24 months at l0 +/- 2 degrees C, pH had no effects on PETH; however, PEC of MLV decreased.

Cetirizine↗
PubMed2005

Population pharmacokinetics of levocetirizine in very young children: the pediatricians' perspective.

Developmental changes during infancy and childhood can affect drug pharmacokinetics (PK), i.e., absorption, distribution, metabolism, and renal excretion. This, in turn, influences optimal dosing, efficacy, and safety. To date, of the 40 H1-antihistamines available worldwide, only 11 have been studied in children using a PK approach. Here, we provide the pediatricians' perspective on the population PK of levocetirizine, the pharmacologically active enantiomer of cetirizine, in very young children who received oral cetirizine, and describe the factors that influence levocetirizine PK in this population. In a prospective, randomized, double-blind, parallel-group, placebo-controlled study, very young children received oral cetirizine 0.25 mg/kg twice daily for 18 months. Plasma levocetirizine concentrations were measured in timed, sparse blood samples collected at steady-state (3, 12 and 18 months after commencement of treatment) for the purpose of monitoring safety, and levocetirizine population, PK parameters were derived by using non-linear mixed effects modeling. In 343 children (age 14-46 months, body weight 8.2-20.5 kg), a total of 943 blood samples were obtained. Compliance with cetirizine dosing was documented. The population PK model used predicted that with increasing body weight, levocetirizine oral clearance would increase by 0.044 l/h/kg, and levocetirizine volume of distribution would increase by 0.639 l/kg. Levocetirizine PK were not influenced by eosinophilia, sensitization to allergens, allergic disease, gastroenteritis/diarrhea, or concomitant ingestion of other medications. This population PK model predicts that in very young children, the oral clearance of levocetirizine will be rapid and will increase as body weight and age increase, therefore, levocetirizine dosing should be based on body weight and age in this population. Compared with older patients, on a mg/kg basis, relatively higher doses may be needed, and twice-daily dosing may be necessary, as previously reported for the related racemic H1-antihistamine cetirizine.

Administration, Oral↗
PubMed2004

Simultaneous analysis of the H1-antihistamine acrivastine and the decongestant pseudoephedrine hydrochloride by high-performance liquid chromatography.

High-performance liquid chromatography (HPLC) was used for the simultaneous quantification of the H(1)-antihistamine acrivastine and the decongestant pseudoephedrine hydrochloride. Both compounds were detected at the wavelength of 214 nm. The influence of the mobile phase and the detection wavelength was evaluated and optimized. This method was used to assay various samples from studies of the commercial preparation Semprex-D capsules. The method was found to be accurate, specific, selective, rapid, and versatile for use in routine quality control analyses.

Calibration↗
PubMed2004

Cetirizine from topical phosphatidylcholine-hydrogenated liposomes: evaluation of peripheral antihistaminic activity and systemic absorption in a rabbit model.

Cetirizine, an effective, minimally sedating, second-generation H1-antihistamine is widely used orally to treat allergic skin disorders. This study was performed to assess the peripheral H1-antihistaminic activity and extent of systemic absorption of cetirizine from liposomes applied to the skin. Cetirizine was incorporated into small unilamellar vesicles (SUV) and multilamellar vesicles (MLV) prepared using L-alpha-phosphatidylcholine hydrogenated (HPC), and into Glaxal Base (GB) as the control. In a randomized, crossover study, each formulation, containing 10 mg of cetirizine, was applied to the depilated backs of 6 rabbits (3.08 +/- 0.05 kg). Histamine-induced wheal tests and blood sampling were performed before cetirizine application and at designated times for up to 24 hours afterwards. Compared with baseline, histamine-induced wheal formation was suppressed by cetirizine in SUV only at 24 hours, in MLV from 0.5 to 24 hours, and in GB from 0.5 to 8 hours (P < or = .05). Wheal suppression by cetirizine in SUV at 24 hours (91.7% +/- 5.2%) and in MLV from 1 to 24 hours (93.8% +/- 2.2% to 76.2% +/- 6.5%) was greater than in GB (36.5% +/- 7.4% to 60.6% +/- 14.2%) from 1 to 24 hours (P < or = .05). Faster onset, as well as greater and more persistent suppression was obtained from cetirizine in MLV. Plasma cetirizine concentrations from MLV (area under the curve [AUC] of 221.2 +/- 42.3 ng x hr/mL) were lower than from GB (AUC of 248.3 +/- 34.6 ng.hr/mL). In this model, cetirizine from MLV had excellent topical H(1)-antihistamine activity, while systemic exposure was reduced, compared with cetirizine from GB.

Absorption↗
PubMed2004

Mosquito allergy: immune mechanisms and recombinant salivary allergens.

Reactions to mosquito bites are immunological in nature, with the involvement of IgE-, IgG- and T lymphocyte-mediated hypersensitivities. Acquired desensitization to mosquito saliva may occur during childhood and adolescence or during long-term exposure to mosquito bites. Due to the lack of salivary preparations, allergic reactions to mosquito bites are underdiagnosed and undertreated. Recombinant mosquito saliva allergens with biological activity are being developed. These recombinant allergens will significantly improve diagnosis of mosquito allergy and eventually will also improve specific immunotherapy for patients with systemic reactions to mosquito bites.

Adolescent↗
PubMed2004

Cetirizine from topical phosphatidylcholine liposomes: evaluation of peripheral antihistaminic activity and systemic absorption in a rabbit model.

This study was performed to assess the peripheral H(1)-antihistaminic activity and extent of systemic absorption of cetirizine from liposomes applied to the skin. Cetirizine was incorporated into small unilamellar vesicles (SUV) and multilamellar vesicles (MLV) prepared using L-alpha-phosphatidylcholine, and into Glaxal Base (GB), used as the control. In a randomized, cross-over study, each formulation, containing 10 mg of cetirizine, was applied to depilated areas on the backs of six rabbits (3.08+/-0.05 kg). Histamine-induced wheal tests and blood sampling were performed before cetirizine application and at designated times for up to 24 h. Compared with the baseline, histamine-induced wheal formation was suppressed by cetirizine in SUV and MLV from 0.5-24 h and by cetirizine in GB from 0.5-8 h, p</=0.05. Maximum wheal suppression by cetirizine in SUV and MLV ranged from 90.6%+/-4.9% to 89.0%+/-3.8% and 98.0%+/-1.3% to 94.0%+/-2.3%, respectively, from 6 to 8 h. The plasma cetirizine AUC of 201+/-24.2 ng.h/ml from SUV was lower than from PC-MLV, 334.6+/-65.1 ng.h/ml and from GB, 248.3+/-34.6 ng.h/ml. After 24 h, the percent of the cetirizine dose remaining on the backs of the rabbits from SUV was lower than from both MLV and GB, p</=0.05. In this model, cetirizine from both SUV and MLV had excellent topical H(1)-antihistaminic effects, while systemic exposure to cetirizine from SUV was reduced.

Administration, Topical↗
PubMed2004

First-aid treatment of anaphylaxis to food: focus on epinephrine.

Avoiding food triggers for anaphylactic reactions (severe acute systemic allergic reactions) is easier said than done. Most episodes of anaphylaxis to food occur unexpectedly in the community in the absence of a health care professional. All individuals at risk should therefore have an emergency action plan in place. The cornerstone of first-aid treatment of anaphylaxis is epinephrine injected intramuscularly in the vastus lateralis muscle (lateral aspect of the thigh). In this review, we focus on epinephrine. We examine a therapeutic dilemma: the issue of epinephrine dose selection in an individual for whom no optimal fixed-dose auto-injector formulation exists, and a therapeutic controversy: the issue of epinephrine injection versus an oral H1-antihistamine in anaphylaxis episodes that appear to be mild. The pharmaceutical industry could address the first of these issues by providing a wider range of epinephrine fixed doses in easy-to-use auto-injectors, or by providing adjustable epinephrine doses in auto-injectors. The second issue could be addressed in part by development of alternative routes of epinephrine administration for the first-aid, out-of-hospital treatment of anaphylaxis.

Administration, Oral↗
PubMed2004

Selective immune redirection in humans with ragweed allergy by injecting Amb a 1 linked to immunostimulatory DNA.

BACKGROUND: In animal models administration of immunostimulatory DNA sequences preferentially elicits T(H)1-dominated (type 1-dominated) immunity and can inhibit developing or ongoing T(H)2 (type 2) responses. OBJECTIVE: Our objective was to investigate this phenomenon in humans. METHODS: In a randomized, third party-blinded, placebo-controlled, proof-of-concept study conducted entirely in the winter in 19 adults with ragweed allergy, we administered 6 subcutaneous injections of purified Amb a 1 linked to the 22-base-long immunostimulatory phosphorothioate oligodeoxyribonucleotide 1018 (Amb a 1-immunostimulatory DNA sequence conjugate [AIC]). Before the course of AIC or placebo injections and 2 and 16 weeks afterward, we measured recall responses to ragweed, streptokinase, and PHA in short-term primary culture of fresh PBMCs after restimulation with antigen. We quantified regulatory cytokine and chemokine responses characteristic of T(H)2 immunity (IL-5, IL-13, CCL17 [TARC], and CCL22 [MDC]), and T(H)1 immunity (IFN-gamma, CXCL9 [Mig], and CXCL10 [IP-10]), as well as IL-10, a cytokine sometimes linked to regulatory T-cell populations. RESULTS: We demonstrated for the first time that human systemic in vivo ragweed-specific T(H)2 responses were selectively redirected toward T(H)1 responses, with significant increases in IFN-gamma, CXCL9, and CXCL10 and significant decreases in IL-5, CCL17, and CCL22 found at 2 and 16 weeks after the sixth injection. Cytokine and chemokine responses to the unrelated bacterial antigen streptokinase and the global capacity to mount immune responses on polyclonal activation with PHA did not change. No clinically significant systemic or local allergic reactions were associated with AIC or placebo injections. CONCLUSIONS: AIC, injected in concentrations that were approximately 40-fold lower than those used in most murine studies published to date, led to a prolonged shift from T(H)2 immunity toward T(H)1 immunity and appeared to be safe. This novel approach has the potential for immune redirection in human immediate hypersensitivity diseases.

Adjuvants, Immunologic↗
PubMed2004

Immune responses to mosquito saliva in 14 individuals with acute systemic allergic reactions to mosquito bites.

BACKGROUND: Mosquito bite-induced acute systemic allergic reactions are an increasing clinical concern and have not been optimally characterized immunologically. OBJECTIVE: We wanted to study the immunologic basis of these reactions. METHODS: Sera were received from 14 individuals with a history of acute systemic allergic reactions to mosquito bites, defined as the presence of one or more of the following: urticaria, angioedema, wheezing, dyspnea, hypotension, and decrease or loss of consciousness. Ten individuals were from the United States and one each was from Canada, Germany, Japan, and Switzerland. An indirect ELISA was developed to measure specific IgE and IgG antibodies to saliva from 5 common mosquito species with different geographic distributions: Aedes aegypti, Aedes vexans, Aedes albopictus, Anopheles sinensis, and Culex quinquefasciatus. Twenty-nine individuals with negative bite test results from laboratory-reared mosquitoes served as control subjects. RESULTS: Mosquito saliva-specific IgE levels to all 5 species were significantly increased in the individuals with systemic allergic reactions compared with the control subjects ( P < .061 for Aedes vexans and P < .008 for the remaining 4 species). By using the mean of the control subjects plus 1 SD as a cut-off level, 11 individuals had positive results to Aedes albopictus and up to 4 additional species; 3 individuals had positive results to only one species. Saliva-specific IgG levels were not significantly increased in the individuals with systemic allergic reactions compared with levels seen in the control subjects ( P > .05). CONCLUSION: Acute systemic allergic reactions to mosquito bites involve mosquito saliva-specific IgE and can be characterized immunologically. Aedes albopictus is the most common species associated with systemic allergic reactions to mosquito bites.

Acute Disease↗
PubMed2004

Evidence for natural desensitization to mosquito salivary allergens: mosquito saliva specific IgE and IgG levels in children.

BACKGROUND: There are few epidemiologic data on the prevalence of mosquito allergy, although local reactions to mosquito bites are common. OBJECTIVE: To investigate the prevalence of mosquito allergy in children by measuring serum levels of mosquito saliva specific IgE and IgG antibodies that correlate well with the size of mosquito bite local reactions. METHODS: Using enzyme-linked immunosorbent assays to measure mosquito (Aedes vexans) saliva-specific antibodies, we investigated sensitization to mosquito bites in 402 children aged 1 month to 18 years and correlated mosquito saliva specific IgE and IgG levels with age and sex. Twenty-three serum samples from infants who had never been exposed to mosquitos were used as negative controls. RESULTS: Mean levels of mosquito saliva specific IgE and IgG were lowest in the 23 negative control serum samples. In the 402 samples from children who may have been exposed to mosquitos, mean saliva specific IgG levels were higher in boys than in girls (P < .008). Levels of IgE and IgG correlated with each other (P < .001). A significant inverse correlation was found between age and both IgE and IgG levels. IgE levels peaked at the age of 6 to 12 months of age, and IgG levels peaked at 1 to 6 months of age. Levels of IgE and IgG antibodies gradually declined after the age of 5 years. CONCLUSIONS: Based on the presence of mosquito saliva specific antibodies, exposed infants and young children are at increased risk of having allergic reactions to mosquito bites. Antibody levels decline throughout childhood and adolescence, suggesting that natural desensitization may occur.

Adolescent↗
PubMed2004

Evaluation and comparison of five matrix excipients for the controlled release of acrivastine and pseudoephedrine.

For treatment of allergic rhinitis, acrivastine with pseudoephedrine in Semprex-D conventional capsules requires dosing every 6-8 hours. This study was designed to develop a controlled release matrix tablet of acrivastine and pseudoephedrine and evaluate 5 different matrix excipients for their in vitro controlled-release profiles. Compritol 888ATO, Eudragit RS, Methocel K100M, Polyox WSR301 and Precirol ATO5 were used alone or in varying combinations for the formulation of controlled release matrix tablets. In vitro drug dissolution and mathematical modeling were used to characterize drug release rate and extent. All tablet formulations yielded quality matrix preparations with satisfactory tableting properties. Due to the aqueous solubility of pseudoephedrine and the size of the dose, none of the matrix excipients used alone prolonged drug release significantly to meet the desired twice-daily administration frequency. The use of two excipients in combination, however, significantly decreased the dissolution rate of both active ingredients. A combined lipid-based Compritol and hydrophilic Methocel produced optimal controlled drug release for longer than 8 hours for both acrivastine and pseudoephedrine.

Canada↗
PubMed2004

Epinephrine (adrenaline) in the first-aid, out-of-hospital treatment of anaphylaxis.

Epinephrine (adrenaline), the initial treatment of choice for systemic anaphylaxis, is an alpha- and beta-adrenergic agonist with bidirectional, cyclic adenosine monophosphate-mediated pharmacological effects on target organs, and a narrow therapeutic index. In a recent study, 0.95% of a geographically-defined population was found to have had epinephrine dispensed for out-of-hospital use; dispensing rates within this population varied from 1.44% for individuals under age 17 years to 0.32% for those older than 65 years. Although epinephrine is widely available in the community, it is not necessarily given in a timely manner when anaphylaxis occurs. Individuals with anaphylaxis may fail to respond to first-aid treatment with epinephrine for a variety of reasons. These include: (1) delay in treatment (in an animal model, epinephrine injection at the nadir of shock fails to provide sustained haemodynamic recovery); (2) administration of epinephrine by sub-optimal routes such as subcutaneous injection or inhalation from a pressurized metered-dose inhaler instead of intramuscular injection; (3) administration of an inappropriately low epinephrine dose due to the limitations currently imposed by the availability of only two fixed-dose auto-injectors: EpiPen Jr 0.15 mg or EpiPen 0.3 mg; and (4) injection of 'outdated' epinephrine, with inadvertent administration of an inadequate dose. Additional fixed-dose formulations of epinephrine are needed to facilitate optimal first-aid dosing in patients of all ages and sizes.

Adolescent↗
PubMed2003

Allergic humans are hyporesponsive to a CXCR3 ligand-mediated Th1 immunity-promoting loop.

CXCR3 binding chemokine CXCL10 (IP-10) markedly enhances antigen-specific Th1 recall responses in healthy humans, suggesting a role for this pathway in maintenance of clinical tolerance to environmental allergens as well as a potential therapeutic role for CXCR3 ligands in re-balancing the Th2-dominated responses that underlie generation and maintenance of allergic disorders. Here, we investigated the capacity of CXCR3 ligands to modulate allergen-driven IFNgamma production by healthy and allergic individuals characterized by Th1 and Th2 immunity-dominated allergen specific responses, respectively. Exogenous CXCR3 ligands up-regulated antigen-dependent IFNgamma production from healthy individuals' peripheral blood mononuclear cells up to 120-fold, a response neutralized by anti-CXCR3 treatment and not emulated by CCR5 ligands. In contrast, allergic individuals were strikingly hypo-responsive to CXCR3 ligands (P=0.0004). Chemokine-enhanced IFNgamma production correlated with T cell CXCR3 expression (r=0.736, P=0.0001) in vivo and was independent of Th2 cytokine levels. These findings demonstrate that CXCR3-ligation preferentially augments ongoing Th1 over Th2 responses and suggest that reduced capacity of allergic individuals to respond to CXCR3 ligands promotes the maintenance of human allergic disorders.

Allergens↗
PubMed2003

Hydroxyzine from topical phospholipid liposomal formulations: evaluation of peripheral antihistaminic activity and systemic absorption in a rabbit model.

Hydroxyzine, an effective but sedating H1-antihistamine is given orally to treat allergic skin disorders. This study was performed to assess the peripheral H(1)-antihistaminic activity and extent of systemic absorption of hydroxyzine from liposomes applied to the skin. Using L-alpha-phosphatidylcholine (PC), small unilamellar vesicles (SUVs) and multilamellar vesicles (MLVs) containing hydroxyzine were prepared. Hydroxyzine in Glaxal Base (GB) was used as the control. Using a randomized, crossover design, each formulation, containing 10 mg of hydroxyzine, was applied to the shaved backs of 6 rabbits (3.08 +/- 0.05 kg). Histamine-induced wheal tests and blood sampling were performed at designated time intervals up to 24 hours. Compared with baseline, hydroxyzine from all formulations significantly suppressed histamine-induced wheal formation by 75% to 95% for up to 24 hours. Mean maximum suppression, 85% to 94%, occurred from 2 to 6 hours, with no differences among the formulations. The areas of plasma hydroxyzine concentration versus time area under the curve (AUCs) from PC-SUV and PC-MLV, 80.1 +/- 20.8 and 78.4 +/- 33.9 ng/mL/h, respectively, were lower than that from GB, 492 +/- 141 ng/mL/h (P < or =.05) over 24 hours. Plasma concentrations of cetirizine arising in-vivo as the active metabolite of hydroxyzine, from PC-SUV, PC-MLV, and GB, were similar with AUCs of 765 +/- 50, 1035 +/- 202, and 957 +/- 227 ng/mL/h, respectively (P < or =.05). Only 0.02% to 0.06% of the initial hydroxyzine dose remained on the skin after 24 hours. In this model, hydroxyzine from SUV and MLV had excellent topical H1-antihistaminic activity, and minimal systemic exposure occurred. Cetirizine formed in-vivo contributed to some of H1-antihistaminic activity.

Animals↗