Antihistaminic, anti-inflammatory, and antiallergic properties of the nonsedating second-generation antihistamine desloratadine a review of the evidence.docVIP

REVIEWS Antihistaminic,Anti-Inflammatory,andAntiallergic PropertiesoftheNonsedatingSecond-Generation AntihistamineDesloratadine:AReviewoftheEvidence G.WalterCanonica,MD,1 andMichaelBlaiss,MD2 INTRODUCTION istamine,oneofthemostintensivelystudiedmolecules inmedicine, isakeymediatorinallergicrhinitis(AR) andurticaria.Interactingwithauniquegroupofmembrane- boundreceptorswidelydistributedacrossimmunecellsub- types,histamineparticipatesinintricatebidirectionalmessag- ing between cytokines and in?ammatory cells or their precursors,facilitatesmigrationofcellstoin?ammatorysites, stimulateslymphocyteactivity,modulatesaspectsofeosino- phil, neutrophil and mast cell behavior (Fig. 1),1–4 and is directly implicated in the generation of cardinal allergic symptoms such as rhinorrhea; sneezing; congestion; nasal, ocular,anddermalpruritus;hives;and?ushing. TheH -histaminereceptorismostclearlyassociatedwith modulationofproin?ammatoryimmunecellactivity, interaction with histamine is the prime focus of suppressive therapyforARandurticariawithsecond-generationH-antihis- taminessuchascetirizine,desloratadine,ebastine,fexofenadine, levocetirizine,loratadine,andrupatadine. Asaclass,theseantihistaminesareconsistentlyeffec- tive for symptom relief in histamine-mediated diseases. When used at recommended doses, second-generation anti- histaminesareessentiallydevoidofundesirablecentralner- voussystem(CNS)effectssuchassomnolence,andaremuch less likely to cause other undesirable anticholinergic side Abstract:Theallergy cascade presents widespread in?ammatory H and proin?ammatory activation, robust cytokine and chemokine signaling, and heterogeneous immune and endothelial responses that lead ultimately to the manifestations of allergic reaction. Histamine, asmall peptide withinherent vasoactive properties, is released from granules contained within mast cells, basophils, lymphocytes, and other reservoirs and interacts with histamine receptors to regulate numerous cellular functions involve