© Borgis - New Medicine 3/1999, s. 16-17
Ewa Cierpioł-Tracz, Henryk Kawalski, Grzegorz Szpyrka, Mariusz Moś, Marek Kopacz
Comparative study of the application of sympathomimetic generally and locally as combined with loratadine in the initial therapy of allergic rhinitis in older children
Silesian Academy of Medicine - Science and instruction unit, ENT Department, Chorzów
Head: Henryk Kawalski, M.D.
Summary
Typical symptoms of seasonal allergic rhinitis in its initial phase are nasal obstruction accompanied by profuse discharge of secretion, sneezing, and itching of the eyes. All these symptoms cause serious breathing problems in the patient. At this stage the most important aim of the doctor is to free the nasal passages and reduce the amount of discharge. The purpose of this study is to compare 84 patients treated with Clarinase with 60 patients who received Claritin and xylometazoline locally. The analysis included patients´ subjective impressions and objective examination of the free passage of the nose.
Introduction
In recent years the morbidity rate of allergic conditions has increased considerably. About 20% of the population suffer from seasonal allergic rhinitis. A profuse discharge of secretion from the nose, sneezing, and itching of the eyes not only make our lives uncomfortable, but also lead to complications such as bacterial superinfection of the upper respiratory pathways (1, 2).
Antihistaminic drugs do not tolerate any symptoms of allergic reaction.
To reduce swelling of the mucous membrane of the nose, it is necessary to apply sympathicomimetics
Purpose of the study
The purpose of the study was to compare the clinical efficacy of pharmacotherapy using loratadine combined with pseudoefedrine (Clarinase), and loratadine completed with xylometazoline and applied locally in the treatment of seasonal allergic rhinitis in its initial phase (3).
Patients and Methods
Eighty-five children aged 12-15 were put under observation in accordance with the rules for correct clinical examinations applicable in European Union countries, and after the parents of the patients had agreed in writing to allow examination. The Ethical Commission of the Silesian Medical Academy approved the study (4).
Criteria for selecting patients to be put under observation
- symptoms of seasonal allergic rhinitis confirmed by the results of allergologic examination,
- parents and patients agreed to examination,
- non - application of any anti-allergenic drugs locally or generally for 28 days prior to the visit,
- random selection.
Criteria for exclusion
- diseases which excluded taking the above - mentioned drugs,
- violation of the examination procedure,
- failure to come for checking,
- failure to keep an observation record,
- drug intolerance - side effects preventing further treatment.
Clinical observation procedure
Examination was carried out from March to October 1998. Children in the initial phase of seasonal allergic rhinitis (n = 85) were treated in the Laryngologic Outpatient Department of the Children´s Clinic, and in the Polyclinic for Children and Adults in Chorzów.
The patients were randomly selected for one of the two group:
Group I - (n = 47) received Clarinase twice a day (1 tablet) before meals for 5 days.
Group II - (n = 38) received Claritin twice a day (1/2 tablet) and xylometazoline by atomizer (2 sprayings into each nasal duct 4 times a day, for 5 days).
From the sixth day of treatment the patients received Claritin on an empty stomach once a day (1 tablet) in the morning for 25 days. Clinical re-examinations were carried out on the same, third, fifth and thirtieth days of pharmacotherapy.
Conclusions
Since the dose of Loratadine in both groups was the same, the speed of its effect and efficacy was comparable in all patients. (Confirmed by treatment from the sixth to the thirtieth day).
We have made a detailed analysis of the speed of subsidence of rhinitis during treatment with sympathomimetics, and of possible undesirable symptoms.
Table 1. Subsidence of symptoms of seasonal allergic rhinitis during treatment with Loratadine.
| Group 1 | Group 2 |
| 31 patients | 23 patients |
| i.e. about 66% | i.e. about 51 |
Table 2.
| | Group 1
Pseudoephedrine sulphate | Group 2
Xylometazoline |
| Speed of effect | After about 30 min | After about 5-10 min |
| Time of effect | About 12 minutes | About 4-6 hours |
| Undesirable effects | Sensation of dryness in the mouth2 patients i.e. about 4.3%Dizziness - 1 patienti.e. about 2.13% | burning sensation and drynessin the nose - 9 patients i.e. 30% bleeding from the nose 5 patients i.e. about 13% |
| Willingness to take drugs | 46 children willing to take the drug | 21 children willing to take the drug |
| | i.e.about 98% | i.e. about 55% |
Table 3. Subsidence of all symptoms of seasonal allergic rhinitis in the course of treatment with Clarinase and Loratadine and with Loratadine combined with Xylometazoline.
| Group 1 | Group 2 |
| 38 patients | 27% patients |
| i.e. about 81% | i.e. about 71% |
Conclusions
1. Sympathomimetics are very helpful in the fight against obstruction of the nose in seasonal allergic rhinitis.
2. The time of effect of pseudoephedrine is definitely longer than that of Xylometazoline.
3. Undesirable symptoms are fewer during the application of sympathomimetics generally.
4. Sympathomimetics applied generally together with second generation anti-histaminic drugs are effective in the treatment of seasonal allergic rhinitis.
Piśmiennictwo
1. Fireman P.: Otitis media and its relation to allergic rhinitis. Allergy Asthma Proc., 1997 May-Jun 18 (3):135-43. 2. Fireman P.: Otitis Media and eustachian tube dysfunction: connection to allergin rhinitis. J. Allergy Clin. Immunol, 99 (2):S787-97 1997 Feb. 3. Kawalski H. et al.: Rhinocort aeorozol wodny w leczeniu całorocznego nieżytu nosa u dzieci i młodzieży. Otol. Pol. L (suppl 1997:22). 4. Kawalski H. et al.: Skojarzone postępowanie terapeutyczne u dzieci z otitis media secretoria. Pediatria Polska 1998; 7 (LXXIII): 1-4
