Appraisal of Topical Use of Antihistamines

Abstract

The era of antihistaminic therapy was instituted in 1933 when Fourneau and Bovet 1 demonstrated that certain phenolic ethers had the property of counteracting the action of histamine in vivo and in vitro. Their most effective compound, 929 F, as well as compound 1571 F, studied by Staub,2 were so toxic to humans as to preclude their therapeutic usage. In 1942 Halpern 3 reported his studies with compound 2339 RP (antergan\s=r\[dimethylamino-ethyl-benzylamine]), which proved to be well tolerated. Since then numerous antihistamines have been synthesized, studied, and made available for oral, parenteral, and topical use.The rapid succession of "new and better" antihistamines made appraisal of their value difficult and prompted a report by the Council on Pharmacy and Chemistry of the American Medical Association entitled "Too Many Drugs?" 4 Reports relating to the chemistry and pharmacology of the antihistamines and to the results of oral administration are plentiful and have been well summarized by Feinberg and others.5 We will con¬ fine this report to the clinical results obtained by the topi¬ cal application of the various antihistamines and will summarize herein the replies of 200 dermatologists to a questionnaire regarding their experiences with this type of therapy. PREVIOUS STUDIES Ethylenediamine Derivatives.1*-Tripelennamine (py-ribenzamine® [Ciba] ) hydrochloride: Feinberg and Bern¬ stein 7 found that the topical application of 2% tripelen¬ namine hydrochloride in water soluble or anhydrous base ointments afforded relief of itching in 24 of 33 pa¬ tients with atopic dermatitis and in 8 of 9 patients with .pruritus ani. Sulzberger and co-workers8 treated 90 pa¬ tients with tripelennamine cream. Allergic, contact-type, eczematous sensitization confirmed by patch test oc¬ curred in two of them. Sulzberger and co-authors con¬ cluded that 2 to 5 % tripelennamine hydrochloride cream was a good, clean, nonstaining ointment useful in the treatment of lichen simplex chronicus. They were unable to confirm Feinberg's 7 beneficial results in atopic der¬ matitis and pruritus ani. Waldriff and associates 9 in¬ cluded 141 patients treated with tripelennamine topically in their series. Thirty-three of these received good to excellent results, and 50 fair results. It appeared to be most useful in circumscribed neurodermatitis, for which 23 of 29 patients attained at least fair results. In the total series (141 patients) there were 10 reactions.Thenylpyramine ("histadyl" [Lilly]) hydrochloride or methapyrilene (thenylene® [Abbott]) hydrochloride: Bereston 10 used thenylpyramine hydrochloride cream and reported temporary relief of pruritus in 40% of 104 patients with dermatoses in which the cardinal symptom was pruritus, but few permanent or lasting results were observed. No cases of contact dermatitis were seen. Ep¬ stein and Macaulay11 stated that 2% thenylpyramine hydrochloride cream was a valuable adjunct to topical therapy of various forms of allergic dermatoses, especially lichen simplex chronicus. Occasionally the ointm...