Pathophysiology of nasal obstruction and meta‐analysis of early and late effects of levocetirizine

Abstract

Nasal obstruction, also referred to as congestion, blockage or stuffiness, is a crucial symptom in allergic rhinitis (AR) and may affect sleep as well as quality of life. Early- and late-phase-allergic reactions both contribute to nasal obstruction, although it primarily represents a major symptom in the chronic allergic reaction. A complex network of inflammatory and neurogenic phenomena relates to chronic nasal obstruction, including the subepithelial accumulation of inflammatory cells, particularly mast cells and eosinophils, and the release of neuropeptides. Nasal obstruction is a difficult-to-treat symptom. Vasoconstrictors (decongestants) and intranasal corticosteroids, due to their anti-inflammatory properties, have mainly been used for relieving the nasal passages from the congested mucosa. However, there is accumulating evidence recently that the latest-generation potent antihistamines have decongestant properties in AR. This paper aims to review the pathophysiologic background of nasal obstruction and the evidence for an antihistamine, levocetirizine, in relieving nasal congestion. A meta-analysis on the early and late effects of levocetirizine on nasal obstruction under artificial and natural allergen exposure conditions is presented, demonstrating convincingly that levocetirizine shows a consistent effect on nasal obstruction as early as over the first 2 h and sustained over 6 weeks.

BSACI guidelines for the management of allergic and non‐allergic rhinitis

“…Effective predominantly on neurally mediated symptoms of itch, sneeze and rhinorrhoea. Desloratadine, fexofenadine, cetirizine and levocetirizine have modest effects on nasal blockage [60][61][62][63][64][65]. Improve allergic symptoms at sites other than the nose such as the conjunctiva, palate, skin and lower airways [66][67][68].…”

“…Antihistamines are useful if the main symptoms are rhinorrhoea and sneezing, or if there are symptoms outside the nose such as conjunctivitis or rash. Desloratadine, cetirizine, levocetirizine and fexofenadine may also be beneficial for symptoms of nasal congestion [60,61,64,65,193]. For optimal results, they should be given continuously or prophylactically as opposed to 'as required' [194].…”

Efficacy of fluticasone furoate nasal spray and levocetirizine in patients with Japanese cedar pollinosis subjected to an artificial exposure chamber

“…LCTZ has exhibited anti-histamine and several anti-inflammatory effects at clinically relevant concentrations in both in vivo and in vitro allergic studies17. A number of randomized, double-blind, placebo-controlled comparative studies have been published evaluating the efficacy of this drug for the treatment of SAR under natural conditions, and the results showed a significantly greater efficacy for LCTZ, compared with placebo, in reducing the nasal symptom scores and the overall RQLQ scores18.…”

Novos anti-histamínicos: uma visão crítica

“…26,[54][55][56] A meta-analysis demonstrated that LEV exhibits a consistent effect on nasal obstruction within the first hours after administration, maintaining this for 6 weeks. 57 Additionally, LEV has been shown effective in adults for the treatment of chronic idiopathic urticaria 58,59 and for the prevention of immediate and late symptoms resulting from insect bites, particularly in patients with more intense reactions. 60 Levocetirizine does not interact significantly with any of the muscarinic receptor subtypes and, does not therefore manifest marked anticholinergic effects.…”